Background: Although definite treatment for patients with acute pancreatitis is absent and there is no clinically specific laboratory marker to monitor the clinical trajectory of clinical course, new evidences have been found regarding the early treatment of patients with this pathology. When patients with acute pancreatitis develop infection of fluid accumulations, necrotic accumulations and demarcated necrosis, interventional treatment may be required. Data sources: This article provides an overview of current national and international guidelines on treatment of acute pancreatitis, obtained from the Medline database from 2013 to 2021. Results: Indications for the treatment of patients with acute pancreatitis in intensive care units, the amount of conservative care, modern methods of interventional procedures, based on the concept of "step-up", were analyzed. A minimally invasive approach to the treatment of patients with acute biliary pancreatitis is described. Conclusions: Despite numerous randomized and cohort studies, no drug has been identified to improve treatment outcomes in patients with AP. Many patients can be cured without surgery, but sometimes surgery is important to correct conditions that can occur in severe cases. However, there is a further need for higher quality research to determine the best treatment strategies.

Aim: In our study, our aim was to evaluate the effect of overweight on lower esophageal sphincter (LES) laxity in GERD (gas- troesophageal reflux disease) by examining the relationship between LES laxity and body mass index (BMI) in individuals with dyspeptic complaints. Method: The data were collected prospectively and evaluated retrospectively in this study. The study included endoscopies per- formed on 250 patients with reflux and dyspepsia complaints by Hitit University Erol Olçok Training and Research Hospital General Surgery Clinic Gastroenterology Surgery subbranch members between February 2020 and May 2021. BMIs of the patients were recorded during the procedure. The patients were grouped in two according to their BMIs and LES states were compared. Results: 250 individuals who participated in the study were grouped in two as those with a BMI value of <25 kg/m2 and those with a BMI value of >25 kg/m2. The patients were also grouped in two in terms of having LES laxity and they were compared. In the functional LES group, while 41.6% of the patients were in BMI normal or underweight group, this rate was found as 33.3% in patient with LES laxity. In BMI overweight and obese patients, functional LES was found as 58.4%, while LES laxity was found as 66.7%. Although the rate of obese patients was higher in patients with LES laxity, no statistically significant difference was observed (p=0,193). Conclusion: Although obesity is a risk factor in GERD disease, we believe that this is not an independent risk factor associated with LES laxity. In our study, when the patients were grouped in two as patients <25 BMI, in other words as normal and underweight patients and as patients >25, in other words as overweight and obese patients, no significant difference was found in terms of LES laxity. No correlation was found between high body mass index (BMI) and LES laxity.

Background: Symptomatic hiatal hernia is a surgical problem. Surgical management procedures in such conditions are technically difficult and might be associated with many complications as gastric and esophageal perforation. So searching for advanced surgical procedures to decrease operative and post-operative drawbacks is highly needed. Our aim was to estimate the efficacy of laparoscopic cruroplasty with mesh in comparison to fundoplication in surgical management of sliding hiatal hernia with gastroesophageal reflux disease (GERD). Patients and Methods. In our prospective cohort study, we included 40 cases diagnosed with sliding hiatus hernia that were collected and divided into two groups each group included 20 patients; group (1) included patients that were managed by cruroplasty with mesh without wrap and group (2) included patients that were managed by Nissen’s fundoplication technique and crural repair. Results: operative time and post-operative hospital stay in the group of patients that was managed by only cruroplasty with mesh shorter than that in the other group (p<0.001 and =0.049 respectively). Cruroplasty with mesh is better than Nissen’s fundoplication as regard decreasing incidence of postoperative complications (p=0.005) and decreasing incidence of postoperative recurrence (p=0.009) with higher patients satisfaction (0.002). Conclusion: Cruroplasty with mesh insertion, as a management surgical procedure for sliding hiatal hernia with GERD, can be safely carried out with shorter operative time, low incidence of recurrence, low morbidity and mortality rates.

