Current researches define the best management tactics in patients with acute pancreatitis. It includes early diagnosis, determination of etiological factors, adequate visualization, assessment of the severity of the disease. The purpose of the work is to consider recommendations for acute pancreatitis after the IAP/EPC recommendations 2012. The article presents a systematic overview of current guidelines for acute pancreatitis, cited the Medline database from 2013 till 2021. The main criteria for timely diagnosis are highlighted. The approach to determine the etiological reason of the disease is considered. The importance of establishing the severity of clinical course of acute pancreatitis is indicated, for which clinical, laboratory and radiological methods of examination, various integrated scales are used. The indications and terms of imagine procedures (ultrasonography, computed tomography, magnetic resonance imaging) use are determined. Acute pancreatitis is most oftenly associated with biliary or ethyltoxic factors. The diagnosis can usually be made if you know what laboratory parameters and imaging methods should be used in the initial diagnosis and in the course of the disease. Prediction and assessment (reassessment) of the disease is very important to determine the necessary rapid treatment

Background: Numerous options for hialtal hernia repair exist, including primary simple suture of the crura alone, primary repair reinforcement with synthetic mesh, which may cause erosions and dysphagia, or biologic mesh, which is costly and does not reduce long-term recurrence rates. The purpose of the presentwork is to determine the short-term effectiveness of laparoscopic paraesophageal hiatal hernia (PEH) repair with falciform ligament reinforcement. Materials and Methods: This is a prospective study of laparoscopic repair of paraesophageal hiatal herni with a falciform ligament reinforcement. Symptoms severity and frquency were recorded Preoperatively and at 6 months follow-up. patients with neither recurrent hiatal herni nor prior gastric surgery patients were included in the study. Results: Twenty-six individuals with mean age 37.12 (±9.24) years were enrolled, and all participants had postoperative evaluation with an average follow-up of 20.6 ±1.2 months. The mean severity of symptoms reduced from 15.69 ± 2.35 to 10.85 ± 1.69, The mean frequency of symptoms reduced from 23.81 ± 3.62 to 3.69 ± 2.72 and the mean total symptom score decreased from 39.5 ± 4.02to 14.54 ± 3.65, all of them were statistically significant, (p0.0001). Only one case had recurrences during follow up and were detected on radiological assessment. The case refused reoperation. Summary: Laparoscopic hiatal hernia repair with a falciform ligament reinforcement is a promising approach with acceptable recurrence rate. The morbidity rates with the utility of this approach were low.

Background: Because periampullary carcinoma is uncommon, researches on it have not been active and the majority of the studies were small or retrospective. Prognostic variables for overall survival and recurrence in patients with periampullary carcinoma following surgery have been investigated in several studies. Aim of the work: was to determine the most important prognostic factors for recurrence following periampullary carcinoma cu- rative resection. Methods: It was an observational study; it includes 20 patients who underwent Pancreaticoduodenectomy (PD) at Helwan univer- sity hospitals for periampullary cancer. Results: A statistical difference between the two groups concerning lymph node regional metastasis and vascular invasion, How- ever, no statistically significant difference was found regarding degree of tumor differentiation, depth of tumor infiltration , peri- neural spread, resection margin status, posterior margin invasion and size of tumor. Conclusion: vascular invasion and lymph node involvement were the independent risk factors for initial recurrence of periampul- lary carcinoma after curative surgery. Therefore, Patients who meet these factors ought to be given aggressive adjuvant therapy and frequent postoperative monitoring.

Introduction: Hepatocellular carcinoma is the most common primary liver cancer and the fifth most common cancer in the world. Although the risk factors of hepatocellular carcinoma have been identified, its incidence is still high, and the survival rate is still low. Surgery is thought to be a definitive treatment for hepatocellular carcinoma patients. This research focuses on the post- resection survival rate and its associated factors. Method: This cohort retrospective data study was conducted in DR Cipto Mangunkusumo Hospital between January 2010 and December 2020. Information about sex, number of tumors, tumor size, vascular invasion, alpha-fetoprotein level, hepatic cirrhosis, Child-Pugh Score, and histopathologic stage were collected from the medical record. Chi-square analysis was done to investigate the relationship between independent and dependent variables. Multivariate analysis was performed by using the Cox Propor- tional Hazard Regression test. The Kaplan Meier method was used to calculate the survival rate. Results: 86 subjects were recruited for this study; 17 were excluded due to incomplete medical records. The overall mortality in this study was 62.3%. 6 months, 1 year, and 3 years survival rates were 66.6%, 56;5%; and 37.6%, respectively. Our study showed that none of the factors analyzed were associated with survival rates. Conclusion: We had not found any risk factors associated with the survival of patients with hepatocellular carcinoma. We suggest future research with a more significant number of subjects to identify any factors associated with the survival of hepatocellular carcinoma subjects following resection

