Peter Victor Kamel, Ahmed Saad Ahmed, Usama Saeed Imam, Ahmed Safaa Ahmed, Sherif El Prince Sayed
Parotidectomy is a common surgical procedure for the treatment of benign and malignant lesions of the parotid gland. Identification of the facial nerve trunk is essential during surgery of the parotid gland to avoid facial nerve injury. A comprehensive knowledge of its anatomy and meticulous dissection are the keys for the identification of the facial nerve trunk and its branches. To compare between the traditional antegrade parotidectomy and retrograde in identification of facial nerve during superficial parotidectomy, determination the best anatomical landmark, the time of exploration of facial nerve, outcomes, facial nerve complication, duration of surgery, patient satisfaction as well as other complications. Twelve patients who were diagnosed with having parotid gland neoplasms, and had undergone superficial Parotidectomy were recruited and assessed for eligibility at General Surgery Department, Beni-Suef University Hospital. Patients were divided according to the surgical technique into two equal groups, group A (the antegrade dissection group), and group B (the retrograde dissection group), follow-up was 6 months. There was no statistically significant differences between both groups regarding pain, paresthesia and pathology postoperation (P value>0.05). Longer mean operation time was observed in the antegrade dissection group in comparison with the retrograde dissection group (2.06±0.75 and 1.61±0.31 h, respectively), which was statistically insignificant (P value>0.05). There was a statistically significant increase in facial nerve injury among patients in the antegrade dissection group in comparison with the retrograde dissection group (P value=0.046). There was no statistically significant difference between techniques regarding hospital stay duration and complications three months postoperation (P value>0.05). Retrograde facial nerve dissection technique is better than the classical antegrade technique in the superficial parotidectomy within this study.
腮腺切除术是治疗腮腺良性和恶性病变的常见手术方法。在腮腺手术中，识别面神经干是避免面神经损伤的关键。全面的解剖知识和细致的解剖是识别面神经干及其分支的关键。 目的：比较传统的腮腺前路切除术和腮腺后路切除术在腮腺浅表切除术中识别面神经的能力，确定最佳解剖标志、探查面神经的时间、结果、面神经并发症、手术时间、患者满意度以及其他并发症。 贝尼苏伊夫大学医院普外科招募并评估了 12 名被诊断为腮腺肿瘤并接受过腮腺浅层切除术的患者。根据手术技术将患者分为两组，A 组（前向剥离组）和 B 组（逆行剥离组），随访 6 个月。 两组在术后疼痛、麻痹和病理方面的差异无统计学意义（P>0.05）。与逆行剥离组相比，前行剥离组的平均手术时间较长（分别为 2.06±0.75 h 和 1.61±0.31 h），但差异无统计学意义（P 值>0.05）。与逆行剥离组相比，前行剥离组患者的面神经损伤增加，差异有统计学意义（P 值=0.046）。在住院时间和术后三个月的并发症方面，不同技术的差异无统计学意义（P 值>0.05）。 在本研究中，逆行面神经解剖技术在浅表腮腺切除术中优于经典的逆行技术。
{"title":"Different techniques for identification of facial nerve during superficial parotidectomy","authors":"Peter Victor Kamel, Ahmed Saad Ahmed, Usama Saeed Imam, Ahmed Safaa Ahmed, Sherif El Prince Sayed","doi":"10.4103/ejs.ejs_315_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_315_23","url":null,"abstract":"\u0000 \u0000 Parotidectomy is a common surgical procedure for the treatment of benign and malignant lesions of the parotid gland. Identification of the facial nerve trunk is essential during surgery of the parotid gland to avoid facial nerve injury. A comprehensive knowledge of its anatomy and meticulous dissection are the keys for the identification of the facial nerve trunk and its branches.\u0000 \u0000 \u0000 \u0000 To compare between the traditional antegrade parotidectomy and retrograde in identification of facial nerve during superficial parotidectomy, determination the best anatomical landmark, the time of exploration of facial nerve, outcomes, facial nerve complication, duration of surgery, patient satisfaction as well as other complications.\u0000 \u0000 \u0000 \u0000 Twelve patients who were diagnosed with having parotid gland neoplasms, and had undergone superficial Parotidectomy were recruited and assessed for eligibility at General Surgery Department, Beni-Suef University Hospital. Patients were divided according to the surgical technique into two equal groups, group A (the antegrade dissection group), and group B (the retrograde dissection group), follow-up was 6 months.\u0000 \u0000 \u0000 \u0000 There was no statistically significant differences between both groups regarding pain, paresthesia and pathology postoperation (P value>0.05). Longer mean operation time was observed in the antegrade dissection group in comparison with the retrograde dissection group (2.06±0.75 and 1.61±0.31 h, respectively), which was statistically insignificant (P value>0.05). There was a statistically significant increase in facial nerve injury among patients in the antegrade dissection group in comparison with the retrograde dissection group (P value=0.046). There was no statistically significant difference between techniques regarding hospital stay duration and complications three months postoperation (P value>0.05).\u0000 \u0000 \u0000 \u0000 Retrograde facial nerve dissection technique is better than the classical antegrade technique in the superficial parotidectomy within this study.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140218092","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}
A. M. Salama, Mohamed R. Swilem, Ahmed Zidan, Mohamed F. Sherif, A. Nawar
Breast cancer is a significant public health concern, and early detection of breast lesions is crucial for improved patient outcomes. Accurate assessment of axillary lymph node involvement in breast cancer is vital for staging and treatment decisions. The purpose of this study was to assess to what extent positron emission tomography (PET)-computed tomography (CT) can be used in the assessment of negative axillary lymph nodes in breast cancer and to determine if pathological variability can affect the result of the PET-CT. This prospective study was carried out on 50 female patients with locally advanced breast cancer and with negative PET-CT scans for active axillary lymph nodes. All studied cases underwent postoperative pathological examination to be compared with preoperative PET-CT results. Of the studied cases, 84% showed negative axillary lymph node involvement. PET/CT exhibited high sensitivity (95.24%) and specificity (87.5%) in predicting positive nodes, with an axillary maximum standardized uptake value cutoff value of 4.22 (area under the curve=0.923). Logistic regression revealed a significant association between higher T stage and positive lymph nodes (P<0.05). PET/CT demonstrates strong predictive accuracy in detecting metabolically negative axillary lymph nodes in breast cancer patients.
