Publisher: Medknow Publishers   (Total: 427 journals)

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Showing 1 - 200 of 427 Journals sorted alphabetically
Acta Medica Intl.     Open Access   (SJR: 0.101, CiteScore: 0)
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advanced Biomedical Research     Open Access  
Advances in Human Biology     Open Access   (Followers: 5)
Advances in Skeletal Muscle Function Assessment     Open Access  
African J. for Infertility and Assisted Conception     Open Access   (Followers: 1)
African J. of Medical and Health Sciences     Open Access   (Followers: 3)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.25, CiteScore: 1)
African J. of Trauma     Open Access   (Followers: 1)
Ain-Shams J. of Anaesthesiology     Open Access   (Followers: 2)
Al-Azhar Assiut Medical J.     Open Access   (Followers: 2)
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Alexandria J. of Pediatrics     Open Access   (Followers: 1)
Ancient Science of Life     Open Access   (Followers: 6)
Anesthesia : Essays and Researches     Open Access   (Followers: 10)
Annals of African Medicine     Open Access   (Followers: 2, SJR: 0.258, CiteScore: 1)
Annals of Bioanthropology     Open Access   (Followers: 5)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 15, SJR: 0.308, CiteScore: 1)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.434, CiteScore: 1)
Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery     Open Access  
Annals of Indian Psychiatry     Open Access  
Annals of Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 11, SJR: 0.352, CiteScore: 1)
Annals of Saudi Medicine     Open Access   (SJR: 0.238, CiteScore: 1)
Annals of Thoracic Medicine     Open Access   (Followers: 6, SJR: 0.524, CiteScore: 1)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 14, SJR: 0.152, CiteScore: 0)
Annals of Tropical Pathology     Open Access  
Apollo Medicine     Open Access  
APOS Trends in Orthodontics     Open Access   (Followers: 1)
Arab J. of Interventional Radiology     Open Access   (Followers: 1)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2, SJR: 0.187, CiteScore: 0)
Archives of Intl. Surgery     Open Access   (Followers: 10, SJR: 0.302, CiteScore: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 5)
Archives of Medicine and Surgery     Open Access   (Followers: 1)
Archives of Pharmacy Practice     Open Access   (Followers: 12, SJR: 0.102, CiteScore: 0)
Archives of Trauma Research     Open Access   (Followers: 4, SJR: 0.37, CiteScore: 2)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access   (Followers: 1)
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 5)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.856, CiteScore: 2)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 2)
Asian J. of Transfusion Science     Open Access   (Followers: 1, SJR: 0.35, CiteScore: 1)
Asian Pacific J. of Reproduction     Open Access   (SJR: 0.227, CiteScore: 1)
Asian Pacific J. of Tropical Biomedicine     Open Access   (Followers: 2, SJR: 0.491, CiteScore: 2)
Asian Pacific J. of Tropical Medicine     Open Access   (Followers: 1, SJR: 0.561, CiteScore: 2)
Astrocyte     Open Access  
Avicenna J. of Medicine     Open Access   (Followers: 1)
AYU : An international quarterly journal of research in Ayurveda     Open Access   (Followers: 6)
Benha Medical J.     Open Access  
Biomedical and Biotechnology Research J.     Open Access   (Followers: 1)
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access   (Followers: 1)
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 2)
Canadian J. of Rural Medicine     Full-text available via subscription   (Followers: 1, SJR: 0.202, CiteScore: 0)
Cancer Translational Medicine     Open Access   (Followers: 2)
Cardiology Plus     Open Access   (Followers: 1)
Chinese Medical J.     Open Access   (Followers: 10, SJR: 0.52, CiteScore: 1)
CHRISMED J. of Health and Research     Open Access   (Followers: 2)
Clinical Cancer Investigation J.     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 5)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 2)
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 10, SJR: 0.811, CiteScore: 2)
Contemporary Clinical Dentistry     Open Access   (Followers: 5, SJR: 0.353, CiteScore: 1)
Current Medical Issues     Open Access   (Followers: 2)
CytoJ.     Open Access   (Followers: 3, SJR: 0.543, CiteScore: 1)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 5, SJR: 0.152, CiteScore: 0)
Dental Research J.     Open Access   (Followers: 14, SJR: 0.416, CiteScore: 1)
Dentistry and Medical Research     Open Access   (Followers: 1)
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 8, SJR: 0.242, CiteScore: 0)
Education in the Health Professions     Open Access   (Followers: 2)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1, SJR: 1.799, CiteScore: 2)
Egyptian J. of Chest Diseases and Tuberculosis     Open Access   (Followers: 3, SJR: 0.155, CiteScore: 0)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access   (Followers: 1)
Egyptian J. of Internal Medicine     Open Access   (Followers: 1)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access   (Followers: 1)
Egyptian J. of Otolaryngology     Open Access   (Followers: 2)
Egyptian J. of Psychiatry     Open Access   (Followers: 1)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Nursing J.     Open Access  
Egyptian Orthopaedic J.     Open Access   (Followers: 2)
Egyptian Pharmaceutical J.     Open Access   (Followers: 3)
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access   (Followers: 2)
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.822, CiteScore: 2)
Environmental Disease     Open Access   (Followers: 4)
Eurasian J. of Pulmonology     Open Access  
European J. of Dentistry     Open Access   (Followers: 4, SJR: 0.749, CiteScore: 2)
European J. of General Dentistry     Open Access   (Followers: 2, SJR: 0.12, CiteScore: 0)
European J. of Prosthodontics     Open Access   (Followers: 4)
European J. of Psychology and Educational Studies     Open Access   (Followers: 11, SJR: 0.113, CiteScore: 0)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.112, CiteScore: 0)
Genome Integrity     Open Access   (Followers: 2, SJR: 0.153, CiteScore: 0)
Glioma     Open Access  
Global J. of Transfusion Medicine     Open Access   (Followers: 1)
Gynecology and Minimally Invasive Therapy     Open Access   (SJR: 0.311, CiteScore: 1)
Hamdan Medical J.     Open Access  
Heart and Mind     Open Access  
Heart India     Open Access   (Followers: 2)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
Ibnosina J. of Medicine and Biomedical Sciences     Open Access   (Followers: 1)
IJS Short Reports     Open Access  
Imam J. of Applied Sciences     Open Access  
Indian Dermatology Online J.     Open Access   (Followers: 3)
Indian J. of Allergy, Asthma and Immunology     Open Access   (Followers: 1)
Indian J. of Anaesthesia     Open Access   (Followers: 7, SJR: 0.478, CiteScore: 1)
Indian J. of Burns     Open Access   (Followers: 3)
Indian J. of Cancer     Open Access   (Followers: 1, SJR: 0.361, CiteScore: 1)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.37, CiteScore: 1)
Indian J. of Dental Research     Open Access   (Followers: 5, SJR: 0.266, CiteScore: 1)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.468, CiteScore: 1)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 4, SJR: 0.445, CiteScore: 1)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1, SJR: 0.791, CiteScore: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4, SJR: 0.568, CiteScore: 1)
Indian J. of Health Sciences and Biomedical Research KLEU     Open Access   (Followers: 3)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.425, CiteScore: 1)
Indian J. of Medical Microbiology     Open Access   (Followers: 2, SJR: 0.503, CiteScore: 1)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.656, CiteScore: 1)
Indian J. of Medical Sciences     Open Access   (Followers: 3, SJR: 0.102, CiteScore: 0)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 2, SJR: 0.347, CiteScore: 1)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.23, CiteScore: 0)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 3, SJR: 0.225, CiteScore: 1)
Indian J. of Ophthalmology     Open Access   (Followers: 5, SJR: 0.498, CiteScore: 1)
Indian J. of Oral Health and Research     Open Access  
Indian J. of Oral Sciences     Open Access   (Followers: 1)
Indian J. of Orthopaedics     Open Access   (Followers: 8, SJR: 0.392, CiteScore: 1)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.199, CiteScore: 0)
Indian J. of Paediatric Dermatology     Open Access   (Followers: 2)
Indian J. of Pain     Open Access   (Followers: 2)
Indian J. of Palliative Care     Open Access   (Followers: 8, SJR: 0.454, CiteScore: 1)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 4, SJR: 0.276, CiteScore: 1)
Indian J. of Pharmacology     Open Access   (SJR: 0.412, CiteScore: 1)
Indian J. of Psychiatry     Open Access   (Followers: 2, SJR: 0.408, CiteScore: 1)
Indian J. of Psychological Medicine     Open Access   (SJR: 0.368, CiteScore: 1)
Indian J. of Public Health     Open Access   (Followers: 1)
Indian J. of Radiology and Imaging     Open Access   (Followers: 5)
Indian J. of Research in Homoeopathy     Open Access   (Followers: 2)
Indian J. of Respiratory Care     Open Access   (Followers: 3)
Indian J. of Rheumatology     Open Access   (Followers: 1, SJR: 0.119, CiteScore: 0)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.34, CiteScore: 0)
Indian J. of Social Psychiatry     Open Access   (Followers: 1)
Indian J. of Transplantation     Open Access  
Indian J. of Urology     Open Access   (Followers: 5, SJR: 0.434, CiteScore: 1)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Indian Spine J.     Open Access  
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intervention     Open Access   (Followers: 2)
Intl. Archives of Health Sciences     Open Access  
Intl. J. of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
Intl. J. of Academic Medicine     Open Access  
Intl. J. of Advanced Medical and Health Research     Open Access  
Intl. J. of Applied and Basic Medical Research     Open Access  
Intl. J. of Clinical and Experimental Physiology     Open Access   (Followers: 1)
Intl. J. of Clinicopathological Correlation     Open Access   (Followers: 1)
Intl. J. of Community Dentistry     Open Access  
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1, SJR: 0.192, CiteScore: 0)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 4)
Intl. J. of Environmental Health Engineering     Open Access   (Followers: 1)
Intl. J. of Forensic Odontology     Open Access   (Followers: 1)
Intl. J. of Green Pharmacy     Open Access   (Followers: 8, SJR: 0.142, CiteScore: 0)
Intl. J. of Growth Factors and Stem Cells in Dentistry     Open Access  
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 3)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 3)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 6)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.535, CiteScore: 1)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4, SJR: 0.17, CiteScore: 0)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 3)
Intl. J. of Orofacial Biology     Open Access   (Followers: 1)
Intl. J. of Orofacial Research     Open Access   (Followers: 2)
Intl. J. of Orthodontic Rehabilitation     Open Access   (Followers: 2)
Intl. J. of Pedodontic Rehabilitation     Open Access  
Intl. J. of Pharmaceutical Investigation     Open Access   (Followers: 2)
Intl. J. of Preventive Medicine     Open Access   (Followers: 1, SJR: 0.623, CiteScore: 1)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 5, SJR: 0.653, CiteScore: 1)
Intl. J. of the Cardiovascular Academy     Open Access   (SJR: 0.105, CiteScore: 0)
Intl. J. of Trichology     Open Access   (SJR: 0.4, CiteScore: 1)
Intl. J. of Yoga     Open Access   (Followers: 16)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 7)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 3)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  

