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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Background Laparoscopic sleeve gastrectomy (LSG) is a safe and effective surgical treatment modality for morbid obesity. Variations in surgical technique could affect the results. The optimal size of the bougie remains controversial. The aim of this study was to evaluate the first-year outcome of LSG using two different sizes of bougies. Patients and methods Between March 2011 and January 2014, 102 morbidly obese patients underwent LSG. These patients were divided into two groups: group 1 (50 patients) and group 2 (52 patients). In group 1, 32-Fr bougies (orogastric calibration tube) were used, and in group 2 40-Fr bougies were used. Patients completed at least 6 months of follow-up visits. Results The excess body weight loss percentage in group 1 was 53.6 ± 10.96% at 6 months and 69.4 ± 15.6% at 1 year postoperatively, whereas in group 2 it was 52.7 ± 11.27% at 6 months and 66.4 ± 13.4% at 1 year postoperatively, with no statistically significant difference between the two groups. There were neither intraoperative complications nor postoperative mortalities. The overall complication rate was 14.7% (15 patients) with no statistically significant difference between the two groups (14% in group 1 vs. 15.4% in group 2). The postoperative hospital stay was 2.3 days in group 1 versus 2.2 days in group 2. There was 58.8% complete resolution of diabetes mellitus, 60% resolution of hypertension, and 87.5% resolution of sleep apnea 6 months after sleeve gastrectomy with no statistically significant difference between the two groups. Conclusion LSG is a safe and effective treatment method for morbid obesity. Bougie size does not affect the short-term outcomes.

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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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Background Pilonidal sinus disease (PSD) is a common disease that affects the patient's quality of life. We analyzed the outcome of the tension-free primary closure (TF 1ry) in comparison with the modified Limberg flap (MLF) technique. Patients and methods A total of 120 patients suffering PSD were assigned to one of two equal groups by closed envelope balanced randomization. Group I represents TF 1ry method and group II represents MLF. Results There were 102 (85%) male patients and 18 (15%) female patients elected for surgery. The mean follow-up period was 43.5 ± 3.4 months. There were no statistically significant differences between the two groups regarding patients' demographic data, clinical presentation, immediate postoperative complications, and disease recurrences. The operative time, blood loss, hospital stay, surgeon's performance scale, wound hypothesia, wound cosmoses score, patient satisfaction score, and patient quality of life (bodily pain and social functioning) were better in the TF 1ry group. The MLF group had better clinical results regarding frequency of seroma formation and time to drain removal. Conclusion Flap techniques are effective and efficient for PSD. TF 1ry closure can be tailored for female PSD patients and a junior surgeon. MLF can be tailored for male PSD patients and a senior surgeon.

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Background/aim The use of splenectomy for thalassemia major is restricted over concerns of its long-term outcome. The aim of this study was to assess the long-term outcomes of splenectomy for patients with β-thalassemia major. Patients and methods This study included 70 patients with β-thalassemia major. Patients were classified into two groups: 35 patients underwent splenectomy (S group) and 35 patients did not undergo splenectomy (NS group). Patients were assessed by review of medical records, assessment of medical history, and a clinical examination. In addition to complete blood count, liver function tests and serum ferritin were performed. Assessment of lymphocyte populations was carried out by flow cytometry. These investigations were performed at least 2 years after splenectomy in the S group. Results The mean age of the patients who underwent splenectomy was 6.68 ± 2.54 years and the mean postoperative follow-up period was 6.26 ± 3.03 years. Splenectomy improves anemia, but does not reduce iron burden; more patients were found to be on regular iron chelation after splenectomy. Hematocrit and red blood cell indices were significantly increased after splenectomy. Platelet count increased significantly in the S group (644.700 ± 299.400/mm ³ ). There were no significant differences in T-lymphocyte populations between both groups. IgM memory B lymphocytes were lower in the S group compared with the NS group. No overwhelming postsplenectomy infection was reported in this series. Postsplenectomy portal vein thrombosis was reported in one (2.9%) case. Conclusion With long-term follow-up after splenectomy for treatment of thalassemia major, thrombocytosis and the risk of thromboembolic persist. Splenectomy improves anemia, but does not reduce iron burden or the requirement for blood transfusion. Proper preoperative vaccination can reduce the risk of overwhelming postsplenectomy infection.

