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Aim of Study: Laparoscopic colorectal surgery has gained popularity around the Globe. Laparoscopic colectomy significantly improves the short term and long term outcomes of patients. The bowel anastomosis after laparoscopic resection of the tumour can be done in two ways - extracorporeal anastomosis and Intracorporeal anastomosis. Our study observed and evaluated the data of the patients who underwent these two techniques. Materials and Methods: A prospective observational study was conducted in the department of General Surgery, SMHS hospital of Government Medical College, Srinagar. A total of 32 patients were studied out of which 20 patients had undergone intracorporeal anastomosis and 12 patients had undergone extracorporeal anastomosis. The aims of the study were to assess the operative time, post-operative ileus, length of hospital stay, anastomotic leak and other anastomotic complications,wound infections and extraction site hernias. Results: The patients in our study were in the range of 30-85 years with a mean age of 59.18 ± 14.92. and 59.4% of patients were males and the rest 40.6% were females, with male/female ratio of 1.46:1. There was no significant difference in mean operative time between the intracorporeal group and extracorporeal group (188±9.78 minutes’ vs.180.3±13.8 minutes). The patients in the intracorporeal group had earlier return of bowel function than extracorporeal group as reflected by earlier appreciation of flatus and tolerance to orals. This had led to the shorter hospital stay of the intracorporeal group than the extracorporeal group of patients (median of 5 days vs. 6.5 days) The wound infection rate was 6.3 percent in our study, 5.0% in the intracorporeal group and 8.3% in the extracorporeal group. Only 1 out of the total 32 patients developed mesenteric twist to the extracorporeal group (1 out of 12 patients). We observed no leak or incisional hernia in either groups. Conclusion: Intracorporeal anastomosis in laparoscopic colorectal surgeries leads to earlier return of bowel function, earlier resumption of orals and shorter hospital stay than the extracorporeal anastomosis. There does not exist a significant difference between the two modes of anastomosis in terms of anastomotic and wound related complications.

Background: Acute gastro-esophageal reflux disease is a common ailment in kashmiri population. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD. Aims and Objectives: The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophageal reflux disease in terms of operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms. Materials and Methods: The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the study had symptomatic gastro-esophageal reflux (documented by endoscopy) with either persistent symptoms despite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informed consent was taken before surgery in the language, the patients understood. Results: This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and post operative complications. The post operative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months). The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months. Conclusion: We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who are at a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by the surgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring.

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter total hospital stay and reduction in days away from work at the cost of longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis >2 cm from deep inguinal ring in 20, near deep ring

Background: The purpose of this study is to evaluate the role of multi-slice computed tomography (CT) with reference to presence or absence of intestinal obstruction, level of obstruction, the cause of obstruction, and correlating with their clinical diagnosis.Methods: Patients were admitted directly from Out Patient Department or emergency department with complaints suggestive of intestinal obstruction. Computed tomography scan interpretations performed by experienced radiologists were compared with the final diagnosis that was made on the basis of information obtained clinically, by investigations, and by surgical findings.Results: Majority of patients were males 62%. Mean age 51.62±17.46 years. Majority presents with abdominal pain 94% and constipation 72%.The most common cause of obstruction was adhesion bands 18%.The pre CT diagnosis was changed because of CT findings in 28 patients. Only in 50 (89.28%) patients CT findings matched with intra-operative and cause of obstruction was also found, and in 6 (10.71%) patients intra-operative findings are different from CT findings. In bowel obstruction, the CT sensitivity was 89.28%, specificity 90.90%, positive predictive value 92.59%, negative predictive value 86.95% and accuracy 92.59%.Conclusions: We concluded that multi-slice CT is highly sensitive and specific in determining the presence, the cause and site of bowel obstruction, the site of obstruction and cause of obstruction. We recommended the use of CT scan when diagnosis between ileus and obstruction on the basis of clinical and plain radiographic are difficult or in patients in whome small bowel obstruction is diagnosed when conservative management is contemplated.

Background: The hypotensive effect of propofol is attributable to a decrease in sympathetic activity, direct vasodilatation and myocardial depression. The aim of the study was to assess the effect of propofol when injected at different speeds for induction of general anesthesia on the following parameters: blood pressure, time of induction of anesthesia, dose of propofol used.Methods: The present study was conducted in post Graduate Department of Anesthesia and Surgery, Govt. Medical College, Srinagar for a period of two years and included 90 patients from July 2014 to June 16, the study was prospective one.Results: In our study patients divided into three groups with 30 patients in each group. The mean age in group P400, P600, P800 was statistically insignificant p>0.843.The mean weight in group P400, P600, P800 was statistically insignificant p>0.885.The mean height in group P400, P600, P800 was statistically insignificant p>0.748. The mean induction time in P400 and in P600 was statistically significant. The mean systolic blood pressure, pre and post induction in P400, in P600 and in group P800 was statistically significant. The mean diastolic blood pressure, in pre and post induction in P400, P600, P800 was statistically insignificant with a p>0.05. The mean arterial pressure in pre and post induction in P400, P600, P800 was statistically significant (pConclusions: We concluded that induction dose required for loss of consciousness increased with a faster rate of infusion while time for induction was shorter in P800 compared to P400 and P600, and the decrease in mean blood pressure was less after induction in P400. Propofol injection should be slow enough to prevent any hemodynamic deterioration in anesthesia induction.