Objective: Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. Methods: This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Results: Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. Conclusion: Laparoscopic management is feasible, safe and effective surgical option for patients with peritonitis due to different abdominal emergencies in properly selected cases with higher diagnostic yield and a faster postoperative recovery.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

The authors recommend a modified open technique in placing the first port when intraabdominal adhesions are expected.

Laparoscopic-assisted single-stage orchiopexy appears to be a safe, effective procedure for intraabdominal testis in adolescent and older patients.

ABSTRACT… Objectives:To determine the frequency of hepatitis b & c viral infection in surgical patients. Study Design: Descriptive case series. Place and Duration of Study: This study was conducted at surgical department of multiple hospitals and compares the results, JPMC Karachi, Civil Hospital Naushahro Feroze and Jamshoro, Pakistan from August 2014 to December 2015. Methodology: All 2645 patients were admitted for emergency and elective surgery. All patients taken detail history regarding demographic parameter and risk factors like previous surgery, blood transfusion, barbar, Road Traffic accident, haemodialysis, Tattoos/ body piercing, injecting drug user, family history of hepatitis, previous history of jaundice and Hospitalization. Hospital laboratory was used for screened HBsAg and Anti HCV using immunochromatography (ICT method). Patients excluded who were those did not need the surgery or known case of HBsAg and Anti HCV. Data collected was entered into and analyzed by using statistical package for the social science -20. Results: Out of 2645 patients, male to female ratio were 1.9:1. The mean age was 40.2+6.12years (20 to 60 years). Out of 2645 patients, Anti HCV was positive in 288(10.88%) cases followed by HBsAg was in 152(5.74%) cases. While both positive in 36 (1.36%) cases. We observed Previous surgery was main risk factor in the reactive 156(32.77%) cases followed by Barbar, Blood transfusion were 74(15.54%) and 47(9.87%) respectively. Conclusion: We conclude that preoperatively screening of hepatitis B and C should be performed.