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Publisher: Tehran University of Medical Sciences   (Total: 20 journals)   [Sort by number of followers]

Showing 1 - 20 of 20 Journals sorted alphabetically
Academic J. of Surgery     Open Access   (Followers: 17)
Advanced J. of Emergency Medicine     Open Access  
Audiology     Open Access   (Followers: 11)
Basic and Clinical Neuroscience     Open Access   (Followers: 5, SJR: 0.272, h-index: 4)
DARU J. of Pharmaceutical Sciences     Open Access   (Followers: 2, SJR: 0.495, h-index: 21)
Dermatology and Cosmetic     Open Access   (Followers: 5)
Hayat : J. of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences     Open Access   (Followers: 1, SJR: 0.18, h-index: 3)
Hospital     Open Access   (Followers: 2)
Intl. J. of Hospital Research     Open Access  
Iranian J. of Epidemiology     Open Access   (Followers: 2, SJR: 0.186, h-index: 3)
Iranian J. of Nuclear Medicine     Open Access   (Followers: 1, SJR: 0.196, h-index: 8)
Iranian J. of Public Health     Open Access   (SJR: 0.326, h-index: 20)
J. of Dental Medicine     Open Access   (Followers: 1)
J. of Dentistry of Tehran University of Medical Sciences     Open Access  
J. of Medical Ethics and History of Medicine     Open Access   (Followers: 13, SJR: 0.245, h-index: 4)
Medical J. of the Islamic Republic of Iran     Open Access   (Followers: 2, SJR: 0.209, h-index: 6)
Modern Rehabilitation     Open Access   (Followers: 9)
Nanomedicine Research J.     Open Access  
Tehran University Medical J.     Open Access   (Followers: 1, SJR: 0.122, h-index: 6)
Transport Phenomena in Nano and Micro Scales     Open Access  
Journal Cover Journal of Minimally Invasive Surgical Sciences
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  • Comparison of Levels of Depression in Patients with Excessive Obesity
           Before and After Gastric Bypass Surgery

    • Abstract: Conclusions: It can be concluded that depression level of the patients was decreased after the surgery and the recovery progressed gradually.,Results: 40 obese patients with the mean age of 34.20 ± 11.32 years old and mean BMI of 45.31 ± 2.56 kg/m2 were studied. Also, male to female ratio was 7:1. Average of BDI, before and three months after the operation was 27 ± 11.31 and 18.50 ± 9.718, respectively (P < 0.001). The value of 17 ± 7.071 was also obtained six months after the surgery which significantly was decreased compared to patient’s BDI (27 ± 11.31) before the operation (P < 0.0001).,Materials and Methods: This Quasi-experimental study performed on 40 obese patients who underwent gastric bypass surgery with BMI higher than 40 or between 35 to 40 (with FBS > 100 mg/dL) in Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran during September 2011 to September 2012.The Beck depression inventory (BDI) was performed one week before, and three and six months after
      PubDate: Wed, 26 Oct 2016 00:00:00 +033
       
  • Haemostatic Patch Envolving Laparoscopic Trocar to Stop Hemorrhage in the
           Port Site at the Beginning of the Operation

    • Abstract: Conclusions: Our proposal is a simple gesture, easy to reproduce and, with no surgical time waste which we can obtain very good results in major bleeding difficult to control with traditional methods by that.,Background: The number of laparoscopic procedures done each year continues to rise substantially. Clinically significant hemorrhage from secondary port sites at laparoscopy is an uncommon but serious complication and can become unrecognized intraoperatively. Abdominal wall hemorrhage and bruising may complicate laparoscopic operative procedures.,Methods: We propose an easy technical gesture to stop the bleeding at the port site in laparoscopic surgery. A simple technique is described to treat this complication.
      PubDate: Sun, 09 Oct 2016 00:00:00 +033
       
  • Short Assessment of Mini Gastric Bypass on Weight Loss and Diabetes
           Volunteers Client in Sari’s Avicenna Hospital: A Preliminary Study

    • Abstract: Conclusions: In the newly set up center similar to the older one, surgical treatment in our follow up duration was effective for reducing weight, body mass index reduction and achievement of success in biochemical markers on diabetics.,Results: During follow up time after 276 days mean weight decreased from 118.7 ± 23.3 to 82.9 ± 15.7, P < 0.001 BMI also changed from 45.2 ± 1.8 to 32.2 ± 1.3, P < 0.001. There was decrease in percentage of excess weight loss at month of 3, 6 and 9 were 52.1, 32.6 and 16.4 respectively. Fasting blood sugar in diabetic subjects (n = 16) decreased from 170.9 ± 84.5 to 89.8 ± 11.3, P = 0.04.,Methods: Prospective analysis of 27 volunteers of both sexes, aged between 23 - 52 years, using laparoscopic mini gastric bypass in Sari’s Avicenna hospital, were included; personal information, anthropometric and laboratory data in the preoperative, 3, 6 and 9 months were collected. Statistical analysis was done with SPSS, 19 and using the Wilcoxon and Friedman test.,Background:
      PubDate: Mon, 25 Jul 2016 00:00:00 +043
       
  • Laparoscopic Heller Myotomy and Dor Fundoplication: Prospective Evaluation
           of 30 Consecutive Patients

    • Abstract: Conclusions: Our study showed that laparascopic Helermyotomy with Dor fundoplication result in significant relief of dysphagia. Overall clinical symptoms indicate improvement in patient functional status during 18-month follow-up.,Patients and Methods: Thirty patients who underwent Heller myotomy for achalasia via laparoscopy in Alzahra hospital Isfahan, Iran were recorded prospectively (2009 - 2013). Median follow-up was 18 months. Symptoms including dysphagia, regurgitation, chest pain and weight loss were recorded before and after operation. Also, previous treatment for achalasia such as endoscopic pneumatic dilatations and intrasphincteric injection of botulinum toxin or other component, duration of symptoms and duration and complication of operation was recorded.,Results: Among 30 patients, there were 13 (43.3%) females and 17 (56.7%) males, and mean age was 40.8 years (range, 20 - 68 years). The operations were finished laparoscopically in all patients. Mean operative time was 137 ± 36.2 minutes. The patients were symptomatic for at least 30 months before referring for surgery. There are some difficulties in dissection in cases who received Ethanolamine or Botholinum Toxin injection as non-surgical treatment before that. Mean hospital stay was 2.45 days. Regurgitation, chest pain and heartburn relieved significantly in median follow up of 18 months, in 100%, 66.6% and 70%, respectively (P < 0.001, P < 0.01 and P < 0.01, respectively). At that time, except for two (6.6%) patients, all other patients had improvement in dysphagia (P < 0.001) .The mucosa in two (6.6%) of patients was perforated on the gastric end of the xylotomy. The perforations were repaired laparoscopically with single suture without postoperative leak.,Background: Prospective studies evaluating outcome of laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia are less in Asian people.,Objectives: This study conducted to evaluate the results of laparoscopic cardiomyotomy and partial fundoplication for achalasia.
      PubDate: Sun, 03 Jul 2016 00:00:00 +043
       