Introduction: HCC is the dominant primary liver cancer, representing the fourth cancer related mortality. Surgery is the main curative treatment by either resection or transplantation which is the choice to deal with the underlying liver disease together with the tumor, making it the attractive option in cirrhotic patients. However accepted survival could only be achieved by careful patient selection. Pre-treatment assessment with CT and MRI is the corner stone in staging and selection to achieve the desired outcome, so tumor characteristics should be evaluated accurately to guide with the other factors the treatment strategy for those patients. Materials & Methods: A total of 77 HCC patients who had DDLT in Liver unit at Queen Elizabeth Hospital, University of Birmingham NHS Trust, Birmingham, UK were retrospectively and prospectively evaluated by chart review. Five parameters chosen to assess the accuracy of preoperative Radiological Staging methods; CT, MRI, in comparison with their explanted liver histopathological results. These parameters were: (1) Number of nodules, (2) Total tumor size, (3) Vascular invasion, (4) Diameter of the largest nodule and (5) Tumor multi-nodularity Results: Pathologically assessed post-operative nodular number (2.12 ± 1.24) and total tumor sizes (4.75±2.22 cm.) were significantly higher than pre-operative radiological tumors number (1.64 ± 1.10) and total tumors sizes (4.08 ± 2.41) (P 0.005, P 0.051, respectively). Radiological imaging were of the least sensitivity in detecting vascular invasion (sensitivity was 4.17%) while it is most accurate in determining the diameter of the largest tumor as well as the tumor multi-nodularity (sensitivity 45.24%) Conclusions: small sub-centimeter HCC might be missed on 5–10 mm sectioning, potentially accounting for some of the supposed false-positive findings of CT and MRI. Also, the imaging pathology correlation might have been improved with less false positives if the pathologists had been prospectively informed of detailed imaging findings.

Objective: The purpose of this study is to introduce the extra-cervical totally endoscopic techniques in the excision of benign neck ne- oplasms in adolescent patients. Patients and methods:We retrospectively studied twenty adolescent patients with benign neck masses who were treated at Mansoura University Oncology Center between December 2018 to September 2021. The clinicopathological parameters, operative data and the esthetic outcomes were studied. Results: All procedures were completed endoscopically without conversion to open. Endoscopic hemithyroidectomy was performed in 9 cases, endoscopic submandibular sialoadenectomy in 6 cases, endoscopic branchial cyst excision in 4 cases and a single case of en- doscopic parathyroidectomy. Axillo-breast approach was used in 10 cases and anterior chest wall approach was used in the other 10 cases. The mean operative time was 91.75 + 19.08 minutes with a mean operative blood loss of 12.75 + 7.86 ml. The mean volume of the resected lesions was 26.42 + 20.09 ml. The mean postoperative pain visual analogue scale (VAS) score was 3.65 + 0.49, 2.6 + 0.50, 1.40 + 0.50 and 0.30 + 0.47 at first, second, third and seventh postoperative day respectively. No significant postoperative complica- tions were reported apart from temporary deviation of angle of mouth in one patient with endoscopic submandibular sialoadenec- tomy. Ninety percent of the patients/parents were extremely satisfied with the cosmetic results. Conclusion: Extra-cervical endoscopic excision of benign neck neoplasms in adolescents is safe, feasible and effective procedure with- out significant complications. It is an excellent alternative to conventional open approach in selected patients.

Background: Endoscopic therapy remains the mainstay in treatment of upper gastrointestinal bleeding (UGIB). Despite the advancement in endoscopic therapy, the mortality rate for UGIB has remained constant at about 10% for the past few decades. This study aims to determine the prevalence of outcomes post endoscopic therapy in bleeding peptic ulcers. Methods: This is a retrospective record review of patients who underwent emergency upper endoscopy for UGIB from March 2014 to March 2019 in Hospital Serdang, Selangor. Data was collected from endoscopic suite records and the prevalence of permanent haemostasis, re-endoscopy, angio-embolization, surgery and 30-day mortality was calculated. Results: A total of 204 patients who underwent emergency upper endoscopic therapy for UGIB were included in our study. More half of the patients 113 (55.4%) achieved permanent haemostasis after initial endoscopic therapy while 84 (41.2%) had to undergo re-endoscopy due to re-bleeding ulcer. A small percentage had to undergo surgery 10 (4.9%) while only 3 (1.5%) underwent angio- embolization. Out of 204 patients included, there was 34 (16.7%) mortalities and the median length of stay was 5 days. Conclusion: From our study, we can conclude that permanent haemostasis is the outcome with highest prevalence after endoscopic therapy for UGIB in our centre. However, we should strive to reduce our rate of re-endoscopy as it is not up to par with data from other developing countries.

