With the recent development of successful methods to correct valve incompetence in the lower extremity, there is a need for a standardized approach to descending venography. This is the single test that accurately defines the site of the venous valve and demonstrates its competence or degree of incompetence. This report describes a technique of descending venography, including the details of catheter placement, injection procedure, and monitoring techniques. Interpretation of the study requires a method that analyzes both the individual valve function and the overall valvular competence of the entire extremity. Descending venography can separate patients with primary valve incompetence from those with postthrombotic valve destruction, as well as the occasional case of valve aplasia. Points on interpretation of valve function and the use of the Valsalva maneuver for "stressing" the valve are discussed. The descending venographic results are compared with the clinical state and with venous pressure findings in 78 extremities.

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Bariatric surgery as it is called now is not a new thing. First bariatric surgery was performed in 1954. Later the surgical remedy for bariatric surgery remained dormant till the popularity of laparoscopic surgery. Past decade has seen a tremendous increase in the number of bariatric or metabolic surgical procedures. This trend may continue because of the epidemic of obesity throughout globe and its rising prevalence among children. Advocates of bariatric surgery consider it the most effective and only treatment for morbid obesity and its co morbidities. To simplify; two types of procedures are performed. 1. Restrictive-where the intake of calories are prevented by restricting food intake. 2. The other one is malabsorptive-where food rich in calories is prevented to get absorbed. Operations based on these principles are-Laparoscopic adjustable gastric band and Vertical sleeve resection of stomach; for restrictive surgery and Laparoscopic biliopancreatic diversion with or without duodenal switch; for malabsorptive procedures. Both types have their own merits and demerits, many of which are almost unacceptable. To counter each other's' demerits certain combinations of both types are evolved like Roux-en-Y gastric bypass; it combines both restrictive and malabsorptive components. Each operation has its own merits and demerits. Important points for the patient and surgeon alike in the decision to proceed with bariatric operation include -the technical aspects of operation, post-operative complications including long term nutritional problems, Magnitude of initial and later steady weight loss over the period and correction of obesity related comorbidities. Here, the merits and demerits of present day laparoscopic bariatric surgical procedures are reviewed and related controversial aspects related to them are discussed. Right patient selection; right selection of operative procedure for an individual patient and more importantly right selection of surgeon seems criteria to measure success after such surgery.

This study includes the works of various surgeons who adopted newer methods of gall bladder removal vis a vis standard method of laparoscopic cholecystectomy through 4-ports. Newer methods include Single-incision laparoscopic cholecystectomy (SILC) and Natural Orifice Transluminal Endoscopic Surgery (NOTES). The work of various studies of Laparoscopic Cholecystectomy (LC), a gold standard so far analysed against the newer techniques with respect to complications directly related to the procedure such as biliary injury, bile leak, infection, trochar related injury and post-operative incisional hernia; Post-operative hospital stay and return to work and expenses incurred over the surgical procedure .Laparoscopic cholecystectomy 4-port standard procedure, still rules the roost. Newer methods like SILC and NOTES though around for more than 8 yrs but yet to click with surgeons and more importantly with patients. Patients still find the 4-port LC fine and satisfied with it. Laparoscopic cholecystectomy (4-port LC) continues to be the method of choice with surgeons throughout globe except in few pockets. It has been standardized for procedure details and rate of complications and conversions .Till now apart from some extra advantage of cosmetic superiority newer methods do not provide any extra advantage as far as complications, hospital stay, return to normal activity and treatment cost are concerned.