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Background: Chronic pancreatitis being one of the most distressing medical condition, is often complicated by common bile duct obstruction, fibrosis and acute inflammation of the pancreas. Pain, weight loss and diabetes are common in these patients. Surgery is the ultimate option after medical treatment fails to solve the distress. Longitudinal Pancreatico-jejunostomy is widely practiced all over the world as the option of choice. Pancreatico-gastrostomy is also being practiced by a few surgeons in a few centers. Here we practice Longitudinal Pancreaticogastrostomy (LPG) for chronic pancreatitis patients in our setup. This study was aimed to analyze the outcomes and privileges of LPG. Method: This prospective study was monitored and guided by the Department of Hepatobiliary and Pancreatic Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka over a period of 18 months. A total of 36 patients with chronic pancreatitis were allocated for Longitudinal Pancreatico-gastrostomy (LPG) surgery. Study tools included pain gradation, body weight, investigation profiles- serum lipase, blood sugar, USG of abdomen, CT Scan and MRCP. Duration of surgery, blood loss, hospital stay, assessment of post-operative pain relief and surgical complications were the parameters of the study. For pain relief assessment patients were divided into three categories, complete (no complaint pain), satisfactory (mild tolerable pain with normal daily activities) and unsatisfactory (moderate to severe pain requiring medication and hampered daily activities). Results: 36 patients in the group underwent LPG. Mean age in group was 22.94 ± 3.76 years. Majority of the patients had unknown etiology. The mean duration of illness in group was 4.27 ±0.96 years. LPG was easier to perform, took less time, less blood loss and hospital stay was short with less post-operative complications. Pain relief was satisfactory with most patients showing complete pain relief. Diabetes patients got much better glycemic control after surgery. Weight gaining was also significant. Conclusion: LPG is an easier and safer surgery which achieves good pain relief, glycemic control and nutritional improvements. Large volume studies should be done to establish its dominance against other surgical procedures. J Shaheed Suhrawardy Med Coll 2021; 13(1): 58-62

Background: Undoubtedly the port site infections have remarkably enhanced to be a stigma as post laparoscopic morbidity and is still a field of debate and further exploration to surgeons. These port site infections (PSI) are infrequent surgical site infection, complicating the recovery of patients undergoing laparoscopic cholecystectomy. Hence, the necessity of further evaluation of the regarded facts was intended to be explored. Aim: This study was aimed to evaluate the factors that created or provoked PSI after laparoscopic removals of gall-bladder and at analysing which of these factors can be traced and modified to combat PSI in a trail to conquer these complications and to achieve maximum advantages from laparoscopic surgeries. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies in our hospital as well as at other facilities remote from our work stations. Factors as gender, site of infected port, types of microorganism, acuteness versus chronicity of the disease, types of infection (superficial or deep infection) and intraoperative spillage of stones, bile or pus were analysed in our study. Swabs were taken for culture and sensitivity tests in all patients who developed infections. Explorations were done under GA for some patients who had deep surgical site infections and wound debridement was done, excisional biopsies were taken for histopathological studies, and tissue samples for Gene-Xpert analysis for detection of Mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively at our surgery unit rooms. Results: Port site infection rate was recorded in 40 cases amongst 340 procedures from the July 2018 to June 2020 (11.76%). A higher rate was observed in female patients 32 cases (9.41%) and 13 cases (3.82%) of acute cholecystitis. Larger number of cases of the PSI were superficial infections (77.5%) with non-specific microorganism in 34 cases (80.0%). Conclusion: We reconciled a significant association of PSI with spillage of bile or stones during the procedure and with acute cholecystitis. Most of the infections are superficial and more common in males. Precautions and protocols should be taken in measure to avoid unnecessary hurry and faulty procedure of sterilization during and prior to the whole surgery to combat PSI effectively. J Shaheed Suhrawardy Med Coll 2020; 12(2): 76-81

To be true, the name of this specific pathological lesion is not widely encountered in our dayto- day surgical practice, but still, pilomatricoma or pilomatrixoma is notifiable skin neoplasm for which diagnosis can be made histopathological and only after an adequate excision. This case report is of a 23-year-old young female medical student who presented with swelling in neck, that histopathologically diagnosed as pilomatricoma. The purpose of reporting this specific case is that this pathology is rare in occurrence, but more rarely diagnosed because of lack of confirmatory pathological analysis and it is immensely essential to be kept in the differentials of all superficial skin tumors in surgical practice. J Shaheed Suhrawardy Med Coll 2021; 13(1): 86-88

Back ground: Abdominal lipoblastomas which are benign but uncommon soft tissue tumors in children rarely arise from the mesentery.However, benign, these may attain in large size and cause compression symptoms. Complete resection and close post-operative monitoring are necessary for avoidance of recurrence. Histopathology with immunohistochemistry in conjunction with the morphology is the gold standard for diagnosis. Herein such a rare a case of mesenteric lipoblastoma with huge abdominal distention is reported. Case presentation: A 2-year-old girl presented with an enormous abdominal swelling occupying almost all quadrants of the abdomen with repeated dull abdominal pain. The swelling was a non-tender and tensely cystic. USG and CT Scan could not distinguish the proper origin or location of the mass but demonstrated as a large encapsulated and lobulated fatty mass measuring about (16.4x10.0x18.6cm) involving right hypochondriac, epigastric, bilateral ilio-lumber, umbilical & hypogastric regions, pushing the bowel loops upward & laterally with mild mesenteric thickening of perilesional mesentery and separated from the liver & both kidneys and other intraabdominal organs. After exploratory laparotomy there revealed a well capsuled large (about 15x11x14cm)soft yellow mass displacing the entire intra-abdominal contents, connected by a single vascular pedicle with the mesentery and loosely enclosing the mesentery as a whole. Histology and immunohistochemistry of completely resected mass conûrmed the presence of mature adipocytes and immuno-morphology was compatible with Lipoblastoma. Conclusion: This case represents one of the largest mesenteric lipoblastomas in accordance to the patient’s age that histologically, mostly composed of mature adipocytes with few lipoblasts. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 54-57

