Objective:To determine the frequency of post-operative pulmonary complications (PPCs) after cardio-pulmonary bypass and association of pre-operative and intraoperative risk factors with incidence of PPCs.Methods:This study was an observational analysis of five hundred and seventeen (517) patients who underwent cardiac surgery using cardiopulmonary bypass. Incidence of PPCs and risk factors of PPCs were noted. Logistic regression was applied to determine the association of pre-operative and intraoperative risk factors with incidence of PPCs.Results:Post-operative pulmonary complications occurred in 32 (6.2%) patients. Most common post-operative pulmonary complication was atelectasis that occurred in 20 (3.86%) patients, respiratory failure in 8 (1.54%) patients, pneumonia in 3 (0.58%) patients and acute respiratory distress syndrome in 1 (0.19%) patients. The main risk factor of PPCs were advance age ≥ 60 years [odds ratio 4.16 (1.99-8.67), p-value <0.001], prolonged CPB time > 120 minutes [odds ratio 3.62 (1.46-8.97) p-value 0.003], pre-op pulmonary hypertension [odds ratio 2.60 (1.18-5.73), p-value 0.016] and intraoperative phrenic nerve injury [odds ratio 7.06 (1.73-28.74), p-value 0.002]. Operative mortality was 9.4% in patients with PPCs and 1.0% in patients without PPCs (p-value 0.01).Conclusion:The incidence of post-operative pulmonary complications was 6.2% in this study. Advanced age (age ≥ 60 years), prolonged CPB time (CPB time > 120 minutes), pre-op pulmonary hypertension and intraoperative phrenic nerve injury are independent risk factors of PPCs after surgery.

Objectives:To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery.Methods:This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher’s exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant.Results:Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.). Peri-operative chest drainage was significantly high in On-pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups.Conclusions:At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups.

Objective:To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device (PD) circumcision in infants less than 6 months of age.Methods:It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference.Results:Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever (42.0%). Fear of pain and bleeding (66.0%). Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method (P-value <0.0001 and <0.0001 respectively). Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group (p-value <0.0001). Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery (P-value 0.003). About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group.Conclusion:The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent’s satisfaction.

Objective:To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema.Methods:This prospective comparative study was conducted in the department of surgery Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan. Seventy eight (78) patients were included in this study. There were two groups of patients; Group I (n=35) patients treated with fibrinolytic therapy, Group II (n=43) patients treated with open decortication. Data was entered and analyzed in SPSS v16. Student’s t-test was used for comparison of quantitative variables. Chi-square and Fisher’s Exact test were used for comparison of qualitative variables. P-value ≤ 0.05 was taken as significant difference.Results:There was no significant difference in base baseline characteristics of patients of Group I and II. Incidence of comorbidities was also same between the groups. Most of the patients in Group I and II were in empyema stage III. Fluid cultures was positive in 33 (94.3%) patients in group I and 39 (90.7%) patients in group II. 30 (85.7%) was successfully treated using fibrinolytic therapy but this therapy failed in five (14.3%) patients, two of these patients expired within the hospital. There was only one (2.3%) treatment failure in open decortication Group that patient expired within the hospital (p-value 0.04). Overall duration of hospitalization was significantly high in fibrinolytic group, this was 17.6± 1.95 days versus 12.09± 2.18 days in open decortication group (p-value<0.0001). There was no significant difference regarding operative mortality within the two groups.Conclusion:Open Drainage is associated with better outcomes as compared to fibrinolytic therapy when used as a First line treatment of empyema.

