Enterocutaneous Fistula of the Scrotum.

Inguino-scrotal hernia is a very common surgical entity. Though much common in pediatric population, yet no age is exempted. Enterocutaneous fistula in an inguino-scrotal hernia is a very rare surgical entity in both developing as well as developed countries. Comparatively commoner in pediatric age group but no age is exempt, the information gathered from few cases available in the surgical literature. About 08 cases in pediatric age group and 06 cases in adult population are available in the literature that could be revealed from Pubmed/Medline as well as medical library shelf search. We report here two rare cases of scrotal enterocutaneous fistula in an adult in inguinoscrotal hernia.

A Comparitive Study of Mini-Appendectomy & Conventional-Appendectomy in Acute Appendicitis.

The study was undertaken in an attempt to compare Mini-appendectomy with Conventional-appendectomy. 200 patients each in two groups were subjected to mini-appendectomy with 2-2.5 cm transverse incision (Group I) and conventional-appendectomy with standard Grid-Iron incision 6-8 cms (Group II). There were 92 males and 108 females in Group I whereas, 98 males and 102 females were subjected to conventional-appendectomy in Group II. Average age of patients in Group I was 22.3 years (5-65 yr) whereas, in Group II average age was 22.4 years (7-65 yr). Average weight of pts in Group I was 45.7 Kgs (20 kgs to 60 kgs) and 50.2 Kgs (24 kgs to 68 kgs) in Group II. Average time taken to complete surgery in Group I and Group II was 11.4 mt (11-35 mt) and 26.4 mt (25-45 mt) respectively. Average dose of analgesic used in Group I and II were 2.2 doses (2-4 doses) and 4.2 doses (4-8 doses) respectively. Post operative hospital stay in Group I was 2.14 days (2-5 days) and 4.34 days (4-11 days) in Group II. Time to return to work in Group I was 8.2 days (8-12 days) and 13.2 days (9-21 days) in Group II. There was no mortality and negligible morbidity in both the study groups. Mini-appendectomy has definite edge over conventional-appendectomy in terms of operation time, analgesics used, post-operative hospital stay, and return to work hence can be a safe alternative to conventional-appendectomy.

Mini-Appendectomy

Acute appendicits is the most common surgical emergency requiring immediate surgical intervention for total cure and to avoid complications. Appendectomy is practiced worldwide as emergency as well as elective procedure.We, in our series performed appendectomy in emergency successfully in 75 cases (30 males and 45 females) in the age group of 11-63 years with a small transverse incision (2.5 to 3.5 cm long) in the right lower abdomen starting just on the lateral border of rectus muscle and extended laterally in the line of Mc Burney’s point. The only muscle in the operation field was rectus that was retracted medially. No other muscle was cut/split. The time taken to complete the operation was 22.3 minutes (16 to 45 min). Post-operative analgesics used were 2.23 dose per patient (2-5 doses). Post-operative hospital stay was 2.3 days (2-7 days). There was no mortality and negligible morbidity in the form of wound infection (n=02), anterior abdominal wall haematoma (n=01). Better cosmesis and almost invisible scar is the hallmark of small incision appendectomy that is what we have observed in the study. Time to return to work (RTW) was 8.2 days (7-10 days). No complication was seen in follow up period extending from 15 days to 6 months. Success rate of small incision appendectomy was 96% with only 3 cases requiring extension of incision to maximum of 5 cm.We suggest that the operation may be called as Mini-appendectomy.

Diaphragmatic Hernia Presenting as Empyema Thorax

Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of mechanism, seemingly innocent penetrating injuries may be long forgotten by the patient and are the most commonly missed diaphragmatic injury. Diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. We report an unusual case of diaphragmatic hernia presenting as empyema thorax after suffering from penetrating injury.

Laparoscopic Cholecystectomy:An Experience of 200 Caes

The surgical management of gallstones has been revolutionized after the advent of laparoscopiccholecystectomy since 1985/87. This minimally invasive technique has virtually become the gold standard in the management of cholelithiasis. We share our experience of 200 cases of laparoscopiccholecystectomy performed in symptomatic cholelithiasis over a period of five years from 1998 to 2002 in Govt. Medical College, Jammu. There were 32 males and 168 females in the study group. Maximum age of the patients was 65-yr and minimum 17-yr. Patients with high-risk medical problems; deranged LFT, CBD stones and acute cholecystitis were excluded from this study. Average operation time was 61.3 minute (40-130 mt), post-operative analgesic used were 3.02 doses per patient (2-15 doses), post-operative hospital stay was 4.34 days (2-26 days) and time to return to work was 13.2 days (10-40 days). Rate of conversion to conventional-cholecystectomy was 4%. There was no mortality and negligible/acceptable morbidity. No complications were observed in the follow up period ranging from 2 weeks to 6 months. The patients were quite satisfied with the outcome of the procedure.