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Publisher: Medknow Publishers   (Total: 426 journals)

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Showing 1 - 200 of 426 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: 4)
Advances in Skeletal Muscle Function Assessment     Open Access  
African J. for Infertility and Assisted Conception     Open Access  
African J. of Medical and Health Sciences     Open Access   (Followers: 2)
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: 3)
Al-Azhar Assiut Medical J.     Open Access  
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Alexandria J. of Pediatrics     Open Access  
Ancient Science of Life     Open Access   (Followers: 5)
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: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14, 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: 13, 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  
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: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Pharmacy Practice     Open Access   (Followers: 10, SJR: 0.102, CiteScore: 0)
Archives of Trauma Research     Open Access   (Followers: 3, SJR: 0.37, CiteScore: 2)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
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  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access   (Followers: 1)
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Canadian J. of Rural Medicine     Full-text available via subscription   (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: 4)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access  
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 9, SJR: 0.811, CiteScore: 2)
Contemporary Clinical Dentistry     Open Access   (Followers: 4, SJR: 0.353, CiteScore: 1)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.543, CiteScore: 1)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 4, SJR: 0.152, CiteScore: 0)
Dental Research J.     Open Access   (Followers: 12, SJR: 0.416, CiteScore: 1)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 6, SJR: 0.242, CiteScore: 0)
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: 2)
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: 3)
Eurasian J. of Pulmonology     Open Access  
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.749, CiteScore: 2)
European J. of General Dentistry     Open Access   (Followers: 1, SJR: 0.12, CiteScore: 0)
European J. of Prosthodontics     Open Access   (Followers: 3)
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: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
Ibnosina J. of Medicine and Biomedical Sciences     Open Access  
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: 1)
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: 2)
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: 2, 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: 4, 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: 6, SJR: 0.454, CiteScore: 1)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 2, SJR: 0.276, CiteScore: 1)
Indian J. of Pharmacology     Open Access   (SJR: 0.412, CiteScore: 1)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.311, CiteScore: 0)
Indian J. of Psychiatry     Open Access   (Followers: 3, 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: 4)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Respiratory Care     Open Access  
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: 2)
Indian J. of Transplantation     Open Access  
Indian J. of Urology     Open Access   (Followers: 3, 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: 1)
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: 5, 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: 1)
Intl. J. of Orthodontic Rehabilitation     Open Access   (Followers: 1)
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: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)
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  [426 journals]
  • Emergency versus delayed laparoscopic cholecystectomy for acute
           cholecystitis

    • Authors: Ahmed Salah Arafa, Mostafa Mohamed Khairy, Mohamed Farouk Amin
      Pages: 171 - 179
      Abstract: Ahmed Salah Arafa, Mostafa Mohamed Khairy, Mohamed Farouk Amin
      The Egyptian Journal of Surgery 2019 38(2):171-179
      Background Acute cholecystitis (AC) is a major complication of gallstones. Laparoscopic cholecystectomy for AC has still not become routine because the timing and approach to the surgical management in patients with AC is still a matter of debate among general surgeons. The aim of this investigation is to clarify the safety and feasibility of the emergency or early laparoscopic cholecystectomy (ELC) for AC in comparison with the interval or delayed laparoscopic cholecystectomy (DLC) regarding procedure safety, operating time, injury to bile ducts, postoperative pain, total length of hospital stay, cost factor, loss of active days of work (days away from work), and conversions to open cholecystectomy.Patients and methods One hundred forty-eight patients were managed by laparoscopic cholecystectomy for AC and were randomized into two groups; the first (early) group (n=74) was managed by ELC and was carried out within 72 h of onset of symptoms, while the second (interval) group was managed by DLC and was carried out at least 6 weeks after symptoms settled. Clinical presentation, duration of symptoms, ultrasound findings, frequency of conversion to open operation, and numbers/types of complications were recorded. Moreover, the statistical analysis was carried out using the Statistical Package for Social Sciences.Results Our study claimed that ELC has a low conversion rate, shorter operative time, postoperative course, and significantly shorter total hospital stay (P<0.001) but longer operation time without an increase in morbidity to the patient.Conclusion Current evidence supports ELC as the preferred treatment strategy for patients presenting with AC. It allows a shorter hospital stay and greater patient satisfaction, but shares similar operative morbidity, mortality, and conversion rate as DLC.
      Citation: The Egyptian Journal of Surgery 2019 38(2):171-179
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_5_19
      Issue No: Vol. 38, No. 2 (2019)
       
  • Endovascular management of iliac vein compression syndrome: a prospective
           case series of 61 patients

    • Authors: Ahmed K Gabr, Ahmed K Allam
      Pages: 180 - 193
      Abstract: Ahmed K Gabr, Ahmed K Allam
      The Egyptian Journal of Surgery 2019 38(2):180-193
      Context Iliac vein compression syndrome (IVCS) or May–Thurner syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression. The pathology of this condition is secondary to a partial obstruction of the common iliac vein by an overlying common iliac artery with subsequent entrapment of the left common iliac vein. Clinical presentations include, but not limited to, pain, swelling, venous stasis ulcers, and skin discoloration. With extensive deep venous thrombosis, postphlebitic syndrome, with all its sequelae, may also develop. Endovascular interventions of this syndrome have become first-line therapy.Aims To estimate the prevalence of IVCS in patients with unilateral left lower limb venous disease [chronic venous disease (CVD)], assess the sensitivity and specificity of modified computed tomography venography in the diagnosis of IVCS, and evaluate the feasibility and effectiveness of the endovascular treatment.Settings and design This was a prospective case series study. The study was performed at three tertiary referral centers in Kingdom of Saudi Arabia (Security Forces Hospital Program, Al-Noor Specialist Hospital, Makkah, Almoosa Specialist Hospital, Al-Ahsaa) and three hospitals in Egypt (Benha University Hospitals, Nile Insurance Hospital, and Kuwaiti Specialized Hospital, Benha).Patients and methods Between March 2015 and February 2018, we evaluated 369 patients with unilateral left lower limb symptomatic CVD in the outpatient clinic of vascular surgery in the study hospitals. Sixty-one symptomatic patients with IVCS who received endovascular treatment were included in our study.Statistical analysis used The initial data entry used Microsoft excel (2010 version) for logical proofreading and analysis. We expressed continuous data as mean±SD and compared continuous variables using two-sided Student’s t tests. We estimated stent patency using Kaplan–Meier method. We considered P value less than 0.05 to be statistically significant. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences software (version 22 for Windows program package).Results The 1-year patency rates in the nonthrombotic and thrombotic IVCS groups were 95.7 and 80%, respectively (P=0.146). The overall primary patency rate at 1 year after treatment was 93%. Complete pain relief was achieved in 76.7% of patients. The overall edema relief rate was 78.1%. Of the 12 limbs with active ulceration before treatment, 10 (83.3%) healed completely.Conclusion IVCS is not an uncommonly encountered condition, especially among patients with unilateral left lower extremity CVD. Computed tomography venography with three-dimensional reconstruction images was more sensitive and specific as a diagnostic approach for IVCS and provided useful information for the endovascular treatment planning. Moreover, endovascular therapy is feasible and effective for treating left-sided IVCS with high technical success rate and with an acceptable complication profile. So, we concluded that endovascular treatment should be considered as the first line of therapy for patients experiencing IVCS.
      Citation: The Egyptian Journal of Surgery 2019 38(2):180-193
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_108_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Feasibility of laparoscopic cholecystectomy in patients with previous
           upper abdominal surgery

