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Papers by Hazem Zakaria

Clinical & Experimental Hepatology, Dec 31, 2022

Aim of the study: Biliary atresia (BA) is a blockage in the tubes (ducts) that carry bile from th... more Aim of the study: Biliary atresia (BA) is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder. The aspartate aminotransferase to platelet ratio (APRI), and Fibrosis-4 (FIB-4) scores are commonly used compound surrogates for advanced fibrosis. However, the use of APRI and FIB-4 entails a risk of overestimating the fibrosis stage due to the impact of necroinflammatory activity on transaminases. So, we determined the optimal cutoff values of the APRI and FIB-4 indices in prediction of fibrosis in BA patients. The aim of the study was to evaluate the validity of the APRI and FIB-4 indices in prediction of fibrosis in patients with BA. Material and methods: A cross sectional hospital-based study was conducted on 121 children complaining of BA attending the National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt, during the period from January 2022 to February 2023. Results: The APRI score was significantly higher among neglected BA than BA type II a, BA type III, type II b and type I (p = 0.001). Also FIB-4 was significantly higher among neglected BA than BA type II a, BA type II b, type III and type I (p = 0.001). Receiver operating characteristic (ROC) curve analysis showed that the cutoff point of the APRI score in prediction of fibrosis in patients with BA was 1.29, with sensitivity of 88.6% and specificity of 76.0%, while the cutoff point of FIB-4 in prediction of fibrosis in patients with BA was 9.82 with sensitivity of 89.0% and specificity of 70.0%. Conclusions: Our study confirms that FIB-4 and APRI scores are both able to predict severe fibrosis. APRI score and FIB-4 are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis and its extent in patients with BA.

Annals of Medicine and Surgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

International Surgery Journal, 2018

Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection r... more Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection m...

International Surgery Journal, 2017

Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosi... more Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosis that requires prompt diagnosis and aggressive management for better outcome. The aim of this work was to study the diagnostic tools and the optimal management of acute MVT in patients with liver cirrhosis.Methods: It was a retrospective study including 40 patients with liver cirrhosis who were admitted to the surgical emergency and were eventually diagnosed as acute MVT between May 2011 to September 2016. The preoperative clinicopathological data, operative data and postoperative follow up were recorded.Results: Forty patients had acute MVT. Twenty five patients (62.5%) had prolonged prothrombin time, 18 patients (45%) had thrombocytopenia and 22 patients (55%) had low protein C. triphasic CT scan was the main diagnostic image in 28 patients, with sensitivity 100% and accuracy 96.9% in detection of intestinal infarction. Ten patients (25%) underwent conservative treatment with anticoag...

HPB, 2019

or PTFE-graft (n=1) in total vascular occlusion (mean of 29.6 min.). Severe morbidity defined as ... more or PTFE-graft (n=1) in total vascular occlusion (mean of 29.6 min.). Severe morbidity defined as Dindo Clavien >3a was found in 3 patients; one patient died due to small-forsize syndrome. Mean length of stay at ICU and hospital were 9.0 and 34.3 days, respectively. R0-resection was achieved in 5 cases (twice a R1-situation). Disease-free survival was 24.6 months with an overall survival of 34.4 months. Conclusion: Ante situm liver resection offers the opportunity to achieve surgical cure in otherwise unresectable tumors. Nevertheless, this approach remains challenging with need for complex vascular reconstruction.

Annals of Medicine and Surgery, 2020

Background: Biliary injuries after blunt abdominal traumas are uncommon and difficult to be predi... more Background: Biliary injuries after blunt abdominal traumas are uncommon and difficult to be predicted for early management. The aim of this study is to analyze the risk factors and management of biliary injuries with blunt abdominal trauma. Method: Patients with blunt liver trauma in the period between 2009 to May 2019 were included in the study. Patients were divided into 2 groups for comparison; a group of liver parenchymal injury and group with traumatic biliary injuries (TBI). Results: One hundred and eight patients had blunt liver trauma (46 patients with liver parenchymal injury and 62 patients with TBI). TBI were; 55 patients with bile leak, 3 patients with haemobilia, and 4 patients with late obstructive jaundice. Eight patients with major bile leak and 12 patients with minor bile leak had been resolved with a surgical drain or percutaneous pigtail drainage. Nineteen patients (34.5%) with major and minor bile leak underwent successful endoscopic retrograde cholangiopancreatography (ERCP). Sixteen patients (29.1%) underwent surgical repair for bile leak. In Multivariate analysis, the possible risk factors for prediction of biliary injuries were central liver injuries (P = 0.032), high grades liver trauma (P = 0.046), elevated serum level of bilirubin at time of admission (P = 0.019), and elevated gamma glutamyl transferase (GGT) at time of admission (P = 0.017). Conclusion: High-grade liver trauma, central parenchymal laceration and elevated serum level of bilirubin and GGT are possible risk factors for the prediction of TBI. Bile leak after blunt trauma can be treated conservatively, while ERCP is indicated after failure of external drainage.

