Ahmed Abdel Kahaar Aldardeer - Academia.edu (original) (raw)

Papers by Ahmed Abdel Kahaar Aldardeer

Research paper thumbnail of Laparoscopy in acute abdomen between encouragement and inhibition

International Surgery Journal, Sep 26, 2019

The commonest complaint requiring emergency surgical admission is acute abdominal pain. Those pat... more The commonest complaint requiring emergency surgical admission is acute abdominal pain. Those patients may need lots of investigations but diagnosis can still remain uncertain. All strategies for the management of acute abdomen underline the need for a multidisplinary approach for diagnosis and treatment. 1 This requires smart and focused use of efficient diagnostic procedures. Diagnostic laparoscopy (DL) may be a solution to solve the diagnostic issue of nonspecific acute abdomen. Furthermore, it permits inspection of the whole abdomen and also intervention, if needed. 2 Diagnostic laparoscopy was first used in 1901, when Georg Kelling a German surgeon performed a dog peritoneoscopy, "celioscopy". H. C. Jacobaeus, a Swedish internist was the first one to performe the first human diagnostic laparoscopy in 1910. 3 The value of diagnostic emergency laparoscopy has been begun since the 1950s and 1960s but in acute abdomen the use of diagnostic laparoscopy is relatively recent. It was first done by Philippe Moment in 1990. 4 Despite new investigative tools, scans, and ultrasonography, the diagnosis of acute abdominal pain can be difficult at some times. So, the commonest ABSTRACT Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases. Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen. Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of patients but failed to reach the diagnosis in 2 cases and conversion to laparotomy in other 2 cases. Laparoscopic surgery mean was 47.9±12.4 minutes. Hospital stay mean was (1.851) days. Morbidity was 10%. No mortality was found in our study. Conclusions: Laparoscopy can be considered safe for diagnosis and effective in the treatment of patients with acute abdomen. It may be useful to avoid the unnecessary laparotomies in a large number of patients presented with acute abdominal pain.

Research paper thumbnail of Prospective trial comparing open approach of Lichtenstein tension-free mesh with laparoscopic transabdominal preperitoneal approach for repair of inguinal hernia: tertiary center experience

International Surgery Journal, Oct 24, 2019

The introduction of various open mesh and laparoscopic techniques has increased the interest in i... more The introduction of various open mesh and laparoscopic techniques has increased the interest in inguinal hernia surgery. But still controversy persists about the most effective inguinal hernia repair. The aim of this study was to compare the results of open Lichtenstein tension-free mesh technique and laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia. 1 Inguinal hernia is a very common complaint, About 700,000 patients in the United States, 200,000 in Germany and 80,000 patients in England annually undergo surgical repair of their inguinal hernia. 1 The use of mesh to repair inguinal hernias is accepted widely and is replacing repairs by suturing. Many techniques have been described since the first application of laparoscopy to the management of hernias. 2

Research paper thumbnail of Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

International Surgery Journal, Jul 28, 2021

However, the recovery of liver functions after partial hepatectomy depends not only on the volume... more However, the recovery of liver functions after partial hepatectomy depends not only on the volume but also on the quality of the remaining liver parenchyma. 8 It is well ABSTRACT Background: With the current high incidence of hepatocellular carcinoma (HCC), more patients even with large and huge HCC are considered for liver resection. Methods: Medical records of consecutive adult cirrhotic patients who underwent partial hepatectomy for huge HCC (≥10 cm, huge HCC group) versus small HCC (<5 cm, small HCC group) at Sohag university hospital (January 2016 to December 2020) were analyzed. Both groups were compared regarding postoperative morbidity and risk of mortality following post hepatectomy liver failure (PHLF) as defined by the 50-50 criteria (50% mortality occurs among patients who developed increased plasma bilirubin >50 μml/l and reduced prothrombin activity <50% on postoperative day 5 (POD-5). Results: Thirty two patients were enrolled (16 per group), with median age of 56 (range 38-81) years, 22 were males. In correlation with resection of more liver segments in the huge HCC group, post hepatectomy alteration of liver functions (bilirubin rise and reduction of albumin and prothrombin concentration) was significantly pronounced among patients who had resection for huge compared with small HCC (p<0.05). Huge HCC group exhibited significantly worse postoperative complication score (p< 0.05) and needed significantly prologed periods of hospital stay (p<0.05). Concurrent persistence of PHLF and thrombocytopenia until POD-5 occurred in 3 patients (2 with huge HCC and 1 with small HCC). Among those patients, only one from huge HCC group died (mortality 6%) postoperatively. Conclusions: Liver resection provides safe and effective treatment strategy for carefully selected cirrhotic patients with huge HCC.

