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Overview Laparoscopic approach has changed the face of surgical care offered to patients. Almost all surgical procedures across specialties are now undertaken by the laparoscopic approach. Closure of port sites to prevent trocar-site hernias (TSHs) forms an integral part of the laparoscopic procedure. TSH is an area of preventable surgical morbidity. We hereby report our technique that is easily applicable, simple, safe, and highly cost-effective. It requires no additional instruments or retractors, is easy to learn, and has a very favorable safety profile. Materials and Methods This prospective case series enrolled a total of 454 port-site closures in 255 patients undergoing different laparoscopic procedures over a period of 2 years. The intraperitoneal tissue forceps were used in the reverse direction to lift the fascia up and a right-angled retractor was used to retract back the skin and subcutaneous tissue. The port-site closure is done under vision and no adverse events were reported. Results This technique was used in 454 port sites in 255 patients. No intraoperative incidents were noted. There is no requirement of any specialized instruments or retractors. No additional tissue trauma or dissection is required. There is no extension of operative time. The technique is simple to learn and easy to teach. No bowel injuries or TSHs were reported during a follow-up of 26 months. Conclusion The described technique is easy, simple, cost-effective, and has a good safety profile.

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Background: Peripheral arterial disease (PAD) constitutes a significant healthcare problem with immense health and economic implications. Owing to ill-equipped healthcare systems in poor countries the diagnosis of PAD demands the availability of a reasonably reliable and inexpensive diagnostic test. Ankle brachial index (ABI) is a simple, inexpensive office-based test for the diagnosis of PAD. The study was aimed to evaluate the reliability of ABI for the diagnosis of PAD using Doppler ultrasound (DUS) as the gold standard. Methods: The ABI of patients suspected of having lower limb PAD was measured followed by DUS examination. The sensitivity and specificity of ABI for the diagnosis of PAD was calculated by comparing it with DUS which was used as the reference or standard diagnostic test. Results: The ABI of a total of 200 limbs from 100 patients was recorded followed by DUS examination. One hundred and thirty-two limbs (66%) had PAD on DUS which was graded as mild, moderate, and severe in 45.5%, 27.2% and 30.3% respectively. Out of 132 patients who had PAD on Doppler, 96/132 (72.8%) were correctly labelled as PAD on ABI, whereas 36/132 (27.2%) received an erroneous diagnosis of normal on ABI. Conversely, only 6/60 (10%) patients who were labelled as PAD on ABI had a normal arterial system on DUS. The ABI yielded a low overall sensitivity of 72.7% and a high specificity of 90%. The sensitivity was relatively low for mild PAD (52.7%), however, for moderate and severe PAD, ABI demonstrated a high sensitivity of 88.9% and 100% respectively. Overall agreement between ABI and DUS for the diagnosis of PAD was good (k = 0.67). Conclusion: ABI demonstrated a good sensitivity and specificity for the diagnosis of PAD especially in patients with moderate-severe PAD. Combined with the advantages of ready availability, low cost, and technical feasibility the use of ABI should be maximized in routine clinical practice to clinch the diagnosis of PAD in suspected individuals.

Schwannomas are benign slow-growing tumours arising from the Schwann cells of the nerve sheath. They may arise anywhere in the course of the nerves in the body. The clinical presentations are non-specific, and when present in rare locations such as lungs, the diagnosis becomes difficult. The present case series describes the clinical presentation and diagnosis of five cases of lung schwannoma. The diagnosis was mainly assisted by the immuno-histochemical examination comprising markers such as S-100, Calretinin, CD34, CD56, Desmin, and EMA. A definitive diagnosis of benign nerve tumours in such rare locations may help in better pre-operative assessment and surgery for complete recovery of the patients.