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Objectives: To determine the frequency of surgical site infections and surgical site occurrences requiring procedural intervention in patients undergoing inguinal hernia mesh repair. Material and Methods: A cross sectional observational study was conducted over a period of one year, between Feburary 2021 and Feburary 2022. Data of patients with diagnosis of uncomplicated primary inguinal hernia undergoing mesh repair was documented and analysed. Results: Out of 80 patients 10 patients (12.5%) ages between 18-70 years, developed SSI in 5% subjects and SSOPI hematoma (1.6%) and seroma (3.2%) in wound. Therefore they required minor procedural intervention like drainage, washout and stitch removal. Conclusion: This study establishes frequency of surgical site infection and surgical site occurrences requiring procedural intervention single dose of antibiotic after mesh repair for uncomplicated inguinal hernia which will set a reference point for future studies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the outcome of using the semi-rigid ureteroscope and intracorporeal pneumatic lithotripsy on the impacted upper ureteric stones. Methods: This is a retrospective study on patients who underwent ureteroscopy with pneumatic lithoclast fragmentation at Hamdard University Hospital from May 2018 to December 2021. Patients with impacted upper ureteric calculi > 1 cm and having a prior extracorporeal shock wave lithotripsy or medical expulsive therapy of more than 4 weeks were included. Those with persistent pain were also included. Patients <13 years of age, having a distal obstruction, who are pregnant, having spinal deformity, having morbid obesity, or on aspirin were excluded. Results: Out of 72 patients, 53 (73.6%) were males, and the mean age was 39.57 ± 8.81 years. There was a single stone in 66 (91.6%) and multiple in 6 cases. The mean stone diameter was 1.12 ± 0.4 cm. The mean duration of surgery was 32.13 ± 9.71 minutes. The stone-free rate was 79.2% (n = 57), while it migrated in 15 (20.8%) patients which required additional extracorporeal shock wave lithotripsy sessions. A double-J stent insertion was done intraoperatively in 21 (29.1%) patients. No major operative or postoperative complications were observed. Conclusion: Semi-rigid ureteroscope with pneumatic lithotripsy in an experienced hand is still a safe and useful treatment modality for impacted upper ureteric stones with good clearance rates and minimal complications. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of Ketorolac and Ibuprofen on post-operative pain relief after Para umbilical hernia repair. Study design: Randomized clinical trial. Place and duration of study: General Surgery Department of Hamdard University Hospital (HUH) Karachi, Pakistan from September 2016-December 2019. Material and Methods: Patients were selected by non-purposive convenience sampling. 60-patients under went Mesh repair for para-umbilical hernia under general anesthesia are included and divided into two equal groups. Patient with ASA 1 and 2 are included. Age range is 18 years and above. Patients received either 30 mg ketorolac or 800 mg ibuprofen diluted in 200 mL normal saline in a double-blind, randomized fashion, administered over 30 min, in the post-anesthesia recovery unit started within 30 min of skin closure, followed by three additional doses every six hours. Results: There was no significant difference found between the two groups with mean VAS scores of 33.83±9.06 and 33.00±7.61 after six hours of surgery in the Ibuprofen and Ketorolac groups respectively. Both drugs were found to be effective since the mean pain intensity scores were 5.67±4.49 and 6.83±5.17 respectively. Rescue analgesia (Intravenous Tramadol 50mg) was opted for 17 patients in the Ibuprofen group and 25 in the Ketorolac group, where the difference was statistically significant (p=0.024) Conclusion: We concluded that there is no difference in post-operative analgesia provided by both drugs. Ibuprofen showed decrease requirement of rescue analgesia as compared to Ketorolac. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the main-stay diagnostic as well as therapeutic procedure for hepato-biliary and pancreatic diseases. Life-threatening complications such as pneumo-peritoneum, pneumo-retroperitoneum, pneumo-mediastinum, subcutaneous emphysema and pneumo-thorax related to this procedure rarely occur and only a few of these have been reported in the literature. Case Report: Here we report a case of 38-year-old female patient in which she developed acute abdominal symptoms with subcutaneous emphysema and left-sided pneumo-thorax due to duodenal perforation following Endoscopic retrograde cholangiopancreatography on 17th of June 2019. [ABSTRACT FROM AUTHOR]

Objective: To evaluate post graduate surgical residents’ training in minimal access surgery. Methodology: This cross sectional survey was based on a 16-item self reporting questionnaire that was provided to 48 third, fourth and fifth year postgraduate general surgical trainees doing residency in seven Karachi institutions accredited by College of Physicians and Surgeons Pakistan for Fellowship training. All 48 trainees completed and returned the given questionnaire. Results: Eleven were 3rd year, 33 were 4th year and four trainees were 5th year residents. Mean age of the trainees was 30.31(SD 2.8) years (range 27 to 43), Males were 35 (72.92%), females were 13 (27.08%). Forty six (95.83%) answered that laparoscopic surgery was performed in their department, while two (4.17%) replied in negative. Nine (18.75%) said that they had performed Laparoscopic Cholecystectomy under supervision, while 39 (81.25%) responded “no”. Regarding “Dry Lab” access 18(37.5%) responded “yes” while 30 (62.5%) said no. Similarly regarding “Wet Lab” none said “yes”, all (100%) responded by saying “No” as was the case of Virtual Reality Simulator where 45 (93.75%) said “No” while three (6.25 %) did not answer this question and none responded “Yes”. Out of the 48 trainees questioned only nine (18.75%) had ever attended a Basic Laparoscopy workshop while 39 (81.25%) had not. Trainees own perception regarding their skills and status in laparoscopic surgery training was such that none said Excellent, 7(14.58%) said Good, eight (16.67%) labelled themselves as Average while nine (18.75%) thought they were below average, 23 (47.92%) said they were Poor in this Skill and one(2.08%) did not respond. Most 41 (85.42%) would prefer to do a One Year Fellowship in Minimal Access Training following FCPS, while one(2.08%) said “No” and six (12.5%) were not sure. Conclusion: Education and training in Minimal Access Surgery within Institutions of Karachi is not standardized and access to training facilities is limited. [ABSTRACT FROM AUTHOR]

Diffuse B-Cell lymphoma is the most common type of Non-Hodgkin's lymphoma. Non-Hodgkin's lymphoma accounts for 17% of gastrointestinal lymphoma leading to intussusception. Primary gastrointestinal tumours are the rare cause of intussusception in children. The variability in clinical presentation contributes in delayed diagnosis leading to the poor cure rates. We report a rare case of B-Cell lymphoma in a 5 years old boy who presented to emergency department of Hamdard University Hospital with a history of abdominal pain. on abdominal examination abdomen was soft but distanded with no palpable mass rectal examination was un-remarkable finally turned out to be a lead point for intussusception. [ABSTRACT FROM AUTHOR]