Journal of Surgery Pakistan

Index

2026-01-30T06:34:38+00:00

How Advances In the Technology Transforming the Surgical Practices?

2026-01-30T06:46:32+00:00

In the present century, science and technology have progressed at a great pace. Medical fields, including surgical specialties are equally benefiting from this as number of innovations are added into the surgical practices. However, during the 20th century a remarkable leap was also made. It included organ transplantation, the use of heart-lung bypass machine to facilitate open heart surgeries, minimal-invasive surgery, robot-aided surgeries, and many other procedures in different surgical specialties like orthopedics, ophthalmology, to name a few.1

Clinicopathological Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer and Its Relationship With Molecular Subtypes

2026-01-30T07:19:34+00:00

Objective

To evaluate the changes in the clinicopathological features after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer (LABC) and its relation to molecular subtype characteristics.

Study design

Retrospective cross-sectional study.

Place & Duration of study

Department of General Surgery, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from November 2024 to April 2025.

Methods

The study included 54 female patients between the ages of 18 and 70 years who had stage IIB to IIIC invasive ductal carcinoma based on histological examination. All patients received NACT treatment before undergoing surgical resection. The classification of tumors was done by immunohistochemical analysis of estrogen receptor (ER) and progesterone receptor (PR) combined with HER2/neu expression and Ki-67 measurement. The Miller-Payne grading and Residual Cancer Burden (RCB) was used for measuring pathological results. Statistical data analysis was done through SPSS version 26. Quantitative variables such as tumor size before and after neoadjuvant chemotherapy were compared using the paired t-test. Chi square test was used to find out the association of molecular subtype with the response to NACT. A p<0.05 was taken as significant.

Results

Majority of the tumors (n=18 - 33.3%) were of a Luminal B subtype. There were 14 (25.9%) HER2-enriched cases. The triple-negative and Luminal A tumors comprised 12 (22.2%) and 10 (18.5%) respectively. Nineteen (35.2%) patients achieved a pathological complete response (pCR) in general with HER2-enriched tumors showing the highest response rate at 50% along-with triple-negative tumors at 41.6%. Molecular subtype noted to have a statistically relevant connection to pCR results (p=0.041). The tumors decreased in size from 6.2 cm during pre-NACT to 2.4 cm after NACT treatments (p<0.001). Nodal down-staging was noted in 22 (40.7%) patients.

Conclusion

All LABC patients showed remarkable clinicopathological outcomes after NACT therapy based on their molecular subtype analysis. HER2-enriched and triple negative breast cancer subtypes achieved better treatment outcomes. Immunochemical tissue analysis improved the treatment outcome.

Key words

Breast cancer, Neoadjuvant chemotherapy, Molecular subtypes, Pathological complete response, HER2-enriched, Triple-negative breast cancer.

Correlation of ASA Grades of Patients with the Length of Hospital Stay After Emergency Laparotomy

2026-02-03T17:15:55+00:00

Abstract

Objective:

To find out the correlation of ASA grades of the patients with length of hospital stay (LOS) after laparotomy done in emergency.

Study design

Cross-sectional observational study.

Place and duration of study:

Department of Surgery, Dr. Ruth K.M. Pfau Civil Hospital Karachi, from April 2025 to September 2025.

Methods:

Patients aged ≥18 years who underwent emergency laparotomy (EL) were included. Patients with history of malignancy, prior radiotherapy and previous laparotomy were excluded. Data on demographics, BMI, ASA grade, LOS, co-morbid conditions, duration of surgery, postoperative complications, postoperative mobility, oral intake status and ICU stay were recorded. Statistical analysis employed Chi-square/Fisher's exact tests for categorical variables, One-way ANOVA/Kruskal-Wallis for numerical variables, and binary logistic regression for confounders.

Results: A total of 80 patients were studied including fifty-three (66.3%) males. The mean age of the patients was 47.4±14.2 years. Majority (n=27 – 33.8%) were in ASA III category, and 8 (10%) ASA IV and V. Mean operative time was 103±23 minutes and hospital stay 9±3 days. Thirty-five (43.8%) patients required ICU admission and thirty-six (45%) developed complications. Higher ASA grade correlated with older age, lower BMI, more comorbid conditions, longer duration of surgery, greater ICU use, delayed oral intake / mobility, more complications, and longer stay (p < 0.0001). On multivariate analysis, only postoperative complications independently predicted prolonged hospital stay (≥ 9 days - p=0.022).

Conclusion:

Higher ASA grade correlated with worse perioperative outcomes, but postoperative complications emerged as the only independent predictor of prolonged hospital stay after emergency laparotomy.

Key words:

Laparotomy, ASA classification, Hospital stay, Postoperative complications.

Clinicopathologic Spectrum, Management and Outcomes of Phyllodes Tumors of the Breast

2026-02-03T17:10:45+00:00

Objective:

To assess the clinicopathological features, operative intervention, and survival in patients presenting with phyllodes tumors of breast.

Study design:

Retrospective observational study.

Place and duration of the study:

Department of General Surgery Ward 3, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from January 2015 to July 2024.

