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The outcomes of open colorectal anastomosis of side-to-end vs. end-to-end in non-emergent sigmoid and rectal cancer surgery in adults were compared. Methods: A randomized controlled trial on individuals with sigmoid and rectal cancers was conducted between September 2016 and September 2018. Results: The mean age was 62.58 ± 12.3 years in the side-to-end anastomotic (SEA) group and 61.03 ± 13.98 years in the endto-end anastomotic (EEA) group. Except for the operative time, intraoperative data revealed no significant differences between the studied groups, and the SEA group revealed that the mean anastomotic time was significantly shorter. Perioperative blood loss, length of stay, reoperation, inpatient death, infection, and bleeding were significantly associated with leakage. There is a statistically significant change regarding the range of bowel frequency in the EEA group only (P = 0.04). There is a statistically significant difference regarding incontinence for flatus in the SEA group only (P ≤ 0.001). A statistically significant change in both groups regards incontinence for liquid stools (P ≤ 0.001) and clustering of stools (P ≤ 0.001 and P = 0.043). The quality of life in the SEA group significantly dropped at 6 months and then returned to baseline as regards to physical well-being (PWB), functional well-being (FWB), and colorectal cancer symptoms (CCS) with no difference as regards SWB and EWB, while in the EEA group, the exact change happened only as regard PWB and FWB, but SWB and CCS percentage did not return to baseline. Conclusion: The SEA group offers a safe alternative approach to the EEA group.

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Introduction: Cancer rectum and sigmoid is increasing nowadays. Resection is done by open and laparoscopic approaches. Laparoscopic approach is not available in many sites worldwide. Aim of this study: To analyze the outcomes of open side to end (antegrade) colorectal single stapling anastomosis versus open end to end (retrograde) Trans-anal colorectal stapling anastomosis in non-emergent sigmoid and rectal cancers open surgery in adults.Patients and Methods: Randomized controlled trial was performed on patients with sigmoid and rectal cancers between September 2016 and September 2018. Results: The majority of studied group were between 50-70 years with mean of 62.58±12.3 years and 61.03±13.98 years in group A and group B respectively. Intraoperative data showed no significant difference was founded between studied group except at operative time and mean anastomotic time as group A was significantly shorter. Univariate analysis showed that perioperative blood loss, length of stay, reoperation, inpatient death, infection and bleeding were significantly associated with leakage. Multivariate analysis of anastomotic leak showed that infection is the only independent predictors for anastomotic leak. There is statistically significant change as regard range of bowel frequency in end to end group only (p=0.04) and there is statistically significant difference as regard incontinence for Flatus in side to end group only (p=0.00) .There is statistically significant change in both group regard Incontinence for liquid stools(p=0.00) and Clustering of stool(p=0.00 and p=0.043).The quality of life in Antegrade group significantly drop at 6 months and return to baseline after that as regard PWB, FWB and CCS with no difference as regard SWB & EWB while in retrograde group, the same change happened only as regard PWB & FWB but SWB and CCS percentage didn’t return to baselineConclusion: The side-to-end anastomoses approach is a safe approach of anastomosis and may be used as alternative to retrograde approach.

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.

Background: Fistula tract Laser closure (FiLaC) and Ligation of intersphincteric Fistula Tract (LIFT) are feasible and safe techniques with low postoperative pain and minimal incontinence. Objectives: Our study aimed to preserve the anal sphincter and decrease the rate of incontinence and recurrence of the fistula during the management of intersphincteric perianal fistula. Patients and Method: This was a prospective observational study for 6 months at Department of General Surgery, Zagazig University Hospitals. Two groups of 56 patients were formed. Group A underwent fistula tract laser closure and group B ligation of intersphincteric fistula tract. Patients were followed for 6 months for postoperative pain, recurrence, and complication. Results: In our analysis, the average operating time was 19.3 minutes (min), while in the LIFT group it was 48.6 min with a statistically significantly higher mean operation time in the LIFT group. The mean hospital stay time postoperatively in the FiLac group was 8.1 hours, which was significantly lower than in the LIFT group (17.1 hours). In the FiLaC group, the mean time of healing was 16.4 days while in LIFT the mean healing time was 32 days, which was statistically higher than the FilaC group. Postoperative pain was statistically wrose in the LIFT group than the FiLaC group. There was no substantial difference between the two groups after a considerable period of follow-up. Conclusion: Our research found that both approaches are promising techniques, with higher healing rates and a lower risk of incontinence or recurrence after surgery. However, LIFT was quite significantly better for healing rate and recurrence, while fistula tract laser closure was slightly significantly better for postoperative pain and incontinence.