Background: Sickle cell disease is one of the common haemoglobinopathies in the world. Among its various clinical presentations, splenic complications are associated with high morbidity and substantial mortality, the only effective preventive strategy for which is prophylactic splenectomy. The aim of the present study was to observe the safety and effectiveness of splenectomy to prevent frequent requirement of hospitalizations, blood transfusions and splenic complications in patients of sickle cell disease.Methods: The study was carried out in 72 patients of SCD with splenomegaly who underwent splenectomy for some indication in the surgery department of VSSIMSAR, Burla during the period from October 2016 to September 2018. Their preoperative baseline hematological parameters and frequency of transfusion requirement was compared with postoperative status.Results: Of these 72 SCD patients, 49 (68.7%) patients had repeated requirement of blood transfusion and hypersplenism, 22 (30.5%) patients had history of one or more episodes of splenic sequestration crises, one patient had splenic abscess. After splenectomy the mean increase in haemoglobin level, TLC and TPC was respectively 2.83±0.9 gm%, 1.7±0.8 lac/cmm and 2726±1618/cmm. Operative mortality was 0%. None of the patients required any blood transfusion and no major postoperative complications during 6 months follow up period.Conclusions: The morbidity of the patients of SCD in terms of repeated hospitalizations, blood transfusion, living with a huge spleen, accompanying symptoms and its complications can be effectively minimized by the elective splenectomy. With good preoperative preparation and post-operative management, splenectomy in SCD patients is a safe procedure with minimal risk of post-operative complications.

Background: Although acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis is challenging. There may not be classical symptoms and signs of appendicitis always. Accurate diagnosis can be aided by biochemical testings and radiological evaluation and expectant management. These might delay laparotomy and lead to complications of appendicitis and increase the morbidity. Recent research literatures have shown that hyperbilirubinemia is a diagnostic tool for gangrenous/perforation of appendix. This study is designed to evaluate the association between the derangement of liver function test and severity of acute appendicitis and it’s complications like gangrene and perforation of appendix.Methods: This was an observational prospective study on 66 consecutive cases of acute appendicitis done in the department of general surgery, VIMSAR, Burla. After taking informed consent, all patients included in the study were subjected to abdominal ultrasound and blood sample taken for routine blood examination, LFT and after appendicectomy histopathology examination report were collected. A master chat prepared from above data and stastical analysis done.Results: The LFT parameters are deranged in pathological appendix and more specifically the total bilirubin level but the sensitivity, specificity and PPV are specifically high for gangrenous and perforated appendix.Conclusions: LFT can be added as adjunctive test to the investigation of acute appendicitis and its complications and earlier diagnosis of the complications of acute appendicitis and timelier management. It can also help in prevention of negative appendicectomies.

BACKGROUNDVentral Hernia repair remains one of the most commonly performed surgical procedure. Operations for ventral hernia were notorious, because of high failure rate. With continued improvement of the materials and operative procedure, there is decrease in morbidity and overall recurrence rate.

Background: The traditional double layered colonic anastomosis incorporates large amount of ischemic tissue in the suture line causing luminal narrowing and fistula formations. Single layered anastomosis may be done through continuous extramucosal suturing or by interrupted through and through technique using nonabsorbable materials. The single layer of suture has shown to be safe and causes fewer complications.Methods: The study was conducted in the Department of surgery, VIMSAR, Burla during the period from October 2016 to September 2018. All the patients of colonic anastomosis were included in the study. One group consists of extra mucosal continuous prolene repair and other interrupted though and through silk repair. Both groups were followed up and were compared taking different variables.Results: 146 cases of colonic anastomosis were performed, 110 with interrupted through and through silk repair (75.34%) and 36 with continuous extra mucosal prolene repair (24.66%).The mean time taken for silk repair was more (25.67 min) than prolene  (15.5 min). The patients of prolene repair had shorter duration (9 days) of hospital stay than silk (12.4 days). The postoperative ileus was more in silk (16.36%) than prolene (5.56%). Anastomotic leak in prolene is less (2.78%) in comparison to silk (8.18%). The bowel movement appeared earlier with prolene (4.2 days) is less than ssilk (5.3 days).Conclusions: The present study shows single layer monofilament thin diameter prolene for different end to end colonic anastomosis has better prognostic panorama in relation to morbidity and mortality, and had an edge over conventional single or bilayere anastomosis.

Cystosarcoma phyllodes is a rare, predominantly benign tumor of the female breast, comprising less than 1% of all breast neoplasms. The incidence of malignancy in phyllodes tumor is even less, only 25% which usually does not ulcerate the skin or involve the nipple areola complex. 1, 2 Herein we report a case of 16years old girl with a right sided big malignant phyllodes tumor with nipple areola complex involvement and skin ulceration.