Egyptian Journal of Surgery最新文献

{"title":"Difficulties In Laparoscopic Cholecystectomy Regarding Gender: Comparative study","authors":"A. Saleem","doi":"10.4103/ejs.ejs_238_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_238_22","url":null,"abstract":"Background Some authors are concerned about the male sex as a risk factor for laparoscopic cholecystectomy (LC). Aim This study aimed to do a comparative study of difficulties in LC between male and female patients regarding preoperative predictive factors of difficult LC, intraoperative findings, postoperative complications, and outcomes. Patients and methods This is a prospective study of 100 patients. The patients were divided into two groups: female and male groups. Data related to patients were recorded and subjected to analysis to assess the difficulties in LC regarding sex. Results Of the 100 patients, 70% were females and 30% were males. The mean age and total associated comorbidities were significantly increased in males in comparison with females (P=0.001 and 0.027, respectively). Age more than 50 years and history of hospitalization were significantly higher among males versus females (P=0.006 and 0.003, respectively). The mean total preoperative score was significantly higher among males versus females (P=0.001). The majority of males had difficult and very difficult preoperative score (60%) compared with only 34.3% among females, which was statistically significant (P=0.020). Approximately two-thirds of the males had an intraoperative difficult and very difficult course (63.4%), compared with nearly one-third among females (34.3%), with a significant difference (P=0.025). The operative time and postoperative hospital stay were significantly increased in males versus females (P=0.007 and 0.017, respectively). Conclusion Difficult LC was more prevalent in males versus females and the male sex may be considered a risk factor for difficult LC.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1491 - 1506"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43913082","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":"Purse-string closure versus conventional wound closure technique following stoma reversal: a prospective randomized controlled trial","authors":"Ibrahim Abdel-Maksoud, A. Farrag, Ahmed Elnabil-Mortada, M. Khalil","doi":"10.4103/ejs.ejs_284_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_284_22","url":null,"abstract":"Background Stoma reversal is associated with a high risk of postoperative wound infection of up to 41%. The conventional method of skin closure during stoma reversal has been primary skin closure (PC) with interrupted nonabsorbable sutures. The purse-string skin closure (PSSC) method creates a hole in the center of the wound to promote secondary intentional healing. This alternative technique of skin closure can reduce the risk of wound infection. Patients and methods A prospective randomized controlled trial was conducted on all patients undergoing stoma closure at Ain Shams University hospitals between September 2020 and December 2021. Patients were divided using computerized randomization into two groups based on skin closure technique: PC or PSSC. Results A total of 52 patients were included: 27 patients underwent primary closure (group 1) and 25 patients underwent PSSC (group 2). There was a statistically significant increase in the incidence of wound complications in the PC group compared with the PSSC group. Seroma occurred in 12 (44.4%) cases in group 1 compared with no cases in group 2. There were 10 (37.0%) wound infection cases in group 1, and three (12.0%) in group 2. There was prolonged healing time among the PC group (4.22±1.48 weeks) compared with the PSSC group (3.16±0.62 weeks). In terms of patient satisfaction, patients in the PSSC group were more satisfied, having more favorable survey-based satisfaction. Conclusion PSSC for stoma reversal significantly reduces wound complications and surgical site infection and shortens the wound healing time.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1611 - 1617"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42040727","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":"Incidence of positive exfoliative peritoneal lavage before and after tumor resection for colorectal cancer","authors":"Mahmoud Alabassy, M. Balbaa, A. Abdou, Osama Elshafie, Soliman Elshakhs, A. Mashal","doi":"10.4103/ejs.ejs_260_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_260_22","url":null,"abstract":"Background Colorectal cancer (CRC) represents the seventh commonest cancer in Egypt. Early detection of peritoneal metastasis is a major challenge in CRC management. The aim of this study was to assess the incidence of positive malignant cells in peritoneal lavage before and after resection of CRC. Patients and methods This prospective study was conducted from May 2020 to June 2022 and included 50 patients who underwent colorectal tumor resection. Intraoperative peritoneal lavage before and after tumor resection was done to