Purpose To evaluate the laparoscopic approach advantages for the management of acute appendicitis in morbidly obese patients. Methods A prospective study included all morbidly obese patients who had presented to the emergency department at Sohag University Hospitals and were diagnosed with acute appendicitis between the 1st of June 2022 and the 31st of January 2023. All those patients were invited to participate in the research by randomization. The authors informed patients and their first-degree relatives about both techniques, signed a consent form for participation in the study. The authors categorized them into two groups; laparoscopic approach (group I) and open approach (group II). Comparisons were based on operative time, intraoperative complications, length of hospital stay, postoperative complications, and time until return to normal daily activities. Results The study enrolled 64 patients: 33 had a laparoscopic appendectomy, and 31 had an open appendectomy. The groups were similar in terms of clinicopathologic characteristics. The operating time was significantly shorter for Group I patients than Group II (Group I, 49.09±16.21 min vs. Group II, 68.03±15.78 min; P value less than 0.05). Regarding the length of hospital stay, twenty-six patients (78.8%) were discharged within the 1st 24 h in the laparoscopic group versus 17 patients (54.8%) in the open group (P value 0.041). The time until return to the routine daily work was significantly shorter in the laparoscopic group (11.27±2.6 days) than in the open group (17.23±4.8 days) (P value less 0.05). Four postoperative complications were reported in the study population: wound complications (infection, seroma formation), residual abdominal abscess, paralytic ileus, and thromboembolic complications (Deep venous thrombosis and pulmonary embolism). Group II had a statistically significant higher complication rate (32.3%) than Group I (9.09%) (P value 0.007). Conclusion Laparoscopic appendectomy had superior clinical outcomes than an open appendectomy in morbidly obese patients. In addition to minimal invasiveness and better cosmetic results, it has a great advantage as a diagnostic and therapeutic tool in morbidly obese patients with suspected appendicitis. It is also a safe and feasible approach with a low rate of complications with a well-trained expert surgeon.
{"title":"Comparison between laparoscopic versus open appendectomy in morbid obese patients","authors":"A. M. Galal, A. Saleem, M. Helmy","doi":"10.4103/ejs.ejs_98_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_98_23","url":null,"abstract":"Purpose To evaluate the laparoscopic approach advantages for the management of acute appendicitis in morbidly obese patients. Methods A prospective study included all morbidly obese patients who had presented to the emergency department at Sohag University Hospitals and were diagnosed with acute appendicitis between the 1st of June 2022 and the 31st of January 2023. All those patients were invited to participate in the research by randomization. The authors informed patients and their first-degree relatives about both techniques, signed a consent form for participation in the study. The authors categorized them into two groups; laparoscopic approach (group I) and open approach (group II). Comparisons were based on operative time, intraoperative complications, length of hospital stay, postoperative complications, and time until return to normal daily activities. Results The study enrolled 64 patients: 33 had a laparoscopic appendectomy, and 31 had an open appendectomy. The groups were similar in terms of clinicopathologic characteristics. The operating time was significantly shorter for Group I patients than Group II (Group I, 49.09±16.21 min vs. Group II, 68.03±15.78 min; P value less than 0.05). Regarding the length of hospital stay, twenty-six patients (78.8%) were discharged within the 1st 24 h in the laparoscopic group versus 17 patients (54.8%) in the open group (P value 0.041). The time until return to the routine daily work was significantly shorter in the laparoscopic group (11.27±2.6 days) than in the open group (17.23±4.8 days) (P value less 0.05). Four postoperative complications were reported in the study population: wound complications (infection, seroma formation), residual abdominal abscess, paralytic ileus, and thromboembolic complications (Deep venous thrombosis and pulmonary embolism). Group II had a statistically significant higher complication rate (32.3%) than Group I (9.09%) (P value 0.007). Conclusion Laparoscopic appendectomy had superior clinical outcomes than an open appendectomy in morbidly obese patients. In addition to minimal invasiveness and better cosmetic results, it has a great advantage as a diagnostic and therapeutic tool in morbidly obese patients with suspected appendicitis. It is also a safe and feasible approach with a low rate of complications with a well-trained expert surgeon.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"488 - 496"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49616160","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. Fathy, Emad El-din Hussein, Mohammed Ahmed Ismail, Mostafa Ismail Mohamed Abd Allah, Islam Mohamed Soliman Atta
Objectives This was an open-label randomized comparative two arms study to assess the efficacy and clinical outcome of endovenous thermal ablation on reticular veins and telangiectasias in patients with lower limbs varicose veins with incompetent Sapheno-femoral Junction. Patients and methods A total of 40 patients [15 (37.5%) males and 25 (62.5%) females] with reflux of the long saphenous vein were subjected to radiofrequency ablation (RFA). 20 patients had RFA alone while the other 20 patients underwent RFA and injection sclerotherapy. Then patients were followed up on 1 week after the procedure, 3 months, 6 months, and 1 year by duplex and clinically using venous clinical severity score. Results There were 37.5% males and 62.5% females. There was a statistically significant difference in both groups regarding patients’ symptoms (pain, heaviness, and swelling) before and after serial times of follow-up, which was assessed by the VCSS, denoting marked improvement of patients’ symptoms. Also, there was a statistically significant difference (P<0.001) concerning duplex results regards the reflux before and following RFA. Reticular veins follow-up, we found that in group A they were present among 35% of patients on 1-week follow-up. This increased to reach 70% after 1 year of follow-up, however, in group B they were absent among all patients on 1 week follow-up. They were present among 15% of patients after 1 year of follow-up. Conclusion RFA with concomitant sclerotherapy for the associated minor veins have proved to be safe, cost-effective and more patient satisfaction than RFA without concomitant sclerotherapy.
