Objective: The effectiveness of teaching operative notes in surgical resident training program at King Abdulaziz University Hospital, Jeddah was studied. Materials and Methods: This was a prospective study done at Department of Surgery, King Abdulaziz University Hospital to evaluate the effect of teaching the surgical residents how to write operative notes. Twenty-one residents were asked to write operative notes of appendicectomy. Their operative notes were evaluated for medical record number (MRN), date and time of the operation, preoperative and postoperative diagnosis, names of surgeon, assistant, and anesthetist, name of the operation, incision, findings, closure, hemostasis, estimated blood loss, whether histopathology specimen was sent to the pathology department or not, postoperative orders, whether the patient went to the recovery room in a satisfactory condition or not, and signature of the operating surgeon. Two months of effective teaching of operative notes was given to them. They were again asked to write operative notes of appendicectomy. Notes were collected and studied and comparison was made with previous notes. Legibility of the operative notes was also studied. Results: In our study, we found that there was improvement of 29-39.9% in recording MRN and the date of operation by our residents after they were taught the art of writing operation notes. There was marginal improvement (4.7%) in stating whether it was elective or emergency operation. Documentation of surgeon's name, assistant's name, and anesthetist's name improved to 12.4-32.8%. Writing the name of the procedure and pre- and postoperative diagnosis improved to 31%. Details of the procedure such as position of patient and incision improved marginally to 5.9%. Mentioning the findings and description of the procedure showed no improvement, as it was 100% before teaching. Documenting hemostasis, estimated blood loss, and transfer to recovery room improved to 58.4%; however, there was no improvement in writing post-op orders and histopathology sent to the pathology department.Improvement of signature was only 9%. Conclusion: Effective teaching of how to write operative notes helps in the training of surgical residents.

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Objective: The aim was to study the prophylactic effect of tamsulosin on postoperative urinary retention in benign anorectal surgeries. Background: Acute urinary retention (AUR) after anorectal surgeries is essentially a type of postoperative urinary retention (POUR). It is the most common complication of the procedure. Use of tamsulosin, a super selective alpha 1a adrenergic blocker has been found to reduce the risk of POUR. Patients and Methods: Patients who underwent anorectal surgeries for benign anorectal conditions were included in this study. Patients were randomly assigned into two groups. In one, group (cases), patients were given 0.4 mg of oral tamsulosin only 6 h preoperative and 6-8 h postoperatively. Inability/difficulty to pass urine, which necessitated catheterization after following patient for 24 h was labeled as POUR. Results: A total of 626 patients who underwent surgery for benign anorectal condition were included in the study and grouped into two groups with 313 patients in each group, control and case group. In the control group, 56 patients (17.9%) had inability to pass urine and required catheterization and in the case group, only eight patients (2.5%) needed catheterization following POUR. The difference in the requirement of catheterization following POUR was statistically significant (P = 0.04). Hemorrhoidectomy was the most common anorectal surgery associated with POUR. Conclusion: The use of tamsulosin in preoperative and postoperative period has been found effective to reduce the incidence of POUR following surgeries for benign anorectal pathologies.

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Background: Most major hepatocellular carcinoma (HCC) staging systems recommend hepatic resection only for patients with early-stage of HCC. Still there is controversial about resection of patients with large HCC (defined as >5 cm). The aim of this retrospective study is to investigate the clinicopathological features that impacted the long-term outcomes of 1 year after hepatectomy of large HCC >5 cm in cirrhotic patients. Materials and Methods: From February 2012 to December 2015, a total of 92 patients with resection of large HCC on liver cirrhosis were reviewed retrospectively and considered for clinicopathological features that impacted the long-term outcomes. Time to recurrence (recurrence-free survival) and overall survival (OS) were determined by Kaplan-Meier analysis. Results: Twenty-nine (31.5%) patients developed tumor recurrence. The mean time until tumor recurrence was 12.4 ± 6.6 months. The cumulative 1-, 2-, and 3-year disease-free survival rates were 73%, 28%, and 18%, respectively. On multivariate analysis, male gender, α-fetoprotein >400, bilobed tumors, patients with portal hypertension, plasma transfusion, and absence of tumor capsule remained independent predictors for recurrence of HCC. The OS rates at 1, 2, and 3 years were 73%, 31%, and 16%, respectively. On multivariate analysis, α-fetoprotein >400 and plasma transfusion remained independent predictors for death. Conclusions: Liver resection is suggested in patients with large HCC and can be performed with acceptable overall and disease-free survival and morbidity rates. Identification of risk factors and close postresection follow-up with early detection are mandatory measures for prompt treatment of tumor recurrence which is reflected by a beneficial survival rate for this group of patients.