Aim: This systematic review and meta-analysis aimed to analyze 90 days mortality after liver resection, and also study various factors associated with mortality via univariate and multivariate metaregression. Methods: PubMed, Cochrane Library, Embase, google scholar, web of science with keywords like ‘liver resection”; ”mortality”;” hepatectomy”. Weighted percentage 90 days mortalities were analyzed. Metaregression was done by DerSimonian-Laird meth- ods. Heterogeneity was assessed using the Higgins I2 test. Publication bias was assessed using a funnel plot. Funnel plot asym- metry was evaluated by Egger’s test. Results: Total 29931 patients underwent liver resection .1257 patients died within 90 days postoperatively. Weighted 90 days mortality was 3.6% (95% C.I 2.8% -4.4%). , I2 94.625%.(p<0.001). We analyzed various covariates like major hepatectomy, age, blood loss, open surgery, hepatocellular carcinoma or colorectal liver metastasis, and cirrhotic liver to check for their association with heterogeneity in the analysis and hence 90 days mortality. On univariate metaregression analysis major hepatectomy (p<0.001), Open hepatectomy (p<0.001), blood loss (p=0.002) was associated with heterogeneity in the analysis and 90 days mortality. On multivariate metaregression, Major hepatectomy(p=0.003), cirrhotic liver (p=0.003), and Open surgery (p=0.012) were independently associated with higher 90 days mortality, and liver resection for colorectal liver metastasis was inde- pendently associated with lesser 90 days mortality (z= -4.11,p<0.01). Residual heterogeneity after all factor multivariate me- taregression model was none (I2=0,Tau2=0, H2=1) and nonsignificant (p=0.49). Conclusion: Major hepatectomy, open hepatectomy, and cirrhotic background are associated with higher mortality rates and colorectal liver metastasis is associated with lower perioperative mortality rates.

Background: Seroma is the most common problem occurring after breast cancer surgery, causing patient discomfort, repeated seroma aspirations with the risk of infection, prolonged hospital stay, delayed wound healing, skin flap necrosis, delay in receiv- ing adjuvant therapies, and higher surgical expenditures. The purpose of our study is short term follow up" within two months after operation" to evaluate the effectiveness of using Tetracycline and closure of the dead space in reducing seroma after Modi- fied Radical Mastectomy (MRM). Patients and methods: Interventional study was conducted on 56 females with breast cancer to evaluate different techniques for reduction of seroma formation after modified radical mastectomy at general surgery department of Zagazig University Hospi- tals, during the period from October 2018 to April 2020. Patients were divided into 2 groups each one enrolls 28 patients Group A: we used tetracycline, suction drain and tight bandage while in Group B: we used mechanical closure of dead space, suction drain and tight bandage, "without tetracycline" All patients were subjected to Demographic data taking, complete clinical exam- ination, Laboratory investigations and breast ultrasound. Results: In this study the percentage of seroma occurred in total cases was (26.8%) this is considered good results when com- pared to worldwide percentage (73%). In group A (Tetracycline) seroma occurred in 32% of 28 cases and 21.4% of 28 cases in group B. Conclusion: There was no significant difference between using Tetracycline and mechanical closure of dead space in reducing seroma after MRM.

Background: Although Papillary thyroid carcinoma (PTC), has a high prevalence but it is not a fatal malignancy, so, any studies pointed to using less aggressive conservative surgical approaches as management strategies for PTC, including the option of hemi- thyroidectomy for small PTC up to 4 cm.The extent and type of surgical approaches for PTC is still controversial. In the current retrospective study, we aimed to explore the long-term outcome of patients with PTC patients who underwent he- mithyroidectomy in comparison with similar stage PTC patients who underwent total thyroidectomy. Patients and methods: This is a retrospective comparative cohort study included fifty patients with a proven diagnosis of PTC. Of the 50 included patients, 20 patients underwent hemi-thyroidectomy and 30 patients underwent total thyroidectomy. We followed all patients for about 3 years to detect recurrence and survival rates. Results: we showed that patients who underwent total thyroidectomy were older than patients underwent hemi-thyroidectomy (p=0.039). Patients who underwent total thyroidectomy have high liability of; extra-capsular invasion (p=.002), higher stage (p=0.005), higher incidence of cervical lymph nodes metastases (p=0.006), performing lymph node dissection (p=0.008), post- operative hypocalcemia (p=0.001), and laryngeal nerve paralysis (p=0.008), than patients underwent hemi-thyroidectomy. No signifi- cant differences in recurrence and survival between patients who underwent total thyroidectomy or hemi-thyroidectomy. Conclusion: hemi-thyroidectomy in adequately selected cases could be an excellent surgical approach for management of PTC which yielded curative results with fewer post-operative complications.

