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Randomized Comparative Study Between Laparoscopic Transabdominal Pre-Peritoneal Versus Totally Extraperitoneal Approach in Inguinal Hernia Repair
Abdelaziz Osman Elhendawy,
Osama Hasan Abd-Raboh,
Taha Ahmad Ismail,
Abdelmonem Ahmad Nagy
Issue:
Volume 6, Issue 1, June 2018
Pages:
1-6
Received:
13 January 2018
Accepted:
26 January 2018
Published:
19 February 2018
Abstract: Background: Whether totally extraperitoneal inguinal hernia repair (TEP) is associated with better outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this study is to compare outcomes between patients undergoing TEP or TAPP. Methods: This prospective randomized comparative study was carried out in Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospitals from May 2016 to May 2017, on 30 patients with inguinal hernia, divided into 2 equal groups: Group I: subjected to Transabdominal Pre-peritoneal (TAPP) inguinal hernia repair (15 cases). Group II: subjected to Totally Extraperitoneal (TEP) inguinal hernia repair (15 cases). Results: The mean age was 47.8±10.4 ranged from 19-65 years. All patients were presented with indirect inguinal hernia. All cases were male except one female patient. Operative time was 151.7±24.8 in TAPP approach in comparison to 88.42±30.6 minutes in TEP approach. Post-operative scrotal edema was higher in TAPP approach (9 cases) in comparison to TEP approach (3cases). Postoperative Hematoma and ileus were higher in TAPP technique (2cases). Postoperative Surgical emphysema was higher in TEP technique (3cases). Hospital stay in TAPP approach was longer than TEP approach. There was no difference regarding wound infection, mesh infection and recurrence. Follow up for 6 months of all cases for complication. Conclusion: TEP approach as the laparoscopic procedure of choice for inguinal hernia repair due to short operative time and less hospital stay than TAPP approach.
Abstract: Background: Whether totally extraperitoneal inguinal hernia repair (TEP) is associated with better outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this study is to compare outcomes between patients undergoing TEP or TAPP. Methods: This prospective randomized comparative s...
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The Incidence of Early Recurrence After Anatomical Versus Non-Anatomical Liver Resection in Patients with Hepatocellular Carcinoma
Mohamed Abdallah Hablus,
Osama Hasan Abd-Raboh
Issue:
Volume 6, Issue 1, June 2018
Pages:
7-15
Received:
17 January 2018
Accepted:
26 January 2018
Published:
19 February 2018
Abstract: Aim: This retrospective study compares the incidence of early recurrence after anatomical versus non-anatomical resection in patients with hepatocellular carcinoma (HCC). Patients and Methods: This retrospective study included 26 patients who had a preoperative diagnosis of a single hepatocellular carcinoma (HCC) and who underwent anatomical and non-anatomical liver resection. The patients were divided into two groups. AR Group; anatomical resection group (n= 12) and NAR Group; Non-anatomical resection group (n = 14). The effect of the type of resection (anatomic vs non-anatomic) on early HCC recurrence was studied in both groups. Other risk factors that might play a role in early tumor recurrence such as the TNM staging, tumor size, vascular invasion, pathologic grading and high AFP values were also evaluated. Results: During the follow up period, 5 patients (41.7 %) from AR Group and 6 patients (42.9 %) from NAR Group developed recurrence. Mean time of recurrence was 13.05 ± 4.63 versus 12.53 ± 4.12 months (p 0.764). The univariate analysis method was used to analyze different epidemiological, clinical and pathological variables and there was no statistically significant risk factor in both groups in terms of recurrence. The mean disease-free survival was calculated for both groups using Kaplan–Meier curve and it was 16.013±2.324 for AR group versus 15.657±2.765 months for NAR group (p: 0.98). The cumulative overall survival proportion at end of research was 59.6% for AR group versus 69.87% for NAR group. The mean overall survival was 17.956±2.254 months for AR group versus 20.876±1.263 for NAR group (p: 0.21). The recurrence rate was 41.7%% in AR group and 42.9% in NAR group (p = 0.951). This suggests that the type of resection did not have an impact on early recurrence in HCC patients undergoing liver resection. Conclusion: This study concluded that recurrence-free and overall survivals after both anatomical and non-anatomical resection were not significantly different from the statistical point of view. Liver resection in cirrhotic patients should be performed with good expertise and should pursue strict selection criteria. Non-Anatomical resection may be more appropriate in cirrhotic patients with small HCC to preserve adequate functioning hepatic parenchyma and to avoid increased postoperative morbidity and mortality.
