BackgroundEnhanced recovery after surgery (ERAS) protocols are nowadays considered the standard of care for various elective surgical procedures. However, its utilization remains low in tier-two and tier-three cities of India, and there exists a significant variation in the practice. In the present study, we have investigated the safety and feasibility of these protocols or pathways in emergency surgery for perforated duodenal ulcer disease. MethodsA total of 41 patients with perforated duodenal ulcers were randomly divided into two groups. All the patients across the study were treated surgically with the open Graham patch repair technique. Patients in group A were managed with ERAS protocols, while patients in group B were managed with conventional peri-operative practices. A comparison was established between the two groups in terms of the duration of hospital stay and other postoperative parameters. ResultsThe study was conducted on 41 patients who presented during the study period. Group A patients (n=19) were managed with standard protocols, and group B patients (n=22) were managed with conventional standard protocols. As compared to the standard care group, patients in the ERAS group showed quicker postoperative recovery and lesser complications. The need for nasogastric (NG) tube reinsertion, postoperative pain, postoperative ileus, and surgical site infections (SSI) were all significantly lower in the patients of the ERAS group. A significant reduction in the length of hospital stay (LOHS) was found in the ERAS group when compared to the standard care group (relative risk {RR}=61.2; p=0.000). ConclusionsThe application of ERAS protocols with certain modifications in the management of perforated duodenal ulcers yields significant outcomes in terms of reduced duration of hospital stay and fewer postoperative complications in a selected subgroup of patients. However, the application of ERAS pathways in an emergency setup needs to be further evaluated to develop standardized protocols for a surgical emergency group of patients.

Aim and Objectives:The present study was undertaken to evaluate the effectiveness of single port laparoscopy incongenital inguinal hernia repair with respect to operative time, intra and postoperative complications, hospital stay and rate of recurrence. Materials And Methods: Total 30 patients of age between 2-15 years admitted with diagnosis of congenital inguinal hernia, unilateral or bilateral hernia, with reducible non obstructive, primary were included in the study. All cases were performed under general anaesthesia by using a modication of technique described by Ozgediz et al. Results: Among 30 patients, 25 (83.3%) were male and 5 (16.7%) were female. Maximum numbers of patients were in the age group of ≤5 years (56.7%) with mean age of patients was 6.39 ± 3.43 years. Most of the patients (17; 56.7%) had right inguinal hernia. Mean operative time required was 16.23±4.39 minutes. Only in one patient (3%) extra port placement needed to reduce the contents of hernia. Intra operatively, one patient (3.3%) had retro peritoneal hemorrhage and post operatively one patient (3.3%) had complained of nausea for some hrs. The mean hospital stay was 1.48±0.58 Day. There was no recurrence occur in any case. Conclusion: In the paediatric population, single port laparoscopic inguinal hernia repair can be performed safely. This enables extension of the advantages of reduced access surgery to patients with limited resources to be handled. It also incorporates the benet of being fast, shortened operating time and better cosmesis. The benet of limited instrumentation and the intracorporeal knotting avoidance makes this a feasible technique