detect intraperitoneal free cancer cells by conventional cytology. Results Preresection cytology was positive in four (8%) patients and negative in 46 (92%) patients. Postresection cytology was positive in five (10%) patients and negative in 45 (90%) patients. Positive preresection cytology was significantly prevalent in cases with mucinous carcinoma (P<0.031) and in cases with positive lymph node metastases (P<0.008). Positive postresection cytology in originally negative preresection one was significantly prevalent in the younger age group (P=0.046). There was more incidence of change of negative preresection cytology to positive postresection cytology whenever the tumor was located in the rectum than in cases of left or right tumor location. Conclusions Positive intraperitoneal free cancer cells are a prognostic factor of recurrence for patients treated for CRC, and it may be used as a criterion for selecting patients for further management.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1572 - 1578"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41856857","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":"[ARTICLE_TITLE]","authors":"Abdulkareem Alhuthaifi, Ahmed Abdelazim, Saeedah Alfaifi","doi":"10.4103/ejs.ejs_271_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_271_22","url":null,"abstract":"[ABST]","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1864 - 1868"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46112653","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":"Impact of foot arch status on the outcome of infra-popliteal bypasses in critical limb ischemia patients with tissue loss","authors":"M. Soliman, H. Tawfek, Mohamed Zidan","doi":"10.4103/ejs.ejs_235_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_235_22","url":null,"abstract":"Objective This study evaluates the effect of arterial pedal arch quality on patency rates, freedom from major amputation, and wound healing in patients with critical limb ischemia (CLI) with tissue loss undergoing distal bypasses. Materials and methods A retrospective analysis of prospectively collected data of all patients with CLI with tissue loss who underwent distal bypass between 2017 and 2021 at a single institution was done. Post-bypass pedal angiography was performed to classify patients according to the foot arch status into three groups: complete pedal arch (CPA), incomplete pedal arch (IPA), and no pedal arch (NPA). Patency, amputation-free survival, patient survival, and wound healing rates are assessed at 1-year follow-up and compared among the three groups. Results A total of 88 patients had infrapopliteal bypasses (62 male; mean age, 74±9; hypertension, 85%; diabetes mellitus, 76%; smoking, 78%; and dyslipidemia, 71%). Overall, 49% of the distal bypasses originated from the popliteal artery, 31% from the superficial femoral artery, and 20% from the common femoral artery. The most common outflow artery was the anterior tibial artery (39%) followed by the posterior tibial artery (36%). At 1-year follow-up, primary patency rates in the CPA, IPA, and NPA groups were 62, 53, and 45%, respectively (P=0.41). Assisted primary patency rates were 91, 76, and 83%, respectively (P=0.424). Secondary patency rates are 100, 88, and 83%, respectively (P=0.193). Overall patient survival at the end of the follow-up period was 81%. There was a statistically significant difference in terms of 12-month amputation-free survival among the three groups (CPA 100% vs. IPA 98% vs. NPA 83%, P=0.015). Moreover, a statistically significant difference existed in wound healing rates between the study groups (CPA 81% vs. IPA 90% vs. NPA 61%, P=0.039). Conclusion Pedal arch status has a positive effect on major amputation-free survival and wound healing in patients with CLI with foot wounds undergoing infrapopliteal bypass grafting.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1472 - 1478"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45800660","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":"Comparison between damage control resuscitation and traditional treatment in resuscitation of elderly trauma patients in an Emergency Department, Egypt","authors":"Nashwa M. Abdelgeleel, Noha Awad, Aya Nofal, M. Ismail","doi":"10.4103/ejs.ejs_273_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_273_22","url":null,"abstract":"Background In the recent decade, a new paradigm in early trauma resuscitation, especially in case of ongoing, uncontrollable bleeding, has emerged. This paradigm change stresses on damage control resuscitation, a combination process of hypotensive resuscitation, hemostatic resuscitation, damage control surgery, and damage control radiology. This study was designed to determine the effect of damage control resuscitation, especially hypotensive resuscitation, as a factor in improving the outcome in traumatized elderly patients because vigorous fluid resuscitation is associated with rebleeding and a high mortality rate. Aim This study was conducted to improve the resuscitation