Methods:

All patients diagnosed clinically with features suggestive of phyllodes tumors on radiology and subsequently proven on histopathology were included. Demographics features, characteristics of the tumor, histological subtypes, surgical treatment provided and outcomes were noted. IBM SPSS version 26.0 was used for data entry and analysis.

Results:

Eighty-one patients were treated during the study period. The median age of the patients 46.5 years (from 18 – 83-years), and 75.3% were aged ≥ 40 years. A family history of breast carcinoma was found in 16% of the patients. Lumpectomy (44.4%), wide excision (30.9%), and mastectomy (22.2%) were the surgical procedures performed. Tumors measuring 5-cm were detected in 53.1% of the patients. Local recurrence was noted in 14 (17.3%) patients and was significantly associated with large tumor size, while the association with surgical margin status did not reach statistical significance (p=0.074). In three cases of malignancies, bone metastasis and death were documented. These patients were treated with palliative radiotherapy. None of the patients received chemotherapy.

Conclusion:

Phyllodes tumors are less common mostly benign lesions. A tumor margin-negative excision is possible in many patients.

Key words:

Phyllodes tumor, Breast neoplasm, Tumor recurrence, Histopathology, Borderline phyllodes, Malignant phyllodes.

Comparison of Frequency of Hypocalcemia Following Total Thyroidectomy For Thyroid Carcinoma and Benign Multinodular Goiter

2026-01-30T07:07:09+00:00

Objective

To compare the frequency of temporary hypocalcemia after total thyroidectomy done for thyroid malignancy and benign multinodular goiter.

Study design

Cross sectional comparative observational study.

Place & Duration of study

Department of General Surgery, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from March 2023 to September 2023.

Methods

A total of 35 patients, 18- 80 years of age, both genders who underwent total thyroidectomy were included. Patients with comorbid conditions and preoperative hypocalcemia were excluded. Preoperative serum calcium level was estimated in all patients. In postoperative period serum calcium levels were measured at 12, 24, and 48-hours. Patients with serum calcium level below 8 mg/dl within 48-hours after surgery were considered as hypocalcemic, and their serum parathyroid hormone (S.PTH) levels were then assessed.

Results

The age of the patients was 18 to 80-years with a mean age of 49.17±11.72 years. There were 13 (37.14%) males and 22 (62.86%) females with a male to female ratio of 1:1.7. Temporary hypocalcemia was found in four (11.43%) patients. It occurred less commonly in benign conditions (4.35%) as compared to patients with malignant lesions (25.0%).

Conclusion

The frequency of temporary hypocalcemia after total thyroidectomy was high in patients with malignant.

Key words

Thyroidectomy, Hypocalcemia, Thyroid carcinoma, Benign multinodular goiter.

Comparison of Patients’ Satisfaction Between Same Day Versus Preoperative Day Admission of Laparoscopic Cholecystectomy

2026-02-12T05:28:15+00:00

Objective

To compare the satisfaction levels of patients who were admitted on the same day for laparoscopic cholecystectomy (LC) with those who were admitted the day before the scheduled surgery.

Study design

Cross sectional comparative study.

Place & Duration of study

Department of Surgery Liaquat National Hospital Karachi, from May 2025 to September 2025.

Methods

Patients diagnosed with symptomatic cholelithiasis and scheduled to undergo laparoscopic surgery under general anesthesia were recruited. The patients were divided into two groups: those who were admitted on the same day of surgery (Group A) and those admitted the day before surgery (Group B). Patients’ satisfaction was assessed through a 10-item validated questionnaire. The satisfaction was defined as a score of 70% or higher. Demographics, satisfaction level, operative time, and length of hospital stay were recorded. The differences in satisfaction level among groups were analyzed using Chi square / Fisher's exact test with p <0.05 regarded as statistically significant.

Results

A total of 138 patients, divided equally between Group A and Group B, who underwent LC were included. There were 110 females and 28 male patients. All patients were in class I and II of ASA. The length of hospital stay for patients in Group A was lower than patients in Group B. Patients’ satisfaction was 95.7% for Group A and 98.6% for Group B (p=0.619).

Conclusion

Patients’ satisfaction after laparoscopic cholecystectomy was high regardless of admission timing. Since same-day admission shortens the hospital stay without affecting the quality of care this may be considered as appropriate mode of admission.

Key words

Hospital admission, Laparoscopic cholecystectomy, Patients’ satisfaction.

Complete Placenta Previa In Uterus Didelphys With Previous Cesarean Delivery: A Case Report

2026-02-03T17:00:23+00:00

Uterus didelphys is a rare Müllerian duct anomaly that may remain undiagnosed until pregnancy or delivery. Its coexistence with placenta previa is extremely unusual and poses diagnostic as well as surgical challenges. We report a 28-year-old gravida 2, para 1, woman with a previous cesarean section who presented for an elective cesarean section due to placenta previa. Antenatal ultrasound did not reveal any uterine anomaly. However, intraoperatively, two separate uteri with endometrial cavities, and cervices were found. This case emphasizes the importance of recognizing uterine anomalies in patients with atypical intraoperative findings to ensure safe management and counselling.

Key words

Uterus didelphys, Placenta previa, Cesarean section, Antenatal, Mullerian duct anomalies.