Waleed Thabet

Long term predictors of success after laparoscopic sleeve gastrectomy

BACKGROUND To evaluate early, mid and long term efficacy of laparoscopic sleeve gastrectomy as a definitive management of morbid obesity and to study factors that may predict its success. MATERIALS AND METHODS A retrospective study was conducted by reviewing the database of patients who underwent LSG as a definitive bariatric procedure, from April 2005 to March 2013. Univariate and multivariate analysis were performed. RESULTS 1395 patients were included in this study. Mean age was 33 years and women:men ratio was 74:26. The mean preoperative BMI was 46 kg/m(2). Operative time was 113 ± 29 min. Reinforcement of staple line was done only in 447 (32%) cases. 11 (0.79%) cases developed postoperative leak, with total number of complications 72 (5.1%) and 0% mortality. Percentage of excess weight loss (%EWL) was 42%, 53%, 61%, 73%, 67%, 61%, 59% and 57% at 6 months, 1-7 years. Remission of diabetes (DM), hypertension (HTN) and hyperlipidaemia (HLP) occurred 69%, 54% and 43% respectively. 56 (4%) patients underwent revision surgery, for insufficient weight loss (n = 37) and severe reflux symptoms (n = 19). Mean follow up was 76 ± 19 (range: 6-103) months. Smaller bougie size and leaving smaller antrum were associated with significant %EWL. Bougie ≤36F remained significant in multivariate analysis. CONCLUSION This study supports safety, effectiveness and durability of LSG as a sole definitive bariatric procedure. Smaller bougie size and shorter distance from pylorus were associated with significant %EWL.

Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse

BACKGROUND Rectal prolapse is a distressing and socially disabling condition. controversy exists regarding the preferred surgical technique for the treatment of complete rectal prolapse. OBJECTIVE We compared Delorme operation alone or with postanal repair and levatroplasty in treating complete rectal prolapse. METHODS Consecutive patients treated for rectal prolapse at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive Delorme operation only (GI), or Delorme operation with postanal repair and levatorplasty (GII). MAIN OUTCOME MEASURES The primary outcome measure was recurrence rate; secondary outcomes included improvement of constipation, incontinence, operative time, anal manometery and postoperative complications. RESULTS Eighty-two consecutive patients with rectal prolapse were randomized. There was a significant difference between the two groups with longer operative time in group II. Recurrence rate after one year was (14.28% in GI, and 2.43% in GII, respectively (P = 0.043). Constipation improved in group I & II but there was a significant difference in constipation scores postoperatively between the two groups. There was improvement in continence mechanism in both groups postoperatively but being higher in group II and this produce a significant statistical difference (0.004). Mean satisfaction score was significantly higher in group II than group I. Both groups succeed to produce a significant change in resting and squeeze pressure before & after the operation. CONCLUSIONS Delorme operation seems to be an effective procedure for treating complete rectal prolapse especially if combined with postanal repair and levatorplasty. CLINICAL TRIAL REGISTRATION NCT01656369.

Laparoscopic ventral mesh rectopexy versus Delorme's operation in management of complete rectal prolapse: a prospective randomized study

Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delormes operation for complete rectal prolapse.

Novel Approach of Treatment of Pilonidal Sinus Disease With Thrombin Gelatin Matrix as a Sealant.

BACKGROUND: Sacrococcygeal pilonidal sinus disease is a condition caused by insertion of fallen hair shafts into the skin. Different types of operations have been described for the management of pilonidal sinus, yet none of them have proven to be superior to the others. Recently, sealants like fibrin glue have been successfully used. OBJECTIVE: This study aimed to assess the efficacy of thrombin gelatin matrix as a new sealant for pilonidal sinus treatment. DESIGN: This was a prospective study conducted from March 2013 to March 2015. SETTINGS: The study was conducted in private hospitals in Mansoura City. PATIENTS: The study included 36 male patients (72%) and 14 female patients (28%), with a median age of 22 years. INTERVENTIONS: Fifty patients with pilonidal sinus were admitted and treated with thrombin gelatin matrix injection. MAIN OUTCOME MEASURES: Incidence and time of pilonidal sinus recurrence, postoperative pain and complications, duration of hospital stay, healing status, and time to return to work were recorded. RESULTS: The median duration of symptoms was 13 months, median operative time was 18 minutes, and median hospital stay was 6 hours. All of the procedures were conducted as day-case surgeries. Median follow-up duration was 24 months. Three patients (6%) had a breakdown of the sealant, and the wound was managed with daily dressings. Recurrence at 1 year was observed in 2 patients (4%). A total of 96% of patients were satisfied with the outcome of the procedure, and 92% of patients resumed their daily activities within 3 days. LIMITATIONS: Follow-up for a longer duration is required to ascertain the efficacy of this new technique. The cost of this treatment might be challenging for resource-limited communities. CONCLUSIONS: Management of pilonidal sinus using thrombin gelatin matrix, despite being expensive, is an effective, simple treatment that is easy to perform and associated with low recurrence rate, minimal morbidity, and rapid recovery.

Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure

OBJECTIVES The objective of this study was to evaluate the efficacy of transcutaneous electrical posterior tibial nerve stimulation in treatment of patients with chronic anal fissure and to compare it with the conventional lateral internal sphincterotomy. PATIENTS AND METHODS Consecutive patients with chronic anal fissure were randomly allocated into two treatment groups: transcutaneous electrical posterior tibial nerve stimulation group and lateral internal sphincterotomy group. The primary outcome measures were number of patients with clinical improvement and healed fissure. Secondary outcome measures were complications, VAS pain scores, Wexners constipation and Peascatori anal incontinence scores, anorectal manometry, and quality of life index. RESULTS Seventy-three patients were randomized into two groups of 36 patients who were subjected to transcutaneous electrical nerve stimulation and 37 patients who underwent lateral internal sphincterotomy. All (100%) patients in lateral internal sphincterotomy group had clinical improvement at one month following the procedure in contrast to 27 (75%) patients in transcutaneous electrical nerve stimulation group. Recurrence of anal fissure after one year was reported in one (2.7%) and 11 (40.7%) patients in lateral internal sphincterotomy and transcutaneous electrical nerve stimulation groups respectively. Resting anal pressure and functional anal canal length were significantly reduced after lateral internal sphincterotomy. CONCLUSION Transcutaneous electrical posterior tibial nerve stimulation for treatment of chronic anal fissure is a novel, non-invasive procedure and has no complications. However, given the higher rate of clinical improvement and fissure healing and the lower rate of fissure recurrence, lateral internal sphincterotomy remains the gold standard for treating chronic anal fissure.

Enteropathogenic Escherichia coli (EPEC): Does it have a role in colorectal tumourigenesis? A Prospective Cohort Study

BACKGROUND Despite the characterization of many aetiologic genetic changes. The specific causative factors in the development of sporadic colorectal cancer remain unclear. This study was performed to detect the possible role of Enteropathogenic Escherichia coli (EPEC) in developing colorectal carcinoma. PATIENTS AND METHOD Fresh biopsy specimens have been obtained from the colonic mucosa overlying the colorectal cancer as well as from the colon of the healthy controls. Culture, genotyping and virulence of EPEC were done using (nutrient broth culture, and PCR). Strains biochemically identified as Escherichia coli were selected from the surface of a MacConkeys plate and were serogrouped by slide agglutination tests. RESULTS From January 2011 to June 2014, 213 colorectal cancer patients (Group 1) and 248 healthy controls (Group 2) were prospectively enrolled in this study. EPEC was positive in 108 (50.7%) in group 1 and 51 (20.6%) in group 2 (P = 0.0001). A significant difference between both groups was observed regarding serotyping, genotyping (eae gene) and virulence category (P = 0.0001). A significant difference between the 2 subgroups of colorectal cancer cases was observed regarding genotyping (eae, bfb genes) and virulence category. CONCLUSION The incidence EPEC was higher significantly in patients with colorectal cancer. E. coli in patients with colorectal cancer significantly differed serotypically and genotypically from the E. coli in normal population. E. coli colonization of the colonic mucosa may be a cause colorectal cancer.

Evaluation of anatomical and functional results of overlapping anal sphincter repair with or without the injection of bone marrow aspirate concentrate: a case-control study

Overlapping anal sphincter repair (OASR) is used for treatment of faecal incontinence due to an external anal sphincter (EAS) defect; however, it is not the optimal treatment as its functional results tend to deteriorate significantly with time. The present study aimed to evaluate the effect of local injection of bone marrow aspirate concentrate (BMAC) on the outcome of OASR.

Management of Post-Traumatic Posterior Rectal Pouch Through a Posterior Approach

Proximal fecal diversion is the treatment of choice in the cases of extra-peritoneal rectal injuries that are not amenable for primary repair due to their distant location or high grade. The posterior approach enables complete excision of well-defined abscess cavities that communicate with the rectal lumen with full-thickness repair of the rectal defect. An important privilege of pouch excision through the posterior approach was the preservation of rectal reservoir and the sensation that would have been compromised if proctectomy with coloanal anastomosis was alternatively performed.

Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial

BACKGROUND Although several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND. METHODS This was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes. RESULTS Sixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence. CONCLUSIONS The Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.

Pattern of major injuries after motorcycle accidents in Egypt: The Mansoura Emergency Hospital experience:

Background and aim Motorcycle accidents are one of the leading causes of road traffic injuries and mortality. The aim of this study was to determine the common patterns of major injuries associated with motorcycle accidents in patients attending Mansoura University Emergency Hospital in Egypt, and to measure the magnitude of the problem in our community. Patients and methods Patients involved in motorcycle crashes who were admitted to the hospital during August 2014 to April 2015 were retrospectively reviewed. All age groups and both genders were included. Results Two hundred patients (181 males) with a mean age of 30.7 ± 10.5 years were included with the majority of patients aged 20–40 years. Head injuries were the most frequent fatal injuries (9/61) patients; orthopedic injuries were the most common injuries, occurring in 78.5% of victims. Multisystem injuries occurred in 28% of patients. None of the motorcyclists involved in accidents wore helmets. Conclusion Motorcycle accidents are a common cause of road traffic injuries and mortalities in Egypt, occurring mainly in males aged 20–40 years. The majority of victims had an isolated trauma to single body system. Orthopedic injuries were the most common and least fatal type of injuries. The highest fatalities were among patients with chest injuries then patients with head injuries. None of the victims wore protective clothing or helmets at the time of accident.