Research paper thumbnail of Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

International Surgery Journal, Nov 26, 2019

However, with increasing expertise in laparoscopic procedures, more and more surgeons have starte... more However, with increasing expertise in laparoscopic procedures, more and more surgeons have started ABSTRACT Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC). Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed. Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. ingroup B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open). Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability.

Research paper thumbnail of Laparoscopic Inguinal Hernia Repair; Sohag Experience

The Egyptian Journal of Hospital Medicine, 2021

Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many cente... more Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many centers. Objective: We aimed with this study to evaluate the technique regarding its advantages and disadvantages in Sohag University Hospital. Patients and Methods: This was a prospective observational study included 50 patients suffering from inguinal hernia admitted electively to Sohag University Hospital between September 2019 and April 2020. Patients were enrolled for laparoscopic Trans Abdominal Pre Peritoneal (TAPP) repair. Patients were evaluated regarding demographic criteria, clinical picture, operative, and postoperative course after an outpatient follow-up period of 6 months. Results: The mean operative time in minutes ±SD was (125±12.5) for the early 10 patients while it was (69.8± 24) for the last 25 patients. Intraoperative complications were encountered in two cases of visceral injury and one case of bleeding arising from the inferior epigastric artery that was managed laparoscopically without surgical sequelae. The duration of hospital stay ranged from 24-48 hours. Postoperative complications were encountered in 3 patients whom had surgical emphysema which resolved conservatively. Patients returned to full activities in 7.14 ± 0.96 days and returned to their work in 14 ±2.5 days. On follow-up, recurrence was not encountered allover the period of 6 months postoperatively. Conclusion: TAPP repair for inguinal hernias is justified as a feasible, reproducible, and safe technique with rapid recovery and early return to work as well as comparable morbidities to other techniques. It is recommended as the procedure of choice in elective groin hernia repair especially in bilateral cases, with short learning curve requiring little facilities in the center.

Research paper thumbnail of Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

International Surgery Journal, 2021

Background: With the current high incidence of hepatocellular carcinoma (HCC), more patients even... more Background: With the current high incidence of hepatocellular carcinoma (HCC), more patients even with large and huge HCC are considered for liver resection.Methods: Medical records of consecutive adult cirrhotic patients who underwent partial hepatectomy for huge HCC (≥10 cm, huge HCC group) versus small HCC (<5 cm, small HCC group) at Sohag university hospital (January 2016 to December 2020) were analyzed. Both groups were compared regarding postoperative morbidity and risk of mortality following post hepatectomy liver failure (PHLF) as defined by the 50-50 criteria (50% mortality occurs among patients who developed increased plasma bilirubin >50 μml/l and reduced prothrombin activity <50% on postoperative day 5 (POD-5).Results: Thirty two patients were enrolled (16 per group), with median age of 56 (range 38-81) years, 22 were males. In correlation with resection of more liver segments in the huge HCC group, post hepatectomy alteration of liver functions (bilirubin rise ...

Research paper thumbnail of Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

International Surgery Journal, 2019

Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, relia... more Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Grou...

Research paper thumbnail of Laparoscopy in acute abdomen between encouragement and inhibition

International Surgery Journal, 2019

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal disease... more Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of...

