Background: As a part of modern surgical procedure, laparoscopic mesh repair of inguinal hernia should be safe, effective and have a short period of convalescence. Objective: This study was designed to compare the outcome following inguinal hernia repair, performed by laparoscopic technique and open mesh Lichtenstein (tension-free) repair. Materials and Methods: This prospective quasi experimental study was carried out in the department of surgery, Bangabandhu Sheikh Mujib Medical University, for a period of twelve (12) months. Total thirty six patients of inguinal hernia were included in this study. Result: Mean (±SD) age was 38.17 (±8.64) years. Mean (±SD) time for unilateral inguinal hernias were 55.30 (±11.01) minute in open mesh repair where as 76.07 (±13.71) minute in laparoscopically. For bilateral inguinal hernia, mean (±SD) time for open mesh repair was 92.4 (±10.26) minute and 81.2 (±10.44) minute in laparoscopically Seroma formation was in 4 patients of open mesh repair where as 5 patients of laparoscopic mesh repair. Sixteen patients of laparoscopic mesh repair needed more anaesthetic narcotics 16 patients of laparoscopic mesh repair had return to work within two weeks of surgery whereas only 10 (55.6%) patients of open mesh repair had return to work during same period of time. Pain at surgical site and discomfort was more in open mesh repair. Conclusion: Laparoscopic mesh repair is better than open mesh repair of inguinal hernia.

Introduction: Bedside teaching is the core teaching strategy in the clinical study in undergraduate medical education of Bangladesh. Many of the environments and opportunities available for bedside teaching and learning have changed. Students’ views about current status of bed side teaching in Obstetrics and Gynaecology was studied in this study.Methodology: This was a cross sectional study conducted in seven (three public and four private) medical colleges in Bangladesh from July 2012 to June 2013. A total 578, 5th year MBBS students were enrolled who have completed at least 15 days of bedside teaching in Obstetrics and Gynaecology department. A self-administered structured questionnaire (Annex 1) with a five point Likert scale (1- strongly disagree, 5-strongly agree) was used for obtaining information from the students. The questionnaire had four main sections- physical environment of bedside sessions, issues regarding patient’s comfort and attitude towards patient, teaching tasks, group dynamics and there was a space to write any other comments. Each section had a number of items and total 25 items were observed. For each variable frequency distribution, mean score and standard deviation (SD) were calculated. Here mean score 5- no need of further improvement, as it covered all the required criteria, 4 to <5- very minimum effort, 3 to <4- some effort, 2 to <3= moderate effort, 1to <2= considerable efforts are needed to fulfill the required criteria.Result: The overall mean score on physical environment factors was 2.75(.44), issues regarding patient’s comfort and attitude toward patient was 3.74(.48), teaching tasks was 3.12(.45) and group dynamics was 3.08(.21).Conclusion: In all aspects of bed side teaching minimum to moderate efforts are necessary to make it more effective. The administrators and teachers should ensure comfortable physical environment in bedside teaching and must learn how to involve patients and learners in the educational process. So along with training on general principles of teaching, the clinical teachers should be provided with special training on bedside teaching skills.J Bangladesh Coll Phys Surg 2017; 35(4): 163-169

Introduction: Bedside teaching is the cornerstone of clinical teaching for the health professions. Different strategies have emerged to make it more effective. Many of the environments and opportunities available for bedside teaching and learning have changed.Methodology: This was a descriptive type of cross sectional study conducted in seven (three public and four private) medical colleges in Bangladesh over a period from July 2012 to June 2013 to determine the ways of conduction of bedside teaching in undergraduate medical education of Bangladesh. Total 30 Bedside teaching (BST) sessions conducted in the ward in Obstetrics and Gynaecology departments were observed by researcher herself and data was collected in a structured check list by using 5 points rubric (1-lowest quality, 5-highest quality). The checklist had four main sections- physical environment of bedside sessions, issues regarding patient's comfort and attitude towards patient, teaching tasks and group dynamics. Each section had a number of items and total 27 items were observed. For each variable frequency distribution, mean score and standard deviation (SD) were calculated.Here mean score 5- no need of further improvement, as it covered all the required criteria, 4- very minimum effort, 3- some effort, 2= moderate effort, 1= considerable efforts are needed to fulfill the required criteria.Result: Among physical environment factors the mean score of temperature, noise, space, teacher-student ratio were >2 but <3 and for light the mean score was >3 but <4. Among the issues regarding patient's comfort and attitude toward patient the mean scores on introducing everyone to the patient, maintaining privacy, explaining findings to the patient, genuine encouraging closure were >1 but <2 and on taking consent from the patient, showing appropriate attitude toward patient, teaching based on data about that patient were >2 but <3. Among teaching tasks the mean score on supervision of student during history taking, giving chance to practice the skills of the session, summarizing the session were >1 but <2 and on selection of the patient, supervision of student during physical examination, giving feedback, acting as a role model in physician- patient interactions, duration of the classes were >2 but <3 and on assisting a student during practicing a skill when needed, asking students to apply clinical reasoning skills were >3 but <4. Among group dynamics the mean score on active participation of the students and setting tasks for individual student were >1 but <2 and on setting goals for the group at the beginning of the class and setting time limit for every task were >2 but <3 and on active participation of the patients were >3 but <4.Conclusion: In all aspects of bed side teaching minimum to considerable efforts are necessary to make it more effective. A bedside teacher must know the importance of comfortable physical environment in learning and must learn how to involve patients and learners in the educational process, so faculty development is essential.Bangladesh Journal of Medical Education Vol.4(1) 2013: 2-7

