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Introduction: In our study, we reviewed efficacy and complication rates of open subinguinal varicocelectomy (OSV) and loupe assisted subinguinal varicocelectomy (LASV) using seminal and hormonal parameters in a prospective randomized study. Materials and Methods: We prospectively studied 60 males with Grade 2 and Grade 3 varicocele. Thirty patients underwent OSV and the other 30 patients underwent LASV. Intra-operative and post-operative complications along with pre-operative and post-operative seminal, hormonal parameters and testicular volume were compared between the groups. Results: Sperm count, motility and morphology increased significantly in both groups, but the improvement was significantly better in LASV group. (Group A – improvement in sperm count, motility and morphology by 25%, 8.5%, 10.3%, respectively and in Group B – improvement in sperm count, motility and morphology by 110%, 68.59%, 71.1%, respectively. Decrease in serum follicular stimulating hormone (FSH), luteinizing hormone (LH) and increase in serum testosterone were significant in both groups, but the improvement was significantly better in LASV group. (Group A – serum FSH and LH decreased by 17.2%, 23%, respectively and serum testosterone increased by 13.7% and in Group B – serum FSH and LH decreased by 56.9%, 56.65%, respectively and serum testosterone increased by 95.9%). The recurrence (OSV = 13.2% and LASV = 0, P = 0.01) and complication rates were significantly lower in LASV group. Conclusion: Our study shows that LASV is significantly better than OSV regarding efficacy and complication rates.

OBJECTIVE: To evaluate the darning method of inguinal hernia repair with polypropylene. MATERIAL AND METHODS: 125 Patient of unilateral or bilaterally inguinal hernia were admitted. After thorough investigations, all patients were operated for hernia repair by standard procedure using no-1 polypropylene. Patients were operated under spinal, general anesthesia or local anesthesia. Patients were followed up at one week, four weeks and six months after operation for wound healing and complications. RESULTS: Out of 125 patients, ranging in age from 18 to 85 Years, 90 patients (72%) were given spinal anesthesia, 28 Patients, (22.4%) were operated under general anesthesia, 7 patients under local anesthesia. Patients were discharged from the hospital after 4 days. 20 Patients were above 50 yr. who were operated under spinal anesthesia were catheterized to prevent urinary retentions. Recurrence rate was 1.6% CONCLUSION: Darning methods of inguinal hernia repair with polypropylene is a safe and cheaper method of hernia repair.

SUMMARY: Twelve patients with empyema of the gall bladder were diagnosed among 325 cases of gall-bladder disease presenting to our department of surgery in three years period (March 2010 to March 2013). Abdominal pain was present for average of eight days in four cases andin four cases, for between one and four months. In some cases, the disease was painless and was found unexpectedly at operation for chromic cholecystitis disease. The severity of the problem was subdued by the often scanty physical signs. Less than 50% the patients had pyrexia of more than 38.5C and the presence of sepsis was rarely suspected clinically. None of the patients died. This considerable morbidity could be reduced by the wider use of blood culture in cases of cholecystitis and by greater awareness that empyema of the gallbladder is sometimes chronic, painless, and afebrile. INTRODUCTION: Empyema of the gall bladder was described extensively in surgical texts of the early years of this century1-3 but now rarely mentioned4. In addition, it appears to have been largely forgotten that its course can be chronic2, 3. It could be due to the wider use of antibiotics, along with the increasingly followed policy of early cholecystectomy for acute gall-bladder disease4-6. We have recently treated several elderly patients in whom the disease was markedly milder event. As the number of old people in the population is rising, it seemed important to determine whether this neglected disease is still an important problem and to redefine its natural history. We decided, therefore, to review all cases of empyema of the gall bladder which had presented to our hospital over a period of three years. METHODS: Empyema was defined as an inflamed gall bladder which contained pus (figure 1, 2, 3).The presence of inflammation and pus were established from the operation record, the gallbladder swab report, and the histology report on the resected gall bladder, cases of generalized infection of the biliary tree were designated as cholangitis and excluded from the study. From the 325 sets of case notes, 12 patients (3.69%) were identified who fulfilled these criteria and, on stringent review by all the authors, were agreed to be true examples of this disease. These cases were analyzed to determine their age and sex distribution, and their clinical and pathological features. RESULTS: The 12 patients were mostly elderly, their average age being 60 years (range 40-80 years). There were nine women and three men, giving a female preponderance of three to one. Six patients had no abdominal pain and the empyema were found unexpectedly, two at ultrasonography and in a further four patients, empyema was found at routine cholecystectomy, after a long history of apparently mild pain. The remaining six patients (50%) presented with abdominal pain of sufficient

Occurrence of Spigelian Hernia is rare accounting for 0.12% of all ventral hernias 1 . It is most commonly reported in adults while pediatric cases are rare. Though the association of Spigelian-Cryptorchidism syndrome has been comprehensively reported in pediatric patients, the same has not been detailed so far for the adult patient population. We herein discuss two cases of Spigelian hernia, both adults in whom intra-operative exploration revealed associated ipsilateral undescended testis. Not only is the pre-operative diagnosis seldom if ever, the imaging studies may not be successful in differentiating the type of hernia2,3. Even in the present cases radiological studies were inconclusive and definitive diagnosis was only attained intra-operatively.

