Objective: This study was conducted to evaluate different vascular accesses for hemodialysis in the pediatric age group in our locality as regards feasibility, complications, and outcomes. Patients and Methods: This was a prospective, descriptive, longitudinal nonrandomized study with an analytical component that was conducted on pediatric patients suffering from chronic renal failure. Patients were divided into two groups according to the clinical evaluation and duplex assessment. Group 1 was submitted to arteriovenous fistula (AVF). This group included 79 cases, while group 2 was submitted to a permanent central venous catheter (CVC). This group included 41 cases. Results: Primary patency among the studied groups was 88.6% for AVFs and 92.7% for permanent catheters at 3 months ( P=0.4 ). At 6 months, 82.3% of AVFs remained patent compared to 85.4% for permanent catheters ( P=0.6 ). At 9 months, AVFs had a patency of 79.7%atent versus 70.7% for permanent catheters ( P=0.2 ). At 12 months, AVFs had a patency of 78.5% compared to 51.2% for permanent catheters ( P=0.002 ). At 18 months, AVFs had a patency of 62% compared with 24.4% for permanent catheters ( P≤0.001 ). At 24 months, AVFs had a patency of 54.4%whereas permanent catheters had a patency of 4.9% ( P≤0.001 ). There were 22.8% with thrombosis and 0% with infection in AVFs and 34.15% with thrombosis and 26.83% with infection in permanent catheters. Conclusion: CVCs permit less effective hemodialysis and are accompanied by much higher complications and access failure rates in comparison to AVFs, resulting in earlier consumption of the vascular access reserve in patients facing years of renal replacement therapy. The detected high rate of transient uncuffed CVCs used temporarily in patients with AVF proposes frequent suboptimal vascular access planning in these patients
{"title":"Pediatric vascular access for hemodialysis: Feasibility and outcome","authors":"Mohamed Emad Eldin, Mohamed Farag, Reem Soliman, Mohamed Eissa, S. Regal, Hossam Zaher, Khalid Mowafy","doi":"10.21608/ejsur.2024.357114","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357114","url":null,"abstract":"Objective: This study was conducted to evaluate different vascular accesses for hemodialysis in the pediatric age group in our locality as regards feasibility, complications, and outcomes. Patients and Methods: This was a prospective, descriptive, longitudinal nonrandomized study with an analytical component that was conducted on pediatric patients suffering from chronic renal failure. Patients were divided into two groups according to the clinical evaluation and duplex assessment. Group 1 was submitted to arteriovenous fistula (AVF). This group included 79 cases, while group 2 was submitted to a permanent central venous catheter (CVC). This group included 41 cases. Results: Primary patency among the studied groups was 88.6% for AVFs and 92.7% for permanent catheters at 3 months ( P=0.4 ). At 6 months, 82.3% of AVFs remained patent compared to 85.4% for permanent catheters ( P=0.6 ). At 9 months, AVFs had a patency of 79.7%atent versus 70.7% for permanent catheters ( P=0.2 ). At 12 months, AVFs had a patency of 78.5% compared to 51.2% for permanent catheters ( P=0.002 ). At 18 months, AVFs had a patency of 62% compared with 24.4% for permanent catheters ( P≤0.001 ). At 24 months, AVFs had a patency of 54.4%whereas permanent catheters had a patency of 4.9% ( P≤0.001 ). There were 22.8% with thrombosis and 0% with infection in AVFs and 34.15% with thrombosis and 26.83% with infection in permanent catheters. Conclusion: CVCs permit less effective hemodialysis and are accompanied by much higher complications and access failure rates in comparison to AVFs, resulting in earlier consumption of the vascular access reserve in patients facing years of renal replacement therapy. The detected high rate of transient uncuffed CVCs used temporarily in patients with AVF proposes frequent suboptimal vascular access planning in these patients","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"200 1‐2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708365","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357130
Zeinab S. Hassanin, Elghamry E. Elghamry, Soliman M. Soliman, Mohamed M. Elsheikh
{"title":"Fibrin glue versus tacked fixation of mesh in laparoscopic transabdominal preperitoneal repair of inguinal hernia: A prospective study","authors":"Zeinab S. Hassanin, Elghamry E. Elghamry, Soliman M. Soliman, Mohamed M. Elsheikh","doi":"10.21608/ejsur.2024.357130","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357130","url":null,"abstract":"","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"13 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710462","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357112
Ahmed M. Mohii Eldein, Ahmed M. Hussein, Walid G. Elshazly, Mohammed A. Shehata
