The Egyptian Journal of Surgery最新文献

{"title":"Study of the value of core biopsy for establishing tissue diagnosis compared to excisional biopsy in enlarged cervical lymph nodes","authors":"Karim N.F. Mahmoud, Ahmed A.E.A. ء A.E.A. Elmged, Omnia A. Seyam, B. Ayoub, A. Elghandour","doi":"10.21608/ejsur.2024.357124","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357124","url":null,"abstract":"Background: Core tissue biopsy involves sampling tissue with a wider gauge than is used for fine-needle aspiration cytology. Core biopsy may be used as an alternative to surgical excisional lymph node biopsy as it would provide less risk to the patients as regards wound infection, scar, bleeding, accessory nerve injury, and the risk of complications of general anesthesia. The aim of this work was to assess the accuracy, specificity, and sensitivity of core biopsy in establishing tissue diagnosis of enlarged cervical lymph nodes. Patients and Methods: This prospective study was carried out on 100 patients, 50 for core biopsy and 50 for excisional biopsy, aged more than 18 years old, both sexes, with cervical lymphadenopathy indicated for ultrasonography (US)- guided core biopsy. Results: Based on our study, the diagnostic rate of core needle biopsy (CNB) is 53 cores and 10% of them need an excisional biopsy. 95% of lymphoma patients were diagnosed by core biopsies. Every CNB patient underwent hydrodissection and got a safe puncture distance. In cervical lymphadenopathy diagnosis, CNB had 89% sensitivity, 100% specificity, 100% positive predictive value, and 66% negative predictive value. Conclusion: Performing core samples of cervical lymph nodes in cases of cervical lymphadenopathy, especially US-guided core biopsy, can be beneficial in achieving a diagnosis as well as decreasing the need for excisional biopsies performed under general anesthesia.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Toupet versus Nissen fundoplication for the treatment of gastroesophageal reflux disease: Randomized prospective study","authors":"M. El sorogy, Mahmoud Haggag, A. Elghawalby, E. Hamdy, Rami Said","doi":"10.21608/ejsur.2024.274542.1012","DOIUrl":"https://doi.org/10.21608/ejsur.2024.274542.1012","url":null,"abstract":". ABSTRACT Objective: To compare laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication in terms of postoperative acid reflux control and postoperative complications, especially dysphagia and gas bloat on a short-term basis. Patients and Methods: This prospective randomized study included 50 patients with gastroesophageal reflux disease who presented at Gastrointestinal Surgical Center, Mansoura University, for antireflux surgery from August 2021 to August 2022. Results: The incidence of dysphagia was higher in the Nissen group than in Toupet in early postoperative follow-up (3 months) compared with the Toupet group ( P=0.008 ), but the incidence of dysphagia decreased among the Nissen group during follow-up periods while no incidence of dysphagia in Toupet group ( P=0.077 ). Regarding heartburn score, there was no statistically significance between the two groups Toupet and Nissen ( P=0.200 ) at early follow-up periods. However after 18-month postoperative, Nissen group showed better control of heartburn symptoms when compared to the Toupet group ( P=0.045 ). In the current study, according to quality of life after 1 year and patient satisfaction, there was no significant difference between the two procedures ( P=0.059 ). Conclusion: Nissen fundoplication shows a high incidence of dysphagia and gas bloat symptoms during early postoperative periods when compared with Toupet fundoplication, but this incidence decreases along follow-up periods. On the other hand, Nissen fundoplication shows better acid reflux control all over the follow-up periods","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective comparative study between anterior approach and conventional approach right formal hepatic resection for large hepatocellular carcinom","authors":"Zeinab Hassan Ibrahim Awad, Mahmoud T. Rayan, Hesham Hassan Wagdy, H. S. Saber","doi":"10.21608/ejsur.2024.287458.1065","DOIUrl":"https://doi.org/10.21608/ejsur.2024.287458.1065","url":null,"abstract":"Background: A study is carried out to assess the possible advantages of operative and postoperative outcomes of the anterior approach (AA) over the conventional approach (CA) in major right hepatectomy for large hepatocellular carcinoma (HCC). Patients and Methods: A prospective randomized controlled study was performed on 50 patients who had a large (≥5 cm) right lobe of the liver HCC and underwent curative right formal