prospective, randomized comparative study between mini and conventional laparoscopic nephrectomy

Background: Renal cancer is the commonest renal tumor and is usually treated by radical nephrectomy. Development of laparoscopic surgery was associated with reduction of post-surgical complications and the invent of mini laparoscopic devices proposed to be associated with marked reduction of postoperative complications

Objective: to compare between mini and conventional laparoscopic nephrectomy as regards perioperative complications

Patient and Methods: Eligible patients underwent transperitoneal conventional or minilaparoscopy [ML] or conventional laparoscopy depending on surgeon preference. Preoperatively, patients were evaluated by history and clinical examination, with routine Lab and radiological investigations. Both operative and postoperative data were collected and documented

Results: both groups were comparable as patient demographics, associated medical diseases, preoperative data or the type of nephrectomy. However, operative time was significantly shorter, while blood loss was significantly larger in conventional group. In addition, postoperative pain was significantly higher and duration of hospital stay was significantly longer in conventional group. Finally, total cosmoses score was statistically decreased in conventional group

Conclusion: Compared with mini-laparoscopy, conventional laparoscopy showed better intraoperative parameters as shorter operative time, blood loss and less need for conversion to open surgery. However, the overall complications were comparable for both groups

Pelvic floor dyssynergia: Efficacy of biofeedback training

Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia [anismus]. It is a behavioural disorder [no associated morphological or neurological abnormalities]; consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback. Sixty patients [35 females and 25 males] with a mean age of 30 +/- 12 years and a 4 year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions [colon-transit time, anorectal manometry, EMG and defaecography] were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of [6 +/- 2] sessions. At the end of sessions, 55 out of 60 patients [91.6%] reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient's satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions. Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia

Surgical management of gastric gastrointestinal stromal tumor: a single center experience

Gastrointestinal stromal tumors [GISTs] are the most common mesenchymal tumors of the gastrointestinal tract. Surgery remains the mainstay of curative treatment. Our objective is to evaluate the outcome of surgical treatment of primary gastric GIST. Between January 1997 and April 2008, thirty seven consecutive patients underwent resection for GISTs [35 patients with primary gastric GISTs and two patients with intestinal GISTs who were excluded from the study]. These patients underwent upper endoscopy +/- biopsy, barium meal and abdominal CT scan. Patients' demographics and clinical presentations were analyzed. Perioperative parameters measured included operative times, estimated blood loss, intraoperative finding, surgical techniques, morbidity length of hospitalization. Recurrence and survival were also analyzed. Of the 35 patients with gastric GISTs included in the study, 63% were female. The median age was 59 +/- 14 years [range, 23 to 75 years]. The primary presenting symptoms were bleeding and dyspepsia; 43% of these tumors were located mainly in the body of the stomach. Tumor size was <10 cm in 80% of the patients. The average tumor size was 6.3 +/- 3.2 cm [range from 3 to 13 cm]. regarding the surgical management, 20 patients [57%] underwent gastric wedge resection, eight patients [23%] underwent partial gastrectomy and the remaining seven patients [20%] underwent total gastrectomy. Radical resections were found in 32 patients [91.5%] while palliative resections were found in three patients [8.5%]. The resected lymph nodes were negative in 32 patients [91.5%]. Recurrence was noted in three patients, with a median time to recurrence of 14.3 months [range, 7 to 28 months]. The three-and five-years survival in patients who underwent wedge resection was 92% and 81%, respectively, where it was 95% and 87%, respectively, in patients who underwent gastrectomy [either partial or total]. There were no major intraoperative complications or mortalities. Complete surgical resection either through wedge resection or gastrectomy with negative margins remains the gold standard treatment of patients with primary respectable gastric GISTs

Endoscopic management of postoperative bile duct injuries: a single center experience

