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.2024.357119
Hosam B. Barakat, Ahmed Badran, Mohamed Elsheikh
Background: Despite the increasing prevalence of obesity among elderly individuals, there is ongoing debate regarding the safety of bariatric procedures in this age group. Objective: This study aimed to assess the efficacy and safety of laparoscopic sleeve gastrectomy (LSG), specifically in patients aged 55 years and older. Patients and Methods: A retrospective analysis was performed on patients subjected to LSG in our institution from 2019 to 2023. Forty elderly patients more than or equal to 55 years were included (study group) and were matched with forty younger patients (control group) based on BMI, sex, and comorbidities distribution. The study compared short-term outcomes regarding weight loss, comorbidities improvement, operative time, hospital stay, and complications. Results: There were no significant differences regarding the demographic characteristics or preoperative comorbidities distribution within the two groups. The mean operative time was slightly longer in the older patients than in the control group (53.85±12.17 vs. 49.25±16.22 min, respectively), but with no statistical significance. There was no perioperative mortality in both groups. The percent excess weight loss at 1 year for the older group was significantly lower than that for the younger group (58.1 vs. 68.74%. respectively). Most comorbidities in both groups were improved or resolved with no significant statistical. The morbidity rate was 15 and 17.5% for the elderly and the younger group, respectively, with no significant difference. Conclusion: LSG is safe and effective in patients more than or equal to 55 years and presents a valuable bariatric option that is efficient in inducing weight loss and improving obesity-related comorbidities and is associated with an acceptable morbidity rate comparable to younger populations.
{"title":"Safety and efficacy of laparoscopic sleeve gastrectomy in elderly patients: A matched case-control study","authors":"Hosam B. Barakat, Ahmed Badran, Mohamed Elsheikh","doi":"10.21608/ejsur.2024.357119","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357119","url":null,"abstract":"Background: Despite the increasing prevalence of obesity among elderly individuals, there is ongoing debate regarding the safety of bariatric procedures in this age group. Objective: This study aimed to assess the efficacy and safety of laparoscopic sleeve gastrectomy (LSG), specifically in patients aged 55 years and older. Patients and Methods: A retrospective analysis was performed on patients subjected to LSG in our institution from 2019 to 2023. Forty elderly patients more than or equal to 55 years were included (study group) and were matched with forty younger patients (control group) based on BMI, sex, and comorbidities distribution. The study compared short-term outcomes regarding weight loss, comorbidities improvement, operative time, hospital stay, and complications. Results: There were no significant differences regarding the demographic characteristics or preoperative comorbidities distribution within the two groups. The mean operative time was slightly longer in the older patients than in the control group (53.85±12.17 vs. 49.25±16.22 min, respectively), but with no statistical significance. There was no perioperative mortality in both groups. The percent excess weight loss at 1 year for the older group was significantly lower than that for the younger group (58.1 vs. 68.74%. respectively). Most comorbidities in both groups were improved or resolved with no significant statistical. The morbidity rate was 15 and 17.5% for the elderly and the younger group, respectively, with no significant difference. Conclusion: LSG is safe and effective in patients more than or equal to 55 years and presents a valuable bariatric option that is efficient in inducing weight loss and improving obesity-related comorbidities and is associated with an acceptable morbidity rate comparable to younger populations.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"73 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714740","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.2024.274273.1008
Muhammad Musalam, Amr Abdel Nasser, Amro Abdelaal, Ahmed Khalil, H. S. Saber
Background: Portal vein thrombosis (PVT) is a relative contraindication in living donor liver transplantation (LDLT). We monitored the outcome of adult patients with PVT in comparison to patients without PVT in LDLT.. Methods: This study is a retrospective cohort study. LDLTs that were performed at Liver Transplantation Unit in Air Forces Hospital and Nasser Institute, between January 2016 and June 2022 were evaluated. 176 cases were divided into two groups according to the presence of PVT, group A included 55 recipients who had PVT compared with group B including 121 recipients without PVT.. Results: In our study (N = 176), postoperative PV complications was recorded in 11 (6.3 %) cases. Five case in each group had postoperative PVT (9.8 % vs. 4.1 %), respectively and a single case of PV stenosis (0.8 %) was documented in non-PVT group. All patients who develop early postoperative PV (n = 3/10) complications unfortunately died because of it, unlike those who developed late PV complications, their 1 year survival rate was 70 % of cases and the overall mortality rate in patients developed PV complications was 40 %. Conclusion: PVT is established not to be a contraindication for LT but needs complex procedures and sophisticated techniques and Surgeons should be aware of these techniques to restore adequate portal flow in transplant for recipients with PVT.