hepatectomy during a 28-month period. The patients were randomized to undergo resection of the tumor using the anterior approach technique (AA group, n=25) or the conventional approach technique (CA group, n=25). The CA involves initial complete mobilization of the right liver followed by extrahepatic vascular control then hepatic parenchymatous dissection is performed. AA consists of initial vascular inflow control and parenchymal transection before mobilization of the right lobe. Results: There was no significant difference between the two groups as regards clinical, laboratory, and pathological parameters. The operative results showed a significant blood loss in the CA group in comparison to the AA group. The AA group had better disease-free survival and overall survival than the CA group. Conclusion: The anterior approach is the recommended technique for right formal hepatectomy for large HCC as it results in improved operative and survival outcomes of the patients.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study between one stage and two-stages superficialization of brachio-basilic arteriovenous fistula as a hemodialysis access procedure","authors":"Ahmed M. El-Mahdi, Hatem K. Elgohary, Karim R. Sallam, Mohamed M. S. Ahmed, Ahmed M. A. Elsayed","doi":"10.21608/ejsur.2024.357131","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357131","url":null,"abstract":"Background: The best technique for creating brachiobasilic arteriovenous fistulas (BBAVFs) is still up for debate. Because of this, the purpose of this study was to examine the patencies, primary failure rates, and complication rates of brachiaobasilic arteriovenous fistulas formed using the one-stage and two-stage superficialization techniques. Patients and Methods: In order to compare one stage and two-stage superficialization of brachiobasilic arteriovenous fistula, a prospective, randomized controlled clinical trial including 38 patients undergoing brachiobasilic arteriovenous fistula operations for end-stage renal disease was carried out. Two groups of patients were created using basic randomization. Patients in Group I underwent a single step of superficialization for their brachiobasilic arteriovenous fistula, whereas patients in Group II got a two-stage superficialization procedure. Results: Patients with two-stage BBAVF had a substantially longer fistula maturation period than patients with one-stage BBAVF. However, patients with two-stage BBAVF also had considerably greater fistula flow rate and primary functional patency when compared to patients with one-stage BBAVF. In terms of the complications in both groups, patients with one-stage BBAVF had a considerably greater incidence of thrombosis and post-operative hematoma than patients with two-stage BBAVF. However, there was no discermible difference in the two groups’ incidence of infection, steal syndrome, hematoma, or pseudoaneurysm. Conclusion:","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of aortic valve prosthesis-patient mismatch on left ventricular mass regression","authors":"Amr A. Ibrahim, Mohamed Attia, Ayman Ammar, Tamer Hikal","doi":"10.21608/ejsur.2024.274048.1003","DOIUrl":"https://doi.org/10.21608/ejsur.2024.274048.1003","url":null,"abstract":"Background: Aortic valve replacement (AVR) aim to allow left ventricular mass (LVM) regression by relieving valve stenosis and lowering LV pressure. When the effective orifice area (EOA) of the prosthetic valve that has been placed is too small in comparison to the body surface area, it is known as valve prosthesis-patient mismatch (PPM). Thus, the aim of this investigation is to determine if PPM and the degree of LVM regression following AVR are related. Patients and Methods: The study was a prospective cohort study of 100 patients with isolated aortic stenosis who underwent AVR for 2 years and were placed in two groups (50 patients in each group); group A consisted of patients with no PPM [indexed effective orifice area (IEOA) > 0.85 cm 2 /m 2 ], and group B consisting of patients with PPM (IEOA ≤ 0.85 cm 2 /m 2 ). The main outcomes of interest are type, size, EOA, and IEOA of the prosthetic aortic valve used, follow-up echocardiography after 12 months including gradient across the prosthetic valve, LVM, and LVM regression. Results: Significant differences were observed between the two groups. In the PPM group, there were fewer reductions in both mean and peak aortic valve gradients compared to the no PPM group. LVM showed a marked absolute regression in the no PPM group (87.0 ± 30.6 g) compared to the PPM group (39.1± 15.9 g, P < 0.001). Conclusion: This study shows that PPM may hamper the regression of LVM after AVR.