BackgroundSelective approach for sending cholecystectomy specimens for histopathology results in missing discrete pathologies such as premalignant benign lesions such as porcelain gallbladder, carcinoma-in-situ, and early carcinomas. To avoid such blunders therefore, every cholecystectomy specimen should be routinely examined histologically. Unfortunately, the practice of discarding gallbladder specimen is standard in most tertiary care hospitals of Pakistan including the primary investigators’ own institution. This study was conducted to assess the feasibility or otherwise of performing histopathology in every specimen of gallbladder.MethodsThis cohort study included 220 patients with gallstones for cholecystectomy. All cases with known secondaries from gallbladder, local invasion from other viscera, traumatic rupture of gallbladder, gross malignancy of gallbladder found during surgery was excluded from the study. Laparoscopic cholecystectomy was performed in majority of cases except in those cases where anatomical distortion and dense adhesions prevented laparoscopy. All gallbladder specimens were sent for histopathology, irrespective of their gross appearance.ResultsOver a period of two years, 220 patients with symptomatic gallstones were admitted for cholecystectomy. Most of the patients were females (88%). Ninety two per cent patients presented with upper abdominal pain of varying duration. All specimens were sent for histopathology. Two hundred and three of the specimens showed evidence chronic cholecystitis, 7 acute cholecystitis with mucocele, 3 acute cholecystitis with empyema and one chronic cholecystitis associated with poly. Six gallbladders (2.8%) showed adenocarcinoma of varying differentiation along with cholelithiasis.ConclusionThe histopathological spectrum of gallbladder is extremely variable. Incidental diagnosis of carcinoma gall bladder is not rare; if the protocol of routine histopathology of all gallbladder specimens is not followed, subclinical malignancies would fail to be identified with disastrous results. We strongly recommend routine histopathology of all cholecystectomy specimens.

ObjectivePeritonitis is the most common life threatening surgical emergency, which requires urgent surgical intervention and is a significant cause of morbidity and mortality. The objective of this study was to highlight the frequency of secondary peritonitis and to analyze the site and causes of perforation, in our tertiary care setup.MethodsA retrospective analysis of 311 patients of secondary peritonitis was done from July 2008 to June 2010 at Liaquat University Hospital Jamshoro, Hyderabad, Sindh, Pakistan. All cases found to have peritonitis as a result of perforation of any part of gastrointestinal tract at the time of surgery were included in the study. All cases with either primary peritonitis or that due to anastomotic dehiscence were excluded.ResultsA total of 311 patients were studied. Most of the patients were males (77%) and (89%) were in the third and fourth decades of life. Majority of the patients presented with pain (97%) associated with bowel symptoms. Most common site of perforation was small bowel (ileal 59%, jujenal 2%). In this series, most common risk factor of perforation was typhoid (43%). Ileostomy was the most commonly performed procedure. Overall morbidity was 48.5% and mortality was 17%.ConclusionConsidering the relatively higher rate of typhoid perforation quoted in this study, it is vital that typhoid fever ought to be eliminated by improved sanitation and immunizing programmes, otherwise surgeons will be confronted with its complications.

Recurrent inguinal hernia is still frequently observed today, and the Lichtenstein tension-free repair has gained great acceptance worldwide and is currently considered the procedure of choice for primary and recurrent inguinal hernias.

Aim: To determine the outcome of laparoscopic repair in ventral hernia. Study design: Prospective observational study. Place and duration of study: General Surgery Department of Tertiary Care Hospital, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro Sindh from 1st March 2017 to 30th June 2020. Methodology: Eighty six patients with ventral wall hernia were enrolled. Hernia was approached laterally and ports were placed from farther side of abdomen. In all cases three trocars were used one for 10mm and 2 ports for 5 mm. polypropylene mesh was used for hernia repair. Mesh was placed using intracorporeal mesh fixation technique. Results: The mean age of patients was 46±8.3 years. Fifty two (60.4%) were females and 34 (39.5%) were males. The ratio of females with ventral wall hernia is higher than males requiring surgery. The mean BMI of study participants was 30.8±4.3 kg/m2. Bowel perforation is characterized to be the most severe complications of laparoscopy and it affected 3.4% of the participants. The most common complication post-operatively was severe pain in 26.7% of patients, controlled by I/V pain killers for two to three days followed by seroma formation Conclusion: Laparoscopic ventral hernia repair is an excellent technique as compared to conventional techniques and has fewer complications but it requires surgical expertise and specific instruments. Although it is an ideal procedure for simple ventral wall hernias, it is not used for complex hernia. Key words: Laparoscopic repair, Ventral hernia, Mesh repair

