Breast cancer, which is the most prevalent cancer affecting women worldwide, stands as a significant contributor to cancer-related deaths. The American Joint Committee on Cancer has adopted a comprehensive approach to breast cancer staging, which now integrates biomarkers like ER, PR, HER2, and tumour grade alongside the traditional T, N, and M staging system. Biomarkers have emerged as key players in patient management, aiding in the selection of optimal systemic therapies. Physicians, especially those involved in breast cancer care, must acknowledge the critical role of biomarkers. Assessing the status of ER, PR, and HER2, with particular attention to Ki-67 and CDK4/6, is essential for guiding treatment decisions and predicting outcomes. This review aims to offer concise insights tailored to breast surgeons, general surgeons, and physicians, with the goal of enhancing understanding regarding the complexities surrounding the use of breast cancer biomarkers in everyday clinical practice.

Introduction: Despite the development of minimally invasive radiological and endoscopic approaches, surgery is still used for biliary bypass when there is an indication. The laparoscopic approach remains marginal in Western literature, while no studies were found on this approach in Africa. This study is thus a preliminary report of our experience on this technique. Methodology: This was a longitudinal descriptive study with prospective data collection over a period of 5 years 7 months in two referral hospitals in Cameroon (Central Africa). All patients who underwent laparoscopic choledochoduodenostomy (CDD) procedures with a known 30- day post-operative follow-up were included. Results: We registered a total of 15 patients. The mean age of the patients was 64.2 ± 15.7 years, with a sex ratio of 1.14. Clinically, all patients had cholestatic jaundice. The main indication for laparoscopic choledochoduodenostomy was unresectable pancreatic head tumors (66.7%; n = 10). In 26.7% of patients, per-operative difficulties were mostly a very distended gallbladder. The average time of surgery was 186 ± 45 mins. Blood loss was less than 100 cc in 73.3% of cases. There was no conversion to laparotomy. The morbidity rate was 26.7%, with one patient presenting with a biliary fistula which resolved with conservative treatment. The average hospital stay was 5.8 ± 2.9 days. One case of death was recorded, thus, a mortality rate of 6.7%. Conclusion: CDD is reproducible, safe and effective, with low morbidity and satisfactory results even in low-income settings.

Background: Given the known consequences of Gastroesophageal reflux disease (GERD), it is important to develop and optimize techniques that decrease the chance of a resulting reflux after surgery. Concomitant repair of the hiatus hernia (HH) during sleeve gastrectomy is a safe option, which may have some impact on the symptoms of reflux. Aim: The goal of our study was to compare the results of anterior and posterior cruroplasty during sleeve gastrectomy and their effect on GERD resolution and recurrence rates. Methods: This was a comparative surgical study including 40 morbid obese patients who underwent LSG with cruroplasty conducted at Helwan University hospitals comparing anterior cruroplasty and posterior cruroplasty on morbid obese patients undergoing LSG and were diagnosed with HH. Results: RSI scores were significantly reduced in both groups postoperatively. GERD symptoms resolution was better in the posterior cruroplasty group but statistically there was no difference between anterior cruroplasty and posterior cruroplasty (p = 0.29). There were no postoperative complications in both groups. Each group had 2 patients who needed redo surgery for recurrence of HH. Conclusion: LSG with cruroplasty is an effective and safe method weight reduction and treatment of GERD caused by HH in morbid obese patients.

Background: Single anastomosis sleeve jejunal (SASJ) bypass is a promising technique compared to the currently used bariatric procedures. This study compared SASJ bypass to sleeve gastrectomy (SG) and one- anastomosis gastric bypass (OAGB). Patients and Methods: This randomized clinical trial included 90 patients assigned to three groups (SG, OAGB, and SASJ). Postoperative follow-up visits were scheduled at 3, 6, and 12 months. In each visit, the patients were assessed regarding the actual body weight (ABW), excess weight loss (EWL), actual body mass index (aBMI), excess BMI loss, frequency scale for symptoms of gastroesophageal reflux disease (FSSG) symptoms, the Gastrointestinal Quality of Life Index (GIQLI), and improvement in obesity-related comorbidities. Results: We found no significant differences regarding the ABW, EWL, aBMI, excess BMI loss, or rate of improved comorbidities among the studied groups. The SASJ bypass group showed significantly lower FSSG scores compared to SG and OAGB groups at 3, 6, and 12 months postoperatively. Additionally, the SASJ bypass group had significantly higher scores of GIQLI than the other two groups at 3 months. Meanwhile, the GIQLI scores of the SASJ bypass group were still significantly higher than the OAGB group at 6 and 12 months, but insignificantly higher than those of the SG group. Conclusion: The SASJ bypass is a safe, effective technique of bariatric surgery that provides comparable results to SG and OAGB but with less frequency of gastroesophageal reflux disease and better quality of life. Future studies should compare the long-term outcomes of SASJ to the gold standard procedures.

