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Outcome of Laparoscopic Totally Extraperitoneal Approach with Direct Dissection and Mesh Hernioplasty in the Treatment of Inguinal Hernia
Osama Hasan Abd-Raboh,
Taha Ahmed Ismael,
Hamdy Abdel-Hady Mohamed
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
1-7
Received:
25 December 2016
Accepted:
26 December 2016
Published:
6 February 2017
DOI:
10.11648/j.js.s.2017050301.11
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Abstract: Aim of the work: To evaluate total extraperitoneal repair with direct telescopic dissection and mesh hernioplasty for inguinal hernias. Patients and methods: This study was conducted at Gastrointestinal, Liver & Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospital, over the period from 1st Jan 2014 to last of June 2015 on 20 patients having inguinal hernia. Results: This prospective study included 20 adult patients with primary unilateral inguinal hernia, all of them were males. Age of study patients ranged from 22 to 64 years old. There were 11 patients with right inguinal hernia (55%) and 9 patients with left inguinal hernia (45%). Mean operative time was 99.30 ± 25.13 min. (with range between 60 -160 min). The mean time for analgesia was 3.75 ± 1.62 days (ranged 2 - 7 days). 24 hours post-operatively, mean visual pain score was 2.8 ± 1.15. There was one case of scrotal edema (5%). Minor surgical emphysema occurred in two cases (10%). Hospital stay ranged from 1-3 days, and the mean was 1.35 ± 0.67 days. The mean time until return to work was 14.8± 4.26 days, ranged from 7 – 21 days. The mean time of follow up was 7.6 ± 2.1 months (range 6-12 months). There were no reported cases of hernia recurrences. Conclusion: Laparoscopic TEP repair is an excellent alternative to open preperitoneal repair of inguinal hernia. Operative time is relatively long but still comparable to many of studies discussing TEP technique and improving over the time of the study indicating the need for long learning curve. This technique was proved safe, as it was not associated with major morbidity or recurrence. Complication rate was average with other studies while there was no hernia recurrence during the period of follow up.
Abstract: Aim of the work: To evaluate total extraperitoneal repair with direct telescopic dissection and mesh hernioplasty for inguinal hernias. Patients and methods: This study was conducted at Gastrointestinal, Liver & Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospital, over the period from 1st Jan 2014 to last of June 2015 o...
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Closure of Appendicular Stump Using Absorbable Polydioxnon Endoclips in Laproscopoic Appendictomy
Wael Barakaat Ahmed Mohamed,
Ahmed Eisa Ahmed
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
8-11
Received:
26 December 2016
Accepted:
27 December 2016
Published:
6 February 2017
DOI:
10.11648/j.js.s.2017050301.12
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Abstract: Background: Since 1983 when the 1st laparoscopic appendectomy was described by Semms, different methods for closure of the appendicular stump during laparoscopic appendectomy such as linear stapler (Endo GIA), endoloop ligature, intracorporeal suture and metal endoclips were used. The use of non-absorbable plastic clips was described in several studies which reported the low cost and easy application of these clips. Objective: to evaluate the efficiency of closure of appendicular stump using polydixanone AP 400 endosclips techniques as regard the intraoperative and postoperative complications. Patients: From October 2014 to October 2015, 40 patients from General surgery department Sohag university hospitals undergoing laparoscopic appendectomy with closure of appendicular stump using polydixanone AP 400 endosclips was done for all the patients. Primary outcome measures: were feasibility of the clip, intra-abdominal surgical site (abscesses, stump leakages) and superficial wound infections. Results: The staples were applicable in nearly 80% of patients. Reasons for not applying the clip were mainly aninflamed caecum or a too large diameter of the appendix base. Superficial wound infections were found in two (5%), intra-abdominal abscesses in one (2.5%), no leak from the appendicular stump was detected. Conclusions: The results suggest that the polydiaxnone endo clip is a safe and effective option in securing the appendicular stump in laparoscopic appendectomy.
