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Short Term Outcomes of Laparoscopic Totally Extraperitoneal Repair of Uncomplicated Groin Hernia Using Polyester Anatomical Mesh Without Fixation
Hamdy Sedky Abdalla,
Sherief Abd-Alfattah Saber,
Ahmad Waheed Al-Zayady,
Mohammad Hamdy Abo-Ryia,
Sherif Abd-Alaziem Mustafa,
Gamal Ibrahim Moussa
Issue:
Volume 5, Issue 6, December 2017
Pages:
86-92
Received:
25 September 2017
Accepted:
29 September 2017
Published:
6 November 2017
Abstract: Background: Totally extraperitoneal (TEP) repair of groin hernia can be performed with or without mesh fixation. Fixation can result in postoperative pain or paresthesia due to nerve entrapment. Compared to polypropylene mesh, polyester anatomical mesh (Parietex®, Covidien, Mansfield, MA, USA) has a special configuration to fit the posterior inguinal anatomy. Also, the polyester-based chemistry and the rapidly absorbable biological coating increase the hydrophilicity of the mesh, which is thought to result in a fast and intimate tissue ingrowth that may obviate the need for fixation. Patients and Methods: Laparoscopic TEP repair using Parietex® anatomical mesh without fixation was performed for 60 patients presenting with 63 uncomplicated groin hernias. Results: All patients were males with a mean age of 44.7±14.75 years. There were 60 (95.3%) primary, 3 (5%) bilateral inguinal and 2 (3.3%) femoral hernias. The mean operative time was 64.8±22.6 minutes. There were no major operative complications or conversions to transabdominal preperitoneal or open repair. In the early postoperative period, 54 patients (90%) had mild or no pain. Nine patients (15%) developed minor postoperative complications. The mean length of hospital stay was 1.1±0.3 days and the mean time of return to normal daily activities and to work was 2.6±0.64 and 7.15±1.13 days respectively. No patient developed chronic groin pain, mesh-related complications or recurrences during the study period. Ninety one percent of patients described their satisfaction with surgery as good or excellent. Conclusion: laparoscopic TEP repair of uncomplicated groin hernia using Parietex® anatomical mesh without fixation is safe and does not increase the risk of hernia recurrence.
Abstract: Background: Totally extraperitoneal (TEP) repair of groin hernia can be performed with or without mesh fixation. Fixation can result in postoperative pain or paresthesia due to nerve entrapment. Compared to polypropylene mesh, polyester anatomical mesh (Parietex®, Covidien, Mansfield, MA, USA) has a special configuration to fit the posterior ing...
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Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?
Mohammed Abdallah Hablus,
Amir Fawzy Abdelhamid,
Mahmoud Mostafa Alsherief,
Osama Hasan Abd-Raboh
Issue:
Volume 5, Issue 6, December 2017
Pages:
93-96
Received:
18 September 2017
Accepted:
8 October 2017
Published:
10 November 2017
Abstract: The non-therapeutic laparotomy in managing cases with blunt liver injuries is not without risks, so selective non-operative treatment in stable patients was tried in many centers and has become the standard of care of these patients The aim of this study was to assess the feasibility and safety of selective non-operative management of blunt liver injury in our institution Patients and Methods: This prospective study was conducted on 40 patients with blunt liver injury who met our inclusion criteria admitted to Tanta University Hospital during the period from January 2012 to January 2014. All patients were treated by selective non-operative treatment (repeated clinical examination, serial U/S and CT study and follow up) Results: The age of our patients ranged from 26 to 40 years with a mean (±SD) of 31.3 ± 3.77 years. 36 patients were males (90%), while 4 patients (10%), were female. Total length of stay was ranged from 2 days to 15 days with a mean (±SD) of 5.8 ± 3.27 days as regards all cases. Intensive care unit stay was in 2 cases (5%) which FNOM with mean (±SD) of 1.5 ± 0.7 days. CT study was done in all cases (100%), 2 cases (5%) was operated after 6 hours of conservatism in ICU due to hemodynamic instability after initial assessment of stability. Conclusions: Selective non operative management of blunt liver injury in bunt abdominal trauma is safe, efficient, and cost-effective in the appropriate clinical setting and can lead to fewer unnecessary laparotomies in patients with liver injury. Proper patient selection, resources that permit close observation, and frequent abdominal examinations are paramount in obtaining the best results.