{"title":"Accuracy of positron emission tomography-computed tomography in the assessment of metabolically negative axillary lymph nodes in breast cancer","authors":"A. M. Salama, Mohamed R. Swilem, Ahmed Zidan, Mohamed F. Sherif, A. Nawar","doi":"10.4103/ejs.ejs_314_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_314_23","url":null,"abstract":"\u0000 \u0000 Breast cancer is a significant public health concern, and early detection of breast lesions is crucial for improved patient outcomes. Accurate assessment of axillary lymph node involvement in breast cancer is vital for staging and treatment decisions. The purpose of this study was to assess to what extent positron emission tomography (PET)-computed tomography (CT) can be used in the assessment of negative axillary lymph nodes in breast cancer and to determine if pathological variability can affect the result of the PET-CT.\u0000 \u0000 \u0000 \u0000 This prospective study was carried out on 50 female patients with locally advanced breast cancer and with negative PET-CT scans for active axillary lymph nodes. All studied cases underwent postoperative pathological examination to be compared with preoperative PET-CT results.\u0000 \u0000 \u0000 \u0000 Of the studied cases, 84% showed negative axillary lymph node involvement. PET/CT exhibited high sensitivity (95.24%) and specificity (87.5%) in predicting positive nodes, with an axillary maximum standardized uptake value cutoff value of 4.22 (area under the curve=0.923). Logistic regression revealed a significant association between higher T stage and positive lymph nodes (P<0.05).\u0000 \u0000 \u0000 \u0000 PET/CT demonstrates strong predictive accuracy in detecting metabolically negative axillary lymph nodes in breast cancer patients.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140214832","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}
Mohie El-Din M. Madany, Mansor M. Kabbash, H. A. Mostafa, Ahmed M. Maghraby, Mahmoud S. Ahmed
Securing the cystic duct in laparoscopic cholecystectomy (LC) can be achieved through suturing ligation (intracorporeal or extracorporeal), clips, electrocautery, and ultramodern vessel sealing energy devices. Suturing ligation is a safe and a cost-effective measure in low-resource settings such as developing countries. The rationale of this current prospective study was to establish the safety and feasibility of intracorporeal suturing ligation for securing the cystic duct during LC in the local setting. Patients who were eligible for LC at the Aswan University Hospital’s General Surgery Department were included. In all, 260 patients were included in our study. Most of the participants were females, representing 92.69% of patients. The mean age of participants was 39.82±9.96 years, and 95.77% were overweight or obese. The mean±SD time for cystic duct ligation and closure was 3.03±0.64, and the median [interquartile range (IQR)] was 2.90 min (1.11 min). The mean±SD operative time was 88.19±27.81 min, and the median (IQR) was 84 min (31.75 min). Also, the mean±SD hospital stay was 1.11±0.55 days, and the median (IQR) was 1 day (0 day). There was no intraoperative significant bile duct injury, bile leak, or bleeding. No visceral injury was encountered. The success rate of the operation was 100%. None needed to be redone. No case needed conversion to open surgery. No bile leakage or other complication was seen during the follow-up period. In resource-constrained settings, suture ligation of the cystic duct is a safe technique with low rates of postoperative complications. Cystic duct control with intracorporeal suture ligation is an essential technique that can be learned, requiring knot-tying skills.
