Egyptian Journal of Surgery最新文献

{"title":"A comparative study between the closed tie-over and open vacuum suction drainage procedures in patients with sacrococcygeal pilonidal sinus disease","authors":"M. Abdu, Ahmed M. Fareed, M. Shetiwy, M. Aziz, M. Mahmoud","doi":"10.4103/ejs.ejs_276_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_276_22","url":null,"abstract":"Background Multiple surgical techniques have been adopted for the management of patients with pilonidal disease. A great debate still exists among surgeons regarding the best option. We describe our experience in comparing the tie-over and open excision with vacuum suction drainage for the management of such a disease. Patients and methods This retrospective study reviewed the data of 65 patients diagnosed with pilonidal disease, who were allocated into two groups according to the performed procedure. The first group included 35 patients who underwent the tie-over approach, and the second one included 30 patients who underwent open vacuum drainage. Results The demographic and preoperative clinical patient criteria were statistically comparable between the two groups. The tie-over approach showed a significant prolongation of the operative time (75.29 vs. 50.57 min in the vacuum group). Hospital stays and pain scores showed no significant difference between the study groups. Time to painless walking had median values of 6 and 8 days, whereas the same values were 7 and 9 days for painless toilet seat in the tie-over approach and the vacuum group, respectively. Return to daily activities occurred after 3 and 4 weeks, whereas complete wound healing was noticed in 2 and 5 weeks in the tie-over approach and the vacuum group, respectively. Recurrence was noted in 5.71 and 3.33% of patients in the tie-over approach and the vacuum group, respectively. Conclusion The tie-over approach was associated with better postoperative outcomes, including faster wound healing and better recovery profile, with comparable recurrence rates, compared with the open vacuum suction approach.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1746 - 1753"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44304010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study between excisional hemorrhoidectomy and laser hemorrhoidoplasty in third-degree piles","authors":"M. Yassin, M. Nada, Essam Ebeid, Ayman Boutrous","doi":"10.4103/ejs.ejs_311_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_311_22","url":null,"abstract":"Background One of the most prevalent benign anorectal conditions is hemorrhoids. It is thought to be the most problematic gastrointestinal illness. Sometimes, they may sag, prolapse, enlarge, and bleed. Aim This is a prospective randomized comparative study to compare excisional hemorrhoidectomy (EH) with laser hemorrhoidoplasty (LHP) in the treatment of symptomatic third-degree piles prospectively. Patients and methods In this study, 60 patients participated. The study participants were split into two groups in a randomized manner. EH was done for 30 patients using the Milligan–Morgan procedure, whereas another 30 patients underwent LHP. Results We compared between the outcomes of LHP with Milligan–Morgan open hemorrhoidectomy in terms of duration of surgery, intraoperative blood loss, postoperative pain, duration of hospital stay, days taken for return to work, and postoperative complications on both short and long runs. Conclusion In the treatment of third-degree piles, LHP was superior to EH by the Milligan–Morgan technique as LHP significantly reduced the length of the procedure, the amount of blood lost during the procedure, and the degree of postoperative pain while having no effect on fecal continence. Regarding postoperative complications, including postoperative hemorrhage, urine retention, stenosis, and recurrence rate, there were statistically nonsignificant differences between both the procedures.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1801 - 1809"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45096993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small bowel bacterial overgrowth following laparoscopic one-anastomosis gastric bypass: a prospective study based on small bowel aspiration and culture","authors":"Michael Shenouda, T. Nabil, S. Mikhail, A. Abdelsalam, Ayman Salah, George Aiad, Y. Ayoub, M. Abeid, N. Riad, A. Wassef","doi":"10.4103/ejs.ejs_290_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_290_22","url":null,"abstract":"Background Gastric resection for bariatric surgery is associated with nutrients deficiency, including thiamine and folic acid. Other sequelae of bypass surgeries have been described. The alteration in the anatomy and the motility pattern of the bowel may result in a blind bowel with subsequent small intestine bacterial overgrowth (SIBO). Aim The present study aimed to assess the prevalence of SIBO in patients undergoing one-anastomosis gastric bypass (OAGB) and the effect on thiamine and folic acid levels. Patients and methods The study included 40 patients planned for OAGB. Data on the prevalence of SIBO following OAGB and its implications on the nutritional status were collected. Results At the 6-month