Background: Endoscopic thyroidectomy (ET) was first introduced in 1996 by Gagner and in 1997 by Huscher. There are different approaches for ET among these approaches the axillary and breast approach (ABA)are the most popular ones. Objective: To evaluate the feasibility, safety , outcome and patients satisfaction. Methods: This is a retrospective study. Details of demographic profile, preoperative parameters, operative parameters, and postoperative management were collected for all the cases between January 2015 till April 2019. Results: A total of 42 cases underwent endoscopic hemithyroidectomy, 1 completion of thyroidectomy and 4 cases required conversion to open. Mean operating time were +120.12 minutes. The average hospital stay is 3.61 days. Post-operative histopathological examination revealed 43 cases were benign and 5 were malignant. Post-operative complications were seen in 16 cases (37.2%) . Seroma was the commonest seen in 8 (29%) cases, erythematous 7 (25%) cases and hoarseness of voice 5 (18%) cases respectively. Surgical site infection seen in 4 (13%) cases, ecchymoses seen in 2 (7%) cases and subcutaneous emphysema and dysphagia is seen in 1 (4%) case respectively. Patient satisfaction with regards to the surgery as a whole was assessed via numerical rating scale and overall rating in terms of scar satisfaction was 100%. Conclusion: ET is a feasible surgery with a steep learning curve. The general outcome is good and the complications that arise are not life threatening and are able to be treated conservatively.

Introduction: Despite the evolution of neck dissection operations from radical to selective and more recently the application of sentinel lymph node biopsy, they still leave relatively unsightly neck scar. We are evaluating the safety, feasibility and the outcomes of elective neck dissection (END) in patients with early oral squamous cell carcinoma (SCC) using totally endoscopic chest wall approach in comparison to the open approach. Materials and methods: Forty patients with node negative early oral SCC were included from November 2019 to May 2021. Of them 20 patients underwent elective cervical node dissection using the open conventional approach and 20 patients underwent extra- cervical endoscopic cervical node dissection. Clinico-pathological characteristics, surgical, oncologic and cosmetic outcomes of both groups were compared. Results: The endoscopic group showed longer mean operative time but less estimated median blood loss compared with the open group (120.5+17 mins vs 72.2+23.6 mins & 20 ml vs 100 ml respectively). The open group reported higher mean number of lymph node retrieved than the endoscopic group (24.9 + 3.99 vs 19.4 + 3.82, p value 0.01). Cosmetic satisfaction scores were significantly higher in the endoscopic group than the open group (p = 0.01). Local recurrence was reported in two cases of the open group and one case of the endoscopic group (p = 0.54). Conclusion: Despite being lengthy, costly and with a relatively steep learning curve, endoscopic elective neck dissection appears as a safe, feasible and esthetic alternative to open conventional technique in selected patients with node negative early oral SCC.

Objectives: The aim of this study is to compare open retrorectus and open onlay mesh repair in the management of midline ventral hernia in terms of duration of surgery, wound complications, post-operative pain and recurrence rate. Methods: This is a prospective interventional comparative study including patients with ventral hernia admitted in ABVIMS andDr Ram Manohar Lohia hospital New Delhi, over a period of 3 years (1 November2019 to 31 March 2021). Data were collected and compiled for various parameters. Minimum 60patients were recruited in the study with 30patients in each arm (Last patient was taken till 31st Dec 2020), who underwent either open retrorectus oropen onlay mesh repair at our institute, were reviewed. Data regarding primary outcomes like duration of surgery, wound complications, post-operative pain and secondary outcomes like recurrence rate were analyzed. Results: Out of 60 patients, the mean age (Years) was 38.80 ± 10.51.24 (40.0%) of the participants were males, while 36 (60.0%) of the participants were females. 32 (53.3%) of the participants had Incisional hernia, 16(26.7%) of the participants had Paraumblical hernia and 12 (20.0%) of the participants had Umbilical hernia. The mean Duration of Surgery (Minutes) was 74.97 ± 14.90. The mean Post-Operative Pain by visual analogue scale (VAS) was 5.30 ± 1.06.10 (16.7%) of the participants had hematoma formation whereas seroma formation occurred in 20 (33.3%) of the participants. Mesh in 4 (6.7%) of the participants got exposure postoperatively. Sinus/Fistula formation was not seen as a complication in any of the participants. 2 (3.3%) of the participants got Mesh Removed. Recurrence was seen in only 4 (6.7%) of the participants. Conclusion: As per the study low postoperative pain and longer duration of surgery was found to be associated with retrorectus meshplasty as compared to onlay repair.Onlay mesh repair is associated with higher postoperative pain, hematoma formation, Seroma formation, infection, mesh exposure/ removal and recurrence than retrorectus mesh repair.While the ease of the technique and the time it takes to perform onlay mesh repair over retrorectus repair give onlay repair an advantage, but the related problems limit its utilization.

