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AIMS:Study the efficacy of stapled haemorrhoidectomy using circular stapler in terms of benefits as duration of surgery, length of hospital stay, postoperative pain, time to return to normal daily or social activity and usefulness as for patient satisfaction. MATERIAL AND METHODS: Prospective study using circular stapler for grade II, grade III and grade IV haemorrhoids between age group 20 to 70 years was done over a period of Jun 2011 to Nov 2013. OBSERVATION AND RESULTS: Study enrolled 30 symptomatic patients. 21(70%) were males and 9(30%) females. Most common complaint was bleeding per rectum in 29 (96.66%) patients followed by itching 11 (36.66%) patients & constipation 8 (26.66%) patients. 19(63.33%) patients were grade III haemorrhoids, 6 (20%) were grade II and rest 5 (16.66%) grade IV. Mean operative time was 31.76 minutes for our team with same surgeon operating all cases. Postoperative pain recorded using VAS score was max 24 hours after the surgery with mean VAS 2.31 + 0.46(VAS -1 no pain). During stay 28(93.33%) patients required Step 1 pain analgesics (NSAIDS) while only 2(6.66%) were put on Step 2(opioids). Mean hospital stay of patients was 34.96 hours (1.45 days). 28(93.33%) patients were able to return to social activity by day 8 post operatively. 28(93.33%) were complication free while others had minor problems dealt accordingly. No recurrences in 6months follow up in all patients with 28(93.33%) patients reporting satisfaction for their treatment through the procedure. CONCLUSION: Haemorrhoids is a socially embarrassing disorder and this new procedure of stapler haemorrhoidectomy delivers a smile and dignity especially to Indian patients. Hence it should practiced and promoted for patients benefit.

Obesity has assumed a pandemic and is responsible for serious medical, social, psychological, and economic implications, affecting all ages and socioeconomic groups. Hence, this prospective study was carried out to study the surgical benefits in such patients. A Prospective interventional study was carried out from June 2010 to November 2012 at IGGMC Nagpur performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients, and its efficacy was determined. A total of 56 patients were studied. 26 (46.42 %) being males and 30 (53.57 %) females. The maximum number of patient's, i.e., 32 (57.14 %) were in the range of BMI 40-44.99 kg/m(2) with mean BMI-43.25 kg/m(2). Mean weight was 117 kg (range 92-180 kg). Common comorbidities observed were hypertension in 43 (76.78 %), bronchial asthma in 31 (55.35 %), and diabetes in 21 (37.5 %). All patients treated with LSG had a mean operative time of 154.9 min (range 110-310 min) with 0 % leak, one conversion to open, and no mortality. Postoperative hospital stay was 3.54 days (range 3-7). Complications were minimal with prolonged vomiting seen significantly in 28 (50 %) patients. Follow up at 24 months showed mean weight 74.72 kg (68-81 kg) with mean excess weight loss of 67.71 % (62.79-71.05 %) causing a mean BMI of 28.42 kg/m(2) (26.56-30.44 kg/m(2)). It also reduced mean BP to 120.36 mmHg (110-144 mmHg) and mean fasting blood sugar to 100.63 mg/dl (80-146 mg/dl). Surgery for obesity is definitely an answer for this gift of modernization, and LSG is a safe and effective technique for achieving weight loss. Quality of life improves astonishingly and adds confidence to this mentally traumatic entity called "OBESITY".

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Background: Video-assisted thoracic surgery (VATS) had been widely accepted because of its low complication rate, tolerable postoperative pain and early recovery of pulmonary function. Hence the present study was undertaken to assess safety and efficacy of VATS and also analyze the surgical outcomes of VATS procedures for non-malignant thoracic pathologies.Methods: A total of 32 patients with non-malignant pathologies of thorax to undergo VATS lobectomy and thoracotomy conversion cases initially approached by VATS lobectomy were enrolled. Demographic data and surgical information were noted and compare between infection and non-infection group. Primary outcomes were thoracotomy conversion rate, period of thoracic drainage, length of hospital stay, and complications.Results: The majority of patients were in the age group of 36-45 years (28.12%) with female predominance (62.50%). The commonest clinical presentation was hydropneumothorax (28.12%). Most common infective and non-infective aetiology was lung hydatid (28.12%) and benign nodule (18.75%) respectively. The commonest surgical procedures conducted using VATS were lobectomy (34.37%), and decortication (25%). The mean blood loss among the cases was 315.9±36.46 ml. Mean operative time was 157.18±12.37 minutes. Among 6.25% cases thoracotomy was conducted in view of difficult hilar dissection, while among 3.12% cases each of indistinct anatomy and bleeding. Mean duration of thoracic drainage was 6.78±1.69 days and mean hospital stay was 8.2±3.2 days. 6.25% cases had fatal complications while 21.87% cases had milder complications. Only one case recurred while 96.87% cases cured.Conclusions: VATS lobectomy for benign disease is feasible and effective in selected cases, regardless of the presence of infection.