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Egyptian Journal of Surgery
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1110-1121 - ISSN (Online) 1687-7624
Published by Medknow Publishers Homepage  [427 journals]
  • Could local curative breast surgery improve survival in women with
           oligometastatic breast cancer?

    • Authors: Mohamed I Abdelhamid, Mohamed M Alkilany, Loay M Gertallah, Walid A Mawla
      Pages: 283 - 288
      Abstract: Mohamed I Abdelhamid, Mohamed M Alkilany, Loay M Gertallah, Walid A Mawla
      The Egyptian Journal of Surgery 2020 39(2):283-288
      Background Patients who initially present with a few metastatic lesions from breast cancer are termed as having oligometastatic disease (OMD). The long-term OMD survivors are young patients with a good performance status. Recently, there has been an improvement in systemic and hormonal therapy which could improve patients’ outcome. However, the roles of surgical management of the primary tumor for patients with OMD still need clarifications.Aim The aim was to evaluate treatment effects and patient outcome of surgical excision of the primary tumor in patients with cancer breast, who were initially presented with OMD.Patients and methods This study included 60 patients with breast cancer with OMD. Patients included in our study were divided into three groups, and each group included 20 patients: first, the first group underwent systemic therapy before surgery; second, the second group underwent surgery before systemic therapy; and third, the third group underwent systemic therapy alone. The authors followed all patients for ∼3 years and identified survival rates and patients outcome.Results Young patients underwent surgery more often than old patients after systemic therapy (P=0.006). There is a statistically significant difference between the studied groups regarding recurrence (P=0.038), death (P=0.017), recurrence-free survival (P<0.001), and overall survival (P=0.003). The group that underwent combined surgery and systemic therapy had the most significant longer recurrence-free and overall survival rates.Conclusions Surgical removal of the primary tumor has a curative role in patients with breast cancer with OMD, and it improves patients’ outcome and survival rates.
      Citation: The Egyptian Journal of Surgery 2020 39(2):283-288
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_187_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Outcome of combined partial liver resection and intraoperative
           radiofrequency ablation in colorectal liver metastases

    • Authors: Mostafa Abdo, Haytham M Nasser
      Pages: 289 - 296
      Abstract: Mostafa Abdo, Haytham M Nasser
      The Egyptian Journal of Surgery 2020 39(2):289-296
      Background Liver metastases occur in 40% of patients with colorectal cancer. A minority of the patients are eligible for resection, with 5-year survival rates of 18–38%. Intraoperative radiofrequency ablation (IRFA) could be an alternative for resection to reduce loss of liver remnant. A median survival of 36 months was achieved by using multidisciplinary approach, doubling the survival rate.Patients and methods This is a prospective consecutive study. Between June 2016 and June 2018, 32 patients with colorectal liver metastases (CRLM) were divided into group A, comprising 15 patients with unilateral CRLM that can be resected with adequate residual volume, and group B, comprising 17 patients with unilateral CRLM that cannot be resected, but they are still eligible for complete hepatic clearance using combined liver resection and IRFA. All were followed up for 6 months.Results Fifteen patients underwent anatomical liver resection and 17 patients had partial resection combined with IRFA. The Clavien’s complication rate was significantly lower in group B (35%) vs 60% in group A, and most complications were minor. Only two patients in group A had a grade III complication, where they underwent pigtail insertion for biliary leakage. Liver progress in IRFA group was seen in one patient. Liver recurrence was seen in 13 and 17.5% in groups A and B, respectively. During the first 3 months, complete hepatic response was observed in 14 patients in group A and 15 patients in group B (93 and 88%, respectively). After 6 months, all patients were alive, without liver tumor burden in 11 (73%) patients in group A and 17 (70%) patients in group B, but three patients developed colonic tumor recurrence.Conclusion Combined IRFA and liver resection augments the number of patients who can be treated surgically.
      Citation: The Egyptian Journal of Surgery 2020 39(2):289-296
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_190_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Role of endovascular interventions in treatment of thromboembolic
           occlusion of superior mesenteric artery

    • Authors: Medhat E El-Laboudy, Ahmed H Abouissa, Waleed A Sorour, Ayman A Salem, Ahmed M Tawfik
      Pages: 297 - 304
      Abstract: Medhat E El-Laboudy, Ahmed H Abouissa, Waleed A Sorour, Ayman A Salem, Ahmed M Tawfik
      The Egyptian Journal of Surgery 2020 39(2):297-304
      Objective The aim was to evaluate the efficacy and safety of endovascular management of acute thromboembolic occlusion of superior mesenteric artery (SMA).Patients and methods Our prospective study was conducted at Vascular Surgery Department, Zagazig University Hospitals, Egypt, and Vascular Surgery and Intervention Radiology Departments, Alnoor Specialist Hospital, Makkah, Saudi Arabia, from March 2015 to September 2019. Eleven cases diagnosed as having thromboembolic occlusion of SMA by computerized tomographic angiography underwent endovascular intervention. Mean age was 54±11 years, and seven patients (63.6%) were males. Abdominal pain and nausea were the commonest symptoms, and none of the patients had acute peritonitis. Median time from start of symptoms to hospital admission was 9 h and from hospital admission to endovascular intervention was 11 h. Etiology was embolic in six (54.5%) patients and thrombotic in five (45.5%) patients. All patients underwent catheter-directed thrombolysis. Median dose of alteplase was 23 mg, and median infusion rate was 0.8 mg/h. Median duration of thrombolysis was 24 h. Two patients underwent balloon dilatation, and one patient underwent balloon dilatation and stenting.Results Technical success was seen in seven (63.6%) patients, whereas failure of endovascular revascularization in four (36.4%) patients (two of them were thrombotic and died before planned laparotomy and the other two patients were embolic and underwent laparotomy for surgical embolectomy and resection of necrotic bowel segment). Postoperative complications occurred as bleeding in four (36.4%) patients and technical complications in two (18.2%) patients. Three (27.3%) patients died during hospital admission.Conclusion Endovascular intervention can be an alternative to open surgery for intestinal revascularization for the treatment of early cases of acute SMA occlusion. Computerized tomographic angiography rapid diagnosis, urgent endovascular management, and intensive care and follow-up are the cornerstone for good prognosis.
      Citation: The Egyptian Journal of Surgery 2020 39(2):297-304
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_198_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Carotid artery stenting in high-risk patients: immediate and short-term
           results

    • Authors: Khaled M Abdo Elhindawy, Osama A Ismail, Mohamed T.M Eldien
      Pages: 305 - 312
      Abstract: Khaled M Abdo Elhindawy, Osama A Ismail, Mohamed T.M Eldien
      The Egyptian Journal of Surgery 2020 39(2):305-312
      Aim To review the immediate and short-term results of carotid artery stenting (CAS) in high-risk patients for surgery.Patients and methods This prospective study was carried out on 36 patients experiencing significant CAS. Patients were scheduled for CAS during the period between December 2015 and June 2018 and followed up for 1 year. All procedures were done in 6 October Insurance Hospital and Mahmoud Mosque Specialized Hospital. Most carotid lesions were internal carotid artery [33 (91.7%) patients], and only three (8.3%) patients had common carotid artery lesions. Overall, 31/36 patients had symptomatic carotid stenosis, whereas 5/36 patients were asymptomatic. The commonest presentation was stroke (58.3%) and transient ischemic attack (27.8%).Results Technical success was achieved in all patients. Embolic protection devices were used in all cases. Three (8.3%) patients developed stroke; two patients had intraoperative stroke after stent deployment and the other occurred during the 12-month follow-up. One (2.8%) patient developed cerebral hemorrhage. Six (16.7%) cases developed transient ischemic attack. Acute myocardial infarction occurred in three (8.3%) patients.Conclusion Management of CAS is challenging in high-risk patients. Stroke prevention is the main goal of successful treatment. Risk–benefit assessment should be based on patient status and procedural risk, rather than on the controversy between carotid endarterectomy and CAS.
      Citation: The Egyptian Journal of Surgery 2020 39(2):305-312
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_203_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Limb saving by profundoplasty in patients with no distal runoff

