Background: Appendicitis is a common surgical emergency world over, requiring surgical intervention immediately or as elective procedure to avoid complications. Various methods of appendisectomy are in practice, which includes conventional and laparoscopic appendectomy. One other method of appendectomy called mini appendisectomy is performed in selected patients. This study analyses the advantage, feasibility and utility of using mini incision Appendectomy for patients with appendicitis at Saveetha Medical College and Hospital, a teaching tertiary care hospital, Chennai, India.Methods: A total number of 70 cases diagnosed with appendicitis underwent this technique of mini incision appendisectomy mostly under spinal anesthesia. The study period was from 2013 to 2016, for 4 years duration.  Patients detailed history, physical examination, operative details, post-operative complications, length of hospital stay, pain scores, analgesic requirements and patient satisfaction scores were collected.Results: Mini-incision appendectomy was performed in 70 patients with 2 cases (2.8%) which required an extension of the incision to 3.5 cm. Wound infection occurred in 2 patients which was treated conservatively. The average operating time was 25 minutes (20-45 minutes). No post-operative mortality. Patients had minimal post-operative pain.Conclusions: Hence mini incision appendectomy is a safe and advantageous technique in performing appendectomy in all hospitals.

Background: Helicobacter pylori is a gram-negative bacterium that causes chronic gastritis and plays important role in peptic ulcer disease, gastric carcinoma, and gastric lymphoma. The main aim and objective of the study were to study the incidence of H. pylori. To find the efficacy of rapid urease test (RUT) and histopathological examination of gastric biopsy in diagnosing H. pylori organism. Methods: This study was conducted at saveetha medical college and hospitals for 6 months. A comparative study between rapid urease test and histopathological examination to diagnose H. pylori infection. Some 100 patient with gastritis was taken for this study. Result: A total No of patients 100 (100%) were taken for this study in which 64 patients were detected positive for H. pylori by RUT method and 63 patients were detected positive for H. pylori by HPE method.The total no of cases positive for both RUT and HPE is 60.An association between RUT and HPE finding in the study group with the sensitivity being 95.24%, specificity being 89.19%, positive predictive value 93.75%, negative predictive valve 91.67% and accuracy 93.00%. Conclusion: Our study shows when comparing rapid urease test and histopathological examination. RUT and HPE show the same level of accuracy in the diagnosis of H. pylori infection. Since the rapid urease test is a rapid technique to perform so it is a good alternative for histological examination in a resource-poor environment.

Background: The two common procedures which are nowadays commonly performed for laparoscopic repair of inguinal hernia are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair. This retrospective study was aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes.Methods: In this retrospective study, we included 50 cases of inguinal hernia who underwent laparoscopic approach of inguinal hernia repair at Saveetha medical college and hospital between 2014 and 2016 for a duration of 3 years. Various parameters including the age, sex of patient, type of hernia, preoperative and post-operative complications, duration of hospital stay was analysed.Results: Of the 50 patients who underwent laparoscopic repair, 26 patients underwent TEP and 24 patients under went TAPP procedure. 31 cases were indirect inguinal hernias and 30 cases were direct inguinal hernias, totalling 61 hernia repairs, as 11 patients had bilateral hernia. One female inguinal hernia and 4 cases of recurrent hernia were operated by TAPP method. Postoperative complications like seroma formation; subcutaneous emphysema was seen in TEP group. Two cases of TEP were converted to TAPP and open lichenstein procedure. Postoperative pain was less in both the group. Patients who underwent TEP procedure spent less time in the hospital compared to those who underwent TAPP procedure.Conclusions: There is no major difference in the outcome after TEP and TAPP surgeries except for some minor complications and the results are comparable in both techniques TAPP and TEP. Both the procedures can be practiced according to surgeon’s familiarity of the procedure.

Gastrointestinal stromal tumours (GIST) are mesenchymal tumours that arise most commonly from the stomach. They are the 3 rd most common tumour diagnosed behind adenocarcinomas and lymphomas. The majority of these tumours are asymptomatic and incidentally diagnosed in UGI scopy or contrast enhanced CT abdomen and pelvis studies. Obstruction, ulceration, gastrointestinal (GI) haemorrhage and perforation warrants an urgent surgical intervention. GIST is medically managed by tyrosine kinase inhibitors and surgically by resection and anastomosis. This case report highlights the diagnosis and management of a 42-year-old gentleman who presented with vague right iliac fossa mass. Informed consent was obtained from the patient for publication of this case. This case was chosen to be reported because of the rare incidence of small intestine GIST in South India and the effectiveness of minimally invasive laparoscopic surgery in management.