postoperative follow-up, the mean percentage of total weight loss was 27.61%. No statistically significant differences were found in the thiamine or folate levels as compared with the preoperative levels. A total of 20 (50%) patients had at least one GI disturbance symptom occurring at least once per week. Jejunal aspirate culture revealed SIBO in 31 (77.5%) patients. Comparing between patients according to the presence of SIBO revealed higher weight measures in patients who developed SIBO compared with those who did not. This difference reached the level of significance only in the preoperative and postoperative weight measures. There were no statistically significant differences in the percentage of total weight loss, the thiamine and folate levels, the other demographic data, or the gastrointestinal tract symptoms. Conclusion SIBO was highly prevalent after OAGB, with no apparent association with the thiamine or folate levels. The relationship between gastrointestinal tract symptoms and bacterial overgrowth was not statistically significant, with high incidence of asymptomatic SIBO. OAGB is an effective procedure for weight loss and resolution of comorbidities.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1637 - 1642"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44634407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of tumescent fluid infiltration during saphenous stripping and ligation operation of varicose veins to reduce postoperative complications","authors":"Amr Mahmoud, Mohamed Elbahat","doi":"10.4103/ejs.ejs_279_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_279_22","url":null,"abstract":"Objectives Saphenous stripping and high ligation is the traditional operation for varicose veins globally. Postoperative complications like pain, subcutaneous ecchymosis, hematoma, and wound dehiscence are possible. The study assesses the role of ultrasound-guided tumescent fluid infiltration through saphenous fascia to reduce these complications. Patients and methods A single-arm prospective cohort study was conducted on 300 cases between February 2020 and February 2022 at Ain Shams University Hospital and Shebin El-Kom Teaching Hospital. Results A total of 300 patients who received saphenous stripping and high ligation operation were associated with ultrasound-guided infiltration of tumescent solution through saphenous fascial. Pain was assessed by visual analog scale score between first day and 1 week, which showed significant improvement. Ecchymosis was assessed based on the ecchymosis score between 1 and 4 weeks, with significant improvement. Subcutaneous hematoma and wound complications were also observed at 1 and 4 weeks, without significant improvement. Conclusions Ultrasound-guided tumescent solution infiltration along saphenous fascia possibly improves postoperative pain score and ecchymosis but not hematoma and wound complications.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1754 - 1758"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47427648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of using pleural vent for managing spontaneous pneumothorax","authors":"Ayman M. Shaalan, Abdulkareem Alhuthaifi, Eman E. Elwakeel, Tamer H Ezeldin","doi":"10.4103/ejs.ejs_314_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_314_22","url":null,"abstract":"Background The pleural vent is a minimally invasive, small-sized portable device that has been used successfully for management of spontaneous pneumothorax (SP). The use of pleural vent in such cases is still limited compared to the use of routine large chest tube connected to underwater seal. Aim To evaluate the long-term outcome and complications of using a pleural vent for the treatment of cases with SP. Patients and methods This was a 2-year retrospective cohort study that enrolled all patients who had pleural vents inserted either as an initial treatment after admission or after a period of observation. Results This study included 53 patients with SP who were managed by inserting pleural vent as a portable device. All patients completed their 2-year follow-up period. The outcomes comprised a significantly low recurrence rate within 6 months (7.5 vs. 92.5%), after 1 year (3.8 vs. 96.2%), and after 2 years (17.0 vs. 83.0%). Four (7.5%) patients required a change to the chest tube, and a significantly low percentage (5.7%) developed wound infections (P<0.001). The frequency of the use of narcotics (7.5%) analgesia was significantly low. Moreover, patient satisfaction was excellent. Conclusions The use of pleural vents for management of primary and secondary SP is well tolerated and safe and had low incidence of complications. Follow-up for 2 years after the pleural vent use showed low recurrence rates and better patient satisfaction.