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Coronary artery ectasia (CAE) often presents in the form of an acute coronary syndrome (ACS) caused by slow blood flow leading to thrombus formation in ectatic coronary arteries. The usual approach is thrombectomy with intracoronary thrombolysis but often does not guarantee immediate blood flow. A 45-year-old male presented with anginal chest pain and was diagnosed with ST-segment elevation myocardial infarction (STEMI), managed Immediately with tissue plasminogen activator(t-PA) followed later with coronary angiography revealing diffused Multiple coronary ectasia MCEA with no identified culprit lesions afterward. The patient was followed up periodically, with favorable outcomes on daily aspirin, direct oral anticoagulant (DOAC), and guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) and reduced ejection fraction heart failure (HF-rEF). This case management strategy was dictated by available resources at the time of presentation; however, it signifies the importance and favorable outcome of thrombolysis in CEA/STEMI patients. Future large-scale studies are required toward defining the duration as well as the choice of long-term anticoagulation.

Background Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. Methods A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. Results The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Conclusion Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure, yet can be followed by complications such as staple line leak and bleeding, vomiting, and gastroesophageal reflux disease (GERD). Various attempts have been described in the literature to improve the early outcome of LSG through various measures. This study aimed to assess the impact of adding T-shaped omentoplasty to LSG on the short-term outcome of the procedure. This was a retrospective cohort study on patients with morbid obesity who underwent LSG in the period of November 2015 to November 2018. The outcome of patients with morbid obesity who underwent LSG combined with T-shaped omentoplasty (group I) was compared with that of a similar number of patients who underwent classical LSG without staple line fixation (group II). The main outcome measures were the rates of staple line bleeding and leak, postoperative nausea and vomiting (PONV), GERD, gastric axial rotation, other complications, and weight loss. The study included 106 patients of a mean BMI of 49.8 kg/m2. Group II had significantly higher PONV) scale at 1 week and 1 month than group I. Group I had significantly lower rates of staple line bleeding (0 vs 9.6%, p = 0.02) and GERD (3.7% vs 17.3%, p = 0.02) than group II. Both groups had similar rates of staple line leak and comparable operation time. Staple line fixation using the T-shaped omentoplasty technique was associated with lower incidence of significant PONV, staple line bleeding, and GERD as compared with classical LSG.

Background: The most common cause of hyperthyroidism and the most common autoimmune disorder in Toxic goiter is Grave's disease. Antithyroid medications, radioiodine therapy, and surgery have all been employed in the treatment of this disease. Nevertheless, thyroidectomy remains an important option for correcting hyperthyroidism. Objective: The aim of the study was to compare both total and Near total thyroidectomy as regard “Outcome, Complications and Curability“ in patients with controlled Toxic Goiter. Patients and Methods: This prospective randomized controlled study included a total of 84 patients with toxic goiter, attending at Endocrine Surgery Unit, General Surgery Department, Mansoura University Hospitals. This study was conducted between February 2018 and January 2019. The included subjects were randomly divided into two groups; Group 1 (TT) consisted of 42 patients underwent total thyroidectomy, Group 2 (NTT) consisted of 42 patients underwent near total thyroidectomy. Results: Compared to Near total thyroidectomy, total thyroidectomy gave better results regarding the recurrence of toxic manifestations which occurred in 7% of cases 1 year later. Conclusion: It could be concluded that total thyroidectomy (TT) gives good results in management of patients with toxic goiter compared to near total thyroidectomy (NTT). Total thyroidectomy (TT) is advised to be done in patients with toxic goiter due to less liability for postoperative recurrence, provided to be done by experienced endocrine surgeon in a qualified center.

Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ different mechanisms of action to induce weight loss. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and roux-en-Y gastric bypass RYGB with long biliopancreatic limb (BPL) in terms of weight loss, remission of comorbidities, complications, and nutritional status. This was a single-center cohort study on patients with morbid obesity who underwent RYGB with long BPL of 150 cm or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 12 months, nutritional status, and complications. The present study included 92 patients (59.8% females) of a mean age of 38.4 years and mean BMI of 42 kg/m2. RYGB and SASI bypass were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar. The serum albumin levels showed a significant decline after RYGB, but not after SASI bypass. The postoperative serum iron levels were higher after SASI bypass than after RYGB. There was no significant difference in regard to complication rates (13% vs 4.3%, p = 0.27). RYGB with long BPL and SASI bypass achieved satisfactory weight loss and improvement in comorbidities that were comparable among the two groups. Long BPL RYGB was followed by a significant decrease in serum albumin and iron levels at one year, which was not observed after SASI bypass.

Obesity and diabetes comprise a great health epidemic, involving millions of people that may not be corrected by healthy diet and exercise. Metabolic surgery represents the new hope to control both diseases. More than 50 implemented surgical operations have been developed to fight obesity and metabolic syndrome. However, unfortunately, up to 10–50% of patients that undergo restrictive bariatric procedure such as sleeve gastrectomy (SG) will suffer from inadequate weight loss or weight regain and will require a secondary bariatric surgical rescue operation. This chapter addresses rationale for a revisional bariatric surgical procedure following SG, available options, and how to choose the procedure, focusing on Single Anastomosis Sleeve Ileal (SASI) Bypass; its role in weight reduction and type 2 diabetes mellitus (T2DM) remission, technique, clinical outcomes, and perioperative morbidity. The SASI bypass is an effective, safe, of low and minor complication rate bariatric and metabolic surgical procedure that can be added to suboptimal or failed SG to fight weight recidivism with remarkable improvement in obesity-related comorbidities, namely T2DM and gastroesophageal reflux disease.

