A 16 years old boy presented with three months history of left inguinal hernia. On examination, he had two normal testicles in scrotum, one on either side. During left inguinal exploration for hernia repair, a third undescended testicle was found incidentally, which was excised.

Background: Laparoscopic cholecystectomy (LC) has been established as the gold standard treatment for gallstone disease. However, there is a debate regarding the post-operative placement of a drain in LC. Aim: To compare the outcome of patients undergoing placement of drain versus patients without a drain following elective LC. Methodology: A quasi-experimental study was conducted at Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan from September 2017 till August 2019. A total of 136 patients of cholelithiasis were randomly allocated to two groups: A (drain placed) and B (no drain placed). Clinical variables such as age, gender, BMI, duration of surgery, duration of hospital stay, vomiting, abdominal fluid collection and wound infection were recorded for all patients in two groups. Results: The mean age of the patients was 38.6±0.2 years. The mean time of surgery in group A was 44.2±10.3 minutes compared to 45.4±10.3 minutes in group B. The mean time of hospital stay in patients of group A was 2.3±1.0 days compared to 2.3±0.9 days in group B. After surgery, 16(23.5%) patients in group A experienced vomiting compared to 22(32.4%) in group B. Seven (10.3%) patients in group A had abdominal fluid collection compared to 12(17.6%) in group B. Moreover, eight (11.8%) patients in group A developed wound infection compared to 11(16.2%) in group B. Conclusion: There is no need to place a subhepatic drain routinely after laparoscopic cholecystectomy in uncomplicated cases. Keywords: Laparoscopic cholecystectomy; cholelithiasis; wound infection; vomiting; fluid collection; drain.

Objective: This research aims to learn how often iatrogenic bile duct injuries caused during laparoscopic cholecystectomy are treated and how well they heal after surgery. Study Design: A retrospective study Place and Duration: General Surgery Department of different hospitals of Khyber Pukhtunkhwa i.e Bacha Khan Medical Complex, Swabi, Peshawar Institute of Medical Sciences, Peshawar and Naseer Teaching Hospital, Peshawar for duration of two years from February 2020 to January 2022. Methods: In this research, 105 patients of both genders aged 18-68 years were enrolled. Included patients had iatrogenic bile duct injuries during laparoscopic cholecystectomy. Age, sex, place of residence, and body mass index were among the specific demographics of the enrolled cases that were calculated after receiving informed written consent. Strasberg classification was used to classify bile duct injuries. The outcome of treatment in all cases was measured in terms of effectiveness, complications, mortality and need for repeated treatment. SPSS 23.0 was used to analyze all data. Results: Among 105 presented cases, there were 68 (64.8%) females and 37 (35.2%) males. The mean age of the patients was 55.2±6.30 years and mean BMI 23.8±4.19 kg/m2. 55 (52.4%) patients were from urban areas. Most common symptom was epigastric pain, followed by fever, chills and jaundice. We found that Strasberg A was the most common injury found in 56 (53.3%) cases, followed by Strasberg D in 17 (16.2%) cases and Strasberg C in 12 (11.4%) cases. In all 105 cases, the majority of the patients received endoscopy in 67 (63.8%) cases and surgical treatment in 38 (36.2%) cases. Complications were bile leakage from the incision site, abdominal pain and bile leakage from the drain. Frequency of mortality was 4 (3.8%). Conclusion: We concluded in this study that the iatrogenic bile duct injuries were effectively treated with endoscopy and surgical treatment by using Strasberg classification. There was higher effectiveness and the mortality rate was low. Keywords: Iatrogenic Bile Duct Injury, Endoscopy, LC, Surgical, Mortality, Complications

A 16 years old boy presented with three months history of left inguinal hernia. On examination, he had two normal testicles in scrotum, one on either side. During left inguinal exploration for hernia repair, a third undescended testicle was found incidentally, which was excised.

Objective: The purpose of this research is to assess the efficacy of vascular surgery and endovascular therapy for critical limb ischemia. Study Design: Prospective study Place and Duration: This prospective study was conducted at Dow International Medical College and Dow University of Health Sciences, OJHA Campus, Karachi in the period from April, 2022 to September, 2022. Methods: Total 90 patients had critical limb ischemia were presented. All the patients were enrolled after taking informed written consent. Included patients were admitted for revascularization and divided equally in two groups. Group I received vascular surgery in 45 cases and 45 cases of group II received endovascular treatment (PTA). At 3 months post-revascularization, all patients were evaluated using the ankle-brachial index (ABI), the 6-minute walking test, and the Nottingham Health Profile (NHP) questionnaire. SPSS 22.0 was used to analyze all data. Results: The mean age of the included cases in group I was 64.6±5.57 years and in group II mean age was 69.5±8.44 years. There were majority males 33 (73.3%) in group I and 36 (80%) in group II. Comorbidities were DM, HTN, Hyperlipidemia and CAD among all cases. ABI and 6-minute walking distance improved significantly three months after the treatment in both groups. At six months post-procedure, both groups had similar NHP Part I and Part II total scores. However, the surgical revascularization group had substantially higher domain scores in social isolation and physical abilities with p value <0.012. Conclusion: Our findings indicate that patients undergoing surgical revascularization or PTA for SFA stenosis have comparable overall scores on the NHP questionnaire three months after revascularization. Subjects who undergo surgical revascularization score significantly higher than those who undergo percutaneous transluminal angioplasty (PTA) on the NHP's social isolation and physical ability dimensions. Keywords: Peripheral bypass surgery, Peripheral arterial disease, Quality of life, Endovascular treatment