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Publisher: Medknow Publishers   (Total: 425 journals)

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Showing 1 - 200 of 425 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   (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: 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: 5)
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: 12, 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   (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: 4)
Archives of Medicine and Surgery     Open Access  
Archives of Pharmacy Practice     Open Access   (Followers: 11, 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   (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: 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: 8, SJR: 0.811, CiteScore: 2)
Contemporary Clinical Dentistry     Open Access   (Followers: 5, 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: 13, 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: 7, 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: 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: 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: 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: 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: 3, 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: 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: 1)
Indian J. of Transplantation     Open Access  
Indian J. of Urology     Open Access   (Followers: 4, 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: 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: 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  
J. of Acute Disease     Open Access   (SJR: 0.163, CiteScore: 1)

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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  [425 journals]
  • Endovascular tibial arteries revascularization and its outcome on wound
           healing with split-thickness skin grafts for limb salvage in patients with
           below-the-knee vascular disease

    • Authors: Ahmed K Allam, Ahmed E.A Moamen, Gamal I El-Habbaa
      Pages: 627 - 637
      Abstract: Ahmed K Allam, Ahmed E.A Moamen, Gamal I El-Habbaa
      The Egyptian Journal of Surgery 2019 38(4):627-637
      Background Continuous and rapid advancement in percutaneous endovascular therapy has led to a significant increase in its use as a primary option for revascularization replacing surgical bypass, and it has become a standard treatment for critical limb ischemia (CLI). Clinical success of percutaneous revascularization has been mostly judged by patency rate and limb salvage, but there is paucity of reports on the outcomes of the wound. We present a retrospective study of immediate angiographic and 6-month clinical outcome of patients who underwent endovascular recanalization of tibial arteries for CLI followed by surgical debridement and wound reconstruction with split-thickness skin graft (STSG) for patients with grade 2 ulcer according to the Wound, Ischemia, foot Infection score.Patients and methods Between January 2016 and April 2017, 47 consecutive adult patients with CLI who underwent endovascular recanalization of infra-popliteal arteries due to more than 50% stenosis or chronic total occlusion with grade 2 chronic wound that was reconstructed using STSG and who had a clinical follow-up of at least 6 months were selected for analysis.Results Forty-seven patients underwent endovascular reconstruction. Forty (85.1%) patients underwent only balloon angioplasty and remaining seven (14.9%) underwent additional bailout stenting for proximal tibioperoneal or anterior tibial arteries. Twenty-eight (59.6%) patients had multiple vessel recanalization, while 19 (40.4%) patients had single vessel recanalization. Linear flow to the foot was achieved in at least one artery, mostly the anterior tibial artery in 32 (68.1%) patients postrevascularization. Successful wound healing occurred in 37 (80.4%) patients, 24 (64.9%) of them underwent wound covering with STSG with graft uptake in 20 (83.3%) patients. Limb salvage was achieved in 41 (89.1%) patients at a 6-month follow-up.Conclusion Endovascular recanalization of tibial arteries is an effective procedure for the treatment of CLI. STSG can be considered a reliable option for achieving wound healing in diabetic foot patients after successful revascularization and proper wound debridement. Normal outflow with at least one of the three infra-popliteal vessels being patent is essential for adequate healing and graft taking.
      Citation: The Egyptian Journal of Surgery 2019 38(4):627-637
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_221_18
      Issue No: Vol. 38, No. 4 (2019)
       
  • Modified technique for Kasai porto-enterostomy in biliary atresia and its
           impact on clinical outcome

    • Authors: Ahmed Sallam, Sherif Saleh, Mohamed Taha
      Pages: 638 - 642
      Abstract: Ahmed Sallam, Sherif Saleh, Mohamed Taha
      The Egyptian Journal of Surgery 2019 38(4):638-642
      Background Traditionally, the principle of the Kasai procedure is to remove the atretic extrahepatic ducts so as to establish bile flow to the intestine at an early stage and prevent further progression of the disease. Here, we describe modifications to the procedure via a wider and deeper dissection.Aim To assess the new modified technique over the traditional technique used for type III biliary atresia and its impact on the clinical outcome.Patients and methods This is a retrospective study that assessed the outcome of 66 patients who underwent Kasai portoenterostomy (KPE) at Hepatobiliary and Pancreatic Surgery Department, National Liver Institute, Menoufia University between July 2014 and December 2017. The patients were divided into two groups and the outcome after the modified KPE were compared with the traditional KPE regarding clinical outcome and overall survival.Results In all, 66 patients were identified. Of these, 32 were in the traditional KPE group and 34 in the modified KPE group. The modified technique had better short-term clinical outcome than the traditional technique group at 3 and 6 month postoperatively with statistical significance (P=0.006 and 0.017, respectively). The rate of native liver survival was 68.8 versus 31.5% and overall survival was 88.2 versus 65.6%.Conclusion Deep and long incision in fibrous remnant and meticulous anastomosis was associated with favorable outcomes.
      Citation: The Egyptian Journal of Surgery 2019 38(4):638-642
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_27_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Esthetic outcomes of using latissimus dorsi flap for breast reconstruction
           after breast-conserving surgery

    • Authors: Mahmoud Abdelbaky Mahmoud, Mohamed A Amin Saleh
      Pages: 643 - 655
      Abstract: Mahmoud Abdelbaky Mahmoud, Mohamed A Amin Saleh
      The Egyptian Journal of Surgery 2019 38(4):643-655
      Background Lesion location and the volume of breast excised in correlation to the total breast volume are cornerstone issues in oncoplastic surgery after surgical breast-conserving surgery affecting the esthetic management plan and protocol implemented.Aim of the study Verifying the value of using latissimus dorsi (LD) myocutaneous flaps in secondary breast reconstruction after surgical breast conservation.Patients and methods A total of 73 cases that have undergone unilateral surgical breast conservation and postoperative radiotherapy, subsequently followed by secondary reconstruction of the breast using the latissmus dorsi as a myocutaneous flap at Ain Shams University Hospital and Bahya Hospital of Breast Cancer between January 2015 and January 2018.Results Binary logistic regression statistical analysis have shown that preoperative overall esthetic score was the only significant predictor of having postoperative excellent/very good esthetic score (P<0.005). Neither age, BMI, location of the tumor, nor duration between surgical breast conservation and LD myocutaneous flap was statistically significantly correlated with postoperative esthetic outcomes.Conclusion The current research study verifies the usefulness of LD flap in the restoration of adequate esthetic outcomes required after surgical conservative manner of breast tumor removal; however racial, ethnic, and anatomical differences should be considered in future research
      Citation: The Egyptian Journal of Surgery 2019 38(4):643-655
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_50_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Efficacy of mastectomy flap fixation in minimizing seroma formation after
           breast cancer surgery

