Open versus laparoscopic anterior highly selective and posterior truncal vagotomy in the treatment of chronic duodenal ulcer

Vagotomy has almost replaced gastric resection in the treatment of chronic duodenal ulcer in most of surgical centers, and the highly selective type is a logical step in the direction of more conservatism. In the present study, open versus laparoscopic anterior highly selective vagotomy [HSV] and posterior truncal vagotomy [TV], were used for the treatment of chronic duodenal ulcer [CDU] and the results were evaluated. Anterior HSV and posterior TV were used to treat 38 patients with CDU. Twenty patients were managed by open surgery [group I], and 18 by laparoscopic surgery [group II]. Laparoscopic surgery was performed successfully in 15 patients [83%], while it failed in 3 patients [17%] and converted into open surgery. The mean operative time was 90 minutes in the open surgery group [OSG], and 150 minutes in the laparoscopic surgery group [LSG]. The mean postoperative hospital stay was 12 days in the OSG, while it was 3 days in the LSG. The basal acid output [BAO] and the maximal acid output [MAO] reduced significantly in both the OSG and LSG groups [P<0.01]. By assessment using the Visick scale, in the OSG, 14 patients [70%] were Visick grade I, 4 patients [20%] were Visick grade II, and 2 patients [10%] were Visick grade III, Using the same scale in the LSG. 12 patients [80%] were Visick grade I. one patient [7%] was Visick grade II, and 2 patients [13%] were Visick grade IV. Recurrence occurred in 2 patients [10%] of the OSG, and in one patient [7%] of the LSG. We concluded that although both open and laparoscopic surgery offers satisfactory results in the treatment of CDU, the later could be considered as a reasonable alternative. It is a minimally invasive technique with minimal operative and postoperative morbidity and short hospital stay

Thrombosis and cavernomatous transformation of the portal vein among hepatic diseases and hepatic arterial buffer response

Portal vein thrombosis [PVT] and cavernomatous portal vein [CPV] are rare conditions that may affect both children and adults. In this study the incidence of PVT and CPV among different liver conditions were recorded and the results were evaluated. From January 1993 to December 1999, 353 patients with different liver conditions were evaluated, regarding the clinical presentation, the liver pathology and the ultrasonographic findings in the portal system and hepatic artery. Of the 353 patients, 224 were males [63.5%] and 129 were females [36.5], with a mean age of 36 years [range 9 to 58 years]. The early clinical presentation was abdominal pain and vomiting and/or fever, while the late presentations were that due to portal hypertension such as variceal bleeding. The liver pathology was periportal fibrosis [PPF] in 124 cases [35.1%], cirrhosis in 48 cases [13.6%], mixed cirrhosis and PPF in 163 cases [46.2%], hepatocellular carcinoma [HCCa] in 16 cases [4.5%] and post-splenectomy acute PVT in 2 cases [0.6%]. By ultrasonography, PVT was found in 22/353 patients [6.2%] with the different liver conditions. CPV transformation was found in 4/353 of such cases [1.1%]. By studying the hepatic arterial buffer response, the resistive index [RI] was found to be as low as 0.558 in cirrhosis and HCCa patients with PVT and as low as 0.490 in postsplenectomy patients with acute PVT. We concluded that Early diagnosis of PVT or CPV transformation, in patients with risk factors, by their clinical presentation and a meticulous technique of duplex scanning of the portal system, is very important to avoid early bowel ischaemia or late variceal hemorrhage

Laporoscopic assisted orchiopexy for impalpable undescended tests

Multiple approaches exist for the management of impalpable undescended testicle. With the use of diagnostic laparoscopy widely accepted in the setting of the non-palpable testis, laparoscopic orchiopexy seemed to be a logical extension. We report our experience with laparoscopic orchiopexy in treating 36 impalpable testis in 32 children at Tanta University Hospital, three of them had undergone a negative groin exploration at other centers, Twelve children had an absent testis at the side under investigation [33.3%]. Twenty children with 24 intra-abdominal testes underwent laparoscopic assisted orchiopexy. Eighteen of them were submitted to a single - stage standard subdartos orchiopexy, and two-stage orchiopexy for the remaining six with a success rate reaching 87.5%. There were no technical failures or laparoscopy-related complications in all of these children. We concluded that laparoscopic assisted orchiopexy is a satisfactory and reliable technique which has the advantage of being accurate diagnostic and proper therapeutic in one setting