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Ain Shams Journal of Surgery
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2090-7249
Published by Ain Shams University Homepage  [5 journals]
  • Appraisal of Ilio-popliteal Bypass Surgery for Limb Salvage (In Patients
           with Critical Lower Limb Ischemia and Infected Femoral pseudoaneurysms)

    • Abstract: Introduction: Critical limb ischemia is usually involving a spectrum of clinical features to describe long termsevere compromise limb perfusion that manifested by rest pain, with or without trophic skin changes or tissue loss,including ischemic ulceration and/or ischemic gangrene for more than two weeks. A patient who was diagnosedwith infected femoral pseudo aneurysm might be misdiagnosed as a simple groin abscess, and drug abuse is themost common cause of infected femoral pseudo aneurysms. Long ilio-popliteal bypass in critical limb ischemia maybe required depending on a good arterial segment as a donor and recipient.Aim: The aim of this study was to assess the different aspects of ilio-popliteal bypass surgery as a long conduit inpatients presented with critical limb ischemia and infected femoral pseudo aneurysms.Setting and design: Forty patients were admitted in the vascular surgery units, and they were diagnosed withcritical lower limb ischemia. An ilio-popliteal bypass was done to save their limbs. The patients were selected anddivided into two groups; A and B. Group A: This group included twenty patients suffering from atheroscleroticcritical ischemia, while group B included twenty patients suffering from infected femoral pseudo-aneurysm as aresult of intra-arterial drug injection and drug abuse.Patients and methods: All patients were assessed at the pre-operative stage as regards to the present conditionsand symptoms related to critical lower limb ischemia; the lower limb was locally examined as well. Angiography wasdone for all patients. Ilio-popliteal bypass using a PTFE synthetic graft was done, with station on the deep femoralartery in certain patients, anatomically in group A, and placed laterally extra anatomic in group B after ligation ofthe pseudo aneurysm. One year follow up was conducted mainly clinically and by the ankle brachial pressure index(ABI).Statistical analysis: Statistical Package for the Social Sciences, version 15.0 was used. Values were comparedwith a paired samples t test. P values less than 0.05 were considered significant.Results: During the follow up period, the ABI values were recorded immediately after the procedure, 24 hours,one week, and then one, three, six and twelve months later. There were no significant changes in the ABI changesamong patients indicating the continuation of the hemodynamic success. At the end of the study follow up period,limb salvage rate was 90%, and four major amputation following graft occlusion took place in the twenty studiedpatients. Primary patency was 80% as eight grafts were occluded.Conclusions: Although the ilio-popliteal bypass is a long conduit, it is a reasonable solution for limb salvage inpatients with critical limb ischemia, anatomical bypass with station on the deep femoral artery should be performedwhen possible, meanwhile in drug abuse cases with infected groin pseudo aneurysm, the healthy arterial axis ismaintaining the patency of the long lateral extra anatomic graft.
       
  • Composite Grafts as an Alternative Conduit to Prosthetic Grafts in Below
           Knee Femoro-popliteal Bypass in Patients of Chronic Lower Limb Ischemia

    • Abstract: Background: Chronic limb threatening lower limb ischaemia (CLTI) gives high limb loss and mortality. InfragenicularFemoro-popliteal bypass offers in-line flow to target vessels. When vein not available, composite andprosthetic grafts are used.Aim of the work: Comparing composite vs synthetic femoro-popliteal bypass conduits in treatment of CLTI.Patients and methods: 20 adult patients were included in this prospective study from July 2020 to July 2021having CLTI requiring below knee femoro-popliteal bypass, no suitable vein conduit. Ten had composite graftsbypass (group A) and 10 patients had synthetic graft (group B), and followed for 6 months.Results: Improved clinical manifestations in both groups and significant increase of ankle brachial index. 6 months1ry and 2ry patency were 90% and 100% in group A, and 67% and 78% in group B. Limb salvage were 100% ingroup A and 89% in group B. No significant difference between groups’ outcome, complications, and ABI.Conclusion: Both types of conduit showed acceptable feasibility and outcome.
       
  • One Anastomosis Gastric Bypass Versus Roux-en-y Gastric Bypass Surgery as
           Revisional Surgery after Restrictive Bariatric Operations

    • Abstract: Background: Restrictive bariatric procedures, such as gastric banding and sleeve gastrectomy are technicallysimple, and effective in achieving weight loss and managing obesity-related comorbidities in the short term. Asubset of patients who underwent restrictive bariatric procedures needs revisional surgery for unsuccessful weightloss, gastroesophageal reflux disease, or anatomic complications after primary surgery.Aims: To compare revisional one anastomosis gastric bypass (r-OAGB) against revisional Roux-en-Y gastric bypass(r-RYGB) after failed or complicated restrictive procedures.Patients and methods: This prospective study was conducted on 40 patients who met the inclusion criteria withminimal follow-up of 1 year. Twenty patients were converted to OAGB/MGB and 20 patients were converted toRYGB as a revisional procedure. Both groups were compared for operative time, hospital stay, intraoperative andpostoperative complications and short-term outcome.Results: The operative time was significantly longer for r-RYGB with a mean time of 258.25±75.21 mins comparedto 216.75±47.30 mins for r-OAGB. Hiatus hernia was found and repaired in 3 patients of the r-OAGB group and 10patients of r-RYGB. Postoperative complications occurred in 10% of r-OAGB group and 25% of r-RYGB. The meanpostoperative weight and BMI were significantly lower than preoperative weight and BMI in both groups with nosignificant difference between both groups. The mean %EWL was 75.06 ± 24.28 for r-OAGB compared to 64.54 ±30.40 for r-RYGB therefore EWL% was statistically significant higher after r-OAGB. Overall comorbidities improvedin both groups postoperatively while anemia was recorded in 6 patients after r-RYGB compared to 3 patients afterr-OAGB.Conclusion: One anastomosis gastric bypass is a simple and effective revisional procedure with less complications,shorter operative time and satisfactory weight loss.
       