Objective: This work aimed to compare the postoperative quality of life and functional results after an anticlockwise right colon inversion procedure as a salvage technique for colorectal anastomosis after extended left hemicolectomy with the results of total colectomy and ileorectal anastomosis. Patients and Methods: This study was conducted as a prospective case–control study in Alexandria University Hospital between May 2021 and January 2023A total of 40 patients were operated on with extended left hemicolectomies for different indications, and the transverse colon could not reach the rectum in the usual clockwise direction and so the bowel integrity had been regained either by colorectal anastomosis using right colon transposition procedure as a salvage technique for colorectal anastomosis (group A) or with ileorectal anastomosis after total colectomy(group B). Postoperative quality of life and functional results were assessed during the follow-up. Results: Group A consisted of 10 (50%) males and 10 (50%) females while group B consisted of 12 (60%) males and eight (40%) females, with a mean age of 53.40 years (range, 21–75 years) in group A and 52.20 years (range, 25.0–73.0 years) in group B. Assessment of the continence using the Wexner score was done on discharge and 12 weeks after the surgery, and it was found that continence was statistically better in patients of group A when assessed on discharge and the mean Wexner score was 1.30 (range, 0.0–4.0) while in group B the mean Wexner score was 4.75 (range, 2.0–8.0). Conclusion: The right colonic transposition is a safe alternative procedure allowing a tension-free colorectal anastomosis instead of total colectomy and ileorectal anastomosis as it offers a better quality of life and better functional outcome through preservation of the ileocecal valve.
{"title":"Quality of life and functional outcomes of anticlockwise right colon transposition procedure after extended left colectomies","authors":"Ahmed M. Mohii Eldein, Ahmed M. Hussein, Walid G. Elshazly, Mohammed A. Shehata","doi":"10.21608/ejsur.2024.357112","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357112","url":null,"abstract":"Objective: This work aimed to compare the postoperative quality of life and functional results after an anticlockwise right colon inversion procedure as a salvage technique for colorectal anastomosis after extended left hemicolectomy with the results of total colectomy and ileorectal anastomosis. Patients and Methods: This study was conducted as a prospective case–control study in Alexandria University Hospital between May 2021 and January 2023A total of 40 patients were operated on with extended left hemicolectomies for different indications, and the transverse colon could not reach the rectum in the usual clockwise direction and so the bowel integrity had been regained either by colorectal anastomosis using right colon transposition procedure as a salvage technique for colorectal anastomosis (group A) or with ileorectal anastomosis after total colectomy(group B). Postoperative quality of life and functional results were assessed during the follow-up. Results: Group A consisted of 10 (50%) males and 10 (50%) females while group B consisted of 12 (60%) males and eight (40%) females, with a mean age of 53.40 years (range, 21–75 years) in group A and 52.20 years (range, 25.0–73.0 years) in group B. Assessment of the continence using the Wexner score was done on discharge and 12 weeks after the surgery, and it was found that continence was statistically better in patients of group A when assessed on discharge and the mean Wexner score was 1.30 (range, 0.0–4.0) while in group B the mean Wexner score was 4.75 (range, 2.0–8.0). Conclusion: The right colonic transposition is a safe alternative procedure allowing a tension-free colorectal anastomosis instead of total colectomy and ileorectal anastomosis as it offers a better quality of life and better functional outcome through preservation of the ileocecal valve.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"15 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715765","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357128
Ahmed Aly Khalil, Kareem Gamal, Tarek Yousef, Mohamed Gouda, Kareem Kamel
Background: Laparoscopic right colectomy is a widely accepted surgical technique for colon cancer resection, commonly using either intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). Our study compares the benefits of ICA versus ECA, as ICA has been suggested to provide faster recovery and shorter hospital stays. However, there is a lack of scientific evidence in this regard. Patients and Methods: An randomized clinical trial was conducted from November 2021 to June 2023 to compare intraoperative technical events and short-term postoperative clinical outcomes. Results: A total of 71 were randomized. The median operative time for the ECA group was 226.67 min (range: 167–310) and 222.78 min for the ICA group (range: 158–263) with no significant difference between them ( P=0.606 ). There is no significant difference in the number of harvested lymph nodes between the ECA group (mean: 13.88, range: 12–15) and the ICA group (mean: 13.78, range: 12–16) ( P=0.664 ). The incidence of postoperative ileus, vomiting, and intestinal obstruction did not differ significantly between the two groups ( P=0.728 , 0.795, and 0.885, respectively). Significantly, there was a higher incidence of wound infection in the ECA group ( P=0.047 ). The ICA group had significantly lower pain scale scores on the postoperative day ( P<0.001 ). Significantly shorter mean length of postoperative hospital stays was seen in the ICA group (4.15 vs. 5.27 for ECA, P<0.001 ). Delayed postoperative complications showed no significant difference ( P=0.061 and 0.362 for incisional hernia and internal hernia, respectively). Conclusion: ICA has less postoperative pain, shorter time to first flatus, shorter length of hospital stays, and lower rates of wound infection with nearly the same operative time compared with ECA.
