Objective: To determine the incidence of surgical site infection following open hernioplasty, and to compare the infection rate among ventral and groin hernia repairs. Method: The retrospective study was conducted from April 2 to November 30, 2021, at the Government Tehsil Headquarter Hospital Sabzazar, Lahore, Pakistan, and comprised data form June 2018 to December 2020 of patients with ventral abdominal and groin hernia. All patients underwent hernioplasty by a single consultant surgeon and were discharged within 2 days of surgery. Surgical-site infections were recorded on follow-up visits up to 30 days of operation, and were compared between ventral and groin hernia cases. Data was analysed using SPSS 22. Results: Of the 218 patients with mean age 37.07±4.94 years, 117(53.67%) were males, 108(49.54%) smokers and 127(58.25%) hypertensive, while 110(50.45%) had ventral abdominal hernia and 108(49.54%) had groin hernias. Mean operative time and mean hospital stay were 56.53±6.20 minutes and 3.06±1.31days, respectively. Mean wound drainage in abdominal hernia cases was 8.99±2.02 days. Surgical site infection incidence following open hernioplasty was 2(0.91%). Infection rate among ventral abdominal and groin hernioplasty were 1(0.90%) and 1(0.92%) (p=0.50). Conclusion: Incidence of surgical site infection following open hernioplasty showed no significant difference between ventral abdominal and groin hernia repairs. Key Words: Surgical site infection, Hernioplasty, Groin hernia.

Objective: Comparison of the efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh hernioplasty. Methodology: We planned this Randomized Control Trial consisting of 200 cases, from Surgical outdoor booked for hernioplasty. All patients were examined in a comfortable environment. All the information was kept confidential. The patients were not aware of the randomization arm and selected via lottery method. All patients underwent Lichtenstein mesh hernioplasty under local anesthesia. Before surgery, a course of prophylactic antibiotics consisting of 1 g of IV cefazolin was administered to each patient. All procedures were done by skilled post graduate general surgical residents under consultant supervision. Predictable bias and confounding factors were controlled by restriction (inclusion and exclusion criteria) and randomization. Rest was addressed during final analysis through stratification. GROUP A patients undergo mesh fixation using Prolene 1. (non-absorbable) GROUP B patients undergo mesh fixation using Vicryl 0. (absorbable). For all treatments, a conventional tension-free uniformed surgical method was adopted. Patients were evaluated at 3 months followup to record the efficacy. Results: Mean age was calculated as 44.7+9.45, mean pain score on VAS was calculated as 2.04+0.72 in Group-A and 1.54+0.76 in Group-B,p-value=0.018. Comparison of efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh Hernioplasty shows that 83(n=83%) in Group-A and 94(n=94) in Group-B had efficacy while, p value 0.014 showing a significant difference. Conclusion: Our findings indicate that, following Lichtenstein mesh hernioplasty, absorbable suture is more effective than non-absorbable suture regarding post operative pain. Keywords: Inguinal hernia, hernioplasty, absorbable versus non-absorbable sutures, efficacy

Objective: To evaluate the outcome of laparoscopic Intra-abdominal Ventral Hernia Repair with Tissue Separating Mesh. Methodology: Patients aged 18-60 years old with documented ASA grade I or II, ventral hernias >5 cm in size (clinically assessed by palpable expansile cough impulse and as abdominal wall defect on ultrasound), and no general contraindications to laparoscopy (such as bleeding disorders, low platelet counts, or prolonged clotting times) were excluded. Patients' permission was obtained after they were fully informed of the risks and benefits. Name, age, gender, and contact details were also recorded. After that, laparoscopic ventral hernia repair was performed. These surgeries were performed under general anaesthesia by a single surgical team led by a senior doctor with at least three years of expertise in laparoscopic surgery. The moment of incision served as the starting point. Tissue-separating mesh was inserted intraoperatively, and the operational time was recorded once again during closure. The patients were sent to the ward for further observation. Discharge documentation revealed a patient's postoperative hospital stay. Results: Mean age of the patients was calculated as 37.03+11.32 years. The gender breakdown reveals that men as majority, with 51 (51%) compared to 49 (49%) females. The outcome of laparoscopic intra-abdominal ventral hernia repair using tissue Separating Mesh showed that the mean operation time was 116.21+8.27 minutes, and the length of hospital stay was documented as 2.4+0.38 days. Conclusion: We concluded that outcome of laparoscopic Intra-abdominal Ventral Hernia Repair with Tissue Separating Mesh with regards to duration of operation and post operative hospital stay is feasible in our population Keywords: Intra-abdominal Ventral Hernia Repair, Tissue Separating Mesh, outcome, post-operative hospital stay, duration of operation

The patient presented in Emergency with Pain right iliac fossa for last 24 hours. It was sudden in onset, mild in intensity, non-radiating to any site, and was associated with mild fever. About 5-6 episodes of vomiting occurred in that period. Her menstrual history was normal. She was taking medication for Rheumatoid Arthritis fort last three months. With Alvarado Score of 6 a clinical diagnosis of Acute Appendicitis was made. X-ray Abdomen did not reveal any abnormality, Blood C/E, Urine C/E, Blood sugar blood urea and serum electrolytes. After preparation, patient was taken to the theatre. Rutherford Morrison incision was made. Her appendix was difficult to locate but was normal. Strangely a toothpick was seen in the mesentery of appendix and there was a pinpoint perforation in terminal ileum about two inches proximal to ileocaecal junction Fig 1. Margins were fresh and it did not give a look of old perforation. There were adhesions between loops of small intestine, which were also adherent to under surface of liver. After adhesionolysis, margins of perforation were trimmed and it was repaired in two layers (Inner vicryl 2/0 continuous and outer with prolene 4/0 interrupted. Appendicectomy was also performed. After washing abdominal cavity with 0.9 normal saline wound was closed in layers. Patient was given postoperative antibiotics and an analgesic, kept NPO for 24 hours, and was discharged successfully after 3 days. Later on patient was asked and she admitted taking a burger three days earlier but she did not remember any toothpick.