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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: 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: 3)
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: 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: 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: 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   (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: 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: 8, 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: 13, 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: 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: 3)
Eurasian J. of Pulmonology     Open Access  
European J. of Dentistry     Open Access   (Followers: 3, 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: 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: 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: 3, SJR: 0.276, CiteScore: 1)
Indian J. of Pharmacology     Open Access   (SJR: 0.412, CiteScore: 1)
Indian J. of Plastic Surgery     Open Access   (Followers: 13, SJR: 0.311, CiteScore: 0)
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: 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: 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: 14)
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]
  • Vena cava filter deployment prior to percutaneous endovenous therapy for
           

    • Authors: Ahmed K Allam, Mohamed Ismail
      Pages: 383 - 393
      Abstract: Ahmed K Allam, Mohamed Ismail
      The Egyptian Journal of Surgery 2019 38(3):383-393
      Context Anticoagulant therapy remains the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive rise in the use of percutaneous endoluminal clot dissolution techniques such as using catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy (MAT) devices due to their established short-term benefits. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue.Aims Our study aims to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and MAT techniques.Settings and design Retrospective.Patients and methods Percutaneous endoluminal clot dissolution using either CDT or MAT for proximal lower extremity DVT was performed on 64 limbs in 58 patients of 148 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 32 patients prior or during the procedure.Statistical analysis Statistical analysis was performed by using IBM SPSS Statistics, version 22, for Windows program package (SPSS Inc., Chicago, Illinois, USA).Results From 58 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 30 (51.7%) patients. Trapped thrombus in the deployed filters as revealed on venocavography was observed in 8/30 (26.7%) filters deployed prophylactically with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques was 11/58 (18.9%) patients.Conclusion CDT could be done safely and effectively without routine prophylactic IVC filter placement in treating acute DVT. Selective filter placement may be considered in patients undergoing mechanical thrombectomy or patients with more proximal thrombus pattern with multiple risk factors.
      Citation: The Egyptian Journal of Surgery 2019 38(3):383-393
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_151_18
      Issue No: Vol. 38, No. 3 (2019)
       
  • Impact of diagnostic laparoscopy in the management of gastric cancer in
           Egyptian patients

    • Authors: Mostafa R Elkeleny, K. Ahmed
      Pages: 394 - 398
      Abstract: Mostafa R Elkeleny, K. Ahmed
      The Egyptian Journal of Surgery 2019 38(3):394-398
      Background Gastric cancer (GC) is one of the leading causes of cancer-related deaths. In Egypt, it is the 14th among cancers mortality. Preoperative imaging as Computed Tomography and Endoscopic Ultrasonography have limitations in predicting the advanced disease, leading to many unnecessary laparotomies with more morbidity and mortality. Therefore, diagnostic laparoscopy (DL) may play a vital role in preoperative staging.The aim of the work was to evaluate the role of diagnostic laparoscopy (DL) in detecting peritoneal, liver metastasis and malignant ascites.Methods 40 patients of GC were involved, preoperative abdomen CT scan was done. DL was done under general anesthesia through 3 ports, the liver and whole peritoneal surfaces were examined for any metastasis, also any ascites was aspirated if there was no ascites irrigation with saline was done and re-aspirated. Any metastasis was biopsied and examined by frozen section also any aspirate was underwent immediate cytological examination.Results DL was positive in 12 patients (30%), detected as the following; 6 patients with liver deposits, 4 patients with peritoneal deposits and 2 patients with positive cytology. Therefore these 12 patients avoided unnecessary laparotomy, while the remaining 28 patients underwent curative resection of the tumor.Conclusion About 30% of GC is advanced once diagnosed. DL may be very helpful in detecting metastatic tumor missed by CT scan. Liver metastasis is the commonest metastasis of GC. Patients with positive DL avoid unnecessary laparotomy, and this does not delay them of having palliative treatment.
      Citation: The Egyptian Journal of Surgery 2019 38(3):394-398
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_198_18
      Issue No: Vol. 38, No. 3 (2019)
       
  • Outcome of pudendal thigh flap in scrotal reconstruction and its effect on
           testicular function

    • Authors: Mohamed T Younes, Ahmed M Nawar, Ahmed A Shoulah
      Pages: 399 - 405
      Abstract: Mohamed T Younes, Ahmed M Nawar, Ahmed A Shoulah
      The Egyptian Journal of Surgery 2019 38(3):399-405
      Introduction Reconstruction of major scrotal defects represent a great challenge for surgeons. Although a lot of therapeutic methods have been established for the reconstruction of these defects, each technique has its own advantages and disadvantages. The pudendal thigh flap is an axial and sensate fasciocutaneous flap based on the terminal branches of the superficial perineal artery, which is a continuation of the internal pudendal artery (below the urogenital diaphragm). The data on the testicular function after reconstruction of cover for the testes have been rarely reported. In this study, follow-up of patients with pudendal thigh flap was done regarding esthetic outcome, functional outcome, and testicular function.Aim The aim of this study was to show the versatility and usefulness of posteriorly based pudendal thigh flap for scrotal reconstruction and to evaluate its effect on testicular function.Patients and methods A total of 19 flaps in 13 patients with major scrotal defects were subjected to reconstruction using posteriorly based pudendal thigh flap. The cause of scrotal skin loss was Fournier gangrene in nine cases, trauma in three cases, and animal bite in one case. Six patients underwent bilateral flap reconstructions, and seven patients underwent unilateral flap reconstructions.Results All 19 flaps survived completely with good color matching. The donor site was closed directly, and the scar was hidden in the inguinal crease. One patient had wound dehiscence in the donor site and required a secondary procedure for healing. Testicular function regarding spermatogenesis and hormonal functions showed nonsignificant changes 6 months and 1 year after flap coverage.Conclusion Posteriorly based pudendal thigh flap is a good option for reconstruction of major scrotal defects. This flap gives a wide coverage with excellent esthetic appearance of the scrotum, without any significant effect on testicular function.
      Citation: The Egyptian Journal of Surgery 2019 38(3):399-405
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_206_18
      Issue No: Vol. 38, No. 3 (2019)
       
  • Laparoscopic one-anastomosis gastric bypass: results of the first 310
           patients

    • Authors: Mahmoud Zakaria, Ahmad Elhoofy
      Pages: 406 - 410
      Abstract: Mahmoud Zakaria, Ahmad Elhoofy
      The Egyptian Journal of Surgery 2019 38(3):406-410
      Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-risk procedure and can be reversed.Patients and methods Between June 2014 and September 2018, 310 morbidly obese patients have undergone LOAGB surgery.Results The mean operating room time was 69 min. Median postoperative length of stay was 2.1 days. The;Deg;BM;Deg;I has decreased from 49.3±9.9 to 38.8±9.7 kg/m2, 33.7±4.7 and 28.8 kg/m2 at 6, 12, and 24 months postoperatively, respectively. The percentage of excess weight loss is, respectively, 50±26, 62±25, and 72±18% at 6, 12, and 24 months postoperatively.. Major complications have occurred in a total of 11 (3.5%) patients. One patient has suffered from postoperative gastrojejunal anastomotic leakage. Five patients have suffered from massive postoperative bleeding. Two patients have intractable bile reflux after minigastric bypass. Omega loop gastric bypass was converted to Roux-en-Y gastric bypass in these two patients. One anastomotic stenosis needed dilatation over three sessions. One patient developed port site hernia 6 months postoperatively. This patient was explored and managed laparoscopically. One patient presented 15 months after minigastric bypass with perforated gastrojejunal anastomotic ulcer that was treated by omental patch repair. There were no postoperative mortalities.Conclusion LOAGB can be regarded as a simple, safe, effective, and reversible bariatric procedure.
      Citation: The Egyptian Journal of Surgery 2019 38(3):406-410
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_218_18
      Issue No: Vol. 38, No. 3 (2019)
       
