Procedure Of Choice Research Articles

Comparative Study between Outcome of Standard and Tubeless Percutaneous Nephrolithotomy (PCNL) at District Level Tertiary Hospitals in Bangladesh

Renal calculus is one of the commonest problems of the urinary tract. Surgical approach is more effective treatment option to remove it. Among all surgical procedures, Percutaneous Nephrolithotomy (PCNL) has gradually become a preferred option in last two decades for renal calculus that has largely replaced the open approach. Currently, it is the procedure of choice for renal calculus > 2 cm, or those are refractory to ESWL. The crucial step in Standard PCNL is placing a nephrostomy tube. In recent years, it has been reformed as 'Tubeless' PCNL with some modifications in which a Double-J (D-J) stent is placed without any nephrostomy tube for internal drainage. This study was done to compare the outcomes of Standard PCNL and Tubeless PCNL at district level tertiary hospitals in Bangladesh among 46 patients with renal calculus up to 3 cm size. Many authors agree that Tubeless PCNL or its modifications are effective as well as safe. Although, nephrostomy tube is responsible for an increase of post- operative morbidity, in our study, we did not find any statistically significant difference between these two procedures.

Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome.

Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release. A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed. 20 patients met the inclusion criteria and underwent either laparoscopic (n = 3) or robotic (n = 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90-290) vs. 125 (80-254); p = 0.765), the median length of hospital stay (days: 4 (3-4) vs. 5 (3-6); p = 0.179) and intraoperative blood loss (< 50ml in both groups, p = 1.0) showed significant differences. Peak systolic velocity in the CA was significantly reduced postoperatively (cm/s: 320 (200-765) vs. 167 (100-500), p < 0.001). Postoperatively, 17 (85%) patients reported symptom improvement, while 4 (20%) patients had no symptom relief at last follow-up. In 3 cases, follow-up imaging showed evidence of respiratory-related CA stenosis. Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes.

Persistent Gastroesophageal Reflux Disease After RYGB: What Shall we do Next?

Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications. This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication. Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population. There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients.

Ejaculation preserving TURP (Ep-TURP): A viable alternative in sexually active males with BOO-a single centre prospective randomized study.

Benign prostatic hyperplasia (BPH) is a common urological condition, particularly among middle-aged and elderly men. Trans urethral resection of prostate (TURP) has some drawbacks, particularly concerning ejaculatory function. Ejaculation preserving TURP (Ep-TURP) is one such technique that aims at preserving the tissues that are primarily responsible for antegrade ejaculation. In this prospective study, patients with bothersome LUTS were randomized into Ep-TURP and standard TURP groups. Supramontal tissue was preserved in Ep-TURP while standard TURP group had resection of the entire prostatic tissue up to the verumontanum. The outcomes with regard to IPSS, Qmax, IIEF(Q9), Ejaculation and PVR were studied. Ejaculation projection score was separately calculated and assessed. About 60 patients were studied, with 30 in each group. At 6 months' follow-up, complication rates were the same in both groups. The IPSS, Qmax, IIEF were similar and comparable. There was no change in erection in all patients (P = 0.559). The ejaculation was well preserved in Ep-TURP (p<0.001). Ejaculation projection score was maintained at 3.77 in the Ep-TURP group while in the standard group it was 0 (P<0.001). Ep-TURP is a safe and a cost-effective method of preserving ejaculation in patients undergoing TURP. This procedure adds a better quality of life that greatly aids in enhancing the improving his psychological outlook towards life. Ep-TURP has now emerged as the standard procedure of choice in sexually active young males needing TURP, as the degree of ejaculation is largely well preserved in patients undergoing this procedure.

Laparoscopic Hartmann's procedure for complicated diverticulitis is associated with lower superficial surgical site infections compared to open surgery with similar other outcomes: a NSQIP-based, propensity score matched analysis.

