Abstract Background: Seroma formation after breast surgery could result in significant morbidity and subsequent delay to commence the adjuvant therapy. A prospective randomized study was done to assess the effect of obliterating the axillary dead space by sutures with Flap fixation after Breast cancer surgery either by Modified Radical Mastectomy (MRM) or Conservative Breast Surgery (CBS) prospectively. In addition, Factors predicting the formation of seroma were analyzed and reported. Methods: A total of 164 patients diagnosed as Breast cancer, they were randomized to have the post mastectomy dead space obliterated (intervention group) or standard wound closure (control group) following either MRM or CBS. Those had immediate reconstruction were excluded from the study. Drains were routinely left in place until the preceding 48-hour output was 30 milliliters/day. The duration of the drains left in place and the incidence of seroma formation were reported. A multivariate analysis for the potential factors associated with seroma formation was done. Results: Fifty -eight (n=58) patients were assigned to the treatment group and 106 (n=106) to the control group. MRM was performed on 105 patients (64%) and CBS on 59 (36%). Ten of the 58 patients (17.2%) in the intervention group developed a seroma in comparison to 33 of the 106 control patients (31.1%) (P=0.03). There was a significant reduction in the duration of suction drain in situ with obliteration of the dead space (P=0.001). No statistically significant differences were observed between intervention and control groups with respect to patient and pathological parameters or the incidence of other wound complications. Multivariate analysis revealed that Significant risk factors for seroma formation were Diabetes Mellitus (DM) (P=0.01), neoadjuvant CTH (P=0.019), number of retrieved L node (P=0.019), and dead space obliteration (P=0.04). Conclusion: On multivariate analysis, the most significant factors affecting seroma formation were DM, neoadjuvant CTH, number of retrieved L node and Dead Space Obliteration. Dead Space Obliteration following breast cancer surgery is a simple technique that reduces the time of suction tubal drainage, and incidence of seroma formation.

Abstract Background: Seroma formation after breast surgery could result in significant morbidity and subsequent delay to commence the adjuvant therapy. A prospective randomized study was done to assess the effect of obliterating the axillary dead space by sutures with Flap fixation after Breast cancer surgery either by Modified Radical Mastectomy (MRM) or Conservative Breast Surgery (CBS) prospectively. In addition, Factors predicting the formation of seroma were analyzed and reported. Methods: A total of 164 patients diagnosed as Breast cancer, they were randomized to have the post mastectomy dead space obliterated (intervention group) or standard wound closure (control group) following either MRM or CBS. Those had immediate reconstruction were excluded from the study. Drains were routinely left in place until the preceding 48-hour output was 30 milliliters/day. The duration of the drains left in place and the incidence of seroma formation were reported. A multivariate analysis for the potential factors associated with seroma formation was done. Results: Fifty -eight (n=58) patients were assigned to the treatment group and 106 (n=106) to the control group. MRM was performed on 105 patients (64%) and CBS on 59 (36%). Ten of the 58 patients (17.2%) in the intervention group developed a seroma in comparison to 33 of the 106 control patients (31.1%) (P=0.03). There was a significant reduction in the duration of suction drain in situ with obliteration of the dead space (P=0.001). No statistically significant differences were observed between intervention and control groups with respect to patient and pathological parameters or the incidence of other wound complications. Multivariate analysis revealed that Significant risk factors for seroma formation were Diabetes Mellitus (DM) (P=0.01), neoadjuvant CTH (P=0.019), number of retrieved L node (P=0.019), and dead space obliteration (P=0.04). Conclusion: On multivariate analysis, the most significant factors affecting seroma formation were DM, neoadjuvant CTH, number of retrieved L node and Dead Space Obliteration. Dead Space Obliteration following breast cancer surgery is a simple technique that reduces the time of suction tubal drainage, and incidence of seroma formation.

