Predictor factors for success or failure of advancement anocutaneous flap closure of high fistula in ano

The fistula in ano is an ancient and common problem. Different methods of treatment evolved, but the ideal method up till now is not recognized because of the problems of recurrence and incontinence, specially in case of high fistula in ano. The aim of current study is to predict factors of success or failure of advancement ano cutaneous flap closure of high fistula in ano. or in other words to predict the patients who are suitable for treatment by this procedure. 30 cases with high fistula in ano were available for the study. 7 patients were shifted to another line of treatment because of inability to complete the procedure by the present procedure [2 cases with recurrent supra sphincteric fistulas, 2 cases with recurrent high anal fistulas, and case of suprasphincteric, ulcerative colitis fistula and two cases of suprasphincteric, crohn's disease fistulas], and the procedure was completed in the remaining 23 cases with neither recurrence, nor incontinence during the follow up period. In The procedure of ano cutaneous advancement flap closure of high fistula in ano is technically simple, comfortable to the patient, with neither recurrence nor incontinence, but unfortunately is suitable only for selected cases.

simple method to avoid recurrence in Licthenstein free hernioplasty in huge, longstanding inguinoscrotal hernia

Inguinal hernia [I.H] repair is one of the commonest surgical procedures and is an important training operation for youngs as it combines a low mortality risk and appropriate technical challenge. The optimum method for I.H. repair has not yet been determined. The recurrence rates for non mesh sture repair of I.H. vary between 0.2-33%, but licthenstein free hernioplasty [L.F.H.] has a world wide reported recurrence rate of 1%. The present study tried to compare the results of L.F. mesh onlay hernioplasty alone and the above method plus narrowing of U shaped internal inguinal ring to admit the tip of the little finger only by plication of the fascia transversalis as a separate step in huge, long standing inguinoscrotal hernia. There was no recurrence by adding this step compared by 3 cases of recurrences [16.6%] in control group. Adding U/S examination to the groin led to discovery of recurrence in two cases with groin pain but without bulge on straining

Will treatment of pilonidal sinus by elliptical rotation flap in selected cases prevent its recurrence?

Pilonidal sinus disease is a common, chronic intermittent disorder, with different theories regarding its etiology. There are different methods and procedures for the treatment. In current study, from January 2002 to January 2005, 32 patients were selected for the study. 2 cases were excluded. The surgical procedure is a vertical elliptical excision of the sinus and the diseased tissue and closure of the defect by rotational elliptical transverse flap without drain. There was neither recurrence rate nor other major complications. Mean follow up period was 14 months and hospital stay ranged from 12-24 hours. Elliptical rotation flap is recommended in selected cases for closure of the defect in case of pilonidal sinus disease with no recurrence rate and shorter hospital stay

Laparoscopic cholecystectomy conversion in relation to previous laparotomy

Laparoscopic cholecystectomy [L.C] has replaced open cholecystectomy for the treatment of gall bladder disease. However, certain cases still require conversion to open procedure. Several studies have predicted the operative condition and conversion rate of L.C from clinical manifestations, laboratory findings, ultrasonic findings, surgeon skill, etc. Previous laparotomy was considered as contraindication for L.C while in its beginning. The current study tried to predict the patients with previous laparotomies who are liable to conversion to open cholecystectomy. 22 patients with previous laparotomies were selected for the study and a similar number were chosen as a control group. Modified method of L.C was performed for the first group and classic L.C for control group. two cases from the first group needed conversion to open cholecystectomy [9%], while no one needed conversion from the control group [0%]. No major complications for all, but minor complications in both group [4 cases-18%] had occurred. Except for patients with previous laparotomy for peritonitis, L.C is a safe procedure

