Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

Objective: To determine the outcome of endoscopic pilonidal sinus treatment (EPSIT): Is a new minimally invasive treatment in pilonidal sinus. Study Design: This is a observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2020 to Feb 2021. Materials and Methods:  Patients aged between 20-40 years, both gender having sinus in the cleft of the buttocks on clinical examination with associated symptoms like pain when sitting or standing, reddened, sore skin around the area, pus or blood draining from sinus, hair protruding from the lesion and formation of more than one sinus tract, or holes in the skin were included in this study. Patients with abscess and recurrent pilonidal sinus were excluded. Outcome measurements were postoperative pain, return to normal daily activities and complication rates including infection, recurrence. Results: 44 patients with Pilonidal Sinus were included in this study.  15 to 40 years with mean age ± SD (range) was 26.56±4.1 years. 40(90.90%) were male where as 4(9.09%) were females. Mostly patients have single external openings in 37(84.09%) patients with midline opening location in 26(59.09%) patients. The mean operative time±SD (range) was 21.09±3.62 minutes (15 to 45 min). According to the visual analog scale (VAS) score for postoperative pain assessment after 48 hours of surgery, 36 patients (81.81%) reported a VAS between 1 to 3, and 8(18.18%) reported a score between 4 to 6. Postoperative wound infection was seen in one case 2.27% while recurrence was observed in two cases 4.54%. The overall healing rate was 93.18%. The mean time to return to normal daily activities was 6.1±11 (range, 2–15) days.  Conclusion: To conclude that the EPSiT is safe, effective, simple, repeatable and very welcomed by the patients if explained correctly. We can say that EPSiT can be labeled as a day surgery, with fast post-operative recovery and early return to work.

Objective: To determine the outcome of video-assisted anal fistula treatment (VAAFT): A new minimally invasive treatment option for fistula in ano. Study Design: This is an observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form January 2020 to June 2020. Material & Method: Inclusion criteria for this study were patients aged 18-60 years visiting the outpatient department with primary/recurrent fistula having symptoms. Among these individuals having anal fistula due to secondary causes like IBD, tuberculosis or any malignancy were not included in the study. VAAFT was performed by experience general surgeon and post-operative follow up was done till 1 years. Results: A total of 68 patients with fistula in ano were selected for video assisted anal fistula treatment (VAAFT) in our setup. It included 67.6% (n=46) males and 32.3% (n=22) females who agreed for the procedure. The mean age of patients were found to be 43+13 years. Post-operatively complete healing was observed in 75% (n=51) patients and 14.7% patients had persistent fistula after the procedure.  Conclusion: VAAFT is a minimally invasive surgical intervention implied to treat primary and recurrent anal fistulas, having lesser rates of recurrence and few post-operative complications. It should be implied over large scales for treatment of primary and recurrent anal fistula as it  carries the lowest rate of anal incontinence.

Objectives: Toevaluate the outcome of laparoscopic cholecystectomy as compared with open cholecystectomy in compensated cirrhotic patients. Study Design: Prospective randomized study. Setting: Department of Surgery, Liaquat University Hospital, Jamshoro. Liaquat University Hospital is Tertiary Care Hospital in the region of Hyderabad and Jamshoro. Period: Three years from January 2011 to December 2014. Patients and Method: Total 172 patients presentedwithsymptomatic gall stone disease and compensated cirrhosis were randomly divided in to two groups, open cholecystectomy group and laparoscopic cholecystectomy group. Study variables were age, sex, cause of cirrhosis, surgical time, blood loss during and after surgery, hospital stay and postoperative complications. After inform consent, data was collected on preformed proforma. For statically analysis SPSS 16 were used, statically significance were defined a P value < 0.05. Results: In patients for open cholecystectomy group cirrhosis was developed due to secondary infection hepatitis C in 56 (65.88%), hepatitis B in 21 (24.70%) and hepatitis B & C in 08 (9.42%). In laparoscopic cholecystectomy group patients cirrhosis was developed due secondary infection with hepatitis C in 62 (71.26%), hepatitis B in 15 (17.24%) and hepatitis B & C in 10 (11.5%). Laparoscopic cholecystectomy was done on 79 (90.80%) and eight (9.20%) patients converted in to open cholecystectomy due to difficult dissection in three patients and bleeding  developed into five patients. The time of surgery was shorter in laparoscopic cholecystectomy group (60.15±15 min) as compared to 75.10±15 minutes in open cholecystectomy group. Oral diet was started early (08-18H) after laparoscopic cholecystectomy as compared to open cholecystectomy (24-12) hours. Hospital stay was also shorter in laparoscopic cholecystectomy group (1.5±1) days versus 03±01 day in open cholecystectomy group. Conclusion: Laparoscopic cholecystectomy is safe, more feasible, needless operative time and less postoperative complicationsin compensated cirrhotic patient as compare to open cholecystectomy but laparoscopic cholecystectomy needs more expertise and availability of instruments.

Introduction: Contaminated abdominal surgical laparotomy incisions and their care are basic principles in the field of surgery. In emergency or trauma laparotomy, the primary surgeon's pivotal role is to optimize the untoward incision wound response, excise or debride viable/nonviable tissues, and alleviate the process of wound healing near to normal function. In contaminated abdominal surgeries, wound contamination is unavoidable that occurs at the time of surgery, and several methods are used to prevent wound complications. Material and Methods: To assess the impact of subcutaneous negative suction versus simple subcutaneous drains on the outcome of surgical wound infection, we conducted an observational study involving patients with contaminated abdominal surgical laparotomy wounds. The study was conducted in the Department of Pediatric Surgery at Liaquat University Hospital Hyderabad. Over five years from January 2015 to December 2020 about 300 patients underwent emergency or trauma laparotomy. Patients were divided into two groups A and B 150 each group by random sampling. Results: In our study, negative suction drain versus simple subcutaneous drain without suction during the closure of the contaminated abdominal surgical wound in emergency or trauma laparotomy, the negative suction drain is highly suggestive to decrease postoperative wound infection, seroma formation, and wound disruption. Compared to a simple subcutaneous drain, the utilization of a subcutaneous suction drain following the closure of the abdominal sheath result in effective wound drainage, reducing the risk of wound infection and disruption. Conclusion: Subcutaneous suction drain has a better outcome as compared with simple subcutaneous without suction in the management of contaminated surgical laparotomy wounds. Keywords: Negative suction drain, simple drain, seroma, wound disruption.