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BACKGROUND: Colorectal cancer (CRC) is the most common malignant tumor of the gastrointestinal tract with unfavorable prognosis. Therefore, novel biomarkers that may be used for new diagnostic strategies and drug-targeting therapy should be developed. OBJECTIVES: To investigate the expression of miR-29b in CRC and its association with ETV4 and cyclin D1 expression. Moreover, the current work aims to investigate the association between them and the clinicopathological features of CRC. METHODS: The expression of miR-29b and ETV4 (by qRT-PCR) and ETV4 and cyclin D1 (immunohistochemistry) was investigated in 65 cases of colon cancer and surrounding healthy tissues. RESULTS: MiR-29b down-regulated and ETV4 and Cyclin D1 up-regulated significantly in colon cancer tissues compared to normal nearby colonic tissues. In addition, significant associations between ETV4 and cyclin D1 expressions and progressive stage and lymph node (LN) metastasis (P< 0.001 for each) were found. Furthermore, there was a negative correlation between miR-29b gene expression and ETV4 gene expression (r=-0.298, P

Background This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh. Methods Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck's first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study. Results The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level Conclusion Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117.

Introduction ingrown toenail is commonly met in clinical practice especially in adolescent. However, there are few literatures on managing this problem regarding the change of biomechanics of toe. The aim of this study was to determine the effect of central resection of toenail on changing toe biomechanics in dealing with ingrown toenail as regard easy technique, rapid resolution of the problem, post-technique pain and recurrence rate. Aim To compare between central toenail resection with ordinary lateral wedge toenail resection in managing ingrown toenail as regard technique duration (in minutes), postoperative pain (according to visual analogue scale of pain) and postoperative recurrence rate. Method One hundred Patients in a representative sample from January 2017 to January 2018 who had ingrown toenail. These patients were divided into 2 groups: group (A): underwent central toenail resection and group (B): underwent wedge toenail resection at the side of the affected toe. Treatment was prescribed and outcome at one month, two month and six months after management were analyzed. Result in group (A): There was a significant shorter operative time, shorter hospital stay, better postoperative outcome as regard pain and no recurrence, after 6 month follow up period. Conclusion Ingrown toenail is best be treated by central nail resection as it is simple surgical technique with no significant complications.

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.

Background: Cyclooxygenase (COX) is a rate limiting enzyme in synthesis of prostanoids pathway and it has 2 isoforms (COX-1 and COX-2). It has many biological roles in inflammation and oncogenesis. Cox-2 was incriminated in performing disturbances in the cell cycle control in CRC, but its role of in CRC needs clarification of the mechanisms by which Cox-2 might affect the process of colorectal carcinogenesis. Cyclin D1 is an oncogene that regulates G1 phase progression to S phase of the cell cycle. Its stimulatory role on cell cycle is antagonized by Cyclin D1-dependent kinase (CDK) inhibitors like p21. P21 plays an essential role in cell cycle regulation; it may have a pro-apoptotic or an antiapoptotic role in cancer. P21 was found to have many roles in cancer; invasion metastases, cellular senescence and stem cells aging. The roles of combined expression of Cox-2, Cyclin D1 and P21 in CRC tissues and their role of prognosis and patients survival are not sufficiently clarified. Aim of the Study: To evaluate tissue expression of Cox-2, Cyclin D1 and P21 in CRC and to correlate such expression with pathological parameters, clinical and prognostic data of the patients. Methods: Cox-2, Cyclin D1 and P21 are evaluated in colon cancer tissues. Correlations between their level of expressions pathological parameters, clinical and prognostic data of patients were analyzed. Results: Cox-2, Cyclin D1 over-expression was associated with higher grade, higher incidence of occurrence of lymph node & distant metastasis and advanced stage (P = 0.000). Cox-2 was related to higher tumor recurrence rate (P = 0.04) and decreased overall patients survival rate (p = 0.002). (r correlation coefficient = +0.987). Conclusion: Cox-2 and Cyclin D1 are markers of poor prognosis colon cancer patients.

Background As 70–90% of patients with carcinomas of the head of the pancreas and ampullary region have jaundice at presentation and going to have gastric outlet obstruction, palliation that ensures biliary and gastric drainage represents a large proportion of the hepatobiliary surgeon’s workload. As barely 20% of patients with pancreatic cancer are suitable for curative resection, good palliative therapy is extremely important. Aim of the work To compare the effectiveness of palliation between patients with advanced head of pancreas cancer who underwent surgical bypass and those who underwent dual stenting and morbidity and mortality rates of both procedures. Patients and methods This prospective study was conducted between April 2015 and April 2017. Only 38 patients were eligible for this study. Follow-up was at 1, 3, and 6 months after each procedure. Evaluation of patients regarding efficacy and feasibility, morbidity, mortality, hospital stay, ICU admission, readmission rate, and survival was done. Results We identified 38 patients, of whom 19 underwent endoscopic stenting and 19 underwent a surgical bypass either by choledechojejunostomy or cholecystojejunostomy-en-Y with gastrojejunostomy. There were no significant differences in complications or mortality rates; however, all results were in favor of dual stenting, owing to short procedure time, hospital stay, ICU admission, and survival rates being better than surgical bypass, although without significance. Conclusion Dual stenting was found to be more feasible and efficient in palliation of advanced head of pancreas cancer with short procedure time and short hospital stay and less morbidity and mortality and ICU admission with higher cost in comparison with surgical bypass. Surgical bypass is mandatory in patient with gastric outlet obstruction or failed Endoscopic Retrograde Cholangiopancreatography (ERCP) trial due to huge mass obstructing the duodenum.