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Context and Aims: Pneumatic reduction has a higher success rate and lower incidence of complications compared to barium enema and hydrostatic reductions. What is deterrent to its common use is the cumbersome technique. Our technique is simple that can be used in any hospital with locally available facilities. Settings and Design: This was a prospective study. Subjects and Methods: A total of 25 children were enrolled in the study between September 2015 and June 2016 at our institute. Patients were given air enema under US guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 min each were allowed. Statistical Analysis Used: We just used simple statistic to calculate average. Results: There were 17 males and 8 females. The average age of the patients was 8.5 months. Twenty-two (88%) of the cases were reduced successfully while 3 (12%) failed to reduce. A majority of those that did not reduced had symptoms for at least 4 days. No bowel perforation occurred in our study. All cases of the intussusception have length <5 cm were reduced with pneumatic reduction in our study. Conclusions: The technique described is easy to assemble, safe, and effective. We recommend it for regular use in pneumatic reduction of intussusception, especially in the center have limited resources.

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Glomus tumors (GT) are cutaneous and soft tissue mesenchymal neoplasms. The malignant variant that is, glomangiosarcomas (GS) are rare and account for <1% of all GT. GS are usually seen in adults with a wide age range of 20-89 years. GS usually have an indolent course with local aggressiveness. The treatment is complete surgical excision with excellent prognosis though metastasis workup is advised. Herein, we report an unusually large GS de novo in a 6-year-old girl. Complete surgical excision was performed. There was no evidence of recurrence or metastasis over the last 15 months of follow-up postoperatively. GS should be considered as one of the differential diagnosis of cutaneous and soft tissue neoplasms.

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Gastric volvulus, wandering spleen and eventration of diaphragm share a common pathologic cause of absence or laxity of intraperitoneal ligaments. We hereby present a rare case of a 15-year-old male child with cerebral palsy presenting with organo-axial type of acute gastric volvulus resulting in gangrene of whole of stomach, associated with an infarcted wandering spleen, eventration of the diaphragm and cholelithiasis.

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Cecal volvulus as an uncommon cause of acute intestinal obstruction is due to axial twist of the cecum and terminal ileum around their mesentery. Cecal volvulus is a surgical emergency requiring urgent laparotomy. Resection and anastomosis is the proposed choice of the operation depending on the general condition of the patient. In addition, to its rarity, lack of familiarity causes diagnostic doubt and consequently delays in treatment. In this paper, we report a case of cecal volvulus seen in a 31-year-old Saudi male presented with vomiting, abdominal pain, and distension.

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Objective: The aim was to determine the role of laparoscopy in the management of nonspecific abdominal pain (NSAP). Background: NSAP constitutes a good proportion of surgical admissions, both in emergency and elective settings with considerable diagnostic dilemma. Patients and Methods: All patients who presented with pain abdomen with no immediate cause and were labeled as NSAP after clinical assessment and investigations and following that underwent laparoscopy to make a definitive diagnosis were included in the study. Results: A total of 88 patients were included in the study. There were 59 (67%) females and 29 (33%) males. The mean age was 26 years (range 18-58 year). The common mode of admission was out-patient department 69 (78.4%) patients. Twenty-five (28.4%) patients presented with NSAP in lower abdomen, followed by 21 (23.8%) with right lower abdominal pain and 19 (21.5%) with central pain radiating to right lower abdomen. Diagnosis was established in 75 (85.2%) patients. In 13 (14.7%) no pathology was found. The most common diagnosis was pathology of appendix in 29 (32.9%) patients followed by pelvic pathology in 18 (20.4%) and abdominal tuberculosis in 14 (15.9%) patients. Most 37 (42%) of the patients stayed in the hospital for 24 h. There was no readmission and no major postoperative complications. Conclusions: Laparoscopy has a definitive role in diagnostic dilemma associated with NSAP. It has at the same time role in treatment of the condition; hence laparoscopy has a diagnostic and a therapeutic implication in management of NSAP.

