Anal fistulae can be a very difficult disease to manage. The management of complex fistulae is even more challenging. The risk to the fecal continence mechanism due to damage to the anal sphincters and refractoriness to the treatment (high recurrence rate) pose the two biggest challenges in the management of this disease. Apart from these, there are several other challenges in the treatment of complex fistulae. The intriguing and uphill task is that satisfactory solutions to most of these challenges are still not known, and there is hardly any consensus on whatever treatment solutions are available. To summarize, there is no gold-standard treatment available for treating complex anal fistulae, and the search for a satisfactory treatment option is still on. In this review, the endeavor has been to discuss and highlight recent path-breaking updates in the management of complex anal fistulae.

Background: Hernia is defined as abnormal protrusion of viscus through a normal or abnormal weakness in the wall of its containing cavity. Incidence of Incisional hernias is 60%. It is the most common complication after exploratory laparotomy followed by LSCS.Methods: Data was collected for 30 cases of incisional hernia according to the proforma which included detailed history, clinical examination and investigation. Data was tabulated, analyzed and results interpreted.Results: Incisional hernia was more common in females with the ratio 1.5:1. The incidence of incisional hernia was highest in the age group ranging from 30-50 years. Most of the patients presented with chief complaint of swelling (100%) followed by pain and swelling (24%). Incisional hernia was more common in patients of previous history of abdominal procedures (explorative laparotomy 53%) followed by gynaecological operations (23%). Out of 30 patients studied, 20 underwent only mesh hernioplasty (67%), 10 underwent sublay mesh hernioplasty (23%).Conclusions: With prosthetic mesh, defects of any size can be repaired without tension. The polypropylene mesh, by inducing inflammatory response sets up scaffolding that in turn induces the synthesis of collagen. Thus, the superiority of mesh repair over suture repair can be accounted for.

INTRODUCTIONIntestinal perforation is one of the most serious and frequently encountered surgical emergencies. It presents as acute abdomen and requires urgent exploratory laparotomy and corrective surgery. Out of all emergency surgical hospital admissions due to acute abdomen, the prevalence of intestinal perforation could be up to 20-40%. 1 The diagnosis is clinically obvious in many cases, though radiological confirmation is invariably sought before surgical intervention. The morbidity and mortality is adversely affected by several factors pertaining to delay in seeking treatment, poor clinical condition at admission, type of perforation and complicating features. A wide range of pathologies can damage both small and large intestines. Clinically, such patients may present with features of acute intestinal obstruction or perforation. Intestinal obstruction often but not necessarily precedes perforation. Gastrointestinal tract perforations can occur for various causes such as infective etiology, peptic ulcer, inflammatory disease, blunt or penetrating trauma, iatrogenic factors, foreign body or a neoplasm, requiring an early recognition and, often, urgent surgical intervention. The underlying etiological factors of intestinal perforation vary between developed and developing countries. Infectious diseases like typhoid, tuberculosis and HIV infection are the common causes in the developing countries whereas non-infectious conditions like malignancy and diverticulitis are more common in developed nations. 2 The site of intestinal perforation depends on the underlying pathology. Perforation in the duodenum or stomach is a serious complication of peptic Results: The site of perforation was gastric 27.5%, duodenum 20%, jejunum 5%, ileum 35%, appendix 10% and colon 2.5%. Main causes included peptic ulcer 42.5%, typhoid 25% and few cases of trauma, tuberculosis, appendicitis and malignancy. Peritonitis was universal. Primary repair, resection with anastomosis, appendectomy and stoma were the operative procedures. Morbidity rate was 60.0% and mortality rate was 12.5%. Conclusions: Commonest site of perforation was gastro-duodenal while commonest cause was peptic ulcer disease. Morbidity and mortality was comparable with other studies.