Background: One of the most commonly performed surgeries globally is Laparoscopic Cholecystectomy (LC) which is the gold standard surgical procedure for removal of gallbladder. It provides numerous benefits over open cholecystectomy but has also shown higher complication rates. Therefore, a system devised for pre operative assessment of intra operative difficulty level of Laparoscopic Cholecystectomy should be adopted to help with preparedness for complications and ensure an efficient course of surgery. Objective: The aim of this study was to validate a scoring system made by Randhawa Et al to assess intra operative difficulty level of Laparoscopic Cholecystectomy preoperatively. Study Design: This is a non randomized prospective observational study Methodology: This study was conducted in the department of general surgery unit 2 at Dow University Hospital, Karachi, Pakistan on 202 patients. Age, gender, BMI, history of previous hospitalization, examination finding of palpable gallbladder, previous abdominal surgery scars and sonographic findings including wall thickness of gallbladder, pericholecystic collection and impacted stone were considered to score a patient preoperatively. Results: Male gender and presence of pericholecystic fluid collection were found to be statistically significant in predicting intraoperative difficulty in patients undergoing laparoscopic cholecystectomy. Practical implications: Around 7 to 35% of laparoscopic cholecystectomy ends up getting converted into open cholecystectomy. This could be due to various reasons one of which is due to lack of preparedness for intraoperative difficulty in performing the surgery. For this reason, a scoring system that accurately predicts difficulty of surgery could help reducing this rate. Keeping this benefit in mind, a preformed scoring system was tested for its validity in assessing the intraoperative difficulty level of LC preoperatively. Keywords: Laparoscopic cholecystectomy, Scoring system, complications

Persistent Mullerian Duct Syndrome (PMDS) is a rare disorder of defective sexual development in males. It is characterized by aberrant synthesis or inadequate action of Mullerian inhibiting factor resulting in derivatives of Mullerian duct, i.e. uterus, fallopian tube and upper vagina, to persist in a phenotypic male with 46XY karyotype. Here, we report a 19-year-old male with bilateral undescended testes. Further evaluation revealed that the patient had both his testes placed intra-abdominally along with a rudimentary uterus.

Background:C-Reactive Protein (CRP) is an acute phase reactant that is routinely used in evaluation of cases with acute abdomen. We determined levels of CRP in patients with surgical causes that were either treated with operative or with non operative measures, and patients with non-specific abdominal pain. Objective: The aim of this study was to identify the use of C-reactive protein in differentiating between surgical causes of acute abdomen and non specific abdominal pain. Study Design:This is a prospective observational cohort study. Methodology: This study was conducted in General Surgery Department of Dow University Hospital, Ojha Campus, Karachi from January 2022 till October 2022. A total of 116 patients admitted with acute abdomen via Emergency were included in this study. Results: A total of 7 patients had non specific abdominal pain whereas the remaining 109 patients had surgical causes. 57 of those patients were managed conservatively while 52 underwent surgical interventions. Median value of CRP turned out to be 50, however CRP levels of the three groups had no significant impact on the evaluation of acute abdomen. Practical Implications: CRP levels are actively monitored in patients with acute abdomen. This study was conducted to find out if CRP levels can help assess the treatment of choice in such patients. The end result showed that CRP alone isn’t a helpful parameter to assess patients with acute abdomen. Conclusions: CRP is not a reliable marker in determining whether the patient has surgical abdominal pain or a non specific one. There is still room for further analysis to look for acute inflammatory markers that could help us evaluate the cause behind abdominal pain and guide us in devising a management strategy for the same. Keywords: CRP, C-reactive protein, Acute Abdomen, Non specific abdominal pain, operative intervention, non-operative intervention.

0.2% Glyceryl trinitrate is vastly used for treatment of chronic anal fissure and it has proven its effectiveness by decreasing anal tone and promoting healing. However, lateral sphincterotomy is considered a standard treatment for anal fissures. OBJECTIVE: The aim of our study was to compare application of 0.2% GTN and lateral sphincterotomy as a treatment for chronic anal fissure. STUDY DESIGN: It was an observational prospective cohort study. METHODOLOGY: This study was conducted in General Surgery unit 2 of Dow University Hospital Ojha, Karachi. A total of 192 participants were included in the study with their signed consent 96 of whom were given GTN and the remaining 96 were advised lateral sphincterotomy RESULTS: Both treatment modalities showed promising results. Upon follow up after 2 and 4 weeks, patients’ symptoms decreased more in the lateral spincterotomy group. Around 29.17% patients became asymptomatic at 2weeks and 87.5% at 4 weeks in the lateral spincterotomy group. While 11.46% became asymptomatic at 2 weeks and 87.5% at 4 weeks in the conservative management group. CONCLUSION: Lateral sphincterotomy shows more effective results in treating chronic anal fissure as compared to application of 0.2% GTN however, as 0.2% GTN has quite comparable results as well, surgeons should opt for it as the first line of management before resorting to lateral sphincterotomy. Keywords: Chronic anal fissure, 0.2% Glyceryl Trinitrate, lateral sphincterotomy.