    • Authors: Hisham F Desoky, Samir A Zied, Ahmed G Karmota
      Pages: 313 - 316
      Abstract: Hisham F Desoky, Samir A Zied, Ahmed G Karmota
      The Egyptian Journal of Surgery 2020 39(2):313-316
      Background With the great advancement of endovascular intervention in the management of both chronic and acute peripheral vascular disease, the need for open surgical intervention has markedly decreased over the past decade; however, in certain cases, a simple surgical intervention remains the only hope for limb saving. In this study, the authors presented a review for the effect of one of the oldest surgical vascular procedures, which is ‘profundoplasty’ and the authors focused on its role and outcome in cases presented with threatened limb with no distal runoff to the foot.Patients and methods This is a retrospective study conducted on 18 cases presented with 20 threatened limbs with no distal runoff and managed with either isolated profundoplasty or combined with other procedures in the period between May 2016 and May 2018 at the Vascular Surgery Department of Kasr Al Aini with the limb salvage as the end point.Results The study included 18 male patients with mean age of 50 years presented with 20 threatened limbs: 10 patients presented with critical limb ischemia classified according to Rutherford classification between class 4 and 6, and eight patients with 10 delayed acute limb ischemia category IIb (two patients presented with bilateral lower limb affection). Technical success was 100%; two cases of critical limb ischemia ended up with unilateral below-knee amputation, with limb salvage rate of 90%.Conclusion Profundoplasty remains a very effective procedure in the management of lower limb ischemia either acute or chronic, especially when other options cannot be performed and the case seems to be hopeless.
      Citation: The Egyptian Journal of Surgery 2020 39(2):313-316
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_207_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Laparoscopic common bile duct exploration for choledocholithiasis (primary
           repair vs T-tube drainage)

    • Authors: Mahmoud Hasabelnabi, Abdelmoniem I El-Khateeb, Gamal A Makhlouf, Ahmed S Aboulhassen, Bashir A Fadel, Mohamed Abdel-Tawab
      Pages: 317 - 324
      Abstract: Mahmoud Hasabelnabi, Abdelmoniem I El-Khateeb, Gamal A Makhlouf, Ahmed S Aboulhassen, Bashir A Fadel, Mohamed Abdel-Tawab
      The Egyptian Journal of Surgery 2020 39(2):317-324
      Background Laparoscopic common bile duct exploration (LCBDE) offers good clinical outcomes in dealing with common bile duct stones. Surgeons experienced in laparoscopy can perform this procedure securely and efficiently. The goal of this study was to assess the security and possibility of primary repair as a substitute to usual T-tube drainage after LCBDE.Patients and methods This was a prospective study that included 40 successive patients who were subjected to LCBDE for common bile duct stones. After LCBDE, the choledochotomy was repaired either by primary repair (group A) in 20 patients or with T-tube insertion (group B) in 20 patients. The preoperative data, intraoperative details, and postoperative results of the two groups were assessed and evaluated with a mean follow-up of 12 months.Results The mean operation period was considerably lesser in group A than group B (101.1±27.7 min for group A vs 140.3±26 min for group B; P=0.000). Moreover, the hospital stay was considerably shorter in group A than in group B (2.8 days for group A vs 6.1 days for group B; P=0.017). Postoperative bile leakage occurred in two cases in each group.Conclusion Primary repair of choledochotomy is a secure alternate to usual T-tube insertion after LCBDE.
      Citation: The Egyptian Journal of Surgery 2020 39(2):317-324
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_208_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Acute iliofemoral deep vein thrombosis: does catheter-directed
           thrombolysis affect outcomes?

    • Authors: El-Sayed A Abd El-Mabood, Waleed A Sorour
      Pages: 325 - 337
      Abstract: El-Sayed A Abd El-Mabood, Waleed A Sorour
      The Egyptian Journal of Surgery 2020 39(2):325-337
      Purpose The aim was to assess the role of catheter-directed thrombolysis (CDT) in improving patency of the treated venous segments and to examine the correlation of residual thrombus with post-thrombotic syndrome (PTS).Background Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic morbidity when treated with anticoagulation alone. CDT allows early removal of thrombus and reduce valvular reflux and PTS.Patients and methods This prospective randomized controlled two-arm study was conducted on 42 patients with iliofemoral DVT. The patients were randomly allocated into two groups according to the intervention performed. Group A: CDT followed by oral anticoagulants [N=21 (50%)], group B: standard DVT therapy [N=21 (50%)]. The follow-up period was 24 months.Results Patients of group A complained of less pain at 10 and 30 days (P=0.02 and 0.04, respectively). Also, there was significant decrease in leg circumference in group A at 10 and 30 days (P=0.001 and 0.03, respectively). A total of three (15%) clinically relevant nonmajor bleeding complications were reported in the CDT group. Using CDT is associated with less PTS at sixth month, 1 year, and 2 years; six (27.3%), seven (31.8%), and nine (40.9%), respectively, as compared with group B; 11 (47.8%), 13 (56.5%), and 15 (65.2%), respectively (P=0.024, 0.017, and 0.035, respectively).Conclusion Addition of CDT in the treatment of acute iliofemoral DVT was safe and tolerated by most of the patients with better effect to reduce leg pain and circumference. It was considered a protecting weapon to prevent PTS and thereby improving the quality of life and was related to achievement of higher iliac vein patency and less reflux.
      Citation: The Egyptian Journal of Surgery 2020 39(2):325-337
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_209_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Comparison between effectiveness of mini gastric bypass and sleeve
           gastrectomy in weight reduction in super obese patients

    • Authors: Mohamed S Abouelela, Farouk A Mourad, Hisham A Reyad
      Pages: 338 - 343
      Abstract: Mohamed S Abouelela, Farouk A Mourad, Hisham A Reyad
      The Egyptian Journal of Surgery 2020 39(2):338-343
      Background Morbid obesity is defined as BMI more than 40 kg/m2, and those individuals with BMI more than 55 kg/m2 are classified as super obese patients. Super obese patients have been associated with higher morbidity and mortality and increased surgical risk. The optimal surgical management of these patients is controversial. The current work was designed to compare laparoscopic mini gastric bypass (MGB) and sleeve gastrectomy (SG) in super obese patients.Patients and methods This study included 50 super obese patients who were randomly divided into two groups: group 1 included 25 patients treated by laparoscopic MGB, and group 2 included 25 patients treated by laparoscopic sleeve gastrectomy (LSG).Results The mean age of MGB group was 44.87±10.34 years, with a range between 34 and 58 years, whereas it was 45.11±9.09 years in case of SG group, with a range between 27 and 55 years. Most patients in both groups were females (60% in the case of MGB group and 68% in case of SG group). Mean percent of excess weight loss after 1 year was insignificantly higher in MGB group (79.76±5.78) in comparison with the SG group (76.11±5.22; P=0.06), whereas BMI after 1 year was insignificantly lower in MGB group (35.12±3.89) in comparison with the SG group (36.22±4.87; P=0.32).Conclusion Bariatric surgeries (LSG and MGB) are effective procedures for weight reduction, with insignificant differences between both, but the study suggests that MGB has a better and earlier effect than LSG.
      Citation: The Egyptian Journal of Surgery 2020 39(2):338-343
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_211_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Impact of pedal arch revascularization on clinical outcomes of diabetic
           patients with critical limb ischemia

    • Authors: Osama A Ismail, Ahmed A Ahmed
      Pages: 344 - 351
      Abstract: Osama A Ismail, Ahmed A Ahmed
      The Egyptian Journal of Surgery 2020 39(2):344-351
      Aim The aim was to evaluate the effect of pedal arch revascularization in diabetic patients suffering from critical limb ischemia (CLI) on wound healing, time to heal, and limb salvage.Materials and methods The study was carried out from March 2016 to February 2019 at Sohag University Hospitals on 60 diabetic patients diagnosed with CLI. Pedal arch revascularization was combined with traditional management. Patients were divided into complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA) groups. Wound healing, time to heal, limb salvage, and freedom from minor amputations were evaluated and compared among the patient groups.Results The patients were classified into CPA group (15 patients, 25%), IPA (26 patients, 43.3%), and APA group (19 patients, 31.7%). There were no statistical difference between groups in age, sex, or risk factors. CPA patients showed a significantly higher rate of wound healing and shorter time-to-heal than other patient groups, 93.3% in CPA, 73.1% in IPA, and 52.6% in the APA group (P=0.003). Time to heal was 3.4±2.5 months in CPA patients, 4.0±2.9 in IPA, and 6.1±3.2 in APA group (P=0.02). Limb salvage rate was significantly better in CPA patients (100% in CPA, 88.5% in IPA, and 68.4% in APA group; P=0.01). Freedom from minor amputation was 86.6, 76.9, and 47.4% (P=0.086) in CPA, IPA, and APA group, respectively.Conclusion Pedal arch patency has a positive clinical impact on wound healing rate, time to heal, and limb salvage in the management of diabetic patients with CLI undergoing endovascular intervention.
      Citation: The Egyptian Journal of Surgery 2020 39(2):344-351
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_213_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Comparative study between Milligan-Morgan hemorrhoidectomy, stapled
           hemorrhoidopexy, and laser hemorrhoidoplasty in patients with third degree
           hemorrhoids: a prospective study