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single anastomosis sleeve jejunal bypass versus one anastomosis gastric bypass in treatment of obesity and metabolic diseases: A randomized controlled trial","authors":"Y. K. S. M. Salem, S. A. A. Maaty, K. S. Abdelsamee, Ahmed M. Farrag","doi":"10.21608/ejsur.2024.357109","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357109","url":null,"abstract":"Introduction: Bariatric surgeries are an effective treatment for morbid obesity and its associated co-morbidities including type 2 diabetes mellitus, hypertension (HTN), and dyslipidemia. Single anastomosis sleeve jejunal (SASJ) has not been well studied in the literature or compared with other bariatric surgeries. We aim to compare one anastomosis gastric bypass (OAGB) to SASJ in terms of reduction in BMI, resolution of co-morbidities, postoperative complications, and nutritional status. Patients and Methods: A randomized clinical trial of patients undergoing either OAGB or SASJ at 1:1 ratio for treatment of morbid obesity. Participants were enrolled since April 2022 and were followed for at least 12 months at bariatric surgery department at Ain Shams University Hospital, a tertiary care center. Inclusion criteria for participant’s enrollment were age between 18 and 60 years old and BMI greater than or equal to 40 or BMI 35–40 with obesity-related comorbidities. Patients were excluded if preoperative upper gastrointestinal endoscopy showed GERD class C or Barrett’s esophagus, previous upper gastrointestinal tract surgery or liver cirrhosis, on oral steroid therapy, previous bariatric surgery, contraindications for abdominal insufflation as those with severe cardiovascular or severe restrictive respiratory diseases, Not fit for general anesthesia, significant abdominal ventral hernia, major psychiatric illness, and pregnant. Primary outcome involves weight loss, BMI loss, total weight loss %, and excess weight loss (EWL%). Secondary outcomes include resolution of comorbidities, biliary reflux, postoperative complications, readmissions, reoperations, and nutritional status. Results: Since April 2022, 68 patients have been enrolled into the study. The mean age, weight, and BMI of the entire cohort are 38.32±10.08 years old, 124.72±18.75 kg, and 43.97±5.47 kg/m 2 . A higher number of patients had DM and/or HTN in SASJ (38.2% DM, 47.1% HTN) compared with OAGB. Comparison between both groups showed no significant statistical difference in postoperative complications ( P=0.135 ), readmissions ( P=1 ), reoperations ( P=0.555 ), and bile reflux ( P=0.09 ). Both SASJ and OAGB groups had comparable postoperative weight loss, BMI, EWL % at 6 and 12 months of follow-up, however, OAGB had significantly higher total weight loss % at 6 months only. SASJ patients had a significantly higher rate of resolution from DM compared with OAGB patients ( P=0.012 ). No significant difference between both groups in the resolution of HTN ( P=0.07 ) and dyslipidemia ( P=0.03 ). Patients who had OAGB had a higher rate of gallstones postoperatively compared with SASJ patients ( P=0.001 ). None of the patients had anemia, hypoalbuminemia, or iron deficiency. Regarding vitamin D and calcium, no significant differences between both surgeries (SASJ and OAGB) were noted. Conclusion: Remission rates of DM are higher in SASJ in comparison to OAGB. SASJ had similar weight loss, BMI lo","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latest follow-up after primary surgical correction of tetralogy of Fallot in adulthood","authors":"Amr Alsalakawy, Hassan Moftah, WALEED I ibraheem, Ahmed M Afifi, Ahmed Mahgoub, Mohamed Adel","doi":"10.21608/ejsur.2024.357123","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357123","url":null,"abstract":". ABSTRACT Background: Tetralogy of Fallot (TOF) is a prevalent congenital heart disease that requires early surgical intervention in infancy to enhance survival rates. However, some overlooked cases of TOF can persist into adulthood. Yet, they are vulnerable to serious complications from the long-standing cyanosis, which emphasizes the need for surgical correction. Nevertheless, primary surgical repair poses greater risks compared to pediatric cases due to coagulation defects, myocardial dysfunction, and previous palliative procedures. Additionally, severely dysplastic pulmonary valves often cannot be preserved, and a transannular patch can result in severe pulmonary regurgitation (PR), leading to complications such as right ventricle dysfunction and arrhythmia. Hence, in adult patients, pulmonary valve replacement (PVR) is a strong