Objective: To assess if there is significant risk associated with early reversal of stomas (less than 6 weeks) when compared to a delayed closure in the setting of a Tertiary Care Hospital in Karachi. Study design: Observational longitudinal study Study place and duration: Dow University, Karachi 6 months 1st April 2022 till 1st September 2022 Methods: Pre- and post-operative data were collected for 50 patients assigned to each group respectively. The parameters assessed were the American Society of Anesthesiologists (ASA) grade, Surgery duration, Post-operative and Overall Hospital Stay, Surgical and Medical complications and day of occurrence, Clavein-Dindo Classification, and mortality. Results: Significant variance in ASA Grade was noted between the two groups, P-Value=0.005 with a lower grade observed in patients who underwent early closure. The post-operative and total hospital stay showed significant variation, with P-values of 0.011 and 0.011, respectively for both outcomes. The incidence of post-operative complications was also significant with p-value=0.004. The median day at which post-operative complication occurred was 4.5 vs 3 days with a significant p-value of 0.038. Conclusions: Late closure is associated with a significantly higher risk of complications and a resultant greater length of hospital stay. Keywords: Ileostomy, stoma, intestinal perforation, and typhoid

Background/Objective: Few studies have clearly shown a correlation between obesity and wound complications. We analyzed the correlation between body mass index and the complication rate of mesh-based open paraumbilical hernia repair. Method: This observational study after the approval from the institute review board using non-probability consecutive sampling, recruited 150 participants scheduled to have open mesh surgery for paraumbilical hernia repair from 01/may/2022 to 30/Oct/2022 at Department of General Surgery, Civil Hospital Ruth Pfau, DUHS, Karachi and divided into two groups; BMI 26-30 (n=62) and BMI 31-36 (n=88). Completed surveys were analyzed for demographic and clinical data, hernia features, surgical procedures, and patient outcomes. Results: The average age of the participants in the present study was 44.32 years, with an average BMI of 30.97 kg/m2. Out of 150 recruited participants 78 were female and 72 were males. Mean hernia width of the recruited participants was 10.12, with average operative time of the participants was 101.58 minutes. The Mean± S.D of hospital stay (days) of both study groups was 0.82±0.61 and 2.55±0.77 years, and a significant association (0.000) in their mean difference was observed. 26% participants in BMI (26-30) and 58% participants in BMI (26-30), got readmitted to hospital and a significant association (0.000) in their mean difference was observed. 13% participants in BMI (26-30) and 43% participants in BMI (26-30), got wound infection and a significant association (0.000) in their mean difference was observed. Practical implication: this study will help to understand what type of surgery procedures can be beneficial in different BMI classes. Conclusion: The developing SSI and SSOPI after paraumbilical hernia repair rise steadily with increasing BMI. More research is needed to see whether dropping some pounds before surgery will mitigate this correlation. Keywords: paraumbilical hernia repair, BMI, Wound infections, Wound classification.

Background: Patients with life-threatening hemorrhages due to blunt torso trauma are at a particularly high risk of being underdiagnosed. The pulse pressure (PP) starts narrowing down before the traditional parameters start changing, making it a useful tool for assessing and planning early intervention. Objective: To assess the utility of low PP in predicting massive transfusion (MT) or operative intervention in patients with isolated blunt abdominal trauma. Material and methods: A total of 186 patients were included. The PP and mean arterial pressure (MAP) were calculated. Vitals, PP, and MAP were monitored every 15 min during the first 6 h, then every 30 min during the next 6 h, and afterward, every 4 h until discharge. A Chi-square test and an independent t-test (as appropriate) were applied to compare variables with PP at the time of presentation. Differences were considered statistically significant at p-value ≤ 0.05. Results: A total of 55.9% of these patients had injuries due to road traffic accidents (RTA). Emergency operative intervention was provided to 26.3% of the patients. Death was 4.3%. MT was required by 26.3% of the patients. There was a statistically significant association between low PP and sex, length of stay, repeat extended focused assessment with sonography in trauma (eFAST), emergency operational intervention, outcome, MT, number of crystalloids consumed within the first four hours after presentation, injury severity score, systolic blood pressure (SBP), and pulse rate. Conclusion: The PP <30 mmHg was observed as a useful predictor for increased blood loss requiring blood transfusion or operative intervention.

Background: Patients with life-threatening hemorrhage due to blunt torso trauma are at a particularly high risk of being under-diagnosed. The pulse pressure starts narrowing down before the traditional parameters start changing, making it a useful tool for assessing and planning early intervention. Objective: Toassess the utility of low pulse pressure in predicting massive transfusion or operative intervention in patients with isolated blunt torso trauma. Material and Methods: total of 186 patients were included. The pulse pressure and mean arterial pressure were calculated. Vitals, pulse pressure, and mean arterial pressure were monitored every 15 min during the first 6 h, then every 30 min during the next 6 h and afterwards, every 4 h until discharge. Chi-square test and an independent t-test (as appropriate) were applied to compare variables with pulse pressure at the time of presentation. A Differences were considered as statistically significant at p-value ≤ 0.05. Results: total of 55.9% of these patients had injuries due to road traffic accidents. Emergency operative intervention was provided to 26.3% of the patients. Death was 4.3%. Massive transfusion was required by 26.3% of the patients. There was a statistically significant association between low pulse pressure and sex, length of stay, repeat eFAST, emergency operational intervention, outcome, massive transfusion, number of crystalloids consumed within the first four hours after presentation, injury severity score, systolic blood pressure, and pulse rate. Conclusion: The pulse pressure <30 mmHg was observed as an independent predictor for increased blood loss requiring blood transfusion or operative intervention.

Objective: The purpose of this research was to examine the success of non-surgical therapy for patients in stable condition who had come with serious liver injuries to the emergency department of a public tertiary care hospital in Karachi, Pakistan. Method: This retrospective research was carried out between February 2022 to August 2022 in department of General Surgery, Civil Hospital Ruth Pfau, DUHS, Karachi, after the ethical approval of the institute ethical review board. Patients were divided into two groups, group I receiving conservative care and group II undergoing surgery. Demographics, injury categorization, related lesions, surgical therapy, morbidity, mortality, and length of hospital stay were all were recorded through a questionnaire. Results: The average age of the 200 participants in the present research was 39.15± 10.47 years. There were 133 (66.5%) males who sustained injuries. The majority of patients (n=150, 75%) were found to have only mild liver damage (grades I–III), whereas 50 patients (25%) had more severe liver damage (grades IV–V). 150 patients (75%) were treated with conservative (NOM) care, whereas 50 patients (25%) had surgical intervention. Twenty-one deaths (10.5 %) were recorded in total. Conclusion: Conservative care is the preferred course of action for patients with stable hemodynamics, whereas surgical intervention is the treatment of choice for those with hemodynamic instability. Patients undergoing conservative treatment should be closely monitored. Mortality and morbidity rates were not significantly higher in patients whose conservative therapy failed.