Background: Postoperative infectious complications which results in prolong hospital stay carries a significant risk to patients and burdanise health care system as well. Many risk factors are known to increase the incidence of post operative infectious complications and length of hospital stay. The aim of present study is to determine the association of time duration of surgeries with post operative infectious complications and length of hospital stay. Methodology: This prospective observational study was conducted on 462 patients who underwent various major surgical procedures in the Department of General Surgery in PIMS Hospital, Islamabad from January 2020 to December 2021. Patients <16 years and admitted for trauma were excluded. The time duration of various surgeries from incision to closure was recorded. Post operative complications sepsis, pneumonia, wound infection, urinary tract infection and length of hospital stay was recorded as well. Data was analyzed by spss version 22 .Any Correlation between time duration of surgeries with post operative complications and length of hospital stay determined. Results: Of the total 462 patients who underwent various surgical procedures, the post operative infectious complication rate increased linearly with operation duration at 2.5% per ½ hours ranging from 2.5% to 30.6% in 1 hour to 6 hours respectively. Infectious complications such as UTI, wound infection, pneumonia, and sepsis showed positive correlation with time duration of surgeries. The post operative infectious complications increased after one hour of surgery compared to half hour. Conclusion: As the time duration of surgeries increase the chances of post operative infectious complications also increase, hence increasing the length of hospital stay as well. Keywords: Post operative infectious complications, Hospital stay, Duration of surgeries.

Objective:  systematic review assessed the overall incidence of hypoparathyroidism after Total thyroidectomy (TT) for benign goitres. Methods: A systematic search of PubMed, google scholar, Cochrane, and Pakmedinet under PRISMA (preferred reporting items for systematic reviews and Meta-analyses) guidelines was performed. All studies during the last 50 years where TT was performed for benign goitres and post-operative hypoparathyroidism was assessed were included.  The total incidence of both transient and permanent hypoparathyroidism was calculated after TT for benign goitres. The risk of bias was also assessed. Results: Twelve studies were included in total including eight retrospective, three prospective observational studies, and one randomized trial. Three studies were from Turkey, 2 from Pakistan, 2 from Greece, and one each from Saudi Arabia, India, Denmark, Egypt, and the USA. 2809 TT were performed for benign goitres. Overall Transient hypoparathyroidism (THP) was noted in 290 (10%) patients while permanent hypoparathyroidism (PHP) was noted in 33(1.17%) patients. The highest incidence of permanent hypoparathyroidism was 17% in one study while the lowest was 0% in three studies. The highest incidence of transient hypoparathyroidism was 28.5% in one study while the lowest incidence was 2.5%. The risk of bias was high. Conclusion: TT for benign goitres is associated with 1.17 % overall risk (range 0%-17%) of PHP and 10% (range 2.5%-28.5%) of THP.

Aim: To find out efficacy of plastibell circumcision and to establish certain technical considerations to minimize complications. Study design: Cross-sectional Descriptive study Place and duration of study: Department of Surgery, Aero Hospital Hassan Abdal from 1st September 2016 to 31st August 2020. Method: Total of 400 infants and neonates were included in present study. Children was taken upto six months of age and 1% lignocaine was used as a source of local anesthesia. Plastibell was used for circumcision under strict aseptic conditions. Parents were allowed to take child home after half hour of retention in the hospital and follow up done after one week of circumcision. Parents were given telephonic access to surgeon during this week. During follow up baby was examined, results recorded and complications were treated if any. Results: Ring block using 1% lignocaine provided adequate pain relief in neonates and infants. There were 345 boys were brought for circumcision during first month of their life while 55 were infants between one to six months of age. Six patients had post-operative bleeding during immediate post op period and two patients presented after 12 hours with bleeding which needed removal of plastibell and maintenance of hemostasis. The mean time of plastibell detachment was 06 days (range 03-12 days). Plastibell was ctuck in few patients which needs to be removed early. Paracetamol was also used post-operatively as an oral analgesia and provided adequate pain relief. Two patients presented with infection after plastibell detachment. The foreskin was removed in every boy except one. Handling of the babies was easy for mothers. Conclusion: Plastibell proved to be an effective method of circumcision provided few technical points like size of plastibell, use of bipolarcautery, hemostasis of frenular area, and threading around plastibell are properly taken care off. Keywords: Circumcision, Plastibell, Neonate, Infant, Lignocaine, Frenular, Foreskin

Objective: To compare the outcome (in-terms of mean post-operative pain and hospital stay) of intraperitoneal onlay mesh (IPOM) with open sublay mesh repair in patients undergoing ventral hernia repair. Materials and Methods: A total number of 150 patients of ventral hernia planned for hernia repair were included in this randomized controlled trial from Jan-2020 to June-2021. Patients were divided into Group I (IPOM) and group II (OSM). IPOM; in these patients intraperitoneal onlay mesh (IPOM) repair was done laparoscopically. OSM group; in these patients open mesh repair was done. Post-operative pain score and hospital stay were main study outcomes. Results: Mean duration of herniation was 5.96±3.24 months in IPOM and 6.28±2.35 months in OSM group (p-value 0.49). Hypertension was the commonest morbidity was hypertension, diagnosed in 40 (53.3%) patients in IPOM and in 41 (54.7%) patients in OSM group (p-value 0.88). Mean post-op pain was significantly high in OSM group; 2.60±1.06 versus 1.68±1.06 in OSM group (p-value <0.0001). Mean hospital stay was shorter in IPOM group; 4.44±1.62 days versus 5.65±1.98 days in OSM group (p-value <0.0001). Conclusion: IPOM repair is a viable and safe option, according to the results of our research. The open SUBLAY approach has a higher morbidity than IPOM laparoscopic ventral hernia repair. A shorter hospital stay is another benefit of the IPOM. Keywords: undergoing intraperitoneal onlay mesh (IPOM), open sublay mesh repair hernioplasty, post-operative pain.

Objective: To compare the outcome of clamp-and-tie with Ligasure technique in total thyroidectomy patients. Material and Methods: A total 60 (30 in each group) patients undergoing near total thyroidectomy for benign goiter were included in this study. After taking informed consent, demographic data (age, gender, duration of goitre, place of living and BMI) were noted. All selected cases were be divided into group A & B by lottery method. In group A patients total thyroidectomy was done by using ligasure while in group B patients, near total thyroidectomy was done by clamp-and-tie technique. Operation time and intra-operative blood loss were measured for each patient. Results: Mean age of patients was 45.60±12.1 years included in this study. Mean disease duration was 7.8±4.5 months. Mean BMI was 24.80±3.61 kg/m2. There were 43 (71.67%) females and 17 (28.33%) male patients. There were 13 (21.67%) patients were from rural area and 47 (78.33%) were from urban area. Mean operative time in group A was 61.33±5.98 hours versus 75.06±6.61 hours in group B (p-value <0.001). Mean intra-operative blood loss was 53.40±6.11 ml in group A versus 81.47±9.29 ml in group B (p-value <0.001). Conclusion: Thyroid surgery with Ligasure resulted in dramatically reduced mean operational time and postoperative blood loss compared to traditional approach. Keywords: clamp-and-tie technique, Ligasure, total thyroidectomy.