Open Hartmann's procedure has traditionally been the procedure of choice to treat complicated diverticulitis. We analyzed the ACS-NSQIP database to compare outcomes in patients who underwent emergent laparoscopic Hartmann's procedure (LHP) to those who had an open Hartmann's procedure (OHP). Data analyzed from 2015 to 2019 using ICD-10 codes. Patients were matched on several important covariates using a propensity score matching method (PSM). Patients were matched in a 4:1 ratio of controls to cases based on the propensity score. We identified 5026, of which 456 had LHP and 4570 had OHP. PSM analysis yielded 369 LHP and 1476 OHP patients. LHP had lower rates of superficial surgical site infection (SSSI) compared to OHP (2.44% vs. 5.89%, p = 0.007). LHP had similar post-operative outcomes compared to OHP, including 30-day mortality (5.15% vs. 2.98%, p = 0.060), organ space surgical site infection (OSSSI) (14.36% vs. 12.60%, p = 0.161), wound disruption (1.36% vs. 2.44%, p = 0.349), median LOS (8 vs. 9 days, p = 0.252), readmission within 30 days (11.92% vs. 8.67%, p = 0.176), rate of reoperation (6.0 vs. 6.5%, p = 0.897), and discharge to home (76% vs. 77%, p = 0.992). LHP had longer operative times compared to OHP (median 129 vs. 118min, p < 0.0001). The LHP is associated with lower rates of SSSI. However, it is not associated with lower rates of mortality, OSSSI, readmissions and reoperations within 30 days. Surgical times are longer in LHP. More studies are needed to determine whether LHP offers advantages in the long-term, particularly in rates of incisional hernia and colostomy closure.

Photorefractive Keratectomy: Technical Evolution, Refractive Outcomes, Corneal Wound Healing Response, and Complications.

Photorefractive keratectomy (PRK) was the first excimer laser procedure developed to treat refractive errors. The safety and efficacy of PRK established it as one of the most performed corneal refractive procedures worldwide. With the introduction of laser in situ keratomileusis (LASIK), and more recently keratorefractive lenticule extraction (KLEx) procedures, many corneal surgeons favor these newer corneal procedures as the first choice due to faster visual rehabilitation and less discomfort during the early postoperative period. Importantly, however, PRK remains a viable alternative for most corneal refractive candidates and there are many situations in which PRK remains the refractive procedure of choice. This review addresses the technical evolution of PRK-mechanical epithelial debridement versus alcohol-assisted epithelial removal versus excimer laser-assisted epithelial debridement (transepithelial) PRK-and reports the PRK refractive outcomes compared to other keratorefractive laser procedures. The corneal wound response associated with each PRK technique and the indications, limitations, and complications of PRK are reviewed to aid refractive surgeons to best position PRK in their overall practice. [J Refract Surg. 2024;40(10):e754-e767.].

Adults who Smoke Should Have Pulmonary Function Testing Before and After Coronary Artery Bypass Grafting (CABG)

Background: Recent research has shown that coronary artery bypass grafting (CABG) has a mortality rate of 0.6–3.0%, making it a popular and generally safe cardiac operation. The purpose of this study is to examine the relationship between sex, age, and diabetes in the early changes in lung volumes measured by pulmonary function tests before and after coronary artery bypass grafting (CABG) in individuals who smoke. Subjects and procedures: Elective coronary artery bypass surgery was the procedure of choice for 200 consecutive patients in this prospective controlled trial. Participants who were not part of the trial were those who were in an emergency or who had a valve operation done alongside a CABG procedure. Based on the data from the operation, the cardiopulmonary bypass time was 98.89 minutes with a standard deviation of 25.14 minutes. The average time for cardiac ischemia was 67.8 minutes with a standard deviation of 26.6 minutes and a range of 25 to 227 minutes. The total time spent in the intensive care unit was 53.54 hours with a standard deviation of 27.98 hours and a range of 4 to 102 hours. Thirteen patients, or 6.5%, were cold, while the remaining patients were warm. Thirteen patients, or 6.5%, used ice slush as a topical cooling method. The results of the pulmonary function tests taken before and after surgery were significantly different. Conclusion: Postoperative obstructive and restrictive breathing problems are associated with cigarette smoking's detrimental effects on pulmonary functioning. Patients with a smoking history who are scheduled for elective revascularization surgery should have their pulmonary status evaluated before surgery, and they should be strongly encouraged to quit smoking as soon as possible before surgery to minimize the risk of respiratory complications after surgery.