Background: Primary restrictive procedures such as Vertical Banded Gastroplasty (VBG), Laparoscopic Adjustable Gastric Banding (LAGB) or Laparoscopic Sleeve Gastrectomy (LSG), have shown safety and efficiency as bariatric methods. However, these procedures pose the risk of weight recidivism. Roux en Y gastric bypass (RYGB) is the most often used revision technique. One-anastomosis gastric bypass (OAGB) has gained popularity during the past ten years. Aim and Objectives: Comparative study between OAGB and RYGB as revisional procedures after failed primary restrictive procedures in terms of weight loss and quality of life improvement throughout a 1-year follow-up period. Patients and Methods: The study included 88 adult patients who presented to the general surgery department, Kasr Al-Aini hospital with morbid obesity after failed laparoscopic sleeve gastrectomy (LSG), vertical banded gastroplasty (VBG) or laparoscopic adjustable gastric band (LAGB). Candidates are classified into 2 equal groups: Group A who are candidates for one- anastomosis gastric bypass (OAGB) and group B who are candidates for laparoscopic Roux-en-Y gastric bypass (LRYGB). This comparative study evaluates weight loss and quality of life improvement over 1- year follow-up period. Results: A significantly lower mean operative time was shown in the OAGB group. The rates of early postoperative complications were comparable in both groups. One year after surgery, both groups showed comparable weight loss and significant improvement in the obesity-associated comorbidities. A higher incidence of DE novo GERD was shown in the OAGB group, so quality of life shown to be better in RYGB group. Conclusion: This study supports the efficacy and safety of OAGB for revision of failed restrictive procedures. There remains concern regarding post-OAGB GERD, and RYGB should be preferred in cases of postoperative GERD.

Background: Rectal intussusception (RI), also termed internal intussusception, occult rectal prolapse, intrarectal prolapse, and internal procidentia, is a telescoping of the rectal wall during fecal evacuation [1]. The pathophysiology and cause of RI is not well known. postulated theories of etiology include two general lines of thought: RI is a dynamic anomaly which may proceed to rectal prolapse; or RI is secondary to other abnormalities of pelvic floor function. Loosely fixed rectum to the sacrum or connective tissue disorders may add to RI. It is postulated that symptoms of obstructed defecation due to RI occur due to the circular infolding of the rectal wall with resultant occlusion of the rectal lumen [2]. Objective: To assess the incidence of defecation urgency post stapled trans-anal rectal resection using double PPH stapler in the surgical management of obstructed defecation Methods: 19 patients with rectal intussusception underwent STARR operation using double PPH staplers. Results: Regarding post-operative defecation urgency, 6 patients out of 19 patients suffered from defecation urgency which improved in 4 patients and still present in 2 patients after 12 months follow up.

Backgrounds and aims: The aim of our study is to evaluate the relation between obstructed defecation syndrome (ODS) and levator diameter by TRUS (transrectal ultrasound). Patients and methods: The study was conducted upon 43 patients presenting with obstructed defecation syndrome. Detailed history and examination was done. MRI and TRUS done for all patients. Results: 58.1% of obstructed defecation patients had intussusception and 69.8% had rectocele. There was significant P value between levator hiatus diameter and Renzi score (0.001). There was significant P value between rectocele and Renzi score (0.001). There was significant P value between intussusception and Renzi score (0.001). There was significant P value between ARJ descent and Renzi score (0.001). There was a significant P value between rectocele and levetor hiatus diameter (0.011). There was a significant P value between intussusception and levetor hiatus diameter (0.023). Conclusion: Our conclusion is that there is a significant relation between obstructed defecation syndrome and levator hiatus diameter. Also, there is a significant P value between rectocele and Renzi score. There is a significant P value between rectocele and levator hiatus diameter.