{"title":"Safety and feasibility of cystic duct control with suture ligation during laparoscopic cholecystectomy","authors":"Mohie El-Din M. Madany, Mansor M. Kabbash, H. A. Mostafa, Ahmed M. Maghraby, Mahmoud S. Ahmed","doi":"10.4103/ejs.ejs_2_24","DOIUrl":"https://doi.org/10.4103/ejs.ejs_2_24","url":null,"abstract":"\u0000 \u0000 Securing the cystic duct in laparoscopic cholecystectomy (LC) can be achieved through suturing ligation (intracorporeal or extracorporeal), clips, electrocautery, and ultramodern vessel sealing energy devices. Suturing ligation is a safe and a cost-effective measure in low-resource settings such as developing countries.\u0000 \u0000 \u0000 \u0000 The rationale of this current prospective study was to establish the safety and feasibility of intracorporeal suturing ligation for securing the cystic duct during LC in the local setting. Patients who were eligible for LC at the Aswan University Hospital’s General Surgery Department were included.\u0000 \u0000 \u0000 \u0000 In all, 260 patients were included in our study. Most of the participants were females, representing 92.69% of patients. The mean age of participants was 39.82±9.96 years, and 95.77% were overweight or obese. The mean±SD time for cystic duct ligation and closure was 3.03±0.64, and the median [interquartile range (IQR)] was 2.90 min (1.11 min). The mean±SD operative time was 88.19±27.81 min, and the median (IQR) was 84 min (31.75 min). Also, the mean±SD hospital stay was 1.11±0.55 days, and the median (IQR) was 1 day (0 day). There was no intraoperative significant bile duct injury, bile leak, or bleeding. No visceral injury was encountered. The success rate of the operation was 100%. None needed to be redone. No case needed conversion to open surgery. No bile leakage or other complication was seen during the follow-up period.\u0000 \u0000 \u0000 \u0000 In resource-constrained settings, suture ligation of the cystic duct is a safe technique with low rates of postoperative complications. Cystic duct control with intracorporeal suture ligation is an essential technique that can be learned, requiring knot-tying skills.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140216768","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}
Nasr Al-Qadasi, Yahia Al-Sayaghi, Abdullfatah Al-tam, Raddad AL-Fakih
The most effective treatment for nonmelanotic fascial skin cancer is surgical excision. Preoperative planning and a thorough grasp of reconstructive procedures, such as primary closure skin grafting, locoregional tissue flaps, remote tissue flaps, and free tissue transfer, are essential for the surgical therapy of these tumors. The choice of nonmelanoma skin cancer (NMSC) therapy is very specific to each patient and is influenced by the patient’s age, size, histologic subtype, and location of the disease. Treatment is to obliterate the lesion while maintaining normal tissue, function, and appearance. The ideas and methods of surgical excision and reconstruction of skin malignancies unique to the face were covered in this study. This study involved 98 patients of various ages and sexes. Of them, 89% had basal cell carcinoma and 11% had squamous cell carcinoma, both low-and high-risk tumors with varying sizes, locations, and histological subtypes. A safety margin of 3–5 mm is used for excision of low-risk malignancies and 5–10 mm for high-risk cancers. In 17 patients, skin grafts (split-thickness skin grafts and full-thickness skin grafts) are employed. 56 patients underwent local advancement, transposition, and rotational flaps; 15 patients underwent regional interpolation flaps; 6 patients sustained neck lymph node infiltration so they underwent cervical block dissection and distant pedicled flaps as latissimus dorsi muscle flaps; and 4 patients underwent cervical block dissection and free tissue transfer. Six patients experienced problems in the form of two partial graft and flap losses, two wound infections, and one scar retraction; however, with targeted care, they recovered well. Ninety-two percent of patients found the cosmetic outcomes satisfactory, and the functional outcome was good. Wide excision and appropriate surgical reconstruction are ideal treatment modalities and may yield good aesthetic results or functional outcome, also the use of split-thickness skin grafts does not come as a first priority, where a lot of cases could have been treated with local flaps, as demonstrated in this consecutive series of treated patients. Treatment of NMSC on the face required a basic knowledge, presents a challenge to plastic surgeons, and is based on achieving the best oncological, functional, and cosmetic result. It is crucial to emphasize the need of patient education and appropriate tumor monitoring after NMSC therapy. A review of a big series of facial malignancy that may guide further studies cannot be understated.
