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Objective: To evaluate the frequency of surgical site infection after pressure saline irrigation in open appendectomy for uncomplicated and complicated cases. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2017 to Mar 2018. Methodology: A total of 300 patients of both gender with inflamed appendix perioperative who underwent open appendectomy were included. The per-operative procedure and post-operative findings were recorded. The patients were grouped into experimental and control Groups on basis of whether saline irrigation was done or not. Then the patients were monitored again on 5th and 10th post-operative day for any surgical site infection. The maximum follow-up time was for a month. Results: Age range in this study was from 10-50 years with mean age of 29.280±6.40 years in Group-A while 29.446±8.28 years in Group-B. Male gender was dominant in both Groups. Surgical site infection was seen in 10(6.7%) patients in Group-A (saline irrigation Group) as compare to 35(23.3%) cases in Group-B (p<0.001). Pressure Saline irrigation did not significantly prevent surgical site infection in uncomplicated cases (p-value=0.331), however, it was effective in preventing infection in complicated cases (p-value<0.001 OR 0.074 95% CI 0.024-0.230). Conclusion: Saline syringe irrigation of wound is a nontoxic, economical, and easily available procedure in any operation theatre to decrease the rate of surgical site infection especially in complicated appendectomy. [ABSTRACT FROM AUTHOR]

Background: In view of importance for competency-based education (CBE), we undertook a self-study to elicit the available operative surgical workload and supervision for residents in the general surgical residency program at the teaching hospital in Karachi. Methodology: This was a cross-sectional study spanning a 5-year period between January 2015 and December 2019. The numbers of surgical residents during this period were identified. Five procedures were selected as core general surgical procedures: incision and drainage of superficial abscess, laparoscopic appendectomy, laparoscopic cholecystectomy, open inguinal hernia repair, and perianal procedures. Trends of the number of residents per year and the numbers of procedures per year were determined. The mean number of core procedures per eligible resident during their entire training was calculated to represent potential operative surgical experience and were benchmarked. The ratio of the average number of residents rotating in general surgery per year to the number of attending surgeons was determined as a measure of available supervision. Result: The mean total number of general surgical residents per year was 31.2 (range 28–35). The numbers of core general surgical procedures were consistent over the years of study. Potential exposure of eligible residents to each core procedure during their entire training was: 19.5 cases for incision and drainage of superficial abscess; 89 cases for laparoscopic appendectomy; 113.6 for inguinal hernia repair, 267.5 for laparoscopic cholecystectomy and 64.5 for perianal procedures. The average yearly residents to full-time attending surgeons' ratio was 2.5. The workload of core general surgical procedures at AKUH was higher than the Accreditation Council for Graduate Medical Education (ACGME) recommended volumes for operative surgical experience for residents in the US. Conclusion: This method of assessing the potential of a surgical program for transitioning to CBE appears practical and can be generalized. [ABSTRACT FROM AUTHOR]

