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Background: Empyema Thoracis, a condition in which purulent fluid accumulates within the pleural cavity, is commonly caused by bacterial infection (both Gram-positive and Gram-negative), such as Mycobacterium tuberculosis, and rarely by fungal infection. Timely intervention significantly reduces morbidity and mortality. Surgical intervention is needed in advanced disease. This study aimed evaluate decortications performed through video-assisted thoracoscopic surgery (VATS) and open thoracotomy. Methods: This retrospective study included 47 patients who underwent decortications by either VATS or open thoracotomy for empyema Thoracis at the Department of Surgery of, BLDE DU Shri B M Patil Medical College from May 2015 to August 2020. Results: Tuberculosis was the most common etiological factor for empyema Thoracis. In 19 patients who underwent VATS decortications, VATS was converted to open thoracotomy in 11 patients. Only 8 patients achieved successful decortication with VATS. Thirty-nine patients (including 11 whose VATS was converted to open thoracotomy) underwent successful open thoracotomy decortications. Thirty-two patients had postoperative bronchopleural fistula, and all cases were successfully managed conservatively. The timing of the surgical intervention is critical in reducing morbidity and mortality. The more advanced the disease, the higher the failure rate of VATS in attaining complete decortications. Conclusion: Open thoracotomy decortication remains the gold standard in attaining complete decortications in advanced empyema Thoracis.

Background: The most important step in appendectomy is the closure of the stump. There a lot of variations to appendiceal stump closure as newer methods have been introduced although a consensus has not been reached as to which is best method. Aim: The aim of the study was to evaluate the safety and ease of use of titanium clips versus conventional knotting for appendiceal stump closure in laparoscopic appendicectomy. Methods: A total of 90 patients were included in this study, 45 in each group. The patients were divided into two groups- The first group included patients undergoing Endoclip closure (EC) and the second group included patients undergoing suturing (S). Results: In this study majority of patients belonged to the age group of less than 20 years, that is 57.8% in EC group and 40% in S group. In study group mean time of surgery was found to be 57.20+/-1.254 minutes. In control group it was 66.89+/-1.72 9minutes. P value was found to be significant. There were no intra operative or post-operative complications noted in both groups. Post-operative pain was comparable among both the groups. Conclusion: It can be concluded that titanium endoclips can be safely used for closure of appendiceal stump. It has several advantages like shorter time of surgery and lesser learning curve.

BACKGROUND: Appropriate training and obtaining adequate competency in basic surgical skills is very essential for a fresh postgraduate in surgical specialties to deliver effectively various responsibilities. Due to absence of any methodology to assess these skills before entry into the surgical residency program, anxiety and low confidence regarding the skills, there is delay in allotting graded responsibilities by the faculty and seniors. Hence a short structured training program to address these skills was planned and implemented. MATERIALS AND METHODS: One hundred and forty two trainees underwent this course in last five years. The training included very basic surgical skills demonstrated and hands on training in controlled environment of clinical skills laboratory. Secondary outcome was assessed for available forty three trainees. RESULTS: The immediate feedback suggested that the training was necessary, very useful and perception wise the trainees felt their competencies improved significantly from 60 -80%. They also opined that these facilities should be allowed to use regularly and all of them opined that they wish to be assessed after three months to assess internalization of skills obtained. Retention test was conducted for 43 available postgraduates in the form of OSCE .Their scores revealed good improvement in the skills by 60-80% suggesting the utility of the training and improvement in the competencies. CONCLUSION: Training of various basic surgical skills in a controlled environment improves competencies of fresh postgraduates, improves their confidence and reduces time for allotting graded responsibilities

Introduction: Umbilical hernias are encountered at the umbilical ring and may be present at birth or develop subsequently in later part of life. Adults having asymptomatic and small defects need to be followed clinically. Surgical treatment needs to be offered if the hernia enlarges or symptoms occur or if incarceration occurs.Laparoscopic repair of ventral hernias including umbilical hernias is gaining popularity in the recent times. Further the choice of mesh for laparoscopic repair is controversial. Material and Methods: This was a prospective study conducted at BLDEU’s shri B. M. Patil Medical College, Vijayapur from Oct 2015 to Aug 2017 and included 68 patients with umbilical/ paraumbilical hernia. All 34 patients in the laparoscopic group underwent intraperitoneal onlay mesh repair (IPOM) and 34 in the open mesh repair underwent onlay mesh repair. Polypropylene mesh was used in both the groups. Result: The laparoscopic repair (LR) group had a mean operative time of 74.4 min which was significantly more than the operative time of 52.5 min in open mesh repair group. The mean length of hospital stay at 6.9 days was higher in the open mesh repair (OR) group compared to 3.9 in laparoscopic group. There was no significant difference in the rate of complications among the two groups. Further the laparoscopic group showed advantages to the patient in terms of early post-operative mobilization and less post-operative pain. Conclusion: Although the use of mesh fixation device contributes to the higher cost of laparoscopic IPOM repair and the operating time is also longer laparoscopic repair of umbilical and paraumbilical hernia using polypropylene mesh offers advantage to the patient in terms of reduced hospital stay, decreased postoperative pain and a comparable complication rate to the widely practiced open mesh repair. Laparoscopic IPOM with polypropylene mesh is technically safe, effective and feasible with a better clinical outcome in patients requiring treatment for umbilical and paraumbilical hernia.

Introduction: Surgery by itself will add a lot of stress to the patients. It is associated with a lot of morbidity, the problems related to the wound healing and its complications and mortality at times. There are battery of factors that can predict the problems related to the complications. It will be invaluable to have the predictors that can assess the complications before the operative procedures so that the deficit factors can be corrected in order to reduce the morbidity associated with the surgical procedures. This study is taken up to assess one of such important factors that is the effect serum albumin on the surgical out come. Aim: To study effect of protein (s.albumin) levels and the wound healing and related complications like wound infection, wound dehiscence and anastomotic leak. Materials & Methods: The study is conducted in the department of Surgery Shri. B.M. Patil Medical College. A total of 130 patients were studied over period of 2 years and were evaluated for serum albumin and the wound related complications. Results: Significant wound related complications were noted in hypoalbuminemic patients as compared to the patients with normal albumin levels. Conclusions: Serum albumin levels can be considered to be one of best predictors for the wound related complications.

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. Aim: To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. Materials and Methods: This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Results: Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. Conclusion: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection.

Breast masses are uncommon in childhood. Juvenile fibroadenoma is a rare clinical entity and forms 4% of the total fibroadenomas, and giant juvenile fibroadenoma constitutes only 0.5% of all fibroadenomas. A rare case of bilateral juvenile giant fibroadenoma of breasts in a pre pubertal child who developed mass related complications of ulceration, bleeding and backache is reported here.

The treatment of infected necrotizing pancreatitis has evolved from time to time and the success of surgical intervention depends on the timing of necrosectomy. Bacterial infection occurs in 40–70% of patients with necrotizing pancreatitis. Infection is the main risk factor for mortality among patients with pancreatic necrosis. Timely intervention is generally required for pancreatic necrosis but is now deferred until four weeks after disease onset in order to permit encapsulation and demarcation of the necrotic material. Demarcation facilitates necrosectomy and reduces complications related to the drainage and debridement procedures. The approach to pancreatic necrosectomy has evolved from primary open necrosectomy to minimally-invasive radiologic, surgical and endoscopic procedures. Direct endoscopic necrosectomy is a minimally-invasive technique that was introduced in recent years for the treatment of walled-off necrosis. The pancreas is approached through the posterior wall of stomach and debridement is done.