Background: Stapled haemorrhoidopexy is a non-excisional approach for haemorrhoids as opposed to conventional open Milligan-Morgan and Ferguson closed haemorrhoidectomy techniques. It repositions the prolapsed haemorrhoid tissue and also causes vascular interruption to the haemorrhoids. This causes faster recovery and lesser post-operative pain.Methods: In authors institute, stapled haemorrhoidopexy was being carried out using two rows proximate PPH circular haemorrhoidal stapler. In February 2018, MIRUS three rows circular stapler was introduced. This is a retrospective observational study carried out at Artemis Hospital, Gurgaon, India. Authors studied records and operative notes of all patients who underwent stapled haemorrhoidopexy between February 2018 and September 2019 and compared key parameters.Results: A total of 224 patients underwent stapled haemorrhoidopexy between February 2018 and September 2019. 116 using MIRUS three rows circular stapler and 108 using two rows proximate PPH circular haemorrhoidal stapler. Most of the studied parameters were comparable with only significant statistical difference seen in higher use of haemostatic sutures in two rows stapler group compared to three rows stapler group. Haemostatic sutures were needed in three row stapler group for 27 patients and in two rows stapler group for 39 patients.Conclusions: Author’s initial experience shows slightly better haemostasis with three rows stapled haemorrhoidopexy with no significant difference in other parameters.

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Aims: Stapler hemorrhoidopexy (SH) has evolved over time as a procedure of choice over conventional surgery due to less postoperative pain. Laser hemorrhoidoplasty (LH) is a novel procedure aimed at shrinking the terminal branches of hemorrhoidal arteries with fewer complications. The present study is aimed to compare these procedures (SH and LH). Study Design: Prospective comparative study. Place and Duration of Study: Patients operated for hemorrhoids at the Department of General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon from April 2018 to March 2019. Methodology: 50 patients with grade II-III hemorrhoids were allocated to two groups: Stapler hemorrhoidopexy (SH) and Laser hemorrhoidoplasty (LH) with 25 patients in each group. Results were compared and patients were followed up for minimum period of 3 months. Results: The mean operative time was 24.6 min (LH) and 28.6 min (SH) (P =.122). The average blood loss was 8.32 ml (LH) and 11.64 ml (SH) (P <.05). The mean hospital stay 21.44 hours (LH) and 32.64 hours (SH) (P <.05). Mean postoperative pain score (VAS) at 12 hours was 2.64 (LH) and 4.76 (SH) (P <.05), at 24 hours was 1.88 (LH) and 3.6 (SH) (P <.05), at 1 week was 0.36 (LH) and 0.88 (SH) (P =.054) and at 3 months 0.04 (LH) and 0.12 (SH) (P =.53). One patient in LH (4%) had postoperative bleeding on 4th postoperative day. In SH group, 2 (8%) had severe postoperative pain with VAS > 8, requiring longer hospital stay, 2 (8%) had bleeding on the same day, 1 (4%) had bleeding on follow up and 1 (4%) had recurrence. Conclusion: In terms of early postoperative pain and complications, LH offers better results as compared to SH. It was associated with a shorter hospital stay and early return to work. No significant complications were noted in LH compared to SH. LH is an extremely viable alternative to the popular SH for grade II-III hemorrhoids.

Decision was taken to proceed with TEP for hernia repair. Anaesthetic evaluation was done and patient was ABSTRACT Giant inguinal hernias are typically described as those which reach patient's mid-thigh level in upright position. These present a challenge to the surgeon as surgical repair is technically challenging. Although conventionally open repairs have been done for giant inguinal hernias more recently laparoscopic techniques are being adopted. Total extra peritoneal (TEP) and trans abdominal pre peritoneal (TAPP) are two common laparoscopic approaches used. Here we present a case of a 64-year-old patient with a long standing giant inguinal hernia. Hernia was repaired with a TEP approach and patient's recovery was satisfactory.

Obesity is becoming an increasingly common disease across the world. Various restrictive and malabsorbptive surgical procedures have been developed to tackle morbid obesity. These procedures though efficient in causing weight loss and decrease in co – morbidities present with their own unique complications. Sleeve gastrectomy is one of the more recent, mainly restrictive procedure which has been gaining rapid popularity. Stricture of the gastric sleeve pouch is a rare and distressing complication of this procedure. Here we present a case of a 44-year-old woman who underwent Sleeve gastrectomy in Gulf 5 years back. She developed a stricture of the sleeve pouch for which she underwent two endoscopic dilatations which did not provide much relief. She was finally treated with a Roux – en – y gastro-jejunostomy which finally improved her symptoms.