Laparoscopic inguinal hernia repair has become popular as an alternative to open surgery. The classical TEP technique is the laparoscopic technique of hernia repair which is considered closest to ideal for inguinal hernia repair, but this technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. Extendedview modification, the eTEP technique, which overcomes several of these drawbacks. The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures , ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication. The purpose of this study was to evaluate the safety and effectiveness of eTEP procedure with placement of polypropylene mesh and fixation by tackers. Method : It was a observational study of 25 cases. The study was conducted in Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2018 to June 2019. Sociodemographic status, operation time, peroperative blood loss, unwanted events like peritoneal tear, vessel injury, nerve injury, duration of hospital stay, postoperative pain and urinary retention were recorded. All the patients were followed up for at least 3 times at the end of 1st week, 1st month and 3rd month. Any surgical site infection, mesh infection, seroma, scrotal swelling, severity of pain according to visual analogue scale, haematoma and recurrence within this time was recorded. All the data were analyzed on SPSS. Result : Among the 25 patients average time of operation was 1 hour and 35 minutes, peroperative blood loss was below 20 ml in all patients, peritoneal tear occurred in 2 patients, 1 vessel injury but no nerve injury was observed during the procedure. One patient had mild chronic pain even after the end of 3rd month. One patient developed scrotal swelling which subsided by the end of 1st week. No SSI, mesh infection, seroma, wound hematoma, and recurrence found within this period. Conclusion : This study showed that, eTEP procedure is cost effective, has minimum complication with easier learning. In the hands of an experienced surgeon, eTEP repair can be safe and effective. New study can be done to find out it’s effectiveness in incisional hernia in lower abdomen and bilateral inguinal hernia. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 96-100

Introduction: Intussusception is very common in childhood between the ages of 5 months to 1 year. In adults it is a rarity, in whom it commonly presents with a nonspecific, repeated, chronic or subacute intestinal obstruction. Ninety percent of them have a variable number of secondary pathological ‘lead point’- from benign lesion to malignant.5 Objective: This study aims to find out the variations & the commonest ‘Lead points’ in rare adult intussusceptions. Methodology: Study period was from January 2015 to June 2019. All patients of adult intussusceptions, admitted in Shaheed Suhrawardy Medical college Hospital, were examined, investigated, & analysed peri-operative findings with post-operative histopathological results, in this prospective observational study. Result: In this study, among 15 patients, GIST found to be the commonest (46%) Lead point in adult intussusceptions. Others include Adenocarcinoma, Leiomyomatous polyp, Meckel’s Diverticulum, intestinal TB, etc. Male was mostly sufferer (67%). Ileoileal (II) variety was found more in male & Ileocecal (IC) variety in female. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 138-141

Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano. Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16. Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases. Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19

To be true, the name of this specific pathological lesion is not widely encountered in our dayto- day surgical practice, but still, pilomatricoma or pilomatrixoma is notifiable skin neoplasm for which diagnosis can be made histopathological and only after an adequate excision. This case report is of a 23-year-old young female medical student who presented with swelling in neck, that histopathologically diagnosed as pilomatricoma. The purpose of reporting this specific case is that this pathology is rare in occurrence, but more rarely diagnosed because of lack of confirmatory pathological analysis and it is immensely essential to be kept in the differentials of all superficial skin tumors in surgical practice. J Shaheed Suhrawardy Med Coll 2021; 13(1): 86-88

Idiopathic Sclerosing Encapsulating Peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. We report one such rare case, outlining the fact that an intra-operative surprise diagnosis could have been facilitated by previous investigations. Journal of Surgical Sciences (2015) Vol. 19 (2) : 75-79

Introduction: Male breast malignancy is a relatively rare condition among all the malignancies. It accounts for 0.2% of all malignant cases & less than 1% of all breast cancer. Methods and Materials: A retrospective observational study was done among the male patients with breast malignancy, admitted in Surgery ward in Shaheed Suhrawardy Medical College Hospital, Bangladesh from January 2014 to December, 2018. Results: Our series includes 09 patients. The mean age of the patient was 60 years. Most of the patients complaint breast lump with some degrees of skin colour changes. One has previous history of breast surgery (lumpectomy). Eight (8) patients went under simple mastectomy with axillary clearance after tissue diagnosis. One (1) patient got neo- adjuvant chemotherapy followed by surgery. Specimen was sent for histopathological & receptor study. Among them Infiltrating was ductal carcinoma was found in 07 cases, Sarcoma was in 01 (one) case & papillary carcinoma in 01 (one) case with 66.6 % positive oestrogen and progesterone receptor activity. Conclusion: Surgeons should be kept in mind that male breast malignancy is not uncommon and all male breast lumps should be evaluated properly before surgery. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 48-51

Periampullary neoplasms are a heterogeneous group of tumors arising within 2 cm of the ampulla of Vater. Neuroendocrine tumors can originate throughout the entire body from neuroendocrine cells. These neoplasms exhibit deep differences, according to their origin and biological behavior. The synchronous presence of a primary tumor in patients affected by a neuroendocrine tumor is reported in the literature; incidence is variable and the most common site is the gastrointestinal tract. Here we report a case of 68 years old female presented with jaundice, anorexia and weight loss. She was mildly anaemic. Gall bladder was palpable. There was no organomegaly. Her CT scan and MRCP revealed a growth in periampullary region. So she underwent Whipple’s procedure. Histopathological report showed synchronous presence of periampullary carcinoma and a carcinoid tumor in stomach. As the carcinoid tumor was nonfunctioning and very small in size, it was not identified in pre-operative work up. J Shaheed Suhrawardy Med Coll 2021; 13(2): 183-186

Background: Write the background in 1 to 2 sentences]. Objective: The purpose of the present study was to estimate the efficacy of resistive index (RI) of color Doppler ultrasonography in different space occupying liver lesions. Methodology: This cross sectional study was conducted at in Bangabandhu Sheik Mujib Medical University (BSMMU), Dhaka from July 2010 to December 2012. All the patients presented with the suspicion of hepatic space occupying lesions were enrolled for this study who were later diagnosed clinically or ultrasonographically. This patients were also examined by color Doppler flow imaging. All patients were examined by gray scale Ultrasonography, color Doppler and FNAC. To visualize the blood flow, standard color Doppler sonography is used for each lesion. Within the lesions, pulsed Doppler samples are assessed whenever possible on the basis of pulsatile flow. At least three measurements of resistive index (RI) of intra tumoral and peritumoral arterial blood flow would be the last mean value. Results: The detection rate of arterial flow in primary malignant tumors was 94.4% and 87.7% in hepatic metastasis. Doppler spectrum analysis showed the resistance index in primary malignant tumor was 0.75±0.12, 0.73±0.09 in metastatic tumor and was below 0.6 in benign lesions. The difference was significant (p<0.001). This difference was related with its histopathologic structure. The arterial flow with RI >0.6 in CDFI within the liver lesion can be regarded as a criterion of malignant tumors, RI <0.6 can be regarded as benign lesions. Conclusion: RI is more helpful in differential diagnosis of benign and malignant lever lesions. [J Shaheed Suhrawardy Med Coll, 2014;6 . Primary liver lesion differs from the vascularity of the hepatic secondaries, and able to discriminate these two without need of surgical intervention. Therefore, colour Doppler ultrasonography is a good option for the radiological diagnosis of Hepatocellelar Carcirome (HCC) hepatic secondaries and also to differentiate benign and malignant lesions. The purpose of the present study was to estimate the efficacy of resistive index (RI) of color Doppler ultrasonography in different space occupying lesions of liver.