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Background/Aim:To assess the prognostic indicators preoperatively presenting and influencing the mortality rate following esophagectomy for esophageal cancer.Materials and Methods:This study was a retrospective cohort study, conducted at the Department of Surgery, Lady Reading Hospital, Peshawar, from 1 January 2003 till 31 December 2008. Group 1 included patients who had undergone sub-total esophagectomy and were alive at completion of 12 months; whereas Group 2 included those patients who died by the completion of 12 months. Data were recollected from the Data Bank. A list of variables common to all patients from both groups was categorized and subsequently all data related to each individual patient were placed and analyzed on the version 13.0 of SPSSR for Windows.Results:Significant findings of a lower mean level of serum albumin from Group 2 were observed, whereas serum transferrin levels, also found lower in Group 2, were not statistically significant. Findings of serum pre-albumin, with a mean value of 16.12 mg/dl (P<0.05) and Geansler’s index for the evaluation of the presence of obstructive pulmonary disease prior to surgery showed a lower reading of mean ratio in Group 2. Anastamotic leak was not a common finding in the entire study. In most cases, the choice of conduit was the remodeled stomach. Nine patients from Group 2 were observed with evident leak on the fifth to seventh post-operative day following contrast swallow studies. This was statistically insignificant (P = 0.051) on multivariate analysis.Conclusion:Pre-operative variables including weight loss, low serum albumin and pre-albumin, Geansler’s index, postoperative chylothorax, pleural effusion, and hospital stay, are predictive of mortality in patients who undergo esophagectomy for esophageal cancer.

Background/Aim:To compare outcomes of light and heavy weight mesh for repair of inguinal hernia.Materials and Methods:This study was conducted at the Department of Surgery; Lady Reading Hospital, Peshawar from January 1, 2007 to December 31, 2008. Patients were divided into two groups based on the type of mesh implanted for inguinal hernia repair. Group 1 included patients in whom light weight composite (VyproII®) mesh is implanted: Group 2 included patients in whom polypropylene (ProleneR) mesh is implanted. Data concerning the complications and post operative pain in the perioperative and postoperative period were collected and analyzed. Categorical data were presented as percentages with 95% confidence intervals and compared using a χ2test and P<0.05 were considered significant.Results:Following allocation and exclusion of violating cases, 111 patients in group 1 and 138 patients in group 2 were analyzed. The mean age in group 1 was 38.20 ± 13.34 years and in group 2 was 39.55 ± 13.70 (P = 0.434). In group 1, hematoma formation was observed in four cases (3.6%), while it was observed in six cases (4.2%) in group 2 (P = 0.766). During the entire study, ten patients in all developed urinary retention, three of which required transient catheterization. One year post operation, there was a recurrence in only five cases overall, while only two patients complained of pain (P = 0.826).Conclusion:The frequency of postoperative pain and complications in patients was similar in both groups.

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Objectives: To assess the outcomes of Single anastomosis Gastric Bypass in the management of Morbid Obesity.Materials and Methods: This study was conducted at Lady Reading Hospital, Peshawar between 1st June, 2017 and 28th February 2021 and included 88 patients that underwent Mini-gastric Bypass/ One anastomosis gastric bypass. Following DVT prophylaxis with subcutaneous enoxaparin, a 15-18 cm long gastric pouch was formed over a bougie 36-40Fr and a variable length of biliopancreatic limb was decided between 150-200cm, which was anastomosed to the terminal part of the gastric pouch. All anastomoses were Antecolic fashioned and a minimum 3cm anastomosis preferably to the anterior wall was performed. In all cases Covidien ENDO GIA TristapleTM technology reloads were used and enterotomies were closed using Barbed V-lockR 2/0 sutures. During follow-up relevant investigations based of emerging complaints and monitoring of weight was performed and documented on an approved proforma.Results: Out of totla 88 patients, the mean age of patients was 38.7 years (+12.3) with predominantly male patients (53.4%). Mean Body Mass Index was 55.1(+7.8) with a mean operative time of 127.6(+37.1) min. Remission of diabetes, hypertension and improvement in patients with obstructive sleep apnea at end of 6 months was observed in 37 patients (66%), 41patients (80.3%) and 25 patients (89.2%) respectively. Excess body weight loss at one month was 26.5% and at six months was 58.1%. There were no leaks observed in this study and two cases had bleeds (2.2%). One mortality (1.1%) was observed due to pulmonary embolism. Conclusion: One Anastomosis Gastric Bypass is a safe and eff ective procedure which can be modified and tailored to the individual needs of most bariatric patients including Super Obese patients. It has good results in maintaining remission of Diabetes and Hypertension.

Objective: To compare the outcome of early versus late repair of incisional hernia that developed following laparostomy for enterocutaneous fistula. Material and methods: This Randomized controlled trial study was conducted at Surgical C unit, Lady Reading Hospital, Peshawar from 22nd May, 2014 till 21st May, 2017. Following ethical approval, 69 patients were enrolled in the study, amongst which three were lost to follow-up. So, 33 patients in both groups were later on included. In group A, patients were asked to present at an early 3-month delay following confirmation of successful enterocutaneous fistula management after discharge, and Group B patients were asked to come one year later. Both groups were subjected to the same procedure of component separation technique with reinforcement with polypropylene mesh. Data was recorded on a Proforma and post-operative complications were mentioned for a period of 12 months that included seroma/hematoma formation, superficial wound infection, mesh infection, enterocutaneous fistulas, recurrence and mortality. Results: Following allocation to two groups, the group planned for surgery by the component separation technique (CST) in the early group had a slightly smaller hernia (21.3cm) but this was not significant a difference in comparison (p=0.68). The study was focused at a follow-up for duration for one year during which 19 patients (28.7%) in total had clinical or radiological evidence of recurrence of the incisional Hernia out of which ten patients(30.3%) were from group A. Recurrence in group B occurred in 9 patients(27.2%) (p=0.88) This included three patients (4.5%) from both groups with infected meshes that needed removal. Conclusion: Component Separation technique is a feasible staged approach to management of a ventral wall defect (incisional hernia) with reinforcement of the wall with polypropylene mesh in early phase of recovery after enterocutaneous fi stulas.