{"title":"Nonmelanoma facial skin cancer: surgical planning for resection and reconstruction","authors":"Nasr Al-Qadasi, Yahia Al-Sayaghi, Abdullfatah Al-tam, Raddad AL-Fakih","doi":"10.4103/ejs.ejs_294_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_294_23","url":null,"abstract":"\u0000 \u0000 The most effective treatment for nonmelanotic fascial skin cancer is surgical excision. Preoperative planning and a thorough grasp of reconstructive procedures, such as primary closure skin grafting, locoregional tissue flaps, remote tissue flaps, and free tissue transfer, are essential for the surgical therapy of these tumors. The choice of nonmelanoma skin cancer (NMSC) therapy is very specific to each patient and is influenced by the patient’s age, size, histologic subtype, and location of the disease.\u0000 Treatment is to obliterate the lesion while maintaining normal tissue, function, and appearance. The ideas and methods of surgical excision and reconstruction of skin malignancies unique to the face were covered in this study.\u0000 \u0000 \u0000 \u0000 This study involved 98 patients of various ages and sexes. Of them, 89% had basal cell carcinoma and 11% had squamous cell carcinoma, both low-and high-risk tumors with varying sizes, locations, and histological subtypes. A safety margin of 3–5 mm is used for excision of low-risk malignancies and 5–10 mm for high-risk cancers. In 17 patients, skin grafts (split-thickness skin grafts and full-thickness skin grafts) are employed. 56 patients underwent local advancement, transposition, and rotational flaps; 15 patients underwent regional interpolation flaps; 6 patients sustained neck lymph node infiltration so they underwent cervical block dissection and distant pedicled flaps as latissimus dorsi muscle flaps; and 4 patients underwent cervical block dissection and free tissue transfer.\u0000 \u0000 \u0000 \u0000 Six patients experienced problems in the form of two partial graft and flap losses, two wound infections, and one scar retraction; however, with targeted care, they recovered well. Ninety-two percent of patients found the cosmetic outcomes satisfactory, and the functional outcome was good.\u0000 \u0000 \u0000 \u0000 Wide excision and appropriate surgical reconstruction are ideal treatment modalities and may yield good aesthetic results or functional outcome, also the use of split-thickness skin grafts does not come as a first priority, where a lot of cases could have been treated with local flaps, as demonstrated in this consecutive series of treated patients. Treatment of NMSC on the face required a basic knowledge, presents a challenge to plastic surgeons, and is based on achieving the best oncological, functional, and cosmetic result. It is crucial to emphasize the need of patient education and appropriate tumor monitoring after NMSC therapy.\u0000 A review of a big series of facial malignancy that may guide further studies cannot be understated.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140212796","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}
A. Shaker, Hany A. Mawla, Baker M. Ghoneim, Ahmed R. Tawfik
Endovascular treatment is increasingly chosen as the first option for treating infrainguinal peripheral arterial disease. Although open surgical bypass provides the most durable option for limb salvage, it has substantial morbidity and mortality. The aim of the study is to determine the causes of failure of endovascular intervention and treatment modalities of failed endovascular intervention and results of each modality. A prospective case series study that addresses the outcomes of managing 40 patients with chronic limb ischemia due to femoropopliteal disease treated by endovascular intervention, and the intervention was failed. Causes of failure within 30 days were analyzed. We had 13 (27.5%) females and 27 (72.5%) males; their age ranged from 45 to 77 years with a mean of 62.20±7.44. Presentation with rest pain: three (7.5%) patients, minor tissue loss: 18 (45%) patients, major tissue loss: 19 (47.5%) patients the length of lesion was between 5 and 10 cm in three (7.5%) patients and more than 10 cm in 37 (92.5%) patients. Runoff in anterior tibial artery: 23 (57.5%) patients, posterior tibial artery: 19 (47.5%) patients, and peroneal artery: 15 (37.5%) patients. We had no complications in 26 (65%) patients, failure to pass in 12 (30%) patients, and distal embolization in two (5%) patients as intraprocedural complications. During the 30-day follow-up: Acute stent thrombosis in 7 (17.5%) cases, flow-limiting dissection in 8 (20%) cases, residual stenosis in 3 (7.5%) cases, acute thrombosis in 2 (5%) cases, missed iliac lesions in 2 (5%) cases, post-procedural distal arterial tree embolization in 2 (5%) cases, and clinical failure was the cause in 2 (5%) cases. The management was: Redo endovascular in 18 (45%) patients, surgical bypass in 14 (35%) patients, primary amputation in six (15%) patients, and medical treatment in two (5%) patients. After 6 months follow-up limb salvage was in 57.5% of the cases with transmetatarsal amputation in 69.6% of them and major amputation was in 42.5% of the cases Failed endovascular intervention procedures within 30 days were associated mainly with long lesions. So, surgical bypass appeared to be superior to endovascular intervention for long lesions. Improvements in endovascular equipment and angioplasty technique might ultimately improve the outcome results and decrease the failure rate of endovascular interventions
{"title":"Optional management of failed endovascular intervention for infrainguinal arterial occlusive disease","authors":"A. Shaker, Hany A. Mawla, Baker M. Ghoneim, Ahmed R. Tawfik","doi":"10.4103/ejs.ejs_307_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_307_23","url":null,"abstract":"\u0000 \u0000 Endovascular treatment is increasingly chosen as the first option for treating infrainguinal peripheral arterial disease. Although open surgical bypass provides the most durable option for limb salvage, it has substantial morbidity and mortality.\u0000 \u0000 \u0000 \u0000 The aim of the study is to determine the causes of failure of endovascular intervention and treatment modalities of failed endovascular intervention and results of each modality.\u0000 \u0000 \u0000 \u0000 A prospective case series study that addresses the outcomes of managing 40 patients with chronic limb ischemia due to femoropopliteal disease treated by endovascular intervention, and the intervention was failed. Causes of failure within 30 days were analyzed.