Study Design: Prospective study Place and Duration: The study is conducted at Surgical A ward Mardan Medical Complex, Mardan and Surgery department of Ahmed Hospital, Bagh Azad Kashmir during the period from June to November 2021. Methods: There were 85 patients of both genders with ages 22-80 years included. Patients were included into the study after obtaining written permission from all participants. All the patients had high perforation peritonitis treated with percutaneous peritoneal drainage with local anesthesia. Post-operative success rate, mortality and complications among all cases were recorded. SPSS 22.0 version was used to analyze complete data. Results: Among 85 cases, 54 (63.5%) were males and 31 (36.5%) patients were females with mean age 51.7±8.71 years. COPD was mostly found among 29 (34.1%) cases, followed by ischaemic heart disease in 20 (23.5%) cases, congestive heart failure in 14 (16.5%) cases, cerebrovascular stroke 12 (14.1%) and 10 (11.8%) patients had comorbidity of steroid use. After drainage, improvement observed in urine output and in blood pressure. Post-operative effectiveness was found among 70 (82.4%) cases and 15 (17.55) patients died. In Post-operative, we found that the surgical site infection (SSI) was the most common symptom followed by chest infection. Conclusion: According to our findings and experience, the use of percutaneous peritoneal drainage under local anaesthesia in patients who have been reported late or are critically ill improves their general condition and allows them to be better prepared to undergo further surgery, which could ultimately save their lives. Keywords: Percutaneous Peritoneal Drainage, Perforated Peritonitis, Mortality, Complications

Objective: To compare the efficacy and safety between onlay mesh technique and sublay mesh technique in patients undergoing paraumbilical hernia repair. Study Design: Retrospective/Observational Place & Duration: In the department of surgery, Muhammad Teaching Hospital, Peshawar and Fauji Foundation Hospital, Rawalpindi and conducted during the period from March 2021 to August 2021. Methods: A total of 166 patients with both genders having ages 18 to 65 years who were undergoing para-umbilical hernia repair were included. Patients demographic including age, gender were recorded after informed consent. Patients were equally divided into two groups Group O and Group S. Group O (83 patients) received onlay mesh technique and Group S (83 patients) received sublay technique. Outcomes such as post-operative pain, wound infection, seroma formation and hospital stay were recorded and compare the results between both groups. Results: In group O 48 (57.83%) patients and in group S 47 (56.63%) patients were females while 35 (42.17%) and 36 (43.37%) patients were males in group O and S. There was significant difference in term of post-operative pain 6.01+2.26 vs 3.58+1.44 (P-value <0.05). In group O 14 (16.87%) patients and in group S 4 (4.82%) patients had wound infection. 8 (9.64%) patients in Group O and 2 (2.40%) patients in Group S had seroma. Mean Hospital stay in days was high in Group O compared to Group B 5.32+1.74 vs 2.46+1.38 days (p=<0.05). There was a statistical significant difference regarding efficacy between both procedures with p-value 0.036. Conclusion: We concluded that sublay mesh technique for para-umbilical hernia repair was safe and effective with very low rate of complications as compared to onlay mesh procedure. Keywords: Paraumbilical Hernia Repair, Onlay Mesh Technique, Sublay Mesh Technique, Outcomes.