Abstract: Background: Papillary thyroid cancer (PTC) is one of the most common cancers worldwide and is considered to be the most common endocrinal malignancy with a higher increase in its incidence every year. This rapid continuous increase in the incidence of thyroid cancer is suggested to be as a result of many factors as the newly developed and used radiological studies which can detect subclinical cases not discovered by physical examination.

Abstract: Patient and methods: It is a prospective observational study which was held in Menoufia University, general surgery department between September 2018 and October 2021. Eighty obese patients with their body mass index (BMI) between 35kg/m2 and 60 kg/m2, and their age ranging between 18 and 65 years were included. All of them underwent laparoscopic sleeve ileal bypass SASI bypass. We studied the impact of SASI bypass on weight loss and metabolic comorbidities.

Abstract: Objective: Diagnosis of lower limb lymphedema depends on clinical signs in most health organization. One of the recent investigational tools for lymphedema diagnosis is near infrared fluoroscopy lymphangiogram. The aim of our study was to evaluate the accuracy of clinical signs in lymphedema diagnosis in comparison to fluoroscopic lymphangiography. Also, to know the value of immediate and delayed lymphangiography in clinically diagnosed lymphedema patients. Patients and methods: Prospective Cohort study of 44 patients with 73 lower limbs swelling. All patients assessed by history, clinical examination. Body mass index has been measured. Immediate and delayed findings (After 24 hours) of near infrared lymphography of subcutaneous injection of Indocyanine Green has been documented. Results: The sensitivity and specificity of clinical signs in predicting fluoroscopic -confirmed lymphedema were 77% and 58% respectively. The overall accuracy was 69 %. Forty six out of 73 limb swellings showed the classical clinical signs of lymphedema. Twenty five of them showed normal lymphatic pattern by immediate fluoroscopy. One half of this group showed changes of images of fluorescent lymphangiography after 24 hours of injection into dermal backflow pattern. The sensitivity of clinical signs in predicting lymphedema was 77%, specificity was 58%. The overall accuracy was 69%. Conclusions: These results would suggest clinical signs of lymphedema unreliable in making a correct diagnosis of lymphedema in about one third of pateints. Also, we cannot rely on immediate lymphangiographic fluoroscopy to exclude lymphedema.

Abstract: Background: Liver donation is a respectable human gift. It is essential that complications should be minimized as much as possible and must be safely performed. Aim of the work: To evaluate feasibility and safety of using CUSA for liver resection in living donor liver transplantation (LDLT) in comparison with harmonic scalpel. Patients and methods: This prospective study included 40 consecutive donors for LDLT held at Nasser Institute and Air Force Specialized Hospital during the period from September 2017 to September 2018. Results: Harmonic scalpel significantly reduced operative time (p=0.000) with a reduced blood loss (p=0.016), however it caused higher rate of biliary leakage (40% vs 15% respectively). On the other hand, CUSA showed lower bile leak leading to shorter hospital stay (p=0.000). Conclusion: Although harmonic scalpel is a faster method, CUSA is more effective and safer with a lower complication rate despite being cumbersome and need a longer learning curve.

Abstract: Background: Chronic limb threatening lower limb ischaemia (CLTI) gives high limb loss and mortality. Infragenicular Femoro-popliteal bypass offers in-line flow to target vessels. When vein not available, composite and prosthetic grafts are used. Aim of the work: Comparing composite vs synthetic femoro-popliteal bypass conduits in treatment of CLTI. Patients and methods: 20 adult patients were included in this prospective study from July 2020 to July 2021 having CLTI requiring below knee femoro-popliteal bypass, no suitable vein conduit. Ten had composite grafts bypass (group A) and 10 patients had synthetic graft (group B), and followed for 6 months. Results: Improved clinical manifestations in both groups and significant increase of ankle brachial index. 6 months 1ry and 2ry patency were 90% and 100% in group A, and 67% and 78% in group B. Limb salvage were 100% in group A and 89% in group B. No significant difference between groups’ outcome, complications, and ABI. Conclusion: Both types of conduit showed acceptable feasibility and outcome.

Abstract: Background: Reversal of Hartmann’s procedure is a demanding, difficult colorectal operation that may be associated with several postoperative complications. This can be achieved either in an open approach or laparoscopically. Laparoscopic procedure were documented to have more advantages than open one. This study was designed to assess the perioperative outcomes and safety of laparoscopic reversal of Hartmann’s procedure after open sigmoidectomy among Egyptian patients.