Surgery, Gastroenterology and Oncology, 2018

Background: The value of preoperative biliary drainage (PBD) on the surgical outcome after pancre... more Background: The value of preoperative biliary drainage (PBD) on the surgical outcome after pancreaticoduodenectomy (PD) is still a point of controversy. The aim of this study was to identify the impact of biliary drainage (BD) prior to PD on the postoperative outcome. Methods: The data of patients, who underwent PD from February 2009 to February 2017, were retrospectively studied. A comparison was performed between 2 groups of patients; group A (with PBD) and group B (without PBD), according to preoperative, operative and postoperative data. Results: PD was performed in 158 patients with periampullary lesions. Group A, included 76 patients (48.1%) while 82 patients were included in group B (51.9%). The incidence of major postoperative complications was significantly higher in group A (P=0.04). The infectious complications were higher in group like; positive intraoperative bile culture (P=0.06), intraabdominal abscess (P=0.07) and wound infection (P=0.04). Also, hospital stay and mortality were higher in group A (P=0.05 and 0.08, respectively). High preoperative bilirubin level was not a risk factor for major postoperative complications (P=0.12). Conclusion: Patients with PBD had a significantly higher incidence of major postoperative complications mainly of infectious ones, thus PBD should be performed only in selected patients, not as a routine prior PD.

Annals of Medicine and Surgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

HPB, 2019

Conclusion: Preliminary results show that LPD is safe and feasible, although high conversion rate... more Conclusion: Preliminary results show that LPD is safe and feasible, although high conversion rate when done in nonselected patients. No differences in clinical outcomes were observed between approaches.

Canadian Journal of Gastroenterology and Hepatology, 2022

Background/Objectives. Studying the predictors of survival after liver transplantation is essenti... more Background/Objectives. Studying the predictors of survival after liver transplantation is essential to optimize the outcome. The balance of risk (BAR) score is a predictive model which incorporates six recipient and donor factors. It showed superiority over other predictive models. We aimed to evaluate its performance in the prediction of survival after living donor liver transplantation (LDLT). Methods. 146 adult liver transplant recipients were included. Univariate and multivariate analyses were used to determine the independent predictors of survival at 3 months, 1 year, and 5 years. The receiver operating characteristic (ROC) curve for the BAR score was plotted, and the area under the ROC curve (AUROC) was calculated. Kaplan–Meier curve and log-rank test were used to compare survival above and below the best cutoff values. Results. The mean age was 52.45 ± 8.54 years, and 59.6% were males. The survival rates were 89, 78.8, and 72% at 3 months, 1 year, and 5 years, respectively. ...

The Egyptian Journal of Surgery, 2019

Background Portal vein embolization (PVE) has been developed with the principle of inducing hyper... more Background Portal vein embolization (PVE) has been developed with the principle of inducing hypertrophy of the future liver remnant (FLR) (10–50% after a period of 2–8 weeks). Tumor progression and insufficient hypertrophy of the FLR are the commonest causes that preclude definitive surgery in 10–30% of patients. Recently, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed, with the goal of achieving a faster and magnified hypertrophy (74–87.2% in 9–13 days) for patients with extensive colorectal liver metastases or hilar cholangiocarcinoma. However, introducing ALPPS for hepatocellular carcinoma (HCC) on top of cirrhosis has been questioned and not thoroughly investigated. Patients and methods A prospective observational study was conducted on patients who were admitted to the National Liver Institute from 2016 to 2018 with nonresectable liver tumors owing to insufficient FLR. Hypertrophy of the FLR, perioperative morbidity and mor...

