Background and aims: The paper offers a generalized experience of surgical treatment in patients with chronic pancreatitis. Material and method: We treated 249 patients with chronic pancreatitis (223 males and 26 females). Their average age amounted to 45.8±0.8. Variations of partial pancreatic resection were performed in 157 (63.1 %) cases. Various open, laparoscopic, and endoscopic drainage procedures were performed in 92 (36.9 %) patients. Results: Frey procedure was applied in 113 of 157 (71.9 %) patients, original Beger procedure with the Berne modification – in 7 of 157 (4.5 %) patients, pancreaticoduodenectomy – in 18 of 157 (11.5 %) patients, pancreatic left resection – in 19 of 157 (12.1 %) patients, laterolateral pancreatojejunostomy – Partington–Rochelle-procedure – in 41 of 92 (45.7 %) patients, cystojejunostomy – in 20 of 92 (21.7 %) patients, cystopancreaticojejunostomy – in 6 of 92 (6.5 %) patients, endoscopic cystoduodenostomy – in 5 of 92 (5.4 %) patients, ERCP, and removal of calculi from the pancreatic duct with its further stenting – in 20 of 92 (21.7 %) patients. Early postoperative complications were encountered in 14 of 249 (5.6 %) patients. Five (2.1 %) patients died after surgical interventions. Conclusions: The surgical management of chronic pancreatitis in patients with ineffective pharmacological treatment includes a variable group of surgical interventions of varying levels of complexity, which can be selected based on clinical signs, preoperative examination results, and surgeon’s experience and has a low incidence of early postoperative complications (5.6 %)

Background: A complete rectal prolapse is an intussusception that extends beyond the anus. Rectal prolapse can be treated with a variety of surgical procedures, either abdominal or perineal, although no optimum approach has been identified. Objective: The aim of the present study was to compare Delorme's procedure, with Laparoscopic ventral mesh rectopexy (LVMR), regarding the clinical and functional outcomes and the incidence of recurrence of each approach to explore the best management of rectal prolapse. Patients and methods: A prospective randomized study was conducted on 24 patients with complete rectal prolapse who were admitted to the colorectal surgery unit of Zagazig University Hospital in the period from 2021 to 2023. Patients equally divided according to performed surgical technique into LVMR group and Delorme's procedure. Hospital stay and complications were recorded among the studied groups. Wexner continence score and constipation score were performed for the studied groups pre- and postoperative. Patients were followed- up for 18 months. Results: There was a statistical significance increase in operation duration among Group I compared to Group II. There were no statistically significant variations in preoperative symptoms between the tested groups. Postoperatively, Group I had fewer of all symptoms than Group II, although there was no statistically significant difference between both groups. There was a very statistically significant drop in the Wexner continence score postoperatively in both groups (by 86.91% in Group I and 67.91% in Group II), according to comparisons between pre- and post-in each group. There was a statistically significant increase in hospital stays. Although LVMR's recurrence rate was lower than Delorme's method, there was no statistically significant difference between the two groups. The frequency of recurrence did not statistically significantly differ across the groups. Conclusion: In terms of the clinical and functional outcome at 18 months after surgery, no method was superior to the other.

Objective: The aim of this study was to evaluate the wound site infection and the factors that may cause this infection in patients who underwent Percutaneous Endoscopic Gastrostomy in our hospital. Materials and methods: Our study included patients who underwent PEG between July 2022 and December 2022 in the adult intensive care unit and palliative care center of a secondary state hospital. Demographic data, comorbidities, growth agents and blood tests were recorded. Differences between patients with and without wound site infection were analyzed. Results: A total of 85 patients underwent PEG procedure in our study. Fifty-five (64.71%) of the patients were female. Twenty-two (25.9%) patients developed wound site infection. The most common symptoms were discharge and erythema, and the most common causative agent grown in tissue cultures was pseudomonas species. Patients with wound site infections had lower serum albumin levels, higher serum urea levels and lower age. Conclusion: Percutaneous Endoscopic Gastrostomy is a reliable route for enteral nutrition. In our study, there were no significant differences between the results obtained and the complications seen in the literature. PEG infections are thought to be multifactorial. It is a simple, safe, practical, effective method with low infection and other complication rates

