Bashir A. Fadel, Tameem M. Ibraheem, Waleed A. Hassan, Amira E. Mohammed, Mahmoud Moubark, Mahoud H.E.A. Elrazik
Although hepaticojejunostomy provides durable and efficient access for bilioenteric continuity, it is not free from complications, as stenosis could occur in 25% of cases. Radiologically guided interventions are the best options for managing stenosed anastomoses. However, about 30% of stenosed patients show failure. Thus, surgical intervention (redo) is a must in such circumstances. Herein, we describe the outcomes of redo surgery for patients diagnosed with stenosed hepaticojejunostomy after failed radiological interventions. During the study period, we encountered 52 patients with stenosed hepaticojejunostomy, from whom 20 cases showed failed radiological intervention, and they were enrolled in our study, and their data were collected and retrospectively reviewed. The primary procedure was performed for cholecystectomy-related biliary injury (80%), choledochal cyst (15%), and as a step of the Whipple procedure (5%). All patients presented with jaundice, while 25% of them had cholangitis. Radiological assessment showed Bismuth class I, II, III, and IV in 20, 45, 25, and 10%, respectively. The time interval between the primary and the redo procedure ranged between 6 months and 5 years. Operative time ranged between 110 and 150 min, and hospital stay ranged between 4 and 10 days. Postoperative complications included bile leakage (5%), pulmonary embolism (5%), wound infection (20%), and incisional hernia (10%). No patients developed restenosis during the follow-up period. History of cholangitis was a significant risk factor for postoperative morbidity. Revisional procedures for stenosed hepaticojejunostomy are considered safe and efficacious. The safety is manifested in the accepted complication rate, while the efficacy is manifested in the excellent success rate. However, it should be preserved only for patients with failed radiological interventions.
{"title":"Outcomes of revisional surgery for stenosed hepaticojejunostomy procedures","authors":"Bashir A. Fadel, Tameem M. Ibraheem, Waleed A. Hassan, Amira E. Mohammed, Mahmoud Moubark, Mahoud H.E.A. Elrazik","doi":"10.4103/ejs.ejs_324_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_324_23","url":null,"abstract":"\u0000 \u0000 Although hepaticojejunostomy provides durable and efficient access for bilioenteric continuity, it is not free from complications, as stenosis could occur in 25% of cases. Radiologically guided interventions are the best options for managing stenosed anastomoses. However, about 30% of stenosed patients show failure. Thus, surgical intervention (redo) is a must in such circumstances. Herein, we describe the outcomes of redo surgery for patients diagnosed with stenosed hepaticojejunostomy after failed radiological interventions.\u0000 \u0000 \u0000 \u0000 During the study period, we encountered 52 patients with stenosed hepaticojejunostomy, from whom 20 cases showed failed radiological intervention, and they were enrolled in our study, and their data were collected and retrospectively reviewed.\u0000 \u0000 \u0000 \u0000 The primary procedure was performed for cholecystectomy-related biliary injury (80%), choledochal cyst (15%), and as a step of the Whipple procedure (5%). All patients presented with jaundice, while 25% of them had cholangitis. Radiological assessment showed Bismuth class I, II, III, and IV in 20, 45, 25, and 10%, respectively. The time interval between the primary and the redo procedure ranged between 6 months and 5 years. Operative time ranged between 110 and 150 min, and hospital stay ranged between 4 and 10 days. Postoperative complications included bile leakage (5%), pulmonary embolism (5%), wound infection (20%), and incisional hernia (10%). No patients developed restenosis during the follow-up period. History of cholangitis was a significant risk factor for postoperative morbidity.\u0000 \u0000 \u0000 \u0000 Revisional procedures for stenosed hepaticojejunostomy are considered safe and efficacious. The safety is manifested in the accepted complication rate, while the efficacy is manifested in the excellent success rate. However, it should be preserved only for patients with failed radiological interventions.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140214268","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}
Mohamed Abd Allah Abd Elhady, Mohamed Khidr Mohamed, Mohamed Hafez, Mohamed Mostafa Mahmoud
Damage control surgery (planned second look) is preferred by many surgeons in the management of patients with acute mesenteric ischemia (AMI) with established bowel necrosis. However, some surgeons prefer to perform primary anastomosis during the first operation, making the second look only when indicated. Herein, we compare the perioperative outcomes of the previous two approaches in AMI patients. In this prospective, randomized study, AMI was diagnosed in 74 patients who were divided into group A (one-stage approach) and group B (two-stage approach). The one-stage approach spent more operative time compared with the first step of the other approach (110 vs. 70 min, respectively). The planned second look had an average of 75 min, and intestinal resection was done in 35.14% of cases due to advancing ischemia. The incidence of leakage was higher in the one-stage group (32.43%) compared with the other (5.4%), leading to a high reoperation rate in the former. ICU stay was longer with the damage control approach. Nonetheless, no difference was detected regarding the hospitalization period. The one-stage approach was associated with a higher 30-day mortality rate (29.73 vs. 8.11% in the other group). Risk factors for mortality included shock at presentation, prolonged operative time, and postoperative leakage. The application of the damage control approach in patients with AMI is of great benefit as it is associated with low leakage rates, less need for reoperation, and less incidence of 30-day mortality compared with the one-stage approach.
