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.2024.357129
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.2024.274802.1014
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.2024.357117
Ahmed M. Elashry, Hossam A. Elfeki, Amir A. Eldawody, Hesham M. El-Gendy
Background: Patients often experience various symptoms from the immediate postoperative period to even years after. Rowachol is a terpene mixture that enhances the solubility of cholesterol, calcium carbonate, and calcium phosphate, which makes it a potent choleretic agent. Ursodeoxycholic acid can improve gallbladder contractility by decreasing cholesterol content in the plasma membrane of muscle cells and can stimulate biliary secretion, leading to relieved cholestasis. Aim: To determine whether Rowachol and ursodeoxycholic acid were useful in the prevention of postcholecystectomy pain. Patients and Methods: This randomized, clinical trial included 225 patients who underwent laparoscopic cholecystectomy and were randomly distributed into three groups according to the type of interventions. Group A included 75 patients who received Rowachol at a dose of 100 mg three times daily for 3 months; group B included 75 patients who received ursodeoxycholic acid at a dose of 300 mg twice daily for 3 months, and the control group included 75 patients who did not receive any. Technical difficulties were assessed also using the Parkland grading scale, which assesses the initial view of the gallbladder. Postoperatively, the patients were assessed by biliary pain score. Results: A higher percentage of patients in groups A and B had a Parkland score of more than II (21.3; 16%) compared to the control group. There were no statistically significant differences between the studied groups as regards postoperative complication incidence or postoperative pain grade. Mean Parkland grading was higher among intervention groups than the control group with a statistically significant difference. A higher percentage of patients in intervention groups experienced grades III and IV postoperative pain than the control group with a statistically significant difference. Mean values for postoperative pain grade were higher among the intervention group than the control group with a statistically significant difference. Conclusion: In conclusion, both Rowachol and ursodeoxycholic acid did not have a significant effect on postlaparoscopic cholecystectomy pain incidence
背景：从术后初期到数年后，患者经常会出现各种症状。罗瓦乔尔是一种萜烯混合物，能增强胆固醇、碳酸钙和磷酸钙的溶解度，因此是一种强效利胆剂。熊去氧胆酸可通过降低胆囊肌细胞质膜中的胆固醇含量来改善胆囊收缩力，并能刺激胆汁分泌，从而缓解胆汁淤积。目的：确定络活喜和熊去氧胆酸是否有助于预防胆囊切除术后疼痛。患者和方法：这项随机临床试验包括 225 名接受腹腔镜胆囊切除术的患者，根据干预类型随机分为三组。A 组包括 75 名接受罗伐乔尔治疗的患者，剂量为 100 毫克，每天三次，为期 3 个月；B 组包括 75 名接受熊去氧胆酸治疗的患者，剂量为 300 毫克，每天两次，为期 3 个月；对照组包括 75 名未接受任何治疗的患者。技术难度的评估也采用帕克兰分级表，该分级表评估胆囊的初始视图。术后对患者进行胆道疼痛评分。结果：与对照组相比，A 组和 B 组中 Parkland 评分超过 II 级的患者比例更高（21.3%；16%）。在术后并发症发生率和术后疼痛分级方面，研究组之间没有明显的统计学差异。干预组的平均帕克兰评分高于对照组，差异有统计学意义。干预组术后出现 III 级和 IV 级疼痛的患者比例高于对照组，差异有统计学意义。干预组术后疼痛等级的平均值高于对照组，差异有统计学意义。结论总之，罗瓦霍和熊去氧胆酸对腹腔镜胆囊切除术后疼痛的发生率没有明显影响
{"title":"Effect of Rowachol and ursodeoxycholic acid in the prevention of postcholecystectomy pain after laparoscopic cholecystectomy","authors":"Ahmed M. Elashry, Hossam A. Elfeki, Amir A. Eldawody, Hesham M. El-Gendy","doi":"10.21608/ejsur.2024.357117","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357117","url":null,"abstract":"Background: Patients often experience various symptoms from the immediate postoperative period to even years after. Rowachol is a terpene mixture that enhances the solubility of cholesterol, calcium carbonate, and calcium phosphate, which makes it a potent choleretic agent. Ursodeoxycholic acid can improve gallbladder contractility by decreasing cholesterol content in the plasma membrane of muscle cells and can stimulate biliary secretion, leading to relieved cholestasis. Aim: To determine whether Rowachol and ursodeoxycholic acid were useful in the prevention of postcholecystectomy pain. Patients and Methods: This randomized, clinical trial included 225 patients who underwent laparoscopic cholecystectomy and were randomly distributed into three groups according to the type of interventions. Group A included 75 patients who received Rowachol at a dose of 100 mg three times daily for 3 months; group B included 75 patients who received ursodeoxycholic acid at a dose of 300 mg twice daily for 3 months, and the control group included 75 patients who did not receive any. Technical difficulties were assessed also using the Parkland grading scale, which assesses the initial view of the gallbladder. Postoperatively, the patients were assessed by biliary pain score. Results: A higher percentage of patients in groups A and B had a Parkland score of more than II (21.3; 16%) compared to the control group. There were no statistically significant differences between the studied groups as regards postoperative complication incidence or postoperative pain grade. Mean Parkland grading was higher among intervention groups than the control group with a statistically significant difference. A higher percentage of patients in intervention groups experienced grades III and IV postoperative pain than the control group with a statistically significant difference. Mean values for postoperative pain grade were higher among the intervention group than the control group with a statistically significant difference. Conclusion: In conclusion, both Rowachol and ursodeoxycholic acid did not have a significant effect on postlaparoscopic cholecystectomy pain incidence","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"22 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704714","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.2024.276258.1021
