Surgical Research and Reviews

  • KYRLE’S DISEASE (KD): “AN UPDATE WITH REVIEW OF LITERATURE” A SPONGEBOB SKIN PORES SIMULATION

    Kyrle’s disease (KD) is a Chronic skin condition first described by Austrian pathologist Josef Kyrle in 1916. Kyrle referred to this condition as hyperkeratosis follicularis & parafollicularis in cutem penetrans. These diseases are characterized by the phenomenon of transepidermal elimination of denatured dermis an acquired form of perforating dermatosis [14]. It is characterized by keratotic crater plugs that develop in hair follicles penetrating the epidermis and extending into the dermis [4]. This trans epithelial migration and elimination of proteinaceous components is associated with systemic disorders like renal, liver diseases, chronic heart failure and diabetes mellitus. We present two case scenarios of a young Males with multiple chronic papular eruptions along with a review of literature for Kyrle’s disease (KD).

  • ELECTROSURGICAL ENERGY. IS IT A RISK FACTOR FOR POST-THYROIDECTOMY HYPOCALCAEMIA?

    Aim and objective: The aim of this study was to investigate a relationship between the different types of electrosurgical energy (monopolar, bipolar, and ultrasonic-harmonic scalpel) and postoperative hypocalcaemia after total thyroidectomy. Additionally, to analyze the frequency of postoperative hypocalcaemia, according to age group, gender, and pathological diagnosis. Materials and Methods: An observational, retrospective and correlational study was carried out in a series of patients who underwent total thyroidectomy in a public and a private hospital in Quito, Ecuador, South America, from January 2016 to July 2019. Results: Among 665 patients, post-thyroidectomy hypocalcaemia was observed in 127 (18.8%) patients. There was no significant difference between males and females. Hypocalcaemia was significantly higher in patients aged between 26 and 35 years, patients operated for malignant tumors and in patients in whom at least one parathyroid gland was removed. Postoperative hypocalcaemia occurred in 52.2% of patients (n = 24) [RR: 3.14; 95% CI: 2.26-4.36; p: 0.001] in the bipolar group, 29.2% (n = 7) [RR: 1.56; 95% CI: 0.82-2.97; p: 0.087] in the harmonic group, 17.3% (n = 34) [RR: 0.87; 95% CI: 0.61-1.24; p: 0.219] in the monopolar group, and 15.2% (n= 60) [RR: 0.61; 95% CI 0.45-0.84; p: 0.001] in the monopolar + harmonic group. Conclusions and clinical significance: The use of a bipolar device appears to be a risk factor for hypocalcaemia, while the use of monopolar + harmonic seems to be a protective factor. Although, when analyzing monopolar + harmonic vs monopolar alone, the addition of the harmonic scalpel didn’t provide statistically significant additional protection against hypocalcaemia.

  • A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC HERNIA REPAIR AND OPEN HERNIOTOMY OF INGUINAL HERNIA IN PAEDIATRIC AGE GROUP: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

    Background: Inguinal hernia in children remains one of the most common congenital anomaly observed by surgeons. Prompt diagnosis and early treatment of the inguinal hernia continues to be the mainstay to avoid the complications. The present study was undertaken to compare the effectiveness of laparoscopic hernia repair and open herniotomy of inguinal hernia in paediatric age group. Method: A total 104 healthy children of age

