Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding.

Penile prosthesis surgery plays a vital role in the treatment of erectile dysfunction (ED). As far as outcome is concerned, it is one of the most rewarding procedures for both patients and surgeons. We describe our surgical technique for implantation of the three-piece inflatable penile prosthesis and point out the major surgical pitfalls accompanying this procedure and their specific management. The psychological outcome of penile prosthesis surgery is also discussed. Different surgical approaches are available when performing the procedure. A number of procedure-related problems can be encountered and a thorough knowledge of these is of paramount importance. Penile prosthesis surgery has a favorable psychological outcome. Surgery for implantation of an inflatable penile prosthesis is a rewarding procedure, with a high yield of patient satisfaction. Urologists should have thorough understanding of the surgical pitfalls peculiar to this procedure and their management.

Aim : Nowadays laparoscopic-assisted appendicectomy using the two-port technique is gaining popularity due to its certain benefits over the open version. General anesthesia with positive pressure ventilation is the preferred mode of anesthesia in this technique. We conducted a pilot study using the two-port technique in adult patients, with uncomplicated appendicitis under local anesthesia, to evaluate its feasibility. Materials and Methods: In this prospective study 12 consecutive patients of ASA grade I and II, with a mean age of 22.5 years, suffering from acute appendicitis, were included. All the patients received ondansetron, diazepam, and pentazocine as premedication. Monitored anesthesia care was given. The site of trocar insertions were infiltrated with 1% lignocaine with adrenalin. The pneumoperitoneum was created using carbon-di-oxide. After exteriorization of the appendix using the trocar, appendicectomy was performed as in the open procedure. Results : Eleven out of twelve patients were successfully operated using this method without converting it into an open method. Two cases required an extra port to free the appendix from the adhesion. There were no intra- or post-operative complications present. Conclusion: Two-port laparoscopic-assisted appendicectomy under local anesthesia is a safe and effective method for uncomplicated appendicitis in adults, and the procedure is suitable where limited set-up for anesthesia is present.

Everyday, neurosurgeons face the problem of orientation within the brain but the advent of stereotactic surgery and neuronavigation have solved this problem. Frame-based stereotactic systems (FBSS) and neuronavigation systems have their own strengths and priority and pitfalls, which were the main driving force for us to design a new system. This hybrid system comprises three main parts: main frame, monitoring system, and pantograph, which are connected to each other and to the operating table by particular attachments. For using this system, after performing CT SCAN or Magnetic Resonance Imaging (MRI) the axial view will be transferred to Liquid Cristal Display (LCD). In the operating room, the head of the patient fixes to the operating table and registration is completed by two arms of pantograph. We made a simulation operation with our system on an occipital cavernous angioma and a frontal oligodendroglioma. The software, which have been used for simulation were as follows; Poser (version-7), Catia (version 5- R18), and 3 Dimension Max (version 2008). The accuracy of this system is approximately two millimeter. The advantages of this system are: easy to use, much less expensive, and compatible with different devices, which may be needed during neurosurgical operation. For countries that do not have the opportunity to have sophisticated technology and neuronavigation system, we believe that our system is a one-stop solution.

Wireless capsule endoscopy is a new tool in the armamentarium of the gastroenterologist to evaluate the small bowel non-invasively. It allows improved diagnostic yield with low complication rates relative to traditional modalities. But this new technology has its own set of complications, some which can lead to significant morbidity. Here, we present a case of complete small bowel obstruction following a capsule endoscopy. A 65-year-old female with a long standing history of anemia and obscure gastrointestinal bleed presented to the Emergency Department 72 hours after a wireless capsule endoscopy procedure complaining of worsening abdominal pain, distension, and frequent vomiting. An X-ray was suggestive of complete distal small bowel obstruction with the capsule at the transition point of dilated proximal and collapsed distal small bowel. The patient was resuscitated and taken up for an explorative laparotomy where a short segment stricture was noted with the capsule endoscope caught proximal to it. The segment was resected and patient made an uneventful recovery. Wireless capsule endoscopy is now becoming the preferred method to image the small bowel. Our report illustrates the importance of appropriate patient selection and evaluation of functional patency of the small bowel may be with a contrast series prior to wireless capsule endoscopy to avoid any post procedural morbidity.

We present a 32-year-old woman with primary cutaneous aspergillosis and an apparently normal immune status. She is a dietitian who carried out research on Aspergillus contamination of palm oil over a six-month period, during which she apparently shaved her axillae and perineum using a safety razor blade. She presented with nodular lesions, which became extensive ulcers after an attempt at incision and drainage. Diagnosis was based on culture and histology. The patient was treated with itraconazole 200 mg twice a day, with surgical excision and a rhomboid flap cover of the axillae. She has remained disease-free five years after discharge. This highlights the likely benefits of a combination of surgical excision and drug therapy, in achieving a cure in this patient.

The canal of Nuck is analogous to a patent processus vaginalis in a male, which normally loses its communication to the peritoneal cavity within the first year of life. Failure of obliteration of this tract can result in a hydrocele. We present a rare case of a 3-year-old girl with right-sided groin swelling over a year, diagnosed as hydrocele of canal of Nuck. Patient underwent surgical exploration and excision of hydrocelea. This entity should be considered in young females presenting with an inguinal swelling.

The most common somatic type malignancy arising in patients with testicular germ cell tumors (GCTs) is sarcoma. Development of carcinomas, especially squamous cell carcinoma is an extremely rare event. Most cases of metastatic umbilical nodules (Sister Mary Joseph nodule) develop from adenocarcinomas. Fifteen percent of such cases have unknown origin; but development from a testicular squamous cell carcinoma has not yet been reported in the literature. We report a rare case of somatic type squamous cell carcinoma arising in a testicular teratoma. It is also possibly the first reported case of its kind which presented with a metastatic umbilical nodule. This possibility should be kept in mind while evaluating metastatic umbilical nodules in young male patients.

Open musculoskeletal injuries remain a difficult problem to manage especially in resource-poor regions. They are complicated by prolonged morbidity and chronic osseous infections and sometimes gangrene. Our objective was to look at ankle arthrodesis as a primary and useful salvage procedure through simple technique for cases of severe open ankle injuries. Three patients with severe open ankle injuries between January 2007 and December 2009 were seen and had wound debridement done and compressive ankle arthrodesis with a Charnley's arthrodesis clamp. Tibiotalar and tibiocalcaneal arthrodesis was the procedure carried out. Patients were followed up for 3-12 months. Wound breakdown was seen in two cases and one later had skin grafting. All patients expressed satisfaction with the outcome of surgery. Ankle arthrodesis is a simple and useful salvage procedure for severe ankle disruption, guaranteeing patients satisfaction as against amputation.

Laparoscopic radical nephrectomy is a minimally invasive surgical procedure and is in practice since 1992 in USA. We describe the novel technique of this procedure with an added advantage. Controlling renal vessels first at the hilum with lymphadenectomy is our principle of surgery. This technique is known as transperitoneal medial to lateral approach radical nephrectomy.