Breast cancer is a systemic disease and precision medicine must play an important role in management of this disease. A lot of predictive factors can affect our decision about line of treatment and hence affect response rate and survival. The Residual Cancer Burden (RCB) index has been developed in 2007 by Symmans and colleagues from the M.D. Anderson Cancer Center to quantify residual disease following NAC. RCB was significantly associated with BC outcomes. Two hundred patients who received neoadjuvant chemotherapy were retrospective collected from the electronic medical records available in OCMU system. we verified using the RCB index to stratify patients treated with NAC based on survival outcomes. In our study, only 7% of cases achieved pCR/ RCB-0, (4%) of the cases were staged as RCB-I, (42%) as RCB-II, and (47%) as RCB-III. Class type of RCB was statistically significant (p 0.001) with number of chemotherapy cycles, tumor type, ACR, LVI, PNI and RCB parameters. With a median follow-up of 70 months, 48 patients experienced relapse. Among the whole population, RCB was significantly associated with over all survival. 5-years relapse free survival was good in RCB-0 and RCB-I group, whereas the prognosis was intermediate in RCB-II patients (39.8%) and poor in RCB-III patients (20.9%). Our study concluded that the RCB index can stratify survival outcomes of patients after NAC. Increasing RCB was associated with an increased risk of poor relapse. Further studies should be devoted for new cut-off values and to the incorporation of biological factors to improve predictive accuracy.

Background: Breast cancer is the most common type of cancer and the second leading cause of cancer deaths among women. Early-stage diagnosis of breast cancer increases the chances of survival and, therefore, reduces mortality rates. Accurate staging and proper management of axillary lymph nodes are important for the treatment of breast cancer. Sentinel lymph node biopsy (SLNB) provides accurate assessment of nodal status. Objective: Comparison between the use of methylene blue dye versus patent blue dye in identification of Sentinel Lymph node in early-stage node negative breast cancer and to assess their complications. Methods: One hundred female patients with early-stage node negative (Tis-1-2 N0 M0) were recruited and randomized into 2 groups; group (A) in which SLNB was done using methylene blue dye and group (B) where patent blue dye was used. SLNB and frozen section examination were done then managed according to ACOSOG Z0011 criteria with follow-up of average 12 months. Results: The mean age was 51.5 ± 6.63 years in group A and 51.52 years ± 6.38 years in Group B. Identification rate in group A using methylene blue dye was 96% while in group B using patent blue dye was 98%. In group A, Frozen section pathology examination was negative for micro/macro metastatic disease or extracapsular extension in 39 patients (78%), positive for micro/macro metastatic disease in 3 nodes without extracapsular extension in 7 patients (14%) for whom ALND was not performed and SLNB was enough. And positive for gross extracapsular extension in 2 patients (4%) for whom ALND was performed. While in group B, Frozen section pathology examination was negative for micro/macro metastatic disease or extracapsular extension in 41 patients (82%), positive for micro/macro metastatic disease in 3 nodes without extracapsular extension in 7 patients (14%) for whom ALND was not performed and SLNB was enough. And positive for extracapsular extension in 1 patient (2%) for whom ALND was performed. Systemic complications seem to be related to patent blue rather than methylene blue. As 10 % of Group B (Patent blue Group) complicated by systemic complications in the form of anaphylaxis 2%, urticaria 2% and factitious hypoxemia 6%. While none of Group A patients experienced these complications. While local skin complications were related to Methylene blue injection. As 2 patients from group A (4%) suffered from superficial areolar necrosis while none (0%) of group B suffered from any local complications. Conclusion: One % MB and Patent blue dye are very effective as a single agent in SLNB in early-stage node negative breast cancer with comparable identification rate with possibility of skin complications with 1% methylene blue and systemic complications with patent blue dye. Applying ACOSOG Z0011 criteria to the patients shows no locoregional recurrence after 12 months follow-up.

