Introduction: The Lichtenstein technique is currently one of the popular methods in practice as it provides very good results consistently. However many patients suffer from wound indurations' and chronic wound pain which are often underreported. The transinguinal preperitoneal technique (TPT) avoids these complications by placing the mesh in preperitoneal plane by open approach.

Introduction:Having long experience of open upper abdominal surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia, we performed this study of laparoscopic cholecystectomy with low-pressure pneumoperitoneum under spinal anesthesia to assess its safety and feasibility.Materials and Methods:In a private rural health set-up, 300 patients were selected prospectively for laparoscopic cholecystectomy under low-pressure (8 mm) pneumoperitoneum under spinal anesthesia in a span of three years. Only 3.5 ml of 0.5% bupivacaine was used for spinal anesthesia. Fourth port positioned at lower than usual at the level of umbilicus, change of position of the table with different stages of operation, massaging of right shoulder in cases of shoulder pain, removal of smoke if formed during dissection to diminish shoulder pain and holding the body of the gallbladder by the fourth port grasper at the level of lower margin of the liver in cases of long gallbladder were some modifications of standard laparoscopic cholecystectomy made in this study.Results:We successfully performed the operations in 291 patients without major complications. Four patients denied operation under spinal anesthesia. Spinal anesthesia was converted to general anesthesia in two patients due to severe shoulder pain. The operation was converted to open cholecystectomy in three patients. Mean age was 34.6 years (range 21-82 years). Mean BMI was –23.1 (range 20.8-28.3). Mean duration of operation was 39.6 min (range 18-78 min). Mean O2 saturation was 97.6%. Mean peak respiratory rate was 23.4 (range 16-38). 90.08% patients complained of right shoulder pain – most of them managed by shoulder massage alone. All patients were satisfied on follow up.Conclusion:Laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum can be performed safely and satisfactorily without major complications by experienced surgeons.

Giant linear syringocystadenoma papilliferum of the backSir, Syringocystadenoma papilliferum (SCAP) is a rare benign hamartomatous adnexal tumor of the apocrine or eccrine sweat glands. Most patients present with a solitary lesion in the head and neck region. Presentation with multiple lesions is rare, and in those arising outside the head and neck region is even more uncommon. We present a case of SCAP with multiple papulonodular lesions arranged in a linear fashion and located on the lower back.A 12 year-old boy had four asymptomatic discrete skin-colored papular lesions on the lower back since birth, and they had gradually increased in number and size over the years. They were conglomerated and presented as a single linear lesion. No other cutaneous or systemic complaints were reported. Some local medications were applied but the lesions never subsided.On examination, a 20-cm-long and 7-cm wide fleshy cauliflower-like erythematous papulonodular lesion arranged in a linear array transversely on the lower back of the boy with obvious increase in vascularity and oozing of sero-sanguinous fluid [ Figure 1] was seen. It had about a 2-cm-wide long narrow pedicle. Net LetterHow to cite this article: Kar M, Kar JK, Maiti S. Giant linear syringocystadenoma papilliferum of the back. Indian J Dermatol Venereol Leprol 2012;78:123.

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