Ashraf Abdelkader - Academia.edu (original) (raw)
Papers by Ashraf Abdelkader
Ain-Shams Journal of Anaesthesiology, 2015
Background Single-incision laparoscopic cholecystectomy (SILC) allows decreasing the number of in... more Background Single-incision laparoscopic cholecystectomy (SILC) allows decreasing the number of incisions and tissue trauma. Efforts have been made to decrease port incision pain, as it constitutes up to 70% of postoperative pain. Rectus sheath block provides effective analgesia to the midline. Aim The aim of the study was to evaluate the efficacy of ultrasound (U/S)-guided rectus sheath block for pain management following SILC surgery. Patients and methods A total of 50 patients undergoing elective SILC were allocated randomly into two groups: U/S-guided rectus sheath block, the R group, or local infiltration, the L group. All patients received the same general anesthetic technique. In the L group, port-site infiltration was made by the surgeon using 0.5% bupivacaine. In the R group, bilateral U/S-guided rectus sheath block was performed using 10 ml of 0.5% bupivacaine. Total fentanyl amount received intraoperatively was recorded. Patient Controlled Analgesia (PCA) morphine was used for postoperative analgesia and the morphine consumption was recorded. Lornoxicam was given as rescue analgesia and its time was recorded. Pain was measured by visual analogue score. Sedation score (from 0 awake to 5 unarousable) was used. Any adverse events were recorded. Results In all, 45 patients completed the study. Total amount of fentanyl was not different and no adverse events were reported. The number of patients who received rescue analgesia was not different. In addition, neither PCA start time nor PCA morphine consumption was different, whereas the total PCA morphine use in 24 h was lower in the R group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after SILC surgeries.
The Egyptian Journal of Surgery, 2017
Objective The objective is to check the efficacy and safety of two operative techniques designed ... more Objective The objective is to check the efficacy and safety of two operative techniques designed for treating morbidly obese patients: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients and methods The study includes 72 morbidly obese patients, who were divided into two groups: group A, 40 (55.5%) patients treated using LSG, whereas group B, 32 (44.5%) patients managed by LRYGB. Operations were completed according to the rules of laparoscopic surgery. Collected operative data included operative time, intraoperative complications, postoperative (PO) complications, ICU, and hospital stay. All patients were monitored throughout the first 2 PO years at 3rd, 6th, 12th, and 24th PO months. Results There is a significant difference between both groups regarding operative time. The rates of early PO complications were higher in LRYGB than LSG group. Both groups showed a significant weight loss at the first 12 months postoperatively. The mean BM...
Background: The Platelet-rich plasma (PRP) used widely in several clinical settings. It is well r... more Background: The Platelet-rich plasma (PRP) used widely in several clinical settings. It is well recognized for its adhesive, hemostatic, and healing properties. These properties of PRP are owing to the several growth factors elaborated from the platelets into the wound environment. However, its useful outcome on the split-thickness skin graft (STSGs) is quite debatable. Aim The aim of this work is to assess the process of wound healing histopathologically in STSG after injection of PRP to the recipient bed compared to the traditional method of graft fixation to determine if PRP could improve STSG outcomes. Patients and Methods: the study incorporated 60 patients had a large skin defect in the lower limb, with age ranging from 19-61 years old. Of these patients, 32 males and 28 females. The cause of these raw areas was trauma in 25 patients, tumor excision in 13 Patients, burn in 11 patients and chronic ulcer in 11 patients. Patients were allocated sequentially into one of the two gr...
Objective We aimed to analyze the effect of diagnostic laparoscopy in the identification of the c... more Objective We aimed to analyze the effect of diagnostic laparoscopy in the identification of the cause of ascites that had been failed to be known by all other diagnostic procedures. Patients and methods This study included 20 patients with an ascites of unknown cause. Before diagnostic laparoscopy, all patients underwent clinical, laboratory, and radiological evaluations; however, all these tools failed to identify the actual cause of this abnormal free fluid collection in the abdominal cavity. Data collection and statistically analysis were done. Results The cause of ascites was identified in 18/20 of our patients, with an accuracy of 90%. Overall, 40% of ascites in our study were owing to tuberculosis, whereas malignancy was the cause of ascites in 20% of patients, and liver cirrhosis and peritonitis were the cause in 15% of each. Conclusion Laparoscopy can help in the safe and effective diagnosis of cases of ascites of unknown etiology.