    • Authors: Ahmed S Arafa, Fady Fayek, Joseph RizkI Awad
      Pages: 656 - 661
      Abstract: Ahmed S Arafa, Fady Fayek, Joseph RizkI Awad
      The Egyptian Journal of Surgery 2019 38(4):656-661
      Background Seroma formation is considered the most frequent postoperative complication after breast cancer surgery. Serous fluid is collected just under the skin flaps or in the axillary pace immediately following mastectomy preventing adherence of the flaps to the underlying fascia and muscles leading to delay wound healing, infected wound due to repeated aspiration, wound dehiscence, prolonged hospital stay, delay of adjuvant treatment, and finally generating additional costs.Patients and methods A randomized, controlled study was carried out among 138 female patients, who were candidates for mastectomy and axillary clearance. A control group without quilting (69 patients) had a traditional wound closure and the intervention (quilted) group (69 patients) had a sutured flap fixation.Results There were significant differences regarding seroma formation between both groups since it was detected in 22 (31.9%) of the 69 in the suture group and in 39 (56.5%) of 69 in the control group (P<0.004). There were significant differences between means of the number of seroma aspirations among patients with seroma (n=61) by study groups being significantly reduced in in the quilting group (4.3%) versus (18.8%) in the nonquilting group in comparison to the nonquilting group with P value less than 0.008. The range of operative time was 146 (80–160) in the quilting group and 100 (70–135) in the control group.Conclusion Quilting sutures postmastectomy is the most advised technique to minimize seroma formation and its complications. Hence, we recommend quilting of flaps as a routine step at the end of any mastectomy.
      Citation: The Egyptian Journal of Surgery 2019 38(4):656-661
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_57_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • A prospective study for superior medial technique as an oncoplastic
           procedure for lower and outer quadrant breast cancer: oncological safety
           and clinical outcomes

    • Authors: Mahmoud Abdelbaky Mahmoud, Samy Gamil, Hany Rafik
      Pages: 662 - 673
      Abstract: Mahmoud Abdelbaky Mahmoud, Samy Gamil, Hany Rafik
      The Egyptian Journal of Surgery 2019 38(4):662-673
      Background Breast cancer is the most common site of cancer in women in Egypt as it accounts for ∼38.8% of total malignancies among Egyptian women; it is an important cause of mortality among women. For many women with early-stage breast cancer, a combination of partial mastectomy and radiation therapy − together referred to as breast-conserving therapy − is preferable to total mastectomy.Objective To focus on superior medial technique as an oncoplastic procedure for the management of breast cancer and to assess the technique clinically regarding oncological safety, surgical outcomes, and patient satisfaction.Patients and methods It was a prospective, analytical study that included 20 patients aiming to assess clinically the superior medial oncoplastic technique for lower and outer quadrant breast cancer regarding oncological safety and patient satisfaction. This study was conducted at Bahya Specialized Breast Cancer Hospital and Ain Shams University Hospitals.Results All the 20 patients underwent oncoplastic breast surgery which implied two major technical steps, excision of the tumor with a wide safety margin through a predesigned incision with frozen section examination for margins along with formal axillary dissection, followed by immediate reconstruction using superior medial technique. Breast cancer, like other cancers, occurs because of an interaction between an environmental (external) factor and a genetically susceptible host. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues. Cells become cancerous when they lose their ability to stop dividing, to attach to other cells, to stay where they belong, and to die at the proper time.Conclusion This approach has enabled us to increase the number and extend the indications of breast-conserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome.
      Citation: The Egyptian Journal of Surgery 2019 38(4):662-673
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_68_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Laparoscopic preperitoneal ventral hernia repair with prolene mesh with
           fixation through transabdominal prolene stitches

    • Authors: Mohamed S Ghali, Mahmoud Abdelbaky Mahmoud, Samy Gamil
      Pages: 674 - 678
      Abstract: Mohamed S Ghali, Mahmoud Abdelbaky Mahmoud, Samy Gamil
      The Egyptian Journal of Surgery 2019 38(4):674-678
      Objective To evaluate the efficacy and safety of our technique in laparoscopic repair of ventral hernias.Summary background data Laparoscopic ventral hernia repair (LVHR) was first reported in 1993. The successful application of laparoscopic techniques for the repair of ventral hernias has been well accepted. The recurrence rate after standard repair of ventral hernias may be as high as 10%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair.Patients and methods Data on all patients who underwent LVHR performed using our procedure between February 2013 and February 2015 were collected retrospectively.Results LVHR was completed in 27 of the 30 patients (nine men and 21 women) in whom it was attempted. The patients’ mean BMI was 36.5; the mean defect size was 3.2 cm. Mesh averaging 6.3 cm was used in all cases. Mean operating time was 105 min, and hospital stay averaged 1.9 days. Our complication rates were 16.6%. The most common complications were ileus (6.6%) and prolonged seroma (6.6%). During a mean follow-up time of 12 months, the hernia recurrence rate was 3.3%. Overall, 10% of patients had pain for 1 month. Recurrence was associated with vigorous exercise within the first 3 months postoperatively.Conclusion In this series, the preperitoneal laparoscopic technique for ventral hernia repair had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence avoiding the potential complications related to intraabdominal mesh position.
      Citation: The Egyptian Journal of Surgery 2019 38(4):674-678
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_70_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Validation of revised trauma score in the emergency department of Kasr Al
           Ainy

    • Authors: Doaa A Mansour, Hisham A Abou Eisha, Amgad E Asaad
      Pages: 679 - 684
      Abstract: Doaa A Mansour, Hisham A Abou Eisha, Amgad E Asaad
      The Egyptian Journal of Surgery 2019 38(4):679-684
      Background High-flow trauma centers face a huge variety of injury patterns and severity warranting an objective measure to reflect injury severity and consequently the intensity of care required in a resource-limited environment. The revised trauma score (RTS) is a physiological triage system based upon Glasgow coma scale, systolic blood pressure, and respiratory rate that can be used as a prognostic tool in trauma patients.Patients and methods During the initial assessment of 200 blunt trauma victims presenting to Kasr Al Ainy emergency department between October 2015 and February 2016, the RTS was calculated and correlated with injury severity, discharge from the emergency room after initial assessment, ICU admission, length of hospital stay, and mortality. A cut-off RTS was thought to guide the decision-making process and anticipation of the required resources.Results An overall 78.5% of male individuals and 21.5% of female individuals with a mean age of 31.2 years with blunt abdominal trauma presented with a mean RTS of 11.41. No patient with an RTS of 10 or less could be discharged home from the emergency department. There was a statistically significant correlation between RTS and ICU admission and mortality (P<0.001 for both). A cut-off RTS of less than 11 (RTS=10 or less) predicts mortality with a sensitivity of 92.9% and specificity of 81.8%, with area under the curve=0.929. Correlation between RTS and length of hospital stay did not reveal statistical significance (P=0.310).Conclusion RTS can support the discharge decision process and reflect injury severity by predicting the need for ICU and mortality.
      Citation: The Egyptian Journal of Surgery 2019 38(4):679-684
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_82_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Endoscopic preaponeurotic mesh placement in cases of divarication of recti
           associated or not with midline hernia

