Publications by authors named "Sameh Hany Emile"

117 Publications

When Is a Diverting Stoma Indicated after Low Anterior Resection? A Meta-analysis of Randomized Trials and Meta-Regression of the Risk Factors of Leakage and Complications in Non-Diverted Patients.

J Gastrointest Surg 2022 Aug 1. Epub 2022 Aug 1.

Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.

Background: Anastomotic leak (AL) is a potentially life-threatening complication after low anterior resection (LAR). This meta-analysis aimed to compare outcomes of LAR with and without diverting stoma and to determine factors associated with AL in non-diverted patients.

Methods: This was a PRISMA-compliant systematic review of electronic databases (PubMed, Scopus, and Web of Science). Randomized controlled trials comparing LAR with and without diverting stoma were included. Main outcome measures were AL, complications, and operation time in the two groups and risk factors of AL in non-diverted patients.

Results: Nine randomized control trials (RCTs) (946 patients; 53.2% male) were included. The diverting stoma group had lower odds of complications (OR: 0.61, 95%CI: 0.461-0.828; p < 0.001), AL (OR: 0.362, 95%CI: 0.236-0.555; p < 0.001, I = 0), abscess (OR: 0.392, 95%CI: 0.174-0.883; p < 0.024, I = 0), and reoperation (OR: 0.352, 95%CI: 0.222-0.559, p < 0.001, I = 0) than the no-diversion group. Both groups had comparable odds of bowel obstruction, surgical site infection, and perioperative mortality. The weighted mean operation time in the diverting stoma group was longer than the no-diversion group (WMD: 34.804, 95%CI: 14.649-54.960, p < 0.001). Factors significantly associated with AL in non-diverted patients were higher body mass index (BMI), ASA ≥ 3, lower tumor height, neoadjuvant therapy, open surgery, end-to-end anastomosis, and longer operation time.

Conclusions: Non-diverted patients with increased body mass index, high American Society of Anesthesiologists scores, low rectal cancers, received neoadjuvant therapy, underwent open surgery, end-to-end anastomosis, and longer operation times were at a higher risk of AL after LAR.
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http://dx.doi.org/10.1007/s11605-022-05427-5DOI Listing
August 2022

Authors' Reply: Efficacy and Safety of Non-operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta-analyses.

World J Surg 2022 Aug 30;46(8):2010-2011. Epub 2022 May 30.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.

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http://dx.doi.org/10.1007/s00268-022-06606-wDOI Listing
August 2022

Comprehensive literature review of the applications of surgical laser in benign anal conditions.

Lasers Med Sci 2022 May 23. Epub 2022 May 23.

General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt.

Surgery for benign anal conditions is a common practice and is usually followed by a good outcome. The present review aimed to summarize the emergence and evolution of different laser techniques used for the treatment of benign anal conditions and report their current outcome. PubMed and Scopus were searched for studies that assessed the use of laser in benign anal conditions. Anal conditions reviewed were hemorrhoids, anal fistula, anal warts, anal stenosis, and anal fissure. The full text of the studies retrieved was summarized in a narrative and tabular form. Laser techniques used for the treatment of hemorrhoidal disease were laser open hemorrhoidectomy, laser hemorrhoidoplasty, and Doppler-guided hemorrhoidal laser dearterialization. Resolution of hemorrhoidal symptoms was reported in 72-100% of patients after laser treatment. YAG laser, fistula laser closure, and photodynamic therapy have been used for the treatment of anal fistula with success rates ranging from 20 to 92.6%. Anal warts can be treated with photodynamic therapy with or without YAG or CO laser with a success rate up to 88%. A few studies reported the use of laser in the treatment of chronic anal fissure and anal stenosis. The use of laser in the treatment of benign anal conditions is associated with promising outcomes. Laser was most assessed in hemorrhoidal disease and anal fistula and showed more consistent success rates with hemorrhoidal disease than with anal fistula. Preliminary reports assessed the outcome of laser treatment in other conditions as anal fissure and warts with acceptable outcomes.
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http://dx.doi.org/10.1007/s10103-022-03577-1DOI Listing
May 2022

Development and Validation of an Artificial Intelligence-Based Model to Predict Gastroesophageal Reflux Disease After Sleeve Gastrectomy.

Obes Surg 2022 08 21;32(8):2537-2547. Epub 2022 May 21.

