Hisham Ahmed | Benha University (original) (raw)
Papers by Hisham Ahmed
Der Urologe. Ausg. A, 2011
A case of urinoma with posterior urethral valves and its management is presented. Diagnostic inve... more A case of urinoma with posterior urethral valves and its management is presented. Diagnostic investigations and therapy strategies are discussed. Though rare, this possibility should be considered in the differential diagnosis of neonates presenting with rapidly expanding cystic masses in the abdomen. Early diagnosis and management are the most important prognostic factors that ensure a good outcome in such cases.
Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the s... more Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides.
Objectives
The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children.
Methods
A total of 40 children were enrolled into this prospective study; they were aged ≥6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25–30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried.
The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence.
Results
Table
Patients demographics, operative time and post-operative hospital stay.
Age (years) 3.4 ± 1.8Side Right 28 (48.3%)Left 20 (41.7%)Laterality Pre-operative Unilateral 32 (80%)Bilateral 8 (20%)Intra-operative Unilateral 23 (67.5%)Bilateral 17 (32.5%)Operative time (minutes) Unilateral 25 ± 4Bilateral 34.6 ± 3.8Hospital stay (hours) 4.3 ± 1.5
Discussion
The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively.
The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV.
Conclusion
Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time.
Keywords:
Laparoscopically assisted, High ligation, Patent processus vaginalis, Children
Objective: To study the feasibility ,advantages and disadvantages of combined cholecystectomy ... more Objective: To study the feasibility ,advantages and disadvantages of combined cholecystectomy at the time of cesarean section, and to compare laparoscopic versus mini-laparotomy approache.
Material and methods: This study comprises of 36 patients scheduled to have combined cholecystectomy at the time of cesarean section After obtaining informed surgical consent , all patients have been subjected to combined L.S.C.S. and cholecystectomy at the same time. The patients have been divided into two groups, group A (18 cases) subjected to laparoscopic cholecystectomy. Group B (18 cases) subjected to cholecystectomy using minilaparotomy approach after assessing the anatomy via cesarean section wound.
Results:. The mean operative time in group A was 65 minutes versus 85 minutes in group B. No conversion from laparoscopic to open cholecystectomy was needed especially in those with potential technical difficulties, the procedure has been accomplished successfully by laparoscopy. Three cases of group B needed wound extension to facilitate cholecystectomy. Only one case in group B developed wound infection in the subcostal wound incision. The average hospital stay was 2 days and 4 days for group A and group B respectively.
Conclusion: Combined cesarean section and cholecystectomy is feasible and has many advantages like single anaesthesia, single hospitalization, low cost, less drug therapy and safe to the mother and fetus.
Laparoscopic cholecystectomy is better than minilaparotomy cholecystectomy in operative and post-operative periods.
Silent gall stones patients undergoing cesarean section under general anaesthesia are best treated by cholecystectomy at the same time to avoid the complications of gall stones in young patients.
Key words: lower segment cesarean section (L.S.C.S.), cholecystectomy, laparoscopic cholecystectomy, minilaparotomy, combined approach.
Objectives: To determine the burden of gastroesophageal reflux disease (GERD) on patients' qualit... more Objectives: To determine the burden of gastroesophageal reflux disease (GERD) on patients' quality of life (QOL) and the extent of change imposed by GERD laparoscopic surgical correction.
Patients & Methods: The current study included 52 patients presenting with symptomatic GERD that was not adequately controlled with medical treatment. After clinical examination, all patients underwent upper gastrointestinal endoscopy, esophageal manometry to estimate lower esophageal sphincter (LES) pressure and were asked to complete the items of the gastroesophageal reflux disease impact scale (GIS) questionnaire and total score was calculated. Laparoscopic hiatal defect closure through crural approximation using stitches and circumferential placement of polypropylene mesh fixed to both crura, and then 360o fundoplication was performed. Operative and postoperative (PO) data were collected. GIS questionnaire and esophageal manometry were repeated 8-weeks and 6 months PO, respectively.
Results: All patients passed smooth intraoperative course without complications or need for laparotomy. Mean operative time was 60.9±12.6 minutes, mean time till 1st ambulation and oral intake was 5.4±1.2 hours and 9.5±1.2 hours, respectively. Mean duration of hospital stay was 27.7±9.8 hours and mean duration till attaining full daily activities was 6.8±2.4 days. All patients showed significant improvement of the individual items of GIS questionnaire compared to preoperative scores with significantly higher total PO score compared to preoperative total score. PO manometeric measurements of LES pressure were significantly higher compared to preoperative pressure measures.
Conclusion: Laparoscopic anti-reflux surgery (LARS) with mesh repair of hiatal hernia is a safe and effective procedure for management of GERD with significant improvement of patients' QOL.
