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Background: General surgery residency is considered a stressful field with residents facing many problems including learning operative procedures, competition with fellow colleagues, gender discrimination and balancing their marital and family life.Methods: A cross-sectional study was conducted using a self-structured questionnaire, containing questions about perspective of general surgical residents about residency structure and problems in Pakistan and about allotment of surgical procedures to them. A total of 1624 general surgical residents were conveniently enrolled in this study from different tertiary care hospitals of Pakistan.Results: Mean age of residents was 29 years (range 24-35 years).70.44% of residents were male while 29.55% were female. Majority of the residents were from 2nd year residency (30.66%). 889 (54.7%) of the residents thought that the general surgery residency had put negative effects on their family and marital life while 1365 (84%) stated that they suffered from anxiety depression sleep deprivation at some time during the residency (p<0.01). 864 (53.2%) residents disagreed that surgical procedures are allotted according to the year of residency.901 (55.4%) residents were not sure that buttering their seniors will get them more cases. 887 (54.6%) were unsure about gender discrimination in the general surgery (p<0.01).Conclusions: Gender discrimination in general surgery is now obsolete. Main factor in the allotment of operative procedure is the responsible behaviour of the resident, past operative records and level of pre-and post-operative care of the patients. Grid system should be adopted for the allotment of surgical procedures.

Background: Gall bladder perforation presents in various forms with the most common being peritonitis. The most common causes include gall stones obstructing the cystic duct and necrosis of gall bladder due to ischemia. Case Presentation: A 19-year-old female presented to the emergency department of East Surgical Ward of Mayo Hospital Lahore, Pakistan, with a history of abdominal distension for 4 months for which she was counseled because of pregnancy. She gave birth to healthy baby 1 month prior, but abdominal distension did not resolve. On examination, she had a distended and tender abdomen with visible striae. She was tachycardiac with a pulse rate of 124 per minute and blood pressure of 110/80 mmHg. Fluid cytology showed negative for malignant cells and total leukocyte count of 17 × 109 /l. Abdominal ultrasound showed a huge thick-walled cystic area with internal echoes measuring 31 × 19 × 19 cm with total amount of fluid volume in the cyst was approximately 5 l arising from the right hypochondrium. On opening the abdomen, a huge cyst was encountered extending from the epigastrium to the pelvis with dense adhesions. The cyst was opened and fluid aspirated. Communication between cyst was found with gall bladder in the epigastrium. The cyst wall was excised partially, and cholecystectomy carried out. The patient was discharged on 5th post-operative day. Conclusion: The development of thick-walled huge cyst within abdominal cavity after gall bladder perforation is a rare entity, especially when the patient had gone through full-term pregnancy with the presence of the cyst.

Background: Enteric fever leading to enteric perforation is very common surgical emergency in the developing nations. The two surgical solutions used worldwide are to repair or exteriorize the perforation as ileostomy. The aim of the study was to setup and validate a statistically reliable scoring system for decision between repair and ileostomy in patients with peritonitis due to enteric perforation.Methods: It was an observational cross-sectional study done at East Surgical Ward of Mayo Hospital, Lahore. 256 patients were selected by consecutive non-probability sampling after ethical approval. The duration of study was 2 years from 1st August to 2018 to 30th July 2020. Patients with age more than 13 years presented in emergency department with diagnosis of peritonitis due to enteric perforation were included. A preformed scoring criterion named as East surgical ward enteric perforation (ESWEP) score was set by giving each variable a score of 1 to 3. Cut-off value between repair and ileostomy was observed.Results: 142 (55.4%) patients were male and 114 (44.5%) were female. Male to female ratio was 1: 1.24. The average age of patients is about 37 years with SD of ±9.67 years. ROC curve showed cut-off of pre-operative ESWEP score of 4 (sensitivity78%, specificity of 88%), per operative score of 7 (sensitivity 96%, specificity of 85%) and total ESWEP score of 11 (sensitivity 94%, specificity of 88%).Conclusions: ESWEP score is new score which helps in standardization of operative procedure done for the patients with peritonitis due to enteric perforation.

Objective: To compare the open appendectomy with & without peritoneum closure in term of post-operative pain and operative time. Study Design: Comparative study. Setting: EAST Surgical Ward, MAYO Hospital Lahore, Pakistan. Period: July 2019 to June 2020. Material & Methods: Sample size of 150 patients were selected by consecutive non probability sampling technique. Patients were divided into 2 groups with 75 patients in each group. In Group A patients, peritoneum was closed while in Group B patients, peritoneum was not closed. The results of both groups were compared. Data was collected by pre designed proforma and evaluated by SPSS 26. Results: Out of total 150 patients, 96 (64%) were male and 54 (36%) were females. Most common age group was between 31 years to 40 years. The mean operation time taken by the patients in which peritoneum was closed was about 41 minutes with standard deviation of ± 10.54 minutes as compared to the Group B in which peritoneum was not closed and it took about 32 minutes with standard deviation of ± 6.22 minutes (P Value 0.025). On first post-operative day, mean pain experienced, by visual analogue score by Group A patients was 5.6 while 3.9 in Group B patients (P Value = 0.03). Conclusion: Non closure of peritoneum after open appendectomy reduces the operative surgery time and post-operative pain.