  • Prospective study evaluating malignancy in solitary thyroid nodule

    • Authors: Mohamed M El Sayed Ibrahim, Wael Omar, Ahmed Elhofy
      Pages: 411 - 417
      Abstract: Mohamed M El Sayed Ibrahim, Wael Omar, Ahmed Elhofy
      The Egyptian Journal of Surgery 2019 38(3):411-417
      Objective The aim of this study was the preoperative evaluation of patients with solitary thyroid nodules (STNs) for the presence of malignancy to avoid unnecessary total thyroidectomy.Patients and methods A total of 83 patients with STNs who underwent hemithyroidectomy, total thyroidectomy, and total thyroidectomy with modified neck dissection in Ain Shams University Hospitals and Helwan University Hospital between September 2016 and December 2017 were evaluated. Parameters including demographics, ultrasonographic, and pathological data were analyzed.Results After evaluation of the final pathology, results showed that malignancy was found in 33/83 (39.8%) patients. A total of 24 (72.7%) of these lesions were papillary carcinoma. Multinodular goiter accounted for 90% of all benign cases. Of 19 malignant cases, 14 (73.7%) were males, whereas of 64 benign cases, 45 (70.3%) were female patients. Nodule echogenicity, nodule calcification, nodule vascularity, nodule shape, and nodule margins were found to have significant prediction for malignancy. Among these factors, increased vascularity and irregular nodule margins were the most important factors. Nodule size did not affect the risk of malignancy. Moreover, lymph node characteristics were found to have significant prediction for malignancy. The FNA results of BII-V reports showed that 17.2% of patients with STN nodule had false negative results.Conclusion Multivariate analysis revealed that in STN, the highest malignancy predictor was the ‘No halo and irregular Margin’ in ultrasound, and that microcalcifications, hypoechoic, and taller nodules were highly suspicious factors for malignancy.
      Citation: The Egyptian Journal of Surgery 2019 38(3):411-417
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_8_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy
           mandatory?

    • Authors: Amro El Hadidi, Nashaat Noaman, Mohamed Abdelhalim, Ahmed Taha, Mohamed Shetiwy, Mohamed S.A Attia
      Pages: 418 - 423
      Abstract: Amro El Hadidi, Nashaat Noaman, Mohamed Abdelhalim, Ahmed Taha, Mohamed Shetiwy, Mohamed S.A Attia
      The Egyptian Journal of Surgery 2019 38(3):418-423
      Background Currently, laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgeries. Concomitant cholecystectomy is routinely performed for symptomatic patients. However, the management of patients with asymptomatic gallstones is still controversial. Again, the incidence, the prospective presentation of postoperative cholelithiasis in patients without previous gallstones disease is also deficient and unpredictable.Patients and methods This prospective study included 95 patients with asymptomatic gallstone disease (group A) and 755 patients without gallstone disease (group B) who underwent LSG. The endpoint was the development of symptomatic gallstones requiring surgical intervention. Types of presentation, relevant preoperative workup, and operative and postoperative findings were reported.Results In groups A and B, the mean age was 35.6±7.6 and 35.34±7.7 years; the preoperative BMI was 39.4±1.02 and 40.3±0.76 kg/m2; the percentage of excess weight loss was 50±2.54% and 67±2.8% at the time of presentation, and 67.4 and 71.3% patients were women, respectively. Symptomatic gallstones were found in 17 (18%) patients in group A, two of whom had acute presentation. Two hundred and eighteen (29%) patients in group B had newly developed symptomatic gallstones, 35 (16%) of whom had acute presentation; two of them showed obstructive biliary symptoms. The time of presentation was significantly different between the two groups (group A: 10.5±1.7 months; group B: 21±6.6 months; P=0.0001). The mean follow-up periods were 26±9 and 28±12 months in groups A and B, respectively. Our results showed a high incidence of symptomatic gallstone after LSG. Family history and percentage of excess weight loss were also significantly correlated with symptom development. No operative difficulties were encountered in any patients, and no conversion occurred in our study.Conclusion Symptomatic cholelithiasis can present soon after sleeve gastrectomy and may warrant surgical intervention. A significant number of preoperatively healthy patients develop gallstones, with acute presentation in some cases. Although no consensus on concomitant cholecystectomy for treating asymptomatic patients has been reached, we found this procedure mandatory for high-risk patients.
      Citation: The Egyptian Journal of Surgery 2019 38(3):418-423
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_10_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Descending thoracic aortobifemoral bypass in the management of aortic
           occlusive disease in surgically fit patients: ‘the forgotten
           operation’

    • Authors: Mahmoud Nasser, Hossam Zaghlol
      Pages: 424 - 428
      Abstract: Mahmoud Nasser, Hossam Zaghlol
      The Egyptian Journal of Surgery 2019 38(3):424-428
      Aim of the work To study the efficacy of using the descending thoracic aorta as the inflow artery for patients with aortoiliac occlusions regarding its morbidity, mortality, and patency rate.Patients and methods This is a prospective study done in Cairo University Hospitals from May 2014 till November 2018 using the descending thoracic aortobifemoral bypass. Inclusion criteria included surgically fit patients with juxtrarenal aortic occlusion or hostile abdomen. Exclusion criteria included unfit surgical patients and/or no adequate runoff vessel and/or contraindications for thoracotomy.Results This study included 15 patients, who underwent descending thoracic aortobifemoral bypass, with 12 male and three female patients, with a patient mean age of 61 years. Patient presentations were disabling claudication pain in eight (53.3%) patients, rest pain in four (26.7%) patients, and tissue loss in three (20%) patients. Indications of intervention were juxtarenal aortic block in nine (60%) patients and hostile abdomen in six (40%) patients. Estimated blood loss ranged from 500 to 900 ml. The duration of the ICU stay ranged from 1 to 4 days (mean, 1.8 days) and the total hospital stay ranged from 5 to 10 days (mean, 8.2 days). Clinical improvement was evident in all 15 (100%) patients. No mortality was reported in our study. Procedure-related complications occurred in four (26.7%) cases; one case developed dehiscence of the abdominal wall, two cases of pneumonia, and one patient suffered from groin wound gapping. Primary patency rate at 12 months was 100% with no major amputations.Conclusion Thoracobifemoral bypass offers a good alternative to aortofemoral bypass due to less embolization and good patency rate. We recommend its use as an alternative procedure in fit patients with juxtarenal aortic occlusive disease or failed previous aortic bypass surgery.
      Citation: The Egyptian Journal of Surgery 2019 38(3):424-428
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_13_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Survival of primary adenocarcinoma of the urinary bladder after radical
           treatment: National Cancer Institute, 5-years’ experience

    • Authors: Ahmed Abbas, Ibrahim Abdelrahman, Ghada Abdelsalam
      Pages: 429 - 438
      Abstract: Ahmed Abbas, Ibrahim Abdelrahman, Ghada Abdelsalam
      The Egyptian Journal of Surgery 2019 38(3):429-438
      Introduction Primary adenocarcinoma of the urinary bladder (UB) is rare but often aggressive urologic cancer. It represents 0.5–2% of all bladder cancers and affects patients mostly in their sixth decade of life. The incidence is greater in areas where bilharziasis is endemic and is more common in men than women.Aim of the work The aim of the study was to review this rare UB malignancy with special emphasis on patients’ survival including; disease-free survival (DFS) and overall survival (OS) in relation to different clinical and pathological factors.Patients and methods We conducted this retrospective review of 40 patients with primary UB adenocarcinoma who were treated and followed up in the National Cancer Institute, Cairo University between January 2013 and December 2017.Results The study included 40 patients with a male to female ratio of 82.5 : 17.5%. The mean age at diagnosis was 61 years. Hematuria was the most common presenting symptom followed by dysuria and frequency. Pathologically, stage III disease, tumor grade II, and adenocarcinoma, not otherwise specified, were the most common findings. Radical cystectomy was done in 82.5% of cases, while anterior pelvic exenteration was done in 17.55% of cases followed in both by different methods of urinary diversions. The median follow-up was 31 months, and the 2-year DFS of all patients was 60.7%. Two-year DFS was significantly affected by tumor grade, disease stage, and lymph node (LN) status (P=0.019, 0.021, 0.001, respectively). Furthermore, 3-year OS of all groups was 57% with a median follow-up of 39.9 month. Tumor grade, disease stage, and LN involvement had an impact on OS. However, the only statistically significant effect is due to LN involvement (P=0.037).Conclusion Patients with UB adenocarcinoma commonly present in an advanced disease. DFS and OS are affected by disease stage, tumor grade, and LN involvement. We recommend radical rather than any form of conservative surgery as a primary treatment modality.
      Citation: The Egyptian Journal of Surgery 2019 38(3):429-438
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_18_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Role of fine-needle aspiration cytology in the diagnosis of thyroid
           diseases

