Sclerosing encapsulating peritonitis, or abdominal cocoon syndrome (ACS), is a rare cause of intestinal obstruction in which the small bowel is encapsulated by a fibro-collagenous membrane. We present the case of a 29-year-old male who presented to us with acute intestinal obstruction. The imaging performed suggested the presence of ACS. The patient underwent laparoscopic adhesiolysis and the small bowel was released. In cases of recurrent small bowel obstruction, a high index of suspicion is required for the diagnosis of ACS. Computed tomography can be a useful imaging modality, and surgery remains the mainstay of treatment.

ObjectiveTo assess the outcome and safety of staple line over-sewing for patients undergoing laparoscopic sleeve gastrectomy (LSG).Study design and locationRetrospective descriptive analysis conducted at Shifa International Hospital Islamabad.Materials and methodsConsecutive patients undergoing LSG as a treatment for morbid obesity from October 2013 to December 2016 were included in the study after approval from the ethical review board. Patients were divided into two groups: group A who underwent reinforcement using Vicryl 2.0 and group B where no reinforcement was done.ResultsA total of 225 patients underwent LSG between October 2013 and December 2016, including 147 females (65.4%) and 78 males (34.6%). Both groups were comparable in terms of age, body mass index (BMI) and gender distribution (p-value more than 0.05). There was one leak in group A (1.36%), none in group B. The bleeding rate was 4.3% in group A and 2.7% in group B.ConclusionThis was a retrospective analysis of all the patients who underwent LSG, and it was observed that there was no added benefit of sewing the staple line in terms of rate of bleeding and leak.

Chylothorax is a severe complication of esophagectomy. Those who do not respond to conservative measures require reoperation. We have described a minimally invasive technique to control a late postoperative chyle leak. A 41-year-old patient underwent an Ivor-Lewis esophagectomy. Day 4 after surgery he was found to have an esophageal leak. He underwent thoracotomy and esophageal stent insertion. On day 20, a radiologic drain was placed to control a small supradiaphragmatic collection. The collection was found to be chyle, and 2.5 L was drained per day. As this was 3 weeks after thoracotomy, a technique of sinus track dilatation and cavity visualization was carried out with clipping of the chyle channel. The patient recovered well from the procedure. He was extubated postoperatively and only required simple analgesia.

Objectives: To explore the learning curve associated with laparoscopic totallyextraperitoneal repair of inguinal hernia, procedure being carried out by single surgeon attertiary care hospital. Study Design: Prospective cohort. Place and Duration: It was conductedat Shifa International Hospital Islamabad from October 2014 to March 2016. Patients andMethods: Consecutive patients undergoing Laparoscopic TEP repair for unilateral or bilateralinguinal hernia from October 2014 to March 2016 were included in the study and divided in twogroups: group 1 of first 50 and group 2 consisting of the next 50 patients. Results: A total of100 patients divided in two groups (50 in each) were included in the study. Group I includedfirst 1 to 50 cases with mean age of 46.6 years (SD +14.81) including 46 (92%) male and 4 (8%)female with similar distribution in group II which consisted of 51 to 100 cases with mean age45.3 years (SD +14.43) including 44 (88%) male and 6 (12%) female. The mean operative timein group I was 78 min (SD +32.30) while in group II the mean operative time was 41.2 minutes(SD+15.99). Conclusion: Although our results are from single centre and single surgeon study,we believe that at least 20 to 30 laparoscopic TEP hernia operations are required to help youngsurgeon familiarize with the anatomy of the region. The learning curve for TEP according to ourstudy is 50 cases.

Objective: To compare the mean pain score with inguinal block under general anesthesia versus subarachnoid block in adult patients undergoing inguinal hernioplasty. Design of the Study: Randomized controlled trial Study Settings: This cross-sectional study was conducted at Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore from January 2021 to June 2021. Materials and Methods: Sample of 200 cases was included through non probability purposive sampling. In group A, patients were given inguinal block and in group B, patients were given subarachnoid block. In Inguinal block group, a 10mL of Bupivacaine (0.5%) will be given at junction of 2/3 form umbilicus and 1/3 from anterior superior iliac spine after administration of general anesthesia with laryngeal mask airway. Patients were followed at 1, 2 and finally on 4 hours after surgery for measurement of pain. Results: The mean age of 39.63±6.50 years. Out of total 200 patients, 186 (93%) were males and 14 (7%) were females. The mean pain score at 1st hour in inguinal group was 0.76±0.87 whereas pain score in Subarachnoid block was 1.18±0.92. Similarly after 2nd hour inguinal group pain score was 0.88±0.84 and with Subarachnoid block was 1.33±1.04. At 3rd hour, with inguinal block mean pain score was 1.02±0.92 and with Subarachnoid block was 1.80±1.20. At 4th hour, with inguinal block mean pain score was 1.59±1.07 and with Subarachnoid block was 3.09±1.60. Statistically there is highly significant difference of mean pain score between both groups i.e. p-value<0.05. There was drastic increase in mean main score at 4th hour with subarachnoid block as compared to inguinal block showing that inguinal block is more effective in reducing pain after 4 hours of surgery. Conclusion: It was concluded from results of this study that inguinal block is more beneficial in controlling pain after inguinal hernia surgery as compared to subarachnoid block Keywords: Inguinal Hernia, Inguinal block, Spinal anesthesia, General anesthesia