Introduction: Endoscopic mucosal resection (EMR) is the endoscopic removal of benign, premalignant and even early stage malignant tumors. For lesions smaller than 2 cm, success is high. Objectives: The aim of our article is to share our results of endoscopic mucosal resection in the lower gastrointestinal tract and to contribute to the literature. Methods: Our study included 90 endoscopic mucosal resection procedures performed between January 2023 and December 2023. 69 patients were included in the study. The procedures were performed in the endoscopy unit of Bursa High Specialization Training and Research Hospital. The cases were grouped according to the age and sex of the patients, appearance, localization, size, pathological results, complications and surgical necessity of the lesion. The information of the patients was recorded retrospectively. Findings: The mean age of the patients was 60.6 years (35-85). 45 patients were male and 24 were female. Lesions were located in 4.4% anal canal, 18.8% rectum, 28.8% sigmoid colon, 18.8% descending colon, 2.2% splenic flexura, 8.8% transverse colon, 5.5% hepatic flexura, 3.3% ascending colon, 6.6% cecum. The lesions were sessile polyps. 84.4% of the lesions were smaller than 2 cm. One lesion was 40 mm, 4 lesions were 30 mm and 9 lesions were 20 mm in size. According to the pathology results, 40% of the lesions were tubular adenomas, 22.2% were tubulovillous adenomas, 2.2% were villous adenomas, 18.8% were hyperplastic polyps, 8.8% were adenomatous polyps, 4.4% were inflammatory polyps and 3.3% were adenocarcinomas. Surgical margins were negative in three patients with adenocarcinoma pathology results. Two patients were operated due to operation request. Follow-up was planned for one patient. Hemorrhage was observed in two lesions during the procedure and hemotasis was achieved by submucosal injection. Conclusion: Endoscopic mucosal resection is a minimally invasive technique used in the treatment of benign and malignant lesions. It is safe and effective especially in lesions below 2 cm. The complication rate is low.

Background/Aim of the study: The Bogotá bag technique is a commonly used method to achieve temporary abdominal closure (TAC). We explored the indications and outcomes of Bogotá bag use in TAC at a regional hospital in Durban, South Africa. Material (patients) and methods: A retrospective clinical audit was conducted and eligible patients were identified from electronic patient records over a two-year study period. Data on demographic characteristics, comorbidities, procedural characteristics, and postoperative outcomes were collected. This study was approved by the Biomedical Research Ethics Committee of UKZN (BREC/00000959/2020). Results: We identified 48 patients that met the inclusion criteria for the study. Most were males (77.1%, 37/48), and the median age was 31 years (IQR: 24-41). The most common indication for TAC was intraabdominal sepsis (39.6%, 19/48) followed by penetrating abdominal trauma (35.4%, 17/48). Seventeen patients (35.4%) had primary abdominal closure, 11 patients died (22.9%), two patients (4.2%) had a delayed ventral repair, 14 (29.2%) were awaiting definitive surgery, and four (8.3%) were lost to follow-up. Of the 14 patients awaiting ventral hernia repair, all were unemployed at 1-year follow-up, and only four (28.6%) had received a social grant. Conclusion: The COVID-19 pandemic impacted data collection, hence the small patient numbers, however, more patients did receive primary abdominal closure following the use of the Bogotá bag. Persistent ventral hernia after Bogotá bag use is associated with a negative socioeconomic impact.

Introduction: Perforated peptic ulcer (PPU) carries high risk for morbidity and mortality. The mainstay treatment is surgery which includes either primary repair or gastric resection. The main aim of this study is to evaluate the factors affecting outcomes from different surgical approaches in giant PPU. Methods: A retrospective review of all patients with PPU who underwent surgery from January 2016 to December 2020 was done. Patients with PPU less than 2 cm were excluded. Patient demographics and perioperative data were recorded. Length of stay, post-operative complications need for ICU admission and all-cause mortality were reported. Results: Fifty-four patients with a median age of 60 (range 15-83) years old had PPU ≥ 2 cm. Eighteen (33.3%) patients presented within 24 hours from the onset of abdominal pain. The median American Society of Anaesthesiology score was 3 (range 1-4). Twenty-four patients had primary repair and 30 patients had gastrectomy. Duration of surgery is significantly longer in gastrectomy group (p 0.001). The overall incidence of anastomotic leak, intraabdominal collection, re-oper ation and 30 days mortality was 18.5%, 25.9%, 9.3% and 27.8%, respectively. No difference in post-operative outcomes between the two groups was detected: intra-abdominal collection (p = 0.172), post-operative leakage (p = 0.754), re-operation (p = 0.834) and all-cause mortality (p = 0.736). Conclusions: Giant PPU can be managed by either primary repair or gastrectomy, perioperative outcomes between two groups are comparable hence a careful selection of surgical approach should be made with consideration of perioperative factors to reduce post-operative morbidity and mortality.

