Hernia is a common word that most surgeons are familiar with. A retrospective study was planned to analyse the spectrum of abdominal wall hernias in a rural population in India. Majority of the patients were of 40-70 yrs. Male to female ratio was 7:1. Incidence of groin hernias showed an increasing trend with advancing age. Out of total 320 cases, inguinal hernias were predominating in 77.81% cases. Ventral hernias were present in about 18% cases. However, femoral hernias were rare. We concluded that spectrum of abdominal wall hernias is almost the same all over the globe despite having differences in their socioeconomic and educational status.

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction in which loops of ileum and sigmoid colon wrap around each other. It is very uncommon in western world when compared with the African and Asian region. It is rapidly a progressive, fatal disease. Early diagnosis and intervention is the key of better outcome. We are reporting a case of 51-year-old male who presented with shock within 24 h of onset of symptoms. Exploratory laparotomy revealed ISK causing gangrene of ileum and sigmoid colon. In view of haemodynamic unstability, end ileostomy was done after excising gangrenous segments. The patient expired after 2 weeks due to complications of short bowl syndrome. We are also tabulating all cases of ISK reported in the literature till date.

Background: Gallstones can cause varied spectrum of histopathology. Xanthogranulomatous cholecystitis and metaplasia have been shown to have association with carcinoma gallbladder. Incidental carcinoma of the gallbladder is a nightmare for the patient. Routine histopathology of all cholecystectomy specimens is an effective policy for its early diagnosis and management. Methods: It is a retrospective study of histopathology of cholecystectomy specimens related to gallstones disease done at a rural government in north India. All patients with preoperative or intraoperative gross malignancy of gallbladder were excluded from study. Results: In our study, females were predominating over males with a ratio of 6.07:1. The mean of all patients was 44.16±14.64 years. Chronic cholecystitis was most common (69.81%) histopathological entity. Incidental carcinoma was also revealed in 1.9 % of the cases. Metaplasia and xanthogranulomatous cholecystitis was reported in about 6% cases. Mixed stones were most common type reported in 76.79% cases. Multiple stones (72.8%) were more common than single stones. Majority (58%) of the cases in our study were operated by laparoscopic technique. Gallbladder perforation was most common complication noticed in about 4.15% cases. Conclusions: Despite meticulous preoperative investigations and gross specimen examination, incidental carcinoma of gallbladder is a rule rather than exception in significant number of cases. A routine histopathology of specimen should be considered especially in high risk zones of carcinoma gallbladder.

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.

NTRODUCTIONThe conception of laparoscopy has revolutionized the art of surgery due to its vantages over classical open technique.The lately innovated laparoscopy cholecystectomy has been drastically refined over the years by better exploration of ergonomics, instauration of new energy sources and endo suturing. The conventional four ports access technique has been modified to three ports, two ports and single incision laparoscopic surgery with corresponding results. [1][2][3] Further cystic duct closure methods like clipping, harmonic scalpel, plasma kinetic and intra corporeal ligation have been tried with gratifying results. 4Metallic clip is the most commonly used method for cystic artery and duct closure which may be due to ease of learning and its execution, short operative time and timetested safety of technique. Although it is not less than a boon for a budding surgeon but it is not free from complications. Bile leaks, migration of clip, inadvertently clipping of common bile duct and right hepatic artery have ABSTRACT Background: Although in the era of laparoscopic cholecystectomy cystic duct occlusion has been tried by clips, harmonic and plasma kinetic quite effectively but cost, availability and inadvertent injury to biliary duct are concerning factors. Intra-corporeal ligation has evolved to address these issues effectively as a boon especially for the peripheral centres where availability and cost of energy sources weighs heavier than their associated ease. Triple ligation technique is a time preserving modification without any compromise in safety and quality of surgery. The aim of our study is not only to elucidate the importance of intra-corporeal ligation in safety and cost of surgery but also to enlighten its role in safe management of even difficult cases of cholecystitis. Methods: A retrospective observational study. All cases of symptomatic gallstones operated by laparoscopic triple ligation technique were included in the study. Results: More than half (63.4%) of the cases in our study were having chronic cholecystitis was reported in 63.4% of the cases while 36.4 % cases have acute cholecystitis. Mean duration of surgery was 46.4 and 71.2 minutes in chronic and acute cases respectively. No case of bile duct or vascular injury has been reported in our study. Only 3.8% of the cases were converted to open. Gallbladder perforation was most common complication noted in 12.8% of the cases. Conclusions: Triple ligation technique of laparoscopic cholecystectomy is not only a time sparing modification but is also a veritable, safe and frugal tool with excellent results even in complicated cholecystitis without compromising its outcome and prime.