Aim: To determine the intraoperative and postoperative complications of three dimensional (3D) laparoscopic cholecystectomy. Methodology: This prospective observational study was carried out General Surgery Department of multiple hospitals of Sindh during the time period of 1st July, 2021 to 30th June 2022. Cholelithiasis were included in the study were included. The baseline and specific assessments in all patients, especially abdominal ultrasound for diagnosis of gallstone disease were done. All prepared were 3D laparoscopic cholecystectomy. Results: Sixty nine (88.46%) were females and 9(11.53%) were males with mean age was 37.32±4.03 years. Common intraoperative complications were gallbladder rupture observed in 3(3.84%) cases tight adhesions around gallbladder, bleeding from liver bed in 2(2.56%) cases. Post-operatively 4(5.12%) patients had nausea, postoperative fever in 5(6.40%) cases, port-site bleeding in 3(3.84%) cases and port site infection in 4(5.12%) cases. Conclusion: Intraoperative and postoperative complications are more common in patients with older age and male gender. Keywords: Intraoperative complications, Postoperative complications, 3D laparoscopic cholecystectomy

Objective: To determine the outcome of endoscopic pilonidal sinus treatment (EPSIT): Is a new minimally invasive treatment in pilonidal sinus. Study Design: This is a observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2020 to Feb 2021. Materials and Methods:  Patients aged between 20-40 years, both gender having sinus in the cleft of the buttocks on clinical examination with associated symptoms like pain when sitting or standing, reddened, sore skin around the area, pus or blood draining from sinus, hair protruding from the lesion and formation of more than one sinus tract, or holes in the skin were included in this study. Patients with abscess and recurrent pilonidal sinus were excluded. Outcome measurements were postoperative pain, return to normal daily activities and complication rates including infection, recurrence. Results: 44 patients with Pilonidal Sinus were included in this study.  15 to 40 years with mean age ± SD (range) was 26.56±4.1 years. 40(90.90%) were male where as 4(9.09%) were females. Mostly patients have single external openings in 37(84.09%) patients with midline opening location in 26(59.09%) patients. The mean operative time±SD (range) was 21.09±3.62 minutes (15 to 45 min). According to the visual analog scale (VAS) score for postoperative pain assessment after 48 hours of surgery, 36 patients (81.81%) reported a VAS between 1 to 3, and 8(18.18%) reported a score between 4 to 6. Postoperative wound infection was seen in one case 2.27% while recurrence was observed in two cases 4.54%. The overall healing rate was 93.18%. The mean time to return to normal daily activities was 6.1±11 (range, 2–15) days.  Conclusion: To conclude that the EPSiT is safe, effective, simple, repeatable and very welcomed by the patients if explained correctly. We can say that EPSiT can be labeled as a day surgery, with fast post-operative recovery and early return to work.

Objective: To determine the outcome of video-assisted anal fistula treatment (VAAFT): A new minimally invasive treatment option for fistula in ano. Study Design: This is an observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form January 2020 to June 2020. Material & Method: Inclusion criteria for this study were patients aged 18-60 years visiting the outpatient department with primary/recurrent fistula having symptoms. Among these individuals having anal fistula due to secondary causes like IBD, tuberculosis or any malignancy were not included in the study. VAAFT was performed by experience general surgeon and post-operative follow up was done till 1 years. Results: A total of 68 patients with fistula in ano were selected for video assisted anal fistula treatment (VAAFT) in our setup. It included 67.6% (n=46) males and 32.3% (n=22) females who agreed for the procedure. The mean age of patients were found to be 43+13 years. Post-operatively complete healing was observed in 75% (n=51) patients and 14.7% patients had persistent fistula after the procedure.  Conclusion: VAAFT is a minimally invasive surgical intervention implied to treat primary and recurrent anal fistulas, having lesser rates of recurrence and few post-operative complications. It should be implied over large scales for treatment of primary and recurrent anal fistula as it  carries the lowest rate of anal incontinence.