Introduction:Acute appendicitis is the most common abdominal surgical emergency worldwide, with peak incidence between the second and third decades of life. Appendectomy, performed for over a century, remains the standard treatment. Aim:We aimed to compare the safety and efficacy of laparoscopic appendectomy using the LigaSure system vs UltraCision harmonic scalpel (HS). Materials and methods:This prospective comparative observational study was conducted from January 2023 to January 2025, and included 600 patients diagnosed with suspected acute appendicitis at 2 research centers. The patients were randomized into 2 equal groups: Group A (n = 300) underwent laparoscopic appendectomy using the UltraCision HS, and Group B (n = 300) underwent the procedure using the LigaSure system. Results:All 600 procedures were completed laparoscopically without conversion to open surgery. Mean (SD) operative time was 27.4 (6.7) minutes (range, 24-49 min) for Group A and 28.1 (7.4) minutes (range, 25-51 min) for Group B. Mean hospital stay was 1.14 (0.53) days for Group A and 1.16 (0.47) days for Group B. No major complications occurred. Two cases of minor postoperative complication (fever) were recorded (1 in each group), both of which resolved completely within 1 week. Conclusions:Both the LigaSure system and UltraCision HS are safe and effective for laparoscopic appendectomy in acute appendicitis, resulting in short operative times, minimal postoperative pain, low complication rates, and brief hospital stays.

Laparoscopic appendectomy is now the gold-standard treatment for acute appendicitis, requiring three ports for a classic procedure. Recent laparoscopy improvements aim to minimize surgical trauma and improve cosmetic quality through smaller, fewer portal incisions, such as two-port laparoscopic appendectomy, resulting in reduced postoperative pain. We aimed in this study to describe a novel technique to facilitate two-port laparoscopic appendectomy using the endoscopic snare. The data for a total of 85 patients, who underwent the two-port laparoscopic appendectomy using the endoscopic snare, at two research centers in Zagazig city, Egypt, from July 2022 till July 2023, is retrospectively analyzed. Overall length of hospital stay was the primary outcome, and the duration of operation and patient cosmetic satisfaction were secondary endpoints. All the 85 laparoscopic procedures were completed without difficulty. The mean operative time was 43.78 ± 8.46 min (minimum: 34 min, maximum: 57 min). Length of hospitalization was 1.12 ± 0.74 days (min: 1 day, max: 2 days). No major complications were encountered. Four cases of minor postoperative complication occurred, in which the patient developed port site infection, which was completely resolved at one week postoperatively. Laparoscopic appendectomy, using only two ports and endoscopic snare, is generally feasible and has been linked to high patient satisfaction and excellent cosmetic outcomes.

The use of minimally invasive techniques has not attained the same widespread acceptance for the treatment of more advanced tumors, principally because of existing concerns about its feasibility and oncological adequacy. Laparoscopy is rarely used to treat stomach malignancy. We compared the outcomes of laparoscopic gastrectomy with those of open surgery, and results evaluated . There is still a debate regarding whether one of these options is superior. We need to compare the primary and secondary outcomesof laparoscopic versus open gastrectomy in patients with locallyadvanced gastric cancer, therefore, complete acceptance as a legitimate therapy is hampered by the lack of thorough investigation of long-term oncological consequences, including recurrence and fatality. Methods We retrospectively evaluated patients who underwent laparoscopic or open gastrectomy between February 2015 and November 2022. After collecting the database from the board sheet of our Zagzig University Hospital and six other specialist surgical hospitals, patients were divided into two groups: open surgery and laparoscopic surgery. Logistic regression was used to compare the 30-day complications and fatalities in both groups. Results The Risk ratio (RR) and 95% confidence interval (CI) were calculated. For consistent results, the mean difference (MD) or standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. The meta-analysis was conducted using Review Manager 5.3 and STATA software. A total of 8,232 gastric cancer patients were divided into two groups based on the type of surgery they underwent: open gastrectomy (n= 7,450; 90.5%) and laparoscopic surgery (n = 782; 9.5%). Preoperative measurement of risk variables was important (CI = 0.45-0.82, p = 0.001, odds ratio [OR] 0.61, 95% confidence interval). We found no significant differences in mortality between groups when the preoperative risk variable was measured (OR = 0.74; 95% CI = 0.32-1.72; p = 0.481).