{"title":"Comparative study for the outcome of living donor liver transplantation in patients with portal vein thrombosis in comparison to patients without portal vein thrombosi","authors":"Muhammad Musalam, Amr Abdel Nasser, Amro Abdelaal, Ahmed Khalil, H. S. Saber","doi":"10.21608/ejsur.2024.274273.1008","DOIUrl":"https://doi.org/10.21608/ejsur.2024.274273.1008","url":null,"abstract":"Background: Portal vein thrombosis (PVT) is a relative contraindication in living donor liver transplantation (LDLT). We monitored the outcome of adult patients with PVT in comparison to patients without PVT in LDLT.. Methods: This study is a retrospective cohort study. LDLTs that were performed at Liver Transplantation Unit in Air Forces Hospital and Nasser Institute, between January 2016 and June 2022 were evaluated. 176 cases were divided into two groups according to the presence of PVT, group A included 55 recipients who had PVT compared with group B including 121 recipients without PVT.. Results: In our study (N = 176), postoperative PV complications was recorded in 11 (6.3 %) cases. Five case in each group had postoperative PVT (9.8 % vs. 4.1 %), respectively and a single case of PV stenosis (0.8 %) was documented in non-PVT group. All patients who develop early postoperative PV (n = 3/10) complications unfortunately died because of it, unlike those who developed late PV complications, their 1 year survival rate was 70 % of cases and the overall mortality rate in patients developed PV complications was 40 %. Conclusion: PVT is established not to be a contraindication for LT but needs complex procedures and sophisticated techniques and Surgeons should be aware of these techniques to restore adequate portal flow in transplant for recipients with PVT.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696689","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.2024.357107
Ahmed F. Elkased, Naser M Abdel Bary, Mohamed S. Amar, Sherif Y. Hassan, Galal M. Abdel Kawy, Mohamed H. Elmelegy
. ABSTRACT Background: The current standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. Recent research has highlighted the possible advantages of induction chemotherapy before concurrent Chemoradiotherapy (CRT) for individuals with locally advanced rectal cancer (LARC). Our research assesses the efficacy and viability of induction chemotherapy before concomitant chemoradiotherapy for locally advanced rectal cancer. Patients and Methods: Forty patients with locally advanced cancer rectum were enrolled in our study in 2019–2021. Initially, they underwent an induction chemotherapy regimen consisting of 3 cycles of FOLFOX (oxaliplatin, leucovorin, 5 fluorouracil) over 3 months. Response assessment of the patients was done by pelvic MRI. Concurrent chemoradiotherapy was given 2 weeks after completion of induction chemotherapy. Four weeks later, the patients were reassessed by pelvic MRI, computed tomography chest, and abdomen. Total mesorectal excision was performed at 6–8 weeks after the end of radiotherapy. Included patients were evaluated for pCR, Circumferential resection margins (CRM), RO resection, sphincter preservation, treatment toxicity, and postoperative morbidity and mortality. Results: In this study, sphincter preservation was achieved in eight out of 21 (38%) patients with low rectal tumors less than or equal to 5 cm who were candidates for Abdominoperineal resection (APR) and shifted to Anterior resection (AR); complete pathological response was achieved in seven (20.5%) patient; R0 resection was achieved in 34 (92%) patients; CRM was positive in three patients; two of them developed local recurrence and one of them developed distant metastasis. Conclusion: For locally
