Background After bariatric surgery, many patients are contented with the progress in loosing weight; but on the other hand, they become frustrated by the developing fat apron. At this point, patients should perform body contouring and to work out a proper treatment plan. The most common body contouring surgical procedure after massive weight loss is abdominoplasty. Methods The study started from January 2014 to January 2015 in Elfayoum University hospital , this study included 25 post bariatric consecutive patients. We presented data on patient demographics, operative procedures, wound complications and revision surgeries.All excised specimen was sent for histopathology. The aim of the study is to detect the histopathological changes in subcutaneous fatty layer and its correlation with post bariatric wound healing complications. Results Wound complications occurred in 15 abdominoplasty patients, surgical revision was necessary in 9 of these patients. These problems were associated with microscopic findings, applied on the cutaneous and subcutaneous tissue taken from the horizontal scar during abdominoplasty. Conclusions With the increasing number of high weight loss patients, the need for body-contouring surgeries increases. Surgeons operating on post bariatric patients should be concerned that they are not handling healthy structures, therefore, accurate knowledge of microscopic changes in these patients is necessary for a better choice of reconstructive procedure and avoidance of complications.

Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. Objective The aim of this study was to compare the results between LRYGB and LSG in the management of morbid obesity and its comorbidities. Methods Between January 2010 and January 2015, 434 morbid obese patients were randomized, operated upon, and followed up for 2 years in Al Ahli Hospital, Doha, Qatar. A total of 214 patients underwent LSG, and 220 patients underwent LRYGB. The mean BMI of all patients was 44 ± 10.8 kg/m ² ; their mean age was 43 ± 4.9 years; and 72% of them were female. Patients were followed up at 3, 6, and 9 months and at 1 and 2 years. Operative time, length of hospital stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. Results Age, sex, BMI, and comorbidities were equal in both groups. The mean operative time for LSG was 86.9 ± 51.6 min and that for LRYGB was 108.4 ± 41.8 min. The conversion rate was 0.9% in both groups. Minor complications occurred more often in LRYGB than in LSG (17.2 vs. 8.4%). However, the difference in major complications did not reach statistical significance (4.5% for LRYGB vs. 1.4% for LSG). One-year excessive BMI loss was similar between the two groups (71.8 ± 21.9% for LSG and 77.2 ± 21.3% for LRYGB). The comorbidities were significantly improved after both procedures, except for gastroesophageal reflux disease, which showed a higher resolution rate after LRYGB. Conclusion Two years after surgery, both procedures were almost equally efficient regarding weight loss and improvement of comorbidities, except gastroesophageal reflux disease. LSG was associated with shorter operation time and fewer complications compared with LRYGB. Long-term follow-up data are needed to confirm these results.

Background Sacrococcygeal pilonidal disease (SPD) is a common and frustrating problem, but there is still no consensus on the optimal treatment. Many studies recommend off-midline closure if any excision is to be done. The aim of this study was to compare the modified Limberg flap (MLF) and cleft lift procedures. Patients and methods From February 2010 to February 2013, the authors prospectively studied 200 patients with SPD who presented at two hospitals. The patients were randomly assigned to undergo either MLF transposition (n = 100) or the cleft lift procedure (n = 100). Surgical findings, complications, recurrence rates, and degree of patient satisfaction were compared. Results Operation time was longer in the MLF group. There was no significant difference between the two groups in terms of time to complete healing, time off work, complication rate, and recurrence rates. The two groups reported similar rates of satisfaction. Length of hospital stay was slightly longer in the MLF group because of delay in drain removal. During the follow-up period of 21.5 ± 6.8 months for group 1 and 22 ± 7.6 months for group 2, a single case of recurrence (1%) was detected in group 2 versus two patients (2%) in group 1. Conclusion On the basis of the results of this study, the MLF technique and the cleft lift procedure appear to generate comparable results in the management of SPD. Both techniques are safe and easy to learn and have now become our standard procedures for treating chronic, symptomatic SPD.

