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Antibiotic prophylaxis is being commonly used in mesh repair of inguinal hernia but its role has been questioned in a recent Cochrane analysis performed in 2003. Routine use of antibiotic prophylaxis in mesh repair of inguinal hernia can lead to bacterial resistance and increase in cost. In a present double-blind placebo controlled trial involving 120 patients undergoing inguinal hernia repair using prolene hernia system, we did not find any benefit of the routine use of antibiotic prophylaxis in terms of wound infection rate.

BACKGROUND:Peritonitis secondary to small bowel perforation is a common surgical emergency seen across the globe.METHODS:A young male patient presented with ileal perforation that was repaired primarily. He recovered uneventfully after the operation.RESULTS:Histopathology of the margins of the perforation revealed tuberculosis. A search for evidence of a primary focus of tuberculosis was unsuccessful. The patient was started on anti- tubercular therapy and he was followed up with good results.CONCLUSION:This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

Background: Partial cholecystectomy is usually performed with the aim of preventing bile duct injury and/or vascular injuries in situations where there is difficulty in performing

A 65-year-old man presented with history of pain in the right side of abdomen for last 2 years with concomitant dyspepsia. On examination, there was no icterus, and abdominal examination was unremarkable. The patient had been investigated earlier and referred to tertiary center in view of common bile duct (CBD) stones. Magnetic resonance cholangiopancreaticography (MRCP) showed dilated CBD packed with stones. The patient was subjected to ERCP and stenting, and then underwent open cholecystectomy with CBD exploration. On opening the CBD, there was a single large stone occupying whole of the CBD and extending into both hepatic ducts. The stone could not be removed in toto, so it was extracted in two pieces which measured approximately 9×4 cms (Fig.

BACKGROUND:Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered. METHODS:A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy. RESULTS:The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fi brocollagenic tissues with a mixed infl ammatory infi ltrate, without any evidence of tuberculosis. CONCLUSIONS:Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.

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BackgroundTo assess the feasibility and safety of a pancreas preserving operative technique in the management of isolated complete pancreatic neck transection following blunt abdominal trauma.MethodsTwo patients with isolated blunt fracture of the pancreatic neck underwent pancreas preserving procedure comprising of oversewing of the proximal pancreas and Roux-en-Y pancreatico jejunostomy to the distal remnant. A feeding jejunostomy tube was placed for postoperative nutritional support in these patients. Both patients received subcutaneous octreotide 300 µg/day.ResultsTheir ages ranged from 15 years to 20 years, mode of injury was bicycle handle-bar injury (n = 2). Both had pancreatic transection at neck in the line of superior mesenteric vessels. One had ascites. These patients had pancreas parenchyma preserving surgery – internal drainage of the left remnant in a Roux-en-Y jejunal loop. The postoperative course was uneventful in these and both are well on follow-up.ConclusionsPancreas preserving strategy – suture of head side of pancreas and an internal drainage of left remnant with a Roux-en-Y jejunal loop is feasible and safe and should be considered in selected cases. Substantial amount of normal pancreatic parenchyma is preserved.