Background: Inguinal hernia is a very common surgical problem for which, mesh-based techniques, particularly the Lichtenstein repair is considered standard. However, problems like foreign body sensation, wound infection, cord fibrosis, chronic pain and recurrence are major concern. Desarda tissue repair (non-mesh technique), which was given by an Indian surgeon, is now being used in many countries because of low cost of procedure with very low recurrence rates. The objective of this study was to evaluate the feasibility of Desarda tissue repair at a tertiary care centre of Central India as a treatment of primary inguinal hernia, by comparing it with Lichtenstein repair in terms of various post-operative parameters.Methods: Patients between age of 18 and 70 years with primary inguinal hernia were included in this randomised controlled trial. Patients with strangulated, obstructed or recurrent hernia, surgically unfit patients and patients having unmanaged urinary obstruction, cough or constipation were excluded. Randomization was done by sealed envelope method into Lichtenstein and Desarda arm and respective surgeries were performed.Results: 90 patients were included in the study and average duration of follow-up was 15.1 months. Operative time was significantly less in Desarda arm (14.75 min compared to 21.32 min in Lichtenstein arm). Cost, incidence of seroma formation, post-operative pain, foreign body sensation and chronic pain were also significantly less in Desarda arm. No recurrence was observed in both arms.Conclusions: Desarda repair is easy to perform and takes less time to perform and proves cost effective. Desarda repair is comparable to Lichtenstein repair in terms of many parameters and superior in terms of post-operative pain and foreign body sensation and can be preferred for young patients. In infected and strangulated cases, Desarda repair can be used effectively without fear of mesh infection.

Background/Purpose: To compare the changes in hepatic enzymes and comfort level of the surgeon in low-pressure pneumoperitoneum laparoscopic cholecystectomy (LPPLC, 7 mm Hg) with that of normal pressure pneumoperitoneum laparoscopic cholecystectomy (NPPLC, 14 mm Hg). Methods: Eighty-two patients were randomly divided into 2 groups (LPPLC and NPPLC). Serum levels of bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, alkaline phosphatase, and lactate dehydrogenase were measured before the operation, at the time of reversal from anesthesia, 24 hours after the operation, and on day 7. Serious adverse events, intra-operative complications, surgeon’s comfort level of dissection, operative time, conversion rates to an open procedure, or normal pressure pneumoperitoneum were recorded. Results: Of the 41 patients randomized for LPPLC, 8 patients were converted to NPPLC due to difficulty in dissection and 1 converted to open in each group. There was statistically significant fall in mean serum bilirubin level in both the groups in the immediate postoperative period (P<0.05). Statistically significant increase in its level was observed after 24 hours in the NPPLC group only (P<0.05). Levels of mean serum serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, and lactate dehydrogenase increased significantly (P<0.05) in immediate postoperative period and a further increase was observed after 24 hours (P<0.05) in the NPPLC group only. The comfort level of surgeon was found to be significantly better in the NPPLC group. Conclusions: LPPLC is a safe procedure, especially in the hands of an experienced surgeon with clinically insignificant systemic effects. But the comfort level of surgeon is better in normal pressure when compared with low pressure. In patients with deranged hepatic functions undergoing advanced laparoscopic procedures, it is advisable to start the surgery with low-pressure pneumoperitoneum. Pressure may be escalated further as per the surgeon’s comfort.

Background: Pain following Milligan Morgan hemorrhoidectomy is a significant cause of morbidity. The present study was carried out to find out if using metronidazole in the post-operative period of these patients results in less post-operative pain.Methods: This was a prospective randomized controlled trial which was conducted on 67 consecutive patients attending the Surgical OPD at SRN Hospital, Allahabad during the study period between August 2016 and July 2017 who underwent surgery for grade 2, grade 3 and grade 4 hemorrhoids. The patients were allocated to 3 groups-one group was the control group, the second group received oral metronidazole post-operatively for 7 days while the third group received only topical metronidazole for 7 days. All the three groups received 500 mg of metronidazole in 100 ml infusion pre-operatively. The post-operative analgesic usage was standardized for all the three groups. Appropriate tests of significance were applied to assess if the difference in the intensity of post-operative pain was significant in the immediate post-operative period and on days 1, 3 and 7 post-surgery.Results: Pain relief was significantly better in the groups using metronidazole at post-operative day 1, 3 and 7 and this was also borne in the lesser number of analgesics used by the patients of these groups.Conclusions: Use of oral or topical metronidazole in the post-operative period results in clinically significant pain relief. There is no additional benefit of one over the other and hence either can be used.

