Fluorescent imaging is increasingly being used to assist surgeons in making intraoperative decisions, which requires the use of fluorescent dyes that accumulate in anatomical or pathological structures, and their radiation is recorded by a laparoscope, with the function of detecting fluorescence. This review focuses on the use of fluorescent imaging in gastrointestinal surgery. The ad- vantage of using fluorescent dyes is that they are highly selective for the target of interest. When using the indocyanine green, the intensity of the fluorescence signal detected in the tissue can be used as a marker of tissue perfusion, to assess the state of intes- tinal perfusion, intestinal anastomoses, anastomotic leaks, and the presence of affected lymph nodes. According to our data, the introduction of ICG into the mucosa around the tumor at the beginning of the operation makes it possible to clearly define the boundaries of the tumor lesion, which excludes the intersection of the intestine near the tumor. In addition, it is possible to visu- alize all the lymph nodes and lymphatic vessels through which the outflow of lymph from the tumor occurs. This makes it possible to determine the primary "sentinel" lymph node, the defeat of which requires an extended lymph node dissection, and in patients in whom the "sentinel" lymph node is not affected, you can limit yourself to a smaller volume of surgery. There is now increasing evidence that the use of fluorescence imaging during laparoscopic surgery can help the surgeon make intraoperative decisions in a wide range of situations, especially in assessing tissue perfusion, tumor pathology, lymphatic drainage, and identification of the urinary tract.

Background: Following pancreatic resection, postoperative pancreatic fistula (POPF) is still the leading cause of significant morbidity and death. As pancreaticoduodenectomy (PD) is one of the greatest challenges in gastrointestinal surgery, the current study aimed to evaluate either internal or external drainage is the best technique for preventing pancreatic fistula (PF) following pancreaticoduodenectomy (PD). Patients and methods: After the exclusion of 12 patients, 48 patients were included and subdivided into two groups; the internal drainage group: the pancreatic duct was drained into the intestinal lumen, and the external drainage group: the pancreatic duct was drained through the anterior abdominal wall. Results: Following up the patients for one month after the surgery revealed no significant difference between the two studied groups regarding the liver parameters. Postoperative drain amylase was less in the internal group than the external group. Operative time and hospital stay were slightly increased in the external group while the postoperative pancreatic fistula (POPF) was slightly increased in the internal group. Conclusion: there were no significant differences in the risks of postoperative complications between the internal and external drainage groups.

Background: Postpancreatectomy hemorrhage (PPH) is one of the most difficult complications. An attempt was made to evalu- ate the effectiveness of argon plasma coagulation to stop late intraluminal postpancreatectomy hemorrhage in patients after pancreaticoduodenectomy and pancreaticogastrostomy at the reconstructive stage. Patients and method: For the 2017-2021 period, 17 cases of late intraluminal postpancreatectomy hemorrhage (PPH) were considered (6 men and 11 women). Intraluminal PPH was stopped endoscopically using argon plasma coagulation. Results: All patients had bleeding from the stump of the pancreas into the stomach lumen. The average duration of bleeding was 46.6±14.1 hours. Patients with PPH Grade B had bleeding from 24 to 70 hours, patients with PPH Grade С – from 60 to 72 hours (OR 23.36, 95%, CI 6.74-80.98, p0.001). The positive effect of the one-stage endoscopic hemostasis with the use of argon plas- ma coagulation was observed in 100.0 % of patients with PPH Grade B and in 75.0 % of patients with PPH Grade C (one patient underwent relaparotomy). No iatrogenic complications were developed after endoscopic hemostasis. Conclusions: Our experience of using argon plasma coagulation demonstrates its safety and effectiveness. The results obtained by performing the endoscopic stoppage of hemorrhage with the use of an ionized argon stream (argon plasma) put this method on a par with the most effective and proven means of hemostasis.

Rapidly increase of medical diagnosis and assiduous depiction of imaging findings led to proper therapeutic mapping among clinical entities. In most of cases, especially in surgical controversial issues, use of endoscopic expertise increase potential therapeutic strategy. Neoplasms of the ampulla of Vater are uncommon, with a reported prevalence of 0.04% to 0.12%. Advances in endoscopy during the last 30 years have rendered endoscopic papillectomy (EP) a safe and less invasive therapeutic modality for small, benign periampullary tumors. Aim of our study, consists depiction of our surgical implementation in 5 cases (4 males and 1 female patients) of papillary adenomas accompanied with proper diagnosis and treatment.