许多外科医生在治疗急性肠系膜缺血（AMI）且已出现肠坏死的患者时，都会首选损伤控制手术（计划中的第二次手术）。然而，一些外科医生更倾向于在第一次手术中进行初级吻合，只有在有必要时才进行第二次手术。在此，我们比较了前两种方法对 AMI 患者的围手术期效果。 在这项前瞻性随机研究中，74 名患者被确诊为 AMI，他们被分为 A 组（一步法）和 B 组（两步法）。 与另一种方法的第一步相比，一步法花费的手术时间更长（分别为 110 分钟和 70 分钟）。计划中的第二次检查平均耗时75分钟，35.14%的病例因缺血加剧而进行了肠切除。一期手术组（32.43%）与二期手术组（5.4%）相比，渗漏发生率更高，导致前者的再次手术率较高。损伤控制法的重症监护室住院时间更长。不过，在住院时间方面没有发现差异。一期手术与较高的 30 天死亡率有关（29.73%，另一组为 8.11%）。死亡的风险因素包括发病时休克、手术时间延长和术后渗漏。 在急性心肌梗死患者中应用损伤控制方法非常有益，因为与单级方法相比，该方法的漏损率低、再次手术的需求少、30 天死亡率低。
{"title":"One-stage versus two-stage procedure for the surgical management of patients with acute mesenteric ischemia","authors":"Mohamed Abd Allah Abd Elhady, Mohamed Khidr Mohamed, Mohamed Hafez, Mohamed Mostafa Mahmoud","doi":"10.4103/ejs.ejs_323_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_323_23","url":null,"abstract":"\u0000 \u0000 Damage control surgery (planned second look) is preferred by many surgeons in the management of patients with acute mesenteric ischemia (AMI) with established bowel necrosis. However, some surgeons prefer to perform primary anastomosis during the first operation, making the second look only when indicated. Herein, we compare the perioperative outcomes of the previous two approaches in AMI patients.\u0000 \u0000 \u0000 \u0000 In this prospective, randomized study, AMI was diagnosed in 74 patients who were divided into group A (one-stage approach) and group B (two-stage approach).\u0000 \u0000 \u0000 \u0000 The one-stage approach spent more operative time compared with the first step of the other approach (110 vs. 70 min, respectively). The planned second look had an average of 75 min, and intestinal resection was done in 35.14% of cases due to advancing ischemia. The incidence of leakage was higher in the one-stage group (32.43%) compared with the other (5.4%), leading to a high reoperation rate in the former. ICU stay was longer with the damage control approach. Nonetheless, no difference was detected regarding the hospitalization period. The one-stage approach was associated with a higher 30-day mortality rate (29.73 vs. 8.11% in the other group). Risk factors for mortality included shock at presentation, prolonged operative time, and postoperative leakage.\u0000 \u0000 \u0000 \u0000 The application of the damage control approach in patients with AMI is of great benefit as it is associated with low leakage rates, less need for reoperation, and less incidence of 30-day mortality compared with the one-stage approach.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140217872","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}
Mohamed Khattab, Goerge A. E. F. Nashed, Mostafa M. Abdelfatah, Malek M. M. Mahmoud, Mohamed Saber Mostafa
Obstructive sleep apnea (OSA), the most prevalent major sleep disorder in the world, has been associated with obesity. Besides reducing weight, bariatric surgery has been reported to improve OSA. Data on the effects of bariatric surgery on OSA are scarce in Egypt. This study aimed to evaluate the short-term effects of bariatric surgery on OSA. This is a prospective study that was conducted on patients who were candidates for bariatric surgery at our institution who completed the STOP-Bang questionnaire before the surgery with a score greater than or equal to 4 and underwent re-evaluation 6 months after surgery. All patients underwent a standardized clinical assessment. The 6-month follow-up data were recorded and analyzed. The present study included 30 patients, with a mean baseline BMI of 54.32±9.77 kg/m2. The surgeries performed were Laparoscopic Sleeve Gastrectomy (LSG) (n=21, 70%) and Laparoscopic Roux en Y gastric bypass (LRYGB) (n=9, 30%). The mean baseline STOP-Bang score was 5.3±1.09. At the 6-month follow-up, the mean 6-month postoperative STOP-Bang score was 1.13±1.04 (P<0.001). No statistically significant differences were noted in the BMI or the STOP-Bang score before and after surgery according to the surgery type (P>0.05). There was a statistically significant positive correlation between the 6-month BMI reduction and the Snoring, Tiredness, Observed apnea, Pressure, BMI, Age, Neck, Gender (STOP-Bang) score improvement (r=0.397, P=0.0298). This study demonstrated the bariatric surgery-initiated evident improvement and even complete resolution of OSA in patients with obesity, as measured by the STOP-Bang score.
