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  Citation statistics : Table of Contents
   2015| January-March  | Volume 34 | Issue 1  
    Online since March 17, 2015

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Use of laparoscopy in the management of abdominal trauma: a center experience
Morsi Mohamed, Wael Mansy, Yahia Zakaria
January-March 2015, 34(1):11-16
Background The role of laparoscopy in diagnosis as well as therapeutic interventions has increased markedly in the last few years. In trauma, it has become a viable alternative for the diagnosis of intra-abdominal injury following penetrating and blunt trauma. The number of negative and/or nontherapeutic laparotomies performed has decreased since the use of laparoscopy in diagnosis and management. Patients and methods Sixty-five patients with abdominal trauma (21 blunt trauma, 44 penetrating trauma) were treated by the Trauma Team at the Emergency Unit of Zagazig University from November 2011 to August 2014 using laparoscopy for diagnosis. All patients underwent a physical examination, ultrasound, and computed tomography (abdomen and pelvis). Laparoscopy was used in the management of these patients through three trocars: one for 30° scope and two working trocars. Results In our series, we avoided laparotomy in 81.5% (53/65) of cases. Therapeutic laparoscopy was effective in 15 patients: six patients with stomach penetrations, four with liver lacerations, three with diaphragmatic injuries, and two with splenic lacerations. Conclusion Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma.
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Laparoscopic sleeve gastrectomy versus laparoscopic gastric greater curvature plication: a prospective randomized comparative study
Mohamed M Abouzeid, Osama Taha
January-March 2015, 34(1):41-47
Background Laparoscopic sleeve gastrectomy (LSG) involves resection of a significant portion of the stomach. Laparoscopic greater curvature plication (LGCP) is a relatively new alternative procedure similar to LSG, but without the need for gastric resection. Patients and methods Fifty patients fulfilled the National Institutes of Health criteria and were assigned randomly to receive either LGCP (n = 25) [16 women and nine men; mean age 32.1 years (19-49 years) and mean BMI 47.8 kg/m 2 (42-57 kg/m 2 )] or LSG (n = 25) [18 women and seven men; mean age 34.8 years (18-58 years) and mean BMI 46.8 kg/m 2 (41-55 kg/m 2 )] by a block randomization method. Patients were studied in terms of postoperative weight loss, changes in hypertension, HbA1c, and postoperative complications. Results All procedures were completed laparoscopically. Follow-up was 24 months. The mean hospital stay was 36 h (range 24-144 h) for both groups. No intraoperative complications occurred. Postoperatively, one case of minor leak was detected after LSG and two cases of stenosis following LGCP. All patients experienced postoperative excess weight loss and improvement in HbA1c. The improvement was significantly better in the LSG group in terms of the change in BMI (mean 14.45 compared with 10.35 in LGCP) and change in HbA1c (mean 1.2 compared with 0.5 in LGCP); the change in hypertension was not statistically significant. Conclusion LGCP is feasible, safe, and effective, but has an inferior weight-loss effect and is less effective in diabetes compared to LSG for morbidly obese patients with BMI above 40 kg/m 2 .
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Risk factors for post-ERCP pancreatitis: a prospective multicenter study in upper Egypt
Mohammed A Omar, Ahmed E Ahmed, Omar A Said, Hussein El-Amin
January-March 2015, 34(1):1-10
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) has become widely available for diagnosis and treatment of pancreatic and biliary diseases. Pancreatitis is the most common and serious complication to occur after ERCP resulting in substantial morbidity and occasional mortality. The aim of this study was to evaluate the potential patient and procedure-related risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) in a prospective multicenter study. Patients and methods Consecutive ERCP procedures were prospectively studied at five centers (two universities, three private). Data were collected on patient characteristics and endoscopic techniques before the procedure, at the time of procedure, and 24-72 h after discharge. PEP was diagnosed and its severity graded according to consensus criteria. Results Pancreatitis occurred after 104 (8.9%) of 1162 consecutive ERCP procedures and was graded mild in 66 (63.5%), moderate in 30 (28.8%), and severe in eight (7.7%) cases. On univariate analysis, 11 of 18 evaluated variables were found to be significantly associated with PEP. On multivariate analysis, significant risk factors with adjusted odds ratio (OR) were: difficult cannulation (OR: 10.2), previous PEP (OR: 8.1), previous pancreatitis (OR: 7.9), at least two pancreatic duct injections (OR: 3.1), pancreatic duct cannulation (OR: 2.7), difficult stone extraction (OR: 2.2), and precut sphincterotomy (OR: 1.2). Conclusion Technique-related risk factors are probably more numerous and potent than patient-related ones in determining high-risk predictors for PEP.
