Background: Acute pancreatitis is an acute inflammation of the pancreas resulting from an auto-digestion of the gland. Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. In 20–25% of acute pancreatitis are severe, characterized by the development of pancreatic or peri-pancreatic necrosis, resulting in general and local complications responsible for a high mortality rate. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Aims: The aim is to study the intervention to surgery and its outcome in managing severe acute pancreatitis and its complications. Methods: A total of 36 patients with severe acute pancreatitis with its complications not responding to conservative treatment were studied. In this prospective observational study, patients were divided based on the mode of treatment received: percutaneous drainage with pigtail catheterisation, endoscopic cystogastrostomy/drainage procedure and necrosectomy (in patient failed to respond by other intervention). Results: In our study, out of 36 patient 22 patient are treated with percutanous drainage with pig tail catheterization,8 patient are treated with endoscopic cystogastrostomy,6 patient underwent necrosectomy (3 patient underwent minimally invasive laparoscopic necrosectomy and 3 underwent open necrosectomy).Higher complication occured in patient underwent surgical intervention.Mortality occurred in 80% of patient who underwent necrosectomy. Most common cause of death is sepsis with multi organ failure. Conclusion: Surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis .Patients with acute pancreatitis should be managed conservatively in a step up approach. Early surgical intervention is not recommended even for necrotizing pancreatitis. Infected..

Background: The external branch of the Superior Laryngeal nerve (EBSLN) is at high risk of injury in surgery for large multi-nodular goitre (MNG) since the upper pole is high in the neck, well cephalad to the EBSLN. We present a technique of drawing the lobe caudally by retrograde thyroidectomy in order to minimize nerve injury. Design & method: All patients having surgery for benign MNG were included. Cases with previous thyroid surgery, malignant and toxic disease were excluded. The thyroid lobe was mobilized from its inferior aspect and capsular dissection performed cephalad with bipolar cautery, lifting the gland off the trachea while separating it from the parathyroids and branches of the inferior thyroid vessels. The ligament of Berry is divided and the entire lobe freed, attached only by the superior pedicle which is drawn caudally well below the EBSLN prior to ligation. Patients were followed for voice change at 24 hours, 7 days and 3 months. Results: Ninety-one consecutive lobectomies were done in 60 patients, 31 bilateral. Forty-four (73%) patients had voice change at 24 h, 10 (11%) at 7 days and 1 at 3 months. The patient with persistent voice change complained of change in tone but not volume; vocal cords were normal on indirect laryngoscopy. Conclusion: Retrograde thyroidectomy is recommended for large MNG where the EBSLN lies well below the upper pole; it minimizes risk to the nerve.

Objective: To find out the frequency of various types thyroid carcinomas and their management in tertiary care hospital of Bengaluru. Study design: Retrospective study. Place &Duration of study: Department of General Surgery, KIMS Hospital and Research Centre, Bangalore. 2016 -2021. Methodology: All patients with well differentiated thyroid carcinoma and medullary thyroid carcinoma were included in the study. Patients with anaplastic carcinoma were excluded. Written and informed consent were taken from the patients and data was recorded on a pre-designed form. Results: One hundred and twenty four patients were included in this study. Eighty four patients were female and fourty male with female to male ratio of 2:1. Papillary carcinoma was found to be the most frequent thyroid carcinoma encountered (n=78 – 62.90%) followed by follicular and medullary carcinoma, 34 (27.42%) and 12 (9.67%) respectively. Various surgical procedures were done to deal with these malignancies, that included total thyroidectomy (n=68 – 54.84%), total thyroidectomy plus modified radical neck dissection (n=18 – 14.51%) completion thyroidectomy (n=32 – 25.81%), completion thyroidectomy with modified radical neck dissection (n=4 – 3.22%), and modified radical neck dissection (MRND) alone in (n= 2 -1.65%) patients. Conclusions: Papillary carcinoma was the most common thyroid malignancy encountered. Frequency of medullary carcinoma was found almost equal to the follicular carcinoma.

Background: Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). The condition of the patient, the level of experience of the surgeon and technical factors all play a role in the decision for conversion. Inability to define the anatomy and difficult dissection are the leading reasons for conversion. Aims and objectives: To compare between and to validate: preoperative ultrasonographic based scoring system and intraoperative scoring system (SURGUE ET AL, IRELAND) as predictors for difficult laparoscopic cholecystectomy. Materials and Methods: This prospective randomized study was conducted at Kempegowda Institute of Medical Sciences Hospital, Bangalore after obtaining the Hospital Ethical Committee clearance for a period of 6 months from AUGUST 2018-JANUARY 2019. Pre-operative Ultrasonographic based scoring system was compared with Intra-operative scoring system to predict laparoscopic cholecystectomy. Results: In the study among those with Easy Pre-operative score, 90.9% had easy, 9.1% had moderate Intra-operative score. Among those with difficult pre-operative score, 33.3% had easy, 11.1% had moderate, 22.2% had difficult and 33.3% had extreme Intra-operative score. There was significant association between Pre-operative score and Intra-operative score. Conclusion: With the help of accurate prediction, high risk patient may be informed beforehand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. Surgeons can also be aware about the possible complications that may arise in high risk patients. Our study also concludes that radiological parameters are good predictors of difficulty.