The American Journal of Tropical Medicine and Hygiene, 2021

Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease p... more Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease prevention strategies, but the serotype distribution varies among patient groups. The objectives of this study were to establish the group B Streptococcus (GBS) serotype distribution in patients from Egypt and to assess antibiotic sensitivity of invasive GBS isolates. A total of 490 patients participated in this multicenter study; 160 had urinary tract infection, 115 complained of diabetic foot ulcers, 125 men had genital tract infections, and 30 women females had genital tract infections. Others had bronchopneumonia, otitis media, synovitis, or meningitis. Serotyping of the isolated GBS was performed at the CDC in the United States. Antibiotic sensitivity patterns were determined using the disk diffusion method. In men, the most common serotypes were II, III, and V, whereas types Ia, II, III, and V were isolated from women. Macrolides (erythromycin) resistance occurred in 4.1% of the iso...

Egyptian Journal of Radiology and Nuclear Medicine, 2020

Background Recently, the living donor liver transplantation (LDLT) surgery is employed as the tre... more Background Recently, the living donor liver transplantation (LDLT) surgery is employed as the treatment of choice for end-stage chronic liver disease and hepatocellular carcinoma. The role of liver biopsy in donor’s selection protocol for adult living liver donors (LLDs) candidates is a point of controversy. Hepatic magnetic resonance elastography (MRE) is a promising technique particularly in grading of liver fibrosis that can be used for pre-transplantation evaluation of the LLDs candidates. The aim of the current study was to evaluate the diagnostic performance of hepatic MRE as a pre-transplantation imaging tool for LLDs candidates, prior to LDLT surgery. Results Thirty-seven eligible healthy LLDs candidates (28 males and 9 females; their ages ranged from 24 to 45 years) were the subject of the current study. A cut-off value ≥ 2.24 kilo Pascal (kPa) was assumed for discrimination between normal and abnormal hepatic tissues with high accuracy (99.24%). Also, a cut-off value ≥ 2.3...

HPB, 2018

Objectives: For difficult CBD stones that cannot be extracted by ERCP, patients can be managed CB... more Objectives: For difficult CBD stones that cannot be extracted by ERCP, patients can be managed CBD exploration. The aim of this study was to assess these surgical procedures after endoscopic failure. Methods: We retrospectively analyzed 85 patients underwent surgical management of difficult CBD stones after ERCP failure, in the period from mid 2013 to mid 2018. Results: There was significant correlation between number of ERCP sessions and post ERCP complications (P = 0.001). Impacted large stone was the most frequent cause of ERCP failure (60%). LCBDE and OCBDE were 29.4% (n = 25) and 70.6% (n = 60) respectively. Primary CBD repair, Ttube insertion, HJ and TDS were done in 45.9%, 40%, 8.3% and 5.9% respectively. By comparing LCBDE and OCBDE groups, patient age and hospital stay were significantly lower in laparoscopic group, while, T-tube insertion, choledocoscope use, operative time and post operative bile leak were significantly higher. Furthermore, patients underwent choledocoscope had significant direction to primary CBD repair and lower missed stones rate. While, on comparing T-tube with primary closure of CBD groups, there was significant lower operative time and hospital stay in the later. Conclusion: Difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, choledocoscope has a good impact on stone clearance rate with direction towards doing primary repair that is better than Ttube regarding operative time and hospital stay.

World journal of gastrointestinal surgery, Jan 27, 2016

To identify the current indications and outcomes of total pancreatectomy at a high-volume center.... more To identify the current indications and outcomes of total pancreatectomy at a high-volume center. A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was performed. One hundred and three patients underwent total pancreatectomy for indications including: Pancreatic ductal adenocarcinoma (n = 42, 40.8%), intraductal papillary mucinous neoplasms (n = 40, 38.8%), chronic pancreatitis (n = 8, 7.8%), pancreatic neuroendocrine tumors (n = 7, 6.8%), and miscellaneous (n = 6, 5.8%). The mean age was 66.2 years, and 59 (57.3%) were female. Twenty-four patients (23.3%) underwent a laparoscopic total pancreatectomy. Splenic preservation and portal vein resection and reconstruction were performed in 24 (23.3%) and 18 patients (17.5%), respectively. The 90 d major complications, readmission, and mortality rates were 32%, 17.5%, and 6.8% respectively. The 1-, 3-, 5-, and 7-year survival for patients with benign indications were 84%, 82%, 79.5%, ...