Background: Rectal surgery is a common encounter procedure among general surgeons, especially colorectal practitioner. Problems with loss of the normal rectal reservoir function, urinary continence issues, and sexual dysfunction are frequently reported in patients after rectal surgery. These disorders markedly affect the overall quality of life (QoL). At current trend, the use of sphincter- preserving surgery and more fine pelvic dissection technique has increased, and all these surgical techniques have important sequels that modify the QoL of the patients. For these reasons, QoL has begun to gain important aspects to be manage for post rectal surgery operation especially maintaining the fecal continence, sexuality and urinary function Objectives: To determine the extent QoL of patients who underwent a rectal resection and to improve surgical techniques for good functional outcomes in future practice. Methods: Cross-sectional observational study, standardized questionnaire regarding bowel, urinary and sexual function. The data was taken minimum 6 months post operation between 1st January 2019 until 1st June 2020. Results: Total of 42 patients was recruited out of 93 patients underwent rectal surgery which included Anterior Resection (AR), Low AR and Ultra low AR. Out of the 42 patients, 34 (81%) of them statically showed significantly decrease in QoL. Conclusion: The qualities of life after rectal cancer surgery is affected post operatively in our study. Therefore, it is crucial for the clinical practitioners to understand well the influence of different techniques and approaches on functional outcomes and QoL. This will encourage the surgeons to be able to determine related factors preoperative, anticipate intraoperative and post operative complications and inform patient of the treatment benefits and risk of postoperative dysfunctions.

There are many factors which are associated with risk of colorectal cancer; some of these factors are modifiable and others are not. The non-modifiable risk factors that have been identified include a personal or family history of colorectal cancer or adenomatous polyps, and a personal history of chronic inflammatory bowel disease. Modifiable risk factors which have been associated with an increased risk of colorectal cancer include physical inactivity, obesity, and high consumption of red or processed meats, smoking, and moderate-to-heavy alcohol consumption. Materials and Method: This case control study was carried out in Hospital University Science Malaysia (HUSM) from December 2013 to September 2014 (10 months). Patients involved were subjected to elective colonoscopy procedure due to bowel symptoms. Locations involved in this research were Endoscopy Unit, Department of Surgery and Microbiology Laboratory of HUSM. Results: After completing history and clinical examinations, patients will be subjected for colonoscopy procedure. Out of 66 patients, 33 patients showed normal colonoscopy results and two biopsies were taken from the sigmoid colon and rectal mucosa (one for each part). Another 33 patients showed malignant findings and among these patients with positive colonoscopy findings, 25 patients had a tumor in the rectum and 8 patients had a tumor in the sigmoid colon. Patients who were diagnosed with colorectal tumour had relatively lower tendency of diabetes mellitus, hypertension and other diseases compared to patients in the non-tumour group. However, 5 patients with colorectal tumor (from total sample of 66 pateints) had ischemic heart disease compared to 4 normal patients. One patient in each group has had history of malignancy. One of them in the non-tumour group had history of caecal tumour and had undergone right hemicolectomy previously while another patient who currently had rectosigmoid cancer had right mastectomy done before for right breast cancer. Conclusions: From this research, even though multiple risk factors do not contribute much significance to colorectal cancer development but still there are correlation between the risk and the disease.

Background: Ostomy surgery is a common procedure that is performed with increasing frequency. The creation of an ostomy is a life-changing event in which patients might experience surgical complications and psychosocial problems. Anxiety and depres- sion are the most prevalent psychiatric issues among patients who have undergone ostomy surgery. In this study, we aimed to determine the rate and predictors of depression and anxiety in patients with a stoma in Saudi Arabia. Material and Methods: This cross-sectional study included all adult patients who underwent stoma formation surgery in Saudi Arabia. Two validated tools—the Generalized Anxiety Disorder-7 (GAD-7) questionnaire and the Patient Health Questionnaire-9 (PHQ-9)—were administered. Additional clinical variables collected for each participant included age, gender, chronic diseases, details regarding stoma surgery, and stoma care assistance factors. Results: Eighty patients were enrolled in the study and had a mean age of 39.5 ± 15.3 years. Half were male (41, 51%) and half had undergone a colostomy (41, 51%). Overall, 75 patients (94%) had stoma-related complications. The prevalence of anxiety was 56% (45 patients) and of depression was 67% (54 patients). Females, patients with a colostomy, and those who were having problems obtaining spare parts for their stoma had significantly higher GAD-7 scores, and females and patients who reported having problems obtaining spare parts had significantly higher PHQ-9 scores. Conclusion: Anxiety and depression are common among patients with a stoma. Several factors could influence their psychosocial well-being, including those related to the patient, to the surgery, and to the patient’s health care support.

