Splenic autotransplantation in irreparable splenic injuries, is it functioning or not? [preliminary experience]

The spleen is an important organ in the body and its removal may result in serious complications especially in children, so we have to preserve it as much as we can. Splenic autotransplantation has been considered in the instances in which it is impossible to preserve any vascularized fragments or segments of the injuried spleen depending on the fact that sequestrated splenic fragments may survive and function. In this study 20 patients with major splenic injuries presented to the emergency unit, 14 males and 6 females, their age was less than 10 years in 6 patients while in 10 patients their age was ranged from 11 to 30 years and 4 patients were over 30 years. The mode of trauma in all cases was blunt abdominal trauma, Motor vehicle in 12 patients, fall from height in 7 patients and direct blow to the abdomen in one patient. The operative time ranged between 39 to 63 minutes with a mean time of 51 minutes. Our patients were followed up by repeated abdominal ultrasound to assess the maturation of the implanted splenic tissue and to observe occurrence of complications as abscesses at the site of implantation also after a period of 6 weeks postoperatively we assessed the function of the implanted tissue by scintigraphy. The implanted tissue grew and reached different sizes in all patients indicating success of the autotransplantation, also no complications were observed in any patient. In conclusion, splenic autotransplantation is a simple and safe procedure that does not require special skills and should be remembered to preserve the function of the spleen both in adults and children

Pre-peritoneal versus subcutaneous mesh repair for adult para-umbilical hernia

This study was a randomized clinical trial comparing pre-peritoneal versus subcutaneous mesh repair for adult para-umbilical hernia [P.U.H] in 40 patients, The outcome was carried over a period of 2 years between March 2002 to March 2004, in El-Minia university hospital, the patients were classified randomly into two groups; 20 patients in each. The first group underwent pre-peritoneal mesh repair for P.U.H and the second group underwent subcutaneous placement of the mesh for hernial repair. The operation was done under general or spinal anaesthesia. All patients received standardized pre-operative prophylactic antibiotic. The mean age of patients in both groups was [45.1] years, the majority of patients were females [30] representing about [75%]. we compared between the two groups as regard many, factors such as, difficulty of the technique, operative time, post-operative complications [seroma and wound infection, recurrence, and removal of mesh in the subcutaneous group]. The mean duration of surgery was longer in the lst group [45 min.] than in the 2nd group [35 min], hospital stay was longer in the 2nd group, postoperative complications were developed in 3 patients in the 2nd group [15%] while in one patient in the 1st group [5%]. In pre-peritoneal mesh repair although it is to some extent more difficult and more lengthy but it is more better with less complications and less hospital stay than the subcutaneous placed mesh repair for P.U.H and it is more satisfactory in males

Modified alvarado score: is there a role for reducing rate of negative appendicectomy?

To evaluate the usefulness of modified Alvarado scoring system in reducing rate of negative appendicectomy. In the period from July 2002 to April 2004, 122 patients with lower right abdominal pain were admitted and subjected to this prospective trial According to the modified Alvarado score [MAS] patients had ether a score = 7 or a score > 7. For those patients with mostly suspected appendicitis [score > 7] [73 patients] appendicectomy was performed. For those patients with possible appendicitis [score < 7] [14 patients] diagnostic laparoscopy was performed whenever indicated to confirm or refute the diagnosis The presence of a high score [over 7] was found to be an easy and satisfactory aid to early diagnosis of appendicitis in children and men with a diagnostic accuracy of 100%, 96.1% respectively, while in women, it falls disappointingly short of expectations [67%] with false positive rate over 30%. In patients with low score [<7] the diagnostic accuracy of MAS was 60%, 57.1%, and 50% in men, women and children respectively without statistically significant difference. However the use of laparoscopy reduced the negative appendix rate to zero% in this group. The Modified Alvarado score [did well in reducing rate of negative appendicectomy in children and men but diagnostic laparoscopy should be considered in women particularly in the childbearing age and in patients with possible appendicitis [score < 7]

Karydakis versus rhomboid flap in management of sacrococcygeal pilonidal sinuses

Many procedures have been described for the management of symptomatic pilonidal sinus, none of which, judged by the yardsticks of primary healing and recurrence of disease, is perfect. In our study, we are trying to compare the results of two widely practiced flap techniques, the Karydakis asymmetrical unilateral sliding flap and the rhomboid transposition flap suggested by Azab et al.1984. Forty patients were randomly divided into two groups. The first group was 20 patients and was treated by Karydakis flap. The second group was 20 patients and treated by rhomboid. The mean duration of symptoms was 7 months. The two groups were compared for age, sex, severity of the disease, operation time, complications and recurrence. Results and Discussion: We reported no great difference in recurrence rate [2 patients in Karydakis operation group and 1 patient in Rhomboid flap group], and also no great difference in the postoperative complications. The difference was recorded in the mean operative time [75 min in Karydakis flap group and 120 in Rhomboid flap group] and hospital stay [2 -5 days in Karydakis flap group and 7-9 days in Rhomboid flap group] and this reflects that the Rhomboid flap is more techniqually demanding procedure and so the patient usually needs to stay longer at hospital. The more complexity of the procedure explains the slight increase in the incidence of the postoperative complications