{"title":"Evaluation of the role of neoadjuvant chemotherapy in the management of rectal cancer","authors":"Ahmed F. Elkased, Naser M Abdel Bary, Mohamed S. Amar, Sherif Y. Hassan, Galal M. Abdel Kawy, Mohamed H. Elmelegy","doi":"10.21608/ejsur.2024.357107","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357107","url":null,"abstract":". ABSTRACT Background: The current standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. Recent research has highlighted the possible advantages of induction chemotherapy before concurrent Chemoradiotherapy (CRT) for individuals with locally advanced rectal cancer (LARC). Our research assesses the efficacy and viability of induction chemotherapy before concomitant chemoradiotherapy for locally advanced rectal cancer. Patients and Methods: Forty patients with locally advanced cancer rectum were enrolled in our study in 2019–2021. Initially, they underwent an induction chemotherapy regimen consisting of 3 cycles of FOLFOX (oxaliplatin, leucovorin, 5 fluorouracil) over 3 months. Response assessment of the patients was done by pelvic MRI. Concurrent chemoradiotherapy was given 2 weeks after completion of induction chemotherapy. Four weeks later, the patients were reassessed by pelvic MRI, computed tomography chest, and abdomen. Total mesorectal excision was performed at 6–8 weeks after the end of radiotherapy. Included patients were evaluated for pCR, Circumferential resection margins (CRM), RO resection, sphincter preservation, treatment toxicity, and postoperative morbidity and mortality. Results: In this study, sphincter preservation was achieved in eight out of 21 (38%) patients with low rectal tumors less than or equal to 5 cm who were candidates for Abdominoperineal resection (APR) and shifted to Anterior resection (AR); complete pathological response was achieved in seven (20.5%) patient; R0 resection was achieved in 34 (92%) patients; CRM was positive in three patients; two of them developed local recurrence and one of them developed distant metastasis. Conclusion: For locally","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706355","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.2024.357126
M. Mohamed, Mohamed M. Mahmoud, Mohamed A. AbdElhady
Background: In Egypt, open Lichtenstein mesh repair is the standard management option for symptomatic unilateral inguinal hernia. The use of drains is routinely done by many surgeons after such procedures with no proven evidence of their benefits and complications. That motivated us to conduct the present study to evaluate the value of drain insertion in such patients. Patients and Methods: The data of 60 consecutive patients (30 patients in the drain group and another 30 patients in the drainless group) diagnosed with unliteral inguinal hernia and underwent open Lichtenstein hernioplasty were retrospectively reviewed. The main outcome was the incidence of postoperative adverse events, mainly seroma, hematoma, and wound infection. Results: Our analysis revealed no notable differences between the drain and drainless groups regarding patient and hernia characteristics. The operative time and hospitalization period were also statistically comparable. The incidence of postoperative complications did not show noteworthy differences between the two approaches. The incidence of wound infection was similar in both groups (3.3%). Seroma occurred in only one (3.3%) patient in the drainless group. Hematoma occurred in 3.3% of drain cases and 6.7% of drainless cases. Moreover, wound edema was encountered in 6.7 and 13.3% of cases in the same groups, respectively. No patients developed recurrence during the 1-year follow-up period. Conclusion: The use of drains is not associated with significant protective effects against posthernioplasty complications. Its use should be individualized to decrease the impact of drain-associated complications.