Mina Natey, A. Negm, H. Elghadban, Mohamed Shetiwy
Background: Endoscopic thyroidectomy via the axillary, anterior, and breast approaches has been introduced in many individual surgical institutions around the world. The unilateral axillo-breast approach is a surgical resection of the thyroid lobe remotely from the neck without a neck scar shifting the scar to an area that is covered by clothing. Endoscopic thyroidectomy requires meticulous surgical dissection, absolute hemostasis, en bloc tumor resection, and adequate visualization of the operative field. Aim: To assess the feasibility and safety of endoscopic hemithyroidectomy via the axillary–breast–shoulder (ABS) approach in the management of solitary thyroid nodules and subsequent complications of this procedure. Patients and Methods: In all, 25 individuals with benign solitary thyroid nodules smaller than 5 cm in one lobe were included in our study. All patients have opted for endoscopic thyroid surgery. Using fine-needle aspiration cytology, the patients included met the benign criteria (FNAC). Within 48 h, we used a visual analog scale to assess postoperative discomfort. Assessment of the patient’s satisfaction with the cosmetic outcomes was made 1, 3, and 6 months following surgery. Results: The majority of studied cases (23 cases) had no intraoperative complications, while two cases had either ecchymosis or emphysema. There was a statistically significant difference as regards cosmetic results change during follow-up between 1 month and 3 months, between 1 month and 6 months, and between 3 and 6 months. There was a statistically significant difference as regards VAS change during follow-up between 12 and 24 h, between 12 and 48 h, and between 24 and 48 h. Conclusion: This study provided evidence that, in certain individuals with benign thyroid disease, endoscopic thyroidectomy via ABS route is a safe, successful treatment that yields great esthetic outcomes. The ABS technique is a viable, safe, and aesthetically pleasing substitute for a traditional open thyroidectomy.
{"title":"Outcomes of endoscopic hemithyroidectomy via axillary–breast– shoulder approach in benign thyroid nodules","authors":"Mina Natey, A. Negm, H. Elghadban, Mohamed Shetiwy","doi":"10.21608/ejsur.2024.276258.1021","DOIUrl":"https://doi.org/10.21608/ejsur.2024.276258.1021","url":null,"abstract":"Background: Endoscopic thyroidectomy via the axillary, anterior, and breast approaches has been introduced in many individual surgical institutions around the world. The unilateral axillo-breast approach is a surgical resection of the thyroid lobe remotely from the neck without a neck scar shifting the scar to an area that is covered by clothing. Endoscopic thyroidectomy requires meticulous surgical dissection, absolute hemostasis, en bloc tumor resection, and adequate visualization of the operative field. Aim: To assess the feasibility and safety of endoscopic hemithyroidectomy via the axillary–breast–shoulder (ABS) approach in the management of solitary thyroid nodules and subsequent complications of this procedure. Patients and Methods: In all, 25 individuals with benign solitary thyroid nodules smaller than 5 cm in one lobe were included in our study. All patients have opted for endoscopic thyroid surgery. Using fine-needle aspiration cytology, the patients included met the benign criteria (FNAC). Within 48 h, we used a visual analog scale to assess postoperative discomfort. Assessment of the patient’s satisfaction with the cosmetic outcomes was made 1, 3, and 6 months following surgery. Results: The majority of studied cases (23 cases) had no intraoperative complications, while two cases had either ecchymosis or emphysema. There was a statistically significant difference as regards cosmetic results change during follow-up between 1 month and 3 months, between 1 month and 6 months, and between 3 and 6 months. There was a statistically significant difference as regards VAS change during follow-up between 12 and 24 h, between 12 and 48 h, and between 24 and 48 h. Conclusion: This study provided evidence that, in certain individuals with benign thyroid disease, endoscopic thyroidectomy via ABS route is a safe, successful treatment that yields great esthetic outcomes. The ABS technique is a viable, safe, and aesthetically pleasing substitute for a traditional open thyroidectomy.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"115 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712870","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.2024.357108
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}
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}
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