bailout option when valve preservation techniques fail to achieve satisfactory outcomes. Aim: The objective of this study is to examine information gathered from 56 adult patients with TOF who received primary repair with PVR. The study will investigate the patients’ preoperative characteristics, operative details, early postoperative progress, and recent follow-up results. The study findings will enhance the current understanding of PVR outcomes and the challenges adult TOF patients face. Patients and Methods: We studied 56 patients, 16 years of age or older, who underwent primary surgical correction of TOF in adulthood using PVR from March 2013 till March 2023. We examined their preoperative characteristics, operative technical details, postoperative outcomes, and findings from their last follow-up visit. Results: The mean age is 22.16±7.06 years. Twenty-one (37.5%) patients had palliative procedures. The majority were in NYHA grade 3. The mean oxygen saturation was 76.7%, while the mean hemoglobin level was 19.18. Cyanotic spells occurred in 10.71% of patients, and palpitations in 3.57%. The mean right ventricular outflow tract (RVOT) pressure gradient (PG) was 94.55 mmHg. Twenty-eight patients had a PVR with a freestyle valve, while the other half received tissue valves or homografts. The postoperative mean RVOT PG was 14.93 mmHg. There was no significant gradient difference between the different valve types. The mean ICU stay was 3.73 days, while the mean hospital stay was 8.64 days. Pleural effusion was the most common complication occurring in seven patients. While high intercostal tube drainage requiring evacuation occurred in four patients. Only one patient required revision of his ventricular septal defect patch due to significant residual. Cerebrovascular stroke occurred in two patients and resolved completely before discharge. The cohort was followed yearly. The mean follow-up years was 3.52 years. Fifty-four patients remained in NYHA 0. The mean RVOT PG was 21.3 mmHg, without significant difference between valves. Eleven patients had grade 1 PR and one had grade 2 PR. Conclusion: TOF repair in adulthood ","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative EUS elastography: A new tool for predicting postoperative pancreatic fistulas","authors":"Doaa A. Mansour, Sami M. Said, Younan K. Ayoub, Abanob Talaat, Ahmed M. Ghobashya","doi":"10.21608/ejsur.2024.357132","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357132","url":null,"abstract":". ABSTRACT Background: Post-operative Pancreatic fistula (POPF) is one of the significant serious complications following a PancreaticoDudenectomy (PD) or Distal Pancreatectomy (DP), and its incidence ranges from 13 to 50%. Identification of patients at a greater risk could assist in tailoring the management approach, which may involve implementing different methods for anastomotic techniques, placing additional drainage, and using somatostatin analogues as a preventive measure. Objectives: Assessing the stiffness of the pancreas using EUS elastography before surgery is an objective, quantitative, and dependable method. This detailed evaluation prior to surgery could enable surgeons to personalize and adjust the management plan in the perioperative period, leading to the best possible outcomes. Patients and Methods: This prospective case series study was conducted in Cairo University (Kasr Al-Aini Hospital) over a 12-month period between April 2021 and March 2022. Fifty-one patients underwent pancreatic surgeries either PD or DP were enrolled into the study. EUS was done for all patients by the same operator using pentax 3870 attached to a HITACHI Avius sonographic machine. Elastography was performed for all patients in two different points of pancreas and the mean was taken for both. The reading was translated to soft, intermediate, hard texture of pancreas where soft was ≤1.40 m/s, intermediate was >1.40 m/s but ≤2 m/s, hard was >2 m/s. Amylase in drain was done at day 1, 3, 5 postoperative. Results: A statistically significant correlation was observed between presence of pancreatic fistula and EUS findings, as soft pancreas showed higher significant prevalence of pancreatic fistula ( P=0.030 ). On the other hand, grade A fistula was higher in cases with soft and intermediate stiffness but did not reach the significance level ( P=0.053 ). By using ROC-curve analysis, EUS elastography can insignificantly predict postoperative pancreatic fistula in patients undergoing pancreatic surgeries at cutoff 2.0 m/s with sensitivity, specificity, PPV and NPV was 95.2%, 30.0%, 57.6% and 86.2% respectively ( P=0.514 ). Conclusion: The current research showed that pancreatic stiffness could be measured by preoperative elastography. Moreover, we discovered that the elastic ratio can be employed to detect a ‘soft pancreas’. This information is valuable as it can help predict the probability of POPF following pancreatectomy.