Mine blast injuries occupy one of the leading places among the total number of injuries received during combat operations. Victims who are lucky enough to survive the incident often lose working capacity for life. Significant contamination and complete or partial loss of limb tissue require urgent medical care followed by tissue reconstruction aimed at restoring limb function and eliminating pain syndrome. At the same time, in the absence of adequate cleaning of the injury of the limbs and the impossibility of its reconstruction, the most frequent result in the treatment of patients of this category is the amputation of the affected limb. Among the possible effective means that help to improve the results of treatment and reduce the risks of negative consequences is the wound therapy with negative pressure (Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT)), which has become a generally accepted method in the process of curation of patients with mine blast injuries.

Introduction: Renal hyperparathyroidism is a known problem among patients with end-stage renal failure. Total parathyroidectomy is the mainstay of treatment in patients who fail to respond to medical treatment. However, the role of preoperative localization of parathyroid glands remains debatable. Objective: To determine the detection rate and sensitivity of ultrasound in locating the parathyroid glands preoperatively and the surgical outcome (completion rate of total parathyroidectomy). Method: Retrospective review of 93 patients with secondary or tertiary hyperparathyroidism due to end-stage renal failure who underwent total parathyroidectomy in our centre between January 2015 and December 2019. We compared the completion rate between patients who underwent and those who did not undergo preoperative neck ultrasound. Results: The detection rate of ultrasound in identifying enlarged parathyroid glands was 33.4% in patients with renal hyperparathyroidism, with a sensitivity of 77%. The completion rate of total parathyroidectomy in our centre was 82.8%. On the contrary, the completion rate was 75% in patients without preoperative localization of parathyroid glands. Conclusion: Conventional bilateral neck exploration had a higher detection rate in locating parathyroid glands as compared to preoperative ultrasound. Therefore, total parathyroidectomy without preoperative localization in patients with renal hyperparathyroidism can be considered a safe practice in breast and endocrine centres.

Background: Intestinal resection is a lifesaving procedure, one of the two options following resection is anastomosis which carries the best opportunity for the patient and his quality of life. However, A set of complications mainly leakage may follow with a variety of consequences that may threaten patient’s life. Strong efforts are being made to avoid anastomosis leak through avoiding factors which may increase incidence of leak and finding additional factors to promote anastomotic healing. The pedicled omental transposition (omentoplasty) for reinforcing the anastomotic suture line is tested regarding the incidence of leakage after intestinal resection. Methods: A prospective comparative study has been conducted on patients who have performed gastrointestinal surgery at Kasr El Ainy hospital from 2021 to 2022. Patients have been divided into 2 groups. The first group included patients who had undergone omental wrap around anastomosis [group A] [n=32] and the other group included patients who didn’t go through omental wrap around anastomosis [group B] [n=32]. Age range for both groups ranged from 18 to 73 years [mean 44.5 years]. Data analysis performed using SPSS statistical package. Results: Results revealed presence of statistically significant decrease in complication associated with anastomosis between the group undergone omental wrapping and the group undergone anastomosis without omental wrapping in favour of omental wrapping [P-value =0.047]. Conclusions: Anastomotic leakage is an expected complication after gastrointestinal anastomosis. Omental wrap proved to be a technique that enhances decreasing the post anastomosis leakage after gastrointestinal anastomosis.

Purpose: This study aims at detecting the leakage post Graham's patch repair of perforated peptic ulcer using inflammatory biomarkers (ESR, CRP and neutrophil lymphocyte ratio [N/L]) pre-operatively and day 2, 5 postoperatively. Methods: A prospective cohort study was performed at Cairo University's Kasr Al-Ainy Emergency Department. The study com- prised 75 patients who presented to the emergency room with a perforated peptic ulcer. The research lasted for six months. Results: On the second postoperative day, the N/L ratio was higher in patients with leakage than in those without leakage, but the difference was not statistically significant. On the fifth postoperative day, the N/L ratio was statistically higher in patients with leakage than in those without leakage, with a significant increase in C-reactive protein (CRP). On day 2, there was no differ- ence in ESR levels between patients with leakage and those without leakage. On day 5, there was an increase, but it was not sta- tistically significant. Conclusion: It is possible to detect early leakage after Graham's patch repair of a perforated peptic ulcer by monitoring CRP and NLR levels.

