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Objective: To determine the role of gastrografin in adhesive intestinal obstruction. Study Design: This is an observational study. Setting: Study carried out at General Surgery Department, Liaquat University of Medical and Health Sciences Jamshoro and Shaheed Benazir Bhutto Medical College, Lyari Karachi, from January 2020 to July 2021. Material & Method: Patients having clinical and radiological signs evidence of adhesive bowel obstruction over the age of 18 years were selected for the study. One hundred milliliters of gastrografin were given via nasogastric tube and its transit was followed by serial abdominal radiographs and fluoroscopy. Results: In the time of 1 and half years, we received 53 patients with adhesive intestinal obstruction. It included 54.7% (n= 29) males and 45.2% (n=24) females with a mean age of 61 years. Out of 53 patients, 46 patients had a single previous abdominal surgery. After complete examination and investigations emergency laparotomy was performed in 15% (n=8) patients. Hence, out of total 53 patients, 27 patients fit into our criteria for gastrografin meal and follow through. Fluoroscopy revealed a partial obstruction in 19 patients and complete obstruction in 8 patients. After gastrografin follow through obstruction was relieved in 17 patients within the meantime of 63 hours (range 20-78h). Conclusion: In our study, gastrografin is found to be of great diagnostic and therapeutic value, with fewer adverse effects. It also reduces the need for surgery, hence decreasing the financial burden of operative treatment. In Pakistan, its use is still limited because of a lack of equipment, expertise, and radiological imaging facilit.

Objective: To determine the frequency of incidental findings on diagnostic laparoscopy in patients undergoing elective laparoscopic cholecystectomy at tertiary care hospital Jamshoro. Study design: This is a descriptive cross sectional study. Setting: Study carried out at department of general surgery, Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro from 1st February 2019 to 30th July 2019. Materials and methods: A total of 164 patients of both gender undergoing diagnostic laparoscopy in patients of laparoscopic cholecystectomy were included in the study. Laparoscopy was done under general anesthesia in all patients. The whole of peritoneal cavity was sequentially visualized using trendelenberg and reverse trendelenberg positions, and right or left tilt as required. Results: Age range in this study was from 20 to 79 years with mean age of 43.622±9.31 years. 40.2% patients were of male gender and 59.8% patients were females. Peritoneal band & adhesions was seen in 9.8% patients, Ovarian Cyst 5.5%, Abdominal Tuberculosis 19.5% and Gall Bladder Carcinoma was 3%. Conclusion: We conclude that laparoscopy is very safe, can obviate the need for a full exploratory laparotomy & minimize the surgical trauma in chronically ill patients.

Objective: To determine the outcome of laparoscopic treatment of hydatid cyst of liver at tertiary care Hospital. Methodology: This cross sectional, study was conducted at public and private sector Hospitals of Jamshoro/Hyderabad from June 2017 to Sept 2019. It includes all diagnosed patients of Hydatid cyst of liver with either of gender and age range from 15 to 65 years who were operated laparoscopically. Patient’s demographic information, postoperative complications, operative time and hospital stay were recorded via self-made proforma and data was analyzed by using SPSS version 20. Results: Total 29 patients were admitted with hydatid disease of liver and out of them 21 patients underwent laparoscopic treatment during study period; their mean age was 46.7±13 years. Males were commonest 71.42% and 28.57% were female. Mean operative time was 98.3±18 minutes. According to postoperative pain, the average of visual analog score was 07.85±1.38 at 24 hours and 3.42±1.50 at 72 hours. VAS mean was 07.8 and 3.4 respectively. Cavity related infection was noticed in 3 cases; port site infection in two cases, bile leak in two and residual cyst was also found in two patients. Mean postoperative Hospital stay was 6.6 days. Conclusion: Laparoscopic surgery for hepatic hydatid disease can be conducted safely as it provides advantages of minimal invasive surgery. Careful selection of the patient is utmost important to achieve good results especially in initial phases.