    • Authors: Hazem Nour, Hatem Mohammad, Mohamed I Farid
      Pages: 685 - 690
      Abstract: Hazem Nour, Hatem Mohammad, Mohamed I Farid
      The Egyptian Journal of Surgery 2019 38(4):685-690
      Background Divarication of rectus abdominis muscle is common especially after childbirth. Usually it is asymptomatic but may be associated with backache. Its problem is mainly esthetic and managed by plastic surgeons. General surgeons are called for management of divarication if associated with hernia defects. Till now, there is no unique procedure for the optimal management of divarication of recti associated with midline hernia defects. Open surgical repair, subcutaneous endoscopic repair, and transabdominal laparoscopic repair all with or without mesh fixation could be an accepted solution.Aim of the study The aim of this study is to evaluate the subcutaneous endoscopic plication of the divarication of rectus abdominis muscle, repair of the hernia defect if present, and placement of preaponeurotic nonabsorbable mesh.Patients and methods The study is a prospective clinical trial carried out in Zagazig university hospitals in the period between March 2018 and October 2018, where endoscopic placement of nonabsorbable prolene mesh on the anterior rectus sheath after plication and repair of the defect in cases of divarication of rectus abdominis muscles associated or not with midline hernia was done.Results A total of 19 patients underwent endoscopic plication of rectus abdominis muscle; 12 of them had midline hernia, in whom repair of the defect was done, and the nonabsorbable mesh was placed over the anterior rectus sheath, with good outcome comparable to most studies on that topic, apart from seroma, which occurred in five cases, and prolonged operative time.Conclusion Preaponeurotic endoscopic technique for plication of divarication of rectus abdominis muscle and onlay mesh placement is better than open surgical management. It is a safe, reproducible, and effective alternative for patients with ventral hernias associated with divarication of rectus abdominis muscle.
      Citation: The Egyptian Journal of Surgery 2019 38(4):685-690
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_88_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Post-right hemicolectomy ileostomy and mucous fistula through single skin
           opening: comparative study with ileostomy and mucous fistula through two
           skin openings

    • Authors: Mahmoud Farghaly, Tarek Youssef
      Pages: 691 - 699
      Abstract: Mahmoud Farghaly, Tarek Youssef
      The Egyptian Journal of Surgery 2019 38(4):691-699
      Background Right Hemicolectomy (RHC) is a common procedure for various right-sided colon pathologies; cancer colon or terminal ileum, perforated appendix with unhealthy cecal base, traumatic injuries and other less commonly indications. Ileo-colic anastomosis is the preferred next step following resection of the diseased segment, however, in certain situations, ileostomy (IL) and mucus fistula (MF) may be done due to excessive soiling or post-leakage of ileo-colic an astomosis or due to bad general condition of patient at this situation. Analternative approach can be done in such cases, which is the construction of aside-to side ileo-colic anastomosis which is then brought out in the right abdominal wall anastoma, so that reconstruction can be done with out midline laparotomy. Here, in our study we did a short term comparison between two groups of patients underwent ileosto my with mucousfistula.The first under went posterior wall anastomosis and the second without.Aim of Study Compare between Two groups of patients post RHC; one underwent IL&MF through single skin opening with posterior wall anastomosis and the other one did IL&MF through separate skin openings, regarding postoperative and restoration of continuity outcomes.Patients and Methods This is a retrospective cohort study. Data retrieved from the medical records of Ain Shams University Surgery Hospital medical records. Patients were divided into 2 groups according to the type of ileostomy and mucus fistula; Group A: underwent ileostomy and mucusfistula with posterior wall anastomosis. Group B: operated up on by ileostomy and mucus fistula without posterior wall anastomosis.Results Twenty-three patients underwent ileostomy and mucus fistula through single skin opening with posterior wall anastomosis, while 25 patients were through 2 skin openings without posterior wall anastomosis. No statistically significant difference between both groups regarding postoperative stoma-related complications. Restoration of continuity showed significantly more rate of wound infection in-case of ileostomy and mucus fistula through separate skin openings that’s attributed to midline laparotomy.Conclusion Ileostomy and mucus fistula through single skin opening with posterior wall anastomosis, is associated with similar complications rate to separate skin openings ileostomy and mucus fistula, however, its less risk of wound related SSI along with its ramifications as wound dehiscence and incisional hernia, due to avoidance of midline laparotomy when restoring bowel continuity is a worthy advantage.
      Citation: The Egyptian Journal of Surgery 2019 38(4):691-699
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_91_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Arterioarterial prosthetic loop: a new approach for hemodialysis access as
           an unusual vascular access

    • Authors: Islam Atta, Ahmed Sawaby, Amr El Abd
      Pages: 700 - 706
      Abstract: Islam Atta, Ahmed Sawaby, Amr El Abd
      The Egyptian Journal of Surgery 2019 38(4):700-706
      Background Vascular access has always been the Achilles repair of hemodialysis. Developments in health care have carried forward patients requiring management who have no veins appropriate for formation of arteriovenous fistula or insert of central venous catheters. This study reports arterioarterial prosthetic loop (AAPL) graft as an effective access for hemodialysis patients with venous occlusion.Objective To assess AAPL graft regarding primary and secondary patency rates and incidence of complications.Patients and methods This study was performed on 20 patients with the end-stage renal diseases. The age of the patients ranged between 47 and 72 years, with a mean age of 57.9 years.Results The primary patency rates were 100, 100, 95, 90, and 80%, respectively, and the secondary patency rates were 100, 100, 100, 95.0, and 95.0% at 1, 3, 6, 9, and 12 months, respectively.Conclusion AAPL can offer an efficient access for hemodialysis in such special group of patients with unsuitable arteriovenous access or having cardiac insufficiency.
      Citation: The Egyptian Journal of Surgery 2019 38(4):700-706
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_95_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Outcome of laparoscopic intervention in acute and chronic small bowel
           obstruction

    • Authors: Hassan A Awaad, Amr Abdel Bari, Ahmed M El Teliti, Hassan Ashour
      Pages: 707 - 712
      Abstract: Hassan A Awaad, Amr Abdel Bari, Ahmed M El Teliti, Hassan Ashour
      The Egyptian Journal of Surgery 2019 38(4):707-712
      Introduction Major abdominal operations result in severe unpredictable scar tissue formation that may contribute to adhesions and then recurrent attacks of acute bowel obstruction, chronic abdominal pain, or both problems. Laparoscopic adhesiolysis provides good relief of symptoms in patients with chronic abdominal pain and/or acute bowel obstruction but without major previous abdominal surgery or severe peritonitis (necrosis or perforation). Early laparoscopic intervention for acute or chronic bowel obstruction has been tried many times worldwide but without complete data about the safety and outcome for both conditions.Patients and methods Between February 2017 and January 2019, a prospective randomized controlled study was done on 32 patients admitted for small bowel obstruction (14 patients with acute bowel obstruction and 18 patients with chronic small bowel obstruction). Patients selected for early laparoscopic adhesiolysis were those who had no preoperative finding of perforation, torsion, strangulation, or any clinical signs or radiological evidences of peritonitis. The outcome of the study was evaluated depending on length of postoperative hospital stay, enteral nutrition, 30-day mortality, positive bowel movement and stool passage, the length of sick leave (return to work), and recurrence of bowel obstruction during the 2-year follow-up.Results A total of 32 patients with a diagnosis of small bowel obstruction were identified and divided into two groups. Group A included 18 patients with chronic bowel obstruction who were treated with laparoscopic adhesiolysis, and group B included 14 patients having acute intestinal obstruction who were treated with laparoscopic adhesiolysis. The follow-up period was ∼24 months.Conclusion Laparoscopic adhesiolysis is a safe and effective management option for patients with prior abdominal surgery with acute or chronic abdominal pain or recurrent bowel obstruction.
      Citation: The Egyptian Journal of Surgery 2019 38(4):707-712
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_100_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Outcomes of laparoscopic one-anastomosis gastric bypass in treatment of
           morbid obesity: a retrospective analysis

