The aim of this study is to present the outcome of operative and non-operative management of patients with liver injury treated in a single institution depending on imaging. This study was conducted at the Causality Unit of Minia University Hospital, and included 60 patients with hepatic trauma from March 2012 to January 2013. In our study, males represent 80 % while females represent 20 % of the traumatized patients. The peak age for trauma found was 11-30 years. Blunt trauma is the most common cause of liver injury as it was the cause in 48 patients (80 %). Firearm injuries are the most common cause of penetrating trauma (60 %) followed by stab injuries (40 %). More than one half of our patients (34 out of 60) were treated with non-operative management (NOM) with a high success rate. The operative procedures done were suture hepatorrhaphy (20 cases), non-anatomical resection in one case, anatomical resection in one case, and damage control therapy using pads in two cases. In another two cases, nothing was done as subcapsular hematoma had resolved. Minia University Hospital is a big tertiary Hospital in Egypt at which blunt liver trauma is more common than penetrating liver trauma. Surgery is no longer the only option available. It has been reserved for extensive lesions with condition of hemodynamic instability or for the treatment of the complications. NOM is an effective treatment modality in most cases.

This study has shown that intra-operative blood loss was not associated with increased median length of stay nor did it increase the 30 day re-admission rate. However, increased intra-operative blood loss was associated with increased incidence of post-operative morbidity and risk of reoperation within 30 days.

Preoperative tumour localisation is extremely important to correctly identify the site of tumour or lesion at laparoscopy. A standardised departmental protocol should be implemented by all endoscopists to place three spots of tattoo one mucosal fold distal to any significant lesions found. Failure to tattoo lesions/cancers preoperatively can lead to intraoperative delays and potential harm to patients from on-table endoscopy.

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Aim: To evaluate the impact of age, type of hernia, size of the mesh used, and fixation of the mesh on the competence of laparoscopic repair of inguinal hernia. Materials and methods: Randomized controlled clinical study carried out from November 2016 to July 2017 in 98 patients with inguinal hernias admitted to surgery Department of Minia University Hospital. Patients were divided into two groups randomly. Group I includes 49 patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty and group II includes 49 patients who underwent laparoscopic totally extra peritoneal (TEP) hernioplasty with and without fixation of the mesh. Results: Operative time in group I ranges between 40 minutes and 110 minutes with mean time of about 66.85 minutes, while in group II ranges between 20 minutes and 105 minutes with mean time of about 52.65 minutes. This difference was statistically significant. Pain was 8.2% in group I and 10.2% in group II. Scrotal edema was 0% in all patients in both groups. Urinary retention was 2% in group I and 4.1% in group II. Seroma was the same (6.1%) in both groups. Recurrence after 6-month follow-up was 2% in both groups. All recurrent cases are nonfixed. Conclusion:There is no difference between TEP and TAPP, but TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair. Clinical significance: The TEP approach can be offered to patients with bilateral and recurrent hernias. TEP procedure was associated with more adverse events during surgery but less postoperative pain, faster recovery of daily activities, quicker return to work, and less impairment of sensibility after 1 year.

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