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Four-port laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder disease. To reduce the invasiveness of standard four-port laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy (SILC) has come about an attractive option for the performance of laparoscopic cholecystectomy. There have been no studies on SILC from Indian subcontinent. The present study was designed to compare the outcomes of SILC with the standard four-port LC in a prospective randomized controlled trial. All patients with symptomatic gallstone disease were evaluated between May 2012 and April 2014. Patients were randomized to either standard four-port laparoscopic cholecystectomy (LC group) or single-incision laparoscopic cholecystectomy (SILC group). Demographic profile, preoperative and intraoperative variables, postoperative complications, hospital stay, and pain scores were recorded. WHO-QOL BREF was used for quality of life analysis. Patients were followed up at regular intervals, and satisfaction scores were recorded. Statistical analysis was done using STATA 12 and p value

Cholecystectomy is one of the commonest general surgical procedures performed all over India. The risk of bile duct injury (BDI) during laparoscopic cholecystectomy is two to three times higher than during open cholecystectomy. The worldwide incidence of bile duct injury is 0.5% or 1 in 200 cases. BDI and its consequences result in significant morbidity and may even cause mortality. BDI increases the cost of treatment and is a common reason for a medicolegal suit against the surgeons. To minimize the incidence of BDI and to manage it timely and appropriately, a set of guidelines was deemed necessary by a group of senior surgeons during a Society of Endoscopic and Laparoscopic Surgeons of India (SELSI) meeting in 2016. Guidelines for “Safe Laparoscopic Cholecystectomy” and bile duct injury management formulated by other international societies are already available. The applicability of these guidelines to Indian subjects especially in small peripheral centers was limited. Hence, a decision was taken to form a set of guidelines for general surgeons with basic laparoscopic skills with little or no advanced laparoscopic skills. Those working in a solo practice, nursing homes, and small private hospitals at talukas or districts should have “Safe Cholecystectomy” guidelines and management of BDI suitable to their situation. These guidelines were formed after three consensus meetings and have been approved by a SELSI Expert Group.

Various modifications of the reconstruction following pancreaticoduodenectomy (PD) have been described. Pancreaticogastrostomy (PG) was first described clinically by Waugh and Clagett from the Mayo Clinic in 1946. Despite recent randomized trials and meta-analysis, the literature is still ambiguous as to which is a safer procedure. We hereby describe our experience of more than 400 pancreaticogastrostomies. The legacy of performing only pancreaticogastrostomy (PG) started by the senior author (BMLK) continued from 1977 to date in this surgical unit of a tertiary care hospital. We present the results of this case series analysis of a total of 467 Whipple’s pancreaticoduodenectomy in whom PG was performed. The mean operative time was 260.8 ± 50.3 min (180–390 min) with an average blood loss of 1068 ± 606.19 ml (400–2600 ml). None of the patients had clinically significant POPF. Thirty-five patients had postoperative bleeding out of which 12 were early and 23 had delayed hemorrhage. The most common postoperative complication was delayed gastric emptying which was seen in 96 patients (20.5%). Transient bile leak was seen in 84 patients (18%). Wound infection was seen in 70 (15%) patients. The overall 30-day mortality was 2% (10 out of 400). PG as a reconstructive technique is a safe option following PD with minimal incidence of clinically significant postoperative pancreatic fistula (POPF) as shown in our series of more than 400 patients. This is the largest series to date of pancreaticogastrostomy following PD.

Initiation of an advanced laparoscopic surgery program requires skill and proper training. Despite description of multiple surgical training modules, an ideal method for training of surgeons for advanced laparoscopic procedures is lacking. We propose an abbreviated self-imposed proctored preceptorship training model as the optimum training method for training skilled laparoscopic surgeons in advanced laparoscopic procedures like laparoscopic donor nephrectomy. The laparoscopic donor nephrectomy program was started at the Institute using preceptorship-proctorship model. One hundred left laparoscopic donor nephrectomies were performed over the course of 2 years. Outcomes in terms of performance related (Surgeon) outcomes in the form of learning curve and patient outcomes in terms of donor outcomes and recipient results and were studied. Learning curve was calculated using the moving average method and calculation of mean operative time of every five consecutive cases. Mean operative time for laparoscopic donor nephrectomy was 108.1 ± 26.5 min, the warm ischemia time averaged at 3.5 ± 1.3 min and the mean blood loss was 130.1 ± 54.9 ml. Moving average analysis revealed that approximately 20 LDN cases were needed to complete the learning phase. According to the mean operative time of every five consecutive cases, learning phase of LDN was completed between 26 and 30 cases. We believe that the abbreviated self-imposed proctored preceptorship model of training is an optimum model for starting a new advanced laparoscopic surgery program and can help surgeons to overcome the initial learning curve.