    • Authors: Amr Elsayed Fetouh, Sherif Abd El-Fatah Saber, Tamer Elmahdy, Ahmed Swelam, Sherif Elgarf, Hamdy Sedky Abdallah, Gamal Ibrahim Moussa
      Pages: 713 - 721
      Abstract: Amr Elsayed Fetouh, Sherif Abd El-Fatah Saber, Tamer Elmahdy, Ahmed Swelam, Sherif Elgarf, Hamdy Sedky Abdallah, Gamal Ibrahim Moussa
      The Egyptian Journal of Surgery 2019 38(4):713-721
      Background Laparoscopic one-anastomosis gastric bypass (OAGB) is a promising bariatric procedure with multiple apparent benefits. However, concerns have been expressed about reported complication rates and the extent of follow-up, with recommendations to establish a registry of complications and revisional procedures.Aim of study To retrospectively analyze outcomes of OAGB performed for treatment of morbid obesity regarding weight loss, improvement in comorbid conditions, complications, and quality of life.Patients and methods OAGB was performed for the treatment of morbid obesity in 60 patients, and they completed at least 1 year of follow-up postoperatively at the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University, Egypt.Results The study population included 60 patients, with a mean age of 33.52±8 years. The mean preoperative;Deg;BM;Deg;I was 53.29±6.91 kg/m2. Early complications were encountered in eight (13.3%) patients. Late complications occurred in 21 (35%) patients: nutritional sequelae developed in eight (13.4%) patients, four (6.7%) patients developed gall stones, gastritis owing to biliary reflux occurred in eight (13.4%) patients, and severe malnutrition developed in one (1.7%) patient. Preoperative obesity-related comorbidities were hypertension in 11 cases and diabetes mellitus in seven cases. The mean;Deg;BM;Deg;I 24 months after surgery was 34.14±4.17 kg/m2. Most of the comorbidities improved or resolved; 81.8% for hypertension and 85.6% for diabetes mellitus.Conclusion OAGB surgery is an easy, safe, and effective bariatric surgical technique for the treatment of morbidly obese patients producing significant weight loss, resolution or improvement of comorbidities, and improvement of patient quality of life. Strict postoperative follow-up with surveillance for vitamins, protein, and minerals deficiencies is essential, and endoscopic examination when indicated is recommended.
      Citation: The Egyptian Journal of Surgery 2019 38(4):713-721
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_102_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Effect of preoperative stoma site marking on early and late outcomes of
           intestinal stoma creation

    • Authors: Khaled S Abbas, Khaled M Madbouly, Mohamed Abdel Salam Abbas, Ahmed Mahmoud Mohii El Dein
      Pages: 722 - 728
      Abstract: Khaled S Abbas, Khaled M Madbouly, Mohamed Abdel Salam Abbas, Ahmed Mahmoud Mohii El Dein
      The Egyptian Journal of Surgery 2019 38(4):722-728
      Purpose To evaluate how preoperative markings of the stoma site influence patients’ quality of life (QOL), whether they improve patients’ independence, and what is their effect on the rates of postoperative early and late complications.Patients and methods This is a nonrandomized prospective cohort study that included 60 patients who underwent elective intestinal stoma creation in Alexandria Main University Hospital. Patients were divided into two groups. Group A included 30 patients who experienced preoperative marking of their stoma site according to the educational guide developed by the American Society of Colon and Rectal Surgeons and the Wound, Ostomy and Continence Nurse Society, and group B included 30 patients who did not experience preoperative marking of their stoma site. A structured, validated questionnaire was used to assess patients’ QOL and the stoma QOL 1 month after surgery. The occurrence of complications was noted during regular outpatient follow-up encounters, with median follow-up of 1 year, and was evaluated by stoma and equipment-related complication scale.Results A total of 60 patients (48.3% females and 51.7% males) were included. Their mean age was 48.32±14.10 years. It was found that the QOL score of patients whose stoma site was marked (group A) was significantly better (45.03–65.01 vs. 33.58–56.19). Overall satisfaction was significantly better in group A (5.27±1.78 vs. 2.73±2.32).Conclusion The patients whose stoma sites were preoperatively marked had significantly better QOL and significantly fewer early postoperative complications, and these results are irrespective of the stoma type.
      Citation: The Egyptian Journal of Surgery 2019 38(4):722-728
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_104_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Short-term results of angioplasty for management of central venous
           obstruction and stenosis in hemodialysis patients

    • Authors: Hany Abdelmawla Mohamed, Maher Abdelmoneim, Mohamed Sabry
      Pages: 729 - 732
      Abstract: Hany Abdelmawla Mohamed, Maher Abdelmoneim, Mohamed Sabry
      The Egyptian Journal of Surgery 2019 38(4):729-732
      Introduction Central venous obstruction and stenosis are common complications that lead to access dysfunction and morbidity in patients on dialysis.Patients and methods This is a prospective study that was conducted at a tertiary referral center, and 30 patients on regular dialysis who presented with venous hypertension in the upper limb were enrolled. Proper history and examination was done. All patients underwent angioplasty of the lesions, and follow-up was planned at 1, 3, 6, and 12 months. Assessment of primary and assisted primary patency rates were used as the main outcome of this study with assessment of short-term results of percutaneous transluminal angioplasty (PTA) of failed and failing arteriovenous fistula in hemodialysis patients.Results The study was conducted on 30 patients with end-stage renal disease, comprising 21 males and nine females. The mean age was 53.8±14.5 years. Technical success was achieved in 24 (80%) patients. The rest of the patients showed an improvement of their lesions but with a residual stenosis of 30–60%.Conclusion Endovascular management of central venous stenosis and occlusion is an effective and safe procedure in patients on regular hemodialysis with acceptable primary and assisted primary patency rates.
      Citation: The Egyptian Journal of Surgery 2019 38(4):729-732
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_106_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Evaluation of versatility of drug-coated balloons in prevention of
           restenosis after angioplasty of superficial femoral artery occlusive
           lesions: a 2-year surveillance study

