Aim of the study was to study the effect of pneumoperitoneum on liver function tests, Serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), gamma glutamyltransferase (GGT), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) in patients who had undergone laparoscopic cholecystectomy (LC) and to compare the alterations in liver function tests with those patients who underwent open cholecystectomy (OC). MATERIAL AND METHODS Indoor records of 201 patients were taken who were admitted to the hospital with complain of symptomatic gall stone diseases from 1 August 2011 to 31 Jul 2014. Out of 201 patients, 180 patients underwent Laparoscopic cholecystectomy at intraperitoneal pressure 12-15 mmHg and 21 patients underwent open cholecystectomy. Two groups were made for the purpose of study, laparoscopic cholecystectomy (LC) group and open cholecystectomy (OC) group. Serum levels of AST, ALT, GGT, LDH and ALP were assessed preoperatively and 24 hours after the surgery and finally at 3 weeks after the surgery, in both the groups i.e. Laparoscopic cholecystectomy (LC) group and open cholecystectomy (OC) group. Laparoscopic surgeries other than Laparoscopic cholecystectomy, CBD stone and CBD stricture, gas used other than CO2 for peritoneal inflation, Deranged LFT in preoperative period were excluded from the study. RESULTS Statistical analysis revealed that there is significant alteration of liver enzymes AST, ALT, GGT and LDH in patients who underwent laparoscopic cholecystectomy compared with patients underwent open cholecystectomy. CONCLUSION Altered liver enzymes which occurred after laparoscopic cholecystectomy may be attributed to effect of intraoperative pneumoperitoneum on hepatic blood flow. Although most of these changes return to normal limit after 3 weeks of surgery, this does not seem to be clinically important but care should be taken before performing Laparoscopic cholecystectomy in patients with hepatic insufficiency.

OBJECTIVE:To compare the efficacy, associated side effects in short term as well as long term use of topical Diltiazem and topical GTN in the management of chronic anal fissure. MATERIAL AND METHODS: Out patients records of 231 patients with chronic anal fissure who reported to hospital from August 2011 to August 2014 and treated were randomly selected for both types of management of which 118 patients had received topical 2% diltiazem and 113 were treated with 0.2% glyceryl trinitrate topical ointment thrice daily for 6 weeks. They were assessed at the time of presentation, then at the end of 1st week, 3rd week and at the end of 6 th week of treatment. Records of patients with anal fissure due to other diseases like inflammatory bowel disease, malignancy, sexually transmitted diseases, previous treatment with local ointment or surgery, patients who required anal surgery for any concurrent disease like hemorrhoids, pregnant women, patients with significant cardiovascular conditions and patients who did not turned up for follow up were excluded. Signs and symptoms and side-effects were noted at the given time. RESULTS: The study results are comparable to national figures and other studies. CONCLUSION: Topical application of both the ointments, 2% Diltiazem and 0.2% Glyceryl trinitrate observed to be quite effective in treatment of chronic fissure in Ano. However, topical Diltiazem is preferred to topical glyceryl trinitrate due to its lesser side effects and long term better control.