Introduction: In locally advanced breast carcinoma, neo-adjuvant systemic therapy (also called primary systemic therapy or induction therapy) has become a valuable strategy. But not all patients in this category respond well to Neo-adjuvant chemotherapy (NACT). Only in 30% of patients does complete or partial response occur after neoadjuvant chemotherapy. If chemotherapy is given early for micro-metastasis, the disease can be controlled. Moreover, NACT prior to surgery can make inoperable tumor operable and increase the rate of breast conservative surgery. The aim of this study was to estimate the efficacy of paclitaxel in down staging of carcinoma breast and to correlate clinical responses in carcinoma breast. Methods And Materials: This Prospective comparative study was conducted in tertiary care centreAll patients fulfilling inclusion criteria with carcinoma Breast who visited surgery OPD in Krishna Hospital & Medical Research Centre, Karad within the duration of December 2020 to July 2022 were included. They were divided in to two groups for neoadjuvant chemotherapy, group A were treated with Adriamycin & cyclophosphamide for 4 cycles and group B were treated with Adriamycin & cyclophosphamide for 4 cycles followed by paclitaxel for 4 cycles. The clinical responses were compared in between the two groups and results were obtained. Results:The current study was conducted at a tertiary healthcare center to assess the role of Neoadjuvant Paclitaxel chemotherapy in carcinoma breast In the present study majority of the study subjects belonged to the age group of 45 to 55 years (36.36% and 34.09% in either group), followed by 56 to 65 years (29.55% and 36.36% in either groups.). Right side was the commonest side involved among the study subjects (61.36 and 56.82% in either study groups). In the present study, majority of the study subjects presented with stage III disease (63.64% and 56.82% in either study groups), followed by stage IV (29.55% and 34.09% in either study groups). Respectively 3 and 4 subjects presented with stage IIb with Conservative breast surgery recommended. Majority of the study subjects were ER positive (75% and 77.27% in either group), followed by PR positive (70.45% and 68.18% in either study groups). 29.55% and 34.09% subjects in either group were HER 2 Neu receptor positive status. In the present study we assessed Clinical Tumor stage among the study subjects. We observed that T3 was the commonest clinical stage of tumour (52.27% and 47.73% in either group), followed by T4 (31.82% and 29.55% in either study groups).In the present study, Infiltrating Duct Carcinoma was the commonest type (56.82% and 65.91% in either study groups), followed by Infiltrating Lobular Carcinoma (20.45% and 15.91% in either group), other types were Mucinous Adenocarcinoma, Squamous Carcinoma, and Medullary Carcinoma. Complete clinical response was observed more in group B study subjects (81.82%), as compared to group A study subjects (50%). Conclusion:From the study it can be concluded that neoadjuvant chemotherapy of paclitaxcel with AC regimen has a significantly better results in downstaging the carcinoma breast when compared to AC regimen alone. This also shows the efficacy of the paclitaxcel in treating breast cancer.Anyhow, more studies in high sample size is necessary to look for the adverse drug effects and efficacy of paclitaxcel alone.

Background: This study was planned to compare the traditional method of laparoscopic cholecystectomy (LC) versus LC using harmonic as regard the safety and efficacy. Material and methods: This study included group LC (laparoscopic cholecystectomy) (30 patients) in whom LC was conducted using the traditional method (TM) by clipping both cystic duct and cystic artery, group HLC (Harmonic scalpel assisted laparoscopic (30 patients) HLC was conducted using harmonic scalpel (HS) closure. The intraoperative and postoperative parameters were collected including duration of surgery, antibiotic (days), complications and duration of hospital stay. Results: HLC provides a shorter operative duration than LC (35.1 ± 4.079 vs. 47.933 ± 8.026, respectively, p<0.0001). The antibiotic used in LC (4.367 ± 0.809) and HLC (3.267 ± 0.691). It was found statistically significant. Postoperative bile leak was occurred (6.67%) in LC and it occurred in (0%) of patients in HLC. LC provides a more duration of hospital stays than HLC (4.4 ± 0.855 vs. 3.1 ± 0.547 respectively, p<0.0001). Conclusion:HLC provides a better hemobiliary stasis and is a safe alternative to stander clip of cystic duct and artery. It provides a shorter operative duration, less incidence of gallbladder perforation and less rate of conversion to laparoscopic cholecystectomy