{"title":"Short-term outcomes of intracorporeal versus extracorporeal ileotransverse anastomosis in laparoscopic right colectomy: A prospective randomized study","authors":"Ahmed Aly Khalil, Kareem Gamal, Tarek Yousef, Mohamed Gouda, Kareem Kamel","doi":"10.21608/ejsur.2024.357128","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357128","url":null,"abstract":"Background: Laparoscopic right colectomy is a widely accepted surgical technique for colon cancer resection, commonly using either intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). Our study compares the benefits of ICA versus ECA, as ICA has been suggested to provide faster recovery and shorter hospital stays. However, there is a lack of scientific evidence in this regard. Patients and Methods: An randomized clinical trial was conducted from November 2021 to June 2023 to compare intraoperative technical events and short-term postoperative clinical outcomes. Results: A total of 71 were randomized. The median operative time for the ECA group was 226.67 min (range: 167–310) and 222.78 min for the ICA group (range: 158–263) with no significant difference between them ( P=0.606 ). There is no significant difference in the number of harvested lymph nodes between the ECA group (mean: 13.88, range: 12–15) and the ICA group (mean: 13.78, range: 12–16) ( P=0.664 ). The incidence of postoperative ileus, vomiting, and intestinal obstruction did not differ significantly between the two groups ( P=0.728 , 0.795, and 0.885, respectively). Significantly, there was a higher incidence of wound infection in the ECA group ( P=0.047 ). The ICA group had significantly lower pain scale scores on the postoperative day ( P<0.001 ). Significantly shorter mean length of postoperative hospital stays was seen in the ICA group (4.15 vs. 5.27 for ECA, P<0.001 ). Delayed postoperative complications showed no significant difference ( P=0.061 and 0.362 for incisional hernia and internal hernia, respectively). Conclusion: ICA has less postoperative pain, shorter time to first flatus, shorter length of hospital stays, and lower rates of wound infection with nearly the same operative time compared with ECA.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"43 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141698067","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357106
Yahya Kamal
Target: The goal of the study was to compare the outcomes of two different approaches to treating hand and wrist ganglia: the lay-open procedure and typical surgical excision. Patients and Methods: This study was conducted at the surgery department of the Alqureen General Hospital in Sharkia, Egypt, between January and December of 2023. This survey was completed by 40 individuals who had wrist or hand ganglions. Patients were divided into two categories based on casual distribution. Traditional surgical excision was used to treat one kind (group A), whereas a lay-open technique was used to treat the other kind (group B). Recurrences were noted during the 6-month proceedings for both. Results: The typical surgical excision took much longer to complete (61.2 vs. 23.7 min; P<0.001 ) than the lay-open procedure. There was a considerable variance between the two sorts with relation to the operating maneuver complexity ( P<0.001 ). Group A experienced more satisfied postoperative complications. However, when it came to wound infection and the appearance of minor postoperative discomfort, the difference between the two types was not statistically significant ( P=0.3 ). Patients in type B reported higher levels of satisfaction (90 vs. 45%; P<0.001 ). Conclusion: When compared with typical surgical excision for the treatment of hand and wrist ganglion cysts, the lay-open procedure appears to be preferable.
