, a total of 695 patients with hernia and intestinal obstruction were considered retrospectively. Of these, 545 patients were hernia cases (both elective and emergency), and the rest were intestinal obstruction cases, from other causes. Among the hernias most were inguinal hernias (397 patients) and internal hernias were constituted by 6 cases. All of them presented as acute intestinal obstruction, constituting 1.8% of acute intestinal obstruction cases [Table/ Fig-1].CASE 1: Patient presented to our emergency department with features of intestinal obstruction. History of similar complaints were present previously which had subsided on its own. He was dehydrated and tachycardia was present. Abdomen was distended with diffuse tenderness and guarding. X ray abdomen showed multiple air fluid levels and dilated bowel loops. He was posted for emergency exploratory laparotomy. Intraoperatively ileum was found herniating through the left paraduodenal fossa with constricting band formed by inferior mesenteric vein and the proximal small bowel was found dilated [Table/ Fig-2]. The contents of the hernia were reduced and the inferior mesentric vein was preserved. Defect was closed with the free peritoneum to the lateral border of duodeno-jejunal flexure, retroperitonialising the inferior mesenteric vein. Postoperative period was uneventful and he was discharged on day 7. CASE 2: Patient presented to our casualty with features of intestinal obstruction. He was febrile and dehydrated, tachycardia was present. Abdomen was distended, with diffuse tenderness, guarding and rebound tenderness. X ray abdomen showed multiple air fluid levels and dilated small bowel loops. He was posted for emergency exploratory laparotomy. During laparotomy ileum was found herniated in the left paraduodenal fossa with 50 cm of ileum found gangrenous within it and proximal segment dilated 4]. The constriction band was formed by inferior mesenteric vein. The contents were reduced, gangrenous bowel was resected and an end to end ileo-ileal anastomosis was done in two layers. The defect was closed with peritoneum to the DJ flexure after preserving the inferior mesenteric vein. Postoperative period was uneventful and he was discharged on postoperative day 9.CASE 3: A chronic liver disease patient admitted in medicine ward presented to emergency department with features of intestinal obstruction. X ray abdomen showed multiple air fluid levels and Contrast Enhanced Computerized Tomography (CECT) abdomen showed encapsulation of distended bowel loops in an abnormal location in the left hypochondrium, with hepatomegaly and ascites [Table /Fig-5]. She was transferred to the surgery department for emergency exploratory laparotomy. Intraoperatively ascites was present. Liver was massively enlarged and ileum was found herniating through the left paraduodenal fossa and covered by peritoneal sac and the constricting band was formed by the inferior mesenteric vein causing obstruction [Table/ Fig-6]. Sac was opened, contents were reduced and the defect was closed w...

Background: Fat grafting was developed in recent years with refinement mainly based on Coleman technique. The method consists of taking fat removed by liposuction under low pressure, fat processing and then placement of fat on the treated area.Methods: Patients who presented with depressed or retracted scars were considered. 12 patients were selected for the study as one year. Patients were given fat injection by Coleman’s technique and were evaluated at 1, 3 and 6 months. Patient and observer scar assessment score (POSAS) was used for evaluation.Results: The present study infers that there is a significant decrease in POSAS score on both the patient and observer side after fat injection for retracted scars. The overall patient score decreased from 5.75 (±0.866 SD) pre-operatively to 3.17 (±1.115 SD) post-operatively with a p value of less than 0.005. The difference between the scores is 2.58 which are comparable to other studies. The overall observer score decreased from 4.25 (±1.422 SD) pre-operatively to 2.58 (±0.996) post-operatively with a p value of less than 0.005. The difference between the scores is 1.67 which is comparable to other studies.Conclusions: Autologous fat grafting seems to be a promising and effective therapeutic approach for scars with different origins such as trauma, burns, post-surgery. In general, we can affirm that treated areas regain characteristics similar to normal skin, which are clinically perceptible, leading not only to aesthetic but also functional results.

INTRODUCTIONThe suturing of any incision or wound needs to take into consideration the site and tissues involved and the technique for closure should be chosen accordingly. Therefore, the correct choice of suture technique and suture material is vital, but will never compensate for inadequate operative technique, and for any wound to heal well, there must be a good blood supply and no tension on the closure. 1 The selection of the proper incision, suture material, and closure technique is very important to assist the patient's own repair mechanism and restore normal anatomic relationships after surgery. Attention to these details also prevents such complications as dehiscence and infection, assuring a good cosmetic result. Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. SSIs are classified into incisional and organ/space infections, and the former are further sub-classified into superficial (limited to skin and subcutaneous tissue) and deep incisional ABSTRACT Background: Wound closure is as important as any other action performed by the surgeon. Apart from the need for producing a healthy and strong scar, it is the surgeon's responsibility to ensure its aesthetically pleasing physical appearance. Skin staples are an alternative to regular sutures in offering this advantage. The present study has helped to highlight the benefits of skin stapler. Methods: Out of the 120 participants, 60 underwent skin closure with Stainless steel skin staples and the remaining 60 with non-absorbable Polyamide mattress sutures randomly. They all received one mandatory dose of pre-operative parenteral antibiotic 1 hour prior to the incision. On the 3 rd postoperative day, the wound was evaluated for inflammation, infection and wound gape. Participants were re-evaluated for infection/gape/inflammation during follow-up on 7 th day. The wounds were evaluated at 1 months follow up which were rated for cosmesis by Visual Analogue Score. The data was coded and entered in Microsoft excel and then analysed using statistical software SSPS. Results: Study population consisted of 79 males (65.8%) and 41 females (34.2%). Mean age of the study population was 49.35 with an SD 16.739. Wound infection was found to be higher in stapler group (30%) when compared to conventional suture group (11.7%)which was found to be statistically significant with chi-square value 6.114 and p value 0.013. Mean time for closure was significantly shorter in stapler group 4.55 minutes, when compared to suture group (11.22 minutes). Better cosmetic outcome was observed in conventional suture group. Conclusions: Preventing wound infection, especially in abdominal wounds, is of importance as it may lead to wound gaping. Incidence of post-operative wound infection was more with skin staples. Cosmesis is essential and important aspect in this day and age. A cosmetic scar not only gives satisfaction to the patient but also mental ease to the surgeon. Conventional sutures provi...

In this study, the application of reinforced circular staplers reduced the incidence of gastrojejunal anastomotic complications in patients undergoing Roux-en-Y gastric bypass.

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