Background: Acute appendicitis, one of the most common surgical emergency is also one of the most challenging surgical dilemma for every surgeon, both in diagnosis and treatment. A negative exploration on one hand has to be weighed against the risk of subsequent perforation during expectant management especially in doubtful cases. We conducted a study to find out if diagnosis by scoring systems and graded ultrasonography improves clinical outcomes for patients with suspected appendicitis.Methods: It was a prospective and observational study including 52 patients of clinically suspected acute appendicitis presenting in the surgical emergency. All patients underwent clinical scoring using Alvarado scores and Ohmann’s score and Ultrasonography. Later, based on the intra operative findings and histopathological diagnosis of acute appendicitis, the sensitivity, specificity, positive predictive value and negative predictive value were calculated individually and by combining the scoring systems and imaging together.Results: The sensitivity, specificity, PPV and NPV of ultrasonography when combined with scoring systems (both Alvarado and Ohmann’s) is increased significantly as compared to when used individually for diagnosis of acute appendicitis. As calculated by our study, the sensitivity of USG was 90.32%, specificity 80.95%, PPV 87.5%, NPV 85% and diagnostic accuracy of 86.54% which has been comparable with the other studies in the previous literature.Conclusions: Combination of scoring systems with Ultrasonography leads to the prompt diagnosis and early treatment of many cases of appendicitis. Hence, improving clinical outcomes in doubtful cases.

Background: Adequate cleansing is essential for reliable diagnostic and surgical colon procedures. Accuracy and safety depend on good preparation. Patient compliance is enhanced by simplicity and well-tolerated method. About mechanical bowel preparation with PEG and Nap, it is noted that PEG is more effective and better tolerated than the diet combined with cathartic regimens that were used before 1980. PEG also is safer and more effective than high-volume balanced electrolyte solutions. The aim of this prospective study is to assess whether perioperative outcome is affected by administrating a calculated amount of intravenous fluid during bowel preparation as compared to subjects who do not get I V fluids during bowel preparation.Methods: This is randomized prospective case control study, carried out government general hospital and teaching tertiary care institute located in Mumbai. Total 86 patients were included in this and randomly allocated to case or control group after applying inclusion and exclusion criteria.Results: More and more studies then compared the quality of preparation of bowel during colonoscopy with PEG and NaP and superiority of one over other was discovered. Also, this led to development of low dose 2 lit regimen of PEG and flavoring agents. Studies then were more inquisitive regarding the side effect of bowel preparation in regard to healing of anastomosis, chances of leak and effects of dehydration postoperatively. Present study is for same purposeConclusions: In present study it is observed that there is increase in I V fluid requirement in the patients in whom mechanical bowel preparation is given without I V fluid rehydration and the post-operative outcome in view of returning of bowel activity was unaltered.

Background: Laparoscopic surgery is one of the most significant surgical advances of twentieth century. Laparoscopic cholecystectomy is criterion standard for the treatment of benign gall bladder diseases, and it is the most common laparoscopic surgery worldwide. The aim of the study was to compare the intra-operative and post-operative complication, conversion rate and outcome of single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy on short term follow up.Methods: This prospective analytical observational design study was carried out in Tertiary Health care centre.  As per convenience sampling 60 consecutive patients of cholelithiasis. Data obtained was analyzed and inferences were drawn regarding the outcomes of the SILC in terms of cosmesis, post-operative pain and any other complications and compare the outcomes against the conventional four port laparoscopic cholecystectomy.Results: In our study we found the mean operating time for SILC was 90.5±16.37 minutes, whereas the mean operating time for CLC was 74±17.83 (p = 0.0004). Intra-operative blood loss for SILC and CLC was comparable and statistically insignificant. Pain in the SILC group was found to be significantly low than CLC group (p ≤0.0001).  The median cosmetic scale score for SILC group was 20 with range 13-21 and in conventional laparoscopic cholecystectomy group it was 16 with range 12-18 (p <0.0001).Conclusions: The major advantage of SILC is cosmetic satisfaction, while the disadvantages of SILS are longer operative time. There was no statistically significant difference in the intra-operative blood loss and conversion rate, and complications in both the techniques. Single incision laparoscopic cholecystectomy (SILC) was developed with the aim of reducing the invasiveness of traditional laparoscopy.