A rare case report on neurocysticercosis – A parasitic disease

Neurocysticercosis is commonly known as cysticercosis, which is the most common parasitic disease of the human nervous system caused by the parasitic tapeworm The development of lesions in the brain and leptomeninges and the consequent onset of symptoms associated with NCC is mainly due to the host immune-inflammatory response. The absolute diagnostic criteria include histological conformation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. It is treated by a course of steroids or immunosuppressants; for intravascular cysts, endoscopic surgery is the procedure of choice as it is minimally invasive.We present a case of 8-year-old female patient who was admitted to the Neurology ward with the chief complaints of loss of consciousness, involuntary movements, headache, fever, and onset of seizures associated with vomiting. She had a seizure episode at the age of 2 years associated with fever, but no treatment was done. She was not on any past medication and was hemodynamically stable. Her lab investigations of magnetic resonance imaging show infective granuloma in the left parietal lobe with mass effect as described above, suggesting neurocysticercosiswhich should be carefully observed at an early stage. We summarized the case report of neurocysticercosis, its diagnosis, and treatment plan.

Ultrasound-guided pulsed radiofrequency of the greater occipital nerve in chronic migraine; proximal approach versus distal approach, a single-blind, randomized controlled trial

Background &amp; Objective: Ultrasound-guided pulsed radiofrequency treatment of the greater occipital nerve can be used at distal and proximal levels of the greater occipital nerve in patients with chronic migraine. We aimed to evaluate the treatment efficacy, procedure duration, and pain experienced during the procedure for both methods. Methods: In the study, 60 chronic migraine patients randomly divided into two groups using a computer programme were evaluated. In the proximal group, the greater occipital nerve was accessed at the level of the 2nd cervical vertebra, while in the distal group it was accessed at the level of the protuberencia occipitalis. Patients completed the Migraine Disability Rating Scale, Visual Analogue Scale and a headache diary before treatment as well as at 1 month and 3 months afterwards. The time from the beginning of the intervention to the spread of the stimulus to the C2 dermatome during the sensory stimulation test was recorded. Patients were asked to rate their pain during the procedure using a Visual Analogue Scale. Results: The Visual Analog Scale scores and headache frequencies were significantly decreased in both the proximal group and distal group (p&lt;0.001). The procedure time was shorter (p&lt;0.001) and was less painful in the distal group (p&lt;0.001). Conclusions: In this study, we observed that pulsed radiofrequency of both distal and proximal levels of the greater occipital nerves effectively treated migraine. A shorter procedure time and superior patient tolerability make the distal stimulation the procedure of choice.

362. DELAY IN SOLID GASTRIC EMPTYING IS ASSOCIATED WITH SILENT REGURGITATION EVENTS, PULMONARY MICROASPIRATION AND LARYNGOPHARYNGEAL REFLUX DISEASE

Abstract Background Pulmonary micro-aspiration (PMA) is a feared complication of severe and sometimes silent gastroesophageal reflux disease (GORD). A novel scintigraphic test that shows refluxate contamination of the pharynx, upper and lower airways has recently been developed. This test and multiple observations allowed the development of a hypothesis that prolongation in solid gastric emptying (SGE) may be a more critical than delays in liquid gastric emptying (LGE) in micro-aspiration into the airways. Methods Standard LGE and SGE studies together with the novel microaspiration test were evaluated in paired studies in patients with medially resistant symptoms GORD to measure rates of micro-aspiration after each meal. Either water labelled with 99m Technetium Phytate for the LGE or a labelled egg sandwich for the solid meal was utilised. Major symptoms were noted and the cough and reflux severity index (CSI &amp; RSI) obtained in all patients. Results A total of 131 patients were included in this study (59M/72F). The age range was 21 to 83 years with a mean of 52 years. Patients were in the overweight range for body mass index (BMI), with a mean of 26.8. Major symptoms were of bloating, nausea, belching and dyspepsia as well as cough, throat clearing and globus. Less than 20% complained of heartburn. Results. SGE was abnormal in 92% (Mean 766 min) and LGE was abnormal in 53% (Mean 82 min). PMA was shown in 35% after the SGE and in 71% after the LGE. PMA positive patients were older. SGE and PMA were significantly correlated (p&amp;lt;0.00) but not LGE. The only significant symptom in the PMA group was bloating. RSI was abnormal in 64% and CSI in 46%. Conclusion The majority of patients with PMA do not complain of heartburn. Bloating in patients with severe GORD should raise the possibility of gastroparesis and PMA. Prolonged SGE may be critical in the physiology of atypical reflux and present another treatment goal with addition of pyloroplasty to anti-reflux procedure of choice.

