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Conventional hemorrhoidectomy for grade III and IV hemorrhoids is a tedious procedure associated with significant morbidity and a prolonged convalescence. We compared Ligasure™ hemorrhoidectomy with conventional 'closed' Ferguson's hemorrhoidectomy for the treatment of grade III and IV hemorrhoids. Forty-eight consecutive patients of grade III and IV hemorrhoids were randomized to either the Ligasure™ hemorrhoidectomy (28 patients) or Ferguson's hemorrhoidectomy (20 patients). The hemorrhoidal predicle was coagulated with Ligasure™ in the Ligasure™ group and transfied with 2/0 chromic catgut in Ferguson's method. In comparison with Ferguson's method, Ligasure™ hemorrhoidectomy had a shorter operating time (29 vs 12.5 min), less blood loss (22 vs 11.5 ml), less post operative pain as measured on VAS scale and less postoperative complications including hemorrhage (10% vs 3.5%), urinary retention (10% vs 3.5%) and wound breakdown (20% vs 14%). The submucosal dissection technique with Ligasure™ coagulation of the hemorrhoidal pedicle is safe and effective. The blood vessels and tissue are reduced to a wafer thin seal with good hemostasis. Suturing is not required as the mucosal tissue over the pedicle is sealed off with the current. There is minimal lateral spread of either thermal or electrical energy. The external components of the hemorrhoids can also be treated at the same time. Because of its ease of use and less postoperative pain and complication Ligasure™ hemorrhoidectomy can be preformed as a day-care procedure. [ABSTRACT FROM AUTHOR]

Jejunojejunal intussusception with internal herniation of the stomach through a gastrojejunostomy stoma is one of the rarest complications of the previous gastric surgery. The incidence is reported to be less than 0.1 %. An elderly male presented to the emergency room with signs of intestinal obstruction for 1 day. There was also history of appearance of a lump in the mid-abdomen. A primarily healed midline scar of the previous surgery was present; the details of which were not known. X ray abdomen in the erect posture showed multiple air fluid levels. Ultrasonography (USG) revealed dilated stomach with central hyperechogenicity with a peripheral rim of decreased echogenecity. Contrast-enhanced computed tomography (CECT) scan showed jejunojejunal intussusception with internal herniation of the stomach. On laparotomy, it was found that there was a previous gastrojejunostomy with jejunal invagination leading to gangrene of a segment. Resection anastomosis was done. The postoperative period was uneventful. [ABSTRACT FROM AUTHOR]

Spontaneous common bile duct (CBD) perforation is an unusual cause of acute abdomen. It is rarely suspected or correctly diagnosed preoperatively. Clinical presentation is as biliary peritonitis. The common causes are CBD calculus disease, tumors of the bile duct, choledochal cyst and sometimes idiopathic. Treatment is surgical and consists of CBD exploration and repair over a T tube. [ABSTRACT FROM AUTHOR]