HPB, 2016

and LT was 127 months. Complete or partial histological response was observed in 6 (50%) and 5 (4... more and LT was 127 months. Complete or partial histological response was observed in 6 (50%) and 5 (42%) patients, respectively. Blood loss was higher in the CRT + group (1700 vs 1128 ml, p = 0.037). During the 3 months following LT, one patient in the CRT + group died from bowel ischemia, which was unrelated to CRT. Overall severe postoperative morbidity (Clavien >2) was higher but not significantly increased in the CRT + group (58% vs 34%, p = 0.186). However, specific anastomosis-related complications (ARC) occurred more frequently in the CRT + group (42% [n = 5] versus 14% [n = 7], p = 0.044); 1 bile duct necrosis associated with portal thrombosis, 1 rupture of hepatic artery, 1 hepatic artery stenosis, 1 biliary stenosis, 1 biliary leakage occurred in the CRT + group, while 3 hepatic artery stenosis, 3 biliary leakage and 1 biliary necrosis associated with portal thrombosis occurred in the CRT-group. Hospital stay was longer in the CRT + group (4327 vs 3222 days) but the difference was not statistically significant (p = 0.084). Conclusions: Conformal radiotherapy combined with transarterial chemoembolization may be an effective downstaging or neoadjuvant therapy before LT for HCC, but it results in intraoperative surgical difficulties and postoperative ARC.

HPB, 2016

diagnosed as Gilbert's syndrome. Another 20 (30%) donors had other mutations of UGT1A1 gene. Rema... more diagnosed as Gilbert's syndrome. Another 20 (30%) donors had other mutations of UGT1A1 gene. Remaining 10 (15%) donors were UGT1A1 wild type. Conclusions: In graft selection, FLR / total liver volume > 30% is suitable for safe donor liver resection. On the basis of this graft selection criteria, hyperbilirubinemia after donor liver resection had mutations of UGT1A1.

HPB, 2016

complications were observed in 14 recipients (6.3%), 54 recipients (23.6%), 9 recipients (4%) and... more complications were observed in 14 recipients (6.3%), 54 recipients (23.6%), 9 recipients (4%) and 75 recipients (32.8%), respectively. Those complications included biliary (20.7%), vascular (12.1%), graft complications [small for size, acute rejection] (12.6%), and other surgical and medical complications (21.3%). KaplaneMeier survival curves were plotted and Log Rank test was done. The test result was significant with p-value less than 0.05. Conclusion: Clavien Grading System was efficiently useful in summarizing the outcome of Adult living donor liver transplantation recipients. It also provides a simple disclosure of data and a helping tool in comparing different centers aiming at improving the outcomes.

Journal of Liver: Disease & Transplantation, 2016

Objectives: Both complications and mortality of recipients are annoying problems after living don... more Objectives: Both complications and mortality of recipients are annoying problems after living donor liver transplantation (LDLT). The aim to analyze early (<6 months) mortality of patients after adult to adult LDLT (A-ALDLT) in a single center. Methods: Between April 2003 and February 2013, we performed 167 A-ALDLT in National Liver Institute, Egypt. We retrospectively analyzed early mortality in recipients. Results: The overall incidence of early mortality was 34.1% (n=57), it was classified into in hospital (28.7%) and post-hospital discharge (5.4%) mortalities. The most frequent causes of in hospital and post hospital discharge mortalities were SFSS (10/48) and sepsis (5/9) respectively. On univariate analysis, the following factors were significant predictors of early mortality (Female gender, Lt Lobe graft, GRWR<0.8, mean blood transfusion 10.8 ± 9.8 units,(vascular, renal, chest, neurological, bacterial infection and small for size syndrome (SFSS)) complications. While on multivariate analysis by Cox regression, mean blood transfusion 10.8 ± 9.8 units, vascular and neurological complications were independent predictors. Conclusion: Reduction of blood transfusion units, prevention and management of vascular and neurological complications is required for better early outcome after A-A LDLT.

