Background: Since the introduction of successful thyroidectomy no change occurred in the technique but with the innovation of sutureless surgery, sutureless thyroidectomy becomes a competitor for the conventional technique. In this study we tried to analyze the outcomes of each.Methods: This was a prospective cross armed uncontrolled randomized study included 65 patients suffering from non-malignant goiter who underwent total thyroidectomy, admitted to Sohag University Hospital from September 2017 to October 2018. Patients were randomly allocated into two groups; Group (S) managed with sutureless thyroidectomy, and Group (C) managed with conventional knot tying technique. The data of the patients were gathered and analyzed considering the operative and post-operative outcomes. All patients were followed-up for 6 -12 months.Results: We found a significantly shorter operative time (p=0.001), also the amount of intra-operative blood loss was highly significant less in Group S (p=0.001). There was higher incidence of post-operative pain in Group C (p<0.001), post-operative drainage volume was highly significantly less in Group S (p=0.001). Regarding post-operative complications; the incidence of recurrent laryngeal nerve paralysis (RLNP) was insignificant between both groups (p=0.38), in the same time the incidence post-operative transient hypocalcaemia was significantly more in Group C (P=0.025). The overall post-operative complication rate was significantly more in Group C (p=0.002). The duration of hospital stay was highly significant shorter in Group S (p=0.0001).Conclusions: The use of Harmonic FOCUS® is beneficial for both patient and surgeon; it is efficient and a trustable safe substitute to the conventional knot tying technique.
IntroductionOncoplastic surgery has emerged as a new approach to allow wide excision for breast conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer. Objective:To study the different methods of oncoplastic surgery for breast reconstruction to achieve better aesthetic outcome and improve quality of life. Patients and Methods: Thirty patients with breast cancer, treated at Sohag University Hospital between July 2016 to May 2017 were included in this study. The oncoplastic techniques performed were Local glandular tissue displacement in (60%), latissimus dorsi flap (LD) in (16.6%), superior pedicle flap in(10%), implant insertion in (6.6%) and Transverse rectus abdominus myocutanous flap (TRAM) in (6.6%). The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree. Results: The number of patients included in the study were thirty. The median age was 43 years (range; 20-60 ys). There were three major complications that require repeating the oncoplastic techniques. Recorded complications included wound infection (5/30, 16.6 %) donor site seroma (10/30, 33.3 %), postoperative haematoma (1/30, 3.3%), flap ischemia and necrosis (1/30, 3.3%). The 12-months subjective patient satisfaction was excellent in 27 (90%) patients, and bad in 3 (10 %) patients. There were two local recurrence, no systemic metastasis after an average follow-up duration of 12 months. Conclusion:Restoring the defect after resection of the breast cancer can be safely achieved using oncoplastic procedures including the previous techniques with immediate breast reconstruction. In our patients, these procedures yield a satisfactory aesthetic outcome with lower morbidity.
Background: The goal of this study was to compare herrnioplasty with or without mesh fixation for inguinal hernias, paraumbilical hernia and epigastric hernia.Methods: This study included 288patients (170 males and 118 females) of different age groups with hernia who were admitted to general surgery department of sohag university hospital during the period from April 2018 to march 2019. Analysis of the clinical presentation, type of hernia and patients risk factors was done. All patients with above mentioned hernias without history of previous operations, was eligible for the study.Results: A total of 288 patients, 123 patients (42.7%) had oblique inguinal hernia, 75 patients (26%) had epigastric hernia, 77 (26.7%) had Para umbilical hernia and 13 (4.5%) had direct inguinal hernia. We had two groups, group (I) with mesh fixation included 141 patients (49%), while group (II) included patients (51%) without fixation of the mesh. Methods of fixation of the mesh in group (I) included suturing in 94 patients (32.6%), while using staples in 47 patients (16.3%). From 288 patients, 26 patients (9%) were hypertensives, 13 patients (4.5%) were diabetic and 13 patients (4.5%) were smokers. Follow up period extended for eight months post operatively, patients without fixation to their mesh had less pain and infection.Conclusions: Herrnioplasty can be carried out either with fixation of the mesh or not, it will not affect recurrence of the hernia and has less cost and operative time.
Background: Early closure of a temporary stoma is usually associated with low morbidity and mortality. However, some cases of stoma reversal may develop complications which may need surgical correction with subsequent major complications. We aim to evaluate early bowel stoma closure; de-functioning diversion stoma closure within the same admission (8-15 days) and study morbidity, health related quality of life (QOL) and length of stay at hospital (LOH). Methods: This study was done at general surgery department, Sohag faculty of medicine; in the period between March 2020 and March2021, 28 patients were closed early (at the same admission). Which are chosen randomly. The 28 patients who underwent early temporary stoma reversal following bowel surgery and abdominal exploration between March 2020 and March 2021 were included. The rate of complications (medical and surgical) following early stoma closure were assessed. Health-related QoL and LoH were assessed.Results: Total 28 patients were taken up for early stoma closure, reversal of stoma occurred between 8-15 days following its creation. Postoperative complications occurred in 53% of our patients, skin excoriation the commonest (28%). No difficulty was encountered during stoma closure surgery. Post-operative complications occurred in 53% of patients. 5 patients develop Ileus which were managed conservatively and one patient (3.5%) develop intra-abdominal abscess and treated with aspiration under sonographic guided. In our study no mortality occurred.Conclusions: Early stoma closure is feasible in selected patients, with reduced hospital stay, adhesions, bowel obstruction and medical complications and leads to better QOL, but a higher wound complication rate.
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