Background Living donor liver transplantation (LDLT) is an acceptable treatment option for hepatocellular carcinoma (HCC). Traditional transplant criteria aim at best utilization of donor organs with low risk of post transplant recurrence. In LDLT, long term recurrence free survival (RFS) of 50% is considered acceptable. The objective of the current study was to determine preoperative factors associated with high recurrence rates in LDLT. Methods Between April 2012 and December 2019, 898 LDLTs were performed at our center. Out of these, 242 were confirmed to have HCC on explant histopathology. We looked at preoperative factors associated with ≤ 50%RFS at 4 years. For survival analysis, Kaplan Meier curves were used and Cox regression analysis was used to identify independent predictors of recurrence. Results Median AFP was 14.4(0.7–11,326.7) ng/ml. Median tumor size was 2.8(range = 0.1–11) cm and tumor number was 2(range = 1–15). On multivariate analysis, AFP > 600 ng/ml [HR:6, CI: 1.9–18.4, P = 0.002] and microvascular invasion (MVI) [HR:5.8, CI: 2.5–13.4, P <  0.001] were independent predictors of 4 year RFS ≤ 50%. When AFP was > 600 ng/ml, MVI was seen in 88.9% tumors with poor grade and 75% of tumors outside University of California San Francisco criteria. Estimated 4 year RFS was 78% for the entire cohort. When AFP was < 600 ng/ml, 4 year RFS for well-moderate and poor grade tumors was 88 and 73%. With AFP > 600 ng/ml, RFS was 53% and 0 with well-moderate and poor grade tumors respectively ( P <  0.001). Conclusion Patients with AFP < 600 ng/ml have acceptable outcomes after LDLT. In patients with AFP > 600 ng/ml, a preoperative biopsy to rule out poor differentiation should be considered for patient selection.

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Introduction: Despite the fact that the common bile duct (CBD) is thought to dilate following surgery, post-cholecystectomy CBD dilatation still remains a source of debate. Intravenous cholangiography made it possible to measure the common duct directly. Although most patients did not have a substantial increase in duct diameter following cholecystectomy, there was a trend toward a modest degree of duct dilatation, according to prospective studies employing sonography to assess the common duct. Objective: To determine the frequency of common bile duct dilatation after cholecystectomy for chronic cholecystitis. Study Design: Descriptive study Place and Duration of Study: General Surgery Department, Hayatabad Medical Complex, Peshawar from 1st February 2020 to 31st January 2021. Methodology: Eighty seven patients and age range is 20-60 years booked for cholecystectomy in outpatient department were included and followed up to 6 month to determine the frequency of common bile duct dilatation. Results: The mean age was 38.6±10.3 years with 25 (28.7%) males and 62 (71.2%) females. Mean body mass index of the sample was 25±2.3kg/m2. Sixty (68.9%) underwent laparoscopic cholecystectomy while 17 (19.5%) underwent open cholecystectomy. Mean baseline common bile duct diameter on ultrasound was 1.3±0.1 mm while the mean follow up common bile duct diameter was 1.8±0.2 mm (p<0.001). Common bile duct dilatation was recorded in 20 (22.98%) patients. Conclusion: Common bile duct dilatation after cholecystectomy is controversial, but in asymptomatic patients, a dilation of up to 10mm should be accepted as normal. Keywords: Cholecystectomy, Cholecystitis, Common bile duct dilatation, Body mass index

Background: Due to the complex nature and diversity of bile duct injury (BDI) controversy exists regarding the best management plan of BDIs and sometimes this problem may be difficult to be managed even in the hands of an experience surgeon. Aim: To evaluate different procedures used in the management of bile duct injuries Study Design: Prospective cohort study Place and Duration of Study: General Surgical Department, Hayatabad Medical Complex KPK, Pakistan from 1st January 2016 to 31st December 2020. Methodology: Twenty five patients were enrolled for appropriate management of bile duct injuries. The age range was 15-70 years. Results: Seven (28%) were males and 18 (72%) were females with mean age was 42 year. CBD injury occurred in 17 (68%) patients after open and 8 (32%) after laparoscopic cholecystectomy. Majority of the patients presented with obstructive jaundice 76% and bile leak 16%. Other presentation include biliary peritonitis, biloma, cholangitis etc were 8%. Fourteen (56%) patients had type E injuries and underwent Roux-en-y hepatico-jejunostomy. No patient presented with major bile leak or disruption of anastomosis. Minor leak occurred in 4 (16%), wound infection in 6 (24%), bleeding in 1 (4%), pulmonary embolism in 1 (4%). Conclusion: Simple bile duct injuries can be treated with lateral repairs however for more major injuries Roux-en-y hepatico-jejunostomy can produce satisfactory results depending on Strasberg-classification and bile duct status. Keywords: Reconstruction, Roux-En-Y hepaticojejunostomy, Bile duct injuries, Biliary stricture

Aim: To determine the frequency of helicobacter pylori among patients presenting with duodenal perforation. Study design: Descriptive cross-sectional study. Place and duration of study: General Surgery Department Hayatabad Medical Complex Peshawar from 1st March 2021 to 30th September 2021 Methodology: One hundred and seventy five patients who had a first-time duodenal perforation, were between the ages of 20 and 60, and had a prior history of peptic ulcer disease lasting at least six months were included. Results: Thirty three (18.8%) patients had H pylori in body mass index of 18.5-24.9kg/m2, 39(22.3%) in BMI 24.9-29.9kg/m2 and 19(10.8%) in BMI 30-32.2 kg/m2. Fifty nine (33.7%) patients had H. Pylori who had peptic ulcer disease (PUC) since 7-11 years and 32(18.36%) had the condition with PUC 11-15 years. 69(39.4%) belongs to Urban areas, while 22(12.6%) belongs to rural areas. 18(10.3%) patients found to be chain smoker, while diabetes mellitus and hypertension was noted in 15(8.6%) Conclusion: Our population frequently develops duodenal perforation from H. Pylori owing to peptic ulcer disease. It is a serious problem and we advise more study to identify risk factors linked to this high H. Pylori burden and preventive measures to stop its spread and the morbidity linked to it. Key Words: Helicobacter pylori, Duodenal ulcer, Gastric ulcer, Peptic ulcer, Perforated peptic ulcer, ELISA