Abdominal access injuries in laparoscopic surgery, a retrospective study

This study was performed to assess the incidence, diagnosis, management and morbidity and mortality of laparoscopic access injuries. Using available injury based reports,patients documents and some available video tape recording of some laparoscopic procedures, 54 patients were collected and reported of having laparoscopic access injuries out of total 608 laparoscopic surgical and gynecological procedures done in Kasr Elaini teaching hospital during the period from August 2001 to April 2003 representing 8.8% of the total cases in comparison to what was reported in the literature which showed low incidence of these access injuries ranging from 5/10000 to 1.3%. Most of the reported injuries were minor vascular injuries [2.6%] and extraperitoneal gas insufflation [3.7%]. These minor complications caused only some technical difficulties during the procedures but they had no impact upon morbidity and mortality of the patients and were managed conservatively. Major retroperitoneal vascular injuries and visceral injuries, although represented minor incidence in our study 0.5% and 1.3% respectively, yet they were the major source of morbidity and mortality to the patients. Not only so but they also necessitate termination of the primary procedure and conversion to open surgery for their management. It seems that there is no single method of laparoscopic access safer than the other since there was no significant difference between them in inducing injury. In although laparoscopic access injuries seem to be of low incidence, yet they should be minimized. Since access injuries may be the result of integration between patient related factors, surgeons factors and the technique of access, so adoption of good laparoscopic technique, improvement of learning curve of junior surgeons proper site selection and port placement and proper choice of equipment, all may reduce the risk of access complications

Trauma score systems: prediction of hospital outcome of critically ill trauma patients: a validation study

Most standard trauma score systems have been developed to predict the outcome and assess the severity of trauma patients. This study test the validity of seven current trauma scoring systems [Glasgow coma scale, APACHE II score, trauma score [TS], Revised Trauma Score [RTS], Injury Severity Score [ISS], TRISS TS, TRISS RTS in 612 patients. Between January 1, 2003 and December 31. 2003, all trauma patients who were admitted to the surgical ICU in Kasr Al Aini hospital with a trauma score [TS] below 16 were included in this study [n=625]. Complete evaluation was successfully done for 612 patients [97%]. Their hospital outcome regarding morbidity and mortality was correlated with their individual score result. All trauma score systems under study showed high accuracy rates. TR1SSRTS and TRJSSTS performed the best accuracy rates in assessing the hospital outcome of trauma patients

Lymphatic mapping and sentinel node analysis to optimize resection and staging of colorectal cancer

30 patients with clinically localized colorectal neoplasms or premalignant polyps underwent preoperative submucosal injection of isosuflan blue dyevia colonoscopv. Blue stained lymphatics were visualized during surgery and followed to sentinel lymph node [SLN], which was tagged with black silk sutures. Colectomy was completed in the standard fashion. Postoperatively' all [SLN] were stained by haematoxilin and eosin, and multiple sections of each SLN were examined by immunohistochemical staining using cytokeratin antibody. SLN was identified intraoperatively in all patients. The SLN accurately predicts the tumour status of the nodal basin in 93% of cases. In 8 cases [29%]. an unexpected lymphatic drainage pattern altered the extent of mesenteric resection, and in 4 cases [14%] tumour deposits were identified by immunohistochemical staining and limited to the SLN. This study confirms that SLN mapping can alter the margins of resection and may improve proper staging of tumour and hence adjust the need of post Operative adjuvant therapy and minimize the possibilities of recurrence

role of total mesorectal excision and short term preoperative radiotherapy in improving the outcome of rectal cancer surgery

Colorectal cancer is the most common gastrointestinal cancer. One of the main problems in the treatment of rectal cancer is the development of local recurrence. Recurrences of rectal cancer are often confined to the pelvis without distant metastases and considered as a loco-regional failure. Total mesorectal excision [TME] was described 25 years ago and is now being established as the therapeutic gold standard for rectal cancer surgery in a number of countries worldwide. The analysis of this study which included 54 patients who underwent potentially curative radical surgery for rectal cancer showed that the introduction of TME has led to substantial lower loco-regional recurrence rate within the first 2 years postoperatively from 66.6% in group A [20 patients] to 33.3% in group B [34 patients]. Further improvement was recognized in group B2 who underwent TME + short course of preoperative radiotherapy. However the risk of anastomotic leak was higher among the low anterior resection+ TME group [5 patients] 25%, specifically in those who received a short term preoperative radiotherapy, in comparison with patients among [group A] who underwent curative low anterior resection without TME. Despite the initial controversy. TME + preoperative short term adjuvant radiotherapy is now a feasible, reproducible, adjunctive therapy in the management of rectal cancer

Laparoscopic vertical banded gastroplasty versus laparoscopic adjustable gastric banding in morbidlty obese patients: a comparative study

To compare between laparoscopic vertical banded gastroplasty and laparoscopic adjustable gastric banding as regard the operative procedure, efficiency, clinical results and complications, in the treatment of morbid obesity A total of 40 morbidly obese patients, with body mass index [BMl] 40 to 50 kg/m[2] were selected to either laparoscopic adjustable silicone banding [LASGB] [n = 21 cases] or laparoscopic vertical banding gastroplasty [LVBG] [n 19 cases]. The patients were operated upon during the period between February 2000 to November 2001 with a follow up period of 24 months postoperatively There were no deaths in both groups but conversions to open surgery in one case in [LVBG]. Mean operative time was 94.2 minutes in [LVBG] versus 65.4 minutes in [LASGB] [P < 0.05] Early morbidity rate was lower in LASGB [6.1%] versus LVBG [9.8%]. Mean hospital stay was shorter in LASGB [3 days] versus LVBG [6 days [P < 0.05,]. Late complications in LVBG was 14% and in LASGB was 32.7% [P < 0.05]. The most frequent complication was slippage of the band [18%]. Late reoperations rate in LVBG was 0% versus 24.5% in LASGB [P < 0.001]. Weight loss in LVBG after 2 years was [63.5%], versus 41.4% in LASGB. BMI in L VBG at 2 years was 29.7 kg/m[2] versus 34.8kg/m[2] in LASGB. This study demonstrates that, in patients with BMI 40 to 50 kg/m[2], LASGB requires shorter operative time and hospital stay but LVGB is more effective in terms of late complications reoperations and weight loss