Minimal access surgery is the gold standard for several abdominopelvic procedures in the present era. The prime advantage with minimal access surgery is the minimal surgical trauma in comparison to the conventional surgery. The other advantages of laparoscopy like less operative time, less pain, early recovery and return to work and above all better cosmetics have been well proven."Change is constant in life," SILS and NOTES are the two newly emerging novel techniques in laparoscopy. SILS is a new advancement in laparoscopy, where the whole surgery is conducted through a single umbilical incision whereas NOTES is totally incisionless. In real sense, the incision in NOTES is not externally visible because of the natural orifices like oral cavity, vagina, urethra and anus that are used as entry sites. SILS have the advantages of better cosmetics, less blood loss, faster recovery, less complications, early return to work, versatility, better patient acceptance and easy tissue retrieval, etc. The critics are high cost, need of high expertise and more chances of port site hernia and infection. Similarly, NOTES has its edges over traditional laparoscopy surgery with the advantages of highest cosmetic value (no visible scar), less pain, requirement of less immunosuppressant and less anesthesia, faster recovery, and no external wound complications (hernia, hematoma and abscess). But it has also its own critics like questionable safety, unproven data about complications, requirement of high expertise, low patient acceptance, requirement of advanced endoscopic instruments, difficulty in closing internal wounds, intraperitoneal infection, gastrointestinal fistula and high cost. Poor acceptance is a major concern for NOTES.Aims: To explore the positive and negative aspects of above two procedures in order to find out the better option. ABSTRACT SINGLE INCISION LAPAROSCOPIC SURGERY (SILS)

Background and Aims Etomidate, an intravenous (IV) induction agent known for its stable myocardial action, can produce myoclonus which can be detrimental for the cardiac patients. Though lignocaine has proven its efficacy in attenuating the etomidate-induced myoclonus, the ideal dose of lignocaine is not known. The aim of our trial was to analyze two different doses of lignocaine on the occurrence and intensity of etomidate induced myoclonus. Materials and Methods A total of 120 patients were randomly assigned into three groups of 40 each. Patients in group A were injected lignocaine 0.5 mg/kg intravenously, group-B patients were injected lignocaine 1 mg/kg intravenously, and group-C patients were injected saline placebo. After 2 minutes, anesthesia was induced with 0.3 mg/kg of etomidate over 30 seconds. The patients were assessed for myoclonus using clinical severity scoring system during first 2 minutes of induction. Our primary outcome was the incidence of myoclonus. The severity of myoclonus and adverse effects were the secondary outcomes. Results No remarkable variation was found regarding demographic profile among three groups. Incidence of myoclonus in groups A and B was 35% and in group C was 98%, the difference being statistically significant. Both doses of lignocaine reduced the severity of myoclonus up to same extent. Conclusion Pretreatment with IV lignocaine 0.5mg/kg and 1 mg/kg IV remarkably decreased the occurrence and severity of myoclonus induced by etomidate up to same extent.

Objective Our aim was to estimate the occurrence of adrenal suppression in critically ill patients with septic shock who have got admission in intensive care unit and to evaluate the effectiveness of hydrocortisone in these patients in relation to mortality of patient, development of septic shock, and effect on total leucocyte count. Methods Serum cortisol was measured in 120 patients with sepsis. Patients with decreased cortisol level were split in to two groups (group A and B). Group A received 50 mg of hydrocortisone 6 hourly and group B was given matching placebo. At day 7, serum cortisol level was estimated for both A and B groups. The results were calculated and compared with relation to incidence of adrenal insufficiency, development of septic shock, effect on total leucocyte count, and survival at 28 days. Results The occurrence of adrenal suppression in patients having sepsis in our study was 44 out of 120 patients, that is, 36.6%. After supplementation of corticosteroid for 7 days the mean value of serum cortisol of group A was 40.38 ± 8.44 µg/dL and group B was 24.30 ± 6.47 µg/dL (p < 0.001). At day 7, in group A, 22.7% developed septic shock, whereas in group B, 36.4% developed septic shock (p < 0.001). In group A and B, mortality rate of the patients at 28 days was 18.2 and 22.7%, respectively. Conclusion Hydrocortisone supplementation in critically ill patients with low random basal serum cortisol level with sepsis does not significantly improve the overall survival.

Background: Tropical Chronic Pancreatitis (TCP) is a form of chronic calcific non-alcoholic pancreatitis seen mostly in developing tropical countries. This article gives an account of experiences with surgical management of TCP. Methods: Out of 454 patients of Tropical Chronic Pancreatitis (TCP), 98 patients have undergone surgical procedures according to the stage of the disease. In most of the cases, pain unresponsive to medical treatment seems to be the very important feature (98%). Results: It was evident that in most of the cases the presenting feature was pain with/without diabetes and a significant percentage of patients (74%) were found between 21 years to 50 years of age denoting that the disease affected during the prime period of life. Out of 454 numbers of patients of TCP referred to our department within a period of about sixteen years, 98 patients required surgical operations. However, in majority of cases who had undergone surgery, uncontrolled pain was the main complain. Conclusion: Frey's procedure is the best surgical option for TCP amongst other drainage procedures.

Background: Extrahepatic portal vein obstruction (EHPVO) is a common cause of variceal bleeding in a children and young adult in India. Management with endoscopic means provide temporary palliation.