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Objective: To compare the outcomes of three-port versus four-port laparoscopic cholecystectomy (LC) and assess the safety and efficacy of three-port LC as routine procedure. Study Design: Retrospective comparative study. Place and Duration of Study: Combined Military Hospital Kohat/CMH Multan, from Oct 2013 to Dec 2016. Methodology: Total of 403 patients were selected and were divided into two groups based on the principles of non-randomized clinical trial; group A having three-port laparoscopic cholecystectomy (LC) and group B having four-port laparoscopic cholecystectomy (LC). Fourth port in right axillary line at umbilicus level was not established in group A. Outcomes were recorded in terms of operating time, complications, pain assessment/analgesic requirement and hospital stay. Results: A total of 218 (54.09%) patients in group A and 185 (45.91%) patients in group B were assessed. The difference in terms of verbal pain score, analgesic requirement and duration of hospital stay/return to activity were significant statistically, all being less in group A. Cosmetic outcome as perceived by patients was also better in the group A because of less numbers of scars. Operative time (minutes) was less in group A in our study (35.59 ± 10.75) as compared to group B (50.17 ± 10.14). Results of other variables including intra-operative/postoperative complications were comparable among the two groups. Conclusion: Three-port LC has advantages of being less painful, with less analgesics requirement and reduced hospital stay without compromising the safety and efficacy. It is more acceptable to patients due to less numbers of scars and better cosmesis. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic variance in location and histopathological findings of esophageal carcinoma in Punjab-Pakistan. Study Design: Observational cross sectional study. Place and Duration of Study: This study was conducted in Multicentre Tertiary Care Hospitals of Combined Military Hospital/Pak Emirates Military Hospital/Army Medical College Rawalpindi, Combined Military Hospital Kharian and Combined Military Hospital Multan from 2010 to 2017. Methodology: Patients with dysphagia and histopathology proven malignancy were included in this study. All patients had undergone flexible upper gastrointestinal endoscopy. Patients with lesions other than carcinoma, causing dysphagia and those with inconclusive histopathology were excluded from our study. The morphological site of the carcinoma were divided into upper, middle, lower and at gastro-esophageal junction. Histo pathologically proven carcinoma of esophagus was reviewed for subtype of grading differentiation. Statistical analysis was done using IBM version SPSS 22. Results: Out of 150 patients, 85 (57%) were males and 65 (43%) were females. Their age ranged between 30 to 85 ± 12.33. Among one hundred and fifty patients 107 (71.33%) had Squamous Cell Carcinoma, 42 (28%), Adenocarcinoma and metastasis in two cases. Frequency of distribution of esophageal carcinoma in North, East and South Districts of Punjab was 73%, 18% and 9% respectively. Esophageal Carcinoma in upper, middle, lower and Gastroesophageal junction was 22.5%, 35%, 15% and 27.5% respectively. Frequency of well differentiated SCC was 46 (30.6%) and well differentiated AC 31 (20.7%) respectively. Conclusion: SCC with male preponderance is more common in North of Punjab. Lower 1/3rd and GE junction esophageal tumor are the commonest sites in all North, East and South Punjab. Histopathological differentiation revealed Well Differentiated SCC along with significant rise in Adeno-carcinomas compared to previous national studies. [ABSTRACT FROM AUTHOR]