The Egyptian Journal of Surgery, 2020
Objective We are aiming to identify the safety and feasibility of early laparoscopic cholecystect... more Objective We are aiming to identify the safety and feasibility of early laparoscopic cholecystectomy (LC) directly after the improvement of manifestations of an attack of mild acute biliary pancreatitis (MABP). Patients and methods This study included 150 patients of MABP. Patients were allocated into two groups: group same admission-laparoscopic cholecystectomy (SA-LC) (n=80) who underwent LC in the same hospital admission of MABP after improving the indicator of the acute inflammation, and group delayed laparoscopic cholecystectomy (D-LC) (n=70) who underwent LC 4–6 weeks after recovery of acute biliary pancreatitis. Patients’ data were collected during and after surgery; thereafter, the gathered data were statistically analyzed. Results No significant differences between both groups about the mean operative time (P=0.162) were observed; however, the mean operative time was higher in the delayed elective group (SA-LC=48.12±10.44 and D-LC=50.56±11.43). The incidence of bile leakage was 1/80 and 1/70 in SA-LC and D-LC, respectively. Moreover, there was no significant difference between both groups with regard to the conversion rate, length of ICU admission, and the postoperative hospital stay days. Conclusion Undergoing LC during the same hospital admission after an attack of MABP is a feasible and safe operation. Furthermore, it stops the event of readmission due to gallstone-related complications.
Annals of Pathology and Laboratory Medicine, 2018
Objectives: We are trying to improve and detect the accuracy of the diagnostic tools of thyroid n... more Objectives: We are trying to improve and detect the accuracy of the diagnostic tools of thyroid nodules by comparing the findings of thyroid ultrasound (US) using the thyroid image reporting and data system (TI-RADS) with the results of fine needle aspiration cytology (FNAC) that were reported according to the Bethesda system for reporting thyroid Cytopathology (TBSRTC), through matching the results of both maneuverswith the final postoperative (PO)pathology reports. Methods:The study included 100 patients suffering from thyroid swelling.Patients underwent ultrasound assessment using TI-RADS and FNAC biopsy using TBSRTCand then, all patients underwent thyroidectomy operation. Specimens sent to a laboratory for histological examination. The results of TI-RADS compared with Bethesda categories, and then both results were matched with the final histology reports. Data collected and statisticallyanalyzed. Results: The overall concordance rate between US TI-RADS and TBSRTC is 67.6%. (82% in benign cases, 70.9%, in indeterminate cases, 50% in malignant cases). The overall concordance rate of results of TI-RADS versus FNAC with the final PO pathological results for predicting malignancy were(75.4%, 81.8%)with a sensitivity of (76.9 %, 81.8%) and specificity of (91.3%,98%), positive predictive valueswere (PPV)(71.4%,90%), and negative predictive values were (NPV)(76.4%, 96%), respectively. Conclusion: TI-RADS and TBSRTC classification systems could be considered as feasible and effective diagnosticmodalities for predicting malignant lesions in patients had thyroid nodules. It's important for the clinicians to implement these diagnostic tests to improve their clinical performance and surgical outcomes.
