Introduction: Intra-peritoneal access and creation of pneumoperitoneum through a quick, safe and reliable technique is important for Laparoscopic Surgery. Specially in an resource constrained setting where there is paucity of needed equipment and cost is prohibitive, utilization of the fewer instruments available and accompanid by excellent functional and cosmetic outcomes should be the aim of a laparoscopic surgeon. Objectives: To describe a modified method of primary trocar introduction that utelizes fewer available instruments. Materials and Methods: A vertical incision is made in the trans-umblical region at the base of to an everted umblicul scar. The linea alba is incised and the resultant opening bluntly developed after which the 1st port is inserted using tocar as an guide. The trocar is withdrawn while the canula is pushed in. Results: We included total 124 patient (Male-44, Female-80) in the study period, from Jan 2017 to December 2018. In one single surgical unit, with the age limit 18-75 years, With no significant complications. Conclusion: This modified open trans-umblical approach is a simple, quick, and reliable way to primary port insertion. Access is gained easily in different age groups and umblicus types, through a small congenital umblical defect that is almost universally present. It is associated with minimum morbidity and has excellent outcome. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 67-70

Introduction: The aim of this study was to screening the Sensitivity of Alvarado score among the hospitalized suspected appendicitis patients at Dhaka National Medical College Hospital for determine the diagnostic accuracy. Materials and Methods: It was an observational type of descriptive study, conducted in the Dhaka National Medical College Hospital, Dhaka, during the study period of July 2015 to December 2015. The study was approved by the institutional ethical committee. Results: Most of the appendicitis patients belonged to the between 21-30 years which was 64 (32%). Male appendicitis patients (52%) are more than the female patients (48%). Majority of the patients (69%) complains pain occurs in the Right iliac fossa. The sensitivity of Alvarado scores was 81.60%, specificity 74.58%, accuracy 79.35%, positive and negative predictive values were 87.18% and 65.67% respectively. Conclusion: Alvarado score has more specificity. Medicine Today 2020 Vol.32(1): 45-47

Introduction: Most perianal abscesses originate from an infected anal gland. Obstruction of these glands leads to stasis, bacterial overgrowth and ultimately abscess. Approximately 10% of perirectal abscesses are thought not to be due to infected anal glands. It is unclear why some patients completely heal and others have recurrent disease. Objective: To assess the incidence of anal fistula and recurrent abscess after incision and drainage of perianal abscess. Materials and Methods: A prospective observational study was done on 140 patients operated upon for perianal abscess in Combined Military Hospital, Dhaka. They underwent for one group only drainage, for other group drainage with primary fistulotomy under general or spinal anesthesia over two years from January 2015 to December 2016. The patients were followed up for an average 13 months (range, 4-18 months) after abscess drainage or until a fistula appears and abscess recurs. Their duration of hospital stay was 1–3 days. After discharge from hospital, they were examined in follow-up within 7 to 14 days. Subsequently, they were examined on a monthly basis until drainage ceased or until it became obvious that a fistula-in-ano had developed. Results: Total 140 patients were treated for perianal abscess. Those patients were divided into two groups. The first group of 84 patients (60%) who underwent incision and drainage only. The second group consisted of 56(40%) patients who had low fistulas identified at the time of abscess drainage and underwent primary fistulotomy. The incidence of fistula formation after the operative procedures were 37(44.05%) in incision and drainage group and 5(8.93%) were in primary fistulotomy group. The most common site of abscess formation was posterior to anus. The incidence of recurrent abscess were 7(8.33%) in incision and drainage group; 2(3.57%) in primary fistulotomy group. The overall fistula formation (44.05% and 8.93%) and recurrence of abscess (8.33% and 3.57%) is low in primary fistulotomy group. Conclusion: In this study the overall incidence of anal fistula is much higher than recurrence of perianal abscess following management of perianal abscess. Primary fistulolotomy at the time of drainage for perianal abscess reslult in a fewer persistent fistulas and recurrence of abscess. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 26-29