Background: Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin, that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. Aim and objectives: To compare between Open Rives-Stoppa Hernial repair and Laparoscopic Transabdominal Prepreritoneal (TAPP) repair for bilateral inguinal hernia regarding postoperative Pain. Subjects and methods: Randomized control clinical trial experiment conducted in Kasr AlAiny General Surgery Department the study conducted on 50 patients with bilateral inguinal hernia, the patients divided to two groups 25 patients in Open Rives-Stoppa Hernial repair group and 25 patients in Laparoscopic Transabdominal Preperitoneal (TAPP) repair group. Result: There was statistically significant difference between Open Rives-Stoppa Hernial repair group and Laparoscopic Transabdominal Preperitoneal (TAPP) repair group as regard Post-operative Pain. Conclusion: Our results showed that the mean post-operative pain was significantly lower in Laparoscopic Transabdominal Preperitoneal (TAPP) repair group than in Open Rives-Stoppa Hernial repair group.

Background: Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease or with acute liver failure. Biliary complications (BCs) are the most common complications after LT. Purpose: To assess risk factors, radiological assessment and management of post-liver transplant biliary complications. Methodology: The study included all patients received live-donor liver transplantation in Cairo El-Fatemic Hospital in the duration between 2022 and 2024. All included patients had postoperative biliary complication. Patients with major comorbidities and vascular complications were excluded. Preoperative (donor and recipient), intraoperative and postoperative data were collected. The included patients were divided into 2 groups: Group A: patients who underwent conservative, endoscopic or percutaneous management for biliary complications; Group B: patients who underwent surgical intervention for biliary complications after failure of other methods. Results: After exclusion of early mortality and missed data patients, the total number of patients included in the study was 187 patients. Right lobe was used in 93.6% of patients and 54.5% of patients had double ducts. Duct-to-duct anastomosis was used in 89.3% of patients and ductoplasty was done for 14.7% of patients. Biliary Complications were reported in 13.4% of patients as biliary stricture was found in 10.2% of patients and biliary stricture and leakage was present in 3.2% of patients. Mortality rate among the included patients was 9.5%. Ductoplasty was done in higher percent of patients who experienced postoperative biliary complications (p = 0.018). The significant differences between patients with biliary stricture with and without leakage were total leucocytic count and platelets postoperatively. Age was significantly lower in patients needed re-exploration. SBP was significantly higher in patients needed re-exploration. Ductoplasty was significantly higher among non-survivors (p = 0.04). Conclusion: Postoperative biliary complication was reported in 13.4% of patients and mortality rate was 9.6%. Ductoplasty was associated with higher incidence of postoperative biliary complication. Postoperative biliary complication could be managed safely by ERCP.

Aim: To compare outcomes of same-admission cholecystectomy for acute cholecystitis with elective cholecystectomy for symptomatic cholelithiasis. Methods: We reviewed 200 cholecystectomies performed over 3 years, comparing those done during the same hospital admission for acute cholecystitis (n = 73) with elective procedures for symptomatic cholelithiasis (n = 127). Outcomes assessed included conversion to open cholecystectomy, intraoperative and postoperative complications (Clavien-Dindo ≥ 2), length of stay, readmission within 30 days, and 90-day mortality. Results: Complications of Clavien-Dindo grade 3 or higher occurred in 13 patients (9 symptomatic cholelithiasis, 4 acute cholecystitis), with no significant difference between groups (p = 0.637). Mortality within 90 days was similar (p = 0.108). Conversion rates (p = 0.940) and need for subtotal cholecystectomy (p = 0.348) were also similar. Univariate analysis showed higher age (p 0.001) and lower hospital stay (p = 0.04) in the acute cholecystitis group, while multivariate analysis identified shorter operative time as associated with acute cholecystitis (odds ratio 0.979, p = 0.01). Conclusion: Same-admission cholecystectomy for acute cholecystitis provides outcomes comparable to elective cholecystectomy for symptomatic cholelithiasis, except for longer operative times.

