Outcome of loupe assisted sub-inguinal varicocelectomy in infertile men

Sub-inguinal varicocelectomy has gained wide reputation among surgeons. The aim of this study was to evaluate outcome of varicocelectomy using a modified microsurgical method, specifically a loupe assisted one, and its effects on sperm parameters in infertile men. This study was carried out in 40 patients who presented with varicocele. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and confirmed with color Doppler ultrasound. Routine investigations as required preoperatively were done. Semen analysis and hormonal profile was also done and repeated postoperatively for follow up. Half of the patients [20 patients] were treated by subinguinal approach assisted with loupe magnification [Group-A] and the other half was treated by the same approach but without magnification [Group-B]. To facilitate the procedure, an x3.0 loupe was used during the spermatic cord dissection at the level of the external inguinal ring. During dissection, the dilated veins were ligated and divided including vassal veins and external spermatic veins. A total of 40 patients were followed up for more than 6 months. Age of the patients varied from 25 to 38 years [mean 32.5]. No intra-operative complications occurred in both groups. As regard post-operative complications, group [A] [loupe assisted] showed only one patient [5%] who developed scrotal hematoma and two [10%] developed wound infection, while in group [B] complication rate was higher, two cases [10%] developed scrotal hematoma, two cases [10%] developed wound infection, three cases [15%] developed hydrocele, two cases [10%] developed recurrence and two cases [10%] developed scrotal edema. As regard to seminal parameters there was much improvement in sperm count, sperm motility and decrease in abnormal forms after surgery with significant differences in Group A [patients treated with a modified microsurgical method] but in Group B [patients treated with sub-inguinal approach without loupe assistant] there was improvement in sperm count, sperm motility and decrease in abnormal forms but without significant differences. Loupe-assisted sub- inguinal varicocelectomy is a safe, simple, and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment and has significant improvement in sperm parameters

Needle aspiration of breast abscess could be considered a standard practice?

The revolution, in surgery, of laparasopic cholecystectomy as the gold standard for the treatment of gall stone, has urged many surgeons to apply this minimally invasive technique in varieties of surgical problems including breast abscess. In this study the technique of needle aspiration, being a minimal invasive approach has been done for 24 patients aged between 18 and 40 years [median 27]. There were 22 abscesses in the right breast [9 1.6%] and 2 abscess in the left one [7.4%]. Twenty patients were lactating [83.3%] while 4 were non lactating [16.7%]. The total number of patients who benefited from aspiration was 21[87.5%] [11 needed once aspiration 45.8%, 6 needed twice aspirations 25% while 4 needed 3 aspirations 16.7%]. No complications as milk fistula were seen with incision and drainage. No distress for mother or baby as regard breast feeding [all lactating patients were encouraged to continue breast feeding]. No need for general anaesthesia with its hazards, hospital stay or post treatment dressing which in turn minimized the cost. In conclusion, needle aspiration is effective alternative to incision and drainage in management of breast abscess and may surpass it, being less painful, less distressing, less costly with minimal morbidity and could be considered a standard for treatment of breast abscess

Haemorrhoidectomy by ligasure versus closed [Ferguson] technique; randomized controlled trial

In this study, 40 patients with hemorrhoids were randomized to undergo LigaSure [20 patients] or Ferguson; closed technique [20 patients]. The operating time, amount of analgesic needed and overall outcome were documented. The study has revealed that LigaSure group had shorter operating time [median 4.3] than Ferguson technique [median 13.4]. Also, postoperative analgesic requirements was less in the former group [30%] needed injection of NSAID, immediately postoperative [after recovery from anesthesia] in comparison to 70% of the other group. In conclusion, hemorrhoidectomy by LigaSure is quick, easy to learn, bloodless and, although as painful as other surgical interventions, analgesic requirement is reduced. The only drawback is the high cost