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Background and Aim: Bile duct injuries (BDIs) are complex complications developed during laparoscopic cholecystectomy leading to the postoperative morbidity and mortality. Auxiliary bile duct injury, vascular structures injuries, portal vein, cyst duct leakage and damage to right hepatic artery are caused by bile duct injuries. The purpose of the present study was to investigate the incidence, clinical presentation, and treatment modality of bile duct injuries during laparoscopic cholecystectomy. Patients and Methods: This descriptive case series was conducted on 96 extra hepatic biliary injuries in the Department of General Surgery, Rehman Medical Institute, Peshawar from April 2022 to March 2023. Patients with extra hepatic biliary injuries of either gender were enrolled. Abdominal ultrasonography, ERCP, and MRCP were the different investigating modalities performed on each individual. Complete blood picture, activated Partial thromboplastin time (APTT), liver function tests, blood sugar, prothrombin time (PT), Creatinine, serum electrolytes, and Urea were thoroughly performed on each patient. HIV, HBs, and HCV were various screening tests performed. SPSS version 27 was used for data analysis. Results: Of the total 96 patients, there were 26 (27.1%) male and 70 (72.9%) females.

Pilonidal sinus is a widespread condition. There have been several surgical methods described for treating the sacrococcygeal pilonidal sinus. The Limberg flap after rhomboid excision is the method that is most frequently utilized. By flattening the natal cleft, a big, well-vascularized flap is used to create a tension-free repair. The best treatment options are said to have a recurrence rate of 0–5% and complication rate during surgery of 0–16%. Aim: This study was held to assess patient characteristics and treatment outcomes for pilonidal sinus patients who had rhomboid excision and reconstruction with Limberg flap in our setting. Methods: Information was collected retrospectively by analyzing the records of patients who were done with rhomboid excision and reconstruction with Limberg flap for sacrococcygeal pilonidal sinus in General Surgery department, Lady Reading Hospital, Peshawar during the period from January 2020 to December 2022. Results: The study included 40 patients in total, 34 (85%) men and 6 (15%) women. The mean age was 25.10. (range 18–45 years). The mean stay in hospital was 4.2 days, with 3 to 7-day of range. The primary disease affected 38 out of the 40 individuals, and a recurring disease affected 2 patients.

The intussusception adults are rare and almost always as a result of secondary condition. The aim of this study is to review the adult intussusception's presentation, diagnosis, and pathophysiology was the goal of this study. Methods: This retrospective analysis study was held in the surgical department of Lady Reading Hospital, Peshawar from April 2022 to September 2022. This study included 24 cases of intussusception in patients >18 years of age. Results: 24 cases of intussusception among adult were reported. The mean age was 49.2 years on average (range 20-75 years). All patients' initial complaints in this study was pain accompanied by abdominal distension (37.5%), Vomiting (79.2%) and currant-jelly stools (33.3%) were other symptoms.12 patients (50%) had a palpable lump, while 8 patients (33.33%) had tenderness and generalized guarding was seen in 6(25%) of patients. Eleven patients (45.8%) had an acute intestinal obstruction on admission. The range of symptoms' lengths was 20 hours to 10 months, with a median of five days. The laparotomies were done in 19 patients. Five patients; two with ileoileal intussusception and three with ileocolic, were scheduled for surgery, but over the course of a few hours, their lump disappeared with symptoms improvement.

Introduction: The hernioplasty or Open herniorrhaphy procedures have typically been used to repair inguinal hernias. The advent of minimal access surgery in the past ten years has changed the trends. Aim: The goal of this study is to govern the efficacy of minimal access surgery (Laparoscopic repair) in the treatment of inguinal hernia repair. Methods: This prospective descriptive study was held in the General Surgery department, Lady Reading Hospital, Peshawar during the period from January 2022 September 2022. All patients above the age of 18 who presented with inguinal hernias had the choice of either laparoscopic or open surgery. In the study, those who opted for laparoscopic repair were included. Results: Seventy patients having 18-65 years of age with 32 years of median age at admission were included. Out of them 65 were male and 5 females. Most of the patients had age group 31–40 years, followed by 41–50 years. Ten (14.3%) patients had bilateral hernias, 45 (64.3%) unilateral right hernias, and 15 (21.4%) unilateral left hernias . Just 8 hernias (11.4%) were direct, while the remaining of hernias 62,( 85.7%) were indirect.

