No definitive procedure for cleft repair has been identified yet as the gold standard. Accordingly, this work tried to appraise the hypothesis that if the bony detachment and full retropositioning of the levator veli palatini muscle can ideally present an anatomical C-shape muscular sling restoration and if this is accompanied with pushback palatoplasty, would this present a better result in terms of tissue fistulation and phonetic impairment? A series of 74 different degrees of palatal clefts were operated by pushback palatoplasty combined with a modified approach of the levator vili palatini. This muscle was dissected only from the oral mucosa while kept attached to the nasal one as a musculo-nasomucosal unit. This unit was completely detached from the bony margin of the hard palate and then medially rotated and retropositioned in a typical C-shape mobile sling. Evaluations included suture line assessment and fistula development, and following the child’s need for speech therapy. There were no intraoperative complications. Definite anterior fistulae with nasal air and foot leakage were observed in 2 cases. Four cases had postoperative velopharyngeal incompetence with a need for speech therapy. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all cleft types, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this unpublished technique.

OBJECTIVES: Tamsulosin is proved to promote spontaneous passage of distal ureteral and juxtavesical calculi. Our aim is to prospectively evaluate the role of neoadjuvant tamsulosin during ureteroscopic treatment of lower ureteric stone. METHODS: One hundred thirty-eight adult patients with lower ureteral calculi underwent ureteroscopic management. Stone length varied from 7 to 12 mm. Before treatment, the patients were randomly divided into 2 groups; the study group (n = 70) received tamsulosin 0.4 mg once daily for 3-6 weeks and the control group (n = 68) received standard analgesia only. Preoperative medications were blinded to the endourologists. The primary endpoint was the need for intraoperative ureteral dilatation. Postoperative complications were recorded for both groups. RESULTS: Of the 120 patients available for follow up, the need for intraoperative ureteral dilatation was 30% in the study group, compared with 86.7% in the control group (p0.001). Of the control group, 5% had postoperative pyelonephritis episodes, in contrast to only 1.7% of the study group (p=0.619). CONCLUSIONS: Preopertive tamsulosin simplifies ureteroscopic management of lower ureteric calculi. To the best of our knowledge, this is the first study to show the value of neoadjuvant tamsulosin in ureteroscopic management of distal ureteric calculi

Although the seroprevalence of hepatitis E virus (HEV) is approximately 80% in adult Egyptians living in rural areas, symptomatic HEV-caused acute viral hepatitis (AVH) is sporadic and relatively uncommon. To investigate the dichotomy between HEV infection and clinical AVH, HEV-specific immune responses in patients with symptomatic and asymptomatic HEV infection during a waterborne outbreak in Egypt were examined. Of 235 acute hepatitis patients in Assiut hospitals screened for HEV infection, 42 (17.9%) were acute hepatitis patients confirmed as HEV-caused AVH; 37 (88%) of the 42 patients were residents of rural areas, and 14 (33%) were from one village (Kom El-Mansoura). Another 200 contacts of AVH cases in this village were screened for HEV and 14 (7.0%), all of whom were family members of AVH cases, were asymptomatic HEV IgM-positive. HEV infections in this village peaked during the summer. Asymptomatic HEV seroconverters had significantly higher levels of epitope-specific neutralising (p=0.006) and high avidity (p=0.04) anti-HEV antibodies than the corresponding AVH cases. In conclusion, naturally acquired humoral immune responses appear to protect HEV-exposed subjects from AVH during an HEV outbreak in Egypt.

PURPOSE: A prospective study to evaluate the postcholecystectomy problem management. PATIENTS AND METHODS: From March 2005 to April 2007, 210 patients were managed using surgery, endoscopy, and percutaneous approaches. RESULTS: Endoscopy was therapeutic in 183 cases [stones (81), stricture (55), leakage (35)], and only diagnostic in 24 cases. Percutaneous approaches were carried out in 34 cases as diagnostic in 19 cases, stenting in 2 cases, and combined with endoscopy in 13 cases. Surgery was carried out in 40 cases either urgent in 10 cases (4.8%), or planned in 30 cases (14.3%), for peritoneal lavage in 7 cases, choledocholithotomy in 8 cases, undo ligation and T-tube drainage in 5 cases, common bile duct repair splinted by T tube in 3 cases, choledochoduodenostomy in 1 case, and Roux-en-Y choledochojejunostomy in 18 cases. CONCLUSIONS: Endoscopy is effective and safe not only for diagnostic but also for therapeutic approaches, especially when combined with percutaneous approaches that help in failure cases, but surgery remains as the gold standard treatment not only for the cases, which failed to be treated by less invasive approaches, but also in cases that are mandatory to be explored as peritonitis.

Aim: to evaluate safety and efficacy of harmonic scalpel in closure/division of the cystic duct and artery, and bladder dissection in laparoscopic cholecystectomy as a single working instrument, with the use of two working trocars technique, compared with regular laparoscopic clip/cautery, three trocars technique. Method: A prospective study included 160 patients with symptomatic gall stone disease were randomly assigned for laparoscopic cholecystectomy by either harmonic shear as a single working instrument, with two trocars technique (group I = 80 patients), or group II (regular clip/cautery, 3 trocars technique) including 80 patients. Results: No significant complications were encountered in either group; however 1 case of regular laparoscopy group suffers mild leakage treated conservatively. Intra-operative bile spillage was insignificantly comparable in both groups (10% vs. 13%; P=0.46). The median operative time was statistically significantly shorter in harmonic group (20 vs. 45 minutes; P=0.0001). Also hospital stay was significantly shorter in harmonic group (1 vs. 1.5 days respectively; P=0.001), but no statistically significant difference was found in the incidence of post operative complications. The overall cosmetic results and patient satisfaction was better in harmonic group. Conclusion: Harmonic shear is as safe and effective as clip/cautery technique in laparoscopic cholecystectomy in achieving hemo-biliary stasis; with shorter operative time especially if used solely as a working instrument. Two trocars technique is safe, feasible, and provides better cosmetic results and patient satisfaction.

Purpose: A prospective and retrospective work to evaluate management of post-cholecystectomy biliary injuries. Patients and Methods: From March 2000 to February 2010, 419 patients (224 females and 195 males) complaining of post-cholecystectomy biliary injuries were managed using surgery in 135 patients and endoscopy in 317 patients, in addition to percutaneous techniques in 32 patients. Results: Endoscopy was very successful initial treatment of 317 patients (76%), as being less invasive, with low morbidity and mortality, and being competitive with surgery in treatment of mild/moderate biliary leakage (82%) and biliary stricture (74%). Its success increased by 2.8% and 8.3% for leakage and stricture, respectively, by addition of percutaneous techniques. However, surgery was needed for major leakage and massive stricture in 19% and 14% of cases, respectively. Surgery remains the choice in common bile duct transection, ligation, and combined injuries of stones, stricture, and leakage in 60% of cases. Bilio-enteric anastomosis was the procedure of choice, done in 76 cases, with trans-anastomotic stent in 30 cases with unhealthy or small ducts. Stricture was encountered in 5 cases (6.5%), treated by the percutaneous route in 3 cases and repeat surgery in 2 cases. The learning curve seems influential in both endoscopy and surgery. The cumulative experience increased the success of endoscopy from 60% to 95%. Also, surgery improved with decreased morbidity and mortality. Conclusions: Endoscopy was competitive with surgery in initial treatment of simple problems, but in major leak, ligation, transection, and complex problems, surgery plays the main treatment with its invasiveness and high morbidity and morbidity. Cumulative experience influences endoscopic and surgical treatment of such challenging problems.