Background: Intestinal perforation as a complication of enteric fever is still a serious problem in developing nations. Enteric ileal perforation is associated with high morbidity and mortality and many patients present in a severe toxic state because of delay in diagnosis and late presentation to hospital.Methods: A prospective study was conducted to assess the prognostic factors in enteric ileal perforation. Observations were made regarding symptoms, signs, duration of illness and presentation of patients to the hospital after acute episode. Per operative findings regarding site, size and number of perforations were recorded. Operative procedures were simple closure, ileostomy, or resection of diseased segment including right hemicolectomy done for associated caecal perforation and entero enteric anastomosis. Post-operative complications like wound infection, wound dehiscence, residual abscess, faecal fistula and deaths were documented.Results: There were 50 enteric ileal perforation cases with a age range of 13-80 with a mean age of 30.7. Male: female ratio was 11: 1. 85% of patients presented within 48 hrs of onset of symptoms of perforation and there is significant mortality in patients who presented more than 48 hrs of onset of symptoms of perforation (57.14%). Mortality was high in multiple perforation group (40%) and also higher incidences of fecal fistula and wound dehiscence.Conclusions: Age and sex have no bearing on the outcome. Perforation presentation interval, delay in surgery, number of perforations are important prognostic markers for typhoid ileal perforation.

Background: Thyroid swelling is a common disease in India. It is very important to differentiate malignant thyroid swellings from benign swellings for definitive planning of appropriate surgery and relevant patient counselling. The present study is undertaken to analyse the pattern of thyroid disease in patients coming to Department of General Surgery and to evaluate the accuracy of thyroid FNA and its correlation with histopathological examination following thyroid surgery, thereby its role in the preoperative diagnosis of thyroid swellings.Methods: A total of 114 thyroid patients were evaluated for a period of one year. The demographic data, clinical features were documented. FNAC was done in 77 patients and results were correlated with 47post operative histopathology reports and diagnostic accuracy of preoperative Fine needle aspiration cytology (FNAC) was evaluated.Results: Age of the patients ranged from 14-70 years. Females were higher than males. Most patients presented with Multinodular goitre and most were in euthyroid state. Sensitivity of FNA was found to be 67% and Specificity was found to be 100%: Accuracy was found to be 93.6% in present study. Positive predictive value was found to be 100%. Negative predictive value (NPV) was found to be 92.7%.Conclusions: Fine needle aspiration cytology has essential role in the evaluation of thyroid patients. We wish to stress the importance of doing multiple aspirations at different sites and usage of USG guidance for representative areas of suspected pathology. The diagnostic accuracy can be improved when combined with advanced imaging techniques.

Background: Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. Laparoscopic inguinal hernia repair was started in year 1999 and since then has gained popularity over the last 2 decades. The introduction of a laparoscopic technique has sparked a debate in the literature over the superiority of this method versus open repair. Even though for bilateral and recurrent inguinal hernias, laparoscopic approach is recommended, there is not enough literature to recommend its routine use in unilateral inguinal hernia repair.Methods: A randomised prospective study was conducted at a tertiary care teaching hospital, comparing both Laparoscopic inguinal hernia repair and lichensteins tension free mesh repair as treatment modalities for unilateral inguinal hernia. Total number of patients in the study group was 60. Patients who were willing for the study were selected for the open or laparoscopic procedure in a randomised way. Open procedure was done by 2 senior surgeons and laparoscopic procedure was performed by 2 other senior surgeons at associate professor designation. Various parameters like the complication rate, post-operative pain, post-operative stay and time to return to work were analysed.Results: Out of the 60 patients, 30 patients underwent open inguinal hernia repair and another 30 patients underwent Laparoscopic inguinal hernia repair. The mean age group was 46.73 in open surgery group and 42.10 in laparoscopic group. 23.3% of the patients in open hernioplasty developed seroma, hematoma in the post-operative period. Whereas 10% had seroma collection in laparoscopic group. No incidence of recurrence in both the groups. No significant difference in pain score between both the groups during immediate post-operative period on POD 0, however there was significant difference in pain score on POD 3 (mean pain in open group 4.13 and lap group 2.87) and POD 7(mean pain in open group 2.90 and lap group 1.23). Mean duration of stay in hospital for open hernioplasty was 7.8 days and for Laparoscopic hernioplasty was 3.07 days. Mean duration of return to work in open hernioplasty was 14.37 days and in laparoscopy group was 9.13 days.Conclusions: There are potential benefits for laparoscopic inguinal hernia repair over lichtenstein’s repair for unilateral inguinal hernias in terms of post-operative pain, hospital stay and early return to work.