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Background: Spleen is the most common intra-abdominal organ injury in blunt abdominal trauma. Splenectomy (open or laparoscopic) is the role in treatment of severe injuries of spleen or after failure of conservative treatment.Aim of the work: Compare the outcomes between open versus laparoscopic in high grade splenic injuries.Methods: This study includes 70 patients with various grades of splenic injuries in abdominal trauma. The patients were 15 years and older. They were categorized into two groups: open splenectomy group (35 patients) and laparoscopic splenectomy group (35 patients). The study was performed from January, 2012 to July 2017. Variables included demographics data, splenic injury graded by computerized tomography, duration of operation (in minutes), intra-operative blood loss (in ml), and intraoperative blood transfusion, length of hospital stay (in days), complications and mortality.Results: There was no significant difference or association between groups as regard age, sex and causes of splenic injury (p=0.374, 0.41, 0.38).Most cases were under 35 years old male patients exposed to motor car accidents. As regard intraoperative data, no statistically significant difference between both groups except for blood loss and transfusion that were statistically significant to the open group (p=0.039*).In the laparoscopic group, operational time was longer than open but no statistically significant (p=0.11).as regard conversion, we found that 14% of laparoscopic group (5 cases) had conversion. Most cases operated by laparoscopic approach were in grade III, IV with no cases tried in grade V (p=0.06). No statistically significant difference between both groups as regard postoperative variables except Pain (p=0.0003), and hospital stay(p=0.00) that were significantly longer among open group.The immediate postoperative complications showed that Wound infection, Missed injuries, pancreatic fistula and ileus were significantly higher among open group (p=0.00, 0.006, 0.02, 0.0004).The delayed postoperative complications where Incisional hernia (p=0.001) and Adhesive intestinal obstruction (p=0.00) were significantly associated with open group.Conclusion: In high-grade splenic injuries patients, this study found that laparoscopic splenectomy is safe.

Introduction: Cancer rectum and sigmoid is increasing nowadays. Resection is done by open and laparoscopic approaches. Laparoscopic approach is not available in many sites worldwide. Aim of this study: To analyze the outcomes of open side to end (antegrade) colorectal single stapling anastomosis versus open end to end (retrograde) Trans-anal colorectal stapling anastomosis in non-emergent sigmoid and rectal cancers open surgery in adults.Patients and Methods: Randomized controlled trial was performed on patients with sigmoid and rectal cancers between September 2016 and September 2018. Results: The majority of studied group were between 50-70 years with mean of 62.58±12.3 years and 61.03±13.98 years in group A and group B respectively. Intraoperative data showed no significant difference was founded between studied group except at operative time and mean anastomotic time as group A was significantly shorter. Univariate analysis showed that perioperative blood loss, length of stay, reoperation, inpatient death, infection and bleeding were significantly associated with leakage. Multivariate analysis of anastomotic leak showed that infection is the only independent predictors for anastomotic leak. There is statistically significant change as regard range of bowel frequency in end to end group only (p=0.04) and there is statistically significant difference as regard incontinence for Flatus in side to end group only (p=0.00) .There is statistically significant change in both group regard Incontinence for liquid stools(p=0.00) and Clustering of stool(p=0.00 and p=0.043).The quality of life in Antegrade group significantly drop at 6 months and return to baseline after that as regard PWB, FWB and CCS with no difference as regard SWB & EWB while in retrograde group, the same change happened only as regard PWB & FWB but SWB and CCS percentage didn’t return to baselineConclusion: The side-to-end anastomoses approach is a safe approach of anastomosis and may be used as alternative to retrograde approach.

Background:The numbers of elderly persons have greatly increased worldwide due to improvement of medical health. Elderly complains of cardiopulmonary diseases and the incidence of emergent gall bladder diseases increase with age. Laparoscopic cholecystectomy is the usual approach in dealing with cholithiasis that greatly replace open approach even in acute emergency gall bladder diseases.Aim: compare between initial Fundus first cholecystectomy followed by Calot dissection VS Calot first cholecystectomy in Emergency laparoscopic cholecystectomy with low pressure pneumo-peritoneum in cardiopulmonary risk patients as regard intraoperative data and postoperative complications.Patients and methods:This prospective randomized controlled study was carried out in the Department of Emergency General Surgery on 470 cases with acute cholecystitis, biliary colic, mucocele and pyocele of gall bladder. The patients were divided into two groups, Group A: fundus-Calot group (235cases) and Group B (235cases): classical Calot first approach.ResultsIn most cases of group A, the operating time was up to 90 minutes, while in group B, most cases were more than 90 minutes. Intraoperative bleeding, visceral injury and biliary injury were higher in group B than in group A and therefore the conversion was higher in group B than in group A (14% vs. 4%). Postoperative sequelae were reported to be greater than in group B in regard to bleeding, biliary leakage and wound infections. Remote complications were more pronounced for biliary restrictions in Group B (14%) than in Group A (2%)Conclusion:Laparoscopic low-pressure pneumoperitoneum cholecystectomy with initial Fundus first method is an excellent and safe approach in treating acute gallbladder diseases in cardiopulmonary risk patients.

Introduction : cholecystectomy is the standard surgical option of symptomatic gallbladder disease. The symptoms persist after cholecystectomy in 10 - 20% of cases. Residual gall bladder/cystic duct stump stone is one of the most important cause. Aim : to compare between open and laparoscopic completion cholecystectomy for gall bladder (GB) remnant and cystic duct stump stones as regard short and long term outcome.Methods : This study was conducted on 84 cases with residual GB/cystic duct stump stone that were divided into 2 groups, the open completion cholecystectomy group and the laparoscopic completion cholecystectomy group. The diagnosis was made by ultrasound and magnetic resonance cholangio-pancreatography.Results : The mean operative time was 120±13 minutes in open group and 160±10 in laparoscopic group. Blood loss occurred in 8 cases in open group and 2 cases in laparoscopic group that necessitated blood transfusion. Biliary injuries detected intraoperative occurred in 3 cases with open approach and 2 cases with laparoscopic approach and suture immediately by vicryl 3/0. The mean hospital stay was shorter in laparoscopic group than open group. .Conclusion : laparoscopic Completion cholecystectomy is a safe surgical approach for cystic duct stump stone.Research question: is laparoscopic completion cholecystectomy is safe in managing gall bladder and cystic duct stump stones?Hypothesis: laparoscopic completion cholecystectomy is safe in managing gall bladder and cystic duct stump stones.All ethical approval was given by our local Faculty of Medicine ethical committee.Registration at clinicaltrials.gov protocol registration quality control review criteria: NCT04329143 registered in 31 March 2020.retrospective registeredThe work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.