Background and aim of study: Renal cell carcinoma (RCC) can cause tumour thrombus in the inferior vena cava (IVC), which makes surgical intervention more difficult –approximately 4-10% of RCC patients present with this condition. We report on the surgical outcomes of patients with RCC and extensive IVC thrombosis who underwent treatment at our centre. Patients and methods: Retrospective data collection was conducted for all patients who underwent radical nephrectomy and IVC thrombectomy at our centre from 2017 to 2021. The level of thrombus was classified according to the Mayo Clinic classification. Patients with level III or IV thrombus were included in the study. Surgical complications were classified according to the Clavien-Dindo classification system. Results: Six of the 12 patients with RCC and IVC thrombus were eligible for the study. Three patients had level III thrombus, while the others had level IV thrombus up to the right atrium and pulmonary vessels. Two of the patients with level IV thrombus also had nodal and distant metastasis. All patients received surgical treatment by multidisciplinary teams. Mean operative time was 10 hours (range: 8-12 hours). Perioperative mortality was 33.3% (2/6; both patients had non-metastatic disease). Surgical complications among the surviving patients were minor (Clavien I-II). The two patients with metastatic disease survived for three months and seven months after surgery. Conclusion: Surgical intervention in RCC with extensive IVC thrombosis is very challenging, with a higher risk of morbidity and mortality. Our results suggest that patients with extensive thrombosis and non-metastatic disease might benefit from the surgery.

Background: Candida auris is a worldwide emerging fungus with high resistance to antifungal agents, which complicates the management and treatment of colonized patients. The aim of this study was to find a potentially effective protocol for disinfecting patients who tested positive for skin Candida auris, potentially leading to their decolonization. Material and methods: This study involves patients who were colonized with Candida auris in skin fold cultures (inguinal and axillary). The patients were isolated in single-bed rooms and then underwent whole-body washing three times daily with a 0.11% polyhexanide antiseptic solution. New skin fold cultures were taken on the fourth day and then every three days thereafter. Results: From October 2023, seven patients colonized with Candida auris were admitted to our Department. Cultures of two patients became negative on the fourth day after disinfection washes, two more on the seventh day, and the remaining three on the thirteenth day. Conclusions: In conclusion, Candida auris is a rising opportunistic pathogen for which both prevention and management are imperative. The protocol we used appears to be highly effective in decolonizing patients with Candida auris, eliminating the nosocomial spread of the fungus, and reducing the overall number of patients who will become infected from this multi-drug-resistant pathogen.

Acute mesenteric ischaemia is one of the more difficult diseases to be diagnosed. As one of the rarer causes of acute mesenteric ischaemia, acute mesenteric venous thrombosis (AMVT) is even more challenging to diagnose and treat. With the advent of specialized devices such as aspiration or mechanical thrombectomy systems, endovenous procedures is increasingly popular as a viable option to treat AMVT. However, not all centers or patients can afford the total cost of these specialized systems. Thus, we present a case of AMVT which was successfully treated with a combination of percutaneous aspiration thrombectomy and catheter directed thrombolysis (CDT) using devices that were not originally intended for such purposes. This report discusses and highlights the key point at each stage of patient’s management from diagnosis, choice of treatment and follow-up.