Abstract: Aim: This retrospective study compares the incidence of early recurrence after anatomical versus non-anatomical resection in patients with hepatocellular carcinoma (HCC). Patients and Methods: This retrospective study included 26 patients who had a preoperative diagnosis of a single hepatocellular carcinoma (HCC) and who underwent anatomical and no...
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Laparoscopic Cholecystectomy of Gangrenous Cholecystitis Safety and Feasibility
Sherif Abd-Al Fattah Saber,
Ahmed Abd-Al Fattah Elshoura,
Osama Hassan Abd-Raboh
Issue:
Volume 6, Issue 1, June 2018
Pages:
16-19
Received:
24 February 2018
Accepted:
11 March 2018
Published:
3 April 2018
Abstract: Background: Laparoscopic Cholecystitis (LC) of gangrenous Cholecystitis (GC) which is a serious complication of acute Cholecystitis (AC) is challenging especially in the presence of dense inflammatory adhesions and pericholecystic collection. The aim of this study is to clarify the feasibility and safety of LC in GC. Materials and methods: This is a prospective study done in GIT and LAP surgery unit, General Surgery Department in Tanta university hospital between January 2014 and 2018 on 40 cases of GC from 350 cases of laparoscopymanaged AC. Demographic data, intraoperative time, difficulties of the procedure, postoperative ICU admission, and hospital stay and complications were recorded. Results: GC was suggested preoperatively from old age, DM, CVD, fever > 38°C, tachycardia > 90 beats /minute, leucocytosis> 13,000 /cumm and gallbladder wall thickening>4mm and pericholecystic collection. LC introduces shorter time less difficulties intraoperatively, less need for ICU, shorter hospital stay and less frequent postoperative morbidity. Conclusion: The use of LC in GC is feasible and safe.
Abstract: Background: Laparoscopic Cholecystitis (LC) of gangrenous Cholecystitis (GC) which is a serious complication of acute Cholecystitis (AC) is challenging especially in the presence of dense inflammatory adhesions and pericholecystic collection. The aim of this study is to clarify the feasibility and safety of LC in GC. Materials and methods: This is ...
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Local Phenol Application Versus Excision with Modified Primary Closure Technique in Pilonidal Sinus Disease: A Comparative Study
Adel Morad Abdallah,
Mohammed Abd-Alaal Mohammed,
Radwa Mamdouh El-Sabban
Issue:
Volume 6, Issue 1, June 2018
Pages:
20-26
Received:
24 April 2018
Accepted:
10 May 2018
Published:
31 May 2018
Abstract: Background: Different procedures are practiced nowadays for management of pilonidal sinus disease (PSD), ranging from the minimally invasive techniques to the complex flap techniques. Each procedure has its own advantages and drawbacks in terms of patient’s satisfaction, follow up and recurrence rate. Local phenol application into the sinus track was practiced with encouraging results. The limited excision and modification of the primary closed technique has shown both low wound dehiscence and recurrence rates. The objective of this study is to evaluate and compare the local application of phenol 80% in the pilonidal sinus tracks after minimal debridement with the limited excision and modified primary closure technique. Methods: 52 patients suffering from chronic pilonidal sinus disease were divided equally into 2 groups. Patients in group I were managed with local phenol application under local anesthesia. In group II, the patients were operated upon by limited excision of the skin bearing the sinus pits and the underlying granulation tissue with modified primary closure technique using the gluteus maximus fasciae to close the cavity left followed by closure of the subcutaneous tissue and skin with leaving a suction drain inside. Results: The median duration of phenol applications procedure was 20 ± 11 minutes versus 41 ± 13 minutes in the modified primary closure technique. There was a significant difference between both groups as regards the duration of pain killers’ use. By 5 weeks, signs of complete healing were shown in 22 patients (84.5%) of the phenol group, versus 25 patients (96.2%) in the surgery group with no statistic difference between both. The recurrence of PSD in the phenol group was detected in 2 cases (7.7%) while it was one case (3.8%) in the surgery group (p=0.163). Conclusion: both procedures are simple, less surgically demanding, having simple postoperative care, low complication and recurrence rates, early recovery and good patient satisfaction.