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Cyclo-oxygenase-2 and vascular endothelial growth factor expression in colorectal cancer patients
Mohammed S Hedaya, Ahmed Hazem Helmy, Houssin Ezzat, Olfat Hammam
January-March 2015, 34(1):35-40
Introduction Colonic neoplastic lesions represent a common health problem in Egypt. Colorectal carcinoma (CRC) is one of the common malignancies among Egyptians. There is considerable interest in the involvement of cyclooxygenase-2 (COX-2) in colon carcinogenesis and its progression. Vascular endothelial growth factor (VEGF) is a well-characterized tumor angiogenesis factor which has a role in the development, progression and risk of metastases of CRC The aim of the present study was to explore the correlation between COX-2 and VEGF colon tissue expression profile in colorectal cancer patients with a special emphasis on clinicopathological features. Patients and methods This study was carried out on 40 patients with colorectal cancer (CRC). CT and Colonoscopy were mandatory for staging and grading. CRC classification, grading and staging was done following the American Joint Committee on Cancer (AJCC) staging system. Results Contralateral site control biopsies were totally negative for both biomarkers in the CRC patients. COX-2 & VEGF were over expresed intensly in the advanced stage and grade of the postive expression in the CRC samples obtaind during surgery. Conclusion The over-expression of COX-2 and VEGF in colorectal cancer suggests the role of both of them as a risk biomarker particularly in patients with advanced stage and grade.
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Laparoscopic resection rectopexy versus laparoscopic mesh rectopexy for rectoanal intussusception
Sameh Hany, Saleh El-Awady, Sabry Ahmed, Mohamed Abo-Elkheir, Hosam Ghazy, Mohamed Farid
January-March 2015, 34(1):48-55
Background and aim Rectoanal intussusception (RI) can be treated by laparoscopic rectopexy successfully following different techniques. This study aims to compare laparoscopic resection rectopexy with laparoscopic ventral mesh rectopexy in patients with RI. Patients and methods From February 2012 to February 2014, 28 patients with RI were admitted to the Colorectal Surgery Unit, Mansoura University. The patients were divided into two groups: the ventral mesh rectopexy group and the resection rectopexy group. Postoperative improvement in clinical symptoms, symptoms scores, anorectal manometry, and defecography were evaluated over 12 months. Results Eleven (39.3%) patients were male and 17 (60.7%) were female, with a mean age of 43.42 years. Improvement in obstructed defecation symptoms was observed in 22 (78.5%) patients overall: 85.7% in the resection rectopexy group and 71.4% in the ventral mesh rectopexy group (P = 0.648). The mean Wexner score dropped from 15.57 to 4.8 at 3 months (P = 0.0025). The mean operative time was 2.97 h in the resection rectopexy group versus 2.14 h in the ventral mesh rectopexy group (P = 0.0003). Minor morbidities were detected in five cases and no mortality was reported. Recurrence was diagnosed in six (21.4%) patients at 1 year. Conclusion Laparoscopic resection rectopexy is superior to ventral mesh rectopexy despite longer operative time, longer hospital stay, and higher risk of complications
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Transabdominal gastroesophageal devascularization with versus without esophageal stapler transection in the control of variceal bleeding in cirrhotic patients
Wael E Lotfy, Taha A Biomy, Mohamed I Abdelhamid, Sherif M Galal, Mohamed M Refaey
January-March 2015, 34(1):56-63
Aim The aim of the study was to assess the efficacy and safety of adding esophageal transection to the devascularization operation in controlling variceal bleeding. Patients and methods A total of 115 patients with acute variceal bleeding who finally needed surgery were included in this study. They were divided into two groups: group I included 32 patients who underwent transabdominal gastroesophageal devascularization and esophageal transection and group II included 83 patients who underwent transabdominal gastroesophageal devascularization only. Survivors were followed up for at least 3 years by endoscopy to check for recurrence of esophageal varices. Results The incidence of early bleeding, residual varices, and recurrent varices was significantly lower in group I than in group II and there was no statistically significant difference in both early and late morbidity and mortality between the two groups. Conclusion Esophageal stapling is a safe and effective procedure for both short-term and long-term control of bleeding varices.