Objectives: To determine frequency of Transient & permanent hypocalcemiaafter Thyroid Surgery for Malignant thyroid disease. Study Design: Observational study.Setting: Public & Private Sector Hospitals of Hyderabad. Period: December 2008 to April 2016.Materials and Methods: All patients of Thyroid pathology who fulfilled the inclusion criteriawere admitted in the ward. They were evaluated preoperatively & surgery was performed.Postoperatively patients were assessed clinically & biochemically for Hypocalcaemia. Patient’sdata was recorded & analyzed for variables like age, sex, diagnosis of thyroid disease on FNAC,Type of thyroid Malignancy, type of thyroid surgery, Transient & permanent hypocalcemia inrelation to type of type of thyroid surgery performed & the hospital stay. Results: Total 254patients were operated for different thyroid pathologies. It includes 91(35.82%) male & and163 (64.17%) female patients making ratio of 1: 1.79. Mean age was 37.29 ±7.4 years.Amongst them 33 patients were diagnosed as Malignant Thyroid diseases. Most commontype of thyroid malignancy detected was papillary carcinoma in 48.48% patients followed byfollicular carcinoma in 42.42% patients. Most common surgical procedures performed includescompletion thyroidectomy in 57.57% patients with 01(3.03%) of them underwent cervicalneck dissection followed by total thyroidectomy in 36.36% patients with 02(6.06%) of themunderwent cervical neck dissection. Postoperative hypocalcemia was noted in 45.45% patientswith 36.36% patients developed hypocalcemia within 24 hours of operation, 6.06% within 24to 48 hours & 3.03% patients after 48 hours of surgery. Transient hypocalcemia was noticed in13/33 (39.39%) cases & permanent hypocalcemia in 02/33(6.06%) patients. Mean hospital staywas 4.13± 0.32 days. Conclusion: Hypocalcaemia was noted in 15(45.45%) patients operatedfor thyroid Malignancy. Revision surgery & cervical lymph node dissection were noted as riskfactors.

Background: Wound infection has been a major problem in the surgical fieldsince long time. Significant improvements in sterilization, preoperative preparation of patient forsurgery, surgical techniques & prophylactic usage of preoperative antibiotics have not been ableto eradicate wound infections. Development of wound infection increases the hospital stay, costof treatment & increase morbidity & mortality associated with surgery. Objectives: To assesstype of organism responsible for postoperative wound infection & its drug sensitivity patterns atPublic & private sector hospitals of Hyderabad. Study Design: Prospective, descriptive study.Setting: Public & Private Sector Hospitals of Hyderabad, Pakistan. Period: June 2013 to May2014. Materials & Method: All patients of either sex above the age of 13 years who underwentsurgery & developed wound infection were included in the study. Samples to assess culture &sensitivity pattern of organism were taken from infected wounds. Subject’s data was collectedon preformed proforma for age, sex, diagnosis, co morbid illness, type of surgery, presence orabsence of wound infection, grade of infection, and culture & sensitivity pattern of organismisolated. Results: During this 1 year period total of 424 patients of different pathologies relatedto General surgery were finally included in analysis. Mean age was 27.35 years with 61.08%were male and 38.91% female. Inguinoscrotal operations were the commonest proceduresperformed in 113(26.65%) patients followed by Appendicectomy in 102(24.06%) patients.Surgical site infection was noticed in 54(12.74%) patients with 47(13.27%) had this of grade II& above. It includes 23(22.55%) patients of Appendicectomy followed by 09(33.33%) patientsof Laparotomy. 47(13.27%) samples were sent for Culture & sensitivity with 41(11.58%) ofthem showed positive yield. E. coli noticed as commonest organism isolated in 26(63.41%)patients followed by Staphylococcus Aureus in 08(19.51%). Most sensitive antibiotics againstnoted were Meropenem & Pipracillin with Tazobactum which showed sensitivity to E.coli in25(96.15%) patients & 24(92.31%) patients respectively while their sensitivity against S.Aureus was 07(87.5%) & 06(75%) patients respectively. Vancomycin was found sensitiveagainst Staphylococcus Aureus in 07(87.5%) patients. Sensitivity of Ampicillin to most ofthese organisms was found significantly low. Conclusion: Wound infection is responsible forsignificant morbidity in developing world with the frequency of 15.53% in this study. It puts upsignificant economic burden on the hospitals.

Background: The incidence of maxillofacial fractures is greater in Pakistan.This research has the crucial aim of achieve and indexing maxillofacial injuries in poly traumapatients. Objectives: To assess the concomitant injuries with maxillofacial trauma. StudyDesign: Descriptive case series. Setting: The department of Emergency and Oral & MaxillofacialSurgery, Liaquat University of Medical and Health Sciences, Jamshoro. Period: Jan 2014 to Dec2015. Methods: Total 489 patients of both genders, aged ≥20 years were included. Results:more injuries 359 (73.40%) occurs among the age of 20-39 years. The mainly documentedetiologic factor for injury was RTA with 69.38%, followed by assault (16.76%), fall (11.04%)and sports injury was (2.87%). With respect to related injuries, a sum of 48 patients introducedhead injuries and other concomitant injuries. The most common fracture noted was mandible296 (60.53) followed by maxillary fractures 191 (39%), Zygomatic bone complex fractures 65(13.29%), Naso-orabital ethmoid fractures was 44 (8.99%), majority of patients 186 (38.0%)were arrived in morning time followed by 176 (35.9%) in evening, 88 (17.9%) in afternoon and 39(7.9%) in night, regarding the day’s most patients came on first working day that was Saturday142 (29.0%). Regarding hospital mortality, 11 (2.2%) people died within less than two days afteradmittance. Conclusion: The results of this study may support the oral surgeons to rule outother injuries at the time of primary survey and may have a key role in awareness of individualsin prevention of road traffic accidents.

