Our study showed that intraoperative methylene blue test for leakage is a very sensitive and effective method for detecting leakage during sleeve gastrectomy and should be done routinely in all cases. Routine postoperative contrast study is not needed to detect leakage unless clinically indicated in selected cases, and in such cases contrast-enhanced CT scans are the modality of choice.
Mesh hernioplasty is crucial to prevent recurrence, and it is safe to utilize it in repair of acutely incarcerated hernias even if associated with intestinal resection.
Objective: We attempted to examine the success rate of varicocele ligation when performed for the treatment of pain and to evaluate all the predictor factors that may affect the resolution of pain. Patients and Methods: From January 2008 to January 2011, a total 152 patients presented with painful varicocele to our out-patient clinic. While waiting for surgery, 7 patients (4.6%) resolved their pain with conservative management and 145 patients underwent varicocelectomy due to failure. The first follow-up visit was after 1 week to check the wounds and 130 patients attended the second visit after 3 months. Follow-up evaluation included physical examination, questioning of pain severity (compared with preoperative pain severity), development of any postoperative complications, and color Doppler to study recurrence reflux. Results: During the study period, 145/397 (36.5%) patients underwent varicocelectomy for pain. Of the 145 men operated on for pain 130 (89.6%) were available for follow-up. A subinguinal approach was used in 93 patients (71.5%) and high ligation in 37(28.5%). Of the 130 patients contacted after surgery, 109 (83.8%) reported complete resolution of pain, 7 (5.4%) had partial resolution of pain and 14 did not show benefit from surgery. There was no association between varicocele grade, quality of pain, type of varicocele ligation, or recurrence and pain resolution after surgery, only the duration of pain seems to be a factor that is considerably associated with pain resolution. Conclusion: Varicocelectomy is a successful option for treatment of painful varicocele in selected patients. The duration of pain may predict outcomes in these patients.
Background: Various causes can be claimed for abdominal pain during pregnancy. Acute appendicitis is the most common cause of abdominal pain during pregnancy. Diagnosis of acute appendicitis during pregnancy is a quiet challenging due to anatomical and physiological changes that occur during pregnancy.Methods: On the period from January 2010 to January 2012we reviewed the number of pregnant patients presented to our facility by abdominal pain and diagnosed as acute appendicitis. Total number was 23 patients. 2 patients were excluded as their magnetic resonance imaging showed normal appendix and were discharged. 6 patients presented on the 1st trimester, 7 patients presented on the 2nd trimester and 8 patients on the 3rd trimester. Laparoscopic appendectomy performed in 9 patients while 12 patients had open appendectomy.Results: The operative time on the laparoscopic group ranged from 50-80 minutes while on the open appendectomy ranged from 40-60 minutes. The length of stay after laparoscopic procedure was 1.5-3 days in comparison to 3-5 days following open appendectomy. Postoperative wound infection detected in 2 patients after open appendectomy (16%) compared with 1 patient (11%) following laparoscopic appendectomy. The postoperative pathology was classified as normal appendix, suppurated appendix and complicated appendix. Table 2 showed the postoperative pathological examination. Preterm labor detected in one patient only had open appendectomy. Fetal outcome was evaluated by Apgar scoring together with fetal length and weight after delivery with no significant abnormality.Conclusions: Laparoscopic appendectomy is safe for both the mother and the fetus during pregnancy irrespective of gestational age, and the procedure is associated with a low risk of post-operative complications.
Background: The purpose of this retrospective study is to evaluate our institutional practice on the management of traumatic liver injuries and evaluate the main causes of failure of non-operative management (NOM).Methods: This is a retrospective study done in Mafraq Hospital, Abu Dhabi, UAE, during the period between January 2014 and January 2016. The patients were reviewed with regards of the grade of liver injuries, blood transfusion, imaging done, surgical intensive care unit (SICU) admission and serial vital signs and hemoglobin level. Also, we included the patient who required emergency laparotomy and damage control surgery. Focused assessment by ultrasound for trauma (FAST) was done in all liver trauma patients upon arrival to ED along with arterial blood gases, chest and pelvic X-rays. Computed tomography (CT) scans with angiography was done in all responder and stable patients. In transient responder patient CT was done on the window period of responding to resuscitation. Non-responder patients were taken immediately for exploration laparotomy, which include either control of bleeding or perihepatic packing.Results: This study included 75 patients admitted to our facility with different grades of liver injuries. 36 (48%) patients were admitted with grade I, II liver injuries which represent most of our admissions. 27 (36%) patients were admitted with grade III, 10 (13.33%) patients with grade IV while the least number was with grade V (2 patient, 2.66%). Non-operative management (NOM) or conservative treatment was successful in 34 patients admitted with grade I, II liver injuries whereas other 2 patients were explored for associated mesenteric and splenic injuries. On the patients admitted wit grade III liver injuries NOM was successful on 22 patients. The results of management of grade IV injuries showed that NOM was successful on 5 patients while the patients with grade V were managed operatively due to instability.Conclusions: Management of traumatic liver injuries is a multidisciplinary team work requiring trauma surgeon, interventional radiology, intensive care unit beside facility for trauma CT and massive blood transfusion. Management of traumatic liver injuries is depending on hemodynamic status of the patient and not the grade of injury.
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