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Single-incision transperineal repair of simple and recurrent rectovaginal fistula with a vital bulbocavernosus muscle flap
Tamer Youssef, Rafik Barakat, Mohamed Farid
January-March 2015, 34(1):64-69
Background Rectovaginal fistulas (RVFs) are abnormal epithelium-lined connections between the rectum and the vagina. RVFs may be simple or complex. This study analyzed the outcome of single-incision transperineal repair of simple RVFs with a vital bulbocavernosus muscle flap. Patients and methods A total of 11 consecutive patients with simple and recurrent RVFs were included and assigned to single-incision transperineal repair with a vital bulbocavernosus muscle flap. Postoperatively, patients were followed up at the outpatient clinic or through telephone interviews with specific questionnaires to collect information on the status of fecal control, flatus, or fecal leakage from the vagina, and on the quality of personal and social life. Functional results were evaluated after 6 months by means of anal manometry and a questionnaire reflecting the symptomatic results, Wexner Incontinence Score and the Female Sexual Functional Index. Results The mean hospital stay was 10.37 ± 1.12 days. The mean follow-up period was 8.81 ± 2.56 months. The results of mean anal pressure measurements postoperatively showed no significant differences compared with preoperative measurements. The results of preoperative and postoperative Wexner Incontinence scores and Female Sexual Function Indices showed high significant postoperative improvements in all patients (P = 0.001). By the time of the last follow-up, there was no recurrence of RVF, and all patients reported normal fecal continence and had returned to a normal life. Conclusion Although RVF is troublesome for surgeons, it can be cured using our procedure. It seems that this technique is both simple and effective, giving excellent anatomical and functional results without the need for a protecting stoma.
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Postmastectomy seroma: how much is it affected by serum levels of IL-6 and CRP and how much is it reduced by intravenous hydrocortisone injection?
Ahmed Talha, Rabie Ramadan, Shreif Abdelhamid, Salwa Hamdi
January-March 2015, 34(1):17-21
Background Seroma is extremely common after breast surgery, and this could be because of the inflammatory response during wound healing. Several factors such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been detected in the seroma fluid that support this assumption; therefore, inhibition of the inflammatory response by using hydrocortisone might decrease seroma formation. We aimed to evaluate the effect of adding hydrocortisone to the anesthetic regimen in the perioperative serum level of IL-6 and CRP and consequently in postmastectomy seroma formation. Patients and methods The study included female patients with primary operable breast cancer who were randomly allocated to two groups; each included 40 patients. Patients in group I received general anesthesia with hydrocortisone, and patients in group II received general anesthesia without hydrocortisone. Venous samples were collected for measuring IL-6 serum levels before surgery, 6 h after the end of the procedure, and 24 h after the procedure and for measuring CRP serum levels before surgery and 24 h after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation, and management of seroma. Results Patients in group I had a lower total drainage volume (P = 0.001), had the drain removed earlier (P = 0.009), and had a lower incidence of postmastectomy seroma formation (P = 0.005). Postoperative serum levels of IL-6 and CRP showed a significant decrease in group I compared with group II. Conclusion Postmastectomy seroma is likely a proinflammatory process and can be reduced by giving intravenous hydrocortisone on induction of anesthesia and 2 h later, which significantly decreases the inflammatory mediators (IL-6 and CRP) that significantly reduce the incidence of seroma.