{"title":"Fate of minor lower limb varicosities after Endovenous Thermal Ablation in patients with lower limb Varicose veins with incompetent Sapheno-femoral Junction","authors":"A. Fathy, Emad El-din Hussein, Mohammed Ahmed Ismail, Mostafa Ismail Mohamed Abd Allah, Islam Mohamed Soliman Atta","doi":"10.4103/ejs.ejs_74_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_74_23","url":null,"abstract":"Objectives This was an open-label randomized comparative two arms study to assess the efficacy and clinical outcome of endovenous thermal ablation on reticular veins and telangiectasias in patients with lower limbs varicose veins with incompetent Sapheno-femoral Junction. Patients and methods A total of 40 patients [15 (37.5%) males and 25 (62.5%) females] with reflux of the long saphenous vein were subjected to radiofrequency ablation (RFA). 20 patients had RFA alone while the other 20 patients underwent RFA and injection sclerotherapy. Then patients were followed up on 1 week after the procedure, 3 months, 6 months, and 1 year by duplex and clinically using venous clinical severity score. Results There were 37.5% males and 62.5% females. There was a statistically significant difference in both groups regarding patients’ symptoms (pain, heaviness, and swelling) before and after serial times of follow-up, which was assessed by the VCSS, denoting marked improvement of patients’ symptoms. Also, there was a statistically significant difference (P<0.001) concerning duplex results regards the reflux before and following RFA. Reticular veins follow-up, we found that in group A they were present among 35% of patients on 1-week follow-up. This increased to reach 70% after 1 year of follow-up, however, in group B they were absent among all patients on 1 week follow-up. They were present among 15% of patients after 1 year of follow-up. Conclusion RFA with concomitant sclerotherapy for the associated minor veins have proved to be safe, cost-effective and more patient satisfaction than RFA without concomitant sclerotherapy.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"509 - 515"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45238738","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}
T. Hassan, Ayman Kamal, M. Kaddah, Karim Mostafa, W. Omar
Background Nonalcoholic fatty liver disease (NAFLD) is the cause of the new epidemic of chronic liver disease. Most patients are asymptomatic and accidentally diagnosed by imaging. Unfortunately, NAFLD can progress to inflammation, NASH, fibrosis, cirrhosis, HCC, decompensated cirrhosis, death, and/or liver transplantation might be required. Laparoscopic sleeve gastrectomy (LSG) has positive effects on the comorbidities associated with obesity. FibroScan and controlled attenuation parameter (CAP) can assess NAFLD non-invasively by measuring an area a hundred times larger than a biopsy sample. Aim To assess hepatic steatosis pre and post LSG by laboratory investigations and imaging (fibroscan and CAP). Methods Thirty patients were included in a prospective observational study according to the inclusion criteria. Full medical history, preoperative laboratory investigations and imaging were recorded. All patients underwent LSG and were followed up for 6 months postoperatively. Data were coded and analysed by using (SPSS) version 29. Results LSG was associated with a significant improvement in the controlled attenuation parameter CAP values, stiffness values and accordingly grades of steatosis and fibrosis as well as a highly significant decrease in BMI, and on follow-up fibroscan 6 months postoperatively. There was a significant improvement in total cholesterol, triglycerides, LDL and HDL. Conclusion LSG is associated with a significant improvement in BMI, lipid profile, CAP measurement and liver stiffness measurements which means improvement of steatosis. In morbidly obese candidates of bariatric surgery, Fibroscan with CAP (using the XL probe) was used as a simple non-invasive tool for detecting steatosis and fibrosis.