Colorectal cancer represents a substantial percent of global cancer burden. Left side-based cancer are sometimes complicated by anastomotic leak. As such stoma is selectively reconstructed to decrease the impact of leak. 112 patients from a tertiary hospital were recruited and reviewed for basic data and compared for the risks of establishing stoma and its outcomes. Most of the patients had a sigmoid cancer, stoma was performed in 35.7% of studied patients. The only risk factors were obstruction and prolonged op- eration time. However, neither the complications rate, recurrence rate, nor perioperative mortality were different between those who underwent stoma and those who did not. In conclusion, careful selection of the patients candidate for stoma formation is cru- cial.

Background: Acute complicated appendicitis is a common emergency in children. Unlike simple appendicitis, Laparoscopy is not an accepted procedure for complicated appendicitis in children for many pediatric surgeons. This procedure is associated with a more inside of postoperative abdominal abscess reported in some cases. We study the security, efficacy and complications of laparoscopy in children with complicated appendicitis . Methods Between May 2018 and May 2021, 50 children aged 4 to 16 years with complicated appendicitis were treated by laparoscopic appendectomy in all cases at the department of Pediatric Surgery, Faculty of medicine, Tanta university hospital, Egypt Primary outcomes were incidence of complications, intraabdominal abscess and wound infection. Secondary outcomes were length of operation, hospital stay, resumption of diet and incidence of bowel obstruction. Results: LA was performed in 50 children aged 4 to 16 years (mean of 8.3±4.212 year) over a 3-year period. All cases had complicated appendicitis (either localized or generalized peritonitis). There was one conversion to open appendectomy (OA) in a patient with gangrenous perforated base with friable cecum. The Average duration of symptoms was four days (ranged 3-6 days). The mean length of operation was 51.7 ± 18.5 min (ranged 40-80 minutes). The average length of hospital stay was 2.6 days with range of 2-7days. intraabdominal collection was presented in 3 patients(6%), Postoperative ileus in 2 patients (4%), wound seroma in 4 patients (8%), wound infection in 4 patients (8%). The average follow-up was 3 months. Conclusions: Laparoscopic appendectomy is safe, feasible, and effective procedure in the management of complicated appendicitis in children, with no evidence of any increase in the postoperative complications.

Background:Hemorrhoids a very common anorectal diseases that affected both genders at any age with a peak incidence ~ 45 and 65 years. There are different hemorrhoids treatment modalities ranging from conservative approach for 1st and 2nd, whereas 3rd and 4th degree usually require surgical intervention like; milligan-morgan hemorrhoidectomy (MMH) and laser hemorrhoidoplasty (LHP). The current study aimed to assess efficacy and postoperative outcomes of MMH comparing with LHP in patients with 3rd degree he- morrhoids. Patients and methods: Our prospective comparative clinical study was carried out on 30 patients with 3rd degree hemorrhoids in- tending for treatment. Fifteen patients underwent a standardized MMH technique, (group I), and the other 15 operated upon with LHP (group II), using diode laser of 980 nm (Lasotronix). Postoperative pain was assessed using a visual analog scale (VAS) at 7, 14, 28, 42 and 180 days post-operation. Operative time, hospital stay, and postoperative bleeding were also assessed. Results: There was a statistically significant difference between the 2 groups regarding operative time, hospital stay and postopera- tive pain (p value < 0.001), with less time taken for the LHP group 14.60 ± 3.13 versus 29.53 ± 4.05 minutes in MMH group. The mean VAS score of 9.53 ± 0.51 in group I vs 5.9 3 ± 0.79 in LHP group, 1 day postoperation, with a significant improvement in LHP group at follow up days (~ 0 VAS score). Regard bleeding and infection, there was no significant difference was found between 2 groups. Conclusion: Taken together, our outcomes endorse our assumption that, although open MMH technique is the mainstays for 3rd degree hemorrhoids management, LHP is an innovative, effective, and could be a promising alternative with a good patient ac- ceptance and postoperative outcome improvement.