This systema+c review aims to describe the clinical outcomes, safety, and efficacy of autologous fat gra:ing (AFG) in breast reconstruc+on. We have reviewed 15 studies that encompass various aspects of AFG, including pa+ent-reported outcomes, fat gra:ing techniques, immediate reconstruc+on, aesthe+c evalua+on, pain allevia+on, stromal vascular frac+on enhancement, oncological safety, and clinical outcomes with different processing techniques. Overall, the studies suggest that AFG is a safe and effec+ve method for breast reconstruc+on, with promising results in improving breast aesthe+cs and reducing postopera+ve pain. Although lipofilling with autologous fat is widely used in breast reconstruc+on, further research is needed to op+mize fat gra:ing techniques and determine long-term oncological safety.

Background: Giant cell tumor of the tendon sheath (GCTTS) is a relatively common tumor of the hand with indeterminate aetiol- ogy and pathogenesis, although several theories have been put forward. Objectives: To conduct a study examining the association of presenting pathology and post-operative functional and sensation improvement and the risk of recurrence. Methods: In this retrospective study we reviewed and collected data of 29 patients with GCTTS operated over a period of 10 years. All patients underwent a complete excision of the tumors. Results: Follow-up was up to 110 months. A statistically significant improvement of the range of motion in the majority of the digital joints was documented. Statistical analysis of the static two-point discrimination showed no difference before and after surgery. Recurrence was seen in five patients (17.2%) and was not proved to be associated to patients’ age and gender, location and/or size of the tumor. Conclusion: Age, gender, size and location of the GCTTS have no influence on the recurrence rate, but meticulous surgical exci- sion is of paramount importance to reduce high recurrence rates.

Background: Bariatric surgery is still evolving and numerous procedures with a plethora of variations are presently advocated as a method of choice to treat morbid obesity. Aim and objectives: The current study aimed to compare short-term outcomes of sleeve gastrectomy operation with those of combined sleeve gastrectomy and loop bipartition procedure regarding weight loss, operative time, hospital stay and early complications. In addition to improve our surgical management strategy of obesity and its related co-morbidities by using the best surgical procedure. Patients and methods: A prospective randomized controlled trial was conducted in the period between January 2020 and November 2022. It was conducted at Department of General Surgery of Assiut University Hospitals. Results: The main findings of the current study were; 1) mean operative time was significantly lower operative time in group A (72.89 ± 8.98 vs. 98.11 ± 10.11 (minute), 2) majority of both groups had no complications, 3) group B had significantly lower mean percentage of excess weight loss (73.45 ± 10.12 vs. 60.16 ± 9.99 (%) and body mass index after one year was insignificantly lower in group B (29.12 ± 1.45 vs. 34.22 ± 1.11 (kg/m2) after one year and 4) group B had significantly higher frequency of remission rate of diabetes mellitus (90.5% vs. 68.4%) and gastroesophageal reflux disease (90.9% vs. 52.3%). Conclusion: The percentage excess weight loss at 12 months after SASI bypass was significantly higher than after sleeve gastroectomy. SASI bypass conferred better remission and improvement in diabetes mellitus and gastroesophageal reflux disease and had longer operation time than sleeve gastroectomy. Both procedures had similar weight loss at 6 months postoperatively and comparable complication rates.

Background: Ventral abdominal hernias are common surgical conditions which can be presented as emergency and elective cases. The repairs of ventral hernias have always been a big challenge to the surgeons. Mesh hernioplasty was considered as a golden choice to prevent or minimize incidence of recurrence but the question is where the surgeons should put the mesh sublay or onlay. Objective: To compare onlay versus sublay technique in ventral hernia repair in term of procedure and outcome. Methods: A prospective study of (120) patients submitted for ventral hernias repair in Surgical unit of Al-Imam Al-Hussein medical city. We collected cases in one year from (1st January 2015 to 1st January 2016) and follow up continue until (January 2017). Sixty patients were managed by onlay (group A) mesh repair and 60 patients were managed by sublay (group B) mesh repair. Data collected in both groups was made with regards to operation time, placement and duration needed for drain removal, wound infection, and recurrence rate. Follow up every three month for 24 months was done. Data were analyzed using SPSS 18.0 software with, Fisher’s exact test as appropriate; p 0 .05 was considered to be statistically significant. Results: In sublay group Seroma formation was found in two patients (3.33%) while 12(20%) in onlay group. Wound infection was found in one patient (1.66%) in sublay group while 6(10%) in onlay group. No septic mesh was removed in sublay while one mesh was removed in onlay type. In onlay group recurrence was found in 4 patients (6.66%) while there is no recurrence in the sublay group. Conclusion: Sublay mesh hernioplasty is a better alternative to onlay mesh hernioplasty for all forms of ventral hernia cases.

