Objective: We aimed to compare the rate of complications of Gomco and Plastibell circumcision techniques ininfants. Study design:Prospective Randomized Clinical TrialStudy. Place and duration of study:Department of Pediatric Surgery, Sheikh Zayed Hospital, Rahim Yar Khanfor six months from August 2020 to July 2021. Patients and method: A total of 80 patients were enrolled in the study, equally divided into two groups. Group 1 included patients undergoing circumcision via the Gomco technique, while group 2 circumcised with the Plastibell method. All healthy male patients aged one day old to 4 years of age were included. Patients with any congenital abnormalities, e.g., urethral or penile shaft abnormality, local infection, hypospadias. Jaundice and bleeding disorders were excluded. All procedures weredone under local anesthesia, postoperatively topical antibiotic was prescribed to each patient. Data was entered and analyzed using SPSS 25.0. Frequencies and percentages were expressed for qualitative variables like gender and postoperative outcomes, i.e., bleeding, penile edema, and redundant skin. Mean ± S.D represented quantitative variables like age, weight, and BMI. A Chi-square test was used to compare the complication rate between both groups. A p-value ≤0.05 was considered significant. Results: In the Gomco technique, there was no Penile edema, surgical site infection, hematoma, and need for Repeat surgery/manipulation. We found that bleeding was more common in Gomco compared to Plastibell. On the other hand, penile edema, reductant skin, slipped ring, and the need for repeated surgery/manipulation was more often in the Plastibell technique. Conclusion: We propose using the Gomco method for circumcision because of its lower rate of complication and better aesthetic outcome than the Plastibell method. Keywords: Circumcision, Gomco, Infant, Plastibell.

Objective: To find the diagnostic accuracy of hyperbilirubinemia as a prediction of appendicular perforation in acute appendicitis. Study Design: Cross Sectional study. Setting: Department of Surgery, Allama Iqbal Medical College/ Jinnah Hospital Lahore. Period: March 2019 to March 2020. Material & Methods: A total 345 patients meeting selection criteria were included. Serum bilirubin was measured pre-operatively and histopathology of specimen was collected. The data was analyzed using SPSS v 26 and mean ± SD, frequency and percentages were calculated. Results: There were 214(62%) males and 131(38%) females. On histopathology perforated appendicitis was seen in 70(20.3%) and 275(79.7%) cases had non-perforated appendicitis. A total of 77(22.3%) cases had hyperbilirubinemia and 268(77.7%) of the cases had normal bilirubin level. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of hyperbilirubinemia was 90%, 94.91%, 81.82%, 97.39%, 93.91% respectively. Conclusion: The diagnostic accuracy of hyperbilirubinemia is high enough to identify early detection of perforated appendicitis. Hence, by early identification and appropriate management techniques, potentially life-threatening complications can be minimized.

Objective: The objective of our study is to compare the surgical outcomes of two surgical techniques namely Fisher’s technique and Millard’s Rotational Advancement Flap, particularly in terms of white roll symmetry, lip length, lip height, scar quality, notching, cupids bow and alar base symmetry. Study design: Prospective Randomized Clinical Trial study. Place and duration of study: Department of Pediatric surgery, Sheikh Zayed Hospital, Rahim Yar Khan for a period of six months from 1st March 2021 to 31st August 2021. Patients and method: A total of 56 patients were enrolled in the study, equally divided into two groups. Group 1 will include patients undergoing treatment via Millard's Rotational Advancement Flap technique, while group 2 will include those receiving Fisher's procedure. A single consultant performed the procedure. Variables like lip length, Alar base symmetry, scar quality, cupids bow symmetry, and notching were accessed postoperative via the Steffensen grading method, and Vernier caliper was used for anthropometric measurements. The SPSS v 23 was used to evaluate the data. All numerical data were provided in mean and standard deviation (SD) formats. Frequencies were computed for qualitative data. Nonparametric tests (paired and unpaired t-tests) and parametric tests (Fisher's exact test) were utilized to compare the variables. P-value of < 0.05 was considered statistical significant. Results: Both groups had identical outcomes in terms of lip length, nasal symmetry, and alar dome. On the other hand, Fisher's approach was superior in terms of vermilion roll symmetry, white roll symmetry, scar appearance, and Cupid Bow. Anthropometric measures, such as lip height and breadth, were taken; however, the results were statistically insignificant. There was no discernible difference between the outcomes of complete and incomplete cleft lip. Conclusion: We propose using the Fisher's surgical method in unilateral cleft lip repair since it produces better outcomes than the Millard's procedure. Keywords: Anthropometric measurement; Fisher; Lip Notching; Millard; Scar; Unilateral cleft lip.

Introduction: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gall stone disease all over the world. In laparoscopic cholecystectomy gall bladder is traditionally removed through umbilical port. In this approach surgeon has to change his position and telescope has to be changed in xiphoid port. Another approach to remove the gallbladder is through 10mm xiphoid port without changing position of telescope and surgeon. Both approaches are compared for their pros and cons regarding post-operative pain at site of removal. Study Design: Randomized control study. Setting: Department of surgery of Allama Iqbal medical college/ Jinnah hospital Lahore. Period: August 2017 to February 2018. Material & Methods: To compare mean post-operative pain in gall bladder retrieval through umbilical versus xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis. Patient were divided in two equal groups with first group had their gall bladder retrieved through umbilical port while the other underwent retrieval through xiphoid port. Standard analgesia was used in both groups and post-operative outcome was noted. Results: A total 70 patient with equal distribution in two groups were enrolled to compare post-operative pain at port site comparing umbilical versus xiphoid process. Mean post-operative pain visual analogue scale (VAS) was as lower (p<0.0001) at 1, 6, 12 & 24 hrs. In umbilical port group as compared to xiphoid port group. Conclusion: Mean post-operative pain in gall bladder retrieval umbilical port give advantage in post-operative period regarding significantly reduced pain when compared with xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis in selective cases.