    • Authors: Moheb S Eskandaros, Ahmed A Darwish
      Pages: 352 - 363
      Abstract: Moheb S Eskandaros, Ahmed A Darwish
      The Egyptian Journal of Surgery 2020 39(2):352-363
      Context Hemorrhoids are dilated blood vessels under the anal mucosa. Hemorrhoids are classified into four degrees. The third and fourth include severe prolapse requiring surgical intervention. Many methods of treatment are available.Aim This study aimed to compare Milligan-Morgan hemorrhoidectomy, stapling hemorrhoidopexy, and laser hemorrhoidoplasty (LHP) in patients with third degree hemorrhoids.Settings and design This is a prospective randomized comparative study.Materials and methods A total of 120 patients were included. The study took place from April 2017 till October 2019. The patients were allocated into three groups, with 40 patients each: groups A (Milligan-Morgan hemorrhoidectomy), B (stapling hemorrhoidopexy), and C (LHP). Operative time, hospital stay, return to daily activities, postoperative pain, urinary retention, postoperative hemorrhage, recurrence, and anal stenosis were assessed.Statistical analysis Continuous variables were expressed as mean and SD. Categorical variables were expressed as frequencies and percentage.Results The operative time was 27.5±5.3, 25.9±4.7, and 22.8±3.9 min in groups A, B, and C, respectively; the hospital stay was 2.1±0.6, 1.1±0.3, and 0.7±0.3 days, respectively; and time to return to activity was 26.2±4.3, 17.2±4.5, and 11.3±2.4 days, respectively. Postoperative pain (visual analog scale) on day 1 was 6.9±1.1, 4.5±0.8, and 2.8±0.5 in groups A, B, and C, respectively; on week 1 was 5.2±0.9, 2.5±0.8, and 0.8±0.5, respectively in groups A, B, and C, respectively; and on week 2 was 4.1±0.8 and 0.7±0.6 in groups A and B, respectively. On week 3, it was 2.9±0.7, on week 4 was 1.2±0.7, and on week 8 was 0.4±0.5 in group A. On week 1, postoperative bleeding occurred in 27, eight, and three patients in groups A, B, and C, respectively. On week 2, postoperative bleeding was seen in 15 and two patients in groups A and B, respectively. On week 3, postoperative bleeding was seen in 12 patients and on week 4 in one patient in group A. Urine retention occurred in three and two patients in groups A and B, respectively. Recurrence occurred in one, three, and four patients in groups A, B, and C, respectively. Anal stenosis occurred in two patients in group A.Conclusions This study clarified that LHP is the most suitable technique for primary third degree hemorrhoids. However, a large-scale study has to be carried out for clarification of the minor differences.
      Citation: The Egyptian Journal of Surgery 2020 39(2):352-363
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_214_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Study the association among human papilloma virus subtypes 16 and 18,
           codon 72 P53 gene polymorphism, and oral squamous cell carcinoma in Upper
           Egypt: a case–control study

    • Authors: Salah El-Dein G Shaltout, Heba M.S El-Dein, Dalia A Elsers, Mohammed S Shahine, Hamdan S Abbas, Mohammed H Osman
      Pages: 364 - 370
      Abstract: Salah El-Dein G Shaltout, Heba M.S El-Dein, Dalia A Elsers, Mohammed S Shahine, Hamdan S Abbas, Mohammed H Osman
      The Egyptian Journal of Surgery 2020 39(2):364-370
      Objectives To investigate the possible association among oral squamous cell carcinoma (OSCC), human papilloma virus (HPV) subtypes 16 and 18, and P53 codon 72 genotypes in Upper Egypt population.Patients and methods The present case–control study included patients presented to Maxillofacial Unit, General Surgery Department, Faculty of Medicine at Assiut University Hospital, Egypt. The biopsies were collected from patients with OSCC, patients with leukoplakia, and healthy oral mucosa as a control group. The P53c72 genotypes and gene expression for HPV subtypes 16 and 18 were determined using the real-time PCR method.Results The study was done on 69 patients: 45 cases (28 OSCC cases and 17 leukoplakia cases) and 24 patients as a control group. There was no statistically significant association between both OSCC and leukoplakia and P53 codon 72 gene polymorphism. The distribution of P53 genotypes in patients with OSCC was 21.4% were wild, 39.3% were mutant, and 39.3% were heterogeneous, whereas in leukoplakia, 23.6% were wild, 17.6% were mutant, and 58.8% were heterogeneous when compared with controls, where 45.8% were wild,12.5% were mutant, and 41.7% were heterogeneous.Conclusion No statistically significant correlation between HPV 16 and 18 genotypes and OSCC in the present study could be noted. Moreover, there is no association between codon 72 of P53 gene polymorphism and OSCC, so other environmental factors should be studied to detect the causal factors of oral carcinoma in our society.
      Citation: The Egyptian Journal of Surgery 2020 39(2):364-370
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_215_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Outcomes of anterior resection after laparoscopic and open surgery

    • Authors: Sherif AbdelHalim ElMaghrabi, Youhanna S Shafik, Heba T Abdelaziz
      Pages: 371 - 378
      Abstract: Sherif AbdelHalim ElMaghrabi, Youhanna S Shafik, Heba T Abdelaziz
      The Egyptian Journal of Surgery 2020 39(2):371-378
      Background The introduction of the laparoscope has improved the feasibility and patient health, owing to being a less invasive procedure. The use of a laparoscope for colorectal cancer surgery was debatable for fear of recurrence, tumor spillage, and nonradical tumor excision. However, the tendency for using laparoscopy in colorectal cancer surgery is in favor nowadays.Aim The aim was to compare the results of laparoscopic and open surgical techniques in colorectal cancer located in the rectosigmoid region.Patients and methods This prospective study included 50 patients with upper rectal cancer attending the outpatient clinic of Ain Shams University Hospitals, who were treated over a 3-year period. Patients underwent anterior resection either by open technique (first group) or using laparoscopy (second group). Comparative items included operative events (time, blood loss, efficacy of tumor resection, etc.), early postoperative complications (wound infection, anastomotic leakage, etc.), and late postoperative complications (stricture and local recurrence).Results This study shows no significant difference between the two groups regarding length of specimen, safety margins, number of retrieved lymph nodes, tumor recurrence, or mortality. However, it shows significantly longer procedure, less blood loss, and less wound complications in the laparoscopic group.Conclusion Both laparoscopic and open procedures for rectal cancer surgeries can achieve the same radical resection; however, wound complications seemingly are more frequent in cases having open colorectal resections. The time consumption problem of advanced laparoscopic surgery will improve by gaining more experience and using the best equipment.
      Citation: The Egyptian Journal of Surgery 2020 39(2):371-378
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_218_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Surgical and functional outcomes after colectomy and ileorectal
           anastomosis in patients with familial adenomatous polyposis

    • Authors: Ahmed M.M Gomaa, Hassan BA Abdelnaby, Sameh T Abu-Elela
      Pages: 379 - 386
      Abstract: Ahmed M.M Gomaa, Hassan BA Abdelnaby, Sameh T Abu-Elela
      The Egyptian Journal of Surgery 2020 39(2):379-386
      Introduction Familial adenomatous polyposis (FAP) is a distressing genetic disease for both symptomatic and asymptomatic carriers. Thus, early management is paramount to reduce risk of malignancy. Surgical management options for FAP become more variable; but each option comes with a cost. While restorative proctocolectomy with ileal pouch anal anastomosis is considered the gold standard, further surgeries surpass its advantages after critical selection of candidates. Total colectomy with ileorectal anastomosis (IRA) can be the future gold standard when candidates are wisely selected. This study evaluates the surgical, functional, and oncological outcomes of IRA.Patients and methods This study is a prospective cohort study conducted between June 2013 and June 2018 with a minimum follow-up of 12 months and included 33 patients with FAP. All patients underwent total colectomy followed by IRA. Then they were followed up for a mean period of 28.4 months to evaluate the postoperative surgical and functional outcomes as a primary endpoint with evaluation of long-term risk of rectal carcinoma as a secondary endpoint.Results Thirty-three patients had total colectomy followed by IRA. Ten patients developed early postoperative complications and seven had late complications. Bowel function was well preserved in 94% of patients and only 30% of the patients continued to use antidiarrheal medications beyond 6 months after the operation. One month postoperatively, the mean of bowel motions was 4.8 a day, which decreased to 2.6 times after 1 year of follow-up. Recurrence of polyposis was detected in 30% of patients, and only one patient had developed rectal malignancy.Conclusions With appropriate patient selection, IRA provides better surgical, functional, and oncological outcomes. Patient characteristics and disease features should be considered in surgical decision making.
      Citation: The Egyptian Journal of Surgery 2020 39(2):379-386
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_219_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Is polytetrafluoroethylene circular banding an effective technique for
           treatment of high-flow vascular access-induced steal syndrome?

