INTRODUCTIONA midline incision is the most commonly used access route for emergency laparotomy as it is simple, quick, bloodless, has best extensibility and provides excellent exposure.1,2 But it's drawbacks are comparatively increased incidence of postoperative wound dehiscence and an incisional hernia compared to other incisions. 3Many factors influence wound complications like wound sepsis and dehiscence. Some of the patient related factors are their nutritional status, hypoalbuminaemia, anaemia, immunosuppressed states, renal failure, uncontrolled diabetes, malignancies, steroid therapy and obesity. Other set of factors which influence the strength of repair and healing are related to the technique of suturing. Some of them are the size and type of suture material used (monofilament versus polyfilament, absorbable vs. nonabsorbable, natural versuss synthetic) and also the ABSTRACT Background: Mass closure of midline laparotomy fascial wound is undoubtedly superior to layered closure technique. For elective surgeries continuous method is recommended over interrupted to avoid wound dehiscence, but controversy exists in the literature about the best method of midline fascial suturing in contaminated cases. Thus this is the study to compare two techniques of closure. Methods: Prospective non-randomised study. Two groups are study group who underwent modified smead-Jones method of fascia closure and control group who underwent interrupted closure. Outcome parameters studied were time required for closure, length of suture material needed, postoperative wound infection and wound dehiscence. Data was analysed statistically using Chi-square test. Results: Time required for study group was significantly lesser than control and the length of suture required was also significantly less. Wound infection rate in study group was lesser than control but the difference was statistically insignificant (p >0.05). Wound dehiscence rate was significantly less in the study group (p < 0.05) compared to control group. Conclusions: In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to see-saw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.

Intestinal obstruction due to volvulus is a well-known entity in India, one of the ‘volvulus belt’ countries; but volvulus of the splenic flexure is a rare condition, even more so when metachronous. Only about half a century of citations has been mentioned in the surgical history since its first mention in literature. Our patient, a young man with a history of previous two abdominal operations presented with signs of intestinal obstruction which were confirmed by radiological findings to be volvulus of splenic flexure. Following failed attempted derotation by flatus tube, he underwent laparotomy, intraoperative derotation of the volvulus followed by resection of the involved segment and colo-colic anastomosis with diverting loop ileostomy. Apart from surgical site infection, his postoperative recovery was uneventful.

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Abstract:Old laryngeal foreign bodies may sometimes present with features simulating acute laryngotracheobronchitis in pediatric population. Here we present a case of a 3 year old girl, presenting with stridor that was initially diagnosed as laryngotracheobronchitis. The patient required emergency tracheostomy to relieve stridor, but check bronchoscopy for evaluation of the airway revealed a subglottic foreign body (impacted stone) which was removed under general anaesthesia. The case was unique as the presentation mimicked acute laryngotracheobronchitis which in most of the cases relieves on conservative management.

Introduction Postoperative surgical site infection (SSI) forms the major burden of nosocomial infections in surgical patients. There is prevalent practice of surgical site hair shaving as a part of preoperative preparation. There is uncertainty regarding the benefit versus harm of shaving for SSIs. Hairs at surgical sites are removed prior to surgery most often by shaving. We performed this study to look for what impact preoperative hair removal by shaving has on postoperative SSI. Methods We performed prospective comparative cohort study in patients undergoing elective abdominal surgeries. We included clean and clean-contaminated surgeries in immunocompetent patients of which half were shaved and other half not shaved prior to surgery. Other confounding factors like skin cleaning, aseptic technique of surgery, antibiotic prophylaxis and treatment, and postoperative wound care were as per care. Patients were assessed for presence and grade of SSI postoperatively on day 7, 14, and 30. Results were analyzed statistically using chi-square and Fischer's exact tests for significance in entire sample as well as in demographic subgroups. Results Overall SSI rate was 11.42%. There was no statistically significant difference in SSI rates between patients who underwent preoperative surgical site hair removal by shaving (232) and who did not have shaving (232) on all the three different assessment timelines in postoperative period, namely, day 7, 14, and 30. Although the absolute number of patients who had SSI was more in those who underwent preoperative surgical site hair removal by shaving, the difference was not statistically significant (p > 0.05). But on subgroup analysis patients with clean-contaminated surgeries (p = 0.037) and patients with surgeries lasting for less than 2 hours (Fischer's exact = 0.034) had significantly higher SSI in the shaved group compared with unshaved on day 14. Conclusion As per our results, preoperative shaving did not significantly increase overall SSI except in subgroup of clean-contaminated surgeries and in surgeries of less than 2 hours' duration. So especially in these patients avoiding preoperative surgical site hair shaving may be used as one of the infection control measures.