    • Authors: Radwa Attia, Fatma Kotb, Omnia M Rabie
      Pages: 439 - 450
      Abstract: Radwa Attia, Fatma Kotb, Omnia M Rabie
      The Egyptian Journal of Surgery 2019 38(3):439-450
      Background Fine-needle aspiration cytology (FNAC) is a gold standard investigation in the diagnosis of thyroid diseases. It is a simple, safe, cost-effective, and quick-to-perform procedure, with excellent patient compliance. It has high sensitivity, specificity, and accuracy as a preoperative investigation of thyroid gland diseases.Aim To determine the accuracy of FNAC in the diagnosis of thyroid diseases and to correlate the relationship between FNAC findings and histopathology of excised specimen.Patients and methods This was a prospective study conducted on 80 patients between September 2015 and September 2017. All patients with thyroid lesions were subjected to FNAC at Al Zahraa University Hospital. All patients with a clinically diagnosed solitary thyroid nodule, euthyroid multinodular goiter, and hypothyroid or hyperthyroid were excluded from this study.Results The study population was female predominant, represented by 73 (91.25%) patients, with age ranging from 18 to 65 years. Most cases were non-neoplastic, representing 42 (52.5%) cases, whereas 12 (15%) cases were neoplastic. The commonest lesion in thyroid gland was colloid goiter, and papillary carcinoma was the commonest among malignant lesion. On statistical analysis of our study, data showed the diagnostic accuracy of FNAC to be 80%, sensitivity to be 80%, and specificity to be 87.5% in neoplastic lesions, but results in carcinomatous lesions had accuracy of 92.5%, sensitivity of 80%, and specificity of 95.38%.Conclusion FNAC is an excellent first-line method as a preoperative investigation of thyroid swelling showing the nature of the lesion. It is a safe, minimally invasive, cost-effective diagnostic tool and correlates with the findings of tissue biopsy.
      Citation: The Egyptian Journal of Surgery 2019 38(3):439-450
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_32_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Effectiveness of cavity shave margin versus standard partial mastectomy in
           early stage breast cancer patients

    • Authors: Ahmed Salah Arafa, Abdelwahab S Almoregy, Alaa Fiad
      Pages: 451 - 458
      Abstract: Ahmed Salah Arafa, Abdelwahab S Almoregy, Alaa Fiad
      The Egyptian Journal of Surgery 2019 38(3):451-458
      Background Breast-conserving surgery (BCS) is considered the gold standard of early stage invasive breast cancer treatment that achieves adequate surgical margins with an acceptable cosmetic outcome. The margin status is an important prognostic factor for local recurrence after BCS in patients with early breast cancer. The patients receiving BCS have a lifelong risk of local recurrence. To minimize this risk, a technique of margin evaluation, called cavity shaving or cavity margin shaving has been proposed and applied by some surgical teams to reduce the need for re-excisions and to detect multifocality.Patients and methods In the present prospective, randomized trial between August 2015 and August 2018, we assigned 40 women with breast cancer of stages 0–III who were undergoing partial mastectomy and divided into two groups; shave group and lumpectomy group. Excision of cavity shave margins consists of resection of breast tissue from four margins; superior, inferior, medial, and lateral after the excision of the primary specimen in the same procedure. We classified the margins as negative (>2 mm), close (<2 mm), or positive based on the distance from the tumor to the margin of resection.Results We have 40 patients in the current study. Overall, patients who underwent BCS plus cavity shaving had a higher rate of negative margins (92%) compared with patients who underwent BCS (66.7%). In shaving lumpectomy group (SLG), patients with negative margins before shaving were 15 (60%) versus 23 (92%) after shaving. All patients with positive margins (n=7) were offered a re-excision procedure.Conclusion Comparing to the lumpectomy alone, cavity margin shaving plus lumpectomy during BCS for early stage invasive breast cancer results in a higher rate of negative microscopic margins for tumor and a lower reoperation rate, although it increases the operation time, the resection volume.
      Citation: The Egyptian Journal of Surgery 2019 38(3):451-458
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_35_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • An auspicious experience with laparoscopic common bile duct exploration

    • Authors: ElGhamry E ElGhamry, Mohamed ElSheikh, Hamdy Abdelhady, Mohamed A Hablus, Amir F Abdelhamid, Hosam Soliman, Ahmad Nassar
      Pages: 459 - 470
      Abstract: ElGhamry E ElGhamry, Mohamed ElSheikh, Hamdy Abdelhady, Mohamed A Hablus, Amir F Abdelhamid, Hosam Soliman, Ahmad Nassar
      The Egyptian Journal of Surgery 2019 38(3):459-470
      Background and aim Common bile duct (CBD) stones are the second most common complication of gallbladder stones. The best management of patients with it remains controversial. The aim of this study was to evaluate the methods, operative time, failure rate, complications, and hospital stay of laparoscopic common bile duct exploration (LCBDE).Patients and methods This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. We used transcystic or transcholedochotomy approaches for LCBDE either with or without choledoschopic guidance. Primary repair of the choledochotomy incision was done.Results The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients, 20% presented with jaundice while 16.7% presented with both jaundice and right hypochondrial pain. The transcystic approach for CBD exploration was used in 16 cases without conversion; 11 cases completed without a choledochoscope, while five cases with choledochoscopic-guided extraction. Choledochotomy approach had been used in 13 cases, six cases completed with a choledochoscope and seven cases without it, two of them failed. One case failed from the beginning and went for open exploration. Five previously inserted stents through endoscopic retrograde cholangiopancreatography were removed. The mean operative time was 162.33±74.67 min. Transcholedochotomy approach takes longer time than transcystic. Bile leakage occurred in two cases following the choledochotomy approach. The mean hospital stay was 3.37±1.38 days. The hospital stay increased with long operative time and postoperative complications, especially bile leakage.Conclusion LCBDE is an auspicious approach to CBD stones. It is a feasible, effective, and safe procedure, depending on proper training and gaining experience. The availability of adequate equipment is mandatory and can avoid the drawbacks of endoscopic retrograde cholangiopancreatography and open CBD exploration.
      Citation: The Egyptian Journal of Surgery 2019 38(3):459-470
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_36_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Cyanoacrylate glue mesh fixation versus suture mesh fixation in
           Lichtenstein inguinal hernia repair

    • Authors: Ahmed Salah Arafa, Mostafa Mohamed Khairy, Tamer Rushdy, Mohammad Alsayed Gomaa
      Pages: 471 - 477
      Abstract: Ahmed Salah Arafa, Mostafa Mohamed Khairy, Tamer Rushdy, Mohammad Alsayed Gomaa
      The Egyptian Journal of Surgery 2019 38(3):471-477
      Background Lichtenstein hernioplasty is becoming more popular in repairing inguinal hernia as it has a low recurrence rate, simplicity to learn, teach, and low costs to the hospital. Cyanoacrylate adhesives have developed over time, mainly through the lengthening of their chemical chains, making them more biocompatible, leading to minimize the toxicity and adverse effects in the host tissue, so it is an optimal choice for the atraumatic mesh fixation. The aim of our study is clarifying the efficacy of the cyanoacrylate glue versus nonabsorbable sutures for mesh fixation in Lichtenstein hernia repair methods with special regard to postoperative groin pain, operative duration, and any other postoperative complications during the follow-up.Patients and methods One hundred and sixty patients with primary inguinal hernia managed by the Lichtenstein hernioplasty were randomized into two groups to receive either glue (Histoacryl) or nonabsorbable polypropylene sutures for polypropylene mesh fixation. The chronic groin pain, recurrence, and other complications were analyzed postoperatively. The statistical analysis was carried out using the Statistical Package for the Social Science.Results We reached 160 patients to the present study. There was a significant difference regarding the groin pain during the first month postoperatively (acute postoperative pain) that is reduced in the glue fixation group (3.8 vs. 25%) (P<0.001). There was no significant differences in the chronic inguinal pain between the study groups that is reduced in the glue fixation group (7.5 vs. 15%) (P=0.133). The operative time was significantly longer in the suture than in the glue (median, 41 min; range, 33–44 min vs. median, 31 min; range, 30–38 min).Conclusion Compared with suture fixation of a mesh, the using of cyanoacrylate glue fixation is a safe and good alternative for Lichtenstein hernia repair with less postoperative pain, a shorter operating time, and a lower rate of recurrences.
      Citation: The Egyptian Journal of Surgery 2019 38(3):471-477
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_37_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Management of infantile periorbital hemangiomas: a revisit