Clinical & Experimental Hepatology, Dec 31, 2022

Aim of the study: Biliary atresia (BA) is a blockage in the tubes (ducts) that carry bile from th... more Aim of the study: Biliary atresia (BA) is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder. The aspartate aminotransferase to platelet ratio (APRI), and Fibrosis-4 (FIB-4) scores are commonly used compound surrogates for advanced fibrosis. However, the use of APRI and FIB-4 entails a risk of overestimating the fibrosis stage due to the impact of necroinflammatory activity on transaminases. So, we determined the optimal cutoff values of the APRI and FIB-4 indices in prediction of fibrosis in BA patients. The aim of the study was to evaluate the validity of the APRI and FIB-4 indices in prediction of fibrosis in patients with BA. Material and methods: A cross sectional hospital-based study was conducted on 121 children complaining of BA attending the National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt, during the period from January 2022 to February 2023. Results: The APRI score was significantly higher among neglected BA than BA type II a, BA type III, type II b and type I (p = 0.001). Also FIB-4 was significantly higher among neglected BA than BA type II a, BA type II b, type III and type I (p = 0.001). Receiver operating characteristic (ROC) curve analysis showed that the cutoff point of the APRI score in prediction of fibrosis in patients with BA was 1.29, with sensitivity of 88.6% and specificity of 76.0%, while the cutoff point of FIB-4 in prediction of fibrosis in patients with BA was 9.82 with sensitivity of 89.0% and specificity of 70.0%. Conclusions: Our study confirms that FIB-4 and APRI scores are both able to predict severe fibrosis. APRI score and FIB-4 are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis and its extent in patients with BA.

Annals of Medicine and Surgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

International Surgery Journal, 2018

Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection r... more Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection m...

International Surgery Journal, 2017

Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosi... more Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosis that requires prompt diagnosis and aggressive management for better outcome. The aim of this work was to study the diagnostic tools and the optimal management of acute MVT in patients with liver cirrhosis.Methods: It was a retrospective study including 40 patients with liver cirrhosis who were admitted to the surgical emergency and were eventually diagnosed as acute MVT between May 2011 to September 2016. The preoperative clinicopathological data, operative data and postoperative follow up were recorded.Results: Forty patients had acute MVT. Twenty five patients (62.5%) had prolonged prothrombin time, 18 patients (45%) had thrombocytopenia and 22 patients (55%) had low protein C. triphasic CT scan was the main diagnostic image in 28 patients, with sensitivity 100% and accuracy 96.9% in detection of intestinal infarction. Ten patients (25%) underwent conservative treatment with anticoag...

HPB, 2019

or PTFE-graft (n=1) in total vascular occlusion (mean of 29.6 min.). Severe morbidity defined as ... more or PTFE-graft (n=1) in total vascular occlusion (mean of 29.6 min.). Severe morbidity defined as Dindo Clavien >3a was found in 3 patients; one patient died due to small-forsize syndrome. Mean length of stay at ICU and hospital were 9.0 and 34.3 days, respectively. R0-resection was achieved in 5 cases (twice a R1-situation). Disease-free survival was 24.6 months with an overall survival of 34.4 months. Conclusion: Ante situm liver resection offers the opportunity to achieve surgical cure in otherwise unresectable tumors. Nevertheless, this approach remains challenging with need for complex vascular reconstruction.

Annals of Medicine and Surgery, 2020

Background: Biliary injuries after blunt abdominal traumas are uncommon and difficult to be predi... more Background: Biliary injuries after blunt abdominal traumas are uncommon and difficult to be predicted for early management. The aim of this study is to analyze the risk factors and management of biliary injuries with blunt abdominal trauma. Method: Patients with blunt liver trauma in the period between 2009 to May 2019 were included in the study. Patients were divided into 2 groups for comparison; a group of liver parenchymal injury and group with traumatic biliary injuries (TBI). Results: One hundred and eight patients had blunt liver trauma (46 patients with liver parenchymal injury and 62 patients with TBI). TBI were; 55 patients with bile leak, 3 patients with haemobilia, and 4 patients with late obstructive jaundice. Eight patients with major bile leak and 12 patients with minor bile leak had been resolved with a surgical drain or percutaneous pigtail drainage. Nineteen patients (34.5%) with major and minor bile leak underwent successful endoscopic retrograde cholangiopancreatography (ERCP). Sixteen patients (29.1%) underwent surgical repair for bile leak. In Multivariate analysis, the possible risk factors for prediction of biliary injuries were central liver injuries (P = 0.032), high grades liver trauma (P = 0.046), elevated serum level of bilirubin at time of admission (P = 0.019), and elevated gamma glutamyl transferase (GGT) at time of admission (P = 0.017). Conclusion: High-grade liver trauma, central parenchymal laceration and elevated serum level of bilirubin and GGT are possible risk factors for the prediction of TBI. Bile leak after blunt trauma can be treated conservatively, while ERCP is indicated after failure of external drainage.