    • Authors: El-Sayed A Abd El-Mabood, Waleed A Sorour, Mohamed A Elbegawy
      Pages: 733 - 742
      Abstract: El-Sayed A Abd El-Mabood, Waleed A Sorour, Mohamed A Elbegawy
      The Egyptian Journal of Surgery 2019 38(4):733-742
      Purpose To assess superiority of paclitaxel drug-coated balloons (DCB) in prevention of neointimal hyperplasia and restenosis after treatment of symptomatic superficial femoral artery (SFA) occlusive lesions.Background Endovascular treatment (ET) has become the first choice for SFA atherosclerotic lesions. Despite enhanced immediate technical success, neointimal hyperplasia and restenosis remain the Achilles heel of ET.Patients and methods This prospective randomized controlled two-arm blind interventional study was conducted on 134 patients with symptomatic SFA atherosclerotic lesions. Patients were randomly allocated by using simple random allocation method, where 134 cards were used for allotment of cases into two groups (67 patients were assigned to group A, in which patients were subjected to treatment with paclitaxel DCB and other 67 were assigned to group B, where patients were subjected to treatment with plain old balloon angioplasty). Follow-up was for 2 years.Results Primary patency and limb salvage after 1 and 6 months were statistically insignificant in both groups (P=0.21 and 0.19 and 0.049 and 0.051, respectively), but after 12 and 24 months, primary patency and limb salvage were statistically highly significant in group A (P=0.0018 and 0.0011 and 0.0019 and 0.0023, respectively).Conclusion ET with DCB has equal risks but higher antirestenotic efficacy than plain old balloon angioplasty in femoropopliteal artery disease. The use of DCB increases patency and limb salvage. Stenting still has a rising role in bail-out in the treatment of SFA occlusive disease and is associated with better acute angiographic results.
      Citation: The Egyptian Journal of Surgery 2019 38(4):733-742
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_112_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Assessment of glycosylated hemoglobin as a routine preoperative
           investigation in bariatric surgery: an Egyptian experience

    • Authors: Ahmed AbdElsalam, Ahmed Ghobashy, Mohamed Elshal, Ramy Elhawary, Michael Magdy Shenouda, Doaa M Hasan
      Pages: 743 - 747
      Abstract: Ahmed AbdElsalam, Ahmed Ghobashy, Mohamed Elshal, Ramy Elhawary, Michael Magdy Shenouda, Doaa M Hasan
      The Egyptian Journal of Surgery 2019 38(4):743-747
      Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. Besides being a worldwide public health problem, obesity is a major risk factor for a number of noncommunicable diseases, including diabetes, cardiovascular diseases, and cancer. Once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low-income and middle-income countries, particularly in urban settings. In Egypt, obesity prevalence is on the rise. Weight loss or bariatric surgeries are gaining more and more popularity as a surgical solution to tackle obesity. This is a cross-sectional study conducted at a specialized center of bariatric surgery for 1-year period on 396 patients who underwent bariatric surgeries (sleeve gastrectomy, OAGB) with age range from 15 to 64 years and BMI range from 32 to 76 kg/m2. All surgical procedures were performed by the same bariatric surgical team. Postoperative follow-up consisted of visits with a multidisciplinary team, including the surgeon, physician assistant, and registered dietitian, at 3 weeks, 3, 6, 9, 12 months, and then yearly. The role of surgery in the treatment of diabetes is evolving. A noteworthy reduction in glycosylated hemoglobin (HbA1c) levels at postoperative was noted in diabetic patients. Our study suggests a relation between HbA1c levels and BMI. This relation states that reduction in BMI (i.e. tackling obesity) leads to reduction in HbA1c. It is of paramount importance to assess the long-term clinical outcomes of the surgical weight loss interventions. Obesity-related comorbidities should be evaluated in depth.
      Citation: The Egyptian Journal of Surgery 2019 38(4):743-747
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_113_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Efficacy of Y-shaped bilateral self-expandable metallic stent placement
           for the management of malignant hilar biliary strictures

    • Authors: Ahmed M Yehia, Mohamed F Amin, Mostafa M Elaidy
      Pages: 748 - 753
      Abstract: Ahmed M Yehia, Mohamed F Amin, Mostafa M Elaidy
      The Egyptian Journal of Surgery 2019 38(4):748-753
      Background Malignant hilar stricture (MHS) is a clinical challenge because of the current therapeutic approach and poor prognosis. Although still controversial, bilateral stenting may be the best option for the palliative drainage of malignant hilar biliary obstruction. Recently, the self-expandable metallic stents have clarified more efficacy than plastic stents for the palliation of MHSs, with the bilateral stent-in-stent technique registering a high success rate. The aim of our investigation is to evaluate the technical and clinical efficacious of the endoscopic bilateral metal stenting using a biliary Y-stent for the management of MHS.Patients and methods Twenty-five patients with advanced hilar cholangiocarcinoma were managed by Y-shaped bilateral self-expandable metallic stent placement. The prospective analysis was performed over a period of 3 years from May 2015 to June 2018 at the Department of General Surgery, Zagazig University Hospitals.Intervention For bilateral metal stent placement, a biliary Y-stent with central wide-open mesh was used exclusively at first. A second stent was placed into the contralateral hepatic duct through the central open mesh of the Y-stent.Results Bilateral metal stenting using a Y-stent technique successful was achieved in 23 of 25 patients (technical success, 92%), and successful drainage was achieved in all patients (100%). Early complications rate was 0%, and the stent occlusion rate was two (9%) of 23 patients. Two patients were managed with the insertion of a plastic stent through the occluded metal stent, and the remaining patients were treated with percutaneous biliary drainage. The median stent patency period was 221 days (range, 102–480 days).Conclusions The Y-shaped endoscopic bilateral stenting using a Y-stent is more effective and feasible method with a high technical success rate of 92% and low stent-related complications for the management of MHS.
      Citation: The Egyptian Journal of Surgery 2019 38(4):748-753
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_115_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Different techniques in radiofrequency ablation of varicose veins
           (traditional method and tumescentless method)

    • Authors: Mohamed H Abdelmawla, Ayman Refaat, Abdulaziz Z Algaby, Ahmed S Abd El Basset
      Pages: 754 - 759
      Abstract: Mohamed H Abdelmawla, Ayman Refaat, Abdulaziz Z Algaby, Ahmed S Abd El Basset
      The Egyptian Journal of Surgery 2019 38(4):754-759
      Introduction Treatment of refluxing chronic venous insufficiency nowadays has entered a new era. Now, models of venous ablation with minimally invasive surgery have replaced surgery. Performing venous ablation requires the use of tumescent anesthesia instilled locally deep to the saphenous fascia. This application of tumescent anesthetic made the procedure lengthy with some difficulty. It is supposed that application of ice cold saline topically on the skin leads to anesthetic effect and absorbs the heat generated to the surrounding area and adds ease to the procedure as well.Patients and methods A total of 40 patients with Doppler-confirmed great saphenous vein insufficiency underwent radiofrequency ablation between July 2017 and May 2019. Patients were divided into two groups according to anesthetic management. Group A consisted of 20 patients who received tumescent anesthesia before the ablation procedure, and group B consisted of 20 patients who received local hypothermia and compression technique, and no tumescent anesthesia was administered. The visual analog scale was used and recorded. Clinical examinations were performed at each visit, and Doppler ultrasonography was performed in the first and sixth month.Results Mean ablation time was significantly lower in group B compared with group A. The immediate occlusion rate was 100% for both groups. Visual analog scale was higher in group B. All patients returned to normal activity within 2 days. The primary closure rate of group A was 90% and group B was 100% at 6 months, and there was no significant difference between the groups (P>0.05) regarding primary closure, but there was a difference regarding the cost and length of procedure in favor of group B.Conclusion The topical application of ice cold saline during venous ablation led to less lengthy procedural time with effectiveness.
      Citation: The Egyptian Journal of Surgery 2019 38(4):754-759
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_117_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • The role of laparoscopy in the diagnosis of ascites of unknown etiology

