Aim: To compare the outcomes of laparoscopic approach with open method in patients undergoing primary ventral hernia repair. Study Design: Randomized control trial Place and Duration: This study was conducted at Kuwait Teaching Hospital and Lady Reading Hospital Peshawar during the period of January 2017 to December 2019. Methods: One hundred and ninety patients of both genders with ages ≥18 years were included. All the patients were divided in to two groups, i.e’ Group A consists of 95 patients received open procedure and Group B with 95 patients received laparoscopic approach for primary ventral hernia repair. Outcomes in term of complications, hospital stay and recurrence rate were examined and compare the results between both groups. Data was analyzed by SPSS 23.0. Results: There were 65 (68.4%) females and 30 (31.6%) males in Group A and in Group B 35 (36.8%) males and 60 (63.2%) females. Mean age of patients in Group A was 40.14±3.31 years and in Group B it was 42.94±8.55 years. In Group B hospital stay was shorter than Group A (3.11±1.20 days Vs 5.9±3.9 days). According to the wound infection we found significant difference between Group A and Group B (12.6% and 4.2%);[p-value <0.05]. In Group A 5.3% patients had developed wound dehiscence while in Group B none of patient found to have wound dehiscence (p-value <0.05). Recurrence rate was also high in Group A 7.4% vs 2.1% in Group B (p=<0.05). Conclusion: It is concluded that laparoscopic repair of primary ventral hernia is safe and effective with lesser complications as compared to open method. Keywords: Ventral Hernia, Laparoscopic, Open Procedure, Wound Infection, Wound Dehiscence, Recurrence

Background: The gold standard treatment of acute appendicitis is appendectomy. Early surgery reduces a number of complications such as appendicular mass formation, abscess and perforation. However, diagnostic inaccuracy especially in female gender can lead to negative appendectomy because other gynecological diseases have quite similar presentation. The objective of our study is to determine the diagnostic accuracy of Alvarado scoring system in the diagnosis of acute appendicitis in comparison to the gold standard histopathology in patients with acute pain right iliac fossa. Methods: This descriptive Cross-sectional study was carried out on 253 patients with acute pain in right iliac fossa at Surgical Department of MTI, Lady Reading Hospital from 14th July 2020 to 14th January 2021. Results: Mean age was 37 years with standard deviation ± 10.09. 111(44%) patients were male and 142(56%) patients were female. 129(51%) patients were married while 124(49%) patients were unmarried. Based on Alvarado scoring Acute appendicitis was diagnosed in 197(78%) patients and missed in 56(22%) patients. Diagnosis of Acute appendicitis was confirmed by histopathology report in 245(97%) patients while in 8 (3%) patients histopathology did not reveal acute infection. Diagnostic accuracy of Alvarado scoring analyzed with histopathological diagnosis was 78.65%. Conclusion: Alvarado scoring has a sensitivity of 79.18%, specificity 62.5%, PPV 98.47%, NPV 8.92% and diagnostic accuracy of 78.65% in diagnosis of acute appendicitis taking histopathology as gold standard in patients with acute pain right iliac fossa. Keywords: Acute Appendicitis, Alvarado, Histopathology, Diagnostic accuracy

Objective: Breast carcinoma is the commonest cancer affecting female gender and is the second major cause of mortality in females globally. Among different surgical options, modified radical mastectomy (MRM) with or without neoadjuvant therapy is the most frequent surgery carried out globally for breast carcinoma. In this study we aimed to determine the frequency of early post-operative complications following modified radical mastectomy (MRM) in patients with breast carcinoma. Material and methods: This dual setting retrospective descriptive study was conducted at General surgery departments of Kuwait Teaching Hospital and MTI-Lady Reading Hospital Peshawar between January, 2018 and June, 2019. A total of 60 patients aged >18 years with biopsy proven stage-I to stage-III breast carcinoma who underwent modified radical mastectomy were included.All patients were followed on weekly basis for six weeks at the out-patient department (OPD) and evaluated for the development of early complications such as seroma/hematoma, flap necrosis and wound infections. Results: Seroma formation found in 9 patients (15%) and wound infection seen in 5 patients (8.3%) were the commonest complications. Conclusion: In our study seroma formation was the most common complication followed by wound infection. Skin flap necrosis, wound dehiscence, hematoma formation and development of early lymphoedema were less common. None of our patients presented with muscle paralysis secondary to nerves injury. Keywords: Breast carcinoma, modified radical mastectomy, complications, seroma, wound infection.

Background: Head injury is the most serious problem all around the world. Over the last 200 years both surgical and conservativemanagement have been evolved. Chronological surgical management yields better outcome by decreasing mortality andmorbidity. Wound debridement, repair of dural defect and closure of wound are standard principles in management.Objective: To study the outcomes of surgical management of depressed skull fracture.Material and methods: This study was conducted in Shifa Medical center from 1st June 2016 to 30thJune 2019. Clinical featurescause, and computerized tomography (CT) pictures were compiled in proforma. Whenever depressed fracture size exceeded than5mm, cosmetically disfiguring and fracture over the sinus were operated. All the patients were followed for six months.Results: Total of 60 patients were included 42 patients (70%) were male and 18(30%) were female. Pediatric population was majorcontributor 36 out of 60 patients (ratio60%). 56 patients (93.33%)operated, 4 patients (6.67%) were treated conservatively. These 4patients(6.67%) had severe head injury and were put on ventilator 32 patients (53.3%)fully recovered, 12 patients (20%) hadmoderate disability, 8 patients (13%) had severe disability and 3 patients(4.8%)pass away in this study.Conclusion: It was found that, depressed skull fracture was mostly common in children. Usage of antibiotic and anticonvulsantshad effective results in term of preventing infection and epilepsy during perioperative period. Initial stage surgical treatment isexceptionally required where size of fracture exceed 5mm. Outcome depended upon the sternness of injury and existence ofassociated intra cerebral lesion.Key words: surgical management, depressed skull fracture (DSF) and CSF leakage.

Background and Aim: Talus is the important tarsal bone that connects the leg two long bones with the human foot through the ankle joint. The current study aims to determine the incidence of neck bone modification of the talus. Methodology: This cross-sectional study was carried out on 82 Tali of either gender in the Department of Anatomy, Saidu Medical College, Swat and Women Medical and Dental College Hospital, Abbottabad during the period from February 2021 to July 2021. Careful examination of the talar neck dorsal surface was carried out for the presence of facets either squatting or medial, gutter-shaped facets, combined facets, and trochlear surface extension. All the data gathered were tabulated and SPSS version 23 was used for data analysis. Results: Of the total 82 human dry tali, the prevalence of lateral squatting facets, medial and bones squatting facets, gutter-shaped facets, and combined facets were 34 (41.5%), 13 (15.9%), 14 (17.1%), and 12 (14.6%) respectively. About 11 (13.4%) tali had no facets. Trochlear surface lateral extension and medial trochlear extension were observed in 70 (85.4%) and 9 (11%) respectively. Gutter, medial and combined facets were more common on the left side compared to the right side whereas on the right side, lateral squatting facets were more common. Lateral extensions were common in medial extensions. Conclusion: The occurrence of various types of squatting facets is caused by cultural habits, squatting position, and genetic inheritance. The dorsal surfaces modifications occurrence of the talus's neck serves as a critical anthropological factor in determining regional origin of unclaimed skeletons. Keywords: Talus, Squatting Facets, Bony modification