Surgery, Gastroenterology and Oncology, 2018

Background: The value of preoperative biliary drainage (PBD) on the surgical outcome after pancre... more Background: The value of preoperative biliary drainage (PBD) on the surgical outcome after pancreaticoduodenectomy (PD) is still a point of controversy. The aim of this study was to identify the impact of biliary drainage (BD) prior to PD on the postoperative outcome. Methods: The data of patients, who underwent PD from February 2009 to February 2017, were retrospectively studied. A comparison was performed between 2 groups of patients; group A (with PBD) and group B (without PBD), according to preoperative, operative and postoperative data. Results: PD was performed in 158 patients with periampullary lesions. Group A, included 76 patients (48.1%) while 82 patients were included in group B (51.9%). The incidence of major postoperative complications was significantly higher in group A (P=0.04). The infectious complications were higher in group like; positive intraoperative bile culture (P=0.06), intraabdominal abscess (P=0.07) and wound infection (P=0.04). Also, hospital stay and mortality were higher in group A (P=0.05 and 0.08, respectively). High preoperative bilirubin level was not a risk factor for major postoperative complications (P=0.12). Conclusion: Patients with PBD had a significantly higher incidence of major postoperative complications mainly of infectious ones, thus PBD should be performed only in selected patients, not as a routine prior PD.

Annals of Medicine and Surgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

HPB, 2019

Conclusion: Preliminary results show that LPD is safe and feasible, although high conversion rate... more Conclusion: Preliminary results show that LPD is safe and feasible, although high conversion rate when done in nonselected patients. No differences in clinical outcomes were observed between approaches.

Canadian Journal of Gastroenterology and Hepatology, 2022

Background/Objectives. Studying the predictors of survival after liver transplantation is essenti... more Background/Objectives. Studying the predictors of survival after liver transplantation is essential to optimize the outcome. The balance of risk (BAR) score is a predictive model which incorporates six recipient and donor factors. It showed superiority over other predictive models. We aimed to evaluate its performance in the prediction of survival after living donor liver transplantation (LDLT). Methods. 146 adult liver transplant recipients were included. Univariate and multivariate analyses were used to determine the independent predictors of survival at 3 months, 1 year, and 5 years. The receiver operating characteristic (ROC) curve for the BAR score was plotted, and the area under the ROC curve (AUROC) was calculated. Kaplan–Meier curve and log-rank test were used to compare survival above and below the best cutoff values. Results. The mean age was 52.45 ± 8.54 years, and 59.6% were males. The survival rates were 89, 78.8, and 72% at 3 months, 1 year, and 5 years, respectively. ...

The Egyptian Journal of Surgery, 2019

Background Portal vein embolization (PVE) has been developed with the principle of inducing hyper... more Background Portal vein embolization (PVE) has been developed with the principle of inducing hypertrophy of the future liver remnant (FLR) (10–50% after a period of 2–8 weeks). Tumor progression and insufficient hypertrophy of the FLR are the commonest causes that preclude definitive surgery in 10–30% of patients. Recently, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed, with the goal of achieving a faster and magnified hypertrophy (74–87.2% in 9–13 days) for patients with extensive colorectal liver metastases or hilar cholangiocarcinoma. However, introducing ALPPS for hepatocellular carcinoma (HCC) on top of cirrhosis has been questioned and not thoroughly investigated. Patients and methods A prospective observational study was conducted on patients who were admitted to the National Liver Institute from 2016 to 2018 with nonresectable liver tumors owing to insufficient FLR. Hypertrophy of the FLR, perioperative morbidity and mor...

