Skin sparing mastectomy in large tumor breast cancer

Skin sparing mastectomy [SSM] with immediate reconstruction has been approved to be safe treatment approach for early-stage [T1 or T2] breast carcinoma. This prospective study was undertaken to assess both the feasibility and oncological safety of SSM in patients with large tumor breast cancer. Twenty patients with large T2 and T3 breast cancer were included. All patients were subjected to [SSM] with immediate reconstruction with either Transverse Rectus Abdominis Myocutaneous [TRAM] flap or Latissimus Dorsi [LD] myocutaneous flap with an implant. The patients were followed up for a period ranged from 12-22 months with a mean of 14.55 +/- 2.96 months. The mean tumor size was 5 +/- 0.73 cm [range 4-6cm]. Postoperatively, 3 cases [15%] developed necrosis of a part of their native skin flaps, one case [5%] had partial TRAM flap necrosis, and 5 cases developed seroma. All cases received postoperative chemotherapy that was initiated in a mean of 21.5 +/- 7.87 days, then radiotherapy after chemotherapy completion. Throughout the follow up period, none of the patients developed local recurrence while only one case [5%] developed distant bony metastases. SSM is feasible and oncologically safe in large tumor breast cancer; however, longer period of follow up is required

Retromsacular preperitoneal versus traditional onlay mesh repair in treatment of incisional hernias

Incisional hernia is a common surgical condition with a reported incidence of 2-11% following all laparotomies. Repair of large abdominal incisional hernia is a difficult surgical problem with recurrence being a common outcome that may reach up to 33%. The introduction of polypropylene mesh repair opened a new era of tension-free herniorrhaphy. However, implantation of the mesh by open techniques requires wide dissection of soft tissue contributing to an increase in wound infection and wound-related complications. The objective of this study was to compare preperitoneal versus onlay mesh repair in treatment of incisional hernia. This study included 67patients with incisional hernia from January 2004 to January 2007. The patients were randomly divided into two groups; Group I, [32 patients] for whom onlay mesh repair was done and Group II, [35 patients] for whom preperitoneal mesh repair was done. Both repairs were evaluated in regards to operative time, intraoperative difficulties and postoperative complications. Results were documented and statistically analyzed. 67 patients with incisional hernia were included in this study. Group I included 32 patients for whom traditional onlay mesh was preformed while group II included 35 patients for whom retromuscular preperitoneal mesh repair was performed. There was no statistically significant difference between both groups as regards age and sex [P > 0.05]. The mean operative time in Group I was 70 +/- 8.6 min, while it was 74 +/- 9.8 min in Group II with no statistically significant difference between both groups [P > 0.05]. The mean of the period of drainage was 7 +/- 1.3 days, while it was 2 +/- 0.8 days in Group II which was statistically longer than group I [P < 0.05]. Seroma occurred in 4 patients in Group I, while it was not encountered in any patient in Group II [P < 0.05]. No recurrence was reported throughout the period of follow up which ranged from 6-36 months in both groups. Based on this analyses, we believe that preperitoneal mesh repair is the ideal operation for incisional hernias. There are however, very few publications covering this technique of repair

comparative study between colonic J-pouch and coloplasty anastomosis after ultra-low anterior resection for middle and low rectal cancer

Rectal cancer is the second common gastrointestinal tumour and its surgical treatment varies according to its distance from anal verge. After low anterior resection and colorectal anastmosis, for upper 1/3 rectal tumour, patients usually have normal habits with minimal affection. However, for middle and lower rectal cancer, they require a pouch to minimize the functional disorders resulting from the rectal pouch and may be also related to the loss of normal anorectal sensation. To compare the functional results of coloplasty pouch [CP] versus the colonic J- pouch [JP], after low anterior resection. Thirty patients diagnosed to have an operable middle and low rectal carcinoma, were randomized into two equal groups, the J-pouch and the coloplasty group. All the patients underwent low anterior resection with temporary ileostomy diversion, after colo-anal asnastmosis with CP or JP formation. The patients had a preoperative and postoperative anal manometric study, at 6 months and 12 months interval after closure of ileostomy. This includes resting anal pressure, maximum squeeze pressure, and maximum tolerable volume, as well as the recto-anal inhibitory reflex. Patients had a questionnaire based on Hida et al. scoring system where different variables [evacuation, continence, urgency, perineal soiling and others] were graded from zero to two to quantify the overall functional results. There was no significant difference between both groups regarding intra-operative or postoperative complications, or hospital stay. Bowel evacuation was better for CP patients, at 6 months, however, it equalized in both groups with no significant difference at 1-year interval. Although, the resting anal pressure and the maximum squeeze pressure were lower than the preoperative values, but there was no significant difference between both groups after six months or one year duration. Finally there was a significant inverse correlation between the total functional score and the anasto-motic distance from the anal verge for both groups, the smaller the distance from the anal verge, the higher was the functional score [poorer function]. Patients with colo-plasty pouches were able to defer their bowel movement better, and had less nocturnal leak, at 6 months, however, bowel function equalized in both groups at 1 year, with no significant difference between both groups