Open versus laparoscopic anterior highly selective and posterior truncal vagotomy in the treatment of chronic duodenal ulcer

Vagotomy has almost replaced gastric resection in the treatment of chronic duodenal ulcer in most of surgical centers, and the highly selective type is a logical step in the direction of more conservatism. In the present study, open versus laparoscopic anterior highly selective vagotomy [HSV] and posterior truncal vagotomy [TV], were used for the treatment of chronic duodenal ulcer [CDU] and the results were evaluated. Anterior HSV and posterior TV were used to treat 38 patients with CDU. Twenty patients were managed by open surgery [group I], and 18 by laparoscopic surgery [group II]. Laparoscopic surgery was performed successfully in 15 patients [83%], while it failed in 3 patients [17%] and converted into open surgery. The mean operative time was 90 minutes in the open surgery group [OSG], and 150 minutes in the laparoscopic surgery group [LSG]. The mean postoperative hospital stay was 12 days in the OSG, while it was 3 days in the LSG. The basal acid output [BAO] and the maximal acid output [MAO] reduced significantly in both the OSG and LSG groups [P<0.01]. By assessment using the Visick scale, in the OSG, 14 patients [70%] were Visick grade I, 4 patients [20%] were Visick grade II, and 2 patients [10%] were Visick grade III, Using the same scale in the LSG. 12 patients [80%] were Visick grade I. one patient [7%] was Visick grade II, and 2 patients [13%] were Visick grade IV. Recurrence occurred in 2 patients [10%] of the OSG, and in one patient [7%] of the LSG. We concluded that although both open and laparoscopic surgery offers satisfactory results in the treatment of CDU, the later could be considered as a reasonable alternative. It is a minimally invasive technique with minimal operative and postoperative morbidity and short hospital stay

Prosthetic versus non-prosthetic rectopexy with temporary anal circulage through posterior sagittal approach in the treatment of adult complete rectal prolapse

Twenty-four adult patients with complete rectal prolapse [CRP] were admitted to the Surgical Department, Tanta University Hospital. The patients were divided, with random selection, into two equal groups; group I, in whom prosthetic rectopexy [PRP] were performed and group II, in whom non-prosthetic rectopexy [NPRP] were performed, using the posterior sagittal approach [PSA] with temporary anal circulage. The mean age of patients was 35 years and the follow-up period ranged from 6-36 months. Complete cure of the prolapse occurred in all patients, and only 2 anterior mucosal prolapse [16.7%] were observed in group II patients and treated by simple mucosal excision 2 months later. Incontinence to flatus was present in 4 patients [33.3%] of group I and in 3 patients [25%] of group II. Incontinence to loose stool was present in 3 patients [25%] of group I and in 2 patients [16.7%] of group II. Incontinence to flatus and loose stool improved within one month postoperatively in both groups. Superficial wound infection occurred in 3 patients [25%] of group I and in 2 patients [16.7%] of group II and resolved within 3 weeks postoperatively. No recurrence was observed during the period of follow-up. The management of adult CRP, by rectopexy through PSA, either by using polypropylene mesh [PRP] or without using mesh [NPRP], with temporary anal circulage, is a safe and easy procedure with good mobilization and fixation of the rectum and an easy access to the repair of pelvic floor muscles

Thrombosis and cavernomatous transformation of the portal vein among hepatic diseases and hepatic arterial buffer response

Portal vein thrombosis [PVT] and cavernomatous portal vein [CPV] are rare conditions that may affect both children and adults. In this study the incidence of PVT and CPV among different liver conditions were recorded and the results were evaluated. From January 1993 to December 1999, 353 patients with different liver conditions were evaluated, regarding the clinical presentation, the liver pathology and the ultrasonographic findings in the portal system and hepatic artery. Of the 353 patients, 224 were males [63.5%] and 129 were females [36.5], with a mean age of 36 years [range 9 to 58 years]. The early clinical presentation was abdominal pain and vomiting and/or fever, while the late presentations were that due to portal hypertension such as variceal bleeding. The liver pathology was periportal fibrosis [PPF] in 124 cases [35.1%], cirrhosis in 48 cases [13.6%], mixed cirrhosis and PPF in 163 cases [46.2%], hepatocellular carcinoma [HCCa] in 16 cases [4.5%] and post-splenectomy acute PVT in 2 cases [0.6%]. By ultrasonography, PVT was found in 22/353 patients [6.2%] with the different liver conditions. CPV transformation was found in 4/353 of such cases [1.1%]. By studying the hepatic arterial buffer response, the resistive index [RI] was found to be as low as 0.558 in cirrhosis and HCCa patients with PVT and as low as 0.490 in postsplenectomy patients with acute PVT. We concluded that Early diagnosis of PVT or CPV transformation, in patients with risk factors, by their clinical presentation and a meticulous technique of duplex scanning of the portal system, is very important to avoid early bowel ischaemia or late variceal hemorrhage