Early oral feeding in patients undergoing elective colonic anastomosis

Recent evidence seems to indicate that immediate postoperative feeding if feasible is safe after either laparoscopic surgery or laparotomy. This study is done to assess the safety, outcome of early oral feeding and shows factors affecting early postoperative feeding after colorectal procedures. Between June 2005 and April 2008, 120 consecutive patients underwent elective colonic anastomosis were then randomized into 2 groups. Early feeding group began fluid on the first postoperative day and regular feeding group were managed in the traditional way- nothing by mouth until the resolution of the ileus. The majority of patients [75%] tolerated the early feeding. The time to first passage of flatus [3.3 +/- 0.9 d vs. 4.2 +/- 1.2 d] and stool [4.1 +/- 1.2 d vs 4.9 +/- 1.2 d] were significantly sooner in group 1. Hospital stay is significantly shorter in early feeding group [4.2 +/- 0.2 d vs. 6.9 +/- 0.5 d]. Operative time and amount of blood loss had a significant impact on tolerability of early feeding while age, gender, type of operation, and previous abdominal operation had no significant impact. Early oral feeding after colorectal surgery is safe, tolerated by the majority of patients. Operative time and amount of blood loss has impact on the tolerability of early feeding

Limited excision and primary closure for pilonidal sinus

Pilonidal disease is a common disorder of the sacrococcygeal region. Various techniques have been used but no method provides the ideal treatment. This study was done to establish to what degree pilonidal sinus could be treated with limited excision and primary closure. 39 patients with chronic pilonidal sinus were treated by limited excision and primary closure between July 2005 and January 2008 by the authors at general surgery department Mansoura University Hospital. They were followed up in the early postoperative period and thereafter for 12 to 30 months. One patient had mild seroma, another one developed irregular scar with accepted healing outcome. All patients were discharged from hospital in the 2nd postoperative day. Operative wounds healed in a period ranged from 12-22 days. The postoperative follow-up now ranges from 12 to 30 months, and no recurrences have been recorded so far. Limited excision of Pilonidal Sinus represents a good therapeutic option for treatment of pilonidal sinus This method has the advantages of having a low morbidity, short hospital stay, early return to work, no recurrence and good long-term results

Rubber band ligation for 550 patients of symptomatic haemorrhoids out of 2200 patients retrospective study

This retrospective study was conducted to elucidate the results of the treatment for symptomatic haemorrhoids using rubber band ligation [RBL] method. Method: a retrospective study for 550 patients who came to the colorectal unit from June 1998 to June 2006, data was retrieved from archived files. Forty four patients with haemorrhoid had liver cirrhosis.RBL was performed using the Mc Gown applicator on an outpatients basis. The patients were asked to return to out-patient clinic for follow up at 2 week, 1, 6, months and through telephone call every 6 month for 2 years]. After RBL 496 patients [90.18%] were cured with no difference in outcome for first, second or third degree haemorrhoids [P value = 0.31]. symptomatic recurrence was detected in 16.03% after 2 years then repeated RBL or surgery were done for them. A total of 88 patients [16%] had 155 complications from RBL which required no hospitalization. Complications were registered; pain in 10.37%, rectal bleeding in 8.36% and vaso-vagal symptoms in 7.81%. RBL is a safe and successful method for treating symptomatic haemorrhoids, even in cirrhotic patients

Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Proximally based versus distally based gluteus muscle flap in treatment of end stage fecal incontinence

To compare proximally based versus distally based gluteus maximus muscle flap transposition in patients with end stage fecal incontinence. Between August 2005 and August 2007, this prospective randomized study was performed on twenty patients with an end stage anal incontinence. They were sixteen men and four women with an age ranging from 7 to 31 years. A proximally based gluteus maximus flap [group III] was carried out in ten patients while, a distally based flap [group I] was done in the other ten. Patients were followed up for 6 - 18 months both subjectively and objectively with evaluation of their incontinence score, anorectal manometry, saline enema test and magnetic resonance imaging [MRI]. Overall, 6/10 patients [60%] in group I and 8/10 patients [80%] in group II were clinically improved with down staging of their incontinence scores from C3 to 0 [P 0.003 and 0.0001 respectively]. This was confirmed by the significant changes in anorectal manometry and saline enema test. MRI done one month postoperatively showed disruption in three patients. Proximally based gluteoplasty appears to be an excellent encirclement procedure that restores voluntary squeeze pressure as well as rectal sensation when compared with unilateral distally based gluteoplasty

sensitivity and specificity of ultrasound-guided core-needle biopsy of neck masses

Neck masses are common presentations that often require tissue sampling to guide therapy. While open biopsy is invasive, fine needle aspiration cytology includes a high rate of nondiagnostic samples. We performed a retrospective analysis on 166 ultrasound-guided core-needle biopsies form the necks of 68 patients. The target tissue was correctly sampled in 64 patients, and on revision biopsy it reached to 66 patients [97%]. We experienced 97% success in obtaining high quality histopathologic specimens [66 out of 68 cases]. In these 66 patients the sensitivity and specificity in differentiating benign from malignant lesions was 97.6%, and 100% respectively. We conclude that ultrasound-guided core-needle biopsy is a safe and reliable technique in the diagnosis of neck masses with high diagnostic yield and high tissue quality for histopathology that represents a sufficient alternative to open biopsy, even in diagnosis of lymphoma

