Introduction: The optimal surgical method in parotidectomy, with respect to dissection and postoperative drainagefactors, is under ongoing debate. Benign parotid surgery was initiated to compare between electrocautery and ascalpel for skin flap elevation and to determine the use of postoperative surgical drainage.Aim of work: The study compared four different approaches to parotidectomy to determine the effects ofsurgical instrument choice and drain placement on outcomes such as blood loss, operative time, complications,postoperative pain, and length of stay.Patients and methods: A prospective, randomized, and controlled study was conducted on 40 patients withparotid tumors and was divided into four groups: group A: scalpel with a drain (10 patient), group B: scalpelwithout drain (10 patient), group C: electrocautery with a drain (10 patient), and group D: electrocautery withoutdrain (10 patient). The primary outcome was intraoperative blood loss and the secondary outcomes were operativetime, postoperative pain, hematoma/seroma, and hospitalization.Results: Electrocautery significantly reduced the amount of blood loss compared to the scalpel group; it reducedintraoperative blood loss from 217.50 mL to 101.25; p < 0.001, which represented a reduction of approximately53%. Operative time was similar among all groups (130.5-136.0 minutes), with no significant difference; p =0.145. Drain placement increased postoperative pain scores at 12 hours post-op and 24 hours post-op; p < 0.001.Hospital stay was almost doubled for drain placed groups (48-50 hours) versus 24 hours; p < 0.001. There was nodifference in intraoperative complication rates or major post-operative complications.Conclusion: Electrocautery significantly reduces intraoperative blood loss while maintaining safety and flapintegrity. Routine postoperative drain placement substantially increases pain and hospital stay without providingclinical benefit for hematoma prevention in parotid surgery.
Introduction: Large hepatic hemangiomas (>4cm) pose significant surgical challenges due to their hypervascularnature and bleeding risk. Pre-operative intra-arterial embolization (PIAE) has emerged as a promising adjunctivetechnique to reduce operative risks.Aim of work: This study evaluated perioperative outcomes and safety of PIAE in patients undergoing surgicalresection of large hemangiomas.Patients and methods: This retrospective cohort study included 40 adults who underwent surgical treatment forlarge hepatic hemangiomas. Patients were stratified by whether they received PIAE (n=20) or proceeded directlyto surgery (n=20). Statistical comparisons utilized t-tests, chi-square, and Kruskal-Wallis tests (α=0.05).Results: Mean age was 40.8±8.2 years; 75% were female. Median hemangioma diameter was 7.1cm (PIAE)versus 8.6cm (non-PIAE). Enucleation was performed in 90% and 80% respectively. Median intraoperative bloodloss was comparable (245mL vs 205mL, p=0.512), with equal transfusion rates (20%). Hospital stay was longer inPIAE group (10.5 vs 6.4 days, p=0.028). Total bilirubin elevation occurred in PIAE patients (p=0.037). No 30-daymortality occurred in either group.Conclusion: Pre-operative intra-arterial embolization enables safe resection of large hepatic hemangiomas withcomparable bleeding outcomes, though associated with longer hospitalization and transient biochemical changes.PIAE represents an effective risk-reduction strategy for high-risk patients requiring hemangioma resection.
Introduction: Complex” ventral hernia is a common complication after laparotomies that is difficult to deal withdespite markedly affecting patient`s daily life. Preoperative injection of botulinum toxin can facilitate repair of suchhernias.Patients and methods: Thirty patients with complex ventral hernia at the midline, scheduled for abdominalwall reconstruction, had their lateral abdominal wall (LAW) muscles injected with Botulinum toxin A (BTA) beforedefinitive procedure. The results were compared to those of another correlated thirty patients from our database asregards the operative time, the need for bridging composite mesh, postoperative pain and surgical site occurrenceinfection (SSI) within a short-term interval follow up of 1 month.Results: Superior results were recorded for the study groups for both: primary (operative time and need forcomplementary techniques) and secondary (SSIs and postoperative need for opioid analgesia) outcome.Conclusion: Within certain limit and according to the short term outcome results, downstaging complex midlineventral hernias with preoperative BTA injection, is a safe and non-inferior technique for management of complexventral hernias.
Introduction: Symptomatic marginal veins and progressive limb overgrowth are hallmark features of Klippel-Trenaunay Syndrome and other PIK3CA-related overgrowth spectrum (PROS) disorders. Management is challengingbecause of anomalous venous anatomy and frequent deep venous hypoplasia. Prospective pediatric data onendovenous laser ablation (EVLA) remain limited. Furthermore, the applicability of EVLA is limited by the highincidence of deep venous anomalies in this population.Aim of worke: To evaluate the safety and efficacy of early 1940-nm EVLA for symptomatic marginal veins inpediatric patients with limb overgrowth secondary to Klippel-Trenaunay Syndrome, specifically in those with apatent deep venous system.Patients and methods: A prospective single-arm cohort study was conducted between January 2024 and June2025. Twenty-two pediatric patients (mean age 12.5 years) with confirmed Klippel-Trenaunay Syndrome underwentEVLA. Inclusion required a target marginal vein diameter between 8 mm and 20 mm and a patent deep venoussystem on MR venography. The primary endpoint was technical success at 1 month. Secondary endpoints includedperioperative complications, changes in limb diameter, vein QOL scores, and reintervention during the 6 monthsfollow-up.Results: Technical success was achieved in all patients (100%). Mild transient pain and skin complications resolvednearly completely within 1 month (p < 0.001). Mean vein QOL scores improved significantly from 828.4 ± 93.9to 1498.9 ± 158.6 (p < 0.001). Mean leg and thigh circumferences decreased by 7.7 cm and 8.4 cm, respectively(p < 0.001). Early recanalization occurred in 9.1% but resolved spontaneously. Freedom from clinically significantresidual varicosities at 6 months was 86.4%. No major adverse events, deep vein thrombosis, or pulmonaryembolism occurred.Conclusion: Early 1940-nm EVLA is a safe and effective minimally invasive treatment for symptomatic marginalveins in pediatric Klippel-Trenaunay Syndrome, providing significant clinical and QOL improvements with excellentsafety outcomes.