Introduction: Laparoscopic cholecystectomy is the standard surgical procedure for gallstone disease. Difficulties could face the surgeons regarding the identification of the Critical View of Safety. Many techniques that are called salvage or bail-out techniques had been developed to deal with such conditions. We investigated a combination of three techniques namely laparoscopic fundus first lumen guided sub-total reconstituting cholecystectomy as another option. Methodology: A prospectively collected data from 1783 laparoscopic exploration of gallstone disease. Data on patient demographics, (Nassar) operative difficulty grade, operative time, perioperative complications, and mortality were recorded. Results: One hundred twenty-six patients were found to have Nasser difficulty grade above 3 and were involved in this study of whom 39 were males and 87 were females with average age of 49.9 years. The difficulties were dense adhesions at Calot’s, Hartman's pouch stones, short wide cystic duct, and small contracted and gangrenous gall bladder respectively. There is one incidence each of conversion surgery, CBD stone, biliary fistula, paralytic ileus, and port site infection and we report two cases of sub-hepatic collection. Conversion to open cholecystectomy was done in one patient in whom difficulties still even with such measures. The mean duration of our surgical procedure was 70.1±18 minutes; a result that is statistically significant more than the classical procedure where the critical view of safety was visualized and less than that when each technique was performed separately. The sub-hepatic drain was put routinely in all salvage techniques to minimize post-operative Sub hepatic collections. triple techniques significantly decreased the incidence of bile duct injuries and hence open conversion when compared with conventional procedures in difficult cholecystectomy but not in simple ones. Mortality is a very rare complication. In all techniques. only a few cases have been reported but for a cause unrelated to the procedure. For the same reason; the triple technique is associated with a statistically significant reduction in post-operative hospital stay when compared with classical techniques related to the dramatic reduction in the associated complications. Conclusion: A combination of three salvage techniques namely, laparoscopic fundus first subtotal reconstituting cholecystectomy will help to minimize but not eliminate the complications associated with operation to difficult gall bladder and will assist the surgeon in managing difficult operative conditions.

Background. Acute biliary pancreatitis (ABP) is an inflammation of the pancreas associated with gallstones. However, only 4 % to 8 % of patients with biliary stones in the common bile duct develop acute pancreatitis, suggesting that other factors should play a role. Materials and methods. We analyzed the results of treatment of 318 patients with confirmed ABP. 152 had an early cholecystec- tomy (EC) (within 72 hours). In 166 patients, cholecystectomy was not performed for various reasons. The main key points for evaluating the effectiveness of EC in ABP were regression of hyperthermia, regression of basic clinical manifestations: respiratory disorders, hemodynamic disorders, enteral disorders, fluid in the abdomen, SIRS, liver dysfunction, renal dysfunction, metabolic disorders (4 days of treatment) and the number of complications (14-21 days of treatment). Results. EC had a positive effect on the regression of hyperthermia. In patients after cholecystectomy, we observed a faster re- gression of respiratory disorders (p=0.042; χ2=4.12), enteric disorders (p=0.024; χ2=5.03) and SIRS (p=0.033; χ2=4.50). We did not notice a significant difference in the regression of such indicators as hemodynamic disorders (p=0.799; χ2=0.06), renal dysfunction (p=0.749; χ2=0.10) and metabolic disorders (p=0.492; χ2=0.47). After EC, the frequency of peripancreatic fluid collection was lower (р=0.043). Pancreatic abscess (p=0.008) and pancreatic pseudocyst (p=0.009) were less frequently diagnosed in them. Conclusion. There is no doubt that the effectiveness of treatment of ABP depends on a complex of measures, which include a combination of drug therapy and surgical measures: endoscopy and laparoscopy. However, in our opinion, EC should be consid- ered in patients with ABP, regardless of the severity of pancreatitis at the time of first hospitalization.