{"title":"Value of drain in reduction of seroma and wound infection in Lichtenstein repair of inguinal hernia","authors":"M. Mohamed, Mohamed M. Mahmoud, Mohamed A. AbdElhady","doi":"10.21608/ejsur.2024.357126","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357126","url":null,"abstract":"Background: In Egypt, open Lichtenstein mesh repair is the standard management option for symptomatic unilateral inguinal hernia. The use of drains is routinely done by many surgeons after such procedures with no proven evidence of their benefits and complications. That motivated us to conduct the present study to evaluate the value of drain insertion in such patients. Patients and Methods: The data of 60 consecutive patients (30 patients in the drain group and another 30 patients in the drainless group) diagnosed with unliteral inguinal hernia and underwent open Lichtenstein hernioplasty were retrospectively reviewed. The main outcome was the incidence of postoperative adverse events, mainly seroma, hematoma, and wound infection. Results: Our analysis revealed no notable differences between the drain and drainless groups regarding patient and hernia characteristics. The operative time and hospitalization period were also statistically comparable. The incidence of postoperative complications did not show noteworthy differences between the two approaches. The incidence of wound infection was similar in both groups (3.3%). Seroma occurred in only one (3.3%) patient in the drainless group. Hematoma occurred in 3.3% of drain cases and 6.7% of drainless cases. Moreover, wound edema was encountered in 6.7 and 13.3% of cases in the same groups, respectively. No patients developed recurrence during the 1-year follow-up period. Conclusion: The use of drains is not associated with significant protective effects against posthernioplasty complications. Its use should be individualized to decrease the impact of drain-associated complications.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715819","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.2024.273846.1001
S. Saber, Tarek M. Sehsah, Mahmoud A. Eissa
Background: Revisional bariatric surgeries for weight regain are rising; however, they are considered as riskier and less efficient than primary bariatric procedures. This study aimed to study short-term postoperative outcomes after Roux-en-Y gastric bypass (RYGB) for revision after failed Sleeve gastrectomy versus primary RYGB in Bariatric patients regarding Weight loss, comorbidity resolution, Postoperative complications, hospital stay, mortality, and readmissions. Patients and Methods: This retrospective study was designed to compare early postoperative outcome between 2 groups of patients admitted to General Surgery Department, Tanta University Hospitals during the period from June 2018 and June 2023. Results: A total of 254 patients were included in the study, with 87 patients in revisional RYGB and 167 patients in primary RYGB. Groups were matched for age, sex, smoking, preoperative weight, and comorbidities. The duration of revisional RYGB was significantly longer than primary RYGB (201.1±49.85 vs. 161.9±45.05; P <0.001 ). Revisional RYGB patients stayed longer in the hospital (2.54±0.74 vs. 1.87±0.78; P <0.001 ). Total weight loss was significantly higher after 6 months and 1 year in Primary RYGB than group revisional RYGB ( P value<0.05 ). However, no differences were detected in postoperative complications, readmissions, reoperation rates, and comorbidity resolution. Conclusion: RYGB as revisional surgery after a previous Sleeve gastrectomy is a complex procedure that must be indicated with care. It is a safe technique, with postoperative complication rates similar to those of primary RYGB, while it may need longer operative
{"title":"Short-term outcome after Roux-en-Y gastric bypass for revision after failed sleeve gastrectomy versus De novo Roux-en-Y gastric bypass for bariatric patients","authors":"S. Saber, Tarek M. Sehsah, Mahmoud A. Eissa","doi":"10.21608/ejsur.2024.273846.1001","DOIUrl":"https://doi.org/10.21608/ejsur.2024.273846.1001","url":null,"abstract":"Background: Revisional bariatric surgeries for weight regain are rising; however, they are considered as riskier and less efficient than primary bariatric procedures. This study aimed to study short-term postoperative outcomes after Roux-en-Y gastric bypass (RYGB) for revision after failed Sleeve gastrectomy versus primary RYGB in Bariatric patients regarding Weight loss, comorbidity resolution, Postoperative complications, hospital stay, mortality, and readmissions. Patients and Methods: This retrospective study was designed to compare early postoperative outcome between 2 groups of patients admitted to General Surgery Department, Tanta University Hospitals during the period from June 2018 and June 2023. Results: A total of 254 patients were included in the study, with 87 patients in revisional RYGB and 167 patients in primary RYGB. Groups were matched for age, sex, smoking, preoperative weight, and comorbidities. The duration of revisional RYGB was significantly longer than primary RYGB (201.1±49.85 vs. 161.9±45.05; P <0.001 ). Revisional RYGB patients stayed longer in the hospital (2.54±0.74 vs. 1.87±0.78; P <0.001 ). Total weight loss was significantly higher after 6 months and 1 year in Primary RYGB than group revisional RYGB ( P value<0.05 ). However, no differences were detected in postoperative complications, readmissions, reoperation rates, and comorbidity resolution. Conclusion: RYGB as revisional surgery after a previous Sleeve gastrectomy is a complex procedure that must be indicated with care. It is a safe technique, with postoperative complication rates similar to those of primary RYGB, while it may need longer operative","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"115 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713174","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.2024.274248.1006