Research paper thumbnail of Mesh fixation versus non fixation in open herrnioplasty

International Surgery Journal, 2019

Background: The goal of this study was to compare herrnioplasty with or without mesh fixation for... more Background: The goal of this study was to compare herrnioplasty with or without mesh fixation for inguinal hernias, paraumbilical hernia and epigastric hernia.Methods: This study included 288patients (170 males and 118 females) of different age groups with hernia who were admitted to general surgery department of sohag university hospital during the period from April 2018 to march 2019. Analysis of the clinical presentation, type of hernia and patients risk factors was done. All patients with above mentioned hernias without history of previous operations, was eligible for the study.Results: A total of 288 patients, 123 patients (42.7%) had oblique inguinal hernia, 75 patients (26%) had epigastric hernia, 77 (26.7%) had Para umbilical hernia and 13 (4.5%) had direct inguinal hernia. We had two groups, group (I) with mesh fixation included 141 patients (49%), while group (II) included patients (51%) without fixation of the mesh. Methods of fixation of the mesh in group (I) included s...

Research paper thumbnail of Total thyroidectomy: Conventional Suture Ligation technique versus sutureless techniques using Harmonic Scalpel or Maxium

Annals of Medicine & Surgery, 2016

h i g h l i g h t s HS and MAX are safe useful and fast alternatives to conventional techniques i... more h i g h l i g h t s HS and MAX are safe useful and fast alternatives to conventional techniques in total thyroidectomy. These two devices facilitate surgical procedures and cancel any need for clips and suture ligations. They significantly reduce operative time without increases in the amount of blood losses and hospital stay. Probably the only disadvantage of these two devices is the cost of the single-use devices.

Research paper thumbnail of Axillary dissection versus non dissection in negative sentinel node biopsy patients

International Surgery Journal, 2019

Background: The goal of this series was to compare performing axillary clearance versus none perf... more Background: The goal of this series was to compare performing axillary clearance versus none performing in patients with node biopsy negative.Methods: This study included 114 patients had breast cancer , presented with breast mass no enlarged axillary node either clinically or radiologically and all patients had negative sentinel lymph node intraoperatively those patients presented to Sohag Cancer Center and General Surgery Department Sohag, Egypt during the period of May 2018 to May 2019. Analysis of the clinical presentation, grade of breast cancer and radiological findings was done. All patients with above mentioned criteria were fitted for the study.Results: A total of 114 patients, all of them had sentinel lymph node negative, axillary dissection done in 55 patients of them while 59 patients had no dissection. We divided the patients in our series into group A (with axillary dissection) and group B with non-dissection; in group A 27 (49.1%) patients had lymphoedema on post-oper...

Research paper thumbnail of Validity of no-zone approach for management of isolated penetrating neck injuries in hemodynamically stable patients

International Surgery Journal, 2021

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamic... more Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodyn...

Research paper thumbnail of Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamic... more Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in t...

Research paper thumbnail of Oncoplastic breast surgery:current strategies and outcome

Sohag Medical Journal, 2018

Introduction Oncoplastic surgery has emerged as a new approach to allow wide excision for breast ... more Introduction Oncoplastic surgery has emerged as a new approach to allow wide excision for breast conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer. Objective:To study the different methods of oncoplastic surgery for breast reconstruction to achieve better aesthetic outcome and improve quality of life. Patients and Methods: Thirty patients with breast cancer, treated at Sohag University Hospital between July 2016 to May 2017 were included in this study. The oncoplastic techniques performed were Local glandular tissue displacement in (60%), latissimus dorsi flap (LD) in (16.6%), superior pedicle flap in(10%), implant insertion in (6.6%) and Transverse rectus abdominus myocutanous flap (TRAM) in (6.6%). The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree. Results: The number of patients included in the study were thirty. The median age was 43 years (range; 20-60 ys). There were three major complications that require repeating the oncoplastic techniques. Recorded complications included wound infection (5/30, 16.6 %) donor site seroma (10/30, 33.3 %), postoperative haematoma (1/30, 3.3%), flap ischemia and necrosis (1/30, 3.3%). The 12-months subjective patient satisfaction was excellent in 27 (90%) patients, and bad in 3 (10 %) patients. There were two local recurrence, no systemic metastasis after an average follow-up duration of 12 months. Conclusion:Restoring the defect after resection of the breast cancer can be safely achieved using oncoplastic procedures including the previous techniques with immediate breast reconstruction. In our patients, these procedures yield a satisfactory aesthetic outcome with lower morbidity.

