Comparative study between open anterior approaches using the prolene patch and open posterior [pre-peritoneal] using a configured prolene mesh in treatment of recurrent inguinal hernia

Recurrence of inguinal hernia is not an infrequent problem seen by the surgeon. Usually repair of such hernia is technically more demanding than a primary repair, with a potential for new recurrence and a high risk of complications. The objective of this study is to compare between the anterior approach using the prolene patch and a pre-peritoneal approach with prolene mesh configuration. A comparative study was done from June2004 to December 2006, at Assiut university hospital on thirty patients with recurrent inguinal hernia selected for this prospective comparative study. The studied patients were allocated into two groups: group A [anterior approach n=15 patients] and group B [posterior approach n= 15 patients]. Thirty patients with recurrent inguinal hernia were operated. All of them were males. Incidence of cord injury in group A was 6.6%, while no injury of the occurred in group B. the incidence of haematoma [6.6%], scrotal oedema [20%] and testicular atrophy [6.6%] were encountered in group A while no reported cases were seen in group B. Although both anterior and posterior approachs are effective treatment modalities for treatment of recurrent inguinal hernias, yet the open pre-peritoneal approach is technically easier, safer, cheaper, is followed by minimal morbidity and has a low re-recurrence rate

Effect of bilateral Truncal ligation of the inferior thyroid artery on serum calcium levels after subtotal thyroidectomy

Hypocalcaemia is a well recognized complication of thyroid surgery. We have compared the prevalence of hypocalcaemia in our patients following ligation and non-ligation of the inferior thyroid artery after thyroid surgery. A prospective study was done from January 2004 to December 2007, at Assiut University Hospital. All patients [110 patients] undergoing subtotal thyroidectomy were placed in two groups at random. Group I [55 patients] had inferior thyroid arteries ligated whereas in Group II [55 patients], inferior thyroid arteries were not ligated Serum calcium levels were measured before and after surgery. 110 patients were operated [90 females and 20 males], 55 patients in Group I and similar number in Group II Transient hypocalcaemia was observed in 2 [3.63%] patients in Group I and in one [1.81%] patient in Group II. Permanent hypocalcaemia was observed in one [1.81%] patient in Group I and no permanent hypocalcaemia recorded in Group II. Results were statistically insignificant. There is no significant difference in post-operative hypocalcaemia whether or not the inferior thyroid arteries were ligated

randomized comparative study between needle aspirations versus surgical drainage in liver abscess

To compare the therapeutic effectiveness of ultrasound guided needle aspiration versus open surgical drainage in treatment of liver abscess. Between March 2003 and May 2006, 60 consecutive patients with liver abscesses were treated with intravenous antibiotics and randomized in two groups: ultrasound guided intermittent needle aspiration [18G disposable trocar needle]; and open surgical drainage. There was no statistically significant difference between the two groups regarding patient demographics, abscess size and number, the presenting clinical symptoms and laboratory findings. The success rate was 80% in needle aspiration group versus 100% of open surgical group, the number of aspirations required varied from one aspiration [10 patients] up to 3 aspirations in 8 patients. The average time needed for clinical relief and the mean hospital stay for the successful treated patients were similar in both groups. Although both needle aspiration and open surgical drainage are safe methods for treatment of liver abscesses, open surgical drainage is more effective

Role of systemic inflammatory response in prognosis and survival after curative resection of colorectal cancer

Some studies have shown that the presence of a systemic inflammatory response, as evidenced by raised circulating concentrations of C. reactive protein [CRP] predicted recurrence and overall survival in patients with colorectal cancer. The aim of this study was to examine the relationship between the inflammatory response and prognosis and survival in patients undergoing potentially curative resection for colorectal cancer. 90 patients considered to have undergone curative resection were studied. Circulating CRP concentration was measured before and after operation. The majority of patients were aged 65 years or more, had colonic tumours and Dukes stage B lesions. 23 patients had raised preoperative value, 11 [47.8%] of them, had raised concentration after operation. 67 patients with a normal preoperative value, 60 [89.5%] of them had normal postoperative value. During follow up, 17 [18.8%] patients developed recurrence and 25 [27. 7%] died. In patients who have undergone potentially curative resection for colorectal cancer the presence of a systemic inflammatory response predicts a poor outcome

Tailored lateral internal sphincterotomy in management of chronic anal fissure with hypertonic internal anal sphincter. a modified minimal invasive technique and its clinical and manometric outcome

To do tailored lateral internal sphincterotomy extending up to upper end of fissure in patients having hypertonic internal sphincter [IAS] by technique has advantages of open and closed methods to keep continence. Clinical and anomanometric outcome will be assessed. 70 patients and 70 controls were subjected to anal manometric study. All patients had hypertonic IAS compared with controls. Sphincterotomy was done through 5-7mm perianal incision just lateral to lower edge of IAS. It extended up to upper end of fissure. Sentinel tags, anal polyps and fibrotic fissure were excised. Results were assessed as persistence of symptoms, complications, healing, postoperative resting anal pressure [RAP] and recurrence. Preoperative RAP significantly higher in patients [132.89 +/- 6.61 cm H2o] than controls [79.64 +/- 71, P >0.001]. Sepsis of sphincterotomy wound occurred in 1.4%, bruising in 1.4%, transient minor soiling in 11.4% and no incontinence. In 97.2%, fissures healed within 6 weeks, postoperative RAP dropped significantly [78.09 +/- 6.62 cm H2o, P >0.001]. After 15.8 months mean follow up period, recurrence occurred in 4.3%. tailored lateral internal sphincterotomy is effective treatment of CAF with anal hypertonia. Our technique is safe and does not affect continence