Abstract: Background: Since 1983 when the 1st laparoscopic appendectomy was described by Semms, different methods for closure of the appendicular stump during laparoscopic appendectomy such as linear stapler (Endo GIA), endoloop ligature, intracorporeal suture and metal endoclips were used. The use of non-absorbable plastic clips was described in several stu...
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The Role of Laparoscopy in Diagnosis of Ascites of Obscure Etiology
Wael Barakaat Ahmed Mohamed,
Ahmed Eisa Ahmed,
Usama Ahmed Arafa
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
12-15
Received:
26 December 2016
Accepted:
27 December 2016
Published:
6 February 2017
DOI:
10.11648/j.js.s.2017050301.13
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Abstract: Background: The role of diagnostic laparoscopy was markedly decreased with the advent of major developments in noninvasive imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. However, many reports suggest that imaging has a limited role in the diagnosis of exudative ascites. The aim of the present study was to answer the question if there still a place of laparoscopy in the diagnosis of ascites of obscure etiology?. Methods: We prospectively evaluated patients with undiagnosed exudative ascites seen in the internal medicine and general surgery departments in Sohag university hospital, Sohag, Egypt in the period from September 2014 till November 2016. Results: 32 patients were included in our study; 30 females(93.75%) and 2 males (6.25%) with a mean age of (range from 16 to 68 years. All patients were referred to surgery department due to ascites of obscure origin. No mortality was registered in this study; all patients were discharged from hospital the 2nd day after laparoscopy andreturned to their home activity. The final pathological diagnosis after examination of ascetic fluid and biopsies that weretaken by laparoscopy were carcinomatosis peritoneii in 24 (75%), tuberculous peritonitis in 6 (18.75%) and liver cirrhosis in 2 cases (6.25%). Conclusion: Despite great advances in noninvasive diagnostic imaging techniques; diagnostic laparoscopy is stilla valuable option for diagnosis of ascites of obscure etiology.
Abstract: Background: The role of diagnostic laparoscopy was markedly decreased with the advent of major developments in noninvasive imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. However, many reports suggest that imaging has a limited role in the diagnosis of exudative ascites. The aim of the present study ...
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Is C-reactive Protein an Independent Risk Factor for Complication of Laparoscopic Cholecystectomy for Acute Cholecystitis
Hamdy A. Elhady,
Taha Ahmed Esmail
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
16-22
Received:
1 January 2017
Accepted:
5 January 2017
Published:
6 February 2017
DOI:
10.11648/j.js.s.2017050301.14
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Abstract: Background: Acute cholecystitis (AC) is the most common complication of gall bladder stones. C-reactive protein (CRP) level is only used as a diagnostic criterion of AC. Because there is the lack of studies demonstrating a better discrimination power of CRP measurement on AC, The aim of this study was evaluate the discriminative power of CRP in AC management and treatment outcome. Patients and methods: The number of patients in this study was 30 patients presented with AC. After clinical examination, Laboratory and radiological investigations and resuscitation within 1st 24h. of admission, all patients treated by laparoscopic cholecystectomy (LC). Results: Out of total participants, 8 patients were males (26.7%) and 22 females (73.3%). There ages ranged from 21 to 66 years with mean ± SD 11.29. Higher levels CRP were found in cases of high grade fever, palpable tender RT. hypochondrial mass and pyocele cases with significant difference was 0.001, 0.001 and 0.005 respectively. Timing of intervention was within 7 days from 1st symptom day ranging 2-7 days with mean 4.37. Total operative time was ranging from 42-180 minutes with mean 109.57. Blood loss ranging from 50-200 cc with mean 95. Total hospital stay ranged from 4-6 days. Conclusion: High levels of CRP with male sex, high grade fever preoperatively, presence of palpable tender RT. hypochondrial mass, high total leucocytic count, cases of pyocele and presence of intra-operative adhesion and timing of intervention are risk factors for difficulty, complications, operative and postoperative out come in patients undergoing laparoscopic cholecystectomy for Acute cholecystitis.