Background: For certain nonampullary duodenal neoplasms, a straightforward treatment approach is local duodenectomy and primary closure. A safe primary duodenal closure requires curability and minimization of the resection area. However, finding the proper resection line from the serosal side can be challenging. To improve the safety and ease of local duodenectomy, we created a clip-guided local duodenectomy. To validate the safety of this procedure, we conducted retrospective observational research. Methods: During the procedure, four endoscopic metal clips were placed on the margin surrounding the tumor three days prior to surgery. The clips are then used to determine the extent of the tumor during X-ray imaging; an incision is made to the duodenum just outside of the clips; a full-thickness resection of the duodenum is performed using the clips as guides to demarcate the tumor; and the incision is closed transversely using a Gambee suture. Between March 2010 and February 2020, one surgical center evaluated the clinicopathological data and surgical outcomes of patients who underwent local duodenectomy under clip guidance. Results: There were eighteen patients in total. Adenoma (11 patients), adenocarcinoma (6 patients), and GIST (1 patient) were pathologically diagnosed. The primary location of the tumors was in the second part of the duodenum, accounting for 66% of the total tumor size, with a mean size of 18 ± 6 mm. Primary sutures were used for each patient to repair the duodenal defect. The mean operation time was 191 minutes, while the mean blood loss was 79 millilitres. There was a 22% morbidity rate, and all complications were Grade II complications according to the Clavien‒Dindo system. There was no evidence of anastomotic leakage or stenosis. All six of the adenocarcinoma patients had pT1a disease, and there was no evidence of postoperative recurrence. The overall 1-year survival rate was 100%, with no recurrences. Conclusion: Clip-guided local duodenectomy is a safe and effective way to remove nonampullary duodenal neoplasms such as duodenal adenoma, GIST, and early adenocarcinoma with minimal damage to the surrounding tissue.

Background Intra-ductal cancer (IDC) is the most common type of breast cancer, with intra-lobular cancer (ILC) coming in second. Surgery is the primary treatment for early stage breast cancer. There are now irrefutable data demonstrating that the immune context of breast tumors can influence growth and metastasis. Adjuvant chemotherapy may be administered in patients who are at a high risk of recurrence. Our goal was to identify the processes underlying both types of early local recurrences. Methods This was a case-control observational study. Within 2 years of receiving adjuvant taxan and anthracycline-based chemotherapy, as well as modified radical mastectomy (MRM), early stage IDC and ILC recurred. Vimentin, α-smooth muscle actin (SMA), platelet-derived growth factor (PDGF), matrix metalloproteinase (MMP1), and clustered differentiation (CD95) were investigated. Results Of the samples in the ductal type group, 25 showed local recurrence, and 25 did not. Six individuals in the lobular-type group did not experience recurrence, whereas seven did. Vimentin ( p = 0.000 and 0.021), PDGF ( p = 0.000 and 0.002), and CD95 ( p = 0.000 and 0.045) expressions were significantly different in ductal and lobular carcinoma types, respectively. Measurement of ductal type was the sole significant difference found in MMP1 ( p = 0.000) and α-SMA ( p = 0.000). α-SMA and CD95 were two variables that helped the recurrence mechanism in the ductal type according to the pathway analysis. In contrast, the CD95 route is a recurrent mechanism for the lobular form. Conclusions While the immune system plays a larger role in ILC, the tumor microenvironment and immune system both influence the recurrence of IDC. According to this study, improving the immune system may be a viable cancer treatment option.

