Dr Tayyab Riaz Ch

04/04/2026

𝗦𝗵𝗼𝘂𝗹𝗱𝗶𝗰𝗲 𝗶𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝗥𝗲𝗽𝗮𝗶𝗿
Shouldice Repair is a Mesh free tissue based repair that uses a four-layer, continuous suturing method to imbricate (overlap) the fascia, reinforcing the abdominal wall with the patient's own tissue. It has 99.5% success rate
Watch complete step by step video 👇🏽

Shouldice inguinal hernia repair ...

04/04/2026

𝗦𝗵𝗼𝘂𝗹𝗱𝗶𝗰𝗲 𝗶𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝗥𝗲𝗽𝗮𝗶𝗿
Shouldice Repair is a Mesh free tissue based repair that uses a four-layer, continuous suturing method to imbricate (overlap) the fascia, reinforcing the abdominal wall with the patient's own tissue. It has 99.5% success rate
Visit my youtube channel "drtayyabriazch" for detailed learning based video

𝗟𝗮𝘆𝗲𝗿 𝟭: 𝗠𝗲𝗱𝗶𝗮𝗹 𝘁𝗼 𝗹𝗮𝘁𝗲𝗿𝗮𝗹 𝗶𝗺𝗯𝗿𝗶𝗰𝗮𝘁𝗶𝗼𝗻
The first suture line is started at the p***c tubercle using continuous polypropylene 2-0 suture, and The inferior flap of the transversalis fascia is sutured to the deep surface of the superior flap
𝗟𝗮𝘆𝗲𝗿 𝟮: 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝘁𝗼 𝗠𝗲𝗱𝗶𝗮𝗹 𝗶𝗺𝗯𝗿𝗶𝗰𝗮𝘁𝗶𝗼𝗻
At the internal ring the suture is reversed and continued medially by approximating the free edge of the superior flap to the shelving edge of the inguinal ligament.
𝗟𝗮𝘆𝗲𝗿 𝟯: 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝘁𝗼 𝗺𝗲𝗱𝗶𝗮𝗹 𝗖𝗹𝗼𝘀𝘂𝗿𝗲 (Reinforcement of conjoint tendon to inguinal ligament)
The third suture line is started at the level of the internal ring where the conjoined tendon is approximated to the inguinal ligament and tied when the p***c tubercle is reached.
𝗟𝗮𝘆𝗲𝗿 𝟰: 𝗠𝗲𝗱𝗶𝗮𝗹 𝘁𝗼 𝗹𝗮𝘁𝗲𝗿𝗮𝗹 𝗖𝗹𝗼𝘀𝘂𝗿𝗲 (Reinforcement of conjoint tendon to inguinal ligament)
Using the same suture of 3rd layer, the fourth suture line attaches these same structures to one another and is tied at the level of the internal ring

01/04/2026

While taking clinical exam today i asked student where are Valvulae conniventes present ?
"Sir in Large gut"
And where are the Haustrations present ?
"Sir in colon"
Okay what is jejunum ?
"Sir it is Large part of small intestine"
🤯🤯🤯🤯

28/03/2026

How to Remove a Chest Tube Safely ✔️💯

26/03/2026

How to Excise a Pipilloma under 1 minute ✔️💯

22/03/2026

What is Phantom Limb, Phantom Pain and Phantom Sensations. Different Theories of its underlying pathophysiology and Management

18/03/2026

𝗘𝗻𝗱𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗧𝗵𝗼𝗿𝗮𝗰𝗶𝗰 𝗦𝘆𝗺𝗽𝗮𝘁𝗵𝗶𝗰𝗼𝘁𝗼𝗺𝘆 (𝗘𝗧𝗦) for Primary Palmar Hyperhydrosis
What is palmar hyperhydrosis ?
Primary Palmar hyperhidrosis is a condition characterized by chronic, excessive, and often unpredictable sweating of the palms, typically starting in childhood or adolescence and often linked to sympathetic nerve hyperactivity.
Cause is mostly idiopathic, though it often runs in families and is not necessarily linked to any underlying disease.
Treatment Options:
• Topical Agents: Antiperspirants containing aluminum chloride.
• Iontophoresis: A device using water and mild electrical currents to shut down sweat glands.
• Botox Injections: over multiple points on palms effective only for 6–12 months.
• Oral Medications: Anticholinergics can help reduce overall perspiration.
Endoscopic Thoracic Sympathicotomy (ETS): Endoscopic Thoracic Sympathectomy/sympathicotomy is only permanent solution for patients where other options fail or if its severe hyperhydrosis.
In Sypathectomy segment of the thoracic sympathatic shain is excised leading to severe side effects while in sympathicotomy only transection of the thoracic chain is done either at T3 or T4 level with T4 producing more promising results and lower side effects.
Watch complete 𝗘𝗻𝗱𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗧𝗵𝗼𝗿𝗮𝗰𝗶𝗰 𝗦𝘆𝗺𝗽𝗮𝘁𝗵𝗶𝗰𝗼𝘁𝗼𝗺𝘆 (𝗘𝗧𝗦) video on my youtube channel.