Indian Journal of Surgical Oncology, 2018
We are trying to illustrate operative, short-term, and pathological outcomes of transanal total m... more We are trying to illustrate operative, short-term, and pathological outcomes of transanal total mesorectal excision (TaTME) as a surgical procedure for patients who are suffering cancer in the lower or middle rectum. This study included 25 consecutive patients who underwent TaTME for the mid and low cancer rectum. The primary outcome measures included frequency of postoperative (PO) bleeding, leakage, ileus, days to regain bowel function, days for Foley’s removal, and erectile function. The secondary outcome measures included operation time, status of resection margins, number, the quality of TME, and duration PO hospital stay. No recorded intraoperative complications. The mean hospital stay was 6.9 ± 2.6 days. The mean duration need for urinary catheter removal and flatus passage were 2.4 ± 2.1 and 1.5 + 0.9 days, respectively. The mean IPSS was returned to normal 12 months after surgery. The mean distal margin distance was 1.9 ± 1.1. Circumferential margin distance was > 1 mm in 23 (92%) patients. The mesorectum was complete in 22 (88%) patients. The survival rate was 88% over 3 years. TaTME could be considered as a safe, feasible, and effective surgical modality for patients who had mid and lower rectal tumors with an excellent pathological outcome.
HPB Surgery, 2018
Objective. We are trying to investigate the possibility, safety, and benefits of replacing the ro... more Objective. We are trying to investigate the possibility, safety, and benefits of replacing the role of T-tube by another more safe and effective procedure for biliary decompression in the case of common bile duct (CBD) exploration. Methods. Our present study includes fifty consecutive patients who underwent a traditional CBD exploration due to choledocholithiasis. Patients were divided into 2 equal groups. In the 1st group, a spontaneously expelled Nelaton tube is placed in the CBD to aid in bile drainage to the duodenum, while in the 2nd group, a conventional T-tube is placed to decompress the CBD in the early postoperative (PO) days to a drainage bag. Operative and PO data as well as PO hospital stay time were recorded. All data were collected and statistically analyzed. Results. The mean operative time and PO hospital stay days were significantly low (p value < 0.05) in the Nelaton tube drainage group compared with the T-tube drainage group. On the other hand, the mean time ne...
The Egyptian Journal of Surgery, 2017
Conclusions: Results suggest that the CF Foundation's new web pages related to NBS are achieving ... more Conclusions: Results suggest that the CF Foundation's new web pages related to NBS are achieving the intended outcomes for most parents. Additional minor revisions may further enhance the quality of the web pages. This project was supported by a grant from the Cystic Fibrosis Foundation.
Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NO... more Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NOT) for the management of acute appendicitis (AA), to avoid the risk of unnecessary surgery. Methods: The study includes 400 consecutive patients who were diagnosed as AA. The study involved patients with symptoms <72 h and the first attack of AA. Patients divided into two equal groups using the “alternation” method. In the first group, patients were hospitalized and received medical treatment, while in the second group, appendectomy was done. After discharge, follow-up was done in all cases for 2 years. Data collected and statistically analyzed. Results: The NOT was effectively completed in 185 patients, while 15 patients (7.5%), did not respond to the NOT regimen as they had continued or deteriorating symptoms and underwent an appendectomy. During the follow-up period, 14 patients (7%) of the NOT group were readmitted and treated successfully, while 17 patients (8.5%) underwent an ap...
Clinical Journal of Surgery
Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NO... more Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NOT) for the management of acute appendicitis (AA), to avoid the risk of unnecessary surgery. Methods: The study includes 400 consecutive patients who were diagnosed as AA. The study involved patients with symptoms <72 h and the first attack of AA. Patients divided into two equal groups using the "alternation" method. In the first group, patients were hospitalized and received medical treatment, while in the second group, appendectomy was done. After discharge, follow-up was done in all cases for 2 years. Data collected and statistically analyzed. Results: The NOT was effectively completed in 185 patients, while 15 patients (7.5%), did not respond to the NOT regimen as they had continued or deteriorating symptoms and underwent an appendectomy. During the follow-up period, 14 patients (7%) of the NOT group were readmitted and treated successfully, while 17 patients (8.5%) underwent an appendectomy. The success rate of the NOT was 84% with safety of 100%. Among patients of the surgery group, 160/200 showed a pathologically inflamed appendix with an efficacy of 80%. Conclusion: In selected cases, AA can be managed by NOT taking into consideration patient assurance, proper observation, communication, and follow up.