{"title":"Assessment of hepatic steatosis before and after laparoscopic sleeve gastrectomy","authors":"T. Hassan, Ayman Kamal, M. Kaddah, Karim Mostafa, W. Omar","doi":"10.4103/ejs.ejs_90_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_90_23","url":null,"abstract":"Background Nonalcoholic fatty liver disease (NAFLD) is the cause of the new epidemic of chronic liver disease. Most patients are asymptomatic and accidentally diagnosed by imaging. Unfortunately, NAFLD can progress to inflammation, NASH, fibrosis, cirrhosis, HCC, decompensated cirrhosis, death, and/or liver transplantation might be required. Laparoscopic sleeve gastrectomy (LSG) has positive effects on the comorbidities associated with obesity. FibroScan and controlled attenuation parameter (CAP) can assess NAFLD non-invasively by measuring an area a hundred times larger than a biopsy sample. Aim To assess hepatic steatosis pre and post LSG by laboratory investigations and imaging (fibroscan and CAP). Methods Thirty patients were included in a prospective observational study according to the inclusion criteria. Full medical history, preoperative laboratory investigations and imaging were recorded. All patients underwent LSG and were followed up for 6 months postoperatively. Data were coded and analysed by using (SPSS) version 29. Results LSG was associated with a significant improvement in the controlled attenuation parameter CAP values, stiffness values and accordingly grades of steatosis and fibrosis as well as a highly significant decrease in BMI, and on follow-up fibroscan 6 months postoperatively. There was a significant improvement in total cholesterol, triglycerides, LDL and HDL. Conclusion LSG is associated with a significant improvement in BMI, lipid profile, CAP measurement and liver stiffness measurements which means improvement of steatosis. In morbidly obese candidates of bariatric surgery, Fibroscan with CAP (using the XL probe) was used as a simple non-invasive tool for detecting steatosis and fibrosis.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"543 - 548"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42252222","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}
E. M. Khedr, Selmy Awad, Majed Asiri, Musab AlThomali, Esraa J. Kaheel, Shumukh Alkhammash, Abdullah A Altalhi, Hashim M. Atallah, Hamed A. Alshehri, Nadiah G. Al-Amri, Z. A. Assmary, A. F. Alotaibi, Manal A. Kaabi, A. Alshamrani, Azzah Alzahrani, Malak F. Almogathali, Abdou Salim, A. Tarabay
Background Umbilical hernias are likely to develop in liver cirrhosis patients with ascites as the disease progresses. It is debatable how to handle cirrhotic patients who have an umbilical hernia. Our goal was to examine the perioperative outcome, safety, and efficacy of surgical management of umbilical hernia in ascitic patients using anatomical repair and intraperitoneal mesh repair. Methods 180 patients who reported to between June 2017 and September 2022 with umbilical hernias complaints related to chronic liver disease were included in the study and divided into three groups: − Group A (56 cases) 4 instances were lost to followup, Group B (60 cases), and Group C (60 cases). Results There was a little difference between cases treated surgically and ones treated conservatively. Typically, child B was involved. In group A, 34 patients (60.7%) experienced solitary or combined problems in total. Of these, 14 candidates (25%) involved strangling, eight (14.3%) involved blockage, and twelve (21.4%) involved leaking hernias. Four instances (6.7%) of seroma, four cases (6.7%) of hematoma, twelve cases (20%) of ascitic leak, 32 cases (53.3%) of recurrence, and four cases (5.6%) of encephalopathy were in group B cases. In group C, there were 16 instances (13.3%) of ascetic leak, 12 cases (20%) of wound infection, 12 cases (20%) of seroma, ten cases (16.7%) of recurrence, and four cases (6.7%) of encephalopathy. Conclusion It is advised to do elective treatment for umbilical hernias. mesh reinforcement of abdominal wall hernias is more common as it has a lower risk of hernia recurrence.
{"title":"The perioperative challenge of umbilical hernias management in chronic liver disease: a multicentric comparative study","authors":"E. M. Khedr, Selmy Awad, Majed Asiri, Musab AlThomali, Esraa J. Kaheel, Shumukh Alkhammash, Abdullah A Altalhi, Hashim M. Atallah, Hamed A. Alshehri, Nadiah G. Al-Amri, Z. A. Assmary, A. F. Alotaibi, Manal A. Kaabi, A. Alshamrani, Azzah Alzahrani, Malak F. Almogathali, Abdou Salim, A. Tarabay","doi":"10.4103/ejs.ejs_86_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_86_23","url":null,"abstract":"Background Umbilical hernias are likely to develop in liver cirrhosis patients with ascites as the disease progresses. It is debatable how to handle cirrhotic patients who have an umbilical hernia. Our goal was to examine the perioperative outcome, safety, and efficacy of surgical management of umbilical hernia in ascitic patients using anatomical repair and intraperitoneal mesh repair. Methods 180 patients who reported to between June 2017 and September 2022 with umbilical hernias complaints related to chronic liver disease were included in the study and divided into three groups: − Group A (56 cases) 4 instances were lost to followup, Group B (60 cases), and Group C (60 cases). Results There was a little difference between cases treated surgically and ones treated conservatively. Typically, child B was involved. In group A, 34 patients (60.7%) experienced solitary or combined problems in total. Of these, 14 candidates (25%) involved strangling, eight (14.3%) involved blockage, and twelve (21.4%) involved leaking hernias. Four instances (6.7%) of seroma, four cases (6.7%) of hematoma, twelve cases (20%) of ascitic leak, 32 cases (53.3%) of recurrence, and four cases (5.6%) of encephalopathy were in group B cases. In group C, there were 16 instances (13.3%) of ascetic leak, 12 cases (20%) of wound infection, 12 cases (20%) of seroma, ten cases (16.7%) of recurrence, and four cases (6.7%) of encephalopathy. Conclusion It is advised to do elective treatment for umbilical hernias. mesh reinforcement of abdominal wall hernias is more common as it has a lower risk of hernia recurrence.