阻塞性睡眠呼吸暂停（OSA）是世界上最普遍的主要睡眠障碍，与肥胖有关。据报道，除了减轻体重，减肥手术还能改善 OSA。在埃及，有关减肥手术对 OSA 影响的数据很少。本研究旨在评估减肥手术对 OSA 的短期影响。 这是一项前瞻性研究，研究对象是在我院接受减肥手术的患者，他们在手术前完成了 STOP-Bang 问卷调查，得分大于或等于 4 分，并在手术后 6 个月接受了重新评估。所有患者均接受了标准化临床评估。对 6 个月的随访数据进行了记录和分析。 本研究共纳入30名患者，平均基线体重指数（BMI）为54.32±9.77 kg/m2。所实施的手术包括腹腔镜袖带胃切除术（LSG）（21 人，70%）和腹腔镜 Roux en Y 胃旁路术（LRYGB）（9 人，30%）。基线 STOP-Bang 评分的平均值为 5.3±1.09。随访 6 个月时，术后 STOP-Bang 评分的平均值为 1.13±1.04（P0.05）。术后 6 个月体重指数下降与打鼾、疲劳、观察到的呼吸暂停、压力、体重指数、年龄、颈部、性别（STOP-Bang）评分改善之间存在统计学意义上的正相关（r=0.397，P=0.0298）。 这项研究表明，通过 STOP-Bang 评分，肥胖症患者的 OSA 可在减肥手术后得到明显改善，甚至完全缓解。
{"title":"Effect of bariatric surgery on obstructive sleep apnea: using the STOP-Bang score as a screening tool","authors":"Mohamed Khattab, Goerge A. E. F. Nashed, Mostafa M. Abdelfatah, Malek M. M. Mahmoud, Mohamed Saber Mostafa","doi":"10.4103/ejs.ejs_262_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_262_23","url":null,"abstract":"\u0000 \u0000 Obstructive sleep apnea (OSA), the most prevalent major sleep disorder in the world, has been associated with obesity. Besides reducing weight, bariatric surgery has been reported to improve OSA. Data on the effects of bariatric surgery on OSA are scarce in Egypt. This study aimed to evaluate the short-term effects of bariatric surgery on OSA.\u0000 \u0000 \u0000 \u0000 This is a prospective study that was conducted on patients who were candidates for bariatric surgery at our institution who completed the STOP-Bang questionnaire before the surgery with a score greater than or equal to 4 and underwent re-evaluation 6 months after surgery. All patients underwent a standardized clinical assessment. The 6-month follow-up data were recorded and analyzed.\u0000 \u0000 \u0000 \u0000 The present study included 30 patients, with a mean baseline BMI of 54.32±9.77 kg/m2. The surgeries performed were Laparoscopic Sleeve Gastrectomy (LSG) (n=21, 70%) and Laparoscopic Roux en Y gastric bypass (LRYGB) (n=9, 30%). The mean baseline STOP-Bang score was 5.3±1.09. At the 6-month follow-up, the mean 6-month postoperative STOP-Bang score was 1.13±1.04 (P<0.001). No statistically significant differences were noted in the BMI or the STOP-Bang score before and after surgery according to the surgery type (P>0.05). There was a statistically significant positive correlation between the 6-month BMI reduction and the Snoring, Tiredness, Observed apnea, Pressure, BMI, Age, Neck, Gender (STOP-Bang) score improvement (r=0.397, P=0.0298).\u0000 \u0000 \u0000 \u0000 This study demonstrated the bariatric surgery-initiated evident improvement and even complete resolution of OSA in patients with obesity, as measured by the STOP-Bang score.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140218231","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}
S. Saber, Tamer M. Elmahdy, S. Elgarf, A. Swelam, Gamal Mousa, Mahmoud A. Eissa
The controversy of treatment of acute colonic obstruction between the classical Hartmann’s procedure (HP) and the on-table lavage technique with primary colorectal anastomosis (PCA) for a safe, tolerable, and definitive operation with the least complications is still standing. So we conducted this prospective study to distinguish between both techniques as regards the efficacy and safety. In group A (n _ 30) the conventional Hartmann’s procedure was done by colonic resection and construction of left-sided stoma. In the B group (n _ 30), colonic resection was followed by colonic lavage, then a primary two-layered anastomosis with covering ileostomy was performed. The whole postoperative outcomes were comparable between both techniques. We believe that on table lavage technique with colorectal anastomosis is a notable choice during the treatment of acute obstruction of the left colon.