Mohamed Mahmoud Ezzat, Mohamed Adel Mohamed, Yasser Baz, Gehad Ahmed, Manal M. El Mahdy
. ABSTRACT Background: Breast cancer is the most commonly diagnosed cancer in women. Breast-conserving surgery is a common standard for treating many breast cancer patients. However, MRM (Modified radical mastectomy) is still done in ⁓ 30 % of patients undergoing surgeries. Our goal of the study is to identify factors that predict histopathological retro-areolar ducts and skin lymphatics tumor involvement, as well as to formulate bases extending the indication of skin sparing, especially nipple–areola complex (NAC) sparing mastectomy. Patients and Methods: The study is an observational analytic study conducted on 145 cases. Inclusion criteria of the study are females sex, aged more than 18 years with locoregional breast disease who are candidates for MRM. Exclusion criteria are cases with grossly involved NAC, inflammatory breast cancer, skin ulceration, and nodules, Paget’s disease of the nipple, and candidates for conservative breast surgery. Preoperatively, all patients were subjected to a triple assessment of the breast cancer. Postoperatively, all mastectomy specimens are sent for the histopathological assessment. Results: By univariate analysis, factors significantly affecting skin and NAC tumor involvement were age, tumor size, multifocality, nodal metastasis, histological grade, localized skin edema (peau d’orange), and lymphovascular invasion. By multivariate analysis, factors significantly increasing skin and NAC tumor involvement were nodal metastasis, localized skin edema, unexposure to neoadjuvant chemotherapy, and HER2 neo positive cases. Conclusion: We can extend indications of SSM (Skin sparing mastectomy) in cases with negative nodal metastasis and absence of localized skin edema, who were exposed to neoadjuvant chemotherapy and HER2 neo negative cases.
{"title":"Correlating preoperative clinicopathological factors with skin and/ or nipple–areola complex tumor involvement in postmastectomy specimens","authors":"Mohamed Mahmoud Ezzat, Mohamed Adel Mohamed, Yasser Baz, Gehad Ahmed, Manal M. El Mahdy","doi":"10.21608/ejsur.2024.274248.1006","DOIUrl":"https://doi.org/10.21608/ejsur.2024.274248.1006","url":null,"abstract":". ABSTRACT Background: Breast cancer is the most commonly diagnosed cancer in women. Breast-conserving surgery is a common standard for treating many breast cancer patients. However, MRM (Modified radical mastectomy) is still done in ⁓ 30 % of patients undergoing surgeries. Our goal of the study is to identify factors that predict histopathological retro-areolar ducts and skin lymphatics tumor involvement, as well as to formulate bases extending the indication of skin sparing, especially nipple–areola complex (NAC) sparing mastectomy. Patients and Methods: The study is an observational analytic study conducted on 145 cases. Inclusion criteria of the study are females sex, aged more than 18 years with locoregional breast disease who are candidates for MRM. Exclusion criteria are cases with grossly involved NAC, inflammatory breast cancer, skin ulceration, and nodules, Paget’s disease of the nipple, and candidates for conservative breast surgery. Preoperatively, all patients were subjected to a triple assessment of the breast cancer. Postoperatively, all mastectomy specimens are sent for the histopathological assessment. Results: By univariate analysis, factors significantly affecting skin and NAC tumor involvement were age, tumor size, multifocality, nodal metastasis, histological grade, localized skin edema (peau d’orange), and lymphovascular invasion. By multivariate analysis, factors significantly increasing skin and NAC tumor involvement were nodal metastasis, localized skin edema, unexposure to neoadjuvant chemotherapy, and HER2 neo positive cases. Conclusion: We can extend indications of SSM (Skin sparing mastectomy) in cases with negative nodal metastasis and absence of localized skin edema, who were exposed to neoadjuvant chemotherapy and HER2 neo negative cases.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"36 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690415","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.2024.291145.1080
Mohammed M. Raslan, Amr Y. El-Shayeb, Mohammed A.M. Ghoneim, Ahmed S. Khalifa