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"444 - 449"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42362190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed H.A. Mostafa, Ahmed Mohamed, M. Mohamed, H. AboElNeel
Background Over the years, there have been significant advancements in the treatment of varicose veins. In most surgical settings, the open procedure is still the primary approach. Yet, the popularity of less invasive procedures like EVLA and RFA has produced fantastic outcomes. Objective to assess the safest power of laser which gives maximal effect and least complications in ablation of varicose veins. Methodology A prospective observational study inducing EVLA of different laser power settings (7W & 10W) with preoperative assessment then follow up by CEAP & VCSS and duplex ultrasound measuring great saphenous vein (GSV) diameter and also post-operative complications and time to return to work. Results This study included 50 patients (52 limbs). The Patients were distributed as regard laser power used into two groups (7W, 10W) of 26 limbs for each one. As regard GSV measures changes, there was highly statistically significant decrease in GSV diameter after 1 m and after 3 m compared to preoperative, with P value P<0.001, among patients group. Also, there is higher number of cases with GSV>10 mm in power of laser ‘10w’ group compared to ‘7w; group, with P value (P<0.001); while there is no statistically significant difference between power of laser 7w versus 10w, because all patients ≤10 mm after 1 month and after 3 months, with P value >0.05.Statistically there was no significant difference between 7W & 10W groups as regards time to return to work, CEAP scores and postoperative complications except the significant difference in Pain over the treated vein being less in 7W laser power group. Conclusion For endovenous laser ablation of varicose veins, both 7W and 10W laser power are indicated. They are risk-free and provide the greatest impact with the fewest difficulties for the chosen vein diameter. In our investigation, we came to the conclusion that patients with small GSV diameter required low laser power (7W), while those with large GSV diameter required high laser power (10W).
{"title":"The safest power to be applied in relation to diameter of the vein to give maximal benefit with least complications in endovenous laser ablation of varicose veins","authors":"Mohamed H.A. Mostafa, Ahmed Mohamed, M. Mohamed, H. AboElNeel","doi":"10.4103/ejs.ejs_87_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_87_23","url":null,"abstract":"Background Over the years, there have been significant advancements in the treatment of varicose veins. In most surgical settings, the open procedure is still the primary approach. Yet, the popularity of less invasive procedures like EVLA and RFA has produced fantastic outcomes. Objective to assess the safest power of laser which gives maximal effect and least complications in ablation of varicose veins. Methodology A prospective observational study inducing EVLA of different laser power settings (7W & 10W) with preoperative assessment then follow up by CEAP & VCSS and duplex ultrasound measuring great saphenous vein (GSV) diameter and also post-operative complications and time to return to work. Results This study included 50 patients (52 limbs). The Patients were distributed as regard laser power used into two groups (7W, 10W) of 26 limbs for each one. As regard GSV measures changes, there was highly statistically significant decrease in GSV diameter after 1 m and after 3 m compared to preoperative, with P value P<0.001, among patients group. Also, there is higher number of cases with GSV>10 mm in power of laser ‘10w’ group compared to ‘7w; group, with P value (P<0.001); while there is no statistically significant difference between power of laser 7w versus 10w, because all patients ≤10 mm after 1 month and after 3 months, with P value >0.05.Statistically there was no significant difference between 7W & 10W groups as regards time to return to work, CEAP scores and postoperative complications except the significant difference in Pain over the treated vein being less in 7W laser power group. Conclusion For endovenous laser ablation of varicose veins, both 7W and 10W laser power are indicated. They are risk-free and provide the greatest impact with the fewest difficulties for the chosen vein diameter. In our investigation, we came to the conclusion that patients with small GSV diameter required low laser power (7W), while those with large GSV diameter required high laser power (10W).","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"450 - 458"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46754292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Abou-Ashour, Mahmoud Sayed Ahmed Shahin, Mohamed Nazeh Shaker