Background: ERCP is a relatively safe endoscopic procedure; however, there is the potential for severe, life-threatening complica- tions Aim and objectives: This clinical audit aim was to identify the gap between the management strategy of post ERCP duodenal perforation in Assiut university hospitals and the ideal practice "the guidelines published by the American society for Gastrointes- tinal endoscopy (ASGE) and to set recommendations for appropriate management strategy of post ERCP duodenal perforation to improve patient care and minimize morbidity and mortality. Patients and methods: The current study was conducted at Department of General Surgery of Assiut University Hospitals with reviewing the medical records of patients with post-ERCP duodenal perforation. It was done in period between 2018 and 2021. Results: All those patients had pneumoperitoneum and duodenal leakage. Only three patients had free collection. Regarding the surgical intervention; it was primary repair (100%), CBD exploration (100%), T-tube exploration (100%), duodenal exclusion (30.8%) and/or gastro-jejunostomy (30.8%). Conclusion: Accurate diagnosis and timely intervention are very important in patients with post-ERCP duodenal perforation. Clin- ical symptoms, imaging methods, and the mechanism of injury should be evaluated, and all these parameters should be considered before deciding whether to operate.

Background: The problem of unplanned surgical resection of breast cancer is a common clinical problem encountered in our prac- tice. It represents a demanding challenge for oncoplastic surgeons that often limits the available options for definitive surgery due to unplanned skin incision, unreliable vascular anatomy, and obscure safety margin status. Patients and Methods: The authors retrospectively reviewed the data system of the hospital for patients diagnosed with breast cancer between June 2008 & June 2018. 490 patients had unplanned resected breast cancers (Tx) and were enrolled in this study. The epidemiologic, pathologic, and operative data of these patients were analysed. Results: The average annual rate of unplanned resected breast cancer (Tx) in our hospital was about 17% among the new cases diagnosed with breast cancer. The age of the patients ranged from 21 to 57 (median 42.2)years. 409 patients underwent mastec- tomy (MRM or radical) without reconstruction and 14 patients received conventional conservative breast surgery. While 10 pa- tients had volume displacement oncoplastic surgery and 57 patients had volume replacement oncoplastic surgery. Subjective patient satisfaction was excellent in 55 cases, good in 22 cases, fair in 3 cases & poor in one case. Conclusion: Unplanned excision of breast cancer is still a surgical challenge; however, the application of oncoplastic techniques with wise selection results in a satisfactory aesthetic outcome, low morbidity, and comparable oncologic outcome.

Background: Metaplastic breast cancer (MPBC) contains one or more cell lines that have undergone metaplastic differentiation, converting from glandular to non-glandular morphology. They commonly harbor a triple-negative breast cancer (TNBC) phenotype, yet has a worse prognosis and decreased survival compared to the non-metaplastic TNBC. Methods: This is a retrospective study, where the institutional registry at the Oncology Center, Mansoura University was searched for patients diagnosed with metaplastic breast cancer. The objectives of the study were the assessment of disease epidemiology, the pattern of recurrence, and metastasis. The primary endpoint was disease-free survival, while the secondary endpoints were recurrence and distant metastasis. Results: Sixty patients were included in the study. More than half of the patients had clinically negative axilla (56.7%). In addition, 3 patients were metastatic at the time of diagnosis. Eighty percent of the patients’ final paraffin sections revealed mixed metaplastic carcinoma. About 3⁄4 of the patients (76.7%) were assigned as triple-negative. Only 23.3 % of the patients received neoadjuvant chemotherapy (NAC), and 11 patients (78.6% of the NAC patients) showed a regressive course (although non showed complete response). Recurrence occurred in 17 (28.3%) of the patients during follow-up (median 15 months). The 5-year DFS was 32%. The DFS was significantly related to the type of axillary surgery where those who did not do axillary staging had the worst prognosis (p-value.001), T stage (.001), and pathologic node-positive (.018), progression on neoadjuvant therapy (.025). Conclusions: Metaplastic breast cancer is uncommon breast cancer that cannot be easily diagnosed preoperatively. It tends to metastasize early and more frequently to the lungs. Complete pathologic response is not anticipated in these patients with neoadjuvant chemotherapy and only one-third of the patients will be disease-free for 5 years.