    • Authors: Tamer Nabil, Ahmed Hussein, Salah Soliman, El-Ashraf Thabet
      Pages: 194 - 197
      Abstract: Tamer Nabil, Ahmed Hussein, Salah Soliman, El-Ashraf Thabet
      The Egyptian Journal of Surgery 2019 38(2):194-197
      Background and aim There is still a considerable percentage of patients in whom laparoscopic cholecystectomy (LC) cannot be successfully performed and conversion to open surgery is required. The potential risks have dissuaded some surgeons from using the laparoscopic procedure in patients with symptomatic gallstones and previous upper abdominal surgery (UAS). The aim of this study is to investigate the impact of previous UAS on the successful performance of LC.Patients and methods Between September 2016 and September 2017, 50 patients with previous UAS and symptomatic cholelithiasis were subjected to LC. Intraoperative data regarding difficulties, duration of surgery, rate of conversion, and any incidental postoperative event were recorded.Results No mortality occurred. Adhesiolysis was not required in all cases. There were no complications directly attributable to adhesiolysis. Postoperative complications occurred in 12 (24%) patients. The procedure was completed laparoscopically in 44 patients with a 12% conversion rate.Conclusion Previous UAS is not a contraindication to safe LC, but is associated with an increased need for adhesiolysis, a longer operative time, an increased open conversion rate, and sometimes a larger number of trocars.
      Citation: The Egyptian Journal of Surgery 2019 38(2):194-197
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_112_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Comparative study between no touch technique and conventional method in
           the distal radio cephalic arterio venous fistula for hemodialysis

    • Authors: Mahmoud S Eldesouky
      Pages: 198 - 203
      Abstract: Mahmoud S Eldesouky
      The Egyptian Journal of Surgery 2019 38(2):198-203
      Background The distal radiocephalic arteriovenous fistula (RC-AVF) is the gold standard for hemodialysis but has significant failure rates owing to occlusions and failure to mature. The size and quality of the veins play an important role in the patency of the fistula.Objective The aim of this study was to evaluate the no-touch technique compared with the conventional method in the distal radiocephalic fistula for hemodialysis in terms of patency and complications.Patients and methods A prospective randomized study including 80 patients with ESRD in need for hemodialysis access was done between March 2016 and March 2017 and followed up to October 2017 at Menoufia university hospital. The patients were randomly categorized into two groups (no-touch group that included 40 patients where the vein and artery were dissected with the surrounding tissue cushion and conventional group that included 40 patients). Primary failure, primary and secondary patency rates, and complications of each group were collected and analyzed. Patients with vein caliber less than 2.5 mm, previous arteriovenous fistula, without venous continuity in the arm, or with severely atherosclerotic radial artery were excluded from the study.Results In the no-touch group, primary fistula failure was 7.5%, whereas three (7.5%) fistulas failed later one owing to thrombosis (one case), anastomotic pseudoaneurysm (one case), and anastomotic stenosis (one case). Primary and secondary patency rates at 6 months were 85 and 90%, respectively, whereas in the conventional group, primary fistula failure was 17.5%, whereas eight (20%) fistulas failed later owing to thrombosis (two cases), anastomotic pseudoaneurysm (two cases), anastomotic stenosis (three case), and venous hypertension (one case). Primary and secondary patency rates at 6 months were 62.5 and 67.5%, respectivelyConclusion The results of this study indicate that no-touch technique can be used for primary radiocephalic fistula surgery with better patency rate and less complications compared with conventional method. This method offers the potential to create a RC-AVF in patients with distal cephalic veins 2.5 mm or more in caliber with encouraging results.
      Citation: The Egyptian Journal of Surgery 2019 38(2):198-203
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_142_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Drug-eluting balloon angioplasty versus bare-metal stent in treating
           chronic total occlusion of femoropopliteal arterial segment: a review of
           1-year outcome of 90 patients with TASC C and D lesions

    • Authors: Ahmed K Allam, Mohamed Ismail
      Pages: 204 - 213
      Abstract: Ahmed K Allam, Mohamed Ismail
      The Egyptian Journal of Surgery 2019 38(2):204-213
      Background Bare-metal stent (BMS) scaffolding of superficial femoral artery occlusive lesions has been associated with high rates of late clinical failure. Maintaining the patency of recanalized arterial segments was the main issue behind the concept of leaving nothing behind to be evolved and percutaneous balloon angioplasty becomes the preferred option for endovascular therapy. Drug-eluting balloons (DEBs) have shown to be an effective alternative to BMS for patients with de novo complex superficial femoral occlusive disease.Aims The aim was to compare the outcome of DEB versus BMS in treating complex chronic total occlusion of superficial femoral and proximal popliteal artery in patients with disabling claudication and critical limb ischemia regarding technical success, primary patency, clinically driven target lesion revascularization (cd-TLR), and limb salvage rate.Materials and methods The current study is a multicenter, prospective, randomized study. Ninety patients (110 limbs) complaining of disabling and critical limb ischemia due to complex femoropopliteal occlusive lesions were randomly allocated into two groups according to the intervention method performed. Group A included 48 patients (57 limbs) who were submitted for treatment with paclitaxel DEBs and group B included 42 patients (53 limbs) submitted for treatment with BMS. The follow-up period was for 1, 6, and 12 months. Statistical analysis was performed by using the IBM SPSS Statistics version 22 for Windows Program Package (SPSS Inc., Chicago, IL, USA).Results BMSs seem to have lower patency and higher cd-TLR rates compared with patients who received paclitaxel drug-coated balloons but was not statistically significant. The primary patency rates were 100, 96, and 86.2% at 1, 6, and 12 months’ respectively’ in the DEB group versus 100, 89.8, and 77.6% at 1, 6, and 12 months, respectively, in the BMS group. Clinically driven TLR rates were 2 and 7.8% at 6 and 12 months, respectively, in the DEB group versus 6.1 and 14.2% at 6 and 12 months, respectively, in the BMS group.Conclusion Percutaneous therapy for Trans atlantic inter-societies consensus (TASC) C and D femoropopliteal lesion using DEB or BMS is safe and effective with a high patency rate of 1 year. Paclitaxel drug-eluting balloons seem to have a promising role in the prevention of restenosis and recurrence of peripheral arterial occlusive disease. However, stents are still playing important bailout role in the treatment of residual stenosis and dissection. Further follow-up is essential to obtain and document long-term outcome of different percutaneous therapy for complex and long superficial femoral artery (SFA) lesions.
      Citation: The Egyptian Journal of Surgery 2019 38(2):204-213
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_146_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • The effect of laparoscopically assisted versus open resection of rectal
           cancer on short-term and pathological outcomes: a randomized controlled
           trial

    • Authors: Radwan A Torky, Ashraf A Helmy, Ahmed Ali, Abdallah B Abdallah, Ahmed T Zayan
      Pages: 214 - 220
      Abstract: Radwan A Torky, Ashraf A Helmy, Ahmed Ali, Abdallah B Abdallah, Ahmed T Zayan
      The Egyptian Journal of Surgery 2019 38(2):214-220
      Background Laparoscopic surgery in colon cancer is well established, but its use in rectal cancer is still controversial as it needs a long duration of learning curve; moreover, its oncological adequacy is questionable. This study was conducted to compare laparoscopic and open approaches regarding the short term as well as the oncological outcomes.Materials and methods A prospective randomized study was conducted to compare between open and laparoscopic surgeries regarding short-term and oncological outcomes. Two groups (31 patients in LAP group and 32 patients in the OPEN group) were classified in the study.Results A total of 63 patients with rectal cancer included in the study in the period between January 2015 and March 2016 were classified into two groups: LAP group (31 patients) and OPEN group (32 patients). They underwent rectal cancer resection according to the allocated surgery. There was a longer operative time in LAP group with a significant improved short-term outcomes (blood loss, postoperative pain, postoperative hospital stay, and rapid gastrointestinal tract recovery). There was no difference in morbidities and local and distant recurrence between the two groups. The conversion rate was 12.9% in the LAP group, whereas the median number of removed lymph nodes was 12 in the LAP group and 10 in the OPEN group, with no significant difference.Conclusion Laparoscopy can be used safely in rectal cancer resection with an acceptable short-term outcomes, but it is a difficult technique and needs a learning curve. Its oncological outcomes are still a matter of debate.
      Citation: The Egyptian Journal of Surgery 2019 38(2):214-220
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_167_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Double-mesh technique abdominal wall reconstruction for severe rectus
           diastasis and ventral hernia repairs (two for two)