  - 2,105 172
Outcome of laparoscopic diagnosis and treatment of intestinal malrotation in infants and young children
Yasser M El Basatiny, Mohamed R Abdella
January-March 2015, 34(1):22-27
Objective The aim of this study was to evaluate the safety and efficacy of laparoscopy in the diagnosis and treatment of intestinal malrotation in infants and young children. Patients and methods Diagnostic laparoscopy was performed on 27 infants and young children aged 4 months-5 years with suspected intestinal malrotation on clinical examination, imaging studies, or both. All patients with malrotation on exploration were treated with laparoscopic Ladd's procedure. After completion of laparoscopic Ladd's procedure, patients were followed up for 3-18 months. Results On diagnostic laparoscopy, seven patients (26%) with normal rotation, two patients (7.4%) with volvulus converted to open surgery, and 18 patients (66.6%) with malrotation only underwent laparoscopic Ladd's procedure. The rate of conversion to laparotomy was 18.5% in all patients and 11.1% in patients who underwent laparoscopic Ladd's. There was a significant association between presence of malrotation and preoperative presentation with bilious emesis. Sixteen patients completed laparoscopic Ladd's procedure for mlarotation with an average operative time of 46 ± 16 min, an average time to normal feeding of 2.7 ± 1 days, and an average postoperative hospital stay of 4.8 ± 2 days. There were no early postoperative complications, and there were no cases with late volvulus. Wound infection occurred in one patient who underwent open approach for volvulus and early adhesive small bowel obstruction in another patient who underwent open laparoscopic Ladd's. Conclusion Laparoscopy is a safe and effective method in the diagnosis and treatment of intestinal malrotation in infants and young children, with or without preoperative symptoms.
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Evaluation of the versatility of superiorly based pedicled gastrocnemius myo- or myo-cutaneous flap, in upper leg defects after trauma or tumor excision: which is better?
Ayman M Adbelmofeed, El-Sayed A Abd El-Mabood, Refaat S Salama, El Sayed M Bayomy
January-March 2015, 34(1):28-34
Purposes The current study aimed to focus on the versatility of the superiorly based pedicled gastrocnemius muscle flap or myocutaneous flap, either medial or lateral head, in upper-leg defects after trauma or tumor excision and the importance of these flaps to improve bone healing in trauma and to ensure an adequate safety margin in malignant tumors with minimal complications. Patients and methods A prospective, randomized trial was conducted on 27 patients suffering from upper-leg defects after trauma or tumor excision to compare postoperative outcomes, especially bone healing, using superiorly based pedicled gastrocnemius muscle flap covered by a split thierch skin graft [group A; 14 (51.8%)] against myocutaneous flap [group B, 13 (48.2%) cases], either medial or lateral head. Postoperative follow-up was for 6 months. Results Rapid healing of the tibial fracture was noticed in 8 (57.1%) cases in group A and in 8 (61.5%) cases in group B within 2 weeks after surgery, and there was no flap loss apart from partial skin loss, minor hematomas, or infections, all were noticed significantly more in group A [5 (35.7%), 6 (42.9%), and 4 (28.6%) cases, respectively], compared with group B [1 (8%), 2 (15.4%), and 1 (8%) cases, respectively; P < 0.05]. Conclusion Both gastrocnemius myocutaneous and myocutaneous flaps for upper-leg reconstruction are considered as a reliable option to ensure a good safety margin in malignant tumor cases and to help bone healing in trauma cases, and myocutaneous flaps are safer, with no redo and lesser postoperative complications.
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