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

Objective: The aim of this study is to compare the outcome of percutaneous aspiration with incision drainage for management of breast abscess. Study Design: Comparative Study Place and Duration: The study was conducted at Surgery departments of Lady Reading hospital, Peshawar during the period of six months from August 2020 to January 2021. Methods: Total 110 women were presented in this study. Patients were aged between 20-45 years. Patients’ detailed demographics including age, weight, height and body mass index were recorded after taking informed written consent. Women had breast abscess were included. Patients were equally divided into two groups, I and II. Group I had 55 patients and received percutaneous aspiration while in group II 55 patients were underwent for incision drainage. Outcomes among both groups were compared in terms of early restoration of breast feeding, pain score by using VAS and time of healing. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 30.11±8.56 years with mean BMI 26.9±3.77 kg/m2 while mean age in group II was 29.17±9.44 years with mean BMI 26.08±3.27 kg/m2. Mean weight of patients in group I was 72.19±17.44 kg and in group II mean weight was 74.35±19.78 kg. Mean height in group I was 154.12±9.55 cm and in group II was 156.08±8.71 cm. Restoration of breast feeding among group I was 47 (85.45%) and in group II 32 (58.2%) patients restored breast feeding. Satisfaction among patients in group I was higher than that of 45 (81.82%) as compared to group II 31 (56.4%). Conclusion: We concluded in this study that percutaneous aspiration in breast abscess was successful and affective as compared to incision drainage with less complications and high satisfaction rate among the women. Keywords: Breast abscess, Percutaneous aspiration, Incision drainage,

Objective: To determine the complications of laparoscopic cholecystectomy in patients of acute cholecystitis. Study Design: Prospective study. Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders with ages 20 to 60 years were included in this study. Patients’ detailed demographics were recorded after taking written consent. Patients with history of abdominal surgery were excluded. All the patients underwent laparoscopic cholecystectomy for gall bladder diseases. Post-operative pain was analyzed by VAS. Complications were recorded at 5th postoperative day. Data was analyzed by SPSS 24.0. Results: Out of 120 patients 30 (25%) patients were males and 75% patients were females. Most of the patients 50 (41.67%) were in the age group 31 to 40 years followed by 37 (30.83%) patients were ages between 41 to 50 years. 70 (58.33%) patients had surgical size port incision was 5mm and 50 (41.67%) patients had 10mm. Mean pain score was 2.24+1.1 at 5th postoperative day. Wound infection was found in 10 (8.33%). Port site hernia was found in 12 (10%). Conclusion: Laparoscopic cholecystectomy is safe and effective treatment procedure with no major complications. Keywords: Laparoscopic Cholecystectomy, Acute Cholecystitis, Wound Infection, Port Site Hernia, Pain

Aim: The aim of this study is to compare the outcomes between laparoscopic and open appendectomy in terms of surgical site infection. Study Design: Prospective/ Observational Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2021 to June 2021. Methods: In this study 200 patients of both genders with ages >10 years presented with acute appendicitis were included. Patients’ demographics including age, sex and body mass index were recorded after written consent. Patients were equally divided into two groups. Group I consist of 100 patients and received laparoscopic appendectomy and Group II with 100 patients received open appendectomy. Outcomes such as surgical site infection, hospital stay and time duration of procedure were examined and compare the results between both groups. Data was analyzed by SPSS 26.0. P-value <0.05 was set as significant. Results: There were 120 (60%) patients (60 Group I, 60 Group II) were males while 80 (40%) patients (40 Group I, 40 Group II) were females. Mean age in group I was 27.9+4.45 years and in group II mean age was 28.5+4.21 years. Mean BMI in group I was 24.08+8.22 kg/m2 and in group II mean BMI was 25.03+6.17 kg/m2. There was a significant difference in term of surgery time duration between both groups 42.88+13.75 minutes Vs 33.35+9.55 minutes; P=0.003.Hospital stay was greater in group II 6.03+3.12 days as compared to group I 4.07+6.13 days. Post operatively less SSI was found among laparoscopic group 6 (6%) in which 4% had superficial SSI and 2% had deep SSI as compared to group II 12 (12%) SSI was found among in which 8% had superficial SSI and 4% had deep SSI. Conclusion: We concluded in this study that laparoscopic appendectomy is better in terms of less hospital stay with less surgical site infection as compared to open appendectomy. We found that less operative time was observed in open appendectomy as compared to laparoscopic. Keywords: Appendectomy, Outcomes, Laparoscopic, Open, Acute appendicitis

Objective: The aim of this study is to determine the effectiveness of internal tension sutures in term of wound healing in patients undergoing laparotomy. Study Design: Prospective cross sectional study Place and Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from 15th November 2020 to 15th May 2021. Methods: One hundred and fifty patients of both genders were presented this study. Patients were aged between 20-60 years of age. Patients’ detailed demographics including age, sex and body mass were recorded after taking informed written consent. Internal tension sutures technique were used for laparotomy among patients who had intestinal obstruction, fire arm injury or stab wound to abdomen, intra-abdominal malignancies, pancreatitis. Mean post-operative pain was measured by using VAS. Outcomes in terms of healing and complications were observed at the end of study. Complete date was analyzed by SPSS 27.version. Results: There were 115 (76.7%) patients were males and 35 (23.3%) were females. Mean age of the patients were 39.09±12.24 years with mean BMI 28.17±8.42 kg/m2. Among 150 cases, majority of the patients 120 (80%) were treated as elective and 30 (20%) were treated in emergency. Symptoms among patients were peritonitis, intestinal obstruction, trauma, mesenteric ischemia, intra-abdominal malignancy, pancreatitis and obstructive jaundice found. Effectiveness was found among 140 (93.3%) cases and only 10 (6.7%) adverse outcomes were found i.e. wound infection and incisional hernia. Patients’ satisfaction was 94.7% among all cases. Conclusion: We concluded in this study that use of internal tension sutures technique for laparotomy is an effective and safest technique in terms of less complications and wound infections with excellent outcomes. We observed that majority of the patients were satisfied by this technique. Keywords: Wound dehiscence, Internal tension sutures, Laparotomy, Incisional hernia