Abstract: Obesity is the second leading cause of preventable death in the United States, currently outdone only by smoking. However, obesity as a separate disease entity is still underappreciated and certainly misunderstood. The fact that the American Medical Association waited until the summer of 2013 to acknowledge obesity as a disease entity illustrates this statement: “Obesity is a disease and is likely multifactorial in its origin”.1

Abstract: Background: Restrictive bariatric procedures, such as gastric banding and sleeve gastrectomy are technically simple, and effective in achieving weight loss and managing obesity-related comorbidities in the short term. A subset of patients who underwent restrictive bariatric procedures needs revisional surgery for unsuccessful weight loss, gastroesophageal reflux disease, or anatomic complications after primary surgery. Aims: To compare revisional one anastomosis gastric bypass (r-OAGB) against revisional Roux-en-Y gastric bypass (r-RYGB) after failed or complicated restrictive procedures. Patients and methods: This prospective study was conducted on 40 patients who met the inclusion criteria with minimal follow-up of 1 year. Twenty patients were converted to OAGB/MGB and 20 patients were converted to RYGB as a revisional procedure. Both groups were compared for operative time, hospital stay, intraoperative and postoperative complications and short-term outcome. Results: The operative time was significantly longer for r-RYGB with a mean time of 258.25±75.21 mins compared to 216.75±47.30 mins for r-OAGB. Hiatus hernia was found and repaired in 3 patients of the r-OAGB group and 10 patients of r-RYGB. Postoperative complications occurred in 10% of r-OAGB group and 25% of r-RYGB. The mean postoperative weight and BMI were significantly lower than preoperative weight and BMI in both groups with no significant difference between both groups. The mean %EWL was 75.06 ± 24.28 for r-OAGB compared to 64.54 ± 30.40 for r-RYGB therefore EWL% was statistically significant higher after r-OAGB. Overall comorbidities improved in both groups postoperatively while anemia was recorded in 6 patients after r-RYGB compared to 3 patients after r-OAGB. Conclusion: One anastomosis gastric bypass is a simple and effective revisional procedure with less complications, shorter operative time and satisfactory weight loss.

Abstract: Results: The mean operative time was (154± 10) minutes, mean blood loss was (75 ± 10) ml, the mean time to return to anal tone (Anal exhaustion time) was (58± 6) hours, and mean postoperative hospital stay was (5.4 ± 1.3) days. The severity of the patients’ pain was determined using the Visual Analogue Scale (VAS). The patients had a mean VAS pain score of (2.8± 0.8) after surgery. The average number of lymph nodes extracted was 16.2. (Ranging from 12 to 18). One female patient in the trial required conversion to open laparotomy due to extensive pelvic adhesions due PID.

Abstract: Introduction: Persistent sciatic artery (PSA) is a rare anomaly of high clinical significance. Embryological, part of the sciatic artery involutes and other parts develop into the popliteal and peroneal arteries. Most cases present silent with aneurysm formation. Treatment is aneurysm exclusion with maintaining limb vasculature. Aim: Was to outline presentations and management PSA patients. Patients: First was female with bilateral pulsating gluteal masses. A bypass was done between the internal iliac and popliteal arteries because the femoral arteries were hypoplastic bilaterally. Second was 59y female presented with critical left lower limb ischemia. Femoropopliteal bypass with exclusion of the aneurysm was done. Third patient was 52y male with right painful pulsating gluteal mass with hypoplastic femorals. Conclusions: PSA is a rare vascular anomaly. Treatment depends on clinical and angiography presentation. Usually surgery is preferred. PSA awareness is in favor to appropriate management.

Abstract: Results: The follow-up period for PSD in our study was 12 months, during which we encountered 3 cases of recurrence, all of them in the group (B). In our study, we found that the percentage of males with pilonidal sinuses was more than females, and, also females suffered from lower rates of complications and no recurrence. Our study included patients with different occupations; PSD was found to be more common in particular jobs such as jeep drivers, workers who sit for more than six hours per day, and students.