Abstract: Background: This study details Assiut and South Valley universities experience in treating combined gall bladder and common bile duct stones in a single session, either with Endoscopic Retrograde Cholangio-Pancreatography (ERCP) for Common Bile Duct (CBD) stone extraction followed by laparoscopic cholecystectomy (LC), or totally laparoscopic treatment. Patients and methods: In this prospective randomized study, 46 consecutive patients with confirmed cholecystocholedocholithiasis were randomized to 2 groups. Group (A) included 24 patients treated with single-session ERCP for CBD stone extraction and laparoscopic cholecystectomy [ERCP-LC]. Group (B) included 22 patients treated with laparoscopic CBD exploration and laparoscopic cholecystectomy [LCBDE-LC]. Demographic data, operative time, CBD clearance success rate, short term complications and duration of hospital stay were recorded. Results: Patients included 28 females and 18 males with mean age of 42.1 ± 12.1 years (range 17 – 71 years). In 22/24 patients (91.7%) ERCP-LC was done successfully. Mean operative time was 105 ± 19.1 minutes (50-150 min.). No intra-operative complications occurred. Early post-operative complications occurred in 3 patients (12.5%). Mean hospital stay was 2.1 ± 0. 91 days (1-6 days). In the other group, LCBDELC was performed successfully in 22/22 patients (100%). Mean operative time was 145 ± 23 minutes (100-180 min.). Minor intra-operative complications (bleeding) occurred in 2/22 cases (9%). Minor early post-operative complications (bile leak, ileus, bleeding) occurred in 4/22 patients (18%). Mean hospital stay was 2.8 ± 0.83 days (2-7 days). Conclusion: Single session ERCP-LC and LCBDE-LC procedures for management of cholecysto-choledocholithiasis are feasible, safe, and effective and have comparable outcome regarding success rate, peri-operative complications. ERCP-LC has statistically significant less operative time and less hospital stay.

Abstract: Background: This study details Assiut and South Valley universities experience in treating combined gall bladder and common bile duct stones in a single session, either with Endoscopic Retrograde Cholangio-Pancreatography (ERCP) for Common Bile Duct (CBD) stone extraction followed by laparoscopic cholecystectomy (LC), or totally laparoscopic treatment. Patients and methods: In this prospective randomized study, 46 consecutive patients with confirmed cholecystocholedocholithiasis were randomized to 2 groups. Group (A) included 24 patients treated with single-session ERCP for CBD stone extraction and laparoscopic cholecystectomy [ERCP-LC]. Group (B) included 22 patients treated with laparoscopic CBD exploration and laparoscopic cholecystectomy [LCBDE-LC]. Demographic data, operative time, CBD clearance success rate, short term complications and duration of hospital stay were recorded. Results: Patients included 28 females and 18 males with mean age of 42.1 ± 12.1 years (range 17 – 71 years). In 22/24 patients (91.7%) ERCP-LC was done successfully. Mean operative time was 105 ± 19.1 minutes (50-150 min.). No intra-operative complications occurred. Early post-operative complications occurred in 3 patients (12.5%). Mean hospital stay was 2.1 ± 0. 91 days (1-6 days). In the other group, LCBDELC was performed successfully in 22/22 patients (100%). Mean operative time was 145 ± 23 minutes (100-180 min.). Minor intra-operative complications (bleeding) occurred in 2/22 cases (9%). Minor early post-operative complications (bile leak, ileus, bleeding) occurred in 4/22 patients (18%). Mean hospital stay was 2.8 ± 0.83 days (2-7 days). Conclusion: Single session ERCP-LC and LCBDE-LC procedures for management of cholecysto-choledocholithiasis are feasible, safe, and effective and have comparable outcome regarding success rate, peri-operative complications. ERCP-LC has statistically significant less operative time and less hospital stay.