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Introduction: The established success of damage control surgery (DCS) in trauma of torso motivates surgeon to apply similar concept in managing complicated intra-abdominal sepsis. The main objective of this study is to audit our new practice of such in nontrauma emergency abdominal surgery. Materials and Methods: We retrospectively reviewed all emergency abdominal surgeries (nontrauma) done from February 2013 to February 2014. All patients who had damage control procedures done for complicated intra-abdominal sepsis were analyzed. Results: A total of 60 patients were operated within that period. Six patients (10%) had undergone DCS with or without laparostomy. All were male with mean age of 48.5-year-old (26-61-years-old). Most were in ASA 3 (83%, 5 patients) with only one in ASA 4. Primary indications were ischemic bowel with mesenteric vein thrombosis (3 patients, 50%), abdominal compartment syndrome (ACS), bleeding post near total splenectomy for splenic abscess and gangrenous proctitis with purulent peritonitis. Nearly, all patients (5 patients, 83.3%) were severely acidotic with pH <7.2 intra-operatively, which triggered the DCS. Nevertheless, only 3 patients (50%) benefited from laparostomy and all of them achieved complete fascial closure within 2.6 days (mean). Their mean total Intensive Care Unit (ICU) stay was 15 days (9-32 days). Overall predicted mean Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity mortality rate was 51%. However, the observed (actual) mortality rate was only 33% (2 patients). Conclusion: The result of the practice of DCS in the septic abdomen is very encouraging. It appears able to reduce the mortality by 35%. A comparative analysis with larger series is therefore warranted to further confirm the findings.

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H-type rectourethral fistula in males is a rare congenital anorectal malformation. It is associated with anal stenosis at normal site which generally delays diagnosis. We describe a case of a 6-month-old male child who presented with intermittent passage of fecal matter in urine along with ribbon-shaped stools through anal orifice, on straining. Investigations revealed an H-shaped rectourethral fistula with anal stenosis. Minimal sagittal anorectoplasty with fistula ligation was done.

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Background: Despite the increasing incidence of colorectal cancer in Nigeria, there is no established colorectal screening program in Nigeria and only a few studies have been done on the pathologic features of colonoscopic biopsies in Nigeria. Materials and Methods: The lower gastrointestinal tract biopsy specimens were assessed in the histopathology surgical day books. The demographic information on the age and sex and the clinical information, presenting complaints and endoscopic findings were obtained from the original request cards. All of the archival slides were retrieved and reviewed with the diagnosis confirmed. Also, all available formalin fixed and paraffin embedded tissue blocks of lower gastrointestinal colonoscopic biopsies were sectioned at 3-5μm and stained with haematoxylin and eosin. Each lesion was diagnosed based on specific pathologic findings, clinical history and endoscopic findings as a guide. Neoplastic lesions were classified using the World Health Organization classification (2010]. Study Design: The study aims to describe the common lesions diagnosed on lower gastrointestinal (GI) endoscopy. The clinical history, endoscopic findings, slides, and paraffin-embedded blocks of all endoscopic biopsies of the lower GI tract seen from 2008 to 2012 were studied, and data obtained were analyzed using the SPSS version 16 software. Results: Two hundred and forty-nine specimens were studied. Fifty-seven (22.9%) of these biopsies were normal colonic mucosa and 192 (77.1%) of these biopsies had remarkable pathologies. The most common clinical indication for colonoscopy in this study was hematochezia and over half of these patients (48.6%) had malignant lesions. The most common lesions seen on endoscopy were polyps which were seen in 18.5% of cases. Seventy (36.5%) of these lesions were malignant, with epithelial cancers 67 (95.7%) being the vast majority. Thirty-five (18.2%) of the lesions were benign neoplastic lesions, 52 (27.1%) were inflammatory lesions, 18 (9.4%) were inflammatory bowel disease, 10 (5.2%) were hyperplastic polyps, and 7 (3.6%) were vascular lesions. Conclusion: A wide spectrum of lesions was diagnosed in this study with the predominant lesion diagnosed being malignant neoplastic lesions. The most common clinical indication for endoscopy was hematochezia with over half of these patients having a malignant lesion.

