Laparoscopic fenestration versus percutaneous aspiration and alcohol instillaion in the management of symptomatic simple non parasitic liver cysts

This study included 20 patients with definitely symptomatic nonparasitic liver cysts who were divided randomly into two groups, each included 10 matched cases. A follow up was done for a period of 12-24 months for the recurrence of symptoms or cysts on the follow up CT or ultrasonography. In the laparoscopy group, a wide fenestration was possible in all cases without mortality or long-term morbidity, the mean hospital stay was four days and the patients were asymptomatic with no evidence of recurrence on the serial follow up CT during the period of follow up. In the radiological group, the procedure could be accomplished in all cases with no mortality or side effects, the mean hospital stay was two days, but failure occurred in two cases with large cysts and recurrence occurred in one case after six months in follow up CT

Prophylactic gastrojejunostomy in the palliative management of irresectable periampullary cancer should be routine or selective?

In cases with irresectable periampullary carcinoma of the pancreas whenever open surgery is deemed necessary for palliation, biliary - enteric bypass is a routine but adding prophylactic gastrojejunostomy in the absence of duodenal obstruction is a matter of controversy despite a lot of research. This study is a prospective comparative study that includes 60 patients diagnosed either pre-or intra-operatively as irresectable peniampullary carcinoma of the pancreas without evidence of impending duodenal obstruction Patients included in the study are divided into three groups. Group I include 26 patients diagnosed preoperatively and palliated by endoscopic biliary stenting alone. Group II include 17 patients where open surgery is deemed necessary for palliation, either due to failure of endoscopic biliary stenting or intraoperative diagnosis of irresectability, palliation is done by biliary diversion only [Roux- en-Y choledochojejunostomy]. Group III include 17 patients with the same criteria as group II but palliation is done by biliary diversion together with prophylactic gastrojejunostomy. Follow up is that done tilt development of duodenal obstruction or cancer related death. The result is that there is no increase in mortality or morbidity by adding prophylactic gastrojejunostomy to the initial operation .Late duodenal obstruction occurred in 17.6-19% when no gastrojejunostomy was done with high mortality 20-33% after late intervention. We recommend adding prophylactic gastrojejunostomy as a routine in the palliation of irresectable periampullary carcinoma whenever open surgery is needed even in absence of duodenal obstruction

V-Y advancement island flap for the management of low resting pressure chronic anal fissure

The majority of patients with chronic anal fissure show higher resting anal pressure than normal and responds well to sphincter weakening procedures [surgical or chemical] and lateral internal sphincterotomy is the gold standard for treatment. But there is a subset of patients that show low resting anal pressure and should be identified as application of a sphincter weakening procedure here may endanger continence. In this study patients with chronic anal fissures were subjected to careful history taking, examination, anal manometry and endoanal ultrasound Patients with resting anal pressure less than 90 cm H2O and maximum squeeze pressure less than 260 cm H[2]O and / or endoanal ultrasound showing anatomical defect in anal sphincter, provided absence of incontinence or stenosis and absence of specific pathology, were eligible for the study Thirty patients were included and were managed by V-Y advancement skin flap and were followed up for 6 months All fissures were healed without recurrence during follow up and continence was preserved. The flaps were taken in all cases without necrosis or contracture but transient wound infection occurred in 3 cases [10%].The result was described as excellent in 90% and as satisfactory in 10% of cases

Evaluation of blunt abdominal trauma with a protocol using both diagnostic peritoneal lavage and computed tomography

The purpose of this study is to try to evaluate blunt abdominal trauma patients for presence of intra-abdominal injury rapidly and effectively .A protocol is tested combining and selecting the use of physical examination, diagnostic peritoneal lavage [DPL] and abdominal computed tomography [C.T] with the aim to avoid missing injuries or to do non therapeutic laparotomies and also aiming to reduce health cost. Preprotocol period [20 months] include 651 cases that were triaged according to haemodynamic stability and result of abdominal examination, into 3 groups. Group I [stable patients with suspicious or unreliable abdominal examination] include 150 patients that were evaluated by abdominal CT. Group II [unstable patients] include 52 patients that were evaluated by DPL alone. Group III [stable patients with reliable and normal or mildly symptomatic abdomen] include 449 patients that were evaluated by physical examination alone. The protocol period [16 months] include 512 patients that were triaged, as in the pre-protocol period, into group l[153 patients], group ll[26 patients] and group III [333 patients]. Evaluation in groups II and III were the same as in the pre protocol period while in group I cases were evaluated by DPL followed in positive cases by abdominal C.T to decide upon conservative treatment. The results in groups II and III were comparable in both pre-protocol and protocol groups. However in group I in the protocol period there is drop in the use of emergency C.T from 23% to 8%, drop in missed injuries from 6% to zero% and no non therapeutic laparotomies were done in either the protocol or pre-protocol period. This protocol is recommended to be used in the evaluation of blunt abdominal trauma patients