Biliary endoscopic procedures may be less invasive than surgery for management of postoperative bile duct injuries [POBDI]. This retrospective work presents the experience of a single referral center during a period of 14 years in endoscopic management of POBDI. Between 1994 [March] and 2008 [May], ERCP had been performed on 277 patients suspected to have POBDI. Patients shown to have complete transaction of bile duct were prepared for definitive surgery. For patients with simple biliary leak, sphincterotomy was performed with stenting. Pneumatic dilatation and stenting were done on patients with biliary stricture and preserved ductal continuity. ERCP was repeated every 3 months till the site of narrowing disappeared. The mean age was 45.3 years, 162 [58.5%] were females. The most common previous surgery was cholecystectomy [open, [N=119] 44%, and laparoscopic, [N=77] 28%]. ERCP failed in 17 patients [6.1%]. For successfully cannulated cases [N=260, 93.9%], the type of bile duct injury diagnosed at ERCP was completely ligated CBD [N=31/260, 11.9%]. Bile leakage was detected in [N=167/260, 64.2%] all patients with endoscopic sphincterotomy and stent insertion, the leak stopped in all of them. Biliary stricture was diagnosed in 33/260 patients [12.7%] and 17 of them had repeated balloon dilatation with stenting while the remaining had surgical correction. The success rate of endoscopic therapy for biliary strictures was 82%. Cholangiogram was normal in 29 patients [11.2%]. Endoscopic therapy is safe and effective in the management of postoperative bile duct leak. For postoperative bile ductal strictures, ERCP is a less favorable option

Outcome of pouch surgery for ulcerative colitis: Single center experience

The purpose of the present study is to present the experience of our center in surgical management of ulcerative colitis [UC], stressing on evaluating the outcome of pouch surgery. Fifty eight patients underwent surgery for UC between 1996 and 2007 at Mansoura Gastroenterology Center. A retrospective analysis has been done of all patients with UC undergoing surgery which includes details of the patient's history, indication of surgery, type of operation, postoperative morbidity, and functional outcome. The main indication for operation was failed medical treatment [n=42, 72.4%]. Pouch surgery was performed in 25/58 patients [43.1%]. The majority of patients, 23/25 [92%] had J-shaped pouch. Twenty patients [80%] had a defunctioning ileostomy. There was one postoperative death after pouch surgery. Early complications after pouch surgery included pelvic sepsis [n=4], small bowel obstruction [n=2], pouch hemorrhage [n=1], wound sepsis [n=3]. The most common long-term complication after pouch surgery [n=14] was anastomotic stricture [n=9, 42.6%]. Five patients [35.7%] presented with pouchitis. Median daytime stool frequency was 5.1. Three patients [21.4%] presented with fecal incontinence. Pouch surgery is a major one that attains many complications. However, the long term results and patient's satisfaction are reasonable

Secondary antireflux surgery

With the introduction of laparoscopy, the number of antireflux surgeries [ARS], and consequently failed fundoplication, had increased many folds. We report the mechanisms of fundoplication failure in patients having ARS, and present our experience in surgical correction of such failure. Twenty three patients who had failed fundoplications were reoperated. Pre-and postoperative evaluation of patients included symptom severity endoscopy, barium study, esophageal motility and 24-hour pH metry. The initial procedures were Nissen in 13, Toupet in 8, and Nissen-Rossetti in 2 patients. The causes of failure were transdiaphragmatic migration of fundoplications [n=6], disrupted fundoplications [n=5], tight fundoplications [n=4], slipped/misplaced fundoplications [n=3], paraesophageal herniation [n=3], and tight crural repair [n=2]. The secondary ARS performed were Nissen [n=12], Toupet [n=7], paraesophageal hernia repair with crural repair [n=2], widening of tight crural repair [n=1], and taking down fundoplications [n=1]. Per-[n=4] and postoperative [n=5] complications were minor with no mortality. At follow-up, symptoms were significantly improved. Reoperations for failed ARS may be performed safely with excellent results. Proper patient selection and paying attention to some technical dnils at initial ARS could safe the patient another surgery

Pneumatic balloon dilatation in achalasia: the optimum size of the balloon

Background: Pneumatic dilatation is considered to be the first line therapy for achalasia, but long-term outcome studies are scarce and limited by their retrospective design. There is also no consensus on the Optimal method for performing pneumatic dilation as regard to balloon diameter, amount and the rate inflation pressure

