Background: Perforation peritonitis is very common surgical emergency and despite newer and advanced technology as a monitoring system APACHE 2 score have a good predictive power to predict outcome and monitoring in such patientMethods: This is a prospective study by which APACHE 2 score was applied over the patient before the surgery and after the surgery at first post operative day and score was calculated in selected preformed and result was concludedResults: The outcome of the Patients largely depends on age, perforation size, duration of presentation, and duration of hospitalization all these are well correlated with APCHE 2 score to predict outcome and monitoring.Conclusions: The accuracy of APACHE 2 score to predict the outcome in perforation peritonitis increases when the result of score was combined which was applied two time prior to surgery and after the surgery.

Background: Relaparotomy after emergency surgery is a catastrophic situation associated with significant morbidity and mortality. Incidence is highly variable depending not only on hospital set up but also on the patient’s characteristics as well as on the initial surgery and postoperative care given. This study was thus, planned to identify the indications, procedure, risk factors and outcomes of relaparotomy so that timely intervention can lower incidence and morbidity.Methods: This was a retrospective cohort study conducted in department of general surgery, Gandhi Medical College and associated Hamidia Hospital from January 2018 to December 2019. All patients irrespective of age and sex, who have undergone emergency re-exploration of the abdomen during the period of hospitalization after the first operation and discharge of patients. Data were recorded in pre-validated case record form.Results: 32 cases of relaparotomy were identified. All patients had emergency laparotomy as primary surgery. Majority of patients required relaparotomy for anastomotic site leak in 16 cases (50%) followed by intestinal obstruction in 10 cases (31%), hemorrhage in 4 cases (16%) while the least cause being intra-abdominal sepsis in 2 cases (6.2%). Relaparotomy was associated with increased mortality and morbidity. Out of 32 patients, 4 (12.5%) patients died.Conclusions: Relaparotomy is a rare complication and a lifesaving procedure for patients. Calculative experience guided decision on relaparotomy can decrease the incidence of morbidity and mortality associated with the procedure.

Background: Wound dehiscence is separation of some or all layers of incision. It may be partial or complete. It is called as complete when all layers of the abdominal wall have been separated with or without evisceration of viscous. The study aims to find out and record the prognostic factors for wound dehiscence in vertical midline laparotomy.Methods: This was a prospective study in 1400 laparotomies that developed wound dehiscence operated in Gandhi Medical College, Bhopal from august 2017 to august 2019. All the patients with burst abdomen operated during emergency or elective setting by midline vertical laparotomy were included.Results: Wound dehiscence was most common in 51-60 years age group (26%). Majority patients were males (62%). Emergency laparotomy showed maximum incidence (71%). Bursts were seen mostly during 6th to 10th postoperative day. 78% patients presented as partial wound dehiscence and remaining as complete wound dehiscence. 46% presented as early wound dehiscence (7 days).Conclusions: Post laparotomy wound dehiscence has multifactor etiology. Respiratory infections, anemia, and hypoproteinaemia are the contributing factors. Improper haemostasis during surgery and poor surgical technique are the predisposing factors.

BackgroundAutologous hamstring graft remains to be a commonly used graft for Anterior Cruciate Ligament (ACL) in sportspersons. With less graft failure rates, better mechanical stability and proprioception with preserved insertion hamstring graft, we investigated long term outcomes of hamstring graft with preserved insertion. Methods: 441 sportspersons were enrolled in the study. They were divided into two groups by computerized randomization. In Group I, ACL reconstruction was done using hamstring free graft (STGF), and in Group II, ACL reconstruction was done using hamstring graft with preserved tibial insertion (STGPI). Postoperatively, patients were assessed for graft rupture, knee stability, Lysholm score, tegner activity and WOMAC score.ResultsThe average age of the patients was 24 ± 2 years in group 1 and 27 ± 8.5 years in group 2. At 5 years, the mean KT-1000 difference was 2.01 in group 1 and 1.96 in group 2 (P = 0.77); the mean Lysholm score was 97.80 and 98.60(p = 0.07), respectively; mean WOMAC score was 3.09 and 3.12(p = 0.89) respectively; mean difference between the pre-injury and post-surgery Tegner level of sports activity was 1.78 and 0.54(P < 0.05), respectively and graft failure rate was 4.1% and 7.7%.(p < 0.05), respectively.ConclusionWe report STGPI to be a more viable option than hamstring free graft in sportspersons for ACL reconstruction due to less graft failure rates and better tegner activity score postoperatively. Further, STGPI is an option with low graft failure rate like that of Bone Patellar Tendon Bone graft,with added advantage of not having significant donor site morbidity.Level of EvidenceLevel 1, Randomized Controlled Trial

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