Ain-Shams Journal of Anaesthesiology, 2015
Background Single-incision laparoscopic cholecystectomy (SILC) allows decreasing the number of in... more Background Single-incision laparoscopic cholecystectomy (SILC) allows decreasing the number of incisions and tissue trauma. Efforts have been made to decrease port incision pain, as it constitutes up to 70% of postoperative pain. Rectus sheath block provides effective analgesia to the midline. Aim The aim of the study was to evaluate the efficacy of ultrasound (U/S)-guided rectus sheath block for pain management following SILC surgery. Patients and methods A total of 50 patients undergoing elective SILC were allocated randomly into two groups: U/S-guided rectus sheath block, the R group, or local infiltration, the L group. All patients received the same general anesthetic technique. In the L group, port-site infiltration was made by the surgeon using 0.5% bupivacaine. In the R group, bilateral U/S-guided rectus sheath block was performed using 10 ml of 0.5% bupivacaine. Total fentanyl amount received intraoperatively was recorded. Patient Controlled Analgesia (PCA) morphine was used for postoperative analgesia and the morphine consumption was recorded. Lornoxicam was given as rescue analgesia and its time was recorded. Pain was measured by visual analogue score. Sedation score (from 0 awake to 5 unarousable) was used. Any adverse events were recorded. Results In all, 45 patients completed the study. Total amount of fentanyl was not different and no adverse events were reported. The number of patients who received rescue analgesia was not different. In addition, neither PCA start time nor PCA morphine consumption was different, whereas the total PCA morphine use in 24 h was lower in the R group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after SILC surgeries.
The Egyptian Journal of Surgery, 2017
Objective The objective is to check the efficacy and safety of two operative techniques designed ... more Objective The objective is to check the efficacy and safety of two operative techniques designed for treating morbidly obese patients: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients and methods The study includes 72 morbidly obese patients, who were divided into two groups: group A, 40 (55.5%) patients treated using LSG, whereas group B, 32 (44.5%) patients managed by LRYGB. Operations were completed according to the rules of laparoscopic surgery. Collected operative data included operative time, intraoperative complications, postoperative (PO) complications, ICU, and hospital stay. All patients were monitored throughout the first 2 PO years at 3rd, 6th, 12th, and 24th PO months. Results There is a significant difference between both groups regarding operative time. The rates of early PO complications were higher in LRYGB than LSG group. Both groups showed a significant weight loss at the first 12 months postoperatively. The mean BM...
Background: The Platelet-rich plasma (PRP) used widely in several clinical settings. It is well r... more Background: The Platelet-rich plasma (PRP) used widely in several clinical settings. It is well recognized for its adhesive, hemostatic, and healing properties. These properties of PRP are owing to the several growth factors elaborated from the platelets into the wound environment. However, its useful outcome on the split-thickness skin graft (STSGs) is quite debatable. Aim The aim of this work is to assess the process of wound healing histopathologically in STSG after injection of PRP to the recipient bed compared to the traditional method of graft fixation to determine if PRP could improve STSG outcomes. Patients and Methods: the study incorporated 60 patients had a large skin defect in the lower limb, with age ranging from 19-61 years old. Of these patients, 32 males and 28 females. The cause of these raw areas was trauma in 25 patients, tumor excision in 13 Patients, burn in 11 patients and chronic ulcer in 11 patients. Patients were allocated sequentially into one of the two gr...
Objective We aimed to analyze the effect of diagnostic laparoscopy in the identification of the c... more Objective We aimed to analyze the effect of diagnostic laparoscopy in the identification of the cause of ascites that had been failed to be known by all other diagnostic procedures. Patients and methods This study included 20 patients with an ascites of unknown cause. Before diagnostic laparoscopy, all patients underwent clinical, laboratory, and radiological evaluations; however, all these tools failed to identify the actual cause of this abnormal free fluid collection in the abdominal cavity. Data collection and statistically analysis were done. Results The cause of ascites was identified in 18/20 of our patients, with an accuracy of 90%. Overall, 40% of ascites in our study were owing to tuberculosis, whereas malignancy was the cause of ascites in 20% of patients, and liver cirrhosis and peritonitis were the cause in 15% of each. Conclusion Laparoscopy can help in the safe and effective diagnosis of cases of ascites of unknown etiology.
