The aim of this prospective randomized study is to compare single session endoscopic and laparoscopic management of concurrent cholodocolithiasis and cholecystolithiasis with the current practice where laparoscopic cholecystectomy is performed days after endoscopic stone extraction.Patients and methods: This study was performed on 62 patients with concurrent cholodocolithiasis and cholecystolithiasis randomly categorized into 2 groups through a computer randomization program. Group I (30 patients) underwent endoscopic stone extraction and Laparoscopic cholecystectomy (LC) during the same session. This group was compared to 32 patients (Group II) who underwent endoscopic stone extraction and LC at least 3 days later.Results: The characteristics of the two treatment groups, including baseline preoperative laboratory results showed no significant difference. In group I mean operative time was 97.3±17.9 minutes. In group II, collective mean operative time was 104±13.6 minutes (P = 0.27). Mean hospitalization time was 2.33±1.45 in Group I and 2.94±1.29 days in Group II (P = 0.23). Mean Time to return to normal activity was16.2±3.49 and 15.9±4.31 days (p = 0.85). Success rate of endoscopic procedures was 90 % and 93.75% (P = 0.67). Pancreatitis was observed in 2 patients in each group. Sphincterotomy related hemorrhage occurred in one patient in each group. One patient in group II experienced cholangitis. Total rates of endoscopic complications were 10% and 12.5 % (P = 1.000). Complications of ERCP were treated conservatively. No mortality was observed in both groups. Bile duct injury was not observed in this study. The overall LC related morbidity (including conversion) was 1/27 in group I and 2/30 in group II (P = 1.000). Level of direct bilirubin returned to normal values in the blood 9 days after procedure in both groups. Mean patient satisfaction score was 8. 20±1.47 versus 8.44±1.50 (p = 0.66).Conclusion: Endoscopic stone extraction and LC performed during the same session is feasible, safe and effective alternative to two-stage ERCP and LC for concurrent cholodocolithiasis and cholecystolithiasis . It has many advantages including avoiding a second procedure without increasing the length of operation, hospital stay or conversion rates to open procedure. We recommend more studies to be done on this subject before its routine recommendation in surgical practice.

Oncoplastic breast surgery (OPS) is a new strategy for expanding breast-conserving surgical options, lowering mastectomies rates, and preventing deformities. OPS is based on the use of plastic surgical reconstruction after breast cancer removal. The study aims to assess volume displacement oncoplastic procedures for early primary breast cancer in terms of recurrence and cosmoses. A case series study was done on 20 patients with early breast cancer who underwent oncoplastic volume displacementtechniques in the period from March 2019 to March 2021 in Kafrelsheikh University Hospital, Egypt. OPS techniques included were Racquet, Benelli, Batwing and Grisotti technique. The study concluded that OPS are oncologically safe (100%) with no recurrence and a better aesthetic outcome (90%).Keywords: Mastectomy, Breast Cancer, Plastic, Oncoplastic.

The objective of this prospective randomized study was to compare outcome and complications between LGCP and LSG.Patients and methods: This study was performed on 40 patients randomly categorized into 2 groups through a computer randomization program. Group P included 20 patients who underwent LGCP. This group was compared to 20 patients who underwent LSG. (Group S). The mean length of follow up was 65.1±15.7 and 63.9±15.6 months (P = 0.810).Results: Mean operative time was 117±17.9 in group P and 111±17.3 minutes in group S (P = 0.31). Mean hospitalization time was 4.85±1.81 and 3.55±1.32 days (p = 0.013). Mean time for return to normal activity was19.2±3.69 and 18.9±4.29 days (p = 0. 0.81). There was no surgery related mortality. One at each group (5 %) needed conversion to open surgery. Eleven patients (55.0 %) in Group P and 5 patients (25.0 %) in the Group S had minor complications (p 0.02). One patient (5 %) in Group P had port-site bleeding. In Group S gastric leak occurred in 1 patient. She was treated by re-stapling the leak site and placing an abdominal drain. One patient in the group S required readmission during the first 30 days after surgery, for subphrenic abscess that was treated conservatively. (p: 0.41). During late follow-up, there were 3 surgical interventions, laparoscopic cholecystectomy was done for cholelithiasis in one patient from each group and hernioplasty for umbilical port hernia was done to the other Group P patient. Loss of feeling of hunger at 6, 12 and 60 months postoperatively showed significant differences. The patients in Group S had a greater BMI loss and PEWL after surgery compared with those in Group P. No weight loss failure was observed in any patient of the two groups. After 12 months follow-up, the major comorbidities improved markedly in both groups, and there was no significant difference between the two groups. The mean patient satisfaction score for was 8.75±1.35 versus 9.04±1 (p = 0.51). Conclusion:LGCP is feasible and safe when applied to morbidly obese patients, but compared with LSG it is inferior to LSG as a restrictive procedure for weight loss, despite its less cost and simpler procedure.