Abstract: Background: Acute cholecystitis (AC) is the most common complication of gall bladder stones. C-reactive protein (CRP) level is only used as a diagnostic criterion of AC. Because there is the lack of studies demonstrating a better discrimination power of CRP measurement on AC, The aim of this study was evaluate the discriminative power of CRP in AC ...
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Laparoscopy in Simple and Complicated Appendicitis: How Does It Differ
Abdelnaser Zaid,
Mohammed Kottb,
Emad Hokkam,
Aly Saber
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
23-27
Received:
20 January 2017
Accepted:
21 January 2017
Published:
18 February 2017
DOI:
10.11648/j.js.s.2017050301.15
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Abstract: Introduction: laparoscopic appendectomy (LA) has been established as a surgical technique in the management of acute appendicitis in several studies. Although LA is considered safe and effective in acute non-complicated cases, the technique is not gaining the same widespread acceptance in the complicated cases. The considerable high rate of conversion into open surgery and safety of the procedure in complicated cases makes the outcome somewhat different from that of the non-complicated cases. This study was designed to compare the outcome of the LA in both simple and complicated acute appendicitis. Methods: The study included ninety patients who were above 18 years of age with either acute simple or acute complicated appendicitis. There are divided into two groups (G1 & G2). G1 included complicated cases while G2 included simple cases. LA was performed to all patients. The outcome of the procedure in terms of rate of conversion to open surgery, operation time, hospital stay, time of return to work and the complications rate was compared between both groups. Results: Gl included 40 patients (44%) while G2 included 50 patients (56%). The operative time was significantly longer in Gl than G2 (115 ± 18.6 vs 65 ± 10.4) (P=0.02). Conversion to open surgery occurred in 11 patients (27.5%) of G1 and in 4 patients (8%) of G2 (P=0.01). The main causes of conversion were difficult skeletonization of the appendix and inability to control bleeding from non-visualized source. The overall length of hospital stay was significantly higher in G1 patients (P=0.02) while the time needed to return to work was statistically insignificant between both groups (P=0.12). The incidence of complications was greater in G1 (8/40) as compared to G2 (2/50) (P=0.001). There were no mortalities and no patients required re-operation in either group. Conclusion: LA is feasible and advantageous in both simple and complicated appendicitis. However; great caution and high level of experience are need in complicated cases because of its relatively high rates of complication and conversion to open procedure.
Abstract: Introduction: laparoscopic appendectomy (LA) has been established as a surgical technique in the management of acute appendicitis in several studies. Although LA is considered safe and effective in acute non-complicated cases, the technique is not gaining the same widespread acceptance in the complicated cases. The considerable high rate of convers...
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Laparoscopy in Acute Cholecystitis: To Drain or Not to Drain
Aly Saber,
Emad Hokkam,
Abdulmonem Alshayeb
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
28-32
Received:
25 January 2017
Accepted:
29 January 2017
Published:
18 February 2017
DOI:
10.11648/j.js.s.2017050301.16
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Abstract: Introduction: Regarding cholecystectomy for acute cholecystitis, there is still debate regarding drain insertion. The aim of the present study was to detect if there is a beneficial added value to drain the abdomen in case of laparoscopic cholecystectomy for acute cholecystitis. Patients and Methods: A total of 120 patients diagnosed having acute cholecystitis were enrolled to this study and were divided according to the drain insertion into two main groups; with drain (group A) and without drain (group B). End Points: The primary endpoint was the presence of operative field fluid collection at abdominal ultrasonography when performed twenty four hours after surgery. Secondary endpoints included postoperative abdominal, length of hospital stay and wound infection. Results: Concerning the demographic data, there was no statistical significant difference between the two groups regarding age, sex and body mass index. The mean operative time, hospital stay, postoperative pain and wound infection rate were higher in drain versus no drain group. Conclusion: The present study showed that there was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis. Drain insertion may be a cause of delayed discharge and prolonged hospital stay after laparoscopic procedures. Increased intensity of postoperative pain and wound infection are claimed to be due to drain insertion.