Abstract: The non-therapeutic laparotomy in managing cases with blunt liver injuries is not without risks, so selective non-operative treatment in stable patients was tried in many centers and has become the standard of care of these patients The aim of this study was to assess the feasibility and safety of selective non-operative management of blunt liver i...
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Short Term Outcomes of Laparoscopic Totally Extraperitoneal Repair of Uncomplicated Groin Hernia Using Polyester Anatomical Mesh Without Fixation
Hamdy Sedky Abdalla,
Sherief Abd-Alfattah Saber,
Ahmad Waheed Al-Zayady,
Mohammad Hamdy Abo-Ryia,
Sherif Abd-Alaziem Mustafa,
Gamal Ibrahim Moussa
Issue:
Volume 5, Issue 6, December 2017
Pages:
97-104
Received:
17 September 2017
Accepted:
29 September 2017
Published:
12 November 2017
Abstract: Background: Totally extraperitoneal (TEP) repair of groin hernia can be performed with or without mesh fixation. Fixation can result in postoperative pain or paresthesia due to nerve entrapment. Compared to polypropylene mesh, polyester anatomical mesh (Parietex®, Covidien, Mansfield, MA, USA) has a special configuration to fit the posterior inguinal anatomy. Also, the polyester-based chemistry and the rapidly absorbable biological coating increase the hydrophilicity of the mesh, which is thought to result in a fast and intimate tissue ingrowth that may obviate the need for fixation. Patients and Methods: Laparoscopic TEP repair using Parietex® anatomical mesh without fixation was performed for 60 patients presenting with 63 uncomplicated groin hernias. Results: All patients were males with a mean age of 44.7±14.75 years. There were 60 (95.3%) primary, 3 (5%) bilateral inguinal and 2 (3.3%) femoral hernias. The mean operative time was 64.8±22.6 minutes. There were no major operative complications or conversions to transabdominal preperitoneal or open repair. In the early postoperative period, 54 patients (90%) had mild or no pain. Nine patients (15%) developed minor postoperative complications. The mean length of hospital stay was 1.1±0.3 days and the mean time of return to normal daily activities and to work was 2.6±0.64 and 7.15±1.13 days respectively. No patient developed chronic groin pain, mesh-related complications or recurrences during the study period. Ninety one percent of patients described their satisfaction with surgery as good or excellent. Conclusion: laparoscopic TEP repair of uncomplicated groin hernia using Parietex® anatomical mesh without fixation is safe and does not increase the risk of hernia recurrence.
Abstract: Background: Totally extraperitoneal (TEP) repair of groin hernia can be performed with or without mesh fixation. Fixation can result in postoperative pain or paresthesia due to nerve entrapment. Compared to polypropylene mesh, polyester anatomical mesh (Parietex®, Covidien, Mansfield, MA, USA) has a special configuration to fit the posterior inguina...
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Post-Splenectomy Portal Venous Thrombosis in Cirrhotic Patients: An Observational Clinical Trial
Hamdy Sedky Abd Allah,
Mohamad Hamdy Abo-Ryia,
Sherif Abd-Al Fattah Saber
Issue:
Volume 5, Issue 6, December 2017
Pages:
105-110
Received:
22 September 2017
Accepted:
4 October 2017
Published:
12 November 2017
Abstract: Background: Post-splenectomy portal venous thrombosis (PS-PVT) carries multiple threats to patients’ lives. Different variables were identified as risk factors for PS-PVT in cirrhotic patients. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of PS-PVT in cirrhotic patients. Patients and methods: Sixty cirrhotic patients of Child class A submitted to open splenectomy were observed, both clinically and by Duplex ultrasound (US) examination, for the development of PS-PVT. Results: Overall, 17 patients (28.3%) developed PS-PVT at a median interval of 4.5 days (21 hours-7 days) post-splenectomy. Univariate analysis showed that lower preoperative platelet count (P<0.0460) and white blood cell (WBC) count (P<0.0001) and wider splenic vein diameter (SVD) (P<0.0001) correlated with PS-PVT. Multivariate analysis identified lower preoperative WBC count [odds ratio (OR): 0.651, 95% confidence interval (CI): 0.245-0.893, P<0.005] and wider SVD (OR: 2.383, 95% CI: 1.558-3.646., P<0.001) as independent risk factors of PS-PVT. While 16 out of the 17 patients (94%) who had these 2 risk factors developed PS-PVT, only 1 out of the 43 patients (2.3%) who didn’t have the same risk factors developed thrombosis. All 17 patients had complete resolution of their thrombosis on anticoagulation therapy within 3-6 months without complications or mortality. Conclusion: PVT is a common complication of splenectomy in cirrhotic patients. Patients with low WBC count and wide SVD are highly susceptible to develop this complication mandating close observation from the 1st PO day and immediate anticoagulation after diagnosis.