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Objective: The aim of this study is to describe the computed tomography (CT) features of primary and secondary omental infarction. Materials and Methods: Five cases of primary and seven cases of secondary omental infarction are described with emphasis on CT features. The etiology and clinical features are described with the ultimate clinical outcome. Results: In this case series of 12 patients, five omental infarcts (42%) were classified as primary. Seven cases (58%) were postoperative with four infarcts following cesarean section, one following a total abdominal hysterectomy, one occurring after a laparoscopic ovarian cystectomy, and one occurring after laparoscopic hemicolectomy. Of the seven secondary omental infarctions, one was associated with secondary thickening of the transverse colon and one patient developed an abscess. Three patients from the secondary group and one patient from the primary group underwent omentectomy. Primary infarcts showed an ill-defined fat attenuation lesion with thin stranding located in the right upper quadrant in three and left lower quadrant in two patients. The postoperative omental infarcts showed more pronounced inflammatory change and soft tissue attenuation foci interspersed with fat density foci. They were located in the right lower quadrant in four patients, in the right upper quadrant in two patients, and in the left lower quadrant in one patient. The patients were followed to clinical resolution. Conclusion: It is possible to distinguish primary and secondary omental infarcts on the basis of CT features. Even though, a nonsurgical cause of acute abdomen, surgical management may become necessary in patients with secondary omental infarction and secondary infection who fail to respond to antibiotics and percutaneous drainage. The majority of the secondary cases followed cesarean section in our series.

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Introduction: Perforation is defined as an abnormal opening in a hollow organ or viscus. Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. The present study was conducted to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality encountered at SMS Medical College and Hospital, Jaipur, India. Materials and Methods: The study was a hospital-based prospective observational study conducted from April 2012 to October 2013 in the Department of General Surgery. During the study period, a total of 442 patients underwent surgery for secondary peritonitis. The patients included in the study were patients (>12 years) presenting with gastrointestinal perforation and undergoing emergency laparotomy. Results: Out of 442 patients, 91.2% (403) were males, with male-to-female ratio being 10.33:1. The mean age was 39.13 years. About 79.2% of the patients were below 50 years. Free gas under diaphragm on chest X-ray was noted in 86.2% cases. Duodenum was the most common site of perforation in 158 patients. The most common etiology for perforation was acid peptic disease (41.4%). Simple closure was the most common surgical procedure being performed in 63.8%. Overall morbidity and mortality recorded in this study were 42.8% and 14.7%, respectively. Conclusion: Early diagnosis, resuscitation with fluids, and timely surgical intervention are the most important factors deciding the fate of the patient with perforation peritonitis.

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Background and Objective: Surgical residents are at high risk of sustaining sharp injuries. Our aim is to identify predisposing factors of sustaining sharp injuries in operating rooms among surgical residents and their attitudes and behaviors in dealing with sharp injuries. Methods: In this cross-sectional study, a random sampling technique was adopted to recruit a representative sample of surgical residents who were involved in operative procedures in King Abdulaziz University Hospital. Data were collected between September and December 2016 by completing a self-administered questionnaire on attitude toward the most recent sharp injuries, predisposing factors for sharp injuries, and practice of universal precautions during the surgical procedures. Results: Among the 78 recruited residents, 46 (58.9%) had sharp injuries during surgical procedures. Most of the injuries (60%) were self-induced, and (72.9%) of the injuries took place while suturing. Twenty (43.5%) of those who had injuries did not report any injury, 15 (32.6%) reported some, and 11 (23.9%) claim that they reported all their sharp injuries. 44.9% of the participants are fully aware of sharp injuries local policy and procedures in the hospital. Most of the injured participants during surgeries did not follow each step of the local sharp injury policy. The perceived causes of sharp injuries among the participants were due to rushed (61.1%), fatigue (43%), lack of skills (19.4%), lack of assistance (15.3%), lack of sleep (13.9%) and (16.7%) though it is not preventable. 55.1% of all participants have never participated in any sharp-related safety training. 10.2% practiced all three universal precautions of double-gloving, face shields, and hands-free technique. Conclusions: Sharp injuries are common among the surgical residents but are not reported by most of them. Target training about sharp injuries during residency may improve their attitude and behavior toward prevention of sharp injuries in the operative room.