Aim. Surgical approaches for the treatment of splenic cysts (SC) in children remains controversial. There are various methods of organsaving operations on spleen with its cystic lesions in children. Aim of the stufy is to evaluate different options for surgical treatment of SC in children. Materials and methods: a retrospective study of diagnostic work-up and treatment of 265 children ages from 1 month to 18 years with splenic cyst from January 1998 to December 2019 was performed. 175 (66.04%) children underwent surgery. The other 90 (33.96%) patients were under dynamic observation. Results. 119 (68.00%) open and 56 (32.00%) laparoscopic interventions were performed in children with different localization of Among open operations, partial resection of the spleen was most often performed – in 70 patients, partial cystectomy with unroofing – in 36 children, partial cystectomy – in 12 patients, and splenectomy – in 1 child with total cystic lesion of the spleen. Recurrence of the cyst was observed in 2 (1.68%) patients, which was corrected by repeated partial cystectomy by laparotomy. Laparoscopic partial cystectomy was most commonly used in 30 children, cystectomy with unroofing – in 21 cases, and partial splenic resection in 5 children. Cyst recurrence was observed in 3 (5.36%) patients. Recurrence was also corrected laparoscopically in 1 case and open access – in 2 children. Minimal residual cyst cavity in the remote period was observed in 9 (7.56%) children after open and in 7 (12.50%) – after laparoscopic correction of the SC, which healed on its own within 1-2 years. Conclusion. Partial resection of the spleen, taking into account its segmental blood supply by laparoscopic or open method, is a rational organ-preserving method of treatment of splenic cysts. Partial cystectomy should be used for small cysts that occupy only one segment of the spleen. At cysts with a diameter up to 20 mm dynamic observation is rational

Introduction: Intestinal stoma following emergent abdominal surgery is a common surgical necessity. Caring about stoma creation is greatly affecting patient physical and psychological health. Many risk factors are contributing incidence of local stoma complications. Patients and Methods: 138 eligible patients were enrolled in this retrospective study. Patients characteristics and surgical variables were studies and the co-incidence of different early local stoma complication were reported to detect risk factors for developing stoma complications. Results: superficial mucocutaneous separation was the commonest complication (11.59%). Significant higher incidence of complications rate were found in patients with colorectal malignancies (40.57%). Loop colostomy has higher complications rate (55.17%) when compared with Hartmann's colostomy or ileostomy. Conclusion: Loop colostomy especially in colorectal malignancy has higher incidence local stoma complications.

Aim: The SMSA scoring system is a scoring system that assesses the difficulty of polypectomy by evaluating the size, morphology,site and access to the polyp during colonoscopy. The aim of this study was to evaluate the risk stratification of advanced pathology using the SMSA scoring system. Materials and Methods: This retrospective study included patients who underwent endoscopic mucosal resection for colon polyps in the endoscopy unit of the Gastroenterology Surgery Clinic between 2014-2019. Results: A total of 354 procedures were evaluated. Of the total lesions, 92.9% were 2 cm. 71.8% were sessile, 70.9% were in the left colon and in 91.2% the access was easy. Stages of the lesions were determined as 34.7% at stage 1, 57.9% at stage 2, 6.5% at stage 3 and 0.8% at stage 4. It was observed that the possibility of additional procedure, complication, surgical necessity, piecemeal resection and advanced pathology increased with increasing SMSA score (p0,001). Conclusion: The SMSA scoring system can be used to assess the risk stratification of advanced pathology in colorectal polyps.