    • Authors: Medhat E El-Laboudy, Waleed A Sorour, Ahmed M Tawfik
      Pages: 387 - 392
      Abstract: Medhat E El-Laboudy, Waleed A Sorour, Ahmed M Tawfik
      The Egyptian Journal of Surgery 2020 39(2):387-392
      Objective The aim was to evaluate the efficacy and safety of polytetrafluoroethylene (PTFE) banding for treatment of high-flow vascular access-induced steal syndrome.Patients and methods The prospective study was conducted at Vascular Surgery Departments, Zagazig University Hospitals, Egypt and Alnoor Specialist Hospital, Makkah, Saudi Arabia from February 2016 to October 2019. The study included 19 cases (11 women). The mean age was 54 years. The access was brachiocephalic; arteriovenous fistula (AVF) in 11 patients, transposed brachiobasilic AVF in three patients and upper-arm synthetic in five patients. The mean duration of access was 1.2 years. Stages of steal were (stage II: three cases, stage III: nine cases, stage IV: seven cases).Results There was complete relief in 15 (79%) patients, while only partial improvement in four (21%) patients; one patient achieved complete relief with another banding, one patient continued to use his access with partial (but tolerable) symptomatic relief, one patient required distal revascularization and interval ligation, and the remaining patients underwent ligation. The average initial flow in native AVF was 2074 ml/min and in synthetic access was 2437 ml/min, and the average flow reduction after banding was 1025 ml/min (49%) in AVF and was 1247 ml/min (51%) in synthetic access. Only minor complications occurred in the form of cellulitis in two cases and mild bleeding in one case. Banding-related thrombectomy was done in three (16%) patients. Follow-up was for 1 year. Primary patency was 74 and 63% at 6 and 12 months, respectively, and secondary patency was 84 and 74% at 6 and 12 months, respectively.Conclusion PTFE banding is a simple technique to preserve the access function and treat symptoms of steal caused by high flow access. It is less time consuming, with lesser complications and accepted success rate and can be done as a day case procedure when compared with bypass techniques. So, PTFE banding can be used as an initial successful procedure for treating steal associated with high-flow access.
      Citation: The Egyptian Journal of Surgery 2020 39(2):387-392
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_222_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Biliary stricture after Roux-en-Y hepaticojejunostomy for bile duct
           injury–surgical challenge: a single-center expertise

    • Authors: Mohamed A.S.A Hamid, Haytham M Nasser, Hatem Sayed
      Pages: 393 - 400
      Abstract: Mohamed A.S.A Hamid, Haytham M Nasser, Hatem Sayed
      The Egyptian Journal of Surgery 2020 39(2):393-400
      Background Laparoscopic cholecystectomy has been considered the gold standard since the 1990. Yet the incidence of bile duct injury (BDI) has increased from 0.06 to 0.3% for open cholecystectomy to 0.5 to 1.4% when done laparoscopically. Roux-en-Y hepaticojejunostomy (RYHJ) is the most widely approved management for most post-cholecystectomy BDIs, yet some patients experience incapacitating biliary complications, such as jaundice or recurrent attacks of cholangitis, in addition to anastomotic stricture.Aim The aim of this study was to assess the short-term outcomes of a multidisciplinary approach regarding failed RYHJ after post-cholecystectomy BDI.Materials and methods A total of 15 patients were enrolled in the descriptive study after failure of RYHJ performed because of post-cholecystectomy BDI. Patients comprised six males and nine females. All patients after definitive treatment underwent follow-up by abdominal ultrasound and liver function tests for at least 11 months.Results One (6.7%) patient had liver transplantation because of liver cirrhosis. Four (26.7%) other cases were managed by revisionary surgery for the hepaticojejunostomy as the stricture was so tight. The reminder 10 cases underwent trial of percutaneous trans-hepatic cholangiography (PTC), but unfortunately six of them (40% of the whole group) failed to be dilated adequately, and they indeed underwent surgery, and the other four (26.7%) were dilated successful. During the follow-up, three (20%) patients had biliary leakage and two patients developed re-stricture, with one mortality because of pulmonary embolism.Conclusion Good long-term results can be achieved in patients with RYHJ stricture through a case-by-case analysis and an immediate multidisciplinary approach in expert hepatobiliary center.
      Citation: The Egyptian Journal of Surgery 2020 39(2):393-400
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_224_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Two-stage repair for delayed presentation of anorectal malformation with
           vestibular and perineal fistulae in females

    • Authors: Mohamed Ahmed Negm, Mohamed Mahmoud Khedre
      Pages: 401 - 408
      Abstract: Mohamed Ahmed Negm, Mohamed Mahmoud Khedre
      The Egyptian Journal of Surgery 2020 39(2):401-408
      Background/aim In spite of advances in knowledge and techniques in the management of anorectal malformation (ARM), delayed presentation of female ARM with vestibular and perineal fistulae is quite common especially in developing countries. In this literature, there is no standardized surgical algorithm for late presentation of these female ARM. This study aimed to present the experience of two pediatric surgery tertiary centers regarding delayed presentation of vestibular and perineal fistulae using two-stage procedures.Patients and methods This prospective study was conducted on 28 female patients with late presentation of vestibular and perineal fistulae from November 2014 to April 2019. Lower contrast study was done for all patients. Laxative, frequent rectal wash enemas, and Hegar’s dilators were used for 2–3 weeks preoperatively. All patients were repaired by anterior sagittal anorectoplasty (ASARP) with covering high sigmoid loop colostomy, and colostomy closure was performed after 2–3 months. Krickenbeck continence score was used for assessment of anal continence.Results Of 28 patients included, 25 patients completed the study. There were 14 patients with perineal and 11 with vestibular fistulae. The age of patients ranged from 8 months to 18 years. The main reasons for delay were socioeconomic, unawareness, and overlapping causes. Sphincter-saving ASARP was used in 15 patients and the classic ASARP was used in 10 patients. Tapering proctoplasty was needed in one patient. Minor wound infection developed in three patients. Constipation occurred in 11 (44%) patients. Follow-up period ranged from 6 to 50 months (median 30 months). Good continence was obtained.Conclusion Although delayed presentation of vestibular and perineal fistulae in female patients is accompanied by comorbidities, with good surgical management, successful results can be obtained by using two-stage procedure.
      Citation: The Egyptian Journal of Surgery 2020 39(2):401-408
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_225_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Modification of Turnbull–Cutait transanal colon pull-through as a
           salvage procedure in cases of failed low colorectal anastomosis

    • Authors: Ahmed A Abou-Zeid, Sherif A Halim
      Pages: 409 - 414
      Abstract: Ahmed A Abou-Zeid, Sherif A Halim
      The Egyptian Journal of Surgery 2020 39(2):409-414
      Introduction In 1961, Turnbull and Cutait described the colon pull-through with delayed anastomosis for patients with rectal cancers below peritoneal reflection, Hirschsprung disease, and Chagas disease. With the technological upgrading, the surgical staplers offered an easy and safe primary anastomosis in the bottom of the pelvis and replaced the pull-through. Despite this, the pull-through still has a role nowadays in patients with complex anorectal diseases in whom achieving primary anastomosis is difficult even with the use of surgical staplers.Aim The authors are reporting the experience in Turnbull-Cutait pull-through operation, its indications, the technical modification, and the results.Patients and methods A total of 28 patients had two-stage transanal pull through procedure after completing the original resection for different anorectal problems. In the first stage, the left colon was completely mobilized, pulled through, and fixed to the anal canal, and the perianal skin was done, and covering ileostomy was raised. In the second stage, the pull-through was excised few cm below the anal verge, and the ileostomy was closed. Patients were followed up for 6 months to document the continence status and the development of any complications.Results Autoamputation of the colon stump occurred in 10 patients. Retraction of the pulled colon occurred in five patients causing severe pelvic sepsis in three of them. The three patients were treated by dismantling the anastomosis terminal colostomy. Other minor complications included anal pain and discharge. The patients showed wide range of continence state with clear improvement after 6 months.Conclusion Salvage Turnbull–Cutait pull-through is an easy procedure that can be used in patients with complex anastomotic complications and difficult pelvic anatomy. Retraction and gangrene of the colon stump are serious complications that need to be studied to improve the outcome of this procedure. Continence is definitely reduced, but it is accepted by most patients.
      Citation: The Egyptian Journal of Surgery 2020 39(2):409-414
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_226_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Does the degree of stone-induced hydronephrosis affect the outcome of
           shock-wave lithotripsy in patients with proximal ureteral stones?