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Background: Post operative ileus (POI) is the transient absence of gut motility without any mechanical obstruction, commonly occuring after abdominal surgery. It is reported to occur in 25% patients. Although it may resolve spontaneously with two-three days there have been many studies which have evaluated the role of early feeding in recovery from postoperative ileus. The study was conducted to evaluate the role of chewing gum for early recovery of postoperative ileus. Materials and Methods: This prospective comparative study was conducted from March, 2017 to September, 2017 on patients who underwent exploratory laparotomy and any kind of intestinal anastomosis either during emergency or elective surgeries. The patients were divided into 2 groups each group having 25 patients. Patients in study group (n=25) were asked to chew one stick of chewing gum for 30 min four times a day until passing flatus while the control group (n=25) patients were kept nil per orally until the passage of flatus. A probability value of less than 5% (P < 0.05) was considered significant. The Chi-square test was used to check for differences between proportions. Results: Total male patients were 33 and 17 were female. There was no significant difference in the appearance of bowel sounds, mean time of passage of flatus, stool passage and feeling of hunger between study and control group. In all these variables the mean time was shorter in study group. The patients were discharged early in study group with a statistically significant difference. Conclusion: Based on the results it can be concluded that the chewing gum does not seem to be significant to reduce the duration of post operative ileus. Although it was seen that the duration of overall recovery of bowel movements in form of appearance of bowel sound, passing flatus and motion and feeling of hunger, occurred early in patients chewing gum but was not significant statistically.

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Background: Oral cancer is one of the common cancers in India with dismal survival in advanced stages. Most of the patients present in advanced stages with borderline operability and such patients may be helped by chemotherapy to render them operable. It is well known that tumor growth is angiogenesis-dependent and thus vascular endothelial growth factor (VEGF) may be a surrogate marker of growth and angiogenesis. At present, there is a scarcity of predictive markers for oral cancer. In this prospective study, we studied VEGF expression and its role as a predictive marker in oral cancer. Materials and Methods: Patients with locally advanced oral cancer having borderline operability or unfit to undergo surgery in the primary setting were included in the study. VEGF expression of the cancerous tissue was studied in all patients. Three cycles of neoadjuvant chemotherapy (NACT) was administered before definitive treatment in locally advanced cases and response is assessed. VEGF levels were analyzed in cancer tissue and compared with normal surrounding mucosa. The response to chemotherapy was then correlated with VEGF score in patients receiving NACT to evaluate it as a predictive marker. Results: All forty patients were VEGF-positive and had a mean score of 1023 with 63% patients having Grade 3 expressions, whereas the normal surrounding mucosa had a VEGF score of 30. It was seen that in patients showing no response to treatment, the mean total VEGF score was significantly higher as compared to those showing complete or partial response. VEGF score correlated inversely with chemotherapy response, but no significant association was seen between VEGF grade and chemotherapy response. Conclusion: We can conclude from this study that VEGF is significantly overexpressed in cancer mucosa as compared to normal mucosa and overexpression of VEGF was found to be associated with chemoresistance and thus may serve as a negative predictive marker.