Background: We evaluated our modified extra fascial transfissural technique for liver resection. Methods: Extra-fascial transfissural Technique: We mobilize the liver by dividing the triangular ligaments. For right and left hepatectomies, we start by dividing the main portal fissure; for right posterior sectorectomy and left trisegmentectomy, we divide the right portal fissure; and for right trisegmentectomy and left lateral segmentectomy, we divide the left portal fissure. We approach the Glissonian pedicle extrafascially and intrahepatically. The Glissonian pedicle is cut and ligated en masse, followed by liver transection. We reviewed all liver resections performed using our technique over the last 5 years, assessing in-hospital mortality, 90-day mortality, overall complications, and bile leaks. Normality was tested with the Shapiro-Wilk test. Categorical values were evaluated with chi-square tests, continuous variables with the Mann-Whitney U test, and multivariate analysis was conducted using logistic regression. Results: From November 2019 to August 2024, we performed 74 liver resections: 63 major and 11 minor. The breakdown included 30 right hepatectomies, 16 left hepatectomies, 7 right tri-segmentectomies, 3 left tri-segmentectomies, and 18 parenchyma-preserving resections. The cohort comprised 52 males and 22 females, with a median age of 54. The median operative time was 180 minutes, the median hospital stay was 4 days, and the median blood product requirement was 2 units. In-hospital mortality was 2.7%, 90-day mortality was 6.7%, overall complication rate was 14.8%, and bile leak rate was 8.1%. No factors independently predicted morbidity or mortality. Conclusion: Our modified extra fascial transfissural approach, is feasible and reproducible.

Background and Aim: Preoperative proinflammatory markers and nutritional factors are known prognostic indicators in malignancies. This study evaluates their prognostic value in resectable pancreatic cancer. Materials and methods: We retrospectively analyzed consecutive patients who underwent pancreatic resection for pancreatic cancer between 2018 and 2023. Preoperative parameters, including PLR, NLR, and PNI, were documented alongside disease-free survival (DFS), overall survival (OS), and actuarial survival. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic accuracy and optimal cut-off values for PNI, NLR, and PLR in predicting survival outcomes. Cancer-specific survival was estimated using the Kaplan-Meier method, while univariate and multivariate Cox regression models were employed to identify independent prognostic factors. Results: A total of 52 patients were included, with a mean age of 62 years. The median OS was 21.3 months, while the median DFS was 17.8 months. The 1-, 2-, and 3-year overall survival rates were 88.5%, 59.6%, and 37.5%, respectively. Univariate analysis identified elevated PLR (>92.85) and NLR (>1.85) as significant predictors of poorer outcomes, alongside adverse histopathological features, such as lymph node positivity, lymphovascular invasion (LVI), and perineural invasion. Multivariate analysis confirmed that high preoperative PLR (>92.85) and NLR (>1.85) were independent prognostic factors for decreased survival (P = 0.027 and P = 0.028, respectively). Conclusion: Preoperative PLR and NLR serve as valuable independent prognostic biomarkers for overall survival following pancreatic resection in patients with pancreatic cancer. Their routine assessment may facilitate more accurate risk stratification and personalized treatment planning.

Background: Anastomotic leak (AL) is one of the most feared complications following colorectal cancer surgery. Its incidence and implications on morbidity, mortality, and long-term oncologic outcomes necessitate early detection. This study investigates the potential role of C-reactive protein (CRP) and white blood cell (WBC) count in the early identification of AL. Materials and methods: This prospective study included patients undergoing elective colorectal resection with primary anastomosis for malignancy at South Egypt Cancer Institute. CRP and WBC levels were recorded daily for the first five postoperative days. Patients were divided into two groups based on the clinical and radiological diagnosis of AL. Comparative analysis and ROC curve evaluation were performed to determine diagnostic accuracy. Results: Elevated CRP and WBC levels were significantly associated with anastomotic leakage from postoperative day 3. CRP showed high negative predictive value, and combining CRP with WBC count improved diagnostic sensitivity and specificity. The ROC curve analysis demonstrated superior diagnostic performance of CRP, with the highest AUC observed on POD 5. Conclusion: Serial monitoring of CRP and WBC levels postoperatively can serve as a valuable tool for the early prediction of AL. Implementing this biomarker-guided surveillance may support timely intervention and/or safe patient discharge, especially in ERAS protocols.