Background: Gastric cancer is one of the main causes of mortality due to malignancy. Tumor-associated neutrophil (TAN) has an immunosuppressor role and is related to prognosis. But the mechanism is unknown. The present study investigated the role of CD15 (TAN) in gastric cancer. Methods and Materials: Our study was cross-sectional and made on 40 recognized patients of gastric cancer. Immunohistochemical staining for CD15 was done on gastric cancer tissues. Tumor behaviors were estimated by histopathological assessments. Results: CD15 positivity was revealed in 17 (42.5%) of all evaluated patients. The evaluation of the connection between CD15 expression and demographic data and tumor characteristics revealed no significant relationship between CD15 expression and patients’ sex, age, tumor site, and size, subtype of tumor, tumor grade and stage, perineural invasion, and lymphovascular invasion (Pvalue>0.05). Conclusion: Gastric cancer prognosis is related to diverse immune cells in the tumor microenvironment but in our society, the CD15 expression hasn’t any relationship with aggressive histopathologic features of this tumor.

Background. Magnification endoscopy- Narrow Band Imaging (NBI) is a form of advanced endoscopic imaging technique (AEIT) which uses optical image enhancement over white light endoscopy (WLE) as a reliable method for identifying gastrointestinal lesions and predicting its histology in real time as well as the depth of involvement. Materials and Methods. High-resolution (HR) Olympus Evis Exera III CLV-190 HD endoscope with magnifying narrowband imaging (NBI-ME) was used to perform upper and lower GI endoscopy in 327 patients with symptoms related to gastrointestinal system at our endoscopy suite (Department of General Surgery) by an endoscopist with more than 10 years of experience in the field. Real time endoscopic assessment of lesions using NBI-ME classification systems for both upper and lower GI endoscopy was done. Targeted biopsies were taken in each case for comparative analyses. The study design was approved by the institutional ethics committee (D.No.1795/FM). Results. Out of total 327 patients, 177 underwent upper GI endoscopy & 150 underwent lower GI endoscopy. Mean age of resentation was 41.14 ±16.0 years. Overall sensitivity, specificity, PPV, NPV and accuracy of NBI-ME for upper GIT for nonneoplastic lesions was 96.8,91.1,96.8,91.1 & 95.3% respectively & for neoplastic lesions was 90.0, 99.2, 96.4 ,97.6 & 97.4 (%) respectively. For lower GI endoscopy, Japanese NBI Expert Team (JNET) classification system was applicable in 90 polypoidal lesions. As per lower GI NBI endoscopy performed, the sensitivity, specificity, PPV, NPV and accuracy for detecting neoplastic lesions was 92.3, 98.2, 94.7, 97.3 and 96.6 (%) respectively. Overall, the sensitivity, specificity, PPV, NPV and accuracy parameters of NBI endoscopy for both neoplastic and non-neoplastic lesions of upper GIT and for JNET-NBI type 1 and type 3 lesions is high. Conclusion. Targeted biopsies from suspicious areas using narrow band imaging endoscopy has a higher yield in detecting various GI lesions.