Abstract Background The need for lateral neck dissection (LND) in papillary thyroid microcarcinoma (PTMC) might be better understood by identifying risk variables for occult lateral lymph node metastasis (LLNM). This study's goal was to create a nomogram for predicting the likelihood of LLNM in individuals with cN0 unifocal PTMC. Methods A total of 9744 patients with cN0 unifocal PTMC who had treatment at our facility between February 2013 and April 2020 were the subject of our retrospective analysis. The risk variables for LLNM were identified using logistic regression analysis, and a nomogram was created based on these risk factors. Results 3.2% of the population had LLNM. Compared to tumours in the lower or middle lobe with a size less than or equal to 7 mm, tumours in the upper lobe had a substantially increased risk of LLNM (odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.80–3.62; p 0.001) and OR = 2.59, 95% CI 1.85–3.62. ETE tumours had a significantly increased probability of developing LLNM (OR = 1.41, 95% CI 1.01–1.99; p = 0.044). One or two central lymph node metastases (CLNMs) or three or more of them (OR = 5.84, 95% CI 3.83-8.93; p 0.001) increased the probability of LLNM in comparison to having none (OR = 2.91, 95% CI 1.93-4.42; p 0.001). The receiver operating characteristic (ROC) curve of a nomogram that took these risk factors into account showed an area under the curve (AUC) of 0.777, indicating a good level of predictive accuracy. Conclusion Three or more CLNMs, especially three or more, and upper lobe tumours larger than 7 mm in size were independent risk factors for LLNM in cN0 unifocal PTMC. Based on these variables, the nomogram showed good predictive value and consistency.

Abstract There is ongoing debate on the extent of dissection in patients with papillary thyroid cancer. Evaluating Delphian lymph nodes (DLNs) at the time of the procedure could be helpful in determining the extent of dissection. The objective of this study was to evaluate the frequency and features of DLN in patients with papillary thyroid carcinoma. Methods This cross-sectional study included patients who underwent PTC surgery for papillary thyroid carcinoma. The patients were classified according to whether their DLNs were involved. Age, sex, mass location, lymphatic involvement, tumor size, tumor features, pathology report, and parts of the surgical note were compared between the two groups. The final pathology slides of the patients were evaluated for DLN features. Results Among the 61 patients (mean age:38.2 ± 12.0), 45 (73.8%) were female. Of the 13 patients (21.3%), one patient's interaction with DLNs was documented. Other lymph nodes on the same side (P = 0.001), opposite side (P = 0.041), and central lymph nodes (P = 0.001) were significantly associated with DLN involvement. Furthermore, vascular invasion was significantly higher in patients with DLN involvement (P = 0.012). Conclusion As DLN involvement is strongly linked to significant nodal involvement, it is suggested that DLNs be evaluated during surgery to determine the correct level of dissection.

Abstract Objective The present research aimed to examine the clinical importance of preoperative total bilirubinemia in patients with acute appendicitis and determine whether it has any practical application for predicting severe appendicitis. Methods A retrospective analysis of appendicectomies was done in one hospital (N = 636 cases of acute appendicitis presented to the emergency department between December 2019 and January 2023). Using multivariate analysis, we looked at predictive data for complex (perforated or gangrenous) appendicitis, including demographics, gender, white blood cell count, degree of C-reactive protein (CRP) elevation, high-temperature peritoneal signs and indicators, and total bilirubin level. Results Those with total bilirubin (>1.1 mg/dL), high CRP levels (>0.5 mg/dL), positive peritoneal irritated symptoms, and a temperature (>37.3 C) had considerably higher rates of acute appendicitis. Age (>64 years), hyperbilirubinemia, high CRP level, and fever (odds ratios of 3.36, 1.75, 7.61, and 2.43, respectively) were identified by multivariate analysis as associated risks for complex appendicitis. High temperatures, raised CRP levels, and hyperbilirubinemia were also found to be risks for complex appendicitis in all individuals, especially those under 65 years old (odds ratios: 1.99, 5.90, and 2.72, respectively). Conclusions High temperatures, elevated CRP, and high total bilirubin were good predictor factors of acute appendicitis, especially useful among cases younger than 65 years, but total bilirubin was a more precise indicator.

Pancreaticoduodenectomy procedures early done in young individuals, few days about the risk and survival after robotic pancreaticoduodenectomy. Our goal was to report the results of robotic pancreaticoduenectomy in patients older than 50.