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Purpose There is no doubt that cholecystectomy relieves presurgical symptoms of gallbladder (GB) disease. The persistence of symptoms following cholecystectomy is termed as postocolecystectomy syndrome, the incidence of which ranges from 10 to 30%. The present study was conducted to evaluate patients who had a residual GB stone/cystic duct stump stone after cholecystectomy, and to study the surgical outcomes. Patients and methods This retrospective study was conducted on 21 cases with residual GB/cystic duct stump stone. The diagnosis was guided by ultrasound and magnetic resonance cholangiopancreatography. All the cases were managed by using completion cholecystectomy − either open or laparoscopic. All preoperative, operative, and postoperative data were collected. Results Preoperative endoscopic retrograde cholangiopancreatography and papillotomy were required in nine cases that presented with obstructive jaundice. Laparoscopic completion cholecystecomy was feasible in 14 cases. The conversion rate was 1/14 cases. The mean operative time was 127±31.3?min and the mean blood loss was 165±74.5?ml. Intraoperative minor biliary injury occurred in one case. The mean hospital stay was 3.1±1.8 days (1–9 days). All patients were reported to be symptom-free at the follow-up after surgery. Conclusion Residual GB/cystic duct stump stone is a preventable and correctable cause of postocolecystectomy syndrome. Completion cholecystectomy is a proven treatment of choice to relieve symptoms and avoid complications, and, furthermore, it can be carried out laparoscopically.

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Background Circumcision is the most common surgical procedure performed for a male newborn. This trial aimed to compare between three commonly used techniques for male circumcision in our institute. Patients and methods From January 2014 to January 2015, 150 babies were randomized into three groups according to the circumcision technique: babies circumcised using the bone-cutter forceps with thermal cautery (group I), Gomco clamp (group II), and the Plastibell device (group III). Intraoperative details, postoperative pain and complications, cosmetic outcome, and parent satisfaction were recorded. Results Operative time was significantly shorter for group I (P<0.001). Postoperative dressing was needed in 50% of infants in group II compared with 12% in group I. Analgesic consumption was significantly lower in group I (P<0.001). No significant differences were found between the three groups as regards the peer assessment score for the final cosmetic outcome. Parent satisfaction was significantly higher in groups I and II (P=0.023). Infection was reported only in the Plastibell device group, and 10% had device-related complications. Conclusion The thermal cautery with bone-cutter technique proved superiority in hemostasis, operative time, and parent satisfaction, with less pain in the postoperative period. All three techniques had comparable final cosmetic outcome.

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Purpose This study aimed to compare platelet-rich plasma (PRP) versus conventional ordinary dressing in the management of diabetic foot wounds. Background Diabetic foot wound treatment poses a considerable burden on the medical system, with long waiting times for healing in the public hospital system. PRP enables efficient treatment of many patients with hemostatic, anti-inflammatory, and analgesic substances. Patients and methods This prospective study was focused on 80 diabetic feet wounds. Patients were divided into two groups: group A received conventional ordinary dressing (N=40, 50%) and group B received PRP dressing (N=40, 50%). The mean follow-up period was 12 weeks. Results The estimated time of wound healing was 12 weeks for 82.5% of the patients in group A and 97.5% of the patients in group B; the PRP group was found to be more effective with fewer complications, less infection, exudates, pain, and failed healing: 17.5, 12.5, 32.5, and 2.5% versus 27.5, 42.5, 62.5, and 17.5% in group B, respectively (P=0.001). The highest healing rate was observed for both groups at the fourth week, but it was better for the PRP group (group B): 0.89±0.13 versus 0.49±0.11 cm²/week in group A. Conclusion There have been considerable advancements in the use of PRP in therapeutic processes in recent years in tissue regeneration therapy. PRP is a powerful tool for the treatment of chronic wounds and very promising for diabetic foot wounds; PRP enables healing, and reduces infection rates and exudates.