Abstract: for more than two weeks. A patient who was diagnosed with infected femoral pseudo aneurysm might be misdiagnosed as a simple groin abscess, and drug abuse is the most common cause of infected femoral pseudo aneurysms. Long ilio-popliteal bypass in critical limb ischemia may be required depending on a good arterial segment as a donor and recipient. The aim of this study was to assess the different aspects of ilio-popliteal bypass surgery as a long conduit in patients presented with critical limb ischemia and infected femoral pseudo aneurysms. admitted in the vascular surgery units, and they were with critical lower limb ischemia. An bypass was done to save their limbs. The patients were selected and divided into two A and This twenty patients suffering from atherosclerotic ischemia, twenty patients suffering from infected femoral pseudo-aneurysm as a of and regards to the present and related to critical lower ischemia; the lower limb was locally examined as well. Angiography was for a PTFE was done, with station on the deep femoral artery in certain patients, anatomically in group A, and placed laterally extra anatomic in group B after ligation of the pseudo aneurysm. One year follow up was conducted mainly clinically and by the ankle brachial pressure index (ABI). Statistical analysis: Statistical Package for the Social Sciences, version 15.0 was used. Values were compared with a paired samples t test. P values less than 0.05 were considered significant. Results: During the follow up period, the ABI values were recorded immediately after the procedure, 24 hours, one week, and then one, three, six and twelve months later. There were no significant changes in the ABI changes among patients indicating the continuation of the hemodynamic success. At the end of the study follow up period, limb salvage rate was 90%, and four major amputation following graft occlusion took place in the twenty studied patients. Primary patency was 80% as eight grafts were occluded. Conclusions: Although the ilio-popliteal bypass is a long conduit, it is a reasonable solution for limb salvage in patients with critical limb ischemia, anatomical bypass with station on the deep femoral artery should be performed when possible, meanwhile in drug abuse cases with infected groin pseudo aneurysm, the healthy arterial axis is maintaining the patency of the long lateral extra anatomic graft.

Abstract: Background: Posterior Component Separation through Transversus abdominus Muscle Release (PCS-TAR) is considered as a better option for Abdominal Wall Reconstruction (AWR) during large ventral wall IH repair as it has advantage over both Rives-Stoppa (Retro muscular) repair and Anterior Component Separation (ACS) repair in avoiding injury of the nerve supply to rectus muscle, and in the ability to achieve more lateral dissection, providing better quality of life (QoL). Aim of work: To evaluate 30-day post operative outcome of PCS-TAR regarding both; Visual Analogue Scale (VAS) and Surgical Site Occurrence (SSOs) classification provided by Ventral Hernia Working Group (VHWG) in 2010. Patients and methods: This prospective observational study was conducted to 30 patients who have a midline incisional hernia with defect size ≥ 10 cm in widest diameter (W3) and underwent IH repair through (PSC-TAR) after routine laboratory investigations, abdominal ultrasonography, and CT. Informed consent was taken from all cases. Results were reviewed and evaluated. Results: Out of 30 patients, 13 patients (43.3%) developed SSOs. 3 patients (10%) developed cellulitis. 3 patients (10% of patients) presented with superficial infection. Seroma occurred in 5 patients (16.7%) 3 of which (10%) developed complicated seroma that needed procedural intervention (SSOpi). Hematoma was observed in 2 patients (6.7%). Conclusion: Retro muscular, Ravis Stoppa technique and ACS are comparable to PCS-TAR regarding patient reported outcomes (PROs). However, PCS-TAR still has resulted in a better quality of life (QoL). The outcome of PCS-TAR is still better even in the presence of comorbidities such as high BMI, DM, and COPD.

Abstract: Objectives: The Lichtenstein technique is currently the first to repair unilateral primary groin hernias. We aimed to conduct long lateral chain cyanoacrylate as tissue adhesive glue for open inguinal hernias mesh Fixation. Methodology: 60 patients of inguinal hernia repair were divided randomly into two groups, Group A, sutures did mesh fixation. Group B, mesh fixation was done with cyanoacrylate glue. Postoperative pain was measured with VAS by direct interview or phone call at 24 hours, 48 hours, seven days, 15 days, one month, three months, and six months after the operation. Results: There was a statistically significant difference regarding the postoperative pain with a p-value <0.05 between two study groups after 24 hours of operation and after 15 days, 1, 3, and 6 months, with a low mean score among the glue group, which indicated low pain score among glue group. There was a statistically significant difference with p-value <0.05 between the two study groups regarding operative time with low mean duration among group used glue, which indicated that using glue instead of suture will consume less time in operation. Conclusion: Mesh fixation with glue causes less postoperative pain, both acute and chronic, than the classical suture fixation, with similar morbidity and recurrence rates.