Background: Chronic inflammation, mucus hypersecretion and airway blockage are the characteristics of asthma. Current treatments of asthma are effective but cause adverse effects on their long term use. This research was designed to explore anti-inflammatory effect of Torilis leptophylla (T. leptophylla) on allergic inflammation of airways by estimation of blood total leukocyte count (TLC) and differential leukocyte count (DLC) to compare its effect with a standard drug in an animal model. Materials and methods: This experimental study was carried out in Pharmacology Department, University of Health Sciences, Lahore. A total of 48 healthy, adult, male BALB/c mice were randomly divided into six groups. Group I (control), group II (diseased); groups III, IV and V were given 100, 200, 400 mg/kg T. leptophylla methanolic extract (TLM) respectively, and Group VI treated with standard drug monteleukast. Airway inflammation was induced in all groups with ovalbumin except control group. On day 28, cardiac puncture was done to collect the blood and TLC and DLC (lymphocytes, neutrophils, eosinophils and monocytes) were measured in blood. All the data was interpreted as mean ± SD. SPSS 20 was used to carry out statistical analysis. Results: T. leptophylla extract resulted in significant (p-value ≤ 0.05) decrease of TLC and DLC in blood. T. leptophylla cause 59-67% decrease in TLC, 67-80% decrease in lymphocytes, 69 - 72% decrease in neutrophils, and 45-51.7% decrease in eosinophils Conclusion: In current study T. leptophylla successfully treated inflammation in asthmatic mice by reducing proportion of inflammatory cells.

Aim: To compare the early cholecystectomy versus conservative management in mucocele gall bladder. Study design: Retrospective study Place and duration of study: Department of General Surgery, Ward-2, JPMC/Jinnah Sindh Medical University, Karachi from 1st October 2020 to 30th September 2022. Methodology: One hundred patients suffering from cholelithiasis with mucocele gall bladder were included. The patients were divided into two groups on the basis of stone location. Group 1 was those where the stone was found on the base of common bile duct (CBD) and elective/early surgery was conducted for the cases of cholelithiasis. Group 2 was those where conservative/delayed surgical technique was applied due to stone location not in the CBD for treatment. While in each group there were 50 cases which were age and gender matched. The first priority for surgical option was through laparoscopic surgery. Results: The mean age of the patients was 45.2±3.3 years. Out of the total cases in group 1 the process of ERCP was conducted in 64% of the cases before laparoscopy. There were 1% and 10% cases which were shifted to open surgery from laparoscopic in group1 and 2 respectively. Consequently, the mean operative time and hospital duration was increased in group 2. Within the Group 2 cases the risk of sepsis, wound contamination and perforation of gall bladder was much higher than in the Group 1 by a value of 10%, 12% and 6% respectively. There was 1 case of mortality and 2 cases of pancreatitis in group 2. Conclusion: The early cholecystectomy is a much safer and efficient procedure on treatment of mucocele gall bladder cases verses conservative management. Keywords: Early cholecystectomy, Conservative management, Mucocele gall bladder

Aim: To comparative analysis of vein stripping versus no stripping in varicose vein disease. Study design: Comparative study Place and duration of study: Department of Surgery, CMH Kharian Medical College, Kharian from 01-01-2019 to 31-12-2021. Methodology: Eighty cases of varicose vein which were having sapheno-femoral valve incompetence as well as perforators-incompetence were enrolled. The age of the cases was between 16 and 70 year. Electrocardiography (ECG), as well as venous Doppler of the affected limb was accomplished. Each group comprised 40 cases. Group A and Group B were constituted in accordance to difference in the operating procedure where vein stripping was done in Group A and without vein stripping was conducted in Group B. Results: The mean age of the patients was 42.3±4.5 years. There was higher number of females than males in this study. In the present study there were higher cases of hematoma observed in group A than in Group B with a percentage difference of 27.7% to 4.4% which was statistically significant. Ambulation comfort was observed higher in cases with ligation then having venous stripping. Pain relief of the patients post 2 months of the surgery was analyzed as higher in the Group A such as venous stripping group in comparison with the without venous stripping group (Group B). Conclusion: The technology of ligation where no vein stripping is conducted is more efficient and reliable then vein stripping methods in terms of pain, hematoma reduction, and trauma reduction with augmenting ambulation comfort. Keywords: Varicose, Mortality, Peroneal vein, Tibia, Femor