Background The basic concern in parotid surgery is facial nerve preservation. Various methods of dissection have been used to excise the parotid tissue and spare the facial nerve and its branches. Combined (blunt, mosquito tip, monopolar, and bipolar electrocautery, and scissor dissection) procedures are the most widely used techniques. Further new methods were used as an alternative for hemostasis and dissection such as ligasure and ultrasonic devices. New emerging technology of bipolar energy with high voltage and low current gave a benefit of deep coagulation and powerful cutting with less spread of heat to the surrounding tissue. In this study, we tried a new dissection technique with the pure auto-cut bipolar electrodissection with the new versions of bipolar technology to report its effect in parotid tumor surgery. The primary objective of the study was to evaluate the safety and efficacy of new bipolar pure cut electrodissection and weighing its benefits in the preservation of the facial nerve branches and reducing the postoperative complications. The secondary objective of the study was to compare the result of the new technique with the results of the conventional technique that was previously performed in our department and the complication of this new technique if any. Patients and methods This prospective and retrospective study was held in Menoufia University Hospital. Our study included 30 patients with parotid tumors, where 15 retrospective patients underwent conventional parotidectomy (superficial and/or total parotidectomy) and were referred as group B, and 15 prospective patients underwent parotidectomy (superficial or total parotidectomy) and were referred as group A, using the bipolar pure auto-cut electrodissection technique by advanced bipolar technology. Results The mean operative time was significantly lower in group A patients than in group B, where the time for superficial parotidectomy was 100±14 min in group A and 117±11 min in group B and for total parotidectomy was 118±12 min in group A and 139±18 min in group B (P=0.001). Regarding postoperative complications, in group A, we reported one case with temporary nerve affection. However, in group B, we reported two cases of wound infection, one case with salivary fistula, two cases with seroma, two cases of temporary nerve affection, two cases of permanent nerve branch affection, and one case of Frey syndrome. Regarding tumor recurrence, we reported only one case in group B. Conclusions Using the new bipolar pure cut technique in various types of parotid tumors is technically easier for meticulous fast dissection around the facial nerve branches, showing significantly shorter operative time and less incidence of seroma, wound infection, salivary fistula, and facial nerve injury.
背景腮腺手术的基本问题是面神经的保存。各种解剖方法已被用来切除腮腺组织和保留面神经及其分支。联合(钝、蚊尖、单极、双极电灼和剪刀解剖)是最广泛使用的技术。进一步使用新的方法作为止血和解剖的替代方法，如结扎和超声装置。新兴的高电压和低电流双极能量技术，有利于深层凝固和强大的切割，减少热量传播到周围组织。在这项研究中，我们尝试了一种新的解剖技术，即纯自动切割双极电解剖和新版本的双极技术，以报告其在腮腺肿瘤手术中的效果。本研究的主要目的是评估新型双极纯切电切术的安全性和有效性，并权衡其在保存面神经分支和减少术后并发症方面的益处。本研究的次要目的是比较新技术的结果与我科以前使用的传统技术的结果，以及新技术的并发症(如果有的话)。患者和方法本前瞻性和回顾性研究在Menoufia大学医院进行。本研究纳入30例腮腺肿瘤患者，其中15例回顾性患者行常规腮腺切除术(浅表和/或全腮腺切除术)，称为B组;15例前瞻性患者行腮腺切除术(浅表或全腮腺切除术)，称为A组，采用先进双极技术的双极纯自动切割电解剖技术。结果A组患者的平均手术时间明显低于B组，其中A组腮腺浅表切除术时间为100±14 min, B组为117±11 min; A组腮腺全切除术时间为118±12 min, B组为139±18 min (P=0.001)。术后并发症方面，A组报告1例暂时性神经损伤。而在B组，我们报告了2例伤口感染，1例唾液瘘，2例血清肿，2例暂时性神经损伤，2例永久性神经分支损伤，1例Frey综合征。结论采用新型双极纯切技术治疗各种类型腮腺肿瘤，技术上更容易对面神经分支周围进行细致快速的清扫，手术时间明显缩短，血清肿、创面感染、唾液瘘、面神经损伤发生率明显降低。
{"title":"The use of bipolar pure cut mode technology in dissection of parotid tumors: A novel technique","authors":"H. Abou-Ashour, Mahmoud Sayed Ahmed Shahin, Mohamed Nazeh Shaker","doi":"10.4103/ejs.ejs_24_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_24_23","url":null,"abstract":"Background The basic concern in parotid surgery is facial nerve preservation. Various methods of dissection have been used to excise the parotid tissue and spare the facial nerve and its branches. Combined (blunt, mosquito tip, monopolar, and bipolar electrocautery, and scissor dissection) procedures are the most widely used techniques. Further new methods were used as an alternative for hemostasis and dissection such as ligasure and ultrasonic devices. New emerging technology of bipolar energy with high voltage and low current gave a benefit of deep coagulation and powerful cutting with less spread of heat to the surrounding tissue. In this study, we tried a new dissection technique with the pure auto-cut bipolar electrodissection with the new versions of bipolar technology to report its effect in parotid tumor surgery. The primary objective of the study was to evaluate the safety and efficacy of new bipolar pure cut electrodissection and weighing its benefits in the preservation of the facial nerve branches and reducing the postoperative complications. The secondary objective of the study was to compare the result of the new technique with the results of the conventional technique that was previously performed in our department and the complication of this new technique if any. Patients and methods This prospective and retrospective study was held in Menoufia University Hospital. Our study included 30 patients with parotid tumors, where 15 retrospective patients underwent conventional parotidectomy (superficial and/or total parotidectomy) and were referred as group B, and 15 prospective patients underwent parotidectomy (superficial or total parotidectomy) and were referred as group A, using the bipolar pure