Background: Health care-associated infections (HAI) continue to be a significant global community health issue and a concern to patient safety despite significant progress in infection control strategies. Among the most often reported illnesses acquired in hospitals are surgical site infections (SSI) (HAI). Methods: This prospective observational study was held in the various Surgical departments of Bakhtawar Amin Trust Teaching Hospital Multan and Fauji foundation hospital Peshawar cantt.April, 2022 to September, 2022. The study comprised a total of 400 individuals who underwent clean and clean contaminated procedures. Data on comorbidities, post-operative stay, kind of surgery, length of operation, use of prosthesis, day of SSI event, demographics, and re-suturing were gathered and evaluated. Pus aspirate/swab from patients suspected of having SSI was sent for culture and sensitivity testing. Results: The study covered 400 clean contaminated and clean surgeries. 5 percent of cases developed SSI. There was a correlation between SSI and age group, gender and also depends on the procedure type as emergency or elective. The stay in hospital was prolonged post-operatively (>7 days) in 14 (70%) patients who acquired SSI. 13 (65%) of the patients with SSI had co-morbidities. E.

Introduction: In terms of surgery, cholecystectomy performed using laparoscopy is the current standard of care for Cholelithiasis. This operation is by far the most common type of surgery done today. However, the literature is still divided on whether or not drainage should be performed following an elective laparoscopic cholecystectomy. Objectives: The aim of this study was to examine whether or not patients undergoing laparoscopic cholecystectomy at Ayub Teaching Hospital, Abbottabad were more likely to develop an infection in the wound if a drain was used. Results evaluation: Checks for wound infections were performed for up to a month after surgery to determine the outcome. Study Design: The study used a randomized controlled trial design. Settings: The study lasted for six months, from January 01, 2022, to June 30, 2022, and took place in the Department of General Surgery, Ayub Teaching Hospital, Abbottabad. Subjects: Patients having laparoscopic cholecystectomy for gall bladder disease were used as subjects.

Laparoscopic cholecystectomy (LC) is supposed to be a first line treatment for complicated bile stones and is regarded as the minimally invasive surgery. Objectives: To determine the levels of CRP as a measure of stress response after open and Laparoscopic cholecystectomy. Methods: A total of 120 patients of both genders aged 20 years or above with fever, abdominal pain, vomiting, nausea and anorexia with symptomatic gall stone were chosen. Laboratory tests, ultrasound and chest radiography were carried out to verify the diagnosis of cholecystectomy and prevent a negative abdomen exploration. The comparison of CRP levels between the two groups was done at 4, 8 and 24 hours. The values ​​of CRP in both procedures were compared with the t-test with P-0.000 taken as significant. Results: The patients mean age was 36.09 ± 8.10 years. There were 50 men and 70 women. Mean CRP was 7.20 ± 2.10 after 4 hours of laparoscopic cholecystectomy; however, after open cholecystectomy, it was 11.30 ± 1.80, CRP after 8 hours in LC was 13.50 ± 7.01 and 21.04 ± 2.14 after open cholecystectomy. The mean CRP levels in laparoscopic cholecystectomy after 24-hrs were 23.40 ± 7.92 and 34.81 ± 7.04 after open cholecystectomy. The most affected age group was 20-35 years in 39(32.5%) patients, 31-50 in 47(39.2%) and 51-65 in 34(28.3%) patients. This study did not find postoperative complications or mortality. Conclusions: CRP is a valuable marker in determining the response to stress in subjects with laparoscopic and open cholecystectomy.

Herniation of the ovaries is a rare congenital anomaly that may be complicated by strangulation, torsion, and infertility. Female pelvic structures such as the ovaries, fallopian tubes, ligaments, and uterus can rarely enter inside a hernial sac. The Aim of this review was to emphasise the fact that early intervention can save ovary from complication and infertility of the patient. A systematic search was conducted from literature published up to 2013 using the Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning ovaries in the inguinal canal were considered eligible for inclusion in the review. Seventeen papers comprising 24 patients (mean age45.5) were evaluated. A left-sided hernia was noted in 18 cases (75%) whereas 4 patients had a right-sided hernia(25%).This case is unique in its existence because of age of presentation (0ne Month) and comormids of horse shoe kidney. Ovarian inguinal hernias can present as early as on day one of birth. Thorough history and examination followed by investigations can lead to prompt and adequate treatment. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.