Background: Thoraco- Dorsal Artery Perforator (TDAP) flap is one of the volume replacement techniques that solved the dilemma of breast reconstruction in small- to moderate-sized breasts with good aesthetic outcome. Intra-operative direct exploration of the per- forators of Thoraco-Dorsal Artery during flap harvest is a tedious process with significant impact on the operative time. The aim of our study was to evaluate the role of preoperative duplex mapping of the perforators of the Thoraco- Dorsal Artery (TDAP) in providing oncoplastic surgeons with reliable data for flap harvest and its impact on the operative time ,flap harvest time and perioperative complications. Patient and Methods: Thirty one patients that were operated by TDAP flap for breast reconstruction in breast cancer patients in the period from October 2016 to June 2021. . Those Patients were divided into two groups; first group (N=15) patients with preoperative Duplex mapping, and second group (N=16) without mapping. Results: Preoperative duplex perforator mapping significantly reduced the total operative time and flap harvest time (P= 0.0001). This technique did not affect the perioperative complications rate. Conclusion: Preoperative duplex perforator mapping of Thoraco-Dorsal Artery Perforator (TDAP) flap decreases the operative time significantly. We recommend preoperative coloured doppler ultrasound mapping as a useful tool in planning of TDAP flap.

Background: Pain after laparoscopic cholecystectomy is still important issue that prolonged hospitalization and also increased mortal- ity and costs. One of the recent issues is intraperitoneal washing with a solution containing bicarbonate vials, as CO2 gas cause acidosis and pain after laparoscopic surgery. The aim of this study was to evaluate the effect of intraperitoneal washing with normal saline in combination with bicarbonate on postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods: This clinical trial was performed in patients who underwent laparoscopic cholecystectomy with the installation of 4 trocars. Patients were randomly divided into two groups. In group A (52 patients), patients receive intraperitoneal normal saline (20 cc / kg) and Bicarbonate (8.4% 50mEq/50mL (1mEq/mL) 50mL VIAL) at the end of surgery. In group B (49 patients), patients did not receive any intraperitoneal washing. Pain was assessed using visual analog scale (VAS) 2, 6 and 24 hours and also 1 week after surgery in right and left shoulder tip, umbilical, epigastric, midclavicular and right flank trocars. Results: Demographic characteristics of patients in each group including gender and age was equal. Based on this study, postoperative pain was significantly lower in case group in right and left shoulder tip, umbilical and epigastric trocars 2 and 24 hours after surgery and in midclavicular and right flank trocars 2 hour and 1 week after surgery (P>0.05). Also, demand dose of analgesia was lower in sodium bicarbonate group. Conclusions: Intraperitoneal washing with sodium bicarbonate is an effective method that reduce pain after laparoscopic cholecystec- tomy.

Objective: Determine the effectiveness of Roux-en-Y gastric bypass (RYGB or RYGB) versus vertical partial gastrectomy (VPG) in the control of patients with type 2 diabetes mellitus (T2DM) refractory to medical treatment. Methods: Analytical, observational, longitudinal retrospective cohorts during 2010 to 2017. 60 medical records of patients with type 2 diabetes mellitus refractory to medical treatment, operated on the General Surgery Department of the Santa Mónica Clinic, Lima, Peru, were reviewed. A convenience sample was divided into 30 patients with RYGB and 30 with GPV. Results: The average age was 43.3±8.09 years, range from 25 to 59; 60% were men; the body mass index (BMI) was 41.22±2.84. Fasting plasma glucose and glycosylated hemoglobin values were 110.1 mg/dL, 6.85% in RYGB and 110.9 mg/dL, 7.19% in VPG (p=0.000). The BMI in RYGB was 36.5 (p=0.000) and 38.4 in GPV (p=0.0009), respectively. Global control was achieved in 61.7%. RYGB achieved 51.4%, with a RR of 1.056 (95% CI=0.708-1.574; chi2=0.071, p=0.791). Likewise, of 12 controlled women, 66.7% corresponded to RYGB (RR=0.59, 95% CI=0.242-1.442) and of 25 controlled men, 56% to GPV (RR=1.139, 95% CI=0.732-1.772). Conclusions: Diabetes control occurred in 62%. RYGB was no more effective than PVG in controlling patients with refractory T2DM. The promotion of metabolic surgery and larger studies, with longer follow-up and multicenter, are suggested