Background: Bikini line laparoscopic cholecystectomy is a safe method, used as a hidden scar cosmetic port technique for gall bladder diseases in obese patients as a day case. Objective To investigate the safety and efficacy of an elective Bikini line laparoscopic cholecystectomy in obese patients with chronic calculus cholecystitis and review our experience with this technique as a day case minimal invasive, scarless technique. Sieda BM., et al. Surg Chron 2022: 27(1): 79-86. Patient and method A Prospective randomized controlled trial study was undertaken between January 2017 and February 2021. The sample consisted of 480 patients, of which only 416 were analyzed, 216 patients underwent multi-port laparoscopic cholecystectomy, and 200 patients underwent Bikini Line laparoscopic cholecystectomy at two institutes. Procedures were performed under general anesthesia, and most of the cases underwent day-case surgery. The variables to be analyzed were operative time, the success of day case and length of stay, conversion rate, complications, pain scoring, and aesthetic results. BMI fell to between 25 to 39.9Kg/m2. Results: No differences were found between both groups about the baseline characteristics. Bikini line laparoscopic cholecystectomy achieved the target of one-day case surgery with better, faster recovery and reduced length of stay. Operative time was nearly the same, postoperative pain was significantly lower, and Cosmoses was better. Conclusion: Bikini Line laparoscopic cholecystectomy is a technically safe and effective day surgery procedure for chronic cholecystitis patients, with higher patient satisfaction about pain and cosmoses. Obesity, intended as BMI 40, is not an obstacle to the technical feasibility of BLLC.

Background: Aortoenteric fistula (AEF) is uncommon condition but may be one of a fatal causes of bleeding from gastrointestinal tract and Operative management of aortoenteric fistula is associated with high incidence of mortality and morbidity. Objectives: To assess the different methods of management of patients presented with primary or secondary aortoenteric fistulas and the outcomes of management. Patients and Methods: This study was conducted to patients presented to Kasralainy teaching hospital with upper gastrointestinal bleeding with history of aortic aneurysm or aortic graft in which two different methods of treatment either open surgery or endovascular intervention was done for these patients with assessment of outcomes and postoperative complications. Results: This study included 9 patients 7 of them were males and 2 females with mean age (±51.6 years). Hematemesis was the main presentation in 6 patients, bleeding per tectum in 3 cases, shock in 2 patients and groin infection in 2 patients. According to type of fistula, three patients presented with primary AEF and the other 6 patients presented with secondary aortoenteric fistula Conclusion: Patients with AEFs have high incidence of mortality. Endovascular management gives an alternative to open surgery and associated with low perioperative mortality and morbidity and a short hospital stay with accepted survival rate.

Background: Current management of diabetic foot ulcer consists of an effective systemic and local therapy. Despite these measures infection control has been found to be inadequate leading to amputation in as high as 28.4% of these patients. Recent studies have shown local hyperglycaemia at the wound site as a cause of poor wound healing. Aim: To compare the rate of wound healing following topical insulin and conventional dressing in patients with diabetic foot ulcer. Material and Methods: All patients with diabetic foot ulcer above 18 years of age had undergone appropriate debridement and regular conventional dressing till the wounds were deemed clean. Subsequently, the patients were randomised into either Group A which received topical insulin dressing or Group B which received normal saline dressing. Ulcer size was measured once a week in both the groups till 12 weeks or complete re-epithelization of the wound. Random blood glucose levels were measured 10 minutes before and 1 hour after application of topical insulin in Group A patients. Results: A total of 66 patients were included in the study and randomised into two groups (33 each). The demographic, biochemical and ulcer characteristics were comparable between the groups. The rate of wound healing in group A was 48.97±6.54mm2/day and in the group B was 41.62±5.84mm2/day (p-value 0.05). Mean blood glucose levels pre and post insulin dressing was 139.87±14.20 mg/dl and 139.47±15.50 mg/dl respectively. Conclusion: The wounds, which are treated with topical insulin, have healed faster than those receiving conventional dressings with normal saline.