在治疗急性结肠梗阻时，传统的哈特曼手术（HP）与带原发性结肠直肠吻合术（PCA）的台上灌洗技术之间，如何选择一种安全、可耐受、彻底且并发症最少的手术方法仍存在争议。因此，我们进行了这项前瞻性研究，以区分这两种技术的有效性和安全性。 A 组（n _ 30）采用传统的哈特曼手术，切除结肠并造左侧造口。在 B 组（30 人）中，结肠切除后进行结肠灌洗，然后进行原发性两层吻合并覆盖回肠造口。 两种技术的术后效果相当。 我们认为，在治疗左侧结肠急性梗阻时，台上灌洗技术与结肠直肠吻合术是一个不错的选择。
{"title":"The controversy of management of left-sided colon obstructions: our experience","authors":"S. Saber, Tamer M. Elmahdy, S. Elgarf, A. Swelam, Gamal Mousa, Mahmoud A. Eissa","doi":"10.4103/ejs.ejs_295_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_295_23","url":null,"abstract":"\u0000 \u0000 The controversy of treatment of acute colonic obstruction between the classical Hartmann’s procedure (HP) and the on-table lavage technique with primary colorectal anastomosis (PCA) for a safe, tolerable, and definitive operation with the least complications is still standing. So we conducted this prospective study to distinguish between both techniques as regards the efficacy and safety.\u0000 \u0000 \u0000 \u0000 In group A (n _ 30) the conventional Hartmann’s procedure was done by colonic resection and construction of left-sided stoma. In the B group (n _ 30), colonic resection was followed by colonic lavage, then a primary two-layered anastomosis with covering ileostomy was performed.\u0000 \u0000 \u0000 \u0000 The whole postoperative outcomes were comparable between both techniques.\u0000 \u0000 \u0000 \u0000 We believe that on table lavage technique with colorectal anastomosis is a notable choice during the treatment of acute obstruction of the left colon.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140218796","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}
H. Adamou, Ibrahim Magagi Amadou, O. Adakal, Abdel Nasser M. Hamidou, M. Hassane, L. J. Didier, Rachid Sani
In our context, hernial strangulation has a high incidence. The aim of this work was to investigate prognostic factors in adults diagnosed with strangulated groin hernia. This was a retrospective cross-sectional study conducted at Zinder National Hospital between 1 January 2016 and 31 December 2022 (7 years). Clinical and prognostic data were collected. Out of 568 patients who underwent surgery for groin hernia, 230 cases were strangulated (40.49%). Mean age was 47.8±16.6 years. The proportion of males was 86.65%, i.e. the sex ratio was 5.96. Inguinal hernia accounted for 85.2% (n=196). The median operative time was 7 h. The Bassini procedure was the most common with 83.5% (n=192). Small bowel was the content of the hernia sac in 80% (n=184). Intestinal necrosis occurred in 10.9% (n=25). This was associated with femoral location (OR=5.39, P=0.00003). Intestinal resection was performed in 13.9% (n=32) and stoma in 1.7% (n=4). Postoperative complications occurred in 25.2% (n=58). The overall mortality (grade V) was 6.5% (n=15). Mortality was statistically associated with age > 60 years (OR=5.16; P=0.0016), admission time (OR=3.20; P=0.028), time to surgery > 8 h (OR=4.20; P=0.005) and occurrence of necrosis (OR=9.39; P=0.000). Strangulated groin hernia is a common surgical emergency. Its prognosis is associated with advanced age, femoral location, and diagnostic and therapeutic delay.