The Egyptian Journal of Surgery, 2020
Objective We are aiming to identify the safety and feasibility of early laparoscopic cholecystect... more Objective We are aiming to identify the safety and feasibility of early laparoscopic cholecystectomy (LC) directly after the improvement of manifestations of an attack of mild acute biliary pancreatitis (MABP). Patients and methods This study included 150 patients of MABP. Patients were allocated into two groups: group same admission-laparoscopic cholecystectomy (SA-LC) (n=80) who underwent LC in the same hospital admission of MABP after improving the indicator of the acute inflammation, and group delayed laparoscopic cholecystectomy (D-LC) (n=70) who underwent LC 4–6 weeks after recovery of acute biliary pancreatitis. Patients’ data were collected during and after surgery; thereafter, the gathered data were statistically analyzed. Results No significant differences between both groups about the mean operative time (P=0.162) were observed; however, the mean operative time was higher in the delayed elective group (SA-LC=48.12±10.44 and D-LC=50.56±11.43). The incidence of bile leakage was 1/80 and 1/70 in SA-LC and D-LC, respectively. Moreover, there was no significant difference between both groups with regard to the conversion rate, length of ICU admission, and the postoperative hospital stay days. Conclusion Undergoing LC during the same hospital admission after an attack of MABP is a feasible and safe operation. Furthermore, it stops the event of readmission due to gallstone-related complications.
Annals of Pathology and Laboratory Medicine, 2018
Objectives: We are trying to improve and detect the accuracy of the diagnostic tools of thyroid n... more Objectives: We are trying to improve and detect the accuracy of the diagnostic tools of thyroid nodules by comparing the findings of thyroid ultrasound (US) using the thyroid image reporting and data system (TI-RADS) with the results of fine needle aspiration cytology (FNAC) that were reported according to the Bethesda system for reporting thyroid Cytopathology (TBSRTC), through matching the results of both maneuverswith the final postoperative (PO)pathology reports. Methods:The study included 100 patients suffering from thyroid swelling.Patients underwent ultrasound assessment using TI-RADS and FNAC biopsy using TBSRTCand then, all patients underwent thyroidectomy operation. Specimens sent to a laboratory for histological examination. The results of TI-RADS compared with Bethesda categories, and then both results were matched with the final histology reports. Data collected and statisticallyanalyzed. Results: The overall concordance rate between US TI-RADS and TBSRTC is 67.6%. (82% in benign cases, 70.9%, in indeterminate cases, 50% in malignant cases). The overall concordance rate of results of TI-RADS versus FNAC with the final PO pathological results for predicting malignancy were(75.4%, 81.8%)with a sensitivity of (76.9 %, 81.8%) and specificity of (91.3%,98%), positive predictive valueswere (PPV)(71.4%,90%), and negative predictive values were (NPV)(76.4%, 96%), respectively. Conclusion: TI-RADS and TBSRTC classification systems could be considered as feasible and effective diagnosticmodalities for predicting malignant lesions in patients had thyroid nodules. It's important for the clinicians to implement these diagnostic tests to improve their clinical performance and surgical outcomes.
