Background/aim The use of splenectomy for thalassemia major is restricted over concerns of its long-term outcome. The aim of this study was to assess the long-term outcomes of splenectomy for patients with β-thalassemia major. Patients and methods This study included 70 patients with β-thalassemia major. Patients were classified into two groups: 35 patients underwent splenectomy (S group) and 35 patients did not undergo splenectomy (NS group). Patients were assessed by review of medical records, assessment of medical history, and a clinical examination. In addition to complete blood count, liver function tests and serum ferritin were performed. Assessment of lymphocyte populations was carried out by flow cytometry. These investigations were performed at least 2 years after splenectomy in the S group. Results The mean age of the patients who underwent splenectomy was 6.68 ± 2.54 years and the mean postoperative follow-up period was 6.26 ± 3.03 years. Splenectomy improves anemia, but does not reduce iron burden; more patients were found to be on regular iron chelation after splenectomy. Hematocrit and red blood cell indices were significantly increased after splenectomy. Platelet count increased significantly in the S group (644.700 ± 299.400/mm ³ ). There were no significant differences in T-lymphocyte populations between both groups. IgM memory B lymphocytes were lower in the S group compared with the NS group. No overwhelming postsplenectomy infection was reported in this series. Postsplenectomy portal vein thrombosis was reported in one (2.9%) case. Conclusion With long-term follow-up after splenectomy for treatment of thalassemia major, thrombocytosis and the risk of thromboembolic persist. Splenectomy improves anemia, but does not reduce iron burden or the requirement for blood transfusion. Proper preoperative vaccination can reduce the risk of overwhelming postsplenectomy infection.

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Background A major deterrent to providing qualitative surgical care in developing countries is the lack of adequate facilities and severe shortage of human resources. Therefore, most of the surgical workforce in rural areas and urban slums predominantly includes general practitioners with little formal training in providing surgical care. There is a need for constant review of patients' care in this setting with the aim of improving service delivery and conforming to the internationally acceptable standard of practice. Materials and methods A 5-year descriptive retrospective study, from January 2007 to December 2011, of general surgery cases at State Specialist Hospital Ikere-Ekiti (Nigeria) was carried out. Results A total of 80 patients underwent 85 surgical operations. Most of them (86.2%) had ward admission for a mean duration of 4.6±1.4 days. The most frequent elective operation was hernia repair [66 (77.7%)]; whereas that of emergency was appendectomy [seven (8.2%)]. Other operations included lumpectomy [three (3.5%)], hydrocelectomy [two (2.4%)] and orchidectomy and laparotomy [three (3.5%) each]. All patients received postoperative antibiotics, with 71.3% receiving two or more antibiotics. Fifteen (18.8%) patients had surgically excised specimens with no histopathological evaluation. Only four (5%) patients were followed up beyond 4 weeks. No mortality was recorded. Conclusion Surgical volume was grossly low and there is a need for the government to equip secondary healthcare centres with basic facilities and strengthen surgical capacity for maximum utilization and improved quality of care. Periodic training programmes for general practitioners to ensure strict adherence to the international best practices will be helpful. In addition, health education should be available for everyone to reduce sociocultural-related problems.

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Benign multicystic peritoneal mesothelioma is a rare disease that arises from the peritoneal mesothelium. We report on a 52-year-old woman who presented with a large abdominal multicystic mass presumed to be a pancreatic pseudocyst. Laparoscopic exploration revealed a multicystic mass with area of calcification originating from the lesser curvature of the stomach. The whole tumor was successfully excised laparoscopically. Histopathology revealed benign multicystic peritoneal mesothelioma with an area of calcification. Treatment by a minimal access approach allowed the patient to recover rapidly with a short convalescence. Our case confirms the feasibility and safety of a minimal access surgical approach to a rare pathological entity.

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Background It is not always easy to achieve an adequate arterio venous fistula in long-term dialysis patients; hence, permanent cuffed tunneled central venous catheters represent necessity in some ESRD patients like those with advanced age and/ or comorbid conditions. Purpose To report the technique and the results of the permanent tunneled catheters as a vascular access . Patients and methods This report describe the technique and the results of the permanent tunneled catheters as a vascular access for hemodialysis at Mansoura University Hospitals. Catheter was inserted by seldinger percutaneous technique with the use of radioscopic guidance by an experienced vascular surgeon. Results The study included 33 patients for whom 38 catheters were inserted (17 males,16 females), nine of whom were hypotensive, with a mean age of 48,9 years.The cumulative primary patency rate at 1 year was 52.6% and at 2 years, 21.05%. Complications developed including ,tunnel haematoma, thrombosis, and infection. Conclusion Permanent cuffed, tunneled catheters play a larger role, particularly among those in whom finding a vascular access can be challenging.