Objective: To compare the post-operative outcomes in pregnant patients with appendicitis undergoing laparoscopic versus open appendicectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgery Department, Qazi Hussain Ahmed Medical Complex, Nowshera Pakistan, from Jan 2018 to Dec 2019. Methodology: This study consisted of patients with acute appendicitis during pregnancy who were presented to Surgery Department or referred to it from Obstetrics and Gynecology Department. Patients were divided into 2 groups: Group A had patients who underwent Laparoscopic appendicectomyand Group B had patients who underwent Open appendicectomy. Postoperative outcomes in both groups including fetal loss, preterm delivery, operative time and surgical complications were observed. The p-value of <0.05 was considered significant. Results: Total of 90 pregnant women were included. Group A consisted of 44 cases and 46 patients were in Group B. The mean maternal age was 24.5 ± 5.2 year (Group A) and 23.5 ± 4.2 years (Group B). About 30 patients (33.33%) were in the first trimester, 38 (42.22%) in second while 22 (24.44%) patients were in the third trimester. Wound infection occurred in two patients in Group B (p=0.08). Fetal loss occurred in one patient in Group A and in 3 patients in Group B (p=0.09). Hospital stay was significantly shorter in Group A (1.4 ± 1.9 days). Conclusions: Laparoscopic appendectomy is safe with low incidence of post operative maternal as well as fetal complications. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of obstructive appendicitis in patients undergoing open appendectomies for acute appendicitis. Negative appendectomy rate will also be calculated. Study Design: Cross-Sectional study. Setting: Department of General Surgery of Ayub Teaching Hospital Abbottabad. Period: September 2019 to February 2020. Material & Methods: The study population included patients of any gender, age from 10 years to 45 years found to have acute appendicitis diagnosed by clinical and ultrasound findings and confirmed by open appendectomy. Sample size of 174 was calculated, using WHO software for sample size calculation. After detailed examination and investigations, patients who underwent open appendectomy as per advice of visiting consultants were included; by filling predesigned research per forma. Results: Mean age of the patients was 26.33±11.177 and more than half were male i-e 106 (60.9%). Where majority i-e 93(53.4%) of appendices were of obstructed type, this wasn't statistically higher than the non-obstructed type (p=0.363). In frequency of operative findings, acutely inflamed appendix was most common with 71(40.8%) patients. While suppurative, gangrenous and perforated samples were noted in 55(31.6%), 13(7.5%) and 8(4.6%) cases respectively. Negative appendectomy was done in 27(15.5%) patients. Conclusion: This study concluded that obstruction was noted in more than half of the cases i-e 93(53.4%), but it was not statistically higher from the other subtype. Negative appendectomy rate was 15.5%; higher than globally set target, but was similar to the one noted in Pakistan by previous researchers. [ABSTRACT FROM AUTHOR]

Objective: To compare intra-operative wound irrigation with normal saline versus irrigation with Imipenem and Cilastatin solution to develop surgical site infections in open appendectomy wounds. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Bahawalnagar Pakistan, from Oct 2015 to Oct 2017. Methodology: Patients diagnosed with cases of acute appendicitis and planned to undergo open appendectomy were randomly divided into two equal groups; Group-A and Group-B. Group-A was subjected to intra-operative wound irrigation with 100 ml saline solution before skin closure. Group-B was irrigated with Imipenem and Cilastatin solution (500 mg diluted in 10ml of distilled water). Development of post-operative Surgical Site Infection was checked till the 30th Post-Operative Day. Results: Frequency of post-operative Surgical Side infection was comparatively less in Group-B (2.4%) as compared to Group-A (8%), which was found to be statistically significant (p-value=0.046) Conclusion: Intra-operative wound irrigation with Imipenem and Cilastatin solution was superior to normal saline irrigation regarding the development of Surgical Site Infection in cases undergoing open appendectomy. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is most frequent cause of acute abdomen in younger population, and surgical site infection (SSI) is commonest complication of appendectomy. The objective of this trial was to compare the efficacy of post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan. Materials & Methods: The randomized placebo trial was conducted at Agency Headquarter Hospital, Wana, South Waziristan, Pakistan from October 1, 2016 to November 18, 2018. One hundred fifty (150) patients were randomly allocated into two groups, 75 in experimental group, to whom antibiotics were given and 75 in placebo group, to whom antibiotics were not given. Age groups and presence of SSI were two variables, being on nominal scale, were described by count and percentage with CI at 80%CL. McNemar chi-square test was applied to test the hypothesis to see the significance of difference between the experimental and placebo groups in terms of frequency of SSI at alpha .05. Results: SSI was present in nine (12%, 80%CI 7.19-16.80%) out of 75 cases in experimental group and in 12 (16%, 80%CI 10.57-21.42%) out of 75 cases in placebo group. McNemar chi-square test showed no significant difference between the experimental and placebo groups in terms of frequency of SSI (p=.2482). Conclusion: The results are comparable for post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan. [ABSTRACT FROM AUTHOR]