Sclerotherapy versus surgery in the treatment of varicocele: a randomized study

To evaluate the differences between surgical and seminological results observed in two groups of patients with primary varicocele who underwent, respectively, open surgery or antegrade sclerotherapy. From Jan. 2005 to Jan. 2006, we recruited 60 patients with left sided varicocele for this study. Before treatment all patients were evaluated by a physical examination, color Doppler ultrasonography of the spermatic cord, and abdominal and scrotal ultrasonography and semen analysis. These patients were randomized to two groups; group A: 30 patients [open surgery] and B: 30 patients [antegrade sclerotherapy]. At the current follow up, it is possible to evaluate all the patients for whom we have preoperative and postoperative Doppler imaging and semen analysis. A satisfactory significant improvement of the rate of fast progressive spermatozoa and reduction in immotile spermatozoa in those patients who underwent sclerotherapy compared to the patients who underwent open surgery. The outcomes of all other parameters [number and morphology] are fully comparable. Operating time is decidedly shorter for antegrade sclerotherapy, but there are no significant differences in terms of early or late postoperative complications. Our results demonstrate that sclerotherapy combines shorter surgical time and faster recovery of normal daily activities with significant improvement in sperm motility

Mesh plug repair for paraumbilical hernia

The standard method of repair of paraumbilical hernia [PUH] is by Mayo's technique, using a double breasted flap of the rectus sheath. The present study describes and evaluates the application of prolene mesh plug in the repair of PUH. The use of a mesh plug in hernia repair is not a new concept with previous investigators yielding consistently excellent results in the repair of femoral and inguinal hernia. Twenty patients with paraumbilical hernia [PUH] admitted to Assiut University Hospital, General Surgery Departments between April 2004 and April 2006. There were twelve [12] female [60%] and eight [8] male [40%] with median age group 53 years [range 34-86 years]. Whenever local anaesthic was used. This technique included 3-4cm incision either supra or infraumbilically, the sac was dissected from the surrounding tissues till the margin of the hernial ring, the content of the sac reduced followed by reduction of the sac in the abdomen. Cigarettes stub was done from prolene mesh sheet [2.5cm x10cm]. The stub inserted into the defect with its external margin flush with the hernial ring and fixed to it with prolene 3/0 suture. Then suction was inserted subcutaneously and the wound closed with subcuticular suture. Follow up was done for 18 month. Patients with local anaesthesia discharged from the hospital within 24 hours and those with general anaesthesia discharged within 48 hours without anaesthetic complications and post-operative pain controlled with non narcotic analgesia. The post-operative complications were two cases [10%] of wound infection. The patients return to normal activity after 7 days [range from 4-12 days]. Seventeen patients [85%] satisfied the procedure and recurrence occurred in one case only [5%]. Mesh plug repair can be performed with minimal post-operative complications, low recurrence rate, minimal post-operative pain and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anaesthetic could become the standered treatment for PUH in adults

Total cystopericystectomy versus traditional cyst evacuation for treatment of hydatid cysts of the liver

Echinococcosis is a zoonotic disease that occurs throughout the world. Surgery is the recommended treatment for hepatic hydatid cysts. The purpose of this study is to evaluate the technique of cystopericystectomy for treatment of hydatid cysts of the liver comparing it with the traditional surgical technique of cyst evacuation. Twenty six patients [26] admitted with hydatid disease of the liver in Assiut University Hospital from January 2004 to April 2007. All patients were randomized into two groups, group I [13 patients] were managed by total cystopericystestomy and group II [13 patients] managed by conservative technique of cyst evacuation. History, clinical examination chest X-ray abdominal ultrasonography and computed tomography were performed. All patients were treated with oral albendazole dose for two months after surgery. Blood transfusion hospital stay, post-operative complications, and any evidence of hydatid recurrence were recorded. Surgery was performed on 26 patients with liver hydatid disease [14 men and 12 women] with a mean age of 40.2 years [range 21-73 years]. The mean diameter of the cyst was 6.6cm [range 5-11cm]. Blood transfusion was required in 5 patients in the group of cystopericystectomy and in 2 patients of traditional technique of cyst evacuation. The mean hospital stay was 6.1 days in cystopericystectomy group and 8.2 days in the traditional technique of cyst evacuation. During the follow up period which extended up two years postoperatively, no mortality was verified, the incidence of postoperative complications was 7.6% in the group randomized to cystopericystectomy and it was 23.07% in the group randomized to cyst evacuation. Recurrence of hydatid disease was observed in one patient 7.6% in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy group. Surgical treatment of hepatic hydatid disease by total cystopericystectomy combined with medical therapy with albendazole is a valuable alternative to the more conservative technique of cyst evacuation with a lower incidence of morbidity and recurrence

Laparoscopic adhesiolysis for bowel obstruction, preliminary results

Recurrent small bowel obstruction caused by postoperative adhesions has traditionally been treated by conventional laparotomy, but laparoscopic management of acute small bowel obstruction has been demonstrated. Our aim was to evaluate the feasibility of a laparoscopic as a minimal access approach for the management of patients with recurrent adhesive intestinal obstructions. After conservative treatment, elective laparoscopic treatment was attempted in 22 patients hospitalized for recurrent small bowel obstruction after abdominal surgery. The sites of postoperative adhesions were identified laparascopically in all patients. Complete laparoscopic adhesiolysis was feasible in 17 patients [77.3%], while conversion to laparotomy was required for 5 patients [22.7%] due to iatrogenic intestinal injury during adhesiolysis [one patient] or technical difficulties due to adhesion [in four patients]. The mean operating time was 95 minutes. Long-term follow up was possible in three patients for 27 months. One recurrence of small bowel obstructions was noted after 7 months. No available data was obtained [in two patients]. Laparoscopic adhesiolysis is a safe and effective treatment for recurrent small bowel obstruction. Conversion to laparotomy should be considered in patients with dense adhesions