The American Journal of Tropical Medicine and Hygiene, 2021

Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease p... more Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease prevention strategies, but the serotype distribution varies among patient groups. The objectives of this study were to establish the group B Streptococcus (GBS) serotype distribution in patients from Egypt and to assess antibiotic sensitivity of invasive GBS isolates. A total of 490 patients participated in this multicenter study; 160 had urinary tract infection, 115 complained of diabetic foot ulcers, 125 men had genital tract infections, and 30 women females had genital tract infections. Others had bronchopneumonia, otitis media, synovitis, or meningitis. Serotyping of the isolated GBS was performed at the CDC in the United States. Antibiotic sensitivity patterns were determined using the disk diffusion method. In men, the most common serotypes were II, III, and V, whereas types Ia, II, III, and V were isolated from women. Macrolides (erythromycin) resistance occurred in 4.1% of the iso...

Egyptian Journal of Radiology and Nuclear Medicine, 2020

Background Recently, the living donor liver transplantation (LDLT) surgery is employed as the tre... more Background Recently, the living donor liver transplantation (LDLT) surgery is employed as the treatment of choice for end-stage chronic liver disease and hepatocellular carcinoma. The role of liver biopsy in donor’s selection protocol for adult living liver donors (LLDs) candidates is a point of controversy. Hepatic magnetic resonance elastography (MRE) is a promising technique particularly in grading of liver fibrosis that can be used for pre-transplantation evaluation of the LLDs candidates. The aim of the current study was to evaluate the diagnostic performance of hepatic MRE as a pre-transplantation imaging tool for LLDs candidates, prior to LDLT surgery. Results Thirty-seven eligible healthy LLDs candidates (28 males and 9 females; their ages ranged from 24 to 45 years) were the subject of the current study. A cut-off value ≥ 2.24 kilo Pascal (kPa) was assumed for discrimination between normal and abnormal hepatic tissues with high accuracy (99.24%). Also, a cut-off value ≥ 2.3...

HPB, 2018

Objectives: For difficult CBD stones that cannot be extracted by ERCP, patients can be managed CB... more Objectives: For difficult CBD stones that cannot be extracted by ERCP, patients can be managed CBD exploration. The aim of this study was to assess these surgical procedures after endoscopic failure. Methods: We retrospectively analyzed 85 patients underwent surgical management of difficult CBD stones after ERCP failure, in the period from mid 2013 to mid 2018. Results: There was significant correlation between number of ERCP sessions and post ERCP complications (P = 0.001). Impacted large stone was the most frequent cause of ERCP failure (60%). LCBDE and OCBDE were 29.4% (n = 25) and 70.6% (n = 60) respectively. Primary CBD repair, Ttube insertion, HJ and TDS were done in 45.9%, 40%, 8.3% and 5.9% respectively. By comparing LCBDE and OCBDE groups, patient age and hospital stay were significantly lower in laparoscopic group, while, T-tube insertion, choledocoscope use, operative time and post operative bile leak were significantly higher. Furthermore, patients underwent choledocoscope had significant direction to primary CBD repair and lower missed stones rate. While, on comparing T-tube with primary closure of CBD groups, there was significant lower operative time and hospital stay in the later. Conclusion: Difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, choledocoscope has a good impact on stone clearance rate with direction towards doing primary repair that is better than Ttube regarding operative time and hospital stay.

World journal of gastrointestinal surgery, Jan 27, 2016

To identify the current indications and outcomes of total pancreatectomy at a high-volume center.... more To identify the current indications and outcomes of total pancreatectomy at a high-volume center. A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was performed. One hundred and three patients underwent total pancreatectomy for indications including: Pancreatic ductal adenocarcinoma (n = 42, 40.8%), intraductal papillary mucinous neoplasms (n = 40, 38.8%), chronic pancreatitis (n = 8, 7.8%), pancreatic neuroendocrine tumors (n = 7, 6.8%), and miscellaneous (n = 6, 5.8%). The mean age was 66.2 years, and 59 (57.3%) were female. Twenty-four patients (23.3%) underwent a laparoscopic total pancreatectomy. Splenic preservation and portal vein resection and reconstruction were performed in 24 (23.3%) and 18 patients (17.5%), respectively. The 90 d major complications, readmission, and mortality rates were 32%, 17.5%, and 6.8% respectively. The 1-, 3-, 5-, and 7-year survival for patients with benign indications were 84%, 82%, 79.5%, ...

