Tarek Mahdy

Thyroid surgery: use of the LigaSure Vessel Sealing System versus conventional knot tying.

BACKGROUND The aim of this work is to compare the use of conventional knot tying vs. LigaSuretrade mark Vessel Sealing System (Valley Lab, Boulder, CO) in patients undergoing thyroid surgery. We hypothesized that use of the LigaSure would reduce operating time while resulting in a similar rate of complications. METHODS This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. One hundred and ten patients were operated upon by the same team of surgeons using conventional knot tying in 55 and the LigaSure in 55 patients for hemostasis. The medical records of the patients enrolled were reviewed and compared regarding age, sex, histopathological diagnosis, type of operation performed (lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy), operating time, estimated intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, postoperative pain and outcome evaluation. RESULTS The two groups had similar demographics, thyroid pathology, types of operations and complication rates. The LigaSure group had lower operating times, lower intraoperative blood loss, less postoperative pain and early pain-free return to normal activity and return to work. CONCLUSION The LigaSure Vessel Sealing System was as safe as conventional knot tying for thyroidectomy, with the benefit of reduced operating time, postoperative pain severity and early pain-free return to normal activity and return to work.

Effect of methylene blue on intra-abdominal adhesion formation in rats

BACKGROUND Adhesion formation represents an important clinical challenge in gastro-intestinal surgery. In the late era, methylene blue (MB) has been claimed to play a helping role in combating such a problem. In the present study, we investigated the effects of MB administered intraperitoneally on the surgically-induced adhesions in rats and tried to clarify whether its impact is concentration-dependent. MATERIAL & METHODS Seventy adult male Wistar rats were used. They were allocated into seven groups, ten rats each: one control, two sham-operated and four experimental ones. Peritoneal adhesions were evoked by scraping the cecal serosa in the four experimental groups which were given different concentrations of MB, intraperitoneally. The animals of the control group were similarly dealt but were given saline. The rats of the sham-operated groups were given either MB or saline but without any serosal damage. RESULTS After the elapse of two weeks, the resulting adhesions, inflammation and fibrosis were evaluated. In the rats treated with MB 1%, adhesions, inflammatory process and fibrosis scores were similar to those in the sham-operated rats and were significantly lower than those in all other groups. CONCLUSION It could be concluded that MB, 1%, had the best anti-adhesion potential.

Augmented unilateral gluteoplasty with fascia lata graft in fecal incontinence.

Abstract.Background: This study was undertaken to evaluate the results of augmented unilateral gluteoplasty with fascia lata graft in patients with fecal incontinence due to congenital or neurologic disorders. Methods: Between January 2000 and January 2001, we performed a prospective study of 11 patients with longstanding fecal incontinence (stage C3 according to Pescatori scoring system for fecal incontinence). The patients included one girl and 10 boys aged 5–19 years who had already undergone Swensons operation for congenital megacolon (7 patients) or abdominoperineal pull-through for high imperforate anus (4 patients). Preoperative anorectal manometric studies (maximum resting pressure, maximum squeeze pressure, rectoanal inhibitory reflex and functional anal canal length), saline enema test and magnetic resonance imaging (MRI) studies were done. Unilateral gluteoplasty augmented with fascia lata graft was wrapped around the anal canal. Biofeedback retraining was started at the beginning of the fourth postoperative week. Patients were followed both objectively and subjectively for about 6–18 months. Results: Eight of 11 patients (72.7%) were clinically improved, as shown by the change in incontinence score (p=0.01). this was confirmed by the significant changes in manometric studies, functional anal canal length, rectoanal inhibitory reflex and saline enema test. MRI done one month postoperatively showed disruption in one patient. Conclusions: Unilateral gluteoplasty augmented with fascia lata graft leads to encouraging results in patients with end-stage anal incontinence due to irreversible damage to anal sphincter with less incidence of morbidity that could be related to tension on either the muscle flap or its neurovascular bundle.

Effects of MGB on Type 2 Diabetes in Lower BMI Patients

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 <35. Evidence suggests that bypass of the duodenum may provide superiority of MGB over sleeve gastrectomy (SG) and even over Roux-en-Y gastric bypass (RYGB) for T2D remission. MGB and RYGB have similar mechanisms of T2D remission, but being easier to perform, MGB may be the superior option.