Journal of Surgery Pakistan

Index

2025-12-01T07:19:54+00:00

Surgical Management of Complications Due to Illicit Drug Xylazine

2025-12-01T08:01:39+00:00

Substance abuse is the excessive use of a drug which may result in detrimental effects to the user. This includes physical as well as psychologic dependence.¹ Use of opioids and other similar drugs is a well-known public health issue. Illicit drugs can result in a number of complications during treatment of medical and surgical diseases.² In surgical practices care of the patients is affected if they are addicted to the substances like alcohol and other illegal substances. In the postoperative period pain management is a common challenge faced by the surgical team. In addition, complications related to anesthesia like respiratory depression are more likely to occur in those addicted to the opioids. This may prolong the hospital stay. The need of intensive care increases and impaired wound healing is also reported.³ .........

Breast Cancer in Low - and Middle Income Countries: Persistent Challenges and Insights

2025-12-01T05:13:59+00:00

Objective

To determine the disease burden, patterns of referral, obstacles to surgical treatment and outcome of patients with breast cancer managed at a tertiary care hospital.

Study design

Cross sectional observational study.

Place & Duration of study

Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC) Karachi, from January 2023 to December 2024.

Methods

Records of all the patients managed during the study period were analyzed. The data collected included demographics of the patients, the stage of the disease at diagnosis, referral pattern, comorbid conditions, types of surgery performed and postoperative outcomes. The descriptive statistics were employed to report for characteristics of patients. Chi-square test was used to find associations between categorical variables. The binary logistic regression was used to assess the independent predictors of surgical intervention. These were reported as odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 1500 breast cancer patients were registered at the cancer registry of the hospital. Out of this, 549 (36.6%) underwent surgical intervention. The most common surgical procedure undertaken was modified radical mastectomy (n=310 - 56.5%) followed by lumpectomy (n=120 - 21.9%) with breast-conserving (n=38 - 6.9%) and rarely oncoplasty (n=16 – 2.9%) was done. Important obstacles to surgical intervention were advanced stages III and IV of the disease (n=1065 – 71.0%), delays to referral (n=584 - 38.9%), financial barriers (n=504 - 33.6%) and comorbid conditions (n=395 - 26.3%). The predictive value of the disease being treated in its early stages (OR 2.34), the absence of a comorbid conditions (OR 1.58), direct arrival to outpatient services (OR 1.71) and age of less than 45-years (OR 1.43) were the antecedents of surgical treatment.

Conclusion

Late diagnosis and non-availability of the treatment were important factors observed in this study for adverse outcome. About a third of the patients had a surgical procedure done; most common which was modified radical mastectomy. Operative mortality was 2.5%, as fourteen women died in this series.

Key words

Breast cancer, Low- and middle-income countries (LMICs), Diagnosis, Health system, Healthcare. Modified radical mastectomy.

Maternal Outcomes in Pregnant Women with Eclampsia•

2025-12-01T06:00:13+00:00

Objective

To document the maternal outcomes in women with eclampsia in terms of complications during gestation, intrapartum difficulties and post-delivery consequences including mortality.

Study design

Descriptive case series.

Place & Duration of study

Department of Obstetrics & Gynecology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from August 2022 to February 2023.

Methods

All pregnant women with eclampsia between 18 to 40-years of age were included through consecutive non probability sampling. They were above 28-weeks of gestation. The data related to maternal outcomes included frequency of placental abruption, need of cesarean delivery, acute renal failure (ARF), HELLP syndrome, postpartum hemorrhage (PPH), disseminated intravascular coagulation (DIC) and maternal death were collected using SPSS software.

Results

A total of 103 women with eclampsia were included. Most (n=61 - 59.2%) of the women were between 18 and 30-years of age. Seventy-five (72.8%) women were primigravida. In twenty-one (20%) women placental abruption was noted, 47 (45.6%) had cesarean deliveries, 14 (13.6%) suffered from HELLP syndrome, seven (6.8%) had disseminated intravascular coagulopathy, 14 (13.6%) had postpartum hemorrhage, while seven (6.8%) died in this series.

Conclusion

Primigravida were more frequently suffered from the eclampsia. Most of the women were in younger age group. Nearly half of the women required cesarean section. A high maternal mortality was observed in this study.

Key words

Eclampsia, Maternal mortality, Antenatal care, Postpartum hemorrhage, HELLP syndrome, DIC.

Frequency and Trends of Colorectal Cancers Among Different Age Groups

2025-12-01T06:10:05+00:00

Objective

To assess the trends of colorectal cancers across various age groups.

Study design

A cross-sectional observational study.

Place & Duration of study

Department of General surgery, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from June 2024 to March 2025.

Methods

The study included patients diagnosed with colorectal carcinoma by biopsy. The data included the demographics of the patients, family history, presenting symptoms, details of histopathology report and grade of the tumor. Comparison of the carcinoma and grade of the tumor among different age groups was made using the Chi-square test. A p-value <0.05 was considered as significant.

Results

The study included a total of 300 patients consisting of 191 males (63.7%) and 109 females (36.3%). There were 59 (19.7%) patients in the age group of 15-30 years, 136 (45.3%) between 31-45 years, 85 (28.3%) from 46-60 years, and 20 (6.7%) above 60-years of age. Grade 2, 3, and 4 tumors were more common among patients of age less than 45-years of age (p=<0.0001).