    • Authors: Hassan A Saad, Ahmed M El Teliti, Alaa A Fiad, Ibrahim A.I Heggy
      Pages: 221 - 230
      Abstract: Hassan A Saad, Ahmed M El Teliti, Alaa A Fiad, Ibrahim A.I Heggy
      The Egyptian Journal of Surgery 2019 38(2):221-230
      Introduction Standard rectus plication techniques may not suffice for severe cases of rectus diastasis, especially with ventral hernia. In our study, prosthetic subfascial sublay mesh and onlay mesh may facilitate the repair of severe rectus diastases, especially with concomitant ventral hernias. There is little agreement about the most appropriate technique to repair these defects, in spite of the fact in the prevalence of ventral hernias we are often faced with reinforcement with prosthetic meshes. In the component separation technique, we found high unaccepted recurrence rate. In an attempt to reduce recurrences, we attempt to use sublay mesh and onlay mesh to inforce the defect and prevent or to decrease the recurrence. Our objective was to determine prosthetic mesh practice patterns of onlay and sublay reconstructive methods regarding indications.Patients and methods A total of 32 consecutive patients who underwent abdominal wall reconstruction by means of component separations associated with polypropylene mesh were included. A technique of placing mesh in a sublay manner, deep to the rectus muscles without anterior dissection of rectus abdominis from anterior sheath to avoid damage of its blood supply and damage deep umbilical perforators during dissection ended by onlay mesh on anterior rectus sheath, was applied. The complications were recorded and follow-up data were obtained after double-mesh technique.Aim To use prosthetic polypropylene mesh sublay (above or anterior to the posterior rectus sheath) with another onlay mesh (above the anterior rectus sheath) for rectus diastasis with or without ventral hernia.Results From May 2016 to January 2018, we had 16 patients who underwent cosmetic abdominal repair either for a ventral hernia repair with mesh or a rectus diastasis repair with mesh. Three patients had (isolated) rectus diastasis alone. The mean age of the patients was 55 years, with a range of 35–75 years of age. Overall, 92% of the patients were female. The mean;Deg;BM;Deg;I of the patients was 32 kg/m2 (range: 25–40 kg/m2). There were no surgical-site infections but three surgical-site occurrences − seromas, which were treated with drainage in the office. After an average of 365 days of follow-up, none of the patients had recurrence of a bulge or a hernia.Conclusion This study used a double-mesh reinforcement procedure, with a low rate of recurrence and occurrences. Moreover, the repair of a large, complex hernia by double-mesh repair technique augmented with polypropylene onlay mesh and sublay results in lower recurrence rates compared with historical reports of component separation technique alone.
      Citation: The Egyptian Journal of Surgery 2019 38(2):221-230
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_178_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Failing arteriovenous access: endovascular option

    • Authors: Abdulaziz Z AlGaby, Alaa A.H Marzouk, Khaled Shawky, Mohamed H Abdelmawla
      Pages: 231 - 238
      Abstract: Abdulaziz Z AlGaby, Alaa A.H Marzouk, Khaled Shawky, Mohamed H Abdelmawla
      The Egyptian Journal of Surgery 2019 38(2):231-238
      Objective Hemodialysis access is considered the lifeline for patients with end-stage renal disease. So, maintaining it is extremely crucial for these patients. This study is designed to show the rule of percutaneous intervention to maintain their access.Patients and methods It is a prospective study conducted in Beni Suef University hospital from June 2016 to January 2018 on 20 patients with failing arteriovenous (AV) access. They were subjected to endovascular ballooning to relieve stenosis of their access and/or outflow vein. Efficacy, represented by technical success and clinical success, and complications of the procedure were assessed.Results The study revealed that 80% of the patients had technical success. However, 60% of the patients had their symptoms improved and succeeded to maintain their dialysis access. No major complications were attributed to the intervention. There was a strong association between lesions of total occlusion and technical failure.Conclusion Percutaneous treatment of dysfunctional or failing autologous dialysis fistulas can successfully and safely extend functional lifespan. Attention should be paid to lesions of total occlusion as they are difficult to cross and subsequently balloon dilatation.
      Citation: The Egyptian Journal of Surgery 2019 38(2):231-238
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_179_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Aortic remodeling after thoracic endovascular repair of acute
           uncomplicated type B aortic dissection

    • Authors: Hany A Mohamed, Ahmed R Tawfik, Mohammed Ali, Rana K Ali
      Pages: 239 - 244
      Abstract: Hany A Mohamed, Ahmed R Tawfik, Mohammed Ali, Rana K Ali
      The Egyptian Journal of Surgery 2019 38(2):239-244
      Introduction The classical treatment of type B aortic dissection is based on either medical treatment for uncomplicated aortic dissection or open surgery. Now with improvements in endovascular intervention, it seems to be more effective, safe, and with favorable effects on aortic remodeling.Patients and methods This is a retrospective study that aimed to evaluate the effect of thoracic endovascular repair (TEVAR) on remodeling in uncomplicated acute type B aortic dissection. Serial contrast-enhanced computed tomography scans of 32 patients with acute type B aortic dissection were performed and the data were collected between March 2018 and October 2018. Thirteen patients received best medical therapy only and 19 patients received best medical therapy and TEVAR, and the effect of TEVAR on aortic remodeling was compared by a computed tomography scan.Results Data of 32 patients (20 men and 12 women) with a median age of 59 years were collected; the median follow-up period was 6 months. TEVAR resulted in an increase in the true lumen diameter (from 2.0085 to 3.039 cm) and a decrease in the false lumen diameter (from 1.8767 to 0.785 cm). However, in the medical group only, the diameters remained almost unchanged (true lumen diameter ranged from 1.9024 to 2.3898 cm and false lumen diameter ranged from 1.9045 to 1.7245 cm).Conclusion TEVAR for acute type B aortic dissection resulted in a significant increase in the true lumen diameter and decrease in the false lumen diameter.
      Citation: The Egyptian Journal of Surgery 2019 38(2):239-244
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_181_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Comparative study of safety and effectiveness of rivaroxaban and warfarin
           in patients with acute deep venous thrombosis

    • Authors: Yahia M Al Khateep, Nehad A Zaid, Osama R.F Salim
      Pages: 245 - 249
      Abstract: Yahia M Al Khateep, Nehad A Zaid, Osama R.F Salim
      The Egyptian Journal of Surgery 2019 38(2):245-249
      Objectives To evaluate the safety and effectiveness of the oral anti-factor Xa (rivaroxaban) in comparison with that of traditional oral (warfarin) anticoagulants in patients in acute stage of deep-vein thrombosis.Background Standard treatment for venous thromboembolism (VTE) consists of a heparin combined with vitamin K antagonists. Direct oral anticoagulants have been investigated for acute and extended treatment of symptomatic VTE; their use could avoid parenteral treatment and/or laboratory monitoring of anticoagulant effects.Patients and methods A prospective study was conducted to compare the efficacy and safety of rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg once daily) with standard therapy (enoxaparin 1.0 mg/kg twice daily and warfarin or acenocoumarol). Patients were treated for 3, 6, or 12 months and followed for suspected recurrent VTE and bleeding.Results Our study included 200 patients in the acute stage of deep venous thrombosis. Half of them were treated by oral anti-factor Xa (rivaroxaban), which showed no significant difference in safety and effectiveness with warfarin. Partial and complete recanalization occurred in 64 and 16%, respectively, for rivaroxaban and in 48 and 24%, respectively, for warfarin, whereas pulmonary embolism and bleeding occurred in 8 and 16%, respectively, for rivaroxaban and 16 and 12%, respectively, for warfarin. Rivaroxaban was noninferior to warfarin with respect to primary efficacy and adverse effect outcome.Conclusion Our study results show nonsignificant difference between oral anti-factor Xa and the Low Molecular Weight Heparin (LMWH) and vitamin K antagonist technique in the treatment of acute stage of deep-vein thrombosis, but the oral anti-factor Xa (rivaroxaban) has an upper hand in being orally taken and needs less monitoring of coagulation profile.
      Citation: The Egyptian Journal of Surgery 2019 38(2):245-249
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_183_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Clinical assessment of short-term outcome of sphincter-sparing surgery in
           patients with low rectal carcinoma