  • Clinical Outcome of Retrograde Laparoscopic Appendicectomy Using Single
           Hem-O-Lock Clip for Complicated Versus Non-Complicated Appendicitis

    • Abstract: Conclusions: Retrograde laparoscopic appendicectomy using single polymer clip makes easy access to operating in complicated and non-complicated appendicitis.,Results: Four patients (15.4%) were converted to open surgery; three patients in group I and one in group II. Four patients developed postoperative complications; three patients in group I and one in group II. Operative time was less in group II and was statistically different and the P value was significant < 0.001. The difference in conversion rates and post-operative complication between two groups is not statistically significant with a P > 0.05.,Objectives: To evaluate the clinical outcome of using single Hem-O-Lock polymer clip and to compare technical feasibility of retrograde laparoscopic appendicectomy for complicated versus non-complicated appendicitis in adults.,Patients and Methods: A single institute prospective study was done between August 2012 and April 2014. From 78 patients presenting with acute appendicitis to emergency unit, Zagazig University hospitals, Only 60 patients were eligible.3 retrograde laparoscopic appendicectomy ports were used in both groups (Group I, complicated appendicitis and group II, non-complicated appendicitis) and a single Hem-O-Lock polymer clip was applied to secure the appendicular stump. Standardized data collection was performed and data collected by the attending resident and attending physician. The primary clinical outcome was the severity of pain at 1 - 7 days. Secondary outcomes included the duration of operation (minutes), procedure-related complications, conversion rates, and length of hospital stay.,Background: Laparoscopic appendicectomy is safe and feasible for non-complicated appendicitis. The use of retrograde appendicectomy allows feasibility also for complicated cases. Using single polymer clip for securing appendicular stump is safe as well as two clips.
      PubDate: Sun, 03 Jul 2016 00:00:00 +043
       
  • Synchronous Morgagni and Bochdalek Hernias: A Case Report of a Unique
           Approach to a Rare Finding

    • Abstract: Conclusions: From this experience, we argue that in the right circumstances a completely minimally invasive approach can be taken for synchronous congenital diaphragmatic hernias.,Case Presentation: In this case report we have a 2day old who developed respiratory distress and on CT scan was found to have a congenital diaphragmatic hernia (CDH) or eventration. This patient is ideal for this case report because he meets a lot of the previously established criteria for minimally invasive repair of congenital diaphragmatic hernias - minimal respiratory compromise, no congenital heart defects - and he has synchronous defects which have very rarely been seen before. Here we present the first reported case of concurrent ipsilateral Bochdalek and Morgagni hernias repaired in a one-stage minimally invasive fashion, approaching the Bochdalek hernia thoracoscopically and the Morgagni laparoscopically. The patient had a quick recovery post-operatively and he continues to do well.,Introduction: Multiple unilateral congenital diaphragmatic hernias (CDH) are extremely rare, described only five times in the medical literature. Concurrent ipsilateral Bochdalek and Morgagni hernias are rarer still with only two cases previously described. In all reported cases of multiple concurrent defects, the hernias were repaired in an open fashion, either via a thoracotomy or laparotomy with both of the two combined Bochdalek and Morgagni hernias repaired via laparotomy.
      PubDate: Mon, 06 Jun 2016 00:00:00 +043
       
  • Assessment of the Serum Levels of Hemoglobin, Ferritin, and Vitamin B12 in
           a Sample of Iranian Population with Morbid Obesity

    • Abstract: Conclusions: Morbid obesity may result in two important hematologic and metabolic changes including increased hemoglobin level and reduced vitamin B12 level. Since, vitamin B12 has vital role in the body, providing adequate vitamin B12 is essential in these patients even by using vitamin supplements. Also, regular screening of the level of hematologic markers in these patients is strongly recommended.,Results: Overall, 1252 patients with morbid obesity were included in the study. The mean age of participants was 39.77 ± 10.84 years (ranged 10 to 70 years) and 80.3% of them were female. The mean body weight was 126.75 ± 21.58 kg and the mean BMI was also 46.99 ± 5.87 kg/m2. In result, 9.8% were anemic according to the low value of hemoglobin level, 46.6% had ferritin lower than the normal range and the average serum level of vitamin B12 was lower than the normal value in 21.1%. By applying the Pearson’s correlation test, a positive association was found between BMI value and the level of hemoglobin (r = 0.074, P = 0.009).,Patients and Methods: This cross-sectional study was conducted on 1252 consecutive patients with morbid obesity referred to obesity clinic at Rasoul-e-Akram hospital from 2009 to 2015 in Tehran, IR Iran. Morbid obesity was defined as body mass index (BMI) equal to or higher than 40 kg/m2. Serum hemoglobin level (gr/dL) was measured using the cyan methemoglobin method. Serum ferritin level (ng/mL) can be measured by the human ferritin enzyme immunoassay test. Also, serum vitamin B12 concentration (pg/mL) was measured using the solid-phase, competitive chemiluminescent enzyme immunoassay method.,Background: Considering the importance of providing vitamins and minerals in body health, it obviously seems to be necessary to assess the deficiencies of these nutrients in obese patients.,Objectives: The present study aimed to evaluate the level of hemoglobin, ferritin, and vitamin B12 in a sample of Iranian population with morbid obesity.
      PubDate: Tue, 31 May 2016 00:00:00 +043
       
  • Surgical Wound Infections After Laparoscopic Appendectomy with or Without
           Using Reusable Retrieval Bag; Retrospective Study

