bluuebunny/crossref_metadata_2025 huggingface dataset:
Trigger Factors of Migraine in Patients Attending Headache and Neurology Outpatient Clinics at Ain Shams University Hospitals
Authors: Elguindy Nourhan N , Elbagoury Lamyaa S , Fouad Mohamed M , Emara Tamer H , DA Marzouk
Published: August 2023

Background

Migraine is the second most common cause of headache, affecting approximately 15% of women and 6% of men. Also, it is one of the most ten disabling diseases in the world.

Objectives

To determine the triggers of migraine headache in migraine patients attending Headache clinic at Ain Shams university hospitals.

Methods

A descriptive study was carried out among 292 migraine subjects from different parts of Cairo governorate from December 2019 to March 2020. Case definition of migraine was based on the International Headache Society (IHS) criteria.

Results

Females constituted 85.6% of the study sample. The majority of the sample (71.3%) aged 18-39 years. Psychological problems as: stress and family problems were the commonest triggers (89%), followed by fatigue (86.3%), too little sleep (staying up late) (82.2%), loud noises (77.7%), hunger, fasting and missing meals (75.3%), bright lights or and sun exposure (75%), and in relation to females menstruation (61.9%), hot weather (61.3%), too much sleep (46.9%), odors (46.2%). The least triggers were physical exercise, caffeinated drinks, smoking, chocolate and dairy products, and ice-cream were 28.8%, 26%, 24.7%, 23.3%, 16.1% respectively. Forty percent of the study population had positive family history of migraine, 30.1% of them reported major stresses (moving of residence, marriage, or death of a close relative) in the last year.

Conclusion

Stress, anxiety, family problems, fatigue, too little sleep, and loud noises were the commonest triggers of migraine headache. Family history was present in 41.1% of migraine patients.
Ethical Challenges Opposing Health Care Professionals Working at Artificial Kidney Units of Ain Shams University Hospitals and a Proposed Guide to Deal with Them
Authors: Abbas Sara G , Ahmed Sanaa I , Mahmoud Nesrine A , Attia Eman A
Published: August 2023

Background

Treatment for end-stage kidney disease is a major economic challenge and a public health concern worldwide. Renal-replacement therapy poses several practical and ethical dilemmas of global relevance for patients, clinicians, and policy makers.

Aim

The aim of the present work was to highlight ethical challenges encountered by health care professionals working at Artificial kidney units of Ain Shams University hospitals which may oppose their practice and lead to malpractice. In addition, outlining an ethical guide; in a trial to metigate some of these challenges, and ameliorate the practical environment to minimise malpractice issues.

Method

The present study is a descriptive cross-sectional study that was held on health care professionals (physicians and nurses) working at the Artificial Kidney Units of (El Demerdash and Ain Shams specialized University hospitals).

Results

More than half of the physicians (57.9%) agreed that all patients admitted to kidney units should sign a legal informed consent, while 78.9% of physicians admitted that not all patients could give a legal informed consent. Nearly all physicians (94.7%) endorsed that the clinician should provide the patient with all needed information; then, the patient decides freely based on his priorities and values. 57.9% of the physicians and 48.3% of the nurses negated any discussion about patients’ private information within the earshot of others. The vast majority of physicians (92.1%) and nurses (83.9%) were completely convinced of the right of any patient -in need- to have an equal access to any form of treatment. Most of the physicians (71.5%) and 90.3% of nurses were convinced that beneficence and non-maleficence are not two opposing ethical concepts.

Conclusions

The current study clarified that significant proportion of physicians and nurses were aware of the universally recognized ethical principles which are essential part of clinical practice in nephrology. The present study found that some healthcare professionals reported encountering a number of ethical issues when dealing with patients.

Recommendations

The growing public and professional discourse about ethical issues in nephrology creates an atmosphere in which the special issues in End Stage Renal Disease treatment can be addressed openly. As some healthcare providers in this study reported some ethical issues when dealing with hemodialysis patients, thus, there is a need for ongoing education of ethics to ensure the optimal approach to patient care. It is recommended to follow our guideline proposal in order to help health care professionals in dealing with the confronted ethical challenges.
Role of Endovascular Intervention in Management of Chronic Mesenteric Ischemia
Authors: Ali Abd Al-Rahman Najm-Eldin Sultan , Farahat Mahmoud Saad , Elmaleh Haitham Mostafa , Fakhr Mohamed Emam
Published: August 2023

Background

Chronic mesenteric ischemia (CMI) can be treated with surgical revascularization (SR) or endovascular revascularization (ER). - The management of symptomatic atherosclerotic chronic mesenteric ischemia which is an uncommon disorder is challenging. Although surgical revascularization (SR) has been considered as the gold standard since its introduction based on observational data published over the last 25 years, there has been increased use of endovascular revascularization (ER) in treating CMI. This review seeks to assess, through the available literature, the role of endovascular intervention in management of chronic mesenteric ischemia and determine the benefits as well as the withdraws of the intervention.

Objective

to assess the role of endovascular intervention in management of chronic mesenteric ischemia and determine the efficacy (in terms of patency), and safety, (in terms of perioperative morbidity and mortality) of endovascular revascularization (ER) in treating patients with CMI, using the currently available literature and applying a systematic review and meta-analysis.