{"title":"Strangulated groin hernia prognosis in adults in sub-Saharan African context: Retrospective study at Zinder, Niger","authors":"H. Adamou, Ibrahim Magagi Amadou, O. Adakal, Abdel Nasser M. Hamidou, M. Hassane, L. J. Didier, Rachid Sani","doi":"10.4103/ejs.ejs_253_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_253_23","url":null,"abstract":"\u0000 \u0000 In our context, hernial strangulation has a high incidence. The aim of this work was to investigate prognostic factors in adults diagnosed with strangulated groin hernia.\u0000 \u0000 \u0000 \u0000 This was a retrospective cross-sectional study conducted at Zinder National Hospital between 1 January 2016 and 31 December 2022 (7 years). Clinical and prognostic data were collected.\u0000 \u0000 \u0000 \u0000 Out of 568 patients who underwent surgery for groin hernia, 230 cases were strangulated (40.49%). Mean age was 47.8±16.6 years. The proportion of males was 86.65%, i.e. the sex ratio was 5.96. Inguinal hernia accounted for 85.2% (n=196). The median operative time was 7 h. The Bassini procedure was the most common with 83.5% (n=192). Small bowel was the content of the hernia sac in 80% (n=184). Intestinal necrosis occurred in 10.9% (n=25). This was associated with femoral location (OR=5.39, P=0.00003). Intestinal resection was performed in 13.9% (n=32) and stoma in 1.7% (n=4). Postoperative complications occurred in 25.2% (n=58). The overall mortality (grade V) was 6.5% (n=15). Mortality was statistically associated with age > 60 years (OR=5.16; P=0.0016), admission time (OR=3.20; P=0.028), time to surgery > 8 h (OR=4.20; P=0.005) and occurrence of necrosis (OR=9.39; P=0.000).\u0000 \u0000 \u0000 \u0000 Strangulated groin hernia is a common surgical emergency. Its prognosis is associated with advanced age, femoral location, and diagnostic and therapeutic delay.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"67 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439825","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}
Mahmoud Aziz, Ahmed Elghrieb, Mohamed E. Abdu, Mohamed M. Mahmoud
Abdominal wall dehiscence is one of the critical postoperative complications following abdominal surgeries. Emergency surgery highly contributes to the incidence of a burst abdomen due to a lack of proper preoperative preparation and the presence of intraabdominal sepsis. Anterior component separation was primarily evolved in abdominal wall reconstruction in the open abdomen and huge ventral hernia repair. This prospective study included 50 patients operated by midline laparotomy for non-traumatic abdominal emergencies. Anterior component separation technique was randomly applied in 25 patients before laparotomy closure, the other 25 patients were closed using the traditional midline closure method. Preoperative patient’s demographics, operative time, and different postoperative complications were reported. Incidence of burst abdomen in both groups was reported. Preoperative patient’s demographic data showed no significant difference between both groups; the mean age of the patients was 53.69±7.34. Operative time was significantly longer in the Anterior Components Separation (ACS) group (P<0.001). The incidence of abdominal wall dehiscence after ACS technique (4.3%) was significantly less than after traditional technique (24%). Postoperative seroma and hematoma were the common postoperative complications after ACS however the incidence was not statistically significant. Incisional hernia was detected in (13.04%) in ACS group and in (32%) in traditional group. Application of ACS technique during laparotomy closure in abdominal emergencies seems to lower the incidence of abdominal wall dehiscence with no increase in different postoperative complications.
{"title":"Impact of anterior component separation technique on lowering the incidence of abdominal wall dehiscence and incisional hernia after emergent laparotomy: a feasibility study","authors":"Mahmoud Aziz, Ahmed Elghrieb, Mohamed E. Abdu, Mohamed M. Mahmoud","doi":"10.4103/ejs.ejs_238_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_238_23","url":null,"abstract":"\u0000 \u0000 Abdominal wall dehiscence is one of the critical postoperative complications following abdominal surgeries. Emergency surgery highly contributes to the incidence of a burst abdomen due to a lack of proper preoperative preparation and the presence of intraabdominal sepsis. Anterior component separation was primarily evolved in abdominal wall reconstruction in the open abdomen and huge ventral hernia repair.\u0000 \u0000 \u0000 \u0000 This prospective study included 50 patients operated by midline laparotomy for non-traumatic abdominal emergencies. Anterior component separation technique was randomly applied in 25 patients before laparotomy closure, the other 25 patients were closed using the traditional midline closure method. Preoperative patient’s demographics, operative time, and different postoperative complications were reported. Incidence of burst abdomen in both groups was reported.\u0000 \u0000 \u0000 \u0000 Preoperative patient’s demographic data showed no significant difference between both groups; the mean age of the patients was 53.69±7.34. Operative time was significantly longer in the Anterior Components Separation (ACS) group (P<0.001). The incidence of abdominal wall dehiscence after ACS technique (4.3%) was significantly less than after traditional technique (24%). Postoperative seroma and hematoma were the common postoperative complications after ACS however the incidence was not statistically significant. Incisional hernia was detected in (13.04%) in ACS group and in (32%) in traditional group.\u0000 \u0000 \u0000 \u0000 Application of ACS technique during laparotomy closure in abdominal emergencies seems to lower the incidence of abdominal wall dehiscence with no increase in different postoperative complications.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140517822","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}
