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Background Ventral hernia repair is one of the most common operations performed today, yet when complex and huge it presents a true challenge for the surgical team. Aim of the Work To assess the feasibility, safety and efficacy of Transversus Abdominis release technique in management of ventral hernia with large defects. Patients and Methods This study is a prospective interventional study conducted at Ain Shams University Hospitals on 40 patients diagnosed as having ventral hernia with a defect equal to or more than 10cm in width and operated upon between October 2018 and October 2019 with minimal follow up of 6 months postoperatively. Results 40 ventral hernia patients were enrolled in the study. Mean operative time (in minutes) in TAR patient is 268.5min (4hr 28min) with SD ± 47.4. Postoperative pain evaluation using the visual analogue scale (VAS) score, the postoperative pain was assessed 48hrs postoperatively, the mean VAS score for TAR patient being (6.77 ± 1.70). Early Postoperative wound complications 10 (25.0%). Conclusion After this TAR technique are effective and reliable method in experienced hands.

Background: Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however, there is no "gold standard" operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, considering patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities. The laparoscopic revolution has increased the debate about the safest and most effective inguinal hernia repair. This revolution has broadened our understanding of inguinal anatomy and hernia repair. At the least, surgeons should be aware of the current indications and contraindications for laparoscopic inguinal hernia repair, because some hernias should have a laparoscopic repair. To increase versatility, surgeons should consider becoming skilled at both techniques, with the understanding that outcomes are optimal if one is committed to achieving expertise in laparoscopic repair. Objectives: Our objective in this study is to compare the outcome of mesh fixation using non-absorbable tacks versus absorbable tacks in transabdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia regarding their efficacy and postoperative complications to improve the outcome of patients undergoing surgery for inguinal hernia in Ain Shams University Hospitals. Patients and methods: The present study is a prospective, randomized comparative study that was conducted in Ain Shams University Hospitals in Egypt, and included sixty (60) patients who had inguinal hernia. The patients were divided into two groups each group including 30 patients. In the first group (Group A) titanium non-absorbable tacks were used and in the other group (Group B) absorbable tacks were used. The patients underwent a trans-abdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia using prolene mesh. The study was conducted from July 2016 to July 2017, with 12 months of follow-up post-operatively until July 2018. Results: The mean age of the patients was 36.93 ± 10.23 (19-55) and the mean BMI was 24.83 ± 2.79 (19-32). There was no significant difference between 2 groups as regard preoperative comorbidities. Patients presented mainly with swelling in the groin region 71.67%. Right sided hernia was 46.7% and bilateral hernia was 15%. There was no difference between 2 groups as regard the operative time (p-value=0.056) and intraoperative complications: bleeding (p-value=0.150) and bladder injury (p-value=0.313). Post-operative complications, postoperative hospital stay, time needed to return to normal activity and the recurrence were all alike between the 2 groups. Pain analysis was done four times, and revealed no significant difference between the 2 groups at any time of follow-up. Conclusion: Both non-absorbable tacks and absorbable tacks used in mesh fixation are similarly effective in terms of operative time, the incidence of recurrence, complications and pain at least in the first year of follow up, but it may be less painful after one year after the complete absorption of the absorbable tacks but this needs further investigations and studies containing more patients and with follow-up for longer time.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure, but it had been reported to increase the incidence of gastroesophageal reflux disease (GERD) and its conseq...

Background obesity and its associated type II diabetes mellitus (Type II DM) are an ongoing health-care problem worldwide. Both diseases are closely related and difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. There is strong evidence that bariatric surgery can cure type II diabetes mellitus in patients with obesity. Aim of the Work to determine different predictive factors affecting the outcome of type II diabetes mellitus after laparoscopic sleeve gastrectomy. Patients and Methods this prospective study included 40 obese diabetic patients with type II DM who underwent laparoscopic sleeve gastrectomy. DM type II was diagnosed according to ADA criteria: FPG > 126 mg/dl, HbA1c ≥ 6.5%, random blood glucose ≥200 mg/dl, or use of insulin or oral diabetes medication. Glycemic marker in the form of HbA1c and fasting blood sugar were measured just prior to surgery and at 3 months and 6 months postoperatively. Results a total of 40 patients (70% women) with T2DM were included in the study. Mean age at the time of surgery was 42.48 ± 10.95 years. Median Inter Quartile Ratio (IQR) of diabetes age (diabetes age was calculated from the diagnose date to the operation date) was 4 years (from 3 years to 6 years) with range of 1-20 years. Remission of T2DM was achieved in 42.5% of patients underwent SG. Conclusion This study showed that younger patients, with shorter diabetic age, not using insulin and optimum pre-operative glycemic control(normal fasting blood sugar and HbA1c) were the best candidates to achieve remission (HbA1c