    • Authors: Emad Hokkam, Mohamed Faisal, Mohamed Shams, Ahmed Gomaa, Hamada Fathey
      Pages: 250 - 256
      Abstract: Emad Hokkam, Mohamed Faisal, Mohamed Shams, Ahmed Gomaa, Hamada Fathey
      The Egyptian Journal of Surgery 2019 38(2):250-256
      Introduction Surgical oncology was born in excessive radicalism, but modern oncological surgery has become organ sparing and restorative. On this track, surgery for low rectal cancer is shifting from the abdominoperineal resection to the sphincter-sparing procedure. The new technique eliminates the need for permanent stoma and should provide cure rates equal to the more aggressive types of resection. The main aim of this study is to evaluate early outcome of sphincter-sparing surgery in patients with low rectal cancer.Patients and methods One hundred and fifty-three patients with low rectal cancer were enrolled in this prospective study. The lesions in all patients were located within 8 cm from the anal verge, and all the patients have disease-free sphincter. They were subjected to sphincter-sparing surgeries and followed up for a period ranging from 6 to 24 months to assess the oncological and functional outcome of the procedures.Results The mean distance of rectal carcinoma was 6 cm (4–8 cm) from the anal verge. Neoadjuvant chemoradiotherapy was needed in 49 patients as they had locally advanced lesions (T3 and T4), whereas the remaining 104 patients underwent primary resection. The safety margin ranged between 1.5 and 1.9 cm in 25% of the patients, 2–2.9 cm in 44% of the patients, and 3–3.5 cm in 31% of the patients. The mean safety margin was 2.5 cm. No local recurrence was reported in any patient during the follow-up period. Anastomotic leak was noted in 3.9%, pelvic abscess in 4.6%, anastomotic stenosis in 11.8%, incisional hernia in 9.8%, and grade II incontinence after 6 months of closing the stoma in 5.9% of the patients.Conclusion Patients with low rectal cancer have the chance to preserve their anal sphincter and practice normal defecation after sphincter-sparing surgery. The procedure did not compromise local control and has accepted oncological and functional outcomes.
      Citation: The Egyptian Journal of Surgery 2019 38(2):250-256
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_185_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Bariatric surgery and its role in the management of metabolic syndrome

    • Authors: Wael Omar, Ahmed Elhoofy, Mahmoud Abdelbaky
      Pages: 257 - 266
      Abstract: Wael Omar, Ahmed Elhoofy, Mahmoud Abdelbaky
      The Egyptian Journal of Surgery 2019 38(2):257-266
      Background Obesity has become a worldwide pandemic health problem, and morbid obesity leads to high rate of complications associated with metabolic syndrome, including type 2 diabetes mellitus (DM), hypertension, and hyperlipidemia. Bariatric procedures have become a main therapeutic option allowing improved diabetes, hypertension, and hyperlipidemia control in most patientsPatients and methods A prospective study which was done between December 2015 and December 2017, this randomized study included 120 obese patients with metabolic syndrome who were divided into two groups: group 1 included 60 patients who were treated by laparoscopic sleeve gastrectomy (SG). Group 2 included 60 patients who were treated by laparoscopic minigastric bypass (MGB). The outcome for weight loss, DM control, blood pressure control, and hyperlipidemia were assessed and compared.Results A total of 120 patients were included in the study. The average age was 43.7 years and majority of them were women (80%). In the SG group: 40 (66.7%) patients were resolved (glycosylated hemoglobin<6.5% with no postoperative diabetic medication) from DM and 16 (26.7%) patients showed improvement. As regards hypertension 22 (55%) patients were resolved (no antihypertensive medications). As regards hyperlipidemia, 20 (41.6%) patients were resolved. In the MGB group: 48 (80%) patients were resolved (glycosylated hemoglobin<6.5% with no postoperative diabetic medication) from DM and 12 (20%) patients showed improvement. As regards hypertension 26 (59%) patients were resolved (no antihypertensive medications). As regards hyperlipidemia 30 (62.5%) patients were resolved. In comparison the MGB group has a statistically significant better effect in improvement of DM in early 6 months, and better outcome after 12 months but is not statistically significant.Conclusion SG and MGB are highly effective in the control of diabetes, hypertension, and hyperlipidemia but MGB has better and earlier effect than SG in diabetes remission.
      Citation: The Egyptian Journal of Surgery 2019 38(2):257-266
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_191_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Role of sleeve gastrectomy in control of type 2 diabetes &#8722; a
           prospective clinical study

    • Authors: Radwa Attia
      Pages: 267 - 271
      Abstract: Radwa Attia
      The Egyptian Journal of Surgery 2019 38(2):267-271
      Background Bariatric surgery has prompted weight loss and improved glycemic control in obese patients with high prevalence of type 2 diabetes mellitus (DM) through different techniques, increasing the popularity of bariatric and metabolic operations. Surgeons are faced with patients with relatively more sever type 2 DM disease.Aim The aim was to determine the efficacies of weight-reducing operations on DM control, especially laparoscopic sleeve gastrectomy (LSG), and to explore the correlation between high level of preoperative Hba1c as well as preoperative morbidity and postoperative outcomes after LSG.Patients and methods A prospective study was conducted between August 2015 and August 2017 at Al-Zahra University hospital. A total of 40 patients were included in this study with morbid obesity with BMI ranged from 35 to 45 kg/m2 and aged ranged from 30–55 years old. They had poorly controlled type 2 DM with hemoglobin A1C more than 7.5% after conventional treatment. All patients were operated by the same surgeon to avoid any procedural biasness. At each follow-up visit, weight loss and glycemic control status were evaluated.Result We included 40 patients who underwent LSG, and all completed 12 months of follow-up regarding remission of type 2 DM. In relation to glycemic control, the procedure demonstrated remission of DM up to 60% after 1 year of surgery.Conclusion Bariatric surgery (LSG) is not only a weight reduction surgery but a metabolic surgery, which can cure most of the metabolic syndrome. It is considered the most-effective long-term treatment modality of type 2 diabetes in obese patients.
      Citation: The Egyptian Journal of Surgery 2019 38(2):267-271
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_195_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Two-year experience with selective intraoperative cholangiography in
           laparoscopic cholecystectomy

    • Authors: Mohamed Elsheikh, Mohamed A Hablus
      Pages: 272 - 276
      Abstract: Mohamed Elsheikh, Mohamed A Hablus
      The Egyptian Journal of Surgery 2019 38(2):272-276
      Background Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a radiologic contrast-based examination of the bile duct which can represent a systemic approach to clarify biliary anatomy and avoid complications.Objective The aim of this study was to evaluate the protective effect of selective use of IOC during LC.Patients and methods This study is a prospective study which included 46 patients through 2 years (2017, 2018) who were offered LC, having specific criteria to justify IOC, who underwent LC with IOC. Cases were analyzed as regards operative details and clinical outcomes.Results Cholangiography was successfully completed in all the cases. The mean time of IOC added to LC ranged from 15 to 45 min with a mean of 27.39±8.49. There was a longer LC and IOC time in cases with positive C-reactive protein, pericholecystic fluid, mucocele, and pyocele with statistically significant differences. Although the preoperative evaluation showed a history of obstructive jaundice in 47.8% of the cases, and 65.2% had dilated common bile duct, only 13% of the cases showed abnormal IOC which required further therapies (intraoperative endoscopic retrograde cholangiopancreatography in five cases and postoperative in one case); 17.3% of the cases had elevated total bilirubin; 26% of the cases had elevated direct bilirubin; 19.5% of the cases had mucocele; 15.2% of the cases had pyocele; and 30.4% of cases had pericholecystic fluid. No bile duct injuries were reported in our study.Conclusion IOC is a safe procedure, adding time of average 27 min to total operative time. IOC is very helpful in cases with suspected choledocholithiasis as it saves the patients unnecessary preoperative endoscopic retrograde cholangiopancreatography. The selective use of IOC can provide critical information about biliary anatomy. The routine use should be abandoned.
      Citation: The Egyptian Journal of Surgery 2019 38(2):272-276
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_8_19
      Issue No: Vol. 38, No. 2 (2019)
       