    • Authors: Ossama M Zakaria, Foad S Sadek, Tamer A Sultan, Ahmed Mousa, Karam El Sayem, Mohamed Y Daoud, Ahmed E El-Ssisy, Fahad Al-Wadani, Haytham Al Arfaj, Mohamed Bu Bshait, Hazem M Zakaria, Saif Al-Dossari, Mariam Abdulrahman Alosfoor, Feroze Kaliydani, Sawsan F Al Marzouk, Reema AlSadhan
      Pages: 478 - 484
      Abstract: Ossama M Zakaria, Foad S Sadek, Tamer A Sultan, Ahmed Mousa, Karam El Sayem, Mohamed Y Daoud, Ahmed E El-Ssisy, Fahad Al-Wadani, Haytham Al Arfaj, Mohamed Bu Bshait, Hazem M Zakaria, Saif Al-Dossari, Mariam Abdulrahman Alosfoor, Feroze Kaliydani, Sawsan F Al Marzouk, Reema AlSadhan
      The Egyptian Journal of Surgery 2019 38(3):478-484
      Background Although infantile hemangioma is a common benign childhood tumor, it is still one of the challenging problems.Aim The current prospective study aimed to evaluate the effect of local propranolol gel in the treatment of infantile periorbital hemangioma.Patients and methods A prospective study in the period of 4 years from January 2012 to December 2016 was carried out on infants with periorbital hemangioma with a follow-up period of a minimum of 1 year. All infants underwent a fine-needle histopathological sample. All patients who proved to be capillary hemangioma were divided into two groups. Group I included those patients who were treated with topical timolol maleate gel from 4 to 30 weeks. On the other hand, group II included those patients who underwent a local corticosteroid therapy in the form of clobetasol 0.05% gel for a similar period. Posttherapy clinical and histopathological assessment took place in both groups. The obtained data were statistically analyzed.Results Twenty-eight patients were enrolled in the study. They were 18 women and 10 men with the ratio of women to men being about 2 : 1. In 21 infants, the tumor shrank in a period of 4–10 weeks after topical timolol administration. On the other hand, those who underwent local corticosteroid therapy showed a longer period for the shrinkage of the tumor; the P value is less than 0.003.Conclusion Local timolol gel therapy is superior to topical corticosteroid therapy with a wide range of safety and less side effects. Moreover, its cost-effectiveness is acceptable compared with other modalities such as laser therapy. The number of the study materials are limited; yet, it may be an indicator for a road map of managing infantile periorbital hemangiomas. Further studies with a larger population may be needed, as the problem deserves a full citizenship in the world of pediatric research.
      Citation: The Egyptian Journal of Surgery 2019 38(3):478-484
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_41_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Safety and efficacy of isolated pancreatic anastomosis after
           pancreaticoduodenectomy

    • Authors: Mahmoud A Hemida, Mohamad M Al-Hashash
      Pages: 485 - 490
      Abstract: Mahmoud A Hemida, Mohamad M Al-Hashash
      The Egyptian Journal of Surgery 2019 38(3):485-490
      Background Pancreatic leak after Whipple’s pancreaticoduodenectomy is the most serious complication being responsible for most of morbidity and mortality. Different techniques of reconstruction were developed to reduce the incidence of this complication. This study aims to evaluate the technique of isolated loop pancreaticojejunostomy after pancreaticoduodenectomy regarding its safety and efficacy.Patients and methods Morbidity and hospital mortality were evaluated in 25 patients underwent Whipple’s pancreaticoduodenectomy for malignant tumors followed by isolated loop pancreaticojejunostomy.Results Postoperative complications, occurred in nine (36%) patients, three patients developed anastomotic leak, two (8%) pancreatic and one (4%) biliary, the two pancreatic leaks were of grade A. Delayed gastric emptying developed in one (4%) patient. One (4%) patient died due to pulmonary embolism. The mean operative time was 383.4±38.3 min, the mean time of anastomosis was 136.6±20.03 min, the mean intraoperative blood loss was 525.2±225.8 ml and the mean hospital stay was 12.76±3.6 days.Conclusion Although isolated loop pancreaticojejunostomy associated with somewhat long operative time due to additional anastomosis, it is associated with low rate and grade of pancreatic fistula and contribute to reducing its severity and subsequent sequelae.
      Citation: The Egyptian Journal of Surgery 2019 38(3):485-490
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_46_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • One-stage hybrid management of patients with critical limb ischemia due to
           complex multilevel arterial occlusions

    • Authors: Mohamed Ibrahim, Ahmed Elbadawy, Khaled Attalla
      Pages: 491 - 496
      Abstract: Mohamed Ibrahim, Ahmed Elbadawy, Khaled Attalla
      The Egyptian Journal of Surgery 2019 38(3):491-496
      Aim To evaluate the safety and efficacy of one-stage hybrid revascularization modality in patients with complex multifocal arterial occlusive lesions.Patients and methods A prospective study design was established. Included patients were those admitted to the Vascular and Endovascular Surgery Department between November 2015 and November 2016 and presenting with Rutherford stages 5 and 6 critical limb ischemia due to multilevel arterial occlusion involving common femoral artery and one or both of inflow (iliac) and outflow arteries (superficial femoral and leg arteries) with nonsignificant aortic lesions and underwent a one-stage hybrid revascularization procedure aiming limb salvage. Common femoral artery endarterectomy was a fixed step in all cases. For inflow lesions; plain balloon angioplasty with bare metal stenting was first attempted then a femoro-femoral bypass if failed the endovascular approach. For outflow lesions, plain balloon angioplasty with selective stenting was tried in all cases and to stop if failed provided the presence of sufficient profunda flow. The study end points were 1-year primary patency, secondary patency, limb salvage, and complication rates.Results This study included 30 patients (30 limbs), with a mean age of 65±10.28 years. Technical success was achieved in 46 (95.8%) of 48 performed procedures and hemodynamic or clinical success in all patients (100%). Twelve-month primary and secondary patency rates were 67 and 80%, respectively. One-year limb salvage rate was 93.3%. Postoperative complications were reported in four (13.3%) cases.Conclusion One-stage hybrid procedures may be considered a safe and effective modality in the treatment of patients with critical limb ischemia due to multilevel complex arterial occlusions.
      Citation: The Egyptian Journal of Surgery 2019 38(3):491-496
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_48_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Inferior pedicle technique with immediate nipple–areola
           reconstruction as an oncoplastic procedure for early central breast cancer
           

    • Authors: Mahmoud A Mahmoud, Mohamed A.A Saleh
      Pages: 497 - 510
      Abstract: Mahmoud A Mahmoud, Mohamed A.A Saleh
      The Egyptian Journal of Surgery 2019 38(3):497-510
      Introduction Requirements and indications for usage of an inferior pedicle oncoplastic reduction are cases having breast cancer wishing to preserve their breasts with moderate-sized to large breasts and ptosis. A decreased breast volume tolerates radiation therapy better than a large-volume breast, and aesthetic outcomes have been revealed and displayed to be superior.Aim To evaluate inferior pedicle technique as an oncoplastic procedure for management of central breast cancer.Patients and methods A prospective analytical research study that recruited 15 cases was conducted at Ain Shams University Hospitals and Bahya Specialized Hospital for breast cancer. Approval of the Ethical Committee and written informed consent from all participants were obtained.Results The number of cases given excellent score (score 5) was 9, the number of cases given very good score (score 4) was 4, the number of cases given good score (score 3) was 1, the number of cases given fair score (score 2) was 1, the number of cases given poor score (score 1) was 0, and the number of cases given ugly score (score 0) was 0. All of our patients had clear margins in frozen sections taken during the operations and the postoperative paraffin section results provided by our pathologist, and none of them had recurrence during postoperative follow-up period of 6-month duration.Conclusion Inferior pedicle oncoplastic reduction is a very reliable and adaptable technique for reconstructing the partial mastectomy defects in women with macromastia or ptosis.
      Citation: The Egyptian Journal of Surgery 2019 38(3):497-510
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_49_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Modified technique for two ports laparoscopic cholecystectomy: combined
           safety and economic value