Abstract: Introduction: Regarding cholecystectomy for acute cholecystitis, there is still debate regarding drain insertion. The aim of the present study was to detect if there is a beneficial added value to drain the abdomen in case of laparoscopic cholecystectomy for acute cholecystitis. Patients and Methods: A total of 120 patients diagnosed having acute c...
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Evaluation of the Effect of the Blood Stopper; Ankaferd in Management of Post Laparoscopic Cholecystectomy Liver Bed Bleeding
Emad K. Bayumi,
Aly Saber,
Leonie Sophia Van Den Hoek
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
33-38
Received:
29 January 2017
Accepted:
3 February 2017
Published:
28 February 2017
DOI:
10.11648/j.js.s.2017050301.17
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Abstract: Introduction: The incidence of bleeding complications during laparoscopic cholecystectomy remains a frequent reason for conversion. Ankaferd Blood Stopper is a unique medicinal plant extract that has historically been used as a hemostatic agent and has been approved for the management of external hemorrhage and dental surgery bleeding. The aim of this study was to evaluate the effect of Ankaferd as a blooding stopper; in the management of liver bed bleeding in post laparoscopic cholecystectomy. Patients and Methods: A total of 120 patients; 60 for each group; group A (laparoscopic cholecystectomy with cauterization of gallbladder bed of the liver) and group B (laparoscopic cholecystectomy with application of Ankaferd drops by laparoscopic injector into gallbladder bed). End points: The primary end point of the study was measurement of the intraoperative bleeding as a result of application of both techniques; ankaferd instillation and cauterization of gallbladder bed of the liver. The secondary end points were estimation of the amount and characteristics of postoperative discharge till removal of drains, length of hospital stay and postoperative wound infection. Results: The operative time in group A was 85±34.5 minutes while in group B, it was 56±20.5 minutes. The mean amount of intraoperative bleeding was 58.1±29.97 ml and 37±14.47 ml in group A&B respectively. The mean amount of postoperative fluid drainage was 41.75±12.9 ml in group A while in group B was 30±6.75 ml and the hospital stay, It was 51.6±15.35 hours for patients of group A versus 31.8 ±8.5 hours for patients of group B respectively with significant distribution {P ≤ 0.001}. Conclusion: Ankaferd rapidly achieves hemostasis allowing surgeon to control bleeding properly and therefore the amount of operative bleeding, the operative time and the amount of postoperative fluid discharge on using ankaferd is statistically reduced.
Abstract: Introduction: The incidence of bleeding complications during laparoscopic cholecystectomy remains a frequent reason for conversion. Ankaferd Blood Stopper is a unique medicinal plant extract that has historically been used as a hemostatic agent and has been approved for the management of external hemorrhage and dental surgery bleeding. The aim of t...