Keywords: Laparoscopic anti-reflux surgery, Gastroesophageal reflux disease, Quality of life
Abstract: Zusammenfassung: Wir berichten über einen Patienten mit einem postnatal diagnostizierte... more Abstract: Zusammenfassung: Wir berichten über einen Patienten mit einem postnatal diagnostiziertem Urinom bei posterioren Harnröhrenklappen. Therapiestrategien sowie Management werden präsentiert und diskutiert. Harnröhrenklappen und ihre Sekundärpathologien sollten differentialdiagnostisch bei Neugeborenen mit einer rasch progredienten, zystischen, abdominalen Raumforderung in Betracht gezogen werden. Die frühe Diagnostik und Intervention sind die wichtigsten prognostischen Faktoren, um ein gutes Ergebnis zu gewährleisten.
Abstract: A case of urinoma with posterior urethral valve and its management is presented. Diagnostic investigations and therapy strategies are discussed. Though rare, this possibility should be considered in the differential diagnosis of neonates presenting with rapidly expanding cystic masses in the abdomen. Early diagnosis and management are the most important prognostic factors that ensure a good outcome in such cases.
Objectives: This study aimed to evaluate the short-term outcome of extracorporeal single-port pie... more Objectives: This study aimed to evaluate the short-term outcome of extracorporeal single-port piece-meal closure of the internal inguinal ring in children older than 6 months.
Patients & Methods: The study included 40 patients; 26 males and 14 females with mean age of 3.4±1.8 years. Eight patients (20%) had bilateral and 32 patients had unilateral hernias. Exploratory laparoscopy of the contralateral inguinal region was conducted for cases had unilateral hernia. Under laparoscopic guided vision using 5mm, 30o telescope, a prolene or vicryl 2/0 or 3/0 suture on a curved rounded tapered-ended needle was introduced through an inguinal skin crease incision using a needle holder, passed through the abdominal wall layers till the peritoneum and had manipulated to pick up the peritoneum in piecemeal all around the internal ring and then the needle was pushed to the outside near to the entrance site thus forming half a circle around the internal ring. Finally the needle has passed back subcutaneously towards the entrance site and the suture tied subcutaneously. The frequency of intraoperative diagnosis of bilateral hernias, total theater time, duration of hospital stay, the frequency and severity of complications, duration of follow-up and recurrence rate were determined.
Results: Exploratory laparoscopy detected 9 occult inguinal hernias in patients with unilateral hernia for a frequency of 28.1% for intraoperative detection of synchronous contralateral hernia. Mean operative time was 25±4; 18-30 minutes for unilateral cases and was 34.6±3.8; 30-45 minutes for bilateral cases. No conversion to open surgery was needed. Mean postoperative hospital stay was 4.3±1.5 hours and 70% of patients allowed going home within the range of 3 to 6 hours. Only one patient had bilateral hernia developed recurrence 4-months after surgery and was managed using open approach.
Conclusion: The applied procedure using single trocar for piecemeal closure of internal inguinal ring in children is safe, effective day-case procedure with satisfactory cosmetic appearance and contralateral hernia detection rate of 28.1% without prolongation of operative time and recurrence rate of 1.7% per hernia
To evaluate the short-term surgical and cosmetic outcome of hypospadias repair using tubularized ... more To evaluate the short-term surgical and cosmetic outcome of hypospadias repair using tubularized incised plate urethroplasty (TIPU) with foreskin reconstruction (FSR) in children with distal hypospadias, 50 children with distal hypospadias were categorized according to parental preference either to have TIPU only or to have TIPU with FSR and to be circumcised one-month later. Mothers were trained for the frequent postoperative meatal dilatation and preputial retraction. Patients were followed-up weekly for one-month for the occurrence of complications related to either urethroplasty or FSR. Parents' satisfaction concerning the cosmetic appearance of the penis after FSR and prior to circumcision was inquired. Eleven children had glandular and 39 had coronal hypospadias; 30 children had TIPU and FSR, and 20 children had TIPU only. Five patients (10%); 3 had TIPU only and 2 had TIPU & FSR required redo surgery for repair of urethrocutaneous fistula. Only 3 patients who had FSR developed phimosis but was not hampering meatal dilatation. One patient had FSR gapping and was readmitted for circumcision at 2 weeks after surgery. Two patients in TIPU group required removal of redundant skin. Parents of all patients had FSR were highly satisfied by the appearance of the penis after surgery and liked regaining of its normal anatomical appearance. TIPU and FSR is a simple and safe procedure for distal hypospadias repair with minimal morbidities and a higher satisfaction rate for both children and parents; so, if the objective of distal hypospadias surgery is to restore a penis with an appearance as normal as possible, prepuce reconstruction should constitute a key element of the final result.