  • The role of intraoperative ultrasound in the assessment of hepatic
           deposits in intra-abdominal malignancies

    • Authors: Mostafa R Elkeleny, Hassan Abdel-Salam, Ahmed M Farid
      Pages: 277 - 281
      Abstract: Mostafa R Elkeleny, Hassan Abdel-Salam, Ahmed M Farid
      The Egyptian Journal of Surgery 2019 38(2):277-281
      Introduction/background The liver is the most common site of metastatic disease with up to 40–50% of all cancers having the potentiality for sending liver metastasis during the disease. Consequently, there has been increasing value for surgical resection of hepatic deposits of different types of cancers. The need for accurate evaluation of the extent of hepatic metastasis was established for choosing the most suitable patients for surgery and in planning the extent of hepatic resection.Aim The aim of this study was to evaluate the role of intraoperative ultrasound (IOUS) in the detection of hepatic deposits in intra-abdominal malignancies with special emphasis on its accuracy, sensitivity, and specificity.Patients and methods This study was carried out on 30 patients who were admitted to the Gastrointestinal Surgery Unit, Main Alexandria University Hospital, with intra-abdominal malignancies for whom elective open surgical intervention was recommended in the period from 1 September 2017 till the 31 March 2018.Results This study consisted of 17 (56.7%) men and 13 (43.3%) women. Their mean age at admission was 52.77±9.12 years. Six (20%) of the included patients were found to have hepatic lesions by using IOUS including the four (13.3%) cases already detected by preoperative imaging. Two (6.67%) cases were newly discovered in the operative room by using IOUS.Conclusion This study has proved that IOUS demonstrates superior lesion detection over the various noninvasive preoperative imaging modalities causing significant impact on change of the planned surgical strategy.
      Citation: The Egyptian Journal of Surgery 2019 38(2):277-281
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_197_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Synchronous contralateral asymptomatic inguinal hernia in children
           presented with unilateral inguinal hernia: a comparison between
           preoperative ultrasound and operative findings

    • Authors: Mohamed Ibrahim, Mohamed Zaidan, Khaled Diab, Mahmoud A ElNor
      Pages: 282 - 286
      Abstract: Mohamed Ibrahim, Mohamed Zaidan, Khaled Diab, Mahmoud A ElNor
      The Egyptian Journal of Surgery 2019 38(2):282-286
      Background Is to evaluate the sensitivity and specificity of pre-operative inguinal ultrasonography in detection of CPPV after comparing its results with that found during surgical exploration, and to assess if this policy will be helpful in decreasing the incidence of metachronous inguinal hernia development.Patients and methods A prospective study of children presented clinically with unilateral inguinal hernia, Pre-operative US was performed to all of them to assess the contralateral groin; if the contralateral groin proved to have patent processus vaginalis (PPV) by US, bilateral groin exploration was done. Surgical findings were reported in two categories: Normal groin (no contralateral sac found) or Positive finding (if contralateral hernia sac found), the surgical finding was compared to the US finding. If the contralateral groin has no PPV by US those patients were strictly followed up for at least 18 months to detect the possible development of metachronous inguinal hernia. False positive and false negative cases were recorded and compared to true positive and negative cases and statistically analyzed, US sensitivity and specificity were calculated.Results 137 children diagnosed clinically with unilateral inguinal hernia were included in this study, Ultrasonography detected the presence of contralateral patent processus vaginalis (CPPV) in 52 patients (38%), while 85 patients have no CPPV (62%), After surgical exploration of the clinically negative 52 groin, hernia sac were found in 50 of them (96.2%) , false positive US finding was about 3.8%.The incidence of CPPV was much more common in patients diagnosed with left sided unilateral hernia (54.5%), No contralateral groin exploration was performed in 85 patients, those patients were strictly followed up for the development of metacronous inguinal hernia(MCIH) , only one of them developed MCIH 6 months post-operatively, the incidence of developing a MCIH after negative US finding was 1.17 %.The US proved to have 98% sensitivity and 97.7% specificity in diagnosing the CPPV after comparing its results with that found during surgical exploration.Conclusion pre-operative inguinal US detect the presence of CPPV correctly in almost all cases, contralateral surgical exploration of those patient significantly decreased the incidence of MCIH in our follow up period.
      Citation: The Egyptian Journal of Surgery 2019 38(2):282-286
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_201_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Stapleless, clipless, and ligatureless laparoscopic splenectomy:
           possibilities and hazards

    • Authors: Ayman Essawi, Mohamed Ibrahim, ElAshraf Thabet
      Pages: 287 - 290
      Abstract: Ayman Essawi, Mohamed Ibrahim, ElAshraf Thabet
      The Egyptian Journal of Surgery 2019 38(2):287-290
      Background: Elective open splenectomy is now fading in favor of the laparoscopic approach in different indications to remove the spleen. Reports are being published using either the LigaSure or the Harmonic Scalpel vessel sealing systems beside the classic hemoclips and Endo GIA staplers when dealing with the hilar vascular pedicle. Methods: 35 laparoscopic splenectomies were carried out for different indications since February 2013 till September 2016. Results: Splenic weights ranged from 140 to 1625 grams. Patient presentations were thalassemia major (n=16), hypersplenism (n=9), immune thrombocytopenic purpura (n= 6), hereditary sphirocytosis (n=2), lymphoma (n=1), benign splenic neoplasms (n=1). The Maryland LigaSure was the sole vessel sealing system used for Individual dissection and division of hilar, polar and marginal splenic vessels and for freeing the spleen of its ligamentous attachments. No other sealing system, clips, or staplers were used. Operative time ranged from 47 to 165 minutes. Only one case had to be converted due to bleeding. Sparing the converted case, blood loss ranged from 0 to 150 ml. Complications included one conversion due to hilar bleeding and one subphrenic collection. Conclusion: The sole utilization of the Maryland LigaSure system is safe, time sparing and cost effective in elective Splenectomy for different indications.
      Citation: The Egyptian Journal of Surgery 2019 38(2):287-290
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_200_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Evaluation of portal vein occlusion with or without parenchymal splitting
           in the management of irresectable liver tumors