Methods

The review is a meta-analysis and systematic review that included randomized controlled trials (RCT), case series and retrospective studies which studied the role on endovascular techniques of management of chronic mesenteric ischemia.

Results

Abstracts of articles that were published from 2000-2020 identified using the search strategy were reviewed and articles that appear to fulfill the inclusion criteria were retrieved in full text. Data on at least one of the outcome measures was included in the study. This study included published papers and research written in English language that published from 2000-2020. We excluded papers not written in English, studies before 2000 and case report study.

Conclusion

Endovascular management of chronic mesenteric ischemia is a feasible strategy associated with increased technical and clinical success rate and patency rates. It also associated with low rate of mortality and complications. Restenosis and symptom recurrence were reported in more than 20% of the patients which necessitating preoperative assessment of abdominal pain, good selection of patients and improving the endovascular technique.
Meta-Analysis on Ultrasound Guided Hydrostatic Saline Enema Reduction of Childhood Intussusception
Authors: Elbeheiry Mosad , Khalafallah Mohamed , Bersy Mohamed Ali , Mohamed Abdelrahman Ahmed Adly
Published: August 2023

Background

Ultrasound with color Doppler studies plays a promising role in both the diagnosis as well as the guided reduction of intussusception by using hydrostatic pressure with normal saline enema as we can directly visualize the whole process of the reduction with real time ultrasound.

Aim of the Work

The study aims to assess the role and benefits of the ultrasound as an alternative non-invasive method in the guidance of the hydrostatic reduction of intussusception in children.

Material and Methods

A systematic review and meta-analysis on published studies about ultrasound guided hydrostatic saline enema reduction of childhood intussusception carried out in the period between 2010 and 2020. for pediatric patients suffering intussusception and was performed in accordance with the PRISMA and PICO guidelines. An initial search was carried out using online databases: PubMed/MEDLINE, Google Scholar, Egyptian Knowledge Bank and Science direct. The following search terms was employed: “(Intussusception AND hydrostatic OR saline enema AND ultrasound OR ultrasonography).

Results

A total of 133 articles were identified after duplicates were removed, and 102 were then excluded as they did not meet the inclusion criteria. The 31 remaining full-text articles were reviewed, and 10 were excluded due to (outside our time interval or containing insufficient data or other reasons of exclusion). Thus, 21 articles were included in the systematic review.

Conclusion

Hydrostatic reduction should be the treatment of choice and the first line of management in all cases of intussusception unless it is contraindicated. It is a simple, safe, effective and radiation free technique. It is not time consuming, is cost effective and is associated with almost nil complications and minimal hospital stay.
Comparative Study for Portomesentric Venous Thrombosis after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with BMI 35-45 with and without Anticoagulation, Retrospective Study
Authors: El-Ashry Alaa El-din Abdel-Hameed , Gamal El-Din Mostafa Mohab , El-Azm Hossam Attia Abo , Fouda Abdelrahman Yahya Mohammed
Published: August 2023

Background

Portomesentric vein thrombosis is a rare but documented complication of laparoscopic surgery. This rare complication is currently being encountered more frequently with the increase in the rates of laparoscopic bariatric surgery procedures being performed worldwide. Obesity is a worldwide health problem and Bariatric surgery has demonstrated to be an effective and sustainable method for regulation of morbid obesity, especially when it is resistant to both pharmaceuticals and combinations of diet and lifestyle regimens.

Aim of the Work

This study will evaluate the efficacy of use of anticoagulation after LSG in morbidly obese patients with BMI 35-45, to guard against PVT, through retrospective comparative study.

Patients and Methods

A retrospective analysis was performed on all sleeve gastrectomies performed in Ain Shams University Hospitals & some other hospitals between January 2020 & January 2021 to identify cases complicated by Portomesentric venous thrombosis. A total of 60 patients underwent LSG between January 2020 & January 2021 were divided into two groups in a retrospective comparative Pilot study with an average BMI 39.53 kg/m2. Patients from the two groups 10 patients underwent laparoscopic cholecystectomy along with LSG.

Results

There are chemical prophylactic measures can be used pre and post laparoscopic sleeve surgery however, as suggested by some papers post-operative thromboprophylaxis to all patients for 1 week duration and from 3 to 6 months for thrombophilia and high-risk patients, yet specific recommendation regarding VTE prophylaxis after sleeve gastrectomy is in need for prospective trial to guard from developing PVT.

Conclusion

As a phenomenon with an ambiguous and unpredictable symptom, PMVT should be kept in mind in any patient with unexplained abdominal pain after sleeve gastrectomy; in addition, portal venous phase contrast enhanced studies should always be considered when a diagnostic computerized tomography scan is performed. Strong evidence data about PMVT anticoagulant prophylaxis plan is still lacking, however; extended prophylaxis to 2 weeks in a high-risk patient may lower the PMVT incidence.
Evaluation of the Role of Negative Pressure Wound Therapy (NBWT) in Healing of Diabetic Foot Ulcers (DFU)
Authors: Gad Khaled Hussein , Monaem Ayman Hossam Eldin Abd El , Al-Saadany Ahmad Abd-El-Aal Shebl Ali
Published: August 2023

Background

Because of the variable time required for healing, foot wounds are a major concern in general surgery. Lower limb ulcers are exacerbated by chronic conditions like diabetes, as well as our ageing population. The application of negative pressure wound therapy (NPWT) has resulted in a paradigm change in the treatment of various wound types around the world.