Research paper thumbnail of Laparoscopy in acute abdomen between encouragement and inhibition

International Surgery Journal, Sep 26, 2019

The commonest complaint requiring emergency surgical admission is acute abdominal pain. Those pat... more The commonest complaint requiring emergency surgical admission is acute abdominal pain. Those patients may need lots of investigations but diagnosis can still remain uncertain. All strategies for the management of acute abdomen underline the need for a multidisplinary approach for diagnosis and treatment. 1 This requires smart and focused use of efficient diagnostic procedures. Diagnostic laparoscopy (DL) may be a solution to solve the diagnostic issue of nonspecific acute abdomen. Furthermore, it permits inspection of the whole abdomen and also intervention, if needed. 2 Diagnostic laparoscopy was first used in 1901, when Georg Kelling a German surgeon performed a dog peritoneoscopy, "celioscopy". H. C. Jacobaeus, a Swedish internist was the first one to performe the first human diagnostic laparoscopy in 1910. 3 The value of diagnostic emergency laparoscopy has been begun since the 1950s and 1960s but in acute abdomen the use of diagnostic laparoscopy is relatively recent. It was first done by Philippe Moment in 1990. 4 Despite new investigative tools, scans, and ultrasonography, the diagnosis of acute abdominal pain can be difficult at some times. So, the commonest ABSTRACT Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases. Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen. Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of patients but failed to reach the diagnosis in 2 cases and conversion to laparotomy in other 2 cases. Laparoscopic surgery mean was 47.9±12.4 minutes. Hospital stay mean was (1.851) days. Morbidity was 10%. No mortality was found in our study. Conclusions: Laparoscopy can be considered safe for diagnosis and effective in the treatment of patients with acute abdomen. It may be useful to avoid the unnecessary laparotomies in a large number of patients presented with acute abdominal pain.

Research paper thumbnail of Prospective trial comparing open approach of Lichtenstein tension-free mesh with laparoscopic transabdominal preperitoneal approach for repair of inguinal hernia: tertiary center experience

International Surgery Journal, Oct 24, 2019

The introduction of various open mesh and laparoscopic techniques has increased the interest in i... more The introduction of various open mesh and laparoscopic techniques has increased the interest in inguinal hernia surgery. But still controversy persists about the most effective inguinal hernia repair. The aim of this study was to compare the results of open Lichtenstein tension-free mesh technique and laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia. 1 Inguinal hernia is a very common complaint, About 700,000 patients in the United States, 200,000 in Germany and 80,000 patients in England annually undergo surgical repair of their inguinal hernia. 1 The use of mesh to repair inguinal hernias is accepted widely and is replacing repairs by suturing. Many techniques have been described since the first application of laparoscopy to the management of hernias. 2

Research paper thumbnail of Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

International Surgery Journal, Jul 28, 2021

However, the recovery of liver functions after partial hepatectomy depends not only on the volume... more However, the recovery of liver functions after partial hepatectomy depends not only on the volume but also on the quality of the remaining liver parenchyma. 8 It is well ABSTRACT Background: With the current high incidence of hepatocellular carcinoma (HCC), more patients even with large and huge HCC are considered for liver resection. Methods: Medical records of consecutive adult cirrhotic patients who underwent partial hepatectomy for huge HCC (≥10 cm, huge HCC group) versus small HCC (<5 cm, small HCC group) at Sohag university hospital (January 2016 to December 2020) were analyzed. Both groups were compared regarding postoperative morbidity and risk of mortality following post hepatectomy liver failure (PHLF) as defined by the 50-50 criteria (50% mortality occurs among patients who developed increased plasma bilirubin >50 μml/l and reduced prothrombin activity <50% on postoperative day 5 (POD-5). Results: Thirty two patients were enrolled (16 per group), with median age of 56 (range 38-81) years, 22 were males. In correlation with resection of more liver segments in the huge HCC group, post hepatectomy alteration of liver functions (bilirubin rise and reduction of albumin and prothrombin concentration) was significantly pronounced among patients who had resection for huge compared with small HCC (p<0.05). Huge HCC group exhibited significantly worse postoperative complication score (p< 0.05) and needed significantly prologed periods of hospital stay (p<0.05). Concurrent persistence of PHLF and thrombocytopenia until POD-5 occurred in 3 patients (2 with huge HCC and 1 with small HCC). Among those patients, only one from huge HCC group died (mortality 6%) postoperatively. Conclusions: Liver resection provides safe and effective treatment strategy for carefully selected cirrhotic patients with huge HCC.

