Minilaparotomy approach to the lumbar spine

The anterior Lumbar spine L2-L4 is difficult to access because most neurosurgeons are unfamiliar with the anatomy. This study was performed to evaluate the Minilaparotomy approach to this segment of the lumbar spine. Twenty patients under went Minilaparotomy approach between December 2006 to December 2008. There were 14 men and 6 women, their main age was 42 y [range 16-60] . All patients presented with pain or neurological deficits. The causes of anteriorly located lesions were diverse, although infective spondylitis was most common. Neoplastic lesions in two patients, post traumatic lesions in two and one pathological fracture in one patient. The remaining 15 infective patients, diagnosed post operatively as 10 cases non specific infection, two pott's disease, two no bacterial growth and one patient with fungal spondylitis. The study of the muscle splitting Minilaparotomy approach to the lumbar spine proved to be safe anatomically, preferable surgically and lesser complication than the routine flank muscle cutting approach

Randomized trial comparing harmonic scalpel hemorrhiodectomy, bipolar scissors hemorrhiodectomy, and conventional scissors excision-ligation technique

The aim of this study was to compare the outcome of the patients receiving hemorrhiodectomy using harmonic scalpel, bipolar scissors, and conventional scissors excision-ligation technique. This study included forty five patients with irreducible prolapsing piles, selected from Al-Azhar University hospital,Damietta branch. between January 2008 to June 2009. They were randomly assigned to receive: 1] Milligan Morgan hemorrhiodectomy; 2] Bipolar scissors hemorrhiodectomy; 3] Harmonic scalpel hemorrhiodectomy. The measured outcomes included: 1]Operative time, 2]Blood loss, 3]postopenative hospital stay, 4]pain 4 scone,5]date of first bowel movement,6]number of nalbuphine HCL injection,7]number of diclofinac potassium injection,8] time need to return to work or normal activity, 9] wound healing, 10] satisfaction scone, 11] postoperative complications including anal stenosis and or flatus incontinence. Both harmonic scalpel hemorrhiodectomy and bipolar scissors hemorrhiodectomy were superior to Milligan Morgan hemorrhiodectomy in term of reduced blood loss. Harmonic scalpel hemorrhiodectomy had the best pain score when compared with bipolar scissors hemorrhiodectomy and Milligan-Morgan hemorrhiodectomy, and patients required significantly less nalbuphine HCL injection after harmonic scalpel hemorrhiodectomy than after Milligan Morgan hemorrhiodectomy also the time required to return to work or normal activity reduced in case of harmonic scalpel and bipolar scissors than Milligan Morgan hemorrhiodectomy so, the patient after harmonic scalpel hemorrhiodectomy had the best satisfaction score among three groups. This study shows that harmonic scalpel hemorrhiodectomy is as good as bipolar scissors hemorrhiodectomy in terms of reduced blood loss and operative time and time to return to normal activity but it is superior because it is associated with less postoperative pain and hence, better patients' satisfaction