Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and mortality. This study was conducted to evaluate different spectrum of gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality.   Methods: This was an analytical cross-sectional study conducted in the Surgical Gastroenterology Department at College of Medical Sciences, Bharatpur, Chitwan, Nepal from October 1st 2021 to October 31st 2022. Patients undergoing emergency laparotomy for GI tract perforations were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded.   Results: A total 100 patients with gastrointestinal perforations were analyzed. The mean age was 46.55 years. Male predominance with M:F=1.56:1 was seen. Almost 54% patients presented after 24 hrs of onset of pain. Peptic ulcer disease as a cause of perforation was seen in 26%, trauma in 23% cases, appendicular perforation in 20%, malignant perforation in 8%, tubercular perforation in 7% and foreign body perforation in 3% cases. Duodenal, appendicular and colorectal perforations were seen in 28%, 20% and 17% cases respectively. Total morbidity was 54% and mortality was 13%. Increasing age, delayed presentation, presence of comorbidities, systolic blood pressure less than 100 mm Hg, oliguria, presence of malignancy were significantly associated with high mortality.   Conclusion: Perforations of duodenum, appendix and colorectum are commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.

The rectal foreign body is a rare presentation with rising incidence. We present a case of a 26-year-old heterosexual male with an alleged history of sexual assault with insertion of a large foreign body through the anus two days prior with peritonitis. After investigations, the patient underwent an exploratory laparotomy, foreign body removal, primary repair of perforation with a diverting colostomy. Diversion must be considered in cases where the extent of anal sphincter mechanism injury is in question. The patient had a good outcome. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of perforation.

Introduction: Transversus Abdominis Release is a noble technique for the repair of complex ventral hernia, where the posterior component separation allows a huge pre-peritoneal space advantageous for the placement of large-sized mesh. It has less wound morbidity as compared to anterior component separation due to the preservation of skin perforators. The main objective of this study was to evaluate one-year follow-up results in terms of recurrence, wound morbidity, and various techniques for managing complications of Transversus Abdominis Release. Methods: This is a descriptive crosssectional study that was conducted at the department of surgery, College of Medical Sciences Teaching Hospital. Among 41 patients with complex ventral hernia, 34 patients met the inclusion criteria. Demographic data, intra-operative events like bleeding, operative duration, intraoperative complications, post-operative events like duration of hospital stay, wound morbidity, and follow-up data were analyzed. Results: Posterior rectus sheath closure at midline was possible in 30 (88.2%) patients. In patients, where posterior rectus sheath closure was not possible, the peritoneum of hernia sac was tailored to patch the defect or in some omentum was placed below the raw surface of mesh. The average operative duration and blood losses were 130±12 minutes and 301±133 ml respectively. The semilunar line injury occurred in one case that was diagnosed and repaired at the same time and the TAR plane was re-established. Wound morbidity occurred in three cases that were managed by dressing with commercially available collagen and mupirocin granule. No recurrence was observed in one-year follow-up. Conclusions: Transversus Abdominis Release has a better result with no recurrence in short term follow up and fewer complications which are easily manageable.

Introduction The posterior approach to liver resection is technically difficult, especially when there is a bulky tumor or dense adhesion of right lobe of liver with the risk of tumor dissemination and hepatic vein avulsion. To prevent this, anterior approach of liver resection was used; however, it is technically challenging and can lead to a false line of transection and difficulty in controlling bleeding in deeper parenchymal plane. These technical difficulties are overcome by hanging maneuver liver resection which eases the process of anterior approach. The Objectives of our study were to observe the technical safety, operative duration, operative blood loss, and perioperative complications of hanging maneuver in liver resection. Methods This is a cross-sectional study on the patients who underwent hanging maneuver of liver resection at our center. The perioperative data were analyzed. Descriptive variables were described using frequency and percentage; continuous variables were described using mean and standard deviation. Results A total of 15 patients underwent hanging maneuver of liver resection, majority were male (66.6%) with Child-Pugh score-A of 80%. The most common indication was complex hydatid cyst of liver (33%) and biliocutaneous fistula (13%) that occurred after previous intervention for hydatid cyst of liver (13%). Intraoperative blood loss was 750±343.2 ml and complications grade IIIA were up to 20% as per Clavien Dindo grading system. Conclusions Hanging maneuver of liver resection is a technique that facilitates in elevating liver parenchyma away from IVC and helps in an easier anterior approach. A learning curve and assessment of background liver disease is necessary for its safety.