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Background Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid cancer, occurring in about 80% of cases. Ongoing debates on the best treatment strategy for patients with PTC over the last decades have included the extent of lymphadenectomy, the value of radioactive iodine (RAI) ablation, and the impact of each therapy on the patient's life. The aim The aim of this study was to compare different surgical procedures with regard to their safety, efficacy, and impact on the patient's life, as well as compare surgery with other treatment modalities such as RAI ablation. Patients and methods This study was conducted on 142 patients with PTC. Patients were arranged into three groups according to their clinical presentations: Group I included 34 patients who presented with hidden PTC within multinodular goiter; they were treated with total thyroidectomy (TT). Group II included 52 patients with PTC without palpable lymph nodes; they were treated with TT + prophylactic central neck dissection (pCND). Group III included 56 patients with PTC with palpable lymph nodes; they were treated with TT + central neck dissection (CND) + lateral neck dissection. RAI ablation was given to those patients who showed residual disease in the RAI scan. Completion surgery was performed only in relapsed cases with palpable disease. We compared the results of the three groups regarding complications, recurrence, and impact on patients' life. Results There was a statistically significantly higher incidence of most postoperative complications in groups II and III than in group I, although the final outcome was the same in the three groups. RAI therapy showed a good success rate in ablation of residual impalpable disease. At the end of the follow-up period, all patients were tumor free. Conclusion pCND should be abandoned because of its considerable risks and limited benefit. RAI ablation is a very good treatment option for residual PTC. Completion surgery should be decided only for relapsed bulky disease.

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Background Posthemorrhoidectomy pain represents an annoying problem for the surgeon and the patient; although it can be controlled with an analgesic ladder, its management remains in question. Purposes The current study investigated the efficacy of topical tannic acid powder in reducing postoperative pain, in promoting wound healing after open diathermy hemorrhoidectomy, and in the prevention of secondary hemorrhage. Patients and methods A prospective, randomized trial was conducted on 97 patients suffering from grade 3 or 4 internal or external hemorrhoidal disease to compare posthemorrhoidectomy pain and wound healing with the use of topical tannic acid applied to the surgical site compared with placebo. Postoperative follow-up was for 3 months. Results Postoperative pain in patients given topical tannic acid improved during the first 2 days (VAS: 1.2 ± 0.4 vs. 8.2 ± 0.6; P < 0.05) and on day 7 (VAS: 3.6 ± 0.6 vs. 6.3 ± 0.5; P < 0.05); wound healing also improved significantly [mean postoperative edema score: 3.0 vs. 7.0, P < 0.05; and mean overall wound healing score: 4.0 vs. 6.0, P < 0.05)], although there was no difference as regards primary and secondary healing (P > 0.05). In addition, secondary hemorrhage in the topical tannic acid group was significantly less (mean score, 2.0 vs. 12.0; P < 0.05). Conclusion Topical tannic acid application plays an important role in diminishing postoperative pain, in improving wound healing after open diathermy hemorrhoidectomy, and in preventing secondary hemorrhage.

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Background Surgical site infections (SSIs) are major sources of adverse operation-related events in patients undergoing surgery and include increased morbidity, psychological trauma, additional cost, and delay of postoperative adjuvant therapies. This study aimed to identify the rate, degree, treatment, and causative organisms of SSIs after breast surgery in the hospital of Medical Research Institute, University of Alexandria. Patients and methods The study prospectively included all patients admitted during the period from February 2013 to July 2013 who were selected for breast surgery. Patients were followed up for 30 days after surgery if they had no implant and for up to 1 year if they had an implant placed during the operation. The rate, degree, treatment, and causative organisms of SSIs after breast surgery were registered. Results The study included 146 patients; SSIs were diagnosed after 17 (11.6%) operations. All patients who had SSIs after breast surgery were identified during the outpatient follow-up. Six (35.2%) of the 17 patients who had SSIs after breast surgery needed to be readmitted for management of SSIs. Staphylococcus aureus was the most common pathogen (isolated from 41.2% of patients). Conclusion SSIs are important and common complications after breast surgery. They can occur after any type of breast surgery. Microbiological diagnosis is an essential tool for proper management.