Aim: To address these questions in a large long-term prospective study

Methods: Over a period of 10 Years 262 achalasia patients referred to Mansoura Gastroenterology Surgical Center and Ear, Nose and Throat department, Mansoura University were enrolled. All patients underwent a pre-treatment clinical evaluation and were followed every 6 months. The first 62 patients [group A] underwent dilatation with initial use of a 35 mm balloon with inflation pressure of 10 psi in 10 seconds [5]. In group B [200 patients] we initially used a 30 mm balloon with inflation pressure of 10 psi in 30 s. Dilatation was repeated with incrementally larger balloons [35 and 40 mm] in case of relapse. We used rigiflex balloon and maintained pressure for 60 s after inflation in both groups

Results: Three perforations occurred in group A whereas no perforation took place in Group B. The cumulative proportional remission rate with single dilatation in groups A and B decreased from 83 and 75% in 6 months to 60 and 57% after 30 months of therapy respectively, the differences did not reach statistical significance. In patients who had undergone further dilatations the probability of remaining in remission at 1 year after the first and the second dilatation was 38 and 88% in group A, 20 and 89% in group B respectively. The probability of remaining in remission for 2 years increased from 20% after the first dilatation to 70% after the second dilatation

Conclusion: Graded pneumatic balloon dilatation with 30 mm diameter and slower rate of balloon inflation is an effective and safe initial method of therapy for achalasia. The duration of remission can be extended by repeated dilatation with larger size balloon

Vitamin C and onion juice versus aflatoxin B1 effect on liver nucliec acids of rats: a quantitative histochemical study

In this study four groups of adult female albino rats were used [each 12 rats] first was used as control the second was given aflatoxin B1 intraperitoneal [i.p.] at a dose of 1 mg/kg/day for 5 consecutive days the third was treated as the second, in addition to administration of Vit. C i.p. at a dose of 10 mg/kg/day for 5 consecutive days, while the fourth one was treated also as the second and given onion juice at a dose of 20 ml/kg/day for 5 consecutive days. The quantitative histochemical analysis of liver DNA and RNA was done by measuring their optical density by Licca quantimat 500 + Image Analyzer Equipment. England [easy, rapid technique and supplied by a personal computer]. There was a significant decrease in DNA [65.89%] and RNA [71.19%] levels in the aflatoxin group when compared with control and decreased significantly when compared with the other two treated groups. These changes were related to the effect of aflatoxin and its epoxides on nucleic acids metabolism and formation of nucleic acid adducts.The aflatoxin-Vit. C and aflatoxin-onion juice groups showed non significant change when compared with the control i.e. improved and reached nearly to the control levels. This improvement was explained mainly by the anti-oxidant effect of Vit-C and onion juice constituents as S. methyl methane thiosulfonate and S. methyl-L.cysteine sulfoxide, in addition to some aromatic isothiocyanates, as well as some organosulphur compounds that proved to have an antimutagenic and/or anticarcinogenic effects

Some changes of impotent alloxan induced diabetic male rats

In this study three groups of adult male rats were used; the first as control, the second was of impotent rats of alloxan-induced diabetes under control by insulin and the third was like the second, but without insulin. The serum level of glucose, testosterone, prolactin, L.H, F.S.H, penile nitric oxide synthase enzyme and the weights of whole body, testis, adrenals, prostate and penis were estimated. The glucose level was significantly increased in both impotent groups due to effect of diabetes and was more significantly higher in the third group due to no treatment by insulin. The other parameters showed a significant decrease in both impotence groups when compared with control. There was also a more significant decrease in serum testosterone, penile NOS, weights of adrenal glands, testis, prostate and penis in group 111 than in group II. Testosterone change was due to decrease its formation in the endoplasmic reticulum of Leydig cells, more lipid deposits ultrastructural diabetic change and decrease in human chorionic gonadotrophine receptors. The decrease in prolactin, F.S.H. and L.H. was due to affection of their releasing hormones. As for the penile NOS, its change was due to diabetic effect on putative penile endothelial NOS. The body weight change was due to the diabetic metabolic effect, while the change in weights of adrenal glands, testis, prostate and penis was due to testosterone level decrease [androgenic sensitive organs]