ABSTRACT:Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. 'Tension-free repair' is the procedure of choice. [1] due to its low recurrence rate, these tension-free repair procedures can be roughly categorized into two groups: laparoscopic and open anterior approach. TEP is accepted as the most ideal method because it can avoid entry into the peritoneal cavity, which can cause intraperitoneal complication such as bowel injury or obstruction. [2] Among open tension-free methods are Lichtenstein's operation or Prolene hernia system. In this article, we examine the advantages and disadvantages of two extra peritoneal inguinal hernia repair methods, which are open lichenstein's hernioplasty and Laparoscopic Total Extra Peritoneal approaches of inguinal hernia repair. AIMS AND OBJECTIVES: The aim of this study was to compare the effectiveness and safety of laparoscopic and conventional open hernioplasty repair in the treatment of inguinal hernia and their results were studied in terms of operation time, patient comfort, hospital stay, return to normal activity and postoperative complications. METHODS: This study was done in a post-graduate teaching hospital where 50 cases were included. Of which 25 cases were operated by laparoscopic method and other 25 cases by conventional open hernioplasty. Outcome were compared in demographics and perioperative details with postoperative data. CONCLUSION: Since evidence in the literature does not point to either the laparoscopic or open approaches the clear superior procedure, surgeon preference and circumstantial influences will probably continue to dictate the approach employed in inguinal hernia repair. For primary inguinal hernias in general, the open hernioplasty is superior to the laparoscopic technique, both in terms of recurrence rates and in terms of safety whereas in bilateral inguinal hernia, recurrent inguinal hernia and sliding hernia, laparoscopic approach can be recommended.

Acute appendicitis, though one of the commonest emergencies in surgical practice. Failure of an early diagnosis could lead to the increased risk in its morbidity and mortality. However a negative appendectomy rate of about 25% is described in the surgical literature. This study was performed to evaluate the usefulness of commonly used laboratory tests like leucocyte count, Creactive protein and use of diagnostic scores like Alvorado score along with radiological imaging modalities to diagnose acute appendicitis and decrease negative appendectomies rates. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis. METHODS: This study was done in Shadan Teaching Hospital with 200 patients of acute right iliac fossa pain including both genders and all ages. Out of 200 patients, 40 patients were managed conservatively and 160 patients were operated. Clinical evaluation done using Alvorado scores and radiological imaging like ultrasound and plain X-ray of abdomen before operation. Subsequently, histopathological findings of appendix specimen were compared with preoperative tools and results were noted. STATISTICAL ANALYSIS: The data were entered and analyzed using Statistical Package for Social Science (SPSS) version 14.0. The p value was taken as significant when less than 0.05. RESULTS: In proven acute appendicitis, both WBC count & serum CRP levels were raised. WBC count showed 80% sensitivity & 67% specificity in diagnosis. Alvorado score proved helpful to diagnose complicated appendicitis with significant high scores. Ultrasonography of Abdomen had accuracy of only 58.2% in diagnosis. CONCLUSIONS: Alvorado scoring method proved helpful in decision making for operative intervention in acute appendicitis.

BACKGROUNDFissure in ano is a common painful anorectal condition with high recurrence rates. It is commonly seen due to sedentary lifestyle, which involves prolonged sitting posture, mental stress, low fiber diet and lack of physical activity which causes chronic constipation. Irrespective to whichever modality of existing therapies that are used, the recurrences are common. The traditional surgical option like lateral internal sphincterotomy, which has been into practice since long time carries risk of incontinence. It is a need of an hour to rely on a treatment modality which should be simple, safe, effective and reversible with no permanent sequelae. In this study chemical sphincterotomy using injection, Botulinum toxin gives an alternative modality and proved to be the most safe and reliable non-operative option for treating both acute and chronic fissure in ano.

BACKGROUND:Acute abdominal pain is a common presentation that requires immediate management. It includes traumatic and non-traumatic conditions of abdomen and if not diagnosed and treated promptly in the golden hours, it can lead to high mortality rate. Hence, this study was undertaken to correlate different modes of diagnosis which helps in deciding the immediate line of management proved to be lifesaving. OBJECTIVES: To analyse and compare the efficacy of clinical and radiological methods in early diagnosis of acute abdominal conditions. MATERIALS AND METHODS:This study includes patients admitted in emergency wards of Shadan General and Teaching Hospital, Hyderabad. Total 100 cases were included in this study who presented with acute abdomen. After thorough clinical examination they were subjected to Plain Xray Abdomen and Ultrasonography of abdomen and pelvis. RESULTS: All 100 patients were thoroughly evaluated clinically and subjected to Plain X-ray abdomen with Ultrasonography of abdomen. Acute Abdomen was most common in age group between 20-40 years with male predominance. Acute appendicitis was the most common cause of surgical condition, followed by Peritonitis and then Intestinal Obstruction. The diagnostic accuracy rates in male and female patients were 93% and 80% respectively. Ultrasonography had highest sensitivity rate (97.8%) and plain Xray abdomen had highest specificity rate (88.4%). CONCLUSION: Each of these diagnosing methods in acute abdomen are complementary to each other. With efficient clinical acumen and using ultrasonography and X-ray abdomen as basic diagnostic investigations, one can do early diagnosis with 97% to 99% accuracy and thus can avoid unnecessary operations.