    • Abstract: Results: This patient groups were selected to be similar in both groups A and B in form of appendicitis types. Each group included 27 (45%) acute catarrhal appendicitis, 20 (33.3%) suppurative appendicitis and 13 (21.7%) perforated appendicitis, P = 1.0. The median patients ages were 21 years (range, 16 to 49) in group A and 25 years (range, 18 to 56) in group B, P = 0.053. Group A included 60 patients (35 males and 25 females) and group B 60 patients (32 males and 28 females), P = 0.071. Mean operative time in group A was 55.7 minutes and in group B was 57 minutes, P = 0.0231. Superficial wound infections were recorded in one patient (1.7%) in group A and in 8 patients (13.3%) in group B, P = 0.007. Intra-abdominal abscess formation was a complicated outcome in 2 patients (3.3%) of group B, P = 0.005. Mean hospital stay was 1.6 days in group A and 2.7 days in group B, P = 0.05.,Background: Despite the reported advantages of laparoscopic appendectomy (LA), an ongoing debate exists about a possible increase in postoperative infectious complication rates. The analyses of risk factors associated with surgical site infections (SSIs) after LA, have been limited.,Patients and Methods: One hundred twenty laparoscopic appendectomies performed over one year, were included in this retrospective study. The patients were divided into 2 group; group A was the one in which LA was done with using reusable retrieval bag and group B without using that. Demographic details, operative time, hospital stay and infective postoperative complications were recorded.,Conclusions: Surgical wound infections are less common by using reusable retrieval bag during laparoscopic appendectomy procedure. Also, using reusable retrieval bag has less cost.
      PubDate: Mon, 23 May 2016 00:00:00 +043
       
  • Evolution of Laparoscopic Cholecystectomy: From Multiport to Single Port

    • Abstract: Conclusions: Currently, it has been widely accepted that laparoscopic cholecystectomy is the gold standard for cholecystectomy. Although single site laparoscopic cholecystectomy is becoming more popular with the recent advancements, conventional multiport laparoscopic cholecystectomy is being widely used as the primary treatment modality for the gallbladder removal.,Context: Laparoscopic approach with its several techniques has become the standard method for cholecystectomy over the past decades. As technical instruments have improved and varied, the interest in endoscopic surgery has turned towards minimal invasive single site access surgery with fewer instruments, thus resulting in minimal pain, minimal scarring and better cosmesis.,Evidence Acquisition: A systematic literature searching of databases MEDLINE, EMBASE, and Google Scholar was done from 1982 and updated in December 2015. Search terms were “cholecystectomy”, “laparoscopic cholecystectomy”, “four port laparoscopic cholecystectomy”, “single-incision laparoscopic surgery”.,Results: Four-port laparoscopic cholecystectomy was accepted as the “gold standard” in the treatment of patients with cholelithiasis before millennium. Thereafter, two-port laparoscopic cholecystectomy was reported as a novel, safe and rapid method of gallbladder removal in consecutive reports. Single-site laparoscopic cholecystectomy with non-conventional multi-channel port method was first introduced as an alternative to the standard multi-port laparoscopic cholecystectomy in adult patients in the last decade. Success rates of performing conventional four-port laparoscopic cholecystectomy were ranging from 93% to 100% and single site laparoscopic cholecystectomy was ranging from 84% to 100%.
      PubDate: Sun, 22 May 2016 00:00:00 +043
       
  • Robotic Transanal Endoscopic Submucosal Dissection (RTESD) of Large Rectal
           Tumor in Prone Position

    • Abstract: Conclusions: RTESD in the prone position is safe and presents a feasible alternative for management of large rectal tumors. We also anticipate the technique to further improve with the advancement of robotic technology.,Case Presentation: We describe the first reported case of robotic transanal endoscopic submucosal dissection (RTESD) in Australia for a large circumferential laterally spreading tumor of the rectum using the da Vinci® Si system with the patient in the prone position. The case took 145 minutes and the authors found good manoeuvrability due to the intuitive nature of the robot’s endowristed miniaturised graspers. The prone position facilitated robot docking and reduced the external robotic arm clashing. This procedure was safely performed and the patient was discharged the following day. Colonoscopic follow up to one year revealed no recurrence of disease.,Introduction: Endoscopic submucosal dissection (ESD) of large tumors of the rectum is particularly challenging using colonoscopy or with laparoscopic instruments. More recently robotic assisted technique has been described.
      PubDate: Mon, 16 May 2016 00:00:00 +043
       
  • Mavridis’ Area Targeting for Deep Brain Stimulation in Psychiatric
           Disorders: Stereotactic Microanatomy and Technical Aspects

    • Abstract: Conclusions: MA is nowadays the most accurate stereotactic anatomic guide for targeting the human NA. It is a representative example of how stereotactic microanatomy could serve the development of stereotactic microneurosurgery. Following the currently used trajectory through the ALIC, a DBS electrode placement within the NA, targeting the MA, is feasible, allowing either NA or ALIC stimulation. Simultaneous stimulation of the NA and ALIC is also possible with this application.,Evidence Acquisition: A detailed search of the current literature regarding MA was applied. The critically reviewed literature was then used to discuss the MA as a stereotactic microanatomic target for NA DBS application, emphasizing on technical aspects of targeting the MA. The suggestion of future research directions was also aimed.,Results: Following the currently used trajectory through the anterior limb of the internal capsule (ALIC) in combination with the principles of the ‘port model’, a DBS electrode placement within the NA, targeting the MA, is feasible. MA could be the target area of one, only, of the electrode contacts, preferably contact 1 or 2. It could be also the target area for contact 0 in ALIC DBS and even the target for a combined NA-ALIC DBS. MA is the first and most representative example of the evolution of stereotactic anatomy into stereotactic microanatomy, in order to serve the development of the field of stereotactic microneurosurgery.,Context: The human Nucleus Accumbens (NA) constitutes nowadays a target of deep brain stimulation (DBS) for selected patients mainly suffering from some psychiatric disorders. Mavridis’ Area (MA) of the human brain is the most reliable stereotactically standard part of the NA, regardless of side or gender. Primary purpose of this review article was to discuss the MA as a stereotactic microanatomic target for NA DBS application, emphasizing on technical aspects of targeting the MA.
      PubDate: Mon, 16 May 2016 00:00:00 +043
       
  • Laparoscopic Tapp Inguinal Hernia Repair. Mesh Fixation With Absorbable
           Tacks. Initial Experience

    • Abstract: Conclusions: The use of absorbable tacks during TAPP confers significant benefit regarding the operating time, however it is a disadvantage due to the cost when compared with fibrin glue.,Results: The group of tacks ‘TAPP’ showed good results concerning the level of pain, fatigue and foreign body sensation comparable with those of the historical group. There were significant differences concerning the length of surgery where absorbable tacks performed better. Regarding cost of surgery, the fibrin glue showed effective results.,Patients and Methods: 50 consecutive men (who had bilateral inguinal hernia) were enrolled and followed up for at least 1 year. The primary measured outcome was pain experienced in day 1 of post-op. The secondary outcomes measured were postoperative scores of pain at rest, discomfort, and fatigue, foreign-body sensation, and hernia recurrence after 12 months. The outcomes were measured using a visual analogue scale, a verbal rating scale and numerical rating scales. A comparison was done within a historical group with the same demographic and hernia characteristics where the meshes have been fixed with fibrin glue.,Background: Preliminary studies have indicated advantages of mesh fixation using fibrin glue in TAPP compared with tack fixation.,Objectives: We report the results of a prospective experience in fixing mesh during TAPP with absorbable tacks.
      PubDate: Sun, 24 Apr 2016 00:00:00 +043
       
  • The Relation Between Injection Volumes and Efficacy of Epidural Steroid
           Injections in Treatment of Acute Low Back Pain

    • Abstract: Background: Low back pain (LBP) is one of the most common complaints that is reported by all age groups.,Objective: This study was aimed to investigate the efficacy of epidural steroid injections (EPSI) related to different volume injections for treatment of acute low back pain with radiculopathy.,Patients and Methods: The study is consisted of seventy five patients who had acute discogenic pain. Three groups composed namely Group 1, Group 2 and Group 3. All patients were assigned to one of the groups randomly and recevied combination of triamcinolone (80 mg) and bupivacaine (12.5 mg) as a single epidural dose. Volume of 10 mL, 15 mL, and 20 mL epidural injections were used for Group 1, 2 and 3 respectively. The efficacy of treatment was assessed with visual analog scale; VAS (O = no pain, 10 = unbearable pain) straight leg elevation test; SLET (0° = worst, 85° = best), and oswestry disability ındex; ODI (0 to 20%: minimal disability, 80 to 100%: bed bound patients) before and 2 weeks after the epidural steroid injections (EPSI).,Conclusions: Different volumes of EPSI in patients with acute low back pain associated with radiculopathy causes significant pain relief in all groups. There was no superiority between the groups. Temporary radicular pain we encountered can be explained by high volumes.,Results: Fifty seven 57 (76%) female and 18 (24%) male were entered to the study. Two weeks after the procedure, significant improvement was observed in each group regarding the results of VAS, SLET and ODI. Temporary radicular pain, not required treatment, was reported for 10 patients; 40% of group II and 18 patients; 72% of group III, but not reported in group I (P < 0.001).
      PubDate: Tue, 29 Mar 2016 00:00:00 +043
       
  • Administrative Chief Residents – How Are They Chosen and Does It
           Matter?

    • Abstract: Results: There was a 10% resident response rate, 22% program director, most from a program with 50% female residents. 71% report no clear ACR policy, 64% believe the position appointed. Half report less than 25% female ACRs, 54% zero minority ACRs. Program directors reported more female ACRs, but similar lack of selection policy. 54% believe ACR receives a stipend. 31% report more than 75% went into academics.,Conclusions: Although most surgical programs train 50% female residents, residents perceive that fewer than 25% ACRs are female. ACRs in the United States are often receiving a stipend and going into academic practice. Programs should keep diversity in mind in appointing ACR.,Background: There is no literature on the administrative chief resident (ACR) in surgery or disparities of this leadership position.,Objectives: The aim of this study is to examine the rates of perceived female and minority leadership at the resident level.,Patients and Methods: After institutional review board (IRB) approval, a pilot survey was sent to surgical residents and faculty at a single university surgical program. The survey was revised based on small group feedback and a specialist in study design. It was then sent to all US surgical residents and program directors, and analyzed using Survey Monkey.
      PubDate: Mon, 28 Mar 2016 00:00:00 +043
       
  • Persistence of Symptoms After Laparoscopic Cholecystectomy

    • Abstract: Background: A significant proportion of individuals undergoing cholecystectomy for symptomatic cholelithiasis persist with symptoms even after surgery.,Objectives: This study was aimed to test our hypothesis that age of presentation and duration of symptoms are the risk factors that predispose to negative symptomatic outcome after cholecystectomy.,Patients and Methods: 351 patients with diagnosis of symptomatic gallstones admitted to a tertiary care hospital for elective laproscopic cholecystectomy over a period of three years from 2009. They were provided a standard symptom questionnaire to evaluate the symptomatic outcome and to compare the quality of life at interval of one, three and six months after the procedure regarding the presenting symptoms at the time of admission. Out of 351 patients, 51 patients refused to continue participation in the study and were excluded from the study group. The remaining 300 patients were followed till six months after procedure.,Results: 55.66% of patients were highly satisfied after cholecystectomy with regard to alleviation of preoperative symptoms, while 34.33% of patients were satisfied with the treatment. A minority of 8.6% of patients perceived no change with regard to preoperative symptoms, while 1.3% of them had worsening of symptoms.,Conclusions: We conclude that management of gall bladder stone disease should be tailored precisely with respect to the quality of life index, with increased emphasis on early detection and treatment as well as increased emphasis on counseling in an elderly cohort after considering the prognosis after cholecystectomy differentially.
      PubDate: Sat, 27 Feb 2016 00:00:00 +033
       
  • Petro-Clival Tumours: Role and Indications of Transoral and
           Transsphenoidal Approaches Followed by Hypofractionated Stereotactic
           Radiotherapy

    • Abstract: Background: Petro-clival, clival and spheno-petro-clival tumours are still a neurosurgical challenge. Usually, the classical skull base transpetrous approaches are employed, although they are burdened by an important rate of morbidity, and a very low rate of radical removal is reported.,Conclusions: Anterior transoral and transsphenoidal approaches are indicated for clival and spheno-petro-clival region tumours located ventrally to the brainstem and medially to acoustic meatus, to perform a prevalently median tumour debulking; these approaches allowed an extremely low rate of new neurological deficit and a rapid resumption of vital activities, obviously in relation with preoperative clinical status in our patients.,Results: In no patient radical removal was performed because gross total/subtotal removal had been programmed preoperatively on the basis of tumours extension. Concerning the 4 clival chordomas, gross total in two patients and subtotal removal in the two other ones was performed. Gross total removal was accomplished in the clival meningioma, while subtotal removal was achieved in 5 petro-clival and in 2 spheno-petro-clival meningiomas; partial removal was performed in one spheno-petro-clival and one petro-clival meningioma. No mortality and no neurologic deficits were registered after surgery. Preoperative neurologic deficit improved in the majority of patients.,Patients and Methods: We present 14 patients affected by petro-clival, clival and spheno-petro-clival meningiomas/chordomas with prevalent extension ventrally to the brainstem; cranial nerves V to XII and vertebra-basilar arterial complex resulted posterior and laterally displaced. Preoperative clinical symptoms were represented by aspecific headache in 6 patients, mild and moderate contralateral hemiparesis in 3 and 2 patients respectively, mild and moderate tetraparesis in 2 and 1 patients respectively and cranial nerves deficit in 11 ones. Preoperative planning considered three objectives: to avoid operative and post-operative mortality/morbidity, to achieve satisfactory tumour removal and to avoid tumour regrowth. Anterior approach (transoral in 6 and transsphenoidal in 8 other) was selected for these patients according to postero-lateral approaches complexity due to the anterior-medial position of the tumour in respect of cranial nerves and vascular arteries.,Objectives: We present our indications and results with minimally invasive transnasal and transoral approaches.
      PubDate: Sat, 27 Feb 2016 00:00:00 +033
       
