Effect of gastro-esophageal devascularization and esophageal transection on the prevention of variceal rebleeding

Nineteen patients [Child's A or B grade] with previous variceal bleeding underwent an elective gastro-esophageal devascularization and esophageal transection over two years period. Eight of them [42%] had recurrent bleeding despite medical therapy. There were neither operative death nor intraoperative complications. No anastomotic leakage was observed from the transection line. Nine patients [47%] had 16 postoperative complications. Routine ultrasonography following surgery showed portal vein thrombosis in three patients [16%]. In one patient, this has resulted in a late postoperative death due to mesenteric vein thrombosis. Follow-up endoscopy on the third postoperative month, showed that 42% of the patients had no visible varices and all patients except one showed marked reduction in the grade of esophageal varices. The study suggests that gastro-esophageal devascularization and esophageal transection carries a low operative risk and results in good prevention of recurrent variceal bleeding. The authors believe that this procedure deserves greater attention and can be used for the management of Egyptian patients with esophageal varices who may require surgery. A longer period of evaluation in a larger series of patients is required

Anterior rectus sheath flap repair for inguinal hernias: Preliminary study

Mesh repair for inguinal hernias has not been widely practiced in Egypt due to high financial cost. In this study, the use of a prosthetic mesh was replaced by a triangular flap of the anterior sheath of rectus muscle and was used in repair of 30 uncomplicated inguinal hernias. The flap was folded and sutured to the inguinal ligament to achieve tension - free repair. The postoperative progress of the patients was satisfactory. No severe complications were observed, and 2 years after the procedure no patient was noted to have a recurrence. The study concludes that the triangular flap of the anterior sheath of the rectus muscle is useful in reinforcing the inguinal canal floor and it is hoped that the use of the flap will achieve the same long term results as the prosthetic mesh