Background: Patients undergoing abdomino-pelvic surgeries may have postoperative cardiac events. ECG is a sensitive tool in detecting cardiac abnormalities. In patients above age of 40, ECG is frequently performed before surgery to screen for asymptomatic coronary artery disease. Even with normal preoperative ECG, new postoperative ECG changes may develop. Objectives: To estimate the prevalence of postoperative ECG changes following major elective abdomino-pelvic and laparoscopic surgeries in non-cardiac patients aged ≥ 40, with a normal preoperative ECG.Patients and Methods: The study included 200 non-cardiac patients, above the age of 40 who underwent major elective abdomino-pelvic or laparoscopic surgeries and who had normal preoperative ECG. Patients underwent abdominal vascular surgeries were excluded. Patients were examined clinically pre- and post-operative. A twelve-lead ECG was done pre-, immediately post- and 3 days postoperative. Patients who showed any postoperative ECG changes, were tested for their CK-MB, Na, K, Mg and ionized Calcium serum level.Results: Six patients only (3%) showed postoperative ECG changes, in the form of T-wave inversion. None of the 6 patients experienced cardiac symptoms. None of these patients had concomitant elevation of CM-MB, nor abnormal electrolyte level. The mean age was 55.8 + 9.7 years. Four of these patients (67.6%) were males, 2 (33.3%) were hypertensive, 1 (16.7%) was diabetic and 3 (50%) were current smokers. Three (50%) underwent abdominal, 2 (33.3%) laparoscopic and 1 (16.7%) pelvic surgery. Two of these patients (33.3%) experienced intraoperative hypotension. The mean duration of surgery was 5.0 + 2.5 hours.Conclusion: Postoperative ECG changes suggestive of cardiac ischemia, was uncomon in patients undergoing major elective abdomino-pelvic and laparoscopic surgeries. Despite the T wave inversion suggestive of silent ischemia, there were no cardiac enzyme elevation, no symptoms of ischemia and no electrolyte imbalance.