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Aims Hepatic resections for hepatocellular carcinoma (HCC) in the cirrhotic liver are characterized by early recurrence. In this study, we analyzed several factors affecting disease-free survival after hepatic resection. Settings and design A retrospective and prospective study. Materials and methods From January 2002 to July 2012, 208 patients underwent hepatic resections for HCC in the cirrhotic liver in the Gastroenterology Surgical Center, Mansoura University, Egypt. There were 157 male (75.5%) and 51 female (24.5%) patients, with a mean age of 55.4 ± 9.3 years. Recurrence rates were analyzed using the Kaplan-Meier curve. The prognostic significance of the tested factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Statistical analysis was performed using SPSS18. Results Most patients were in Child-Pugh class A (88%). Major hepatic resection was performed in 73 patients (35.1%), segmentectomy was performed in 74 patients (35.6%), and localized resection was performed in 61 patients (29.3%). Hospital mortality occurred in 19 (9.1%) patients, whereas hospital morbidity occurred in 37% of the patients. The 1-, 3-, and 5-year survivals were 62.9, 25.9, and 19.1%, respectively. The prognostic factors predicting early tumor recurrence were the Child class, multifocality, portal vein (PV) invasion, perioperative blood transfusion, microvascular invasion, local spread, cut margin infiltration, lymph node infiltration, lack of a capsule, the tumor grade, the tumor stage, and preoperative alpha feto protein (AFP). However, tumor multifocality, perioperative blood transfusion, and cut margin infiltration were the main factors predicting early recurrence on multivariate analysis. Conclusion Factors predicting disease-free survival are different and multifactorial. However, the resection of HCC in a cirrhotic liver with preserved liver function is the treatment of choice and can be performed with favorable results.

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Background In past years, the diagnosis of hepatocellular carcinoma (HCC) was always made when the disease was advanced, when patients were symptomatic. However, due to the revolution in the diagnostic tools many patients now are diagnosed at an early stage while liver function is still preserved. In addition, there are different treatment modalities available that will have a positive impact on survival. Patients and methods This prospective study was conducted upon 50 patients with HCC, treated and followed up from March 2008 to May 2012 at Zagazig University hospitals, AL-Azhar University hospitals, and International Medical Center. Results Regarding liver resection, nine patients underwent right hepatectomy, two patients had left hepatectomy, and atypical (localized) resection had been performed in four patients. With respect to living donor liver transplantation, 15 patients had right lobe graft. Regarding radiofrequency ablation, 10 patients underwent this procedure under general anesthesia. With respect to transarterial chemoembolization, 17 sessions were performed for 10 patients. Conclusion Radiofrequency ablation and liver resection are comparable in small HCC lesions. Transarterial chemoembolization is sometimes the only available way for unfit patients and when surgical resection is contraindicated. Liver transplantation is the remaining treatment left for many patients with end-stage liver disease who fulfill Milan criteria.

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Introduction Laparoscopic cholecystectomy is considered the gold standard for the treatment of symptomatic cholelithiasis. Single-incision laparoscopic surgery refers to the operative technique in which a surgical procedure is carried out through one incision. Patients and methods Prospectively randomly selected 30 patients with chronic calcular cholecystitis or gall bladder polyps for whom single-incision laparoscopic cholecystectomy (SILC) was performed between January 2011 and July 2013 were recruited to evaluate the feasibility of the procedure using conventional reusable cannulas and straight instruments with no more cost than that used in conventional four-port laparoscopic cholecystectomy. The Marionette technique at the three-point suspension of the gall bladder was used. Results The operative time ranged from 35 to 110 min, with a mean of 53.3 min. No patient required conversion to open surgery. One patient only required the addition of one more port. Two patients required the placement of a drain. In terms of postoperative complications, no patient developed bile leakage, postoperative bleeding, postoperative jaundice, or incisional hernias. Conclusion SILC was a technically more challenging but safe procedure compared with conventional laparoscopic cholecystectomy because of the close proximity of the working instruments with limited triangulation; limited range of motion of the laparoscope and instruments, and decreased number of ports all contributed toward increased difficulty. The Marionette technique in three points was a very important step in the procedure. The operating time is long initially, but it reduces as surgeons become more experienced.

