Background: An incisional hernia is defined as any abdominal wall gap with or without bulge in the area of postoperative scar perceptible or palpable by clinical examination or imaging. It occurs in about 3 to 20 percent of patients undergoing laparotomy. Open hernia repair methods have an increased incidence of wound infections and wound-related complications. These problems have been overcome by laparoscopy. The placement of a large mesh by laparoscopy allows for an even distribution of forces along the surface area of the mesh, which account for the strength of the repair and the decreased recurrence rates associated with it. The merits of the laparoscopic approach are decreased rates of recurrence, reduced risks of wound complications. The aims and objective of this study were to evaluate etiological factors of incisional hernia, various techniques of laparoscopic repair of incisional hernia, and to investigate the influence of laparoscopic approach on hospital stay, complications associated with the procedure and recurrence rates.Methods: In this hospital based prospective study, total 40 cases of incisional hernia were studied which were operated laparoscopically and followed up over period of two years.Results: Incisional hernia occurrence was common in females (80%) with commonly observed risk factor was postoperative wound related complications (28 cases) and obesity (22 cases). Infraumbilical midline incision (67.5%) and supraumbilical midline incision (27.5%) was most commonly responsible for incisional hernia occurrence. LSCS was most commonly responsible for incisional hernia occurrence (45%) followed by laparotomy for various indications (27.5%). Intraperitoneal onlay mesh repair of single defect without anatomical repair was most common modality of laparoscopic repair (70%). Early postoperative pain (20%) and prolonged ileus (17.5%) was the most common complication observed. Average hospital stay was 4.22 days.Conclusions: Postoperative wound related complications are important risk factor for incisional hernia. Laparoscopic repair of incisional hernia is better choice in view of reduced wound related complications, post-operative pain and hospitals stay.

A 20-year-old male patient presented with complaint of epigastric pain and vomiting, 1 day after an episode of bike handle injury. Ultrasound showed only mild free fluid in the abdomen. The patient gradually developed tachycardia, hypotension and guarding in the abdomen. CT scan revealed complete pancreatic transection between the neck and the body with segmental separation about an inch. Serum lipase was raised. Exploratory laparotomy revealed acute pseudocyst formation and necrotic slough on the transected ends. Distal pancreatectomy without splenectomy was performed. The patient recovered uneventfully.

Background: Conventional thyroidectomy results in transverse scar formation on neck. These scars are uncomfortable and cosmetically unacceptable. Endoscopic thyroidectomy is widely accepted technique in specialized centers. The potential advantages of endoscopic technique include better cosmetic result, decreased hospital stay and better patient comfort. Author started performing endoscopic thyroidectomy at the centre to demonstrate the feasibility of operating thyroid gland endoscopically by axilla breast approach.Methods: Author performed 26 cases of endoscopic thyroidectomy by axilla breast approach from June 2014 to July 2017 in patients presenting with indication for surgical thyroid excision. Author did hemithyroidectomy in 19 patients, total thyroidectomy in 3 patients and near total thyroidectomy in 4 patients. All patients underwent endoscopic thyroidectomy by axilla breast approach by creating subplatysmal space with carbon dioxide insufflation at the pressure of 8 to 10mmHg. Results were compared with the recent studies with comparable number of patients.Results: Author did hemithyroidectomy in 19 patients, total thyroidectomy in 3 patients and near total thyroidectomy in 4 patients. Mean Operative time was 88.19 min. But last 6 cases were completed in 49.60±4.20 min. Thus, as experience increased we tend to complete procedure in progressively lesser time period. Mean blood loss in the series was 21.88ml. Mean Hospital stay was 2.88 days (range 2-5 days). Scar satisfaction on visual analogue scale after 3 months of operation was 9.11. Histopathological examination revealed adenomatous goitre in 24 cases and follicular adenoma in 2 cases.Conclusions: Endoscopic thyroidectomy via axilla breast approach is safe, feasible and minimally invasive surgical method for thyroid diseases, with good post-operative results. Surgeons having adequate training in endoscopic surgery can perform endoscopic thyroidectomy with short learning curve.

Background: Video-assisted thoracoscopic surgery (VATS) is rapidly becoming a popular method for diagnostic and therapeutic purposes. Many diseases of the chest can now be diagnosed by VATS due to ease of look and biopsy. Hence the present study was undertaken to determine diagnostic and therapeutic utility of VATS in different chest pathologies.Methods: In this prospective study, total 36 patients of different age group were subjected to VATS procedure, to measured operative time, intra and post- operative complications, post-operative pain and hospital stay. Then patient was followed up at 15 days, at 1 month, 3 month and at 6 months.Results: VATS was successfully carried out in 28 patients as the only procedure whereas 8 patients required conversion to thoracotomy. Average operative time for patients operated by VATS only was 94.9 minute and for patients operated by VATS converted to thoracotomy was 175.5 minute. Most common intraoperative complication was bleeding (16.66 %) followed by anaphylactic shock observed in only one patient. Most common postoperative complication was prolonged air leak (5.55%) followed by port site infection (2.77%) and postoperative bleeding (2.77%). At 24 hours postoperatively, average pain score observed in VATS group was 3.73 and in thoracotomy group was 6.28. The mean postoperative hospital stay for patients operated by VATS was 7.28 days and for patients operated by VATS converted to thoracotomy was 10.36 days. There was significant difference observed in diagnosis of various chest pathologies by radiological investigations and VATS.Conclusions: VATS should be offered as the first approach to various chest pathologies requiring surgical intervention and preferred over thoracotomy when feasible.