    • Authors: Mahmoud Abuelnaga, Lara Alsadoun
      Pages: 415 - 420
      Abstract: Mahmoud Abuelnaga, Lara Alsadoun
      The Egyptian Journal of Surgery 2020 39(2):415-420
      Background Shock-wave lithotripsy (SWL) is an effective, well-established approach for treating ureteral calculi. Some studies have shown that patients with collecting system obstruction and ureteral stones had lower stone-free rates after SWL than patients with nonobstructed stones. In contrast, other studies acknowledge that stone-induced urinary obstruction does not decrease success with SWL for ureteral stones. The purpose of this study was to assess whether the degree of stone-induced hydronephrosis in patients with solitary proximal ureteral stones influences the outcome and clearance rates after SWL.Patients and methods This prospective study included 30 patients, with solitary proximal ureteric stones and different degrees of hydronephrosis, who were treated with SWL. Patients were divided into three groups according to the degree of stone-induced hydronephrosis. Group 1 (33.33%) had mild dilation, group 2 (33.33%) had moderate dilation, and group 3 (33.33%) had severe dilation. The Dornier MFL 5000 lithotripter was used to treat the patient groups. The results were compared in terms of stone-free rates, number of shock waves, number of sessions, incidence of complications, number of secondary interventions, and time to stone clearance.Results The average stone size was between 8 and 18 mm. The overall success rate was found to be 80% in patients with severe back pressure compared with 90 and 86.6% success rate in moderate and mild hydronephrosis groups, respectively (P=0.749). Furthermore, there was no statistical significance between the three studied groups regarding clearance time (P=0.721).Conclusions The degree of hydronephrosis secondary to proximal ureteral stones of between 6 and 20 mm has shown not to affect the duration till stone clearance or overall treatment success following SWL treatment.
      Citation: The Egyptian Journal of Surgery 2020 39(2):415-420
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_227_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Treatment of male varicoceles by transcatheter ethanolamine oleate
           5% foam sclerotherapy

    • Authors: Mohamed Ibrahim, Khalid Attala, Ah M.N Qwashty
      Pages: 421 - 428
      Abstract: Mohamed Ibrahim, Khalid Attala, Ah M.N Qwashty
      The Egyptian Journal of Surgery 2020 39(2):421-428
      Objective The authors report the experience with foam sclerotherapy with no additional coils, evaluating clinical success, patients’ satisfaction, and complications.Patients and methods The authors conducted a retrospective study of 71 patients with 76 varicoceles (mean age: 29.3 years; range: 13–60 years) who underwent foam sclerotherapy with ethanolamine oleate 5% (range: 2–12 ml) in an outpatient setting between October 2016 and September 2018. For the follow-up, interviews with the patients were conducted (mean follow-up time: 6.4 months, with SD: 5.17 months).Results The technical success rate was 84.2%. There was a 100% response rate to the patient interviews. Follow-up revealed a clinical success rate of 83.9% and a persistence or relapse rate of 16.1%. Of the patients, 85.9% were absolutely satisfied with the outcome. In 94.9% of cases, pain or discomfort resolution was reported, and in 97% of cases, aesthetic issues were no longer a problem. Of partners, 63.2% achieved pregnancy, and in 50% of patients with preprocedural testicular atrophy, catch-up growth was observed. One patient with pampiniform plexus phlebitis received inpatient treatment with no long-term damage recorded.Conclusion Ethanolamine oleate 5% foam varicocele sclerotherapy is a safe and effective procedure, with a high rate of patients’ satisfaction, clinical and technical success, and considerable catch-up growth and pregnancy achievement.
      Citation: The Egyptian Journal of Surgery 2020 39(2):421-428
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_231_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Laparoscopicvs open appendectomy in the management of appendicitis
           complicated by generalized peritonitis: a prospective randomized trial

    • Authors: Amro Elhadidi, Ahmad Taha, Mohamed Shetiwy, Mohamed S.A Attia, Abdelghany Motawea, Mohamed Abdelhalim
      Pages: 429 - 436
      Abstract: Amro Elhadidi, Ahmad Taha, Mohamed Shetiwy, Mohamed S.A Attia, Abdelghany Motawea, Mohamed Abdelhalim
      The Egyptian Journal of Surgery 2020 39(2):429-436
      Background Laparoscopic appendectomy (LA) is performed worldwide in the treatment of acute appendicitis (AP), even if complicated by localized peritonitis. However, the role of the LA in the treatment of AP complicated by generalized peritonitis (GP) is yet controversial. The present study aimed to highlight the efficacy and safety of the laparoscopic approach in AP complicated with GP.Settings This study took place in Mansura University Hospital, Faculty of Medicine.Patients and methods From September 2010 to May 2019, the patients were randomly assigned to undergo either an LA or exploratory open appendectomy (EOA). The demographics of the patient and preoperative parameters, including radiological evaluation, intraoperative finding, and postoperative complications, were evaluated. The follow-up period was 8 months to 2 years (mean: 18 months).Main outcomes The primary outcome of this study was early postoperative complications.Results A total of 120 patients, aged 38±11 years, were analyzed. Of these, 69 (57.5%) patients underwent LA, whereas two (2.9%) were converted to open surgery. All patients presented with diffuse peritonitis. The duration of operation was longer in the laparoscopic group than in the EOA group (P=0.001). No differences were detected in the preoperative patient comorbidities. The rate of postoperative surgical infection and intra-abdominal abscess was similar in the laparoscopic and EOA groups (P=0.3040 and 0.0754, respectively). However, the length of hospital stay was shorter in the laparoscopic group than that in the EOA group (P=0.001).Conclusions The laparoscopic approach for appendicitis complicated by GP is better than the open approach, and hence, it must be the first choice for surgery in the case of clear preoperative diagnosis.
      Citation: The Egyptian Journal of Surgery 2020 39(2):429-436
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_235_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Endoscopic dilatation with and without mitomycin C local application in
           esophageal strictures in pediatric patients

    • Authors: Alaa E.M Shahin, Magdi A Loulah, Tamer Fakhry
      Pages: 437 - 442
      Abstract: Alaa E.M Shahin, Magdi A Loulah, Tamer Fakhry
      The Egyptian Journal of Surgery 2020 39(2):437-442
      Background Esophageal stricture is an important health problem in pediatrics. It affects the patient health and quality of life negatively. The aim was to compare between endoscopic dilatation followed by mitomycin C local application and conventional endoscopic dilatation alone in outcome of treatment of pediatric patients with esophageal strictures.Patients and methods This prospective randomized controlled study was performed on 42 pediatric patients presented with dysphagia resulting from esophageal strictures. The patients were classified into two groups (21 patients in each): group A, where endoscopic dilatation was followed with local application of mitomycin C, and group B, where endoscopic dilatation alone was done.Results There was no significant difference between both groups in age, sex, etiology, and weight before dilatation. Weight after dilatation and weight gain showed significant increase in group A than B. There was significant decrease in number and duration of sessions with significant increase in the intervals between sessions in group A than B. There were no detected complications related to mitomycin C.Conclusion Mitomycin C local application following endoscopic dilatation in esophageal stricture improves the outcome in pediatric patients by decreasing the number of dilatation sessions and shortens the treatment period thus reaching earlier cure.
      Citation: The Egyptian Journal of Surgery 2020 39(2):437-442
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_236_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Low residual volume in donors for living donor liver transplantation,
           donor safety

    • Authors: Mohamed A.S Abdel Hamid, Hany S Abd El Baset, Mahmoud Taalat
      Pages: 443 - 450
      Abstract: Mohamed A.S Abdel Hamid, Hany S Abd El Baset, Mahmoud Taalat
      The Egyptian Journal of Surgery 2020 39(2):443-450
      Background Liver transplantation is the treatment of choice for cirrhotic patients, decompensated disease, fulminant hepatitis, and hepatocellular carcinomas within Milan criteria. In the past decades, liver transplantation has progressed from an experimental approach with a very high mortality to an almost ordinary procedure with good short-term and long-term survival rates.Aim The aim of the present study was to investigate the relationship between donor recovery, postoperative complications, and the volume of remnant liver.Patients and methods This is a retrospective observational cohort study that included 63 liver donors operated upon in Ain Shams Specialized Hospital and in Egypt Air Hospital from January 2016 to January 2018, who were divided into in two groups: group A with residual volume with Middle Hepatic Vein (MHV) ranging from 33 to 35% with 19 donors in it, and group B with residual volume with MHV ranging from 35 to 38% with 44 donors in it.Results There was no significant difference between the two groups regarding age, sex, steatosis, and operation center. Comparing the two groups according to postoperative bilirubin resulted in no significant difference between the two groups. Moreover, comparing complications [grade according to modified Clavien scale of post-operative complications (P=0.966), as well as type ‘respiratory, cardiac, vascular, wound infection, intraperitoneal hematoma, biliary complications, pancreatitis, hernia, and multiple complications’ (P=0.499)] did not result in any statistical difference between the two groups in spite of the mild complications.Conclusion Low residual volume up to 33% in donors of living-donor liver transplantation does not affect their safety, as there is no difference in the increase in the recovery period. Moreover, there is no significant difference in postoperative complications rate regarding donors with residual volume more than 35%, and at the same time, increase the availability of liver graft for patients in need for transplantation.
      Citation: The Egyptian Journal of Surgery 2020 39(2):443-450
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_237_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • In early breast cancer: preoperative ultrasound skin marking reduces
           recurrence in Egyptian patients