Abstract Laparoscopy is rarely used to treat stomach malignancies. We compared the outcomes of laparoscopic gastrectomy with those of open surgery and evaluated the results. However, its complete acceptance as a legitimate therapy is hampered by the lack of thorough investigation into long-term oncological consequences, including recurrence and fatality. As a result, there are sometimes arguments over which of these remedies is the best. Therefore, there is still debate regarding the best outcome. Methods We will evaluate patients who underwent laparoscopic gastrectomy and open gastrectomy from February 2015 to November 2022. After collecting the database from the board sheet of our Zagzig University Hospital specialist surgical hospital, patients were divided into two groups: open surgery and laparoscopic surgery. Logistic regression was used to compare 30-day complications and fatalities in both groups. Results For consistent results, the mean difference (MD) or standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. The meta-analysis was conducted using Review Manager 5.3 and STATA software. A total of 8,232 gastric cancer patients were divided into two groups based on the type of surgery they received: open gastrectomy (n= 7,450; 90.5%) and laparoscopic surgery (n = 782; 9.5%). Preoperative measurement of risk variables is important (CI = 0.45-0.82, p = 0.001, odds ratio [OR] 0.61, 95% confidence interval). We found no significant differences in mortality between groups when the preoperative risk variable was measured (OR = 0.74; 95% CI = 0.32-1.72; p = 0.481).

Abstract Context and purpose Research reviews the findings, course of therapy, and outcomes of gastric metastases (GM). With this investigation, we hope to contribute to the increasing amount of information by providing practitioners with a reliable and practical platform for understanding stomach metastases from various primary malignancies. Methods: This study covered papers published in English from the MEDLINE and Cochrane databases until May 2022. The deleted materials included editorial emails, billboards, surgical photos, and non-English publications. Hematogenous and lymphogenic metastases were noted, yet primary tumor progression and dissemination were not. Using pre-established criteria for eligibility, the ultimate selection was made after the articles and abstracts were reviewed and cross-referenced. Results: A total of 186 GM cases were listed in 1,521 papers that were eventually found. The average of sixty-two years. The majority of GM cases (67) were attributed to reproductive cancers, with lung tumors (33 patients), carcinoma of the kidney (20 patients), and melanomas (19 patients) trailing closely behind. The main treatment strategy for metastases is excision surgery (n = 62), often in combination with immunotherapy or chemotherapy (ChT). Among the 78 therapeutic options, ChT was the second-most preferred choice. Furthermore, immunotherapy was one of the most preferred treatment alternatives (n = 10) following surgery and ChT. Conclusions: Heterogeneity was inevitable because 172 case reports from different journals were included in this systematic review. Certain papers have omitted crucial facts such as comprehensive monitoring and scientific information. Additionally, since every article featured was a personal study, it was not possible to evaluate the quality of the work. In the majority of the 172 cases that were examined, resected procedures occurred; on rare occasions, immunotherapy and ChT were also combined. The best course of action for patients with stomach metastases requires further investigation.

Abstract background The benefits of ghost ileostomy (GI) in avoiding formal covering ileostomies in > 80% of cancer patients have been documented in numerous studies. However, none of the articles explained precisely how the GI tract was removed in the end in 80% of patients for whom formal maturation was not necessary. Goal To describe and evaluate the GIRD technique, including possible issues, hospital stays, and procedure times, for patients with GI for rectal carcinoma who underwent low anterior resection (LAR/uLAR) or ultra-low anterior resection (LAR/uLAR). Methods In this prospective cohort study, patients underwent restorative colorectal resection with GI for rectal cancer. Patients’ ease of GI release and any problems that might arise were then examined. Information was gathered, examined, and deduced. Results The final statistical analysis included 26 patients who required GIRD. Between the seventh and sixteenth postoperative days (POD), treatment was performed, all patients recovered well, and no additional surgeries were required. No further analgesics or injections of local anesthesia were required for any of the patients. The surgery took an average of five minutes, and none of the patients experienced any notable difficulties with GI release. No post-procedural issues emerged. Conclusion Without the need for anesthesia or additional analgesics, the GIRD approach is a rapid, easy, and safe operation that can be performed at the patient's bedside around the tenth POD.