Background: Postoperative pain after open mesh repair of inguinal hernia is an important challenge. Such type of pain sometimes does not respond to medical treatment including non-steroidal anti-inflammatory drugs and opiates. The objective of the present study was to evaluate the effect of preservation or division of the Ilioinguinal nerve on pain and post-operative symptoms, after open mesh repair of inguinal hernia.Methods: All patients undergoing surgery for tension free Lichtenstein mesh repair over a period of 1 year were included. Patients below the age of 18 years and patients with bilateral or recurrent hernias were excluded.Results: In present study of 42 patients, early mean postoperative pain at day 1 was 1.8 on VAS scale in ilioinguinal neurectomised patient compared to 1.5 in nerve preserved group (P=0.1408). Postoperative pain at week 1 was 1.25 in neurectomised patients compared to 1.32 in nerve preserved group (P=0.7161). Late Postoperative pain and chronic groin pain was 0.6 and 0.25 at 1 and 3 months respectively in ilioinguinal neurectomised patients as compared to 1.05 and 0.77 at 1 and 3 months respectively in nerve preserved group (P=0.0184 at 1month and P=0.0335 at 3 months).Conclusions: The difference in postoperative pain at day 1 and at week 1 was not significant and both groups had equal pain. Late postoperative pain (at 1 month) and chronic groin pain (at 3 months) was significantly low in ilioinguinal neurectomised patient compared to nerve preserved group.

Background: Mastalgia is a common problem and 60-70% women encounter it at least once in their lifetime. Many drugs have been used and are been used with varying response, like Tamoxifen, Danazol, primrose oil, topical analgesics and recently Centchroman. The objective of the present study was to compare the three most commonly used drugs in the treatment of mastalgia, namely Centchroman, Tamoxifen and Danazol with a placebo.Methods: All consecutive female patients more than 25 years of age with history of mastalgia for more than 3 months were taken up for the study. Patients were distributed into four groups and administered Centchroman, danazol, tamoxifen and placebo, respectively.Results: In present study of 78 patients, the median visual analogue score (VAS) in Centchroman group were 3, 1 and 3 after treatment of 4, 12 and 24 weeks, respectively with a pre-treatment VAS of 8. Similarly, in the danazol group, VAS at 4, 12 and 24 weeks were 4, 1.5 and 5, respectively. In the Tamoxifen group it was 4, 1 and 3 after treatment for 4, 12 and 24 weeks. On comparison, Centchroman and Tamoxifen both had better pain relief than danazol at 24 weeks (p <0.001) while Centchroman and Tamoxifen had comparable results (p >0.05) despite Centchroman having a lower mean VAS score.Conclusions: Mild cyclical mastalgia can be treated with reassurance and lifestyle measures. Moderate to severe mastalgia usually require drug treatment. Centchroman, Danazol and Tamoxifen are effective. Centchroman appears to have better pain relief relative to the rest.

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The aim of study was to evaluate various types of stoma with regard to their indications, their complications and methods to reduce them, at a tertiary hospital of central India. Methods: The study was carried out in Department of surgery at M. L. N. Medical College, Allahabad from August 2013 to July 2014. Adult patients who were admitted here and had Ileostomy/colostomy formation/closure as a part of their treatment were included. Data was collected by meticulous history taking, clinical examination and investigations. Results: A total of 100 patients were included (Avg. 34 year) and male: female ratio was 1.6:1. The most common stoma constructed was ileostomy (82%) with loop ileostomy (62%) being the most common subtype. Among colostomies, loop was most common (50%). Main indication of stoma formation was intestinal perforation (63%). In individual causes, Typhoid Perforation (44%) was most common indication. 85% patients had stoma complications, most common being peristomal skin excoriation (80%). Study of closure of stoma was done in a total of 50 patients. Closure of 43 ileostomies and 7 colostomies was done. Mean length of postoperative stay was 11 days. 28% developed complication among which paralytic ileus, (16%) was most common. Conclusion: Despite extensive surgical experience, complications of intestinal stomas still occur frequently and result in high morbidity. Meticulous skin care with regular follow-up, early detection of complications with their timely management along with education and counseling can decrease morbidity.

Situs inversus totalis is a rare congenital disorder occurring in 1:5,000 to 1:20,000 of the births. It may be partial, where the transposition is confined to either the abdominal or the thoracic viscera, or complete, i.e. involving both cavities. Change in anatomical position of organs gives rise to abnormal location of signs and symptoms, thus posing a difficulty in diagnosing the ailment, and also demands greater surgical skill. While there is no evidence to suggest that gall stones are more or less common in people with situs inversus, the presentation with left upper quadrant pain may delay the diagnosis of symptomatic gall stones. The approach in the operating room requires modification. We are reporting a case with complete situs inversus who presented with features of chronic cholecystitis and underwent laparoscopic cholecystectomy.