Background Adhesive small bowel obstruction (ASBO) represents a common clinical problem following previous abdominal surgery. The recurrence rate after an ASBO admission is high, especially after conservative treatment. Retrospective studies suggest that laparoscopic approach shortens hospital stays and reduces complications in these patients. However, there are no prospective randomized, controlled trials comparing early laparoscopic adhesiolysis with conservative treatment of recurrent ASBO. Patients and methods A prospective, randomized, controlled study was conducted on 51 patients admitted with the diagnosis of recurrent postoperative ASBO to compare early laparoscopic adhesiolysis with conservative treatment in patients with computed tomography-diagnosed ASBO. The outcome of the study was evaluated depending on the length of postoperative hospital stay, passage of stool, commencement of enteral nutrition, 30-day mortality, complications, the length of sick leave, and recurrence of small bowel obstruction during follow-up for 2 years. Results A total of 51 patients with a diagnosis of recurrent small bowel obstruction were identified and divided into two groups. A total of 26 patients were treated with laparoscopic adhesiolysis (23 patients were successfully treated and three patients needed open surgery) and showed significantly low recurrence, short hospital stay, and early regain of bowel movement. A total of 25 patients underwent conservative treatment, which was filed in three cases that needed surgical interference. There was no significant difference between the two groups as regards morbidity and mortality. Conclusion Laparoscopically treated patients with recurrent ASBO had a lower frequency of recurrence and a longer time interval to recurrence. They also had a shorter hospital stay and early start of oral feeding compared with patients treated nonoperatively. Laparoscopy in well-trained hand may help in the treatment of recurrent ASBO with fewer complications.

Background It has been clinically observed that posthaemorrhoidectomy pain is the most feared symptom by the patient, often leading to avoiding surgery altogether. Opioids and NSAIDs are used to control posthaemorrhoidectomy pain, but they have short duration of action and well-known side effects and may be expensive. These factors justify the need to search for new treatments to decrease posthaemorrhoidectomy pain. Patients and methods A total of 90 patients who had undergone surgery for third-degree and fourth-degree haemorrhoids were included in this prospective, randomized, controlled and double-blinded study. The patients were randomly assigned to two groups. Group A received topical sucralfate in petrolatum base and group B received plain petrolatum base. Patients were evaluated at days 1, 7 and 14 for the severity of pain (using the visual analogue pain scale) and for the amount of analgesia used. On day 28 patients were evaluated for wound healing. Results Patients in the sucralfate group suffered significantly less pain and required less analgesics (narcotic and nonsteroidal) on days 1, 7 and 14 postoperatively (P < 0.001). Also, the rate of wound healing was significantly better in the sucralfate group (37/45) than in the control group (28/45) (P < 0.05). Conclusion Topical sucralfate ointment significantly decreases pain at days 1, 7 and 14 after haemorrhoidectomy and significantly accelerates wound healing.

Purpose The aim of the study was to determine the feasibility and accuracy of sentinel lymph node biopsy (SLNB) in patients with advanced breast cancer after preoperative chemotherapy. Patients and methods A prospective study was conducted on 73 patients with advanced operable breast carcinoma previously treated with preoperative chemotherapy. Sentinel lymph node (SLN) mapping was performed at the time of surgery. Following surgery all patients received comprehensive postoperative radiotherapy at 50 Gy/5 weeks. Results Seventy-three patients with a median age of 52 years who had been previously treated with preoperative chemotherapy at Menofia University Hospital and National Cancer Institute (NCI) between May 2006 and May 2013 were selected for this study. The SLN detection rate was 79.5%. Thirty-three of 58 patients (56.9%) had successfully mapped positive SLNs. The false-negative rate was 22.4%. Conclusion This study confirms the feasibility of SLNB after preoperative chemotherapy in the case of advanced operable breast cancer. According to the detection rate and false-negative rate SLNB may predict metastatic disease in the axilla of patients with tumor response following preoperative chemotherapy.

