BackgroundVentral hernias are commonly encountered problems in the field of general surgery. Incisional hernia is a common complication following abdominal surgery that requires reoperation. This study was conducted to understand the incidence of various types of ventral hernia in both sexes and various age groups, predisposing factors, clinical features, and complications.

IntroductionA pilonidal sinus (PNS) is a small passageway in the subcutaneous tissue which develops most frequently in the sacrococcygeal area. In terms of postoperative outcomes, the decision on the best surgical treatment for PNS is still a challenge for a surgeon. Prevention of the disease recurrence and improving quality of the life can be considered primary goals of the treatment. The current study intends to compare two commonly practiced surgical treatments for PNSes-Rhomboid excision with Limberg flap repair against wide-open excision with healing by secondary intention. MethodsIn a prospective randomized study, 50 patients with sacrococcygeal PNS were divided into two groups. Group A was operated by rhomboid excision with Limberg flap reconstruction and Group B was operated by wide-open excision and healing by secondary intention. Data were collected on a specially designed structured proforma and consisted of patient demographics, medical history, presentation, and postoperative complications assessed for a period of 6 months. Comparative outcomes of interest were postoperative pain, postoperative anxiety, duration of wound healing, duration of work loss, presence of wound infection, and recurrence. ResultsMean age of 28 years was observed across the study with a male preponderance (76%). The mean visual analog scale (VAS) score for pain was greater in Group A during the early postoperative period, i.e., days 1, 3, and 7. However, patients in Group B reported a mean VAS score of 3 ± 0 and 1 ± 0 at one month and 2 months, respectively indicating a longer duration of postoperative pain overall. Patients in Group B also reported a significantly higher VAS for anxiety (VAS-A) score for postoperative anxiety/stress in all the follow-up visits. The mean healing time was 20 ± 2 days in Group A and 57 ± 11 days in Group B showing a significant difference. Duration of work loss was also significantly higher in Group B (31 days). Five patients in Group B developed wound infections. No recurrence was observed across both the groups in this study. ConclusionAccording to the findings of this study, the Limberg flap method outperforms the wide-open excision approach in terms of healing duration, work loss days, postoperative pain, anxiety, and wound infection. Both the techniques, however, are comparable in terms of recurrence.

BackgroundEnhanced recovery after surgery (ERAS) protocols are nowadays considered the standard of care for various elective surgical procedures. However, its utilization remains low in tier-two and tier-three cities of India, and there exists a significant variation in the practice. In the present study, we have investigated the safety and feasibility of these protocols or pathways in emergency surgery for perforated duodenal ulcer disease. MethodsA total of 41 patients with perforated duodenal ulcers were randomly divided into two groups. All the patients across the study were treated surgically with the open Graham patch repair technique. Patients in group A were managed with ERAS protocols, while patients in group B were managed with conventional peri-operative practices. A comparison was established between the two groups in terms of the duration of hospital stay and other postoperative parameters. ResultsThe study was conducted on 41 patients who presented during the study period. Group A patients (n=19) were managed with standard protocols, and group B patients (n=22) were managed with conventional standard protocols. As compared to the standard care group, patients in the ERAS group showed quicker postoperative recovery and lesser complications. The need for nasogastric (NG) tube reinsertion, postoperative pain, postoperative ileus, and surgical site infections (SSI) were all significantly lower in the patients of the ERAS group. A significant reduction in the length of hospital stay (LOHS) was found in the ERAS group when compared to the standard care group (relative risk {RR}=61.2; p=0.000). ConclusionsThe application of ERAS protocols with certain modifications in the management of perforated duodenal ulcers yields significant outcomes in terms of reduced duration of hospital stay and fewer postoperative complications in a selected subgroup of patients. However, the application of ERAS pathways in an emergency setup needs to be further evaluated to develop standardized protocols for a surgical emergency group of patients.

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