Objectives: Analysis of thyroid function test, C-reactive protein (CRP) and lipids profile in subclinical hypothyroidism (SCH) as indicators of vascular atherosclerotic disease. Study Design: Cross sectional (case control) study. Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Hospital from January 2016 to July 2017. Materials and Methods: Subjects for this study were selected by inclusion and exclusion criteria. Sampling technique was non-probability purposive sampling. A case of SCH was defined as Thyroid stimulating hormone (TSH) > 6.2 (μIU /ml) with normal T4 and T3 free levels. 5 ml venous blood was collected from peripheral vein. Blood was centrifuged to extract sera for the detection of serum TSH, T4 and T3, and CRP. 12 hours fasting was mandatory for blood lipid detection. Data was analyzed on software SPSS 22.0 (P-value ≤0.05) at 95% confidence interval (P-value ≤0.05). Results: Cases showed high TC, TAG and LDLc with low HDLc compared to controls (P

Objectives: To determine demographic and clinical profile of Tetanus patientsand to highlight various management strategies as well as the outcome of the tetanus patients.Background: Tetanus, a preventable disease still found in high frequency in developing world.Globally one million cases are recorded annually. This disease found more frequently in patientswho are either non vaccinated or partially immunized. Diagnosis of Tetanus is solely made onclinical grounds with no definitive investigation available to confirm the diagnosis. Mortality ofTetanus is directly related to the grade of tetanus at presentation. Study Design: Descriptiveobservational study. Setting: Public and private sector hospitals of Hyderabad, Pakistan. Period:1st Nov 2008 to 31st Oct 2015. Materials & methods: It includes patients of either sex abovethe age of 13 years who were clinically diagnosed as case of Tetanus. Data was collected forvariables related to demography, incubation period, site of injury, history of tetanus vaccination,co morbidity, stage of presentation, management & outcome of treatment, complications &mortality. Results: Total 131 patients of Tetanus were finally analyzed. It includes 124 (94.65%)male and 07 (5.34%) female patients with mean age of 34.06 years. 69 (52.67%) were farmers byoccupation. History of injury was present in 109(83.20%) patients & incubation period was < 10days in 39(29.77%) patients. Lower limb was the commonest site of injury noted in 86(65.64%)patients. Tetanus immunization history was positive in 63 (48.09 %) patients. Among the clinicalfindings, generalized bodyache or stiffness with backache was noted in 107(81.67%) patients,restricted mouth opening in 101 (70.09%) patients. Grade I Tetanus was noted in 63(48.09%)patients. Complications of tetanus were noted in 43(32.82%) patients. Mortality rate was notedin 33 (25.19%) patients. Mean hospital stay was 12.3±9.0 days. Conclusion: Tetanus is foundin significant frequency in our setup which carries substantial morbidity and mortality.

Introduction: Hydatid disease is a significant health problem with their location at Extrahepatic Intra abdominal sites is a very rare disease. Disease in these sites usually found concurrently with liver hydatid disease. Diagnosis is based blood tests & imaging studies. Surgery is the mainstay of treatment. This study will help us in determining the frequency of Extra Hepatic Intra Abdominal Hydatid Disease. Also different methods to diagnose & treat the disease will be evaluated. Methods: It includes patients of extra hepatic intra abdominal Hydatid cyst above 13 years and underwent surgery from 2009 to 2014. Variables include age, sex, clinical findings, diagnostic investigations, operative findings, operative procedure, post operative complications. Results: Eleven patients; 07 male & 04 female; mean age 37.54 years. Most common symptoms were mass in abdomen in 11 patients & dull pain abdomen in 09 (81.8%) patients. Examination revealed non tender mass in epigastric & umbilical region in 04 (36.3%) patients. Ultrasound Abdomen showed hydatid cyst spleen in 02 (18.1%) patients, epigastrium in 04 (36.3%) patients, beneath left crus of diaphragm in 02 (18.1%) patients & right iliac fossa & pelvis in 1 (9.09%) patient. In 02 (18.1%) patients multiple Hydatid cysts were noted. Hydatid cysts liver found in 07 (63.6%) patients. C.T scan Abdomen was performed in 09 (81.8%) patients. Surgical procedures performed include Saucerization & omental packing in liver Hydatid cysts; Splenectomy for Splenic disease & complete excision of remaining intra-abdominal Hydatid cysts. Postoperative complications noted in 05 (45.4%) patients. Conclusions: Extra hepatic intra abdominal is an infrequent disease presents significant diagnostic & therapeutic challenge for surgeons. Keywords: extra hepatic; hydatid disease; intra abdominal.