Conclusion

The frequency of colorectal cancers (CRC) was high in patients between 31 - 45-years of age. The tumors were more common among male patients. Moreover, the young patients present with advanced stage of the tumor, mostly in grade 2 and 3.

Key words

Colorectal cancer, Grade of tumor, Rectal carcinoma.

Progression of Diabetic Foot Ulcers To Lower Limb Amputations: A Retrospective Analysis

2025-12-01T07:58:17+00:00

Objective

To determine the frequency and perforated risk factor analysis of progression of diabetic foot ulcer (DFU) to lower limb amputation in a tertiary care teaching hospital.

Study design

Retrospective observational study.

Place & Duration of study

Department of General Surgery, East Surgical Ward, Mayo Hospital / Kind Edward Medical University Lahore, from January 2024 to January 2025.

MethodsRecords of 134 adult patients admitted with DFU were reviewed. Data collected included demographic variables, glycemic control (HbA1c), co-morbid conditions, characteristics of the ulcer (site, size, Wagner grade), severity of infection by International Working Group on the Diabetic Foot / Infectious Diseases Society of America (IWGDF/IDSA) criteria, presence of peripheral arterial disease (PAD), ulcer duration before presentation, and outcomes. Associations with amputation were analyzed using Chi-square test. A p-value of <0.05 was taken as significant.

Results

This study included 102 males and 32 females. A total of 101 (75.4%) patients underwent amputation. Amputation was done in 69 (67.6%) out of total 102 males and all the female patients. The mean size of the ulcer was 10.8 ± 11.3 cm². According to the Wagner grade most of the patients were of Grade-4 (n=41 - 40.2%) and Grade-5 (n=46 - 45.1%). Significant associations with amputation was found with higher Wagner grade (p < 0.001), severe infection (p=0.048), chronic kidney disease (p=0.019), and peripheral neuropathy (p=0.041). Other variables like HbA1c status were not found statistically significant.

Conclusion

A high proportion of patients admitted with DFU required amputation. Majority of them presented late with advanced Wagner grade and severe infection.

Key words

Diabetic foot ulcer, Lower-extremity amputation (LEA), Wagner classification, Peripheral arterial disease.

Factors Responsible For Delayed Presentation and Treatment of Breast Cancer

2025-12-01T06:21:28+00:00

Objective

To determine the factors responsible for the delayed presentation and treatment of breast cancer in a tertiary care hospital.

Study design

Cross-sectional observational study.

Place & Duration of study

Department of •General Surgery, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from December 2024 to May 2025.

Methods

All women with a diagnosis of breast cancer were included. A form was designed to collect the demographic data of the patients. Questionnaire was made to enter the factors responsible for the delayed presentation and treatment. Women who presented three months after the appearance of symptoms and signs of breast cancer were considered as delayed presenters. Data were entered into SPSS version 25. Mean ±SD were used to report continuous variable and frequency and percentages for the qualitative variables. Chi-square test was applied to determine the association of risk factors with delayed presentation taking p-value <0.05 as significant.

Results

A total of 150 patients were included. The mean age of the women was 45.7±10.4 years. Thirty-seven (24.7%) women aged between 20 – 40-years, 33 (22.0%) 41 - 50, 45 (30.0%) between 50 – 59-year, and 35 (24.0%) over 60-years of age. Thirty-nine women were considered in delayed care seeking group. Twenty-one (53.8%) reported no pain compared to 27 (24.3%) in the non-delayed group (p<0.0001). Majority (n=33 - 84.6%) of the patients in delayed group did not show concern about their symptoms whereas 52 (46.8%) patients in the non-delayed group sought consultation (p<0.0001).

Access to healthcare significantly contributed to delays as 15 (38.5%) women in the delayed group reported lack of facilities compared to 13 (11.7%) in the non-delayed group (p<0.0001). Most striking observation was the lack of knowledge about breast cancer symptoms among 36 (92.3%) women who presented late compared to 34 (30.6%) in the non-delayed group (p<0.0001).

Conclusion

A quarter of the women with breast cancer presented late for treatment. Absence of pain was reported by many patients. Number of patients ignored the initial symptoms. Lack of knowledge about breast cancer, the value of self-examination, and non-availability of nearby healthcare facility were other significant factors for delay in seeking treatment.

Key words

Breast cancer, Risk factors, Education, Pain, Breast mass.

Cervical Teratoma in a Neonate; Surgical Challenges and Postoperative Outcome: A Case Report

2025-12-01T06:34:27+00:00

Cervical teratomas are rare congenital tumors that may cause life threatening airway obstruction in neonates. Early diagnosis, multidisciplinary planning, and timely surgical excision are crucial for optimal outcome. A 4-hours-old male baby presented with a huge swelling in the neck. Neonate was in a stable condition. Initially feeding was given through nasogastric tube to avoid possible aspiration. After discussion in multidisciplinary team and essential investigations the baby was operated electively at age of 35-days. Endotracheal intubation was uneventful. Mass was excised after careful dissection. The blood supply of the mass was found arising from the right carotid artery. Trachea appeared deformed and was displaced towards the left side. In postoperative period patient was kept on ventilator support. However, the condition of the baby kept deteriorating. Tracheostomy was added to improve the ventilation, however baby expired on sixth postoperative day due to sepsis.

Key words

Teratoma, Neonate, Antenatal, Neck.