Background: Laparoscopic cholecystectomy is a well-established procedure for gallbladder disease. Pain in laparoscopic cholecystectomy is associated with multiple factors: somatic, visceral, and phrenic nerve irritation. Effective analgesic support should, therefore, be a multimodal approach following laparoscopic surgery for better patient compliance.Methods: A prospective, randomized observational study was undertaken at a tertiary research center for a period of two years (2018-2020). 160 patients undergoing laparoscopic cholecystectomy were chosen and randomized using a computer program into 2 groups. No infiltration was given in the control population. The study group was irrigated with a 0.5% bupivacaine solution (20cc in 30 ml normal saline).Results: The bupivacaine group required fewer analgesics in comparison to the control faction, with less pain at 6 hrs. The timing of oral intake and ambulation were comparable in both factions.Conclusions: Combined bupivacaine use led to a considerable decrease in postoperative pain thereby leading to decreased analgesic use.

Cystic lymphangiomas are rare, congenital, benign lesions occurring early in life, mainly in the head, neck, and oral cavity, rarely occur in abdominal wall and its discovery in adult is also very rare. It is due to aberrant proliferation of lymphatic vessels resulting from abnormal development of the lymphatic system. These are soft, variable in size and shape and tend to grow extensively if not surgically excised. These are multilocular cysts filled with clear or yellow lymph fluid, sometime mixed with blood. The present case report describes a case of cystic lymphangioma of right lower abdominal wall in a 36 years old male and its clinical, ultrasonographic, CECT, and histopathological correlation.

Background: Laparoscopic cholecystectomy is the procedure of choice for most patients with gallbladder disease. The key, as in open surgery, is the identification and safe dissection of Calot’s triangle. Surgeons performing laparoscopic cholecystectomy should not think of conversion to open operation as a complication, but rather a sound clinical judgment.Methods: This is an observational, single center study. The scoring system included five aspects; appearance and adhesion of gall bladder (GB), distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery and duct identification. A score of <2 would imply mild difficulty, 2–4 moderate, 5–7 severe and 8–10 extreme. The scores were compared in each patient to conclude the practicality of intra operative predictive score.Results: The most common reason for conversion to open surgery was found to be difficulties in dissection of cystic duct and artery in Calot’s triangle. The moderate and severe category was found to be statistically insignificant to predict the conversion, therefore, one can consider to merge these 2 categories into a single category to forfeit the prediction for conversion.Conclusions: The extreme category was found to be statistically significant for prediction of conversion, therefore, the patients falling into this category forfeits the chances of increased risk of injury and therefore, should be converted early.