Background: hypocalcaemia, which is a major contributing factor for delayed hospital discharge, occurs in many patients following total thyroidectomy. Parathyroid hormone (PTH) measurement has been proposed as a marker of this condition. Aim: the aim of this study was to evaluate the reliability of perioperative parathyroid hormone measurement to predict post-total thyroidectomy hypocalcaemia. Patients and methods: a prospective randomized study was conducted in the period between July 2015 and September 2017 in Ain Shams University, General Surgery Department, Endocrine Surgery Unit, Cairo, Egypt. The study was conducted on sixty patients for whom total thyroidectomy was done. Parathyroid hormone was measured pre-operative and 6 hours postoperative, and serum Ca was measured daily to predict hypocalcaemia. Patients were evaluated for symptoms of hypocalcaemia and treated with calcium and vitamin D supplementation as necessary. Results: the study included 60 patients, 12 males and 48 females with mean age 39.1+ 16.52 (20-65). Co morbid conditions included HTN, DM, ISHD and COPD. Most patients had nodular goiter (48 patients) whether unilateral or bilateral. 63.3% of patients had follicular lesion by FNABC. All patients underwent total thyroidectomy. Hypocalcemia developed in 16.7% (10 of 60) of the patients. Best cut off was 66% reduction giving 77% Sensitivity and 91.4% Specificity. Positive predictive value was 85% and negative predictive value was 94%. Conclusion: the evaluation of PTH and corrected calcium levels 6 hours after thyroidectomy allows for an accurate prediction of the trend of hypocalcemia. This study enables us to discharge most patients safely within 24 hours after total thyroidectomy.

Background & objectives: Gastric cancer accounts for over 10% of cancer-related deaths worldwide and remains the second most frequent cause of cancer death. While surgical resection is considered to be the most suitable treatment for early gastric cancer, it remains debatable for those patients with advanced disease, and adjuvant therapy is still considered the main line of management of these patients. Some studies reported that palliative gastrectomy may be beneficial for survival and improving the quality of life. In spite of that, many studies reported that survival after palliative gastrectomy was associated with significant morbidity and poor quality of life. Our study aims to evaluate the value of palliative gastrectomy with systemic chemotherapy in comparison with systemic chemotherapy alone in management of cases of advanced gastric cancer. Patients and methods: Between June 2013 and March 2017, patients with advanced gastric cancer (T4 N1-3 M0, T1-4 N3 M0, and any T or N with M1) were prospectively included in this study. Enrolled patients were assigned either to have palliative gastrectomy followed by systemic chemotherapy, or to have systemic chemotherapy alone. The patients were followed up regularly after treatment. Postoperative parameters, disease-specific mortality, mean survival & Kaplan-Meier survival analysis were used to assess the outcomes. Results:Twenty-nine patients completed the study. Sixteen patients in the surgery group & 13 in the systemic chemotherapy group were included. Partial gastrectomy was done in 7 cases and total gastrectomy was done in 9 cases. Six patients (37.5%) had postoperative complications & one case (6.3%) of postoperative mortality was recorded. The mean survival of patients of the surgery group was (11.2±1.8 months), which was significantly longer than that of the patients who received systemic chemotherapy alone (7.1±1.3 months). Kaplan-Meier survival analysis showed that the overall survival probability estimate in the surgery group was 32.6% at 1 year and 12.5% at 2 years, compared to 16.1% at 1 year and 0% at 2 years in the chemotherapy group, with difference being statistically significant. Conclusion: Palliative gastrectomy may be done in patients with advanced gastric cancer with acceptable morbidity and mortality rates. It may provide a survival benefit in selected cases of advanced gastric cancer when combined with systemic chemotherapy.

Background: Routine prophylactic central compartment neck dissection in patients with differentiated thyroid carcinoma is not always accepted as a standard management of occult metastasis due to the risk of hypocalcaemia and recurrent laryngeal nerve injury. Aim: To evaluate the accuracy of using sentinel lymph node biopsy as a guide in identifying occult cervical LN metastases early and thus to avoid the morbidity associated with routine unnecessary central lymph node dissection. Patients and methods: A prospective study was conducted in the period between April 2015 and January 2017 in Ain Shams University Hospitals, General Surgery Department, Endocrine Surgery Unit, Cairo, Egypt. The study included fifty two patients who had at least one suspicious thyroid nodule and not accompanied by clinical or radiological cervical LN. The patients underwent sentinel lymph node biopsy via intra-tumoral injection of methylene blue dye 1%, followed by tracking the lymphatics till the sentinel LN then total thyroidectomy and central LN dissection. Results: The study included 52 patients with suspicious thyroid nodule, 11 males and 41 females with mean age 41±6.7 (26-65). Co-morbid conditions included DM, HTN and ISHD. Size of nodules ranged from 0.8- 5.6 cm (1.9± 0.6) and most nodules were confined to one lobe (65.4%). After the final paraffin pathology 24 nodules were found to be benign and 28 proved malignant. SLNs were identified in 21 of 28 malignant cases (75%); number of sentinel LNs detected was 0-6 (2.8±1.9) and size ranged from 0.1- l.6 cm. 18 of identified SLN were positive for metastasis and 10 were negative while non SLN were positive in 15/28 and negative for 13/28. Thus, the sensitivity, specificity, negative predictive values, positive predictive values and accuracy of SLN biopsy were 85.7%, 100%, 70%, 100%, and 75%, respectively. Post-operative complications included temporary hypocalcaemia in 3 patients and extensive laryngeal edema in 1 patient needing prolonged intubation more than one day then recovered. Conclusion: SLN biopsy for patients with differentiated thyroid carcinoma and negative LNs clinically and radiologically is an accurate and noninvasive means to identify subclinical lymph node metastasis and so can be used as a guide to determine the need for zone 6 LN dissection.