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1707 - 1715"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49192769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of sentinel lymph node using carbon nano-particles in patients with early breast cancer","authors":"M. Nagy, A. Eldin, K. Fahmy, M. Elshinawi","doi":"10.4103/ejs.ejs_320_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_320_22","url":null,"abstract":"Introduction Management in breast cancer is heading toward less invasive approaches with high survival and low recurrence rates. Axillary lymph node dissection (ALND) has a high morbidity on breast cancer patients; on the other hand, sentinel lymph node biopsy (SLNB) overcomes such morbidity with comparable survival and recurrence rates. In this study, the authors aim to assess diagnostic accuracy of carbon nanoparticles (CN) in SLNB in patients with early breast cancer. Patients and methods From November 2020 to March 2022, patients with early breast cancer and clinically and radiologically free axillary lymph nodes who had SLN detection using CNs followed by ALND were included. Patients who received neoadjuvant chemotherapy, are pregnant, or refused consent were excluded. Results In this study, 30 patients with clinically node-negative early breast cancer patients were investigated using CN for SLN mapping. Mean age of our participants was 49.2±5.8. CN technique had a sensitivity of 100% (95% confidence interval: 80.49–100), specificity of 92.3% (95% confidence interval: 63.9–99.8), positive predictive value of 94.4%, negative predictive value of 100%, and false-negative rate=0%. The summary receiver-operating characteristics of CN showed excellent diagnostic performance with area under the curve of 0.962 (P=0.0001). Conclusion SLN mapping using proper technique is vital to avoid recurrence and promote survival and decrease morbidity without need for ALND. CN had excellent sensitivity and specificity with low false-negative rate.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1843 - 1847"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45862888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Breast Reconstruction using Synthetic Implants covered by Thoraco-Dorsal Artery Perforator Flap (TDAP)","authors":"S. Roshdy, A. Fathi, K. Wahab, N. Shams, A. Abouzid, Adel Fathi","doi":"10.4103/ejs.ejs_300_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_300_22","url":null,"abstract":"Background Implant-based breast reconstruction specifically with the thoracodorsal artery perforator (TDAP) flap was used with high success rate in partial breast reconstruction, and recently, we used it instead of latissimus dorsi flap with implant for total breast reconstruction to avoid the complications of latissimus dorsi flap and postradiotherapy complications of implant. Patients and methods This prospective study was done in the Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Egypt, from October 2018 to November 2020. A total of 20 patients were enrolled in this study. All patients included had either modified radical, skin-sparing, or nipple-sparing mastectomy with axillary staging, followed by reconstruction using appropriately sized implant with the use of pedicled TDAP flap to cover the inferolateral part of the implant. Results We had six (30%) cases with breast sized cup A and 14 (70%) cases with cup size B. The cases with grade I ptotic breast were two (10%) cases, grade II were 16 (80%) cases, and grade III were two (10%) cases. Donor site complications were as follows: wound gap occurred in two (10%) cases, seroma in one (5%) case, and infection occurred in two (10%) cases. Recipient site complications were as follows: partial flap necrosis in two (10%) cases, infection in two (10%) cases, and wound dehiscence in two (10%) cases. Two cases developed persistent infection in the short postoperative period and needed implant removal. Conclusion TDAP can be safely used in implant-based breast reconstruction with more versatility, reliability, and low morbidity.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1657 - 1665"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46809704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of chest wall perforator flaps in breast-conserving surgery as a volume-replacement oncoplastic procedure","authors":"Mohammad M. Soffar, I. Salem, Nasser A. Ghozlan, Mahmoud A. Alhussini","doi":"10.4103/ejs.ejs_263_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_263_22","url":null,"abstract":"Background Partial breast reconstruction using chest wall perforator flaps (CWPF) is a recent technique used by breast surgeons, mainly for lateral defects with a relatively large volume of excision in small-sized to medium-sized breast. We report our experience of CWPF in breast reconstruction with surgical details, complications, different locations of the tumor, and outcomes. Patients and methods This was a prospective observational cohort study on 20 patients who had undergone breast-conservation surgery plus CWPF reconstruction [lateral intercostal artery perforator (LICAP) flap, lateral thoracic artery perforator (LTAP) flap, anterior intercostal artery perforator flap, and thoracodorsal artery perforator flap]. A survey was done to analyze patient satisfaction at about 6 months after completion of radiotherapy. Results LICAP flap was used in 30% of the patients, anterior intercostal artery perforator flap was used in another 30%, whereas thoracodorsal artery perforator flap was used in 25% of the patients. A combination between LTAP and LICAP was used in 10% of the studied patients, and LTAP alone was used in only 5% of the cases. Regarding the complications, there was no incidence of total or partial flap loss in this series. Only minor complications were reported. Patients’ satisfaction was assessed by a questionnaire, which showed acceptable patient satisfaction. Conclusion CWPF procedures show good outcomes in partial breast reconstruction in terms of oncological safety and patient satisfaction, extending the options for breast conservation to many patients who would otherwise require mastectomy.