Primary common bile duct closure on a choledocho duodenal stent

In this study 49 patients had exploration of common bile duct [CBD]. They undergo primary closure after insertion of choledocho duodenal stent. Our purpose is to evaluate the efficiency of this method, with special attention to post operative complication and stent expulsion. Fourty seven patients with stones CBD and two with iatrogenic injury of their CBD during cholecystectomy, were included in this work. Duct clearance was insured proximally and distally. Nelaton tube 8-10 Fr. was inserted into the CBD down to the duodenum. Choledochotomy incision was closed primarily using polyglycolic acid stutre. Single suction drain inserted subhepatic near the suture line. Patients with stenosed lower end of CBD and sphincter of Oddi were excluded. No operative mortality. mean hospital stay was 4.4 days, one patient stayed for 18 days as he developed pancreatitis Another patient remain in the hospital for 10 days due to chest infection. The stent passed with defaecation spontaneously at 25 - 40 days. No other complication developed during 24 months follow up. Closure of CBD primarily with an internal drainage using choledocho duodenal stent is a safe and effective procedure. It requires a short hospital stay compared with T- tube drainage, many patients return to work within 2 weeks

Lateral approach for treatment of pilonidal sinus with cavity obliteration and pit cauterization

Many surgical methods used for treatment of pilonidal sinus have been described. The persistent unhealed midline wound is commonly seen laying open or excision of the primary disease. Such wound are demand regular medical attention and many persistent for a long periods. Seventy four patients of mean age 27 years and mean duration of the disease was 2.7 years. The sinus was excised through lateral incision about one inch from the midline. The midline pits was cauterized subcutaneously the wound is closed by deep sutures and the edges with subcuticular prolene. A median hospital stay of 2.1 days. Primary healing without complications in 62 patients within two weeks. Subcutaneos haematoma developed in 2 cases and abscess formation in one case. Postoperative wound infection found in 2 cases. Wound disruption occurred in 2 cases. Recurrence of the disease occurred in 5 cases. The complications was treated with healing time 21-25 days. Follow up for two years with no recurrence. These results of this procedure is safe and has rapid cure rate, and short hospital stay

Evaluation of different techniques for localization of biliary tract injury

The present study was designed to evaluate the results of different preoperative techniques for accurate localization of biliary tract injury. Thirty patients [21 females and 9 males] were included in this study. The clinical diagnosis was post operative bile duct injury. They presented mainly with jaundice, pain, dyspepsia, intermittent fever and other symptoms. Ultrasonography done to all patients, intrahepatic biliary radicle dilation, common bile duct dilatation and bile collection were evident findings. The accurate site of pathology was not clear in most of the cases. Percutaneous transhepatic [PTC] done for three patients with high serum bilirubin, after drainage PTC done. Intrahepatic biliary dilatation, proximal segment accurately localized. One patient developed biliary leakage. Retrograde cholangiopancreatography [ERCP] done for twenty patients, it clearly visualized the distal segment of the biliary tract. ERCP was helpful in diagnosis strictures. Failed cannulation occurred in five patients. Two patients developed cholangitis after ERCP. Magnetic resonance cholangiopancreatography [MRCP] done to ten patients. The findings was clear where proximal and distal segments were delineated as well as the intrahepatic dilated biliary radicles. From this study it was concluded that diagnosis of biliary tract injury could start with ultrasonography examination, followed by MRCP to localize the site of the pathology and the proximal segment before biliary reconstruction