  • NEW TRENDS IN TREACHER COLLINS SYNDROME: BONY RECONSTRUCTION AND REGENERATIVE THERAPY

    Aim:Treacher Collins syndrome is a rare congenital disorder of craniofacial development with a highly variable pheonotype. This syndrome occurs with an incidence of 1:50,000, and more than 60% of the cases have no previous family history and arise as the result of de novo mutations. The disorder displays an intricate underlying dysmorphology. Affected patients may suffer life-threatening airway complications and functional difficulties involving sight, hearing, speech, and feeding. Deformation of facial structures produces a characteristic appearance that includes malar-zygomatic hypoplasia, periorbital soft tissue anomalies, maxillomandibular hypoplasia, and ear anomalies. Management requires a specialized craniofacial team, as comprehensive care starts at birth and may require life-long follow-up. Standard craniofacial procedures for bony and soft tissue reconstruction are used. This article outlines current treatment strategies and future concepts for surgical and regenerative management. Methods:The new field of regenerative medicine and therapy offers the promise to improve some of these treatments. In particular, Structural Fat Grafting (lipostructure) seems to be a good strategy to restore the normal volume and contour of the face, and to provide a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. In this work, we present the case of a young girl with Treacher Collins Syndrome who underwent serial sessions of fat grafting in addition to other surgical bony reconstructive techniques. ADSCs have been isolated from the patient’s lipoaspirate, and compared for their stemness properties with those of a healthy subject. Conclusion:Screening of the genome of the Treacher Collins patient using array-Comparative Genomic Hybridization (array-CGH) allowed us to identify some chromosomal imbalances that are probably associated with the syndrome.Correction of these imbalances and asymmetries by modulating ADSCs could be an innovative approach to improve and stabilize the results of the surgical treatment of Treacher Collin Syndrome.

  • MINI-THORACOTOMY VERSUS FULL STERNOTOMY TECHNIQUES IN MITRAL VALVE SURGERY: BLOOD LOSS, WOUND INFECTIONS, POST-OPERATIVE RECOVERY, MORBIDITY AND MORTALITY INVESTIGATION

    Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables. Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed. Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P

  • FACIAL LIPOSTRUCTURE: AN OVERVIEW

    Aim: Facial lipostructure (FLS) is not a new procedure. In the past, many surgeons steered clear of it because the results were poor and unpredictable . In the 80’s however FLS emerged with precise indications, improved techniques, foreseeable and stable results. Its use has become widespread because it produces natural, long-lasting outcomes with minimal donor site morbidity . FLS usually represents the last procedure or retouch in many reconstructive procedures and protocols. Moreover adipose-derived stems cells (ADSCs) represent a promising source of autologous cells for tissue repair and regeneration. Methods: In the maxillofacial area, FLS is indicated primarily to restore and rejuvenate the zygomas, periorbital region, cheeks, nose, lips, chin, mandible and jawline. Recently, it has been applied to correct localized tissue atrophy, burns, hemifacial atrophy (Parry-Romberg syndrome, scleroderma, anophthalmic orbit), and loss of substance resulting from trauma, tumor excision, and congenital craniofacial deformity sequelae. Orthognathic surgery and fat grafting represent a new application and an appropriate indication. It is well known that this surgery moves the skeletal bases (maxilla, mandible, chin) but often this leads to a lack of soft tissue coverage. Some patients, particularly women, complain about this lack of soft tissue volume after bony surgery. Conclusion: FLS was launched as a means to improve volumes and facial aesthetics. Recently, it has been applied in more complex reconstructive and regenerative procedures. It can especially be used on any facial area lacking soft tissue due to posttraumatic outcomes, post tumor deformities, and as a refinement in for many acquired and congenital maxillofacial deformities. The proposed uses for ADSCs in tissue repair and regeneration are quite impressive. Recent works on ADSCs would suggest that adult cells may prove to be an equally powerful regenerative tool in treating congenital and acquired maxillofacial disorders. More importantly, physicians, researchers and international associations need…