Superior mesenteric artery syndrome managed laparoscopically: a case report

BackgroundSuperior mesenteric artery syndrome is a rare condition that has only around 400 reported cases so far. Typically, the superior mesenteric artery branches off the abdominal aorta at 45° to create an aortomesenteric distance of 10–28 mm, with the duodenum passing through. However, if this aortomesenteric angle reduces to less than 25°, the third portion of the duodenum becomes compressed between the SMA and aorta, causing mechanical obstruction.Case presentationThis case report aims to demonstrate the diagnostic difficulties and the laparoscopic management of a 52-year-old Indian male presenting with abdominal pain and vomiting, with associated weight loss. Imaging was further suggestive of high intestinal obstruction, and he was later found to have superior mesenteric artery syndrome.ConclusionTaking into account a significant reduction in morbidity, we propose laparoscopic duodenojejunostomy to be the new procedure of choice for superior mesenteric artery syndrome.

Ultrasound-guided subcostal transversus abdominis plane block versus erector spinae plane block for post-operative pain after percutaneous nephrolithotomy: A comparative observational study

In India, about 12% of the population has kidney stones, and out of these about 50% may end up with some kidney function loss or renal damage percutaneous nephrolithotomy (PCNL) is accepted as the procedure of choice for large or complex renal stones. Significant post-operative pain can occur after PCNL in first 24 hours due to distension in the renal capsule and pelvicalyceal system. The study aim was to compare the efficacy of ultrasonography guided subcostal transversus abdominis plane block with erector spinae plane block in PCNL. This observational study included 67 consecutive cases (16-65 years, ASA grade I-II) divided into 2 groups. Group A (n=33) received subcostal transversus abdominis plane (SCTAP) block and Group B (n=34) received erector spinae plane block (ESPB). Post operative pain in terms of pain scores, opioid consumption, requirement of rescue analgesic in first 24 hours was noted. Quality of recovery and any adverse events were also noted. Post-operative opioid consumption was significantly less in ESPB group (34.41 ± 27.32 mcg), compared to SCTAP Group (270.91 ± 121.41 mcg). Group B patients had better post operative quality of recovery compared to Group A patients. VAS pain scores at almost all time-points were lower in the ESPB group. ESPB provided effective postoperative analgesia and reduced fentanyl consumption postoperatively compared to SCTAP block.

Gall stones in children with sickle cell disease, management and outcomes

Background: It is rare to encounter a gall bladder stones in the paediatric age group. In Saudi Arabia, sickle cell disease (SCD) is common with incidence reach to 19.7%in some provinces. Cholecystitis is responsible for significant morbidity in SCD patients. Laparoscopic cholecystectomy (LC) is now considered as the procedure of choice for treating such cases. Over a period of 3 years, a total of 21 children with sickle cell anemia (SCA) had cholecystectomy. We exclude 3 patients who had splenectomy and cholecystectomy in the same time, the remaining 18 patients (6 males and 12 females) had LC only. Their age ranged from 4 years to 13 years (mean of 7.45±1.94 years). Methods: LC was the standard procedure performed in all the children in our study group. The mean duration of operation was 92.17±27.31 minutes (range from 62-167 minutes). Results: The mean post-operative stay after operation was 2.167±0.5 days (range from 1-3 days). One patient required conversion to open cholecystectomy (OC) because of severe adhesions, there were no immediate postoperative complications in the other 17 patients of our study group. Conclusions: In conclusion, elective LC in well prepared patients, is feasible and safe in children with SCA and should be the treatment of choice for both symptomatic and asymptomatic cholelithiasis. ERCP is a valuable diagnostic and therapeutic investigation both preoperatively and postoperatively.