The new surgical procedure (sleeve gastrectomy with loop bipartition; SG + LB) was derived from the combined concepts of sleeve gastrectomy with transit bipartition (SG + TB), single anastomosis duodenal-ileostomy (SADI), mini-gastric bypass (MGB) and duodenaljejunal bypass (DJB). The outcome of this operation is comparable to other metabolic procedures, but with less nutritional issue and a much safer and easier operation. We modified the Santoros operation (SG + TB) by creating a loop bipartition at antrum instead and the resultant reconstruction (SG + LB) is a very similar operation to the SADI and loop DJB but without division of the duodenum.

Hospital admission of patients presenting foreign bodies in the rectum is a challenge for the emergency physician or surgeon, due to the variety of objects and the difficulty of extraction. Most of the time, the introduction of the foreign body through the trans anal route is done for sexual satisfaction and the patient seeks medical attention after failed extraction attempts. These cases require diagnostic strategies, both clinical and imaging approaches to determine the type and size of the foreign body, the rectal lodging, and the possible perforation of the rectus sigmoid; with all this information either manual, endoscopic, or surgical removal can be considered. We report the case of a 42-year-old man, who went to the emergency room because of a plastic-lined and lubricated flashlight that he inserted into his rectum to feel pleasure; however, he could not remove it on his own. This paper seeks to review through a case presentation the current evidence available and offers recommendations for changes to surgical practice to minimize the complications.

During laparoscopic surgery, iatrogenic injury to the inferior epigastric artery (IEA) or its tributaries can occur. The resultant bleeding is usually self-limiting or can be controlled by routine electrocoagulation methods. In rare situations, there is persistent bleeding from the IEA. The options to manage this situation are discussed

Background: It is well established that the Corona Mortis (CMOR) may be injured during common pelvic surgeries such as pelvic fracture repair and acetabular surgeries. A precise knowledge of the anatomy of the CMOR is of paramount importance to create awareness of the possibility of injury to the CMOR, and may aid in reducing haemorrhagic complications during surgery, minimise iatrogenic injury, and reduce hospital stays. This study aims to explore the prevalence of the CMOR and its clinical significance to the general surgeon. Methodology: This scoping review included studies published on the CMOR and on complications of laparoscopic inguinal hernia repairs. The literature search was conducted using the following databases: PubMed/MEDLINE and Google Scholar, for articles pertaining to the CMOR, between 2000 and 2021. The basic structure of the search included keywords ‘corona mortis’, ‘circle/crown of death’ and ‘laparoscopic inguinal hernia complications’. The types of studies included in the search were qualitative, quantitative or mixed-methods studies. The data extracted was summarised to report the prevalence, anatomical variations, and nomenclature of the CMOR. Results: Twelve studies were included in the final analysis. Of these twelve studies, seven studies evaluated the presence of the CMOR radiologically, whilst five studies assessed the presence of the CMOR on cadavers. The prevalence of the CMOR ranged from 14% to 51% in radiological studies and in relation to cadaveric studies, the prevalence of the CMOR ranged from 45% to 80%. Conclusion: The possible presence of the CMOR, or crown of death, should be appreciated during the inguinal hernia repair procedures, considering its prevalence and anatomical variations. The CMOR can be arterial or venous, as well as bilateral or unilateral in nature. Most studies in this review have described the arterial variant and therefore this is more commonly referred to when discussing the CMOR.