Bariatric surgery is the most effective treatment for morbid obesity. The present study aimed to assess three bariatric procedures with different mechanisms of actions; sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and single anastomosis sleeve ileal (SASI) bypass, in terms of efficacy and safety. This was a retrospective cohort study on patients with morbid obesity who underwent SG, OAGB, or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 6 and 12 months postoperatively, and complications. A total of 264 patients (186 female) with mean preoperative body mass index (BMI) of 43.6 ± 9.9 kg/m2were included to the study. Significant weight loss was recorded at 6 and 12 months after the three procedures. At 6 and 12 months postoperatively, body weight and BMI were significantly lower after SASI bypass than after SG and OAGB. The %total weight loss (%TWL) and %excess weight loss (%EWL) were significantly higher after SASI bypass than after SG and OAGB. SASI bypass was associated with a significantly higher rate of improvement in DM than SG and OAGB (97.7% vs 71.4% vs 86.7%; p = 0.04) whereas improvement in other comorbidities was similar. The short-term complication rate was similar between the three procedures, yet SASI bypass was followed by higher long-term complication rate. Based on retrospective review of data, SASI bypass was associated with more reduction in body weight and BMI, higher %TWL and %EWL, better improvement in T2DM, and more long-term nutritional complications than SG and OAGB.

Introduction: The detection of the multicentericity of thyroid cancer is essential to provide the appropriate surgical decision for the patients aiming to decrease the rate of redo surgery and recurrence Methods: A cohort study was conducted at the surgical unit of the oncology center, Mansoura university on fifty patients with well-differentiated thyroid cancer, all of them underwent total thyroidectomy then entire gland dissection technique for histopathological examination. Results: Preoperative radiology revealed unicentric suspicious nodules in 40 cases (80%) and no suspicious nodules in 10 cases (20%). Among the ten patients those showed no suspicious nodules radiologically, multicentricity was confirmed in 5 patients (50%) pathologically, and unicentric tumors was seen in 5 patients (50%). FNAC was done in the 40 mentioned cases and was diagnostic for them as papillary thyroid carcinoma. Among many variants of prediction during searching for the true incidence of multicentricity, only isthmic invasion and, the extra thyroid extension were the significant variants. Conclusion: Among many variants of prediction during searching for the true incidence of multicentricity, only isthmic invasion and, the extra thyroid extension were the significant variants.

Based on the promising results of transversus abdominis plane (TAP) block in various abdominal procedures, this study aimed to investigate its effect on postoperative pain and early outcome after laparoscopic bariatric procedures. Patients with morbid obesity were randomly assigned to one of two equal groups; group I had US-guided TAP block upon completion of the bariatric procedure and before recovery from general anesthesia and group II did not have TAP block. All procedures were performed laparoscopically with a standardized five-trocar technique. Ninety-two patients of a mean age of 34.7 years and mean BMI of 49.5 kg/m2 were included. The mean pain score in group I was significantly lower than group II at 1 and 6 h postoperatively, whereas no significant differences in pains scores at 12 and 24 h between the two groups were observed. Eight patients in group I required rescue opioid analgesia within the first 24 h postoperatively, compared with 24 patients in group II (P

The Mini-gastric bypass (MGB) has resulted in significant weight loss and resolution of type 2 diabetes (T2D). The current indication for bariatric surgery is mainly for patients with BMI >35 with co-morbidities. However, success is being reported with MGB for T2D with BMI

Background The use of synthetic mesh for ventral hernia repair under contaminated conditions is a controversial issue due to the considerable risk of surgical site infection (SSI). This study aimed to review the outcomes of repair of incarcerated and strangulated ventral hernias with or without synthetic mesh in compliance with established clinical guidelines regarding the incidence of SSI and hernia recurrence. Methods The records of patients with complicated ventral hernias who were treated with or without synthetic mesh repair were reviewed. Variables collected included the characteristics of patients and of ventral hernias, type of repair, and incidence of SSI and recurrence. Results One hundred twenty-two patients (56 males) of a mean age of 56 years were included. Fifty-two (42.6%) and 70 (57.4%) patients presented with incarcerated and strangulated ventral hernias, respectively. Sixty-six (54%) patients were treated with on-lay mesh repair, and 56 (46%) were managed with suture repair. Twenty-one patients required bowel resection. SSI was detected in eight (6.5%) patients. There was no significant difference between both groups regarding the incidence of SSI (7.5% for mesh group vs 5.3% for suture group). Recurrence occurred in seven patients. Median follow-up period was 24 months. The suture repair group had a significantly higher incidence of recurrence than the mesh group. Diabetes mellitus, previous recurrence, and intestinal resection were significant predictors for SSI. Conclusion Following established guidelines, synthetic mesh repair of incarcerated and strangulated ventral hernias attained lower recurrence rate, comparable incidence of SSI, and higher rate of seroma formation than suture repair. Trial registration Research Registry, researchregistry1891