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Objectives The aim of the study was to evaluate the surgical and functional outcome of the Delorme procedure for the management of full-thickness long-segment rectal prolapse (RP) in children. Patients and methods This study included 23 patients with a mean age of 5.5 ± 2 years. The severity of incontinence and impact on quality of life (QOL) were evaluated using the Fecal Incontinence Severity Index (FISI) and the Fecal Incontinence Quality of Life (FIQL) questionnaires. The primary outcome was defined as complete recovery of continence, and partial improvement was defined as improvement in either type or frequency of incontinence or both. Recurrence was defined as recurrent incontinence after complete recovery. The secondary outcome was defined as change in the impact of incontinence on patients' QOL as assessed by the FIQL questionnaire. Results The mean operative time was 60.7 ± 13 min, the mean time until the first oral intake was 8.7 ± 3.9 h, and the mean postoperative hospital stay was 33.4 ± 12 h. All patients showed significantly lower postoperative scores on individual items and the total FISI score. Surgical repair of RP showed a favorable outcome in the form of significantly higher postoperative scores of individual items of the FIQL questionnaire, with a significantly higher postoperative total FIQL score compared with preoperative scores. Throughout the follow-up duration of 25.6 ± 6.9 months, 18 patients (78.2%) showed complete recovery, four patients (17.4%) showed only partial improvement, and one patient (4.4%) developed recurrence of gas incontinence 6 months after the disappearance of his incontinence; however, in all five patients there was an infrequent occurrence of incontinence at a frequency of 1-3 times/month. Conclusion The Delorme procedure is safe and effective for the management of complete RP, with a high complete recovery rate and ability to alleviate the adverse impact of fecal incontinence on QOL even in those with partial improvement. The reported advantages and outcome of the Delorme procedure in children and adulthood could enable discarding old concepts for restricted indications for the procedure for old and/or unfit patients and could make it suitable for all cases with RP without limits of age or general condition.

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Introduction Obesity is a major public health challenge in the 21st century, where medicopsychological management has shown its limitations. Bariatric surgery is now acknowledged as the most efficient therapy, potentially offered to severely obese patients. Among other options, Roux En-Y gastric bypass (RYGBP) is the most frequently performed procedure. Patients and methods This is a retrospective study of 150 patients who underwent a laparoscopic RYGBP at the Saint Maria Nouva Hospital (Reggio Emilia, Italy) and the Ain Shams University hospitals during 2011-2013 with a 1-year follow-up. There were 29 male (19%) and 121 female (81%) patients, with an age range of 18-58 years. Their mean BMI (kg/m΂) was 45.The outcome of this technique was evaluated by the incidence of early surgical postoperative complications, including gastrojejunostomy leakage, postoperative intra-abdominal bleeding or hematoma, reoperation, and mortality rate, and late postoperative complications, such as gastritis, vitamin deficiency, gastrojejunostomy stricture, incisional hernia, and internal hernia, after 12 months' follow-up. Weight loss was followed up every 3 months up to 12 months. Results The average operative time was ~75-90 min. There was no mortality in our series. Early postoperative intra-abdominal hematoma formation occurred in three cases (2%). Anastomotic leaks occurred at the gastrojejunostomy site in three cases (2%). There was no incidence of pulmonary complications or early postoperative wound infection. With long-term follow-up every 3 months up to 12 months, there was one case of incisional hernia after reoperation for leakage (0.6%) and there was no complain of gastritis, no incidence for gastrojejunostomy stricture, or internal hernia. There was no vitamin deficiency during the 12-months follow-up, except for two cases (1.2%) of iron deficiency anemia that needed additional iron supplementation. Regarding weight loss, the mean weight loss after 12 months' follow-up was 35.2 kg and the mean BMI of the patients decreased from 45 kg/m ² preoperatively to 32.3 kg/m ² after 12 months. Conclusion The primary desirable outcomes after bariatric surgery include low rates of perioperative and long-term complications, sustained and meaningful weight loss, significant improvement in the quality of life, improvement or resolution of obesity-associated comorbidities, and extension of life span. All the five outcomes have been shown to be feasible results of laparoscopic RYGBP.

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