Objective: The purpose of this research was to examine the success of non-surgical therapy for patients in stable condition who had come with serious liver injuries to the emergency department of a public tertiary care hospital in Karachi, Pakistan. Method: This retrospective research was carried out between February 2022 to August 2022 in department of General Surgery, Civil Hospital Ruth Pfau, DUHS, Karachi, after the ethical approval of the institute ethical review board. Patients were divided into two groups, group I receiving conservative care and group II undergoing surgery. Demographics, injury categorization, related lesions, surgical therapy, morbidity, mortality, and length of hospital stay were all were recorded through a questionnaire. Results: The average age of the 200 participants in the present research was 39.15± 10.47 years. There were 133 (66.5%) males who sustained injuries. The majority of patients (n=150, 75%) were found to have only mild liver damage (grades I–III), whereas 50 patients (25%) had more severe liver damage (grades IV–V). 150 patients (75%) were treated with conservative (NOM) care, whereas 50 patients (25%) had surgical intervention. Twenty-one deaths (10.5 %) were recorded in total. Conclusion: Conservative care is the preferred course of action for patients with stable hemodynamics, whereas surgical intervention is the treatment of choice for those with hemodynamic instability. Patients undergoing conservative treatment should be closely monitored. Mortality and morbidity rates were not significantly higher in patients whose conservative therapy failed.

Objective: To assess if there is significant risk associated with early reversal of stomas (less than 6 weeks) when compared to a delayed closure in the setting of a Tertiary Care Hospital in Karachi. Study design: Observational longitudinal study Study place and duration: Dow University, Karachi 6 months 1st April 2022 till 1st September 2022 Methods: Pre- and post-operative data were collected for 50 patients assigned to each group respectively. The parameters assessed were the American Society of Anesthesiologists (ASA) grade, Surgery duration, Post-operative and Overall Hospital Stay, Surgical and Medical complications and day of occurrence, Clavein-Dindo Classification, and mortality. Results: Significant variance in ASA Grade was noted between the two groups, P-Value=0.005 with a lower grade observed in patients who underwent early closure. The post-operative and total hospital stay showed significant variation, with P-values of 0.011 and 0.011, respectively for both outcomes. The incidence of post-operative complications was also significant with p-value=0.004. The median day at which post-operative complication occurred was 4.5 vs 3 days with a significant p-value of 0.038. Conclusions: Late closure is associated with a significantly higher risk of complications and a resultant greater length of hospital stay. Keywords: Ileostomy, stoma, intestinal perforation, and typhoid

Background/Objective: Few studies have clearly shown a correlation between obesity and wound complications. We analyzed the correlation between body mass index and the complication rate of mesh-based open paraumbilical hernia repair. Method: This observational study after the approval from the institute review board using non-probability consecutive sampling, recruited 150 participants scheduled to have open mesh surgery for paraumbilical hernia repair from 01/may/2022 to 30/Oct/2022 at Department of General Surgery, Civil Hospital Ruth Pfau, DUHS, Karachi and divided into two groups; BMI 26-30 (n=62) and BMI 31-36 (n=88). Completed surveys were analyzed for demographic and clinical data, hernia features, surgical procedures, and patient outcomes. Results: The average age of the participants in the present study was 44.32 years, with an average BMI of 30.97 kg/m2. Out of 150 recruited participants 78 were female and 72 were males. Mean hernia width of the recruited participants was 10.12, with average operative time of the participants was 101.58 minutes. The Mean± S.D of hospital stay (days) of both study groups was 0.82±0.61 and 2.55±0.77 years, and a significant association (0.000) in their mean difference was observed. 26% participants in BMI (26-30) and 58% participants in BMI (26-30), got readmitted to hospital and a significant association (0.000) in their mean difference was observed. 13% participants in BMI (26-30) and 43% participants in BMI (26-30), got wound infection and a significant association (0.000) in their mean difference was observed. Practical implication: this study will help to understand what type of surgery procedures can be beneficial in different BMI classes. Conclusion: The developing SSI and SSOPI after paraumbilical hernia repair rise steadily with increasing BMI. More research is needed to see whether dropping some pounds before surgery will mitigate this correlation. Keywords: paraumbilical hernia repair, BMI, Wound infections, Wound classification.