\u0000 \u0000 \u0000 \u0000 We had 13 (27.5%) females and 27 (72.5%) males; their age ranged from 45 to 77 years with a mean of 62.20±7.44. Presentation with rest pain: three (7.5%) patients, minor tissue loss: 18 (45%) patients, major tissue loss: 19 (47.5%) patients the length of lesion was between 5 and 10 cm in three (7.5%) patients and more than 10 cm in 37 (92.5%) patients. Runoff in anterior tibial artery: 23 (57.5%) patients, posterior tibial artery: 19 (47.5%) patients, and peroneal artery: 15 (37.5%) patients. We had no complications in 26 (65%) patients, failure to pass in 12 (30%) patients, and distal embolization in two (5%) patients as intraprocedural complications. During the 30-day follow-up: Acute stent thrombosis in 7 (17.5%) cases, flow-limiting dissection in 8 (20%) cases, residual stenosis in 3 (7.5%) cases, acute thrombosis in 2 (5%) cases, missed iliac lesions in 2 (5%) cases, post-procedural distal arterial tree embolization in 2 (5%) cases, and clinical failure was the cause in 2 (5%) cases. The management was: Redo endovascular in 18 (45%) patients, surgical bypass in 14 (35%) patients, primary amputation in six (15%) patients, and medical treatment in two (5%) patients. After 6 months follow-up limb salvage was in 57.5% of the cases with transmetatarsal amputation in 69.6% of them and major amputation was in 42.5% of the cases\u0000 \u0000 \u0000 \u0000 Failed endovascular intervention procedures within 30 days were associated mainly with long lesions. So, surgical bypass appeared to be superior to endovascular intervention for long lesions. Improvements in endovascular equipment and angioplasty technique might ultimately improve the outcome results and decrease the failure rate of endovascular interventions\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140214209","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}
Mohie El-Din M. Madany, Mansor M. Kabbash, Hassan A. Abdallah
Securing the cystic artery in laparoscopic cholecystectomy can be achieved with clips, electrocautery, and ultramodern vessel-sealing energy devices. Bipolar electrocoagulation of cystic artery is safe and a cost-effective measure in developing countries. The rationale of this current prospective study was to establish the safety and feasibility of bipolar electrocautery in securing cystic artery during laparoscopic cholecystectomy in the local setting. Patients who were eligible for laparoscopic cholecystectomy at the Aswan University Hospital’s General Surgery Department were included. One hundred twenty patients were included in our study. Most of the participants were females, representing 93.33% of patients. The mean age of participants was 39.93±9.97 years, and 95.83% were overweight or obese. The mean±SD operative time was 88.57±28.06 min, and the median (interquartile range) was 84 min (33.25 min). Also, the mean±SD hospital stay was 1.12±0.57 days, and the median (interquartile range) was 1 (0) day. There was no intraoperative bleeding from the cystic artery nor from the right hepatic artery. No visceral injury was encountered. The success rate of the operation was 100%. None needed to be redone. No case needed conversion to open surgery. In conclusion, in resource-constrained settings where the harmonic scalpel and all advanced bipolar instruments like ENSEAL and Legasure raise issues regarding cost and accessibility, bipolar diathermy is effective in hemostatic control of the cystic artery during laparoscopic cholecystectomy.
{"title":"Safety and feasibility of cystic artery control with bipolar electrocauterization during laparoscopic cholecystectomy","authors":"Mohie El-Din M. Madany, Mansor M. Kabbash, Hassan A. Abdallah","doi":"10.4103/ejs.ejs_275_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_275_23","url":null,"abstract":"\u0000 \u0000 Securing the cystic artery in laparoscopic cholecystectomy can be achieved with clips, electrocautery, and ultramodern vessel-sealing energy devices. Bipolar electrocoagulation of cystic artery is safe and a cost-effective measure in developing countries.\u0000 \u0000 \u0000 \u0000 The rationale of this current prospective study was to establish the safety and feasibility of bipolar electrocautery in securing cystic artery during laparoscopic cholecystectomy in the local setting. Patients who were eligible for laparoscopic cholecystectomy at the Aswan University Hospital’s General Surgery Department were included.\u0000 \u0000 \u0000 \u0000 One hundred twenty patients were included in our study. Most of the participants were females, representing 93.33% of patients. The mean age of participants was 39.93±9.97 years, and 95.83% were overweight or obese. The mean±SD operative time was 88.57±28.06 min, and the median (interquartile range) was 84 min (33.25 min). Also, the mean±SD hospital stay was 1.12±0.57 days, and the median (interquartile range) was 1 (0) day. There was no intraoperative bleeding from the cystic artery nor from the right hepatic artery. No visceral injury was encountered. The success rate of the operation was 100%. None needed to be redone. No case needed conversion to open surgery.\u0000 \u0000 \u0000 \u0000 In conclusion, in resource-constrained settings where the harmonic scalpel and all advanced bipolar instruments like ENSEAL and Legasure raise issues regarding cost and accessibility, bipolar diathermy is effective in hemostatic control of the cystic artery during laparoscopic cholecystectomy.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140216108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed A. Gheda, Khalid A. Ismail, T. A. Ismail, Emadeldeen Hamed, Reda F. Ali, Osama Eldamshety
Breast cancer is the most common cancer type among women and can lead to death. The surgical management of breast cancer has witnessed a considerable evolution in the past few decades. The aim was to compare the thoracodorsal artery perforator (TDAP) flap with the latissimus dorsi (LD) mini flap in the reconstruction of outer quadrants partial mastectomy defects in early breast cancer patients regarding feasibility, cosmesis, postoperative complications, and early musculoskeletal functional outcome. A prospective randomized study was carried out on 40 consecutive female patients complaining of early breast cancer (stages I, II), undergoing partial breast resection (lumpectomy or quadrantectomy with axillary lymph node dissection), and with a small tumor to breast volume ratio. All patients were randomized into two equal groups in a parallel manner by computer-generated numbers, and their allocation code was kept in a closed opaque envelope: group I: early breast cancer (stages I, II) who underwent mastectomy defect by either TDAP flap. Group II: early breast cancer (stage I, II) who underwent mastectomy the LD mini flap. Operation time, drain removal, and hospital stay were significantly lower in LD mini-flap group than TDAP flap group (P=0.032, P<0.05, respectively). Complications and reoperation were insignificantly different between the two groups. Shoulder mobility 6 months and breast scar satisfaction was significantly higher in LD mini-flap group than TDAP flap group (P=0.045 and 0.009, respectively). Breast scar satisfaction and total score of satisfaction were significantly higher in LD mini-flap group than TDAP flap group (P<0.05). Time of adjuvant therapy (first cycle) was insignificantly different between both groups. In early breast cancer patients, the LD mini flap is a superior technique to TDAP as it had lower operation time, short hospital stays, drain removal, breast scar satisfaction, and total score of patient satisfaction but with high shoulder mobility affection.