HPB, 2016

and LT was 127 months. Complete or partial histological response was observed in 6 (50%) and 5 (4... more and LT was 127 months. Complete or partial histological response was observed in 6 (50%) and 5 (42%) patients, respectively. Blood loss was higher in the CRT + group (1700 vs 1128 ml, p = 0.037). During the 3 months following LT, one patient in the CRT + group died from bowel ischemia, which was unrelated to CRT. Overall severe postoperative morbidity (Clavien >2) was higher but not significantly increased in the CRT + group (58% vs 34%, p = 0.186). However, specific anastomosis-related complications (ARC) occurred more frequently in the CRT + group (42% [n = 5] versus 14% [n = 7], p = 0.044); 1 bile duct necrosis associated with portal thrombosis, 1 rupture of hepatic artery, 1 hepatic artery stenosis, 1 biliary stenosis, 1 biliary leakage occurred in the CRT + group, while 3 hepatic artery stenosis, 3 biliary leakage and 1 biliary necrosis associated with portal thrombosis occurred in the CRT-group. Hospital stay was longer in the CRT + group (4327 vs 3222 days) but the difference was not statistically significant (p = 0.084). Conclusions: Conformal radiotherapy combined with transarterial chemoembolization may be an effective downstaging or neoadjuvant therapy before LT for HCC, but it results in intraoperative surgical difficulties and postoperative ARC.

HPB, 2016

diagnosed as Gilbert's syndrome. Another 20 (30%) donors had other mutations of UGT1A1 gene. Rema... more diagnosed as Gilbert's syndrome. Another 20 (30%) donors had other mutations of UGT1A1 gene. Remaining 10 (15%) donors were UGT1A1 wild type. Conclusions: In graft selection, FLR / total liver volume > 30% is suitable for safe donor liver resection. On the basis of this graft selection criteria, hyperbilirubinemia after donor liver resection had mutations of UGT1A1.

HPB, 2016

complications were observed in 14 recipients (6.3%), 54 recipients (23.6%), 9 recipients (4%) and... more complications were observed in 14 recipients (6.3%), 54 recipients (23.6%), 9 recipients (4%) and 75 recipients (32.8%), respectively. Those complications included biliary (20.7%), vascular (12.1%), graft complications [small for size, acute rejection] (12.6%), and other surgical and medical complications (21.3%). KaplaneMeier survival curves were plotted and Log Rank test was done. The test result was significant with p-value less than 0.05. Conclusion: Clavien Grading System was efficiently useful in summarizing the outcome of Adult living donor liver transplantation recipients. It also provides a simple disclosure of data and a helping tool in comparing different centers aiming at improving the outcomes.

Journal of Liver: Disease & Transplantation, 2016

Objectives: Both complications and mortality of recipients are annoying problems after living don... more Objectives: Both complications and mortality of recipients are annoying problems after living donor liver transplantation (LDLT). The aim to analyze early (<6 months) mortality of patients after adult to adult LDLT (A-ALDLT) in a single center. Methods: Between April 2003 and February 2013, we performed 167 A-ALDLT in National Liver Institute, Egypt. We retrospectively analyzed early mortality in recipients. Results: The overall incidence of early mortality was 34.1% (n=57), it was classified into in hospital (28.7%) and post-hospital discharge (5.4%) mortalities. The most frequent causes of in hospital and post hospital discharge mortalities were SFSS (10/48) and sepsis (5/9) respectively. On univariate analysis, the following factors were significant predictors of early mortality (Female gender, Lt Lobe graft, GRWR<0.8, mean blood transfusion 10.8 ± 9.8 units,(vascular, renal, chest, neurological, bacterial infection and small for size syndrome (SFSS)) complications. While on multivariate analysis by Cox regression, mean blood transfusion 10.8 ± 9.8 units, vascular and neurological complications were independent predictors. Conclusion: Reduction of blood transfusion units, prevention and management of vascular and neurological complications is required for better early outcome after A-A LDLT.