Management of civilian colon injuries

Over the past three decades, primary repair of colonic injuries has become more accepted and there has been a trend toward using this procedure for repairing civilian colonic injures. However, the best procedure remains controversial. Forty patients with colonic injuries alone or associated with other organ injuries were included in the present study over a 44 months period Benha University Hospital. After resuscitation, exploratory laparotomy was done and other organ injuries were appropriately managed. Colonic injuries were dealt with either by primary repair, age, blood transfusion, mechanism and site of injury and injury severity indices. The mechanism of injury was stab injury in 37.5% gunshout in 32.5% iatrogenic in 17% and blunt trauma in 13%. Isolated colon injuries were found in 27.5% and associated with small intestinal injury in 47%. The left colon injuries were found in 40% followed by transverse colon in 37.5%. Primary repair, either by debridement and simple closure in 2 layers or by segmental resection and primary anastomosis was done in 65% of patients while diversion procedures were carried out for 35% of patients. There were 3 mortalities and complications occurred in 30% of the studied patients. From this study we can conclude that there is no single policy for management of colon injuries either by diversion or primary repair. Good results can be obtained by proper decision of an experienced surgeon according to the individual circumstances of each case rather than following solid scheme by less experienced surge Primary suture should be limited to early cases induced by sharp agents or iatrogenic injury. For most severely traumatized patients diversion remains the most dependable method of treatment as it is followed by the least morbidity and mortality

Evaluation of splenectomy and devascularization operation on portal hemodynamics using Doppler ultrasonography

The present prospective study was designed to evaluate the effects of splenectomy and devascularization operation on the hemodynamics of portal circulation and the reliability of color Doppler ultrasonography as a non-invasive tool in the assessment of portal hemodynamics before and after the operation. Thirty patients [19 males and 11 females] with clinical diagnosis of portal hypertension and endoscopic evidence of oesophageal and/or gastric varices who underwent splenectomy and devascularization were included in this study. The mean age of the whole group was 32.12 +/- 1.8 years [range: 17-52 years]. Doppler scanning of the portal vein before and after the operation revealed a sign reduction in the maximum blood velocity postoperatively [mean 10.59 +/- 2.66 cm/sec. versus 12.51 +/- 3.16 cm/sec preoperatively], and a sign reduction in the volume blood flow postoperatively [mean 884.3 +/- 233.9 ml/mm. versus 1073.8 +/- 422.4 ml/mm., preoperatively], and insignificant change in the diameter. Also, the direction of blood flow was hepatopetal in all patients after operation, while it was bidirectional in. one patient and hepatopetal in 29 patients before operation. The study revealed a sign positive correlation between the size of the spleen and the decrease in the blood velocity and volume blood flow of the portal vein after operation. Also, there was a positively sign correlation between the presence of a history of injection sclerotherapy and the diameter and volume blood flow of the portal vein before the operation. From the present study, it was concluded that splenectomy and devascularization could be performed with extremely low mortality in selected elective patients, particularly the non alcoholic, with virtually no postoperative encephalopathy. This is in addition to the preservation of the vascular anatomy of the right upper quad rant for future use in potential liver transplant. The operation did not lead to complete disappearance of oesophageal varices, but sign reduction in their grades and injection sclerotherapy is recommended for variceal remenants. Based on the fact that there is a sign positive correlation between the size of the spleen and the decrease in the blood velocity and volume blood flow of portal vein after the operation, it is suggested that this splenic venous flow contributes, in part, to portal hypertension. The Doppler scanning is an ideal investigation for portal circulation, as it is noninvasive, cheap and provides accurate data about the velocity, volume flow, direction of blood flow and patency of portal circulation

Laparoscpy in diagnosis of acute lower abdominal pain

Thirty patients with acute lower abdominal pain of uncertain diagnosis were the material of this study. After a short time of observation without a definitive diagnosis. laparoscopic exploration was performed to help in establishing a correct diagnosis and management and avoid unnecessary laparotorny. At laparoscopy the diagnosis of acute appendicitis was made in ten patients. Gynaecologjcal pathology was diagnosed in thirteen patients, one patient had Mekel's diverticuiltis, while in six patients no definitive pathology was found. One patient among the last six had acute appendicitis as the appendix was not visualized completely, laparoscopy reduced the number of un necessary laparotomy. The procedures and the results were reviewed with the conclusion that laparoscopy is safe and useful as a diagnostic and therapeutic tool in management of patients with uncertain diagnosis of acute lower abdominal pain