07/03/2026

𝗕𝘂𝗰𝗰𝗶𝗻𝗮𝘁𝗼𝗿 𝗖𝗮𝘃𝗲𝗿𝗻𝗼𝘂𝘀 𝗛𝗲𝗺𝗮𝗻𝗴𝗶𝗼𝗺𝗮
5y old Dua fatima having gradually increaseing right sided cheek swelling from last 2 years. Parents got concerend and reached me for diagnosis and treatment. On clinical examination it was freely mobile, soft to firm, non tender and compressible swelling in right buccinator muscle region. USG confirmed the clinical diagnosis of hemangioma. Small jawline incision planned taking care of the cosmesis and exploration done. Hemangioma was found taking its blood supply from facial artery branches. Feeding vessels were meticulously ligated and hemangioma excised taking care not to damage facial nerve branches. Wound closed in subcut fashion. On followup visit both Dua and parents are happy and satisfied.
A buccinator cavernous hemangioma is a rare, benign, slow-growing vascular tumor arising within the buccinator muscle, often presenting in children and young adults as a progressive, soft tissue mass. Diagnosis is confirmed through imaging and histopathology, with complete surgical excision being the primary treatment, often requiring careful dissection to avoid facial nerve branches.

06/03/2026

𝗜𝗻𝘁𝗲𝗿𝗲𝘀𝘁𝗶𝗻𝗴 𝗰𝗮𝘀𝗲 𝗼𝗳 𝗶𝗹𝗶𝗮𝗰𝘂𝘀 𝗠𝘂𝘀𝗰𝗹𝗲 𝗡𝗲𝗰𝗿𝗼𝘀𝗶𝘀
60y old female presented with complaint of fullness in left iliac fossa region from 2 weeks. History of low grade fever from 1 week. No history of trauma or TB. On examination there was fullness and tenderness in left iliac fossa region with swelling extending into left groin region leading to antalgic posture (flexion) of the left hip - favouring something wrong with iliopsoas.
CT abdomen and pelvis showed an ill-defined collection along the left posterior abdominal wall muscles, showing inferior extension into the left iliacus muscle and further down towards the proximal thigh up to its insertion. Associated muscle swelling and surrounding edema. Spared left psoas muscle.
Exploration done via oblique incision over left iliac fossa placed along and parallel to iliac crest and iliacus muscle reached extraperitoneally which was totally necrosed. Whole muscle till its insertion to lesser trochanter of femur excised, cavity washed with saline and packed. Wound partially closed for later packing and delayed primary closure. Muscle sent for histopathology.

05/03/2026

𝗣𝗿𝗶𝗻𝗰𝗶𝗽𝗹𝗲𝘀 𝗼𝗳 𝗩𝗲𝘀𝗶𝗰𝗼-𝗩𝗮𝗴𝗶𝗻𝗮𝗹 𝗙𝗶𝘀𝘁𝘂𝗹𝗮 (𝗩𝗩𝗙) 𝗥𝗲𝗽𝗮𝗶𝗿 𝘃𝗶𝗮 𝗩𝗮𝗴𝗶𝗻𝗮𝗹 𝗔𝗽𝗽𝗿𝗼𝗮𝗰𝗵
👉 Optimal Timing: Usually delayed for 3–6 months (or up to a year for radiation injuries) to allow inflammation to subside.
👉 Wide Dissection: Complete separation of the bladder and va**na to ensure only healthy, well-vascularized tissue is approximated.
👉 Tension-Free Closure: Tissues must be freely mobilized to prevent pull on the suture line, which can lead to recurrence.
👉 Water-Tight Closure: Meticulous, layered closure (usually 2-3 layers) is essential. The bladder and va**nal tissues should be closed separately.
👉 Interposition Flaps (Omentum/Muscles/Martius flap): Used for complex, recurrent, or radiated fistulas to separate bladder and va**nal suture lines and improve blood supply.
👉 Water-Tight Testing: The integrity of the closure must be verified using dye (methylene blue).
👉 Bladder Drainage: Prolonged postoperative drainage (10–14+ days) via a Foley catheter is mandatory to allow healing.

𝗣𝗼𝘀𝘁-𝗼𝗽 𝗖𝗮𝗿𝗲
The most critical care is ensuring continuous, unobstructed bladder drainage to prevent tension on the repair site.
👉 Foley catheter is kept for 10 to 21 days. For simple fistulae, the WHO recommends a period of 7–10 days.
👉 Before catheter removal, dye test with methylene blue can be performed to confirm the complete healing of fistula
👉 Strenuous exercise, heavy lifting, and straining should be avoided for at least 6 weeks.
👉 Sexual in*******se is strictly prohibited for 6 to 12 weeks to allow the va**nal wall to heal fully.

**nalfistula
**nalfistula

25/02/2026

Modern health culture is obsessed with optimization.
Track everything.
Measure everything.
Improve everything.
But the longest-living populations in the world don’t live in optimization mode.
They live in balance.
As a surgeon, I see the long-term effects of chronic stress, social isolation, suppressed emotions, and burnout.
Longevity is not intensity.
It is alignment.
Which rule resonated with you the most?
Comment the number below.