Repairing of ventral and incisional hernias is a frequently performed surgical intervention in the field of general surgery; this work aimed to compare the extended totally extraperitoneal (eTEP) technique to the intraperitoneal onlay mesh (IPOM) technique for ventral hernias regarding feasibility, cost, operative, and postoperative outcomes of both techniques. This randomized controlled study was conducted on 50 patients complaining of ventral hernia. These patients were admitted to Tanta University Hospitals, Egypt, from January 2021 to January 2023. Patients were divided according to the technique used into two2 equal groups: group eTEP (study group): 25 participants were submitted to eTEP repair. Group IPOM (control group): 25 patients were submitted to IPOM repair. Demographic data were insignificantly different between both groups. Operation time was significantly prolonged in group eTEP compared to group IPOM (P<0.001). Cost and hospital stay were significantly decreased in group eTEP compared with group IPOM (P<0.05). Pain at rest and restriction to normal activity were significantly lower on the first and 14th postoperative days in group eTEP compared with group IPOM (P<0.05). Cosmesis was insignificantly different on the first and 14th postoperative days between both groups. Postoperative seroma, postoperative recurrence, and postoperative ileus were insignificantly different between both groups. Both eTEP and IPOM demonstrated safety and efficacy in the treatment of de-novo ventral hernia repair (comparable few complications in both groups with no recurrence in this study) with superiority toward eTEP as evidenced by lower hospital stay, cost, postoperative pain, and early return to normal activity.
{"title":"Extended Totally Extraperitoneal (eTEP) Technique vs. Laparoscopic Intraperitoneal Onlay Mesh (IPOM) in Ventral Hernia Repair: A Randomized Comparative Study","authors":"Tarek M. Sehsah, Ahmed A. Elshora, O. Abd-Raboh","doi":"10.4103/ejs.ejs_242_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_242_23","url":null,"abstract":"\u0000 \u0000 Repairing of ventral and incisional hernias is a frequently performed surgical intervention in the field of general surgery; this work aimed to compare the extended totally extraperitoneal (eTEP) technique to the intraperitoneal onlay mesh (IPOM) technique for ventral hernias regarding feasibility, cost, operative, and postoperative outcomes of both techniques.\u0000 \u0000 \u0000 \u0000 This randomized controlled study was conducted on 50 patients complaining of ventral hernia. These patients were admitted to Tanta University Hospitals, Egypt, from January 2021 to January 2023. Patients were divided according to the technique used into two2 equal groups: group eTEP (study group): 25 participants were submitted to eTEP repair. Group IPOM (control group): 25 patients were submitted to IPOM repair.\u0000 \u0000 \u0000 \u0000 Demographic data were insignificantly different between both groups. Operation time was significantly prolonged in group eTEP compared to group IPOM (P<0.001). Cost and hospital stay were significantly decreased in group eTEP compared with group IPOM (P<0.05). Pain at rest and restriction to normal activity were significantly lower on the first and 14th postoperative days in group eTEP compared with group IPOM (P<0.05). Cosmesis was insignificantly different on the first and 14th postoperative days between both groups. Postoperative seroma, postoperative recurrence, and postoperative ileus were insignificantly different between both groups.\u0000 \u0000 \u0000 \u0000 Both eTEP and IPOM demonstrated safety and efficacy in the treatment of de-novo ventral hernia repair (comparable few complications in both groups with no recurrence in this study) with superiority toward eTEP as evidenced by lower hospital stay, cost, postoperative pain, and early return to normal activity.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"32 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140517994","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}
Total mastectomy without reconstruction is a commonly adopted procedure for managing breast cancer. Formation of lateral dog ears is very common, especially with large breast cup size. In this study, we assessed the feasibility of adding quilting sutures to the Y plasty technique to achieve more acceptable results in the avoidance of lateral dog ears in comparison to using Y plasty alone. The study included 150 female patients with large breast cup size. Patients were randomized 2 : 1 between group A and group B. In group A, 3–5 quilting sutures were added to the lateral flaps of Y plasty. In group B, Y plasty only was adopted without the quilting sutures. Patients were followed up at 4-month intervals for at least 1 year. One year after surgery, patients filled in a questionnaire inquiring about the degree of discomfort in the area beneath the arm. Also, a plastic surgeon was asked to give a score about the cosmetic outcome of managing lateral dog ears both at 3 weeks and 12 months after surgery. Both groups were comparable in regard to age, BMI, breast cup size, and postoperative radiotherapy exposure. Patients in group A had better scores for satisfaction with the shape of the scar and comfort with the bra. Also, the blinded cosmetic outcome assessment was in favor of group A. Adding quilting sutures to the lateral flap of the V-Y plasty technique is associated with a better cosmetic outcome in the management of lateral dog ears in mastectomy patients with large breast cup size.
