Role of anorectal myectomy in manegment of functional outlet obstruction

this work aim to study the value of anorectal myectomy in diagnosis and treatment of functional outlet obstruction, twenty five patients with functional outlet obstruction were subjected to anorectal myectomy and biopsies were taken and examined for ganglionic state. All patients were subjected preoperatively to colonoscopy or barium, flexible sigmoidoscopy, colon transit time, standard proctograhy, anorectal manometry, pre-operative scoring of their constipation. Postoperatively patients were followed up for at least one year, where colon transit time and anorectal manometry were redone, and rescoring of their constipation. There was clinical improvement in 15 patients [60%] of these 10 were males, and histopathological examination of the specimen proved to be aganglionic in 9 patients [60%]. There was no clinical improvement in the other 10 patients of these 7 were males, and biopsy was aganglionic in only 3 patients [30%].anorectal myectomy is a promising diagnostic and therapeutic options in cases of functional outlet obstruction, provided careful patient selection and adequate physiological tests were done to the selected patients

Evaluation of distal splenorenal shunt as an urgent surgical intervention in the management of acute variceal bleeding

The aim of the work was to evaluate distal splenorenal shunt as an urgent surgical intervention in management of acute variceal bleeding in Egyptian patients with portal hypertension. This study included 26 patients with acute variceal bleeding needing urgent surgery. All patients underwent distal splenorenal shunt, and patients were followed up for at least one year. Preoperatively and during the follow up period hepatic functions, portal homodynamic, and the state of varices were assessed. Control of bleeding was achieved in 88.46% of patients, re bleeding varices was reported in 3 patients [11.54%]. No infra-operative mortality, with a reasonable operative time of 148.00 +/- 50.05 minutes. The immediate post-operative mortality was 7.69%, and one patient died during follow up. Post operative morbidity was in the form of encephalopathy in 23.08% of patients, severe ascites in 15.38%, and partial wound dehiscence in 11.54% of patients. The mean follow up period was 21 +/- 4.34 months. Distal splenorenal shunt is a good surgical option for management of urgent variceal bleeding after failure of conservative measures, provided that there are available well trained personnel