Objective: To study the association of total leucocyte count and acute appendicitis among young patients undergoing emergency appendectomy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Quetta Pakistan, from Mar to Oct 2021. Methodology: The study included one hundred patients diagnosed with acute appendicitis by a consultant surgeon undergoing an emergency appendectomy. The total leucocyte count was calculated for all the patients at the time of diagnosis. The treating surgeon confirmed acute appendicitis findings based on gross examination of the appendix at the time of surgery. The presence of acute appendicitis and other factors was associated with raised total leucocyte count in all the patients. Results: Out of 100 patients diagnosed with acute appendicitis, 59 were male, while 41 were female. The mean age of the study participants was 28.33±3.673 years. On gross examination, 79 had a confirmed diagnosis of acute appendicitis, while 21 did not have an inflamed appendix. 85 had raised total leucocyte count, while 15 patients had total leucocyte count in the normal range. Statistical analysis revealed that acute appendicitis on gross examination and raised C-reactive protein had a statistically significant correlation with raised total leucocyte count (p-value: 0.001). Conclusion: Total leucocyte count was significantly raised in patients who had confirmation of inflammation of the appendix at gross examination during the surgery. Raised total leucocyte count and C reactive protein should be given more weightage in diagnosing acute appendicitis and planning for an emergency appendectomy. [ABSTRACT FROM AUTHOR]

Objective: To conduct a thorough audit of laparoscopy as a diagnostic and therapeutic modality in patients with chronic pain abdomen. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Multan Pakistan, from Jul 2015 to Dec 2021. Methodology: One hundred fifty-three patients with chronic abdominal pain were included in this study. The cause of pain in all patients was unknown despite undergoing thorough history, examination and appropriate investigations. Laparoscopy was performed in all patients, and findings were recorded accordingly. Results: A total of 153 patients were included in this study 67(43.8%) patients were male, and 86 (56.2%) were female. The mean age was 33.268±12.171 years (ranging from 15 to 60 years). The average duration of pain was 10.23±2.204 weeks. The diagnosis was confirmed laparoscopically in 143(93.33%) patients. Ten patients remain undiagnosed (6.66%). The most common cause was chronic appendicitis in 68(44.4%), followed by ovarian disorders 35(22.9%). There was a significant improvement in mean pain scores between the pre-and post-operatively periods [6.765±1.116 Vs. 2.961±1.572 (p-value< 0.001)]. Conclusion: Diagnostic laparoscopy has a higher diagnostic and therapeutic accuracy in patients with chronic abdominal pain. It significantly improves post-operative pain. [ABSTRACT FROM AUTHOR]

Objective: To share our institutional experience and outcome of appendectomy in the pediatric population early in our transition from open approach to laparoscopic. Methodology: This retrospective study was conducted in the Pediatric Surgery Unit of Khyber Teaching Hospital, Peshawar, from January 2015 to July 2017. We reviewed records of 233 patients, who underwent appendectomy. All cases were classified into early stage (ES) and complicated appendicitis (CA) on operative findings. Outcome variable includes operative time, length of hospital stay (LOHS), analgesia requirement, parent/care-giver satisfaction and postoperative complications. Clinical and demographic data were collected and analyzed with SPSS 20. Results: A total of 98 patients were operated by laparoscopic appendectomy (LA) and 135 by open appendectomy (OA). The operative time for LA was higher than OA both for early stage (LA 35.5 ±1.78 min, OA 33.5 ±1.68 min, p =0.53) and complicated appendicitis (LA 55 ±1.32 min, OA 40.6 ±2.05 min, p =0.005). Hospital stay in cases of early stage appendicitis was shorter for LA (1.9 ±0.31 days) as comared to OA (2.8 ±0.57 days), p value =0.000; while in complicated cases it was same in both groups (04 days, p =0.28). Analgesia requirement was low for LA, both for ES (p =0.05) and CA (p =0.01). Parents' satisfaction score was significantly higher for LA than OA. Conclusion: Laparoscopic appendectomy is a safe method and a substitute for open appendectomy among children. It should be preferred over open appendectomy even in cases of complicated appendicitis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the usefulness and safety of early versus late oral intake after appendectomy. Study Design: Randomized clinical trial. Place and Duration of Study: Combined Military Hospital Multan from August 2008 to February 2009. Material and Methods: One hundred patients with uncomplicated acute appendicitis, undergoing appendectomy under general anesthesia were included in the study and randomly divided into two equal groups. Early oral intake group (group A) was allowed fluids, when patients were out of effects of general anesthesia. Delayed fed (group B) was started oral fluids, on appearance of normal bowel sounds or passage of flatus. Low residue solid diet was started, after tolerance of oral fluids, in both groups. Results: Early oral intake resulted in start of solid diet earlier by average 9 hours; these patients had normal bowel sounds, and passed flatus, earlier, after 4 hours and 5 hours as compared to late feeding group. Six (12%) patients had mild ileus in early fed group whereas 4(8%) patients in delayed fed group had mild ileus. Thirty eight (76%) early fed patients were very satisfied, as compared to 29 (58%) delayed fed patients. The hospital stay was prolonged by 2 days in delayed fed group. Conclusion: Early oral feeding implemented after appendectomy is safe and effective, with a shortened hospital stay as the primary benefit in patients after appendectomy. [ABSTRACT FROM AUTHOR]