  • Surgical Treatment of Gastro-Esophageal Reflux Disease: A Review of
           Concepts Misguiding the Indications for Surgery

    • Abstract: Conclusions: A significant number of patients would benefit from surgical therapy to treat their GERD symptoms, but some incorrect beliefs still misguide the indications for the surgical procedure.,Results: Our review showed that: (a) the mortality rate of the surgical procedure is negligible and PPI therapy is also accompanied with mortality; (b) there is a 5% chance of severe dysphagia after anti-reflux operation; (c) postsurgical use of PPI is not an indication of surgical failure, but often represents misuse of the medication; (d) there is a 5% chance of re-operation after surgery, often because of severe dysphagia; (e) reduction in the risk of adenocarcinoma is probable but still controversial; and (f) good results can be achieved in a community setting.,Evidence Acquisition: A thorough search in literature was performed with predefined keywords to identify relevant articles published from 1975 to January 2015, in order to analyze the complications from the aspect of current surgeon’s perspective.,Context: Clinical therapies and surgical interventions are the acceptable treatments for gastro-esophageal reflux disease (GERD). Referrals for surgery are yet limited, because of disadvantages associated to surgical treatment, including: (a) high rate of mortality; (b) high risk of side effects, especially dysphagia; (c) need for acid-reducing medications after surgery; (d) need for revision surgery; (e) unclear benefit of surgery on the risk of cancer; and (f) differences in the outcomes between a community setting and a tertiary care center. In contrast, surgeons report excellent outcomes after anti-reflux operation.
      PubDate: Sat, 13 Feb 2016 00:00:00 +033
       
  • Assessment of Surgical Complications in Morbid Obese Patients, The
           Candidates for 2 Methods of Laparoscopic Bariatric Surgery (Laparoscopic
           Gastric Bypass, Laparoscopic Sleeve Gastrectomy)

    • Abstract: Results: Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001), while no significant difference was found in which the parameters between two studied procedures were in this regard.,Conclusions: To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.,Materials and Methods: Participants were selected regarding the U.S. National Institute of Health (NIH) guidelines, which indicates BMI > 40 kg/m2 alone, or BMI > 35 kg/m2 in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%). The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year.,Objectives: This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up.,Background: In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985). Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery.
      PubDate: Sun, 29 Nov 2015 00:00:00 +033
       
  • Divided Laparoscopic Cholecystectomy for Unusual Gall Stones Complication
           of Mirizzi’s Syndrome

    • Abstract: Results: The mean operative time was 70 minutes (between 60 and 90 minutes). No biliary tract obstruction or leakage or stenosis was recorded in this patient group during the period of follow up (18 months).,Conclusions: Divided laparoscopic cholecystectomy is a safe and effective technique to face the unusual gallstones complications (Mirizzi’s syndrome).,Objectives: This research offers a technique to avoid surgical complications in Mirizzi’s syndrome cases during laparoscopic cholecystectomy.,Patients and Methods: Between November 2012 and February 2015, 17 patients (12 females and 5 males) with mean age of 51 years (between 29 and 57 years) suffering from Mirizzi’s syndrome underwent the divided cholecystectomy. In this technique the gall bladder was divided into two parts above the gall bladder infundibulum. The distal part was dissected for short distance and used to push liver up. The proximal part of gall bladder was cleared from all its contents and reevaluated from inside. Management was achieved according to the stage of disease.,Background: Chronic complications of symptomatic gallstone disease such as Mirizzi’s syndrome are rare. The importance and implications of these conditions are related to their associated surgical complications which are potentially serious such as bile duct injury and to the modern management when encountered during laparoscopic cholecystectomy.
      PubDate: Sat, 28 Nov 2015 00:00:00 +033
       
  • Comparison of Early Outcomes and Costs Between Laparoscopic and Open
           Cholecystectomy for Mild and Moderate Cases of Cholelithiasis in Rural
           Morocco: A Retrospective Comparative Study

    • Abstract: Conclusions: The results of the present study showed that, in a rural hospital setting in a developing country, laparoscopic cholecystectomy for symptomatic cholelithiasis was associated with shorter hospital stay, less infectious morbidity rates, and reduced costs, compared to open surgery. Thus, laparoscopic cholecystectomy should be advised as a routine technique for management of cholelithiasis in rural areas of developing countries.,Results: During the study period, 95 patients were included; among them, 53 patients underwent laparoscopic surgery and 42 laparotomy. There were no statistical differences between the two groups concerning age, gender distribution, American society of anesthesiologists (ASA) classification, and number of acute cholecystitis. Rate of conversion to open surgery was 5.6% (3 patients). Patients in the laparoscopic group had shorter hospital stay (2.9 vs. 4.7 days, P = 0.0001), lower rates of infectious complications (3.7% vs. 16.6%, P = 0.04), and lower costs (169 vs. 231.62 US dollars, P = 0.0001).,Patients and Methods: This retrospective study included all consecutive patients who underwent cholecystectomy for mild and moderate symptomatic gallstone, in the Marche Verte hospital, in the Boulemane province in Morocco between January and December 2011. Demographics, postoperative outcomes, and costs were compared between laparoscopic and open surgery groups. Duration of hospital stay was calculated from the time of operation to the time of discharge. The total costs for each patient included the sum of: the average hospitalization costs per day; the average operating room costs; and material and medications costs. Chi-square test or Fisher’s exact test and student or Mann-Whitney U tests were used for comparison, as appropriate.,Background: Laparoscopic cholecystectomy (LC) was first introduced in the late 80’s, replacing open cholecystectomy as the standard surgical approach for cholelithiasis in developed countries. In contrast, there were initially many controversies in developing countries regarding the laparoscopic techniques.,Objectives: This study aimed to compare the early outcomes and costs between laparoscopic and open cholecystectomy for cholelithiasis in a rural hospital in a developing country.
      PubDate: Sat, 21 Nov 2015 00:00:00 +033
       
