Abdominal access injuries in laparoscopic surgery, a retrospective study

This study was performed to assess the incidence, diagnosis, management and morbidity and mortality of laparoscopic access injuries. Using available injury based reports,patients documents and some available video tape recording of some laparoscopic procedures, 54 patients were collected and reported of having laparoscopic access injuries out of total 608 laparoscopic surgical and gynecological procedures done in Kasr Elaini teaching hospital during the period from August 2001 to April 2003 representing 8.8% of the total cases in comparison to what was reported in the literature which showed low incidence of these access injuries ranging from 5/10000 to 1.3%. Most of the reported injuries were minor vascular injuries [2.6%] and extraperitoneal gas insufflation [3.7%]. These minor complications caused only some technical difficulties during the procedures but they had no impact upon morbidity and mortality of the patients and were managed conservatively. Major retroperitoneal vascular injuries and visceral injuries, although represented minor incidence in our study 0.5% and 1.3% respectively, yet they were the major source of morbidity and mortality to the patients. Not only so but they also necessitate termination of the primary procedure and conversion to open surgery for their management. It seems that there is no single method of laparoscopic access safer than the other since there was no significant difference between them in inducing injury. In although laparoscopic access injuries seem to be of low incidence, yet they should be minimized. Since access injuries may be the result of integration between patient related factors, surgeons factors and the technique of access, so adoption of good laparoscopic technique, improvement of learning curve of junior surgeons proper site selection and port placement and proper choice of equipment, all may reduce the risk of access complications

Acute appendicitis diagnostic accuracy

Acute appendicitis remains a diagnostic challenge to the surgeon. In part, this is because of the variable presentation of the disease and many other diseases mimicking appendicitis, and in part, there is no absolutely accurate diagnostic test to diagnose acute appendicitis. In this study, we investigated the rate of diagnostic accuracy in patients who underwent emergency appendectomy because of suspicion of acute appendicitis in the emergency department of Kasr El-Aini hospital for a total number of 263 patients. Before operation the symptoms and signs of the patients were recorded on special forms, on which the operative findings, the result of the routine histopathologic examination of the removed appendices, and the laboratory studies of total and differential leucocytic count were also recorded. The patients were grouped into 4 groups according to whether it was simple appendicitis or perforated and whether there was surgical or non-surgical disease with the normal appendix. Based on histopathologic and operative findings, the diagnostic accuracy was 79 percent, 84 cases were found to have negative appendix, 6 of them had other surgical disorders indicating immediate surgery, thus diagnostic accuracy of acute appendicitis is 79 percent, but the overall accuracy for acute surgical disease is 80.5 percent

medial gastrocnemius myocutaneous flap with a laterally extended skin paddle

Eighteen gastrocnemius flaps were used to cover soft tissue defects in legs and feet of seventeen male patients. As defects were larger than the standard medial gastrocnemius myocutaneous flap in eight cases, the skin over the lateral belly was elevated medially based together with the flap to compensate for width discrepancy. Based on survival of these eight modified flaps and on a previous anatomical study [Kamal et al, 1992], we conclude that the skin paddle of the medial flap can safely be laterally extended to include the fasciocutaneous tissue overlying the lateral belly