全乳房切除术（无重建）是治疗乳腺癌的常用方法。侧犬耳的形成非常常见，尤其是在乳房罩杯较大的情况下。在这项研究中，我们评估了在 Y 形成形术中加入绗缝技术的可行性，与单独使用 Y 形成形术相比，绗缝技术在避免侧犬耳方面取得了更可接受的效果。 这项研究包括 150 名大乳房罩杯女性患者。患者以 2:1 的比例随机分为 A 组和 B 组。A 组在 Y 形成形术的侧皮瓣上增加了 3-5 条绗缝线。B 组仅采用 Y 形成形术，不进行绗缝。每隔 4 个月对患者进行一次随访，为期至少 1 年。术后一年，患者填写了一份调查问卷，询问手臂下方区域的不适程度。此外，整形外科医生还被要求在术后3周和12个月对狗耳外侧的美容效果进行评分。 两组患者的年龄、体重指数、乳房罩杯大小和术后放疗暴露程度相当。A 组患者对疤痕形状和胸罩舒适度的满意度得分更高。在V-Y成形术的外侧皮瓣上添加绗缝线与处理大乳房罩杯乳房切除术患者外侧狗耳的更好美容效果有关。
{"title":"Adding quilting sutures to Y plasty to avoid postmastectomy lateral dog ears in patients with large cup sized breast","authors":"M. Alhussini, A. Awad, Hassan Kholosy","doi":"10.4103/ejs.ejs_270_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_270_23","url":null,"abstract":"\u0000 \u0000 Total mastectomy without reconstruction is a commonly adopted procedure for managing breast cancer. Formation of lateral dog ears is very common, especially with large breast cup size. In this study, we assessed the feasibility of adding quilting sutures to the Y plasty technique to achieve more acceptable results in the avoidance of lateral dog ears in comparison to using Y plasty alone.\u0000 \u0000 \u0000 \u0000 The study included 150 female patients with large breast cup size. Patients were randomized 2 : 1 between group A and group B. In group A, 3–5 quilting sutures were added to the lateral flaps of Y plasty. In group B, Y plasty only was adopted without the quilting sutures. Patients were followed up at 4-month intervals for at least 1 year. One year after surgery, patients filled in a questionnaire inquiring about the degree of discomfort in the area beneath the arm. Also, a plastic surgeon was asked to give a score about the cosmetic outcome of managing lateral dog ears both at 3 weeks and 12 months after surgery.\u0000 \u0000 \u0000 \u0000 Both groups were comparable in regard to age, BMI, breast cup size, and postoperative radiotherapy exposure. Patients in group A had better scores for satisfaction with the shape of the scar and comfort with the bra. Also, the blinded cosmetic outcome assessment was in favor of group A.\u0000 \u0000 \u0000 \u0000 Adding quilting sutures to the lateral flap of the V-Y plasty technique is associated with a better cosmetic outcome in the management of lateral dog ears in mastectomy patients with large breast cup size.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"275 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140521029","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}
Ahmed M. Saleh, Mohamed Mazloum, Abdelsalam Ismail, Doaa Emara
The aim of this study is to identify possible clinical predictors of complete response after neoadjuvant treatment (NAT) in locally advanced rectal cancer (LARC) patients. This study included 40 LARC patients (16 males and 24 females) who received NAT followed by total mesorectal excision (TME) in the period between August 2020 and February 2023. Two different NAT protocols were used; long-course chemoradiotherapy (LCRT) or consolidation total neoadjuvant treatment (TNT) according to the decision of the multidisciplinary team (MDT). Reassessment of response is done after completion of radiotherapy by digital rectal examination (DRE), proctoscopy, and pelvic MRI to define complete responders. All these responders received TME and were classified according to their pathology specimens into the pathological complete response group (pCR=22 patients) and nonpathological complete response group (non-pCR=18 patients). Statistical analyses were performed to compare the two groups and identify clinical factors associated with pCR. The significant clinical predictors of pCR in the univariate analysis were patients’ age, preneoadjuvant carcinoembryonic antigen (CEA) level and preneoadjuvant lymphocytic ratio (P=0.030, 0.007, and 0.001, respectively). In multivariate analysis, lymphocytic ratio was the only independent predictor for pCR (P=0.017). Lymphocytic ratio (>26%) has high diagnostic performance for predicting pCR, while age (>50 years) and normal CEA (≤5 ng/ml) have lower diagnostic performance which can be much improved when both are used in combination to predict pCR. Preneoadjuvant lymphocytic ratio and the combined use of age and preneoadjuvant CEA level are significant predictors of pCR, this may help the MDT select rectal cancer patients with complete clinical response (cCR), who are candidates for organ preserving strategies, to spare their rectum and avoid unnecessary radical surgeries.