Abstract: Background: Different procedures are practiced nowadays for management of pilonidal sinus disease (PSD), ranging from the minimally invasive techniques to the complex flap techniques. Each procedure has its own advantages and drawbacks in terms of patient’s satisfaction, follow up and recurrence rate. Local phenol application into the sinus track w...
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Prospective Assessment of Elevated Serum Bilirubin Level in Diagnosis of Acute Appendicitis
Ahmed Abdel-Fattah Elshoura,
Mohamed Hamdy Abo-Ryia,
Ayman Elsadany,
Sherif Abd-Al Fattah Saber,
Gamal Ibrahim Mousa
Issue:
Volume 6, Issue 1, June 2018
Pages:
27-30
Received:
28 April 2018
Accepted:
22 May 2018
Published:
12 June 2018
Abstract: Background: The rate of misdiagnosis of appendicitis has remained constant, despite the advance in diagnostic modalities. So, the search for a reliable marker is necessary. The aim of this study was to determine the value of hyperbilirubinemia as a marker for acute appendicitis. Patients and Methods: This prospective study was carried out during the period from April 2014 till April 2017 and included 369 patients presented with right iliac fossa pain diagnosed clinically as acute appendicitis and submitted to appendectomy (open or laparoscopic). Demographic data, data of clinical examination, radiological and laboratory investigations (specifically, complete blood count (CBC), C- reactive protein (CRP) and total serum bilirubin) were collected. Then appendectomy was done, the removed appendices were sent for histopathological examination. Patients were divided into three groups: group (I) histopathologically normal appendix, group (II) simple appendicitis and group (III) Complicated appendicitis. The data of the three groups were analyzed and compared. Results: This study included 369 patiens, 195 (52.8%) are males. Mean age was 22.6 ±7.22 years. Open appendectomy was performed in 306 (91.2%) patients and laparoscopic in 63 (8.8%). Histopathological examination revealed normal appendix in 69 (18.6%) patients, simple appendicitis in 240 (65.0%) and complicated appendicitis in 60 (16.2%). The serum total bilirubin had a higher specificity (87%) compared with white blood cells (WBC) (70%) and CRP (65%), but a lower sensitivity (28% vs. 66% and 58%, respectively) for acute appendicitis versus normal appendix group and a higher specificity (80%) than both WBC (35%) and CRP (45%), but a lower sensitivity than WBC and CRP (60% vs. 70% and 70% respectively) for complicated appendicitis versus simple appendicitis. Conclusion: Hyperbilirubinemia is a significant predictor in diagnosis of acute appendicitis in cases of right iliac fossa pain. It is also a significant predictor of complication (perforation and gangrene) in cases of acute appendicitis.
Abstract: Background: The rate of misdiagnosis of appendicitis has remained constant, despite the advance in diagnostic modalities. So, the search for a reliable marker is necessary. The aim of this study was to determine the value of hyperbilirubinemia as a marker for acute appendicitis. Patients and Methods: This prospective study was carried out during th...
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Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus
Issue:
Volume 6, Issue 1, June 2018
Pages:
31-35
Received:
22 May 2018
Accepted:
12 June 2018
Published:
4 July 2018
Abstract: Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.
Abstract: Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative interve...
