Comparison of open and laparoscopic treatment of acute appendicitis

Appendectomy can be performed using either a laparoscopic or an open technique. This study compares the out come of patients treated for acute appendicitis by open appendectomy with the outcome of those undergoing laparoscopic appendectomy. Patients undergoing appendectomy at Benha university Hospitals between January 1998 and Sept. 2001 were studied. Out come of patients having open appendectomy was compared with that of patients having laparoscopic appendectomy. Three hundred seventy nine [379] patients underwent appendectomy for acute appendicitis during the above mentioned period. One hundred thirty [130] pats. [34.3%] had open appendectomy and 249 [65.7%] had Laparoscopic appendectomy. Patients subsequently found to have a normal appendix had the highest rate of laparoscopic appendectomy, whereas those with gangrenous appendicitis were most likely to have open appendectomy [P<0.05]. There was a significant decline in the postoperative length of stay for open cases during the length of the study. In the final year, the difference in length of stay between open and laparoscopic appendectomy was only 1 day. Patients with gangnenous appendicitis had a significantly longer length of stay than did patients with a normal appendix or suppurative appendicitis. The hospital cost of laparoscopic appendectomy was greater than that for open appendectomy, but the extra expenditure in the operating room was offset by the longer length of stay of the patients having open surgery. Differences in outcome between open and laparoscopic appendectomy are minor. In this study, more difficult cases with gangrenous appendicitis were more likely to require open appendectomy where-as milder forms of oppendicitis, especially in women, were more likely to be treated by laparoscopy. Savings from the slightly shorter hospital stay after laparoscopic appendectomy are offset by the higher surgical cost of the laparoscopic equipment

Micro laparotomy laparoscopically assisted cholecystectomy [MLLAC]

In this study, the results of 50 patients underwent cholecystectomy by new technique including micro single incision [about 2cm length] assisted by laparoscopic instruments through this single small incision [Micro Laparotomy Laparoscopically assisted cholecystectomy] [MLLAC]. These patients included cases presented as symptomatic chronic colcular cholecystitis 40 patients [30%] of patients, and symptomatic chronic non clacular cholecystitis [10%] of patients. The mean operative time was within moderate time within normal consuming time of laparoscopic cholecystectomy only or open only. This procedure was completed in 45 pat [90%] of patients, while in 5 pat [10%] of patients was converted to extended [wide] incision to help completed cholecystectomy without proper complications of the previous microlaparotomy. The mean post operative stay was significantly shorter in MLLAC. No mortality was reported in both groups, while complications rate was simple as post operative fever and wound infection especially in converted cases 10% of patients due to missed subacute cholecystitis and friable gall bladder wall and moderate adhesions which detected during surgery. It is concluded that [MLLAC] is considered the best choice for treatment ofchomic gall bladder disease, since it is safe effective technique even in difficult cases because this procedure includes the benefits of L.C. and minicholecystectomy [M.C] with its cosmetic single microincision, and also its complications can be prevented by proper patients selection with combined proper antibiotics

New technique using mesh plug in treatment of oblique inguinal hernia

Oblique inguinal hernias can be repaired efficaciously by [tension-free] hernioplasty which has dramatically reduced the expected high failure rate of traditional tissue-based repairs. The use of the, mesh plug has been tried and accepted as a valuable tool to block the defect in many inguinal hernias. The present study intended to evaluate open"anterior [tension-free] hernioplasty in inguinal hernia in a prospective randomize pattern, trying to codify the indications for mesh plug. The study included 30 adult male patients with unilatera uncomplicated oblique inguincl hernias. The results obtained from patients were determind for patient hernia types, multiplicity of previous repairs [s], site and size of the defect, operative time, analgesic requirements limitation of daily activity, day-off work, post operative complication, follow up period and recurrence rate The results of the study revealed that the size of the defect was 3cm or less in 76.7% of patients. Also there was significant decrease in post operative complications, operative time, analgesic requirements, limitation of daily activity and day-off work in the mesh plug technique. The recurrence rate was [6.7%] during the follow up period [from 12 to 46 months]. Because many recurrent inguinal hernias, especially first-time recurrence, have a small [3cm or less], rarely more than one defect, the plug repair is optimal, with the advantage of minima dissection, rapid recovery and insignificant post operative complications

Breast conservation therapy in treatment of cancer breast

Breast conservation therapy [B.C.T.] comprises local excision, axillary dissection and post operative radiotherapy. Numerous studies have now shown that although local recurrence may be slightly more common after breast conservation than mastectomy, disease-free survival and overall survival are the same. The primary goals of breast conservation therapy are tumour control and acceptable appearance of the breast. Twenty female patients were included in this study. All patients were suitable for B.C.T. Their ages ranged from 25 to 60 years [mean age 41.3 +/- 8.8 years]. All patients were subjected to mammography, fine needle aspiration cytology [FNAC] and metastatic work up [chest x -ray, abdominal ultra sonography and bone scans].The study included 4 patients [20%] in stage I, 14 patients [70%] in stage II and 2 patients [10%] in stage III One patient showed positive safety margin of the lumpectomy specimen and for whom mastectomy was done. The remaining 19 cases were followed up for two years. The study showed an excellent cosmetic appearance however, local recurrence occurred in 3 cases [15.78%]. The higher incidence of total recurrence in the present study may be related to the histopathological nature of the tumour, the biological behavior of breast cancer in Egypt or even the sample is so small in number