A 40-year-old woman, nulligravida, presented with chronic pelvic pain, intermittent obstructive bowel complaints, and a desire to conceive. She had previously undergone 2 surgeries at 2 different hospitals, an open laparotomy for a right ovarian cyst 7 years before and a laparoscopy with minilaparotomy for frozen pelvis 2 years before, and was referred to our tertiary care center (Sunrise Hospital). She had also received ATT for genital tuberculosis 10 years before. The patient had 6 failed in vitro fertilization cycles subsequently.On ultrasound, a complex left ovarian mass was seen. No x-ray of the abdomen was done, becasue there was no suspicion of gossypiboma. Hysteroscopy was done, which showed a normal uterine cavity and bilateral ostia.On laparoscopy during adhesiolysis, a gossypiboma was found (i.e., mass in a patient's body with cotton matrix surrounded by a foreign body granuloma). Frank pus drained out, and a gauze piece was seen in the left iliac fossa densely adhered to the bowel and surrounding structures (Fig. 1). The gauze piece was removed (Fig. 2), and it did not contain a radio-opaque marker. The bowel was checked by injecting 500 mL diluted methylene blue per rectum. A 1-cm bowel injury was seen at the descending part of the colon, at the site where the gauze piece was densely adhered. Injury was sutured in 2 layers, the first layer with vicryl 2-0 in a continuous fashion and the second with silk 2-0 in an interrupted fashion. The integrity of the bowel was then rechecked by reinjecting methylene blue. Her postoperative course was uneventful.In our experience we have found that in such cases of gossypiboma, the bowel becomes extremely friable and susceptible to injury. Despite careful adhesiolysis, the The authors declare that they have no conflict of interest.

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Most of the surgeons find it difficult to perform myomectomy when it bleeds during the procedure as it becomes difficult to get into the correct plane of dissection. If this bleeding or blood staining of tissues is prevented it will be easier to get into the correct plane of dissection. In several studies, it is found that bilateral uterine artery ligation, at origin, does not interfere with future fertility as the end vessels and collaterals of the uterus are not interfered with. As no energy source is used to incise the myoma once Vasopressin has been used, the myomectomy scar integrity is better, as noted by various surgeons.

Introduction:The best method of primary trocar insertion in laparoscopy remains controversial. There are advocates for both initial Veress needle insertion as well as direct trocar insertion.Aim of the study: This study was carried out to find out the complication rate of direct trocar insertion as a method of laparoscopic entry and find out the learning curve of trainees in a structured fellowship programme.Methodology: Retrospective analysis was done over period of 5 years with a sample size of 2053 subjects.Results: 2053 laparoscopic surgeries were examined. Overall complication rate was 0.38%; subjects with previous abdominal surgery were found to have higher complication rate as compared to ones with no history of prior surgery. [0.46% and 0.35% respectively]. All trainees gained reasonable degree of confidence within 6 months.Conclusion: Direct trocar insertion is a safe method of laparoscopic entry, which can be taught to trainees with no prior laparoscopic experience, without an increase in entry complications.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 51-54

The management of vesicovaginal fistula is difficult and challenging We are presenting a rare case of a 24-year-old unmarried girl with history of vaginoplasty and multiple surgeries done in the past, with a vaginal drain tube kept for 12 years and a Vesicovaginal fistula at the bladder trigone. Patient was successfully treated with a laproscopic Intravesical vesicovaginal Fistula repair. As advances in understanding the etiology of VVF have been made, the laproscopic approach has become the gold standard. Laparoscopy allows an excellent view, good exposure of pelvic structures, provides direct access to the fistula and for repair of complex VVF that may not be amenable to vaginal repair.