BACKGROUND Laparoscopic surgery is unsafe and technically impossible in case a gall-bladder disease has changed the usual anatomic landmarks. Though, open cholecystectomy has fewer incidents of biliary leakage, the risk cannot be avoided. However, it seems that with adoption of preventive measures and requisite skills, the biliary leakage rate has been controlled in laparoscopic surgery. The study aimed to compare the frequency and cause of biliary leak between laparoscopic (LC) and open cholecystectomy (OC).

BACKGROUND Hernia repair is one of the common general surgical operations. Open mesh repair method (Lichtenstein's repair) is known as "Gold Standard" for inguinal hernia. Slowly another technique Total Extra-Peritoneal (TEP) repair emerged. TEP repair is considered to be an "advanced" laparoscopic procedure and still not available widely. MATERIALS AND METHODS Our study compared outcomes of laparoscopic inguinal hernia repair with open mesh hernia repair. Total of 75 patients in each group included in study. RESULTS The mean age of patients presenting with hernia was 36.96 years and 37.08 years, while mean weight was 58.4 kg and 61.56 kg for laparoscopic and open group respectively with age ranged from 21 to 55 years. Mean operative time was 90 minutes (Unilateral), 117 minutes (Bilateral) and 70 minutes for laparoscopic and open mesh hernioplasty respectively. Analgesic dose required for laparoscopic group and open group was 3.58 and 3.16 respectively. The cost of surgery in laparoscopic group was 11000-14000 Rs. (Mean-12,000 Rs.), while in open group was 6000-8500 Rs. (Mean-7000 Rs.). CONCLUSION Although laparoscopic totally extraperitoneal hernia repair has many advantages over open mesh repair, but when it comes to availability of the technical expertise, operative time, cost of surgery, open hernioplasty seems better.

BACKGROUNDHydatid disease of the spleen should be kept as the differential diagnosis of all cystic masses in the spleen/abdomen. The anatomical relations of splenic hydatid cyst should be demonstrated before surgery because of varied presentations. Although the management must be individualised for each patient, a surgical resection is the best curative procedure. Postsurgical pharmacological treatment is necessary to ensure complete healing. Although hydatid disease affects any organ or soft tissue, it is most frequently found in liver (60-70%), lungs (30%), and rarely encountered in the kidney, spleen, bone, thyroid, breast and pancreas. Splenic hydatid disease is very rare with its occurrence less than 3% of the total incidence of Echinococcosis even in endemic areas. Berlot first described splenic hydatid cyst as an autopsy finding in 1790. (1) Primary infestation of the spleen usually takes place by the arterial route after the parasite has passed the two filters (hepatic and pulmonary). KEYWORDS Case ReportA 50-year-old female patient, housewife by occupation, presented to our general surgery clinic with a mass in the left upper abdomen since 10 years. There was left hypochondriac dull aching pain which did not shift or radiate. Lump as stated by the patient was progressive in nature, with history of decreased appetite and fullness of stomach. She had no history of jaundice, cough or respiratory distress, abdominal trauma, weight loss and her past medical history was unremarkable. Physical examination showed an asymmetric abdomen and a growing lump with smooth surface in left hypochondrium with palpable splenomegaly. Abdominal CT scan shows large homogenous cystic lesion in spleen with many septae, originating from the spleen. The cyst in the spleen appeared to fill the left quadrant of the abdominal cavity, most likely suggestive of hydatid cyst. There were no cysts in other Financial or Other, Competing Interest: None. Submission 20-10-2016, Peer Review 11-11-2016, Acceptance 19-11-2016, Published 24-11-2016. Corresponding Author: Dr. Saleem Tahir, Associate Professor, Department of Surgery, Era's Lucknow Medical College and Hospital, Lucknow-226003, Uttar Pradesh, India. E-mail: dr_tahir75@yahoo.com DOI: 10.14260/jemds/2016/1576 abdominal viscera. A radical splenic resection was done via left subcostal incision with removal of the hydatid cyst and section was sent for histopathology examination which came out to be a hydatid cyst. Specimen-Splenic HydatidCT Image

BACKGROUND With growing awareness and increasing literacy, people have now become more conscious about problems related to breast. The commonest mode of presentation of diseases of the breast is "lump" or a "palpable mass". It may not necessarily be a malignant lesion, instead palpable breast masses are common and are usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy. The present study was planned with an aim to evaluate the efficacy of HR-USG, Mammography and FNAC, either individually or in combination for the diagnosis of palpable breast lumps. MATERIALS AND METHODS The descriptive study was carried out at Department of Surgery, Era's Lucknow Medical College, Lucknow. Duration of study was 18 months starting from January 2017 to June 2018. A total of 65 patients were enrolled in the study who underwent HR-USG, FNAC, Mammography and Histopathological examination. RESULTS In present study, majority of cases were histopathologically confirmed as benign (69.2%). Among benign cases, maximum (n=37; 56.9%) were diagnosed as fibroadenoma, 4 (6.2%) were diagnosed as simple benign lesion and 3 (4.6%) were diagnosed as chronic inflammatory lesion. There were 21 (30.8%) malignant cases, for malignancy, FNAC had a sensitivity and specificity of 90% and 100% as compared to 76.2% and 100% for mammography and 71.4% and 97.7% for USG. CONCLUSION The findings of the present study suggest that among three diagnostic modalities being evaluated, FNAC was the best, but one of the limitations of FNAC was inconclusive findings in few cases. However, complementary use of USG for these cases which were inconclusive on FNAC helped to achieve the best diagnostic combination for evaluation of palpable lump.

BACKGROUND Inguinal hernias constitute an important public health problem and often pose a surgical dilemma even for the most skilled surgeon. 1 They are the most common form of abdominal wall hernias. The present prospective study was proposed to compare inguinal hernia repair by Lichtenstein method Vs. Open pre-peritoneal mesh repair regarding drawbacks such as complications, early recurrence and benefits like lower severity of pain and time of hospital stay/surgery. MATERIALS AND METHODS The present study was a prospective randomised study in the Department of General Surgery at Era's Lucknow Medical College and Hospital from October, 2013. All the patients were followed up for 6 months. Out of 100 patients, 50 underwent Lichtenstein procedure and other 50 underwent open pre-peritoneal mesh repair. RESULTS Mean duration of surgery was 51.60±7.03 min. in Group I and 71.50±8.03 in Group II, thus showing a significant difference between two groups (p<0.001). Mean duration of hospital stay was 6.72±0.83 days in Group I and 5.52±1.04 days in Group II. CONCLUSION The findings of present study suggested that post-operative complications, pain and recurrence rates were lower in pre-peritoneal repair group as compared to Lichtenstein repair group, hence open pre-peritoneal hernia repair is recommended as a surgical procedure of choice.