Abstract: Background: This study details Assiut and South Valley universities experience in treating combined gall bladder and common bile duct stones in a single session, either with Endoscopic Retrograde Cholangio-Pancreatography (ERCP) for Common Bile Duct (CBD) stone extraction followed by laparoscopic cholecystectomy (LC), or totally laparoscopic treatment. Patients and methods: In this prospective randomized study, 46 consecutive patients with confirmed cholecystocholedocholithiasis were randomized to 2 groups. Group (A) included 24 patients treated with single-session ERCP for CBD stone extraction and laparoscopic cholecystectomy [ERCP-LC]. Group (B) included 22 patients treated with laparoscopic CBD exploration and laparoscopic cholecystectomy [LCBDE-LC]. Demographic data, operative time, CBD clearance success rate, short term complications and duration of hospital stay were recorded. Results: Patients included 28 females and 18 males with mean age of 42.1 ± 12.1 years (range 17 – 71 years). In 22/24 patients (91.7%) ERCP-LC was done successfully. Mean operative time was 105 ± 19.1 minutes (50-150 min.). No intra-operative complications occurred. Early post-operative complications occurred in 3 patients (12.5%). Mean hospital stay was 2.1 ± 0. 91 days (1-6 days). In the other group, LCBDELC was performed successfully in 22/22 patients (100%). Mean operative time was 145 ± 23 minutes (100-180 min.). Minor intra-operative complications (bleeding) occurred in 2/22 cases (9%). Minor early post-operative complications (bile leak, ileus, bleeding) occurred in 4/22 patients (18%). Mean hospital stay was 2.8 ± 0.83 days (2-7 days). Conclusion: Single session ERCP-LC and LCBDE-LC procedures for management of cholecysto-choledocholithiasis are feasible, safe, and effective and have comparable outcome regarding success rate, peri-operative complications. ERCP-LC has statistically significant less operative time and less hospital stay.

Abstract: cancer stomach is the fifth killer cancer worldwide. Radical gastrectomy for tumor resection is the gold standard for potential cure of resectable gastric cancer. Recent advances in laparoscopy especially high resolution of imaging and energy dissection/vessel sealing devices have allowed laparoscopy to have a role in gastrectomy even radical ones that necessitate lymph nodes dissection. This gives advantages of minimal invasiveness but shouldn’t be on expense of safety and oncologic efficiency of the resection. Several recent studies have discussed the role of laparoscopy in radical gastric resection for cancer. Still further studies are needed in this field. Objective: retrospective comparison between laparoscopic and open radical gastrectomy for resectable gastric cancer, regarding oncologic efficiency (safety margin, number of LNs, tumor free survival, and overall survival) and safety (operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality) for patients operated upon in the Surgery Department, Assuit University Hospital. Patients and methods: This retrospective study involved 47 consecutive patients who had radical gastrectomy for gastric adenocarcinoma. All patients were admitted to the Surgery Department Assuit university Hospital between January 1st, 2014 and December 31st 2016. Patients were divided into 2 groups. Group A; included patients who had totally laparoscopic radical gastrectomy (No 13) and group B; included patients who had open radical gastrectomy (No 34). The two groups were compared regarding pathologic safety margin from the excised tumor, number of LNs, tumor free survival, and overall survival. Also, they were compared regarding operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality, and postoperative hospital stay. Results: in group A (n= 13) all operations were completed laparoscopicaly. There were 7 females and 6 males. Mean age was 49 years old (range 38-59). The clinical TNM stages were stage II in 8 patients (8/13) and stage III in 5 (5/13). Negative safety margin was achieved in 10 (10/13) patients, while margin was close (1 cm) in 3 (3/13) patients. A mean of 19 LNs was harvested (range 11-26). During the follow up period 10-34 months (mean 19) the tumor recurred in 5 patients with a mean tumor free survival of 15 months (range 8-24 months). One year survival was 11/13. Mean operative time was 250 minutes (180-320). Mean blood loss was 230 mL. Postoperative leakage occurred in 2 patients where the leakage trickled out through the tubal drains. In the two patients no operative intervention was needed. No other operative complications had occurred, nor wound infection or incisional hernia. No operative or early postoperative mortality had occurred. In group B (n=34), there were 19 females and 15 males. Mean age was 58 years (range 37-71). The clinical TNM stages were stage II in 19 patients (18/34) and III in 16 (16/34). Negative safety margin was achieved in 29 (29/34) patients, while margin was close (1 cm) in 5 (5/34) patients. A mean of 26 lymph nodes was harvested. During the follow up period (12-31, mean 20 months) the tumor recurred in 9 patients with a mean tumor free survival of 14 months (range 10-24 months). One year survival was 30/34. Mean operative time was 160 minutes. Mean blood loss was 540 mL. No postoperative leakage had occurred. Total number of postoperative complications was 14, and occurred in 6 (6/34) patients. Postoperative bleeding through the drain that stopped spontaneously occurred in 3 patients. Wound infection occurred in 4 patients and incisional hernia occurred in 7 patients. No operative or early postoperative mortality had occurred. Conclusions: the absence of mortality or major complications that necessitate surgical intervention together with the accepted oncologic results regarding safety margin, number of LNs removed, and tumor free survival indicate that totally laparoscopic radical gastrectomy is not only feasible and safe, but it is also oncologically efficient. However, still larger randomized controlled studies are needed for more solid conclusions.