Literature continues to be ambiguous on the type of mesh to be used in laparoscopic incisional and ventral hernia repair. This study presents non-randomised comparison of polypropylene and covered mesh in laparoscopic incisional and ventral hernia repair. Patients undergoing laparoscopic ventral hernia repair from 2004 to 2018 were divided into two groups, i.e. polypropylene or covered mesh. Laparoscopic ventral hernia repair was done following a standard protocol. Patient outcomes were measured in terms of re-exploration, wound/ mesh infection, seroma, subacute intestinal obstruction, fistula formation and recurrence. Patients were followed up regularly. Laparoscopic repair was performed in 527 patients. Conversion to open repair was done in 30 patients. Polypropylene mesh was used in 175 patients and covered mesh in 352 patients. Subacute intestinal obstruction was seen in 12 patients (6.9%) in polypropylene group and in 18 patients (5.1%) in covered mesh group. There were 28 recurrences, 11 (6.2%) in polypropylene group and 17 (4.8%) in covered mesh group. The median duration of recurrence was 2 years with a range of 16–48 months. Outcomes with polypropylene mesh were comparable to covered mesh for laparoscopic ventral hernia repair with regards to early and late post-operative outcomes. The incidence of fistulisation and obstruction was also similar between the two groups. It is safe to use polypropylene mesh in situations where covered mesh is not affordable or available especially in low resource countries.

Breast cancer is the most common cause of cancer death in women with the incidence rising in young women. GST gene polymorphisms are significant because of their role in the detoxification of both environmental carcinogens and also cytotoxic drugs used in therapy for breast cancer. The present study has been designed to identify the role of polymorphisms in GSTT1 and GSTM1 genes in the risk of development of breast cancer, in the prognostication of breast cancer, and in the prediction of response towards chemotherapy. Ninety-nine patients with breast cancer and 100 healthy controls with no history of cancer were taken from blood donors after informed consent. Epidemiological and clinical data was collected from participants and 5 ml of peripheral venous blood was collected for genotype analysis. Null genotype of GSTT1 was detected in 51.04 % of the controls in comparison to 20.2 % of patients with carcinoma breast, which was found to be statistically significant (OR 4.18; 95 % CI 2.01–8.75; P = 0.0001). GSTM1 gene deletion was also significantly more common among controls (60 %) than in patients with breast cancer (33 %) (OR 4.57; 95 % CI 2.20–9.51; P = 0.0001). Tumors more than 5 cm in size had greater tendency for GSTM1 gene expression (P value = 0.019), but other clinicopathological parameters did not show any correlation. GSTT1 and GSTM1 genes status did not show any association with response to chemotherapy. The results indicated the null genotype of both GSTT1 and GSTM1 to be protective for the development of carcinoma breast. None of the known etiological factors have any correlation with GSTT1 and GSTM1 gene deletion. Patients with small tumor size expressed GSTM1 gene deletion. Other tumor characteristics and clinicopathological parameters did not have any correlation with gene deletion.

Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with significant perioperative morbidity, reduced long-term survival and quality of life. There has been little literature on the long-term outcomes after surgical reconstruction and factors affecting it. The aim of this study was to study factors affecting long-term outcomes following surgical repair of iatrogenic bile duct injury being referred to a tertiary care centre. Between January 2005 to December 2011, 138 patients with bile duct injury were treated in a single surgical unit in a tertiary care referral hospital. Preoperative details were recorded. After initial resuscitation, any intra-abdominal collection was drained and an imaging of biliary anatomy was done. Once the general condition of the patient improved, patients were taken up for a side-to-side extended left duct hepaticojejunostomy. The post-operative outcomes were recorded and a hepatobiliary iminodiacetic acid scan and liver function tests were done, and then the patients were followed up at regular intervals. Clinical outcome was evaluated according to clinical grades described by Terblanche and Worthley (Surgery 108:828–834, 1990). The variables were compared using chi-square, unpaired Student’s t test and Fisher’s exact test. A two-tailed p value of