  • Laparoscopic Management of a Cholecystocutaneous Fistula: A Case Report

    • Abstract: Conclusions: Laparoscopic cholecystectomy is a safe and feasible technique to manage cholecystocutaneous fistulas.,Case Presentation: A 55-year-old male with comorbidities presented with a discharging sinus at the right upper quadrant area after an abdominal wall abscess drainage. A Computerized tomography scan showed a biliary fistula. Laparoscopic cholecystectomy was carried out successfully.,Introduction: A cholecystocutaneous fistula an abnormal epithelial tract that allows communication between the gallbladder and the skin, manifests as a rare complication of gall stones.The treatment of choice is definitive surgical excision of both the gallbladder and the tract, usually by an open operation. However, a laparoscopic approach is another option, especially if the patient is elderly and has other co morbidities. We report a case of a laparoscopically managed cholecystocutaneous fistula.
      PubDate: Sat, 14 Nov 2015 00:00:00 +033
       
  • Laparoscopic Colorectal Resection in Patients With Previous Abdominal and
           Colonic Surgery

    • Abstract: Conclusions: Previous abdominal surgery, including previous colonic surgery, confers no added risk of conversion to an open operation, morbidity or mortality for patients undergoing laparoscopic colorectal surgery. The operative time however is longer (30 minutes) for patients with previous colonic surgery.,Results: Out of 718 patients 476 had no previous abdominal surgery (Group A), whilst 190 patients had previous abdominal surgery not involving colonic surgery (Group B), and 52 had previous bowel surgery (Group C). The conversion rate was 4% for all groups, the re-admission rate was 11.8% for Group A, 12.6% for Group B and 9.6% for Group C, the median length of stay was 4 days for Groups A and B and 5 days for Group C. There was no statistically significant difference between groups for any of the above measures. However, there was a statistically significant difference in the length of operative time between groups. Patients in Group A and Group B requiring a median of 180 minutes, whilst Group C required a median of 210 minutes of operative time. (P = 0.026 and 0.002, respectively).,Patients and Methods: Data was collected prospectively from September 2006 to Dec 2010 of all laparoscopic colorectal resections done for both benign and malignant diseases.,Background: Previous abdominal surgery and its related adhesions are usually a relative contraindication for laparoscopic surgery or reason for conversion.,Objectives: This study aim to identify patients with previous abdominal surgery and compare the clinical outcomes in patients with and without previous abdominal surgery.
      PubDate: Sat, 29 Aug 2015 00:00:00 +043
       
  • High Prevalence of Zinc Deficiency in Iranian Morbid Obese Patients
           Undergoing Bariatric Surgery

    • Abstract: Patients and Methods: We assessed zinc status in 996 morbidly obese subjects (BMI > 40 kg/m2 or BMI > 35 kg/m2 with any comorbidities) (841 females, 155 males) who were candidate for bariatric surgery. Comorbidities related to obesity including dyslipidemia, abnormal fasting glucose, hypertension and type-2 diabetes (T2D) were evaluated. Also we checked albumin and SGPT as markers of liver function. Data analyzed by SPSS.,Results: Zinc deficiency was found in 13.6% of patients. Zinc levels had an inverse and significant association with age (P Value = 0.016). Although greater levels of circulating zinc were observed in patients with higher BMI, there were no significant correlation between zinc deficiency and adiposity. Dyslipidemia was found to be the most prevalent comorbidity in this population.,Conclusions: These results show a high prevalence of zinc deficiency in morbidly obese subjects. Thus, we suggest the evaluation of the zinc status in patients undergoing bariatric surgery and treatment of zinc deficiency before doing the surgery.,Background: Bariatric surgery’s efficacy in morbid obesity therapy has been proven; but post-operational zinc deficiency is a problematic issue as its essential role in post-operational recovery of patients.,Objectives: The aim of this study is to evaluate the rate of zinc deficiency in Iranian morbidly obese candidates for bariatric surgery.
      PubDate: Sat, 29 Aug 2015 00:00:00 +043
       
  • Clinical Predictive Factors for Diagnosis of Endometriosis in Iranian
           Infertile Population

    • Abstract: Conclusions: Lower BMI, longer duration of marriage, shorter menstrual cycles, dyspareunia, and dysmenorrhea are predictive factors for diagnosis of endometriosis in infertile population. These clinical factors should be considered prior to diagnostic laparoscopy for infertility.,Results: Of 441 infertile women, 82 (18.6%) had endometriosis. No statistically significant difference was identified in the participants’ age, educational level, duration of breast-feeding, duration of infertility, and menstrual flow. On the contrary, women with endometriosis had longer duration of marriage (OR = 1.03, P = 0.002), older age at first pregnancy (OR = 1.21, P < 0.05), lower BMI (OR = 0.9, P = 0.001), shorter interval of menses (OR = 0.98, P < 0.05), and history of irregular menstrual cycles (OR = 0.54, P < 0.05), compared to those without endometriosis. The risk of the endometriosis also decreased significantly with increased numbers of previous pregnancies. The OR for endometriosis in the presence of dysmenorrhea and dyspareunia were 1.80 (1.02 - 3.04) and 1.82 (1.01 - 3.29), respectively.,Background: Endometriosis changes the management of infertile women.,Objectives: Our aim was to evaluate some of the clinical predictive factors among an Iranian infertile population.,Patients and Methods: Infertile women, scheduled for diagnostic laparoscopy, were recruited into the study and their information including age, weight, height, educational level, marriage and breast-feeding duration, history of fertility, menstrual characteristics, dysmenorrhea, and dyspareunia were collected. Clinical characteristics were then compared with laparoscopic results.
      PubDate: Sat, 01 Aug 2015 00:00:00 +043
       
  • Laparoscopic Mesh Repair of Giant Morgagni-Larrey Hernia With Three Ports:
           A Case Report

    • Abstract: Conclusions: Transabdominal laparoscopic Morgagni-Larrey hernia repairs with reduced number of ports are safe and feasible.,Introduction: A bilateral anterior parasternal hernia is commonly called a Morgagni-Larrey hernia. Morgagni hernias are rare in adults, accounting for 3% of all treated diaphragmatic hernias. This article reports a giant bilateral Morgagni-Larrey hernia, repaired with a laparoscopic reduced-port technique.,Case Presentation: An 83-year-old female was admitted to the general surgery outpatient clinic with gastrointestinal, respiratory symptoms, and retrosternal pain. A computed tomography (CT) scan showed a 12-cm retrosternal hernia defect on the right and a 3-cm defect on the left of the diaphragm The stomach and colon were herniated from the right defect and the omentum was herniated from the left defect to the thorax. The hernia contents were pushed back to the abdomen and the defects were repaired with single sutures through a three-port laparoscopic procedure. A composite mesh material was placed and fixed with pro-tack (Covidien). The patient was discharged on the fourth postoperative day without any complaints.
      PubDate: Sat, 01 Aug 2015 00:00:00 +043
       