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Minimal Access and Minimally invasive Surgery in Veterinary Practice
Aly Saber,
Emad K. Bayumi,
Leonie Sophia Van Den Hoek
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
39-42
Received:
6 February 2017
Accepted:
10 February 2017
Published:
28 February 2017
DOI:
10.11648/j.js.s.2017050301.18
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Abstract: Introduction: Laparoscopic surgery is a major component of the field of minimally invasive and minimally access surgery and is performed through an opening in the abdominal wall with a rigid endoscope allowing visual inspection of the peritoneal cavity and its organs. Laparoscopy has been used in veterinary medicine with any degree of frequency only for the last 25 to 30 years and is primarily centered on reproductive function studies in food animals and equine, nonhuman primate, and various zoo and exotic species. Although the indications for laparoscopy may be far more extensive in human medicine, it still has many potential applications for use in veterinary medicine. It is a procedure that can be performed with a high degree of safety. Indications: There are three indications of using the laparoscope in animals; the 1st is diagnostic, the 2nd is therapeutic and the 3rd is creating the excellent training model for minimally invasive surgery of human diseases. Contraindications: There are several absolute and relative contraindications for performing laparoscopy in human and animals. The absolute contraindications include acute or unstable cardiopulmonary conditions, presence of an uncorrectable or severe coagulopathy, cases in which extensive intraabdominal adhesions could have developed bowel obstruction, abdominal herniation and septic peritonitis. A relative contraindication must be balanced against the need for diagnosis and risks of alternative methods of diagnosis. Complications: The complication rate associated with laparoscopy depends on operator experience, accurate patient assessment and recognition by the clinician of appropriate indications and any possible contraindications, and quality of the laparoscopic equipment used. Conclusion: Owing to the minimal invasiveness and minimal access and short time of hospitalization and recovery of animals, laparoscopic techniques become more and more interesting not only for veterinary surgeons but also for owners of the animals.
Abstract: Introduction: Laparoscopic surgery is a major component of the field of minimally invasive and minimally access surgery and is performed through an opening in the abdominal wall with a rigid endoscope allowing visual inspection of the peritoneal cavity and its organs. Laparoscopy has been used in veterinary medicine with any degree of frequency onl...
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Modified Video-Assisted Thyroidectomy in a Benign Unilateral Thyroid Swelling
Mohamed A. Mlees,
Ahmed A. Darwish
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
43-48
Received:
8 February 2017
Accepted:
9 February 2017
Published:
28 February 2017
DOI:
10.11648/j.js.s.2017050301.19
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Abstract: Background and aim: Conventional thyroidectomy may cause a long neck scar and a variety of potential complications. The concept of minimally invasive surgery has recently found many supporters in the management of thyroid disorders. The aim of this study was to evaluate the suprasternal approach of modified minimal invasive video-assisted endoscopic thyroidectomy (MIVAET) in treatment of unilateral simple nodular goiter in term of: feasibility of the operation, the identification of recurrent laryngeal nerves (RLN) and parathyroid glands, operative time, postoperative pain and cosmetic result. Patients and methods: This study was conducted on 20 patients with a simple solitary thyroid nodule in Surgical Oncology Unit at General Surgery Department, Tanta University Hospital from March 2015 to June 2016. Patients included in the study had small nodule less than 5 cm in maximum diameter, unilateral lesion, no previous neck surgery, benign lesion and euthyroid state. Every patient was subjected to MIVAET through a Suprasternal 2-cm neck incision. Results: The present study comprised 18 females (90%) and 2 males (10%) patients with a mean age of 32 years, The mean operative time was 63 minutes, simple nodular goiter was the commonest pathological finding, 90% of the patients stayed in the hospital one day and 70% were satisfied from cosmetic appearance of their scar 6 months after the operation. Conclusion: Modified minimal invasive video-assisted endoscopic thyroidectomy was feasible, can be done safely and effectively with a better aesthetic outcome and pathological control without increasing the risk of complications.
Abstract: Background and aim: Conventional thyroidectomy may cause a long neck scar and a variety of potential complications. The concept of minimally invasive surgery has recently found many supporters in the management of thyroid disorders. The aim of this study was to evaluate the suprasternal approach of modified minimal invasive video-assisted endoscopi...
