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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.

Objectives The aim of this study was to assess the impact of neoadjuvant chemoradiation on the pathologic response and survival of patients with rectal cancer. Background Colorectal cancer is one of the most common human malignancies; there are a number of potential advantages for using neoadjuvant chemoradiation. They include the ability to deliver higher doses of chemotherapy with radiation, downstage the tumor, which has been noted in 60–80% of patients, and to achieve a pathologic complete response, which occurs in 15–30% of patients. The ability to ‘shrink’ the tumor facilitates surgical resection and performs a sphincter-preserving operation, radiating tissues with a greater oxygen supply, and decreases the likelihood of developing radiation enteritis, because the small bowel is less likely to enter the pelvis. Patients and methods This study included 80 patients with operable cancer rectum. A total of 40 randomized patients were treated with neoadjuvant chemoradiotherapy (CRT) followed by surgery, and the other 40 patients underwent surgery without neoadjuvant CRT. The pathological response to neoadjuvant CRT with regard to tumor necrosis, size, negative margins, number and size of lymph nodes with operative findings with regard to resectability and blood loss were assessed and then the follow-up of patients was carried out and compared with another group. Results We detected a statistically significant difference between both groups with regard to some pathological responses, including grade of tumor differentiation, number and positivity of lymph nodes, perioperative complication, and disease-free survival but no difference in overall survival. Conclusion Neoadjuvant chemoradiation could affect the disease-free survival of patients with rectal carcinoma.

Objectives The objective of this study was to evaluate the two approaches for hemorrhoid surgery - Ligasure hemorrhoidectomy and conventional (Milligan-Morgan) hemorrhoidectomy - in terms of operative time and blood loss, as well as postoperative pain, bleeding, analgesic requirement, urinary retention, discharge, stenosis, fecal incontinence, wound healing, and patient satisfaction. Background To compare the surgical outcome of hemorrhoidectomy performed using Ligasure bipolar diathermy with conventional hemorrhoidectomy. Patients and methods Twenty patients with grade III or IV hemorrhoids were randomized equally to conventional hemorrhoidectomy (group 1) and Ligasure (group 2) hemorrhoidectomy. Operative details were recorded, and patients recorded daily pain scores on a linear analogue scale. Follow-up was weekly for 2 months and then monthly for 6 months to evaluate complications, return to normal activity, ongoing symptoms, and patient satisfaction. Results The mean reduced intraoperative blood loss (±SD) was 1.2 ± 1.6 ml (ranging from 0 to 5 ml) in the Ligasure group (group 2) versus 22.2 ± 6.58 ml (ranging from 15 to 35 ml) in the conventional group (group 1) (P = 0.0001). The mean operative time in minutes in the Ligasure group was 6.6 ± 4.3 (ranging from 5 to 10 min) versus 21.7 ± 4.3 in the conventional group (ranging from 15 to 26 min) (P Conclusion Ligasure is an effective instrument for hemorrhoidectomy, which results in lower volume of blood loss, less postoperative pain, quicker wound healing, and earlier return to work.

The exact causative factor(s) of bone erosion in cholesteatoma are not known. In recent years, the possible role of cytokines has drawn attention. Since the studies on cytokines in cholesteatoma are limited and depend on histopathological methods, the present work approached this subject by biochemical determination of TNF-α lysosomal enzymes, acid phosphatase (total and tartrate resistant), cathepsin B, leucyl aminopeptidase lysozyme together with non-lysosomal enzymes calpain I and II in 50 cholesteatoma samples (epithelial and subepithelial tissues) in comparison with 14 normal skin samples from the external ear canal. The study revealed significantly increased levels of all previous indices in cholesteatoma epithelium and subepithelial tissues compared with healthy skin. The levels of these indices reflected the clinical severity of the disease as reflected by their significant increase in cases with erosion of two or three ossicles, erosion of dural plate, sinus plate and facial canal and more extensive cholesteatoma. It is likely that TNF-α acts both directly by causing bone erosion and indirectly by stimulating the release of lysosomal enzymes. The latter mechanism is supported by the significant correlations observed between TNF-α and lysosomal enzymes. The non-lysosomal enzymes calpain I and II seem to participate in the bone erosion associated with cholesteatoma by their involvement in collagen destruction. Due to the suggested role of TNF-α in bone destruction associated with cholesteatoma the use of anti-inflammatory drugs should be taken into consideration in otitis media to diminish bone destruction. Similarly, antibiotics should be used to prevent the deleterious effects of bacterial endotoxin.