To compare elliptical excision with primary midline closure and rhomboid excision with limberg flap reconstruction techniques for the sacrococcygeal pilonidal sinus. This prospective randomized study of 80 patients of sacrococcygeal pilonidal sinus was performed in SKIMS medical college from 2004 to 2007. After assigning patients randomly to either of the surgical groups, group A patients (40/80) were operated by using rhomboid excision with limberg flap reconstruction whereas group B patients (40/80) were operated by using elliptical excision with primary midline closure. Data was compiled in terms of operative period required, immediate post operative complications, post operative pain (VAS scores), work-off period, hospital stay and recurrences over a follow up of 3 years for the two study groups. Data thereby collected was analyzed by using Microsoft excel. The parameters in which the two techniques were found to differ significantly were work-off period, immediate post operative complications profiles and recurrence rates. Rhomboid excision with limberg flap reconstruction technique surely outscores elliptical excision with primary midline closure in certain important parameters. While facing a patient with uncomplicated sacrococcygeal pilonidal sinus, instead of, which procedure for the patient? Surgeons should pose the question why not rhomboid excision with limberg flaps reconstruction?

Objective: To compare the outcomes of laparoscopic pyelolithotomy and open pyelolithotomy at a single center in terms of operative time, blood loss, intra-and post-operative complications, analgesia requirements, hospital stay, convalescence and cosmesis. Material and methods:This prospective randomized study was conducted in the Department of Surgery of the Government Medical College Srinagar between May 2008 and September 2010. Sixty patients underwent pyelolithotomy during this period, including both open pyelolithotomy (n=30) and laparoscopic retroperitoneal pyelolithotomy (n=30). All patients (age >14 yr) with large (>1.5 cm) renal pelvic stones who met the inclusion criteria were included in the study. The decision to perform open or laparoscopic pyelolithotomy was made randomly by a computer program. Results:The majority of our patients in both study groups were in the 21-40 yr age group. The mean operative time was significantly less (p<0.001) in the open group than in the laparoscopic group (74.83 min vs. 94.43 min). The mean blood loss was less in the laparoscopic group than in the open group (73 mL vs. 103 mL); however, this difference was not statistically significant. In the laparoscopic group, both the resumption of oral intake (10.33 hrs vs. 15.60 hrs) and the drain removal (2.7 days vs. 3 days) occurred earlier, although these differences were not significant. Intraoperative complications occurred more frequently in the laparoscopic group (16% versus 6.66%); however, all of the complications were minor and were managed intraoperatively in the same sitting. There was no statistically significant difference in the postoperative pain scores or analgesia requirements, and postoperative complications were only slightly more frequent in the laparoscopic group in our study. The mean hospital stay in the open group was 5.2 days, while the mean stay of the laparoscopic group was 3.8 days (p<0.03). Patients in the laparoscopic group returned to their routine activities significantly earlier (1.78 vs. 3.83 wks) than did patients in the open group (p<0.001). Conclusion:Laparoscopic retroperitoneal pyelolithotomy for upper urinary tract calculi is superior to open surgery because of the significantly reduced hospital stays and cosmetic outcomes of patients who underwent the laparoscopic surgery. Although the reductions of analgesia requirements and blood loss were not statistically significant in our study, the data still favored the laparoscopic procedure. Disadvantages of retroperitoneal laparoscopy include the decreased working space, the cost of equipment and the availability of a trained surgeon.

Spontaneous evisceration is a very rare and potentially fatal complication of abdominal wall hernia. It has been commonly reported in the case of umbilical hernia in patients with chronic liver disease with tense ascites. With other hernias, such as incisional hernia and inguinal hernia, the complication has been reported only once. Here we present a case report of spontaneous evisceration in an inguinal hernia in a patient with comorbid chronic obstructive airway disease. Management of the condition using prosthetic mesh repair risks mesh infection, while the use of non-prosthetic repair risks recurrence of the hernia due to the absence of stout natural tissues. Use of a biological mesh for the condition seems quite plausible. Thorough saline washes of the eviscerated organ, excision of redundant/unhealthy skin and strict adherence to the fundamental principles of hernia repair is desired in managing the condition.

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Objective: To comparatively study the effectiveness of Laparoscopic nephrectomy vis-à-vis Open nephrectomy in patients of benign non functioning kidney and early stage renal cell carcinoma. It was a prospective, non-randomized study. Patients and Methods: 160 patients underwent open (n=80) or laparoscopic nephrectomy (n=80).The comparison was made in relation to the operative time, intra-operative and postoperative complications, blood loss and transfusions, pain and analgesia requirements, hospital stay and convalescence. Results: The mean operative time (96 minutes Vs 74 minutes) was more in the laparoscopic group. The mean blood loss (127 ml Vs 104 ml) was more in the open group. The resumption of oral intake (30.3 hours Vs 33.6 hours) and removal of drain (2.35 days Vs 2.6 days) was earlier in the laparoscopic group. Intra-operative complications were more in laparoscopic group (5% Vs 2.5%). A total of 4 patients (5%) had to be converted to open because of failure to progress, and bleeding due to major vessel injury. Post operative complications were significantly more in open group. Mean hospital stay in open group was 6.3 ± 1.34 days, significantly more than laparoscopic group of 4.2 ± 1.22 days. Tumor recurrence was seen in both the groups. Conclusion: Laparoscopic nephrectomy for benign and early stage malignant disease is superior to open surgery in terms of reduced blood loss, postoperative complications, hospital stay and cosmetic outcome. The accumulated follow-up oncological data has shown equal oncological efficacy of laparoscopic radical nephrectomy and the results are comparable to open radical nephrectomy.