Background The use of contrast agents in the context of conventional percutaneous transluminal angioplasty (PTA) may pose considerable risks for patients with pre-existing renal impairment, and/or allergic disorders. Duplex ultrasound-guided PTA is one of the established alternative modalities to avoid the risk for contrast use; however, it has its limitations. Aim The aim of the present study was to address the values of combining noncontrast fluoroscopy to duplex ultrasound-guided PTA to overcome the limitations of using the later alone, and to improve the overall outcome. Patients and methods The study was conducted from January 2012 to October 2014 on a total of 32 patients with severe chronic ischemia mainly due to significant femoropopliteal disease, with concomitant iliac and/or tibial lesions in some of them. Patients were randomized equally between two groups, duplex ultrasound-guided PTA and combined noncontrast fluoroscopy and duplex ultrasound-guided PTA. Both groups were compared regarding technically related points and also 6 and 12-month patency rates. Results In the duplex ultrasound-guided PTA group, the technical success rate was achieved in 13/16 (81.2%) patients. Balloon angioplasty was carried out in nine patients (eight with noncompliant balloon); stenting was needed in three patients, whereas hybrid treatment was needed in one patient. At 6 and 12 months, primary patency rates were 76.9 and 61.5%, respectively. In contrast, in the combined noncontrast fluoroscopy and duplex ultrasound-guided PTA group, technical success rate was achieved in 15/16 (87.5%) patients. Balloon angioplasty was carried out in 11 patients (seven with noncompliant balloon); stenting was needed in two patients whereas hybrid treatment was needed in two other patients. At 6 and 12 months, primary patency rates were 80 and 66.6%, respectively. Conclusion In this study, a pioneer step forward was assumed to improve the overall technicality in such situations by adding noncontrast fluoroscopic guidance to duplex guided-PTA, with significantly better periprocedural outcome.

Background Endoscopic thoracic sympathecotomy (ETS) is used for the treatment of a wide range of upper limb disorders. The aim of this study was to represent our experience with ETS as a minimally invasive procedure in the treatment of Morbus Raynaud's phenomenon (RP). Patients and methods From January 2012 to March 2015, 29 patients complaining of Morbus RP underwent ETS in the Vascular Surgery Department, Mansoura University Hospital. Eleven patients (38%) presented with digital ulceration despite intensive medical therapy, and 18 patients (62%) presented with severe ischemia without ulceration. Results Twenty-nine patients were subjected to 58 ETS. There were eight male (27.55%) and 21 female patients (72.5%) with a mean age of 38 years (range 21-67 years). The mean operative time was 30 ΁ 6 min (range 22-45 min). There were no deaths or major intraoperative complications. Initial improvement of symptoms with ulcer healing was achieved in 28 of 29 patients (96.5%). Recurrence of the symptoms occurred in 15 patients (52%); however, the symptoms were less severe compared with preoperative symptoms. There was no recurrence of digital ulceration. Conclusion ETS for RP has good initial effect despite a high rate of recurrence. However, the symptoms were less severe compared with preoperative symptoms and without recurrence of digital ulceration. ETS is a preferred treatment modality for Morbus RP.

Background The esophagogastric cancers (EGCs) are rapidly increasing in Western countries. This study was conducted to elucidate the distribution and surgical outcomes of EGC. Patients and methods We retrospectively studied 90 patients who underwent curative surgery for esophagogastric junction cancer according to Siewert's classification during the period between January 2005 and July 2014. The collected information included preoperative, operative, and postoperative data. We also compared these data among the EGC subtypes. Results A total of 90 patients were eligible and were included in the study. The median follow-up period was 17.68 (0.2-130.92) months. Thirty-five patients had type I (38.9%), 32 had type II (35.6%), and 23 patients had type III tumors (25.6%). There were no significant differences in age, sex, and Borrmann macroscopic types between the three subtypes. Thoracotomy was used most often in type I tumors (74.3%) as compared with type II (28.1%) and type III (13%) tumors (P = 0.0001). Multivariate analysis confirmed that only tumor size (P = 0.023) and lymph node metastasis (P = 0.020) and presence of Borrmann macroscopic appearance of type II tumor (0.039) were significant and independent prognostic indicators for survival after curative resection for EGC. Conclusion The selection of the surgical approach for resection of EGC carcinoma should be tailored and achieving tumor-free safety margin. Tumor size and lymph node metastasis and presence of Borrmann macroscopic appearance of type II tumor were significant and independent prognostic indicators for survival after curative resection for EGC.