    • Authors: Khaled Ammar, Hany Shoreem, Hazem Zakaria, Mohamed Alwarraky, Hesham Abdeldayem, Tarek M Ibrahim
      Pages: 291 - 300
      Abstract: Khaled Ammar, Hany Shoreem, Hazem Zakaria, Mohamed Alwarraky, Hesham Abdeldayem, Tarek M Ibrahim
      The Egyptian Journal of Surgery 2019 38(2):291-300
      Background Portal vein embolization (PVE) has been developed with the principle of inducing hypertrophy of the future liver remnant (FLR) (10–50% after a period of 2–8 weeks). Tumor progression and insufficient hypertrophy of the FLR are the commonest causes that preclude definitive surgery in 10–30% of patients. Recently, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed, with the goal of achieving a faster and magnified hypertrophy (74–87.2% in 9–13 days) for patients with extensive colorectal liver metastases or hilar cholangiocarcinoma. However, introducing ALPPS for hepatocellular carcinoma (HCC) on top of cirrhosis has been questioned and not thoroughly investigated.Patients and methods A prospective observational study was conducted on patients who were admitted to the National Liver Institute from 2016 to 2018 with nonresectable liver tumors owing to insufficient FLR. Hypertrophy of the FLR, perioperative morbidity and mortality, overall survival, and other parameters were compared between patients who underwent ALPPS and patients who underwent PVE.Results Nineteen patients, of which 17 patients had HCC, underwent first-stage ALPPS, whereas 26 patients, of which 20 patients had HCC, underwent PVE. The mean of the percentage of hypertrophy at 2 weeks for ALPPS group was 41.62±39.7. The mean of hypertrophy after PVE at 2 weeks was 37±5.77%. Fourteen (73.6%) patients could be operated upon for definitive resection in the second stage of ALPPS. Fourteen (54%) patients underwent resection after PVE.Conclusion Despite the morbidity and outcomes of ALPPS in patients with cirrhosis, it still can be introduced with strict criteria. Although ALPPS produces more extensive hypertrophy than PVE and less likely progression of the tumor to the FLR, PVE has less overall morbidity and mortality.
      Citation: The Egyptian Journal of Surgery 2019 38(2):291-300
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_202_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Feasibility, advantages, and the outcome of laparoscopic ring closure for
           repair of inguinal hernia in children: a preliminary experience

    • Authors: Tarek T Harb, Mohamed Y Batikhe
      Pages: 301 - 305
      Abstract: Tarek T Harb, Mohamed Y Batikhe
      The Egyptian Journal of Surgery 2019 38(2):301-305
      Background Laparoscopic hernial repair is increasingly adopted even for neonates and has achieved a high success rate with low recurrence rate with long-term follow-up. The main advantages of laparoscopy are no incision of the fascia, exploriation of the other side in case of bilateral hernia, and visualization and safeguarding of the vas deferens and the spermatic vessels. Moreover, it is advantageous over open technique in case of recurrent hernia. Different modalities of techniques have been used for repair such as needlescopic disconnection of hernia sac, flip flap technique, muscular arch repair, and ring closure.Aim The aim of this study was to evaluate the feasibility, advantages, and the outcome of laparoscopic ring closure for repair of the inguinal hernia in children as a preliminary experience in our institution.Patients and methods This prospective study included 30 patients with unilateral and bilateral congenital inguinal hernia who were subjected to laparoscopic repair in the age group of 6 weeks up to 4 years. We use ring closure technique.Results Thirty children met our inclusion criteria; among them, 26 were boys, in whom indirect inguinal hernia sacs were closed (18 right, five left, three bilateral), and in the four girls, all indirect inguinal hernia sacs were closed. Currently, the median operating time for a unilateral hernia is 23 min (range: 19–40 min) and for bilateral hernias is 28 min (range: 25–55 min). There were no complications. Postoperative hydroceles occurred in three boys. Recurrence encountered in two (6.7%) cases.Conclusion The current series shows the feasibility of laparoscopic hernia repair in pediatric patients. Further technical refinement is needed to facilitate its applicability. Even if not used routinely, laparoscopy is a valuable tool for the objective evaluation and management of congenital inguinal hernia in children with advantage of being exploratory and curative with low recurrence and complications rate.
      Citation: The Egyptian Journal of Surgery 2019 38(2):301-305
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_203_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Is local injection ofmethylene blue allow safe parathyroidgland
           preservation during total thyroidectomy?

    • Authors: Ahmed Zidan, Taher H Elwan, Ahmed M Nawar
      Pages: 306 - 312
      Abstract: Ahmed Zidan, Taher H Elwan, Ahmed M Nawar
      The Egyptian Journal of Surgery 2019 38(2):306-312
      Objectives To evaluate surgical and biochemical outcomes of local methylene blue [total thyroidectomy (TT)-MB] injection during subcapsular thyroidectomy in preservation of parathyroid glands (PTGs).Patients and methods The study include 88 patients divided into two groups. The study group (GP) included 44 patients assigned to TT-MB and control GP included 44 patients who underwent conventional total thyroidectomy. All patients underwent clinical and radiological workup and estimation of serum parathyroid hormone (PTH) and serum total and ionized calcium. Operative procedure entails injection of 1–3 ml MB (0.8 mg/ml) in thyroid subcapsular layer, and the procedure was repeated till completion of thyroidectomy.Study outcomes The study outcomes included frequency of PTG localization, frequency and extent of hypoparathyroidism (HPT) as judged by estimated serum PTH on first and sixth postoperative day (POD1 and POD6) in relation to preoperative level, and the frequency and extent of disturbed serum calcium levels. The outcomes in the cases with TT-MB were compared with the outcomes of the control group patients, who had TT without the use of MB.Results Dissection was easy in 38 (86.36%) cases and more difficult in six (13.63%) cases. One study and five control patients had HPT on POD6, and no study patient but two control patients continued experiencing HPT, with significant difference in favor of study group.Conclusion Subcapsular MB injection during subcapsular thyroidectomy facilitates safe thyroid dissection sparing PTG with easy successful dissection rate of 86.36%. Despite decreased serum PTH, its extent was minimal, and only one patient developed transient HPT.
      Citation: The Egyptian Journal of Surgery 2019 38(2):306-312
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_205_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Liver stiffness measurement by transient elastography can predict outcome
           after hepatic resection for hepatitis C virus-induced hepatocellular
           carcinoma

    • Authors: Osama Hegazy, Mahmoud Allam, Aliaa Sabry, Mohamed A.S Kohla, Waleed Abogharbia, Ashraf Abogabal
      Pages: 313 - 318
      Abstract: Osama Hegazy, Mahmoud Allam, Aliaa Sabry, Mohamed A.S Kohla, Waleed Abogharbia, Ashraf Abogabal
      The Egyptian Journal of Surgery 2019 38(2):313-318
      Objective The aim was to assess the predictive value of liver stiffness (LS) measurement by transient elastography (FibroScan) on the risk of postoperative hepatic decompensation in patients with cirrhosis undergoing hepatectomy for hepatocellular carcinoma (HCC).Patients and methods This prospective study was conducted on 40 adult patients with hepatitis C virus (HCV)-related HCC eligible for hepatic resection between 2015 and 2017. LS was prospectively measured for all patients. Preoperative and postoperative variables (patients’ demographics, comorbidities, laboratory, and radiological data) were collected.Results Hepatic insufficiency occurred in 35% of patients (14 patients). Receiver operating characteristic curve analysis of preoperative LS measurement identified a value equal to or higher than 15.4 KPa as the best cutoff value for predicting postoperative hepatic decompensation, with a sensitivity of 100%, specificity 100%, a positive predictive value of 100%, and a negative predictive value of 100%.Conclusion LS measured by transient elastography (FibroScan) is a potentially reliable tool to predict postoperative hepatic decompensation in patients undergoing surgical resection for HCC.
      Citation: The Egyptian Journal of Surgery 2019 38(2):313-318
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_207_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Management of primary uncomplicated varicose veins, endovenous laser
           ablation with sclerotherapy versus traditional surgery: which is the best
           option?