Background: Cirrhosis represents the final common histological pathway for a wide variety of chronic liver diseases Aim and objectives: The aim of this work was to assess the outcome of local repair of umbilical hernia in cirrhotic patient using intraperitoneal onlay mesh technique in terms of conversion rates, postoperative complications and length of hospital stay within and after 3 days of symptoms onset. Patients and methods: A prospective cases series study was conducted at Department of General Surgery of Assiut University Hospitals. It was done in period between 2019 and 2021. Results: It was found that wound infection occurred in 2 (7.4%) patients. three patients had minor bleeding and another one patient had major bleeding. Only one patient was complaining of wound dehiscence and hernia recurrence occurred within one month postoperatively. Conclusion: Conservative management of umbilical hernias in patients with liver cirrhosis and ascites leads to a high rate of incarcerations with subsequent hernia repair in an emergency setting and, therefore, is not advocated. Based on the current study, local repair of umbilical hernia in cirrhotic patient using intraperitoneal onlay mesh technique is feasible and safe, with a high success rate in experienced hands and results in minimal perioperative morbidity.

Background: History of hernia and its repair spans more than two millennia. Today, there are established standards regarding most appropriate approach for managing hernia. However, there is still no uniformity about most appropriate technique for anaesthesia for hernioplasty in a limited-resource setting. Aim: Study aimed at assessing and evaluating intra- and postoperative outcomes among participants who underwent Lichtenstein tension-free hernia repair under either Spinal or Local anaesthesia. Material And Methods: Hospital-based, single-centre, prospective, observational study, involving 144 male patients with unilateral uncomplicated hernias conducted 24 months. Data about duration of surgery, intraoperative and postoperative complications & side effects were recorded. Results: A total of 52 (36%) participants were given LA and the rest 92 (64%) were given SA. The median pain score among participants during surgery in LA and SA group was 2 and 0, respectively, mean duration of surgery among participants in local and spinal anaesthesia groups were 87.4 and 57.8 minutes, respectively. The percentage of participants experiencing headache and nausea were 0% & 2%, in the LA group and 8.7% & 10.8% in the SA group, respectively. The percentage of participants in the LA and SA group: having trouble in micturition was 0% and 19% (p = 0.0014), having urinary retention were 3.8% and 11.26% (p = 0.0011), and needing catheterization were 0% and 7.6% (p = 0.0414). Conclusion: Hernioplasty could be safely and effectively completed under local anaesthesia. Although, the pain during the surgery was a cause of concern both for surgeons and patients.

Background: Acute appendicitis presents with little diagnostic challenge. Various scoring methods have been established, yet there is no conclusive laboratory indicator for diagnosing uncomplicated and complicated appendicitis. Research has illustrated hyperbilirubinemia to be associated with both uncomplicated and complicated appendicitis but importance of the same is not emphasized upon sufficiently. Taking into consideration the aforementioned background, the current study had been undertaken to analyze the relationship between Hyperbilirubinemia and acute appendicitis. Materials and method: This was a Prospective Observational study which included patients who underwent Appendectomies in the study period of 2 years from December 2019- December 2021 at our Centre. Pre-operative levels of serum bilirubin and intra- operative findings were noted and evaluation of sensitivity, specificity, positive predictive value and negative predictive value was done. Results: A total of 63 patients diagnosed with Complicated and Uncomplicated Appendicitis underwent Appendectomies. Both mean Total serum bilirubin and Direct bilirubin levels were found to be significantly raised in patients with Complicated appendicitis with a p value of 0.04 and 0.01. Mean total serum bilirubin levels and levels of direct serum bilirubin in complicated appendicitis were 1.22 mg/dl SD 0.28 and 0.55 mg dl SD 0.29 respectively. Conclusion: Total along with direct serum bilirubin levels emerge as new laboratory markers to diagnose patients with Complicated appendicitis. Cases showing clinical signs and symptoms of appendicitis along with hyperbilirubinemia should be recognized with greater likelihood of Appendicular perforation proposing that hyperbilirubinemia has a foretelling prospect in the diagnosis of Appendicular perforation.

Background: Totally implantable venous access devices (TIVADs) are considered a standard of care for administration of intra- venous (IV) chemotherapeutic drugs in most centers, especially for patients needing long term chemotherapy which aims to achieve easy, painless, and secure venous access. It can reduce the apprehension and anxiety associated with IV access that increases with each chemotherapy. Methods: This prospective study was conducted at KIMSDU Karad, in patients diagnosed with breast cancer. Our primary aim was to assess the morbidity and patient satisfaction of chemotherapy administration via chemoport and comparing it with patients receiving chemotherapy through peripheral venous access. Results: We observed that chemoport insertion through subclavian vein showed more complications compared to internal jugular vein which included blockage and port site infection. However, patients receiving chemotherapy by chemoport showed better satisfaction as it avoided multiple pricks, discomfort, pain, redness or arm edema associated with peripheral IV line. Conclusion: We concluded that satisfaction rate was higher in patients using chemoport for chemotherapy-as it speeded up the sessions, was less painful and only few people felt its presence affecting cosmesis/day to day activities.