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Background Laparoscopic sleeve gastrectomy (LSG) is considered as one of the most popular bariatric procedures worldwide. Although LSG appears simple, there is still no standard procedure across different surgical teams. The most debatable issue in sleeve gastrectomy is the gastric pouch size; by changing the size of the bougie, we can create different volumes of the stomach tube. Aim The aim was to compare the outcome following LSG results when using 32 versus 40-Fr bougie as regards the effects of each on the clinical outcome: weight loss of the patients and possible complications. Patients and methods Our study is a prospective, comparative study of 60 patients, who underwent LSG between ‘March 2015 and March 2016’ with a 1-year follow-up. The patients were classified into two groups: group A (n=30) who underwent LSG using a bougie size of 32 Fr and group B (n=30) who underwent LSG using a bougie size of 40 Fr. We recorded the operative time, hospital stay, and intraoperative and postoperative complications. Results A total of 60 patients [17 (28.3%) men and 43 (71.7%) women] underwent LSG. Patients had a mean age of 35±10 years (range: 18–58 years). The mean;Deg;BM;Deg;I was 46.66±4.30 kg/m² (range: 34.6–57.5 kg/m²); the duration of hospital stay in group A was 56±28.07 h, with group B being 36.4±10.68. As regards the weight loss both groups had the same excess weight loss over 1 year; postoperative persistent vomiting was in favor of group A with four (13.3%) patients, two of them required intervention either by endoscopy or conversion to bypass, in comparison to one patient in group B who was managed conservatively. Conclusion The use of bougie size 32 Fr did not result in significant excess weight loss differences than bougie size 40 Fr; however, more complications were observed.

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Background A major deterrent to providing qualitative surgical care in developing countries is the lack of adequate facilities and severe shortage of human resources. Therefore, most of the surgical workforce in rural areas and urban slums predominantly includes general practitioners with little formal training in providing surgical care. There is a need for constant review of patients' care in this setting with the aim of improving service delivery and conforming to the internationally acceptable standard of practice. Materials and methods A 5-year descriptive retrospective study, from January 2007 to December 2011, of general surgery cases at State Specialist Hospital Ikere-Ekiti (Nigeria) was carried out. Results A total of 80 patients underwent 85 surgical operations. Most of them (86.2%) had ward admission for a mean duration of 4.6±1.4 days. The most frequent elective operation was hernia repair [66 (77.7%)]; whereas that of emergency was appendectomy [seven (8.2%)]. Other operations included lumpectomy [three (3.5%)], hydrocelectomy [two (2.4%)] and orchidectomy and laparotomy [three (3.5%) each]. All patients received postoperative antibiotics, with 71.3% receiving two or more antibiotics. Fifteen (18.8%) patients had surgically excised specimens with no histopathological evaluation. Only four (5%) patients were followed up beyond 4 weeks. No mortality was recorded. Conclusion Surgical volume was grossly low and there is a need for the government to equip secondary healthcare centres with basic facilities and strengthen surgical capacity for maximum utilization and improved quality of care. Periodic training programmes for general practitioners to ensure strict adherence to the international best practices will be helpful. In addition, health education should be available for everyone to reduce sociocultural-related problems.

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Background Laparoscopic sleeve gastrectomy (LSG) is one of the common bariatric procedures for the treatment of morbid obesity. One of the most drastic complications of this procedure is leak. Objective The aim of the study was to discuss the possible technical factors that might contribute to the occurrence of postoperative leak and how to avoid it through analyzing our series. Materials and methods Analysis of the influence of technical adaptations on the outcome of LSG was performed in a nested case-control group of patients. The main modification adapted was performing invaginating sutures over the staple line. The primary outcome was the occurrence of leak. The secondary outcomes were bleeding, operative time, prolonged hospital stay, back pain, and mortality. Results The group who had invaginating sutures (group 2) had a significantly lower frequency of leak (0%) than those without invaginating sutures (7.3%; group 1) (P_F = 0.016). There was no significant difference in the occurrence of postoperative bleeding or mortality between the groups (P_F = 0.162 and 0.250, respectively). The frequencies of a hospital stay longer than 48 h and back pain were significantly higher in group 1 (P_F = 0.004, P_F < 0.001, respectively). There were no significant differences between groups in the preoperative BMI (Student's t = 0−0.763, P = 0.45) or the age (Student's t = −0.5, P = 0.61). The operative time was longer in group 1 (Student's t = 3.56, P < 0.001). There was also a significantly lower intraoperative blood loss in group 2 (Student's t = 1.99, P = 0.048). Conclusion From our experience, leak after LSG could be minimized by invaginating sutures of the staple line and by adapting the ergonomic trocar positioning described herein.