    • Authors: Osman Abu-Elcibaa Osman, Amr Abd El-Hamed El-Heeny, Mostafa Mohamed Abd El-Razeq
      Pages: 319 - 327
      Abstract: Osman Abu-Elcibaa Osman, Amr Abd El-Hamed El-Heeny, Mostafa Mohamed Abd El-Razeq
      The Egyptian Journal of Surgery 2019 38(2):319-327
      Aim To compare between endovenous laser treatment (EVLT) with ambulatory phlebectomy, EVLT with injection sclerotherapy, and the standard surgical procedure.Patients and methods A randomized prospective study was conducted on 60 (72 limbs) patients having primary uncomplicated varicose veins and was carried out at Minia University Hospital. Patients were divided into three groups (20 patients each), each with a different intervention for varicose veins. Group A underwent endovenous laser with injection sclerotherapy, group B underwent endovenous laser with ambulatory phlebotomy, whereas group C underwent traditional surgery.Results Operative time and hospital stay were significantly lower in group A. There was a significant decrease in complications in patients in group A (12.5%) compared with group C (37.5%). The most common complication in groups A and B was superficial thrombophlebitis, represented by 8.3 and 12.5%, respectively, and in group C was hematoma at 12.5%. After 1-month follow-up, residual varicose veins (VV) was 4.2, 16.7, and 8.3% in groups A, B, and C, respectively. Approximately 96% of patients in group A, 83.3% of patients in group B, and 66.7% of patients in group C were satisfied.Conclusion The combination technique of EVLT and injection sclerotherapy appears to be a safe and an efficient treatment method for the treatment of the great saphenous vein and small saphenous vein, achieving good short-term and long-term results.
      Citation: The Egyptian Journal of Surgery 2019 38(2):319-327
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_208_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Thoracic endovascular aortic repair for traumatic injuries of descending
           thoracic aorta

    • Authors: Hany Abdelmawla Mohamed, Mahmoud Nasser, Ahmed A Shaker
      Pages: 328 - 331
      Abstract: Hany Abdelmawla Mohamed, Mahmoud Nasser, Ahmed A Shaker
      The Egyptian Journal of Surgery 2019 38(2):328-331
      Introduction Traumatic transection of the descending thoracic aorta is a highly morbid injury. In aortic thoracic injuries, thoracic endovascular aortic repair (TEVAR) represents a less invasive alternative to open chest operation.Patients and methods This is a prospective study which included 15 patients presented to the Vascular Unit of Cairo University (Kasr Al aini Hospitals) in the period between June 2016 and April 2018. All patients underwent TEVAR for aortic pseudoaneurysms after the descending thoracic aortic injury. Procedures were performed with standard endovascular techniques. All data were collected included age, sex, mode of injury, associated injuries, timing of intervention, diameter and length of graft, site of access, and postoperative complications. Follow-up included computed tomography at 1 and 6 months.Results This study included 15 patients (10 of them men and five women) with a mean age of 28 years. Nine patients presented due to motor car accident, two patients after balloon dilatation of aorta due to aortic coarctation, and four patients due to fall from a height. All injuries were in the descending aorta distal to the left subclavian artery. The success rate was 100% at intervention without any complications.Conclusion TEVAR is an effective and safe management for the patients presented with traumatic injury of thoracic aorta.
      Citation: The Egyptian Journal of Surgery 2019 38(2):328-331
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_209_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Catheter-directed thrombolysis in thrombotic acute lower limb ischemia:
           challenges and management

    • Authors: Mahmoud Nasser, Hany Abdelmawla Mohamed, Abdelaziz A Abdelhafez
      Pages: 332 - 337
      Abstract: Mahmoud Nasser, Hany Abdelmawla Mohamed, Abdelaziz A Abdelhafez
      The Egyptian Journal of Surgery 2019 38(2):332-337
      Background The aim of this study to assess the result of catheter directed thrombolysis (CDT) in acute thrombotic lower limb ischemia with special emphasis on the technique and challenges.Methods It is a prospective study that was held in vascular surgery department, Cairo University from March 2016 to March 2018. Twenty four patients with ALI were recruited with infra-inguinal acute native arterial occlusions less than 14 days. Inclusions criteria were age is less than 75 years, ALI categories I, IIa Rutherford classification. Exclusion criteria were; acute embolic ischemia, ALI category IIb or III Rutherford classification, occluded bypass graft, contraindication of thrombolytic therapy and Patients older than 75 years.Result Twenty four consecutive patients (19 males and 5 females) were included in the study with mean Age 63.5 years. Out of 24 CDTs performed, 20 patients (83.3%) required additional procedures, 15 percutaneous intervention (12 balloon dilatations and 6 stentings for superficial femoral artery (SFA), and 3 cases of aspiration thrombectomy) and 3 open procedures (3 cases of popliteal thromboemolectomy) and 2 hybrid cases of CFA thromboendarterectomy and angioplasty for femeropoliteal segment). Five bleeding complications were reported in the study group with 4 clinically non- major bleeding complications, all were managed conservatively. Major bleeding from groin required surgical intervention in only one case. A total of 4 (16.6%) major amputations were done during the follow-up period, the amputation-free survival was 87.5%, 83.3%, and 83.3 at one, three, and six months post-procedurally. No mortalities in the study patients during 6 months of follow up.Conclusion Thrombolytic therapy remains an effective and valuable option for treatment of ALI. About 25% of patients still required an open procedure post thrombolytic therapy. So; proper patients selection is needed to detect patient who will benefit from primary surgery rather than thrombolysis.
      Citation: The Egyptian Journal of Surgery 2019 38(2):332-337
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_211_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Challenges for huge goiter surgery

    • Authors: Ahmed Abbas, Mostafa Sakkary, Ahmed Naser
      Pages: 338 - 347
      Abstract: Ahmed Abbas, Mostafa Sakkary, Ahmed Naser
      The Egyptian Journal of Surgery 2019 38(2):338-347
      Objective To highlight the technical challenges and perioperative management of huge goiter guided by ultrasound scanning and, in some cases, computed tomography (CT) scan.Patients and methods Twenty-seven patients presented with large thyroid masses, whether primary or recurrent, and were studied and investigated retrospectively. Triple assessment was done for all patients in the form of history and physical examination, imaging studies, and fine-needle aspiration cytology. Intraoperative technical challenges and postoperative complications were focused on. Every patient has been scanned primarily by ultrasound examination of the neck followed by CT scan if ultrasound was unable to answer all the questions asked and requested by the treating physicians.Results All patients underwent surgical intervention in the form of total or completion total thyroidectomy with or without central lymph node dissection. Transient hypocalcemia was seen in six (22.22%) patients. (Three 11.11 %) patients developed postoperative temporary hoarseness of voice. No major intraoperative or postoperative bleeding was encountered, and no evidence of recurrence was detected during the follow-up period from 6 months to 3 years. Ultrasound was considered enough imaging modality in seven out of the 27 patients, whereas CT scan had to be done in the remaining 20 patients.Conclusion Thyroidectomy for huge goiter is a technical challenge but remains the best option for effective and definitive management. Diagnostic radiology is considered an essential part in the preoperative assessment of these patients. Comprehensive perioperative management and team work are crucial for successful outcomes.
      Citation: The Egyptian Journal of Surgery 2019 38(2):338-347
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_212_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • A comparative study of mesh fixation versus nonfixation in laparoscopic
           totally extraperitoneal inguinal hernia repair

    • Authors: Hossam El Din Mohamed, Mohamed ElSheikh, Hosam Barakat, Amir F Abdelhamid
      Pages: 348 - 355
      Abstract: Hossam El Din Mohamed, Mohamed ElSheikh, Hosam Barakat, Amir F Abdelhamid
      The Egyptian Journal of Surgery 2019 38(2):348-355
      Background Inguinal hernia repair is one of the most common elective general surgical procedures, and laparoscopic inguinal hernia repair has become very popular procedure, accounting for 15–20% of hernia operations worldwide.Aim of the work This study was conducted to compare mesh fixation versus nonfixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.Patients and methods This study is a prospective randomized comparative study that was carried out in the Gastrointestinal and Laparoscopic Surgery Department of Tanta University Hospitals for a year on 40 patients with inguinal hernia who underwent TEP inguinal hernia repair. They were randomized into two equal groups (20 cases): group A: with mesh fixation and group B: without mesh fixation.Results All patients of both groups were males. Group A had a longer operative time than group B (P=0.018). There was no significant difference in postoperative pain in both groups (P=0.6). One (5%) patient in each group had an accidental peritoneal tear. No cases needed conversion. Drain was inserted in one (5%) patient in each group (P=1). No cases had seroma or hematoma formation or chronic groin pain in both groups. One (5% each) patient in each group had scrotal edema, and postoperative surgical emphysema was present in two (10%) patients in each group. No cases of postoperative wound infection or mesh infection were seen in both groups. There was a recurrence in one patient in group B (after 1 week postoperative). The mean hospital stay is statistically insignificant in between both groups. The mean total cost is much higher in group A than group B (P<0.001).Conclusion On comparing mesh fixation or nonfixation in laparoscopic TEP repair for inguinal hernia, we recommend the technique without mesh fixation as there were no differences in the complications, hospital stay, or recurrence, but longer operative time and higher cost were seen in mesh fixation technique.
      Citation: The Egyptian Journal of Surgery 2019 38(2):348-355
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_213_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Unintentional parathyroidectomy during thyroid surgery