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The Use of Prophylactic Antibiotics in Day Case Herniotomy at Abia State University Teaching Hospital, Aba, Nigeria
Samuel Chidi Ekpemo,
Sebastain Okwuchukwu Ekenze,
Uchechukwu Obiora Ezomike
Issue:
Volume 6, Issue 1, June 2018
Pages:
36-40
Received:
23 July 2018
Accepted:
17 August 2018
Published:
10 September 2018
Abstract: Background: There has been tremendous improvement in the knowledge of prophylactic antibiotics use in surgery. There are controversies on the use of prophylactic antibiotics clean surgical cases. This study aims to determine if there is need to use prophylactic cefuroxime in day case herniotomy at the Abia State University Teaching Hospital Aba. Objective: To determine if there is need for prophylactic antibiotics in paediatric day case herniotomy and to compare the rate of surgical site infection in patients that receive preoperative cefuroxime to patients that did not receive it. Method: This was a hospital based prospective study carried out between April 2017 and April 2018 during which 126 herniotomy were performed as day cases at the Abia State University Teaching Hospital Aba. The patients were randomly placed into two groups: 63 patients in group A that received prophylactic cefuroxime at induction of anaesthesia and 63 patients in group B that did not receive cefuroxime. The two groups were compared to determine the factors that influenced development of surgical site infection. Results: There were 115(91.3%) males and 11(9.7%} females. Their ages ranged from 1-14 years with a median of 2 years. The average duration of the operative procedure was 34.8 minutes (34.3 minutes in group A and 35.4 minutes in group B). After a follow up of 3 weeks, a total of 8 patients developed surgical site infection (3 patients in group A; 5 patients in group B) (p=0.358). The duration of operation (p= 0.549) and mode of transport (p=0.605) did not affect rate of surgical site infection. Conclusion: Development of surgical site infection after day case herniotomy in our hospital is not affected by the use of prophylactic antibiotics and duration of operation. The study confirms that day case herniotomy can be undertaken without prophylactic antibiotics.
Abstract: Background: There has been tremendous improvement in the knowledge of prophylactic antibiotics use in surgery. There are controversies on the use of prophylactic antibiotics clean surgical cases. This study aims to determine if there is need to use prophylactic cefuroxime in day case herniotomy at the Abia State University Teaching Hospital Aba. Ob...
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Extrahepatic Bile Duct Polyps Combiled with Choledocholithiasis: A Report of one Case
Xuemei Li,
Baohong Gu,
Jike Hu,
Yanling Ma,
Bofang Wang,
Zedong Feng,
Hao Chen
Issue:
Volume 6, Issue 1, June 2018
Pages:
41-44
Received:
1 August 2018
Accepted:
20 August 2018
Published:
13 September 2018
Abstract: Aim: Bile duct polyps is a rare biliary disease, which may lead to bile duct stones and may play an important role in the occurrence and development of cholangiocarcinoma. Calculus of bile duct is a common disease in China and common causes including multiple polyps of the biliary tract and other factors. Therefore, we here to investigate the relationship of both diseases and to summarize some measures to prevent the occurrence of polyps. Method: We here describe a 49-year-old man presented with yellowing of skin and sclera and the pain in the upper abdominal area. We performed exploration of common bile duct + choledocholithotomy and T-tube drainage and polyps were not detected. Result: Yellow staining of skin and sclera reappeared after operation 2 months. The bile duct mucosa was rough and there was amount of black stones under choledochoscopy. Unexpectedly, at the confluence of the right and left hepatic ducts and at the left hepatic duct, there was a sessile polyp respectively. We electrocoagulated the polyps and removed the stones. The biliary tract was flushed with saline on the second day after operation and the total bilirubin was rapidly decreased. Conclusion: Therefore, we think that bile duct polyps and calculus of bile duct may be causality and influence each other, resulting in disturbance of bile duct dynamics and inducing biliary tract diseases.
Abstract: Aim: Bile duct polyps is a rare biliary disease, which may lead to bile duct stones and may play an important role in the occurrence and development of cholangiocarcinoma. Calculus of bile duct is a common disease in China and common causes including multiple polyps of the biliary tract and other factors. Therefore, we here to investigate the relat...
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