Background: Hemorrhoids being a common anorectal problem with its well known morbidity and complications is treated since long by conservative measures, injection sclerotherapy or rubber banding for 1st and 2nd degree and by open Miligan Morgan hemorrhoidectomy or closed Fergusson hemorrhoidectomy for 3rd and 4th degree. However, since 1998, the adoption of Stapled Hemorrhoidopexy has proved over time to be a better alternative in terms of lesser postoperative complication and an overall patient satisfaction.Methods: A prospective study conducted on 114 patients at Department of General Surgery, Kalinga institute of Medical Sciences, Bhubaneswar, Odisha from May 2014 to December 2016.Results: Our study showed stapled hemorrhoidopexy, significantly reduced the time taken for the operative procedure (p <0.001), post operative pain (p <0.01), hospital stay along with early return to work and a better patient satisfaction.Conclusions: Stapled hemorrhoidopexy is an effective alternative to open Miligan-Morgan procedure in treating 3rd and 4th degree hemorrhoids, in terms of lesser time taken for the operative procedure, post operative pain, use of analgesics, hospital stay and early return to work, better post operative patient’s satisfaction and reduced procedure related complication.

Background: Despite the high incidence, the technical aspects of hernia repair continue to evolve making it the most common operations performed by general surgeons. Lichtenstein mesh hernioplasty repairs all hernias without distortion of the normal anatomy and with no suture line tension. This study was performed to evaluate the outcomes of Lichtenstein mesh herinioplasty in emergency inguinal hernia patients.Methods: A 84 patients were operated for complicated (obstructed irreducible) inguinal hernia. A follow-up period of 6 months using the Quantitative and Qualitative Measurement Instrument for evaluation of Lichtenstein hernioplasty outcomes was completed for 44 emergency patients.Results: The age incidence of the hernia patients in the study group was 40% (25-35 years) followed by 24% (15-25 years). The anatomical position of the hernia in the study group was to the right having a dominant percentage of 72% followed by left (24%) with none in bilateral. Early postoperative complications in mesh repair (Lichtenstein hernioplasty) comprising of factors like wound infection (10%), hematoma (5%), seroma (10%) was significantly lower compared to tissue repair with wound infection (20%), hematoma (5%) and seroma (25%). Further mesh rejection in Lichtenstein hernioplasty was 0% for the study population. Similarly, late postoperative complications in Lichtenstein hernioplasty comprising of factors like wound dehiscence (4%), neuralgia (27%) was significantly lower compared to tissue repair with wound dehiscence (27%), neuralgia (41%).Conclusions: The study revealed that the use of polypropylene prosthesis in the emergency setting (obstructed hernia) is safe and outcomes are satisfactory.

A 18 year female presented to the Surgery OPD with pain in the right lower abdomen since 15 days, gradual distension of the upper and mid abdomen for 10 days, 2 bouts of vomiting at onset of pain, mild fever from the beginning, recent onset of anorexia and early satiety since 5 days duration. She had obtained treatment at local hospital and relived temporarily. On examination a soft, cystic, nontender swelling of approximately 15 cm × 15 cm size mostly occupying the epigastrium, umbilical, hypogastrium, right hypochondrium and right lumbar regions, dull to percussion, mildly tender at the right iliac fossa region. She was conscious, oriented, pulse-78/min, BP -112/74 mm/Hg, R/R-18/min and temperature of 99 0 F. She does not give past history of jaundice, chronic cough, weight loss or contact with known TB sufferer. Blood reports revealed a leucocytosis of 14,200/cumm with neutrophilia of 78%, normal amylase, lipase, electrolytes, urea and creatinine. ECG was normal. She ABSTRACT Appendicular pathology is a very common entity and appendicular perforation can present in various forms ranging from right lower abdominal pain, fever and anorexia to frank peritonitis with endotoxaemic shock. We present a 18 year female with fever, anorexia and a large upper and mid abdominal swelling of 2 weeks duration which after admission was treated with intravenous fluids, antibiotics, analgesics and antiemetics. Her CECT abdomen and pelvis revealed a huge fluid containing cystic lesion with a perforated appendix tip and intraluminal faecolith and calculi. She underwent USG guided 10F pigtail catheter drainage of the walled off peritoneal collection on 3rd day of admission. About 700 ml of serous fluid with minimal flecks was drained within 2 hours and another 860 ml over next 3 days. The pigtail drain was removed on day 7 and she was discharged on day 9, with USG abdomen confirmation of complete disappearance of the abdominal collection. Ultrasound guided percutaneous catheter drainage of the appendicular abscess with IV antibiotics cures the patient in selected case scenario.

Polytrauma in a 55 years male due to blunt trauma like fall from a height involving fracture of long bones, undisplaced fracture pelvis, fracture multiple ribs with a preliminary diagnosis of eventration of the hemidiaphragm in a apparently hemodynamically stable patient with a normal CT scan of brain, though poses a major physiological challenge, however runs a better prognosis. But with the passing of hours as patient develops respiratory distress and chest and abdomen CECT confirms a large lacerated hemidiaphragm with herniation of abdominal visceras occupying the hemithorax with lung collapse, alarms the gravity of the injury. An uncommon stress ulcer duodenal perforation on the 2nd day of admission with ensuing pyoperitoneum further threatens the hemodynamics and enhances the morbidity and mortality. This warrants an active and prompt action by multispecialty involvement. Emergency laparotomy to address the pyoperitoneum, closure of the duodenal perforation, reduction of the herniated abdominal visceras from the hemithorax, thorough saline lavage of the abdominal and involved chest cavity, placement of intrathoracic chest tube drain, repair of the lacerated diaphragm, placement of peritoneal cavity drains and closure of the abdomen settles the issue of damage control surgery in this case. Postoperative care in the ICU with ventilator support, higher antibiotics and supportive medications, repeated laboratory and radiological tests helps in overcoming the hemodynamic crisis in such critically ill patients. Our patient subsequently developed pneumonitis and had a postoperative protracted course in the ICU and finally shifted to the general ward on 7th day of his admission.