    • Authors: Mohammad Taha, Ahmed N Sallam, Hazem M Zakaria, Ahmed Nassar
      Pages: 511 - 516
      Abstract: Mohammad Taha, Ahmed N Sallam, Hazem M Zakaria, Ahmed Nassar
      The Egyptian Journal of Surgery 2019 38(3):511-516
      Context The surgeons have tried to reduce the size and number of ports to reduce morbidity and improve the cosmetic appearance in laparoscopic surgery.Aims Assessment of safety and economic value of two-port laparoscopic cholecystectomy using traction stitches after adding left-sided traction stitch to Hartman’s pouch (third stitch) to increase the range of movement (dynamicity) of gall bladder neck (puppet show technique).Patients and methods Between July 2017 and January 2019, 50 patients with symptomatic cholelithiasis were involved into this study (36 females and 14 males) their age 18–65 years (mean±SD=41.6±11.4 years). All the cases were done using two ports; umbilical and epigastric. Three traction stitches were used; one to the fundus and two to the Hartman’s pouch to its right and left sides to increase its range of movement during dissection of the Calot’s triangle (puppet show technique).Statistical analysis used The decreptive data were presented as mean & standard deviation (SD). Data were analyzed using the SPSS package for Windows, version 23, SPSS Inc., Chicago, Illinois, USA.Results The mean operative time was 55.80±18.60 min (30–120 min). There was no need for more trocars or conversion to open surgery. Intraoperative complications occurred in three cases; one had a small liver tear in the gall bladder fossa. The second case had a small diaphragmatic injury (was repaired) and the third case had bleeding from the posterior branch of the cystic artery (was controlled) and spillage of gall stones (were extracted). The postoperative pain was mild in majority of patients (48 cases) and moderate in two patients. All patients started oral feeding and movements 4 h postoperative. The mean hospital stay was 0.950±0.35 days (0.5–2 days). Economically, about $600 were saved for every case (the price of unused disposable two trocars and two graspers).Conclusion Two ports laparoscopic cholecystectomy with three traction stitches (after adding third stitch) (puppet show technique), is an applicable and a safe technique with more patients’ satisfaction due to less scars and better economic value.
      Citation: The Egyptian Journal of Surgery 2019 38(3):511-516
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_51_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Evaluation of different oncoplastic procedures in the management of breast
           cancer from an aesthetic point of view

    • Authors: Mahmoud Abdelbaky Mahmoud, Anas H Mashal
      Pages: 517 - 530
      Abstract: Mahmoud Abdelbaky Mahmoud, Anas H Mashal
      The Egyptian Journal of Surgery 2019 38(3):517-530
      Background Breast cancer, according to the National Cancer Institute, is the most common cancer in women in Egypt as it accounts for ∼38.8% of the total malignancies among Egyptian women. For many women with early-stage breast cancer, a combination of partial mastectomy and radiation therapy referred to as breast-conserving therapy is preferable to total mastectomy.Objective To evaluate the different oncoplastic techniques for the management of breast cancer from an esthetic point of view.Patients and methods This was a prospective, analytical study that included 30 patients aiming to clinically assess the oncoplastic surgical techniques used for the management of early-stage breast cancer. This study was conducted at the Bahya Specialized Breast Cancer Hospital and Ain Shams University Hospitals.Results In our study, none of the patients had any malignant recurrence as confirmed by the pathologist in our multidisciplinary team proving that we had performed a safe oncoplastic technique from the oncological point of view. The follow-up of the malignant recurrence was for the first 6 months as this was the time limitation of our study. In our study, we were able to conduct an excellent cosmetic outcome for relatively large tumor excisions with 90% of the cases falling in excellent and very good score groups with a mean cosmetic outcome score of 4.53. The remaining 10% fall in the good and fair score groups as those patients noticed asymmetry of the two breasts in front of the mirror as they refused bilateral breast reduction mastopexy. None of our cases have had a poor or an ugly score.Conclusion The choice of the oncoplastic technique is mainly based on the location of the tumor, size of the breast, and distance of the tumor from the nipple–areola complex.
      Citation: The Egyptian Journal of Surgery 2019 38(3):517-530
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_54_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Percutaneous Endoscopic Gastrostomy (PEG) vs. Lap-assistedgastrostomy
           (LAG) in children; which is better in pediatric age group?

    • Authors: Mohamed H Soliman, Heba E Elkholy
      Pages: 531 - 534
      Abstract: Mohamed H Soliman, Heba E Elkholy
      The Egyptian Journal of Surgery 2019 38(3):531-534
      Aim To compare the operative and postoperative results in pediatric patients who required gastrostomy insertion via laparoscope versus endoscope.Materials and methods The study was plotted on 49 patients with feeding difficulty and no gastroesophageal reflux requiring gastrostomy during the period between January 2016 and January 2019. They were classified into two groups according to the type of gastrostomy insertion. The first group (25 patients) underwent percutaneous gastrostomy insertion via an endoscope (PEG) and the second group (24 patients) underwent laparoscopic-assisted gastrostomy (LAG) insertion. Data for comparison included the mean operative time and postoperative recovery and the presence of complications.Results Group 1 (PEG group) scored a mean operative time of 16±4.5 min, which was much shorter when compared with the mean operative time of group 2 (laparoscopic insertion) which scored 42±7 min. No intraoperative complications were recorded in the LAG group while in the PEG group we had one case of intestinal injury. Regarding the postoperative course, group 1 (PEG) showed better postoperative recovery with much less postoperative pain with no scars and feeding was initiated as early as the first day postoperatively and we had one case of stomach wall erosion due to tight compression of the PEG lock on the abdominal wall. Group 2 (laparoscope) showed less patient’s tolerability to early feeding when compared with group 1 with a slightly higher score on the pain scale, we had one case of internal hernia which required reexploration.Conclusion Minimal invasive techniques for gastrostomy insertion became the procedures of choice. Better results regarding postoperative recovery and operative time can be achieved when doing it using the PEG technique rather than the LAG technique. Safety is still questionable with PEG techniques and requires more skillful and trained practitioners to avoid complications.
      Citation: The Egyptian Journal of Surgery 2019 38(3):531-534
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_55_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Preoperative laboratory tests as predictors of complicated appendicitis

    • Authors: Muhammad A Baghdadi, Abd-Elrahman M Metwalli, Mohamed I Abdelhamid
      Pages: 535 - 541
      Abstract: Muhammad A Baghdadi, Abd-Elrahman M Metwalli, Mohamed I Abdelhamid
      The Egyptian Journal of Surgery 2019 38(3):535-541
      Background and aims Diagnosis of acute appendicitis is not always straightforward; even the most experienced surgeon may remove normal appendix or sit on the perforated one. The aim of this study is to investigate the role of preoperative laboratory tests in the prediction of complicated appendicitis (CA).Patients and methods A total of 126 patients presented with right iliac fossa pain (appendicitis) were included between March 2018 and January 2019 in the Department of General Surgery, Zagazig University Hospitals. All patients underwent blood sample test, surgical exploration, and management according to operative findings.Results According to the operative and histopathological findings, the participants were divided into group A which included 72 (57%) patients with non-CA and group B which included 54 (43%) patients with CA. The preoperative laboratory predictors such as white blood cells (WBCs), international normalized ratio (INR), serum C-reactive protein (CRP), and total bilirubin (TB) were highly significantly higher in group B (P<0.0001) than in group A. Serum WBCs and CRP showed the highest sensitivity for defining cases with CA followed by INR and TB (92.6, 92.6, 83.4, 68.75%), respectively, while serum TB showed the highest specificity for defining cases with CA followed by INR, CRP, and WBCs (89.7, 74.5, 67.8, 67.8%), respectively.Conclusion The diagnostic accuracy of WBCs, INR, TB, and CRP were between 68% and up to 93% indicating that these preoperative laboratory tests were valid for early detection of CA. Further studies evaluating these laboratory predictors are recommended.
      Citation: The Egyptian Journal of Surgery 2019 38(3):535-541
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_61_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Preoperative indicators of technically difficult laparoscopic
           cholecystectomy using clinical and ultrasonographic parameters