{"title":"Latissimus dorsi mini flap versus thoracodorsal artery perforator flap in reconstruction of partial mastectomy defects in early breast cancer: a prospective comparative study","authors":"Ahmed A. Gheda, Khalid A. Ismail, T. A. Ismail, Emadeldeen Hamed, Reda F. Ali, Osama Eldamshety","doi":"10.4103/ejs.ejs_306_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_306_23","url":null,"abstract":"\u0000 \u0000 Breast cancer is the most common cancer type among women and can lead to death. The surgical management of breast cancer has witnessed a considerable evolution in the past few decades. The aim was to compare the thoracodorsal artery perforator (TDAP) flap with the latissimus dorsi (LD) mini flap in the reconstruction of outer quadrants partial mastectomy defects in early breast cancer patients regarding feasibility, cosmesis, postoperative complications, and early musculoskeletal functional outcome.\u0000 \u0000 \u0000 \u0000 A prospective randomized study was carried out on 40 consecutive female patients complaining of early breast cancer (stages I, II), undergoing partial breast resection (lumpectomy or quadrantectomy with axillary lymph node dissection), and with a small tumor to breast volume ratio. All patients were randomized into two equal groups in a parallel manner by computer-generated numbers, and their allocation code was kept in a closed opaque envelope: group I: early breast cancer (stages I, II) who underwent mastectomy defect by either TDAP flap. Group II: early breast cancer (stage I, II) who underwent mastectomy the LD mini flap.\u0000 \u0000 \u0000 \u0000 Operation time, drain removal, and hospital stay were significantly lower in LD mini-flap group than TDAP flap group (P=0.032, P<0.05, respectively). Complications and reoperation were insignificantly different between the two groups. Shoulder mobility 6 months and breast scar satisfaction was significantly higher in LD mini-flap group than TDAP flap group (P=0.045 and 0.009, respectively). Breast scar satisfaction and total score of satisfaction were significantly higher in LD mini-flap group than TDAP flap group (P<0.05). Time of adjuvant therapy (first cycle) was insignificantly different between both groups.\u0000 \u0000 \u0000 \u0000 In early breast cancer patients, the LD mini flap is a superior technique to TDAP as it had lower operation time, short hospital stays, drain removal, breast scar satisfaction, and total score of patient satisfaction but with high shoulder mobility affection.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140212549","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}
Emad M. Abdelrahman, Hussein Elgohary, Mohamed S. Kharoub, Abdallah H. Diab, Mohamed A. Elsayed
Metabolic syndrome (MetS) is a silent epidemic that is a major global public health concern. Bariatric surgery is an approved treatment for obesity where weight reduction is crucial for the control of metabolic syndrome. This study aimed to report our institutional experience in the effect of single anastomosis sleeve ileal (SASI) on metabolic syndrome. The current prospective study included 50 Morbid Obese Patients with MetS who were eligible for SASI. Follow-up was planned for 1 year. The mean age of patients was 41.56±6.32 years. The mean % EWL was 56.94±4.65 and 83.16±8.09 at 6 and 12 months, respectively. HbA1c showed significant improvement which decreased from 8.34±1.23 to 5.04±0.38 after 1 year follow-up. Triglycerides (mg/dl) and LDL-C (mg/dl) show significant reduction at 6 months and 1 year postoperative from 177.48±30.95 preoperative to 131.98±17.65 and 104.10±14.03 for Triglycerides, and from 180.76±21.04 preoperative to 104.64±7.13 and 77.56±8.93 for low density lipoprotein-C (LDL-C) (<0.001). HDL-C (mg/dl) showed a significant increase from 40.44±10.93 preoperative to 49.58±8.71 and 57.96±6.64 (<0.001). As regards the blood pressure; mean arterial pressure showed a significant decrease from a baseline of 103.38±11.38 to 88.36±5.72 at 6 months and to 74.46±5.83 at 1 year of follow-up. As demonstrated by this study, all MetS characteristics significantly improved following the SASI bypass treatment.
