Although a small sample size is the limitation of this study, POSSUM scoring system is a good indicator of postoperative outcome in patients with perforative peritonitis and was applicable in our setup. It is useful in identifying high risk patients and give preferential care to them for better outcome. Inclusion of factors like perforation to operation time and co-morbid status can improve the scoring system and better care can be provided.

BACKGROUNDRectal prolapses are not life-threatening; however, the bleeding and faecal incontinence associated with them significantly erode quality of life and can cause concern among patients, caregivers in nursing homes. Many procedures have been reported that repair of rectal prolapses and the procedure used depends on the severity of the prolapsed [1] ; however, the treatments are yet to be established. Here, we report a simple and safe procedure to repair rectal prolapse perineally using non-absorbable polypropylene mesh for anoplasty. We performed this procedure on 10 patients. All patients were followed up for over 3 years and none had any recurrences of their rectal prolapses. No complications occurred during the operations and postoperative periods. Most patients who have prolapses are elderly and fragile, so the treatment must be easy, safe and rapid. While rectal prolapse is not life-threatening, the goal of treatment is to alleviate its symptoms. The procedure we describe is consistent with this concept. We suggest that this procedure, which uses non-absorbable polypropylene mesh, might be a better option for the treatment of complete rectal prolapse. We will continue to surgically correct complete rectal prolapses and investigate the long-term outcomes of the procedure.

BACKGROUND There is a routine practice of getting informed written consent in patients undergoing any medical procedure, especially surgical procedure. In case of high-risk surgery, we routinely get an informed high-risk written consent. We get consent from both the patient and the patient's close and reliable relatives. Patients routinely agree and give consent to all medical procedures, but actually most of the patients are unaware of the condition of patient or the disease severity and its complications from which he or she is suffering from at the time of giving consent. When something grave happens to the patient, the entire blame is on the doctor that the patient's relatives were unaware of the condition of the patient and there is lot of stress to the doctor who is treating a high-risk patient and declaring death. In order to modify this, in this study we took one of the patient's close and reliable attender inside the operating room to visualise the pathology in person and explained them in detail the condition of the patient. We suggest that by this method, the stress to the doctors regarding risks to the patient is reduced and they need not explain each and every one about the condition of the patient. We will continue to take attenders inside operating room and explain the condition in high-risk cases.

Obstructed hernia is a common surgical emergency. Over a period of 10 years, six patients had undergone laparotomy to overcome the paralytic ileus following hernioplasty surgery. Here the researcher has designed a test to avoid this rare (post hernioplasty) laparotomy/other modality of intervention. This is a post-operative, retrospective, and observational study. The researcher has observed these findings only in six patients over a period of 10 years. Patients possessing intestinal obstruction with uncomplicated hernia and obstructed hernia are taken in this study, since both conditions present with obstipation. A simple clinical observation named renga sign is designed to differentiate to do hernioplasty or laparotomy/other modality of management. This test is an easy, bedside, clinical method to decide about the type of surgery to be performed. In the study, the researcher proves the application of this simple and easy clinical test even to the junior-most persons who are identified whether a hernioplasty or other modality of intervention is required in this situation.