Abstract Following emergency laparotomy, incisional hernias are associated with considerable morbidity and high expenses. According to recent research on the prevention of incisional hernia formation, a laparotomy closure technique with a slowly absorbable monofilament suture with small fascial steps and bites in a continuous single layer with a suture length to wound length (SL/WL) ratio of at least 4:1. The applicability of this evidence to routine practice is not well understood. Thus, a survey of surgeons at Zagazig University Hospital was conducted. Methods We have added the frame of Effective Closure of LAParotomy in (ECLAPTE) stands for Incisional Hernia (IHs) and followed it in my work to attain suitable and better outcomes. Fewer data are available on laparotomy closure in emergency situations, and guidelines and indications from earlier research have only been applied to elective cases. This work introduces the ECLAPTE project, which is currently being conducted by the World Society of Emergency Surgery (WSES). An online survey including 24 questions was distributed to all members of Our Surgical Society regarding the methods and supplies utilized for abdominal wall closure following midline laparotomy. The ECLAPTE guideline described perfect closure after laparotomy, so we used that recommendation for dissemination. Subgroup analysis was performed according to experience, hospital type, and surgical specialization. Results Of 402 responses, or 26% of the total, 97% of the Zagazig University Hospital Surgical Departments were represented. After following the ECLAPTE recommendation for our surgery, almost 90% of the participants used a slowly absorbable monofilament running suture to seal the abdominal wall in a single mass layer. Only 35% of the participants adhered to an SL/WL ratio of >4:1, and participant preference for suture size varied. Although the risk factors for the formation of incisional hernias were mostly properly identified, more than half of the participants were ignorant of the frequency and timing of incisional hernia occurrence. Based on a subgroup study, surgeons specializing in gastrointestinal and oncological procedures favored sutures with a smaller diameter and a higher ratio of suture length to wound length. Compared with other subspecialties, trauma, vascular, and pediatric surgeons have reported a reduced incidence of incisional hernias. Compared to their counterparts in non-academic institutions, surgeons working at academic hospitals were more likely to utilize smaller suture sizes and fascial steps. Estimations of incisional hernia incidence are less accurate when surgeons perform fewer than 10 laparotomies per year. conclusions It is not common practice to apply the most recent research to abdominal wall closure procedures. The most recent data recommend a 4:1 ratio of suture length to wound length; however, only 35 percent of surgeons use this technique to seal the abdominal fascia. Patients with IH are associated with a detectable rate of bulge perception, but with following ECLAPTE (Effective Closure of LAParoTomy in Emergency (ECLAPTE) initiative decreases the need for emergency laparotomy because of decreased recurrence and bulge complications with improved quality of life and postoperative pain. Preoperative cases must be discussed before making an ideal decision and increasing dissemination of the technique.

Abstract Objective The present study aimed to examine the clinical importance of preoperative total bilirubinemia in patients with acute appendicitis and to determine whether it has any practical application for predicting severe appendicitis. Methods A retrospective analysis of appendicectomies was performed at one hospital ( 636 cases of acute appendicitis presenting to the emergency department between December 2019 and January 2023). Using multivariate analysis, we examined predictive data for complex (perforated or gangrenous) appendicitis, including demographics, sex, white blood cell count, degree of C-reactive protein (CRP) elevation, high-temperature peritoneal signs and indicators, and total bilirubin levels. Results Those with total bilirubin (> 1.1 mg/dL), high C-reactive protein (CRP) levels (> 0.5 mg/dL), positive peritoneal irritated symptoms, and temperature (> 37.3 C) had considerably higher rates of acute appendicitis. Age (> 64 years), hyperbilirubinemia, high CRP levels, and fever (odds ratios of 3.36, 1.75, 7.61, and 2.43, respectively) were identified by multivariate analysis as associated risks for complex appendicitis. This is particularly true for those under 65 years of age. Conclusions High temperature, elevated CRP level, and high total bilirubin level were good predictors of acute appendicitis, especially in patients younger than 65 years; however, total bilirubin level was a more precise indicator.

