Inguinal hernioplasty using cremasteric muscle and fascia: is it effective?

Although there are many techniques of inguinal hernioplasty, the ideal one is not yet reached. Cremasteric muscle and fascia was used many years ago aiming to reduce mesh uses and avoid tension in traditional repairs. To evaluate the effectiveness of inguinal hernioplasty using cremasteric muscle and fascia. This is a prospective randomized study conducted on 64 male patients suffering from different types and degrees of inguinal hernias. After pre-operative evaluation and stratification, they were divided randomly into two therapeutic groups. 32 patients each; group [A] was treated by cremasteric muscle and fascia repair, and group [B] was treated by open on-lay mesh patch tension-free repair. All patients were followed for two years for complications, recurrence and patient satisfaction. This study included 64 male patients their age ranged between 18 to 69 years with mean age = 37 +/- 2.3 years. Comparison between the two therapeutic groups showed similar results apart from chronic groin pain was more in group B and patient satisfaction was more in group A with statistical significance in both. Inguinal hernioplasty using cremasteric muscle and fascia is simple, not requiring extensive dissection or supporting by mesh patch with good post-operative patient satisfaction. So it is an effective alternative repair specially in risky situations to use mesh. It is not only a pure tissue tension free repair but also a physiologic one

Evaluation of laparoscopy in management of acute appendicitis

Acute appendicitis is one of the most common problems requiring emergency surgery. It has been estimated that the accuracy of the clinical diagnosis of acute appendicitis is only between 75-90%. Thus, accurate diagnosis of acute appendicitis is still difficult. This prospective study was aiming to evaluate the role of laparoscopy in management of suspected acute appendicitis. This study included thirty patients having suspected acute appendicitis. The usual clinical and laboratory assessment were done for all patients. Then patients had inclusion criteria were managed laparoscopicaly. Evaluation was made based on the comparison of clinical, laboratory and laparoscopic findings with histological examination of removed specimen. This study included thirty patients, their sex was 18 females and 12 males with mean age was 28.73 +/- 8.39 years. Laparoscopy was able to settle the correct diagnosis in 29 patients with high diagnostic accuracy [96.6%]. There was one patient [3.3%] who developed internal hemorrhage that easily controlled after conversion to open procedure. Laparoscopic assessment was advantageous in cases of diagnostic uncertainty especially if combined with the clinical findings, so can save patients from unnecessary explorations. It has fewer complications, diminished pain, shortened convalescence, decreased wound infection rate and mostly reduced hospital stay

Fresh thyroid auto-transplantation after thyroidectomy for multi-nodular goiter: An alternative to life long thyroxine replacement

Surgery for simple multi-nodular goiter affecting both thyroid lobes usually necessitate near total thyroidectomy to avoid recurrence, but this leads to inevitable postoperative hypothyrosdism requiring thyroxine replacement therapy which not only life long but also not without morbidity. The aim of this study is to evaluate the ability of fresh thyroid auto-transplant after thyroidectomy for muiti-nodular goiter to survive, grow and restore normal thyroid function as an alternative to life long thyroxine replacement. This study includes 25 patients complaining of bilateral simple multi-nodular goiter whom undergo near total thyroidectomy [NTT] with intra-sternomastoid muscle auto-transplantation of about 1 cm of fresh thyroid tissue which was proved normal clinically and by intra-operative frozen section with further post-operative paraffin section examination of all specimens. All patients were followed post-operatively by thyroid function tests and [99]mTc-pertchnetate thyroid scanning. The transplanted fresh thyroid tissue was surviving and growing in all patients but with variable functions. Euthyroid state was obtained in 23 patients within the first 6 months with 2 patients remain in hypothyroid state requiring thyroxine replacement therapy in variable doses. With further follow-up for another 6 months, one patient from euthyroid group developed hypothyroidism necessitated starting thyroxine replacement therapy. The auto-transplanted fresh thyroid tissue is able to survive and grow with the ability to restore normal thyroid function with variable degree making this technique a magic alternative to life long thyroxine therapy in most cases