process and decrease the mortality rate of elderly patients with trauma in the Department of Emergency. Patients and methods This comparative cross-sectional study included elderly patients with trauma (>65 years old) presenting with traumatic hypovolemic shock who were admitted to the Department of Emergency of Suez Canal University Hospital according to the inclusion and exclusion criteria. The patients were divided into two groups: group 1 received damage control resuscitation with hypotensive resuscitation, with the targeted systolic blood pressure being 90 mmHg, and group 2 received traditional treatment, with the targeted systolic blood pressure being 100 mmHg. Results After resuscitation, patients in the damage control resuscitation group had significantly less severe base deficit than those in group 2 (P=0.04). Meanwhile, regarding coagulopathy, patients in the damage control resuscitation group had significantly lower international normalized ratio (<1.5) than those in group 2 (P<0.001). Moreover, we found that patients who took damage control resuscitation had less mortality in the emergency room (21.6%) than those in group 2 (35.1%) (P=0.04). Conclusion The study reported a lower rate of mortality and acid deficit in the group managed by damage control resuscitation. The results regarding the benefits of hypotensive resuscitation in elderly patients with trauma are optimistic. However, many confirmatory studies need to be conducted.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1596 - 1604"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47756336","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":"Hashimoto’s thyroiditis as a risk factor of complications of total thyroidectomy","authors":"Hatem Alwagih, Mostafa Farag, Mohamed Mansy, Essam Gabr, A. Nabawi","doi":"10.21608/alexpo.2022.170386.1492","DOIUrl":"https://doi.org/10.21608/alexpo.2022.170386.1492","url":null,"abstract":"Background Hashimoto’s thyroiditis (HT), a type of chronic lymphocytic thyroiditis, is the most common autoimmune thyroid condition. The diagnosis is primarily made on the basis of serum autoantibodies against thyroid peroxidase and/or thyroglobulin, which may precede clinical symptoms and biochemical hypothyroidism by several years. Medical treatment is usually the choice for most patients with HT. However, surgical intervention may be needed. Surgery for patients with HT tends to be more difficult and riskier as the thyroid gland tends to adhere more to its anatomical surroundings, which results in a higher rate of postoperative complications. Patients and methods A total of 46 patients who had undergone surgery for benign thyroid diseases from December 2021 to May 2022 were included. Group A consisted of 25 patients who had HT, and group B consisted of 21 patients operated for nonmalignant thyroid diseases. Results Patients with HT were younger and more likely to be female. The mean operative time was longer in group A than in group B, and also the mean intraoperative blood loss was higher in the HT group than the non-HT group. Patients who underwent thyroidectomy with HT had also a significantly higher rate of postoperative complications. Conclusions Patients with HT had a higher rate of complications after thyroidectomy when compared with patients without HT. Therefore, careful consideration must be taken before pursuing operative treatment in patients with HT, including providing adequate informed consent regarding the increased risks of surgery.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1685 - 1691"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44996365","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":"Current state of percutaneous cholecystostomy: indications and management","authors":"A. Dogrul","doi":"10.4103/ejs.ejs_282_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_282_22","url":null,"abstract":"Acute calculous cholecystitis is a common surgical problem. Although laparoscopic cholecystectomy is the standard therapy for these patients, some may not be suitable candidates for surgery owing to serious comorbidities, high surgical risk, or severity of the cholecystitis and its local and systemic consequences. In selected cases, percutaneous cholecystostomy may be an alternative to surgery; however, there are no definite recommendations for patient management after this technique is performed. Surgery may be not an appropriate treatment for such patients for the rest of their lives. This review discusses the main indications of percutaneous cholecystostomy and its management based on the findings of recently published literature.