Background: This study aims to determine the factors affecting cecal intubation time (CIT) during colonoscopy and to reveal the correctable ones. Materıals and Methods: A total of 304 adult patients underwent colonoscopic examination were included in this study. Colonoscopic examinations were carried out by three different experienced endoscopists as A, B, and C. While endoscopist A used non-nurse-assisted method during colonoscopy, B and C used nurse-assisted method. The Boston Bowel Preparation Scale (BBPS) was used for the evaluation of colon cleansing. If the total BBPS score was ≥6 and/or any segment’s score was >1, the colon cleansing was defined as adequate. Results: The mean age of the patients was 52 (±13) years and 139 (46%) were male. The numbers of colonoscopies performed by endoscopists A, B, and C were 89 (29%), 100 (33%), and 115 (38%), respectively. The mean BBPS score of the patients was 6.7 (±1.6). The mean CIT of the patients was 4.6 (±2.5) minutes. CIT was significantly longer in patients with a history of abdominal surgery (p=0.001). CIT among the endoscopists were significantly different (p0.001), the shortest being observed for endoscopist A (2.9, 4.6, and 5.9 minutes for A, B, and C, respectively). Furthermore, CIT was significantly longer for the nurse-assisted method and patients with inadequate colon cleansing (p0.001). Conclusion: The experience of endoscopist, colon cleansing score, and the nurse-assisted method were identified as the most important factors determining CIT. Adequate colon cleansing and the nurse-assisted method are changeable factors.

Background and Objectives: The sentinel node (SN) concept allowed the selection of pN+ breast cancer (BC) patients to undergo complete axillary dissection (AD). However, the majority do not have additional axillary nodes involved. Therefore, some centres developed clinical decision rules (CDR), based on clinical and pathology variables, to assist in the decision to perform AD. The aim of our study was to evaluate the CDR of the Breast Center of the Centro Hospitalar Universitário São João in Porto (CHUSJ) and to compare its results with the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial criteria. Methods: We performed a retrospective analysis of a consecutive series of SN-positive BC patients, treated between 2012 and 2019. Results: Among the 418 included patients, 173 (41.4%) were submitted to AD and 245 (58.6%) were spared. In the group submitted to AD, additional positive non-sentinel nodes (NSN) were found in 89 patients (51.4%). In the group spared to AD, two patients (0.8%) had an axillary lymph node recurrence. Conclusions: In BC patients with a positive SN, applying the CHUSJ-CDR reduced the rate of AD to 41.4%, lowering arm and shoulder morbidity caused by this invasive procedure while maintaining a reduced probability of regional recurrence.

Introduction: Breast cancer patients with multicentric disease will require mastectomy advances of screening and genetics have ended in many ladies may needs prophylactic mastectomy nipple and areola sparing is good option for these patients with higher levels of psychosocial wellbeing. Patient and methods: The 300 breast cancer patients all have NSM for the therapy of multicentric breast cancer. The primary end point was tumor recurrence post NSM either was local, regional or metastatic recurrence and, the Secondary end point for this study is to report disease free survival, loco-regional control and overall survival Results: All cases were multicentric invasive duct carcinoma, 6 cases (33.3%) were reported to have distant metastases to lung and bone and 12 cases (66.7%) were reported to have local recurrence within nipple areola complex, among reported recurrence cases the interval time between primary treatment and recurrence was 28 months in 6 cases (33.3%), 43 months in 6 cases (33.3%) and 50 months in 6 cases (33.3%). Among 300 cases that did NSM, 6 cases (2%) died from heavy lung metastases and 294 cases (98%) still alive within period of follow up ranging from 40-96 months. Conclusion: This study revealed a low incidence of cancer recurrence at the NAC after NSM and immediate breast reconstruction. Patients with high stage disease, HER2 positive subtype, high grade lesions and extensive intraductal component had a significantly increased risk of cancer recurrence at the NAC.

Aims: To determine effects of mechanical versus pharmacological prophylaxis for Deep Vein Thrombosis/Pulmonary Embolism in patients undergoing elective surgery in moderate risk patients and to know the difference in cost of treatment in 2 groups. Methods: Patients were selected if they fulfil the eligibility criteria. They were described about the nature of the study and written consent was taken if they were willing to take part in the study. All the surgical procedures were carried out as regular standard of care. Patients were selected into either group (mechanical or pharmacological prophylaxis group). Results: Between March 2021 and July 2022, 149 patients were recruited. 80 patients received mechanical prophylaxis whereas 69 patients received pharmacological prophylaxis. None of the patients developed DVT/ PE, irrespective of the groups i.e. Incidence of DVT/ PE in both groups was zero. The cost of treatment was compared among the two groups and statistically significant difference was noted. The pharmacological prophylaxis with a mean cost of Rs.942 proved to be a cheaper option as compared to the mechanical prophylaxis (DVT-18 stockings) with a mean cost of Rs.1998. Conclusion: For patients who underwent elective surgery and are at moderate risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis or mechanical prophylaxis proved to be equally effective with pharmacological prophylaxis being an economical option.