    • Authors: Hosam M Hamza, Moustafa E Radwan, Tareef S Daqqaq
      Pages: 542 - 547
      Abstract: Hosam M Hamza, Moustafa E Radwan, Tareef S Daqqaq
      The Egyptian Journal of Surgery 2019 38(3):542-547
      Background Laparoscopic cholecystectomy (LC) has rapidly become the operation of choice for routine gallbladder (GB) removal. The purpose of this study is to provide preoperative indicators of a technically difficult LC based on various preoperative clinical and ultrasonographic predictors.Patients and methods This study was conducted in the General Surgery Department, Ohud General Hospital, Al Madinah Al Munawarah, Saudi Arabia, for 280 patients with diagnosis of gallstones confirmed by abdominal ultrasonography and subjected to LC. The technical difficulty of the surgical procedure was assessed postoperatively (either easy, difficult, or very difficult) based on operative time (min), spillage of bile and/or stones, bile duct injury, and the need for conversion to open surgery.Results The present study found that old age; male sex; previous history of acute cholecystitis or acute pancreatitis; history of previous abdominal surgery; urgent surgery after 72 h of the onset of symptoms in acute cholecystitis; morbid obesity; ultrasonographic findings including increased of GB wall thickness, impacted stones, sonographic Murphy’s sign, and pericholecystic fluid collection; and palpable GB increase the technical difficulty of LC. Conversion to open cholecystectomy was seen in only one patient.Conclusion Clinical and radiological patient characteristics are good preoperative predictors for the technical difficulty of LC and can help the surgeon to anticipate the risk for intraoperative complications and the possible need for conversion to open cholecystectomy.
      Citation: The Egyptian Journal of Surgery 2019 38(3):542-547
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_64_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Traumatic arterial injuries: endovascular management

    • Authors: Waleed A Sorour, Medhat E Laboudy, Ahmed H Abouissa, Hossam I Elgebali, Sameh Saber
      Pages: 548 - 557
      Abstract: Waleed A Sorour, Medhat E Laboudy, Ahmed H Abouissa, Hossam I Elgebali, Sameh Saber
      The Egyptian Journal of Surgery 2019 38(3):548-557
      Objective The purpose of this study is to evaluate the efficacy of endovascular management of traumatic arterial injuries.Patients and methods We conducted our prospective study at Vascular Surgery Department and Radiology Department, Zagazig University Hospitals, Egypt, and intervention Radiology Department, Alnoor Specialist Hospital, Makkah, Saudi Arabia, from January 2015 to March 2019. Seventeen interventions were performed. The mean age was 39±3.6 years (range, 27–49 years), and 13 (76.5%) patients were males. The site of arterial injuries included superficial femoral artery in seven (41.2%) patients, deep femoral artery in one (5.9%) patient, one of the branches of internal iliac artery in five (29.4%) patients, anterior division of right hepatic artery in one (5.9%) patient, and subclavian artery in three (17.6%) patients. The injuries were extravasation in seven (41.2%) patients, pseudoaneurysm in five (29.4%) patients, and arteriovenous fistula in five (29.4%) patients.Results Initial success was achieved in 15 (88.2%) patients. We failed in two (11.8%) patients who were converted to open surgery. Nine covered stents were deployed, gelfoam embolization in one patient, microparticles embolization in two patients (successful in one patient and failed in the other in whom vascular plug was used), and coil embolization in three patients. Early complications occurred in four patients (extravasation in one patient, puncture site hematoma in two patients, and partially occlusive thrombus/spasm of deep femoral artery in one patient). Late complications occurred in two patients in the form of stent graft occlusion who underwent short bypass. The median follow-up time was 15 months (range, 5–24 months). Mean intervention-free period was 6.5 months.Conclusion Endovascular management of arterial injuries in hemodynamically stable patients can be a good alternative to open surgery in anatomic regions that are difficult to access and unfit patients for major surgery with possibility of massive blood loss.
      Citation: The Egyptian Journal of Surgery 2019 38(3):548-557
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_66_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Laparoscopic-assisted transgastric endoscopic retrograde
           cholangiopancreatography for management of choledocolithiasis after
           mini-gastric bypass surgery

    • Authors: Mohammed Matar, Mahmoud Zakaria, Mohammed El Kady
      Pages: 558 - 562
      Abstract: Mohammed Matar, Mahmoud Zakaria, Mohammed El Kady
      The Egyptian Journal of Surgery 2019 38(3):558-562
      Background Gallstones commonly form after bariatric surgery owing to rapid weight loss. Choledocolithiasis is one of the dangerous sequelae of gallstones. Mini-gastric bypass (MGBP) excludes the biliary tree from traditional evaluation and treatment with endoscopic retrograde cholangiopancreatography (ERCP). This prevents ERCP to be done through the normal route.Objective To assess the feasibility and outcome of laparoscopic-assisted transgastric ERCP in patients with choledocolithiasis after MGBP for extraction of common bile duct (CBD) stones.Patients and methods A retrospective study was conducted on 15 patients who had gallstones discovered in the CBD after MGBP in five bariatric centers. Overall, 750 participants (BMI >35 kg/m2) were observed after undergoing MGBP over 2 years, and 10 of them were included in the study after being diagnosed with primary CBD stones and presented with jaundice during a period of 2 years after surgery. All patients were hospitalized, and gallstones were extracted laparoscopically through a transgastric approach except for two patients.Results Of 15 patients, 11were managed laparoscopically, and gallstones were extracted successfully. Four patients were converted to open surgery, but the scope was still used in three of them to extract the stones, and the last one underwent open CBD exploration.Conclusion Laparoscopic-assisted transgastric ERCP is an effective and safe way of management of choledocholithiasis in post-MGBP patients.
      Citation: The Egyptian Journal of Surgery 2019 38(3):558-562
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_69_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Gastrojejunal sleeve as a revisional surgery for a failed Roux-en-Y
           gastric bypass

    • Authors: Mohamed Mahfouz, Mahmoud Zakaria, Mohamed Lasheen
      Pages: 563 - 569
      Abstract: Mohamed Mahfouz, Mahmoud Zakaria, Mohamed Lasheen
      The Egyptian Journal of Surgery 2019 38(3):563-569
      Background Roux-en-Y gastric bypass (RYGBP) is one of the best solutions for morbid obesity, but secondary weight regain is seen in about 15–25% of cases. In this prospective study, we assessed the short-term success of gastrojejunal sleeve along with jejunojejunostomy distalization as a revisional procedure in cases of failed RYGBP.Patients and methods This study included 13 cases of failed RYGBP done at least 3 years earlier; all were assessed using three-dimensional virtual gastrography. All patients were followed up for 2 years.Results Mean BMI decreased from 44.2±6.04 to 30.7±4.06 kg/m2; mean excess weight loss was 28.1±23%; and comorbidities improved in 62.5% of cases. Mean operative time was 204±33 min, while the mean postoperative hospital stay was 3 days. No mortalities, conversions, or major complications were observed among the patients included in this study.Conclusion Gastrojejunal sleeve with jejunojejunal distalization is a safe, feasible, and effective revisional procedure for a failed RYGBP.
      Citation: The Egyptian Journal of Surgery 2019 38(3):563-569
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_71_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Comparison between antral resection in laparoscopic sleeve gastrectomy and
           classical laparoscopic sleeve gastrectomy

