Introduction. Diabetic foot ulcers (DFUs) are a major complication of diabetes. Recently, considerable progress has been achieved in techniques that promote wound healing. Autologous platelet-rich plasma (PRP) is one such technique that is gaining popularity. Platelet-rich plasma is thought to stimulate wound healing by releasing growth factors essential for healing. Objective. This research aimed to study the efficacy of PRP in managing chronic DFUs. Materials and Methods. Seventy-two patients with chronic DFUs were equally divided into 2 groups. The first group was treated with activated PRP injection and gel on the surface of the ulcer, and the second group was treated with conventional dressing using normal saline to irrigate the wound, followed by coverage with petrolatum gauze and sterile dressing. Results. Both methods of treatment improved healing, but there was a significant increase in healing rate among the PRP group compared with the conventional dressing group (31/36 patients [86.11%] vs 23/36 patients [63.89%]; P =.029). Additionally, the healing duration was shorter in the PRP group than in the conventional dressing group (10.90 weeks ± 3.40 standard deviation vs 13.48 weeks ± 3.37, respectively; P =.01). Conclusions. The use of autologous PRP results in a higher rate of wound healing in less time compared with conventional wound care in managing DFUs. Platelet-rich plasma is an effective and promising treatment for chronic DFUs; PRP enables healing in less time. This is expected to positively affect the individual’s performance and minimize long-term health care expenditure on foot ulcers.

Background Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage. Methods This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management. Results One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1–2) days in EG, while in SG was 7 (range 6–8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively). Conclusion Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.

Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.

Background: Nowadays laparoscopic appendectomy (LA) is the management of choice for acute appendicitis (AA) in simple, uncomplicated cases. For complicated acute appendicitis (CAA), laparoscopic or conventional open appendectomy (OA) is still in debate.Objective: This study aimed to compare minimally invasive LA and traditional OA in CAA cases. Methods: In this study, 44 patients with CAA (22 for LA and 22 for OA) with 18 years of age or older were enrolled. It was conducted in General Surgery Department, Helwan University Hospital. Results:The operative time difference between the LA and OA groups was statistically significant (18.5 minutes shorter in the OA group, (p<0.001). The median length of hospital stay, return to normal activity, and patient satisfaction were significantly better in the LA group (p-values of 0.001, 0.00, and 0.14 respectively). The need for analgesics in the LA group was significantly lower than in the OA group. There were no detectable statistically significant findings concerning the occurrence of surgical findings, postoperative vomiting, postoperative ileus, wound infection, wound dehiscence, or postoperative intra-abdominal collection. Conclusions: Laparoscopic appendectomy management of CAA is feasible, safe, and has numerous advantages over the traditional open procedure in terms of reducing postoperative pain, requiring fewer analgesics, shortening the postoperative hospital stay, having a low incidence of postoperative infectious complications, and allowing a rapid return to daily activities with improved comfort and satisfaction.

high perianal fistula, platelet rich plasma. Background: The main issue involves high perianal fistula management, as fistulotomy would represent an inacceptable risk of incontinence in such patients. Platelet rich plasma (PRP) is defined as a portion of patient own plasma with high concentration platelet and growth factor levels as obtained by centrifugation. Platelets have alpha granules that contain several proteins with multiple actions on the various aspects of tissue repair. Aim of the study was to evaluate the use of autologous platelet rich plasma in the treatment of perianal fistula. Methods: A prospective study including patients with high perianal fistula who presented to General Surgery Department of Zagazig University in the period from September 2016 to February 2019. Result: We had 16 patients with a diagnosis of high perianal fistula, 9 males and 7 females. We had a clinical success rate of 75% (12 patients out of 16 were completely healed with no recurrence throughout the follow up period). Two patients (12.5%) developed postoperative abscess formation and another two patients (12.5%) showed persistent external opening. Conclusion: Platelet rich plasma is promising in the treatment of high perianal fistula without affection of fecal continence.

Background : Peptic ulcer perforation is a common and life threatening surgical emergency. The traditional , pedical omental patch is performed for the plugging of perforated peptic ulcer was first described by Cellan-Jones in 1929. Although it is attributed to Graham , who described the use of a free graft of the omentum to repair the perforation in 1937. Many endoscopic methods have been used to treat acute perforated peptic ulcer like over the scope clips , standard endoscopic clips , endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.Methods:This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 to August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management . Surgical group (SG): included 50 patients who were subjected to surgical management.Results:Hundred patients were randomized into 2 groups: Surgery Group (SG, n=50) and Endoscopy Group (EG, n=50). Median age of patients was 36( range 27:54) and 47( range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median postoperative hospital stay was 1 (range: 1-2) days in EG , while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever , pneumonia , leak , abdominal abcess , renal failure , incisional hernia, ( 11%, 5%, 5%, 3%, 2%, 3% , respectively). While postoperative complications in EG patients were 24% in form of fever , pneumonia , leak , abdominal abcess , renal failure , incisional hernia, ( 10%, 0%, 2%, 0%, 0%, 0% , respectively). Conclusion:combined endoscopic & interventional radiology can effectively manage acute perforated peptic ulcer without need for general anesthesia , within short time , in high risk surgical patients with low incidence of morbidity & mortality.This study was retrospectively submitted in clinicaltrials.gov in September 2021 (NCT05051683).

Aims and objectives: Acute appendicitis is the most common surgical disease with a lifetime risk of 7-8%. Numerous studies have shown many benefits of laparoscopic appendectomy over open appendectomies, such as better visualization and identification of other abdominal pathologies that can mimic acute appendicitis. Herein, we illustrated the current incidence of non-appendicitis pathologies during laparoscopic appendectomies in our hospital. Materials and methods: A retrospective study was carried out involving patients operated for acute appendicitis laparoscopically at the Surgical Emergency Unit, Zagazig University Hospitals, Egypt, during the period from March 2017 to December 2019. The diagnosis of acute appendicitis was based on clinical examination, laboratory findings, and ultrasonography. We drew out the patients' demographic data, duration of surgery, and surgical procedure reports. Results: One hundred forty-five patients presented clinically, and confirmed by laboratory and ultrasonography with the diagnosis of acute appendicitis. Eighty-nine were males, 56 were females. The median operative time was 56.5 minutes. Eight cases (5.5%) showed a pathology other than acute appendicitis, including gynecological pathologies, Mickel's diverticulitis, inflamed sigmoid appendices epiploica, low-grade appendiceal mucinous neoplasm, and inflamed cecal diverticulum. Conclusion: Diagnosis of acute appendicitis is challenging up to date. We faced many conditions mimicking acute appendicitis during surgical intervention.

Highlights The diagnosis and management of cases with acute biliary pancreatitis. Minimally invasive techniques gave encouraging results with minimal complications. Cholecystectomy is recommended to prevent the recurrence of acute gallstone induced pancreatitis.