Isolated antral inverted L- shaped tube with vascularized pedicle for reconstruction of bismuth type iv bile duct injuries. A live animal experimental study

Surgical repair of hilar biliary injuries is difficult and remains a challenge which requires specific skills and experience. The aim of this study is to improve the outcome of surgical repair of type IV Bismuth BDI in situations in which there is extensive tissue loss by introducing the novel technique of isolated L-shaped tube of biliary reconstruction. This technique is tested in a live animal experimental study. Twenty mongrel dogs underwent biliary reconstruction using antral tube harvested and completely separated from the greater curvature of the stomach with its blood supply based upon right gastroepiploic vessels. The tube was anastmosed to LHD by end to end anastmosis then to RHD by end to side anastmosis then to duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histologic pictures were assessed. One dog died from anaesthetic complication and another three dogs died due to abdominal sepsis. Sixteen dogs survived the procedure and showed uneventful course with no cholestasis. The mean internal diameter at the site of anastmosis with pedicled antral tube was 2.1 mm [range 2-3] for RHD, 3.2 mm [range 3-5] for LHD and 6.5 mm [range 5-7.5] for duodenum. Histologically, anastomotic sites showed good evidence of healing. In mongrel dogs surgical repair of Bismuth type IV bile duct injuries using isolated antral inverted L-shaped tube with a vzscularized pedicle is feasible and produces satisfactory results regarding biliary complications, anastomotic circumference and histological evidence of healing

Evaluation of non-mesh versus mesh repair of primary adult inguinal hernia

Inguinal hernia is the most frequently performed operation. Consequently, failure of inguinal hernia repair has a great impact on society and leads to increased patient discomfort, reoperations and considerable economic burden. The aim of this study was to compare the result of repair of primary inguinal hernia using mesh with the usually performed Bassini repair. Between April 2004 and November 2008, 200 patients with unilateral primary inguinal hernia were entered into the: study patients were distributed into 2 groups A and B. In group A patients, Bassini repair was preformed. In group B mesh repair was preformed. The patients were followed up during their hospital stay and every 6 month for 2 years. The main follow up variables were operating time, duration of hospital stay, postoperative pain, complications, return to normal activities and recurrence rate. Only 81 patient have received follow up examinations. In group B no recurrence occurred [0% versus 4.7%]. Although the mean operating time was longer in group B [56.5 versus 43.7 minutes], the mean duration of hospital stay was shorter [21.8 versus 25.6 hours], postoperative pain and complications were less and return to normal activities was earlier [12.3 versus 23.1 day] than in group A. Mesh inguinal hernia repair is superior to the usually preformed Bassini repair and should be adopted as standard treatment of all adult primary inguinal hernia

Comparative study of different surgical modalities for treatment of sacrococcygeal pilonidal sinus

Pilonidal sinus disease of the natal cleft is a painful debilitating condition which often recurs despite different surgical procedures. In this thesis, the outcome of different methods for treatment of this disease are described and compared. A review of sixty patients were randomized into three groups. Group A were operated upon by sinus excision and leaving the resultant cavity to heal by granulation tissue. Group B were operated by excision with primary closure in natal cleft. Group C were operated by excision with oblique closure by z-plasty. Recurrence was highest in group B [25%] followed by group A [15%] and no recurrence occurred in group C. The mean satisfaction grading was 5, 2 in group A, 7.1 in group B and 9.3 in group c. Excision of pilonidal sinus and oblique closure by z-plasty offers improved patient satisfaction and no recurrence rate

Impact of diagnostic laparoscopy on the management of gastric cancer

In this study, 50 patients with endosmotically proven gastric adencarcinoma were included. Ages of our patients ranged from 35 to 72 years [mean 54 years], with male predominance [male to female = 2.8:1]. The site of the tumours were in the antrum, body of the stomach, proximal 1/3 [20%],5 [10%], 4 [8%] and 2 [4%] cases, respectively. Ultrasonograhy, CT scan and laparoscopy were performed to patients. The sensitivity of the 3 modalities in detection of hepatic metastases were 26.7%, 46.7% and 86.7%, respectively, Also, the sensitivity of the 3 modalities in detection of peritoneal metastases were 33.3%, 16.7% and 83.3%, respectively. Laparoscopy avoided laparatomy in 18 [36%] of our patients We concluded that diagnostic laparasocopy is more accurate than other tests under investigations. It is of increasing imkportance in planning patient management with the use of non-operative methods of tumour palliation in patients with intraabdominal metastases