Abstract: cancer stomach is the fifth killer cancer worldwide. Radical gastrectomy for tumor resection is the gold standard for potential cure of resectable gastric cancer. Recent advances in laparoscopy especially high resolution of imaging and energy dissection/vessel sealing devices have allowed laparoscopy to have a role in gastrectomy even radical ones that necessitate lymph nodes dissection. This gives advantages of minimal invasiveness but shouldn’t be on expense of safety and oncologic efficiency of the resection. Several recent studies have discussed the role of laparoscopy in radical gastric resection for cancer. Still further studies are needed in this field. Objective: retrospective comparison between laparoscopic and open radical gastrectomy for resectable gastric cancer, regarding oncologic efficiency (safety margin, number of LNs, tumor free survival, and overall survival) and safety (operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality) for patients operated upon in the Surgery Department, Assuit University Hospital. Patients and methods: This retrospective study involved 47 consecutive patients who had radical gastrectomy for gastric adenocarcinoma. All patients were admitted to the Surgery Department Assuit university Hospital between January 1st, 2014 and December 31st 2016. Patients were divided into 2 groups. Group A; included patients who had totally laparoscopic radical gastrectomy (No 13) and group B; included patients who had open radical gastrectomy (No 34). The two groups were compared regarding pathologic safety margin from the excised tumor, number of LNs, tumor free survival, and overall survival. Also, they were compared regarding operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality, and postoperative hospital stay. Results: in group A (n= 13) all operations were completed laparoscopicaly. There were 7 females and 6 males. Mean age was 49 years old (range 38-59). The clinical TNM stages were stage II in 8 patients (8/13) and stage III in 5 (5/13). Negative safety margin was achieved in 10 (10/13) patients, while margin was close (1 cm) in 3 (3/13) patients. A mean of 19 LNs was harvested (range 11-26). During the follow up period 10-34 months (mean 19) the tumor recurred in 5 patients with a mean tumor free survival of 15 months (range 8-24 months). One year survival was 11/13. Mean operative time was 250 minutes (180-320). Mean blood loss was 230 mL. Postoperative leakage occurred in 2 patients where the leakage trickled out through the tubal drains. In the two patients no operative intervention was needed. No other operative complications had occurred, nor wound infection or incisional hernia. No operative or early postoperative mortality had occurred. In group B (n=34), there were 19 females and 15 males. Mean age was 58 years (range 37-71). The clinical TNM stages were stage II in 19 patients (18/34) and III in 16 (16/34). Negative safety margin was achieved in 29 (29/34) patients, while margin was close (1 cm) in 5 (5/34) patients. A mean of 26 lymph nodes was harvested. During the follow up period (12-31, mean 20 months) the tumor recurred in 9 patients with a mean tumor free survival of 14 months (range 10-24 months). One year survival was 30/34. Mean operative time was 160 minutes. Mean blood loss was 540 mL. No postoperative leakage had occurred. Total number of postoperative complications was 14, and occurred in 6 (6/34) patients. Postoperative bleeding through the drain that stopped spontaneously occurred in 3 patients. Wound infection occurred in 4 patients and incisional hernia occurred in 7 patients. No operative or early postoperative mortality had occurred. Conclusions: the absence of mortality or major complications that necessitate surgical intervention together with the accepted oncologic results regarding safety margin, number of LNs removed, and tumor free survival indicate that totally laparoscopic radical gastrectomy is not only feasible and safe, but it is also oncologically efficient. However, still larger randomized controlled studies are needed for more solid conclusions.

