Objective. To evaluate the safety and efficacy of intramuscular dexketoprofen for postoperative pain in patients undergoing hernia surgery. Methodology. Total 202 patients received single intramuscular injection of dexketoprofen 50 mg or diclofenac 50 mg postoperatively. The pain intensity (PI) was self-evaluated by patients on VAS at baseline 1, 2, 4, 6, and 8 hours. The efficacy parameters were number of responders, difference in PI (PID) at 8 hours, sum of analogue of pain intensity differences (SAPID), and onset and duration of analgesia. Tolerability assessment was done by global evaluation and adverse events in each group. Results. Dexketoprofen showed superior efficacy in terms of number of responders (P = .007), PID at 8 hours (P = .02), and SAPID 0–8 hours (P < .0001). It also showed faster onset of action (42 minutes) and longer duration of action (6.5 hours). The adverse events were comparable in both groups. Conclusion. Single dose of dexketoprofen trometamol 50 mg given intramuscularly provided faster, better, and longer duration of analgesia in postoperative patients of hernia repair surgery than diclofenac 50 mg, with comparable safety.

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Retained surgical drain in the peritoneal cavity is very rare but potentially dangerous error. Most cases are unreported because of the fear of medico-legal problems. Management of such iatrogenic complications requires repeated laparotomy or wound exploration. We reported a case of a large corrugated rubber drain migrated and retained accidently in the abdominal cavity in a patient who underwent exploratory laparotomy for peritonitis secondary to perforated appendix about five years ago.

Background: Pilonidal sinus disease has been treated with various techniques. There is still no consensus about treatment. However, a long list of surgical techniques available reflects the inability to find an ideal procedure for the treatment. The rhomboid flap of limberg is a transposition flap that has been advocated for treatment of this condition. The objective of this study was to evaluate the limberg flap reconstruction for pilonidal sinus in terms of complications, hospitalization time, days to return to work and recurrence in Indian rural setup. Methods: Patients with simple, complex and recurrent pilonidal sinus were included in the study. Patients presenting with acute abscess were excluded. Patients were followed for a period of three year to report the recurrence. Results: Total 26 patients, with pilonidal sinus disease were treated with rhomboid excision and limberg transposition flaps. All sinus tracts were resected en bloc, and the limberg flap was prepared from the gluteal region and transposed to fill the defect. There were 22 males (80%) and 4 females (20%) with a mean age in males 28.6 years and in females 21.6 years. The mean duration of symptoms was 10.4 months. Mean operative time was about 70.57 minutes. Full primary healing was obtained in 20 patients, 6 patients presented with post-operative complications. Minor infection occurred in 4 patients. 3 patients had minimal necrosis of flap edge and partial gaping of flap. 2 patients developed seroma. But all these complications required no additional treatment except secondary suturing in one patient. The average hospital stay was 4 days. Most patients returned to work within 3.23 weeks. Follow up period was 3 year and no recurrence reported. Conclusions: Limberg flap following rhomboid excision of the sinus area is worth to be considered as the surgical treatment of choice for sacrococcygeal pilonidal sinus disease.

Background: Despite aggressive surgical treatment and evolution of critical care, the prognosis of peritonitis and intraabdominal sepsis is not good especially when multiorgan failure develops. Aim: To study the efficacy of the Mannheim peritonitis index in predicting the outcome in a patient of peritonitis. Material and Methods: Analyzing the case files of all the operated cases of gastrointestinal perforations over the 5 years in the surgical department by open procedure. A total number of 200 cases were studied. The eight prognostic variables included in the Mannheim's peritonitis index entered in a proforma and the MPI score of each patient was calculated. Results: Out of 200 patients 176 were discharged and 26 died. Mortality found in this study was 13%. Patients with MPI score >29 had max mortality (61.5%) and MPI between 21-29 scores had 20.9% mortality. Least mortality recorded in MPI score < 21(0.8%). Conclusion: MPI score is an excellent prognostic index for peritonitis with high accuracy in individual prognosis and that it is cheap, cost-effective, easily measurable, and reproducible.