{"title":"Comparative research for surgical excision and lay-open maneuver in treatment of hand and wrist ganglion cyst","authors":"Yahya Kamal","doi":"10.21608/ejsur.2024.357106","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357106","url":null,"abstract":"Target: The goal of the study was to compare the outcomes of two different approaches to treating hand and wrist ganglia: the lay-open procedure and typical surgical excision. Patients and Methods: This study was conducted at the surgery department of the Alqureen General Hospital in Sharkia, Egypt, between January and December of 2023. This survey was completed by 40 individuals who had wrist or hand ganglions. Patients were divided into two categories based on casual distribution. Traditional surgical excision was used to treat one kind (group A), whereas a lay-open technique was used to treat the other kind (group B). Recurrences were noted during the 6-month proceedings for both. Results: The typical surgical excision took much longer to complete (61.2 vs. 23.7 min; P<0.001 ) than the lay-open procedure. There was a considerable variance between the two sorts with relation to the operating maneuver complexity ( P<0.001 ). Group A experienced more satisfied postoperative complications. However, when it came to wound infection and the appearance of minor postoperative discomfort, the difference between the two types was not statistically significant ( P=0.3 ). Patients in type B reported higher levels of satisfaction (90 vs. 45%; P<0.001 ). Conclusion: When compared with typical surgical excision for the treatment of hand and wrist ganglion cysts, the lay-open procedure appears to be preferable.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706229","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.274802.1014
Mahmoud M.E. Ibrahim, Mostafa Abdo, Amro Abdelaal, Mahmoud T. Rayan
Background: Living donor liver transplantation (LDLT) using the right lobe is now a standard method for adults to alleviate the problem of graft size insufficiency. Without including middle hepatic vein (MHV) in right lobe graft (RLG) may cause severe congestion in segments V and VIII, which leads to graft dysfunction and septic complications. Objective: This study was conducted to evaluate the efficacy of reconstructing the MHV in RLG LDLT with native portal vein (PV) graft versus synthetic graft. Patients and Methods: This study involved 40 patients eligible for LDLT and was divided into group A, which had synthetic graft reconstruction, and group B, which had native PV graft reconstruction, while controlling for patient characteristics. Results: In our study, 13 (32.5%) cases of postoperative venous graft thrombosis were recorded, with a higher incidence in the synthetic graft group (45.0%) compared with the native PV graft group (20.0%). However, the trend was not statistically significant. Timing-wise, thrombosis was observed earlier in the synthetic graft group. The existence of reconstructed veins V5 and V8 was associated with a higher incidence of thrombosis in the synthetic graft group. Sepsis was also found to be a potential risk factor but with no statistical significance. Conclusion: In adult LDLT with right lobe graft, the native PV graft should be the first choice for MHV reconstruction. The patency rate of the native PV graft was higher than the synthetic graft, especially in cases with multiple veins requiring multiple venous anastomosis, which led to a decreased incidence of thrombosis.
{"title":"Effectiveness of anatomic reconstruction of the middle hepatic vein in right lobe graft living donor liver transplantation using natural portal vein graft and synthetic graft","authors":"Mahmoud M.E. Ibrahim, Mostafa Abdo, Amro Abdelaal, Mahmoud T. Rayan","doi":"10.21608/ejsur.2024.274802.1014","DOIUrl":"https://doi.org/10.21608/ejsur.2024.274802.1014","url":null,"abstract":"Background: Living donor liver transplantation (LDLT) using the right lobe is now a standard method for adults to alleviate the problem of graft size insufficiency. Without including middle hepatic vein (MHV) in right lobe graft (RLG) may cause severe congestion in segments V and VIII, which leads to graft dysfunction and septic complications. Objective: This study was conducted to evaluate the efficacy of reconstructing the MHV in RLG LDLT with native portal vein (PV) graft versus synthetic graft. Patients and Methods: This study involved 40 patients eligible for LDLT and was divided into group A, which had synthetic graft reconstruction, and group B, which had native PV graft reconstruction, while controlling for patient characteristics. Results: In our study, 13 (32.5%) cases of postoperative venous graft thrombosis were recorded, with a higher incidence in the synthetic graft group (45.0%) compared with the native PV graft group (20.0%). However, the trend was not statistically significant. Timing-wise, thrombosis was observed earlier in the synthetic graft group. The existence of reconstructed veins V5 and V8 was associated with a higher incidence of thrombosis in the synthetic graft group. Sepsis was also found to be a potential risk factor but with no statistical significance. Conclusion: In adult LDLT with right lobe graft, the native PV graft should be the first choice for MHV reconstruction. The patency rate of the native PV graft was higher than the synthetic graft, especially in cases with multiple veins requiring multiple venous anastomosis, which led to a decreased incidence of thrombosis.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"35 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716793","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357129