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of central versus distal pancreatectomy in management of pancreatic body tumours: A combined retrospective and prospective study","authors":"Ali Salem, Amgad Fouad, Tarek Salah, Mohamed Elyamany, M. El Dosoky","doi":"10.21608/ejsur.2024.357139","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357139","url":null,"abstract":". ABSTRACT Background: Central pancreatectomy is a promising surgical option for patients with benign and low-grade neoplasms affecting the pancreatic body/neck region, as it preserves more pancreatic parenchyma than distal pancreatectomy. However, dealing with two pancreatic stumps carries an increased potential for pancreatic fistula. That is why we conducted this investigation to compare the previous two techniques (central vs. distal pancreatectomy) in patients with such neoplasms. Patients and Methods: Seventy patients were enrolled in our combined prospective and retrospective trial. Group A included 35 central pancreatectomy patients, while Group B included 35 distal pancreatectomy patients. Results: Central pancreatectomy was associated with a prolonged operative time compared to the distal procedure. Tumor size and pathology did not differ between the two groups. However, the length of the resected pancreatic tissue was shorter in Group A. Patients in the same group had longer ICU stays, hospitalization periods, and longer duration till oral intake. However, the incidence of pancreatic fistula was comparable between the two groups (22.9% vs. 25.7% in the two groups, respectively). Other complications, including hemorrhage and wound infection, did not differ between the two groups. Mortality occurred in only one patient in Group A due to secondary hemorrhage. Both endocrine and exocrine insufficiencies were more encountered after distal pancreatectomy compared to the central one. Conclusion: Central pancreatectomy is associated with significantly better postoperative pancreatic endocrine and exocrine functions without increased complication rates compared to distal pancreatectomy.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of graft diameter on the patency rates of axillaryaxillary arteriovenous grafts in hemodialysis patients","authors":"Amr M. Elshafei, Hossam A Elwakeel, Dina G. Abdelzaher, Mohamed Emad Eldin, Farag K Mohamed","doi":"10.21608/ejsur.2024.357105","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357105","url":null,"abstract":"Introduction : End-stage renal disease (ESRD) arises from several heterogeneous disease pathways that permanent alter renal function and structure over months or years. Hemodialysis (HD) is a lifeline treatment for cases with ESRD. A ratio of HD cases exhaust all methods for permanent vascular access (fistula or graft) in both upper limbs. Aim: The current study aims to compare 8 and 6 mm extended polytetrafluoroethylene (PTFE) grafts according to the primary patency in cases undergoing axi-ax arteriovenous grafts. Patients and methods: This retrospective, prospective case–control cohort study included all patients with ESRD referred to the Vascular Outpatient Clinic, Mansoura University hospitals, seeking for creation of HD access and decided for arteriovenous synthetic graft due to the lack of suitable autogenous veins in the arms patient were classified into two groups, in the first group (A) an 8 mm PTFE graft (26 patients) in the second group (B) a 6 mm PTFE graft, grafts (21 patients) were placed on the chest wall anastomosed between first part axillary artery and axillary vein. Results : This study was conducted on 47 patients, a 6 mm graft was used on 21 patients and an 8 mm graft on 26 patients. There was a statistically significant difference between the graft 6 mm group and the graft 8 mm group regarding preoperative axillary artery diameter and preoperative vein diameter ( P < 0.001 and 0.001, respectively) and significant difference between graft 6 mm group and graft 8 mm group regarding complications (thrombosis) ( P = 0.033). And nonsignificant regarding infection ( P = 1.0). Conclusion : The current study revealed that without considering certain changes in 6 and 8 mm grafts, primary patency can be improved by placing 8 mm grafts while respecting the axillary artery and vein diameters.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}