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Background: Overall, 5% to 15% of patients undergoing cholecystectomy for cholelithiasis have concomitant bile duct stones, and the incidence of choledocholithiasis increases with age. Endoscopic Retrograde Cholangiopancreatography (ERCP) with consequent Laparoscopic Cholecystectomy (LC) has been the favored approach for the treatment of choledo-cholithiasis for quite a long time; however in the course of recent years, Laparoscopic Common Bile Duct Exploration (LCBDE) has been offered to patients with suspected choledo-cholithiasis.Aim of Study: The aim of this work is to compare the efficacy, safety, and the surgical outcomes of LCBDE with ERCP followed by laparoscopic cholecystectomy and deter-mine the most appropriate approach for patients with choledo-cholithiasis.Patients and Methods: A prospective randomized clinical study was carried out from March 2017 to September 2018. It included 50 patients with cholecysto-choledocholithiasis who were divided into two groups: Group A (25 patients) included patients who underwent laparoscopic transcystic common bile duct exploration and stone extraction with LC in one stage, and Group B (25 patients) included patients who underwent endoscopic retrograde cholangiopancreatography for CBD stone extraction followed by LC in two stages. The Common Bile Duct (CBD) stone clearance rate, post-operative bile leakage, post-operative morbidity, mortality, overall hospital stay, and patient satisfaction were analyzed.Results: LCBDE and ERCP+LC were similar in terms of clearance rate, operative time postoperative complications, retained CBD stones, and postoperative length of stay, but there was a significant difference in number of procedures and patient satisfaction.Conclusion: Although both approaches have equivalent success rates, LCBDE is better in terms of fewer procedures, and better satisfaction compared with ERCP + LC. Our study suggests that one-stage management is the treatment of choice for patients with cholecystocholedocholithiasis.

Background The ‘gold standard’ for management of gallstones is laparoscopic cholecystectomy, but there is no consensus for treatment of common bile duct stones. There is insufficient information in the literature on the practice of laparoscopic common bile duct exploration (LCBDE) in cases of endoscopically irretrievable stones. This study presents the technical aspects and results of this approach and comparing it with open common bile duct exploration (OCBDE). Aim To assess the management of the patients with calcular obstructive jaundice after failed endoscopic retrograde cholangiopancreatography with LCBDE in comparison with OCBDE. Patients and methods A prospective randomized study was conducted for 2 years started from 2017 to 2019 in Theodor Bilharz Research Institute. A total of 600 patients with calcular obstructive jaundice underwent endoscopic retrograde cholangiopancreatography, with failure of stone extraction in 50 patients. Of them, 30 patients underwent LCBDE and the other 20 patients underwent OCBDE. Overall, 40 patients were female and the other 10 were male. They ranged in age from 23 to 80 years old, with a mean age of 46.72 years. Results The mean postoperative hospital stay, pain score, and analgesia score were significantly short (P 0.05) but with no statistically significant difference. Conclusion LCBDE considered as a safe, efficient and preferred procedure for CBDE whenever possible.

Background The two standard methods for inguinal hernioplasty is open and minimal access laparoscopic technique. Most laparoscopic surgeons use a transabdominal preperitoneal approach but totally extraperitoneal (TEP) approach potentially offers several advantages. Objective The aim in this study was to assess the learning curve, cost value, safety, and feasibility of TEP approach. Patients and methods Prospectively collected data on 185 consecutive patients submitted to laparoscopic TEP hernioplasty for inguinal hernia from 2016 to 2018 in Theodor Bilharz Research Institute Hospital. This study involved repair of primary, recurrent inguinal hernia and femoral hernia. The prolene mesh was used for groin hernia repair in all cases with and without fixation. Results All 185 cases started with the laparoscopic TEP technique with only four cases converted to transabdominal preperitoneal technique (2.1%). In 110 (60.7%) cases the mesh was placed without fixation. In 71 cases the mesh was fixed by Tackers or Histoacryl. In unilateral hernia, the mean operating time was 45 min, while in bilateral hernia it was 61 min. Intraoperative complications included three cases of inferior epigastric vessel injury which were managed by metallic clips of 5 mm. The mean pain score was 7.5, while the mean satisfaction score was 5.4. The mean hospital stay was 16.4 h. Regarding postoperative complications, 10 (5.5%) patients developed a postoperative seroma, four (2.1%) patients developed a hematoma, two (1.1%) patients developed a hydrocele, and five (2.7%) patients experienced neuropathic pain. There were three (1.1%) recurrent cases; all these cases were managed by open hernioplasty. Conclusion In this study, the laparoscopic TEP approach is found to be an effective, and safe technique regarding primary, recurrent open inguinal and femoral hernias with good learning curve to laparoscopic surgeon who started with transabdominal preperitoneal technique technique.

Background Theodor Bilharz Research Institute (TBRI) Hospital comprises clinical departments, research laboratories, and different supporting services. General Surgery Department (GSD) in TBRI hospital has over 30 years of cumulative surgical and research experience. New managerial policy and quality procedures were developed and implemented from 2007 onwards in GSD. The aim of this study was to assess the pattern of change in utilization and performance in GSD in TBRI hospital after implementing the new policies and procedures, from 2007 onwards. Methods This was a retrospective observational study. Electronic data were collected from the medical record unit and annual reports of TBRI hospital from the year 2001 to the year 2016. Hospital utilization indices, admission, surgical operations performed, bed utilization indices, average length of stay (ALOS), bed occupancy rate (BOR), bed turnover rate (BTR), and mortality rate (MR) were calculated before and after implementing the new policies and procedures from the year 2007 onwards. Results The shift to more skilled and major surgical operations was doubled, and the increase of elective surgeries increased to more than three-folds of emergency operations. There was marked increase of outpatient flow to more than three-folds, and decreased MR. The indicators used to show increase of performance in GSD were as follows: improvement in hospital bed indices decreased ALOS, increased BOR, and increased BTR. The year 2016 showed the optimization of all hospital indices: ALOS 5.5, BOR 74.2, BTR 48.9, and MR 0.1. Conclusion Quality improvement may not appear in the initial years of a program. It is recommended to keep up the implemented hospital quality policies and procedures to continue future improvement for better quality of patient care in GSD at TBRI hospital.