Purpose: The ENDOLOOP® Ligation device is widely utilized in clinical practice in procedures including appendectomies and cholecys- tectomies, but data of associated adverse events of the device is scarce. Our study aims to evaluate adverse events associated with the device using the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database. Methods: We analyzed the post-marketing surveillance data from the MAUDE database for the ENDOLOOP® Ligation System from January 2008 through July 2022. Results: 142 reports filed from January 2008 to July 2022 of either device-related or patient-related adverse events were analyzed. 93 reports were of device-related issues and 59 of patient-related events. The most common device-related issue was break of the devices (n=50, 53.76%), followed by tears in the device packaging (n=24, 25.81%). The most common patient-related events were infection (n=20,13.89%), then abscess formation (n=19, 13.19%), and pain (n=13, 9.03%). One death (0.69%) related to pneumonia complicated by empyema was reported. Majority of infections were due to wound infections after procedures (n= 13), with intraabdominal infec- tion (n=10) being the other infection reported. Conclusion: The overall adverse events from the ENDOLOOP® Ligation System remains low as evidenced by the number of reported cases to the MAUDE database since 2008. Break of the devices and infection were the most common device-related problem and patient-related adverse events, respectively. Identifying adverse events is important to optimize device design and improve patient outcomes. Endoscopists and surgeons need to be mindful of these potential adverse events when using the Ethicon ENDOLOOP® liga- tion system

Background: despite the great advancement in endovascular intervention for management of peripheral vascular disease, still surgical interventions are critically needed in many situations, which necessitates both endovascular and surgical interventions to be consid- ered as complementary procedures to obtain optimum results. According to most of literatures, hybrid procedures usually used for management of patients with combined inflow and out flow vascular disease but in this study, we depended on hybrid procedure for correction of complex infra-inguinal outflow vascular disease only. Patients and methods: This is a retrospective study conducted on 29 patients presented by 29 threatened limbs with complex outflow vascular disease affecting the infra-inguinal arterial tree and were managed by combined endovascular and open surgical procedures either with one stage or two-staged procedure. The study was conducted in East Jeddah hospital (Saudi Arabia) in the period between Jan 2018 and Jan 2020 with follow up over two years, the end points of the study were patency rate and amputation free survival over 2 years. Results: the study included 29 patients, 17 patients presented by critical limb ischemia class 5 and 6 according to Rutherford classifi- cation, and 12 patients presented by acute on top of chronic ischemia category 2 according to Rutherford classification, the mean age of patients was 49 years old, male to female ratio 3:1, technical success was 100%, 10 patients required minor foot amputation post operatively, patency rate was 100 % over the first year, dropped to 82 % over the next year, major amputation free survival was 100% over 2 years. Conclusion: Hybrid revascularization is the procedure that ensure optimum results in case of complex vascular lesions when endovas- cular or open revascularization alone is not enough or not possible, also hybrid procedures in management of infra-inguinal disease improved patency rate by shortening the length of bypass procedure and improving the proximal and distal outflow with no need for long distal bypasses

Aim: The aim of this study is to determine prognostic factors of limb salvage after iliac angioplasty ± stenting for chronic limb- threatening ischemia patients with iliac artery disease alone or with concomitant other lesion (femoro-popliteal or infrapopliteal disease). Methods: In this prospective interventional study, 32 patients with symptomatic steno-occlusive iliac artery disease treated by balloon angioplasty ± stenting. Patients’ data & comorbidities are collected and they are followed up for 1 month after iliac artery angioplasty ± stenting for above the knee amputation. Results: Comparison of data for final outcomes of limb salvage versus above-the- knee amputation showed that amputation is more likely with the increase in age with p value 0.035. Moreover, medical comorbidities were of no statistical significance regarding amputation however, angiographic characteristics and TASC classification were statistically significant regarding limb salvage. All the patients with total iliac artery occlusion (5 patients) underwent above-the-knee amputation within 1 month following the intervention while the limb was salvaged in patients with iliac artery stenosis with p value 0.001. In addition, limbs with diseased both CIA and EIA were more prone to above-the-knee amputation than limbs with diseased CIA only with p value 0.009. State of profunda femoris artery was a statistically significant prognostic factor for limb salvage as limbs with diseased PFA were more prone to above-the-knee amputation than limbs with healthy PFA with p value 0.023. Limbs with TASC D were more prone to above-the- knee amputation than TASC A, B, C with p value 0.001. Limb salvage was more reported in patients who underwent iliac artery angioplasty & stenting than in patients who underwent angioplasty only with p value 0.002. Conclusion: Above-the-knee amputation 30 days post iliac artery angioplasty ± stenting is significantly associated with increasing age, total iliac artery occlusion, concomitant CIA & EIA lesions, diseased PFA, TASC D lesions & in patients who underwent iliac artery angioplasty only than in patients who underwent angioplasty & stenting