Background: Preoperative platelet counts outside the normal laboratory reference interval (RI) are associated with postoperative complications, and thus have potential prognostic relevance. However, there are inherent differences in platelet counts between racial groups, and platelet RIs established in Caucasians might not be applicable to other populations. Accordingly, platelet RIs based on Caucasians might yield incorrect perioperative risk estimates in African settings. We tested this hypothesis in a sample of South African (SA) patients undergoing major abdominal surgery. Methods: We conducted retrospective chart reviews involving data from 422 patients who underwent laparotomy at a quaternary SA hospital. We stratified platelet count using the international (150-450 x109/L in both males and females) and local SA (171-388 x109/L in males and 186-454 x109/L in females) RIs. Receiver Operating Characteristic (ROC) curve statistics were used to determine the prognostic accuracy of the two RIs for postoperative mortality, with results presented as C-statistics with 95% confidence intervals (95%CI). Results: Thrombocytopenia (TCP, platelet count < lower limit of RI) was associated with postoperative mortality (p<0.001). Both RIs demonstrated similar prognostic accuracy for postoperative mortality (local SA RI C-statistic: 0.658, 95%CI: 0.586-0.731 and International RI C-statistic: 0.638, 95%CI: 0.564-0.712). The overall performance of both RIs was fair, suggesting that platelet count on its own might be insufficient for perioperative risk stratification purposes. Conclusion: TCP is associated with postoperative mortality in our setting. The prognostic accuracy for postoperative mortality was similar for both RIs. Preoperative platelet count may be useful if incorporated into a multifactorial perioperative risk index.

Η ανώμαλη (έκτοπη) θέση της χοληδόχου κύστης αποτελεί ένα σχετικά σπάνιο εύρημα, καθώς και οι αναφορές στην βιβλιογραφία είναι ελάχιστες. Αποτελεί πρόσκληση για τον χειρουργό, τόσο σε επίπεδο διάγνωσης, όπου η κλινική εικόνα δεν είναι τυπική στις σπάνιες περιπτώσεις εκτοπίας, όσο και κατά τη χειρουργική επέμβαση, ιδιαίτερα όταν συνυπάρχουν και άλλες ανωμαλίες των χοληφόρων. Η έκτοπη θέση προδιαθέτει σε δημιουργία λίθων, πιθανώς λόγω στάσης της χολής. Η λαπαροσκοπική χολοκυστεκτομή, σύμφωνα με τη βιβλιογραφία, έχει εφαρμογή στην χειρουργική αντιμετώπιση της χολολιθίασης, όταν η χοληδόχος κύστη εντοπίζεται σε μη φυσιολογική θέση. Ωστόσο, υπάρχουν περιπτώσεις όπου η λαπαροσκοπική προσέγγιση κρίνεται αδύνατη, οπότε και προτείνεται η ανοιχτή χειρουργική. Σημαντική είναι η έγκαιρη διάγνωση της έκτοπης θέσης της χοληδόχου κύστης, ώστε να επιλεγεί το κατάλληλο χειρουργικό θεραπευτικό πλάνο, με γνώμονα την αποφυγή μειζόνων κακώσεων και την ασφάλεια του ασθενή. Σημαντικός σκοπός είναι η καθιέρωση μιας ταξινόμησης με επίκεντρο τη χειρουργική αντιμετώπιση, που θα καθορίζει την επιλογή της κατάλληλης χειρουργικής προσπέλασης ανάλογα με τη θέση της χοληδόχου κύστης.

Cronh’s disease (CD) can affect any region from mouth to anus. We described a 23 years old guy who has been diagnosed with CD for 5 years and previously had multiple surgeries due to complications of CD who came in with symptoms of intestinal obstruction. 6 weeks prior, he had a metallic stent inserted to relieve the gastric outlet obstruction (GOO) due to the gastroduodenal involvement of CD. The intestinal obstruction was secondary to the migration of the metallic stent. In this case report, we briefly explained regarding complications of placement of metallic stents and possible ways to prevent it.

Introduction: Amyand’s hernia is the presence of a vermiform appendix in an inguinal hernia sac. It is a rare condition found approximately 1% of the reported cases and even more infrequently about 0.1% reported cases associated with acute or perforated appendicitis. Pre-operative diagnosis is very difficult and most of the cases are encountered during hernia repair. Case presentation: We presented a 1 month old child who was diagnosed to have right reducible inguinal hernia since birth. At his elective right herniotomy we inadvertently found a mildly inflammed tip of vermiform appendix in the inguinal sac. The body and base of appendix was healthy and there was no fluid collection seen. We decided not to remove the appendix and only performed herniotomy for this child. Antibiotics were completed for 1 week, post operatively was uneventful and no complications noted during follow up. Discussion: Amyand’s hernia is a very rare disease. In the pediatric age group, computed tomography scan and ultrasound is not commonly practise before the operation, thus its pre-operative clinical diagnosis is very challenging. Treatment includes herniotomy with or without appendectomy depending on the level of inflammation and patient’s general condition. Surgeons should be prepared if they encounter an Amyand’s hernia especially in the symptomatic inguinal hernia over the right side to ensure that no complications and recurrence occur post operatively.