Aim: To evaluate the safety, clinical outcomes, impact on the quality of life, rate of ulcer closure, and the rate of occlusion of the great saphenous vein (GSV) at one year following radiofrequency ablation (RFA). Methods: This is a retrospective study of patients who underwent RFA for refluxing great saphenous veins ablation between June 2018 and June 2019. All patients had symptomatic varicose veins with documented GSVI and were classified according to the clinical, etiologic, anatomic, pathophysiologic (CEAP) classification and venous clinical severity score (VCSS). Patients were included if aged 18-60 years old, having primary GSVI with CEAP 2-6 and GSV diameter >3mm and 15 mm. GSV occlusion rate wasassessedby DuplexUSastheprimaryoutcomeatone,6,and12monthsfromtheprocedure.Secondaryoutcomesincluded improvement in CEAP and VCSS at 6 and 12 months. Results: A total of 60 limbs in 50 patients underwent RFA procedures to treat symptomatic reflux in the GSV. The patients’ age ranged from (28-60) years old. 60 % o f patients were women. Successful GSV closure using RFA was achieved in all 60 limbs at the end of the procedure with a 100% technical success, while 57 limbs were still occluded at one-year follow-up with a 95% technical success. Perioperative complications included postoperative paresthesia in 5 patients (8.3%), ecchymosis in 3 (5%), phlebitis i n 3 (5%), hyperpigmentation i n 2 (3%), skin burns in one case (1.6%), deep vein thrombosis in 2 (3%), and wound infection in one case (1.6), with no incidence of pulmonary embolism or mortality. Conclusion: RFA continues to prove its efficacy in varicose veins treatment with associated low complication rate, satisfactory one- year freedom from recanalization, and improved VCSS.

Background: It is reported that coronavirus disease (Covid-19) can affect the sense of smell and taste of infected people. It is therefore important to explore the impact of COVID-19 infections on olfactory and gustatory functions in patients with comorbid- ities in Northwestern Greece. Material and Methods: We used a questionnaire to collect information about patients' demographics, medical history and symp- toms during infection. The total sample consists of three hundred patients. 150 of them recovered at home while the other half were hospitalized. A subgroup of 53 patients with comorbidities, such as hypertension, diabetes mellitus (type I & II) and cardio- vascular diseases (CVD) were examined separately. Results: Αnalysis of reported symptoms showed that 57% of patients appeared loss of smell during infection, in the total sample. In the subgroup of hospitalized patients this rate was 46,67%, while in self-quarantined patients this rate was 67,33%. A statistically significant difference (p=0.000) was found regarding the loss of smell in home-quarantine patients compared to those who were hospitalized. Μoreover, a statistically significant difference (p=0,008) was shown between the subgroup of patients with comor- bidities and without olfactory loss. Conclusion: Our data, confirm the commonality of chemosensory dysfunction in Covid-19 infection and the significantly less pro- nounced combined symptoms of anosmia and dysgeusia in patients with co-morbidities. Although there are insufficient data on the clinical course of covid_19 disease, our study shows that olfactory dysfunction in patients with covid-19 is statistically signifi- cantly related to the patient's recovery at home, in Epirus, Greece.

Vomiting is a common chief complaint by patients when presented to the emergency department. The causes of vomiting can be either medical or surgical causes. One of the surgical causes of vomiting commonly overlooked by the physician is obstructed gastric volvulus. Here we report a case of an unfortunate man who came with chronic persistent vomiting associated with epigastric and chest pain. During his admission, esophagogastroduodenoscopy and computed tomography (CT) of abdomen/pelvis were performed and confirmed a gastric volvulus with para esophageal hernia. The patient was then subjected to laparotomy, gastric volvulus reduction, gastropexy and fundoplication. He recovered well and was safely discharged home.