Mark M. Fathy, Hazem A E. Mohamed, Ahmed F. Amer, Karim Almoaty
Background: Hemorrhoids are a common anorectal condition causing disability and discomfort in symptomatic patients. Several less invasive techniques including stapled hemorrhoidectomy (SH) and Doppler-guided hemorrhoidal artery ligation (DHL) with mucopexy have been introduced. In our study, we aim to compare these two techniques. Patients and Methods: We included patients with symptomatic grade 3 or 4 prolapsed piles, aged from 18 to 70 years, who underwent either SH or DHL with mucopexy at the General Surgery Department, Ain Shams University hospitals. We excluded patients with previous anal surgery, hemorrhoids accompanied by other anal conditions such as fissure, fistula, or anal stenosis, impaired anal sphincter function or fecal incontinence, recurrent or complicated hemorrhoids. Patients with debilitating disease or American Society of Anesthesiologists III or IV were also excluded. Results: From July 2021 to July 2023, 40 patients were prospectively included in our study. Twenty patients had DHL with mucopexy with a mean age of 35.3±8.8, while 20 patients underwent SH operation with a mean age 34.8±7.3. Both techniques were comparable with no significant difference between them regarding any of the postoperative anal symptoms, except pain, during 1, 3, 6, 12, and 18 months of follow-up. Longo (SH) operation has significantly higher early postoperative pain, using the visual analog scale score, compared with DHL (1 month, P=0.03 , 3 months, P=0.02 , and 6 months, P=0.04 ), but no significant difference in late postoperative pain visual analog scale scores. Conclusion: Both techniques are effective in the management of grade 3 or 4 hemorrhoidal disease, but DHL technique has less postoperative pain.
{"title":"Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study","authors":"Mark M. Fathy, Hazem A E. Mohamed, Ahmed F. Amer, Karim Almoaty","doi":"10.21608/ejsur.2024.357129","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357129","url":null,"abstract":"Background: Hemorrhoids are a common anorectal condition causing disability and discomfort in symptomatic patients. Several less invasive techniques including stapled hemorrhoidectomy (SH) and Doppler-guided hemorrhoidal artery ligation (DHL) with mucopexy have been introduced. In our study, we aim to compare these two techniques. Patients and Methods: We included patients with symptomatic grade 3 or 4 prolapsed piles, aged from 18 to 70 years, who underwent either SH or DHL with mucopexy at the General Surgery Department, Ain Shams University hospitals. We excluded patients with previous anal surgery, hemorrhoids accompanied by other anal conditions such as fissure, fistula, or anal stenosis, impaired anal sphincter function or fecal incontinence, recurrent or complicated hemorrhoids. Patients with debilitating disease or American Society of Anesthesiologists III or IV were also excluded. Results: From July 2021 to July 2023, 40 patients were prospectively included in our study. Twenty patients had DHL with mucopexy with a mean age of 35.3±8.8, while 20 patients underwent SH operation with a mean age 34.8±7.3. Both techniques were comparable with no significant difference between them regarding any of the postoperative anal symptoms, except pain, during 1, 3, 6, 12, and 18 months of follow-up. Longo (SH) operation has significantly higher early postoperative pain, using the visual analog scale score, compared with DHL (1 month, P=0.03 , 3 months, P=0.02 , and 6 months, P=0.04 ), but no significant difference in late postoperative pain visual analog scale scores. Conclusion: Both techniques are effective in the management of grade 3 or 4 hemorrhoidal disease, but DHL technique has less postoperative pain.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688901","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357111
Adam Abdel-monem A.M, Aly Mohamed G
. ABSTRACT Background: Gastric ectopic pancreas is a rare developmental anomaly which is difficult to differentiate from submucosal tumor such as gastric stromal tumor by imaging methods. Since the treatments of the gastric ectopic pancreas and gastric stromal tumor are different, a correct diagnosis is essential. Aim: To identify and investigate ectopic gastric pancreatic tissue from gastric tumors. Patients and Methods: This prospective study was carried out from October 2021 to January 2023. During this period a total of 50 patients underwent a laparoscopic approach to investigate the resected tissue Histopathologically in addition to computed tomography (CT) imaging, all the included patients admitted to the Department of General Surgery, Al-Azhar University Hospitals, Al-Azhar University (Assiut Branch). Results: Significant difference in the distribution of tumors in the gastric fundus between the two groups ( P < 0.001 ). Furthermore, GPT were more likely to have the presence of peritumoral infiltration or fat-line of peritumor ( P < 0.001 ). Moreover, there were significant differences in the necrosis, calcification, surface ulceration, and lymph node. Significant differences in CT attenuation and degree of enhancement ( <0.001 ). Conclusion: Histopathology and CT imaging studies differentiate between ectopic pancreatic tissues from gastric tumors. Ectopic pancreatic tissue is a rare pathological condition that can present as acute cholecystitis of gastric tumor..