Introduction: Fournier Gangrene (FG) is defined as necrotizing fasciitis involving external genitalia, perineal and perianal region. Isolated penile FG is rare owing to its different anatomical and rich blood supply. We reported an unusual case of an isolated penile FG with history of foreign body insertion in our centre. Case presentation: A 42-year-old man with no co-morbid presented to us with one-week history of blackish discolouration and painful swelling of the penis. Further history revealed he had beads insertion to the penile shaft previously. He was promptly treated with suprapubic catheterization and surgical debridement in operation theater after adequate resuscitation and admin- istration of broad-spectrum antibiotics. He recovered and was discharged uneventfully after 10 days. Subsequently he was scheduled for definitive reconstructive surgery in a tertiary centre but he opted for conservative management. Discussion: FG is a surgical emergency caused by fulminant polymicrobial infection involving the fascia and subcutaneous tis- sues. It is associated with high morbidity and mortality. The diagnosis is made on clinical ground and imaging should only be used as an adjunct and not to delay the treatment. Our case of isolated penile FG is related to the foreign body inserted previously as a traumatic insult. Mainstay of treatment for FG include prompt diagnosis, optimal resuscitation, usage of appropriate broad-spectrum antibiotics and early surgical debridement. Structural integrity and reconstruction should be performed when condition is feasible later. Conclusion: There should be low threshold for diagnosis of FG for early treatment. Multidisciplinary approach should be adopted for good surgical outcomes.

Transverse and right colon volvulus is an extremely rare cause of intestinal obstruction. We report a case of a 26-year-old patient where both pathologies occurred in combination with non-rotation of intestines. We discuss the diagnosis and management along with a review of current literature.

Spontaneous rupture of an ovarian artery following vaginal delivery is extremely rare cause of postpartum haemorrhage but usually life-threatening event. The classical presentation including sudden onset of abdominal pain and hypovolaemic shock with no evidence of vaginal bleeding. Early recognition with prompt surgical interventions is mandatory to achieve a favourable outcome for patient because of its association with high maternal and fetal mortality. We report a case of spontaneous retroperitoneal haemorrhage caused by rupture of a right ovarian artery in a post vaginal delivery patient.

Kalimate or kayexalate, also known as Sodium polystyrene sulfonate (SPS) is a cation exchange resin and is commonly used in treating hyperkalemia especially in patients with renal insufficiency. Several literatures have reported among the side effects of kalimate include colonic necrosis and perforation. The pathophysiology that leads to this remains unclear. We presenting a rare incidence of pneumoperitoneum with spontaneous bacterial peritonitis (SBP) developed following administration of oral kali- mate in a patient with chronic renal insufficiency. Laparotomy performed revealed necrotic bowel with no obvious perforation. Part of the omentum was sent for histopathology study showed peritonitis with kayexalate crystal deposition. Surgeons’ suspi- cion for SBP should be heightened in patients with chronic renal insufficiency on oral kalimate.

Background: Follicular variant of papillary thyroid cancer (FV-PTC) is a variant of papillary carcinoma which, while metastasizing rare- ly, can spread and mostly affect the lungs and the bones. It is known to metastasize like classic papillary thyroid carcinoma, mostly disseminating through a lymphatic route and rarely haematogenously. Case Presentation: We present a rare case of a 44 year-old Malay lady presenting with a left scapula mass. She has a history of mul- tinodular goitre for which she underwent a right hemi-thyroidectomy 14 years prior. In her current presentation, biopsy of the left scapula mass revealed metastatic carcinoma consistent with thyroid in origin. She underwent an intra-articular total scapulectomy with sparing of the humeral head, followed by completion thyroidectomy. Histopathological examination of the resected left thyroid lobe showed FV-PTC. However, no lymphatic spread was identified during either surgery, suggesting haematogenous spread. Post- operatively she was well and was discharged on suppressive dose of thyroxine. Conclusion: This case report served to illustrate and discuss the presentation, investigation and various aspects of management of FV-PTC. Most interestingly, while FV-PTC rarely metastasises and, when it does, it mostly disseminated via lymph nodes, our report demonstrated a case of how FV-PTC did not involve lymph nodes during metastasis, but rather was able to metastasise via a haema- togenous route.