Background: Perianal fistula is a troublesome condition both for patient and surgeon with significant morbidity and challenging treatment. MRI is considered as the technique of choice for preoperative evaluation of perianal fistulae, as it provides accurate anatomical information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. The study aimed to describe the role of magnetic resonance imaging (MRI) in the diagnosis and classification of perianal fistulae. Methods: This retrospective study looked at 52 patients referred to the radiology department with a clinical diagnosis of perianal fistula. MRI grading of anal fistula done according to St. James’s University Hospital classification. Results: The MRI showed 46 internal openings in 44 patients; two patients had more than one. The internal opening was mostly at the 6 o’clock position in 59.9% patients, followed by 7 o’clock and 5 o’clock position in 11.3% of patients. According to the St. James’s University Hospital classification, 21 (47.7%) patients had grade 1, 11 (25%) patients had grade 2, 2 (4.5%) had grade 3, 7 (15.9%) had grade 4, and 4 (9%) had grade 5 fistulae. Twenty-five patients had associated abscesses. The most common location of the abscess was in the perianal region (8 patients). Conclusions: MR imaging examinations is a highly accurate imaging method for preoperative evaluation perianal fistula. It provides precise information of the fistulous track, along with its relationship to pelvic structures and plays crucial role for surgical planning.

Introduction: Electrocautery has been widely used except for the skin incisions; this is because of the fear of scarring of skin, post operative pain, poor wound healing and wound infection in view of devitalisation of tissues. Although still not very popular, yet the use of diathermy instead of scalpel for making skin incision and underlying tissue dissection is gradually gaining wide acceptance. The purpose of this study was to compare the scalpel incision with electrocautery incision over skin in patients undergoing hernia repair. Aims and Objectives: To compare the skin wound made by the diathermy and scalpel with a view in; intraoperative incisional time, post operative pain, requirement of analgesia and the quality of wound healing. Material and Methods: This is hospital based comparative study, undergone elective inguinal hernia repair in the department of general surgery at Nepalgunj medical college teaching hospital, Kohalpur from the period of July 2015 to January 2016. Group A, contained 30 patients who underwent skin incision with scalpel and Group B, also contained 30 patients who underwent skin incision with electrocautery. These groups were compared and statistical analysis using SPSS (version 20) was done and p value 0.05 was taken as significant. Results: Compared with a scalpel incision, cutting diathermy resulted in significantly shorter incision time (p <0.002). The two groups did not differ in relation to post operative pain and the post operative analgesics requirements. The postoperative complications viz, seroma and purulent collections were in both the groups though the hematoma collection was seen more in scalpel skin incision. Conclusion: Skin incision made by cutting diathermy was less time taking and there was no appreciable differences in postoperative pain, the requirements of analgesia and the rate of wound complications like seroma, and purulent collection, though the hematoma was seen more in scalpel skin incision. So the use of diathermy for making skin incision is as safe as the use of scalpel in patients undergoing inguinal hernia repair.

Cutaneous horns are cornified hyperkeratotic lesions on the skin, usually present on photo-exposed areas such as the face and scalp. Its presence on the penis is very rare and represents the most unusual site. The role of chronic irritation, phimosis, surgical trauma, and radiotherapy have been implicated in penile horn formation. Penile horns present as elongated, keratinous, white or yellowish projections that range from a few millimeters to centimeters in size arising from the glans penis. Histopathology of the keratotic mass reveals nothing but keratin. One-third of cases of penile horns are associated with underlying malignancies. The standard treatment is electrosurgical excision with the removal of a broad base.

Background: Hernia is the abnormal exit of an organ or fatty tissue, such as the bowel, through the weak wall of the cavity in which it normally resides. Repair of inguinal hernia is common surgical  procedures. This study aims to compare between laparoscopic and open hernia repair. Method: Study is non randomized comparative study. Study includes 76 patients who had undergone surgery for hernioplasty. Among them 38 undergone laparoscopic hernioplasty and 38 undergone open hernioplasty from June 2016 to August 2018. Results: Mean hospital stay was 2.95 days in group 1 and 4.03 in group 2 .VAS was found to be 2.45 in group 1 and 5.71 in group 2 which is significantly low in group 1 patients with p<0.001. Duration of surgery is more in group 1 with mean duration of 94.08 minutes comparing to group 2 with mean duration of 43.55 minutes (with p<0.001). Conclusion: Laparoscopic hernia repair offers advantages over open repair in terms of less hospital stay and lower pain score for patient not contraindicated for general anesthesia and complicated hernia.

Background Minimal invasive surgery (MIS) procedures in the early 90&#39;s as laparoscopic transabdominal preperitoneal repair (TAPP) and totally extra peritoneal repair (TEP), have gained popularity worldwide over open hernia mesh repair with low recurrences, complications and early return to work and activities. This retrospective study aims to compare the two laparoscopic procedures regarding various parameters like duration of surgery, postoperative complications and duration of hospital stay in various ages and different sexes as described in the methodology. Methods This is a retrospective study for over 2 years which included patients with unilateral inguinal hernia both direct and indirect using either (TAAP) or (TEP) technique. Results Among sixty patients with an inguinal hernia, 30 patients had undergone (TAPP) and 30 had undergone (TEP). The duration of surgery for (TAPP) was observed 111.03±13.71 minutes which was significantly higher than that of (TEP) (92.80±8.24 minutes) at P<0.001. The pain score at 6 hours for (TEP) was 6.97±1.01 in comparison to 8±0.00 for (TAPP) (P&lt;0.001). The pain score at 24 hours for (TAPP) was 5.18±1.00 in contrast to 4.27±0.70 for (TEP) (P<0.001). Conclusion Both (TAPP) and (TEP) are feasible surgical options to treat an inguinal hernia. (TAPP) had significantly longer operating time and more early post-operative pain as compared to (TEP). However, there was no significant difference in hospital stay, post-operative complications in both the group.