auto-cut electrodissection technique by advanced bipolar technology. Results The mean operative time was significantly lower in group A patients than in group B, where the time for superficial parotidectomy was 100±14 min in group A and 117±11 min in group B and for total parotidectomy was 118±12 min in group A and 139±18 min in group B (P=0.001). Regarding postoperative complications, in group A, we reported one case with temporary nerve affection. However, in group B, we reported two cases of wound infection, one case with salivary fistula, two cases with seroma, two cases of temporary nerve affection, two cases of permanent nerve branch affection, and one case of Frey syndrome. Regarding tumor recurrence, we reported only one case in group B. Conclusions Using the new bipolar pure cut technique in various types of parotid tumors is technically easier for meticulous fast dissection around the facial nerve branches, showing significantly shorter operative time and less incidence of seroma, wound infection, salivary fistula, and facial nerve injury.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"367 - 377"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41351932","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}
Background Laparoscopic surgery is still gaining popularity in conditions associated with peritonitis, such as a perforated peptic ulcer. Aim of the work This study aimed to compare laparoscopic and laparotomy repair of perforated peptic ulcers regarding intraoperative parameters, postoperative pain, time of the start of oral feeding, postoperative complication, hospital stay, resuming normal activity, and outcomes. Patients and methods This is a prospective study of 50 patients (males and females), of any age with perforated peptic ulcer. Those patients will be divided by the random serial number method into two groups: the laparoscopic group and the open (laparotomy) group. In a period from 15th April 2022 to 15th February 2023 data related to patients were recorded and subjected to analysis. Results All patients were divided into two groups: Laparoscopic group with 25 patients (23 of them underwent successful laparoscopic repair and two patients were converted to open) and the open (laparotomy) group with 25 patients underwent laparotomy repair (of which 23 patients were living, and two patients died on the third and tenth postoperative days). There were no significant differences in baseline characteristics between both groups in terms of age, gender, special habits, preoperative risk factors, comorbidities, laboratory, and radiological findings; also both groups showed insignificant differences regarding the American Society of Anesthesiologists (ASA) scores (P=0.83), total Boey’s score (P=0.77), shock on admission (P= 1.00), and the duration of symptoms > 24 hours (P= 0.77). Operative time was significantly increased in the laparoscopic versus open group (P=0.0001). While, first-day pain score (VAS), opioid requirements, time of starting oral feeding, length of hospital stay, and return to normal activity were highly significantly decreased in laparoscopic repair compared with open repair (P= <0.0001 for each). Total postoperative complications showed insignificant difference between the studied groups (P=0.16), but they were more prevalent between the open group (14 patients, 56%) versus the laparoscopic group (9 patients, 36%). Good cosmetic results of wounds were more prevalent in the laparoscopic group [20 patients (80.00%)] than the open group [13 patients (56.52%)], but insignificant, P=0.17. Conclusion Laparoscopic repair had an upper hand over open repair regarding less intraoperative blood loss, less postoperative pain, requiring less postoperative analgesia, early starting of oral feeding, less postoperative complications, shorter hospital stay, early return to normal activity, and good cosmetic results of wounds.
{"title":"A comparative study of laparoscopic versus laparotomy repair of perforated peptic ulcer: A prospective study","authors":"A. Saleem, Mohamed W. Arafa, A. M. Galal","doi":"10.4103/ejs.ejs_65_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_65_23","url":null,"abstract":"Background Laparoscopic surgery is still gaining popularity in conditions associated with peritonitis, such as a perforated peptic ulcer. Aim of the work This study aimed to compare laparoscopic and laparotomy repair of perforated peptic ulcers regarding intraoperative parameters, postoperative pain, time of the start of oral feeding, postoperative complication, hospital stay, resuming normal activity, and outcomes. Patients and methods This is a prospective study of 50 patients (males and females), of any age with perforated peptic ulcer. Those patients will be divided by the random serial number method into two groups: the laparoscopic group and the open (laparotomy) group. In a period from 15th April 2022 to 15th February 2023 data related to patients were recorded and subjected to analysis. Results All patients were divided into two groups: Laparoscopic group with 25 patients (23 of them underwent successful laparoscopic repair and two patients were converted to open) and the open (laparotomy) group with 25 patients underwent laparotomy repair (of which 23 patients were living, and two patients died on the third and tenth postoperative days). There were no significant differences in baseline characteristics between both groups in terms of age, gender, special habits, preoperative risk factors, comorbidities, laboratory, and