Well tolerated videotelelaryngography in the office

Living direct sight is the best method of documentation, both for the patient and physician. Our study aims to get a precise and well tolerated system for routine diagnostic living documentation of the larynx in the office. This was achieved by using the wide angled 70 degrees telescope sinoscope and attaching it to an endovision telecam, videorecorder and monitor. The slimline telescope, 4 mm diameter and 18 cm long, shows a precise image and is easily tolerated by most patients without topical anaesthesia. The magnified image by telecam is viewed on monitor and recorded by videorecorder as a permanent documentation. This system is applied on our patients from 4 months old. It could be tolerated in up to 100% of patients and resulted in minimizing the failure rate of visualizing the larynx to a very low extent [3%]

Silastic sheets in tympanoplasty: hearing outcome

Chronic inflammation of the middle ear is one of the most common diseases affecting population in our locality. Surgical managements of this disease sometimes result in the development of middle ear adhesions and hearing deterioration and communication disorders. This study included 106 selected subjects suffering from chronic otitis media [suppurative and non suppurative]. Selection depended on intraoperative findings which included the presence of adhesions and intact ossicles. Cases with ossicular necrosis, cholesteatoma, granulation tissues and tympanosclerosis were excluded. The studied subjects were classified into 2 groups. The first group [74 patients] underwent single stage tympanoplasty with insertion of silastic sheets [0.127 mm thick: on the medial wall. lateral to incus long process and between the incus and malleus]. In cases of opening the mastoid cavity a tube like silastic sheet was inserted in the aditus to avoid adhesions and to allow good ventilation. The second group [32 patients] underwent single stage tympanoplasty without silastic sheets insertion. Subjects of the two groups were audiologically evaluated preoperatively and 1 month, 6 months and one year postoperatively. The first group showed better air conduction and bone conduction averages one year postoperatively when compared to those of the second group. The difference was statistically significant. One can conclude that silastic sheets are inert and can prevent the recurrence or formation of adhesions in the middle ear cavity, as reflected by stably improved hearing. Therefore, it would be recommended to use silastic sheets in tympanoplasty for restoration and maintenance of hearing

Videoscopic study of adenoids and adenoidectomy

Videoscopic study was applied in this work for 2 main purposes. Firstly, to diagnose the size of adenoids depending on fixed landmark, that is the posterior lip of the torus tubarius. This was done on 230 patients above 3 years old and resulted in classification of adenoids size into 3 degrees. First degree "normal" has its anterior limit behind the posterior lip of the torus. Second degree has its anterior limit in line with the posterior lip of the torus. Third degree has its anterior limit in front of the posterior lip of the torus [high indication of adenoidectomy]. Secondly, to perform adenoidectomy under magnified vision on monitor and this was applied on 86 patients. By this maneuver, trauma to Eustachian tube orifice and posterior nasopharyngeal wall was avoided, any remnants and control bleeding points could be removed. During the period of follow up of 1-3 years, no case developed complications of recurrence, postoperative bleeding and middle ear troubles

Helicobacter pylori, association with upper gastrointestinal disease in Bahrain

One hundred and fifty consecutive patients with either mild or severe dyspepsia, were investigated for the presence of Helicobacter Pylori [HP]. HP were found in 51% of the patients in the gastric antrum and 26% in the duodenum. Antral HP occurred significantly more often in patients with superficial active gastritis compared to those with no evidence of inflammatory changes [P<0.01], strongly suggesting its role in the pathogenesis of upper gastrointestinal diseases in our patients

Shisha smoking and Reinke's edema

This study was done on 21 females, with age above 35 years, living in Saudi Arabia. All patients were suffering from dysphonia in the form of low pitched deep rough voice. They have only one common habit, i.e. shisha smoking more than 10 years. Indirect laryngoscopy revealed polypoidal swellings of both vocal folds. Microlaryngoscopy was applied for them and proved the nature of the lesions, Reinke's edema. The lesions of both vocal folds were removed in one setting operation following Kleinsasser trend. The treatise coincides with the studies, suggesting smoking as the underlying cause of Reinke's edema, but the pathophysiology is still obscure