  • Laparoscopic Cholecystectomy: A Retrospective Four-Year Study

    • Abstract: Conclusions: Laparoscopic cholecystectomy as the method of choice in treatment of gallbladder stone is associated with high success rate. This approach is increasingly being performed because of the decrease in patients’ hospital stay, morbidity, and rapid return to normal life.,Patients and Methods: This is a retrospective study. Medical records of patients who underwent laparoscopic cholecystectomy from 2004 to 2008 were reviewed. The results and complications of surgery were collected using a checklist.,Results: Participants included 500 patients with mean age of 47 ± 11 years. Three hundred ninety-one (78.2%) were female and 109 (21.8%) were male. Four hundred (80.0%) of patients had symptomatic cholelithiasis. The mean operating time was 70 ± 8 minutes. The most common intra-operative complication was bradycardia during gas insufflation into the abdominal cavity. In 430 (86.0%) of patients length of hospital stay was less than two days. Six patients (1.2%) were complicated by hernia at incision site, 18 (3.6%) by bile leakage, and 15 (3.0%) required laparotomy. Surgical site bleeding and surgical site infection were observed respectively in 11 patients (2.2%) and 17 patients (3.4%). Totally, 52 patients (10.4%) had surgically-induced complications, two (0.4%) of whom died.,Background: Today, laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystectomy, which is mainly due to improved results of laparoscopic surgery compared to the open surgery, and its cosmetic benefits.,Objectives: The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in our institution.
      PubDate: Sat, 23 May 2015 00:00:00 +043
       
  • Eliminating Mentors in Favor of Collaborators: Review and Challenge of
           Current Mentorship Literature

    • Abstract: Results: Traditional paradigms of the mentor plotting the career of the mentee may not be possible in the future. In the ever-changing practice of surgery, time constraints are only increasing, making the act of mentoring more difficult.,Conclusions: The mentee or trainee must take a more active role and seek out mentorship, seek out collaboration, be more proactive, and communicate their needs and career goals early on.,Evidence Acquisition: The objective of this review is to summarize the current literature on mentorship and delineate its future.,Context: Mentorship in academic medicine, surgery, and surgical subspecialties has been examined broadly in the literature at the student, resident, early, and senior faculty level. These studies have explored mentorship in general, as well as gender specific differences or issues that arise. Less studied is the idea of collaboration in surgical training.
      PubDate: Sat, 23 May 2015 00:00:00 +043
       
  • Comparison of Serum Levels of Vitamin D Between Women With and Without
           Endometriosis

    • Abstract: Conclusions: To find a more precise data about the role of vitamin D in pathogenesis and treatment of endometriosis, clinical trials are needed to find if the prescription of vitamin D is effective in treatment of endometriosis.,Results: After laparoscopy, we had 40 cases of endometriosis and 105 cases without endometriosis. Mean serum level of vitamin D was 19.38 ± 1.65 ng/mL in endometriosis group and 19.96 ± 1.13 ng/mL in the non-endometriosis group with no significant difference (P = 0.68). In 83.4% of samples serum level of vitamin D was less than 30 ng/mL.,Patients and Methods: In this cross-sectional analytic study on 145 women (aged 16 - 40 years old) who underwent laparoscopy, we took venous blood samples for serum levels of vitamin D before laparoscopy and then divided the samples into two groups based on findings of laparoscopy with endometriosis and without endometriosis. The data was analyzed to compare serum levels of vitamin D in two groups.,Background: Endometriosis is a prevalent disease in reproductive aged women causing disabling pain (dyspareunia, dysmenorrhea, pelvic pain) and infertility, many factors have been assessed to find its etiology, but its etiology remains unclear. The serum level of vitamin D is one of the factors that is suspected to be effective in diagnosis or treatment of endometriosis.,Objectives: The aim of this study was to determine if there is any significant difference between serum levels of vitamin D of women with and without endometriosis. The answer to this question may help the diagnosis or treatment of endometriosis.
      PubDate: Sat, 23 May 2015 00:00:00 +043
       
  • Large Duodenal Diverticula Treated by Laparoscopic Surgical Excision: A
           Case Report

    • Abstract: Conclusions: For laterally localized and protruded duodenal diverticula, laparoscopic resection is a feasible and safe method. The role of laparoscopy in surgical treatment of complicated diverticula, located in other parts of the duodenum, is unclear because of lack of experience.,Case Presentation: In this article, we present a case report of a large duodenal diverticulum, treated with laparoscopic surgical resection. After an accurate diagnosis; treatment modality should be determined by its localization, type and size. Laparotomy is the gold standard surgical treatment of complicated duodenal diverticular disease.,Introduction: Duodenum is the most common site for diverticular disease of small intestine. Most of duodenal diverticula are asymptomatic or have non-specific upper gastrointestinal symptoms. The complications of duodenal diverticula depend on the location and include acute diverticulitis, perforation, hemorrhage, and obstruction of the biliary or pancreatic ducts. Duodenal diverticulum can be diagnosed with upper gastrointestinal endoscopy or radiographic series.
      PubDate: Sat, 23 May 2015 00:00:00 +043
       
  • Thoracoscopic Esophagectomy in Supine Position

    • Abstract: Results: The mean duration of esophagectomy was 70 minutes and the total operation 180 minutes. The mean amount of bleeding during surgery was 250 cc. Conversion to open approach occurred only in one patient out of 15. No cases of anastomotic leakage or pneumonia was observed. Also, no case of mortality was reported.,Patients and Methods: This is a prospective study of 15 selected patients who underwent laparoscopic thoracoscopic esophagectomy and received preoperative radiotherapy between 2010 and 2011. At first, laparoscopic gastrolysis was carried out and then, transhiatal esophageal release was performed (up to the upper region); thereafter the upper esophagus was exposed by thoracoscopy in supine position and easily released.,Objectives: The present study aimed to investigate the results of performing three phases of esophagectomy through laparoscopy and thoracoscopy in supine position without frequent changes in patients’ position.,Background: Esophageal cancer needs major surgery due to its anatomic position, which is followed by high morbidity in most patients. Thoracotomy, a previously used method, was accompanied by high pulmonary complications, had physical limitations, and low tolerance of patients. Thoracoscopic esophagectomy is a new suitable method with less morbidity.,Conclusions: Thoracoscopic esophagectomy can be easily performed in supine position and in a short time. .
      PubDate: Sat, 23 May 2015 00:00:00 +043
       