Indian Journal of Surgical Oncology, 2018
We are trying to illustrate operative, short-term, and pathological outcomes of transanal total m... more We are trying to illustrate operative, short-term, and pathological outcomes of transanal total mesorectal excision (TaTME) as a surgical procedure for patients who are suffering cancer in the lower or middle rectum. This study included 25 consecutive patients who underwent TaTME for the mid and low cancer rectum. The primary outcome measures included frequency of postoperative (PO) bleeding, leakage, ileus, days to regain bowel function, days for Foley’s removal, and erectile function. The secondary outcome measures included operation time, status of resection margins, number, the quality of TME, and duration PO hospital stay. No recorded intraoperative complications. The mean hospital stay was 6.9 ± 2.6 days. The mean duration need for urinary catheter removal and flatus passage were 2.4 ± 2.1 and 1.5 + 0.9 days, respectively. The mean IPSS was returned to normal 12 months after surgery. The mean distal margin distance was 1.9 ± 1.1. Circumferential margin distance was > 1 mm in 23 (92%) patients. The mesorectum was complete in 22 (88%) patients. The survival rate was 88% over 3 years. TaTME could be considered as a safe, feasible, and effective surgical modality for patients who had mid and lower rectal tumors with an excellent pathological outcome.
HPB Surgery, 2018
Objective. We are trying to investigate the possibility, safety, and benefits of replacing the ro... more Objective. We are trying to investigate the possibility, safety, and benefits of replacing the role of T-tube by another more safe and effective procedure for biliary decompression in the case of common bile duct (CBD) exploration. Methods. Our present study includes fifty consecutive patients who underwent a traditional CBD exploration due to choledocholithiasis. Patients were divided into 2 equal groups. In the 1st group, a spontaneously expelled Nelaton tube is placed in the CBD to aid in bile drainage to the duodenum, while in the 2nd group, a conventional T-tube is placed to decompress the CBD in the early postoperative (PO) days to a drainage bag. Operative and PO data as well as PO hospital stay time were recorded. All data were collected and statistically analyzed. Results. The mean operative time and PO hospital stay days were significantly low (p value < 0.05) in the Nelaton tube drainage group compared with the T-tube drainage group. On the other hand, the mean time ne...
The Egyptian Journal of Surgery, 2017
Conclusions: Results suggest that the CF Foundation's new web pages related to NBS are achieving ... more Conclusions: Results suggest that the CF Foundation's new web pages related to NBS are achieving the intended outcomes for most parents. Additional minor revisions may further enhance the quality of the web pages. This project was supported by a grant from the Cystic Fibrosis Foundation.
Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NO... more Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NOT) for the management of acute appendicitis (AA), to avoid the risk of unnecessary surgery. Methods: The study includes 400 consecutive patients who were diagnosed as AA. The study involved patients with symptoms <72 h and the first attack of AA. Patients divided into two equal groups using the “alternation” method. In the first group, patients were hospitalized and received medical treatment, while in the second group, appendectomy was done. After discharge, follow-up was done in all cases for 2 years. Data collected and statistically analyzed. Results: The NOT was effectively completed in 185 patients, while 15 patients (7.5%), did not respond to the NOT regimen as they had continued or deteriorating symptoms and underwent an appendectomy. During the follow-up period, 14 patients (7%) of the NOT group were readmitted and treated successfully, while 17 patients (8.5%) underwent an ap...
Clinical Journal of Surgery
Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NO... more Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NOT) for the management of acute appendicitis (AA), to avoid the risk of unnecessary surgery. Methods: The study includes 400 consecutive patients who were diagnosed as AA. The study involved patients with symptoms <72 h and the first attack of AA. Patients divided into two equal groups using the "alternation" method. In the first group, patients were hospitalized and received medical treatment, while in the second group, appendectomy was done. After discharge, follow-up was done in all cases for 2 years. Data collected and statistically analyzed. Results: The NOT was effectively completed in 185 patients, while 15 patients (7.5%), did not respond to the NOT regimen as they had continued or deteriorating symptoms and underwent an appendectomy. During the follow-up period, 14 patients (7%) of the NOT group were readmitted and treated successfully, while 17 patients (8.5%) underwent an appendectomy. The success rate of the NOT was 84% with safety of 100%. Among patients of the surgery group, 160/200 showed a pathologically inflamed appendix with an efficacy of 80%. Conclusion: In selected cases, AA can be managed by NOT taking into consideration patient assurance, proper observation, communication, and follow up.