Thyroid surgery: use of ligasure vessel sealing system versus conventional knot tying method

The aim of this study was to compare the use of conventional knot tying vs. LigaSure Vessel Sealing System [Valley lab, Boulder, Colorado] in patients undergoing thyroid surgery. We hypothesized that the use of LigaSure would reduce the time of operation without more complications. This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. 110 patients were operated upon by the same team of surgeons using conventional knot tying in 55 and LigaSure in 55 patients for hemostasis. The medical records of patients enrolled regarding age, sex, histopathological diagnosis, type of operation performed [lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy]; the operation time, intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, as well as the postoperative pain and outcome were reviewed and compared. The two groups had nearly similar demographic data. We have noticed that patients in the LigaSure[TM] group had significant lower operating times [P = 0.000], lower intraoperative blood loss [P = 0.000], less postoperative pain and early pain-free return to normal activity and return to work [P = 0.0001]. LigaSure Vessel Sealing System was as safe as conventional knot tying method for thyroidectomy, with the benefit of a reduced operating time, decreased postoperative pain and early pain-free return to normal activity and return to work

Evaluation of diamond versus house advancement flaps in treatment of postoperative anal stenosis

Cicatricial stenosis of the anal canal is a serious and disabling complication of anal surgery, which may be extremely difficult to manage. In surgical practice, there exists minimal consensus as to the most successful way to surgically manage patients with this condition. Different anoplasties have been described for the management of anal stenosis, such as mucosal advancement anoplasty, S-plasty, Y-V anoplasty, diamond-shaped flap anoplasty or house advancement flap anoplasty. All of which involve local tissue transfer of varying complexity. This comparative randomized study was performed to evaluate the efficacy, complication rate and recurrence of anal stenosis after diamond - shaped pedicle flap versus house advancement pedicle flap in treatment of postoperative severe anal stenosis. In this study, we reported 17 patients with severe postoperative anal stenosis of mean duration 16.9 +/- 7.7 months. Their mean age was 41.64 +/- 8.09 years. Nine had bilateral diamond flap anoplasty and eight underwent bilateral house advancement flap anoplasty. All patients were seen 4 weeks, 6 months, one year and then annually after surgery. At 4 weeks follow up, almost all patients showed complete healing of wounds and most of them reported satisfactory results. Only one patient with diamond flap anoplasty developed flap tip ischemia and wound dehiscence. Six months postoperatively, no further complications were observed. Anorectal manometric studies revealed within normal resting and squeezing pressures for all patients. At one-year follow-up, all patients who underwent house advancement flap had complete remission of the symptoms. Among the 9 patients who underwent diamond pedicle flap, 7 judged their clinical results satisfactory while 2 patients had restenosis. Although our cohort of patients is not huge, and randomized studies comparing the results of many different operative procedures used to correct anal stenosis are lacking in the literature, we can conclude that house advancement flap is simple and safe method to correct postoperative anal stenosis with good long term results

Comparative study between open vs closed methods of partial division of puborectalis in treating patients with anismus

To revive the results of partial division of the puborectalis and to compare the efficacy of open and a newly designed closed method in treatment of anismus. This prospective randomized study included 30 patients. They were 29 males and one female, with a mean age 42.30 +/- 13.01 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into: Group [I]: included 15 patients who underwent bilateral open division of the puborectalis and group [II]: included 15 patients who underwent bilateral closed method. Follow up was conducted for about one year. Improvement was considered when patients returned to their normal habits. Both open and closed methods significantly reduced the preoperative constipation scores. There was 100% initial success. Long term success existed only in 66.6% and 53.3% in group [I] and [II] respectively with no significant difference between the two methods [chi 2:0.556-P: 0.456]. Recurrence was observed in 5 and 7 patients following open and closed methods respectively. Minor degrees of incontinence were confronted in 13.3% in each group with no significant difference. Bilateral partial; division of puborectalis was found to be an effective method in treatment of anismus. Moreover, closed method seems to be simple and attractive

Should rubber band ligation be the first line of treatment of hemorrhoids in outpatient settings?

This prospective study was undertaken to evaluate the suction rubber banding as a simple outpatient procedure in treatment of patients with grade I. II and III hemorrhoids regarding its efficacy, complications, patient satisfaction as well as its Long term outcome. From January 2000 to December 2005 181 patients with 1st, 2nd. and 3rd degree hemorrhoids were treated in our Colorectal Surgery Unit; Mansoura University Hospital. They were 91 males and 90 females. Their mean age was 37.72 +/- 13.89 years. All patients were treated by rubber band ligation without anesthesia in the outpatient clinic. Three bands maximum were applied per session to be repeated 2 months Later If necessary. Patients were followed up after 1, 2 weeks and then monthly for a mean period of 14.71 +/- 5.23 months. Patients were considered satisfied when symptoms disappeared completely, otherwise were considered unsatisfied. the main symptoms were bleeding in 153 patients [84.53%]. protruding mass in 85 patients [46.96%], and other related symptoms in 14 patients [7.73%]. First-, second- and third-degree piles were found in 32 patients [17.68%], 81 patients [44. 75%] and 68 patients [37.5 7%] respectively. The mean number of hemonrrhoids ligated persession was 2-58 +/- 0.49. Early morbidity had occurred in the form of vasovagal attacks in 34 patients [18.78%]. bleeding in two patients [1.10%]. retention of urine in 9 patients [4.97%] and local infection and abscess formation in one patient [0.55%]. Post banding pain was well tolerated in almost all of our patients with an insignificant difference between patients whether one, two or three hemorrhoids were ligated per session [P0.238]. Satisfactory results were noticed in 132 patients [72.93%], 18 patients [9.94%] and 4 patients [2.2 1%] after one, two, and three sessions respectively with an overall satisfactory results in 154/181 [85.08%]. On the other hand, 27 patients [14.92%] were shifted to open hemorrhoidectomy due to recurrence of symptoms and for being unsatisfied in banding. rubber band ligation seems to be a simple, easy, effective and convenient modality in treating first-, second- and third- degree hemorrhoids as an outpatient procedure with a good long term outcome