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Background An innovative therapy for symptomatic hemorrhoids has been recently proposed it relies on the reduction of hemorrhoidal vascular flow by suturing hemorrhoidal arteries, which are previously located by means of an ultrasound transducer. Objective To evaluate retrospectively the outcome of Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Patients and Methods Aretrospective study. The study conducted in Ain Shams University Hosptial (El Demerdash) under supervision of these supervisors. Study period: Six months. Results In our series, the HAL technique has achieved complete control of symptoms in 93.3% of patients after six-monthes follow-up. Conclusion Hemorrhoid ligation with mucopexy is a simple, safe and cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. It can be performed on an outpatient or day care basis on all grades of hemorrhoids to control bleeding and prolapsing hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.

Background Emergence agitation (EA) in children early after sevoflurane anaesthesia is a common postoperative problem, with incidence ranging up to 80%, It is characterized by behavior that can include crying, disorientation, excitation and delirium, several drugs have been tried in this regard including but not limited to propofol, midazolam, ketamine and ketorolac among other drugs. Aim of the Work To compare the effect of intravenous Midazolam vs intravenous Haloperidol & in prevention of Sevoflurane Emergence Agitation in pediatric patients undergoing Inguinal Surgeries. Patients and Methods This prospective randomized study was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include sixty-two pediatric patients, aged 3 to 12 years of both genders, with physical status ASA Ι and ASA ІІ. All surgical procedures were elective of an expected duration of 30 - 60 minutes e.g. inguinal hernia repair, hydrocele, orcheopexy under general anesthesia and caudal block to relief pain. All operations were performed in supine position. Results Our study was applied on age group between 3- 12 years old Haloperidol was associated with 24% EA and was also associated with significant delay in eye opening and time till discharge from PACU when compared to Midazolam. Conclusion I.V Midazolam is more efficient than I.V Haloperidol for prevention of Sevoflurane Emergence agitation in pediatric patients undergoing inguinal surgeries.

Background Anal fistula is abnormal communication between the anal canal and the perianal skin or perineum or buttocks. Anal fistula is almost always a consequence of an anorectal abscess that was drained. While the abscess represents the acute phase of the disease, fistula represents the chronic phase as the fistulous pathway may persist in about 1/3 of cases. Aim of the Work In this study we will perform fistulotomy with primary sphincter repair in high cryptoglandular fistula with assessment of recurrence rate, incontinence rate and patient satisfaction according to pain score, wound healing, discharge and return to daily activity parameters. Methods This was prospective cohort study on 30 patients of high peri-anal fistulae and fistulotomy and reconstruction (primary suture repair) of anal sphincter was done., the patients were followed up 6 months postoperatively regarding their continence using Wexner score, recurrence, discharge and their return to work by scheduled outpatient clinical examination. Results Among 30 patients only three patients complaining usual incontinence mostly as post defecation soiling. Three patients reported anal fistula recurrence: One occurred at the 5th month, while the other two occurred at the 6th month after surgery. The procedure was well tolerated by the patients as most of them complaining only minimal pain and returned to work after two weeks without need of other stage like other procedures. Conclusion Fistulotomy with primary sphincter repair is an effective therapeutic option for patients with high anal fistula. Our study demonstrated that immediate reconstruction of the sphincters after fistulotomy achieved high success rates and low risk of postoperative fecal incontinence, compared to reported rates after simple fistulotomy.

Background Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for earlystage breast cancers. Objectives The aim of this work is to evaluate the Effectiveness of Ultrasound Guided Pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in Modified Radical Mastectomy Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University This study was conducted in the operating theatres of Ain Shams University Hospitals. It included Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 15 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PEC 1 block.

Background Colon and rectal cancer represent the fourth commonest malignancy worldwide. Globally, colon and rectal cancer make up 9.4% and 10.1% in men and women of all cancers, respectively. Colon and rectal tumors are the third most common malignancy after breast and lung cancer, respectively. The main management of rectal cancer involves a multi-disciplinary team approach and an individually tailored treatment routine. Operative surgery remains the primary and definitive treatment for locally confined rectal adenocarcinoma and is the only historical and current treatment which allows for cure. Resection of the colon and rectal cancer can be done either by open surgical excision or laparoscopically. Aim of the work The objective is to compare the radicality of total mesorectal excision for rectal cancer in both open and laparoscopic surgery through the pathology report. Methods In this multicentric, prospective, comparative study, we included the pathologically established rectal cancer patients from 2 hospitals in Cairo, Egypt, Ain Shams University Hospitals and Maadi Military Hospital, Egypt between 2013 and 2016. The sample size was 40 patients divided into two groups; 20 patients for laparoscopic arm and 20 patients for the open trans-abdominal surgery. Inclusion criteria: histopathology confirmed rectal cancer, patients fit for operative resection, and with T1- T3 grades according to the preoperative evaluation. The exclusion criteria: Patients with T4 stage tumor, patients present as emergency cases and patients present with recurrence of the tumor and synchronous colonic tumors. Results The circumferential resection margins (CRM) of the mesorectum when examined pathologically after resection showed no difference between the two arms of the study with laparoscopic group specimens 3.18±1.16 mm mean, (SD) compared to 3.50±0.45 mm mean, (SD) in the open surgery group with no statistically significant difference. The longitudinal resection margins (LRM) was (5.50±1.98 mean, SD) in the laparoscopic group compared to (5.20±2.28 mean, SD) in the open conventional surgery group with no significant difference found between the two groups. Total operative time was significantly shorter in the trans-abdominal surgery group, while the hospital stay period was significantly shorter in the laparoscopy group. Laparoscopy group also showed significantly time before flatus passage, and the patients in the laparoscopy group started oral intake faster than open surgery group. Conclusion In our study, the radicality of the rectal cancer excision in both laparoscopic and traditional open surgery, showed non inferiority of the laparoscopic technique over open surgery Long-term clinical outcomes of overall survival and recurrence is the foremost parameters which should be taken in consideration for decision for laparoscopic surgery for rectal cancer. Additional follow-up results from the current trial are presently being developed, beside with records on other secondary end points, like cost effectiveness and quality of life.