    • Authors: Ashraf M Abdelkader, Nasser A Zaher, Ramy A Mitwally, Sharaf E.A Hassanien, Shaimaa K Dawa
      Pages: 760 - 765
      Abstract: Ashraf M Abdelkader, Nasser A Zaher, Ramy A Mitwally, Sharaf E.A Hassanien, Shaimaa K Dawa
      The Egyptian Journal of Surgery 2019 38(4):760-765
      Objective We aimed to analyze the effect of diagnostic laparoscopy in the identification of the cause of ascites that had been failed to be known by all other diagnostic procedures.Patients and methods This study included 20 patients with an ascites of unknown cause. Before diagnostic laparoscopy, all patients underwent clinical, laboratory, and radiological evaluations; however, all these tools failed to identify the actual cause of this abnormal free fluid collection in the abdominal cavity. Data collection and statistically analysis were done.Results The cause of ascites was identified in 18/20 of our patients, with an accuracy of 90%. Overall, 40% of ascites in our study were owing to tuberculosis, whereas malignancy was the cause of ascites in 20% of patients, and liver cirrhosis and peritonitis were the cause in 15% of each.Conclusion Laparoscopy can help in the safe and effective diagnosis of cases of ascites of unknown etiology.
      Citation: The Egyptian Journal of Surgery 2019 38(4):760-765
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_118_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Retrograde intrarenal surgery versus mini-percutaneous nephrolithotripsy
           to treat renal stones 20 mm or larger in diameter using holmium:YAG
           laser

    • Authors: Ayman Ali, Hany Mostafa, Ahmed Ismail, Mohamed Gamal, Ahmed Salah, Mamdouh Roshdy
      Pages: 766 - 771
      Abstract: Ayman Ali, Hany Mostafa, Ahmed Ismail, Mohamed Gamal, Ahmed Salah, Mamdouh Roshdy
      The Egyptian Journal of Surgery 2019 38(4):766-771
      Objective To evaluate the efficacy and safety of mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the treatment of renal stones 20 mm or larger in the longest diameter using holmium:YAG laser.Patients and methods This was a prospective randomized study that included 40 patients who were divided into two groups, with 20 patients each. Group A underwent mini-PCNL using holmium:YAG laser lithotripsy for renal pelvic and calyceal stones. Group B underwent RIRS in which flexible ureteroscopy was used for pelvic and calyceal stones, and semi-rigid ureteroscope was used for only renal pelvic and upper calyceal stones using holmium:YAG laser. In both groups, the procedure outcomes in terms of operative time, blood loss, hospital stay, complications using modified Clavien grading system, the need of auxiliary procedures, and stone-free rates (SFRs) after 3 weeks by using CTUT were evaluated statistically.Results Statistical analysis of the data showed that there was significant difference in the operative time, which was higher in RIRS group compared with mini-PCNL group, whereas the blood loss in terms of mean±SD change in pre-treatment and post-treatment hemoglobin levels and the hospital stay were significantly higher in mini-PCNL group compared with RIRS group. The complications using modified Clavien grading system were higher in mini-PCNL group compared with RIRS group. The SFR was higher in mini-PCNL group.Conclusion In patients with renal stones 20 mm or larger, results showed that mini-PNCL has significantly shorter operative time with higher blood loss and longer hospital stay compared with RIRS. In both groups, the SFR and the need of the auxiliary procedures were comparable.
      Citation: The Egyptian Journal of Surgery 2019 38(4):766-771
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_120_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Effect of topical application of tranexamic acid on reduction of wound
           drainage and seroma formation after mastectomy

    • Authors: Mahmoud S Eldesouky, Hady S Abo Ashour, Mahmoud A Shahin
      Pages: 772 - 775
      Abstract: Mahmoud S Eldesouky, Hady S Abo Ashour, Mahmoud A Shahin
      The Egyptian Journal of Surgery 2019 38(4):772-775
      Objectives Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Topical tranexamic acid as an antifibrinolytic agent may control fluid accumulation in the dead space under the skin flaps and in the axillary fossa after mastectomy. The aim of this study was to investigate whether moistening a wound surface with tranexamic acid reduces bleeding and fibrinolysis and therefore reduces the total wound drainage after mastectomy and also the incidence of hematoma or seroma formation.Patients and methods We conducted a prospective cohort study on 115 patients with breast cancer who underwent modified radical mastectomy. Topical tranexamic acid was used to moisten the area in some patients to assess its effect on total wound drainage and seroma formation in follow-up period of 1 month.Results The amount of wound drainage was significantly lower in the study group as compared with the control group (798.06±107.3 vs. 1067.1±188.6 ml; P<0.005). The duration of drainage was also lower in the study group as compared with the control group (9.85±1.66 vs. 11.67±1.9 days; P<0.005). Eight (12.3%) patients in the study group had seroma formation after removal of drains as compared with six (12%) patients in the control group. Three (4.6%) patients of the study group had wound infection compared with one (2%) patient in control group; wound was managed by local drainage and antibiotics.Conclusion Tranexamic acid was tolerated without any adverse effects in all patients, and is valuable in reducing the amount and duration of wound drainage after mastectomy without having any effect on the rate of seroma formation.
      Citation: The Egyptian Journal of Surgery 2019 38(4):772-775
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_121_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Drainage fluid C-reactive protein and total Leucocytic count levels as
           early detectors of anastomotic leakage postgastrointestinal resection

    • Authors: Ahmed Nabil, Mona E Saleh, Ahmed H Khalil, Karim Heiba, Mostafa Elshazly
      Pages: 776 - 782
      Abstract: Ahmed Nabil, Mona E Saleh, Ahmed H Khalil, Karim Heiba, Mostafa Elshazly
      The Egyptian Journal of Surgery 2019 38(4):776-782
      Aim Anastomotic leakage (AL) following gastrointestinal resection is a complication associated with significant morbidity and mortality. C-reactive protein (CRP) is produced by the liver in response to inflammatory cytokines and is used as an indicator for postoperative complications. This study investigated the role of CRP and total leukocyte count (TLC) in blood and drainage fluid in the prediction of AL following gastrointestinal resection.Patients and methods Serum and drainage fluid CRP and TLC in blood and drainage fluid were measured on the first, third, and fifth postoperative days (PODs) in 96 patients who underwent gastrointestinal resection.Results CRP in the drainage fluid was significantly elevated in patients who developed AL compared with those who did not have leak on all PODs (P=0.003, <0.001, and <0.001 on the first, third, and fifth days, respectively); however, serum CRP levels were not elevated significantly as a result of AL. We found a significant difference in the levels of the TLC in the first and third PODs and not in the level of TLC in the drain.Conclusion CRP in the drainage fluid was found to be a predictor of AL following gastrointestinal resection especially on the third and fifth PODs with cutoff values of 137.5 and 171.5 mg/l, respectively.
      Citation: The Egyptian Journal of Surgery 2019 38(4):776-782
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_128_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Comparison between direct and indirect revascularization of below-the-knee
           arterial occlusive diseases based on foot angiosome concept