    • Authors: Sherif M Mokhtar, Karim G Moustafa, Ebram A.Y Abdelnor, Ahmed M.H Shazly
      Pages: 451 - 454
      Abstract: Sherif M Mokhtar, Karim G Moustafa, Ebram A.Y Abdelnor, Ahmed M.H Shazly
      The Egyptian Journal of Surgery 2020 39(2):451-454
      Background For patients with early-stage breast cancer, negative surgical margins at the first breast-conserving surgery minimize the need for reoperation and likely reduce postoperative anxiety. Preoperative skin mapping of the breast mass by ultrasonography (US) is one of the applied techniques to delineate optimal resection margins to insure safety without jeopardizing the cosmetic outcome. This study was conducted to evaluate the efficacy of preoperative skin mapping of the breast mass and margins using US to achieve free surgical margins.Patients and methods The study was conducted at the General Surgery Department of Kasr Al-Aini Cairo University Hospital from December 2017 through July 2018. It included 30 female patients who presented with stages 1 and 2 breast cancer and planned to be candidates for breast-conserving surgery. They were divided into two equal groups: groups I and II. Preoperative skin mapping of the tumor margin by US was done in group I, while group II patients were kept as a control without US mapping.Results Group I patients had negative margins in 93.3% compared with 80% in group II. Positive margins necessitated re-excision.Conclusion Preoperative US-guided skin mapping of breast tumor margins is an easy, noninvasive technique that is not time consuming, and gives a better chance to the surgeon to excise the tumor safely with free surgical margins.
      Citation: The Egyptian Journal of Surgery 2020 39(2):451-454
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_239_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Comparison between Australasian triage scale and emergency severity index

    • Authors: Zaynab M Elsayed, Asmaa B El-Zeny, Mohamed S Moustafa, Hany A Ellouly
      Pages: 455 - 460
      Abstract: Zaynab M Elsayed, Asmaa B El-Zeny, Mohamed S Moustafa, Hany A Ellouly
      The Egyptian Journal of Surgery 2020 39(2):455-460
      Background The aim of triage system is to ensure that the treatment of patients in the Emergency departments will be according to their clinical urgency. Also, it decreases waiting time and helps in proper direction of the patients to the most suitable area for better assessment and treatment.Aim of the Work The purpose of this study is to compare the efficiency of Australasian Triage Scale versus the Emergency Severity Index triage systems.Methods Full medical history of 167 Patients arrived at the ED from January till March 2016 were recorded, chief complain, examination, resources number also were recorded and triaged by both systems.Results Our results revealed that the most frequent age group was between 20 to 40 years old, while the least frequent age group was ≥80 years old. The frequency of male patients was higher than the female patients. ATS and ESI were agreed in urgency level 1. Urgency level 2 and 5 was higher in ESI system while, Urgency level 3 and 4 was higher in ATS. The majority of the patients were discharged, while only 2.4 percent were dead. There were insignificant differences between ATS system and final outcome regarding degree of urgency. While, there was significant over-triage in urgency level 2, while there was significant under-triage in urgency levels 3–5 in comparison to final outcome.Conclusion We found that both systems are applicable, but ESI showed some limitation. So we recommended using ATS since it was easier to use and did not show any limitation.
      Citation: The Egyptian Journal of Surgery 2020 39(2):455-460
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_1_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • Laparoscopic totally extraperitoneal hernioplasty: Theodor Bilharz
           Research Institute preliminary experience

    • Authors: Hesham A Elmeligy, Ayman E Nafea, Mohamed E Esmat, Ahmed M Abdelaziz, Amr Mostafa
      Pages: 461 - 465
      Abstract: Hesham A Elmeligy, Ayman E Nafea, Mohamed E Esmat, Ahmed M Abdelaziz, Amr Mostafa
      The Egyptian Journal of Surgery 2020 39(2):461-465
      Background The two standard methods for inguinal hernioplasty is open and minimal access laparoscopic technique. Most laparoscopic surgeons use a transabdominal preperitoneal approach but totally extraperitoneal (TEP) approach potentially offers several advantages.Objective The aim in this study was to assess the learning curve, cost value, safety, and feasibility of TEP approach.Patients and methods Prospectively collected data on 185 consecutive patients submitted to laparoscopic TEP hernioplasty for inguinal hernia from 2016 to 2018 in Theodor Bilharz Research Institute Hospital. This study involved repair of primary, recurrent inguinal hernia and femoral hernia. The prolene mesh was used for groin hernia repair in all cases with and without fixation.Results All 185 cases started with the laparoscopic TEP technique with only four cases converted to transabdominal preperitoneal technique (2.1%). In 110 (60.7%) cases the mesh was placed without fixation. In 71 cases the mesh was fixed by Tackers or Histoacryl. In unilateral hernia, the mean operating time was 45 min, while in bilateral hernia it was 61 min. Intraoperative complications included three cases of inferior epigastric vessel injury which were managed by metallic clips of 5 mm. The mean pain score was 7.5, while the mean satisfaction score was 5.4. The mean hospital stay was 16.4 h. Regarding postoperative complications, 10 (5.5%) patients developed a postoperative seroma, four (2.1%) patients developed a hematoma, two (1.1%) patients developed a hydrocele, and five (2.7%) patients experienced neuropathic pain. There were three (1.1%) recurrent cases; all these cases were managed by open hernioplasty.Conclusion In this study, the laparoscopic TEP approach is found to be an effective, and safe technique regarding primary, recurrent open inguinal and femoral hernias with good learning curve to laparoscopic surgeon who started with transabdominal preperitoneal technique technique.
      Citation: The Egyptian Journal of Surgery 2020 39(2):461-465
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_2_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • Retrograde popliteal and pedal access in management of superficial femoral
           artery occlusion after failed antegrade approach: a comparative study

    • Authors: Osama A Ismail
      Pages: 466 - 475
      Abstract: Osama A Ismail
      The Egyptian Journal of Surgery 2020 39(2):466-475
      Aim To evaluate feasibility, efficacy, and safety of popliteal access compared to tibial retrograde approach for management of chronic total occlusion of superficial femoral artery after failed antegrade recanalization.Patients and methods The study was carried out from January 2016 to April 2019 at Sohag University Hospitals on 30 patients experiencing chronic total occlusion of superficial femoral artery and underwent retrograde transpopliteal or transpedal approach after failed antegrade intervention. Technical success and procedure-related complications were evaluated and compared among patient groups.Results Popliteal access was performed in 14 patients, whereas pedal puncture was accessed in 16 patients. Mean age was 57 (50–64) and 63 (52–65) years in popliteal and pedal access groups, respectively. There were no significant differences in patient baseline characteristics. Arterial puncture was successful in pedal than popliteal access (94.4 vs. 92.9%, P=0.96). Technical success was higher in patients with pedal access than those with popliteal puncture (87.5 vs. 78.6%, P=0.19). Operative time was shorter in pedal access than popliteal access (90±35, 120±28 min, P=0.04). Time to achieve hemostasis was 12±4.6 and 5±1.7 min in popliteal and pedal access, respectively (P=0.022). Access-site hematoma was higher in popliteal access group than pedal access group (28.6 vs. 6.3%, respectively, P=0.042). Spasm of pedal vessels occurred in three (18.8%) patients, acute thrombosis in two (6.7%) patients, access-site occlusion in one (6.3%) patient, and wire perforation in two (12.5%) patients.Conclusion When antegrade revascularization fails, retrograde access offers another endovascular option to treat critical limb ischemia before going to open vascular surgery, especially in high surgical risk patients. When both popliteal and pedal approaches are available, pedal access procedure is more preferable as it is relatively easier with less puncture-site complication.
      Citation: The Egyptian Journal of Surgery 2020 39(2):466-475
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_4_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • Twenty-year experience in the treatment of horseshoe perianal fistula by
           one-stage lay-open operation

    • Authors: Ahmed A Abou-Zeid, Sherif A Halim, Mostafa M.S Ismail
      Pages: 476 - 482
      Abstract: Ahmed A Abou-Zeid, Sherif A Halim, Mostafa M.S Ismail
      The Egyptian Journal of Surgery 2020 39(2):476-482
      Background Perianal fistula is an abnormal hollow track or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracks may be multiple and can extend from the same primary opening. Horseshoe fistula is a type of trans-sphincteric fistula with multiple complex secondary tracks. Treatment of horseshoe fistula is challenging.Aim The aim was to describe the surgical technique that we use for the treatment of horseshoe perianal fistula and to study its effect on recurrence and continence.Patients and methods This is a single-center 20-year experience study in the management of horseshoe fistula. A total of 893 patients with horseshoe perianal fistula were enrolled into the study by retrospective method. The study is conducted in Ain Shams University Hospitals. All patients underwent single-stage lay-open technique. Follow-up continued till 2 years after surgery to detect recurrence and/or incontinence.Results After 6 months of follow-up, only 71 (7.95%) patients had recurrent fistula. Moreover, 26 patients were incontinent to stool and flatus, 39 patient to gases only, and 34 patients were complaining from staining of the underwear once per week using Wexner score. A total of 794 (88.9%) patients were completely continent to both stool and flatus.Conclusion Single-stage lay open is an effective technique to eradicate the complex horseshoe perianal fistula with minimal recurrence and acceptable degrees of incontinence.
      Citation: The Egyptian Journal of Surgery 2020 39(2):476-482
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_5_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • Management of postlaparoscopic cholecystectomy bile leakage: in the
           presence of MRCP, when to send the patient to undergo ERCP?