ACUTE HEMORRHAGIC ABDOMEN IN YOUNG PATIENTS: CLINICAL MANIFESTATIONS AND SURGICAL TREATMENT

Acute hemorrhagic abdomen represents a surgical emergency that requires rapid diagnosis and immediate treatment. In young patients, the most common causes include perforated peptic ulcer, ruptured ectopic pregnancy, ovarian cyst torsion, and abdominal trauma. The clinical presentation is variable, but intense and sudden abdominal pain, associated with signs of hypovolemic shock (hypotension, tachycardia, pallor), is characteristic. Delay in diagnosis and treatment can lead to serious complications, such as hemodynamic instability, infection and death. Objective: The objective of this systematic review was to synthesize the available scientific evidence on the clinical manifestations and surgical treatment of acute hemorrhagic abdomen in young patients, with the aim of assisting health professionals in decision-making and therapeutic planning. Methodology: A systematic review of the literature was carried out, following the PRISMA checklist criteria. The PubMed, Scielo and Web of Science databases were searched using the following descriptors: “acute abdomen”, “hemorrhagic abdomen”, “young people”, “surgery”, “emergency”. Original articles published in the last 10 years were included, which addressed young patients diagnosed with acute hemorrhagic abdomen and described the clinical manifestations of the disease and the results of surgical treatments. Case studies, narrative reviews and articles that were not available in full were excluded. Results: The review identified a total of 17 studies that addressed acute hemorrhagic abdomen in young patients. The results demonstrated that intense and sudden abdominal pain is the most common symptom, often associated with nausea, vomiting and bloating. The presence of signs of peritoneal irritation, such as muscle guarding and pain upon sudden decompression, is suggestive of peritonitis. Complementary tests, such as blood count, coagulogram and computed tomography, are essential for diagnosing and staging the disease. The treatment of acute hemorrhagic abdomen is surgical and aims to control bleeding, remove the cause of hemorrhage and repair tissue damage. Exploratory laparotomy remains the gold standard for treatment, although laparoscopy has become increasingly popular in specialist centers. Conclusion: Acute hemorrhagic abdomen in young patients is a surgical emergency that requires a quick and effective approach. Early diagnosis and surgical treatment are essential for the patient's survival. High clinical suspicion, associated with the performance of appropriate complementary tests, allows diagnosis and initiation of treatment in a timely manner. Exploratory laparotomy remains the procedure of choice, but laparoscopy has proven to be a safe and effective alternative in many cases.

Clinical predictors of successful outcomes for couples with nonobstructive azoospermic male partners undergoing micro-TESE.

Nonobstructive azoospermia (NOA) is the most challenging and complex clinical scenario for infertile men. Besides circumstances such as hypogonadotropic hypogonadism, surgical sperm retrieval is typically necessary, and microdissection testicular sperm extraction (micro-TESE) is the procedure of choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection (ICSI) in comparison to all other techniques for surgical sperm retrieval in men with NOA. Several factors may affect sperm retrieval rate and ICSI outcomes, including the patient's age, testicular volume, histopathological and genetic profile, and serum hormone levels. This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.

Safety of Phacoemulsification with Gradual Hydro Dissection on Posterior Polar Cataract

Introduction: Phacoemulsification has been a procedure of choice for treating cataractous lenses and restoring visual function. Posterior polar cataract have been one of many cases in which phaco surgeons should be careful and aware for more to perform phacoemulsification. One hydrodissection procedure is safe to perform as an alternative to hydrodileniation during phacoemulsification for posterior cataract. It is called gradual hydrodissection. Methods: This study performed a quasi-experimental pre-post study that tested the safety of gradual hydrodissection in phacoemulsification in 50 eyes of 50 patients. The safety parameter used in this study includes the incidence of posterior capsule rupture and nucleus drop during phacoemulsification until surgery is finished. Descriptive statistics were used to summarize the characteristics of the study participants, such as age, sex, race, eye laterality, and previous intraocular surgery. A paired student’s t-test was conducted to compare preoperative and postoperative values for visual acuity and intraocular pressure. The P &lt;0.05 was considered the level of statistical significance. Results: There was no complication of the posterior capsule during the hydrodissection procedure. There was a statistically significant difference in visual acuity and intraocular pressure before and after surgery by P value &lt;0.001. All of the phacoemulsification studies were considered uneventful and successful. Conclusions: Gradual hydrodissection may be safe to be performed in phacoemulsification for posterior polar cataract.

Per oral endoscopic myotomy in esophageal achalasia in children. First endoscopic procedures

BACKGROUND: Achalasia is an esophagus lesion which is characterized by disorders of its motility. It is met extremely rare in childhood. Among the existing techniques of achalasia management, Heller's laparoscopic myotomy is a procedure of choice. Peroral endoscopic myotomy (POEM) is an endoscopic method for AP treating proposed by P. Pasricha in 2007. AIM: To describe the experience of per oral endoscopic myotomy in children. METHODS: The authors performed a retrospective analysis of data taken from the patients with confirmed esophageal achalasia who had had POEM. Clinical efficacy was assessed using the Eckard scale. RESULTS: In 2018–2021, 8 children with average age 14.4 years were treated with POEM surgery. Before POEM, 2 children underwent balloon dilatation of the cardia. The surgery was technically performed in all children. Dysphagia was eliminated in all patients, and none of them required any additional intervention. A significant decrease in Eckard scale scores was registered in all children after surgery. CONCLUSION: Our results confirm findings that POEM is an effective procedure for treating esophageal achalasia. However, a longer follow-up period and a larger group of patients are needed to confirm POEM role in the management of children with esophageal achalasia.