We describe the hematological and clinical features of homozygous Hb Luton (OMIM 141800.0172), a high affinity α-globin variant that has not been previously described in the homozygous state. The proband was found to have a high hemoglobin (Hb) concentration following a routine blood count prior to a planned appendectomy at the age of 16 years. Investigation showed that she was homozygous for both Hb Luton [α89(FG1)His→Leu (CAC>CTC), a high oxygen affinity Hb)] and homozygous for α++-thalassemia (α++-thal), while her mother, maternal aunt and half-brother were heterozygous for these conditions. Further investigation showed that she also had Gilbert's disease and Raynaud's syndrome. As far as we are aware, this is also the first reported family with a subject homozygous for both Hb Luton and α-thal so that the proband has no nomal α-globin. The parents of the proband are first cousins and originate from Pakistan. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare length of hospital stay, pain scores and the rate of wound infections between laparoscopic and open appendectomy. Design: Randomized Controlled trial. Place and Duration of study: This study was conducted in surgical unit I Holy Family hospital, Rawalpindi from 1st June 2009 to 31st May 2010. Patients and methods: The patients were divided into open and laparoscopy groups and their age, sex, time of discharge, pain scores and wound infection rates were compared and analyzed. Results: Total of 160 patients were included in the study, 80 in each group. There were 58% male and 42% female patients. Mean age was 22.78 years (±6.2).Post operative pain scores were significantly less in the laparoscopic group (p<0.05). The length of hospital stay in open group was 35.10 hrs (±5.4) hours and in the laparoscopic group was 38.70(4.8) hrs with a p value of 0.592.Wound infection was 0.037% in open and 0.025% in the laparoscopic group. Conclusions: Laparoscopic appendectomy is superior in terms of less morbidity and shorter post operative hospital stay in the setting of an overworked tertiary care surgical floor of a Pakistani hospital. [ABSTRACT FROM AUTHOR]

Background/Aim: The aim of the study was to compare laparoscopic and open appendectomy (OA) in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009. Patients and Methods: A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy (LA), whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean ±SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability ≤0.05 (P ≤0.05) was considered significant. Results: After randomization, 72 patients in group A and 75 patients in group B were analyzed. The mean age of patients in groups A and B was 23.09 ±8.51 and 23.12±10.42 years, respectively, (P = 0.981). The mean hospital stay was 1.52±0.76 days in group A and 1.70±1.06 days in group B (P = 0.294). The mean operative duration in group A and B were 47.54±12.82 min and 31.36±11.43 min, respectively (P < 0.001). Pain (overall level) was significantly less in group A compared with group B (P = 0.004). The two groups were comparable in terms of other postoperative complications, such as hematoma (P = 0.87), paralytic ileus (P = 0.086), urinary retention (P = 0.504), and wound infection (P = 0.134). Conclusion: LA is an equivalent procedure and not superior to OA in terms of primary outcome measures. [ABSTRACT FROM AUTHOR]