Background: Hernias are among the oldest known afflictions of human kind and elective inguinal hernia repair is commonly performed operation in general surgery. General or spinal anesthesia are still the most common types of anesthesia being used in India. Studies comparing the recovery profiles of local, general and regional anesthesia show that local anesthesia is ideal for day care surgery.Methods: This study had included 60 cases of male single sided reducible indirect long standing (more than 5 years) inguinal hernia. Patients were divided randomly into two groups of 30 each named Group A and Group B. Patients in group A were subjected to inguinal hernia mesh repair under local anesthesia and patients in group B were subjected to inguinal hernia mesh repair under spinal anesthesia. Tension free Lichtenstein hernioplasty was done in both groups.Results: Time taken in local anesthesia is higher than spinal anesthesia. Intraoperative pain is higher in local anesthesia than spinal anesthesia. There is no difference on post-operative pain. Post-operative complications are more in spinal anesthesia group.Conclusions: Patient selection is very important and patient with long history should be avoided under local anesthesia.

Background Biloma is the collection of bile outside the biliary tree and can be intra or extrahepatic. It is most commonly iatrogenic, secondary to surgery or percutaneous transhepatic procedures or secondary to abdominal trauma. Spontaneous bilomas are very rarely described in the literature. Case reports Case 1: A 32-years-old female presented as lump abdomen in the epigastric region. Blood investigations were normal. Chest radiographs were unremarkable. Ultrasound examination revealed two cystic lesions about left lobe of liver and cholelithiasis with choledocholithiasis. Ultrasound-guided pigtail catheter drainage of the collection was done. ERCP failed to manage the choledocholithiasis. CBD exploration with choledocholithotomy and T-tube drainage and cholecystectomy was done. The postoperative period was uneventful, and the T-tube was removed on the 10th day after a normal T-tube cholangiogram. Case 2: A 32-year-old female admitted in an emergency with a complaint of acute pain in abdomen since two days. Ultrasound shows contracted gallbladder with stone along with focal collection in perihepatic and perigallbladder region extending into the subcutaneous plane with CBD stone. Ultrasound-guided pigtail catheter drainage of the collection was done. After five days she underwent ERCP by which CBD stones were cleared. Elective laparoscopic cholecystectomy was done. Conclusion A high index of clinical suspicion is necessary for prompt recognition and its proper management. Percutaneous treatment should be considered as the first-line option for patients with spontaneous biloma. In cases of persistent bile leaks, endoscopic biliary drainage and endoscopic sphincterotomy with or without stent placement should be performed. Surgery is now performed only in cases with a persistent bile leak or for treatment of an underlying disease.

Background: An appendectomy is the surgical removal of the appendix. Appendectomy may be performed laparoscopically or as an open operation. Laparoscopy is now often used as patient resumed normal activity within a shorter period than had been experienced with open appendectomy. Patients had a superior cosmetic result and experienced significantly less postoperative discomfort. In this study, we attempted to determine the predictors for difficult appendectomy using history and clinical examinations, preoperative laboratory data, ultrasonography findings and intraoperative finding.Methods: The study was conducted in Sarojini Naidu Medical College, Agra. All patients who underwent laparoscopic appendectomy from 1st January 2016 to 30th June 2017 were included in the study. A detailed performa was developed to record information regarding patient history, physical examination, laboratory parameters, ultrasonography (USG) findings and intra-operative details. Laparoscopic appendectomy done in more than 120 minutes, converted into open due to difficulty in surgery and not due to complications, severe adhesions were considered to be a case of difficult appendectomy.Results: We found that the difficult laparoscopic appendectomy can be predicted preoperatively based on age >60 years, history of previous lower abdominal surgery, time of onset to surgery >24 hours, acute appendicitis and peri appendicular collection.Conclusions: There are very few reports to determine the predictors of difficult appendectomy and more research is required to establish it.

Background: Lichtenstein’s tension free mesh repair is the most commonly performed in open inguinal hernias. The present study was done by comparing Lichtenstein Repair (LR) v/s posterior wall repair (PR)+ Lichtenstein repair (LR) of direct Inguinal Hernias to compare the technique of both surgeries and its outcome like postoperative complications and recurrence rate.Methods: This study was conducted in SNMC Agra where patients of unilateral male direct inguinal hernia were included. A total of 60 patients were taken and divided into two groups (A and B) randomly of 30 each. In group A patients were operated by LR and in group B patients were operated by PR+LR and followed up for a period of six months. The outcomes of the both techniques were compared.Results: Mean age was 48.3 years in group A and 49.5 in group B. The mean duration of surgery for group A is around 29.34 min and group B is 46.28 min which was significant. The pain was not statistically significant in both groups on day 1 and 3. There was 1 (3.3%) recurrence in group A and no recurrence in group B. Post-operative complications were similar in both groups.Conclusions: LR+PR were comparatively better than only LR in all direct inguinal hernias because of low recurrence rate (0%).

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