Feasibility of combined laparoscopic cholecystectomy and anti-reflux surgery: evaluation and outcome

This study was designed to evaluate the outcome of combined laparoscopic cholecystectomy and fundoplication during one single laparoscopic procedure. The study included only patients assigned to undergo cholecystectomy for calcular cholecystitis and had symptomatic gastroesophageal reflux disease [GERD], 22 patients [7 males and 15 females] were enrolled in the study. All patients underwent clinical history taking including duration of symptoms, physical examination and upper gastrointestinal endoscopy. Esophageal manometry was performed preoperatively and 2 and 6 months after surgery. Laparoscopic procedures were performed through 5-port access. Operative time and the frequency of conversion to open surgery, time till initiation of oral intake, postoperative hospital stay and complications and time to recover full activity were recorded. Through a monthly visit for 6 months after surgery, patients were monitored for the extent of resolution of GERD-related symptoms. There was a significant increase [p<0.001] of postoperative lower esophageal sphincter [LES] pressure compared to preoperative pressure with a non-significant difference between pressures estimated at 2 and 6 months. No intraoperative complications were encountered and there was no need for conversion to open surgery in any case. The mean operative time was 78.3+/-9.7; range: 60-90 minutes. All patients tolerated oral ingestions after the first 48 hours. The mean duration of postoperative hospital stay was 4+/-0.8; range: 3-5 days and 9 patients [40.9%] were discharged on the 3[rd] postoperative day. The mean duration till resumption of full daily activities was 11.6+1.4 [10-14] days. Clinically, a marked resolution of symptoms due to reflux was observed, only one patient developed dysphagia for solid food and a sensation of trapped air occurred in two patients causing discomfort, however, these three patients were asymptomatic at 6 months after the surgery. It could be concluded that combined laparoscopic surgery for cholelithiasis and GERD is an appropriate procedure, when indicated, giving excellent short-term outcome results and could be managed during one single laparoscopic procedure

One-stage primary ileo-colic or ileo-rectal anastomosis. For acute malignant left colonic obstruction

The aim of this study was to evaluate the immediate and short-terme follow-up results of one-stage subtotal or total colectomy and anastomosis for patients with malignant left colon obstruction. The study comprised 21 patients [10 males and 11 females] with age range of 36-81 years; presented by acute large bowel obstruction with clinical and radiological evidence of obstruction. The choice of the extent of resection was determined by the extent of fecal load, the presence of colonic perforation, serosal tears of the cecum and/or massive colonic distension with concomitant ischemia: the presence of these features in a hemodynamically stable patient favored subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis. The site of obstruction was at the sigmoid colon in 9 patients [42.9%], rectosigmoid in 8 patients [38.1%], splenic flexure in 3 patients [14.3%] and descending colon in one patient [4.7%]. Ileosigmoid anastomoses were done in 13 patients [61.9%] and 8 patients [38.1%] had ileorectal anastomoses. The mean operative time was 201+/-33.2; range: 150-270 minutes, the mean operative blood loss was 633.3+/-408.2; range: 250-1800 cc; 11 patients [45.8%] required blood transfusion with a mean number of blood bags used was 2.8+/-1.2; 1-5 bags. Oral feeding was resumed after a mean period of 4.9+/-0.9; range: 4-7 days and the mean postoperative hospital stay was 10+/-2.2; range: 8-18 days. Overall, after 12-months follow-up only one patient had anastomotic line recurrence with a recurrence rate of 4.75%, one patients died of acute liver failure secondary to hepatic metastasis with mortality rate of 4.75% and 19 patients had follow-up free of morbidity with no-local recurrence or metastasis and a follow-up free rate of 90.5%. Thus, it could be concluded that one-stage subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis are safe procedure with satisfactory outcome for management of obstructing malignant lesions of the left colon

Surgical margins factors determining the extent of tumor resection in breast cancer patients treated by conservative surgery

A total of 102 female patients proven to have breast carcinoma was treated by modified radical mastectomy. Risk factors of local recurrence [tumor size, histological type and grade, presence of extensive intraductal component [EIC], vascular invasion and lymph node status] in addition to resection margins were examined. Immunohistochemical expression of adhesion molecule CD44 and prognostic marker C-erb B-2 were evaluated and correlated to the extent of tumor spread beyond the primary site. Tumor bed biopsies from the modified radical mastectomy specimens were taken at distances from 1-6 cm at six positions [anterior, posterior, lateral, medial, upper and lower] and examined for tumor extension. Risk factors of local recurrence in breast carcinoma [histological type, grade, EIC and lymph node status], in addition to adhesion molecule CD44 and prognostic marker C-erb B-2 should be considered in the selection of patients for conservative lumpectomy treatment and in determining the extent of surgical resection. A safety margin of 3 cm is considered to be sufficient in cases of invasive duct carcinoma without intraductal component

Low molecular weight heparin versus low-dose heparin in thromboprophylaxis after major abdominal surgery

One hundred twenty patients undergoing elective major abdominal surgery were divided into 3 equal groups: Group A [LMWH], group B [low-dose heparin] and group C [placebo, control group]. The results showed that both LMWH and low-dose heparin are equally effective in lowering the incidence of postoperative deep vein thrombosis [one case in each group, while four cases developed deep vein thrombosis in the control group]. The bleeding complications were nearly the same in the first two groups and exceeded those reported in the control group. LMWH as it has the same efficacy and side effects of low-dose heparin is a practically alternative way of thromboprophylaxis in patients undergoing elective major abdominal surgery because of the once-daily regimen with better patient acceptance