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The Efficacy and Safety of Endoscopically Guided Stapled Fundal Mini-Gastrectomy for the Treatment of Bleeding Fundal Varices: A Single Tertiary Care Center Experience
Taha Ahmed Esmail,
Sherief Abd-Elsalam
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
49-55
Received:
19 February 2017
Accepted:
21 February 2017
Published:
6 March 2017
DOI:
10.11648/j.js.s.2017050301.20
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Abstract: Introduction: Gastric varices develop in 5–33% of patients with portal hypertension. Gastric variceal bleeding is a major problem accused for a lot of deaths in cirrhotic sufferers, so its management and early prophylaxis is a must. Surgery turns into the only hope for patients with huge varices or resistant cases to repeated endoscopic management. Fundectomy and devascularization may be a good option in this class of patients. The aim of this study is to evaluate endoscopically guided stapled fundal minigasterectomy with periesophagogastric devascularization and splenectomy in treatment of gastric fundal varices. Patients and methods: This study included twenty two selected patients with gastric varices admitted to Gastroenterology, Liver and Laparoscopic unit, General surgery department, Tanta University Hospitals, during the period from January 2014 to January 2016. All cases were operated by endoscopically guided stapled fundal minigasterectomy with periesophagogastric devascularization and splenectomy. The evaluation included operative characteristics, operative findings and morbidity and postoperative complications. Results: The operative time ranged from 75 minutes to 180 minutes, with a mean of 106 + 15 minutes. Intraoperative bleeding occurred in one patient (4.55%) due to injury of one of the retroperitoneal veins treated by underrunning sutures and blood transfusion. There was no operative or postoperative mortality and only one patient developed recurrent fundal varices (4.55%) without bleeding attacks during the follow up period. Follow up ranged from 1 to 2 years with a mean of 1.5 years. Conclusion: Endoscopically guided stapled fundal minigasterectomy with peri-esophagogastric devascularization is a safe and effective method in the treatment and prophylaxis of fundal varices, and should be a used in treating bleeding fundal varices and in prophylaxis of huge ones.
Abstract: Introduction: Gastric varices develop in 5–33% of patients with portal hypertension. Gastric variceal bleeding is a major problem accused for a lot of deaths in cirrhotic sufferers, so its management and early prophylaxis is a must. Surgery turns into the only hope for patients with huge varices or resistant cases to repeated endoscopic management....
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Giant Lactating Adenoma of the Breast: Safety and Benefits of Surgical Removal
Mohamed Ali Mlees,
Aymen Mohamed Elsaka
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
56-60
Received:
13 March 2017
Accepted:
14 March 2017
Published:
23 March 2017
DOI:
10.11648/j.js.s.2017050301.21
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Abstract: Background and aim: Lactating adenoma is one of the benign tumors of breast that is frequently associated with pregnancy and lactation. Its size ranged from 1cm to 4 cm; however, rare cases with rapid postpartum enlargement up to 25 cm have been reported. Surgical removal of small lactating adenoma usually postponed till weaning, waiting for spontaneous regression and to avoid wound complications. The aim of this study was to assess the safety of surgical removal of giant (more than 5 cm) lactating adenomas during lactation, regarding wound complication specially milk fistula, with maintenance of breast feeding and its benefit. Patients and methods: The present study was conducted on 12 patients with giant lactating breast adenoma in Surgical Oncology unit at General Surgery Department, Tanta University Hospital from March 2013 to July 2016. The patients included in the study were lactating, had solitary breast mass more than 5 cm in size, had subjected to surgical removal through a cosmetic circumareolar or curvilinear incision. The patients resumed breast feeding within 24 hours, then followed-up for wound haematoma, wound seroma, wound infection, milk fistula, psychic and pain relief. Results: The patients' age ranged from 18 to 38 years with a mean age of 27 ± 3.6 years. In all patients; the chief complaint was cosmetically discomforting mass, asymmetry between the two breasts and fear of malignancy, pain was a presenting symptom in 6 patients. The size of the adenoma by ultrasound ranged from 8-18 cm with a mean of 12.6 cm. No wound complications were recorded. Conclusion: Giant lactating adenoma could be safely removed during lactation to alleviate pain, heaviness, and anxiety, to rule out malignancy or coexisting carcinoma with no wound complication, no milk fistula and good aesthetic outcome with maintenance of the breast feeding and its benefits.
