Objective: To determine the frequency of various sources of bleeding in laparoscopic cholecystectomy with special preference to gallbladder bed excluding port site. Methods: This cross-sectional study was consisted of 163 patients admitted through the outpatient department from Peoples Medical College Hospital Nawabshah. Ultrasound of abdomen was done as diagnostic modality and for assessment of gallstone disease. Finally the cases of gallstone were operated through laparoscopic cholecystectomy procedure and observed for sources of bleeding. Results: Out of 163 patients included in this study 138(84.7%) were female and 25(15.3%) patients were male; with female to male ratio of 5.52:1. The mean age was 41.85±7.83 years. Common sources of bleeding in laparoscopic cholecystectomy from liver bed side were 44(27%) cases followed by cystic artery in 17(10.4%) cases, hepatic artery and mesenteric vessel in 1(0.6%) case was observed. Conclusion: Bleeding during laparoscopic cholecystectomy are almost equally common and can prove to be lethal if not identified and managed during the operation. Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.

Objectives: To evaluate the histopathological findings in appendectomy specimens and observe the negative appendectomy rate (NAR). Study Design: Observational study. Setting: Department of Surgery Unit III, Peoples University of Medical & Health Sciences, Nawabshah. Period: January to December 2018.  Material and Methods: 117 consecutive cases of appendectomy. All the demographic data and the clinicopathological details were recorded on a proforma designed for the study. The histopathological assessment was carried out in all cases. The ultrasound examination and CT scan was carried out in selected cases. The data collected was statistically analyzed and the results were tabulated. Results: During study period 117 appendectomies were performed. The mean age of patient was 27+9.4 years, majority of patients (53.8%) were females with female to male ratio of 1.2:1. The histopathological diagnosis was made in all cases and the results indicates that 105 cases having positive appendectomy and in 12 (10.3%) cases the appendix was found histologically normal. Among 105 positive cases, 97 (83%) were diagnosed as acute appendicitis, 2 (1.7%) cases show fibrous obliteration and 6 (5.1%) cases were having unusual pathologies. The cases having histological diagnosis of acute appendicitis includs acute mucosal appendicitis, acute suppurative appendicitis with or without periappendicitis and peritonitis, acute necrotizing appendicitis and perforated gangrenous appendicitis. The 6 cases of unusual pathologies includes 3 cases of granulomatous lesions and one case each of carcinoid tumor, mucinous cystadenoma and worm infestation. The ultrasound was performed in 48 (41%) patients out of them 30 cases had positive findings on ultrasound examination were confirmed on histological examination and all 5 positive cases that were reported on CT scan were confirmed on histopathological examination. Conclusion: High rates of negative appendectomy in the female sex were observed, that can be reduced by the use of diagnostic imaging modalities specially ultrasound. The findings of abnormal pathologies on histopathological examination of the appendix suggest that histopathological analysis is necessary in all of the resected specimens.

Introduction: Abdominal tuberculosis has higher incidence particularly in developing countries. The challenge to Surgeon is to diagnose it as its presentation is very vague and diagnostic tools are dubious.1 Biochemical analysis helps a little bit in this regard. The abdominal tuberculosis which is not so commonly seen as pulmonary TB can be a source of significant morbidity and mortality and is usually diagnosed as late due to its non specific clinical presentation. About 15 to 25% of cases with abdominal tuberculosis here concomitant pulmonary TB.2 Any part of GIT can be affected but it is usually small bowel and sometimes a colon which is affected barium study has some role in diagnosing the ileal tuberculosis and then is on laparoscopic examination.3 Patients and Methods: This is a cross sectional study conducted at People Medical College Hospital Nawabshah. It was conducted in Surgical Unit 1 from January 2019 to December 2021. All the patients admitted in the ward came through OPD or through emergency. History was taken and proper examination of abdomen apart from systemic examination was done. Routine investigations were done. specific investigations like Liver function test (LFT) and serum electrolytes were done. Radiological investigations like ultrasound and x ray chest abdomen in erect and supine posture were done. Diagnosis was made and surgical intervention was done. Results: Total 30 patients were included in this study. Age of patients was between 20-50 years. 9(30%) patients aged between 20-3- years. 10 (33.3%) were of age between 31-40 years and 11 were aged between 41-50 years. Higher prevalence was in 4th and 5th decade of life. Patients with acute emergency were treated by Exploratory Laparotomy. Per operative findings showed stricture in 14 (47%) patients that were treated with resection and end to end anstomosis. 13 (43%) patients had single as well as multiple perforations of more than 4-5 cm in sizes with contamination of contents in abdominal cavity. Covering ileostomy was made in these patients. 3 (10%) patients’ perforations were of .5 to 1 cm with lesser contamination of abdominal cavity. Primary repair was made in these patients. Conclusion: It is concluded that Higher prevalence was in 4th and 5th decade of life. Its prevalence in female is higher as compared to male. .Majority of the patients with Abdominal Tb were treated by resection and end to end anastomisis. Keywords: Prevalence , Gender, Abdominal Tuberculosis, Resection, Anastomosis.