    • Authors: ElSobky Ahmed, Mashaal Anas
      Pages: 570 - 574
      Abstract: ElSobky Ahmed, Mashaal Anas
      The Egyptian Journal of Surgery 2019 38(3):570-574
      Background The objective of this study was to study the effect of the residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy (LSG) and to evaluate the effect of antral resection on weight reduction and complications after LSG.Patients and methods This retrospective study was carried out on the prospectively collected data of patients, who underwent LSG at Safwet Elgolf Private Hospital from February 2015 to July 2016. According to antral resection, the patients were divided into two groups: group A (n=54) underwent a 6-cm antral resection and group B (n=54) underwent a 2-cm antral resection. All patients who completed at least 24 months of follow-up postoperatively, the percentage of excess weight loss (%EWL) was calculated at 3, 6, 12, and 24 months as well as the postoperative complication rate.Results In our study, 110 patients were included. Patients in group B experienced statistically significant greater weight loss than patients in group A. Statistically significant greater weight regain was seen in group A. The mean BMI was 46.1±7.9 kg/m2. In group A, the mean %EWL was 38.1±14.1, 54.9±19.9, 65.6±22.8, and 66.8±28.4% at 3, 6, 12, and 24 months, respectively. However, in group B, the mean %EWL was 42.1±13.4, 63.8±19.8, 80.0±22.1, and 81.5±22.9% at 3, 6, 12, and 24 months, respectively. Group B had a higher incidence of reflux symptoms and vomiting (six patients, 11%) than group B (four patients, 7.1%).Conclusion Radical antral resection in association with LSG safely potentiates the restrictive effect achieved and results in greater and better maintained weight loss, and in higher incidence of reflux symptoms and vomiting.
      Citation: The Egyptian Journal of Surgery 2019 38(3):570-574
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_73_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Predictors of demand for liver transplantation in children undergoing
           Kasai portoenterostomy for biliary atresia

    • Authors: Ahmed Nabil Sallam, Hosam El-Din Mohamed Basiouny, Alif Abd-Elhakim Allam
      Pages: 575 - 582
      Abstract: Ahmed Nabil Sallam, Hosam El-Din Mohamed Basiouny, Alif Abd-Elhakim Allam
      The Egyptian Journal of Surgery 2019 38(3):575-582
      Context Biliary atresia (BA) remains the most common indication for pediatric liver transplantation worldwide. Ultimately, 50–80% of BA patients will require a liver transplant Thus, much of the research in the field has focused on identifying predictors for transplant and optimizing the efficacy of Kasai portoenterostomy (KPE), in order to decrease the need for transplantation and avoid the risks of lifelong immunosuppression.Aim The aim of this study was to identify perioperative risk factors for the need of liver transplantation following KPE operation for BA.Patients and methods A retrospective analysis of 150 patients undergoing KPE for BA at Hepatobiliary and Pancreatic Surgery Department, National Liver Institute, Menoufia University, from May 2013 to May 2018, was carried out. Patients were divided into two groups: group one included 73 (48.7%) patients who survived without the need for liver transplantation and group two included 77 (51.3%) patients with mortality, listed for liver transplantation or transplanted; thereafter, logistic regression analysis was used to identify the independent predictors of cases needing liver transplantation.Statistical analysis used Continuous variables were expressed as mean±SD and categorical variables as proportions. Univariate analysis for the two groups were carried out using the independent samples t test for continuous variables and χ2 test for categorical variables. Logistic regression analysis was used to identify the independent predictors of cases needing liver transplantation. Receiver operating characteristic analysis was used for the cut-off determination of predictive parameters using MedCalc application, version 18.2.1.Results The mean age at the time of operation was 74.9±14.6 days after birth (range, 31–111 days); there were 70 (46.7%) male babies and 80 (53.3%) female babies. The mean preoperative weight was 4.6±0.6 kg, while the mean preoperative height was 57.3±3.58 cm.Total bilirubin and albumin levels at 1 and 3 months following KPE were associated with death or the need for liver transplantation; however, only a total bilirubin level of more than 6 mg/dl at 3 months is an independent predictor of the need for liver transplantation. Age at the time of KPE and postoperative steroid use were not associated with improved transplant-free survival.Conclusion Total bilirubin level of more than 7.3 mg/dl at 1 month and a level of more than 6 mg/dl at 3 months after KPE are predictive of the need for liver transplantation (P<0.001). Albumin level of less than or equal to 2.5 g/dl at 1 month and a level of less than or equal to 3 g/dl at 3 months after KPE are predictive of the need for liver transplantation (P<0.001); however, only total bilirubin level of more than 6 mg/dl at 3 months is an independent predictor of the need for transplantation (P<0.001). Age at the time of KPE and postoperative steroid use were not associated with improved transplant-free survival.
      Citation: The Egyptian Journal of Surgery 2019 38(3):575-582
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_77_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Colorectal emergencies: are there any modifiable factors affecting
           outcome?

    • Authors: Doaa A Mansour, Ahmed Nabil, Alyaa Ibrahim, Hesham M Amer
      Pages: 583 - 587
      Abstract: Doaa A Mansour, Ahmed Nabil, Alyaa Ibrahim, Hesham M Amer
      The Egyptian Journal of Surgery 2019 38(3):583-587
      Background Colorectal emergencies are common and associated with significant mortality. Emergency presentation per se is an independent risk factor for postoperative morbidity and mortality. The aim of this study is to define modifiable factors to account for the high morbidity and mortality in colorectal emergencies.Patients and methods A total of 137 colorectal emergencies presenting to Kasr Alainy Emergency Department were managed according to the general condition of the patient, site and severity of pathology, bowel wall edema, and friability as well as the experience of the surgical team. Morbidity and 30-day mortality were analyzed using univariate followed by multivariate analysis to determine modifiable factors to improve outcome. Studied factors were patient factors (demographic and comorbidities), site of pathology, presence or absence of malignancy, hemodynamic instability, local pathology, and the treatment adopted.Results Mean age was 45.6 years. Of 48.2% females and 51.8% males, 52.6% presented with colorectal cancer-related emergencies, 7.3% with colorectal trauma, and the remaining 40.1% with nononcological pathology (40.1%). Postoperative morbidity and mortality occurred in 18.2 and 20.4%, respectively. Hemodynamic instability after initial resuscitation harbored the highest risk for mortality in the multivariate module (R=6.6), followed by malignancy (R=3.9), type of operative management (R=1.7), and comorbidity (R=1.4).Conclusion Comorbidity and colorectal malignancy are independent nonmodifiable factors increasing perioperative mortality warranting vigilance. Hemodynamic instability after initial resuscitation is the single most important modifiable factor emphasizing the importance of maximized joint efforts in preoperative optimization of these patients using damage control resuscitation principles. Operative time is an important modifiable factor dictating the shortest appropriate surgical option.
      Citation: The Egyptian Journal of Surgery 2019 38(3):583-587
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_80_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Comparative study between the use of self-fixating mesh and
           non-self-fixating mesh in laparoscopic inguinal hernia repair
           transabdominal preperitoneal technique

    • Authors: Ahmed A Khalil, Essam F Ebeid, Ahmed I Ismail
      Pages: 588 - 596
      Abstract: Ahmed A Khalil, Essam F Ebeid, Ahmed I Ismail
      The Egyptian Journal of Surgery 2019 38(3):588-596
      Background Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work.Aim of the work To compare between self-fixating mesh and fixation of non-self-fixating mesh with absorbable tacks in laparoscopic inguinal hernia repair transabdominal preperitoneal approach as regards intraoperative time, complications, postoperative pain, return to normal activity, and incidence of recurrence.Patients and methods Our study is a randomized, prospective study. It was conducted in El Demerdash, Ain Shams University Hospital on 30 patients with inguinal hernia who were operated upon between September 2018 and December 2018 with a minimal follow-up of 3 months.Statistical analysis used Data were collected, revised, coded, and entered to the Statistical Package for the Social Sciences (IBM SPSS), version 23. The quantitative data were presented as mean, SDs, and ranges when their distribution was found parametric. Also qualitative variables were presented as number and percentagesResults Our study demonstrates that laparoscopic inguinal hernia repair using the transabdominal preperitoneal technique with implantation of a new Parietex ProGrip laparoscopic self-fixation mesh is a fast, effective, and reliable method in experienced hands, which combines the advantages of laparoscopic approach with simple and practical implantation of self-fixation mesh, which, according to our results, reduces the occurrence of chronic pain and the recurrence rate.Conclusion After this comparative study, both the use of self-gripping mesh and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature.
      Citation: The Egyptian Journal of Surgery 2019 38(3):588-596
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_83_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Comparison between Lichtenstein procedure using polypropylene mesh and
           self-fixating mesh for management of primary inguinal hernia in adult male
           patients in terms of chronic postoperative pain: a prospective randomized
           controlled trial

