Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Objectives: To study the types of Biliary injuries (BDIs), their timing and clinical presentation, diagnosis and treatment outcomes in patients undergoing laparoscopic cholecystectomy. Study Design: Descriptive study. Setting: Department of General Surgery Hayatabad Medical Complex (HMC) Peshawar. Period: From October 2017 to October 2018. Materials & Methods: including 32 patients with biliary duct injuries (BDIs). Results: This study included 32 patients with BDI, 28 patients were referred to HMC and 4 patients had their primary operation at Department of General Surgery HMC Peshawar. There were 23 females and 9 males with a mean age of 47 years (range, 20–65 years). After diagnostic workup, the type of BDIs was classified according to the Strasberg classification. As for BDI, 4(12.5%) patients had a leak related to the cystic duct (Type A injury).In 11(34.3%) patients, there was lateral injury of CBD (Type D injury). In 15(46.8%) patients, there was complete transection of CBD (Type E injury). In 2 (6.2%) patients, it was impossible to determine the cause of bile leak which was assumed to be related to aberrant ducts although this was difficult to prove. Conclusion: Laparoscopic cholecystectomy is best if done with proper training and expertise otherwise it can lead to biliary injury thus turning the patient into a "biliary cripple". They mainly result from anatomical variations and cognitive misinterpretation of anatomy .Biliary injuries can be prevented to some extent if principles of laparoscopic surgery are followed.

Objectives: The main objective was to evaluate the outcome of laparoscopic cholecystectomy in terms of intra-operative complications and the rate and reasons of conversion to open cholecystectomy. Study Design: Descriptive Study. Setting: Hayatabad Medical Complex, Peshawar. Period: June 2018 to May 2019. Material & Methods: After taking consent of Hospital ethical & research committee, patients admitted with clinical diagnosis of cholelithiasis and chronic cholecystitis, confirmed by abdominal ultrasound, undergoing laparoscopic cholecystectomy fulfilling inclusion criteria were selected. Results: A total of 150 were included in the study. Mean age was 39.2yrs with female to male ratio of 9.75:1. Laparoscopic cholecystectomy was successfully accomplished in 98% cases. In 2% (3 patients) converted cases the most common cause of conversion observed was dense adhesions in the calots triangle. Intra-operative complications were noted in 1.4% patients, those included bile duct injury and leakage from the gallbladder bed. However other complications such as bowel injury, blood vessel injury, and post operative hemorrhage did not occur. Overall morbidity was 1.4% with no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective procedure in our setup to the accepted standards, as evident by the national and international studies. And it can be accomplished with minimal morbidity and low rate of conversion with the increasing surgeon’s experience.

Introduction: The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer. Owing to that, an increased awareness and investment towards better outcomes regarding patients sexual and urinary function has been recently observed. Objective: Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for rectal cancer. Materials and Methods: An observational retrospective study including all male patients who underwent a surgical treatment for rectal cancer between January 2015 to December 2019. A total of 113 patients were included in the study. All patients were underwent major surgery for rectal cancer. An inquiry questionnaire presented to every patient about its sexual habits and level of function before and after surgery. Results: All patients included in the study were males. Patient age range between 40-75 years with mean age of 57 years. Surgical procedure was rectum anterior resection (RAR) in 62(54.8%) patients and an abdominoperineal resection (APR) in 51(45.1%). 71(62.8%) patients described their sexual life as important/very important. Sexual function worsening was observed in 83 (73.4%) patients with complains of erectile dysfunction and ejaculation impairment. 30 (26.5%) patients didnt resume sexual activity after surgery. Increased age (p=0.06), surgery performed (APR) (p=0.04) and the presence of a stoma (p=0.04) were predictors of erectile dysfunction after surgery. Conclusions: This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for rectal cancer. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.