Background: Metastatic melanoma with unknown primary (MUP) accounts for approximately 2-9% of cases of metastatic melanoma [1]. This case report highlights the importance of detailed history taking and physical examination to look for a primary lesion. Case presentation: This is a case report of a 55 years old female with right inguinal region mass. Histopathologically proven to be metastatic malignant melanoma, primary lesion is unknown. Positron Emitted Tomography/Computed Tomography revealed involvement of right external iliac lymph nodes. The patient underwent Right Ilio-inguinal Block Dissection. Post-operatively, she was started on Adjuvant Immunotherapy. Conclusion: This clinical scenario signifies that occult metastatic melanoma should be considered in the differential diagnosis for any patient presenting with a malignancy of unknown origin. Patient education regarding self examination to look out for new symptoms and signs and regular follow-up is of utmost importance. Regional lymph node dissection followed by adjuvant immunotherapy approach is found to improve recurrence-free survival.

Background: Adenomyoepithelioma is an uncommon subtype of breast neoplasm that occurs most commonly in middle-aged and older adults. It usually presents as a solitary palpable mass or is detected on breast radiographic images. Histologically, biphasic tumor with proliferation of both the epithelial and myoepithelial cells. Case presentation: A 25 year old female presented with a painless progressive left breast lump. On examination a 5 × 3 cm, firm, tender, mobile lump noted in the inferior quadrant of left breast extending in the retroareolar region. Sonomammogram of left breast revealed BIRADS 3 lesion. Patient underwent lumpectomy and specimen was sent for histopathology. Biopsy was suggestive of Adenomyoepithelioma, likely benign. Patient was kept on close follow up in view of recurrence. Conclusion: We are reporting this case as it emphasizes on the rarity of occurence, young age of onset, and challenges in diagnosis, and variety of surgical managements available.

Mesenteric cysts are rare and benign gastro-intestinal tumours; more often present as a diagnosis and treatment dilemma to clinicians due to its myriad of non-specific clinically signs and symptoms. A 20-year-old man presented with a lower abdominal swelling for the past 1 year which was increasing gradually. Ultrasound followed by computer tomography abdomen reported a well-defined intra-abdominal cystic lesion with mass effect on the left genito-urinary tract. Laparotomy performed revealed a huge lobulated mesenteric cyst arising from the mesocolon of the sigmoid colon. Histopathological examination showed features of mesothelial cyst. We report a case of giant mesenteric cyst from the large bowel mesentery describing its characteristics and treatment.

Introduction: Phyllodes tumour (PT) is originated from the connective tissue part of the breast, it is commonly reported as benign however carries malignant potential. Case: Our case described a young native lady who is nulliparous came to us with a rapidly growing left breast mass. She was diagnosed to have giant malignant PT. She was scheduled for a 2-stage surgery, the first surgery was a mastectomy and histopathology showed deep margin involvement. Second surgery was a combined operation for left sternotomy, resection of 3rd, 4th, 5th left ribs, left chest wall reconstruction with titanium mesh with skin coverage from left pedicle latissimus dorsi flap and right pectoralis major advancement flap with split skin graft. Subsequently continue her treatment with adjuvant radiotherapy. Discussion: PT tend to be large and malignant. Large malignant PT may need tissue transfer for closure. Resection of bony thoracic structures is rare. Conclusion: Large PT poses a challenging surgical management.

The COVID-19 pandemic, has affected millions of people and burdened healthcare facilities and workers worldwide. Over 25,000+ cases were reported in the District of Udupi, Karnataka, India, and our tertiary health care University hospital had stepped up by providing care to all infected patients, by bringing about a multitude of changes. The objective is to highlight that the need of the hour was to provide timely surgical care to those in need while working along the frontlines of the pandemic. We have reviewed current published literature via a Google Scholar/PubMed search about the changes in the approach and treatment of surgical conditions and malignancies since the onset of the COVID-19 pandemic and we have also detailed our clinical experience. From converting surgical units into teams, the entire surgical workforce had to be restructured to meet the day- to-day patient care. Most of the patients were managed conservatively, and recovered well. Dire, life threatening emergencies were offered surgical care with all precautions. Patients with malignant disease also underwent preoperative chemoradiation, when indicated. From restructuring the workforce into teams, shaping a dedicated operating area for COVID-19 patients, and the usage of appropriate personal protective equipment while performing procedures, and following conservative methods of treatments when feasible.