Objective

To evaluate the role and the effectiveness of (NBWT) in the healing of diabetic foot ulcers (DFU), and to compare the rate of healing and the final outcome with the conventional dressing.

Methods

This randomized controlled prospective study was conducted upon thirteen patients who were presenting with DFU. The study was conducted in Ain Shams university hospitals and National Institute of Diabetes and endocrinology within 6 months.

Results

In terms of demographics and first labs, there was no statistically significant difference between the two groups based on data analysis. Improvement was considerably better in the NPWT group, providing significant confirmation of our findings regarding the efficacy of NPWT on wound outcomes.

Conclusion

Patients who received NPWT had a significant reduction in maximum wound depth as compared to those who received traditional dressings. NPWT may play a function in wound healing, according to this research.
Evaluation of Single Anastomosis Gastric Bypass
Authors: Mostafa Alaa Abass Sabry , El-Shennawy Mohammed El-Sayed , Helmy Medhat Mohamed , Abdrabou Ahmed
Published: August 2023

Objective

The study was performed to evaluate the technique of laproscopic single anastomosis gastric bypass for treatment of morbidly obese patient.

Study design

The patients were enrolled in a Prospective observational study, from May 2013 till May 2015, including 100 patients set for laparoscopic Single anastomosis gastric bypass. Surgical procedures and follow up were performed at Ain Shams University hospitals.

Patient and methods

The study includes one hundred patients; 33 males and 67 females with a mean age of 33±10 years (range, 20–59), who fulfilled the criteria for bariatric surgery with BMI >35 with associated co-morbidities, all patients underwent laparoscopic single anastomosis gastric bypass.

Results

The average operative time was 90 minutes, and the median length of hospital stay was 2 day. No mortality reported within 30 days postoperatively. early postoperative complication within 30 day, no cases of leak reported, endo luminal hemorrhage (2%)treated conservatively. long-term complications were bile reflux(1%), with failed medical treatment which Laparoscopically converted to RYGBP. iron deficiency anemia (1%.). Average weight loss at 1 year was 46 kg (70.08% of excess body weight). (88.8%) of the obesity-associated co morbidities are resolved within 1 year.

Conclusion

Laparoscopic single anastomosis gastric bypass offers major benefits with great satisfactory results over most alternative procedures, is a successful procedure for weight loss and maintaining the weight reduction in morbid obesity, it has highly safe with good technical feasibility, short hospital stay, a low rate of major postoperative complications and growing learning curve
Detection of the Sentinel Lymph Node in Breast Cancer Using Patent Blue Dye Technique, Gamma Probe and Combined Technique
Authors: Amer Ayman Ahmed Talaat Mohamed , El-Shinawi Mohamed El-Sayed , Ahmed Dina Hany , Ali Ayman Hossam Eldin Abd Elmonaem , Shmeila Ayman Aly Abou , Shuman Ahmed Gamal Shawky
Published: August 2023

Background

Breast cancer is the most common cancer among women and the second-leading cause of cancer deaths, Lymphatic mapping with SLN dissection provides a reliable image of the tumor status of the remaining axillary lymph nodes and it has the benefit of reducing the morbidity associated with the axillary lymph node dissection, including pain, sensory deficits, decreased range of movement, seromas and lymphedema, There is several techniques to determine SLN, in this study we used patent blue dye and gamma probe techniques in the detection of the sentinel lymph node.

Objective

To estimate and compare the detection rate of the sentinel lymph node in clinically and radiologically negative axillary node in breast cancer female patients by using of patent blue technique, gamma probe technique and a combination technique.

Patients and Methods

This study is prospective study included 90 female Egyptian women with early breast cancer and clinically negative axilla clinically and radiologically. These women divided into 3 groups according to the technique used in the detection of SLNB (first group used patent blue only, 2nd group used gamma probe only, 3rd group used combined techniques (patent blue and gamma probe).

Results

The most frequent site of lesion in the three groups was the upper outer quadrant; 80% in group I, 76.7% in group II, and 83.3% in group III. The most frequent pathology in the study groups was infiltrating duct carcinoma; 96.7% in all groups. No significant differences were observed between the study groups regarding neuropathic pain (P-value = 0.319). Patients with positive SLN in Group I 16.7%, in group 2 23.3% and in group 3 33.3%. No significant differences were observed between the study groups regarding number of SLN removed (P-value = 0.233), patients with positive SLN (P-value = 0.319) and number of patients underwent axillary clearance (P-value = 0.319).

Conclusion

This study confirms that prediction of axillary lymph node status in breast cancer patients using combined technique has the same accuracy as marking of SN with blue dye alone and therefore should be preferred.
Comparative Study between the Use of Self-Fixating Mesh and Non-Self-Fixating Mesh in Laparoscopic Inguinal Hernia Repair Transabdominal Preperitoneal (TAPP) Technique
Authors: Ghanem Ahmed Ghanem Diab , Wagdy Hesham Hassan , Hassan Mostafa Abdo , Mamdouh Mahfouz Remon
Published: August 2023

Background

Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however; there is no "gold standard" operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities.

