Background Large renal pelvic stones can be effectively managed with laparoscopic pyelolithotomy. The aim of this study was to compare the surgical outcomes of laparoscopic pyelolithotomy versus open surgery for the treatment of large renal pelvic stones. Materials and Methods This prospective comparative study was performed at the Sher-i-Kashmir Institute of Medical Sciences Medical College and Hospital over a period of 8 years. Using computer-generated random numbers, the patients were randomized into two groups: group A received laparoscopic pyelolithotomy, while group B had open pyelolithotomy. The data was collected and analyzed using SPSS software 22. Results Among 74 patients who met the inclusion criteria, the mean age was 39.18 years with 66.21% being males and a male:female ratio of 1.96. Forty-one (55.41%) patients had open surgery and 33 (44.59%) had laparoscopic pyelolithotomy. The difference in mean operative time of laparoscopy (117.66 minutes) and open (78.13 minutes) surgery was statistically significant (p = 0.05). The mean blood loss was significantly lower in the laparoscopic pyelolithotomy group (62.12 mL) than in the open group (92.07 mL) (p = 0.009). The difference in mean hospital stay between the open and laparoscopic groups was significant (p = 0.02). In both laparoscopy and open surgery, we observed a 100% stone-free rate at the end of 1 month. None of our patients expired during the study period. Conclusion Laparoscopic pyelolithotomy is a promising alternative to traditional open and other endourological techniques, with encouraging results. Despite its technical difficulty, it yields high stone-free rates and low postoperative morbidity.

Background: Internal rectal prolapse probably represents the first stage of a progressive anomaly that eventually leads to full thickness external prolapse. Non-surgical treatment modalities like dietary advice and feedback therapy should be used before doing any surgical intervention in such cases. This study focuses on clinical features, pathological outcomes and treatment modalities of internal rectal prolapse.Methods: The study is a combined prospective (from Aug. 2018 to Aug. 2020) and retrospective (from Aug. 2015 to Aug. 2018) conducted at Sher-I-Kashmir institute of medical sciences, Soura, SrinagarResults: A total of 79 patients were studied out of which 39 were retrospective and 40 were prospective. Internal rectal prolapse is usually missed by surgeons as a cause of obstructed defecation syndrome. So, it was worthwhile to study this entity in our patients.Conclusions: Before choosing any treatment strategy for internal rectal prolapse, conservative trial with dietary modification and feedback therapy should be attempted.

Background: Male circumcision is recommended practice in Muslim tradition and one of the oldest operations performed all over the world. Male circumcision is universal in our Muslim-dominated valley of Kashmir for religious reasons. It can be performed by different techniques such as the conventional open methods, the device methods and sutureless methods. The objective of this study was to report our practice of male circumcision amongst children and compare the different common surgical techniques and highlight the circumcision mishaps conducted by quacks in the Kashmir Valley. Materials and Methods: This was a comparative observational study conducted at SKIMS Medical College and Hospital, from 2017 to 2021. Children who presented for primary circumcision were subjected to one of two different surgical techniques; the dorsal slit or Guillotine method. The prospective analysis of children managed for circumcision mishaps conducted by non-professionals was also included in the study. Circumcisions done after 2 years of age were defined as delayed. The data were collected analysed using SPSS software (SPSS version 22, IBM, Armonk, NY, USA). Results: Total of 689 Kashmiri Muslim male children between 1 day and 10 years of age over a period of 5 years were studied. Six hundred and fifty-five children for primary circumcision and 34 children managed for circumcision mishaps were included in the study. Amongst the subjects for primary circumcision, the most number of children were between 1 and 2 years of age (33.28%). One hundred and fourteen (25.73%) hospital-delivered babies and 201 (94.81%) home-delivered babies had delayed circumcision that is after 2 years of age (P = 0.00001). Religious requirement was the only indication for circumcision in this study. Three hundred and ninety-six (60.46%) children were circumcised with dorsal slit and 259 (39.54%) with guillotine method using computer-generated random numbers. Complications were found 8.08% of subjects in dorsal slit method as compared to 16.60% in guillotine technique (P = 0.008). Out of 34 children managed for circumcision mishaps, 11 (32.35%) presented with massive bleeding after primary circumcision by half doctors, 18 (52.94%) had incomplete circumcision, 3 (8.82%) had multiple skin bridges and 2 (5.88%) had incomplete circumcision with glans injury. All the patients with circumcision mishaps were treated with good outcome. There was no mortality. Conclusion: Circumcision occurs at a wide range of ages and male circumcision is universal in our Muslim-dominated valley for religious reasons. Circumcision by quacks and the associated complications are still prevalent in our society. The procedure is safe and free of any major complications when conducted by trained medical personnel under aseptic conditions of the operation theatre and hence should be encouraged.

Background: Fistula-in-ano is an abnormal communication between anal canal/rectum and perianal skin. It is considered to be chronic sequelae of cryptoglandular perianal abscess. Surgical treatment is the standard of care. However, the surgical techniques have evolved over time in order to give a satisfactory non-recurring result without jeopardising continence mechanism. Our aim was to study the feasibility and outcome of various surgical procedures done for fistula-in-ano.Methods: This study was conducted in colorectal division of department of general surgery SKIMS Srinagar, from 2017-2019. All patients underwent a surgical procedure which was deemed feasible for a particular case. Pre-operative data and post-operative outcome/complications were studied over a mean follow up of 12 months. Final inferences were drawn after analysing the data using various statistical tools.Results: Fistula-in-ano has male predominance (8:1), with intersphincteric fistula being the commonest type (48%) in our study. Majority of our patients underwent fistulectomy (72.5%) with or without Seton placement. Over a mean follow up of 12 months, only 19 patients (15.32%) developed recurrence. Incontinence was observed in 15 patients (12.09%). The risk of recurrence was observed to be directly related to the complexity of fistula.Conclusions: Fistulectomy is safe and effective for low intersphincteric and trans-sphincteric fistulas with acceptable rates of recurrence. Benefit of radical excision in high fistulas with multiple secondary tracts should be carefully weighed against risk of post-operative incontinence.