Background: Unanticipated cancellation of scheduled elective operations decreases theatre efficiency and is inconvenient to the patients, their families and the medical teams. It creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations. The aim of this study is to determine the incidence and causes of cancellation of surgical operations in our centre and make recommendations to reduce it.Methods: This was a prospective cross-sectional study carried out over a period of one year in Manipal Teaching Hospital, Pokhara from July 12017 to June 2018. Consecutive sampling method was used. All patients booked for elective surgical procedures were enrolled in the study. The age, gender, diagnosis, proposed surgery and reasons for cancellation were documented and analysed.Results: A total of 794 patients were scheduled for elective surgical operations during the study period and 86 (10.83%) patients’ operations were cancelled. There were 54(62.79%) males and 32 (37.20%) females. Recent change in the medical status of the patient (n=18; 20.9%) was the main reason for cancellation of operation followed by overbooking (n=11; 12.7%), change in plan of management (n=9,10.4%).Conclusions: Avoidable factors are mainly responsible for cancellation of surgeries. Efficient management, pre-operative assessment, utilization of the few available hospital resources, improvement in communication between medical teams and patients would reduce the rate of cancellation of booked surgical procedures.Keywords: Cancellation; efficient management; elective operation.

Liver haematoma complicating pregnancy with HELLP syndrome is a rare but life-threatening condition. Diagnosis requires a high index of suspicion. Here a case of liver haematoma is presented in a 29 years multigravida at 34 weeks of pregnancy. Initially hypertension was not revealed since she had presented in shock. She had presented with on and off epigastric pain for many days. In context of haemoperitoneum in ultrasound, emergency laparotomy was done and liver haematoma diagnosed intraoperatively. Haematoma was managed with packing and second look laparotomy was done to remove the packs. Haematoma gradually resolved over period of months.