Abstract: Background: Post-splenectomy portal venous thrombosis (PS-PVT) carries multiple threats to patients’ lives. Different variables were identified as risk factors for PS-PVT in cirrhotic patients. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of PS-PVT in cirrhotic patients....
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Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis
Issue:
Volume 5, Issue 6, December 2017
Pages:
111-117
Received:
29 September 2017
Accepted:
10 October 2017
Published:
12 November 2017
Abstract: Background: When the critical view of safety (CVS) can't be obtained during dissection of Calot’s triangle in difficult gallbladder, conversion to open surgery or other “damage control” alternatives as cholecystostomy and subtotal cholecystectomy are recommended to prevent bile duct injury. Materials and methods: The medical records of all patients presented with acute calculous cholecystitis (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) with dissection and control of the cystic duct was performed for the remaining 65 patients (91.5%) including 50 females (77%) and 15 males (23%) with a mean age of 42.35±12.4 years. The mean operative blood loss was 45.28±18.6 CC and the mean operative time was 96.3±24.19 minutes. There were no operative complications or mortality. The mean hospital stay was 28±17.8 hours. There was no postoperative jaundice, bile leak, intra-abdominal collections or mortality. Conclusion: When surgery is indicated for difficult ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS can’t be achieved due to obscured anatomy at Calot’s triangle, conversion to open surgery or cholecystostomy must be performed to prevent bile duct injury.
Abstract: Background: When the critical view of safety (CVS) can't be obtained during dissection of Calot’s triangle in difficult gallbladder, conversion to open surgery or other “damage control” alternatives as cholecystostomy and subtotal cholecystectomy are recommended to prevent bile duct injury. Materials and methods: The medical records of all patients...
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Non Operative Management of Isolated Blunt Liver Trauma: A Task of High Skilled Surgeons
Abdallah Mohamed Taha,
Ahmed Mohamed Abdallah,
Mostafa Mohamoud Sayed,
Salah Ibrahim Mohamed,
Mostafa Hamad
Issue:
Volume 5, Issue 6, December 2017
Pages:
118-123
Received:
30 September 2017
Accepted:
16 October 2017
Published:
8 December 2017
Abstract: Background: Liver is the most injured organ in abdominal trauma. The management of blunt liver trauma has markedly changed in the last three decades with a significant improvement in outcomes, due to improvements in diagnostic and therapeutic aids. This study details incidence, grades, causes, types and management of blunt isolated liver trauma in trauma patients admitted to Assiut and South Valley University Hospitals. Patients and Methods: All patients having blunt liver trauma were admitted, history taking, laboratory investigations and resuscitation were performed simultaneously along with ultrasound and CT scan as needed. Data of mechanism trauma, grade of liver injury, method of intervention (Operative or non-operative) and outcome were collected, tabulated and analyzed. Results: Total 174 cases were included in this study with diagnosis of isolated blunt hepatic injuries, mostly young patients were involved, and their mean age was found 24.19+14.65 years. The majority of patients were males 138 (79.31%). Operative management was adopted in 39 patients (22.41%), non-operative management adopted in 129 patients (74.13%), and 6 patients (3.45%) died during initial resuscitation. Most cases of liver trauma were found to be grade-III hepatic injury (41.1%). Chest infection was the commonest complication after surgical management. The mortality rate (12.1%) was significantly associated with severity of injury (grade IV and V). Conclusion: Non-operative management of isolated blunt liver trauma is feasible and safe in haemodynaically stable patient with grade I-III liver injury. Mortality in grades IV and V liver trauma is significantly high, so, early operative intervention is recommended in those patients.