radiological findings; also both groups showed insignificant differences regarding the American Society of Anesthesiologists (ASA) scores (P=0.83), total Boey’s score (P=0.77), shock on admission (P= 1.00), and the duration of symptoms > 24 hours (P= 0.77). Operative time was significantly increased in the laparoscopic versus open group (P=0.0001). While, first-day pain score (VAS), opioid requirements, time of starting oral feeding, length of hospital stay, and return to normal activity were highly significantly decreased in laparoscopic repair compared with open repair (P= <0.0001 for each). Total postoperative complications showed insignificant difference between the studied groups (P=0.16), but they were more prevalent between the open group (14 patients, 56%) versus the laparoscopic group (9 patients, 36%). Good cosmetic results of wounds were more prevalent in the laparoscopic group [20 patients (80.00%)] than the open group [13 patients (56.52%)], but insignificant, P=0.17. Conclusion Laparoscopic repair had an upper hand over open repair regarding less intraoperative blood loss, less postoperative pain, requiring less postoperative analgesia, early starting of oral feeding, less postoperative complications, shorter hospital stay, early return to normal activity, and good cosmetic results of wounds.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"385 - 401"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42773398","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}
Aim This study aims to investigate the effect of anterior segmental maxillary osteotomy in treatment of maxillary prognathism with good molars occlusion. Patients and methods This study includes 20 patients diagnosed with dentofacial deformities − maxillary prognathism visiting maxillofacial surgery outpatient clinic in Assiut University Hospitals during the period between January 2017 and December 2021. Results The common complications which occur is wound infection which occur in two (10%) cases, then postoperative relapse which occur in one (5%) case, palatal mucosal tear which occur in one (5%) case, and unfavorable nasolabial esthetic which occur in one (5%) case. Conclusion Anterior segmental maxillary osteotomy is a recommended treatment modality of choice in patients with maxillary and/or dentoalveolar protrusion.
{"title":"Esthetic and functional advantages of subapical anterior segmental maxillary osteotomy in treatment of dentofacial deformity","authors":"M. Shahine, I. Mwafey","doi":"10.4103/ejs.ejs_68_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_68_23","url":null,"abstract":"Aim This study aims to investigate the effect of anterior segmental maxillary osteotomy in treatment of maxillary prognathism with good molars occlusion. Patients and methods This study includes 20 patients diagnosed with dentofacial deformities − maxillary prognathism visiting maxillofacial surgery outpatient clinic in Assiut University Hospitals during the period between January 2017 and December 2021. Results The common complications which occur is wound infection which occur in two (10%) cases, then postoperative relapse which occur in one (5%) case, palatal mucosal tear which occur in one (5%) case, and unfavorable nasolabial esthetic which occur in one (5%) case. Conclusion Anterior segmental maxillary osteotomy is a recommended treatment modality of choice in patients with maxillary and/or dentoalveolar protrusion.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"402 - 408"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42135791","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. Khalil, A. M. Sabry, Diaa Eldin Sherif, Mohamed H. Zaid
Background Pancreatic cancer is considered the seventh cause of cancer-related death worldwide, and has low resection rate and a poor prognosis. Surgical resection to achieve R0 followed by adjuvant chemotherapy is the treatment of choice. Borderline resectable pancreatic cancer (BRPC) is technically difficult tumor with high risk of non-radical resection R1 and early postoperative recurrence. A neoadjuvant chemotherapy in BRPC instead of upfront surgical resection has advantages of increase R0 resection rate, treatment of undetected micro metastases and decrease postoperative pancreatic fistula. Objective Comparing the short-term outcome between upfront surgery and neoadjuvant chemotherapy for borderline resectable pancreatic carcinoma for venous encasement only as regards the ability to do R0 resection, early surgical complications and the progression rate of the disease Design Prospective cohort. Patients and methods Patients age between 20–70, with only venous encasement (no arterial encasement) with encasement>180 degrees and a segment of venous encasement not more than 2 cm were included. Patients with an arterial encasement, distant metastasis, and not fit for chemotherapy were excluded. Results The upfront surgery group has higher resection rate (75%) with portal/SMV reconstruction needed in one-third of the cases (33.3%) while the neoadjuvant chemotherapy group has higher progression rate (55%) and low resection rate (only 20%). No significant difference between the groups as regards the complication rate (morbidity and mortality), R1 resection(margin invasion), blood loss or time of surgery. Conclusion Upfront surgery can be done in selected patients with BR-PDAC to avoid the progression of the disease with no statistically significant difference as regards the short-term complications in comparison to the neoadjuvant group.