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1447 - 1453"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41968195","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":"Evaluation of immediate breast lipomodeling with breast-conserving surgery in patients with breast cancer","authors":"Bemen Besada, A. Ahmed, M. Motawei, Y. Ahmed, Alkarmouty Ahmed","doi":"10.4103/ejs.ejs_318_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_318_22","url":null,"abstract":"Background The treatment of breast cancer evaluation nowadays relies on the cure rate figures and quality of life. Aim and objectives The aim of this study was to evaluate efficacy, complications, patient satisfaction, and esthetic outcomes of immediate lipomodeling used for correction of deformities resulting from breast-conserving surgery for patients with breast cancer and to evaluate lipomodeling and the incidence of local recurrence in its experimental level. Patients and methods This study was carried out on 50 female patients with malignant breast lesions admitted to the Surgical Department of Medical Research Institute and underwent breast-conserving surgery over a 1-year period. Results According to surgeon and patient assessment, most cases were good [20 (40%)] followed by excellent [18 (36%)] regarding surgeon assessment. Degree of satisfaction was four in 23 (46%) cases and five in 16 (32%) cases. Regarding esthetic results by the breast cancer conservation treatment core (BCCT.core) program, good results were higher, as seen in 23 (46%) patients, followed by fair results, with 18 (36%) patients. Conclusion Lipomodeling is a unique technique that enables autologous breast reconstruction and improves breast reconstructive surgery results by decreasing scar tissue, increasing breast softness, and creating a natural skin texture. It is possible to execute lipomodeling as a day-case procedure after breast cancer surgery, and the technique is safe. Without sacrificing oncological results, it seems to have adequate effectiveness in correcting abnormalities.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1824 - 1833"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43470797","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 perioperative vein diameter and flow volume change rate on predicting primary functional maturation of autogenous arteriovenous fistula","authors":"Shady Elsayed, Atef Mohamed, R. Wahba, H. AboElNeel","doi":"10.4103/ejs.ejs_323_22","DOIUrl":"https://doi.org/10.4103/ejs.ejs_323_22","url":null,"abstract":"Introduction The patients on regular hemodialysis prefer the arteriovenous fistula (AVF) as their vascular access for dialysis. The goal of AVF surgery was to increase the proportion of dialysis patients who use native AVFs. The success of AVF surgery is mainly dependent on the upper limb’s vasculature. Therefore, improved selection of the most appropriate procedure must be coupled with early access surveillance to determine which access would likely mature and when intervention might lead to access salvage. Aim This study aimed to determine the various vascular parameters (vein diameter and flow volume) both preoperatively and postoperatively at prespecified intervals − irrespective of other variables − for optimal hemodynamics of AVFs and their primary functional maturation. Materials and methods This prospective cohort study was conducted at Ain Shams University Hospitals on 80 patients with end-stage renal disease on regular dialysis submitted for autogenous AVF from November 2020 to November 2021. Cephalic vein diameter, basilic vein diameter, as well as both brachial and radial artery diameters, flow, and peak systolic velocity from the wrist to the proximal upper arm were all measured using ultrasound with Doppler preoperatively and postoperatively at postoperative day 1 (POD 1), 6 weeks, and 3 months. Results In all, 80 patients (54 brachiocephalic BC AVF, 18 radiocephalic RC AVF, 8 brachiobasilic BB AVF) were evaluated with a mean age of 54.65±12.24. The male : female ratio was 1 : 1.1. The etiology of renal failure was diabetes related in 36.3%, and the remaining 73.7% were nondiabetic. The overall maturation rate was 81.25%, with 18.75% failure to mature rate. In comparison between different groups of fistulas, a significant difference was found in comparing the preoperative and postoperative vascular diameter and flow rates between the groups. The mean preoperative cephalic vein diameter in mature RC AVF was 2.59±0.55 mm with the mean flow volume at POD 1 being 265.83±61.46 ml/min. The mean preoperative cephalic vein diameter in mature BC AVF was 3.21±0.70 mm with the mean flow volume at POD 1 being 311.79±93.25 ml/min. The mean preoperative basilic vein diameter in mature BB AVF was 3.08±0.95 mm with the mean flow volume at POD 1 being 319.60±45.67 ml/min. Conclusion On the basis of this study, flow volume at POD 1 can be used as a predicting factor for RC and BB AVF maturation. Also, perioperative vein diameter change can be used as a predictor for RC AVF maturation. However, none of these parameters can be used as a predicting factor for maturation in BC AVF. Therefore, further studies of large size are recommended to standardize these parameters.","PeriodicalId":43393,"journal":{"name":"Egyptian Journal of Surgery","volume":"41 1","pages":"1855 - 1860"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48635200","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}