    • Authors: Mohamed M El Sayed Ibrahim, Ahmed Elhofy, Wael Omar
      Pages: 356 - 360
      Abstract: Mohamed M El Sayed Ibrahim, Ahmed Elhofy, Wael Omar
      The Egyptian Journal of Surgery 2019 38(2):356-360
      Objective The aim of this study is to evaluate the potential causes of unintentional parathyroidectomy during thyroid surgery.Patients and methods A total of 157 patients who underwent total thyroidectomy for benign or malignant diseases between May 2016 and May 2018 in the Endocrine Surgery Unit of Ain Shams University Hospital and Helwan University Hospital. Patients with recurrent thyroid disease and parathyroid gland disease requiring parathyroidectomy were excluded.Results There were 18 parathyroid glands removed in 16 patients; seven were intracapsular and six were intrathyroidal parathyroid glands, with a mean size of 4.7 mm which is less than the mean size of the parathyroid gland. In spite of the high percentage of women in the unintentional parathyroidectomy group this was not statistically significant. Also, we found that the patients in the unintentional parathyroidectomy group were higher in BMI (32.25±3.62 kg/m2) with a lower thyroid specimen weight average of 52.56±3.25 g. Total thyroidectomy with lateral neck dissection was found to be associated with high risk of unintentional parathyroid gland removal.Conclusion There are several factors that may affect unintentional parathyroidectomy such as the BMI, thyroid gland weight, site and size of the parathyroid gland and type of operations.
      Citation: The Egyptian Journal of Surgery 2019 38(2):356-360
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_217_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • The role of E-cadherin expression and E-cadherin gene promoter
           hypermethylation in gastric carcinoma

    • Authors: Mohamed K.F Hamed, Gamal Fawzy, Hanna H Hanna
      Pages: 361 - 368
      Abstract: Mohamed K.F Hamed, Gamal Fawzy, Hanna H Hanna
      The Egyptian Journal of Surgery 2019 38(2):361-368
      Background Gastric cancer is the third fatal cancers worldwide after lung cancer and liver cancer. Various studies have been launched to detect the markers helping predict the prognosis of different forms of this disease, thus, modifying the treatment regimen accordingly. The aim of this study was to define the role of the E-cadherin protein in such an important issue.Patients and methods Sixty-four patients with gastric carcinoma were included in this study. For each case, representative sections from the tumor tissue and the adjacent noncancerous tissue were assessed for E-cadherin protein expression by immunohistochemistry and promoter methylation by the methylation-specific PCR analysis technique. The results were correlated with Helicobacter pylori positivity and other clinicopathological variables.Result The frequencies of reduced E-cadherin expression and E-cadherin gene methylation were significantly higher in diffuse than intestinal-type gastric carcinoma. However, no significant relationship was found when being correlated to the T-stage and the N-stage of the corresponding lesions.Conclusion Reduced E-cadherin expression and E-cadherin methylation are common alterations in gastric cancer. These gene alternations facilitate cell invasion and metastatic spread with no significant correlation to the T-stage nor the N-stage of the tumor.
      Citation: The Egyptian Journal of Surgery 2019 38(2):361-368
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_4_19
      Issue No: Vol. 38, No. 2 (2019)
       
  • Karydakis versus Limberg flap reconstruction for the treatment of
           recurrent pilonidal disease: a prospective randomized controlled trial

    • Authors: Amro El Hadidi, Ahmed Negm, Mohamed Abdelhalim, Ahmed Taha, Nashaat Noaman, Ibrahim Dawoud
      Pages: 369 - 375
      Abstract: Amro El Hadidi, Ahmed Negm, Mohamed Abdelhalim, Ahmed Taha, Nashaat Noaman, Ibrahim Dawoud
      The Egyptian Journal of Surgery 2019 38(2):369-375
      Background Pilonidal disease is common among adults and is associated with a high recurrence rate, patient discomfort, and high morbidity.Objective This study aims to assess the perioperative findings, early postoperative outcomes, and the satisfaction level in patients with recurrent pilonidal disease, who have been subjected to either Karydakis flap or Limberg flap techniques.Patients and methods This was a prospective randomized controlled study. The study was conducted on patients with pilonidal disease visiting the Mansura University Hospital, Egypt during the period from February 2014 to September 2017. The patients were randomly assigned to undergo either Karydakis flap or Limberg flap groups. The follow-up period ranged from 18 to 28 months, and the mean follow-up period was about 23 months. Surgical findings, complications, recurrence rates, and the degree of patient satisfaction using a 10-point Likert type scale were analyzed and compared.Results In total, 120 (115 men and five women) patients with a median age of 22 years (range: 18–40 years) participated in this study. There were no significant differences between the two groups in terms of complications rate, length of hospital stay, or recurrence rate. Patients in the Karydakis group reported faster healing and felt completely healed postoperatively.Conclusion The two groups reported similar rates of satisfaction.
      Citation: The Egyptian Journal of Surgery 2019 38(2):369-375
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_107_18
      Issue No: Vol. 38, No. 2 (2019)
       
  • Role of endovascular interventions in chronic renal failure patients with
           central venous obstruction

    • Authors: Waleed A Sorour, Medhat E El-Laboudy, Ahmed H Abouissa
      Pages: 376 - 382
      Abstract: Waleed A Sorour, Medhat E El-Laboudy, Ahmed H Abouissa
      The Egyptian Journal of Surgery 2019 38(2):376-382
      Objective The purpose of this study is to evaluate the efficacy and safety of endovascular management of central venous obstruction (CVO) in chronic renal failure (CRF) patients depending on arteriovenous access.Patients and methods A prospective study was done at the Vascular Surgery Department, Zagazig University Hospitals, Egypt and Intervention Radiology Department, Alnoor Specialist Hospital, Makkah, Saudi Arabia, from July 2015 to December 2018. Twenty-five endovascular interventions were performed in 21 CRF patients with vascular accesses and symptomatic CVO. Seventeen (81%) patients reported insertion of central venous catheters. The study included 12 men and nine women. The mean age was 51±9.5 years (range: 36–65 years). The mean duration of arteriovenous access was 10±3.5 months (range: 2–17 months). The lesions were occlusion in 12 (57.1%) patients and significant stenosis in nine (42.9%) patients. The mean lesions length was 4.5±1.5 cm (range: 2–7 cm).Results Technical success occurred in 17 (81%) patients. Percutaneous transluminal angioplasty was done in 12 patients and stenting was done in five patients. We failed in four patients. Early complications occurred in three (14.3%) patients in the form of dissection in one patient, and limited contrast extravasation in two patients. Late complications occurred in five (23.8%) patients within 4–10 months in the form of restenosis in four patients and thrombosis of access in one patient. Mean intervention-free period was 5.1 months. The primary patency rates were 70.1% at 6 months and 53.5% at 12 months and secondary patency rates were 75.3 and 63.9% at 6 and 12 months, respectivelyConclusion Endovascular management of CVO can be used safely in CRF patients with good results at the short run, but for long run results, regular follow-up and reinterventions are mandatory. Decreasing insertion of central venous catheters, especially in the subclavian vein, is the main prophylaxis against CVO.
      Citation: The Egyptian Journal of Surgery 2019 38(2):376-382
      PubDate: Wed,22 May 2019
      DOI: 10.4103/ejs.ejs_16_19
      Issue No: Vol. 38, No. 2 (2019)
       
 
 
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