  • Persistent Sciatic Artery Aneurysm: Cases Series and Review of Literatures

    • Abstract: Introduction: Persistent sciatic artery (PSA) is a rare anomaly of high clinical significance. Embryological, partof the sciatic artery involutes and other parts develop into the popliteal and peroneal arteries. Most cases presentsilent with aneurysm formation. Treatment is aneurysm exclusion with maintaining limb vasculature.Aim: Was to outline presentations and management PSA patients.Patients: First was female with bilateral pulsating gluteal masses. A bypass was done between the internal iliacand popliteal arteries because the femoral arteries were hypoplastic bilaterally. Second was 59y female presentedwith critical left lower limb ischemia. Femoropopliteal bypass with exclusion of the aneurysm was done. Thirdpatient was 52y male with right painful pulsating gluteal mass with hypoplastic femorals.Conclusions: PSA is a rare vascular anomaly. Treatment depends on clinical and angiography presentation. Usuallysurgery is preferred. PSA awareness is in favor to appropriate management.
       
  • Evaluation of Intra-corporeal Ligation of the Mesoappendix during
           Laparoscopic Appendectomy versus the Use of Energy Devices: A Comparative
           Study

    • Abstract: Background: Studies showed that using Harmonic scalpel for devascularization of the mesoappendix in laparoscopicappendicectomy (LA) is quick and safe. However, in order to reduce the cost of the procedure, endo-clips ormonopolar electrocautery are considered cheaper alternatives. The aim of our study was to evaluate the use ofintra-corporeal ligation as an alternative safe and cost-effective way to devascularize the mesoappendix.Methods: The study included 180 patients who were randomly divided into three equal groups: Group 1 (Intracorporealligation of mesoappendix combined with monopolar diathermy), group 2 (Division of mesoappendix byHarmonic scalpel), and group 3 (division of mesoappendix by monopolar diathermy). All groups were comparedregarding operative time, rate of conversion to open, intra-operative bleeding, postoperative pain, length of hospitalstay (LOS), postoperative complications and the cost of consumables used.Results: There was a statistical significant intra-operative bleeding in groups 2 and 3 compared to group 1. Thecost of consumables used in group 1 were significantly cheaper compared to using Harmonic scalpel . There wasno significant difference regarding the rest of the parameters.Conclusion: Intra-corporeal ligation of the mesoappendix is safe and cost-effective when compared to the use ofHarmonic scalpel or monopolar diathermy alone.
       
  • Randomized Comparative Study between Using Harmonic Scalpel versus
           Cavitron Ultrasonic Surgical Aspirator with Bipolar Cautery in Living
           Donor Hepatectomy for Living Donor Liver Transplantation

    • Abstract: Background: Liver donation is a respectable human gift. It is essential that complications should be minimized asmuch as possible and must be safely performed.Aim of the work: To evaluate feasibility and safety of using CUSA for liver resection in living donor livertransplantation (LDLT) in comparison with harmonic scalpel.Patients and methods: This prospective study included 40 consecutive donors for LDLT held at Nasser Instituteand Air Force Specialized Hospital during the period from September 2017 to September 2018.Results: Harmonic scalpel significantly reduced operative time (p=0.000) with a reduced blood loss (p=0.016),however it caused higher rate of biliary leakage (40% vs 15% respectively). On the other hand, CUSA showedlower bile leak leading to shorter hospital stay (p=0.000).Conclusion: Although harmonic scalpel is a faster method, CUSA is more effective and safer with a lowercomplication rate despite being cumbersome and need a longer learning curve.
       
  • Reliability of Clinical Signs to Diagnose Lower Limb Lymphedema in
           Comparison to Immediate and Delayed Near Infrared Fluoroscopic
           Lymphangiography

    • Abstract: Objective: Diagnosis of lower limb lymphedema depends on clinical signs in most health organization. One ofthe recent investigational tools for lymphedema diagnosis is near infrared fluoroscopy lymphangiogram. The aimof our study was to evaluate the accuracy of clinical signs in lymphedema diagnosis in comparison to fluoroscopiclymphangiography. Also, to know the value of immediate and delayed lymphangiography in clinically diagnosedlymphedema patients.Patients and methods: Prospective Cohort study of 44 patients with 73 lower limbs swelling. All patients assessedby history, clinical examination. Body mass index has been measured. Immediate and delayed findings (After 24hours) of near infrared lymphography of subcutaneous injection of Indocyanine Green has been documented.Results: The sensitivity and specificity of clinical signs in predicting fluoroscopic -confirmed lymphedema were77% and 58% respectively. The overall accuracy was 69 %. Forty six out of 73 limb swellings showed the classicalclinical signs of lymphedema. Twenty five of them showed normal lymphatic pattern by immediate fluoroscopy.One half of this group showed changes of images of fluorescent lymphangiography after 24 hours of injection intodermal backflow pattern. The sensitivity of clinical signs in predicting lymphedema was 77%, specificity was 58%.The overall accuracy was 69%.Conclusions: These results would suggest clinical signs of lymphedema unreliable in making a correct diagnosisof lymphedema in about one third of pateints. Also, we cannot rely on immediate lymphangiographic fluoroscopyto exclude lymphedema.
       
 
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