{"title":"Upfront surgery versus neoadjuvant chemotherapy for borderline resectable pancreatic carcinoma with venous encasement more than 180 degree, comparative study","authors":"A. Khalil, A. M. Sabry, Diaa Eldin Sherif, Mohamed H. Zaid","doi":"10.4103/ejs.ejs_92_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_92_23","url":null,"abstract":"Background Pancreatic cancer is considered the seventh cause of cancer-related death worldwide, and has low resection rate and a poor prognosis. Surgical resection to achieve R0 followed by adjuvant chemotherapy is the treatment of choice. Borderline resectable pancreatic cancer (BRPC) is technically difficult tumor with high risk of non-radical resection R1 and early postoperative recurrence. A neoadjuvant chemotherapy in BRPC instead of upfront surgical resection has advantages of increase R0 resection rate, treatment of undetected micro metastases and decrease postoperative pancreatic fistula. Objective Comparing the short-term outcome between upfront surgery and neoadjuvant chemotherapy for borderline resectable pancreatic carcinoma for venous encasement only as regards the ability to do R0 resection, early surgical complications and the progression rate of the disease Design Prospective cohort. Patients and methods Patients age between 20–70, with only venous encasement (no arterial encasement) with encasement>180 degrees and a segment of venous encasement not more than 2 cm were included. Patients with an arterial encasement, distant metastasis, and not fit for chemotherapy were excluded. Results The upfront surgery group has higher resection rate (75%) with portal/SMV reconstruction needed in one-third of the cases (33.3%) while the neoadjuvant chemotherapy group has higher progression rate (55%) and low resection rate (only 20%). No significant difference between the groups as regards the complication rate (morbidity and mortality), R1 resection(margin invasion), blood loss or time of surgery. Conclusion Upfront surgery can be done in selected patients with BR-PDAC to avoid the progression of the disease with no statistically significant difference as regards the short-term complications in comparison to the neoadjuvant group.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"482 - 487"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42995421","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}
M. Sadek, Mohammed M. Mohammed, Mina Makram Hendy, Saleh Khairy Saleh, Mohamed Abdelzaher
Background Early diagnosis of common bile duct stone (CBDS) is crucial since its presence affects surgical therapy and acute calculous cholecystitis (ACC) has a comparable clinical picture whether or not a CBDS is present. Aim At the time of hospital admission, we sought to discover predictors of CBD stones in acute cholecystitis (AC) patients. Methods Between January 2020 and December 2022, we chose 90 patients who had typical ACC and had previously visited the emergency room at Minia University Hospital in Egypt. The 90 AC patients were split into two groups: the 63 AC patients without CBD stones and the 27 AC patients with CBD stones. The data were obtained and compared between the two groups include gender, age, history of chronic calcular cholecystitis (CCC), white blood cells (WBC), liver function tests (LFT), and common bile duct (CBD) diameter. Results By using simple logistic regression analysis for prediction of CBD stones, old age > 55 years, CBD diameter more than 6 mm and elevated liver functions including total bilirubin, direct bilirubin, serum glutamic-pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) was associated with CBD stones. By using multiple logistic regression analysis, only 2 variable showing significant association with CBD stones, including old age > 55 years (P = 0.013, odds ratio 9.26, confidence interval 1.6–53.61) and direct bilirubin (P = 0.008, Odds ratio 55.67, confidence interval 2.89–1072.35). Conclusion Age, abnormal LFTs greater than twofold, and dilated CBD >6 mm in AC patients increase the likelihood of concurrent CBDS. Knowing about these results might assist physicians develop clinical suspicions for an earlier diagnosis and improved management of CBDS.
{"title":"Prediction of common bile duct stones in acute cholecystitis patients at time of hospital admission","authors":"M. Sadek, Mohammed M. Mohammed, Mina Makram Hendy, Saleh Khairy Saleh, Mohamed Abdelzaher","doi":"10.4103/ejs.ejs_81_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_81_23","url":null,"abstract":"Background Early diagnosis of common bile duct stone (CBDS) is crucial since its presence affects surgical therapy and acute calculous cholecystitis (ACC) has a comparable clinical picture whether or not a CBDS is present. Aim At the time of hospital admission, we sought to discover predictors of CBD stones in acute cholecystitis (AC) patients. Methods Between January 2020 and December 2022, we chose 90 patients who had typical ACC and had previously visited the emergency room at Minia University Hospital in Egypt. The 90 AC patients were split into two groups: the 63 AC patients without CBD stones and the 27 AC patients with CBD stones. The data were obtained and compared between the two groups include gender, age, history of chronic calcular cholecystitis (CCC), white blood cells (WBC), liver function tests (LFT), and common bile duct (CBD) diameter. Results By using simple logistic regression analysis for prediction of CBD stones, old age > 55 years, CBD diameter more than 6 mm and elevated liver functions including total bilirubin, direct bilirubin, serum glutamic-pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) was associated with CBD stones. By using multiple logistic regression analysis, only 2 variable showing significant association with CBD stones, including old age > 55 years (P = 0.013, odds ratio 9.26, confidence interval 1.6–53.61) and direct bilirubin (P = 0.008, Odds ratio 55.67, confidence interval 2.89–1072.35). Conclusion Age, abnormal LFTs greater than twofold, and dilated CBD >6 mm in AC patients increase the likelihood of concurrent CBDS. Knowing about these results might assist physicians develop clinical suspicions for an earlier diagnosis and improved management of CBDS.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"42 1","pages":"433 - 438"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41971393","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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