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Introduction Pilonidal sinus disease is a chronic, recurrent disorder of the sacrococcygeal region, which commonly occurs in young adults following puberty. The male population is affected more frequently compared with the female population. A large number of surgical techniques (with varying complexity) have been described in the literature for the treatment of this disease. Such diversity suggests that no single technique has emerged as the preferred method in preventing recurrence of this condition. Objectives The aim of this study was to compare karydakis lateral flap technique with open technique in the treatment of noncomplicated pilonidal sinus. Patients and methods A total of 70 patients with uncomplicated pilonidal sinus, attending Minoufiya University Hospital and other private hospitals, were included in this study. They were divided into two groups: the karydakis group and the open procedure group. Results A total of 57 male and 13 female patients were included in this study. The mean operative time in the karydakis and the open group was 45 ± 7.27 and 23.4 ± 4 min, respectively. There was a significantly lower rate of wound infection in the karydakis group. Two patients (5.7%) showed recurrence in the karydakis group, whereas eight patients (22.8%) had recurrence in the open group. There was no significant difference between the two groups as regards scar pain and numbness (P > 0.05), but there was a significantly lower recurrence rate in the karydakis group (P = 0.022). The healing time and duration of work-off was significantly shorter in the karydakis group (P < 0.001). Conclusion Karydakis technique showed shorter hospital stay, earlier healing, shorter duration of work-off, and lower rate of complications compared with the open technique.

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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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Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. Objective The aim of this study was to compare the results between LRYGB and LSG in the management of morbid obesity and its comorbidities. Methods Between January 2010 and January 2015, 434 morbid obese patients were randomized, operated upon, and followed up for 2 years in Al Ahli Hospital, Doha, Qatar. A total of 214 patients underwent LSG, and 220 patients underwent LRYGB. The mean BMI of all patients was 44 ± 10.8 kg/m ² ; their mean age was 43 ± 4.9 years; and 72% of them were female. Patients were followed up at 3, 6, and 9 months and at 1 and 2 years. Operative time, length of hospital stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. Results Age, sex, BMI, and comorbidities were equal in both groups. The mean operative time for LSG was 86.9 ± 51.6 min and that for LRYGB was 108.4 ± 41.8 min. The conversion rate was 0.9% in both groups. Minor complications occurred more often in LRYGB than in LSG (17.2 vs. 8.4%). However, the difference in major complications did not reach statistical significance (4.5% for LRYGB vs. 1.4% for LSG). One-year excessive BMI loss was similar between the two groups (71.8 ± 21.9% for LSG and 77.2 ± 21.3% for LRYGB). The comorbidities were significantly improved after both procedures, except for gastroesophageal reflux disease, which showed a higher resolution rate after LRYGB. Conclusion Two years after surgery, both procedures were almost equally efficient regarding weight loss and improvement of comorbidities, except gastroesophageal reflux disease. LSG was associated with shorter operation time and fewer complications compared with LRYGB. Long-term follow-up data are needed to confirm these results.