Research paper thumbnail of Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

International Surgery Journal, Nov 26, 2019

However, with increasing expertise in laparoscopic procedures, more and more surgeons have starte... more However, with increasing expertise in laparoscopic procedures, more and more surgeons have started ABSTRACT Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC). Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed. Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. ingroup B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open). Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability.

Research paper thumbnail of Laparoscopic Inguinal Hernia Repair; Sohag Experience

The Egyptian Journal of Hospital Medicine, 2021

Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many cente... more Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many centers. Objective: We aimed with this study to evaluate the technique regarding its advantages and disadvantages in Sohag University Hospital. Patients and Methods: This was a prospective observational study included 50 patients suffering from inguinal hernia admitted electively to Sohag University Hospital between September 2019 and April 2020. Patients were enrolled for laparoscopic Trans Abdominal Pre Peritoneal (TAPP) repair. Patients were evaluated regarding demographic criteria, clinical picture, operative, and postoperative course after an outpatient follow-up period of 6 months. Results: The mean operative time in minutes ±SD was (125±12.5) for the early 10 patients while it was (69.8± 24) for the last 25 patients. Intraoperative complications were encountered in two cases of visceral injury and one case of bleeding arising from the inferior epigastric artery that was managed laparoscopically without surgical sequelae. The duration of hospital stay ranged from 24-48 hours. Postoperative complications were encountered in 3 patients whom had surgical emphysema which resolved conservatively. Patients returned to full activities in 7.14 ± 0.96 days and returned to their work in 14 ±2.5 days. On follow-up, recurrence was not encountered allover the period of 6 months postoperatively. Conclusion: TAPP repair for inguinal hernias is justified as a feasible, reproducible, and safe technique with rapid recovery and early return to work as well as comparable morbidities to other techniques. It is recommended as the procedure of choice in elective groin hernia repair especially in bilateral cases, with short learning curve requiring little facilities in the center.

Research paper thumbnail of Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

International Surgery Journal, 2021

Background: With the current high incidence of hepatocellular carcinoma (HCC), more patients even... more Background: With the current high incidence of hepatocellular carcinoma (HCC), more patients even with large and huge HCC are considered for liver resection.Methods: Medical records of consecutive adult cirrhotic patients who underwent partial hepatectomy for huge HCC (≥10 cm, huge HCC group) versus small HCC (<5 cm, small HCC group) at Sohag university hospital (January 2016 to December 2020) were analyzed. Both groups were compared regarding postoperative morbidity and risk of mortality following post hepatectomy liver failure (PHLF) as defined by the 50-50 criteria (50% mortality occurs among patients who developed increased plasma bilirubin >50 μml/l and reduced prothrombin activity <50% on postoperative day 5 (POD-5).Results: Thirty two patients were enrolled (16 per group), with median age of 56 (range 38-81) years, 22 were males. In correlation with resection of more liver segments in the huge HCC group, post hepatectomy alteration of liver functions (bilirubin rise ...

Research paper thumbnail of Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

International Surgery Journal, 2019

Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, relia... more Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Grou...

Research paper thumbnail of Laparoscopy in acute abdomen between encouragement and inhibition

International Surgery Journal, 2019

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal disease... more Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of...