Increasing experience with the management of Complex Regional Pain Syndrome (CRPS) Type I (historically Reflex Sympathetic Dystrophy) and CRPS Type II (causalgia) suggests that the distinction between CRPS Types I and II maybe inappropriate. The exist- ence of CRPS Type I has even been challenged. We report our experience with the diagnosis and management of CRPS Type I (including the role of sympathectomy). Methods: A retrospective study of patients diagnosed as CRPS Type I between 2005 – 2020 (as per the Budapest guidelines), was undertaken at King Edward VIII Hospital, Durban South Africa. CRPS presenting within 3 months of symptom onset was considered early, and late beyond this period. When conservative treatment was unsuccessful, patients were considered for minimal access sympathectomy. The pre-operative and post-operative pain scores were assessed on a Visual Linear Analogue Scale. Results: 53 patients (40 females) were diagnosed as having CRPS Type I. Fractures, soft tissue injuries, previous surgery were common predisposing factors; other factors included Herpetic neuralgia, drip insertion, snake bite, HIV, collagen vascular disease. The average age of the patient was 39.3 years (range 22-72). Late CRPS Type I was noted in 43 patients (79%); early CRPS Type I was noted in 11 patients. Thoracoscopic sympathectomy was successful in 48 patients; 2 patients underwent lumbar sympathec- tomy (1 by a minimal access technique, 1 by an open technique). One patient underwent thoracoscopic splanchnicectomy. For the entire group (both early and late; n = 51), the improvement in the pain score was statistically significant [p-value of 0.001 (Wilcoxen signed-rank test)]. The improvement of the pain score noted in the early versus late group was statistically significant with a p value 0.007 (Wilcoxen signed-rank test). The improvement in pain score sustained at the 3 month follow up. No complications were noted following sympathectomy. Conclusions: The management outcome of CRPS Type I approximates that of CRPS type II, suggesting that the distinction between CRPS type I and CRPS type II should be re-visited. Clinical assessment is crucial, since the predisposing factor may not be obvious and available diagnostic evaluation is unrewarding. Sympathectomy has an important role in the management when undertaken timeously

Aim- This study aims to find out whether BPH is a significant risk factor for developing inguinal hernia in males. Methodology: - This 1:1, age-matched, case-control study was conducted at L N medical college and J K Hospital, Bhopal. A total of 62 male participants aged 40 years above: 31 cases and 31 controls were selected according to inclusion criteria. Following prostate gland-related parameters were measured: International Prostate Syndrome Score (IPSS), Prostate volume and Uro-flo- metric in both groups. Result: Only 4 cases and 3 controls mentioned lower urinary symptoms (LUS) as one of the complaints during a clinical examina- tion. The mean IPSS values among the cases and control were 9.12 and 8.62 (p=0.292). None of the participants had a severe IPSS score; only 6 cases and 4 controls had moderate IPSS scores (p= 0.455). The mean prostate volume on USG among cases and controls was 28.8 ml and 27.4 ml (p = 0.844). None of the participants either in the case or control group had Prostatomegaly. On uroflowmetric analysis, the peak flow rate was 16.8 and 16.7 among cases and controls (p = 0.844). Conclusions: There was no significant difference in the prostate-related parameters among patients with and without inguinal hernia

Introduction: assess the factors helping successful angioplasty of the popliteal artery of patient with critical limb ischemia including popliteal alone or concomitant infra-popliteal disease. Methods: a prospective study of symptomatic patients with popliteal occlusive lesions treated by balloon angioplasty. All patients underwent systematic preoperative and postoperative color duplex scan and preoperative angiography. The principal endpoints were primary and primary assisted patency. Results: 51 patients were included in our study, they had a mean age 60.2 ± 10.2 years old. Males were more prevalent among the included patients 68.7% males versus 31.4% females. Comparison of final amputation outcomes among patients showed that patient with dyslipidemia is more borne to undergo major amputation with p value 0.04, hypertensive patients who are also more commonly underwent major amputation with p value 0.02. Moreover, CKD patients were at higher risk for major amputations with p value 0.0001. Regarding clinical presentation, patients with rest pains didn’t undergo any major or minor amputation with p value 0.005, as well as patients with minor tissue loss with p value 0.0001, on the contrary, patients with major tissue loss were more borne for major ampu- tation with p value 0.0001. Patients with arterial stenosis did not commonly undergo major amputation with p value 0.001, while those with total occlusion were at more risk for major amputation with p value 0.001. Conclusion: Major amputation in patients with critical limb ischemia is significantly associated with dyslipidemia, hypertension and CKD. Total arterial occlusion is significantly associated with need for major amputation.