Background: Diabetic foot ulcers (DFUs) are a prevalent clinical issue. Platelet rich plasma (PRP) has a new promise in the therapy of chronic ulcers, with cellular and tissue regeneration, as a result of several breakthroughs in wound care management. The goal of this study was to evaluate the efficacy and safety of PRP local application dressings and local PRP injection for DFU healing to a control therapy of traditional classic dressing. Patients and methods: Forty-five patients with DFU were randomly allocated to PRP local application dressings (n = 15), local PRP injections (n = 15), or traditional dressing alone (n = 15) from August 2019 to March 2021. Ulcer healing and area reduction were the primary objectives at 3, 6, and 12 months. There were additional complications and ulcer recurrences discovered. The study comprised 36 (80.0%) males and 9 (20.0%) females between the ages of 23 and 65 who had DFU for 1 to 10 years. Results: Local PRP injections improved healing (12/15, 80%) greater than local PRP dressings (10/15, 66.7%) and conventional dressings (7/15, 46.7%). When compared to the other two groups, the healing period following local PRP injection was much shorter. At all follow-up visits, the PRP injection resulted in a higher area decrease than the traditional dressing. The groups had similar rates of recurrence and complications. PRP injection accelerates the healing of chronic diabetic ulcers more than PRP local application or traditional dressing. All of them had similar recurrence and safety. Conclusions: PRP injection is a more potent technique for treating DFU than local PRP administration and traditional wound dressings, with less recurrence. Amputation rates, infection rates, and discharges are all reduced with PRP injection.

Background: The first appendectomy was performed in 1880 for the case of acute appendicitis in England. No perfect diagnostic evaluation tool exists if symptoms are vague in nature. There are multiple diagnostic approaches which include symptomatology, physical examinations, laboratory findings and imaging studies such as Ultrasonography (USG), Computerised Tomography (CT) of abdomen. Scoring system is a method which helps in estimating the probability of having the corresponding disease in a patient. Such scoring system is of a simple design and easy to implement. One of the system is Alvarado scoring system which is simple enough to apply and it is effective. This system lacks in certain aspects, it doesn’t include C- Reactive Protein (CRP) as a variable. Appendicitis Inflammatory Response Score (AIRS) was introduced recently which was prepared in the view of the drawbacks in the Alvarado score, includes the CRP value in it. This score can help in diagnosing appendicitis in the suspected patients who require timely surgery or those who are in need of further evaluation. Methodology: 130 patients with pain in Right Iliac Fossa with provisional diagnosis of Acute Appendicitis were taken for study. Informed, valid, written consent for surgery was taken and was operated by experienced surgeons.. Intra-operative findings, histopathological reports, post-operative complications and post-operative hospital stay were recorded. Based on all above findings AIRS score was calculated. Results: Out of 130 patients majority of the patients were found in the score of 5-8 with 67 (51.53%) patients. It was followed by 36 (27.69%) patients having AIRS score >8 and only 27 (20.76%) patients with score 4. This suggests the accuracy level of the AIRS score to diagnose the severity of the acute appendicitis in the study population. Conclusion: AIRS aided in accurate diagnosis of acute appendicitis which can help in taking correct decision regarding the therapeutic approach to manage the patient surgically. AIRS scoring system can help in improving the overall health outcome of the patient due to correct management of the patients.

Background: This study was done to establish the outcomes of surgical procedure in management of Ileal Perforation. Methods: This study included 70 patients admitted to Surgical Emergency with acute abdomen. These patients were divided into 3 groups group A, group B, group C. The surgical management was done as primary repair (group A) and resection and anastomosis (group B) and primary repair with ileostomy (group C) ; Comparative study was done between all procedure. Results: This study highlights the life-saving role of loop ileostomy for postoperative intestinal leakage in cases of primary repair of perforation. It is recommend that whenever intestinal leakage is suspected in the postoperative period, urgent exploratory laparotomy must be undertaken and the continuing peritoneal contamination should be controlled by exteriorizing the site of intestinal leak as loop ileostomy. Conclusion: In our study we have found that, for a single perforation, primary repair is the procedure of choice and for multiple perforation with good systemic support, resection anastomosis is procedure of choice. For patient with poor systemic support, loop ileostomy is preferred procedure as it decreases the mortality.

