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Background COVID-19 disease causes complications that are classified according to likelihood to high such as venous thromboembolism, acute kidney injury, and postintensive care syndrome. Other complications are low in likelihood such as cytokine release syndrome, pancreatic injury, gastrointestinal complications, and pregnancy-related complications. Mortality and morbidity are really high when it is combined with surgical intervention especially under general anesthesia. Objectives To evaluate the incidence of COVID-19 in general surgery emergency and complications associated in different types of management. Patient and method This is a retrospective study from June 2020 to January 2021 including all COVID-19 positive cases admitted in general surgery department during previously mentioned period. Before September 2020, screening for COVID was based on swab for only clinically suspected COVID-positive patients. Starting from September 2020, routine swab to all admitted patients was done. All data collected about included cases in study underwent statistical analysis to get results. Results In this study, incidence of COVID-19 is 1.35%, mortality incidence is 26.4% (about 92.9% of mortality cases underwent surgery) and morbidity incidence is 30.2%. About 74% (73.6%) of positive cases improved and discharged. Management of cases is according to guidelines of management to each disease and decision of ER consultant. About 77.4% of cases are managed surgically; about 70.7% of cases operated upon underwent exploration. However, 60.4% of cases are admitted with sepsis and septic shock. Asymptomatic cases for COVID during admission are 26.4%. Conclusion Incidence of COVID-19 in acute general surgery emergency in Kasr Al-Ainy is not that high. However, cases operated upon in the era of COVID are associated with high incidence of mortality. Cases are presented to our institute late, which might be an effect of lock down. [ABSTRACT FROM AUTHOR]

Background Complicated appendicitis is associated with elevated rates of morbidity and mortality compared with noncomplicated appendicitis. In this study, we aimed to investigate the role of combining total leucocytic count (TLC) and abdominal ultrasound (US) in distinguishing simple from complicated appendicitis. Patients and methods This is a prospective study that included patients with acute appendicitis who underwent appendectomy. The patients' data regarding demographic characteristics, clinical, laboratory, and US findings, as well as intraoperative findings and postoperative complications, were recorded and analyzed. Results This study included 80 patients. Overall, 48 (60%) patients had noncomplicated appendicitis, and 32 (40%) had complicated appendicitis. Patients with complicated appendicitis had significantly higher ages and TLC. Concerning the US findings, significantly higher cases of visualized blind-ended loop (P=0.042), right iliac fossa fluid (P=0.006), and pelvic collection (P < 0.001) were shown in the complicated group. Multiple regression analysis revealed that TLC and the presence of pelvic collection by the US were the only variables significantly predicting complicated appendicitis. Adopting either a TLC cut-off value of 12.95×109/l and/or the presence of pelvic collection for the diagnosis yielded a sensitivity of 90.6%, a specificity of 77.1%, and an accuracy of 82.5%. Conclusion The presence of a TLC cut-off value of 12.95×109/l and/or a pelvic collection in abdominal ultrasound seems to be reproducible for the preoperative prediction of complicated acute appendicitis. [ABSTRACT FROM AUTHOR]