Background: One of the procedures that is conducted the most frequently worldwide is inguinal hernia surgery. Several methods have been developed over time, but Lichtenstein has long dominated all others. This is said to lead to a less painful procedure and less suture tearing out, which lowers the likelihood of recurrence. Because to the paucity and high cost of commercial prosthetic mesh, conventional Bassini operations are still carried out at hospitals with minimal resources in developing nations. Because sutured material for darning repair is readily available, has a little amount of reactivity, and has acceptable recurrence rates, we compared it to Lichtenstein in this study. Inguinal hernia recurrence rates following non-mesh surgery range from 0.1 to 1%. Aim: This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications, recovery and cost. Study Design: Prospective Randomized Control Trial Place and Duration of Study: This study was done in department of General surgery at Central Park Teaching Hospital, Lahore during a period of 4 months that span from October 2021 till January 2022. Methodology: Using a continuous simple random selection, 100 male patients between the ages of 20 and 80 who had been clinically diagnosed with an uncomplicated direct or indirect inguinal hernia were divided into two groups using a lottery system. This prospective randomised control trial included Group A, who underwent Darn Repair, and Group B, which underwent Open Mesh/Lichtenstein repair on the elective list (RCT). With follow-up at one week, six weeks, and one year, the primary end point compared the operating time, post-operative pain, analgesic requirement in the first 24 hours, length of hospital stay, time until return to work, surgical site infection, and hernia recurrence between patients who had Darning Repair (group A) and patients who had LMH (group B). Results: In group A, the average operation time and hospital stay following surgery were less. Early postoperative complication rates and the period before returning to work were comparable in both groups. The required length of analgesia was identical as were the pain scores at 24, 48, and 72 hours. Return to regular activity took an average of 5 weeks for each group, which was also comparable. During the 1-year assessment, the recurrence rates in the two groups were similar, at 4% after mesh repair and 4% following darn repair. Practical Implication: This will help in early and prompt management and repair of hernia even at smaller setups as nylon repair is as good as polypropylene mesh repair. Conclusion: Open inguinal hernia repair with a nylon darn was equal to polypropylene mesh with respect to early assessments of postoperative outcome and recurrence at 1 year. When compared to the Lichtenstein approach in individuals with inguinal hernias, the darn repair technique is straightforward, secure, affordable, and has a similar risk of recurrence. Keywords: Inguinal hernia, Lichtenstein Mesh Repair, Open Darn repair, recurrence rate.

Background: Most of the surgeons in our setups perform open cholecystectomy (OC) in patients of cholelithiasis having previous abdominal surgery. This is the era of laparoscopic and robotic surgery and laparoscopic cholecystectomy (LC) should be the preferred treatment for these patients as well. Aim: To observe the effect of previous abdominal surgeries on laparoscopic cholecystectomy. Study design: Randomized, controlled and multicenter experimental study. Place and duration of study: Department of Surgery, Central Park Teaching Hospital, Lahore, Noor Hospital, Kot Radha Kishan and Bilquees Hospital, Kasur from 1st January 2020 to 31st December 2021. Methodology: Fifty eight patients were allocated into 2 groups (29 in each group) not considering age and sex. Both types of surgeries were analyzed on the basis of operating time, post-operative pain (VAS) and complications. Complications were noted i.e. wound infection, bile leakage from cystic duct/CBD injury, gut injury and per operative bleeding). Type of previous surgery was also noted. Data of conversion to open cholecystectomy from laparoscopic cholecystectomy was also recorded. Results: Mean age of patients in group A was 45.99±13.42 years while mean age of patients in group B was 41.87±14.65 years and p-value 0.105. 75.2% patients in group A were female while 82.1% patients in group B were female (p-value 0.185). Operative time in group A was 45.51±8.32 minutes while operative time in group B was 70.33±13.40 minutes (p-value 0.001). VAS score was 7.34±1.80 in group A while it was 5.24±1.93 in group B (p-value 0.001). 4 patients (13.79%) in group A developed wound infection while 1 patient (3.45%) from group B developed wound infection (p-value 0.005). Bile leakage and gut injury were not seen in any of the patient from both groups. Peroperative bleeding (more than 50ml) was seen in 2 patients of group A (6.90%) while it was seen in 8 patients of group B (27.59%) p-value 0.001. Type of previous surgeries were 24 cases were of mesh hernioplasty (41.38%), 16 cases of herniorrhaphy (27.59%), 10 laparotomies for peritonitis/intestinal obstruction (17.24%) and 8 cases of laparotomies for gynecological problems (13.79%). No case of laparoscopic cholecystectomy was converted to open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a safe and excellent option in patients of cholelithiasis having previous abdominal surgery. Even though LC takes more time due to adhesions but this issue does not out weights the benefits of laparoscopic cholecystectomy over open cholecystectomy. Keywords: Laparoscopic cholecystectomy, Cholelithiasis