Background: Inguinal Hernia is a common entity in general surgical practices across the world. Its management though appears to be straightforward, could still be a nightmare for a surgeon if not dealt with proper attention and care. Lichtenstein’s mesh hernioplasty is still one of the most popular surgeries performed for inguinal hernia repair across the world. At our institute, we commonly perform this surgery with either Onlay mesh hernioplasty technique or combined Onlay-Plug mesh technique. The double mesh placement had always kept us engaged in regards to its post-operative outcomes and its advantage over single onlay mesh. We were also keen to take the subject due to the scarce availability of the recent literature.Methods: This prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India on 200 patients who were randomly and equally divided into two groups. Patients in Group A underwent Onlay mesh hernioplasty surgery, while patients in Group B underwent combined Onlay-Plug mesh hernioplasty surgery. Post-operative outcomes were assessed in both groups for a period of six months.Results: There was a significant difference between the two groups in terms of post-operative pain, scrotal edema, cord tenderness, and wound infection as patients in Group 2 who underwent combined Onlay-Plug mesh repair were found to have more incidences of the above-mentioned post-operative outcomes.Conclusions: Single Onlay mesh placement is sufficient. There is no significant benefit of keeping an additional Plug/Inlay mesh in patients undergoing tension-free mesh inguinal hernioplasty as per our findings.

Introduction- Lower Gastrointestinal bleeding (LGIB) constitutes a major spectrum of signs and symptoms among patients visiting general surgery clinics ranging from occult bleeding to hematochezia and massive hemorrhage with shock. It is a frequent cause of hospital admission, particularly in elderly patients, and is an important determinant of morbidity and mortality. Detailed history taking, thorough clinical examination, and judicious use of diagnostic modalities are paramount in delineating the causative factors. This study aims to understand the distribution and prevalence of various causes of LGIB in the general population visiting a tertiary care center in India. The present study was a prospective observational study conducted Methods- at the Department of General Surgery, Anantshree Multispeciality Hospital, Aurangabad, India to observe the prevalence of various causes of LGIB and their age and sex-wise distribution in the patients visiting the surgery clinic for a period of two years from January 2020 to December 2021. All patients were examined and investigated as per the standard protocols and the inclusion criteria to be included in the study. The sample size came out to be 700. The majority of the Resultsstudy participants were in the age group of 41-60 years and were males. The most common presenting symptom was hematochezia and the most common etiology of LGIB was found to be hemorrhoids in both males and females. The neoplastic cause (carcinoma) was seen in the elderly group of more than 60 years of age. 65.7 % of the patients in this study were found to have anemia. LGIB is a common and alarming Conclusionpresenting condition in the practice of gastroenterology and surgery. A careful clinical history and physical examination with colonoscopic visualization of the lesion with or without biopsy signicantly impact the patients' early diagnosis and proper treatment

Littre's hernia (LH) is a very rare presentation in patients presenting with hernias. It is the presence of Meckel's diverticulum (MD) in a hernia sac. However, it usually presents with obstruction or strangulation. We are reporting here a case of Littre's hernia in a 42-year-old male patient who presented with an irreducible swelling in the left inguinal region. The diagnosis of an incarcerated indirect inguinal hernia was made preoperatively. Intraoperative finding was however an obstructed Littre's hernia with Meckel's diverticulum in a very uniquely appearing hernia sac. The patient was successfully managed by resection of the MD along with ileal segment, primary anastomosis, and mesh hernioplasty on the inguinal floor.