    • Authors: Walid M. Abd El Maksoud, Khaled S Abbas, Ahmed D Mohii
      Pages: 597 - 603
      Abstract: Walid M. Abd El Maksoud, Khaled S Abbas, Ahmed D Mohii
      The Egyptian Journal of Surgery 2019 38(3):597-603
      Aim The aim of this study was to evaluate the self-gripping mesh compared with standard polypropylene mesh (PM) in treating primary inguinal hernia in adult male patients in terms of chronic postoperative pain.Patients and methods One hundred male patients with primary inguinal hernia were randomly allocated into two groups: group I included 50 patients (mean age, 35.92±13.21 years) who were treated with the standard PM and group B included 50 patients (mean age, 36.60±13.12 years) who were treated with the self-fixating mesh (SF).Results Recurrence was encountered in only one patient in the PM group and in one patient of the SF group. Visual analog scale showed significant less early and late postoperative pain in the SF group compared with the PM group. The operative time for the SF group (47.54±6.51 min) was significantly shorter compared with the PM group (58.82 ±11.90 min). Both PM and SF groups showed no significant differences as regards hospital stay (0.78± 0.53 vs.0.74±0.31 days), time to return to domestic activity (1.96±1.16 vs. 1.66±0.80 days), time to return to work activity (7.34±2.17 vs. 6.98±1.66 days), and early postoperative complications.Conclusion After 1 year follow-up, in Lichtenstein repair, using the Self-gripping ProGrip mesh showed significant less chronic postoperative pain compared with the standard PM. The use of Self-gripping ProGrip mesh was also associated with a significantly less operative time.
      Citation: The Egyptian Journal of Surgery 2019 38(3):597-603
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_84_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Evaluation of ligation of intersphincteric fistula tract technique in
           treatment of simple transsphincteric fistula

    • Authors: Olfat I Elsebai, Mohamed S Ammar, Mahmoud S Abdelhaleem, Ahmed A.H Khattab
      Pages: 604 - 609
      Abstract: Olfat I Elsebai, Mohamed S Ammar, Mahmoud S Abdelhaleem, Ahmed A.H Khattab
      The Egyptian Journal of Surgery 2019 38(3):604-609
      Objective To evaluate the success rate of ligation of intersphincteric fistula tract (LIFT) operation in the treatment of simple transsphincteric anal fistula.Background LIFT is a new effective sphincter-preserving technique. One of the main advantages of the technique is the low possibility of an impaired sphincter function (as there is no resection of the sphincter).Patients and methods This is a prospective descriptive clinical study of 30 patients with simple transsphincteric anal fistula. In this variety of fistula, the tract passes from the intersphincteric plane through the external sphincter into the ischioanal fossa, and to the skin. Patients with transsphincteric anal fistulas of cryptoglandular origin with no previous surgical interventions were included. Patients with anal fistulas from another sources, such as Crohn’s disease, tuberculosis, anal cancer, and recurrent fistulas, were excluded. All patients underwent the same technique and were evaluated for 6 months postoperatively.Results We evaluated 30 patients. Their mean age was 42.1 years. The outpatient follow-up was 6 months. The healing time observed in this study ranged from 5 to 8 weeks after the procedure (mean±SD) 6.47±1.19. A primary healing rate of 80% (24 patients) was observed, and the recurrence rate was 20% (six patients). Recurrence occurred in the incision for ligation of the fistulous tract, that is, the fistula turned into intersphincteric type. The postoperative wound infection occurs in five (16.7%) patients. Postoperative urine retention occurred in one (3.3%) patient. No bleeding occurred in any patient. No patient experienced postoperative incontinence to stool.Conclusion LIFT was effective sphincter-preserving technique in the treatment of simple transsphincteric anal fistulas.
      Citation: The Egyptian Journal of Surgery 2019 38(3):604-609
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_92_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Laparoscopic sleeve gastrectomy with loop bipartition versus laparoscopic
           sleeve gastrectomy in treating obese people with type II diabetes
           mellitus: a prospective randomized comparative study

    • Authors: Osama H Khalil, Wael S Mansy, Wael M Abdalla, Taha A Baiomy
      Pages: 610 - 617
      Abstract: Osama H Khalil, Wael S Mansy, Wael M Abdalla, Taha A Baiomy
      The Egyptian Journal of Surgery 2019 38(3):610-617
      Introduction Sleeve gastrectomy with loop bipartition is a new operation based on the modification of Santoro’s operation by making sleeve gastrectomy followed by side-to-side gastro-ileal anastomosis. The aim of this study is to compare this novel operation with sleeve gastrectomy only as a therapeutic method for obese patient with diabetes type II.Patients and methods The trial was designed as a prospective randomized comparative study. The trial protocol was approved by the institutional ethics committee. A total of 51 patients between 18 and 60 years, with a BMI between 40 and 60 kg/m2 and indication for bariatric surgery according to the national institutes of health criteria were randomized to receive either laparoscopic sleeve gastrectomy with loop bipartition (LSGB) (n=26) or laparoscopic sleeve gastrectomy (LSG) (n=25). The primary and secondary end points were assessed before surgery and afterward at discharge and at the time points 3, 6, and 12 months postoperatively.Result Both operations are effective in the treatment of obesity with a significant difference in operative time and blood loss. There was no significant difference between both groups regarding early and late complications. LSGB is more effective than LSG in the decrease of BMI, waist circumference, weight loss, lipids levels, blood glucose, and glycated hemoglobin than LSG group after 1 year of surgery.Conclusion LSGB is an effective easy procedure to treat morbidly obese patients with type II diabetes. This operation showed many advantages with little complications.
      Citation: The Egyptian Journal of Surgery 2019 38(3):610-617
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_98_19
      Issue No: Vol. 38, No. 3 (2019)
       
  • Surgical management of central venous occlusive disease in hemodialysis
           patients

    • Authors: Atef Abdel Hameed, Abdulrahman Mohamed
      Pages: 618 - 625
      Abstract: Atef Abdel Hameed, Abdulrahman Mohamed
      The Egyptian Journal of Surgery 2019 38(3):618-625
      Background Central venous disease is a common and complex problem that compromises functioning access in patients undergoing hemodialysis which may result in loss of the access. Prior ipsilateral insertion of central venous catheters is a common risk factor. Percutaneous angioplasty with or without stenting is considered the primary method to treat central venous stenosis. However, it carries poor long-term patency rates and require multiple and repetitive interventions. Surgical options could be the choice if endovascular approaches are refractory or impossible.Aim The purpose of this retrospective, observational study is to report our experience in the surgical management to maintain hemodialysis access compromised by venous hypertension (VHTN) due to central venous occlusive disease.Patients and methods This is a retrospective analysis of 14 patients with existing upper extremity hemodialysis access who underwent extra-anatomic surgical bypass to treat symptomatic VHTN due to central vein occlusive disease after failure of endovascular management.Results Technical success was achieved in the 14 (100%) cases while clinical success occurred in 13 (92.6%) cases; 12 (85.7%) patients had performed their hemodialysis sessions via their preexisting access within 24 h postprocedurally. Maximum postoperative hospital stay was 3 days. No in-hospital morbidity or death was recorded. The mean primary and secondary patency were 18.3 and 22.7 months, respectively. Primary patency rates at 6, 12, 18, and 24 months were 85, 78, 64, and 57%, respectively. Secondary patency rates at 6, 12, 18, and 24 months were 92, 85, 71, and 64%, respectively.Conclusion Extra-anatomic surgical bypass of central venous obstruction is an effective and safe method to provide symptomatic relief of VHTN and salvage of existing access in hemodialysis patients when endovascular solutions are unfeasible.
      Citation: The Egyptian Journal of Surgery 2019 38(3):618-625
      PubDate: Wed,14 Aug 2019
      DOI: 10.4103/ejs.ejs_109_19
      Issue No: Vol. 38, No. 3 (2019)
       
 
 
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