Transection Of Sternothyroid Muscle Increases The Rate Of Exposure Of The External Branch Of The Superior Laryngeal Nerve During Thyroidectomy.

Objectives: To assess the benefits of transection of the sternothyroid muscle compared to conventional approach for detecting the external branch of the superior laryngeal nerve while dealing with the upper pole of the thyroid gland. METHODS: The randomised controlled clinical trial was conducted at Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised patients who were eligible for total thyroidectomy and met the American Thyroid Association guidelines. They were randomised and divided into conventional approach group A and sternothyroid muscle transection approach group B. The rate of exposure of the external branch of the superior laryngeal nerve, injury, classification, operative time and voice outcomes at 2 weeks and 3 months post-intervention were noted in both the groups. Data was analysed using SPSS 22. RESULTS: Of the 102 patients, 50(49%) were in group A; 5(10%) males and 45(90%) females with mean age 40.48±12.58 years and mean body massindex 30.676±2.305. There were 52(51%) patientsin group B; 5(9.6%) males and 45(90.4%) females with mean age 39.67±11.60 years and mean body mass index 30.096±2.776. The rate of external branch of the superior laryngeal nerve identification was higher and the operative time was shorter in group B compared to group A (p=0.05). No significant difference was noted in terms of voice outcomes either at baseline or at any of the two follow-up points between the groups (p>0.05). CONCLUSIONS: The transection of sternothyroid muscle improved the rate of external branch of the superior laryngeal nerve exposure and preservation compared to the conventional technique during thyroidectomy.

Outcomes Of Mesh Fixation Versus Non Fixation In Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair: A Randomized Clinical Study.

Objectives: The present study aimed to compare the results of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair with and without mesh fixation regarding postoperative pain, recurrence, operative time, and complications. METHODS: This randomized controlled clinical trial included 100 patients who underwent TAPP inguinal hernia with mesh fixation (group A) or a fixation-free procedure (group B) for early onset inguinal hernia at the General Surgery Department, Kafrelsheikh University Hospital, from January 2021 to June 2022. RESULTS: The parameters for pain assessment (NRS) in the first week (mean 7 (5 - 8)), the first month (mean 3 (1 - 5)), and after three months(mean 0 - (70% of patients), (mean 1- (30% of patients) were significantly higher in the fixation group (p<0.001). The fixation group had significantly more operative time than non fixation, with a mean (69.34±13.55, 60.92±10.18) respectively. Recurrence rate and postoperative complications did not show any significant difference between the studied groups. CONCLUSIONS: Mesh non-fixation for laparoscopic TAPP hernia repair is safe, practical, and effective with minimal postoperative pain and no increased risk of recurrence.

Effect Of Laparoscopic Sleeve Gastrectomy On Vitamin D, Parathormone Hormone, And Serum Calcium Levels.

Objectives: To evaluate the effect of laparoscopic sleeve gastrectomy on vitamin D status, parathyroid hormone,serum calcium and the effectiveness of vitamin D supplementation. Method: The prospective study was conducted at the General Surgery Department of Kafrelsheikh University Hospital, Egypt, in November 2019, and comprised morbidly obese patients of either gender who were managed with laparoscopic sleeve gastrectomy. Serum levels of vitamin D, calcium and parathyroid hormone were assessed at baseline and at 6 and 12 months after the surgery. All subjects were given 400 IU/day of vitamin D. If the level of vitamin D was <30ng/ml, further doses of calcifediol 200,000 IU were added every two weeks. Data was analysed using SPSS 22. RESULTS: Of the 40 patients, 28(70%) were females and 12(30%) were males. The overall mean age was 33.9±10.8, mean weight was 136±18.29kg and mean body massindex was 50±4.9kg/m2 . The mean operative time was 64.5±13.6 minutes, and the mean hospitalstay was 1.8±1.1 days. There wassignificant reduction in body massindex values after the surgery (p<0.05). Vitamin D level was 19.2±3.2 ng/ml at baseline, which rose to 21.4±2.7 ng/ml at 6 months and 26.6±2.8 ng/ml at 12 months post-surgery (p<0.05). Preoperative parathyroid hormone level was 58.3±7.8 pg/ml , which went down to 48.6±7.4 pg/ml at 6 months, and 41.3±6.5 pg/ml at 12 months postoperatively (p<0.05). The mean serum calcium level at baseline was 9±0.4mg/dL, which rose to 9.2 ±0.3mg/dL and 9.5±0.4 mg/dL at 6 and 12 months post-surgery (p<0.05). CONCLUSIONS: Low vitamin D complications could be decreased postoperatively by administering vitamin D as a routine treatment. Postoperative monitoring of vitamin D, parathyroid hormone and serum calcium levels is essential.