Background: Anastomotic leakage is a major complication after intestinal and colorectal surgery. Diagnosis is usually established days after it has occurred, which is associated with high morbidity and mortality. Inflammatory markers have been proposed to predict the incidence of anastomotic leakage. Objective: The aim was to evaluate the role of C-reactive protein (CRP), white cell count, gamma-glutamyl transferase, CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR) and hyponatremia in early detection of anastomotic leakage (AL)in preclinical stage following open and laparoscopic colorectal and intestinal surgery. Patients and Methods: A longitudinal prospective cohort study included patients admitted to the general surgery department. Patients were indicated for intestinal anastomosis and were eligible for inclusion. Among them, 55 were on elective settings, and 50 in emergency settings. Results: A total of 105 patients were included. They had a mean age of 49.0±15.1 years and 61% of them were males. Twenty (19%) patients developed postoperative anastomotic leakage, among those, 6 were on the sixth postoperative day. CAR day 3 and CAR day 5 were significantly higher among the mortality patients with P values of 0.041 and 0.027, respectively. CRP level was significantly higher among patients with poor survival outcomes ( P value= 0.024 ). CRP trajectory was significantly associated with a mortality rate as patients who had a rise greater than 50 mg/dl between day 3 and day 5 had a higher mortality rate with a P value of 0.007. Conclusion: CRP trajectory, CAR and Neutrophil/lymphocyte ratio can significantly predict the incidence of anastomotic leakage. Settings of surgery (emergency) was an independent risk factor for development of postoperative leakage.
{"title":"The role of biomarkers in the early detection of dehiscence of intestinal and colonic anastomoses.","authors":"Mohammed M. Raslan, Amr Y. El-Shayeb, Mohammed A.M. Ghoneim, Ahmed S. Khalifa","doi":"10.21608/ejsur.2024.291145.1080","DOIUrl":"https://doi.org/10.21608/ejsur.2024.291145.1080","url":null,"abstract":"Background: Anastomotic leakage is a major complication after intestinal and colorectal surgery. Diagnosis is usually established days after it has occurred, which is associated with high morbidity and mortality. Inflammatory markers have been proposed to predict the incidence of anastomotic leakage. Objective: The aim was to evaluate the role of C-reactive protein (CRP), white cell count, gamma-glutamyl transferase, CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR) and hyponatremia in early detection of anastomotic leakage (AL)in preclinical stage following open and laparoscopic colorectal and intestinal surgery. Patients and Methods: A longitudinal prospective cohort study included patients admitted to the general surgery department. Patients were indicated for intestinal anastomosis and were eligible for inclusion. Among them, 55 were on elective settings, and 50 in emergency settings. Results: A total of 105 patients were included. They had a mean age of 49.0±15.1 years and 61% of them were males. Twenty (19%) patients developed postoperative anastomotic leakage, among those, 6 were on the sixth postoperative day. CAR day 3 and CAR day 5 were significantly higher among the mortality patients with P values of 0.041 and 0.027, respectively. CRP level was significantly higher among patients with poor survival outcomes ( P value= 0.024 ). CRP trajectory was significantly associated with a mortality rate as patients who had a rise greater than 50 mg/dl between day 3 and day 5 had a higher mortality rate with a P value of 0.007. Conclusion: CRP trajectory, CAR and Neutrophil/lymphocyte ratio can significantly predict the incidence of anastomotic leakage. Settings of surgery (emergency) was an independent risk factor for development of postoperative leakage.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"338 5‐6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691796","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.2024.357134
Mahmoud Abdelhameid, Mohamed Abdelshafy, A. Taha
Background: Securing the mesoappendix during appendectomy is a crucial step in this procedure. The current study aimed to evaluate the perioperative outcomes of intracorporeal ligation versus Ligasure in securing the mesoappendix during laparoscopic appendicectomy (LA). Patients and Methods: A prospective randomized comparative study was carried out in a tertiary care hospital. Patients who had laparoscopic appendectomy for acute appendicitis between January 2021 and January 2024 were included in this study. Patients were allocated to one of two groups. Group I: the mesoappendix was secured by intracorporeal suture ligation. Group L: the mesoappendix was secured by LigaSure. Demographic and perioperative data were collected, tabulated, and analyzed by SPSS 23. Results: A total of 100 patients underwent LA. No statistically significant difference was found between the two groups regarding age, sex ratio, or BMI. The technique duration was 8.9±3.5 min in group I, while the duration was 4.9±2.3 min in group L (statistically significant difference P≤0.05 ). None of the patients required conversion to an open surgery. The duration of postoperative hospital stay was 12.1±2 h for group I, and 11.1±8 h for group L ( P>0.05 ). One (2%) patient in group I had a postoperative right iliac fossa-infected hematoma. In group L, there was no postoperative complications. Conclusion: In LA, the incidence of perioperative complications is not affected by the method used for securing the mesoappendix. However, intracorporeal ligation takes a longer time, which could be improved with training, it is cost-effective, safe, and suitable when energy-sealing devices are not available or in low-resource facilities.