Gastrointestinal Surgery Centre, Mansoura University, Mansoura, Egypt.

Purpose: Prediction of the onset of de novo gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) would be helpful in decision-making and selection of the optimal bariatric procedure for every patient. The present study aimed to develop an artificial intelligence (AI)-based model to predict the onset of GERD after SG to help clinicians and surgeons in decision-making.

Materials And Methods: A prospectively maintained database of patients with severe obesity who underwent SG was used for the development of the AI model using all the available data points. The dataset was arbitrarily split into two parts: 70% for training and 30% for testing. Then ranking of the variables was performed in two steps. Different learning algorithms were used, and the best model that showed maximum performance was selected for the further steps of machine learning. A multitask AI platform was used to determine the cutoff points for the top numerical predictors of GERD.

Results: In total, 441 patients (76.2% female) of a mean age of 43.7 ± 10 years were included. The ensemble model outperformed the other models. The model achieved an AUC of 0.93 (95%CI 0.88-0.99), sensitivity of 79.2% (95% CI 57.9-92.9%), and specificity of 86.1% (95%CI 70.5-95.3%). The top five ranked predictors were age, weight, preoperative GERD, size of orogastric tube, and distance of first stapler firing from the pylorus.

Conclusion: An AI-based model for the prediction of GERD after SG was developed. The model had excellent accuracy, yet a moderate sensitivity and specificity. Further prospective multicenter trials are needed to externally validate the model developed.
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http://dx.doi.org/10.1007/s11695-022-06112-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273557PMC
August 2022

Ultrasound-guided versus laparoscopic-guided subcostal transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; a randomized double-blind controlled trial.

Int J Surg 2022 May 27;101:106639. Epub 2022 Apr 27.

General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt. Electronic address:

Background: Transversus abdominis plane (TAP) block is an effective modality for the control of immediate postoperative pain. The present randomized trial aimed to assess the efficacy of ultrasound-guided subcostal TAP (USTAP) and laparoscopic subcostal TAP (LSTAP) block as compared to standard care without TAP block after laparoscopic cholecystectomy.

Methods: This was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. Patients were equally randomized to one of three groups: USTAP, LSTAP, and control group (no TAP block). The main outcome measures were pain scores and analgesic consumption within the first 24 h postoperatively, postoperative nausea and vomiting (PONV), time to ambulation, time to first flatus, and adverse effects of TAP block.

Results: The trial included 110 patients (90% females) with a mean age of 40.9 ± 11.7 years. Both USTAP and LSTAP block groups were associated with significantly lower pain scores at 2, 6, 12, and 24 h postoperatively, lower cumulative dose of paracetamol, less PONV, and shorter time to flatus than the control group. USTAP and LSTAP block were associated with similar pain scores at all time points, similar analgesic requirements, a similar incidence of PONV, and comparable time to first ambulation and time to first flatus. No adverse effects related to TAP block were recorded.

Conclusions: TAP block is a safe and effective method for pain control and improving recovery after laparoscopic cholecystectomy. Both USTAP and LSTAP blocks were equally effective in terms of pain relief, analgesic requirements, PONV, return of bowel function, and time to ambulation.
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http://dx.doi.org/10.1016/j.ijsu.2022.106639DOI Listing
May 2022

Ligation of Intersphincteric Fistula Tract (LIFT) with or Without Injection of Bone Marrow Mononuclear Cells in the Treatment of Trans-sphincteric Anal Fistula: a Randomized Controlled Trial.

J Gastrointest Surg 2022 06 25;26(6):1298-1306. Epub 2022 Apr 25.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, 35516, Dakahlia, Egypt.

Background: Ligation of intersphincteric fistula tract (LIFT) is a sphincter-saving procedure used for treatment of complex anal fistula. The current study aimed to assess the outcome of local injection of bone marrow mononuclear cells (BM-MNCs) in conjunction with LIFT as compared to LIFT alone in regards to healing rate, time to healing, and ultimate success rate.

Methods: This was a prospective randomized trial on patients with trans-sphincteric anal fistula. Patients were randomly allocated to one of two equal groups: LIFT and LIFT with BM-MNC injection. The main outcome measures were healing at 10 weeks of follow-up, recurrence after healing, and complications.