Modified extra dartos pouch orchiopexy: preliminary report of 72 cases

Undescended testes are a common problem, affecting up to 3% of newborn males. The goals of orchiopexy in humans are to provide adequate scrotal fixation, to prevent recurrent torsion of the testis and spermatic cord or ascent of the testis, and to achieve these goals with minimal trauma to the testis. The best method of achieving fixation remains controversial. The aim of our study is to evaluate our modified extradartose pouch technique in retaining testis in the scrotum. Patients and methods: Between August 2005 and September 2008. Our studied group included 61 patients with 72 orchiopexies age ranged from 5 months to 15 years with the mean age of 58.5 +/- 40 months [4.8 years] all cases had palpable undescended testis 20 pa tients [32.7%] had unilateral left side 30 patients [49.1%] had unilateral right side and 11 patients [18%] had bilateral undescended testis. Testis was located in the superficial inguinal pouch in 33 cases [45.85%], intra-canalicular in 39 cases [54.16%]. Hernial sac was found in 69 cases [95.8%], postoperative wound infection occurred in one case[1.38%] and haematoma formation in two cases [2.77%] no ascent of the testis nor testicular atrophy was observed in the follow up period. which extends now up to 3 years and we still follow up those cases.3 patients [4 orchiopexies] lost follow up. Our modified technique for extradartose pouch fixation seems to be a fast reliable method for orchiopexy however comparative studies and long term assessment is still needed to establish this method

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation, 5-fluorouracil and oxaliplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006, 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a fourfield technique to a dose of 50.4Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130mg/m[2] on day 1 plus 30 minute infusion of 100mg/m[2] L-folinic acid and continuous infusion of fluorouracil 350mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction. Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [67.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%] the operative specimen was sterilized and in 2/44 patients [4.5%] only very few residual malignant cells difficult to find microscopically were detected. Pathological downstaging was diagnosed in 70.5% [31 out of 44 patient]. Local and distant progression occurred later in 9 patients and the 2-year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were 12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological downstaging and sphincter-saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen

Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study

Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy [LC] feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy [OC] versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group [55 patients] and LC group [55 patients]. There was no operative mortatity. In LC group 4[7.33%] patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group [96.13+17.35m vs. 76.13+15.12] P<0.05, associated with significantly higher intraoperative bleeding in OC group [P<0.01], necessitatating blood transfusions to 7 [12.72%] patients in OC group. The time to resume diet was 18.36+8.18h in LC group which significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group [6+1.74 days vs. 1.87+1.11 days] P<0.01 with low postoperative morbidity. LC in cirrhotic is still complicated and highly difficult which associates with significant morbidity compared with that pf patients without cirrhosis. However, it offers lower morbidity, shorter operative time, early resume dieting with less need for blood transfusion and reducing hospital stay than OC.

Effect of helicobacter pylori eradication on ulcer healing and recurrence after simple closure of perforated duodenal ulcer

Helicobacter pylori [H.Pylori] plays a fundamental role in the causation of duodenal ulcer. This study was conducted to elucidate the prevalence of H.Pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H.Pylori prevent ulcer recurrence following simple repair of the perforation. Eighty three patients admitted with perforated duodenal ulcer, only seventy seven patients treated with simple closure included in our study. Sixty five patients [84.4%] who had H.Pylori infection were randomly divided into triple therapy group [34 patients] and alone group [31patients]. Follow up endoscopy was performed at 8 w, 16 w and 1 year to show the ulcer healing and determine H.Pylori. The eradication of H.Pylori was significantly higher in triple therapy group than omeprazole alone group [at 8 weeks 91.2% vs. 22.6% respectively]. Initial healing of ulcer was significantly better in eradication group and after one year the difference in ulcer recurrence between the two groups was statistically significant [2[6.1%] in eradication group vs. 8 [29.6%] in omeprazole alone group P=0.001]. H.Pylori was present at a high ratio in patients with duodenal ulcer perforation. Eradication of H.Pylori after simple closure of a perforated duodenal ulcer reduces the incidence of recurrence ulcer

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation. 5-fluorouracil and oxallplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006. 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a four-field technique to a dose of 50.4 Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130 mg/m[2] on day 1 plus 30 minute infusion of 100 mg/m[2] L-folinic acid and continuous infusion of fluorouracil. 350 mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [6 7.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%]. the operative specimen was sterilized and in 2/44 patients [4.5%]. only very few residual malignant cells difficult to find microscopically were detected. Pathological down staging was diagnosed in 70.5% [31 out of 44 patients]. Local and distant progression occurred later in 9 patients and the 2- year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were .12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. - Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological down staging and sphincter saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen