Role of staging laparoscopy in the treatment of hepatic malignancy

The present study evaluated the use of laparoscopy in the staging of hepatic malignancy. Twenty patients have underwent staging laparoscopy prior to a planned laparotomy for resection of a hepatic malignancy that was deemed resectable by computed axial tomographic scan and ultrasonography. Patients who underwent laparoscopy alone had shorter mean hospital stay than historical controls who underwent laparotomy alone. It has been concluded that diagnostic laparoscopy should precede laparotomy for planned resection of hepatic malignancies

Immediate transposition of a latissimus dorsi muscle for correcting a postquad-rantectomy breast deformity

With the aim of improving cosmetics after quadrantectomy, an immediate transposition of latissimus dorsi muscle was carried out. Cosmetic breast changes in transposed and non-transposed patients were evaluated by a Moire topography camera. In five patients, the breast deformity has been corrected only by conization of the residual breast tissue and the breast deformity in other five patients has been corrected by transposed latissimus dorsi muscle. Postoperative appearance and topography showed satisfactory symmetry of breasts in the transposed patients when compared with the non-transposed patients. It has been concluded that the immediate transposition of latissimus dorsi muscle is useful for preventing post quadrantectomy breast deformity

Transanal local excision of selected low rectal cancers

To determine if transanal local excision [TALE] of selected early low rectal cancer is an effective alternative to more radical resection and to determine the need for adjuvant radiotherapy in patients, a retrospective analysis of eight cases over a period of six years was done. Local recurrence occurred in one of three T1 cases, two of five T2 cases. Two of the patients with local recurrence did not receive irradiation while one has received. Two of them had salvage resection and one is alive with no evidence of disease at 21 months post-salvage. Recurrence-free survival at five years was 80% in the irradiated patients and 48% in the unirradiated. Transanal local excision of selected low rectal cancers combined with adjuvant radiotherapy results in low recurrence rate and is, therefore, an effective alternative to more radical resection

Laparoscopic appendectomy does not change the incidence of postoperative infectious complications

It is not clear whether the laparoscopic approach does decrease the incidence of postoperative infectious complications after appendectomy. One hundred twenty nine patients were randomized, 67 with laparoscopic [LA] and 62 with open appendectomy [OA]. Patients in the OA group had a Mc Burney incision, LA was performed in the Lithotomy position. Acute appendicitis was confirmed in 85 percent of patients. The appendix was perforated in 5 patients of the LA versus 2 of the OA group. No conversion to the open procedure was necessary. The median operating time was 35 minutes in the LA group and 31 minutes in the open group [P=0.58]. The median postoperative hospital stay was shorter after Laparoscopic than after open surgery [2 days versus 5 days P= 0.026], where as the time required for return to work was not significantly different [14 versus 15 days]. There were 5 [7.4 percent] patients with superficial wound infection following LA and 6 [9.6 percent] after OA [P=0.67]. Intra-abdominal fluid collections were found in 2 [2.9 percent] patients following LA and 3 [4.8 percent] patients following OA [P =0.60]. In the LA group, 3 patients presented with intra abdominal hemorrhage and another 3 developed a paralytic ileus that was treated conservatively. Laparoscopic appendectomy is as safe as and as effective as the open procedure, however it does not decrease the rate of postoperative infectious complications

Risk of lymphoedema following the treatment of breast cancer

This study included 20 female patients who had lymphoedema following a variety of treatment for operable breast cancer .Our study was assessed in the surgical department of El Minia University Hospital from 1992 to 1997.Patients who had been followed for at least one year after breast surgery were eligible for inclusion in the study, while those with bilateral breast cancer were excluded. Lymphoedema was assessed in two ways: subjective [patient plus observer impression] and objective [physical measurement]. Arm volume measurement 15 cm above the lateral epicondyle was the most accurate method of assessing difference in size of the operated and normal arm. Arm circumference measurement were inaccurate. Subjective lymphoedema was present in 15 percent whereas objective lymphoedema [a difference in limb volume >200 ml] was present in 80 percent. Independent risk factors contributing towards the development of subjective late lymphoedema were the extent of axillary surgery [P <0.05], axillary radiotherapy [P<0.001] and pathological nodal status[P<0.10]. The risk of developing late lymphoedema was unrelated to age, menopausal status, handedness, early lymphoedema, surgical and radio therapeutic complication, total dose of radiation, time interval since presentation, drug therapy, surgery to breast, radiotherapy to the breast and tumor T stage. The incidence of subjective late lymphoedema was similar after axillary radiotherapy alone or axillary sampling plus radiotherapy [0 percent], while axillary clearance alone was [25 percent]. The incidence after axillary clearance plus radiotherapy was significantly greater [33.3 percent, P<0.001]. Axillary radiotherapy should be avoided in patient who have had a total axillary clearance

Unusual abscess pattern following dropped gallstones during laparoscopic cholecystectomy

Laparoscopic Cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. Between 1995 and 1998, 200 laparoscopic cholecystectomy were performed at El-Minia Surgical Department, 3 patients [1.5 percent] subsequently developed abscesses as a consequence of dropped stones during the Laparoscopic Cholecystectomy, while 2 [1 percent] other patients developed trocar site "tumor" masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. This experience closely resembles that of the other centers and points out the existence of late postoperative complications following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies from avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of surgery with or without placement of a drain in the subhepatic space does not prevent this complication