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Background Adhesive small bowel obstruction (ASBO) represents a common clinical problem following previous abdominal surgery. The recurrence rate after an ASBO admission is high, especially after conservative treatment. Retrospective studies suggest that laparoscopic approach shortens hospital stays and reduces complications in these patients. However, there are no prospective randomized, controlled trials comparing early laparoscopic adhesiolysis with conservative treatment of recurrent ASBO. Patients and methods A prospective, randomized, controlled study was conducted on 51 patients admitted with the diagnosis of recurrent postoperative ASBO to compare early laparoscopic adhesiolysis with conservative treatment in patients with computed tomography-diagnosed ASBO. The outcome of the study was evaluated depending on the length of postoperative hospital stay, passage of stool, commencement of enteral nutrition, 30-day mortality, complications, the length of sick leave, and recurrence of small bowel obstruction during follow-up for 2 years. Results A total of 51 patients with a diagnosis of recurrent small bowel obstruction were identified and divided into two groups. A total of 26 patients were treated with laparoscopic adhesiolysis (23 patients were successfully treated and three patients needed open surgery) and showed significantly low recurrence, short hospital stay, and early regain of bowel movement. A total of 25 patients underwent conservative treatment, which was filed in three cases that needed surgical interference. There was no significant difference between the two groups as regards morbidity and mortality. Conclusion Laparoscopically treated patients with recurrent ASBO had a lower frequency of recurrence and a longer time interval to recurrence. They also had a shorter hospital stay and early start of oral feeding compared with patients treated nonoperatively. Laparoscopy in well-trained hand may help in the treatment of recurrent ASBO with fewer complications.

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Background Ischemic stroke represents a major health problem and it is an important cause of long-term disability. The aim of this study was to compare short-term results of carotid endarterectomy and stenting without the use of cerebral protection device. Patients and methods During a 2-year period, we enrolled 40 patients with carotid artery stenosis and performed 18 carotid endarterectomy operations and 22 carotid artery stenting procedures without distal protection devices. Results Mortality was zero. The main postoperative results after endarterectomy were as follows: one patient developed hemorrhagic stroke and another one developed myocardial infarction. With carotid artery stenting, one patient developed minor stroke and two patients developed restenosis. Conclusion No superiority of certain procedure over the other was found. Proper patient selection is the key to successful outcomes when deciding the optimal treatment for carotid artery stenosis. Carotid stent placement without the use of distal protection devices was found to be a safe and effective procedure with a relatively low incidence of periprocedural complications.

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Objective Liver transplantation is an optimal form of radical therapy for selected patients with hepatocellular carcinoma (HCC). Yet, risk factors determining outcome after living donor liver transplantation (LDLT) are still lacking and need to be well identified to maximize recipient benefit and minimize donor risk. Aim The aim of this study was to retrospectively identify and analyze the factors impacting mortality in HCC patients after LDLT. Patients and methods This is a single-center retrospective analysis of data collected from 205 patients who underwent LDLT in the Department of Surgery, National Liver Institute, Menoufia University, between May 2004 and December 2013. Of these patients, 53 proved to have an HCC in the explanted liver. Preoperative data such as demographic criteria of the patients, liver status, tumor burden, and downstaging or bridging procedures, and all intraoperative and postoperative data were collected and compared against mortality outcome. Mortality was divided into three periods: hospital mortality, which occurred within 30 days after operation; early mortality, which occurred between 2 and 6 months postoperatively; and late mortality, which occurred 6 months after transplantation. Results The mean age of all patients was 48±6.1 years; 50 (94.3%) patients were male. During the follow-up period, 22 (41.5%) patients died. The majority of mortality cases (10; 18.9%) were in the perioperative period; six (11.3%) patients died in the early period and six (11.3%) in the late period. There was a statistically significant relation between mortality rate and cytomegalovirus immunoglobulin (CMV-IgG) negativity and TNM classification (IIIB). Concerning the operative data, there was a significant statistical relation between mortality and actual graft weight, actual graft/recipient weight ratio, and number of blood and plasma transfused units. Postoperatively, there was a significant statistical relation between mortality and the grade of tumor differentiation. In multivariate analysis, CMV-IgG negativity, TNM stage (stage III), actual graft weight, and number of blood transfusion units were independent predictors of mortality. Conclusion Several factors have an independent significant effect on post-liver transplantation mortality. CMV-IgG negativity, advanced tumor stage (IIIB), actual graft weight, volume of intraoperative blood transfusion, poor tumor grade of differentiation, and tumor recurrence have an influence on post-transplantation mortality. Because LDLT can be performed regardless of Child–Pugh classification, model of end-stage liver disease score, and portal hypertension, only tumor factors, graft volume, and technical complications should be considered when selecting HCC patients for LDLT.