Abstract: Background and aim: Lactating adenoma is one of the benign tumors of breast that is frequently associated with pregnancy and lactation. Its size ranged from 1cm to 4 cm; however, rare cases with rapid postpartum enlargement up to 25 cm have been reported. Surgical removal of small lactating adenoma usually postponed till weaning, waiting for sponta...
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Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions
Asmaa Aly Saber,
Aly Saber
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
61-69
Received:
13 March 2017
Accepted:
14 March 2017
Published:
23 March 2017
DOI:
10.11648/j.js.s.2017050301.22
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Abstract: Background: Sound travels in waves that transport energy from one location to another. Ultrasound is the name given to sound waves that have frequencies greater than 20000Hz. It's too high pitched for human hearing, but many animals, such as dogs, cats and bats can hear ultrasound. As the ultrasound waves travel through tissues, they are partly transmitted to deeper structures, partly reflected back to the transducer as echoes, partly scattered, and partly transformed to heat. The amount of echo returned after hitting a tissue interface is determined by a tissue property called acoustic impedance which is an intrinsic physical property of a medium defined as the density of the medium times the velocity of ultrasound wave propagation in the medium. Physiologic effect of US: The thermal therapeutic ultrasound include increased tissue temperature, hyperdynamic tissue metabolism, increased local blood flow, increased extensibility of collagen fibers, and reduced viscosity of fluid elements in the tissue. The nonthermal mechanisms include ultrasonic cavitation, gas body activation and mechanical stress or frequency resonance nonthermal processes. Therapeutic effects of US: Therapeutic ultrasound is delivered in two modes; the continuous mode in which the delivery of ultrasound is non-stop throughout the treatment period and the pulsed mode in which the delivery of ultrasound is intermittently interrupted. Essential treatment parameters for therapeutic ultrasound include frequency, intensity, treatment mode, treatment time. Clinical applications: US in damaged muscle accelerates the repair process due to the decrease in the response and number of inflammatory cells and increases the proliferation and differentiation of muscle cell lines together with the formation of the connective tissue, improving mechanical resistance in the early stages. US is used also in chronic pain syndrome, tissue repair and wound healing and extra and intracorporeal shock wave lithotripsy. Cancer therapy: High-intensity focused ultrasound is a noninvasive therapy that makes entire coagulative necrosis of a tumor in deep tissue. HIFU ablation can destroy all proliferating tumor cells and their feeding blood vessels at the same time; this may break interdependent vicious cycle of tumor angiogenesis and tumor growth. Conclusion: Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years. While therapeutic ultrasound is safe for treating many clinical conditions, it may cause substantial bioeffects and patients should be fully informed of possible benefits and risks.
Abstract: Background: Sound travels in waves that transport energy from one location to another. Ultrasound is the name given to sound waves that have frequencies greater than 20000Hz. It's too high pitched for human hearing, but many animals, such as dogs, cats and bats can hear ultrasound. As the ultrasound waves travel through tissues, they are partly tra...
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Early Experience with Laparoscopic Splenectomy in Benign Splenic Disorders
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
70-75
Received:
15 March 2017
Accepted:
16 March 2017
Published:
31 March 2017
DOI:
10.11648/j.js.s.2017050301.23
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Abstract: Background: Laparoscopic splenectomy is evolving procedure and is now considered the procedure of choice in elective splenectomy by many centers, but technically demanding especially in large sized ones. Our aim was to evaluate the outcome of laparoscopic splenectomy for a variety of benign splenic disorders in our early experience. Patients and Methods: This prospective study was carried out on twenty-two patients treated with laparoscopic splenectomy in Tanta University Hospital from January 2014 to January 2016. Patients chart review including patient characteristics, splenic pathology, intraoperative difficulties or complications and postoperative outcome. Follow up ranged from 6 months to 2 years with a mean of 20 months. Results: Age of patients ranged from fifteen to fifty-nine years with a mean of 41.7 years. Fourteen cases (63%) with idiopathic thrombocytopenic purpura (ITP), six cases (27.3%) with hypersplenism and two cases (9.1%) with autoimmune hemolytic anemia. Accessory spleens were found in six patients (27.3%) and removed. Mean operative time was 120±15 minutes. Intraoperative bleeding occurred in six cases (27.3%), laparoscopic control attempted and succeeded in four of them, but conversion was inevitable in two cases (9.1%). There were no major postoperative complications or deaths. Conclusion: Laparoscopic splenectomy is not only safe minimal invasive procedure, with comparable results of the open splenectomy in management of small and medium sized spleens but also, has the advantages of negligible intraoperative blood loss. Larger series with longer periods of follow up are required to evaluate this promising operation.