Research paper thumbnail of Mesh fixation versus non fixation in open herrnioplasty

International Surgery Journal, 2019

Background: The goal of this study was to compare herrnioplasty with or without mesh fixation for... more Background: The goal of this study was to compare herrnioplasty with or without mesh fixation for inguinal hernias, paraumbilical hernia and epigastric hernia.Methods: This study included 288patients (170 males and 118 females) of different age groups with hernia who were admitted to general surgery department of sohag university hospital during the period from April 2018 to march 2019. Analysis of the clinical presentation, type of hernia and patients risk factors was done. All patients with above mentioned hernias without history of previous operations, was eligible for the study.Results: A total of 288 patients, 123 patients (42.7%) had oblique inguinal hernia, 75 patients (26%) had epigastric hernia, 77 (26.7%) had Para umbilical hernia and 13 (4.5%) had direct inguinal hernia. We had two groups, group (I) with mesh fixation included 141 patients (49%), while group (II) included patients (51%) without fixation of the mesh. Methods of fixation of the mesh in group (I) included s...

Research paper thumbnail of Total thyroidectomy: Conventional Suture Ligation technique versus sutureless techniques using Harmonic Scalpel or Maxium

Annals of Medicine & Surgery, 2016

h i g h l i g h t s HS and MAX are safe useful and fast alternatives to conventional techniques i... more h i g h l i g h t s HS and MAX are safe useful and fast alternatives to conventional techniques in total thyroidectomy. These two devices facilitate surgical procedures and cancel any need for clips and suture ligations. They significantly reduce operative time without increases in the amount of blood losses and hospital stay. Probably the only disadvantage of these two devices is the cost of the single-use devices.

Research paper thumbnail of Axillary dissection versus non dissection in negative sentinel node biopsy patients

International Surgery Journal, 2019

Background: The goal of this series was to compare performing axillary clearance versus none perf... more Background: The goal of this series was to compare performing axillary clearance versus none performing in patients with node biopsy negative.Methods: This study included 114 patients had breast cancer , presented with breast mass no enlarged axillary node either clinically or radiologically and all patients had negative sentinel lymph node intraoperatively those patients presented to Sohag Cancer Center and General Surgery Department Sohag, Egypt during the period of May 2018 to May 2019. Analysis of the clinical presentation, grade of breast cancer and radiological findings was done. All patients with above mentioned criteria were fitted for the study.Results: A total of 114 patients, all of them had sentinel lymph node negative, axillary dissection done in 55 patients of them while 59 patients had no dissection. We divided the patients in our series into group A (with axillary dissection) and group B with non-dissection; in group A 27 (49.1%) patients had lymphoedema on post-oper...

Research paper thumbnail of Validity of no-zone approach for management of isolated penetrating neck injuries in hemodynamically stable patients

International Surgery Journal, 2021

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamic... more Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodyn...

Research paper thumbnail of Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamic... more Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in t...

Research paper thumbnail of Oncoplastic breast surgery:current strategies and outcome

Sohag Medical Journal, 2018

Introduction Oncoplastic surgery has emerged as a new approach to allow wide excision for breast ... more Introduction Oncoplastic surgery has emerged as a new approach to allow wide excision for breast conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer. Objective:To study the different methods of oncoplastic surgery for breast reconstruction to achieve better aesthetic outcome and improve quality of life. Patients and Methods: Thirty patients with breast cancer, treated at Sohag University Hospital between July 2016 to May 2017 were included in this study. The oncoplastic techniques performed were Local glandular tissue displacement in (60%), latissimus dorsi flap (LD) in (16.6%), superior pedicle flap in(10%), implant insertion in (6.6%) and Transverse rectus abdominus myocutanous flap (TRAM) in (6.6%). The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree. Results: The number of patients included in the study were thirty. The median age was 43 years (range; 20-60 ys). There were three major complications that require repeating the oncoplastic techniques. Recorded complications included wound infection (5/30, 16.6 %) donor site seroma (10/30, 33.3 %), postoperative haematoma (1/30, 3.3%), flap ischemia and necrosis (1/30, 3.3%). The 12-months subjective patient satisfaction was excellent in 27 (90%) patients, and bad in 3 (10 %) patients. There were two local recurrence, no systemic metastasis after an average follow-up duration of 12 months. Conclusion:Restoring the defect after resection of the breast cancer can be safely achieved using oncoplastic procedures including the previous techniques with immediate breast reconstruction. In our patients, these procedures yield a satisfactory aesthetic outcome with lower morbidity.