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Context Pilonidal sinus PNS is a common condition. Although many methods for treatment are available, there is no consensus on the optimal treatment. Aim The aim of this study was to compare the results of a modified sinotomy method with those of lay-open, limited excision, and primary closure with and without a drain in the management of a PNS. Settings and design This is a prospective randomized comparative study. Patients and material Fifty-eight patients undergoing surgery for primary PNS were enrolled. The patients were randomized into three groups: group A (17 patients) underwent modified sinotomy; group B (22 patients) underwent lay-open, limited excision, and primary closure with a drain; and group C (19 patients) underwent the same procedure as group B but without a drain. Each patient was followed up for 24 months. Statistical analysis Continuous variables were expressed as mean±SD. Categorical variables were expressed as frequencies and percentage. Results Significantly short operative time was recorded in the modified sinotomy group. Postoperative wound complications occurred in 5.9% of patients in group A, in 31.8% of patients in B, and in 21.1% of patients in group C. Significantly short time was recorded between the completion of the procedure and the patient being able to walk, sit, and sit on a toilet comfortably, as well as be able to return to work, in group A; however, the healing duration was significantly longer. Visual analogue scale score showed significantly less pain in group A. Complete wound healing occurred in all patients in groups B and C, but one patient in group A developed failure of healing. Recurrence rate was a slightly higher in group B but with no statistical significance. Conclusion The modified sinotomy technique for treatment of PNS is superior to excision with primary closure either with or without a drain with respect to operative time, hospital stay, comfort in walking, sitting, and sitting on the toilet, return to work, and visual analogue scale scores for pain, although the healing time is longer.

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Background and aim of the work Around 10–18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment can be provided as open cholecystectomy plus open CBD exploration, laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC+LCBDE), or precholecystectomy or postcholecystectomy endoscopic retrograde cholangio-pancreatography (ERCP) in two stages for CBD clearance. The aim of this study is to compare the CBD clearance rate by each procedure in a well-equipped tertiary center. Patients and methods A total of 250 patients with choledocholithiasis were included from the General Surgery Department, Sohag and Assiut University Hospitals, and managed randomly by either conventional surgery, endoscopic, or laparoscopic procedures. Results The ages of our patients ranged from 20 to 60 years (mean=40 years), with a slight female predominance (1.6 : 1); most of them presented with calcular obstruction (54.3%). However, there were also other presentations such as colic, cholangitis, or accidental discovery in 14.3, 10, and 21.5%, respectively. Patients were categorized randomly into three groups: group I included 100 patients (40%) who were treated by open choledocholithotomy and T-tube insertion; the operative time was 90 (60–180) min, with the success rate of the attempted procedures reaching 100%, and CBD clearance of stones was achieved in 95% of cases (five cases of missed stones). Hospital stay was 8 (5–12) days, with no mortality, and morbidity rate reached 15% in the form of wound infection, bile leak, and missed stone. The patient could return to work after 2 weeks (12–20 days). Group II included 100 patients (40%) treated by endoscopic sphincterotomy; basket extraction was performed in 45%, balloon in 25%, the combined maneuver in 15%, and mechanical lithotripsy in 13%, with failure of the technique in two cases (2%); the duration of the procedure was about 30 (20–45) min, with a success rate of attempted procedures of 98%, and CBD clearance of stones was achieved by 100%, with no mortality; the morbidity rate was 9% in the form of cholangitis (3%) and mild pancreatitis with hyperamylasemia (6%). The period of hospital stay was 1 (1–2) days and the patient returned to work after 3 (2–5) days. Group III included 50 patients (20%) treated by laparoscopic approaches: transcystic approaches in five cases and transcholedochotomy approaches in 45 cases. Choledochoscopic exploration was performed in almost all cases (45 cases) to detect, extract the stones, and test CBD clearance, and there was conversion to open techniques in one case. The time needed for this procedure was 123 (70–292) min, with CBD clearance of stones in 96% (two cases of missed stone), with no mortality, and a morbidity rate of about 10% in the form of mild hyperamylasemia, fever, and missed stone. The period of hospital stay was 3.2 (2–4) days, with return to work after 7 (5–10) days. Conclusion Both ERCP/LC and LCBDE were highly effective in CBD clearance, and equal in terms of the overall cost and patient acceptance. However, the overall duration of hospitalization was shorter for LCBDE with elimination of the potential risks of ERCP-associated pancreatitis, further procedures, and anesthesia risks. It is feasible, cost-effective, and ultimately should be available for most patients in each specialized center.

