Background:Laparoscopic cholecystectomy (LC) is accepted as the gold standart treatment of gallstones. Various methods have been developed to close the cystic duct (CD) and cystic artery (CA), but titanium clip application is currently the most frequently used technique. High-tech electrosurgical instruments, such as Harmonic Scalpel (HS), have been used both for dissection of the cystic artery and Cystic duct. The present study was conducted to observe and establish efficacy of clipless cholecystectomy, by use of harmonic scalpel as an alternative, for division and sealing of cystic artery and cystic duct. Methods:This study was a hospital based, retrospective study, conducted in Govt. Medical College, Srinagar, using medical records. A total of 114 patients included in the study, having been operated by a single surgeon over time period of 5 years from February 2014 to january 2019. Results:In our study of 114 patients 82 (71.92%) were females and 32 (28.07%) were males with average age of 41.4years (16-72 yr). No patient was converted to open with average operating time of 24.2 minutes (18-46 minutes). Mean hospital study was 1.42 days (1-8 days) with no mortality. Postoperative complications were found in 6 (5.2%) patients with bile leak from duct of Lushka in 1 (0.8%) patient, port site infection in 2 (1.7%) patients and fever in 3 (2.6%) patients.Gallbladder perforation intraoperatively was seen in 7 (6.2%) patients.Conclusions:Use of harmonic scalpel is an excellent option for the cystic duct closure with less time consumption and less complications.

Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among most common causes of blunt splenic trauma. In 1970s, postsplenectomy complications were published by some authors, revealing the high mortality and morbidity related to overwhelming postsplenectomy infection (OPSI). Therefore, conservative management for splenic trauma was accepted as treatment of choice in all the patients to decrease mortality due to OPSI. Therefore, NOM of traumatic splenic injury has now been accepted as standard treatment of choice for all AAST grade I, II and III, whereas this was not found safe in higher grades of splenic trauma.  Methods: This is a hospital based prospective observational study, done on 45 hemodynamically stable patients of splenic trauma. Results: Out of all studied parameters grade of injury, contrast blush on CT scan, grade of hemoperitoneum showed statistical significance with p value<0.001, however gender, age, mode of injury, showed no statistical significance. In our study, out of 45 patients, 38 (84.44%) patients had successful NOM of splenic trauma.  Conclusions: Non-operative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment in paediatric patients is also highly successful and is standard treatment of choice in both adults and children. Success of NOM of isolated splenic injury depends on multiple factors such as availability of ICUs, high dependency units for strict monitoring, blood banks and availability of multidisciplinary team efforts encompassing anesthetics, trauma surgeons, radiologists, for successful outcome.

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Background: Laparoscopic Nissen fundoplication is currently the surgical treatment of choice for gastro-esophageal reflux disease (GERD) in properly selected patients.Methods: Laparoscopic Nissen fundoplication was performed in 36 patients of GERD, Government Medical College over a period of 2 years. Pre-operative evaluation included baseline investigations and clinical assessment by using GERD Questionnaire and specific investigations i.e., barium esophagram, esophago-gastroduodenoscopy, esophageal manometry and 24 hour ambulatory pH monitoring of the esophagus. All patients underwent laparoscopic Nissen Fundoplication. Patients were evaluated at three months after surgery with symptom scoring questionnaire.Results: Mean age of patients in our study was 38 years and most common symptoms were heartburn and regurgitation. Four patients (11%) developed complications. The conversion rate to laparotomy was 2.7% (1 patient). Average symptom scores decreased from 10/18 to 0/18 after fundoplication (<0.0001) and all the eight patients who underwent postoperative endoscopy had normal results.Conclusions: Laparoscopic Nissen’s fundoplication is a safe and effective procedure for GERD, having an acceptable hospital stay with consistently improved short term symptomatic and endoscopic results.

Gallstones are the stones developing in the gallbladder. Evolution of pathophysiology changes the trends of treatment of a disease. Laparoscopic revolution was only because of gallstones diseases. The shifting of food habits increased the incidence of diseases in developing countries. There are mainly three types of stones Cholesterol, pigment and brown stones. The pathophysiology of which is different for each type. Cholesterol stones being most common owing to the risk factors being prevalent in the developing and developed societies. Pigment stones being most common in blood disorder patients while brown stones are most common in common bile duct and are infected ones.