Abstract: Background: Laparoscopic splenectomy is evolving procedure and is now considered the procedure of choice in elective splenectomy by many centers, but technically demanding especially in large sized ones. Our aim was to evaluate the outcome of laparoscopic splenectomy for a variety of benign splenic disorders in our early experience. Patients and Me...
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Long and Narrow Gastric Pouch versus Classic Globular Pouch in Laparoscopic Proximal Gastric Bypass: Effect on Weight Loss and Dumping Syndrome
Ashraf A. El-attar,
Taha A. Esmail,
Wael Abdel Salam
Issue:
Volume 5, Issue 3-1, May 2017
Pages:
76-82
Received:
2 April 2017
Accepted:
5 April 2017
Published:
15 April 2017
DOI:
10.11648/j.js.s.2017050301.24
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Abstract: Background: Laparoscopic proximal gastric bypass Roux-en-Y (LPGBRY) has been regarded for a long time as the gold standard treatment for morbid obesity and its comorbidities. With the presence of the newer strong options, like the gastric sleeve and the mini gastric bypass, refinements in technique are taking place to avoid its current problems. Early and late gastric dumping are known problems after proximal gastric bypass. Modifications in the technique by providing the patient with a long and narrow pouch might help the problem by slowing the gastric emptying time, also should it keep the weight loss in the acceptable range. Aim: The aim of this study is to evaluate whether constructing a long and narrow pouch can decrease the incidence of early and late dumping after laparoscopic proximal gastric bypass and to evaluate the likely impact of such a long and narrow pouch on the weight loss rates. Patients and methods: The study included 79 morbidly obese patients who received primary LPGBRY for treatment of their morbid obesity. They were divided into two groups; 42 patients who received LPGBRY with a long and narrow pouch (the [LN] group), and 37 patients who received LPGBRY with a classic globular pouch (the [G] group). Their 6 and 12 months’ percentage of excess weight loss (%EWL) were recorded. Also, one year after surgery, all patients were required to fill in an Arabic translation of the Sigstad dumping score questionnaire, followed one hour later by an Arabic translation of the Arts score symptoms of late dumping, only if they scored 7 or more. Results: No significant differences were found in the %EWL between both groups. In the Sigstad questionnaire, the most commonly recorded symptoms were the need to lie down and frequent eructation, followed by dizziness, and distension. Frequent eructation was significantly higher in the [LN] group, while dizziness and palpitation were significantly more common in the [G] group (p < 0.05). Similar over all rates of dumping were observed in both groups (p > 0.05). Half the dumping patients in group [G] had late dumping symptoms. The incidence of late symptoms in the [G] group was significantly higher than in the long and narrow pouch [LN] group (p < 0.05). Conclusion: Long and narrow pouches in LPGBRY achieve similar weight loss rates as in the classic globular pouches. Constructing a long and narrow pouch produces similar overall dumping rate, but added significantly more eructation, less dizziness, less palpitation and less late dumping symptoms when compared to the classic globular pouches.
Abstract: Background: Laparoscopic proximal gastric bypass Roux-en-Y (LPGBRY) has been regarded for a long time as the gold standard treatment for morbid obesity and its comorbidities. With the presence of the newer strong options, like the gastric sleeve and the mini gastric bypass, refinements in technique are taking place to avoid its current problems. Ea...
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