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Objectives: To determine the prevalence, seasonal presentation, and management of Ludwig's angina in Northwest Nigerian Tertiary Health Facility. Patients and Methods: Cases of Ludwig's angina that presented and managed by the Dental and Maxillofacial Surgery Unit of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 2013 and 2015 were retrieved. Data were stored and analyzed using IBM SPSS (IBM Corp., Armonk, NY, USA) Statistics for windows version 20. Results: Over the review period, 36 patients presented with clinical features of Ludwig's angina. Only 28 cases were analyzed and 8 cases had incomplete data and were excluded from the analysis. Of the 28 patients, 23 (82.1%) were males while 5 (17.9%) were females with a male: female ratio of 4.6:1. The mean age of the sample was 32.3 ΁ 11.6, range 18-60 years. A majority of the patients were in low socioeconomic group with 11 (39.3%) patients being peasant farmers. Odontogenic infection was responsible for the disease in 27 (96.4%) cases while only 1 (3.6%) case was idiopathic. Of those with odontogenic etiology, 18 (64.3%) were due to sequelae of caries. Microbiology, culture, and sensitivity in few cases revealed Streptococcus species, Pseudomonas aeruginosa, and Staphylococcus aureus. Most of the cases recorded no bacterial growth after 24 h incubation period. Twenty-five patients (89.3%) survived the disease while 3 (10.7%) died. Conclusions: Management of Ludwig's angina in a resource- and personnel-scarce setting can be very challenging. Early surgical decompression, aggressive empirical antibiotics, and nutritional support have contributed to the low mortality in our series.

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Solid pseudopapillary tumors of the pancreas are rare tumors commonly found in females. Surgery is the primary treatment and the role of adjuvant chemotherapy or radiation is not well defined. Although they are mostly benign, they have the potential for late metastasis, thereby defining the need for long-term surveillance for such patients. This review article describes these tumors in detail and in addition, focuses on the management of the resected tumors and the need and indications for adjuvant treatment in selective cases.

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Neurofibromatosis (NF) is a term that has been applied to a variety of related syndromes, characterized by neuroectodermal tumors arising within multiple organs and autosomal-dominant inheritance. NF-1, known as well as Recklinghausen's disease, is the most common type of the disease accounting 90% of the cases. A case of 50-year-old patient with NF is presented with a mass in the left side of the neck since 1-year and progressive dysphagia since 6 months worse for solids than liquids. Intraoperatively a large solid mass was found occupying the left side of the neck pushing the trachea and esophagus to the right side, infiltrating a portion of the wall of esophagus. The mass was resected en bloc along with a portion of the wall of esophagus, and primary esophageal repair was done. Histology revealed plexiform neurofibroma.

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Metastases in medullary carcinoma thyroid are not an uncommon phenomenon; however, metastases to the breast are extremely rare. Authors are reporting a rare case of medullary carcinoma thyroid metastases to breast in a 42-year-old female. Biopsy was performed to distinguish between primary duct carcinoma and metastatic medullary carcinoma thyroid. Further investigations revealed multiple involvements of cervical as well as axillary lymph nodes, bones, lungs, and dermis. Though survival of isolated metastases of medullary carcinoma thyroid to the breast may be better compared to other solid tumors of the breast, with wide spread dissemination survival is poor. Breast metastases on presentation seem to be a manifestation of wide spread disease.

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Although thyroglossal (TG) cysts are very common in children and young adults, their presentation in the elderly is very rare and often goes unnoticed unless we get the pathology report. This may lead to incomplete excision and recurrence of the cyst, together with the fact that there may be an increased risk of malignancy associated with the cysts in this subset of population. The early identification and complete removal of the cysts is prudent. Here, we endeavor to highlight a series of three cases in the elderly, who presented to us with midline cystic neck mass, which on further evaluation turned out to be a TG cyst.

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It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. A 34-year-old Filipino man was treated with chief complaints of anorexia, abdominal pain, and vomiting. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon after exclusion of any malignant lesions found by systemic computed tomography. Surgical complete resection was performed. The prognosis of this disease seems to be worse than that of adenocarcinoma.