Prevalence of Malnutrition in patients undergoing surgery, especially in patients diagnosed with malignancy is substantially high. Nutritional assessment of colorectal malignancy patients using imaging has been proven to be useful in post operative management and recovery. Accurate measurement of body composition is important in management of nutritional problems and measurement of clinical outcomes. This study has been designed to understand the role of CECT based nutritional assessment in patients undergoing colorectal resection. This is a case series analysis of 74 patients who underwent malignant colorectal resection who had preoperative CECT and monitored postoperatively for complications. This study highlights the gross changes in body composition secondary to colorectal malignancy, which are most often missed when using conventional techniques of nutritional assessment. It brings out significant association between Psoas area, Total Psoas Area Index and major post operative complications. Surgeons can assess Psoas area and Total Psoas Area Index in routine CT viewer without any additional software or expertise and preoperative optimization can be titrated accordingly.

Background/Aims: Acute pancreatitis is one of the most common causes of gastrointestinal hospital admissions and currently it is in an increasing trend. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis.This study aimed to evaluate the Red Cell Distribution Width (RDW) to Total Platelet Count (TPC) ratio (RPR) as an early prognostic marker in acute pancreatitis. The objective was to assess its effectiveness compared to established severity scores like BISAP (Bedside index of severity) in acute pancreatitis and APACHE II (Acute Physiology and Chronic Health Evaluation). Methodology: A cross-sectional study was conducted involving 62 patients diagnosed with acute pancreatitis. Data was collected using a structured proforma and analysed using appropriate statistical methods. The values of RPR were compared with BISAP and APACHE II scores which serve to determine their correlation with the severity of pancreatitis. Statistical significance was determined through ANOVA and T tests, where p 0.05 is considered significant. Results: RPR showed a statistically significant correlation with BISAP (p 0.05) but it demonstrated a weaker correlation coefficient with APACHE II. Using ROC curve analysis,RPR had a cut-off value of 0.053, sensitivity of 86% and specificity of 63% and AUC 0.766 for predicting the severity of acute pancreatitis however RPR did not have any statistical significance for prediction of mortality. Conclusion: RPR is a valuable early prognostic marker for acute pancreatitis, especially in predicting systemic complications. While it correlates well with BISAP, its utility in predicting mortality is limited.

Background: Peritonitis is a fatal condition. It is the inflammation of the peritoneal cavity. Acute Physiological and Chronic Health Evaluation Score (APACHE II) and Mannheim’s peritonitis index (MPI) are the most applied scoring systems to help surgeons make their decisions on peritonitis cases. Objectives: To evaluate the predictive power of MIP versus APACHE II score for morbidity and death in patients suffering from peritonitis resulting from hollow viscus perforation, as well as the elements of each scoring system that are associated with the development of complications. Methods: A longitudinal cohort study was performed on 50 cases of peritonitis caused by perforation of hollow viscous between January 2022 and May 2023 at the emergency department of a tertiary hospital. Data related to morbidity and mortality were recorded. Scores of MPI and APACHE II were calculated. Result: The mean age of the participants was 42.1 ± 16.8 years, with 39 male patients and 11 females. The perforation sites were a pre-pyloric ulcer (46%), appendix (34%), small bowel (10%), sigmoid (6%), and gastric ulcer (4%). The mean APACHE II score was 10.3 ± 5, and the MPI score was 19 ± 8.3. MPI and APACHE II scores could significantly predict the incidence of morbidity with P-values 0.002 and 0.03, sensitivity of 88.9% and 55.6%, and specificity of 61.3% and 90.3%, respectively. However, they can’t significantly predict the incidence of mortality. Conclusion: MPI and APACHE II scores can predict the incidence of morbidity in secondary peritonitis patients due to hollow viscus perforation. However, they cannot predict the incidence of mortality.