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Background Edema occurs because of trauma to tissues from an injury or a surgical procedure and is bothersome to both patients and treating physicians. The presence of edema is an initial component of the inflammatory response to tissue trauma. Chymotrypsin possesses potent anti-inflammatory properties that accelerate the reabsorption of inflammatory edemas as well as postoperative and post-traumatic hematomas and edemas. This study is a pioneer research to evaluate the efficacy and safety of α-chemotrypsin injection in postoperative and post-traumatic edema. Patients and methods A total of 529 patients with postoperative and postfracture edemas were recruited from three centers in Egypt (Orthopedic, Gynecology, and Surgery). Edema grades during visit 1 (V1) and visit 2 (V2) were evaluated and given scores from 1 to 4; their mean values were obtained and compared using the paired t-test for the overall sample, for each center, and by nature of edema (postoperative and post-traumatic). Results Of the 529 patients, 523 (98.9%) cases improved, six (1.1%) cases did not change, and the condition of no patient worsened. The mean edema grade score in V1 in the overall sample was 2.75, which decreased to 1.53 in V2 (P<0.001), with a percent change of −61%. There was a statistically significant difference in edema grade between V1 and V2. No adverse events or serious adverse events were reported during the study. Conclusion α-Chymotrypsin ampoules from Amoun are effective in lowering the edema grade and in managing patients with postoperative edema and postfracture edema as well.

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Context The surgical treatment of breast cancer has changed significantly over time, but modified radical mastectomy (MRM) is still performed in about 20–30% of patients undergoing surgeries. Many articles that have studied the breast lymphatic system claim that the deep fascia is very poor in lymphatic vessels. Aim The aim of our study was to detect the benefits and oncological safety of pectoral fascia preservation in patients undergoing MRM. Materials and methods Totally, 73 patients with early breast cancer underwent MRM. The patients were randomized between removal (n=37) and preservation (n=36) of pectoral fascia. Results The amount of blood loss, operative time and drain output was significantly reduced in a case of pectoral fascia preservation (P>0.00001); in addition, seroma was significantly reduced (P=0.025). No chest wall recurrence had occurred in both groups. Conclusion Pectoral fascia preservation is safe and has many advantages as regards operative time, blood loss, seroma formation and cosmetic appearance of the flaps. It is oncologically safe compared with pectoral fascia resection, provided that good selection of the patient was done.

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Background Few operations in the head and neck region present challenges such as parotidectomy. The tumors detected are usually benign and patients expect normal function postoperatively. Complications of parotidectomy can be divided into early and late complications. The most serious of late complications are Frey syndrome and cosmetic deformity. Our aim is to evaluate the role of dermal fat graft interposition in preventing postparotidectomy complications. Patients and methods This study included 72 patients with benign parotid tumors who were treated between May 2012 and December 2015 in the Department of General Surgery, Menoufia University Hospitals. These patients are randomly divided into two groups: group A (control group) included 36 patients treated with parotidectomy without using dermal fat graft, and group B (study group) included 36 patients treated with parotidectomy and interposition of dermal fat graft. Results Most of our patients were females in both groups (66.7 and 77.8%), respectively. The most common pathology was pleomorphic adenoma in both groups (61.1 and 66.7%). There are no statistically significant differences between both groups as regards the operative time and the incidence of facial nerve palsy. Group B (study group) had a significantly lower incidence of Frey syndrome compared with group A (control group) either by subjective or objective methods (P=0.011 and 0.002). There was also a significant reduction in the incidence of sialocele and cosmetic unsatisfaction in the study group (P=0.030 and 0.003, respectively). Conclusion The dermal fat graft is a simple idea for restoring facial contour and preventing the postoperative complications after parotidectomy.

