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Introduction: Gallstones patients are mostly asymptomatic, but yet, it addsconsiderable burden to health care system as only in United States more than 600000laparoscopic cholecystectomies are performed annually. The introduction of day care withlaparoscopic (LC) surgery in the late 1980s increased the rate of cholecystectomy for about20%. This new intervention introduced changes in indications of cholecystectomy and putfurther impact on health care system. After the introduction of LC, many studies have highlightedand discussed the importance of adequate surgical skills in order to improve the timing andoutcome of surgery. The aim of this study was to see the conversion from laparoscopic to opensurgery in symptomatic patients. Study Design: Descriptive Cross Sectional Study. Period:January 2013 to 2015. Setting: Surgical unit I of Peoples Medical College Hospital Nawabshah.Methods: Study population consists of two hundred cases having non probability consecutivepatients of cholelithiasis who were eligible on inclusion criteria. Results: The conversion ratewas 10 %, seven (3.5%) patients had biliary injury, six (3%) had adhesions, four (2%) patienthad vascular injury, two (1%) patients had gut injury, one (0.5%) patient had dilated commonbile duct. Conclusion: Proper pre-operative assessment and proper anatomical recognition ofCalot’s triangle reduce the rates in conversion from laparoscopic to open surgery.

Introduction: The cleansing of intestinal contents, were considered the mostimportant factor in the prevention of complications by most of the surgeons. While morbidityand mortality have been a matter of main concern in colorectal surgery during the past severaldecades. Despite these drawbacks mechanical bowel preparation is till practiced by most ofthe colorectal surgeons worldwide in elective colorectal surgery. So the aims of this study wereto find out the frequencies of wound infections, hospital stay, anastomotic leak and wounddehiscence’s in patients of two cohorts underwent elective colorectal surgery. Study Design:Prospective randomized control trial (RCT) study after having informed consent of participationas per described policy. Setting: Surgical Unit – I of People’s University of Medical and HealthSciences Nawabshah. Period: January 2012 to March 2016. Methods: 112 patients of bothgenders from 20-65 years in age, who underwent for Elective open colorectal surgery. In MBP,Sulphate and electrolyte free 136gm of polyethylence glycol (PEG) / two sachets with three litersof water were begun over 12 to 16 hours, the day before surgery in cohorts A only. Results:Regarding outcomes, wound infections were 12.5% and 16% in group A & B respectively. Therewas no remarkable difference in post-operative length of hospital stay with mean stay of 8+2and 9+2 in group A & B respectively. While disruption of anastomosis were 5.3% and 9% ingroup A & B respectively, while the frequency of incisional hernia was same in both groups.Conclusion: There is no benefit of enduring MBP in Elective Colorectal Surgery and can safelybe performed without it.

Objectives: To evaluate the management strategies of patients with ileocaecaltuberculosis. Study Design: Cross sectional multi-institutional study. Period: One year. Setting:Liaquat University Hospital Hyderabad / Jamshoro and Peoples University Hospital Nawabshah.Patients and Methods: All the patients of ≥11 years of age, either gender diagnosed asileocaecal tuberculosis were recruited, enrolled and evaluate for management strategies. Thedata was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:During one year study period total 85 patients were identified and diagnosed as ileocaecaltuberculosis. The mean age ±SD for whole population was 39.72±7.73 while it was 37.87±8.83and 40.88±8.52 in male and female population whereas the mean ± SD for duration ofsymptoms of whole study population was 5.52±1.61 months respectively. Sixty nine (81%)patients managed surgical while 16 (19%) managed conservatively. The non specific symptomsi.e. fever, pain and tender abdomen, loss of weight and appetite was observed while 70%subjects had Hb% was 40 mm/1st hour whereascommon radiological impression observed were narrowing of terminal ileum, pulled up caecumand obtuse ileocaecal angle. Conclusion: Ileocaecal tuberculosis management includesconservatives and surgical, the surgical options are ileocaecal resection, right hemicolectomiesand stricturoplasty

… Background: Acute appendicitis continues to be the most common surgical problem till date and its diagnosis in this era of advance innovation still remains to be on lock horns, resulting in the high rates of negative appendectomy. In this perplexed dilemma the designed scoring systems have been forwarded to aid the clinical accuracy in patients for suspicious appendicitis.The appendicitis Inflammatory Response (AIR) score has outperformed the more widespread Alvarado scoring (ALS) in many documented studies. So, the aim of this study was to evaluate and compare the AIR score with ALS system for diagnostic accuracy in patients with suspicious appendicitis. Study Design: Prospective comparative study to evaluate the AIR and ALS at score of (5 – 8) in 150 patients with suspected appendicitis. Setting: Tertiary care hospital. Period: March 2016 to January 2018. Methods: The score were measured and compared for diagnostic accuracy through statistical analysis. Results: This prospective study has drawn an inference that AIR scoring system for suspicious appendicitis has slightly higher percentage (91.07%) of sensitivity compared to ALS system (86.36%). This study enunciates the positive, negative predictive values for profound accuracy of diagnosis with 91.07%, 73.68% and 86.67% by AIRs and 86.36%, 62.50% and 80% by ALS systems (ALs) respectively. Among 150 patients, 30 (20%) were with negative appendectomies. Conclusion: The data of present study appreciate that:AIRs system having variable of CRP and WBC has high diagnostic accuracy in comparison to ALS system of patients with suspected appendicitis.AIRs can safely protect the health care resource by avoiding un-necessary hospitalization, Investigations and interventions.

Objectives: To determine the frequency and clinical pattern of mass in rightiliac fossa. Study Design: Cross sectional multicenter study. Period: One year (from 03 March2014 to 02 March 2015). Setting: Patients with right iliac fossa mass of >11 years of and ofeither gender admitted in department of surgery at Liaquat university hospital Hyderabad /Jamshoro and Peoples University Hospital Nawabshah. Patients and methods: The data wasanalyzed in SPSS 16 and the frequency and percentage was calculated. Results: During oneyear study period, out of 227 patients, 112 subjects were observed to have right iliac fossa massdue to different etiologies, of which 82(73.2%) were males and 30 (26.8%) were females. Themean age ±SD for overall population was 39.32±8.66 while it was 37.88±6.75 and 38.93±7.72in male and female population respectively. The male population was predominant while thepatterns observed were appendicular mass in 19(17%), appendicular abscess in 26(23.21%),ileocaecal tuberculosis in 38(34%), carcinoma caecum in 14(12.5%), psoas abscess in 5(4.46%)and others in 10(9%) respectively. Conclusion: The highest incidence of mass in the right iliacfossa was seen in second, third and four decades with male population predominance. Thecommon disorders identified were ileocaecal tuberculosis, appendicular mass and abscessand carcinoma caecum respectively