Background: ERCP is the standard treatment of obstructive jaundice. Although post ERCP duodenal perforation is not a common complication, it is considered as a serious one with fatal outcome especially if discovered late or neglected. Early discovery and management usually lead to more simple surgical maneuvers and much better outcome. Patients and methods: This study is a retrospective study which was done on patients on whom ERCP was done by surgeons. During the period of this study 15 out of 819 patients were presented by duodenal perforation and all the data were registered with special emphasis on the time of diagnosis, diagnosis/operation interval and the outcome. Results: Although in our study the incidence of duodenal injury was slightly high (1.83%), it still within the reported rate. Also, the outcome in our study was much better with much less mortality rate (13.3%) and less hospital stay and ICU admission days. The time of diagnosis was less than 12 hours in (66.7%) of the patients and 10 out of the 13 operated patients were operated in less than 6 hours from time of diagnosis which directly led to the better outcome. Conclusion: Post ERCP duodenal perforation is not a common complication but is a very serious one. When such complication is diagnosed early and operated directly this leads to much better outcome. This could be a direct impact when the ERCP maneuver is done by surgeons.

Introduction: Many morbidly obese people report experiencing stomach discomfort after laparoscopic gastric bypass and sleeve gastrectomy procedures. The aims of the study were to evaluate the outcomes of drain insertion with non-insertion in postoperative patients who had laparoscopic sleeve gastrectomy and gastric bypass procedures, focusing on pain, detection of bleeding, and leakage. Methods: Fifty-two morbidly obese patients, eligible for LGBP and SG surgeries, participated in the study. They were randomly assigned into two groups depending on whether or not a drain was inserted (n = 52): a drain group (D group = 26) and no drain group (N group = 26). Age, gender, Body mass index, associated comorbidities, any intra/post operative complications, and operative time will be documented. Pain was assessed using the visual analogue scale (VAS) and abdominal US was routinely performed on the first postoperative day for detecting any fluid collection. Results: Mean of (VAS) at post-surgery day 0 was similar in the two groups (3.5 ± 1 in D group vs. 3.2 ± 1.5 in N group; p = 0.589). On post-surgical day 1, patients with drain had significantly higher pain scores (6 ± 2.2 in D group vs. 4 ± 2.2 in N group; p = 0.012). After 1 week, the mean VAS score was lower in the N group compared to the D group (p = 0.006). Conclusions: We may infer that selective drainage, rather than regular drainage, should be favored after LGBP and SG. Leakage may be identified by several clinical and biochemical techniques. Patients without drainage had greater comfort and less discomfort compared to those with drainage.

Background: Bariatric surgery has proven to be of the most effective modalities and a cornerstone for treatment of obesity. Not only does bariatric surgery result in rapid, pronounced and sustained weight loss, but it also leads to improvement or even remission of the associated comorbidities, improving the overall quality of life and reducing mortality. Venous thromboembolism is a leading cause of morbidity and mortality after bariatric surgery in general, and laparoscopic sleeve gastrectomy in specific. Yet, there still has been no precise and established consensus for the optimal dosing and duration of prophylactic anticoagulation needed to help reduce the burden of post-bariatric thromboembolism. Methods: This is a prospective randomized study which included 90 morbidly obese patients. Patients were randomly allocated into 3 groups (30 patients each). Groups A, B, and C received 60 mg clexan 12 hours preoperatively and post-operative clexan 60 mg/day for 1, 2, and 3 weeks, respectively. Mesenteric venous duplex as well as portal vein duplex and bilateral lower limbs venous duplex were done 21 days postoperative Results: In the current study we found that there was an insignificant increase in the incidence of VTE in all three groups (P value = 0.711). Conclusion: Morbidly obese patients are at high risk for venous thromboembolism. The duration of anticoagulation had no significant effect on thromboprophylaxis post-laparoscopic sleeve gastrectomy in the studied groups.