Background: Chemotherapy plays a significant part in the management of breast cancer.In the current study, mastectomy with prompt breast reconstruction, the effects of neoadjuvant and adjuvant chemotherapy were investigated.Objective: The effect of neoadjuvant and adjuvant were given systemically to breast cancer patients to investigate their effect on breast reconstruction following mastectomy.Methods: Two-year postoperative follow-up at Zagazig University Surgical Department for 82 patients who received assistance systemic neoadjuvant (NAC) and (ACT) adjuvant chemotherapy for breast cancer between January 2021 and December 2022, together with mastectomy and rapid reconstructive surgery of the breast.Results: During the trial, 82 patients received fast breast remodeling after mastectomy.34 patients did not receive any systemic therapy, whereas 28 patients had preoperative chemotherapy and 20 patients received postoperative chemotherapy.Conclusion: There were no differences in unscheduled reoperation, donor-site complications, or expander loss across the groups although the adjuvant chemotherapy group had a substantial number of wounds that were infected.

Abstract Purpose It is difficult to repair a large complex recurrent hernia. TAR with anterior fascial re-approximation may not be possible because of more tissue loss, so we find that transverse abdominal muscle repair (TAR) with bridging is a suitable technique for such a condition. We aim to demonstrate the results of bridge works at our hospital after data collection Methods. Our patients were retrospectively matched from our institution board sheet, zagazig university hospital. One Hundredred ninety-two patients were available between 2015 and 2019 for our investigation. Aim of the work: Although the results of TAR with the bridge are not better with multiple recurrent, the life quality is improved; our outcome interesting are the quality of life (HerQLes) and pain severity(PROMIS pain intensity 3a), and recurrence, based on physical examinations and CT scans, Results. In our study, 192 patients were involved. The defect width of a hernia was typically 26±8 centimeters. Incisional hernias were the majority (93%). Recurrent type (71%) had, (21%) had five repeated prior hernia surgeries A total (of 70%) had data accessible. HerQLes rankings confirmed a regular enhancement in the postoperative restoration manner (26± 21, 44± 26, and 60±33 at six months to three years, respectively; P value (<0.001). as did the PROMIS Pain Intensity 3a scores (46±11 at baseline, 45±11 at 30-day follow-up, and 39±11 at ix months–3 years; P=0.001). At a mean follow-up at six months to three years, P = 0.001). A composite recurrence of 46% was detected shortly at a counseled follow-up of 20±10 months, mainly from patients reporting a "bulge" at the site. Conclusion. Synthetic mesh in bridging TAR repairs for patients with recurrent, complex hernias is associated with a higher rate of bulge perception but with improved quality of life. The preoperative cases must be discussed for the ideal decision

Abstract Context Here, we discuss our surgical experience treating traumatic diaphragmatic hernias while attempting to determine the historical influence of various time periods on mortality risk factors and outcomes. methods From Mau 2005 to April 2022, we operated on 126 individuals who had been with traumatic diaphragmatic hernias in emergency Zagazig University Hospital. In order to show the features of the injuries, determine the best course of treatment, identify death risk factors, and compare two time periods (2010–2016 and 2016–2022) separated by the introduction of computed tomography at our institution, the patient records were examined and statistically evaluated. Results The average age of the population was 31.2 ± 16.3 years, with a ratio of 11/52 for men to women. In 38 cases (30.2%), penetrating trauma was the mechanism; in 88 cases (69.9%), blunt trauma was the cause. Computed tomography was performed on two-thirds of the patients in the second group (201 6–2022) but not on any of the patients in the first group (2010–2016). Twenty patients (15.9%), with four in the second group and sixteen in the first (p = .042), received their diagnoses later than expected. Thoracotomies were the most often performed incision (n = 86, 89.6%). Between the two periods, there was no statistically significant variation in either mortality or etiology. According to univariate analysis, survivors outnumbered non-survivors in terms of age, injury severity scores (ISS), and American Association for the Surgery of Trauma (AAST) grade. Increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were found to be risk factors for death in all patients by multivariate logistic regression analysis. In conclusion The preoperative diagnostic rate has increased dramatically with the use of high-definition computed tomography. With favorable results, the transthoracic technique may be performed in certain cases of traumatic diaphragmatic hernia. Patients who are older and have a higher ISS have a higher mortality rate.

