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Introduction: Hematuria has a prevalence rate of 2% to 31% in the population and is therefore a common reason for imaging of the urinary tract. Hematuria has many causes ranging from urinary tract infections to carcinoma. Imaging plays a major role in the investigation of hematuria frequently determining the underlying cause and influencing management. Computed tomography (CT) is increasingly valuable tool for assessing the urinary tract in adults and children. However, its imaging capabilities, while overlapping in some respects, should be considered as complementary, as each technique offers specific advantages and disadvantages both in actual inherent qualities of the technique and in specific patients and with a specific diagnostic question. The use of CT should therefore be tailored to the patient and the clinical question. Aim of the work: Evaluation of CT as imaging techniques for assessment and diagnosis of causes of hematuria and to study the CT features of various etiologies causing it. Patients and Methods: A prospective observational study included 42 cases have hematuria (gross & microscopic) were examined using MDCT. They are presented to the outpatient clinic of the urology and radiology department at Sohag university hospital between September 2015 and September 2018. A written consent was taken from the patients included in the study. An approval was taken from the scientific ethical committee before starting in the protocol of this study. Results: All causes of hematuria of urologic origin were almost covered using multidetector CT that was very conclusive compared to the previous traditional examinations that the patient had. These images have met good acceptance by the referring urologist that was comparable to endoscopic and surgical results, proving that MDCT can give accurate evaluation for hematuria instead of performing multiple traditional studies that may expose the patient to frequent contrast material & to frequent radiation exposure. We recommend CT as an initial investigation of hematuria and appropriate protocol should be tailored for each patient. Conclusion: CT can diagnose wide spectrum of diseases associated with hematuria with good accuracy and considered the initial and comprehensive imaging modality for evaluation of hematuria.

Background:Hematuria has a wide prevalence rate in the population so it is a common reason for imaging of the urinary tract. Hematuria has many causes from urinary tract infections to malignancy. Imaging has a major role in the investigation of hematuria for determining the underlying cause and influencing management. Computed tomography (CT) and magnetic resonance imaging (MRI) is increasingly valuable tools for assessing the urinary tract in adults and children. However, their imaging capabilities, while overlapping in some respects, should be considered as complementary, as each technique offers specific advantages and disadvantages both in actual inherent qualities of the technique and in specific patients and with a specific diagnostic question. Use of CT and MRI should therefore be tailored according to the patient conditions and the clinical question. The present review aim toclarify role of CT and MRI for assessment and diagnosis of causes of hematuria and to study the CT and MRI features of various etiologies causing hematuria.

Highlights • The diagnosis and management of cases with acute biliary pancreatitis. • Minimally invasive techniques gave encouraging results with minimal complications. • Cholecystectomy is recommended to prevent the recurrence of acute gallstone induced pancreatitis., Background Acute pancreatitis (AP) is considered one of the most common gastrointestinal disorders; the annual worldwide incidence for AP is 4.9–73.4 cases / 100,000 people and the total mortality rate is 4–8%, increasing to 33% in patients with infected necrosis. This study aims to assess the outcome of providing standardized evidence-based care to patients with acute biliary pancreatitis. Methods Thirty patients diagnosed with acute biliary pancreatitis, were enrolled in this study and managed according to the Japanese guidelines, 2015 with a complementary scope on other recent guidelines. Results Out of 30 patients in the study, 60% were females. Twenty-five cases were presented in the early phase of the disease while the rest presented in the late phase. Gallstones were the commonest cause (80%). The complications encountered were a systemic complication in one case, organ failure in three cases, and the local complications in the form of fluid collections in (43.3%) of cases.Out of 30 patients, 6 patients had an intervention. The main approach was minimally invasive techniques (4 cases), Open approach was performed in 2 cases. The total mortality rate was 10%. Most mild cases were discharged within one week from admission. Cases readmitted with recurrent attacks of acute pancreatitis were 3 cases, one male and 2 females. Conclusion By applying guidelines in the management of acute biliary pancreatitis, we can reduce disease-related morbidity and mortality. Besides, we can reduce the costs of medical services with the proper investment of healthcare resources.