Background: obesity has become a global health problem. Obesity is associated with multiple comorbidities including type 2 diabetes mellitus, hypertension, obstructive sleep apnea (OSAS), and degenerative joint disease. Currently, bariatric surgery is considered to be the most effective treatment of morbid obesity that can achieve effective and sustained weight loss, together with improvement of obesity related comorbidities and quality of life. Aim and objectives: to compare between Single Anastomosis Sleeve Ileal Bypass (SASI) and One Anastomosis Gastric Bypass (OAGB) regarding improvement of comorbidities. Subjects and methods: this prospective comparative study was conducted in Kasralainy hospital, Cairo university and included 42 patients divided into 2 groups. Result: according to clinical data at interval time, there was there was no statistically significance difference between the studied groups as regarded HTN, hyperlipidemia and obstructive sleep apnea, while there was statistically significant difference as regarded DM. Conclusion: we suggest that single anastomosis sleeve ileal bypass (SASI) is as efficient and safe as one anastomosis gastric bypass (OAGB), as both groups were similar with respect to improvement comorbidities.

The management of ano-rectal fistulas still represents a major therapeutic issue. Objective: The research aimed to compare the early results of two therapeutic approaches for high trans-sphincteric anal fistula: the combination of ligation of the intersphincteric fistula tract (LIFT) with Fistula LASER Closure (FILAC) for the distal tract, and the combination of LIFT with platelet-rich plasma (PRP) injection for the distal tract. Methods: 60 patients were involved and divided into two equal groups: 30 underwent LIFT combined with FILAC, and 30 underwent LIFT combined with PRP. The primary endpoints were achieving complete fistula healing and the time required for healing. Secondary endpoints were postoperative pain, fistula recurrence and complications. Results: Complete healing was reported in 28 (93.3%) cases in the FILAC group and 27 (90%) cases in the PRP group, without significant difference. Healing was achieved more quickly in the FILAC group in contrast to PRP group (23.8 ± 8 days vs. 25.3 ± 8.7 days), but with no significant difference. Pain scores reported early postoperative were significantly lower in the LIFT-PRP group compared to the other group. None of the patients in either group experienced incontinence for flatus or stool. Recurrence was reported in 2 cases out of 28 in LIFT- FILAC group (7.1%) and 3 cases out of 27 in LIFT- PRP group, (11%). Conclusion: LIFT procedure combined with FILAC showed a higher rate of successful healing, faster healing time, and a lower incidence of recurrence compared to LIFT combined with PRP but with no significant difference.

The increasing number of patients requiring hemodialysis in recent years has led to a growing demand for Arteriovenous Fistula (AVF) creations. Surprisingly, less than 10% of total End Stage Renal Failure (ESRF) patients opt for peritoneal dialysis, with the majority choosing hemodialysis. A particularly challenging complication arises for patients with Giant Venous Aneurysm (GVA) accompanied by Central Vein Obstruction (CVO), necessitating the intervention of experienced vascular surgeons and, at times, intervention radiologists for an endovascular approach. This report presents a case series of three ESRF patients who underwent hemodialysis through various types of AVF. All patients exhibited upper limb swelling and dilated veins on the ipsilateral site of AVF, leading to central venogram scans for confirmation of central vein occlusion. Our team adopted diverse approaches to preserve function, safeguard the limb, and, ultimately, ensure the patient’s well-being. Each approach was tailored individually, recognizing the unique circumstances of every patient. In conclusion, ESRF patients with Central Venous Occlusion and Giant Venous Aneurysm require a multimodal approach, necessitating the expertise of experienced vascular surgeons. The primary objective in managing patients with these complications is to preserve the functionality of the fistula, protect the limbs, and, in some cases, safeguard life itself.

Background: Pediatric bezoars are the quite rare pathology. There are four main types of bezoars – trichobezoar, phytobezoar, lactobezoar, and pharmacobezoar. Additionally, to these types may be other types of bezoars, which consisted of different materials, e.g. metals, plastics, sponges, paper, etc. Due to the rarity of this pathology, there are no generally accepted guidelines for its diagnosis and treatment. Aim of this study to present our experience of the pediatric gastrointestinal bezoars management. Material and Methods: Retrospective study enrolled children with gastrointestinal bezoars who were operated for 1997-2025 years. Different imaging modalities (plain abdominal radiography, ultrasonography, upper endoscopy, and computed tomography) were applied for the diagnosis confirmation. Results: Six patients with gastrointestinal bezoars were identified. All patients were operated using laparotomic approach: 4 patients had trichobezoar, including 3 patients with Rapunzel syndrome, in one patient bezoar consisted with undigestible pieces of cotton tissue, which also found in small intestine, and in one patient cluster of chewing gum was revealed. All patients underwent gastrotomy, which in cases of Rapunzel syndrome was supplemented by duodenotomy, and one patient had additional enterotomy due to the presence of bezoar in the ileum. Conclusion: The clinical course of bezoar can be asymptomatic for a long time. The main methods for confirming diagnosis are endoscopy and computer tomography. Despite the possible advantages of endoscopic or laparoscopic bezoars removal, laparotomy continues to be the most appropriate method of treatment.