Extreme Oncoplasty: Oncologically Safe When Compared with Mastectomy

BackgroundExtreme oncoplasty is a breast-conserving operation using oncoplastic techniques in a patient who does not meet the traditional criteria for breast conservation and in whom most physicians would suggest a mastectomy. These tumors are generally multicentric and/or multifocal, they span more than 50 mm, or they can be large recurrences in a previously irradiated breast.MethodsA prospective single institution database was queried from 2008 through mid 2023 for patients who met the criteria for extreme oncoplasty and were treated with excision plus whole-breast radiation therapy (WBRT) or mastectomy without WBRT. Patients with recurrent breast cancer were excluded. Endpoints were local, regional, and distant recurrence as well as overall and breast-cancer-specific survival.Results272 patients were treated with oncoplastic mammaplasty, using a standard or split reduction excision followed by postoperative WBRT. An additional 101 patients elected to be treated with mastectomy without postoperative radiation therapy. With a median follow-up of 7 years, there were no significant differences in local, regional, or distant recurrence, nor in breast-cancer-specific survival or overall survival.ConclusionsWe strongly support extreme oncoplasty plus WBRT as the default procedure of choice for patients with large multifocal/multicentric lesions amenable to reconstruction with volume displacement mammaplasty.

Bilateral Germectomy in Pediatric Patient: Clinical Case Report

Germectomy is a surgical treatment that consists of the extraction of the tooth germ; indicated when there are morphostructural alterations, ectopic impactions or eruption not permitted due to dysplastic alterations of the tooth germ. It is a surgical procedure of choice that involves the extraction of a dental organ with all its embryonic attachments when it is in the early stages, the prevalence of impactions and pathologies of the mandibular third molar can be avoided with this surgical treatment. Objective: To perform a careful cost-benefit evaluation to evaluate the indications of early third molar extraction. Methods: An observational and descriptive study was carried out in the operating room of the dental clinics of the American University from September 2023 to November 2023. An 12-year-old patient was evaluated, surgically intervening on two tooth germs of mandibular third molars. Evaluating the position, location, and morphostructural change of the third molar germ; as well as trans and postoperative complications and the evolution.

Incidence of Pancreatic Leakage in Isolated Biliary Limb Roux-en-Y Reconstruction in Whipple Procedure

Abstract Background Whipple is currently the procedure of choice in the treatment of localized pancreatic cancer. Isolated Roux-en-Y loop pancreaticojejunostomy was proposed as a method of reconstruction following pancreaticoduodenectomy. The idea is to isolate the bile from pancreatic secretions to minimize pancreatic enzyme activation and ultimately pancreatic fistula formation. It was also proposed that if a pancreatic fistula develops, it will be a pure fistula and thereby more benign as opposed to a mixed pancreatic fistula containing bile. Objective To estimate the incidence of pancreatic fistula in patients undergoing isolated Roux-en- Y hepaticojejunostomy reconstruction following pancreaticoduodenectomy. Patients and Methods In this prospective observational study, our aim is to calculate the incidence of post-operative pancreatic fistula in 20 patients that underwent Roux-en-Y isolated biliary limb reconstruction following pancreaticoduodenectomy for the treatment of pancreatic cancer. The study includes patients that underwent this procedure at Ain Shams University Hospitals in the period between January 2021 and July 2022 with a post-operative follow up period of 3 weeks. Patients were diagnosed with pancreatic cancer using MRI or CT scans with some of them also undergoing endoscopic US with biopsy. They were then admitted to one of the two main Ain Shams University Hospitals for pre-operative preparation. Results Our study did no estimate post-operative complications such as delayed gastric emptying and wound infection. Pancreaticoduodenectomy is a major surgery that carries a significant burden in terms of morbidity and mortality. Post-operative pancreatic fistula can be fatal as it can lead to vascular pseudoaneurysms that may fatally rupture. The idea behind using isolated biliary limb roux-en-y reconstruction is to alleviate the morbidity caused by post-operative pancreatic fistula. Conclusion Further comparative studies with a higher number of patients are recommended to assess and compare the value of isolated biliary limb reconstruction when compared to conventional reconstruction.