Background: Recurrent palatal fistula is a common complication of cleft palate repair. The main causes are poor surgical technique or vascular accidents and infection. Local flaps are not adequate for larger and recurrent fistula. The aim of this study is to analyze the utility of tongue flap in recurrent and large palatal fistula repair. Materials and Methods: From January 2008 to July 2016, 18 patients with recurrent palatal fistula were included in the study. All the patients had undergone repair of cleft palate and fistula previously. Tongue flap repair of the recurrent palatal fistula was performed in all 18 patients. The flaps were divided after 3 weeks and final inset was done. Flap viability, fistula closure, residual tongue function, esthetics, and speech impediment were assessed. Results: In all the patients, fistula could be closed primarily by tongue flap. None of the patients developed flap necrosis while flap dehiscence and bleeding were observed in one patient each. No functional deformity of the tongue and donor-site morbidity was seen. Speech was improved in 80% cases. Conclusion: The central position, mobility, excellent vascularity, and versatility of tongue flap make particularly suitable choice for the repair of large fistula in palates scarred by previous surgery. It is very well tolerated by children. We, therefore, recommend tongue flap for large and recurrent palatal fistula in children.

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INTRODUCTIONHernia is derived from a Latin word meaning "a rupture". Abdominal wall hernias are most frequently encountered in surgical practice accounting for 15% -18% of all surgical procedures.1,2 Worldwide, more than 20 million hernias are operated per year.The incidence of abdominal wall hernia in different countries varies from 100-300/100000 per year.3 Of which most common being the inguinal hernias and femoral hernia being the least common. Midline ventral hernias are the next common variety of abdominal wall hernia after inguinal hernia, most common after interventions involving the lower abdomen (incisional hernia). According to their locations, these are further ABSTRACT Background: Abdominal wall hernias are most frequently encountered in surgical practice accounting for 15% -18% of all surgical procedures. The incidence of abdominal wall hernia in different countries varies from 100 -300/100000 per year. Of which most common being the inguinal hernias and femoral hernia being the least common. Midline ventral hernias are the next common variety of abdominal wall hernia after inguinal hernia. Ours is a tertiary care hospital, medical college and PG institute in central India. Apart from routine hernias, we have managed successfully some very rare varieties and developed management protocols. Here we are providing an analysis of these unusual presentations. Methods: This is a retrospective study in which we analyzed the data's of hernia patients presented in our institute over the period of 7 years (2008)(2009)(2010)(2011)(2012)(2013)(2014). Out of 765 patients, who were diagnosed having hernia, 680 were operated in our institute. Among these cases, we have selected 12 very rare and unusual cases which stood as diagnostic and management challenge and which were operated by a single surgeon and his team. Results: Out of the 12 cases of atypical hernias, 11 patients underwent surgical intervention. There was no mortality. 6 patients had some postoperative complications which were managed during their Hospital stay only. After discharge, all the patients were followed at regular intervals. There was no recurrence or other complication noted in 1 year follow up. Most common post-op complication was seroma which was seen in 50% of the operated patients. Other complications were wound infection (16.66%) and wound dehiscence (8.33%). Conclusions:The infrequent encounter with the unusual varieties of Hernias can lead to the mental bias and becomes a diagnostic challenge for the general surgeon. The purpose of publication of these rare varieties is to increase our spectrum of knowledge and to provide diagnostic and therapeutic armamentarium to deal with these difficult situations.

INTRODUCTIONAmongst the diseases of the gall bladder calculous cholecystitis is the most common. Acute cholecystitis can get complicated and result in complications like empyema, gall stone ileus, cholecystoenteric fistula, emphysematous cholecystitis, gall bladder perforation and biliary peritonitis.1 Of these, gall bladder perforation (GBP) is an uncommon but life-threatening complication of acute cholecystitis, with a reported mortality rate of 12-42%. [2][3][4] Niemeier in 1934 has classified gall bladder perforations in three types as follows; Neimeir classification is still in use with minor modifications after so many years. The aetiology of the ABSTRACT Background: Amongst the diseases of gall bladder calculous cholecystitis is the most common. Acute cholecystitis can worsen and result in various complications. Gall bladder perforation leading to generalised peritonitis is a lethal complication. Methods: In this retrospective observational study we have reviewed 550 cases of acute cholecystitis who were admitted to our institution in 8 years i.e. from 2008 to 2015. Perforations due to other causes (trauma, iatrogenic causes, and carcinoma) were excluded. Niemeier classification was used to identify the patients. Direct-abdominal Xray series, abdominal ultrasound scanning (US), abdominal contrast-enhanced computerized tomography (CECT), routine blood cell count, and blood chemistry tests were performed. Results: Fourteen cases (2.5%) were found to have gall bladder perforations during the course of investigations and intraoperatively. Ten (71.42%) were females out of the total fourteen patients. Mean age was 65 years and presenting features on admission were nausea, vomiting, abdominal pain, fever and variable general condition. Aetiopathology of gall bladder perforation remains obscure till date. This clinical condition still remains a diagnostic as well as therapeutic challenge to surgeons. On detailed review of literature, we could not get few references, as the condition is uncommon. Conclusions: We have done this study to analyse the variable clinical presentation, correlation of non-invasive investigations and intraoperative findings and outcome in cases of gall bladder perforations so as to improve our further management of such cases.

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