Objective

to compare between self fixating mesh and fixation of non self fixating mesh with absorbaple tacks in laparoscopic inguinal hernia repair transabdominal preperitoneal (TAPP) approach as regards intraoperative time, complications, postoperative pain, return to normal activity and incidence of recurrence.

Patients and Methods

Our study is a randomized prospective study. It was conducted in El Demerdash, Ain-Shams University Hospital on 08 patients with inguinal hernia who were operated upon between january 2020 and December 2020 with minimal follow up of 3 months.

Results

Based on our prospective randomized study, a few preliminary conclusions can be made. There was no significant difference in operative time between patients who underwent self gripping mesh fixation and those who underwent mesh fixation by absorpable tacks in TAPP reapir. The postoperative pain assessment at 1 week, 4 weeks and 3 months shows that no significant difference between the two groups confirming the atraumatic nature of the self gripping mesh. We found that both surgical approaches had almost the same Postoperative Hospital stay where the mean postoperative hospital stay was 1.5 days versus 1.6 days in Group A and Group B, respectively and all patients returned to normal activity with mean time 7 ± 2 versus 8 ± 2 days in Group A and Group B respectively. We found that no statistically difference as regard the recurrence between the use of Self Gripping mesh versus fixation of by non absorpable tacks.

Conclusion

After this comparative study, both the use of SGM and fixation of mesh by non absorpable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications and chronic pain coinciding with all the available literature.
Impact of Hypomagnesemia on Post-Thyroidectomy Hypocalcaemia
Authors: Kassem Alaa Mohamed Mohamed , Abdraboh Ayman Abdullah , Farahat Mahmoud Saad , Abdelrahim Hossam S
Published: August 2023

Background

Total thyroidectomy is the treatment of choice for many thyroid diseases. The most common metabolic complications are disorders of calcium ion concentrations. In this study we aimed to determine the incidence of hypomagnesemia after total thyroidectomy and to investigate whether hypomagnesemia after thyroidectomy has any impact on post-thyroidectomy hypocalcemia.

Patients and Methods

This study was a prospective analytical one done between July 2019 and July 2020 including fifty patients who underwent total or completion thyroidectomy. Our patients were divided according to adjusted serum calcium levels of day one postoperative and clinical manifestations of hypocalcemia into 2 groups, group (A) for normocalcemic patients (clinical and biochemical) and group (B) for hypocalcemic patients (clinical or biochemical). And each group was subdivided into two subgroups according to serum magnesium levels (normomagnesemia and hypomagnesemia).

Results

These results cleared that, postoperative biochemical hypocalcemia was detected in 36% of cases and hypomagnesemia was detected in 62%, from the hypocalcemic group there were 88.8% with hypomagnesemia while in the normocalcemic group, there were 46.8% with hypomagnesemia. In the postoperative period 24% of patients had manifestations of clinical hypocalcemia; all of these patients (100%) had biochemical hypocalcemia. All of the cases (100%) with symptomatic hypocalcemia had low serum magnesium levels while as for the patients with only biochemical hypocalcemia, 66 % had hypomagnesemia.

Conclusion

Our results concluded that, regarding the correlation between calcium and magnesium, there was a statistically highly significant positive correlation between calcium and magnesium in the first day postoperative of thyroidectomy. Post-thyroidectomy hypomagnesemia was found to be a good predictor of postoperative biochemical hypocalcemia and is closely related to the clinical manifestations of hypocalcemia. So, correction of both hypomagnesemia and hypocalcemia is necessary for prompt resolution of symptoms of refractory hypocalcemia after total thyroidectomy.
Intraperitoneal Bupivacaine in Laparoscopic Cholecystectomy, Efficacy and Feasibility
Authors: Ashry Alaa abdelhamid El , Khalil Medhat Mohammed Helmy , Gbr Amr Abdelbaky Tawfik
Published: August 2023

Background

Laparoscopic Cholecystectomy among the most frequently performed elective daycare surgeries. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress, to determine the efficacy of intraperitoneal bupivacaine instillation on management of early postoperative pain in patient undergoing laparoscopic cholecystectomy.

Aim of the Work

To determined the efficacy of intraperitoneal bupivacaine instillation on management early postoperative pain in patient with laparoscopic cholecystectomy.

Patients and Methods

This is a prospective randomized study with sample size of 50 patients underwent elective laparoscopic cholecystectomy. We recruited patients from surgery department at Agouza Hospital. We randomly assigned patients to undergo laparoscopic cholecystectomy with bupivacaine and 25 ml of physiological saline (0.9% normal saline) on liver bed or without bupivacaine.

Results

Fifty patients finally met our inclusion criteria. In bupivacaine group, mean age was 35 (± 6.6), 64% were females and 36% were males. While in non-bupivacaine group mean age was 37.6 (± 6.6), 68% were females and 32% were males with no statistically significant difference between both groups; age (P value=0.22) and age (P value=0.77), In bupivacaine group there was significant pain reduction compared to non-bupivacaine group in terms of VAS at 2 h (p value=0.04), 12 h (p value=0.02), 24 h (, p value=0.01) and VRS at 2 h (p value<0.01), 12 h (p value<0.01), 24 h (p value<0.01). Hospital stay was lower hospital stay in bupivacaine group 0.94 (± 0.16) than nonbupivacaine group 1.21 (± 0.41) (p value<0.01). Need for additional analgesia was lower in bupivacaine group (P value <0.01).