The most frequent general surgical emergency worldwide is acute appendicitis. Because to its potentially fatal complications, including perforation, it could put patients at danger of death. An appendix that has ruptured frequently results in serious infectious complications as abdominal sepsis, pelvic abscess, and others. Laparoscopic appendectomy for perforated appendicitis raises several questions. In many nations today, laparoscopic treatment of perforated appendicitis is the preferred surgical technique. Aim: This prospective study's objective was to assess the efficacy of laparoscopy in the treatment of complicated appendicitis (perforation). Methods: The study was conducted prospectively during the period from September 2020 to August 2022. The study included 50 individuals who underwent peritoneal lavage after laparoscopic appendicectomy of perforated appendix in the department of Surgery, Lady Reading Hospital, Peshawar. The traditional method, three ports technique was used. Sometimes a fourth port is needed. Telescopic ports are 10 mm in size. The other two ports are 3/5 mm and 5/10 mm, respectively. Unipolar diathermy is a source of energy. Hemostasis and ligation of the appendicular stump are achieved via intra-corporeal knotting, endo-loop, and hemo-clip. Results: The study's age range is 5-70 years, with a mean age of 19 with male predominance. The duration of surgery varies from 30 to 120 minutes, with a mean duration of 65 minutes. Hospital stays range from 48 to 96 hours on average. There were 12 patients with complications, including paralytic ileus was seen in 1(2%), diarrhea in 2(4%), multiple or single (4% and 8%) port infections, and port TB in (4%). Open conversion was seen in 1 (2%) patient due to appendicitis burst haemorrhage. Every complication was treated carefully. Conclusion: Laparoscopy is an excellent method for treating perforated appendicitis. Thus, it is practical, achievable and may be carried out by skilled hands in any centre. That is now regarded as regular operating procedure. Keywords: Laparoscopic appendicectomy, Perforation (burst)

Background: Infections of the anal glands, which drain into the anal crypts, account for more than 95% of all cases of anorectal abscess. Although fistula-in-ano is usually harmless, it can nonetheless cause severe pain and significantly impact patients' day-to-day lives. Even though most anorectal procedures are performed when the patient is under general or regional anesthesia, there is mounting proof that these procedures can be done safely and effectively in an outpatient setting using only local anesthesia. All procedures in the current investigation were performed with local anesthesia, specifically, 2% lidocaine and 0.5 % bupivacaine. Place and Duration of study: Departments of General Surgery, HMC Peshawar and Nishtar Hospital, Multan for the duration of six months from June 2021 to November 2021. Method: Including the time needed to inject the anesthetic, the typical surgical procedure lasted around 26 minutes. No patient reported more than a 7 on a visual analogue scale for pain on the day of surgery, or the first postoperative day. In most cases, patients spend around two days in the hospital. Results: Including the time needed to inject the anesthetic, the typical surgical procedure lasted around 26 minutes. No patient reported more than a 7 on a visual analogue scale for pain on the day of surgery, the day of surgery, or the first postoperative day. In most cases, patients spend around two days in the hospital. Conclusion: With early ambulation, good tolerability, and fewer anaesthetic problems, local fistula in- ano repair anesthesia is a safe and effective option. In-Ano Fistula, VAS, and Local Anesthetics are some of the terms that will be discussed.

Background and Aim: Despite the good outcomes associated with laparoscopic appendectomy for uncomplicated appendicitis, the benefits of this procedure for complicated appendicitis are less obvious due to increased infection risk. The current study aims to assess the effectiveness of laparoscopic appendectomy in children with complicated appendicitis. Patients and Methods: This retrospective study was conducted on 92 complicated appendicitis cases among young children (