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1730 - 1737"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44672655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A combination of preoperative serum direct bilirubin and neutrophil–lymphocyte ratio can discriminate cases of complicated appendicitis","authors":"A. Sakr, A. Salama, Mohamed Abdelfattah","doi":"10.4103/ejs.ejs_254_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_254_22","url":null,"abstract":"Objectives Evaluation of the ability of routine investigations for patients presenting with acute right lower abdominal pain for preoperative prediction of complicated appendicitis (CA). Patients and methods In all, 311 patients who had acute appendicitis were evaluated clinically and by abdominal ultrasonography and obtained blood samples for the estimation of serum C-reactive protein (CRP), direct bilirubin (DB), determination of total leukocyte count, and for the calculation of neutrophil/lymphocyte ratio (NLR). Patients were categorized according to operative findings as CA or uncomplicated appendicitis (UCA). The diagnostic performance of the estimated variables was statistically evaluated as predictors for CA. Results Patients who had CA were mostly males and older than those who had UCA. Preoperative abdominal ultrasonography diagnosed mild, moderate, and severe acute appendicitis in 138, 136, and 37 cases, respectively. Operative findings defined 48 patients had CA and 263 as having UCA. Preoperative total leukocyte count and NLR, and serum CRP and DB were significantly (P<0.001) higher in CA than in UCA patients. Statistical analyses defined high serum DB, high NLR, and high serum CRP as positive preoperative predictors for CA in the decreasing order of significance. Kaplan–Meier analysis defined serum DB level at 0.51±0.03 mg/dl [95% confidence interval (CI): 0.471–0.589], NLR at a level of 4.7±0.04 (95% CI: 4.62–4.84), serum CRP at 13±1.6 (95% CI: 12.3–13.5) as predictors for CA in decreasing positive predictive and specificity values. The percentage of true positive cases of CA in comparison to operative findings was 79.2% on using DB and NLR, 72.9% on using a combination of CRP and NLR, 68.8% with DB and CRP combination, and 87.5% with a combination of DB, CRP, and NLR. Conclusion Preoperative routine laboratory investigations can discriminate against CA cases. Combined estimation of DB and determination of NLR with or without estimation of serum CRP provided a high discriminative ability for CA cases.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1539 - 1545"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49424180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting of occluded native superficial femoral artery after femoropopliteal bypass occlusion in patients with critical limb ischemia using the endovascular approach","authors":"M. Sabry, Hisham Desoky, A. Shaker","doi":"10.4103/ejs.ejs_261_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_261_22","url":null,"abstract":"Background Patients with graft occlusion have poor outcomes, with increased amputation rates. Reoperation is not feasible in some patients with critical limb ischemia owing to high surgical risk, unsuitable target vessels, or lack of conduit. Pertinent progress in endovascular techniques has provided more therapeutic options for patients with critical limb ischemia. Aim This study aimed to assess the short-term outcome of native superficial femoral artery endovascular revascularization in patients with occluded bypass. Patients and methods This is a retrospective study that was based on a prospectively maintained database of patients who attended our hospital with signs of chronic limb ischemia owing to occluded previous femoropopliteal bypass during the period from January 2019 to June 2021. Patients were invited for follow-up visits at 6 weeks and then at 3-month intervals. Results Technical success was achieved in all patients. At the end of the follow-up period, the primary patency rate was 56.14%, the assisted patency rate was 82.5%, and the secondary patency rate was 87.7%. The amputation-free survival rate was 87.7%, and the limb-salvage rate was 96.5%. Conclusion Endovascular recanalization is a feasible, effective, and safe alternative treatment choice for patients with chronic limb ischemia and failed previous graft bypass. It offers high rates of technical success, assisted primary and secondary patency, limb salvage, and amputation-free survival.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1579 - 1584"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42961323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}