{"title":"Differentiation of ectopic pancreatic tissue from gastric tumor","authors":"Adam Abdel-monem A.M, Aly Mohamed G","doi":"10.21608/ejsur.2024.357111","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357111","url":null,"abstract":". ABSTRACT Background: Gastric ectopic pancreas is a rare developmental anomaly which is difficult to differentiate from submucosal tumor such as gastric stromal tumor by imaging methods. Since the treatments of the gastric ectopic pancreas and gastric stromal tumor are different, a correct diagnosis is essential. Aim: To identify and investigate ectopic gastric pancreatic tissue from gastric tumors. Patients and Methods: This prospective study was carried out from October 2021 to January 2023. During this period a total of 50 patients underwent a laparoscopic approach to investigate the resected tissue Histopathologically in addition to computed tomography (CT) imaging, all the included patients admitted to the Department of General Surgery, Al-Azhar University Hospitals, Al-Azhar University (Assiut Branch). Results: Significant difference in the distribution of tumors in the gastric fundus between the two groups ( P < 0.001 ). Furthermore, GPT were more likely to have the presence of peritumoral infiltration or fat-line of peritumor ( P < 0.001 ). Moreover, there were significant differences in the necrosis, calcification, surface ulceration, and lymph node. Significant differences in CT attenuation and degree of enhancement ( <0.001 ). Conclusion: Histopathology and CT imaging studies differentiate between ectopic pancreatic tissues from gastric tumors. Ectopic pancreatic tissue is a rare pathological condition that can present as acute cholecystitis of gastric tumor..","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"181 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695012","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357122
Noha A. Mahmoud, Ahmed E. Ahmed, Omar F. Ali, Alaa A. Radwan
. ABSTRACT Background: A level II volume displacement oncoplastic breast surgery method, the round block, and modified round block procedures entail sufficient tumor removal with a good esthetic result. Peripheral and periareolar lesions are treated with them. Wide local excision could be carried out with ease and a satisfactory safety margin, and the breast tumor was excised with a sufficient macroscopic safety margin. The goal of contemporary breast surgery is to treat patients by repairing and maintaining breast tissue, producing favorable physical and psychological results. Aim: To evaluate the application of modified and round block procedures in oncoplastic breast surgery for early-stage breast cancer. Patients and Methods: Twenty-one patients with breast cancer who were scheduled to have surgery between June 2019 and June 2020 utilizing round block and modified round block procedures were included in the research. Our study’s sample age ranged from 25 to 61 years old, with an average age of 46. Results: The mean age is 46 (range, 25–61 years old) and the tumor size ranges from 1 to 4 cm. Inflammation, wound infection, and gap and local dermatitis are the main postoperative complications and three (14.28%) patients were affected. All specimens were free safety margins with no recurrence. The cosmetic results are excellent in nearly all patients (90.47%), except three (14.28%) patients who had good cosmetic results. Conclusion: Round block and modified round block provide good tumor access and oncological control around the breast with little scar formation and safety. There were neither subsequent changes in the shape nor the position of the areola.