Background: Foam injection sclerotherapy for treating varicose veins is a newly emerging and minimally invasive technique. Its safety profile needs to be investigated. Objective: We documented the adverse effects associated with foam injection sclerotherapy occurring in the first 24 hours and then at 2 and 4 weeks of follow up visits. Material and Methods: This cross-sectional study was conducted at Department of Surgery in Benazir Bhutto Hospital, affiliated with Rawalpindi Medical University, Rawalpindi from 1st July 2021 till 30th June 2022; on 50 patients of varicose veins. A duplex ultrasound was done in all patients. Varicose veins were classified using the CEAP system. Patients having C1 and/or C2 varicose disease with isolated GSV incompetence on duplex ultrasound were included. Results: Only minor complications were encountered and no serious complication was seen. The minor side effects included nausea, hyperpigmentation, matting, headache, vomiting, pruritus around injection site, vomiting and shortness of breath. Serious complications like anaphylactic shock, stroke, TIA, deep venous thrombosis, superficial venous thrombosis, tissue necrosis and skin necrosis were not encountered in any patient. Conclusion: Injection sclerotherapy with sodium tetra decyl sulphate in the foam form for the treatment of varicose veins is a safe modality; since only minor complications were encountered and no serious complication was seen. Keywords: Varicose veins; Foam sclerotherapy; Duplex ultrasound; Complications; Side effects

Introduction: The elimination of unpleasant and time-consuming dressing changes, as well as the potential reduction in overall hospital costs, are potential benefits of primary closure. Recent studies suggest that perforated appendicitis may usually be principally closed without an increase in the wound infection rate compared to delayed primary closure, suggesting that the disagreement surrounding the best ways of wound management has died down. Objective: Studying the efficacy of primary versus delayed primary closure for appendectomy in patients with perforations Study design: Ayyub Teaching Hospital Abbottabad and Timergara Teaching Hospital Dir Lower. Study duration from January 2021 to June 2021. Material and Methods: Perforated appendix patients undergoing appendectomy between the ages of 18 and 45 were included. When an appendectomy was performed, the appendicular stump was not invaginated as is sometimes done nowadays. Interrupted 2/0 vicryl was used to stand in for muscles. Within the PC group, the external oblique was stitched shut with a continuous vicryl 0 suture. Using only regular saline, the wound washed and disinfected. For patients having delayed primary closure, dressing changes occurred daily; in the case of infection dressing changes occurred twice daily until the wound was closed. After the third postoperative day or once the infection had subsided in cases of infected wounds, the wound was closed after rejuvenating the edges. On the seventh postoperative day patients were evaluated for wound infection and length of hospital stay using the operational definition of success. Results: The patients' mean age was 37.3± 610.49 years. The average number of days someone spent in the hospital was 7.38 (1.25). Women made up 37 (or 61.70%) of the total, while men accounted for 23 (or 38.30%). Thirteen patients, or 21.70 percent, had an infected wound. Wound infections occurred in 11 patients in Group-A (the primary closure group) but only 2 patients in Group-B (the delayed closure group) (delayed primary closure). When comparing the rate of wound infection in groups B and A, a statistically significant difference was discovered (p=0.005). Hospitalization time was shorter for those in group A (6.24± 0.47 days) compared to those in group B (8.53± 0.51 days); p 0.001. Conclusion: Patients with a perforated appendix benefit more with primary closure than from delayed primary closure. Keywords: Primary closure, delayed primary closure, and a perforated appendix

Aim: The purpose of this study is to compare the incidence of wound infection in laparoscopic and open appendectomy. Study Design: A randomized, controlled study Place and Duration: In the Surgical department of Khalifa Gul Nawaz Medical Teaching Institute, Bannu and Ayub Teaching Hospital, Abbottabad for the duration from January 2021 to June 2021. Methods: In this study, 220 patients with the diagnosis of acute appendicitis were selected and divided randomly into two groups; OA group (open appendectomy) and LA group (laparoscopic) appendectomy. In both groups, the general anesthesia was given for appendectomy. The wound was examined on the 1st, 2nd and 3rd postoperative day, and then on the 7th and 14th day postoperatively and was scored conferring to the wound asepsis Score. The SSI and total wound asepsis score was calculated subsequently. Results: Total of 200 patients with acute appendicitis were selected. In laparoscopic appendectomy (LA); 22.0±7.85 years was the mean age and 24.12±9.08 years was the mean age in open appendectomy (OA) group. There were 70 men and 40 women in the LA group, and 50 men and 60 women in the OA group. The LA group has M:F ratio of 1.9: 1 in the and 1: 1.3 in the OA group. While 108 patients had no complications and surgical site infection were noticed in two patients only in the LA group, 98 patients in the OA group recovered and surgical site infection were seen in 12 patients. Conclusion: Laparoscopic appendectomy is a safer and better choice than open appendectomy which decreases postoperative complications significantly such as wound infections. Keywords: Open appendectomy, Laparoscopic appendectomy, Acute appendicitis and Surgical site infection.