Conclusion

Intraperitoneal route for administration of local anaesthetic is a safe and effective approach. Bupivacaine is an effective treatment option to achieve postoperative analgesic, limit the duration of hospital stay and the need for additional analgesia. But it did not significantly lower the incidence of nausea and vomiting.
Early versus Delayed Enteral Nutrition after Gastrointestinal Anastomosis in Children: A Systematic Review and Meta-Analysis
Authors: Ahmed Osama Mahmoud Elsayed , AbouZeid Amr Abdelhamid , Nageeb Ramy Mikhael , El-Raheb Athnasious Barsoom Michael
Published: August 2023

Background

Elective intestinal anastomosis is a frequently used surgical procedure in pediatric surgery. This option is used to restore intestinal continuity (ileostomy or colostomy closure), resolve an inflammatory disease or functional or anatomic congenital malformation. It is a common practice to avoid oral feeding in children after intestinal anastomosis surgery, traditionally from 3-5 days. Recently, interest has increased in the concept of early enteral nutrition (EEN) in abdominal surgery in adults, but it needs further research in children.

Aim of the Work

The aim of this study is to determine whether early enteral nutrition following elective gastrointestinal anastomosis surgery in children leads to improved patient outcome measures and to assess whether this practice increases the risk of postoperative complications, according to literature published in the period from 2010- 2020

Patients and Methods

We searched PubMed, Cochrane, Embase, Google scholar, Egyptian Knowledge Bank including Science Direct, Scopus and Web of Science. Data from 2010 – 2020 were obtained using the following Medical Subject Headings (MeSH) terms. For the early aspect of nutrition, we used the MeSH terms ‘‘early’’ or ‘‘enhanced recovery’’ and ‘‘enteral nutrition’’ or ‘‘feeding’’. For the surgical background, we used the MeSH terms ‘‘gastrointestinal’’ or ‘‘bowel/intestinal’’ or ‘‘colorectal’’ and ‘‘surgery’’ or ‘‘anastomosis’’ or ‘‘resection,’’ while for the population we used the terms ‘‘child’’ or ‘‘pediatric’’ or ‘‘infant’’. Multiple outcomes were used. The softwares Review Manager (RevMan 5.3, The Cochrane Collaboration) and STATA (Stata Corp. 2007) were used to analyse the data and formulate the results.

Results

Seven RCT studies met the inclusion criteria, comprising 278 cases with EEF and 323 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = -69.43; 95% CI -72.20 to -66.65; p < 0.0001). The EEF group had an earlier time to first bowel movement (MD -18.18; 95% CI -27.04 to -9.32; p < 0.0001), an earlier time to full diet intake (MD -103.50; 95% CI -126.63 to -80.37; p < 0.00001) and a shorter length of hospital stay (MD -3.57; 95% CI -4.4 to -2.74; p < 0.00001). There was no significant difference in incidence of nausea and vomiting (OR = 1.36; 95% CI 0.56, 3.30; p = 0.5), abdominal distension (OR = 1.68; 95% CI 0.80, 3.53; p = 0.17) or anastomotic dehiscence (OR = 0.58; 95% CI 0.19, 1.75; p = 0.34) between groups. There was significant difference between groups in surgical site infection (OR = 0.27; 95% CI 0.13, 0.57; p = 0.0005) and fever (OR = 0.32; 95% CI 0.16, 0.61; p = 0.0007) in favour of EEN.

Conclusion

When early enteral nutrition was compared to traditional delayed feeding, results showed that EEN is safe and effective in pediatric patients undergoing elective intestinal anastomosis.
Retroyp

ective Com

parative Study between Slee

ve Gastrectom

y and Mini Gastric Bypass Regarding Postoperative Skin Redundancy
Authors: Aamer Mohamed Ahmed Mohamed , Eskandaros Moheb Shoraby , Afifi Amr Hamed , Saeed Ilany Gamal Hazkial
Published: August 2023

Background

Obesity has reached epidemic levels worldwide affecting more than 30% of adults. Mortality rates in patients with morbid obesity are 6-12 times higher in men aged 25 — 44 versus men with healthy weight of the same age. Surgical treatment of comorbidities appears to be cost effective by eliminating use of medications in patients who were previously morbidly obese.

Aim of the Work

to determine and evaluate the impact of sleeve gastrectomy and minigastric bypass procedure on weight loss and post operative skin redundancy.

Patients and Methods

The study included 50 morbidly obese patients that were assigned to two equal groups as regards to the operation they underwent either Laparoscopic MGB or Laparoscopic SG. The primary outcome measured was change in weight and BMI. The secondary outcome was skin redundancy after operation. Patients were followed up to 1 2 months after operation.