Background It is difficult to decide on which is the best surgical procedure for groin hernia repair. Several studies have compared laparoscopic groin herniorrhaphy with open Lichtenstein repair. The Lichtenstein procedure is premuscular but laparoscopic repair is preperitoneal. This prospective study compared open preperitoneal modified Kugel procedure with transabdominal preperitoneal (TAPP) laparoscopic repair under spinal anesthesia. Patients and methods A total of 200 patients scheduled for unilateral inguinal hernia repair were randomly divided into two groups to undergo either laparoscopic TAPP (group A) or open modified Kugel procedure (group B) under spinal anesthesia in our hospitals (three hospitals) between September 2010 and September 2012. Recurrence was the outcome measure in our comparison, and short-term and long-term complications were also assessed. Results There was no significant difference between the two groups in terms of their demographic data. Operative time was significantly shorter in the TAPP group than in the open group (37.8 ΁ 18.4 vs. 64.1 ΁ 20.1 min; P < 0.001). There was significant difference between the two groups in terms of postoperative pain, hospital stay, and recovery with return to work (P < 0.001), but no significant difference in terms of intraoperative complications (P = 0.54), short-term postoperative complications (P = 0.72), wound infection (P = 1.0), and urine retention (P = 0.62). During the follow-up period of 32 months (range = 22-50 months), there were no cases of mortality and no significant difference in terms of recurrence (P = 1.0). Chronic pain and dysesthesia were significantly higher in the open group (P = 0.03 and 0.02, respectively). Conclusion Both open and laparoscopic preperitoneal groin hernia repair under spinal anesthesia are effective and safe with low recurrence rates. The laparoscopic approach is better in terms of operative time, return to normal activity, and chronic pain.

Background Cirrhotic patients with ascites and Child classification B or C impose certain limitations on decision making as regards the elective repair of their inguinal hernias. The aim of this study was to evaluate and compare the outcomes of inguinal hernia repair in cirrhotic patients undergoing elective intervention and in those undergoing emergency interventions. Methods Fifty-six cirrhotic patients (Child B or C) undergoing inguinal hernia repair were evaluated. They were  classified into two groups based on the type of intervention, elective and emergency surgical intervention (28 patients in each group). Patients were followed up for 12 months after surgery. Operative and postoperative outcomes and quality of life of these patients were recorded and analyzed. Results A total of eight (28.5%) patients died within 30 days after emergency hernia repair. One mortality was recorded in the first 30 days postoperatively in the elective group. Moreover, patients who underwent emergency patients presented with a significantly higher number of perioperative class III-V complications according to the Clavien-Dindo classification (60% in the emergency group vs. 7% in the elective group). Conclusion Elective inguinal hernia repair for cirrhotic patients with ascites is a relatively safe procedure. The improvement in quality of life represents a clear indication for elective hernia repair.

Introduction Laparoscopic appendectomy is an effective and safe procedure for acute appendicitis. The cost of laparoscopic appendectomy is higher in both simple and complex cases. In this study, we aim to present a new technique to be used during laparoscopic appendectomy with the aim of reducing the cost. We also present the preliminary results. Patients and methods The technique entails hanging the appendix to the abdominal wall using ties applied through the abdominal wall to inside the peritoneum and back to outside the abdomen. The technique was used on 50 patients during laparoscopic appendectomy. Results The mean operative time was 51.8 min. In three cases, the tie caused a tear in the mesoappendix of the distal appendix. In one case, minimal trauma to the small intestines occurred. In a fifth case the very short and inflamed mesoappendix necessitated the use of a harmonic blade to secure it. Conclusion Within the limitation of this study, we can conclude that laparoscopic appendectomy with hanging of the appendix to the abdominal wall using ties is a technically safe, feasible, and cheap method that can be adopted when facilities and funds are limited.

We represent here, a case of male patient aged 32 years coming complaining of diffuse periumbilical pain since 2 days that shifted to the right iliac fossa and suprapubic areas within 6 h from onset. The condition was accompanied by vomiting (once), constipation, and fever. Abdominal examination revealed tender Mc-Burney point with rebound tenderness in the right iliac fossa; he had a pulse of 97 beats/min, temperature of 38.1΀C, and total leukocytic count of 9000 c/m. Ultrasonography revealed minimal free fluid with noncompressible tubular blind structures, indicating acute appendicitis [Figure 1]. The patient was prepared for appendectomy in the usual manner through Lan's incision. On operation, two bulges were found arising from the antimesenteric border of the distal half of the appendix [Figure 2] as diverticulae with impending rupture of one of them [Figure 3]. Both the appendix and diverticulae are seats of inflammation [Figure 4]. Appendectomy was performed and the specimen was sent for histopathologic examination, revealing diverticulitis of an inflamed appendix (type 2 diverticulosis of the appendix). We reviewed the literature to study cases on such a clinical entity and determine whether appendectomy was sufficient in all cases and whether there was actual increased risk for another diverticulae elsewhere.