BACKGROUNDThe first written reference of varicose veins appears to be the Ebers Papyrus dated 1550 B.C. It is one of the oldest documented pathological conditions in existence today. This study deals with its aetiology, pathology and the different modes of treatment and their efficacy in detail. MATERIALS AND METHODS50 patients with lower limb varicose veins admitted in the Department of General Surgery, KIMS, Karad from October 2014 to July 2016 were included in the study. All patients were subjected to detailed history taking, clinical examination and relevant investigations. Depending on the merits of the disease, appropriate treatment options are selected. All the results are evaluated and analysed by comparing with other standard results. RESULTSIn this study, there were 34 males and 16 females (M:F = 2.1:1). Most of the patients were between 20 -50 yrs. of age (80%); 56% of patients had occupations, which involved prolonged standing. In this study, 48% of patients had positive family history. The most common presenting complaint was prominent veins (100%) and pain in 54% of patients. Right limb was involved in 38% and the left limb involved in 52% of patients. Long saphenous vein was involved in 98% of patients, the second commonest being perforators which were involved in 86% of patients. Majority of the patients had combined saphenofemoral and perforator incompetence (70%). Duplex ultrasound was very accurate in diagnosing perforator incompetence. Treatment was depended upon the individual cases. In patients with venous ulcers Bisgaard's method of treatment was followed till the ulcer heals and then the patient was subjected to further definitive treatment. SFJ ligation with stripping was the most common surgery performed. Among post-operative complications, wound infection was the most common (14%). CONCLUSIONThis study showed that the prevalence of varicose veins of lower limb have a male predominance and is more common in younger age group. Family history and occupation are important contributing factors in the development of lower limb varicose veins. Left lower limb involvement is more than the right. Duplex ultrasound is the investigation of choice of lower limb varicose veins. Saphenofemoral flush ligation with stripping is very effective in the treatment of varicose veins.

BACKGROUNDFistula-In-Ano has been one of the oldest described conditions inflicting man throughout history. It is the commonest cause for a persistent perianal discharge and discomfort. This study deals with its aetiology, pathology and the different modes of treatment and their efficacy in detail.

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BACKGROUND Since its inception by Levin in 1921 and popularisation by Wangensteen in 1933, nasogastric suction has become one of the routine procedures in postoperative abdominal surgery and yet there is little scientific justification. With the advent of fast track and day care surgery in this modern era, the search for postoperative care protocols which reduces costs, post-operative morbidity and shortens the duration of hospital stay continues to dominate surgical practice. MATERIALS AND METHODS The study design is an observational prospective one, conducted in the Department of Surgery of Krishna Hospital and Medical Sciences, Karad. Over a period of 18 months between August 2014 and May 2016, a total of 314 cases of both sexes admitted to surgical wards and underwent emergency or elective abdominal operations were collected. Inclusion criteria included all gastrointestinal tract surgeries. Exclusion criteria included patients who underwent oesophagectomy (These patients needs nasogastric tube as an absolute indication) and patients of gynaecological surgeries. Patients were allocated into two groups: Group I (Those with nasogastric tube) and Group II (Those without nasogastric tube) and in both groups patients were divided into elective and emergency cases. RESULTS The distribution of duration of hospital stay differs significantly across two study groups (P value < 0.001). Significantly higher proportion of cases from Group 1 had higher length of hospital stay compared to Group 2 cases (P value < 0.001). The distribution of duration of hospital stay differs significantly across two study groups (P value < 0.001). Significantly, higher proportion of cases from Group 1 had higher length of hospital stay compared to Group 2 cases (P value < 0.001). The distribution of duration of postoperative return of bowel sound differs significantly across two study groups (P value < 0.001). Significantly, higher proportion of cases from Group 1 had higher duration of postoperative return of bowel sound compared to Group 2 cases (P value < 0.001). The distribution of incidence of pulmonary complications did not differ significantly across two study groups (P value > 0.05). CONCLUSION The study recommends that routine use of NGT in patients undergoing abdominal surgery is unnecessary and unjustified. It should only be used in specific cases as a therapeutic measure, especially in those who present with gross abdominal distension and excessive vomiting. Postoperatively, nasogastric decompression should be continued in surgeries of upper gastrointestinal tract like intestinal perforation primary closure, resection and anastomosis of upper gastrointestinal tract, biliary tract surgeries where upper gastrointestinal tract has been used for anastomosis and adhesiolysis surgeries, where patient usually remains in postoperative ileus. In these cases, nasogastric tubes should be used as a therapeutic rather than a prophylactic tool.

BACKGROUND This is a comparative study of uncomplicated adult inguinal hernia repair under local anaesthesia and spinal anaesthesia, whereas general anaesthesia requires an experienced anaesthetist with modern equipment and spinal anaesthesia entails post-operative invalidation, while local anaesthesia is easy to administer, simple and effective and causes no post-operative complications. Early ambulation which is hallmark of surgery done under local anaesthesia is a relative term, open to many interpretations. Hence, we have taken up this study to evaluate various aspects of adult inguinal hernia surgery carried out under local anaesthesia and compared it to more conventional methods off surgery under spinal/general anaesthesia. MATERIALS AND METHODS The present study consists of 25 cases of adult uncomplicated inguinal hernia. These patients underwent one day post-operative hospitalisation, surgical treatment as detailed below and results were compared with a control group of 25 cases operated and managed in the more conventional delayed ambulation after post-operative repair. These were recorded on a standard proforma. RESULTS There was significant statistical difference when it came to post-operative analgesia, post-operative complications and element of early ambulation. However, wound healing and recurrence were not affected. It also helped reduce economic burden of both hospital and the patient. CONCLUSION Significant reduction in incidence of post-operative complication without any deleterious effect on wound healing or recurrence even after a 6-month follow-up was established. Early ambulation did not cause any hindrance to wound healing or recurrence. There was significant reduction in terms of cost to the patient and also in reduction of hospital expenses and waiting list.