背景：在阑尾切除术中固定阑尾系膜是手术的关键步骤。本研究旨在评估腹腔镜阑尾切除术（LA）中体外结扎与 Ligasure 在固定阑尾系膜方面的围手术期效果。患者和方法：在一家三级医院开展了一项前瞻性随机对比研究。本研究纳入了 2021 年 1 月至 2024 年 1 月期间因急性阑尾炎而接受腹腔镜阑尾切除术的患者。患者被分配到两组中的一组。I组：通过体腔内缝合结扎固定阑尾系膜。收集人口统计学和围手术期数据，制成表格，并使用 SPSS 23 进行分析。结果共有 100 名患者接受了 LA 术。两组患者在年龄、性别比例或体重指数方面无统计学差异。I 组的技术持续时间为（8.9±3.5）分钟，而 L 组为（4.9±2.3）分钟（差异有统计学意义，P≤0.05）。没有患者需要转为开放手术。I 组术后住院时间为（12.1±2）小时，L 组为（11.1±8）小时（P>0.05）。I 组有一名（2%）患者术后出现右髂窝感染性血肿。L 组没有术后并发症。结论在 LA 中，围手术期并发症的发生率不受固定阑尾中段方法的影响。然而，体外结扎需要较长的时间，这一点可以通过培训得到改善，但它成本低、安全，适用于没有能量密封装置或资源匮乏的医疗机构。
{"title":"Securing Mesoappendix during Laparoscopic Appendicectomy: Ligation vs. Ligasure","authors":"Mahmoud Abdelhameid, Mohamed Abdelshafy, A. Taha","doi":"10.21608/ejsur.2024.357134","DOIUrl":"https://doi.org/10.21608/ejsur.2024.357134","url":null,"abstract":"Background: Securing the mesoappendix during appendectomy is a crucial step in this procedure. The current study aimed to evaluate the perioperative outcomes of intracorporeal ligation versus Ligasure in securing the mesoappendix during laparoscopic appendicectomy (LA). Patients and Methods: A prospective randomized comparative study was carried out in a tertiary care hospital. Patients who had laparoscopic appendectomy for acute appendicitis between January 2021 and January 2024 were included in this study. Patients were allocated to one of two groups. Group I: the mesoappendix was secured by intracorporeal suture ligation. Group L: the mesoappendix was secured by LigaSure. Demographic and perioperative data were collected, tabulated, and analyzed by SPSS 23. Results: A total of 100 patients underwent LA. No statistically significant difference was found between the two groups regarding age, sex ratio, or BMI. The technique duration was 8.9±3.5 min in group I, while the duration was 4.9±2.3 min in group L (statistically significant difference P≤0.05 ). None of the patients required conversion to an open surgery. The duration of postoperative hospital stay was 12.1±2 h for group I, and 11.1±8 h for group L ( P>0.05 ). One (2%) patient in group I had a postoperative right iliac fossa-infected hematoma. In group L, there was no postoperative complications. Conclusion: In LA, the incidence of perioperative complications is not affected by the method used for securing the mesoappendix. However, intracorporeal ligation takes a longer time, which could be improved with training, it is cost-effective, safe, and suitable when energy-sealing devices are not available or in low-resource facilities.","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141698287","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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