BackgroundSquamous cell carcinoma of the scrotum is rare and its development in the scar of Fournier's gangrene is still rarer.Case presentationA 65-year-old gentleman presented with a small non-healing ulcer developing on right hemi-scrotum two years after the treatment for Fournier's gangrene. On histological examination it was found to be squamous cell carcinoma. He was successfully managed by surgery in the form of wide local excision and ilio-inguinal lymph node dissection followed by adjuvant radiotherapy and chemotherapy.ConclusionsSquamous cell carcinoma can develop in the scar of Fournier's gangrene after a long delay, which differentiates it from other scar carcinomas or Marjolin's ulcer.

Repair of inguinal hernia is one of the commonest operations performed by surgeons around the world. The treatment of this common problem has seen an evolution from the pure tissue repairs to the prosthetic repairs and in the recent past to laparoscopic repair. The fact that so many hernia repairs are practiced is a testimony to the fact that probably none is distinctly superior to the other. This review assesses the current status of surgery for repair of inguinal hernia and examines the various controversial issues surrounding the subject.

Background:Abdominal lymphadenopathy (AL) - a common clinical scenario faced by clinicians - often poses a diagnostic challenge. In the absence of palpable peripheral nodes, tissue has to be obtained from the abdominal nodes by image-guided biopsy or surgery. In this context a laparoscopic biopsy avoids the morbidity of a laparotomy.Aim:This retrospective analysis of prospectively collected data represents our experience with laparoscopic biopsy of abdominal lymph nodes.Materials and Methods:Between October 2000 and November 2005, 28 patients with AL underwent laparoscopic biopsy. Pre-operative radiological imaging studies had identified a nodal mass in 20, a solitary node in 1, a cold abscess in 1 and a mesenteric cystic lesion in 1 patient. In five patients with chronic right lower abdominal pain and normal ultra-sonographic findings mesenteric nodes were identified and biopsied during diagnostic laparoscopy.Results:The sites of biopsied lymph nodes included para-aortic (10), mesenteric (8), external iliac (3), left gastric (2), obturator (1), aorto-caval (1) and porta hepatis (1). One patient with enlarged peripancreatic nodes mass and another with a mesenteric cystic mass had cold abscesses drained in addition to biopsy. There were no perioperative complications and the median postoperative stay was 2 days (range 1-4 days). Histopathology revealed tuberculosis in 23 patients, reactive adenitis in 2, lymphoma in 1 metastatic carcinoma in 1, and a retroperitoneal sarcoma in 1.Conclusions:In patients with AL, laparoscopy provides a safe and effective means of obtaining biopsy. It is of particular value in patients in whom (a) the nodes are small or present in locations unsuitable for image-guided biopsy, (b) adequate tissue cannot be obtained by image-guided biopsy or (c) previously undiagnosed lymphadenopathy is encountered during diagnostic laparoscopy.

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

Bronchogenic cyst usually presents along the tracheobronchial tree. Rarely, it is found inside peritoneal cavity. Here is a case of 30-year-old man who presented with concerns of abdominal pain. On evaluation, contrast-enhanced CT scan showed hypodense cystic lesion in epigastric region related to right crus of diaphragm. The patient underwent laparoscopic marsupialization/deroofing of cyst. Histopathological examination of resected specimen showed respiratory epithelium. Postoperative period was uneventful.

Schistosomal epididymitis is a very rare condition. Worldwide, very few cases have been reported, especially in India. Here is a case of schistosomal epididymitis that was found on histopathological examination of an epididymal cyst in a 32-year-old man in India. Patient presented with concerns of a right testicular swelling. Ultrasonography of scrotum showed an ill-defined echogenic lesion just above the head of right epididymis. Excision of epididymal cyst was performed. Histopathological examination showed eggs of schistosoma surrounded by abundant inflammatory infiltrate. Post-operatively, the patient was treated with single dose of praziquantel.

Background: With the establishment of laparoscopic cholecystectomy as gold standard for management of cholelithiasis, the current stress is on increasing patient safety. Hence, this study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10mm Hg) versus high pressure pneumoperitoneum (HPP >14mm Hg) in a prospective randomized manner on intraoperative safety, assessing the working space and safety by seeing contact of parietal peritoneum to underlying viscera during secondary port insertion.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14mm Hg) group (n=60) prospectively. Available working space assessed directly, safety by contact of parietal peritoneum to underlying viscera during secondary port insertion and operative difficulty assessed by visualization, dissection and grasping, total duration of surgery; intra-operative gas consumption, and bile spillage were assessed.Results: There was no significant difference in terms of available working space, operative duration, consumption of carbon dioxide, surgeon’s operative difficulty and intraoperative bile spillage. Out of 180 secondary ports inserted, there was evident contact of 20 (11.1%) secondary ports in high pressure groups and 14 (7.7%) secondary ports in low pressure group, which is suggestive of adequate exposure and working space available for surgery at both pressures.Conclusions: Low-pressure cholecystectomy did not compromise intraoperative safety and should be the standard of care in day care surgery.

INTRODUCTIONThe sphenopalatine artery is the main feeding vessel to the lateral wall of nasal cavity and most of the septum. Blocking this artery is believed to reduce the amount of bleeding, and thereby enhancing the visibility during surgery.2 The block involves injecting a local anestheticlignocaine, along with a vaso constrictive agentadrenaline into the pterygopalatine fossa. This study aims to assess if there is any significant difference in bleeding, during FESS, with and without the block. METHODS55 patients (male and female in the age group of 20-45 years) with chronic bilateral sinusitis who attended the ENT out-patient department and were planned for endoscopic sinus surgery on both sides, during the period March 2015 to August 2016, who satisfied the inclusion criteria were enrolled for the study after getting an informed written consent. Study design:Cross sectional observational study. ABSTRACTBackground: The use of the sphenopalatine artery block to reduce bleeding during FESS, has been a debatable issue. This cross sectional observational study aims to study whether sphenopalatine artery block has any significant effect on bleeding. Methods: 55 patients coming to the ENT department of Stanley Medical College from 2015-2016 were included in this study. All patients had bilateral nasal sinus disease and endoscopic sinus surgery was performed on both sides. 20 minutes prior to surgery one side was chosen randomly and sphenopalatine artery block was administered via the greater palatine canal approach. A mixture of lignocaine (2%) and adrenaline (1:80000) was used for infiltration. The surgery was done in an alternating fashion where the surgeon would operate for 15 minutes on one side and then moved onto the other side. The field was graded using the Wormald Grading at 30 minute intervals. The results were tabulated and the Wilcoxon Signed Rank Test was done at each time interval to see if there was a statistically significant difference in the grades of bleeding on both sides at each time interval. SPSS version 22.0 was used to analyse the data. Significance level was fixed as 5% (α=0.05). Results: It was found that for each time interval up to 120 minutes there was a significant decrease in the bleeding on the blocked side. However after 120 minutes the bleeding on both sides appeared to be same. Conclusions: Sphenopalatine artery block given prior to surgery will be effective in reducing bleeding in FESS for the first 2 hours after which the effect of the block wears away.