After a quadratus lumborum (QL) block, the course of QL plane catheter is unpredictable. This case series discusses the course and fate of trans-muscular QL catheters by following and discussing the contrast spread through the fascial planes. Intrao-peratively, the catheters were tracked by the surgeons and were checked for integrity of anterior thoracolumbar fascia (ATLF) by injecting sterile 0.9% saline. The ATLF was intact upon injection and there was cephalad and medial saline spread with slight bulging of ATLF. On day 3 after written informed consent from all patients, computed tomography (CT) contrast studies were performed. Post-operative contrast spread was variable and was visualised in transversus abdominis plane, QL plane, lower thoracic paravertebral space, inter-vertebral foramina and anterior epidural space. CT contrast images demonstrated a variable spread. In conclusion, injection in ATLF of QL can spread along the path of least resistance and is unpredictable.

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Littre's hernia (LH) is a very rare presentation in patients presenting with hernias. It is the presence of Meckel's diverticulum (MD) in a hernia sac. However, it usually presents with obstruction or strangulation. We are reporting here a case of Littre's hernia in a 42-year-old male patient who presented with an irreducible swelling in the left inguinal region. The diagnosis of an incarcerated indirect inguinal hernia was made preoperatively. Intraoperative finding was however an obstructed Littre's hernia with Meckel's diverticulum in a very uniquely appearing hernia sac. The patient was successfully managed by resection of the MD along with ileal segment, primary anastomosis, and mesh hernioplasty on the inguinal floor.

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Background: Inguinal Hernia is a common entity in general surgical practices across the world. Its management though appears to be straightforward, could still be a nightmare for a surgeon if not dealt with proper attention and care. Lichtenstein’s mesh hernioplasty is still one of the most popular surgeries performed for inguinal hernia repair across the world. At our institute, we commonly perform this surgery with either Onlay mesh hernioplasty technique or combined Onlay-Plug mesh technique. The double mesh placement had always kept us engaged in regards to its post-operative outcomes and its advantage over single onlay mesh. We were also keen to take the subject due to the scarce availability of the recent literature.Methods: This prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India on 200 patients who were randomly and equally divided into two groups. Patients in Group A underwent Onlay mesh hernioplasty surgery, while patients in Group B underwent combined Onlay-Plug mesh hernioplasty surgery. Post-operative outcomes were assessed in both groups for a period of six months.Results: There was a significant difference between the two groups in terms of post-operative pain, scrotal edema, cord tenderness, and wound infection as patients in Group 2 who underwent combined Onlay-Plug mesh repair were found to have more incidences of the above-mentioned post-operative outcomes.Conclusions: Single Onlay mesh placement is sufficient. There is no significant benefit of keeping an additional Plug/Inlay mesh in patients undergoing tension-free mesh inguinal hernioplasty as per our findings.

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