Objective: The outcomes of individuals who were admitted to a hepatobiliary unit suffering from acute severe necrotizing pancreatitis will be the focus of this research. Study Design: Observational/ Prospective study Place and Duration: Conducted at Department of Gastroenterology Hayatabad Medical Complex Peshawar, during from the period Jan, 2021 to June, 2021. Methods: There were 85 patients of both genders were presented in this study. Included patients were aged between 20-70 years. All the patients had severe necrotizing pancreatitis were included. Detailed demographics of enrolled cases included age,sex, body mass index, etiology and comorbidities were recorded after taking informed written consent. Outcomes were calculated in terms of complications, hospital stay, number of drains inserted and nutritional support among all cases. SPSS 22.0 was used to analyze all data. Results: Among 85 patients, majority of the cases were males 62 (72.9%) and the rest of the patients were females 23 (27.1%). Included patients had mean age 47.12±8.39 years and had mean BMI 26.2±6.25 kg/m2. Most common comorbidity was diabetes mellitus found in 18 (21.2%),followed by hypertension in 17 (20%) and ischemic heart disease in 9 (10.6%) cases. Gall stones were the most common etiology found in 35 (41.2%) followed by idiopathic in 16 (18.8%) and cigarette smoking in 13 (15.3%) patients. NG feed was the most common nutrition in 19 (22.4%) cases. 10 was the most common CTSI score in 43 (50.6%) cases. Mean hospital stay was 31.9±11.82 days and infected necrosis / peri-pancreatic collections was the most common complication.13 (15.3%) cases received EUS drainage and surgical necrosectomy was given to 8 (9.4%) cases. Frequency of deaths was 10 (11.8%). Conclusion: A specialized hepato-biliary unit with a multidisciplinary team approach improves survival with acute severe necrotizing pancreatitis. Percutaneous and EUS-guided draining of pancreatic collections helps prevent necrosectomy for infected pancreatic necrosis. Keywords: Disease outcome, Acute pancreatitis, Infected pancreatic necrosis, Necrosectomy Acute Necrotizing Pancreatitis

Aim: The aim of this study was to evaluate the effectiveness of percutaneous peritoneal drainage (PPD) as a treatment option for high-risk perforated peritonitis in tertiary care hospitals. Methods: This prospective investigation was conducted at multiple centres including Department of Surgery, Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur and Jinnah International Hospital, Abbottabad from August, 2022 to January, 2023. Patients with peritonitis accompanied by shock or who did not respond to initial resuscitative protocols were included in the study. Patients with primary peritonitis or spontaneous bacterial peritonitis and those with a history of multiple previous abdominal surgeries were excluded. The study evaluated the effectiveness of PPD as a treatment option for high-risk perforated peritonitis. Chi Square test was applied to assess association keeping P value < 0.05. Results: The mean age was 54.81±9.2 years, male patients were 66 (57.9%) while female patients were 48 (42.1%). Regarding mortality after PPD 25 (21.9%) patients died, while 15 (13.2%) patients died after definitive surgery. Mortality after PPD was significantly associated with systolic BP < 90 mmHg and comorbid. Conclusion: Based on our study findings, we have determined that percutaneous peritoneal drainage is a crucial procedure that can potentially save lives and lead to improved outcomes in high-risk patients undergoing laparotomy. Moreover, it has the potential to enhance their preoperative condition. Keywords: High risk patients, Primary peritoneal drainage, Perforation peritonitis