{"title":"Rectal cancer complete responders after neoadjuvant chemoradiation: when to spare their organs?","authors":"Ahmed M. Saleh, Mohamed Mazloum, Abdelsalam Ismail, Doaa Emara","doi":"10.4103/ejs.ejs_235_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_235_23","url":null,"abstract":"\u0000 \u0000 The aim of this study is to identify possible clinical predictors of complete response after neoadjuvant treatment (NAT) in locally advanced rectal cancer (LARC) patients.\u0000 \u0000 \u0000 \u0000 This study included 40 LARC patients (16 males and 24 females) who received NAT followed by total mesorectal excision (TME) in the period between August 2020 and February 2023. Two different NAT protocols were used; long-course chemoradiotherapy (LCRT) or consolidation total neoadjuvant treatment (TNT) according to the decision of the multidisciplinary team (MDT). Reassessment of response is done after completion of radiotherapy by digital rectal examination (DRE), proctoscopy, and pelvic MRI to define complete responders. All these responders received TME and were classified according to their pathology specimens into the pathological complete response group (pCR=22 patients) and nonpathological complete response group (non-pCR=18 patients). Statistical analyses were performed to compare the two groups and identify clinical factors associated with pCR.\u0000 \u0000 \u0000 \u0000 The significant clinical predictors of pCR in the univariate analysis were patients’ age, preneoadjuvant carcinoembryonic antigen (CEA) level and preneoadjuvant lymphocytic ratio (P=0.030, 0.007, and 0.001, respectively). In multivariate analysis, lymphocytic ratio was the only independent predictor for pCR (P=0.017). Lymphocytic ratio (>26%) has high diagnostic performance for predicting pCR, while age (>50 years) and normal CEA (≤5 ng/ml) have lower diagnostic performance which can be much improved when both are used in combination to predict pCR.\u0000 \u0000 \u0000 \u0000 Preneoadjuvant lymphocytic ratio and the combined use of age and preneoadjuvant CEA level are significant predictors of pCR, this may help the MDT select rectal cancer patients with complete clinical response (cCR), who are candidates for organ preserving strategies, to spare their rectum and avoid unnecessary radical surgeries.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"54 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140523778","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}
Amr A.H. Mahmoud, Abdel R.K. Mahmoud, Khalid Z. Mansour, Mohamed I.M. Ismail
Diabetic foot ulcers constitute one of the most important complications of diabetes mellitus. If not treated promptly, progression of infection and sepsis may necessitate a limb amputation. To assess wound healing and to assess the time for wound healing of diabetic foot ulcers using vacuum-assisted closure (VAC) in comparison with nano-silver coated dressing. This was a simple randomized cohort prospective trial included two groups of postoperative diabetic foot patients, in which we had a comparison between VAC and nano-silver dressing in order to investigate which procedures had the least time of follow up weeks for full granulation of wound. VAC significantly reduces the time to complete wound healing by enhancement the formation of granulation tissue. The time to complete wound healing was significantly better in the VAC therapy group as compared with nano-silver dressing.
{"title":"Comparison of Vacuum Assisted Closure Therapy and Nano-Silver Coated Dressing on Wound Healing in Patients with Diabetic Foot Wound: A Randomized Prospective Trial","authors":"Amr A.H. Mahmoud, Abdel R.K. Mahmoud, Khalid Z. Mansour, Mohamed I.M. Ismail","doi":"10.4103/ejs.ejs_248_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_248_23","url":null,"abstract":"\u0000 \u0000 Diabetic foot ulcers constitute one of the most important complications of diabetes mellitus. If not treated promptly, progression of infection and sepsis may necessitate a limb amputation.\u0000 \u0000 \u0000 \u0000 To assess wound healing and to assess the time for wound healing of diabetic foot ulcers using vacuum-assisted closure (VAC) in comparison with nano-silver coated dressing.\u0000 \u0000 \u0000 \u0000 This was a simple randomized cohort prospective trial included two groups of postoperative diabetic foot patients, in which we had a comparison between VAC and nano-silver dressing in order to investigate which procedures had the least time of follow up weeks for full granulation of wound.\u0000 \u0000 \u0000 \u0000 VAC significantly reduces the time to complete wound healing by enhancement the formation of granulation tissue.\u0000 \u0000 \u0000 \u0000 The time to complete wound healing was significantly better in the VAC therapy group as compared with nano-silver dressing.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"64 3-4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140516320","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}
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