Frey's pancreaticojejunostomy effectively reduces pain in tropical pancreatitis, with significant improvement in health-related QOL, which is comparable with the general population in most aspects.

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

Introduction: To review management trends and outcomes of blunt pancreatic injury at 2HPB centres. Methods: A retrospective review of patient registry at 2 public hospitals.(2001e2016).2 study groups were identified. Group 1-patients who underwent operative management (pancreatic resection/repair) Group 2-patients who underwent non operative management (i-either had no abdominal surgery; had abdominal surgery but not pancreatic surgery; had endoscopic or radiology guided interventions only). Patients characteristics, clinical outcome, length of stay, complications and mortality for each group were reviewed. Comparative analysis was performed. Result: 85 patients with all grades of injury were identified. (AAST classification). As time of referral following trauma was variable, there was no specific management strategy that was adhered to. (mean referral time 8.7days-Gr 1 vs 29.3 days-Gr 2) 46% Gr 1 and 26% of Gr 2 had 'damage control surgery' prior to transfer. 40patients (49.3%) Gr 1 vs 41patients (50.6%) Gr 2 sustained pancreatic injury grade I, II, III. All patients with grade IV,V were in Gr 1.Overall specific pancreatic complications-fistula, pseudocyst/collection, abscess, pancreatitis and haemorrhage was lower in Gr 1 (67% vs 78%). Mean hospital stay was longer in Gr 1(41 days vs 15 days, p value 0.000) 2 mortalities were recorded in each group. On multivariate analysis, pseudocyst and isolated pancreatic injury favour non operative management. Conclusion: Non operative management was associated with shorter hospital stay, no significant difference in complication rates and mortality, therefore may be attempted in stable group of blunt pancreatic injury (grade I, II, III) without peritonitis.

Conclusion: Delayed ERCP in ABP with cholangitis could be performed with no differences in term of complication but increased length of hospital stays.

Background: Incisional hernia occurs in 5-11% of patients subjected to abdominal operations. Laparoscopic hernia repair has revolutionized the treatment of incisional hernia by reducing the morbidity and improved post-operative outcomes. The objectives of this study were to compare open incisional hernia repair with laparoscopic incisional hernia repair in our patient population with respect to Operating time, post-operative complications, post-operative recovery, duration of analgesic administration, and cosmetic results. Methods: This is a prospective study of Forty patients who were admitted at Osmania General Hospital, Hyderabad, Telangana, India with a clinical diagnosis of incisional hernia, 20 patients in each group (open and laparoscopic). Results: Both the study groups were comparable in terms of patient characteristics. The duration of laparoscopic repair was significantly more when compared to open repair (mean time 133.75 mins versus 85.8 min respectively). Analgesic requirement, wound infection rate and complication rate were higher in open group. The laparoscopic patients tolerated oral feeds earlier compared to open patients. The duration of hospital stay was significantly longer for open group than for laparoscopic group (mean 9.6 days versus 6.4 days respectively). The cosmetic end result was better in laparoscopic patients. Conclusions: Though ours is a small study, with the benefits of laparoscopy it will be prudent to recommend laparoscopic repair as the first line of management for incisional hernia where the facilities and trained expertise were available. However, there is still a role for traditional open approach in patients who have a specific contraindication to laparoscopic repair or any additional procedures that are not amenable for laparoscopy.