Jejunogastricintussusception through a gastrojejunostomy stoma is one of the rarest complications of the previous gastric surgery. The incidence is reported to be less than 0.1%. An elderly male presented to the hospital with h/o vomiting, pain in abdomen since 10 days. The patient was undergone upper G I Scopy and CT scan abdomen as a suspected c/o carcinoma stomach. A primarily healed midline scar from the previous surgery for large duodenal perforation. On exploration it was found that there was a mass in the stomach, which on gastrotomy revealed gangrenous jejunal loops herniated through previous stoma. Gangrenous jejunum was resected and Billroth II was done.

Pelvi-Ureteric Junction Obstruction (PUJO) is a common anomaly seen affecting children and adults. The structural wall is most of the times the main reason for obstruction while other causes like stones, infection etc. explain the remaining. Regardless of the cause, the end result is impedance in the normal flow of urine from the renal pelvis into the proximal ureter, resulting in caliectasis and hydronephrosis. This may lead to progressive deterioration of renal function and, thus, requires intervention to relieve the obstruction and restore the normal flow of urine. Advances in endoscopy have flourished the approaches for management of this ABSTRACT Background: Pelvi-Ureteric Junction Obstruction (PUJO) is a common anomaly seen affecting children and adults. The structural wall is most of the times the main reason for obstruction while other causes like stones, infection etc. explain the remaining. Regardless of the cause, the end result is impedance in the normal flow of urine from the renal pelvis into the proximal ureter, resulting in caliectasis and hydronephrosis. There is a scarcity of data regarding feasibility of laparoscopic retroperitoneal pyeloplasty in connotation with the Indian background. The research aims to study the procedure its feasibility, success rates and complications. Methods: This prospective study was carried out in the department of surgery of our hospital, over a period of 2 years from Nov 2011 to Nov 2013. Studies have been approved by the institutional ethics committee and Maharashtra University of health sciences, Nashik and have therefore been performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments. Results: Out of the 25 patients, there were 14 (56%) males and 11 (44%) females. Male to female ratio was 1.2:1. Of these 13 (52%) were having right sided PUJO and 12 (48%) were having left sided PUJO. 12 (48%) patients were in the age group of 16-30 years, 7 (28%) in 31-45 years age group, 5 (20%) in 0-15 years group and one (4%) patient in 46-60 years age group. 24 (96%) had history flank pain on the affected side. Of this 9 (36%) had only flank pain as there presenting symptom. 11 (44%) had history of recurrent urinary tract Infection. Only one (4%) patient had only recurrent UTI history. 8 (32%) patients had mixed symptoms most commonly associated with flank pain. 6 (24%) patients had renal lump of which 5 (20%) had associated flank pain and 1 (4%) had both UTI and flank pain. The mean VAS score for pain preoperatively is 6.54 ± 1.18. On investigation the mean serum BUL and mean serum creatinine was 36.6 ± 18.7 mg/dl and 1.1 ± 0.59 µg/dl respectively. Conclusions: Laparoscopic retroperitoneal pyeloplasty is a safe and feasible. It is associated with excellent patient outcomes with good patient satisfaction. It has direct approach to the target organ. Laying a platform this technique can also be expanded for more other procedure related to kidney and ureter.

Squamous cell carcinoma of the nail bed is rare and commonly diagnosed late. Presentation is not specific and diagnosis rests on biopsy of the lesion. This condition can be easily misdiagnosed, especially if there is preceding trauma. We are also reporting such case involving the thumb. A 70 years old male patient presented at OPD with complaints of pain and ulcer over left thumb since last 4 months. Patients had lost his thumb nail 6 month back and since then was treated on Ayurvedic treatment. Patient does not give a history of trauma. Biopsy of the ulcer revealed Squamous Cell Carcinoma. His X-ray did not reveal any infiltration and hence a distal phalanx amputation of thumb was performed. Patient had an uneventful post-operative course and on 9 months follow up showed no recurrence. Rare still subungual squamous cell carcinoma should be considered early in lesions around the nail that fail to resolve after adequate conservative management. Early detection helps change surgical treatment from amputation to more preserving techniques like Moh's or wide local flap reconstruction.