Background: Acute appendicitis is the most common indication for intra-abdominal emergency surgery, and appendectomy is one of the most commonly performed procedures in abdominal surgery. Although laparoscopic appendectomy (LA) has not yet achieved the status of a "Gold Standard" treatment, it is being progressively accepted as the treatment of choice for acute appendicitis. Numerous studies have shown many benefits of LA, including a faster recovery, less postoperative pain, reduced wound infections, shorter hospital stay and earlier return to work. Aim of the Work: To assess the feasibility of using the ultrasonic-activated device (harmonic) scalpel in sealing and division of the appendicular stump during laparoscopic appendectomy. Patients and Methods: This prospective study was carried out at the surgical department of Al Hussein University hospital during the period from June 2016 to April 2018. 40 patients diagnosed as acute appendicitis were included And divided into two groups: group 1 containing 20 patients using loop knots and group 2 containing 20 patients using harmonic scalpel (as a method of appendicular stump sealing. A comparative analysis was done for both techniques considering the post-operative leakage, the post-operative pain, hospital stay, surgery time, post-operative bleeding (if), and post-operative infection. Results: A total of 40 patients were included in this study, 20 in the loop knots group and 20 in the harmonic scalpel group. An analysis of the patients data showed that there was no significant difference between the first group and the second group with respect to difference in either age or gender. There was no mortality occurred in this study. There was no significant difference in the overall complication rates (10% in the LOOP group versus 10% in the harmonic group). Conclusion: Harmonic scalpel and loop knots tying are two promising techniques to secure the appendix stump in laparoscopic appendectomy with similar complication rates. Harmonic scalpel costs were higher than loop knots tying but has shorter operative times. Because of the simplicity of techniques, we highly recommend using of the harmonic scalpel especially by surgeons learning laparoscopic procedures.
Background: Both benign and malignant diseases now have more and more justifications for laparoscopic splenectomy, which is currently considered a standard technique for handling practically all disorders necessitating splenectomy. Objective: We aimed to contrast the consequences of benign versus malignant hematological diseases following laparoscopic splenectomy. Patients and Methods: We carried out seventy-six laparoscopic splenectomies between 2019 and 2022. 38 patients were handled with the use of a unique method, an anterior approach, but 38 patients have been positioned in a semi-lateral position for laparoscopic intervention. Result: Malignant disorder patients had older ages (60.1), whereas benign disorder sufferers had younger ages (35.6), P = 0.001. Laparoscopy was used in 72 of 76 cases (94.7%). Four situations (5.2%) have been modified to open cases. Operative time used to be 2.51 h/min for malignant in distinction to 2.30 h/min for benign tumors (P > 0.05). Conclusions: laparoscopic splenectomy is logically appropriate as a less invasive technique for benign splenomegaly, hematological tumors, or both.
EUS-guided transmural endoscopic drainage It can treat the late stages of Acute Necrotizing Pancreatitis (ANP), Walled-off pancreatic necrosis ( WOPN). Still, in the initial stages of ANP, the endoscopic function s not completely clear. Our aim We are comparing endoscopic draining of WOPN with early endoscopic treatment of Acute Necrotizing Pancreatic Collection (ANCs). Methods There were 142 ANP patients with necrotizing pancreatic collection who received transmural endoscopic drainage. In 50 (35.21%) cases with ANC (Group 1) and 92 (64.79%) individuals with WOPN (Group 2), endoscopic drainage was carried out after the first 4 -5 weeks following ANP. Results The patient's average age was 49.9 years (range: 22–79), and 59%of them were male. In Groups 1 and 2, the mean active drainage timing was 26.8 and 16.9 days (P = 0.0001) in Group 1 and 270.8 and 164.2 days (P = 0.0001) in Group 2, there was a medium of 9.5 and 4.5 endoscopic drainages with (P = 0.0001). No significant differences in long-standing success rates between the two groups (P > 0.05 for each). Conclusion Within the first 4-5 weeks later, ANP, transmural endoscopic intervention is an sufficient treating of early ANCs. However, more procedures and a longer duration of treatment following endoscopy in WOPN of drainage are needed.
Background: Chemotherapy plays a significant part in the management of breast cancer. In the current study, mastectomy with prompt breast reconstruction, the effects of neoadjuvant and adjuvant chemotherapy were investigated. Objective: The effect of neoadjuvant and adjuvant were given systemically to breast cancer patients to investigate their effect on breast reconstruction following mastectomy. Methods: Two-year postoperative follow-up at Zagazig University Surgical Department for 82 patients who received assistance systemic neoadjuvant (NAC) and (ACT) adjuvant chemotherapy for breast cancer between January 2021 and December 2022, together with mastectomy and rapid reconstructive surgery of the breast. Results: During the trial, 82 patients received fast breast remodeling after mastectomy. 34 patients did not receive any systemic therapy, whereas 28 patients had preoperative chemotherapy and 20 patients received postoperative chemotherapy. Conclusion: There were no differences in unscheduled reoperation, donor-site complications, or expander loss across the groups although the adjuvant chemotherapy group had a substantial number of wounds that were infected.
Background: Spleen is the most common intra-abdominal organ injury in blunt abdominal trauma. Splenectomy (open or laparoscopic) is the role in treatment of severe injuries of spleen or after failure of conservative treatment.Aim of the work: Compare the outcomes between open versus laparoscopic in high grade splenic injuries.Methods: This study includes 70 patients with various grades of splenic injuries in abdominal trauma. The patients were 15 years and older. They were categorized into two groups: open splenectomy group (35 patients) and laparoscopic splenectomy group (35 patients). The study was performed from January, 2012 to July 2017. Variables included demographics data, splenic injury graded by computerized tomography, duration of operation (in minutes), intra-operative blood loss (in ml), and intraoperative blood transfusion, length of hospital stay (in days), complications and mortality.Results: There was no significant difference or association between groups as regard age, sex and causes of splenic injury (p=0.374, 0.41, 0.38).Most cases were under 35 years old male patients exposed to motor car accidents. As regard intraoperative data, no statistically significant difference between both groups except for blood loss and transfusion that were statistically significant to the open group (p=0.039*).In the laparoscopic group, operational time was longer than open but no statistically significant (p=0.11).as regard conversion, we found that 14% of laparoscopic group (5 cases) had conversion. Most cases operated by laparoscopic approach were in grade III, IV with no cases tried in grade V (p=0.06). No statistically significant difference between both groups as regard postoperative variables except Pain (p=0.0003), and hospital stay(p=0.00) that were significantly longer among open group.The immediate postoperative complications showed that Wound infection, Missed injuries, pancreatic fistula and ileus were significantly higher among open group (p=0.00, 0.006, 0.02, 0.0004).The delayed postoperative complications where Incisional hernia (p=0.001) and Adhesive intestinal obstruction (p=0.00) were significantly associated with open group.Conclusion: In high-grade splenic injuries patients, this study found that laparoscopic splenectomy is safe.
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