Death is a part of living but doctors have a responsibility towards reducing the mortality of patients to the maximum extent, especially in the surgical field where the outcomes of mortality are decided sometimes by decisions taken by the surgeon. By analyzing the mortalities, doctors hope to identify the major reasons for death in surgical wards. So that they can devise strategies to preempt and hence prevent the terminal events leading to the expiry of any given patient. 1,2 Mortality during surgical care may result directly from the pathologic process necessitating surgical care, as a complication of a surgical procedure and anesthesia, or other co-morbid factors. A study of the mortality pattern can help bridge knowledge gaps in a particular surgical setting and can identify areas of care that require more education, practice modification, and/or policy formulation. 3 Many researchers have tried to do a systematic review of surgical death. There are many reports of similar work in the west and even from African nations. Studies done by Anelechi B et al, Babatunde A et al from Nigeria, Wasim

Appendicitis being the commonest acute abdominal surgical condition, although diagnosis can be made clinically but possess diagnostic difficulty to junior surgeons. The need for appropriate tool/scoring system that can be easily applicable, accurate & reproducible in the diagnosis of appendicitis is essential to have a low negative Appendicectomy rate. This prospective study is designed to assess one such scoring system, i.e., Modified Alvarado Score. MATERIALS AND METHODS: SETTING AND DURATION: Department of Surgery, Hassan Institute of Medical Sciences/Teaching Hospital, Hassan. From August 2013 to September 2014. A total of 227 consecutive male and female patients with age above 14 years presenting with right lower abdominal pain were enrolled in this study, analysed according to eight variables of Modified Alvarado scoring system and were accordingly placed into 3 groups. Group-I patients having score 1-4 were discharged, Group-II patients having score 5-6 were observed, while Group-III patients having score 7-10 were operated and all the operated patients were followed up for 30 days. These groups were compared with intra-operative findings, histopathological results & early post -operative complications. RESULTS: Of the total 227 patients included in this study, 155 underwent Appendicectomy based on the Modified Alvarado scoring system. Out of 155 operated patients 142(91.6%) had acute appendicitis, thus yielding a positive predictive value of 91.6% while negative appendicectomy rate 9.3%. Frequency of negative appendicectomy was 5.3% (5/94) among males and 9.4% (08/61) in females. Post-operative complication rate including wound infection, pelvic abscess, chest and urinary tract infection was 10.3% (16/155). CONCLUSION: The present study showed that Alvarado clinical scoring system has a high diagnostic value of 90%. Alvarado scoring system is dynamic one & its proper application improves diagnostic accuracy. There by reduce the rate of negative appendicectomy, anticipate the post-operative stay & complications. In acute appendicitis, modified Alvarado scoring can be used as an objective criteria for selection of patient for appropriate Medical or Surgical treatment. This scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis especially for junior surgeons.

BACKGROUND: Laparoscopic Cholecystectomy (LC) remains "gold standard" for symptomatic and complicating gallbladder stone disease. Conversion to Open Cholecystectomy (OC) fails to give the intended benefits to the patients. The conversion rate has varied from 3% to 10%. We intend to retrospectively analyze the conversion and complications of LC. OBJECTIVES: 1. To determine the conversion rate of laparoscopic cholecystectomy (LC) and its causes at selected hospitals in Hassan district. 2. To assess complications following laparoscopic cholecystectomy. METHODS: The study period was conducted on patients undergoing LC in two years from Nov 2012 to Oct 2014. Systematic chart review of all cases of LC was done.185 cases of LC were analyzed with regard to demographic profile, conversion and surgical procedure related complications. RESULTS: There were 188 cholecystectomy done during that period. Of which LC was planned in 185 cases and successful in 182 patients. 3 cases were converted due to various reasons. There were also 18 instances of complications. CONCLUSIONS: Reducing the conversion in LC will definitely add to the success of overall management of patients with gallbladder stone disease. Conversion can still a failure though not a complication. The overall complication is low with LC and conversion to OC is also low. This is the current trend around the world.

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