Background: Acute cholecystitis, which is typically associated with gallstones, is one of the most common causes of acute abdomen presenting in emergency departments around the world. The aim of this study was to compare the incidence of biliary leak and hospital stay between early and delayed laparoscopic cholecystectomy for acute cholecystitis.Objectives: To compare the incidence of biliary leak and hospital stay between early and delayed laparoscopic cholecystectomy for acute cholecystitis.Material and Methods: Patients with radiologically confirmed acute calculus cholecystitis and ASA grade I/II were selected from the surgical OPD and prospectively randomized into two equivalent classes between August 1, 2015 and July 31, 2017. Early laparoscopic cholecystectomy was performed on patients in group A, while delayed laparoscopic cholecystectomy was performed on patients in group B. The data was collected from the patients using a non-probability sampling technique.Results: The research included 200 patients with radiologically proven acute calculus cholecystitis and an ASA grade I/II. Overall, patients who had an early laparoscopic cholecystectomy had a shorter hospital stay and less billary leak than those who had a delayed laparoscopic cholecystectomy (P=0.01) (0.00 and 0.11). In comparison to Group-II, the number of post-operative complications was lower in Group-I.Conclusion: When compared to delayed laparoscopic cholecystectomy, early laparoscopic cholecystectomy allows for substantially shorter biliary leak frequency and overall hospital stay.Key Words: Acute cholecystitis, Cholecystectomy, Laparoscopic.

Aim: The aim of this study is to compare the outcomes between laparoscopic and open appendectomy in terms of surgical site infection. Study Design: Prospective/ Observational Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2021 to June 2021. Methods: In this study 200 patients of both genders with ages >10 years presented with acute appendicitis were included. Patients’ demographics including age, sex and body mass index were recorded after written consent. Patients were equally divided into two groups. Group I consist of 100 patients and received laparoscopic appendectomy and Group II with 100 patients received open appendectomy. Outcomes such as surgical site infection, hospital stay and time duration of procedure were examined and compare the results between both groups. Data was analyzed by SPSS 26.0. P-value <0.05 was set as significant. Results: There were 120 (60%) patients (60 Group I, 60 Group II) were males while 80 (40%) patients (40 Group I, 40 Group II) were females. Mean age in group I was 27.9+4.45 years and in group II mean age was 28.5+4.21 years. Mean BMI in group I was 24.08+8.22 kg/m2 and in group II mean BMI was 25.03+6.17 kg/m2. There was a significant difference in term of surgery time duration between both groups 42.88+13.75 minutes Vs 33.35+9.55 minutes; P=0.003.Hospital stay was greater in group II 6.03+3.12 days as compared to group I 4.07+6.13 days. Post operatively less SSI was found among laparoscopic group 6 (6%) in which 4% had superficial SSI and 2% had deep SSI as compared to group II 12 (12%) SSI was found among in which 8% had superficial SSI and 4% had deep SSI. Conclusion: We concluded in this study that laparoscopic appendectomy is better in terms of less hospital stay with less surgical site infection as compared to open appendectomy. We found that less operative time was observed in open appendectomy as compared to laparoscopic. Keywords: Appendectomy, Outcomes, Laparoscopic, Open, Acute appendicitis

Objective: The aim of this study is to determine the effectiveness of internal tension sutures in term of wound healing in patients undergoing laparotomy. Study Design: Prospective cross sectional study Place and Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from 15th November 2020 to 15th May 2021. Methods: One hundred and fifty patients of both genders were presented this study. Patients were aged between 20-60 years of age. Patients’ detailed demographics including age, sex and body mass were recorded after taking informed written consent. Internal tension sutures technique were used for laparotomy among patients who had intestinal obstruction, fire arm injury or stab wound to abdomen, intra-abdominal malignancies, pancreatitis. Mean post-operative pain was measured by using VAS. Outcomes in terms of healing and complications were observed at the end of study. Complete date was analyzed by SPSS 27.version. Results: There were 115 (76.7%) patients were males and 35 (23.3%) were females. Mean age of the patients were 39.09±12.24 years with mean BMI 28.17±8.42 kg/m2. Among 150 cases, majority of the patients 120 (80%) were treated as elective and 30 (20%) were treated in emergency. Symptoms among patients were peritonitis, intestinal obstruction, trauma, mesenteric ischemia, intra-abdominal malignancy, pancreatitis and obstructive jaundice found. Effectiveness was found among 140 (93.3%) cases and only 10 (6.7%) adverse outcomes were found i.e. wound infection and incisional hernia. Patients’ satisfaction was 94.7% among all cases. Conclusion: We concluded in this study that use of internal tension sutures technique for laparotomy is an effective and safest technique in terms of less complications and wound infections with excellent outcomes. We observed that majority of the patients were satisfied by this technique. Keywords: Wound dehiscence, Internal tension sutures, Laparotomy, Incisional hernia

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.