Inguinal hernioplasty by laparoscopic total extraperitoneal versus open lichtenstein techniques: a randomized prospective study

Different techniques of laparoscopic inguinal hernioplasty are performed. The total extraperitoneal approach [TEP] represents an important such techniquc. In a randomized prospective study, we compared the TEP with the standard open repair. namely Lichtenstein hernioplasty. Thirty two adult males with inguinal hernia were included in the study. They were randomly and equally divided into two groups: open Lichtenstein [OL] group and laparoscopic [TEP] group. Data were collected regarding operative time, complications. positoperative pain, hospital stay, and resumption of normal activities. The mean follow up period was 15 months ranging from 10 to 23 months. The OL group included two direct hernias, while the TEP group included three direct hernias while the rest were indirect. The operative time for the OL group was significantly shorter the TEP group with a mean and range of 44 [30-80] versus 95 [60-160] respectively. TEP group had significantly less postoperative pain and analgesic needs compared to OL group. TEP patients resumed their normal activities significantly sooner than OL patients. Hospital stay did not differ between the two groups. Intraoperative bleeding from the inferior epigastric artery occurred once in the TEP group and was well controlled. Minor postoperative complications in the form or seroma, wound infection, and urinary retention were reported in both groups with no statistically significant differences and resolved spontaneously. Although requires longer operative time than open Lichtenstein inguinal hernioplasty, laparoscopic TEP hernioplasty results in less postoperative pain. analgestic, requirements. and earlier return to normal activities with comparable hospital stay and postoperative complications. Consequently, laparoscopic TEP inguinal hernioplasty could be considered as a strong competitor to the standard Lichtenstein technique. Still larger comparative studies with longer follow up are needed to objectively prefer one technique over the other

Efficacy of pre-operative chemotherapy and sequential radiation therapy in irresectable rectal carcinoma

To evaluate the toxicity and relative response rates of addition of cisplatin to 5-fluorouracil and leucovorin preoperative induction chemotherapy followed by local radiotherapy in irresectable rectal cancer and their impact on radical resectability and sphincter preservation. Between January 2002 and April 2006, 29 patients with locally advanced unresectable rectal cancer received two cycles of 5-fluorouracil 600mg/m[2], I.V 6h infusion D[1]-D[5] and D[22]-D[26], Leucovorin 20mg/m[2], I.V 1h infusion D[1]-D[5] and D[22]-D[26] and cisplatin [CDDP] 60mg/m[2], I.V 6h infusion D[1] and D[22] after good hydration. Radiation treatment was administered after two weeks of the second cycle of chemotherapy. The dose was 45 Gray in 25 fractions over 5 weeks prescribed at isocenter of the plan to include the rectum and the draining lymph node chains. Tumor dimensions were assessed by CT scan before the start and 4 weeks after chemoradiotherapy. Tumor response classification was based on the standard World Health Organization criteria. Complete response [CR] is complete disappearance of the disease. Partial response [PR] is a decrease of 50% of the sum of the products of the greatest perpendicular diameters [SPD]. Progressive disease [PD] is appearance of a new lesion or an increase of 25% in SPD. Stable disease [SD] is no change in SPD or a change not reaching PR or PD. Overall response rate [ORR] is CR plus PR. Our regimen was well tolerated. The main toxicity to it was grade II hematological and grade II and III GIT toxicities in 31% and 65.5% respectively. PR occurred in 58.6% [17/29], SD in 20.7% [6/29] and PD in 20.7% [6/26]. Anterior resection of the rectum with total mesorectal excision and sphincter preservation was done in 37.9% [11/29], abdomino-perineal resection in 31.05% [9/29] and palliative colostomy in 31.05% [9/29]. Radical resectability was achieved in 62.1% [18/29] and cytoreductive surgery in 6.9% [2/29]. After 2 years follow up of resected cases, the 2 years disease free survival was 60% [12/20] with 25% [5/20] local recurrence rate and 15% [3/20] distant metastases to the liver. Our pre-operative combined modality therapy seems to have potential advantage in tumor response, local control and sphincter preservation with tolerable acute and chronic toxicity. Sequential use of chemo-radiotherapy needs more studies to estimate the maximum tolerable dose of chemotherapy and radiotherapy with least side effects