Results

After retrospectively comparing the two procedures for a year, almost both procedures have near same effect on loss of weight and MGB has slightly more skin redundancy after operation. The statistical differences observed as regards to BMI and skin redundancy

Conclusion

So this study was carried out to compare the effect on 50 patients undergone laparoscopic sleeve gastrectomy and laparoscopic mini gasteric bypass see if there was effect on weight loss and skin redundancy progress among those patients, 25 patients performed laparoscopic sleeve gasterectomy and 25 patients performed laparoscopic mini-gasteric bypass.
Risk Factors and Outcomes for Colonic Ischemia after Abdominal Aortic Aneurism Repair
Authors: Ahmed Tarek Youssef , Rezk Mohamed Abdelmoneam , Mahmoud Amr Abdelghaffar , Meshref Mahmoud Mohamed
Published: August 2023

Background

Colonic ischemia is a major adverse event after abdominal aortic aneurysm (AAA) repair. incidence of clinically significant colonic ischemia is in the range of 1 to 3% after elective surgery and 10% in case of rupture. When routine postoperative colonoscopy is performed, the incidence is higher.

Aim of the Work

It aims to review the clinical spectrum of mesenteric ischemia (CI) following abdominal aortic aneurysm (AAA) repair and to assess the incidence, overall mortality, and associated factors of occurrence.

Patients and Methods

This is a retrospective study which was done to assess the risk factors and outcomes of mesenteric ischemia after Abdominal Aortic Aneurism repair. This study was performed using Ain Shams University database from February 2018 to February 2021. Patients were identified who had undergone open and endovascular AAA repair using Hospitals general files. The variables of the study were chosen from the list of the original variables within the database for AAA repair including patients underwent AAA repair and had documentation of the presence or absence of postoperative IC in their medical records.

Results

The results of this study provide supporting evidence that repair for a ruptured AAA, open repair and need for blood transfusion, were the most important predictors of postoperative ischemic colitis. Other factors included patient factors such as age, gender, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease and, as well as operative factors, such as long duration of surgury, excessive blood loss and ischemia time. Further, using the common femoral artery as the site of distal anastomosis during open repair and interruption of the hypogastric artery, because of ligation/occlusion during open repair were also predictors of postoperative ischemic colitis. In addition, postoperative ischemic colitis increase the duration of ICU stay and 30-day mortality was much worse in these parients.

Conclusion

This study reveals that although colonic ischemia following AAA repair is rare, their outcome is very poor. The cause of postoperative ischemic colitis is multifactorial. open repair and rupture of the aneurism before surgury proved to be an important predictors. Other risk factors included age, gender, hypertension, coronary artery disease, chronic kidney disease and factors indicative of more operative stress, including longer operative time, and extensive blood loss.
Comparison of Postoperative Complications between Conventional Diathermy Haemorrhoidectomy and Harmonic Scalpel Haemorrhoidectomy
Authors: El Naser Amr Abd El Raouf Ali Abd , Said Kamal Mamdouh Kamal El , El Ghandour Abd El Rahman Mohamed , Ahmad Mennat Allah Muhammad Youssuf
Published: August 2023

Background

For symptomatic grade III and IV haemorrhoids, some form of hemorrhoidectomy remains the accepted modality of treatment. The traditional methods like the Milligan-Morgan method and the Ferguson‟s method have been in practice for more than half a century. Recently we acquired the Harmonic system. It is an ultrasonic dependent technology, using waves to both seal and cut vessels and tissues in a hypothermic condition, now widely used for hemorrhoidectomy. This study will give a comprehensive overview on differences between conventional diathermy haemorrhoidectomy and Harmonic scalpel haemorrhoidectomy focusing on post-operative complications mainly postoperative pain, bleeding, anal stenosis and peri-anal fistulae occurrence.

Objective

To compere between conventional diathermy hemorrhoidectomy and Harmonic scalpel hemorrhoidectomy as regards post-operative pain, bleeding, anal stenosis and peri-anal fistula occurrence.

Patients and Methods

It is a prospective study conducted over 40 patients with grade III and IV hemorrhoids, randomly divided into two groups to compare between conventional diathermy hemorrhoidectomy, Harmonic scalpel hemorrhoidectomy as regards post-operative pain, bleeding, anal stenosis and peri-anal fistula occurrence.

Results

An overall favorable trend exists toward Harmonic scalpel hemorrhoidectomy in all parameters of the current study, in another word, the postoperative complications mainly pain, bleeding, anal stenosis and peri-anal fistula occurrence was much lesser in the Harmonic group.

Conclusion

Harmonic scalpel hemorrhoidectomy is a sutureless, hemorrhoidectomy technique dependent on an ultrasonic unit to achieve vessel and tissue sealing. It is safe and effective, has less blood loss, postoperative pain, bleeding, anal stenosis and perianal fistula occurrence compared to conventional diathermy hemorrhoidectomy.
Early Outcome of Superomedial Pedicle as Extreme Oncoplastic Procedure versus Modified Radical Mastectomy in Patients with Stage T3 Breast Cancer Not Responding to Neoadjuvant Chemotherapy
Authors: Osman Ahmed Gamal-elDin , Atrash Osama Ali El , AbderRazik Mohammad Ahmad , Zaki Michael Bahaa
Published: August 2023

Background

Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women.

Aim of the Work

To assess the feasibility of extreme oncoplasty (achieving negative margins) for T3 breast cancer patients not responding to neoadjuvant chemotherapy by using a superomedial pedicle flap.

