The low inguinal repair with a conical mesh plug is easily reproducible, elegant and probably the best method for femoral hernia repair.

Background: Ultrasound guided abdominal nerve blocks are increasingly being used for anaesthesia and analgesia for surgeries like appendectomy, hernia repair in our centre. The aim of the study was to compare abdominal nerve blocks and subarachnoid block for appendectomy.Method: Retrospective data of patients that underwent appendectomy either under subarachnoid block (Group-S) or abdominal nerve blocks (Group-A) for three months were collected from hospital records. The groups were compared for conversion to general anaesthesia as a primary end point of study and also for the time taken for the procedure, the first requirement of opioids, total opioid consumption and length of hospital stay.Result: Out of 116 patients studied, 75 surgeries were performed under subarachnoid block and 41 under abdominal plane blocks. Two patients in Group-S and 1 patient in Group-A were converted to general anaesthesia due to inadequate blockade. The time taken to perform the block was around four minutes in Group-S and 12 minutes in Group-A. The mean pethidine consumption in 24 hours was 62.33+16.63 mg and 23.17+15.19 mg in Group-S and Group-A respectively. The time to the first dose of pethidine in Group-S groups was 224.66+43.56 minutes and 813.17+361.80 minutes in Group-A. The mean duration of hospital stay in Group-S was 5.14+0.72 days and Group-A was 2.24+0.58 days.Conclusion: Appendectomy can be safely performed under subarachnoid block as well as the abdominal nerve blocks. The abdominal nerve block technique is found to be advantageous in terms of better postoperative analgesia, less opioid consumption and early hospital discharge.

Introduction. Recurrent incisional hernias are difficult to treat. There are many factors involved in the recurrence, and due to extensive dissections, the planes are fused with adhesions, and we may need a new plane for dissection and placement of meshes. Case Report. We report here three cases of recurrent incisional hernias which were dealt by a relatively new method to laparoscopy: the enhanced view totally extraperitoneal repair (e-TEP) retromuscular technique. There were three patients: one after an open onlay repair of lower midline incision, another after an onlay mesh repair of a subcostal incision for open cholecystectomy followed by an intraperitoneal onlay mesh hernioplasty (IPOM) repair, and another after IPOM repair of epigastric hernia. They were treated with the abovementioned technique with satisfying short-term results. Conclusion. The e-TEP technique is a relatively new method of providing minimal access surgery to these patients utilizing the previously unaccessed retromuscular (Rives and/or preperitoneal) space for the repair of these recurrent incisional hernias.

Introduction Though, in developed countries, laparoscopy is now a gold standard for splenectomy, we are lacking in this aspect in the eastern world. Splenectomy has mostly been performed by open surgery in our region. This is our effort to introduce laparoscopic splenectomy in our country. Methods This is a retrospective cohort study done in patients presenting to hematology and surgery department of our hospital who underwent laparoscopic splenectomy for hematological diseases from January 2013 to December 2016. Results There were 50 patients (38 females, 12 males). The diagnoses were idiopathic thrombocytopenic purpura in 31, (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 9, alpha-thalassemia in 3, beta-thalassemia in 2, autoimmune hemolytic anemia in 4, and isolated splenic tuberculosis in 1. Average platelet counts preoperatively were 62000 ± 11000/mm3 (range 52000-325000/mm3). The mean operative time was 130 ± 49 minutes (range 108-224 min). The mean postoperative stay was 4 ± 2.11 days (range 3-9 days). Laparoscopic splenectomy could be completed in 45 (90%) patients. Conclusion Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, especially if spleen is normal or only mildly enlarged, and is an advantageous alternative to open splenectomy. Absence of ideal resources has not limited our progress in minimal access approach.

Ultrasound guided nerve blocks are gaining popularity these days due to its higher accuracy and reduced incidence of complications. Ultrasound guided unilateral paravertebral block in combination with unilateral coeliac plexus block and unilateral Rectus sheath block in patients with multiple co-morbidities provides adequate anesthesia for surgery and it also reduces incidences of mortality, morbidity and hospital stay in comparison to General anesthesia and spinal / epidural anesthesia. Paravertebral block , Coeliac plexus block and Rectus sheath blocks can be performed with higher success rate with the use of ultrasound.  BJHS 2018;3(2)6:508-510.