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Background: Iatrogenic bile duct injuries (IBDIs) remain an important problem in gastrointestinal surgery and represent a big challenge for surgeons. Aim: To review the management of IBDI and describe short- and long-term postoperative complications of surgical repair at our tertiary referral institute. Patients and Methods: This was a retrospective review of the medical record of all patients referred for the management of IBDIs between January 2005 and January 2015. One hundred patients formed the study cohort. Preoperative data including patient demographics, mechanism of injury, operative details, and postoperative outcomes were extracted. Research Ethics Board approval was obtained. Results: There were 36 men and 64 women, with a mean age 45.4 ΁ 11.5 years. Open cholecystectomy was the most common procedure in 61 patients, whereas laparoscopic surgery was the primary treatment in 39 patients. Twenty-nine patients treated by nonsurgical management in the form of endoscopic retrograde cholangiopancreatography (ERCP) and stenting and percutaneous abdominal drainage. Seventy patients underwent operative surgery in the form of Roux-en-Y H.J, and T-tube insertion in the common bile duct in two cases. Short-term complications encountered in 15 (20.8%) cases, with a significant correlation with a previous ERCP intervention (P = 0.047). Long-term complications encountered in 12 (16.6%) patients, with a significant relation with the intermediate timing (within 2 weeks) of repair (P = 0.037). Conclusions: Prompt diagnosis of the type and grade of injury is mandatory before deciding management. Intermediate time for surgical intervention was significantly related to stricture complications. ERCP should be done only in cases that can benefit from conservative management (Strasberg from A-D) as the incidence of postoperative complication is high after surgical repair.

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Introduction: The surgical transversus abdominis plane (TAP) block is a novel approach for postoperative analgesia after abdominal surgeries. The block was given intraperitoneally during the intraoperative period. We evaluated its analgesic efficacy in patients during the first 48 h of the postoperative period after abdominal surgery, in a randomized, controlled, double-blind clinical trial. Materials and Methods: Thirty adult patients undergoing surgery requiring midline abdominal incision were randomized and divided into two groups. Group-T received TAP block with 20 ml of 0.5% bupivacaine intraperitoneally, and Group-P received TAP block with normal saline (placebo). Each patient was evaluated by a blinded investigator in the postanesthesia care unit and at 1, 2, 4, 6, 12, 24, 36, and 48 h. Results: Diclofenac consumption was almost reduced by 50% in TAP group in comparison to placebo group (mean diclofenac requirement of the TAP group vs. placebo group was 110 ± 25 mg and 225 ± 28 mg, respectively; P < 0.0001). Mean time to first request of analgesic was significantly prolonged in TAP block (210 min) as compared to placebo (90 min). Postoperative verbal analog scores at rest and at movement were significantly reduced in TAP block group from 4 to 24 h postoperatively as compared to placebo group. All TAP block patients were quite satisfied with the postoperative analgesic regimen. Conclusion: Postoperative analgesic consumption of diclofenac was almost reduced to half in TAP block group as compared to placebo group, and also, time to first request of analgesic was significantly prolonged in TAP block group. The surgical TAP block is a novel approach for providing postoperative analgesia which is easy to perform, safe and has no adverse effects.

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Background: Haemorrhoids is a common condition seen in general surgery practice. Treatment includes many methods ranging from rubber band ligation, infrared photocoagulation, sclerotherapy to stapler hemorrhoidectomy. Our study is done to evaluate the efficacy of both the procedures in a rural setting. Objectives of the study was to study the efficacy of two surgical methods of treatment of hemorrhoids, in terms of (1) operation time; (2) post-operative pain; (3) hospital stay; (4) return to normal activity and return to work. Methods: A comparative study was done between open and stapling methods for the treatment of symptomatic hemorrhoids in Al Azhar Medical College, Thodupuzha, India. Results: There was major statistically significant difference seen among different parameters between the two procedures of haemorrhoidectomy, open versus stapler procedure for prolapsing hemorrhoids (PPH) as evident from the p value. Conclusions: In our study there is a definite difference noted between two surgical methods in terms of hospital stay and return to work. As far as satisfaction of patient is considered in both the groups satisfaction is similar except for the cost of surgery which was the only cause of dissatisfaction.

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