Patients and Methods

This study was conducted on 30 female patients with stage T3 breast cancer not responding to neoadjuvant chemotherapy with no skin involvement or upper medial quadrant tumor, with large breast size (cup D), accepting both intervention modalities and fit for both anesthesia and radiotherapy. It was performed at the (General Surgery Department) at Ain Shams University Hospitals and El Haram specialized Hospital starting from March 2020. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patients were divided into two groups. Group A includes 15 patients underwent Modified radical mastectomy with axillary clearance. Group B includes 15 patients underwent Superomedial pedicle mammoplasty and axillary clearance.

Results

Superomedial pedicle mammoplasty is equivalent to modified radical mastectomy in terms of oncological safety, with advantages over mastectomy in terms of quality of life and esthetic outcomes. Thus, Extreme oncoplasty provides an alternative to Modified radical mastectomy, extends the scope of breast conservation, provides better clinical outcomes, and improves quality of life.

Conclusion

This study showed that superomedial pedicle mammoplasty technique is a feasible extreme oncoplastic approach for patients with large tumors and not responsive to neoadjuvant chemotherapy considered for Modified radical mastectomy with acceptable complication rates, negligible rates of reexcision and no early recurrence in 3 months period.
Evaluation of Round Block Technique in Different Juxta-Areolar Malignant Lesions in Early Breast Cancer
Authors: Moghny Ashraf Abd El , Elmoaty Karim Fahmy Abd , Ibrahem Abdalla Hamed , Roman Mina Aref Abd Elmalak
Published: August 2023

Introduction

Conservative surgery has become a well-established alternative to mastectomy in the treatment of breast cancer. However, in case of larger lesions or small-sized breasts, the removal of adequate volumes of breast tissue to achieve tumor-free margins and reducing the risk of local recurrance may compromise the cosmetic outcome, causing unpleasant results. To address these surgical techniques, the socalled oncoplastic techniques, have been introduced in recent years to optimize the efficacy of conservative surgery in terms of both local control and cosmetic results.

Aim of the Work

To evaluate round block technique in different juxta areolar malignant lesions up to 50 mm from areola in early breast cancer regarding oncologic, surgical and cosmetic outcome - post-operative complications.

Patients and Methods

A Clinical Interventional descriptive single arm randomized prospective study, conducted on 20 female patients presenting with juxta areolar malignant lesions up to 50 mm from areola in early breast cancer stages T1 and T2. Ages ranging 20 to 70 years to be treated using the “round block” technique.

Results

None of the patients had any malignant recurrence during follow up visits through 1 year after the surgical removal of the tumor proving that we had performed both techniques safely from oncological point of view. The cosmotic results were found to be excellent in 4 cases, very good in 11 cases, good in 3 cases, fair in 1 case, and poor in 1 case. Unacceptable outcomes (either fair or poor) were observed in only 2 cases who underwent 25% excision or in whom the resected area was part of the lower portion of the breast.

Conclusion

The round block technique is useful for performing breast-conserving surgery in the upper portion of the breast. However, if the excision volume is greater than 20% and/or excision of a part of the lower portion of the breast is required, other procedures should be considered.
Impact of Recipient’s Inflow Artery Selection on Hepatic Artery Thrombosis Post Living Donor Liver Transplantation
Authors: Abdelghaffar Mohamed Fathy , elsaid Youssef farouk Youssef, Kamal , Ghobrial Remon Mamdouh Mahfouz , Ismaeil Mohamed Osama Marei
Published: August 2023

Background

Hepatic artery reconstruction is one of the most important steps in liver transplantation, and complications associated with this vascular reconstruction, such as hepatic artery thrombosis (HAT) may have a significant influence on the recipients’ prognosis.

Aim of the Work

The purpose of this retrospective study is to evaluate whether the selection of the recipient’s right versus left hepatic artery for hepatic artery reconstruction as an inflow artery will influence the chance of HAT after living donor liver transplantation (LDLT).

Patients and Methods

This is a retrospective study that analysed and evaluated the hospital records of all patients who underwent LDLT at Ain Shams University specialized Hospital (ASCOT) from January 2010 to January 2020. Records of all 390 patients were reviewed and drop out of 101 patients was performed according to the exclusion criteria.

Results

The study showed that the right hepatic artery was used in 79.5% of cases while the left hepatic artery was used in 20.1% of cases in the study population. The incidence of HAT was 7.3% in the whole study population. On further analysis of the arterial complications and distribution according to the usage of the right or left hepatic artery as the recipient inflow artery, there was an increase in the incidence of HAT when the right hepatic artery was used (7.9 %) compared to left hepatic artery which was (5.2 %) although it did not reach statistical significance.

Conclusion

Incidence of HAT was generally higher following LDLT using the right hepatic artery as the recipient’s inflow artery.
Evaluation of De Epithelization Technique in Management of Pilonidal Sinus Disease
Authors: Abdraboh Ayman Abdullah , Eldin Mohamed Salah , Amer Ahmed F
Published: August 2023

Background

Pilonidal sinus disease (PSD) is a common disorder of the sacrococcygeal region. The incidence is reported in 6 per 100,000 individuals, this method is defined as a flap or graft of thinned cutaneous layer. Aesthetic surgeons usually perform this method for mammoplasty. In this method, after de-epithelization of the cutaneous tissue is performed, cutaneous flap and fatty tissue are inverted to fill the dead space (1). De-epithelialized skin grafts are used for many indications.