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Background Venous ulcer (VU) is a serious health problem that has no satisfactory treatment. Platelet-rich fibrin (PRF) is one of regenerative medicines that promote wound healing by sustained release of growth factor (GF) and protein matrix for more than 7 days. Aim This study aims to evaluate the efficacy and safety of autologous leukocyte-platelet-rich fibrin (L-PRF) with venous leg ulcer. Patients and methods A randomized controlled study was conducted that included 36 patients with VUs. The eligible patients were enrolled in one of two groups (PRF and control groups) according to randomization schedule. Each group included 18 patients. The PRF group was treated with autologous L-PRF dressing, and dressing change was done once weekly. The control group was treated with conventional dressing of VU, but dressing change was done once in 2 days. Results The mean percentage of wound reduction of PRF group was found significantly higher than that of control group. There was a statistically significant difference between the PRF group and control group regarding the rate of completely healed ulcer at the fourth week for ulcer size less than 10 cm² and at the seventh week for ulcer size more than 10 cm². Conclusion Autologous L-PRF is effective and safe for treatment of venous leg ulcer.

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Background Peptic ulcer perforation is an emergency and requires urgent surgical treatment. In spite of rare incidence of elective surgery for duodenal ulcer, frequency of emergency operations is on the rise. Objective This study is aimed at comparing success rate between Graham’s omentopexy (GO) and modified-Graham’s omentopexy (MGO) as an emergency management technique for duodenal perforation. Patients and methods A prospective study was carried out for 2 years with 80 patients. GO was done in 40 patients and 40 patients underwent MGO between March 2015 and March 2017 in the Department of Surgery in Aswan University. Data regarding age, sex, time elapsed between onset of symptoms and hospital admission, comorbid diseases, morbidity, and mortality were recorded. Results MGO was associated with longer operative time, but the incidence of reperforation is less than GO. Mean hospital stay in GO group is higher than MGO group. Conclusion Graham’s patch repair is as effective as modified-Graham’s patch repair in terms of morbidity and mortality. There is no statistically significant difference in undergoing either procedure for repair.

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Context Innumerable surgical options addressing persistent rectal prolapse are available. This study compared the short-term outcome of laparoscopic suture rectopexy (LSR) with posterior sagittal rectopexy (PSR). Patients and methods A prospective randomized study was carried out on patients requiring rectal prolapse surgery. Patients were randomly allocated into LSR and PSR groups. Patients with neurological/musculoskeletal deficits, lower gastrointestinal tract anomalies and those with previous pelvic or perineal surgeries were excluded. Results A total of 66 patients, who had suture rectopexy done, were followed up for a minimum of 6 months following surgery. There were 33 LSR and 33 PSR. The mean duration of symptoms was 19 months (range: 6 months to 7.5 years). The mean age at operation was 5.9 years (range: 2.5–12 years), with a slight female predominance (54.5%). The mean operative time was 87.2 and 51.3 min for LSR and PSR, respectively. The mean postoperative hospital stay was 41.18 and 31.87 h for PSR and LSR, respectively. LSR had better Manchester Scar Scale scores compared with PSR (mean: 6.45 and 10.09, respectively). LSR patients resumed unrestricted activities earlier than those of PSR (mean: 9.84 and 15.15 days, respectively). Both groups showed comparable improvements in bowel functions and quality of life. Complications were a transient partial recurrence in one LSR patient (3.1%) and two wound infections in PSR group (6.2%). There was one conversion to laparotomy in LSR group (3.1%). Conclusion Both techniques seemed equally effective in eliminating rectal prolapse. Without longer operative times and conversion to laparotomy, LSR would have been absolutely superior to PSR.

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