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Introduction: Situs inversus totalis (SIT) is a congenital disorder which refers to a mirror image transposition of thoracic and abdominal viscera. Diagnosis and management of cholelithiasis in patient with SIT leads to a challenge due to an underlying anatomical variation. We reported a case of a 50-year-old female patient who presented with an intermit-tent history of epigastric and left upper quadrant pain continued from a month. Clinical assessment and radiological investigations confirmed the presence of cholelithiasis with an evidence of SIT. The patient underwent elective laparoscopic cholecystectomy with no complication and she had an uneventful recovery. Various intraoperative modifications have been made to overcome the technical difficulties encountered due to an underlying anatomical variation. First successful laparoscopic cholecystectomy in patient with SIT performed in 1991. Surgeons managed to get the better of the technical difficulties by embracing adaptable changes in the techniques of conventional laparoscopic cholecystectomy. The anatomical variation in SIT can influence the localization of symptoms in patient with cholelithiasis, which leads to a delay in diagnosis and management. Laparoscopic cholecystectomy can be safely performed in these cases. However, it is considered as a technically challenging procedure and often requires technique to be altered. [ABSTRACT FROM AUTHOR]

Background: Treating injuries with heat can increase blood flow and make connective tissue more flexible. It can also help minimize inflammation and reduce the incidence of edema or fluid retention. By increasing blood flow to the site of an injury, the deep heat generated with diathermy can accelerate healing. Diathermy is used to treat arthritis, back pain, fibromyalgia, muscle spasms, neuralgia, sprains and strains, tenosynovitis, tendonitis, bursitis. In the second, as an adjunct to surgery, diathermy is used to coagulate, prevent excessive bleeding, and seal off traumatized tissues. It is particularly effective in eye surgery, neurosurgery and dermatology. However, there is still not a lot of evidence to prove that diathermy is the most effective treatment for these conditions. Aim of the study: Aim was comparison of Diathermy incision and Scalpel incision in elective open appendectomy surgery. Materials and methods: 25 patients per group irrespective of sex was sample size. Study Group was subdivided into Study Group A -- Patients were subjected to Diathermy incision. Study Group B -- Patients were subjected to Scalpel incision. After obtaining pre-anesthetic check-up patients were posted for surgery. Data was collected using a proforma meeting the objectives of the study. Results: The treatment group was split into two, Twenty-five cases used diathermy for skin incision and the other twenty-five cases used a traditional scalpel for skin incisions in open appendectomy procedures. 50 patients in the study groups were compared, 4 developed wound gaping which accounts for 8%. Wound gaping was considerably seen in scalpel incision with a highly significant P value of 0.0297 using Pearson-Chi square test. A hypertrophic scar was seen in scalpel incision with a significant P value of 0.074 using Pearson-Chi square test. Keloid was considerably seen in scalpel incision with a highly significant P value of 0.0149 using Pearson-Chi square test. The pain in POD-1 was compared, the mean value was 7.44 and 6.16 in scalpel and diathermy respectively, with a highly significant P value of <0.0001. The pain in POD-2 was compared, the mean value was 6.28 and 4.72 in scalpel and diathermy respectively, with a highly significant P value of <0.0001. Conclusion: All the patients were followed every day in the postoperative period until they were discharged. The following parameters were observed, that is a comparison of the two procedures with relation to the duration of incision, postoperative pain, post-operative complications in both the procedures. Diathermy is the first choice of incision for open appendectomy procedures as there is less chance of postoperative wound complications. [ABSTRACT FROM AUTHOR]