NTRODUCTIONThe conception of laparoscopy has revolutionized the art of surgery due to its vantages over classical open technique.The lately innovated laparoscopy cholecystectomy has been drastically refined over the years by better exploration of ergonomics, instauration of new energy sources and endo suturing. The conventional four ports access technique has been modified to three ports, two ports and single incision laparoscopic surgery with corresponding results. [1][2][3] Further cystic duct closure methods like clipping, harmonic scalpel, plasma kinetic and intra corporeal ligation have been tried with gratifying results. 4Metallic clip is the most commonly used method for cystic artery and duct closure which may be due to ease of learning and its execution, short operative time and timetested safety of technique. Although it is not less than a boon for a budding surgeon but it is not free from complications. Bile leaks, migration of clip, inadvertently clipping of common bile duct and right hepatic artery have ABSTRACT Background: Although in the era of laparoscopic cholecystectomy cystic duct occlusion has been tried by clips, harmonic and plasma kinetic quite effectively but cost, availability and inadvertent injury to biliary duct are concerning factors. Intra-corporeal ligation has evolved to address these issues effectively as a boon especially for the peripheral centres where availability and cost of energy sources weighs heavier than their associated ease. Triple ligation technique is a time preserving modification without any compromise in safety and quality of surgery. The aim of our study is not only to elucidate the importance of intra-corporeal ligation in safety and cost of surgery but also to enlighten its role in safe management of even difficult cases of cholecystitis. Methods: A retrospective observational study. All cases of symptomatic gallstones operated by laparoscopic triple ligation technique were included in the study. Results: More than half (63.4%) of the cases in our study were having chronic cholecystitis was reported in 63.4% of the cases while 36.4 % cases have acute cholecystitis. Mean duration of surgery was 46.4 and 71.2 minutes in chronic and acute cases respectively. No case of bile duct or vascular injury has been reported in our study. Only 3.8% of the cases were converted to open. Gallbladder perforation was most common complication noted in 12.8% of the cases. Conclusions: Triple ligation technique of laparoscopic cholecystectomy is not only a time sparing modification but is also a veritable, safe and frugal tool with excellent results even in complicated cholecystitis without compromising its outcome and prime.

Background: Intestinal stoma is an opening for fecal diversion. The purpose of the present study was to identify indications for emergency laparotomy, commonly performed intestinal stomas and to study complications related to it.Methods: This is a prospective study was carried out in a surgical unit of Saveetha Medical College & Hospital, Chennai, Tamilnadu, from August 2012 to August 2013. Data was collected by meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases. The results were collected, analyzed and compared.Results: A total of 74 patients were evaluated age ranged between 16 to 78 years. Male to female ratio was 7:2. The most common type of stoma made was loop ileostomy (60%) followed by end ileostomy (30%) and loop colostomy (9%). Main indication for emergency laparotomy was intestinal obstruction (44%). The most common type of stoma performed was loop ileostomy (60%). The most dreaded complication of stomal closure is anastomotic leakage.Conclusions: Early referral to the tertiary hospital, early diagnosis, proper preoperative management like intravenous fluids, antibiotics, etc., early detection and prevention of hypotension, reduction of time duration for emergency laparotomy, close post-operative monitoring definitely reduce the morbidity and mortality of stomal closure, when intestinal stomas kept for emergency cases.