Typhoid ileal perforation is the common complication of typhoid fever in third week of its phase of progression. It is the most common cause of mortality in developing countries. Small perforations are dealt with primary repair and the more complicated disease is treated by multiple other options. Prognosis is good with primary repair with least postoperative complications. Objectives: To detect the outcome of typhoid ileal perforation treated by primary repair at tertiary care hospital. Study Design: Cross sectional study. Setting: Surgical Department of PMC Hospital Nawabshah. Period: From August 2017 to December 2018. Material & Methods: This study included total 70 patients. All patients were admitted from surgical OPD and emergency department of PMCH Nawabshah. Out of 70, 45 (64.28%) were females and 25 (35.71%) were male patients. Age ranged from 27 to 52 and 24 to 47 in females and males respectively. The common presentation was pain in whole abdomen along with distention and fever, vomiting. Plain X ray chest/ Abdomen and ultra sonography showed gas under diaphragm. Primary repair was done and also other surgical options but our study included only the postoperative outcomes of primary repair of typhoid ileal perforation. A few complications were detected after primary repair of the gut perforation. Results: Total 70 patients were included in this study. 45 (64.28%) were females and 25 (35.71%) were male patients. In females, 25 (55%) were found single perforations of less than 1cm whereas 7 (15.5%) had size of perforation less than 1.5 cm. In 25 males, 11 (44%) had single perforations of less than 1cm in size. 2 (8%) had < 1.5 cm size perforations and 12 (48%). Over all complication rate in this study was 26%. Conclusion: Primary repair is the best surgical option to treat typhoid ileal perforation in selected patients with least postoperative complications.

Introduction: Epididymo-orchitis is common condition in scrotum found in surgical practice. It is commonly seen in young males. It can occur at any age. The common age is between 2nd to 4th decades of life. Its duration of illness is 6 weeks in acute condition and 12 weeks in in chronic conditions. It mostly occurs associated with sexually transmitted diseases. Chlamydia trachomatis and Neisseria gonorrhea are the common causative organisms. After age 40, the common organisms causing this disease are Escherichia Coli and Coliform bacteria found on G.I.T. There are also other causes of this disease. It is mostly managed conservatively but it can be operated it the condition develops complications. Even Orchidectomy is also done in some conditions. Objective: To evaluate the management options in epididymo-orchitis . Material methods: This is a cross sectional study done at surgical Unit 1 of Peoples Medical Hospital (PMCH) Nawabshah. The duration of study was one year from 10th August 2019 to 9th July 2020. All the patients were admitted through Surgical out Patient Department (SOPD) and emergency department of Peoples Medical College Hospital (PMCH) Nawabshah. Approval of study was taken from Ethical committee. Detailed history and thorough clinical examination was done. Routine investigations were done apart from viral markers including HIV. Urine DR and Culture ,Ultrasound of Scrotum and CT Scan were done. Management was planned accordingly. Results: Total 65 patients were included in this study. Of them, 20 (31%) had left sided pathology, 40 (61%) had right sided and 5(8%) had bilateral. Testicular abscess formation was seen in 8 (12.3%) patients. In 2 (3.07%) patients, testicular infarction was noted. 1 (1.5%) patient became infertile due to bilateral involvement. 3 (4.6%) patients had developed psychosis. Conclusion: It is concluded that most of the patients were treated conservatively and in a few patients, incision drainage and orchidectomy was performed. Keywords: Epididymo-orchitis. Neiserria Gononrhea, E.Coli, Incision Drainage, Orchidectomy.