Introduction: Laparoscopic Cholecystectomy (LC), one of the most commonly performed surgical procedures worldwide, is accepted as the gold standard in the treatment of symptomatic gallstones. Generally laparoscopic cholecystectomy has low incidence of morbidity, mortality and conversion rate to open surgery, but occasionally surgeons encountered diffi culty while doing Laparoscopic cholecystectomy. Preoperative prediction of "diffi cult Laparoscopic cholecystectomy" improve the patient safety as well as useful in reducing the cost of therapy. Aim: To study a scoring system based on various risk factors to preoperatively predict diffi cult Laparoscopic cholecystectomy.

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Spigelian hernia is a rare variety of abdominal wall hernia occurring through the spigelian fascia which is composed of the aponeurotic layer between rectus muscle medially and semilunar line laterally. Generally it is difficult to diagnose because of their location and non specific symptoms. Diagnosis is aided by ultrasonography and Computerized Tomography. Once the diagnosis is confirmed, it is repaired surgically as risk of incarceration is high. We reported this interesting case of spigelian hernia with associated port site hernia in a 53 year old female patient from Arwal district, Bihar who presented with occasional lower abdominal pain. The hernia was reduced and defect was repaired. Her recovery was uneventful.

Introduction: Carcinoma of the gallbladder (GBC), is the most common cancer of the biliary tree. It is also one of the most highly malignant tumours. The aetiology of the carcinoma gall bladder is poorly understood. Chronic cholecystitis and gallstones, choledochal cysts, female gender, old age and exposure to carcinogens are some of the factors implicated in the causation of gall bladder cancer. The current changes in lifestyles of individuals about indulgence in unhealthy fat-rich food, lack of exercise, obesity, sedentary lifestyles and the high incidence of gall bladder carcinoma in Bihar, focused our attention on gall bladder carcinoma and its etiological factors. Methodology: An analytical case-control study was conducted to study the various etiological factors causing carcinoma of the gall bladder in patients of various regions of Bihar coming to PMCH Patna. A total of 101 cases of gall bladder carcinoma and a total of 101 patients without any gall bladder disease in the control group were included in the study.

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