ObjectiveTo assess the outcome and safety of staple line over-sewing for patients undergoing laparoscopic sleeve gastrectomy (LSG).Study design and locationRetrospective descriptive analysis conducted at Shifa International Hospital Islamabad.Materials and methodsConsecutive patients undergoing LSG as a treatment for morbid obesity from October 2013 to December 2016 were included in the study after approval from the ethical review board. Patients were divided into two groups: group A who underwent reinforcement using Vicryl 2.0 and group B where no reinforcement was done.ResultsA total of 225 patients underwent LSG between October 2013 and December 2016, including 147 females (65.4%) and 78 males (34.6%). Both groups were comparable in terms of age, body mass index (BMI) and gender distribution (p-value more than 0.05). There was one leak in group A (1.36%), none in group B. The bleeding rate was 4.3% in group A and 2.7% in group B.ConclusionThis was a retrospective analysis of all the patients who underwent LSG, and it was observed that there was no added benefit of sewing the staple line in terms of rate of bleeding and leak.

Morbid obesity is associated with a large number of complications, including infertility; weight loss can help to improve fertility and increase the number of sperm in males. However, two of our patients developed azoospermia after bariatric surgery for weight reduction. A 30-year-old male presented to the outpatient department (OPD) with a BMI of 81.2 kg/m 2 (258 kg) with no known co-morbidities. The patient had a normal sex life and one child. After bariatric surgery, he noticed a change in the consistency of his semen and azoospermia. In the second case, a 48-year-old man presented to the OPD with a BMI of 52 kg/m 2 (189 kg) with no known co-morbidities. He had three children. He underwent bariatric surgery for weight loss and, after one year, he developed azoospermia. Bariatric surgery is a lifesaving procedure for morbidly obese patients and helps in restoring normal daily activities. This weight reduction surgery helps in decreasing blood pressure, increasing glycemic control and improving sexual activity. However, bariatric surgery may be followed by a further decline in semen parameters, resulting in azoospermia and severe oligoasthenoteratozoospermia. This is caused by the combined effects of two different processes: 1) the subduing of the negative effects of obesity, and 2) a deficiency of nutrients along with the release of some harmful substances. Bariatric surgery patients should be informed about the risk of complications and about the possibility for cryopreservation of sperm. In rare cases, bariatric surgery can result in a decrease in sperm count and infertility in males.

Objectives: To explore the learning curve associated with laparoscopic totallyextraperitoneal repair of inguinal hernia, procedure being carried out by single surgeon attertiary care hospital. Study Design: Prospective cohort. Place and Duration: It was conductedat Shifa International Hospital Islamabad from October 2014 to March 2016. Patients andMethods: Consecutive patients undergoing Laparoscopic TEP repair for unilateral or bilateralinguinal hernia from October 2014 to March 2016 were included in the study and divided in twogroups: group 1 of first 50 and group 2 consisting of the next 50 patients. Results: A total of100 patients divided in two groups (50 in each) were included in the study. Group I includedfirst 1 to 50 cases with mean age of 46.6 years (SD +14.81) including 46 (92%) male and 4 (8%)female with similar distribution in group II which consisted of 51 to 100 cases with mean age45.3 years (SD +14.43) including 44 (88%) male and 6 (12%) female. The mean operative timein group I was 78 min (SD +32.30) while in group II the mean operative time was 41.2 minutes(SD+15.99). Conclusion: Although our results are from single centre and single surgeon study,we believe that at least 20 to 30 laparoscopic TEP hernia operations are required to help youngsurgeon familiarize with the anatomy of the region. The learning curve for TEP according to ourstudy is 50 cases.