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Background: A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening.Methods: All cases of clinically diagnosed fistulae-in-ano admitted in various surgical units in Index Medical College Hospital, Indore during the study period January 1, 2015 to December 31, 2017. A Preformed set of questionnaires will be prepared and tested and the same proforma will be used for the study of selected clinically diagnosed cases of Fistula-in-ano. Clinical history was obtained in all the patients. Clinical examination including per rectal and proctoscopic was done in required patients.Results: Total 44 cases of fistula in ano were selected randomly using closed envelope method and studied in detail the following results were obtained. In this present series, 56.81% of patients were in the age group of 31-60 years followed by 34.09% of patients were in the age group of 11-30 years. Only 9.09% of patients were in the age group above 60 years. About major clinical features were noted perianal discharge, pain, swelling and peri anal irritation were 75%, 65.91%, 43.18% and 11.36% respectively.Conclusions: Early diagnosis and appropriate management is the key to success. Fistula-in-ano forms a good majority of treatable benign lesions of rectum and anal canal. 90%or so of these cases are end results of cryptoglandular infections.

Background: Transverses abdominis plane (TAP) block is a new regional anaesthetic technique for postoperative analgesia in abdominal surgeries, as a part of multimodal analgesia. We evaluated effect of two different doses of clonidine as an adjunct in TAP block in patients underwent unilateral inguinal hernioplasty. Methods: Sixty adult patients undergoing unilateral inguinal hernioplasty were randomized into two groups, Group A (n=30) received bilateral TAP block with bupivacaine 0.25% 38cc + clonidine (1cc) 150 microgram +1cc NS=40cc, Group B (n=30) received bupivacaine 0.25% 38cc+clonidine (2cc) 300 microgram=40cc, at the end of surgery. The postoperative pain was evaluated by visual analog score (VAS) for pain scoring at 2, 4, 6, 12 and at 24 hours. Subjective assessment of duration of analgesia was done. Results: The VAS score in patients who received clonidine 300 microgram Group B as an adjunct was significantly lower than who received 150 microgram Group A. Duration of analgesia was longer in Group B. 2 patients in Group B showed bradycardia treated with atropine. Sedation score was lesser in Group A. Conclusions: Clonidine showed dose dependant analgesia and adverse effect in TAP block for postoperative analgesia. Higher doses of clonidine may be used as an adjunct in TAP block.

Background: Many people have complications after surgery; some transient, others serious, but all are important to patients. The likelihood of postoperative complications is influenced by the type of surgery, the patients pre-existing comorbid state and perioperative management. Anaesthesia result in a variety of metabolic and endocrine responses, but conventional wisdom maintains that anaesthetic technique has little long-term effect on patient outcomes. There is accumulating evidence that, on contrary, anaesthetic management may in fact exert a number of longer-term effects in postoperative outcome.Methods: A prospective study of early post-operative complication in 100 patients’, who underwent major surgery, was done in the Department of Surgery in a tertiary care teaching hospital, Indore. Therefore, the present study was carried out prospectively to study the incidence of postoperative complications in relation to age, sex and other factors which influence them and correlation of post-operative complications with the nature of anaesthesia, duration of operation, type of surgery and in surgery above diaphragm or below diaphragm.Results: The incidence of post-operative complications was more in patients operated with general anaesthesia (48.38% and 12.9% respectively) the morbidity and mortality in patients who were operated under spinal anaesthesia was lower than general anaesthesia, but morbidity was higher in patients who were operated under epidural anaesthesia, but mortality was lower than epidural.Conclusions: There is accumulating evidence that anaesthetic management may indeed exert a number of influences on longer term postoperative outcomes. Further prospective, randomized, large scale, human trials with long- term follow-up are required to clarify the association between anaesthesia technique and postoperative outcome.