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Intraoperative cholangiogram (IOC) is routinely used during cholecystectomy (either open or laparoscopic) in cases of cholelithiasis with history of obstructive jaundice (OJ). It is performed in such cases with no preoperative imaging that confirms the patency of biliary tree and during exploration of common bile duct. Intraoperative ultrasound (IOUS) has recently become a visualizing tool for anatomy and pathology of biliary tree which is safe, faster and less invasive compared to IOC. This is a prospective controlled randomized trial, conducted on 60 patients undergoing laparoscopic cholecystectomy for cholelithiasis with history of OJ, with no present OJ. It was held in the surgery department in Faculty of Medicine, Menoufia University and Theodor Bilharz Research Institute, from 2014 to 2017. Each patient underwent IOUS then, IOC during laparoscopic cholecystectomy. The study compared between both imaging techniques regarding procedure time, visualization of biliary tree, detection of any common bile duct (CBD) stone, biliary or vascular anomalies, and intra-or postoperative complications in the form of obstructive jaundice or iatrogenic biliary injury. The results showed a significant difference in time of the procedure with a mean time (min) of 9.60±1.224 (3-25) in IOUS and 14.391±1.356 (5-30) in IOC. Mean CBD diameter (mm) is 5.280±0.6957 (2.8-18) in IOUS & 7.010±0.7162 (3.5-22) in IOC without significant differences. IOUS has 100% sensitivity and 96.7% specificity while IOC has 100% sensitivity and 100% specificity. A case with vascular anomaly and one with duct anomaly were detected by IOUS. The vascular anomaly could not be detected with IOC. There was no post-operative complication in the form of missed CBD stones or bile leakage.

Background: Repair operation for recurrent inguinal hernia is a more exigent than the primary inguinal hernia. Open hernia repair associated with lower recurrence and fewer complications while the Laparoscopic repair associated with less pain postoperatively, early recovery time with subsequent earlier return to activity and better results regarding the wound.Methods: From November 2015 to March 2019, a total of 86 patients were randomized. 42 patients were recruited to total extra-peritoneal repair (TEP) group and 44 patients for Lichtenstein group. Overall, 86 were operated in general surgery department, Menoufia University hospitals.Results: The mean age of patients was 41.3±14.4, range from (25-55 years). One conversion occurred in the TEP group to Lichtenstein. Operative time was significantly low in TEP group (82.7 min) compared to Lichtenstein group (108 min). Hospital stay was significantly less in TEP group (1 day) compared to Lichtenstein group (1.8 days). Patients undergoing Lichtenstein repair have significant earlier oral intake than TEP group (3.7 vs. 6.6 hours). 12 cases developed seroma in Lichtenstein group with significant p value (0.001). This study showed less immediate and early VAS score in TEP group (2.3) versus high VAS score in Lichtenstein group (5.9) with highly significant p value (0.0001).Conclusions: TEP offer excellent results than LR for treatment of unilateral or bilateral recurrent inguinal hernia with lower morbidity and less incidence of post-operative pain with subsequent earlier return to normal activities.

Background: Routine mobilization of splenic flexure whether partial or complete became an essential step in laparoscopic low anterior resections in order to perform an oncologic re­section and to achieve a safe, tension-free anastomosis.Methods: 60 patients with rectal cancer were operated by laparoscopic low anterior resection with high ligation of inferior mesenteric artery in general surgery department, Menoufia university hospital between February 2016 and January 2019. All patients were divided randomly into 2 equal groups based on the techniques used in splenic flexure mobilization whether partial (group A) or complete (group B).Results: The majority of our patients were male 56.6% and 60% in both groups respectively with mean age (54.6±8.8) years in group A and mean age (58.5±9.2) years in group B. The operative time was highly significant lower in group A (269±17.6 minutes) than group B (304±22.4 minutes) while the conversion rate was significantly higher in group B (26.6%) than group A (6.6%). Regarding the postoperative data there was only significantly higher leak from the anastomosis in group A (20%) than group B (3.3%).Conclusions: Complete splenic flexure offer better oncological outcome and low incidence of anastomotic leak but with higher conversion rate, prolonged operative time, more blood loss and more 30 day mortality rate. So it needs more time to gain more experience to overcome these disadvantages.