Gouda Ellabban

Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial

We aimed to test the hypothesis that Minimally Invasive Video-assisted Thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery, when dealing with patients with unilateral thyroid nodules or follicular lesions, in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain and hospital stay. MATERIALS AND METHODS: This was a single-blinded randomised controlled trial comparing the MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours from operation and self-rated patient satisfaction with cosmetic outcome three months postoperatively. The secondary outcome measures were operative time, incidence of temporary and permanent recurrent laryngeal nerve injury, postoperative haematoma formation, length of incision, and duration of hospital stay. RESULTS: Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Blood loss did not reach significance between procedures. Comparisons between the two procedures with regard to pain scores after 24 and 48 hours, respectively, depicted statistically significant differences in favour of the MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfactory cosmetic results. There were statistically no significant differences between both procedures for the presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. CONCLUSIONS: MIVAT is a safe procedure that produces outcomes, in view of short-term adverse events, similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results.

Laparoscopic elective cholecystectomy with and without drain: A controlled randomised trial

BACKGROUND: Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, a controlled randomised trial was designed to assess the value of drains in elective laparoscopic cholecystectomy. MATERIALS AND METHODS: During a two-year period (From April 2008 to January 2010), 80 patients were simply randomised to have a drain placed (group A), an 8-mm pentose tube drain was retained below the liver bed, whereas 80 patients were randomised not to have a drain (group B) placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, wound infection and hospital stay between the two groups. RESULTS: There was no mortality in either group and no statistically significant difference in postoperative pain, nausea and vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain and it is appearing that the use of drain delays hospital discharge. CONCLUSION: The routine use of a drain in non-complicated laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with longer hospital stay.

Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain

BACKGROUND: The study was designed to compare the effect of intraincisional vs intraperitoneal infiltration of levobupivacaine 0.25% on post-operative pain in laparoscopic cholecystectomy. MATERIALS AND METHODS: This randomised controlled study was carried out on 189 patients who underwent laparoscopic cholecystectomy. Group 1 was the control group and did not receive either intraperitoneal or intraincisional levobupivacaine. Group 2 was assigned to receive local infiltration (intraincisional) of 20 ml solution of levobupivacaine 0.25%, while Group 3 received 20 ml solution of levobupivacaine 0.25% intraperitoneally. Post-operative pain was recorded for 24 hours post-operatively. RESULTS: Post-operative abdominal pain was significantly lower with intraincisional infiltration of levobupivacaine 0.25% in group 2. This difference was reported from 30 minutes till 24 hours post-operatively. Right shoulder pain showed significantly lower incidence in group 2 and group 3 compared to control group. Although statistically insignificant, shoulder pain was less in group 3 than group 2. CONCLUSION: Intraincisional infiltration of levobupivacaine is more effective than intraperitoneal route in controlling post-operative abdominal pain. It decreases the need for rescue analgesia.

The use of topical phenytoin for healing of chronic venous ulcerations

BACKGROUND Many topical agents have been used for promotion of healing of chronic venous ulcers. One such agent that has been tried is phenytoin. The effect of phenytoin on cutaneous healing has been suggested. This study was designed to evaluate the efficacy of topical phenytoin in healing of venous ulcerations. METHODS One hundred and four patients with chronic venous ulcers were recruited in this study. They were divided into study group and control group. The study group was 54 patients while control group was 50 patients. Patients in the study group were subjected to dressing of their ulcers with topical phenytoin once daily while patients in the control group were subjected to dressing with normal saline. All patients were followed up for eight weeks and assessed for their ulcer status and recorded as: complete healing, partial healing, no improvement or worsening of the condition. RESULTS By the end of the eight weeks, complete healing was evident in 35/54 of the patients (64.8%) in the study group and 26/50 of the patients (52%) in the control group. It was statistically significant (p = .04). The rate of reduction in the mean surface area of the ulcers was faster in the study group than control group. Minor side effects were reported among 4 patients (7.4%) of the study group in the form of burning sensation. CONCLUSION Topical phenytoin can be used to enhance healing of chronic venous ulcers in conjunction with the established treatment. It has favorable results and tolerable local side effects.

Perforated Duodenal Ulcer in High Risk Patients: Is Percutaneous Drainage Justified?

Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate.

The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain.

BACKGROUND: Chronic abdominal pain is a difficult complaint. It leads to evident suffering and disability, both physically and psychologically. Many diagnostic and therapeutic procedures have been described in literature, but with little proof or evidence of success. Laparoscopy is one of the modalities that could be of benefit in such cases. We aim to evaluate the diagnostic and therapeutic value of laparoscopy in cases with chronic abdominal pain. MATERIALS AND METHODS: Thirty patients with chronic abdominal pain were included in this prospective descriptive cross-sectional study. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. RESULTS: The most common site of pain was the periumbilical region (30%). A definitive diagnosis was made in 25 patients (83.3%), while five patients (16.7%) had no obvious pathology. Adhesions were the most common laparoscopic findings (63.3%) followed by appendiceal pathology (10%), hernia (3.3%), gall bladder pathology (3.3%), and mesenteric lymphadenopathy (3.3%). Postoperatively, pain relief was achieved in 24 patients (80%) after two months. CONCLUSION: Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.

Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure

ZusammenfassungGRUNDLAGEN: Es galt, die Wirkung von lokalem Nitroglyzerin versus Sphinkterotomie beim Management der chronischen Analfissur zu vergleichen. METHODIK: 80 Personen mit chronischer Analfissur wurden mit GTN 0,2 % (n = 40) oder mit interner Sphinkterotomie (n = 40) behandelt und die Wirksamkeit der Methoden verglichen. ERGEBNISSE: In der GTN-Gruppe war in 85 % der Fälle nach 8 Wochen Therapie eine Abheilung der Fissur zu beobachten. Kopfschmerz als Nebenwirkung bestand bei 65 % der Fälle. In der Sphinkterotomie-Gruppe trat Beschwerdefreiheit bei 97,5 % der Personen nach 8 Wochen ein. Inkontinenz für Gas bestand bei 3 Patienten (7,5 %), Stuhlschmieren bei 2 Personen (5 %) und 1 Patient hatte eine Wundinfektion. Alle Komplikationen waren transient, außer Persistenz für Gas-Inkontinenz bei einem Patienten. SCHLUSSFOLGERUNGEN: Lokales GTN sollte die initiale Therapie bei chronischer Analfissur sein, während die Sphinkterotomie bei Personen angewendet werden, die nicht auf GTN ansprechen oder starke Beschwerden haben.SummaryBACKGROUND: To compare the effectiveness of local glyceryl trinitrate (GTN) versus internal sphincterotomy in the management of chronic anal fissure. METHODS: Eighty patients with chronic anal fissure were enrolled in the study. They were divided into two groups; group (1) included 40 patients treated with topical GTN 0.2% on liposomal base applied to the anoderm twice daily and group (2) included 40 patients treated with internal sphincterotomy. We compared the effectiveness of both techniques in the management of chronic anal fissure. RESULTS: In group 1, healing of fissures occurred in 85% of patients after 8 weeks therapy. Headache as a side effect developed in 65% of patients. In group 2, healing occurred in 97.5% of patients after 8 weeks. Incontinence to flatus occurred in 3 patients (7.5%), mild soiling in 2 patients (5%), and one patient developed wound infection. All complications were temporary except for one patient with persistent incontinence to flatus. At the end of 8 weeks both groups were equal in pain scoring. CONCLUSIONS: Topical GTN should be the initial treatment in chronic anal fissure while internal sphincterotomy may be reserved for patients who did not respond to GTN therapy and those with severe pain (as healing is faster with sphincterotomy).

Total thyroidectomy by loupe magnification: a comparative study

ZusammenfassungGRUNDLAGEN: Die Entfernung der gesamten Schilddrüse ist in der Therapie bei gutartigen und bösartigen Erkrankungen der Schilddrüse etabliert, ist aber potentiell mit erhöhten postoperativen Komplikationen assoziiert. Es geht vor allem um die Schonung der Nervus laryngeus recurrens und der Nebenschilddrüsen. Die Autoren überlegten, ob die Lupenvergrößerung dazu beitragen kann, die angeführten Komplikationen zu vermeiden. METHODIK: Die totale Thyreoidektomie wurde mit (Gruppe A) und ohne (Gruppe B) Lupenvergrößerung durchgeführt. Stimmbandfunktion und Kalziumspiegel wurden postoperativ untersucht. ERGEBNISSE: Die Lupenvergrößerung verbessert die Identifizierung und Schonung des Nervus laryngeus recurrens und der Nebenschilddrüsen. SCHLUSSFOLGERUNGEN: Lupenvergrößerung bei Entfernung der gesamten Schilddrüse ist machbar, verbessert das Ergebnis und sollte von erfahrenen Chirurgen durchgeführt werden.SummaryBACKGROUND: Total thyroidectomy has been accepted as current surgical therapy for benign and malignant thyroidal disorders but extensive resection might increase the risk of postoperative complications. Intensive effort should be spent to prevent recurrent laryngeal nerve injury and hypoparathyroidism, because they can be avoided with appropriate surgical technique during total thyroidectomy. The authors proposed that the use of a loupe for operative field magnification could improve the outcome of total thyroidectomy as regard to identification of both the recurrent laryngeal nerves and the parathyroids. METHODS: Patients were subjected to total thyroidectomy with loupe magnification in group A and without loupe in group B. The status of vocal cords of all patients was checked postoperatively by laryngoscope. Serum calcium concentration immediately postoperatively and during follow-up was checked. RESULTS: Loupe magnification helps identification of external branch of superior laryngeal nerve and parathyroid preservation. CONCLUSIONS: Total thyroidectomy by loupe magnification is feasible, improves the outcome, and should be done by experienced surgeon.

The effect of the management with fresh frozen plasma on the outcome of patients with acute organophosphate poisoning

Background: Organophosphate (OP) poisoning is an important reason for hospitals and intensive care units admission in the developing countries. OP poisoning patients are classically treated with atropine and oximes, these methods are sometimes shown to be of limited benefit. Objective: Assessment of the effectiveness of the management with fresh frozen plasma (FFP) in improving the outcome of patients with acute OP poisoning. Patient and Methods: A randomized clinical trial study was conducted upon 70 acute OP poisoning patients that were referred to the Emergency Department, Suez Canal University Hospital, Ismailia, Egypt. These patients were randomly divided into two groups (35 each); Control group: Treated with the traditional management protocol of OP (atropine and oximes). FFP group: Treated with the traditional management protocol of OP plus FFP. Results: No significant difference was found in cholinesterase level on admission between both groups, Serum cholinesterase level in the FFP group significantly increased after an hour of FFP infusion (2.48 iu/ml vs. 10.36 iu/ml p

Single‐stage procedure in management of uncomplicated acute sigmoid volvulus without colonic lavage

Aim:  The management of sigmoid volvulus remains controversial. We aimed to evaluate the postoperative outcome of patients with acute non‐complicated sigmoid volvulus managed with resection and anastomosis without preoperative colonic lavage.