Nursing role toward patients undergoing abdominal laparoscopic surgery; A suggested training program

Teaching programs for nursing staff constitutes an important part. These programs are urgently designed to assist staff nurses in developing and enhancing their skills needed to provide high standards of care to their patients. In the present study, the researcher tried to investigate and identify needs for developing and implementing a training program designed towards improving the knowledge and performance of nurses working in the surgical departments of Assiut University Hospital. The study aimed to assess the role of nurses in caring for patient's undergoing Abdominal Laparoscopic Surgery and to suggest a training program for nurses caring for patients undergoing Abdominal Laparoscopic Surgery in the surgical department. The assessment needs for developing program was determined by test questionnaire sheet and observation checklist. The study included all male and female nurses [N=63] working in the general surgical departments. They were most of them holders of the diploma of nursing and very small number holders bachelor of nursing. The program was evaluated applying the same tools used in the assessment phase, then immediately after the program implementation. The main results obtained were as follows. The nurses' knowledge and performance related to caring of patients undergoing Abdominal Laparoscopic Surgery in surgical department was quite poor. The educational program showed improvement in nurses knowledge and performance regarding the nursing care of patients undergoing Abdominal Laparoscopic Surgery The results of comparison between the pre-test and post-test showed statistically significant differences. The present study concluded that nurses in general surgical department have unsatisfactory level of knowledge and performance. Attending training or orientation programs about caring for patients undergoing Abdominal Laparoscopic Surgery is absolutely lacking for nurses serving in the general surgical department. During their nursing practice, they usually lose their knowledge and skills related to caring patients after coming form PACU as they are not well trained and are not assigned for such activity. Moreover, they lack background knowledge and any experience as regards pre and post operative caring of patient undergoing Abdominal Laparoscopic Surgery in spite of its crucial importance for managing patients in the general surgical department. However, they can gain the necessary knowledge and technical skills that will enable them to perform better after the exposure to a well planned and organized training program. The present study recommended that educational department should be established within Assiut University Hospital to prepare and improve the nursing staff level of knowledge and performance

Evaluation of clinical significance of prostate specific antigen and other tumor markers in breast cancer

To evaluate the significance of prostate specific antigen [PSA], both total and free, carcinoembroynic antigen [CEA] and carbohydrate antigen 15 -3 [CA15- 3] in breast cancer serum levels of total and free PSA, CEA and CA15-3 were measured in 60 female patients with breast cancer at time of primary diagnosis. The patients were divided into 4 groups according to the stage of breast cancer and the results were compared with those of 25 apparently healthy females as controls. The study revealed that, total PSA was detected in serum of 4% [1/25] of healthy controls and 18% of breast cancer patients. Free PSA is the predominate molecular form of serological PSA in 54% of patients with increased total PSA levels. Free and total PSA, levels were highly significantly increased in advanced stages of breast cancer [III and IV] in comparison to control group, stage I and stage II [P < 0.001]. There was significant negative correlation between PSA [total and free] and age of breast cancer patients [r = 0.285,P< 0.05, r = -0.295, P<0.05 respectively]. There was significant positive correlation between PSA [total and free] and stage of breast cancer [r = + 0.470, P <0.001, r = +0.399, P <0.01 respectively] CEA levels were significantly increased in stage I [P< 0.05], stage II [P < 0.01] stage III and IV [P < 0.001] in comparison with control group. Levels of CEA and CA 15-3 were significantly high in stages III and IV compared with stages I and II [P < 0.001]. There was significant Positive correlation between [CEA, CA15-3] and stage of breast cancer [r = +0.314, P<0.05, r = + 0.547, P <0.01 respectively]. There is a positive correlation between [CEA and CA15-3 [r = +0.597, P<0.001]. In conclusion: Levels of serum PSA and CA 15-3 increased in late stages of breast cancer and so they cannot be used as a screening diagnostic tool for breast cancer. Although CEA increases early in breast cancer, it cannot be trusted as a diagnostic tool for breast cancer as its levels are elevated in a variety of cancers, so it may be used as a screening test. There is a positive correlation between CA 15-3 and CEA, which can be used together for follow up and prognosis of breast cancer