Background: Laparoscopic cholecystectomy is considered the gold standard treatment for most gallbladder diseases. It has now become one of the most common operations performed by general surgeons. At times, it is difficult and takes longer time or some complications may occur or has to be converted in to open cholecystectomy. This study is undertaken to determine predictive factors for difficult laparoscopic cholecystectomy.  The aim of the study was to study pre-operative factors in the patients to predict whether the laparoscopic cholecystectomy will be easy or difficult. And to co-relate the pre-operative factors predicting a difficult Laparoscopic Cholecystectomy with intra-operative findings.Methods: This prospective study was carried out in the Department of General Surgery in IGGMC, Nagpur, Maharashtra, India over a period of 2.5 years. Total 52 patients were included in the study. All patients were evaluated for risk factors preoperatively and intraoperative findings were noted. A chi-square test has been used to find the significant association of findings of the preoperative score with postoperative outcome.Results: History of hospitalization for gall stone diseases, ultrasound abdomen showing gall bladder wall thickness >4 mm, presence of pericholecystic collection, and impacted stone can be considered as individual significant positive predictive factors to predict a difficult laparoscopic cholecystectomy preoperatively. While age >50 years, gender, BMI >25 kg/m2, and history of supraumbilical surgery/scar can’t be considered as an individual positive predictive factor.Conclusions: A uniform scoring system needs to be assessed and thoroughly evaluated by combining all these factors to predict a difficult laparoscopic cholecystectomy.

Malignant renal tumours were described as early as 1826 when Knoig reported 2 patients with modullary sarcoma of the kidney. 1 In 1855, Robin had concluded that renal carcinoma arose from renal tubular epithelium. This interpretation was confirmed by Waldeyer in 1867. 2 Harris in 1982 reported on 100 surgical extripations of the kidney, a sufficient number to permit some sort of analysis of clinical, surgical and pathologic features of renal disorders that require surgery. 2 ABSTRACT Background: In 1894 Lubarch endorsed the idea of these being a suprarenal original tumour, and the term "hypernephroid tumors" indicating origin above the kidney was advocated by Birch-Hirschfeld. It was this semantic and conceptual mistake that led to the introduction of the term "hypernephroma", which predominates in the literature describing parenchymal tumours of the primary renal origin. The objective was to study the surgical profile, treatment modalities for patients with renal cell carcinoma. Methods: Present study was retrospective as well as prospective study and was carried out in the Department of Surgery, Government Medical College and Hospital; Auragnabad for a period of one year Retrospective study was done from the record in Radiotherapy Department of this college. Prospective study was done with the number of cases of kidney tumors admitted during the study period. Total number of cases studied were 44, out of these, 26 was studied retrospectively and 18 cases prospectively. Patients who were absconded after admission are also included. Results: The youngest patient of renal cell carcinoma was found to be of 35 years, and oldest of 70 years old. The maximum incidence was found in 5th and 6th decade of life. In this treatise, maximum numbers of cases were presented with lump in abdomen (78.27%), and classic triad of pain, lump and hematuria was only in 4 cases (17.40%). Maximum numbers of patients were in stage III and IV. Anemia was found only in 6 cases (26.10%) and raised E.S.R. in 2 cases (08.70%). Not a single patient showed hypercalcemia or erythrocytosis. Most commony used treatment modality in our patients was Nephrectomy + RT + CT + HT in 9 cases (39.13%). Conclusions: Commonest etiological factor for renal cell carcinoma is smoking (30.50% of the cases). Maximum cases of renal cell carcinoma were presented with lump in abdomen and classic triad was found in only 17.4% of cases (i.e. pain, hematuria and lump). Maximum cases of renal cell carcinoma were found to be in stage III and IV. Majority of the renal cell carcinomas were treated with nephrectomy, postoperative radiotherapy, chemotherapy and hormonal therapy in combination.

Background:The tissue based techniques are still acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda's no mesh technique, introduced in 2001, is a hernia repair method using an undetached strip of external oblique aponeurosis. This study compares the results with the studies done worldwide on Desarda's technique. Methods: A total 120 cases were studied for 2 years (2015-2017), the primary outcomes measured were postoperative pain scores on day 1,7,30 using visual analogue scale, time taken to return to basic activities, time measured from skin incision to skin closer. Complications like cord oedema, seroma, fever, surgical site infection, chronic groin pain and recurrence were evaluated. Results: After a 15-month mean follow up period, 01 (0.83%) case had a recurrence among 120 patients. Mean operative time is 60 min; mean pain score on day-1, 7, 30 are 3.35, 0.9 and 0.008 respectively. Mean time taken to return back to work is 24 hours; complications like chronic groin pain, foreign bodysensation are not seen in single cases. These results are comparable with the studies done worldwide. Conclusions: In Desarda's technique of inguinal hernia repair does not use mesh, so no complication related with the foreign body are seen and postoperative pain is less, early return to basic activities and Postoperative complications are less.

Background: The present study of role of non-operative management in blunt abdominal trauma with solid organ injury was done to assess the feasibility and safety of non-operative management in hemodynamically stable patients and identify the causes, predictive factors to delineate the rate of non-operative management failure.Methods: A longitudinal observational study was carried out from September 2013 to November 2015. All cases of blunt trauma abdomen with ultrasonological e/o solid organ injury and were hemodynamically stable were included in study.Results: Total 138 cases presented with a history of blunt trauma abdomen of which 56 cases had ultrasonological evidence of solid organ injury. 8 cases were excluded as 6 of these were hemodynamically unstable at presentation while 1 had bowel perforation and another had severe head injury all requiring operative management. Maximum cases were of age group 21-30 years (41.66%) and 31-40 years (31.25%). 42 (87.5%) cases were male and 6 (12.5%) cases of 48 were females.  28 (66.67%) cases presented as Road Traffic Accident. 28 (66.67%) cases had abdominal pain as the commonest symptom while tenderness in 38 (79.17%) cases and tachycardia in 30 (75%) cases was the predominant sign. Most injuries were seen in spleen 23 (47.92%) cases f/b Liver with 14 (29.12%). Conservative management was successful in 40 (83.33%) cases and failed in 8 (16.67%) cases. Mortality of the study was 1 (2.08%) case.Conclusions: Non-operative strategy is a successful approach in patients who are hemodynamically stable and authors strongly recommend it.

Novel pancreaticogastric anastomosis technique in laparoscopic pancreaticoduodenectomy which is simple, feasible to perform, provides secure fixation between stomach and pancreas. The aim of our article is to describe our technique of intracorporeal pancreaticogastrostomy as a promising approach for future widespread application.