Objective: The aim of the study was to explore the surgical outcomes of total laparoscopic hysterectomy. Materials and methods: This was a prospective analysis of total Laparoscopic Hysterectomy (TLH) done between January, 2012 to December, 2018 in Shaheed Suhrawardy Medical College and Hospital. Demographic data, clinical criteria, intra operative and postoperative outcome data were recorded. Data were collected in a predesigned Data collection sheet. Follow up records done during discharge from the hospital, one week and four weeks postoperatively. Results: Total 298, laparoscopic hysterectomy were performed during the period. Among them 96 % (n=286) for benign and 4 %( n=12) for malignant condition were included in the study population. Mean age of the patients was 45.4 ± 5.6 years, mean parity was 1.9 ± 0.64 and the mean body mass index was 27.48 ± 0.57. The most common benign disease was leiomyoma, 51.7 %. Among the study cases 21.8% (n=65) had history of at least one previous abdomino-pelvic surgery. Maximum size of uterus removed was 28 weeks and maximum patients, 48% (n=143) had uterine size of 10-14 weeks. The operating time was variable between 50 min to 180 min and in the course of time, the mean operating time dropped from 130 min to 60 min. The mean length of hospital stay was 2 days and the return to normal activities was within 2 weeks. Major complications observed among 3.7 % of cases among them 2(0.67%) bladder injury, 2(0.67%) vesico-vaginal fistula (VVF), 3(1.0%) ureterovaginal fistula (UVF) and 4(1.3%) peroperative hemorrhage requiring blood transfusion. Among the 7 cases of urological complications, one patient with VVF and one patient with UVF needed relaparotomy. Ultimately all cases were managed without any residual problem. Conversion to laparotomy was 0.3 % (n=1) of case. Conclusion: TLH offers the benefit of minimally invasive surgery to the patient and is a safe and acceptable alternative to standard hysterectomy for various gynaecological indications. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 28-35

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Background: Recent studies suggest that surgical diathermy shows better clinical outcome in the context of incision time, wound related postoperative pain, postoperative wound infections, and length of postoperative hospital stay and cosmetic outcome of scar in cases of elective surgical patients. Objectives: Compare the efficacy and safety of surgical diathermy versus conventional surgical blade for making skin incisions in elective mid-line laparotomy and to evaluate weather cutting diathermy is an effective and better alternative to surgical blade incision. Materials and Methods: This prospective study was carried out in the department of surgery at BSMMU, Dhaka over a period of one year. Sample size was 64 with a follow up duration for 6 month. In Group I (D), skin incision was taken with diathermy, and in Group II (S), incision was taken with surgical blade. Results: Compared with a scalpel incision, cutting diathermy resulted in significantly shorter incision times and reduced post-operative wound related pain (P = <0·001), shorter duration of postoperative hospital stay (P = 0.003) with no differences in the wound complication rate and cosmetic outcome of scar. Conclusions: The study has demonstrated that surgical cutting diathermy is a safe and effective method to make skin incisions in elective surgery KYAMC Journal Vol. 10, No.-3, October 2019, Page 143-146

Background: Preoperative biliary drainage before pancreaticoduodenectomy is a controversial issue. Proponents are in favor of preoperative biliary drainage by ERCP with stent to reduce surgical jaundice with an anticipation of better surgical outcome. Objective: Compare the outcome with or without pre-operative biliary drainage before pancreaticoduodenectomy. Materials and Methods: This observational comparative study was conducted in department of Surgery and Hepatobiliary and pancreatic surgery of BSMMU. Twenty three patients presented with obstructive jaundice due to periampulary carcinoma who subsequently underwent pancreaticoduodenectomy were selected by purposive sampling and finalized by eligibility criteria. Results: Patients with preoperative biliary drainage (PBD) group required a longer operative time (mean 4.12 hours versus 3.83 hours) and had more intra-operative blood loss (mean 662 mL versus 495 mL) compared with non PBD group (P=0.009 and 0.010). No differences were found with respect to operative mortality (4.3%) and incidence of pancreatic leakage (P=0.281). PBD was significantly associated with positive bile culture (P=0.019) and high incidence of wound infection (p=0.029). Conclusion: Preoperative biliary drainage did not increase major postoperative morbidity and mortality but associated with increased operative time, intraoperative blood loss, and incidence of wound infection. Preoperative biliary drainage should be used selectively in patients undergoing pancreaticoduodenectomy. KYAMC Journal Vol. 10, No.-4, January 2020, Page 196-201

Polycythaemia rubra vera is a chronic myeloproliferative disorder that is characterized by excessive red cell production and unlike other forms of polycythaemia, it can cause both bleeding and thrombosis in the same patient. Only few cases have been reported in the literature where polycythaemia rubra vera with surgery was performed successfully .The ideal peri-operative management is currently unknown. Here we present a case of 50 yrs old lady with polycythaemia rubra vera underwent open mesh repair for incisional hernia. After operation, the patient developed hemorrhagic complications needing resuscitation with blood and plasma expander. The patient was managed efficiently. Considering its very rarity, we are reporting the case. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 218-222