Difficult mediastinal dissection during esophagectomy in middle esophageal cancer may lead to thoracic duct injury. Complete response to NACRT may reduce the risk of chylothorax. Early transabdominal en masse ligation carries excellent results. Low output fistula following thoracic duct injury can be managed conservatively.

Severe acute pancreatitis often leads to pancreatic and peripancreatic collections but, rarely, it can lead to collections at sites remote from the pancreas. Three male patients presented with abdominal pain and inguinoscrotal swelling. They were initially misdiagnosed with obstructed inguinal hernia, epididymo-orchitis and hydrocele, respectively. Later, their diagnosis of acute pancreatitis was revealed on laparotomy in one patient and on computed tomography (CT) in the remaining two patients. All these cases had extensive peripancreatic necrosis and paracolic collections tracking along the psoas muscle, downwards towards the pelvis. These collections were initially managed by percutaneous drainage and saline irrigation as a part of the ‘step-up’ approach. Two of these patients required open necrosectomy, while all required incision and drainage of inguinoscrotal collections. All the patients were discharged in satisfactory condition. Inguinoscrotal swelling is unusual as a first presentation of acute pancreatitis. A high index of suspicion, with careful study of patient's history and examination along with CT, may provide an accurate diagnosis. Local drainage may be required to control sepsis and also provide an egress route for intra-abdominal collections.

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Background And Objectives: Elective laparoscopic cholecystectomy has a low risk for infectious complications, but many surgeons still use prophylactic antibiotics. The aim of this study was to investigate the necessity and rationale for giving prophylactic antibiotics in early infective complications in low-risk laparoscopic cholecystectomy. Study Design: Low-risk patients were randomly placed into 2 groups: 70 patients (group A ) did not receive any prophylactic antibiotic and 70 patients (group B) received 1 g Ceftriaxone intravenously at the time of induction of anaesthesia. In both groups, incidence of infective complications were recorded and compared. Results: In group A, there were 3 cases of post operative fever and 1 case of wound infection, while there were no cases of pulmonary infections and urinary tract infection. In group B, there were 2 cases of post operative fever and 1 case of wound infection, while there were no case of pulmonary infections and urinary tract infection. No signicant difference existed in the incidence of complications between the groups. Prolonged duration of surgery and Bile or Stone spillage were statistically signicant risk factors in determining post operative infective complications. Conclusions: Use of prophylactic antibiotic does not affect the already low incidence of postoperative infective complications and surgical site infections. Hence, prophylactic antibiotic is not necessary in low-risk elective laparoscopic cholecystectomy

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Background: Laparoscopic hernia repair is technically difficult and has long learning curve than open repair. Moreover, with increased cost of procedure do patient really get benefited in terms of intraoperative time duration, post-operative pain and complications, length of hospital stays, and time taken to return to usual activity needs to be studied.Methods: In this prospective observational study of 100 patients including unilateral, bilateral, direct and indirect inguinal hernia and excluding obstructed and strangulated hernia, 61 patients underwent open repair and 39 patients underwent laparoscopic hernia repair. Pain analysis was done with visual analogue scale. Unpaired student T test and Chi square test used (p<0.05).Results: Baseline characteristics age, sex of the two groups were similar. Mean operative time in laparoscopic group was 105.38±35.13 minutes and in open group was 79.95±31.12 minutes (p<0.001). There was statistically significant difference in mean pain score of laproscopic verses open techniques (p<0.001). Urinary retention was the most common post-operative complication in both groups but was statistically not significant. Mean hospital stay in laparoscopic group was 1.56±0.50 days and in open group was 1.9±0.50 days (p-0.002). Mean time taken to return to usual activity in open repair was 41.10±27.15 days and in laparoscopic group was 16.23±6.37 days (p-0.001).Conclusions: This study showed that in laparoscopic repair of inguinal hernia patients have less post-operative pain, shorter hospital stays and early return to work. However, the laparoscopic technique had longer operative time duration.

Primary squamous cell carcinoma at ileostomy site is extremely rare and there are only eight reported cases prior to our report. The present case report describes a patient of ileostomy formation 12 years prior to evaluation after total colectomy who now presented with mass at stomal and parastomal site and underwent biopsy and Positron emission tomography (PET) scan. Tumor was suspected and hence wide local excision with en bloc resection of the ileostomy and ileo-rectal anastomosis was done and histopathology showed differentiated Squamous cell carcinoma (SCC), Grade 1. This case underlines the need of regular follow-up of patients with stomas to allow the timely detection of stomal problems and the early diagnosis and management of the rare complication of parastomal squamous-cell carcinoma. Also, persistent peristomal ulcerations and proliferative lesions must undergo biopsies to rule out malignancy. Wide local excision of the carcinoma with en bloc resection of ileostomy and formation of new ileostomy at a different site is usually done to manage such cases.