Der Urologe. Ausg. A, 2011
A case of urinoma with posterior urethral valves and its management is presented. Diagnostic inve... more A case of urinoma with posterior urethral valves and its management is presented. Diagnostic investigations and therapy strategies are discussed. Though rare, this possibility should be considered in the differential diagnosis of neonates presenting with rapidly expanding cystic masses in the abdomen. Early diagnosis and management are the most important prognostic factors that ensure a good outcome in such cases.
Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the s... more Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides.
Objectives
The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children.
Methods
A total of 40 children were enrolled into this prospective study; they were aged ≥6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25–30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried.
The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence.
Results
Table
Patients demographics, operative time and post-operative hospital stay.
Age (years) 3.4 ± 1.8Side Right 28 (48.3%)Left 20 (41.7%)Laterality Pre-operative Unilateral 32 (80%)Bilateral 8 (20%)Intra-operative Unilateral 23 (67.5%)Bilateral 17 (32.5%)Operative time (minutes) Unilateral 25 ± 4Bilateral 34.6 ± 3.8Hospital stay (hours) 4.3 ± 1.5
Discussion
The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively.
The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV.
Conclusion
Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time.
Keywords:
Laparoscopically assisted, High ligation, Patent processus vaginalis, Children
Objective: To study the feasibility ,advantages and disadvantages of combined cholecystectomy ... more Objective: To study the feasibility ,advantages and disadvantages of combined cholecystectomy at the time of cesarean section, and to compare laparoscopic versus mini-laparotomy approache.
Material and methods: This study comprises of 36 patients scheduled to have combined cholecystectomy at the time of cesarean section After obtaining informed surgical consent , all patients have been subjected to combined L.S.C.S. and cholecystectomy at the same time. The patients have been divided into two groups, group A (18 cases) subjected to laparoscopic cholecystectomy. Group B (18 cases) subjected to cholecystectomy using minilaparotomy approach after assessing the anatomy via cesarean section wound.
Results:. The mean operative time in group A was 65 minutes versus 85 minutes in group B. No conversion from laparoscopic to open cholecystectomy was needed especially in those with potential technical difficulties, the procedure has been accomplished successfully by laparoscopy. Three cases of group B needed wound extension to facilitate cholecystectomy. Only one case in group B developed wound infection in the subcostal wound incision. The average hospital stay was 2 days and 4 days for group A and group B respectively.
Conclusion: Combined cesarean section and cholecystectomy is feasible and has many advantages like single anaesthesia, single hospitalization, low cost, less drug therapy and safe to the mother and fetus.
Laparoscopic cholecystectomy is better than minilaparotomy cholecystectomy in operative and post-operative periods.
Silent gall stones patients undergoing cesarean section under general anaesthesia are best treated by cholecystectomy at the same time to avoid the complications of gall stones in young patients.
Key words: lower segment cesarean section (L.S.C.S.), cholecystectomy, laparoscopic cholecystectomy, minilaparotomy, combined approach.
Objectives: To determine the burden of gastroesophageal reflux disease (GERD) on patients' qualit... more Objectives: To determine the burden of gastroesophageal reflux disease (GERD) on patients' quality of life (QOL) and the extent of change imposed by GERD laparoscopic surgical correction.
Patients & Methods: The current study included 52 patients presenting with symptomatic GERD that was not adequately controlled with medical treatment. After clinical examination, all patients underwent upper gastrointestinal endoscopy, esophageal manometry to estimate lower esophageal sphincter (LES) pressure and were asked to complete the items of the gastroesophageal reflux disease impact scale (GIS) questionnaire and total score was calculated. Laparoscopic hiatal defect closure through crural approximation using stitches and circumferential placement of polypropylene mesh fixed to both crura, and then 360o fundoplication was performed. Operative and postoperative (PO) data were collected. GIS questionnaire and esophageal manometry were repeated 8-weeks and 6 months PO, respectively.
Results: All patients passed smooth intraoperative course without complications or need for laparotomy. Mean operative time was 60.9±12.6 minutes, mean time till 1st ambulation and oral intake was 5.4±1.2 hours and 9.5±1.2 hours, respectively. Mean duration of hospital stay was 27.7±9.8 hours and mean duration till attaining full daily activities was 6.8±2.4 days. All patients showed significant improvement of the individual items of GIS questionnaire compared to preoperative scores with significantly higher total PO score compared to preoperative total score. PO manometeric measurements of LES pressure were significantly higher compared to preoperative pressure measures.
Conclusion: Laparoscopic anti-reflux surgery (LARS) with mesh repair of hiatal hernia is a safe and effective procedure for management of GERD with significant improvement of patients' QOL.