    • Authors: Taher H Elwan, Mokhtar A Bahbah
      Pages: 483 - 488
      Abstract: Taher H Elwan, Mokhtar A Bahbah
      The Egyptian Journal of Surgery 2020 39(2):483-488
      Objective The aim was to investigate cases of postlaparoscopic cholecystectomy (LC) bile leakage and aim to check if endoscopic retrograde cholangiopancreatography (ERCP) is mandatory for every patient or only for selected cases.Patients and methods The present study includes 35 patients who had a bile leak following LC and subjected to conservative (nonoperative) management and had a patent biliary tree and normal anatomy in the magnetic resonance cholangiopancreatography (MRCP) study. Patients were distributed into two groups. Group A included 20 patients who did not undergo an ERCP, while the second group included 15 patients who underwent an ERCP from the start. The efficacy and outcomes of both lines of management and the time needed to fistula closure were studied. Data were collected, recorded, and statistically analyzed.The results In group A, conservative management succeeded in 18/20 of patients, while the remaining two patients were sent to undergo ERCP due to a distressing bile leakage after a time of conservative management. In group B, the first ERCP failed to help in the cessation of bile leak in 2/15 patients (13%), so they underwent a second ERCP. The mean hospital stay was higher (but not significant) in the non-ERCP group, 5.19±4.72 vs 4.88±3.41 days in the ERCP group. The pain scores, fever, and many other morbidities were higher in the ERCP group.Conclusion In post-LC bile leak, ERCP is not mandatory for patients who have a patent biliary tree with normal anatomy in MRCP study. In these patients, ERCP is better to be avoided as an initial step and should be restricted to the resistant cases.
      Citation: The Egyptian Journal of Surgery 2020 39(2):483-488
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_6_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • Abdominal wall dehiscence in emergency midline laparotomy: incidence and
           risk factors

    • Authors: Tarek O Hegazy, Salah S Soliman
      Pages: 489 - 497
      Abstract: Tarek O Hegazy, Salah S Soliman
      The Egyptian Journal of Surgery 2020 39(2):489-497
      Background Burst abdomen is a very serious postoperative complication associated with high morbidity and mortality. It has a significant effect on health care cost, for both the patients and the hospitals.Purpose The aim of this study was to assess the incidence and perioperative risk factors of burst abdomen in patients undergoing emergency midline laparotomy.Patients and methods A prospective cohort study was conducted on 250 patients who underwent midline laparotomy at Kasr Al-Ainy Hospital Emergency Department, Cairo University, from August 2017 until August 2018. Factors such as age, sex, BMI, substance abuse, previous laparotomy, malignancy, diabetes mellitus, ascites, albumin, renal functions, bilirubin, hemoglobin, intra-abdominal pathology, suture material, creation of stoma, postoperative chest infection, postoperative paralytic ileus, leakage, and wound infection were observed and analyzed.Results Incidence of burst abdomen was 12.4%. Wound infections (87.1 vs. 18.7%, P<0.001), anemia (48.4 vs. 5%, P<0.001), diabetes (41.9 vs. 10%, P 0.001), hypoalbuminemia (64.5 vs. 27.4%, P<0.001), previous laparotomy (29 vs. 2.7%, P<0.001), creation of stoma (48.8 vs. 18.7%, P<0.001), chest problems (51.6 vs. 15.1%, P<0.001), ascites (22.6 vs. 4.6%, P<0.001), leakage (38.7 vs. 0%, P<0.001), and peritonitis (71 vs. 45.7%, P<0.001) were statistically significant factors.Conclusion Important risk factors according to our study were wound infection, anemia, previous laparotomy, creation of stoma, hypoalbuminemia, ascites, diabetes, type of intra-abdominal pathology, with maximum incidences in peritonitis, postoperative cough, and postoperative leakage. Patient sex, age, associated morbidities such as jaundice and uremia, previous use of steroids, suture material used in closure, and postoperative paralytic ileus were not significant in our study.
      Citation: The Egyptian Journal of Surgery 2020 39(2):489-497
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_7_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • A new modified technique in complicated umbilical hernia repair in
           patients with decompensated cirrhosis: a single center Experience

    • Authors: Taha Yassein, Mohamed Mless, Islam Ayoup, Mohammad Taha, Eman Sayed, Amr Mostafa, Tarek Ibrahim
      Pages: 498 - 504
      Abstract: Taha Yassein, Mohamed Mless, Islam Ayoup, Mohammad Taha, Eman Sayed, Amr Mostafa, Tarek Ibrahim
      The Egyptian Journal of Surgery 2020 39(2):498-504
      Background Patients with decompensated cirrhosis have a high incidence of abdominal wall hernias with a poor outcome after surgical management.Aim The aim was to evaluate the outcome of a new technique in the repair of complicated umbilical hernias in patients with decompensated cirrhosis.Patients and methods In all, 30 consecutive patients with decompensated cirrhosis underwent herniorrhaphy for complicated hernia and were randomized into two groups: group I (n=15) received the new technique: three-transverse-layer technique with regular paracentesis, first, 5–7 interrupted sutures without tie; second, continuous suture starting 3 cm lateral to the angles, third, tie the previous interrupted suture over the continuous tied suture, fourth, the third layer continuous suture to invaginate the previous sutures (using Proline 1/0 at all), fifth, regular paracentesis. Group II (n=15) received two continuous transverse-layer repair, first, suture started 1 cm lateral to the angle and then completed in a continuous manner till 1 cm after the second angle and tied; second, this was then followed by the second layer continuous suture to invaginate the previous sutures.Results Postoperatively, there were complications in 14 (46.67%) patients in the form of wound infection in three (20%) patients in group I and seven (46.67%) patients in group II with no statistical significance between both groups. Wound dehiscence occurred in five (33.33%) patients in group II only with statistical significance between both groups (P<0.05). Wound leakage also occurred in eight (53.33%) patients of group II with statistical significance between both groups (P<0.05). During the follow-up after 6 months and 1 year, the overall recurrence showed statistical significance regarding the new modified technique.Conclusion The new technique of hernia repair in patients with decompensated liver cirrhosis was associated with a significant reduction in wound ascitic leak, wound dehiscence, hospital stay, morbidity, and recurrence.
      Citation: The Egyptian Journal of Surgery 2020 39(2):498-504
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_18_20
      Issue No: Vol. 39, No. 2 (2020)
       
  • Role of biliary stenting for large impacted stone in common bile duct

    • Authors: Amer N Omar
      Pages: 505 - 511
      Abstract: Amer N Omar
      The Egyptian Journal of Surgery 2020 39(2):505-511
      Introduction Large choledocholithiasis is associated with higher rates of failed extraction with conventional endoscopic techniques. Alternative methods such as electrohydraulic lithotripsy and extracorporeal shock wave lithotripsy, laser lithotripsy, and dissolving solutions can remove 90% of difficult common bile stones. However, these methods are indicated only in special situations and require experience and additional equipment that may not be available in every center.Aim The aim of this study was to investigate the efficacy of biliary stenting in the treatment of endoscopically nonextractable common bile duct (CBD) stones.Patients and methods A total of 46 patients with endoscopically nonextractable CBD stones underwent placement of a plastic biliary stent. After 6 months, a second endoscopic retrograde cholangiopancreatography (ERCP) was performed, and endoscopic stone removal was again attempted. Differences in stone size and CBD diameter before and after biliary stenting were compared. The complete stone removal rate after treatment was determined.Results The second ERCP procedure showed that the bile stone disappeared in 11 (23.91%) patients. Decreased stone size with complete stone removal was achieved in 29 (63.04%) patients. No significant changes were observed in the sizes of CBD stones, and stone extraction eventually failed in six (13.04%) patients. Thus, in 40 (87%) patients with nonextractable stones, successful stone extraction was performed during the second ERCP.Conclusion Temporary biliary stenting has an established place in the management of large CBD stones and can facilitate stone extraction by a basket or a balloon catheter in the second ERCP.
      Citation: The Egyptian Journal of Surgery 2020 39(2):505-511
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/ejs.ejs_167_19
      Issue No: Vol. 39, No. 2 (2020)
       
  • Erratum: laparoscopy-assisted transumbilical extracorporeal cyst deroofing
           for the management of neonatal ovarian cysts

    • Pages: 512 - 512
      Abstract:
      The Egyptian Journal of Surgery 2020 39(2):512-512

      Citation: The Egyptian Journal of Surgery 2020 39(2):512-512
      PubDate: Mon,27 Apr 2020
      DOI: 10.4103/1110-1121.283177
      Issue No: Vol. 39, No. 2 (2020)
       
 
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