Background & aim: Many operative methods have been described for treatment of pilonidal sinus, however, no one is completely satisfactory. The Aim of this study was to compare modified Limberg flap transposition versus Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease.Methods: A prospective randomized study was conducted on 40 patients with denovo sacrococcygeal pilonidal diseases at General Surgery Department in Tanta University Hospitals throughout the period from June 2013 to June 2014. The patients were randomly divided into two groups: Group "A" (The patients subjected to modified Limberg flap transposition) and Group "B" (The patients subjected to Karydakis flap reconstruction). This study Compares results of wound infection, wound disruption, wound haematoma, duration of surgery, time of hospital stay and recurrence rate.Results: The majority of our patients were males(85%), drivers(48%),with no significant difference between the two groups regarding duration of surgery or hospital stay. 5% of the patients in group "A" developed wound infection versus 25% in group "B" while no patient in group "A" developed wound disruption versus 20% in group "B". No patient in group "A" had recurrent disease versus 15% in group "B" and this difference was statistically significant. Conclusion:Modified Limberg flap had a superiority over Karydakis flap in the ability to excise all tracts if extensive pilonidal sinus, low incidence of wound infection, and wound disruption, shorter hospital stay with no recurrence. We recommend the use of modified Limberg flap in the treatment of pilonidal sinus disease.

Background and aim: Total thyroidectomy has been the treatment of choice for patients with malignant thyroid disease. However, the efficacy and safety of this procedure for patients with benign disease is still a matter of debate. The aim of this study was to evaluate safety and efficacy of total thyroidectomy in treatment of bilateral benign thyroid disease.Methods: A total of 60 patients underwent total thyroidectomy between January 2013 and May 2014 at General Surgery Department in Tanta University Hospital. Patients with thyroid cancer or suspicion of thyroid malignancy were excluded. Type of benign disease, cancer incidence (histopathological surprise), complication rates, and local recurrence rate in the follow-up period were evaluated.Results: Diagnoses before surgery were; Euthyroid multinodular goitre (n = 42, 70%), Graves disease (n = 11, 18.2%), toxic multinodular goitre (n = 5, 8.3%), and recurrent goitre (n = 2, 3.4%). Temporary unilateral recurrent laryngeal nerve palsy occurred in one patient (1.7%). We observed no temporary or permanent bilateral recurrent laryngeal nerve injury. Temporary hypocalcemia occurred in 5 patients (8.3%) with no permanent hypocalcemia. Postoperative seroma occurred in one patient (1.7%). There was no postoperative hemorrhage, infection or mortality. During the follow-up period, we observed no disease recurrence.Conclusion: Total thyroidectomy is safe and is associated with a low incidence of disabilities, recurrent laryngeal nerve palsy and hypoparathyroidism. Furthermore, it seems to be the optimal procedure, when surgery is indicated, for Graves disease and multinodular goitre, as total thyroidectomy has the advantages of immediate and permanent cure and no recurrences. It also eliminates the requirement of completion thyroidectomy for incidentally diagnosed thyroid carcinoma.

Objectives: To determine the incidence of seroma formation after breast cancer surgery, and its association with common risk factors.Method: The correlational study was conducted at the General Surgery department of Kafrelsheikh University Hospital, Egypt, from March 2020 to March 2022 and comprised patients having breast cancer stage I, II or III, as per the Tumour- Node-Metastasis classification, who were scheduled to undergo modified radical mastectomy, breast conserving surgery or reconstructive surgery. Baseline, intraoperative and postoperative data was collected on a proforma. Data was analysed using SPSS 22.Results: Of the 50 female patients with mean age 45±5.20 (range: 20-70 years), 30(60%) were in the elderly group aged >45 years, while 20(40%) were aged <45years. Overall, 12(24%) cases developed seroma; 9(30%) in the elderly group. There were 24(48%) cases of modified radical mastectomy, and 8(33.3%) had seroma. Electrocautery was used for breast dissection in 30(60%) cases, and, among them, seroma developed in 10(33.3%) patients.Conclusion: Age, body weight, afflicted breast side, site, and size of breast mass were not found to be significant predictors of seroma formation following breast cancer surgery.Keywords: Seroma, Breast neoplasms, Neoadjuvant therapy, Electrocoagulation, Wound healing, Lymph nodes, Obesity.

Background: For many years, traditional surgery for left colon and rectal cancers had developed with variable degrees of morbidity. With the evolution of laparoscopy and by the aid of better visualization and magnification, laparoscopic colorectal surgery had appeared, but technically challenging as it involves almost all advanced laparoscopic techniques, with the benefits of minimal morbidity, less pain, earlier recovery, shorter hospital stay, without compromising oncological results. Aim: The aim of this work was to evaluate laparoscopic resection for left sided colon and rectal cancer as regard feasibility, safety and outcomes. Patients and Methods: This prospective study was conducted on 40 patients having left sided colon and rectal cancer, including 29 patients with rectal cancer and 11 patients with left sided colon cancer within the inclusion criteria are evaluated by clinical examination, radiological and colonoscopic study and biopsy and treated by laparoscopic resection and followed ranged from 6 months to 2 years with mean of 20 months. Results: Twenty seven patients (67.5%) underwent laparoscopic anterior resection, 11 patients (27.5%) underwent laparoscopic left hemicolectomy and only 2 patients (5%) underwent laparoscopic abdominoperineal resection, minimal morbidity, no cancer related mortality and no recurrence during the period of follow up either local or systemic. Conclusion: Laparoscopic resection for left sided colon and rectal cancer is technically feasible, oncologically safe and has more benefits on postoperative recovery.