  • Hepatic Choristoma: an Unexpected Finding During Cholecystectomy

    • Abstract: Conclusions: We outlined its biliary drainage and blood supply, as well as our surgical approach, which may be a guide to surgeons who encounter hepatic choristomas in their clinical practice.,Introduction: Hepatic choristomas, defined as completely separated ectopic liver tissue, are rare. They are most commonly found adjacent to the gallbladder. Details of their anatomy, such as blood supply and biliary drainage, remain ill-defined and are inconsistently described in the literature.,Case presentation: A case of hepatic choristoma was found incidentally in a 77-year-old woman during an elective laparoscopic cholecystectomy.
      PubDate: Fri, 20 Feb 2015 00:00:00 +033
       
  • Leukocytosis After Intraperitoneal Hydrocortisone Instillation

    • Abstract: Conclusions: We conclude that intraperitoneal hydrocortisone instillation caused leukocytosis and is thus suggested not to be used in immune-compromised patients.,Results: The study was completed by 120 patients. Patients who received intraperitoneal hydrocortisone and hydrocortisone plus bupivacaine had higher white blood cell (WBC) count (P < 0.0001). The patients were similar with respect to demographic information, operational characteristics and recovery variables. The abdominal pain scores were significantly lower in patients receiving instilled intraperitoneal hydrocortisone plus bupivacaine and less analgesic was require by them (P < 0.0001).,Background: Laparoscopic surgery provides tremendous benefits to patients, including faster recovery, shorter hospital stay, and earlier return to normal activities and less immunologic impairments.,Objectives: In this study we aimed to study the effect of different intraperitoneal instillations on leukocyte count to evaluate patients’ immunologic response.,Patients and Methods: We studied 125 patients in a double-blind, randomized clinical trial. The patients received either instillation of 250 mL of normal saline (n = 31) or 100 mg bupivacaine diluted in 250 mL of normal saline (n = 31) or 100 mg hydrocortisone diluted in 250 mL of normal saline (n = 31) or 100 mg hydrocortisone plus 100 mg bupivacaine diluted in 250 mL normal saline (n = 32) before insufflation of Carbon Dioxide into the peritoneum randomly. Leukocyte counts were recorded before and after the operation. We recorded abdominal pain using visual analogue scale (VAS), postoperative analgesics needed and recovery variables in the recovery room and 6, 12 and 24 hours after the operation.
      PubDate: Fri, 20 Feb 2015 00:00:00 +033
       
  • A Case of Complete Video-Assisted Thoracoscopic Surgery (VATS) for Thymoma
           With Pure Red Cell Aplasia (PRCA)

    • Abstract: Introduction: Although thymoma is the most common anterior mediastinal tumor, only 5% of thymoma cases develop pure red cell aplasia (PRCA).,Case Presentation: In this article we have reported a 59-year-old man with a large anterior mediastinal mass (diameter of 10 cm) and severe anemia, that thymoma and pure red cell aplasia have been demonstrated by histopathologic and hematological examination. Despite the large mass, a complete video-assisted thoracoscopic surgery (VATS) thymectomy and combinational medical therapy were performed for him successfully. Aplasia remission occurred 6 months after thymectomy and his hemoglobin level reached to 13 g/dL.,Conclusions: We believe that a complete resection in combination with medical therapy is necessary to achieve total remission of PRCA symptoms and conclude that VATS thymectomy is an effective and technically feasible procedure for surgery without any contraindications about the size of the thymoma in these patients.
      PubDate: Fri, 20 Feb 2015 00:00:00 +033
       
  • Appendectomy for Presumed Acute Appendicitis in Pregnancy; an Obsolete
           Concept'

    • Abstract: Conclusions: Our review demonstrated that a pregnant lady suspected of AA poses a great clinical challenge to surgeons, as far as scoring systems are almost unreliable. Positive imaging prior to surgery is warranted, in order to avoid a nontherapeutic surgery which is always associated with high morbidity rates.,Introduction: Acute appendicitis (AA) is one of the most common differential diagnoses in a pregnant lady presented with right iliac fossa (RIF) pain. Traditional concept of early exploration has been questioned, as far as recent evidences showed much higher morbidity rates than expected. Mandatory pre-operative imaging (ultrasound or Computer Tomography scan) has been advocated and proven able to significantly reduce its related avoidable morbidity.,Case Presentation: Three cases are presented: Case 1 was a 41-year-old lady who had acute appendicitis which was successfully managed conservatively. Case 2 was a 29-year-old lady at 25 weeks of gestation, presented with 2 weeks history of RIF pain. Open appendectomy was offered for her, as far as obstetric review and ultrasound were inconclusive. Even though, she had a negative appendectomy, and her postoperative period was complicated by recurrent premature uterine contractions. The third case was an unfortunate lady at 30 weeks of gestation. Laparotomy was done for her, as her RIF pain persisted, which was diagnosed by significant fluids at both iliac fossae with other unremarkable obstetric review. Her postoperative period was complicated by paralytic ileus and intra-uterine death.
      PubDate: Fri, 20 Feb 2015 00:00:00 +033
       
  • Outcome in Patients Undergoing Laparoscopic Cholecystectomy Following
           ERCP; Does Timing of Surgery Really Matter'

    • Abstract: Results: Mean operative time was shortest in group A (57.1 minutes) and longest in group B [63.4 (P = 0.131)]. Mean hospital stay was shortest in group A (2.1 days) and longest in group C (5.7 days) (P = 0.003). Hospital expenses were minimal in group A (P = 0.001). Male sex, serum bilirubin level, White blood cell (WBC) count, duration of ERCP/ES procedure, contracted gall bladder and large calculus size on Ultrasonography (USG) were significantly associated with primary outcome.,Patients and Methods: Data of 77 patients treated for choledochocystolithiasis with ERCP/ES followed by LC were reviewed. Patients were classified into four groups, group A (n = 29): LC performed within 24 hours after ERCP; group B (n = 20): LC performed after 24 hours to 7 days; group C (n = 12): LC done between 8 to 28 days; group D (n = 16): LC done after 28 days of ERCP. Primary outcome was operating time and secondary outcomes included intra- or post-operative complications, hospital stay and hospital expenses.,Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for cholelithiasis.,Objectives: Our study intended to evaluate whether timing of surgery is of any influence on the course of the laparoscopic cholecystectomy (LC) following Endoscopic Retrograde Cholangio-Pancreatography ERCP/Endoscopic sphincterotomy (ES) and to identify and assess various factors that can affect the outcome in these patients.,Conclusions: LC can be performed within 24 hours of ERCP/ES with favorable outcome and less expenses. Timing of LC after ERCP/ES is not significantly associated with outcome of the procedure. Male sex, serum bilirubin level, WBC count, ERCP/ES procedure duration, contracted gall bladder and large size of gall bladder calculus on imaging are significantly associated with difficulty in surgery.
      PubDate: Sun, 15 Feb 2015 00:00:00 +033
       
 
 
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