Background: Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh. This mesh can be placed by either using an open approach or by using a minimal access laparoscopic technique. Objectives: The purpose of the present study was to compare minimal access laparoscopic mesh techniques with open techniques in hernioplasty. Methodology: This pragmatic randomized control trial was conducted in the Department of Surgery at Shaheed Suhrawardy Medical College & Hospital, Dhaka from January 2014 to December 2015 for a period of two years. Patients at any age with both sexes who were presented with inguinal hernia were selected as study population. These patients were divided into two group designated as group A and group B. In group A inguinal hernia repair was performed by laparoscopic technique and in group B open technique was used to repair the inguinal hernia. The comparison was done between open and laparoscopic technique of inguinal hernia repair in terms of duration of operation, per-operative complication, immediate post-operative pain, numbness, duration of hospital stay and time of return to normal activities. Follow up was done from 6 months to 2 years. Results: A total number of 200 patients were recruited for repairing of inguinal hernia. Duration of operation was longer initially in the laparoscopic groups (Laparoscopic approach 90 min vs. Lichtenstein approach 60 min). Post-operative pain was another important outcome to consider when choosing between laparoscopic and open repair of inguinal hernia. Laparoscopic repair had been associated with less post-operative pain than open repair. Operative complications were uncommon for both methods. Length of hospital stay was little shorter in laparoscopic group (laparoscopic 1-2 days vs. open technique 3-4 days); however, return to usual activity was earlier for laparoscopic groups (7 days) where open group: 20-30 days. The data available showed less persisting pain (Overall 8/80 versus 12/100) and less persisting numbness (Overall 3/80 versus 7/100) in the laparoscopic groups. Conclusions: In conclusion, minimal access laparoscopic mesh technique is better than open techniques in inguinal hernia repair. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 75-78

Background: Conventionally it is assumed that raised level of CA 19-9 (Carbohydrate antigen 19-9) is related to malignancies of liver, pancreas and biliary tract. Through our early experience in Shaheed Suhrawardy Medical College Hospital we found that raised level of CA 19-9 is not associated only with malignancies but also with other benign disorders of HBS. The aim of this study was to explore the relationship of raised CA 19-9 with hepatobiliary disorders other than malignancies. Result: We encountered a total of 57 cases at our department of Hepatobiliary Surgery where patients presented with classical features of obstructive jaundice with pain, anorexia and vomiting. Routine investigations of USG and MRCP revealed stone disease in the CBD. Fiftyseven patients with obstructive jaundice were studied retrospectively. Serum CA19-9 levels and some additional biochemical parameters were evaluated before and after treatment. CA 19-9 levels were significantly elevated in most patients, along with levels of total bilirubin, alkaline phosphatase (ALP), and gamma glutamyl transpeptidase (GGT), and 10 patients with benign disorders had extraordinarily high levels of these markers (> 1000 U/mL). The mean CA 19-9 level in the malignant group was greater than that in the benign group (826.83 ± 557.34 vs. 401.92 ± 483.92 U/mL, P = 0.005), and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CA19-9 were 100%, 7.69%, 33.33% and 47.47%, respectively. CA19-9 levels in the whole cohort were correlated with ALP (r = 0.77, P < 0.001), GGT (r = 0.83, P < 0.001), bilirubin (r = 0.69, P < 0.001), and CRP (r = 0.37, P = 0.004). The reduction in serum level of CA19-9 after treatment in the malignant group was remarkably less than that observed in the benign group (97.26 ± 123.24 U/mL vs. 352.71 ± 397.29 U/mL, P < 0.001). CA 19-9 levels may not be sufficient to distinguish between malignant and benign obstructive jaundice diseases. So raised CA 19-9 can obviously denote any hepatobiliary disease other than malignancy that will start to decline 1 to 28 days later after extraction of stone. Conclusion: In conclusion, it is obvious that raised level of CA 19-9 is associated not only with malignancies but also with other benign disorders of HBS to a larger scale. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 119-123

Background: Though rare, pancreas may occasionally serve as a favoured target from metastasis. Metastatic lesion of pancreas have been described for groups of primary origins, including gastric malignancy. Even after neoadjuvants, the surgery still remains a bonafide challenge. Case Presentation: We report a 54-year-old male with epigastric pain, anorexia and trifle weight lossin one month. Whipple’s with partial gastrectomy was advocated for gastric adenocarcinoma with pancreatic metastasis. Histopathology reports depicted metastasis to pancreatic head and in regional lymph nodes. Conclusion: Gastric malignancies may metastasize to unusual sites and even neoadjuvants may be inadequate to aid surgeon in his job. Radical resection gives better prognosis in addition to early diagnosis. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 161-163