Management of bleedine oesophagogastric varices by stapled oesophageal transection and splenectomy vasoligation

This study included thirty patients presented with recurrent bleeding from oesophago-gastric varices, they were resuscitated, diagnosed by fibre-optic endoscopy and subjected to full clinical and laboratory investigations and were classified according to Child-Paugh classification as 18 patients class [A] [60%] arid 12 patients as class [B], [40%] they underwent splenectomy vasoligation, direct gastric variceal ligation and oesophageal transection using EEA stapler, patients were followed up I year for further bleeding and endoscopically to show the fate of varices. Complete eradication of varices was noted in 13 patients [46.4%] and the grade of varices greatly diminished in the others. The mortality rate was 2 patients 6.6%, complications were minors and mostly transitory. included transient dysphagia in 4 patients [13.3%] and persistant dysphagia in one patient [3.3%], pulmonary complications in 4 patients, [13.3%], gastric stasis in one patient [3.3%] and heart burn in 6 patients. [21.4%]. Late complications [in suruived 28 patients] included ascites in 5 [17.8%] patients, Encephalopathy in one [3.57%] and incisional hernia in two patients [7.14%]. It is concluded that oesophageal transection and splenectomy vasoligation with direct ligation of fundic varices in treatment of recurrent bleeing oesophagogaatric varices, is simple, effective method for variceal eradication arid control of bleeding

new method for the repair of Medicine and paramedian incisional herniasa Rectus Repair

Forty four patients with large and difficult mid-line and paramedian incisional hernias were included in. this study; 31 were females [70.5%] and 13 were males [29.5%]. Their ages ranged from 35 to 72 years with mean age .42.5 Twenty eight [64%] patients had infraumbilical incisional hernias, and 16 patients [36%] had supraumblical [cat incisional hernias. This study is a trial to restore the normal anatomy of mid line. Anterior rectus sheath, both recti muscles in close contact to each other, posterior rectus sheath, and peritoneum. This is by utilizing two incisions, one is made in anterior rectus sheath cm or more from the edge of the defect, completely encircle the defect, another two relaxing incisions are made in lateral part of external oblique aponeurosis. So it was called a "Rectus Repair". All patients underwent the rectus repair. Hospital stay ranged from 12 to 21 days.Early postoperative complications were minor as chest infection, seroma, wound infection. serous discharge, wound gaping, and sinus formation, all were conservatively controlled. Follow-up for 1 to 3 years with no detectable recurrence. Rectus repair provides anatomical reconstruction of abdominal wall in layers without tension on the suture lines