INTRODUCTION: Laparoscopic Cholecystectomy has evolved as the standard of care for the treatment of Gall Stone disease over the past decade. Several patient and procedure related factors have been implicated in setting of failure to complete the procedure by minimal invasive method and various scores have been developed to precisely predict a Difficult Laparoscopic Cholecystectomy. AIMS: The present study was conducted to ascertain various patient related preoperative risk factors for conversion of laparoscopic Cholecystectomy to open method and to validate the Risk Score for conversion. SETTINGS & DESIGN: A total of 100 patients with diagnosis of Gall Stone Disease admitted to our surgical Unit between October 2011 and April 2013 were assessed for various pre-determined risk factors and were accordingly categorized into three levels of anticipated difficulty according to RSCLO and our new scoring system. The patients were then subjected to Laparoscopic Cholecystectomy by the same surgical team and the procedure was then graded as difficult or not according to the pre-defined criteria. The findings were analysed by appropriate statistical analysis. RESULTS: Presence of factors like Male sex, history of attacks of acute cholecystitis, increased GB wall thickness, presence of supra-umbilical abdominal scar, obesity and a contracted GB were associated with a significantly higher rate of conversion to open method. RSCLO was found to correlate better with the outcome in this setting than our New Scoring System. CONCLUSION: Several patient related factors may be helpful in predicting a Difficult Laparoscopic Cholecystectomy pre-operatively. RSCLO Scoring system may be useful as a pre-operative tool to predict intra-operative difficulty during LC.

Introduction: Fournier's gangrene is an aggressive disease with high morbidity and mortality. The aim of this study was to assess risk factors associated with mortality among patients of Fournier's gangrene. Materials and Methods: Between May 2011 and September 2012, all patients of Fournier's gangrene treated at our center were included in the study. All patients underwent emergency surgical debridement and received broad spectrum intravenous antibiotics. Their baseline characteristics, treatment, and follow-up data were recorded and analyzed. Results: A total of 30 patients were included in the study. Of these, six patients (20%) died during the treatment. Age >55 years, total leukocyte count >15000 cumm, extent of the area involved, septic shock at admission, visual analog scale (VAS) >7 at admission, and Fournier gangrene severity index (FGSI) score >8 at admission were significantly associated with increased mortality. Conclusion : In patients of Fournier's gangrene, increased age, total leukocyte count, extent of the area involved, septic shock at admission, VAS score, and FGSI score at admission have a significant association with mortality.

Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze within the common bile duct. The patient had previously undergone an open cholecystectomy. Radiological investigations were inconclusive and suggestive of either a calculus or a cholangiocarcinoma. Surgical exploration revealed full length surgical gauze within the common bile duct. Because imaging modalities are often non-determinant, the possibility of biliary tract obstruction from a foreign body should be borne in mind for patients with unusual presentations, especially those who have previously undergone surgery.

Introduction: Acute scrotum is a common reason for emergency consultation. Early scrotal exploration is mandatory if torsion of the testis suspected clinically. Objectives: To study management and clinical outcome of patients admitted with acute scrotal condition. Methods: This was a prospective observational study involving 60 patients hospitalized for Acute scrotum at tertiary rural centre, from September 2014 to September 2016. Patients admitted with complaints of acute pain and swelling of scrotum irrespective of age and gender were included in the study. Patient with painless scrotal swelling and those with chronic scrotal pain were excluded from the study. Patients were monitored post-operatively till discharge and followed for 1 month for any complications. Results: Of the 60 patients in our study, acute epididymo-orchitis (36.6%) was the dominant cause of acute scrotal swelling followed by scrotal abscess (23.3%). 51.6% of the patients were managed conservatively, which were diagnosed as epididymoorchitis and haematocele. 14 patients underwent incision and drainage who diagnosed as scrotal abscess; 7 patients diagnosed as fournier's underwent debridement; 5 underwent orchidectomy or orchidopexy while 3 underwent B/L orchidopexy. Out of 8 cases of torsion of testis, bilateral orchidopexy was done in 3 cases (37.5%) in which we were able to salvage the affected testis. Out of the 60 patients, maximum patients (41 patients) required a hospital stay of 1-10 days. All patients were followed up for a period of 1month after discharge. None of the patients had any serious complications. Conclusion: Acute scrotum can be successfully managed by consevative methods after exclusion of Torsion of testis. Early exploration can salvage the testis in cases of torsion of testis. Key words: Acute orchiepididymitis; Acute scrotal swelling; Fournier's gangrene; Orchidectomy; Orchidopexy; Torsion of testis.