    • Authors: Samy Khalefa, Haitham A Eldmarany, Amr El Bahaey, Maher Abdelmoneam, Khalid Hindawy
      Pages: 783 - 789
      Abstract: Samy Khalefa, Haitham A Eldmarany, Amr El Bahaey, Maher Abdelmoneam, Khalid Hindawy
      The Egyptian Journal of Surgery 2019 38(4):783-789
      Objective Ischemic wounds of the foot are the most common cause for major amputations in vascular surgical patients. It can be presumed that revascularization of the artery directly supplying the ischemic angiosome may be superior to indirect revascularization (IR) of the concerned ischemic angiosome.Patients and methods This prospective study enrolled patients with critical limb ischemia due to isolated infrapopliteal disease (stenosis of ≥70% or complete total occlusions of the crural arteries) presented to our Vascular Department between April 2017 and April 2018. We categorized the treatment groups into two main groups: direct revascularization (DR) and IR. We excluded patients with acute limb ischemia, inflow lesions above the knee, sepsis, myocardial infarction during the previous 14 days, blue toe syndrome (microembolization), and patients who cannot ambulate.Results In this study, there were 23 patients with forefoot ischemia, eight patients had ischemic heel, and two patients had mid-foot ischemia. All patients were followed at 1, 6, and 12 months postoperatively for wound healing, major amputation, or death. Wound healing at 1, 6, and 12 months for DR versus IR was 16.6 versus 9.09%, 56.3 versus 33.3%, and 93.75 versus 87.75%, respectively. The limb salvage rate in the DR group was 88.9% and in IR group was 72.7%. The mortality was 10% for DR and 15.4% for IR at 12 months.Conclusion To obtain better wound healing rates, DR of the ischemic angiosome should be considered whenever possible. Revascularization should not be denied to patients with indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.
      Citation: The Egyptian Journal of Surgery 2019 38(4):783-789
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_131_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Feasibility and long-term effectiveness of endovascular therapy for renal
           artery aneurysms: a retrospective analysis of cases done over 1 year

    • Authors: Haitham A Eldmarany, Samy Khalefa, Amr El Bahaey, Ahmed Sayed
      Pages: 790 - 796
      Abstract: Haitham A Eldmarany, Samy Khalefa, Amr El Bahaey, Ahmed Sayed
      The Egyptian Journal of Surgery 2019 38(4):790-796
      Introduction True renal artery aneurysms (RAAs) are uncommon, and their actual prevalence is unknown. The indications for treating RAAs include symptomatic aneurysms, larger than 20 mm or enlarging aneurysms during follow-up, aneurysms in patients in childbearing age or in pregnant women, ruptured aneurysms, false aneurysms, and aneurysms associated with arteriovenous fistulas or dissection.Aim This retrospective study describes our experience with the endovascular treatment of RAAs with special consideration given to the indications, technical considerations, and complications.Patients and methods Endovascular therapy techniques were offered to selected patients with RAAs presented at Vascular Surgery Department, Cairo University Hospitals, between December 2017 and December 2018.Results During the study period, five patients diagnosed with RAAs were selected for endovascular therapy. Their age range was 35–57 years (mean, 46 years). From the five patients (four males and one female), three patients with RAAs (two true and one false aneurysm) underwent coil embolization, whereas two patients (one female and one male) with true aneurysms underwent stent graft therapy. The average length of postoperative hospital stay was 4.0 days. Technical success was achieved in all patients. Perioperative morbidity was not observed in any patients, and there were no postoperative mortalities. No evidence of growth of the aneurysm sac or endoleak was observed during follow-up in any patient.Conclusion Current data support the high safety of endovascular treatment of RAAs with all of its available techniques.
      Citation: The Egyptian Journal of Surgery 2019 38(4):790-796
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_132_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Assessment of accuracy of axillary sentinel lymph node biopsy in medially
           located breast cancer using methylene blue injection technique: our
           institute experience

    • Authors: Rabie Ramadan, Mahmoud Hemida, Heba G El-Sheredy
      Pages: 797 - 801
      Abstract: Rabie Ramadan, Mahmoud Hemida, Heba G El-Sheredy
      The Egyptian Journal of Surgery 2019 38(4):797-801
      Background Axillary lymph node status is the single most important prognostic factor in breast cancer. Sentinel lymph node biopsy (SLNB) can give an idea about the axillary nodal status, with a high rate of identification. Because the upper outer quadrant is the most common site for breast cancer, most studies of SLNB of the breast have been performed in patients with breast cancer mostly located in this quadrant of the breast, whereas the medial quadrants have much been less studied. In this study, we evaluate the axillary SLNB in medially located breast cancer only, using methylene blue injection technique, regarding identification rate, accuracy rate, and false negativity rate (FNR).Patients and methods The study included 42 female patients with medially located breast cancer and negative axilla, scheduled for modified radical mastectomy or conservative breast surgery. Overall, 4 milliliters of methylene blue 1% was injected in the peritumoral tissue. Sentinel lymph node(s) (SLN) and other axillary nodes were individually sent for pathological assessment.Results Average time taken from methylene blue injection until SLN(s) identification and dissection reached 45 min. SLN identification rate was 92.9% of the patients. The number of SLN removed per patient ranged from 1 to 3 nodes. The number of axillary lymph node removed during axillary lymph node dissection ranged from 10 to 22 nodes. Accuracy rate was 88.1%, and SLN FNR was 4.8%.Conclusion Axillary SLNB is highly valid in medially located breast cancer, with high identification and accuracy rates and low FNR.
      Citation: The Egyptian Journal of Surgery 2019 38(4):797-801
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_135_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Short-term results of intragastric balloon for management of Egyptian
           obese patients

    • Authors: Mohamed Ibrahim, Ahmed Talha, Ehab Hasouna
      Pages: 802 - 806
      Abstract: Mohamed Ibrahim, Ahmed Talha, Ehab Hasouna
      The Egyptian Journal of Surgery 2019 38(4):802-806
      Background Obesity is considered one of the major health problems because of its high incidence and associated comorbidities. Various therapeutic options are available for obesity management, and there has been advancement in bariatric surgery with introduction and development of new techniques.Objective To evaluate the short-term outcomes of intragastric balloon (IGB) in terms of weight loss, tolerance, complications, and its effect on comorbidities.Patients and methods This study included 86 morbidly obese patients who were subjected to IGB with follow-up for a minimum of 1 year. Follow-up was in the form of recording of postprocedure symptoms, complications, and the effect of the procedure on weight loss after 6 months and at 1 year in the form of percentage excess weight loss and percentage excess BMI loss.Results Preoperative BMI ranged from 35.2 to 57.8 kg/m2, with a mean of 42.9±4.8 kg/m2. At 6 months, BMI decreased to 29.4–50.8 kg/m2, with a mean of 37.1±4.2 kg/m2, whereas at the 12 months, it significantly increased to 29.8–51.6 kg/m2, with a mean of 38.7±4.5 kg/m2 when compared with 6 months postoperatively.Conclusion IGB is effective at very short term in weight reduction and improving associated comorbidities with acceptable adverse effects, but weight regain occurred after IGB removal.
      Citation: The Egyptian Journal of Surgery 2019 38(4):802-806
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_138_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Outcome of open abdomen procedure with Bogota bag for temporary abdominal
           closure: our experience in Alexandria University Hospital