Introduction Every year, approximately 4 million individuals are affected by peptic ulcer disease (PUD). Among patients with PUD, the lifetime occurrence of perforation stands at ~5%. Associated with this complication is a mortality rate spanning from 1.3 to 30%. Whether the surgery was done open or laparoscopic, the postoperative plan of management remained dogmatic for many years, especially regarding the presence of a nasogastric (NG) tube. Patients and methods This prospective, single-center, randomized controlled study of patients with perforated peptic ulcer (PPU) presented to Kasr Alainy Emergency Hospital was conducted to assess the dispensability of NG tube postoperatively in perforated peptic ulcer patients. Patients were randomly allocated into two groups, group A (NG tube control group): 40 patients and group B [Enhanced Recovery after Surgery (ERAS) group]: 34 patients. Results The study revealed a significant decrease in hospital stay by approximately 2 days for patients in the ERAS group, compared with those receiving standard care. This reduction in hospital stay was observed without any increase in postoperative complications among the ERAS group. However, this may be clinically nonsignificant due to a limited number of patients in our study. Conclusion The routine use of NG decompression and delayed oral feeding appears to be unnecessary. These practices contribute to prolonged hospital stays without yielding any beneficial effects on morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of negative pressure wound therapy of closed abdominal incisions on wound complications. Background: Surgical wound complications including surgical site infection complicating open abdominal operations are a burden on the economy. The outcomes of SSI include prolonged hospital stays, adjuvant treatment delay, and incisional hernias leading to a decrease in the quality of life. Prophylactic negative pressure wound therapy has recently been tried with promising results. Methods: A randomized controlled trial involving 140 patients post-laparotomy with primary wound closure was divided into 2 groups (70 patients each). For the first group, NPWT dressings were applied for the first 3 days and then conventional dressings for 4 days after. For the second group, conventional dressings were applied for 7 days. Patients were followed up for SSI, seroma, wound dehiscence, and hospital stay. Results: pNPWT was associated with a significantly lower rate of SSI development compared with gauze dressings (3/70 vs. 17/70) (p = 0.001). It also had a significant effect on lowering the incidence of seroma (0/70 vs. 7/70) (p = 0.007) and delayed wound healing (0/70 vs. 8/70) (p = 0.006) and on decreasing days of hospital stay (2.2 ± 0.6 vs. 3.5 ± 1.8) (p <0.00001). No significant difference was observed with regard to hematoma (0/70 vs. 1/70) (p = 0.5) or wound dehiscence (0/70 vs. 2/70) (p = 0.5). No burst abdomens or NPWT complications were recorded in our study. Conclusion: Three-day NPWT applied to primarily closed incisions is effective in reducing the incidence of SSI, seroma, and delayed wound healing in abdominal operations compared to conventional gauze dressings. [ABSTRACT FROM AUTHOR]

Background: Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The one-anastomosis gastric bypass (OAGB) procedure, first introduced by Dr. Rutledge, has demonstrated a 25% greater weight loss efficiency than the traditional Roux-en-Y gastric bypass (RYGB) procedure due to the substantially longer biliopancreatic limb (BPL). Aim of the study: The current work aimed to compare the outcomes of OAGB and long BPL RYGB regarding weight loss and comorbidity resolution. Patients and methods: This randomized controlled trial was done at our institution between September 2019 and January 2021. Patients who were candidates for bariatric surgery were randomly and equally allocated to two groups. Group A underwent OAGB, while group B underwent long BPL RYGB. Patients were followed up for 6 months postoperatively. Results: This study included 62 patients equally allocated to OAGB or long BPL RYGB, with no dropouts during follow-up. At 6 months, there was no statistically significant difference between the two groups regarding postoperative BMI (P = 0.313) and the EBWL (P = 0.238). There was comparable remission of diabetes mellitus (P = 0.708), hypertension (P = 0.999), OSA (P = 0.999), joint pain (P = 0.999), and low back pain (P = 0.999). Seven patients in the OAGB group experienced reflux symptoms (P = 0.011), which were managed by proton pump inhibitors. Conclusion: Extending the BPL in RYGB provides weight loss and comorbidity remission comparable to that of OAGB. Some OAGB-related reflux cases remain a concern. However, they were sufficiently controlled with PPIs. Due to OAGB superior technical simplicity, long BPL RYGB should be preserved for cases whom are more risky for bile reflux. [ABSTRACT FROM AUTHOR]

Background Gastrointestinal surgery is associated with significant risk of postoperative complications, reaching up to 50% of cases especially in major operations. These complications have their detrimental effects not only on the patients, physically and psychologically, but also they induce a significant increase in costs, a timely concern while healthcare expenditures need to be controlled. Aim This study was designed to determine the value of a simple noninvasive parameter − the neutrophil-to-lymphocyte ratio (NLR) − in the first day postoperative in the prediction of early postoperative complications following intestinal obstruction surgery. Patients and methods This study includes 170 consecutive patients complaining of intestinal obstruction due to different primary causes and not having a previous abdominal surgery. The number of the male patients in the study is 97 (57.1%) patients, while the females are 73 (42.9%). The age of the patients was in the range in between 16 and 70 years with a mean age of 53.16±2.57 years. Results The NLR value in the preoperative investigation ranges between 2 and 25 with an average value of 6.71±8.7. The NLR that was done in the first postoperative day ranges between 0.6 and 31.3 with an average value of 6.77±4.75. Although the NLR increases postoperatively, it was found that there is insignificant difference between the NLR before and after 24 h postoperatively. The NLR of the complicated patients ranged between 1.61 and 31.3 with an average value of 8.65±4.83, while that of noncomplicated cases have a range of 0.6–7.63 with an average of 3.985±1.47. The difference of the mean of NLR in first postoperative day between complicated and noncomplicated cases is highly significant. Receiver-operating characteristic curve analysis of NLR suggested that a cutoff value of 5.01 was the optimal value for predicting complications, with an area under the curve of 0.873. This cutoff point produced a sensitivity of 84.61% (95% confidence interval=0.7545–0.9133) and a specificity of 78.37% (95% confidence interval=0.6728–0.8711). The overall model quality is good as it is equal to 0.82. Conclusion NLR is a good, cheap, and easily available investigation that can predict postoperative early complication after operation for intestinal obstruction. It has good sensitivity and specificity in the prediction of early postoperative complications. Further studies that compare other cheap and easily available biomarkers with NLR in predicting postoperative complications are required. [ABSTRACT FROM AUTHOR]