Introduction: Catamenial pneumothorax is a rare condition primarily affecting women of reproductive age. This case emphasizes the importance of recognizing its typical clinical presentation to improve differential diagnosis. Case presentation: A 43-year-old female presented with right-sided chest pain and mild dyspnea coinciding with her menstrual cycle. A chest X-ray revealed a right pneumothorax. Management included closed thoracostomy, with good clinical outcomes. Diagnosis and treatment: Spontaneous pneumothorax associated with the menstrual cycle, successfully treated with thoracic drainage. Conclusion: This case highlights the need to consider catamenial pneumothorax as a differential diagnosis in fertile women with recurrent respiratory symptoms.

Rectal foreign body insertion can present a range of challenges for surgeons, requiring a versatile and flexible approach in the management of these patients. While various objects may be inserted, their size, shape, and location within the rectum significantly influence the complexity of retrieval. We report a rare case of a rectal foreign body causing an intussusception of the upper rectum into the foreign body causing ischemia and an extraperitoneal rectal perforation. This case highlights the importance of a thorough understanding of the rectal and pelvis anatomy, careful pre-operative assessment, and the ability to adapt surgical strategies based on the intraoperative findings.

The subhepatic location of the appendix is reported in extremely few cases of acute appendicitis. Initial diagnosis is challenging, and any delay can lead to appendiceal rupture and subsequent life-threatening complications. A 55-year-old man was referred to a secondary hospital by a rural doctor with a diagnosis of acute appendicitis. Upon arrival, his vital signs were: blood pressure 145/88 mmHg, heart rate 92 bpm, and temperature 37.8 °C. Blood tests revealed: white blood cell count 14.88 × 103/uL (normal range: 4-11), neutrophils 81% (normal range: 35-72), lymphocytes 11% (normal range: 20-45), prothrombin time:12.6 s (normal range: 9.4-12.5), activated partial thromboplastin time 76.6 s (normal range: 25-36), glucose 120 mg/dL (normal range: 74-106), bilirubin 3.26 mg/dL (normal range: 0-1.2), and C-reactive protein 123 mg/dL (normal range: 5). Other blood tests were within normal limits. His medical history included diabetes mellitus treated with metformin 850 mg, a history of angioplasty for common iliac artery stenosis in 2020, and ongoing treatment with salicylic acid 80 mg. Physical examination revealed right hypochondrial pain and a positive Murphy’s sign. Computed tomography confirmed an inflamed subhepatic appendix with appendicitis. The patient underwent laparoscopic appendicectomy with an uneventful postoperative recovery and was discharged on the fifth postoperative day. In patients presenting with right upper quadrant pain and hyperbilirubinemia, the diagnosis of subhepatic appendicitis can be challenging, especially in settings without advanced radiology. Preoperative radiological imaging and diagnostic laparoscopy can aid in timely and appropriate management.

Prosthetic mesh implementation seems to be the treatment of choice for almost every kind of hernia. Although related to lower recurrence rates, this technique is not deprived of complications. We report a case of an 85-year-old male patient with a previously mesh reconstructed incisional hernia complicated by enterocutaneous fistula. Despite conservative management, remarkable clinical deterioration was noted and the patient was submitted to abscission of the infected meshes followed by en block resection of the underlying conglomerated small bowel. Enterocutaneous fistula is rare but one of the most dreadful adverse events reported. A multidisciplinary as well as targeted approach is necessary in order to mitigate threatening complications and secure beneficial prognosis.