Background: Since a long time skin incisions have routinely been made with scalpels. Now a day there is a shift in trend from this method to electrosurgical skin incisions. However, fear of bad scars and improper wound healing has prevented its wide spread use. This Study aimed to compare both methods of skin incisions for different variables. Objectives: The aim of this study was to examine incisional time, blood loss during incision and postoperative wound complications and pain with both methods of skin incision. Patients and Methods: A prospective, comparative and randomized study was conducted at different hospitals of Hyderabad and Nawabshah, Pakistan from 1st of December 2009 to 30th of November 2011. The study included patients of either sex above the age of five years with general surgical pathology who were to undergo surgery. these candidates were randomly put into two groups. In Group A patients incision was made with a scalpel and in group B with diathermy. Data was analyzed for age, sex, comorbid illness, incisional time, blood loss during incision making and postoperative pain and wound complications. Results: A total of 283 patients completed the follow-up and were included in the final analysis. Group A comprised of 143 (50.53%) patients; 83 (58%) males and 60 (42%) females with a mean age of 36.03 years. Amongst the 140 patients of group B, there were 85 (60.7%) males and 55 (39.3%) females with a mean age of 36.52 years. Twenty-five (17.48%) patients of group A and 27 (19.28%) of group B had comorbid illnesses. Mean incision time was 8.9025-sec/cm2 for group A and 7.3057 sec/cm2 for group B patients. Mean blood loss during incision making was 1.8262 mL/cm2 and 1.1346 mL/cm2 for group A and B patients, respectively. Pain was 5.2957 for group A patients on day one and 3.1181 for group B patients. Pain score was 2.1049 and 1.6206 on day two and 0.8191 and 0.7192 on day five, for group A and B patients, respectively. Postoperative wound complications were noticed in 26 (18.18%) patients of group A and 22 (15.71%) patients of group B. Conclusions: Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood is also lower during incision. Diathermy is associated with lesser post-operative pain and complications than the scalpel incision. Diathermy should be method of choice in general elective surgery.

Closure of abdominal incisions with different suture materials has been a matter of great controversy. Polypropylene and Polylactide with Polyglycolide are among the commonest suture materials used for closure of abdominal incisions. Objectives of this study were to assess optimal suture material used for closure of elective abdominal incisions and to see complications associated with these suture materials.This prospective, comparative, randomised study was conducted at public and private sector hospitals of Nawabshah and Hyderabad from 1st Jan 2005 to 31st October 2009. All patients who underwent abdominal surgery under the investigators' supervision were included in the study. Patients were divided into 2 groups on even or odd numbers. In group-A patients' incision was closed with monofilament, non-absorbable Polypropylene (Prolene) No. 1 suture material and in group-B incision was closed with Polyfilament, absorbable, co-polymer of Polylactide with Polyglycolide (Vicryle) No. 1.A total 274 patients were finally analysed for closure of elective abdominal incisions, with 138 (50.4%) patients in Group-A and 136 (49.6%) patients in Group-B. Vicryle was found superior in knot security and suture handling. Superficial wound infection was found in 5.79% patients of Group-A and 6.61% of Group-B. Discharging sinus was found in 3.62% of Group-A vs 0.73% of Group-B. Burst abdomen was seen in 2.17% patients in Group-A and 1.47% in Group-B. Incisional hernia was present in 4.34% of Group-A and 0.73% patients of Group-B. No patient in Group-B developed persistent pain at incisional site while it was found in 8.69% patients of Group-A.Polylactide is an optimal suture material in closure of elective abdominal incisions.

To asses factors responsible for late presentation of breast cancer in Nawabshah.This descriptive study was conducted at a private and a public sector hospital of Nawabshah, Pakistan, from Jan 2004 to Dec 2008.Sixty females were admitted and selected as study subjects during the study period with mean age of 43.5 +/- 10.38 years and range (28-80 years). Patients with poor economic status were 49 (81.6%) and remaining 11 (18.3%) were from middle class. Sixteen (26.6%) patients were literate, with 3 of them being educated to secondary level. In our study 58 (96.6%) patients with breast carcinoma noted lumps in respective breasts as incidental findings in breast self-examination. Only in 2 (3.3%) patients family physicians noted a lump and referred them to a proper health care facility. Fifty-eight (96.6%) patients belonged to rural areas. In 95% patients, first visit regarding the breast symptoms was made after 6 months of initiation of symptoms. Three (5%) patients in this study presented in stage I, 15 (25%) in stage II, 23 (38.3%) in stage III and 19 (31.6%) in stage IV.Most cases of breast cancer presented in advanced stage probably due to poor economic status, illiteracy and negligence by patients or their family members and general practioners.