Background: Laparotomy for small intestinal diseases accounts for a sizable proportion of all emergency operations. The perioperative outcome of these procedures may be enhanced by applying an adapted enhanced recovery after surgery (ERAS) regimen supported by evidence. Aim: This research aimed to appraise the outcomes of near-the-beginning feeding to those of normal eating in patients who had undergone emergency surgery on their digestive tracts (GI) or bowels. Methodology: This study was conducted at the departments of general surgery HMC Peshawar and Nishtar Hospital, Multan. Between November 2021 and April 2022, the data was collected from 84 patients who required emergency intestinal resection and anastomosis. Patients were not eligible if they had short bowel syndrome, intestinal ischemia, protracted bowel perforation, or septic shock. The patients were divided into two groups, those who began eating earlier (group E; n=44) and those who began eating later (group L; n=40). Early feeding entailed starting enteral nutrition within 48 hours of surgery. The surgical and clinical outcomes of the early feeding group were appraised to those of the late feeding cluster. Results: Bowel perforation was the most prevalent reason for surgery, and the miniature intestine was nearly all common areas affected. There was no meaningful difference in the origins, places, or interventions between the two sets of participants. Group L, on the other hand, had a much higher incidence of pulmonary issues (13.6 per cent vs 47.5 per cent, p=0.001) and an extended mean length of stay (LOS) in the ICU (2 days vs 1 day, p=0.038) and hospital (9 days vs 12 days, p=0.012).

Recent developments globally due to coronavirus have hustled the digital disruption and heightened the need for adopting the pillar technologies practised during the pandemic crisis. Clayton Christensen described disruptive technology as when one technology drifts the existing technology and changes the nature or structure of the industry. It is hard to conceive the technologies that will dominate in the post COVID-19 era since trends are changing drastically, changing economies, culture, employment, and the workforce individually and collectively. This study sought to understand how Founder-CEOs of entrepreneurial stage organisations are experiencing decision-making during the hustled digital disruption caused by COVID-19 pandemic. COVID-19 is reshaping the way we function, consume, and connect. Despite causing incredible distress to our work and social lives, it amounts to an outpouring of innovation in other contexts. The innovation will call for breaking down of typical silos both within organisations and within the external network of suppliers. Also, little is known about how operating decisions are made in entrepreneurial stage companies, especially in times of crisis or even in the pre-pandemic era.

Objective/aim: To reduce the morbidity and mortality associated with acute appendicitis, our study aims to identify the factors that contribute to diagnostic delays. Method: This study is a cross-sectional analysis of data collected at a tertiary care facility in Ayyub Teaching Hospital Abbottabad and Timergara Teaching Hospital Dir Lowerover the course of a year January 2022 to June 2022. All patients over the age of 16 who presented to the emergency room with acute appendicitis two or more days after the initial attack and who gave informed consent constituted the study population. All patients under the age of 16 who presented to the emergency room with signs and symptoms of acute appendicitis earlier than two days after the initial attack were excluded from the study. Patients' details were recorded in a standard proforma. Patients' ages, sexes, addresses, delays, doctors' diagnoses, and other relevant details were recorded. SPSS version 23 was used to analyse the data. Results: There were 155 patients in the study, with a mean age of 35±12 years; 95 (65.34%) were male and 60 (40.67%) were female. Forty-seven (32.0%) patients were incorrectly diagnosed by ER doctors and sent home as outpatients; fifty (33.33%) were treated by non-medical professionals such as chiropractic physicians, nurses, patients who self-medicated, spiritual healers, hakeems, and homoeopaths and thirty-two (21.33%) did not seek any medical attention at all during the initial attack of appendicitis. Lack of patient or family financial means was the leading cause of delay (45.34 percent of all cases). Conclusion: Early diagnosis and surgical intervention are critical for the effective care of acute appendicitis, which dramatically reduces complications, morbidity, and death of these patients. An immediate public education effort is required to encourage people to get the care they need at the right time and avoid difficulties. Keywords: Appendicitis, delayed appendicitis, appendicectomy, acute abdomen.