{"title":"Effects Of Single Anastomosis Sleeve Ileal (SASI) Bypass on Morbid Obese Patients with Metabolic Syndrome","authors":"Emad M. Abdelrahman, Hussein Elgohary, Mohamed S. Kharoub, Abdallah H. Diab, Mohamed A. Elsayed","doi":"10.4103/ejs.ejs_312_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_312_23","url":null,"abstract":"\u0000 \u0000 Metabolic syndrome (MetS) is a silent epidemic that is a major global public health concern. Bariatric surgery is an approved treatment for obesity where weight reduction is crucial for the control of metabolic syndrome. This study aimed to report our institutional experience in the effect of single anastomosis sleeve ileal (SASI) on metabolic syndrome.\u0000 \u0000 \u0000 \u0000 The current prospective study included 50 Morbid Obese Patients with MetS who were eligible for SASI. Follow-up was planned for 1 year.\u0000 \u0000 \u0000 \u0000 The mean age of patients was 41.56±6.32 years. The mean % EWL was 56.94±4.65 and 83.16±8.09 at 6 and 12 months, respectively. HbA1c showed significant improvement which decreased from 8.34±1.23 to 5.04±0.38 after 1 year follow-up. Triglycerides (mg/dl) and LDL-C (mg/dl) show significant reduction at 6 months and 1 year postoperative from 177.48±30.95 preoperative to 131.98±17.65 and 104.10±14.03 for Triglycerides, and from 180.76±21.04 preoperative to 104.64±7.13 and 77.56±8.93 for low density lipoprotein-C (LDL-C) (<0.001). HDL-C (mg/dl) showed a significant increase from 40.44±10.93 preoperative to 49.58±8.71 and 57.96±6.64 (<0.001). As regards the blood pressure; mean arterial pressure showed a significant decrease from a baseline of 103.38±11.38 to 88.36±5.72 at 6 months and to 74.46±5.83 at 1 year of follow-up.\u0000 \u0000 \u0000 \u0000 As demonstrated by this study, all MetS characteristics significantly improved following the SASI bypass treatment.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140212572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed A. Gheda, Khalid A. Ismail, T. A. Ismail, W. Elnahas, Osama Eldamshety, Reda F. Ali
Breast cancer is the most common cancer type among women and can lead to death. Over the past few decades, there has been a significant change in the surgical management of breast cancer. The aim of this study is to assess how shoulder function was affected by reconstruction using latissimus dorsi mini flap (LDMF) and thoracodorsal artery perforator (TDAP) flaps following partial mastectomy according to surgeries to axilla. This was a prospective randomized study carried out on 40 consecutive female patients, complaining of early stages of breast cancer (stages I, II), undergo partial breast resection and with small tumor to breast volume ratio. All patients were randomized into two equal groups. Group I: early breast cancer (stages I, II) who underwent mastectomy defect by either TDAP flap. Group II: early breast cancer (stages I, II) who underwent mastectomy LDMF. Axillary surgeries were done to each group either sentinel lymph node biopsy dissection (SLND) or axillary lymph node dissection (ALND). Shoulder mobility affection 6 months postoperative was significantly higher in LDMF group than TDAP flap group (P=0.045). Regarding relation between types of lymph node surgeries and shoulder mobility affection 3–6 months postoperative, shoulder mobility affection was significantly different among the four groups as affected although ALND and LDMF group was higher. Relation between types of lymph node surgeries and effect on shoulder mobility 6 months, shoulder mobility was normal in 16 (72.73%) patients in sentinel lymph node biopsy (SLNB) and in seven (38.89%) patients in ALND and effected in six (27.27%) patients in SLNB and in 11 (61.11%) patients in ALND. Regarding shoulder mobility, affection was significantly higher in ALND than SLNB (P=0.031). The LDMF approach with ALND is with higher shoulder mobility affection in postoperative follow-up after partial mastectomy than LDMF with SLND, TDAP flap with ALND, and TDAP flap with SLND. According to the different types of axillary surgery, ALND had higher shoulder mobility affection.