Background The spleen and liver are the most frequently injured solid organs in blunt trauma of the abdomen. Motor car accidents are the leading cause of injury. Splenic abscess is one of the delayed complications after splenic trauma. It is not a common clinical problem. However, if not diagnosed, splenic abscess has a very high mortality rate. Methods This observational cross-sectional study was conducted at our Hospital Emergency Department. All patients with isolated blunt splenic trauma who were hemodynamically stable and managed conservatively were included in the study. This study was applied on 74 patients; four patients were dropped out during follow-up and two patients were operated upon and excluded from the study. Sixty-eight patients were included in this study and were managed conservatively after splenic injury. Results Follow-up computed tomography (CT) with intravenous contrast was performed to all included 68 patients 1 month after initial admission date, aiming to detect splenic abscess. In the presence of warning symptoms like persistent left hypochondrial pain and fever, follow-up CT was done earlier after proper clinical evaluation. Two (2.9%) cases out of 68 patients had splenic abscess. Their initial CT abdomen showed grade III splenic injury according to the American Association for Surgery of Trauma. Conclusions Follow-up CT abdomen with intravenous contrast is recommended for all patients with grade III or more splenic injury who underwent conservative management of splenic trauma, especially who had persistent fever and left hypochondrial pain. [ABSTRACT FROM AUTHOR]

Background Management of breast abscess involves incision and drainage; however, this is associated with need for general anesthesia, prolonged healing time, regular dressing, difficulty in breastfeeding, and possible unsatisfactory cosmetic outcomes. Ultrasound-guided aspiration has been used successfully and is associated with less recurrence, excellent cosmetic results, and less costs. Patients and methods This study was conducted in the Department of General Surgery in Kasr Al-Ainy Hospital from August 2019 to March 2020. Patients admitted to the hospital with acute lactational breast abscess and met the inclusion criteria were the candidates of this study. A total of 48 female patients with acute lactational breast abscess between 18 and 50 years of age were included. The patients were randomized into group A (ultrasound-guided needle aspiration) and group B (incision and surgical drainage). The patients were followed up for 1 month after complete resolution. Results The mean age of patients in group A was 29.79 years and in group B was 29.04 years, the mean intervention time was 18.05 min in group A and 12.92 min in group B, and the healing time was less in group A (mean=11.6) than group B (mean=22.21). The pain was less in group A than group B in the second and third day postoperatively. All the patients were satisfied with the cosmetic results in group A, whereas in group B, only 54% of the patients were satisfied with the cosmetic outcome. Recurrence was found in two (11.8%) patients in group A, with a success rate of 70%, whereas in group B, the success rate was 100%, with no recurrence. Conclusion Ultrasound-guided needle aspiration could be an effective alternative to incision and surgical drainage in selected cases with acceptable success rate, less healing time, less postintervention pain, better cosmetic outcome, and without the need for general anesthesia. [ABSTRACT FROM AUTHOR]

