ABSTRACT
Duodenal ulcer is a common disease in Egypt. The management of this disease has changed dramatically. Surgery is still indicated for the complications of duodenal ulcer. Pyloric stenosis is a common complication that may result from reluctance of the ulcer patient to seek medical advice or to receive adequate treatment. From 1992 to 2006, 175 patients with cicatricial pyloric stenosis were operated on [open truncal vagotomy with gastrojejunostomy] in our center. The aim of this work is to declare the role of minimally invasive surgery in the form of laparoscopic truncal vagotomy and extracorporeal gastrojejunostomy /or treatment of cicatricial pyloric stenosis. From December 2006 to December 2007, 14 cases of cicatricial pyloric stenosis underwent laparoscopic truncal vagotomy and extracorporeal antecolic gastrojejunostomy through a small 4 cm transverse incision in the left hypochondrium. The advantages of this procedure include reduction of pain, size of the wound and incidence of incisional hernia. The results are comparable to those of a totally laparoscopic truncal vagotomy and gastrojejunostomy. Cicatricial pyloric stenosis is an absolute indication for surgery. The standard surgical approach is truncal vagotomy and gastrojejunostomy. It could be performed totally laparoscopic using either endosteplers or intracorporeal suturing. Laparoscopy- assisted truncal vagotomy with gastrojejunostomy achieves the advantages of .minimally Invasive surgery, easy anastomosis and is cost effective. This procedure is relatively easy to perform as the anastomosis is done extracorporeally. It is less expensive than the use of endostaplers. It achieves the advantage of minimally invasive surgery in a cheap manner. This is very suitable for developing countries like Egypt
Subject(s)
Humans , Male , Female , Vagotomy, Truncal , Laparoscopy , Gastric Bypass , Treatment OutcomeABSTRACT
Gastric volvulus is a rare condition, however it may result in serious complications. It occurs mainly as a result of congenital laxity of the stomach's attachments and might be accompanied by a diaphragmatic hernia. A patient may have acute or chronic disease. We present 6 patients of chronic gastric volvulus who were managed with laparoscopic suture gastropexy. We managed 6 patients with chronic gastric volvulus during the past 4 years. All of them had primary and organoaxial type of volvulus. All of them were proved by barium meal study and underwent elective surgery in the form of laparoscopic posterior suture gastropexy. All patients recovered well from surgery. The postoperative pain was minimal with early ambulation. The average hospital stay was 3 days. There was neither morbidity nor mortality. Follow up with barium meal studies gave good results in all cases. Diagnosis of chronic gastric volvulus needs a high index of suspicion. This is because of its rarity and its similarity with other more common diseases as cholelithiasis and peptic ulcer. Confirmation of diagnosis requires barium meal study. It could be managed either by open surgery, by laparoscopic/ endoscopic approach or by laparoscopic approach alone. Laparoscopic suture gastropexy gives good results. Eventhough worldwide experience in laparoscopic surgery for gastric volvulus is limited, the results are encouraging. Laparoscopic management seems to be safe and feasible
Subject(s)
Humans , Male , Female , Stomach Volvulus/congenital , Chronic Disease , Laparoscopy , Follow-Up Studies , Treatment OutcomeABSTRACT
Immunological factors are important in the pathogenesis of a wide spectrum of hepatobiliary diseases. Using flow cytometry, we determined the changes in lymphocyte subsets and natural killer cells in 123 individuals [81 patients with liver disease and 42 healthy volunteers]. The liver diseases included periportal fibrosis [PPF, 10 patients]. liver cirrhosis [LC, 31 patients], and hepatocellular carcinoma [HCC, 40 patients]. Schistosomiasis and viral hepatitis B and C were the putative etiological agents of liver diseases. Immunophenotyping by indirect immunofluorescence was conducted using monoclonal antibodies to CD3 [T-lymphocytes], CD4 [helper/inducer T-cells], CD8 [suppressor/cytotoxic T-cells] and CD 57 [natural killer cells] cell surface markers. Immunophenotyping of PPF patients showed no significant changes in all markers compared with the healthy controls. However, there was a significant decrease [P<0.01] in CD3 and CD4 T-cells, and a highly significant increase [P<0.001] in CD 57 T-cells in patients with LC or HCC. In addition, LC and HCC patients showed no significant change in CD8 T-cells compared with controls. The progression of liver diseases is associated with a dysregulation of cellular immune responses. T-lymphocytes and natural killer cells may play a role in the immunopathogenesis of LC and HCC