Objective: To assess the in-hospital complications of patients undergoing coronary artery bypass grafting (CABG) with severe LV dysfunction and to recognize the risk factors for adverse outcomes. Methods: This was a prospective descriptive study, containing patients who underwent CABG from 01-June-2019 to 31-Jan-2022 with documented LVEF < 35%. 190 patients for has been selected for this study. Postoperative data in ICU and ward regarding morbidity, mortality, hemorrhage, cardiac arrest, pacemaker implantation, IABP insertion requirement, and discharge data were collected to determine early postoperative outcomes. Results: The study sample enrolled 190 patients with multivessel CAD with severe LV dysfunction (EF <35%), of all patients, 147 were male and 43 female. Post-surgery hemorrhage has been observed in 23 (12.1%) patients, 9 patients were taken for re-exploration. The average ICU stay of 5.1 ± 3.6 days and Overall hospital mortality was 14 (7.3%). Patients with LV dysfunction and diabetes have a high mortality rate (OR 8.66, p-value of 0. 01), which is highly significant. patients with LV dysfunction with renal failure have a significant mortality rate risk (OR 3.85, p-value of 0.014). Conclusion: Our findings that CABG is associated with enhanced survival in multivessel coronary disease with LV dysfunction with low mortality and postoperative morbidity. In patients with LV dysfunction, diabetes and renal failure are important risk factors in decision making. Keywords: LV dysfunction, CABG, In-hospital mortality, coronary artery disease (CAD)

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Introduction: Hirschsprung’s Disease is one of the most common congenital anomalies that Pediatric Surgeons manage. In spite of the various modifications of pull through procedures available, the long term functional results are less than ideal. However, Modified Duhamel Procedure is one which has relatively good functional results and that is the reason we have selected this procedure for Hirschsprung’s disease in Sheikh Zayed Hospital, Rahim Yar Khan. Objectives: To evaluate the outcome of patients after Modified Duhamel Procedure for Hirschsprung’s Disease. Design: This is case series study. Settings: Department of Pediatric Surgery Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Period: Seventeen cases were studied over a period of two year i.e. from November 2006 to December, 2008. Material and Method: Seventeen (17) cases from both sexes were operated for Hirschsprung’s Disease over a period of one year and Modified Duhamel Procedure was adopted for all these cases. All patients were diagnosed cases of rectosigmoidal aganglionosis and follow up was done over a period of one year according to a comprehensive Proforma. Four parameters like normal stool evacuation, abdominal distension, soiling and stool incontinence were followed and then the results were compared with other national and international studies. Results: Fever 19.4% (n=04), wound infection 19.4% (n=04), vomiting 9.52% (n=02), abdominal distension 4.76% (n=01), and bleeding per rectum 4.76% (n=01), were the immediate post operative complications. Fourteen patients (82.35%), used to pass stool once daily. Abdominal distension was observed occasionally in six patients (28.57%). Soiling was seen in five patients (29.41%). Out of Seventeen, stool incontinence was seen in only three patients (17.64%). Conclusion: Modified Duhamel Procedure with the help of linear cutter stapler device is quite safe, easy and less time consuming. Infact Modified Duhamel is a procedure of choice for Hirschsprung’s Disease.

Objective: To determine the incidence of acute kidney injury (AKI) in patients undergoing open heart surgery using cardiopulmonary bypass (CBP) with and without modified ultrafiltration (MUF). Materials and Methods: A total of 150 patients who underwent open heart surgery using CPB in our hospital from Jan-2022 to Dec-2022. In group A patients MUF was performed during the CPB and atleast 1000 ml of volume was removed using MUF. While in group B patients, no filtration was performed during CPB. In ICU all patients were followed till three days after surgery to determine the incidence of AKI. Results: Mean age was 53.4±10.9 years in MUF group versus 55.6±11.8 years in control group, p-value 0.23. Majority, 53 (70.7%) patients were male in MUF and 57 (76%) in control group, p-value 0.55. Mean CPB time was 101.6±45.2 mins in MUF and 96.5±39.1 mins in control group, p-value 0.46. Mean X-clamp time was 47.5±19.3 mins in MUF and 51.4±21.6 mins in control group, p-value 0.43. The incidence of AKI was comparable, with frequency rate of 3 (4.0%) in MUF group versus 1 (1.3%) in control group, p-value 0.31. Conclusion: In present study, the incidence of AKI in MUF and control group was almost similar. So according to the results of present study, the use of MUF has no role in preventing or aggravating AKI in patients undergoing CPB. Keywords: Acute kidney injury, cardiopulmonary bypass, modified ultrafiltration.