Preoperative prediction of morbidity in colorectal cancer (CRC) surgery helps to optimize the surgical outcome. In this study, we aim to develop a dedicated equation for predicting operative morbidity using colorectal possum scoring system and also to validate the predictive accuracy of CR-POSSUM scoring system in prognosticating actual complications. We did a retrospective analysis of 322 patients undergoing colorectal cancer surgery from a single centre in South India from 2004 to 2016. Mortality and morbidity risk factors as defined by CR POSSUM were collected from 322 patients who underwent CRC surgery and were used to derive equations to predict morbidity, and the results were compared with the observed morbidity. Logistic regression analysis was used to derive the equation. The model fit and model discrimination were analysed using the Hosmer-Lemeshow statistical test for goodness of fit, the Nagelkerke R 2 and area under the receiver operating characteristic (ROC) curve respectively. Out of 322 patients, 103 (32%) patients developed complications and 10 (3%) died due to complications. The regression equation we derived has an overall correct classification of about 70% (P < 0.01) with positive and negative predictive value of 60% and 73% respectively. The Hosmer-Lemeshow goodness of fit was 3.147 (P = 0.829), and the Nagelkerke R 2 was 17% and area under ROC as model discrimination was 71.6%. Hence, CR-POSSUM scoring which was originally used for predicting mortality risk can also be extrapolated to predict morbidity.

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial Sir, We appreciate the contribution of Carey et al.1 in the debate on the usefulness of mesh in the surgical management of vaginal prolapse. The study would have been of greater relevance had the authors solely compared traditional repair and mesh repair for vaginal prolapse. In the above study, many women had additional procedures, such as vaginal hysterectomy and repair of stress incontinence, which, by themselves, could have affected the outcomes.A larger homogeneous study population, preferably in the multicentre setting, is recommended for future studies on the optimum surgery for vaginal prolapse.As the success of interventions and their complication rates are operator dependent, the results of future evaluations should ideally be stratified by operator experience.In addition, studies need to be instituted on the optimum operative modalities for primary and subsequent repairs. Attention is also required for the evaluation of long-term postoperative outcomes. These systematic studies would help address issues on the optimum use of mesh and operators' training and mentoring needs. j Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial Authors' ReplySir, We thank Poulose and Saha for their comments. 1 When designing our study, 2 we deliberately chose to include women scheduled for a vaginal hysterectomy and antiincontinence surgery in order to improve the generalisability of the study. Recent research demonstrates that women undergoing prolapse surgery have a prevalence of concomitant hysterectomy and anti-incontinence surgery of 44% and 35.1%, respectively. Our study was a randomised controlled trial.2 The major advantage of randomisation is to control for potential confounding, with the randomisation processes evenly distributing confounders among the two treatment groups.We agree that long-term evaluation of outcomes is important. We are currently undertaking the long-term follow-up of study subjects. j

BACKGROUNDPercutaneous Nephrolithotomy (PCNL) is the gold standard in the treatment of renal and upper ureteric calculus, but involves the placement of nephrostomy tube and Double J stent to aid in drainage of the kidney. The placement of Nephrostomy tube and Double J stent has their own drawbacks like post-operative discomfort, prolonged hospitalisation, pain and stent related symptoms. Hence, we evaluated the safety, efficacy and feasibility of Total Tubeless Percutaneous Nephrolithotomy (TTPCNL) in uncomplicated PCNL patients.