Abstract Traditional manometry-based studies in the past revealed two separate pressure zones in HH patients at the EGJ level, indicating the patial separation of LES and CD; however,they were unable to attain optimal sensitivity. High-resolution manometry (HRM) can accurately determine the differences between CD and LES and evaluate their anatomical relationships. Three EGJ subtypes were described by HRM and determind using LES-CD distinction. However, few studies have been conducted too determine the precision of the diagnosis. The affected individuals' GERD-standard lifestyle is impaired by reflux complications. An operation is a possible option for the cure of illnesses, even though PPIs produce a significant improvement in the management of difficulties owing to the requirement for continued use of the drug and the reality that over three per cent of these individuals still experience problems despite proper use . The objectives of this study were to evaluate the outcomes and side effects of MIS therapy for GERD and asssess the satisfaction of existence associated with GERD before and after GERD and/or hiatus hernia surgery. In addition ,we assessed the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using surgical in vivo measurement as a reference. Methods: Computerized records of individuals with GERD who underwent surgery and/or individuals with sliding or paraesophageal hernias were analyzed in this retrospective study. Individuals who underwent laparoscopy at the Zagazig University Hospital between January 2016 and March 2023 participated in the study. This research was observational, longitudinal, descriptive, and included retrospective data analysis. Surgery was recommended because of poor response to medical therapy, young age, prolonged indicators, or GERD consequences. During surgery, there were 100 cases, and 53 (53%) patients had HHs. Forty-seven (47%) patients were classified as type I EGJ, 35 (35%) as type II, and 18 (18%) as type III EGJ, as examined by manometry (HRM) esophagogram, and EGD. Results: From 2016 to 2023, 320 patients who underwent laparoscopic anti-reflux surgery were examined .The mean age of the 176 women and 144 men who underwent surgery was 46.6± 13.7 years. Before surgery, QS-GERD scores improved compared to post-surgery scores (27.56 10.93 vs. 1.4 2.47, p 0.01). Furthermore, it was discovered that none of the following factors sex, age, body mass index, surgical method, or the number of stitches on the fundoplication valve—were associated with a poorer outcome or failure probability. With a global median of 24 hours and a mean of 28.7 hours, the average hospitalisation was 24 hours for 74.2% of individuals, 48 hours for 19.3%, and 72 hours for 4.6%. There were no initial surgical problems (such as seroma, infections of the wounds, or eventration) or deaths, and no patients who needed blood transfusions were not required. The effectiveness of intraoperative manometry was evaluated in all 100 patients. The kappa values for high-resolution manometry and in vivo evaluation were 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting type I, II, and III esophagogastric junctions compared to endoscopy and esophageal. Conclusions: summarise the body of knowledge that exists on this topic 1-Sliding HH presence has been linked to aberrant esophageal acid exposure, extended esophageal clearance, and a rise in reflux episodes. It is more frequently observed when the GERD becomes more severe. 2-Barium swallow esophagogram and EGD can both be used to diagnose HHs, although these two techniques are hampered by the subjective and oblique evaluation of EGJ components 3-In the treatment of GERD patients, a more accurate diagnostic assessment of HH presence and axial dislocation may be helpful.

The spleen is a responsible significant part of the immune system; after Splenectomy following trauma, the immune system changes; splenic autotransplantation can preserve the immune system after trauma and Splenectomy. Patients can be protected from immune dysfunction by autotransplanting splenic tissues after splenectomy following trauma because their immune systems and spleens are changed. Patients can gain their immune function after splenic autotransplantation. Patient classification methods are into three categories, Group A, 6 cases with auto-translation; Group B, 6 cases without transplantation; Group C, seven regular people serving as the control. The aim of the work is not to compare outcome methods or compare types of autotransplantation; This work aims to document postoperative radiological, immunological, clinical, and hematological investigations. We concentrated on the results of investigations more than the types of operation or approach or types of autotransplantation. We showed that, after comparing each group with normal individuals subjects, patients who did not undergo autotransplantation had significantly higher platelet counts, a more significant percentage of micronucleated reticulocytes, increased levels of naive B lymphocytes, changes in class-switched memory and class-unswitched memory B cells, and higher levels of PD1 on CD8 + T lymphocytes. Nevertheless, neither splenic autotransplant patients nor the average general population showed any appreciable variations in any of the parameters. Spleen’s activities with adequate hemocatheter activity and recovery of the immunological deficit after splenic autotransplantation.