Aim: The present study aimed to identify risk factors for the development of complications following the surgery for ventral hernia. Material and Methods: This was a single-centre, hospital-based, retrospective, observational study. The data relating to all patients who underwent any type of surgery at the JK, Hospital Bhopal is maintained by the institute’s medical records department. For the present study, we analysed the data of all the patients who underwent ventral hernia repair between January 2020 and December 2022 at JK Hospital, Bhopal. For this study, we limited the follow-up time for the development complications to three months from the date of surgery. Results: A total of 30 (24.2%) out of 124 patients who underwent ventral hernia repair at the institute developed complications within 3 months of surgery. Further, according to the Clavien-Dindo classification- 22 patients had Clavien type I–IIIa complications, Clavien type IIIb complications, and 1 patient each had Clavien type IV and Clavien type V complications. Among the analysed risk factors- age, hernia size >63 mm, concomitant GI surgery, being obese (BMI >30), presence of comorbidities, and postoperative hospital stay > 7 days were significantly associated with the development of complications. Further, the gender of patients, smoking, type of surgery, and ASA grade were not significantly associated with the development of complications. Conclusions: Several risk factors increase the likelihood of complications after hernia surgery. Both patients and surgeons should be aware of these risk factors and discuss them during consultation before undergoing surgery. By doing so, they can make an informed decision about the best course of treatment and take steps to minimize the risk of complications.

Oesophageal perforation is a catastrophic and fatal disease without early recognition and optimal management. The rarity of the disease and atypical presentations often delay the diagnosis, and it is associated with high mortality. Good clinical judgement and early suspicion of oesophageal perforation should be emphasised. Surgery has been the mainstay treatment; however, it remains controversial in delayed presentation. A 46-year-old female complained of acute abdominal pain, vomiting and dyspnoea. She had a recent endoscopic intervention for foreign body removal. Her abdominal computed tomography findings suggest a perforated gastric ulcer, and she underwent an exploratory laparotomy. However, no visceral perforation was identified intraoperatively. The diagnosis of oesophageal perforation was eventually confirmed by computed tomography thorax and oesophagogastroduodenoscopy. The patient was successfully managed conservatively and made an uneventful recovery. Our case highlights the feasibility of non-operative management in delayed oesophageal perforation.

Abdominal wall disruption is a rare complication of blunt abdominal trauma, diagnosis of which is often missed. We present a case of 41 year old gentleman presented with swelling over anterior abdomen secondary to blunt abdominal trauma. Physical examination and CECT abdomen revealed traumatic abdominal wall disruption with herniation of viable small bowel loops. He was treated with elective open hernia repair using mesh plasty. Our case reinforces the need for early diagnosis of traumatic abdominal wall disruption and prompt surgical treatment.

Two elderly female with acute suppurative thyroiditis presented with 2 different end of clinical spectrum and two different surgical approach. Both of them had underlying long-standing asymptomatic euthyroid multinodular goitre. Both of them also had diabetes mellitus. The first case had a sterile thyroid abscess while the second case had Pseudomonas as the culprit. Discussion pointed on the need of aggressiveness in the surgical approach with the favourable outcome. It is also important point in management to minimize the risk and complication without compromising the initial diagnosis of infection.

There have been numerous discussions regarding diagnosing and revascularization options for acute mesenteric ischemia to improve its dire outcome. However, equally important is the management of the complications following successful intestinal revascularization. Refeeding syndrome (RS) is one the possible complications, yet there has been lack of report in the literature on this condition following intestinal revascularization. Here, we present a case of acute embolic mesenteric ischemia (AEMI) with RS as one of its complications despite the patient being categorized as low risk to develop it. This report discusses and highlights the key point at each stage of patient’s management, especially the importance of identifying and early treatment of complications post intestinal revascularization