Background: Lymphedema is emotionally frustratingdisease due to its progressive course and no definite curativemethods of treatment, it was found that lymphedema resultsfrom local and/or systemic failure of the lymphatic transportsystem, and according to its cause and onset of lymphedemait is classified into primary and secondary lymphedema.Treatment methods of scrotal lymphedema and reconstructionwere limited in the literature to lymphangioplasty or directexcision of the involved tissue and local tissue reconstruction.The current study present patients with established scrotallymphedema and the way of surgical management in excisionand reconstruction.Patients and Methods: Ten male patients were involvedin the study, their age was ranging between 25-60 years, threepatients were primary lymphedema, seven patients weresecondary lymphedema.Results: Patients in the study were followed-up postoperativelyfor a minimum 6-month period, it was found that aclear improvement of the aspect of the external genitalia andsubsequent improvement of ambulation, hygiene, and abilityto void in the standing position occurred for all patients.Conclusion: The procedure is effective giving good resultswith no major complications were recorded, the techniquebased on anatomical background that is why recurrence wasnot recorded.

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 Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive. Aim of the work to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes. Patients and methods Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months. Results There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups. Conclusion Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.

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.

Background: When results of the FNA are reported as indeterminate, a hemi- or total thyroidectomy may be performed, depending on the suspicion of cancer. Objective: This work was designed is to compare the incidence of complications and surgical outcome of total and completion thyroidectomy in management of suspected thyroid carcinoma Patients and methods: The study included 50 patients with STN and results of the FNA are reported as (indeterminate or a follicular lesion). They divided into 2 groups. (Group I) include 20 patients (40%) were subjected to Completion thyroidectomy and (Group II) include 30 patients (60 %) were subjected to total thyroidectomy. All cases were operated upon in the department of General Surgery department, Zagazig University Hospitals during the period of the research from May 2010 to July 2013.Statistical analysis: SPSS version 19.Results: In the present study there was 38 (76%) were males and 12 (24%) were female and the pathology of residual tissue in (Group I) showed 8 case (40%) had residual malignancy and 12 cases (60.0%) are free from malignancy. From this study the hospital stay in (Group I) ranges from 5 to 8 days with The mean stay was ( 5.9 ± 1.0 days ) which is longer than (group II) ranges from 3 to 5 days with The mean stay was(3.7 ± 0.75 days).From this study the development of hypoparathyroidism was greater in (Group I) (20%) than (group II) (10%) and recurrent laryngeal nerve injury was greater in (Group I) (4%) than (Group II) (2%).Conclusion: The frequency of complications was greater in (Group I) than (Group II) so total thyroidectomy is considered as the treatment of choice for both malignant and benign thyroid disease requiring surgical treatment when performed by experienced surgeons Moreover, it eliminates the requirement of completion thyroidectomy for incidentally diagnosed thyroid carcinoma.

Purpose To establish the feasibility, complications, and outcome of different time intervals between endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) in the management of choledocholithiasis. Patients and methods This study was carried out on 60 patients who were randomized by systematic randomization into three equal groups according to the interval between ERCP and LC defined as short (3 days or less), medium (4–60 days), or long (60 days or more). All patients have undergone ERCP with sphincterotomy followed by elective LC. Patients’ age, sex, history of previous acute cholecystitis, acute pancreatitis and jaundice, abdominal ultrasonography findings, serum bilirubin, alkaline phosphatase, gamma-glutamyl transferase levels, ERCP findings, time interval between ERCP and LC, conversion rate, median operative time, intraoperative complications, hospital stay, and postoperative complication rates were collected. Results There was no statistically significant difference between the demographics of the patients, the preoperative history, laboratory data or ultrasonographic findings in the three groups. The density of encountered adhesions intraoperatively, median operation time, and median postoperative hospital stay in groups 2 and 3 were significantly higher than those of group 1. Other intraoperative and postoperative complications or conversion showed no statistically significant difference. Conclusion Early cholecystectomy after ERCP within 72 h has better outcomes, probably due to less inflammatory processes following ERCP than in groups II and III.

Background and aims Anorectal fistula is one of the most common problematic anal conditions in daily surgical practice. Many treatment modalities are used. This study evaluates the ligation of intersphincteric fistula tract procedure on the basis of its postoperative outcomes. Patients and methods This study was carried out on 25 patients. Participants of either sex diagnosed with anal fistula (transsphincteric fistula, either high or low) were included in the study between April 2016 and May 2018. Patients with recurrent fistulas, Crohn’s disease, and anal or distal rectal cancers were excluded from the study. Results The mean age group of the study participants was 36.6±8.34. The sex distribution showed a higher number of men (n=17) compared with women (n=8). The mean operative time was 35.46±3.6 min and the mean healing time was 6 weeks. Anal incontinence was not observed (0%). A total of two (8%) participants developed recurrence. Conclusion The Ligation of intersphincteric fistula tract procedure is an effective and sphincter-preserving technique for fistula-in-ano with a shorter healing time and a lower incidence of recurrence.