Background & objectives: Although gastric cancer is one of the most common causes of cancer-related death, its prognosis remains poor. Surgical resection with lymph node dissection is the only potentially curative therapy for gastric cancer. However, the appropriate extent of lymph node dissection remains controversial. In East Asian countries, D2 lymph node dissection has been performed as a standard procedure. In western countries, D2 dissection was associated with higher mortality and morbidity with no 5-year survival benefit compared to D1 dissection. More recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on achieving survival benefits comparable to those of reported in eastern countries. The aim of our study is to evaluate the feasibility, safety and outcome of extended (D2) lymphadenectomy for gastric cancer. Patients and methods: Between July 2008 and June 2014, patients with gastric cancer in whom surgical resection was indicated, were prospectively included in this study. Enrolled patients underwent gastrectomy with D2 lymphadenectomy. The patients were followed up regularly after the operation. Postoperative parameters, disease-specific mortality & Kaplan- Meier survival analysis were used to assess the outcomes. Results: 62 patients were included in the study. 33 patients had distal gastrectomy and 29 patients had total gastrectomy. 9 (14.5%) patients had postoperative complications with 2 cases of postoperative mortality recorded. The overall mean survival time was 17.13 ±9.6 months and the disease free mean survival time was 13.4 ±9.39 months. Kaplan-Meier survival analysis showed that the overall survival probability estimate in the study was 100% at 1 year, 88.7% at 2 years, 58.1% at 3 years and 32.3% at 4 years. Nodal disease class & N stage were found to have a statistically significant effect on survival. Conclusion: D2 lymphadenectomy can be performed safely in well-equipped hospitals by experienced surgeons with acceptable morbidity & mortality. It can provide better survival for patients with gastric cancer and low degree of lymph node metastases (N1 or N0).

Background & objectives: Laparoscopic splenectomy had become the golden standard for elective splenectomy, as it is feasible, safe and provides many advantages to the patients in comparison to open splenectomy. However, a learning curve exists for mastering the procedure and defining will be helpful in designing a training program for laparoscopic splenectomy. Methods: 57 patients underwent elective laparoscopic splenectomy for different indications in our hospital between August 2011 and September 2013. Patients' data whether preoperative, operative or postoperative were collected, subdivided in 10 cases groups and certain outcome measures were statistically analyzed to identify the learning curve. Results: Laparoscopic splenectomy was done for all patients. The mean operative times in the 3rd, 4th, 5th and 6th groups were significantly shorter than the 1st and 2nd groups. There was a trend toward decreased blood loss in the latter groups (3rd, 4th, 5th and 61h), and the differences between them and the first two groups were statistically significant. There was a trend of high postoperative complications and conversion rate in the first group in relation to the other groups, but a statistically significant difference between groups couldn't be found. Similarly, there was a trend towards decreased period of ileus with the consecutive groups; but a statistically significant difference couldn t be shown. A statistically significant difference in hospital stay was found between the consecutive groups. The results showed that the outcome measures were seen to improve with the advancement of the experience with a plateau reached after 20-30 cases oflaparoscopic splenectomy. Conclusion: Laparoscopic splenectomy can be done safely by experienced laparoscopic surgeons. A learning curve for mastering the procedure is 20-30 cases, after which the outcome parameters nearly reaches a plateau.

Background & objectives: Laparoscopic colectomy had become a popular choice for treatment of cancer colon, as it is feasible, safe and provides many advantages to the patients in comparison to open colectomy However, the adoption of the technique as the routine treatment for patients with cancer colon is still a subject of clinical trials. Methods: 60 patients with cancer colon were randomly dividedinto 2 equal groups. Group A patients underwent open surgery, and group B patients had laparoscopic surgery.The results of both groups were compared and statistically analyzed to identify the advantage and limitations of the laparoscopic approach. Results: Laparoscopic colectomy was associated with longer operative times than open colectomy The outcomes of patients of the laparoscopic group was comparable {oncological results & recovery of bowel functions) or better (postoperative pain, wound complications and hospital stay) than the open group. Conclusions: Laparoscopic resection for cancer colon is safe, feasible and has better recovery and comparable oncological results than open colectomy More analysis is needed before implementation of the technique in routine practice and training.