Background: The study was done to establish the association between lower extremity venous insufficiency and hemorrhoidal disease. Methods: The study included 120 patients divided into two groups of 60 patients each, the first group comprised of patients having symptoms of hemorrhoidal disease, and the second group comprised of patients who did not have any symptoms of hemorrhoidal disease. a thorough examination was performed on each patient Results: There is a statistically significant association between hemorrhoidal disease and lower extremity venous insufficiency with maximum patients falling into the C1 category of CEAP classification. Conclusion: Patients with hemorrhoidal disease are at an increased risk of having lower extremity venous insufficiency with chronic constipation being a major risk factor in the causation of hemorrhoidal disease

Bleeding hepatic artery pseudoaneurysm is potentially a fatal condition which must be dealt with promptly. The pathology is usually a consequence of trauma, infection and upper abdominal surgery. The treatment ranges from endovascular to surgical intervention. Herein, we report a patient who was a drug abuser with bacterial endocarditis presented with melaena and jaundice. He was hemo- dynamically stable. Imaging revealed he has obstructive jaundice secondary to the blood clot in the bile duct as a result of bleeding from the right hepatic artery pseudoaneurysm. Radiological intervention was done to relief the obstruction as well as percutaneous coil embolization to arrest the bleeding. The treatment for bleeding hepatic artery pseudoaneurysm can be performed via transcatheter intraarterial embolisation by placing coils or arterial stent at the neck of the aneurysm. However, in a dire situation where the patient is unstable, surgical treatment is indicated. Alternatively, in selective cases, angiography and embolisation can be done percutaneously. Conclusion: Percutaneous coil embolisation of bleeding right hepatic artery pseudoaneurysm is a viable option in situation where transcatheter approach is limited and patient has multiple co-morbidities or unfit for surgery

There have been numerous discussions regarding diagnosing and revascularization options for acute mesenteric ischemia to im- prove its dire outcome. However, equally important is the management of the complications following successful intestinal revas- cularization. Refeeding syndrome (RS) is one the possible complications, yet there has been lack of report in the literature on this condition following intestinal revascularization. Here, we present a case of acute embolic mesenteric ischemia (AEMI) with RS as one of its complications despite the patient being categorized as low risk to develop it. This report discusses and highlights the key point at each stage of patient’s management, especially the importance of identifying and early treatment of complications post intestinal revascularization

Acute intestinal obstruction with intestinal gangrene secondary to midgut malrotation in an adult as first clinical presentation is rare. There are very few case reports of this condition. This case study reports this rare presentation and discusses clinical scenario approach and management options of this condition. A female aged 57 years, nil co-morbid, with no past medical or surgical history presented with complaints of colicky abdominal pain of insidious onset for 10 days associated with multiple episodes of non-bilious vomiting, loose stools, and reduced appetite. On clinical examination she was having abdominal distension with a tender mass in the right lumbar and iliac region. On evaluation with CECT abdomen, she was found to have intestinal malrotation with circumferential wall thickening of distal jejunal/proximal ileal loops with evidence of intestinal obstruction. She underwent emergency exploratory laparotomy and intraoperatively found to have complete malrotation of the midgut with 10 cm of jejunal segment about 15 cm from DJ flexure was gangrenous. Patient underwent successful open Ladd’s procedure with resection anastomosis of the gangrenous small bowel. Adults with intestinal malrotation present with vague, non-specific symptoms resulting in delay in diagnosis and its management. This case report highlights the importance of clinical suspicion, approach, and an urgent surgical management of the condition. The midgut malrotation can present with acute intestinal obstruction with bowel gangrene in an adult is a rare presentation. Early diagnosis can favour a successful emergent surgical management

Advances in medical technology now allow the human body to be kept alive in condi7ons that would normally lead to death, but many do not want to be kept alive if there is no chance of recovery. As some pa7ents are unable to express their desires (e.g. state of anesthesia), these desires can be stated in advance, through a life will. Life wills are referred to as advance care guidelines or health care guidelines and are documents that set out pa7ents' instruc7ons, empowering another person to make decisions on behalf of the pa7ent. The purpose of this work is to present and analyze life covenants. Ini7ally, the concept, purpose and historical development of the covenant of life are presented. Then the relevant legisla7on in Greece and abroad is presented and then the advantages and disadvantages of a life will are analyzed. Finally, there is a reference to whether this issue is relevant today, on the occasion of the Covid-19 pandemic