Abstract: cancer stomach is the fifth killer cancer worldwide. Radical gastrectomy for tumor resection is the gold standard for potential cure of resectable gastric cancer. Recent advances in laparoscopy especially high resolution of imaging and energy dissection/vessel sealing devices have allowed laparoscopy to have a role in gastrectomy even radical ones that necessitate lymph nodes dissection. This gives advantages of minimal invasiveness but shouldn’t be on expense of safety and oncologic efficiency of the resection. Several recent studies have discussed the role of laparoscopy in radical gastric resection for cancer. Still further studies are needed in this field. Objective: retrospective comparison between laparoscopic and open radical gastrectomy for resectable gastric cancer, regarding oncologic efficiency (safety margin, number of LNs, tumor free survival, and overall survival) and safety (operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality) for patients operated upon in the Surgery Department, Assuit University Hospital. Patients and methods: This retrospective study involved 47 consecutive patients who had radical gastrectomy for gastric adenocarcinoma. All patients were admitted to the Surgery Department Assuit university Hospital between January 1st, 2014 and December 31st 2016. Patients were divided into 2 groups. Group A; included patients who had totally laparoscopic radical gastrectomy (No 13) and group B; included patients who had open radical gastrectomy (No 34). The two groups were compared regarding pathologic safety margin from the excised tumor, number of LNs, tumor free survival, and overall survival. Also, they were compared regarding operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality, and postoperative hospital stay. Results: in group A (n= 13) all operations were completed laparoscopicaly. There were 7 females and 6 males. Mean age was 49 years old (range 38-59). The clinical TNM stages were stage II in 8 patients (8/13) and stage III in 5 (5/13). Negative safety margin was achieved in 10 (10/13) patients, while margin was close (1 cm) in 3 (3/13) patients. A mean of 19 LNs was harvested (range 11-26). During the follow up period 10-34 months (mean 19) the tumor recurred in 5 patients with a mean tumor free survival of 15 months (range 8-24 months). One year survival was 11/13. Mean operative time was 250 minutes (180-320). Mean blood loss was 230 mL. Postoperative leakage occurred in 2 patients where the leakage trickled out through the tubal drains. In the two patients no operative intervention was needed. No other operative complications had occurred, nor wound infection or incisional hernia. No operative or early postoperative mortality had occurred. In group B (n=34), there were 19 females and 15 males. Mean age was 58 years (range 37-71). The clinical TNM stages were stage II in 19 patients (18/34) and III in 16 (16/34). Negative safety margin was achieved in 29 (29/34) patients, while margin was close (1 cm) in 5 (5/34) patients. A mean of 26 lymph nodes was harvested. During the follow up period (12-31, mean 20 months) the tumor recurred in 9 patients with a mean tumor free survival of 14 months (range 10-24 months). One year survival was 30/34. Mean operative time was 160 minutes. Mean blood loss was 540 mL. No postoperative leakage had occurred. Total number of postoperative complications was 14, and occurred in 6 (6/34) patients. Postoperative bleeding through the drain that stopped spontaneously occurred in 3 patients. Wound infection occurred in 4 patients and incisional hernia occurred in 7 patients. No operative or early postoperative mortality had occurred. Conclusions: the absence of mortality or major complications that necessitate surgical intervention together with the accepted oncologic results regarding safety margin, number of LNs removed, and tumor free survival indicate that totally laparoscopic radical gastrectomy is not only feasible and safe, but it is also oncologically efficient. However, still larger randomized controlled studies are needed for more solid conclusions.

