For the treatment of the Cystic Echinococcosis (CE) different surgical and non-surgical approaches are present. Laparoscopy has replaced the conventional open surgeries that were highly used in the past. This chronic liver infection is caused by the cestode. This disease is increasing the mortality and morbidity cases. Objective: To evaluate the treatment efficacy and complications in patients experienced during the postoperative period. The recurrence rate of the laparoscopic treatment was also calculated. Methods: A total of 24 patients visited the Islam Medical College Sialkot from June 2019 to March 2021 were included in the study. The patients were pre-treated with the albendazole (10mg/kg) for almost one week. Then the Palanivelu hydrated system was used for the laparoscopic partial peri cystectomy. Postoperative complication was classified on the basis of the Clavien-Dindo classification system. Results: The calculated mean age of the 24 patients that participated in the study was 34 ± 15.6 years. The included patient’s age was between 17-76 years. Out of 24, 17 were males and other 7 were females. The 21 patients belonged to the hilly areas. The 19 patients reported the complaint of abdomen pain. While cyst at the right side of the liver was observed in the 90% cases. Abdominal pain and cyst formation were the most common symptoms and pathology reported in the patients. The 10.4±3.1 was the calculated mean size of the cyst. The calculated mean operative time was 80.8±19.8 (60-20) minutes. According to WHO grading of cyst the 4 patients were included in the group with unilocular cyst, while the 7 patients were included in the CE1 hydatid group. Conclusions: The study proved that the laparoscopic treatment is an effective treatment for the hepatic CE. This treatment has reduced the risks of recurrences, mortality and conversion in the treated patients.

Objective: This study was conducted with the aim to approach the diagnostic accuracy of fine needle aspiration cytology in supraclavicular lymph node swelling at outpatient department. Methods: The study is cross-sectional, descriptive conducted at General Surgery department Unit-III, of PUMHSW, Nawabshah, Sind, from 1st January 2019 to 31st December 2020. After the written permission from ethical Review Committee of PUMHS-W, all the patients attending Surgical/Medical outpatient department with supraclavicular lymph node swelling and sent for cytological examination from 1st January 2019-31st December 2020 were entered in SPSS-20, after filling of specially designed proforma. All the variables/demographic details were entered and analyzed by SPSS version 20. Results: Total of 153 cases diagnosed at the Department of Pathology, PUMHS-W, and Nawabshah during the two-year period. The most commonly lesion was TB Lymphadenitis 58(38%),and 43(28%) were cases of Reactive Hyperplasia, while the malignant metastatic lesions were 38(25%) and Lymphoma and NHL were positive in 5(3%) cases. The metastatic lesion were most commonly involve the left side 23(60.5%) and less commonly the bilateral 3(8%) involvement. The common metastatic malignancy found was squamous cell carcinoma 14(37%) followed by adenocarcinoma, undifferentiated carcinoma, small cell carcinoma, papillary thyroid carcinoma, ductal carcinoma breast, hepatocellular carcinoma and seminoma, 10(%), 5(% ),2(%), 2(%), 1(%), 1(%), 1(%) respectively. The most commonly involved age group by mixed lesions were 41-50 years of age, and less common group involved was above 70 years of age. The metastatic malignant lesion were commonly found in 61-70 years of age group and lymphoma and Non Hodgkin Lymphoma were seen up to 60 years of all age groups. Conclusion: Fine Needle Aspiration Cytology is a reliable diagnostic tool as it is cheap, less invasive, and timed modality for diagnosing the supraclavicular lymph node inflammation/metastatic and nodular malignancies.

Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

Background: The surgical treatment of perforated duodenal ulcers is not controversial; however, the best surgical strategy is still up for debate. The perforation closure with an omental patch or without it during surgery is the basis of perforated duodenal ulcers treatment. Laparoscopic surgery can now be used to repair a perforated duodenal ulcer due to developments in minimal access surgery. Aim: In this analysis, the results of open versus laparoscopic repair of perforated duodenal ulcers were compared in terms of operating time, length of hospital stays, postoperative pain and complications after the operation, among other factors. Methods: This prospective comparative study was held at the surgical department of Agha Khan University Hospital, Karachi for one-year duration from January 2022 to December 2022. Patients were divided randomly into two groups, A and B, who underwent operations using laparoscopic and conventional methods, correspondingly, and results were compared. Results: This study found that men between the ages of 51 and 60 were most frequently affected. Laparoscopic group patients experienced much less post-operative pain, need less analgesics, minimum wound infection, and less stay in hospital than open group patients (p 0.05). Conclusions: Laparoscopic repair when performed on carefully chosen patients for perforated duodenal ulcers, it is safe, practical, and produces better outcomes than open surgery. Keywords: Omental patch, laparoscopic repair, open repair, perforated duodenal ulcer

Aim: To access the diagnostic value of the mean platelet volume in children with acute appendicitis. Study design: A case control study Place and duration: In the Surgical department of Bilawal Medical College for Boys LUMHS, Jamshoro and Sheikh Zayed Medical College/ Hospital Rahim Yar Khan for six-months duration from July 2021 to December 2021. Methods: 150 total patients were selected with the WHO formula with SD 1.09, 80% power, 5% significance level with cases to control ratio of 1:1 and expected populace 7.55. The patients were selected with simple random technique of sampling (lottery method). The continuous variables of both groups were compared by means of the t-test. To determine the association of MPV with other variables; correlation test was applied. Results: The study included 150 patients; 35 (46.7%) are men and 40 (53.3%) are women in the study group and 34 (45.3%) men and 41 (54.7%) women in the control group. 8.21 ± 3.51 (1-15 years) was the mean age of the patients in the study group and the mean age of the controls was 8.69 ± 3.51 (1-15 years). The specificity for raised neutrophil and WBC values was 91% and 89%, and the sensitivity was 77% and 84%, respectively. The sensitivity and specificity to MPV reduction was 87% and 54%. Conclusion: The increase in the leukocytes and neutrophils is significantly associated with acute appendicitis diagnosis. It is less costly and less time-consuming which cause more attention to MPV values during complete blood counts in the acute appendicitis diagnosis among pediatric patients. The low MPV levels are encountered in children with acute appendicitis. Keywords: High white blood cell count, acute appendicitis, specificity, mean platelet volume (MPV).