Background Obstructed-defecation syndrome (ODS) is a condition characterized by the inability to completely evacuate or expel a fecal bolus in the presence of the urge to defecate. A series of mechanical lesions may cause OD, including rectocele, rectoanal intussusception, and rectal prolapse, which may be a cause or an end result of obstruction and chronic straining. The problem with OD, is mainly the difficulty in diagnosis and selection of cases, which could benefit from surgery. Moreover, it is very difficult to determine the suitable surgical technique for each individual case, that is, tailoring of cases. Aim Many surgical techniques have been established either through transanal or laparoscopic approach. Each of these techniques has its benefits and its hazards. Most of the studies in the literature focus on advocating or criticizing a specific surgical technique. This study, however, aims at comparing the results of different surgical techniques through laparoscopic (posterior rectopexy, ventral mesh rectopexy) or transanal (Altemeier's, Delorme's, stapled transanal rectal resection) approach in order to answer a simple question: which approach should be the default and when to use the other?Patients and methods A sample of 28 cases of OD was studied, 14 of which were done through laparoscopic and 14 through transanal approach. Comparison was based on the postoperative hospital stay, complications, and the change in OD score using the 'Altomare ODS questionnaire, 2008.'Results Bleeding was more in laparoscopic techniques, occurring in two (14.3%) of the patients, versus one patient (7.1%) only of those done transanally. Incontinence was more among the transanal group as it occurred in three (21.4%) patients, versus one (7.1%) patient only done laparoscopically. Only one (7.1%) patient done transanally (Delorme's technique), had postoperative anal stenosis requiring anal-dilation sessions. Besides, one (7.1%) of the female patients done through transanal approach, developed rectovaginal fistula. Two of the male patients done by laparoscopic posterior rectopexy developed erectile dysfunction. Laparoscopic techniques had more drop in the ODS score than transanal techniques with a mean of 9.5 ± 6 versus 4.64 ± 5.31, respectively, and a P value of statistical significance (P=0.042). Conclusions Laparoscopic approach is superior to transanal approach as regards improvement of OD manifestations, and thus should be the default, yet the techniques that involve dissection along the posterior rectal wall (posterior mesh rectopexy) are not recommended for males, especially adults. [ABSTRACT FROM AUTHOR]

Background and objective Postoperative pain management is a critical aspect of patient care after surgery. It is especially important in obese patients, who have a higher risk of inadequate postoperative ventilation and chest expansion, as well as respiratory depression and obstructive sleep apnea. The usage of opioid drugs for pain management exacerbates these consequences. In these patients, opioid-free regimens incorporating regional anesthetic procedures like the transversus abdominis plane (TAP) block become indispensable. The laparoscopic-guided TAP (L-TAP) block is a new procedure that has shown promise in the treatment of postoperative pain. The main objective of the present study was to demonstrate the effectiveness and safety of TAP block for postoperative pain management under laparoscopic vision undergoing laparoscopic bariatric surgery. Methodology This is a randomized clinical trial including 46 patients, who were divided into two groups, 23 each, one to receive L-TAP and one as control. Postoperative pain in the first 24 h was assessed by Visual Analog Scale (VAS) scores, need for narcotic rescue analgesia, number of rescue doses required, pain scores on ambulation, and incidence of postoperative nausea and vomiting. Results Significantly fewer patients in the intervention group required rescue analgesia (30.4% in the intervention group to 65.2% in the control group, P=0.018). The intervention group also exhibited significantly better pain scores on ambulation (P=0.006). All other parameters showed no statistically significant difference between the two groups. Conclusion L-TAP is a promising technique for the alleviation of postoperative pain in obese patients undergoing bariatric surgery. Further studies are needed to delineate the limits and extents of its efficacy. [ABSTRACT FROM AUTHOR]

Background The rising incidence of blunt abdominal trauma increases the rate of hospital admissions for those cases worldwide, with some of them undergoing emergency laparotomy. Surgical site infection for those patients is still not an uncommon complication, which deserves great attention to be prevented or adequately managed if established. The aim of the study was to focus on the incidence of this complication along with factors that may affect its occurrence. Patients and methods The study was conducted at the general surgery emergency department of Kasr Al-Aini Cairo University hospital from July 2019 through February 2020. It included 30 patients who presented with blunt abdominal trauma and needed emergency laparotomy and then were observed for the occurrence of surgical site infection. Patients were individually correlated to a risk factor scoring system, which we had formulated to be used in the study. Results Overall, 20% of the patients had surgical site infection. The study showed increased incidence of postoperative SSI in patients with higher risk factor total score (score > 7) and low incidence with scores below that, with a significant relation (P value < 0.001). Conclusion The scoring system was helpful in the prediction of surgical site infection in the studied patient group. [ABSTRACT FROM AUTHOR]