Abstract: cancer stomach is the fifth killer cancer worldwide. Radical gastrectomy for tumor resection is the gold standard for potential cure of resectable gastric cancer. Recent advances in laparoscopy especially high resolution of imaging and energy dissection/vessel sealing devices have allowed laparoscopy to have a role in gastrectomy even radical ones that necessitate lymph nodes dissection. This gives advantages of minimal invasiveness but shouldn’t be on expense of safety and oncologic efficiency of the resection. Several recent studies have discussed the role of laparoscopy in radical gastric resection for cancer. Still further studies are needed in this field. Objective: retrospective comparison between laparoscopic and open radical gastrectomy for resectable gastric cancer, regarding oncologic efficiency (safety margin, number of LNs, tumor free survival, and overall survival) and safety (operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality) for patients operated upon in the Surgery Department, Assuit University Hospital. Patients and methods: This retrospective study involved 47 consecutive patients who had radical gastrectomy for gastric adenocarcinoma. All patients were admitted to the Surgery Department Assuit university Hospital between January 1st, 2014 and December 31st 2016. Patients were divided into 2 groups. Group A; included patients who had totally laparoscopic radical gastrectomy (No 13) and group B; included patients who had open radical gastrectomy (No 34). The two groups were compared regarding pathologic safety margin from the excised tumor, number of LNs, tumor free survival, and overall survival. Also, they were compared regarding operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early postoperative mortality, and postoperative hospital stay. Results: in group A (n= 13) all operations were completed laparoscopicaly. There were 7 females and 6 males. Mean age was 49 years old (range 38-59). The clinical TNM stages were stage II in 8 patients (8/13) and stage III in 5 (5/13). Negative safety margin was achieved in 10 (10/13) patients, while margin was close (1 cm) in 3 (3/13) patients. A mean of 19 LNs was harvested (range 11-26). During the follow up period 10-34 months (mean 19) the tumor recurred in 5 patients with a mean tumor free survival of 15 months (range 8-24 months). One year survival was 11/13. Mean operative time was 250 minutes (180-320). Mean blood loss was 230 mL. Postoperative leakage occurred in 2 patients where the leakage trickled out through the tubal drains. In the two patients no operative intervention was needed. No other operative complications had occurred, nor wound infection or incisional hernia. No operative or early postoperative mortality had occurred. In group B (n=34), there were 19 females and 15 males. Mean age was 58 years (range 37-71). The clinical TNM stages were stage II in 19 patients (18/34) and III in 16 (16/34). Negative safety margin was achieved in 29 (29/34) patients, while margin was close (1 cm) in 5 (5/34) patients. A mean of 26 lymph nodes was harvested. During the follow up period (12-31, mean 20 months) the tumor recurred in 9 patients with a mean tumor free survival of 14 months (range 10-24 months). One year survival was 30/34. Mean operative time was 160 minutes. Mean blood loss was 540 mL. No postoperative leakage had occurred. Total number of postoperative complications was 14, and occurred in 6 (6/34) patients. Postoperative bleeding through the drain that stopped spontaneously occurred in 3 patients. Wound infection occurred in 4 patients and incisional hernia occurred in 7 patients. No operative or early postoperative mortality had occurred. Conclusions: the absence of mortality or major complications that necessitate surgical intervention together with the accepted oncologic results regarding safety margin, number of LNs removed, and tumor free survival indicate that totally laparoscopic radical gastrectomy is not only feasible and safe, but it is also oncologically efficient. However, still larger randomized controlled studies are needed for more solid conclusions.

The aim of this research is to describe correlation between urea concentration in the serum and aqueous humor and development of age related cataract. This is a cross sectional analytical study conducted in the departments of Ophthalmology and internal medicine, Assiut University. patients with age related cortical cataract who are otherwise healthy (cases) and two control groups; first systemically healthy subjects with ocular diseases other than cataract and a second control group of patients with impaired renal functions and are not on dialysis treatment and thus have elevated serum urea levels were included. Slit lamp examination was performed to evaluate crystalline lens for opacities. Measurement of serum urea was done for all study subjects. Aqueous humor urea concentration was done only for the group of patients who are planned to have intraocular surge A significantly higher urea concentration was found in the group with clear lenses (P= 0.035) compared to subjects who have cortical cataracts. Even if we look at healthy people alone and exclude the group of uremic patients, a significantly higher serum urea level was also found in patients with clear lens (p=0.028). Aqueous humor levels of urea were found to be correlated with serum urea levels (r= 0.78). Our data shows that a significantly lower urea concentration is found in serum and aqueous humor of patients who have cataracts compared to patients who don't have cataract.