Introduction: Perforated peptic ulcer (PPU) is a surgical emergency associated with high morbidity. Whiletraditional therapy mandates open surgery (Laparotomy), laparoscopy offers significant advantages as a minimallyinvasive approach. However, direct comparison of these approaches regarding early outcomes is relatively rare.Aim of work: To compare the early clinical outcomes of laparoscopy versus laparotomy in the management ofacute PPU, focusing on postoperative recovery time, complication rates and overall patient outcomes.Patients and methods: This prospective comparative cohort study enrolled 50 patients (25 in each group)with acute PPU at Ain Shams University Hospitals from January to May 2025. Patients were randomized to eitherlaparoscopic or open repair, based on hemodynamic stability and perforation size (<2cm). Primary outcomesincluded hospital stay, operative time and complications, while secondary outcomes included costs, pain andrecovery.Results: Both groups were comparable at baseline (Mean age≈37 years; mean Boey score≈1). Mean operativetime was longer in the laparoscopic group, while less blood loss was recorded, with an overall conversion rateof 24.0%. Laparoscopy was associated with faster recovery, lower postoperative pain, shorter hospital stays andfewer wound infections, despite higher costs compared to laparotomy. Other parameters like leak rates, respiratorycomplications and mortality were similar between both groups.Conclusion: Laparoscopic PPU repair enhances early recovery, reduces postoperative pain and wound infections,while providing cost-effective care with comparable safety in selected stable patients. These findings support itsclinical position as recommended by the European Association for Endoscopic Surgery (EAES) guidelines.
Introduction: Gallstone disease is common among morbidly obese patients and its incidence increases further afterbariatric surgery due to rapid weight loss and changes in bile composition. The optimal timing of cholecystectomyin patients with documented gallstones undergoing bariatric surgery remains controversial.Aim of work: This study aimed to compare concomitant versus interval cholecystectomy in morbidly obesepatients undergoing bariatric surgery.Patients and methods: This prospective non-randomized comparative study included 120 morbidly obesepatients with documented gallstones scheduled for bariatric surgery. Patients were divided into two groups:Group I underwent concomitant cholecystectomy during bariatric surgery, while Group II underwent intervalcholecystectomy after significant postoperative weight loss. Operative time, intraoperative blood loss, technicaldifficulty, perioperative complications, and biliary events during follow-up were evaluated and compared betweenboth groups.Results: Interval cholecystectomy was associated with significantly shorter operative time, lower blood loss,reduced intraoperative difficulty, and fewer perioperative complications compared with concomitant cholecystectomy.However, biliary complications such as biliary colic and acute cholecystitis occurred during the waiting period in asubset of patients in the interval group, requiring earlier intervention in some cases.Conclusion: Interval cholecystectomy after bariatric surgery provides technical and anesthetic advantages andis associated with lower perioperative morbidity. Nevertheless, it carries a risk of biliary complications during thewaiting period. Careful patient selection and close follow-up are essential to determine the optimal surgical timingand achieve favorable outcomes.
Introduction: Large duodenal perforations represent a difficult surgical problem because the repair siteis exposed to high intraluminal pressure and continuous biliary and pancreatic secretions, which increase therisk of postoperative leakage. Several operative strategies have been proposed to protect the repair, includingtube duodenostomy, pyloric exclusion, and gastrojejunostomy. The optimal surgical approach, however, remainscontroversial.Aim of work: This study evaluated the effectiveness of tube duodenostomy alone as an adjunct to primary repairin large duodenal perforations and compared its outcomes with diversion procedures involving pyloric exclusionand gastrojejunostomy.Patients and methods: Twenty patients with large duodenal perforations underwent primary repair reinforcedwith an omental patch. Patients were divided into two groups: Group A (n=11) underwent repair with tubeduodenostomy alone, while Group B (n=9) underwent repair with tube duodenostomy combined with pyloricexclusion and gastrojejunostomy. Operative findings and postoperative outcomes were analyzed.Results: Operative time was significantly shorter in Group A (86.91 ± 9.14 vs 122.44 ± 9.46 min, p < 0.001).Postoperative hemoglobin was higher in Group A (12.23 ± 0.82 vs 10.46 ± 0.93 g/dL, p < 0.001). ICU stay wasshorter in Group A (1.0 ± 0.77 vs 1.89 ± 0.78 days, p = 0.021). Oral intake started earlier in Group B (4.0 ± 1.12vs 8.18 ± 1.08 days, p<0.001). Delayed gastric emptying occurred more frequently in Group B (88.9% vs 0%,p<0.001). No duodenal repair leakage occurred.Conclusion: Tube duodenostomy alone provides effective decompression and may safely protect duodenal repairwhile avoiding the increased operative complexity of diversion.