  • THE FEASIBILITY OF EARLY CLOSURE OF DEFUNCTIONING LOOP ILEOSTOMY AFTER LOW ANTERIOR RESECTION FOR RECTAL CANCER

    Background: The advantages of defuctioning loop ileostomy in some cases of rectal carcinoma is not questionable, but many patients experience serious stoma related complications and impaired quality of life. Early closure of the defunctioning ileostomy could mitigate these problem. Methods: This is a controlled randomized study done on 100 patients suffering of rectal cancer who had low anterior resection of the rectum and covering ileostomy at Menofiya University Hospital between April 2016 to august 2019. The patients were randomly divided (by closed envelope method) in two equal groups, Group A (Early group) and Group B (Late group). Results: As regards the pre-closure ileostomy complications: skin infection and maceration occurred in 4 pts. In early group and in 15 pts.in late group while dehydration and electrolyte imbalance occurred in 3 pts. In early group and in11 pts. In the late one, with both complications were significantly higher in late group (P value; 0.009 and 0,04 respectively). The health related quality of life was found to be higher in early group at 2 and 6 months than that in late group, but this did not yet reach significant difference, and at 12 month, the results were almost the same. Conclusion: Early ileostomy closure is safe, and not associated with higher complication rates in patients with an uncomplicated postoperative course and radiologically verified intact distal loopogram study.

  • INTRA-OPERATIVE RUPTURE OF GIANT ASCENDING AORTA AND AORTIC ARCH ANEURYSM IN OPEN HEART SURGERY: A SUCCESSFUL PERI-OPERATIVE MANAGEMENT

    Introduction: Giant thoracic aortic aneurysms are rare. Most of the reported cases are not a known complication of aortic coarctation repair. Otherwise intra-operative aneurysm ruptures are rare cases but a potentially fatal complication in open heart surgery. Case report: In this article, we report the case of a 23-year-old patient with a giant ascending and arch aneurysm associated with a Standford type A chronic aortic dissection. In the patient’s history a coarctation repair at age of five years old was noted. During an open heart surgery for ascending aorta and hemi-arch replacement under cardiopulmonary bypass, aneurysm rupture occurred before aortic cross-clamp. A successful intraoperative and post-operative management was performed. The course was uneventful. The patient was extubated without neurological damage. Moreover, there were no kidney function deterioration, no digestive and limbs ischemia. Conclusion: Intra-operative aneurysm rupture is rare but is a major operative complication whose successful repair depends on an integrated intra-operative management. Cerebrovascular and heart protection are the main determinants of patient survival. Also, the surgical team’s prompt response is the key to the successful execution of the procedure.

  • EVALUATION OF TOTAL MESORECTAL EXCISION WITH OR WITHOUT LATERAL PELVIC LYMPH NODES DISSECTION FOR MIDDLE AND LOWER RECTAL CANCER

    Background: The most important prognostic factor in colorectal cancer is nodal status, and lymph node metastasis is a determining factor for adjuvant chemotherapy and subsequently key to predicting disease free and overall survival. Methods: A descriptive prospective study was conducted on 40 patients presenting with middle and low rectal cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study will require resection of their tumors by total mesorectal excision by open and laparoscopic techniques. Patients will be divided into 2 groups: Group A: was operated without lateral pelvic lymph nodes dissection. Group B: was operated with lateral pelvic lymph nodes dissection during the period between November 2018 and November 2020. Results: The main presentation of patients was bleeding per rectum 12 (30%), 12 (30%) patients have constipation. 28 patients with adenocarcinoma (70%) and 8 mucinous (20 %) and 4 (10%) with signet ring. Sixteen patients undergo Low ant resection (40%), 16 patients with AP. resection (40 %) and 8 patients with Intersphencteic resection (20%). Regarding intraoperative data, with a mean operative time was (90.00 ± 3.84 min.) for without Lateral pelvic L.N dissection and (122.91±4.89 min.) for with Lateral pelvic L.N dissection. Conclusion: Surgical mortality of LPLD is low, but there is an increase of morbidities in the form of prolonged operative time, intraoperative blood loss and genito-urinary malfunction. For avoiding the drawbacks of LPLD extended lymphadenectomies with sparing of the pelvic nerves is recommended. Lateral pelvic lymph node involvement is a regional disease that is curable. LPLD was effective to control recurrence at lateral nodes sites.

  • MODIFICATIONS OF PARAMEDIAN FOREHEAD FLAP

    Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them. Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded. Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction. Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.