Objective

To evaluate De epithelization technique as a new approach in management of pilonidal sinus disease as regard post operative complications and recurrence rate.

Patients and Methods

This Cohort retrospective and prospective study will include 50 cases, admitted to Ain Shams University and Agouza Police hospital from august 2019 till February 2020 who met the inclusion criteria. A total of 50 adult patients with PSD were randomly allocated intraoperatively to undergo De epithelization technique.

Results

According to our scale evaluating outcome, De-epithelization technique is effective and safe with least post operative complications regarding pilonidal sinus disease.

Conclusion

It allows a quicker return to daily activities and reduces costs. Furthermore, we believe that the risk of recurrence may be reduced by increasing the angle of the natal cleft during this technique. Also, this method has a satisfying aesthetic outcome. This preliminary report suggests that this new surgical approach seems to be a reasonable method in the treatment of PSD, especially in patients with uncomplicated primary disease, and is worth studying further.
Retrospective Study between Re-sleeve Gastrectomy and Mini-Gastric Bypass for Failed Sleeve Gastrectomy
Authors: Lasheen Mohammed Ali , Monaem Ayman Hossam Eldin Abd El , Hamad Mohammed Abd El Fattah Mohammed
Published: August 2023

Background

Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health.

Aim of the Work

The aim of this retrospective study is to compare between re-sleeve gastrectomy (RSG) and mini-gastric bypass (MGB) in patients who had previous failed sleeve gastrectomy in the last year concerning time required for operation and hospital stay, complications, and effect on weight loss and comorbidities for each operation.

Patients and Methods

This study is a retrospective cohart study which included 20 patients 10 of them underwent resleeve gastrectomy and 10 underwent minigastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt, From November 2019 to April 2020 with 6 months of postoperative follow up till October 2020.

Results

In our study we compared between re-sleeve gastrectomy and mini-gastric bypass as a revisional procedure for failed sleeve gastrectomy. MGB had longer mean operative time 103.5 mins. and longer mean postoperative hospital stay 3.6 days versus 91.9 mins. and 2.8 days respectively for RSG. Intraoperatively, bowel injury was reported in 20% of MGB cases versus bleeding which was reported in 20% of RSG cases.

Conclusion

Mini-gastric bypass and re-sleeve gastrectomy are efficient operations for reducing weight in morbidly obese patients and also in diabetic control. In patients who had previous failed sleeve gastrectomy; mini-gastric bypass had longer operative duration and postoperative hospital stay, more frequent bowel injury and leak in comparison with re-sleeve gastrectomy but improvements of weight loss, BMI, hypertension and DM were better with mini-gastric bypass. The less technically challenging nature of re-sleeve gastrectomy may be more widely applicable.
Comparative Study between Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI Bypass) versus Laparoscopic Mini-Gastric Bypass (MGB/OAGB) in Controlling Type 2 Diabetes in Morbidly Obese Patients
Authors: Maaty Sameh Abdullah , Sabry Ahmed Mohammed , Nasr Mohammed El-Sayed Abdel-Wahab
Published: August 2023

Background

In our opinion, the most important criteria in the selection of a bariatric procedure remain the safety and efficacy in achieving both weight loss and remission of the metabolic consequences of obesity. Despite the intrinsic limitation imposed by a retrospective study, our results seem to confirm that LMGB is both safe and effective for the treatment of morbidly obese diabetic patients. Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures. However, long-term follow-up period should be performed to evaluate postoperative weight loss, metabolic changes, and nutritional status of patients.

Objective

To compare Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass with Minigastric bypass (MGB/OAGB) in controlling type 2 Diabetes Mellitus in morbidly obese patients.

Patients and Methods

This study is a retrospective comparative study in which morbidly obese Patients with type 2 DM who underwent either Mini-gastric bypass or Single Anastomosis Sleeve Ileal (SASI) bypass with available preoperative Fasting blood Glucose, Hemoglobin A1c& serum cpeptide (As predictive measures for remission of diabetes after surgery) was collected & their data and results was compared to this1,3, 6 & 12 months postoperatively.

Results

As regard glycemic and lipid profile pre and postoperative mean values in MGB group, the present study showed that there were significant differences between before and after surgery as regard FBG, HbA1C, triglyceride, cholesterol, HDL and LDL. Laparoscopic mini-gastric bypass (MGB) is a technically simple and safe procedure in SSO patients. LMGB has the advantages of being a single stage procedure, being easily reversible and revisable in a laparoscopic procedure and does not sacrifice portions of the stomach or implant foreign materials. SASI bypass is a promising operation that offers excellent weight loss and metabolic result. The elimination of two ways for passage of food and one anastomosis decrease nutritional deficiency and the possibility of surgically related complications.

Conclusion

Metabolic surgery is a safe option for carefully selected patients with metabolic syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. Our study suggests that both SASI and MGB are highly effective in controlling Diabetes mellitus, Hypertension and Hyperlipidemia.