    • Authors: Walid M Abd El Maksoud, Khaled Mostafa, Mohamed Abdel-Latif, Habashy A.B Al Hammadi
      Pages: 807 - 813
      Abstract: Walid M Abd El Maksoud, Khaled Mostafa, Mohamed Abdel-Latif, Habashy A.B Al Hammadi
      The Egyptian Journal of Surgery 2019 38(4):807-813
      Aim To evaluate the outcome of abdomen (OA) procedure with Bogota bag as a temporary measure to close the abdomen in patients with abdominal catastrophes in terms of mortality and morbidity.Patients and methods The study included adult patients who were treated for abdominal catastrophes with OA and Bogota bag for temporary abdominal closure during the period 2007–2016 in Alexandria Main University Hospital. Delayed definite abdominal closure was performed by edge-to-edge closure of the fascia if possible or by approximation of the fascia to the nearest available distance and filling the gap by Dexon mesh in a tension-free manner.Results A total of 74 patients were included, with a mean age of 38.19±13.60 years. The etiology was blunt trauma in 32.4%, whereas 67.6% had nontraumatic causes. Ten (13.5%) patients died: six patients owing to their original pathology and four patients owing to pulmonary embolism. Old age and high leukocyte count were significant factors for mortality. Regarding postoperative complications, no patients had abdominal compartment, nine patients had wound infection, two patients had intestinal fistulas, one patient had evisceration, whereas 24 patients had incisional hernia.Conclusion Bogota bag for temporary abdominal closure after OA is an easy and efficient technique for management of abdominal catastrophes by which serious complications of either exposure or closure under tension could be prevented. Postoperative mortality was 13.5% but not related to the technique. Old age and high leukocyte count were found to be significant risk factors affecting mortality.
      Citation: The Egyptian Journal of Surgery 2019 38(4):807-813
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_139_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • A rare combination of synchronous quadruple neoplasms: a case report and
           literature review

    • Authors: Ebrahim K Al-Ebrahim, Abrar N Fatani, Reem J Alshareef, Raneem A Andijani, Haneen A Moumina, Hatim A Alabbadi
      Pages: 814 - 819
      Abstract: Ebrahim K Al-Ebrahim, Abrar N Fatani, Reem J Alshareef, Raneem A Andijani, Haneen A Moumina, Hatim A Alabbadi
      The Egyptian Journal of Surgery 2019 38(4):814-819
      We report an exceptional combination of quadruple neoplasms composed of right-sided adenocarcinoma of the colon, renal cell carcinoma, teratoma of the ovary, uterine leiomyoma, and premalignant high-grade cervix dysplasia. These combinations were not reported before.
      Citation: The Egyptian Journal of Surgery 2019 38(4):814-819
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_93_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Management of bilateral acute iliofemoral venous thrombosis in patients
           with inferior vena cava agenesis

    • Authors: Atef Abdel Hameed, Abdulrahman Mohamed
      Pages: 820 - 827
      Abstract: Atef Abdel Hameed, Abdulrahman Mohamed
      The Egyptian Journal of Surgery 2019 38(4):820-827
      Background Inferior vena cava agenesis (IVCA) is a rare anomaly that presents in 5% of cases of unprovoked lower extremity deep venous thrombosis (DVT), mostly bilateral and significantly under the age of 30 years. Conventional treatment with systemic anticoagulation may not be sufficient in limb-threatening stages. Catheter-directed thrombolysis (CDT) could be the modality of choice in this condition.Aim The purpose of this case series is to report our experience with CDT to manage patients with congenital absence of inferior vena cava presented with bilateral acute iliofemoral venous thrombosis.Patients and methods From February 2015 to March 2017, three patients were referred to Ain Shams University Hospitals and underwent CDT to treat bilateral iliofemoral DVT with IVCA after failure of treatment with systemic anticoagulation. Periprocedural and postprocedural details were recorded. Follow up with clinical examination and duplex ultrasound was performed regularly for 2 years.Results The mean procedural time was 52 h. Technical and clinical success were achieved in all the procedures. No further balloon angioplasty or stent placement was required. No major bleeding occurred. None of the patients had symptoms of pulmonary embolism. The mean postoperative hospital stay was 7 days. During the follow up, none of the patients developed recurrent DVT. Duplex ultrasound showed a patent deep system with only one patient who got unilateral femoral vein reflux, while computed tomography venography showed patency of pelvic and abdominal collaterals in all patients.Conclusion CDT is a safe and effective modality of treatment for patients with bilateral acute iliofemoral DVT associated with IVCA. It helps to reestablish the patient’s baseline venous drainage for limb salvage, rapid symptomatic relief, and prevention of postthrombotic syndrome.
      Citation: The Egyptian Journal of Surgery 2019 38(4):820-827
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_110_19
      Issue No: Vol. 38, No. 4 (2019)
       
  • Discussing the reliability of segmental resections for distal duodenal
           tumors: a case report

    • Authors: Recep Er&#231;in S&#246;nmez, Fatih B&#252;y&#252;ker, &#304;brahim Ali &#214;zemir, &#214;zg&#252;r Ekinci, Orhan Alimo&#287;lu
      Pages: 828 - 831
      Abstract: Recep Erçin Sönmez, Fatih Büyüker, İbrahim Ali Özemir, Özgür Ekinci, Orhan Alimoğlu
      The Egyptian Journal of Surgery 2019 38(4):828-831
      Duodenal tumors are rare neoplasias of the gastrointestinal tract. Despite segmental resections being proposed for tumors located at the distal duodenal segments, there are few studies in recent literature discussing its efficacy with regard to long-term outcomes. The main objective is to put forward the clinical efficacy of segmental resections performed for duodenal tumors with regard to clinical outcomes. Two consecutive adult male patients had been admitted with complaints of abdominal pain, nausea, and upper gastrointestinal bleeding to the Department of General Surgery. After detailed evaluations, they had been diagnosed with obstructing distal duodenal (third and fourth segments) tumors and had undergone segmental resections including lymph node dissections accordingly. Getting benefit from the medical archives of the department, radiological reports, endoscopic evaluations with per-operative findings had been discussed in terms of long-term outcomes. Two patients had undergone (R0) segmental duodenal resections successfully, as they had been diagnosed with adenocarcinoma. The median length of stay at the hospital was 10.5 days. Two patients who had been diagnosed with adenocarcinoma had taken adjuvant chemotherapy. During 29 months of average follow-up time, no evidence of recurrences had been noted so far. Distal tumors of the duodenum may present with vague symptoms so that there is a delay in diagnosis, unlike the proximally located lesions. Nonetheless, when the diagnosis had been made at an early stage, segmental resections with accurate lymph node dissections are reliable in terms of overall survival.
      Citation: The Egyptian Journal of Surgery 2019 38(4):828-831
      PubDate: Wed,16 Oct 2019
      DOI: 10.4103/ejs.ejs_122_19
      Issue No: Vol. 38, No. 4 (2019)
       
 
 
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