Abstract: Background: Liver is the most injured organ in abdominal trauma. The management of blunt liver trauma has markedly changed in the last three decades with a significant improvement in outcomes, due to improvements in diagnostic and therapeutic aids. This study details incidence, grades, causes, types and management of blunt isolated liver trauma in ...
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Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma
Tamer Abd-Elhafez El-Bakary,
Mohamed Aly Mlees
Issue:
Volume 5, Issue 6, December 2017
Pages:
124-129
Received:
5 November 2017
Accepted:
15 November 2017
Published:
11 December 2017
Abstract: Background: The necessity and the benefits of prophylactic central cervical lymph node dissection (PCLND) in clinically node negative patients with early-stage papillary thyroid carcinoma (PTC) remain controversial. Objective: to evaluate the safety of total thyroidectomy without PCLND in clinically node-negative early-stage PTC. Patients & Methods: 34 patients with T1 or T2 & N0 PTC were included in the study and submitted to total thyroidectomy without PCLND. Post-operatively, all patients received TSH suppression therapy & radio-active iodine (RAI) ablation. Any suspicious local neck recurrence during the follow up was confirmed cytologically and treated by RAI ablation. Results: The mean age was 42.1 years. 55.9% of patients were less than 45 years and 44.1% were 45 years old or more. Male to female ratio was 10:24. T1 was found in 14 cases & T2 in 20 cases. Total thyroidectomy was successfully done for all the cases. Central cervical lymph nodes sampling was done in 5 cases. Excised lymph nodes were found in 8 specimens; 5 cases with lymph node sampling (14.7%) and 3 cases (8.8%) with accidental lymph node excision during thyroidectomy. only 6 of these 8 patients (17.6%) showed positive metastasis (pN1). No recurrent laryngeal nerve injury was reported. In 12 patients (35.3%), temporary hypocalcemia was encountered. The mean follow up period was 34.6 months. There were 2 recurrences (5.9%); 1 in the central & 1 in the lateral neck compartment. All recurrences were treated by RAI ablation. No distant metastasis or mortality was reported. Conclusion: total thyroidectomy without PCLND in clinically node-negative early stage PTC is an excellent treatment option that gives adequate loco-regional control of the disease with low rate of surgical complications. Close follow up for longer periods is needed.
Abstract: Background: The necessity and the benefits of prophylactic central cervical lymph node dissection (PCLND) in clinically node negative patients with early-stage papillary thyroid carcinoma (PTC) remain controversial. Objective: to evaluate the safety of total thyroidectomy without PCLND in clinically node-negative early-stage PTC. Patients & Methods...
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Total Hip Arthroplasty in a Developing Country: Epidemiological, Clinical and Etiological Aspects and Indications
Bio Tamou Sambo,
Salako Alexandre Allode,
Gnon Yari Jamilath Ouorou,
Djifid Morel Seto,
Montcho Adrien Hodonou,
Haoudou Romeo
Issue:
Volume 5, Issue 6, December 2017
Pages:
130-133
Received:
29 October 2017
Accepted:
4 December 2017
Published:
22 December 2017
Abstract: Background: Total hip arthroplasty is a prosthetic joint replacement procedure. Its indications remain dominated by hip osteoarthritis. Objective: to describe the epidemiological, clinical and etiological aspects of total hip arthroplasty and its indications in a developing country. Patients and Methods: The work was a descriptive study with retrospective data collection over a six year period from January 1st 2010 to December 31st 2015. It was carried out in the general surgery department of Tanguieta district hospital in Northern Benin. Were included all the patients who received a total hip prosthesis during the study period. Results: Two hundred and forty-five patients including 129 men (52.7%) and 116 women (47.3%) were registered. The average age of the patients was 41 ± 13.7 years with extremes of 17 and 80 years. Thirty patients (12.2%) had bilateral total hip prosthesis. The first three indications were osteoarthritis, osteonecrosis of the femoral head due to sickle-cell disease and pseudarthrose of the femoral neck. Conclusion: Total hip prosthesis at Tanguieta district hospital interests young people. Osteoarthritis and necrosis of the femoral head were the most frequent indications.
Abstract: Background: Total hip arthroplasty is a prosthetic joint replacement procedure. Its indications remain dominated by hip osteoarthritis. Objective: to describe the epidemiological, clinical and etiological aspects of total hip arthroplasty and its indications in a developing country. Patients and Methods: The work was a descriptive study with retros...
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