{"title":"Round block technique and modified round block technique as a cornerstone of oncoplastic breast surgery for early breast cancer","authors":"Noha A. Mahmoud, Ahmed E. Ahmed, Omar F. Ali, Alaa A. Radwan","doi":"10.21608/ejsur.2024.357122","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357122","url":null,"abstract":". ABSTRACT Background: A level II volume displacement oncoplastic breast surgery method, the round block, and modified round block procedures entail sufficient tumor removal with a good esthetic result. Peripheral and periareolar lesions are treated with them. Wide local excision could be carried out with ease and a satisfactory safety margin, and the breast tumor was excised with a sufficient macroscopic safety margin. The goal of contemporary breast surgery is to treat patients by repairing and maintaining breast tissue, producing favorable physical and psychological results. Aim: To evaluate the application of modified and round block procedures in oncoplastic breast surgery for early-stage breast cancer. Patients and Methods: Twenty-one patients with breast cancer who were scheduled to have surgery between June 2019 and June 2020 utilizing round block and modified round block procedures were included in the research. Our study’s sample age ranged from 25 to 61 years old, with an average age of 46. Results: The mean age is 46 (range, 25–61 years old) and the tumor size ranges from 1 to 4 cm. Inflammation, wound infection, and gap and local dermatitis are the main postoperative complications and three (14.28%) patients were affected. All specimens were free safety margins with no recurrence. The cosmetic results are excellent in nearly all patients (90.47%), except three (14.28%) patients who had good cosmetic results. Conclusion: Round block and modified round block provide good tumor access and oncological control around the breast with little scar formation and safety. There were neither subsequent changes in the shape nor the position of the areola.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"65 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697952","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}
Pub Date : 2024-07-01DOI: 10.21608/ejsur.2024.357108
Mohammed Elshwadfy Nageeb Abdelazez, G. Nashed, Amr Anwar, Hany Armia Barsoum, Mohammed Nasr Shazly, Ahmed Maher Hassan
Background: Rhabdomyolysis (RML) is a postbariatric surgical complication that can lead to fatal outcomes, including acute kidney injury, so it needs an early diagnosis. Aim: To determine whether creatinine kinase (CK) assessment should be routinely measured in high-risk patients after bariatric surgery. Patients and Methods: This study was a single-center, prospective, observational study from January to June 2021. All consecutive patients aged 18 years and above who were candidates for bariatric surgery were recruited and assessed for eligibility. With excluding patients who had previous bariatric surgery, significant long-standing heart/lung disease, or alcohol abuse. Preoperatively, full clinical assessments were done, laboratory tests were done, and on day 1, postoperatively, including creatinine, CK, alanine aminotransferase, aspartate aminotransferase, sodium, potassium, and operative data. The primary outcome was the occurrence of RML, depending mainly on CK level on day 1 postoperative. Results: Postoperative RML was diagnosed in eight (25%) patients with a mean BMI level of 60±4.5, operative duration of 5±1 h, and Creatine phosphokinase (CPK) mean level of 3965±2328. Conclusion: As bariatric surgery volumes rise, clinicians should be ready to quickly identify and treat RML, which occurs in 25% of our patients. CK levels may increase 24 h after bariatric surgery. Higher BMI, diabetes, arterial hypertension, and postoperative CPK levels are risk factors for RML. In our series, aggressive fluid therapy and diuretics prevented acute kidney injury when elevated CK values were detected. We recommend routine CPK monitoring after bariatric surgery.
{"title":"Should creatine kinase be routinely measured after bariatric surgery?","authors":"Mohammed Elshwadfy Nageeb Abdelazez, G. Nashed, Amr Anwar, Hany Armia Barsoum, Mohammed Nasr Shazly, Ahmed Maher Hassan","doi":"10.21608/ejsur.2024.357108","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357108","url":null,"abstract":"Background: Rhabdomyolysis (RML) is a postbariatric surgical complication that can lead to fatal outcomes, including acute kidney injury, so it needs an early diagnosis. Aim: To determine whether creatinine kinase (CK) assessment should be routinely measured in high-risk patients after bariatric surgery. Patients and Methods: This study was a single-center, prospective, observational study from January to June 2021. All consecutive patients aged 18 years and above who were candidates for bariatric surgery were recruited and assessed for eligibility. With excluding patients who had previous bariatric surgery, significant long-standing heart/lung disease, or alcohol abuse. Preoperatively, full clinical assessments were done, laboratory tests were done, and on day 1, postoperatively, including creatinine, CK, alanine aminotransferase, aspartate aminotransferase, sodium, potassium, and operative data. The primary outcome was the occurrence of RML, depending mainly on CK level on day 1 postoperative. Results: Postoperative RML was diagnosed in eight (25%) patients with a mean BMI level of 60±4.5, operative duration of 5±1 h, and Creatine phosphokinase (CPK) mean level of 3965±2328. Conclusion: As bariatric surgery volumes rise, clinicians should be ready to quickly identify and treat RML, which occurs in 25% of our patients. CK levels may increase 24 h after bariatric surgery. Higher BMI, diabetes, arterial hypertension, and postoperative CPK levels are risk factors for RML. In our series, aggressive fluid therapy and diuretics prevented acute kidney injury when elevated CK values were detected. We recommend routine CPK monitoring after bariatric surgery.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"7 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699207","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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