{"title":"Shoulder dysfunction after partial mastectomy and mini-latissimus dorsi or thoracodorsal artery perforator flaps for breast cancer according to the type of axillary surgeries","authors":"Ahmed A. Gheda, Khalid A. Ismail, T. A. Ismail, W. Elnahas, Osama Eldamshety, Reda F. Ali","doi":"10.4103/ejs.ejs_305_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_305_23","url":null,"abstract":"\u0000 \u0000 Breast cancer is the most common cancer type among women and can lead to death. Over the past few decades, there has been a significant change in the surgical management of breast cancer. The aim of this study is to assess how shoulder function was affected by reconstruction using latissimus dorsi mini flap (LDMF) and thoracodorsal artery perforator (TDAP) flaps following partial mastectomy according to surgeries to axilla.\u0000 \u0000 \u0000 \u0000 This was a prospective randomized study carried out on 40 consecutive female patients, complaining of early stages of breast cancer (stages I, II), undergo partial breast resection and with small tumor to breast volume ratio. All patients were randomized into two equal groups. Group I: early breast cancer (stages I, II) who underwent mastectomy defect by either TDAP flap. Group II: early breast cancer (stages I, II) who underwent mastectomy LDMF. Axillary surgeries were done to each group either sentinel lymph node biopsy dissection (SLND) or axillary lymph node dissection (ALND).\u0000 \u0000 \u0000 \u0000 Shoulder mobility affection 6 months postoperative was significantly higher in LDMF group than TDAP flap group (P=0.045). Regarding relation between types of lymph node surgeries and shoulder mobility affection 3–6 months postoperative, shoulder mobility affection was significantly different among the four groups as affected although ALND and LDMF group was higher. Relation between types of lymph node surgeries and effect on shoulder mobility 6 months, shoulder mobility was normal in 16 (72.73%) patients in sentinel lymph node biopsy (SLNB) and in seven (38.89%) patients in ALND and effected in six (27.27%) patients in SLNB and in 11 (61.11%) patients in ALND. Regarding shoulder mobility, affection was significantly higher in ALND than SLNB (P=0.031).\u0000 \u0000 \u0000 \u0000 The LDMF approach with ALND is with higher shoulder mobility affection in postoperative follow-up after partial mastectomy than LDMF with SLND, TDAP flap with ALND, and TDAP flap with SLND. According to the different types of axillary surgery, ALND had higher shoulder mobility affection.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140215393","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}
Cholecystectomy is the treatment of choice for acute cholecystitis. However, the mortality rate of emergency cholecystectomy in high-risk patients with severe comorbidities remains unsatisfactory. Endoscopic transpapillary gallbladder stenting (ETGBS) has emerged as a useful interventional endoscopic technique for the management of acute cholecystitis. The purpose of this research was to assess the safety and effectiveness of ETGBS in the treatment of acute cholecystitis in elderly individuals who were not good candidates for surgery. We studied 35 elderly patients, 60 years of age or older, receiving treatment at Aswan University Hospital’s surgery department for acute cholecystitis. Every patient had ETGBS, involving the insertion of a 7-Fr stent into the gallbladder. If ETGBS was unsuccessful, percutaneous transhepatic gallbladder draining was carried out. The effectiveness of ETGBS was the primary outcome measure in this investigation. ETGBS was successful in 30 (85%) individuals with acute cholecystitis. 8.57% (3/35) of the cases had early adverse events (AEs). Three patients had endoscopic sphincterotomy hemorrhage, one had minor pancreatitis, and one patient experienced obstructive jaundice as early AEs. There were 8.57% (3/35) late AEs. Late AEs included cholangitis in one patient and cholecystitis recurrence in two others. Percutaneous transhepatic gallbladder drainage was used for the five individuals in whom ETGBS failed. ETGBS appears to be a successful treatment for elderly patients with acute cholecystitis who are unsuitable for surgery.
{"title":"Endoscopic transpapillary gallbladder stenting for acute cholecystitis","authors":"Hassan A. Abdallah","doi":"10.4103/ejs.ejs_271_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_271_23","url":null,"abstract":"\u0000 \u0000 Cholecystectomy is the treatment of choice for acute cholecystitis. However, the mortality rate of emergency cholecystectomy in high-risk patients with severe comorbidities remains unsatisfactory. Endoscopic transpapillary gallbladder stenting (ETGBS) has emerged as a useful interventional endoscopic technique for the management of acute cholecystitis.\u0000 \u0000 \u0000 \u0000 The purpose of this research was to assess the safety and effectiveness of ETGBS in the treatment of acute cholecystitis in elderly individuals who were not good candidates for surgery.\u0000 \u0000 \u0000 \u0000 We studied 35 elderly patients, 60 years of age or older, receiving treatment at Aswan University Hospital’s surgery department for acute cholecystitis. Every patient had ETGBS, involving the insertion of a 7-Fr stent into the gallbladder. If ETGBS was unsuccessful, percutaneous transhepatic gallbladder draining was carried out. The effectiveness of ETGBS was the primary outcome measure in this investigation.\u0000 \u0000 \u0000 \u0000 ETGBS was successful in 30 (85%) individuals with acute cholecystitis. 8.57% (3/35) of the cases had early adverse events (AEs). Three patients had endoscopic sphincterotomy hemorrhage, one had minor pancreatitis, and one patient experienced obstructive jaundice as early AEs. There were 8.57% (3/35) late AEs. Late AEs included cholangitis in one patient and cholecystitis recurrence in two others. Percutaneous transhepatic gallbladder drainage was used for the five individuals in whom ETGBS failed.\u0000 \u0000 \u0000 \u0000 ETGBS appears to be a successful treatment for elderly patients with acute cholecystitis who are unsuitable for surgery.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140216958","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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