Keywords: Laparoscopic anti-reflux surgery, Gastroesophageal reflux disease, Quality of life
Abstract: Zusammenfassung: Wir berichten über einen Patienten mit einem postnatal diagnostizierte... more Abstract: Zusammenfassung: Wir berichten über einen Patienten mit einem postnatal diagnostiziertem Urinom bei posterioren Harnröhrenklappen. Therapiestrategien sowie Management werden präsentiert und diskutiert. Harnröhrenklappen und ihre Sekundärpathologien sollten differentialdiagnostisch bei Neugeborenen mit einer rasch progredienten, zystischen, abdominalen Raumforderung in Betracht gezogen werden. Die frühe Diagnostik und Intervention sind die wichtigsten prognostischen Faktoren, um ein gutes Ergebnis zu gewährleisten.
Abstract: A case of urinoma with posterior urethral valve and its management is presented. Diagnostic investigations and therapy strategies are discussed. Though rare, this possibility should be considered in the differential diagnosis of neonates presenting with rapidly expanding cystic masses in the abdomen. Early diagnosis and management are the most important prognostic factors that ensure a good outcome in such cases.
Objectives: This study aimed to evaluate the short-term outcome of extracorporeal single-port pie... more Objectives: This study aimed to evaluate the short-term outcome of extracorporeal single-port piece-meal closure of the internal inguinal ring in children older than 6 months.
Patients & Methods: The study included 40 patients; 26 males and 14 females with mean age of 3.4±1.8 years. Eight patients (20%) had bilateral and 32 patients had unilateral hernias. Exploratory laparoscopy of the contralateral inguinal region was conducted for cases had unilateral hernia. Under laparoscopic guided vision using 5mm, 30o telescope, a prolene or vicryl 2/0 or 3/0 suture on a curved rounded tapered-ended needle was introduced through an inguinal skin crease incision using a needle holder, passed through the abdominal wall layers till the peritoneum and had manipulated to pick up the peritoneum in piecemeal all around the internal ring and then the needle was pushed to the outside near to the entrance site thus forming half a circle around the internal ring. Finally the needle has passed back subcutaneously towards the entrance site and the suture tied subcutaneously. The frequency of intraoperative diagnosis of bilateral hernias, total theater time, duration of hospital stay, the frequency and severity of complications, duration of follow-up and recurrence rate were determined.
Results: Exploratory laparoscopy detected 9 occult inguinal hernias in patients with unilateral hernia for a frequency of 28.1% for intraoperative detection of synchronous contralateral hernia. Mean operative time was 25±4; 18-30 minutes for unilateral cases and was 34.6±3.8; 30-45 minutes for bilateral cases. No conversion to open surgery was needed. Mean postoperative hospital stay was 4.3±1.5 hours and 70% of patients allowed going home within the range of 3 to 6 hours. Only one patient had bilateral hernia developed recurrence 4-months after surgery and was managed using open approach.
Conclusion: The applied procedure using single trocar for piecemeal closure of internal inguinal ring in children is safe, effective day-case procedure with satisfactory cosmetic appearance and contralateral hernia detection rate of 28.1% without prolongation of operative time and recurrence rate of 1.7% per hernia
To evaluate the short-term surgical and cosmetic outcome of hypospadias repair using tubularized ... more To evaluate the short-term surgical and cosmetic outcome of hypospadias repair using tubularized incised plate urethroplasty (TIPU) with foreskin reconstruction (FSR) in children with distal hypospadias, 50 children with distal hypospadias were categorized according to parental preference either to have TIPU only or to have TIPU with FSR and to be circumcised one-month later. Mothers were trained for the frequent postoperative meatal dilatation and preputial retraction. Patients were followed-up weekly for one-month for the occurrence of complications related to either urethroplasty or FSR. Parents' satisfaction concerning the cosmetic appearance of the penis after FSR and prior to circumcision was inquired. Eleven children had glandular and 39 had coronal hypospadias; 30 children had TIPU and FSR, and 20 children had TIPU only. Five patients (10%); 3 had TIPU only and 2 had TIPU & FSR required redo surgery for repair of urethrocutaneous fistula. Only 3 patients who had FSR developed phimosis but was not hampering meatal dilatation. One patient had FSR gapping and was readmitted for circumcision at 2 weeks after surgery. Two patients in TIPU group required removal of redundant skin. Parents of all patients had FSR were highly satisfied by the appearance of the penis after surgery and liked regaining of its normal anatomical appearance. TIPU and FSR is a simple and safe procedure for distal hypospadias repair with minimal morbidities and a higher satisfaction rate for both children and parents; so, if the objective of distal hypospadias surgery is to restore a penis with an appearance as normal as possible, prepuce reconstruction should constitute a key element of the final result.