Results: Seventy patients (48 male and 22 female) of a mean age of 37.9 ± 10.4 years were included. The mean time to complete healing after LIFT + BM-MNCs was significantly shorter than after LIFT alone (20.5 ± 5.2 vs 28.04 ± 5.8 days; P < 0.0001). The ultimate success rates of both groups were similar (LIFT = 60% vs LIFT with BM-MNCs = 68.6%, P = 0.62). There was no significant difference in the mean operation time or complication rate between the two groups. Secondary extension and previous anal surgery were significant independent predictors of failure of healing.

Conclusion: LIFT combined with BM-MNC injection was associated with a shorter time to complete healing than LIFT alone. However, BM-MNC injection did not have a significant impact on the overall healing and ultimate success rate.
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http://dx.doi.org/10.1007/s11605-022-05316-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184453PMC
June 2022

Rectal Cancer in Patients with Hereditary Nonpolyposis Colorectal Cancer Compared with Sporadic Cases: Response to Neoadjuvant Chemoradiation and Local Recurrence.

J Am Coll Surg 2022 May;234(5):793-802

Department of Medical Biochemistry (Issa), University of Alexandria, Egypt.

Background: This study aimed to assess the effect of neoadjuvant chemoradiation (nCXRT) on tumor regression and oncologic outcome of middle and low rectal cancer in patients of hereditary nonpolyposis colorectal cancer (HNPCC) compared to sporadic cases.

Study Design: This was a retrospective cohort study that compared the outcomes of patients with HNPCC presenting with middle or low rectal cancer indicated for nCXRT vs patients with sporadic rectal cancer. All patients received long-course nCXRT followed by total mesorectal excision. Primary outcome was pathologic tumor regression grade (TRG) assessed after resection. Secondary outcomes included disease-free survival and overall survival.

Results: Fifty-eight patients with HNPCC (24 female) were included in the study matched with 58 patients with sporadic rectal cancer (out of 166 using propensity score matching). Patients with HNPCC and sporadic rectal cancer were matched regarding tumor pathology TNM stage and lymphovascular invasion. In the HNPCC group, 36 patients (62%) had tumor regression (TRG3 = 6 (10.3%); TRG2 = 12 (20.6%); TRG1 = 18 (31%)) compared to 52 patients (92%) who had tumor regression in the control group (TRG4 = 9; TRG3 = 15; TRG2 = 18; TRG1 = 10) (p < 0.0007). After a median follow-up of 48 months, survival analysis revealed higher local recurrence and lower overall survival in patients with HNPCC compared to patients with sporadic rectal cancer.

Conclusions: Rectal cancer in patients with HNPCC showed poorer response to nCXRT and was followed by higher local recurrence and lower overall survival than patients with sporadic rectal cancer. Tumor regression was detected in <65% of patients with HNPCC compared to >90% of patients with sporadic rectal cancer, and none of patients with HNPCC had a complete response.
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http://dx.doi.org/10.1097/XCS.0000000000000134DOI Listing
May 2022

Comprehensive literature review of the outcome, modifications, and alternatives to double-stapled low pelvic colorectal anastomosis.

Surgery 2022 Aug 4;172(2):512-521. Epub 2022 Apr 4.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address:

Background: The double-stapled technique is widely used for creation of colorectal anastomosis after anterior resection of the rectum. Anastomotic leak has been recognized as one of the serious complications of low pelvic colorectal anastomosis. The present review aimed to illustrate the collective outcome of double-stapled technique, risk factors for anastomotic leak, and the modifications and alternatives of double-stapled technique.

Methods: A comprehensive review of PubMed/Medline, Scopus, and Web of Science was conducted to search articles that entailed patients who underwent low anterior resection with double-stapled low pelvic anastomosis. The main outcome measures were anastomotic leak and complication rates of double-stapled technique and its technical modifications.

Results: Overall, the median anastomotic leak rate across 25 studies was 7.3% (range: 0.7%-24.5%). The most commonly reported predictors of anastomotic leak after double-stapled technique were low tumor location, multiple stapler firings, male sex, longer operation time, and perioperative blood transfusion. Several modifications of the double-stapled technique were described and include hand-sewn colonic J-pouch, vertical division of the rectum, transanal reinforcement of anastomosis, transanal pull-through with single stapling technique, elimination of dog-ears using sutures, the natural orifice intracorporeal anastomosis with extraction of specimen procedure, and transanal transection and single-stapled.

Conclusion: The median rate of anastomotic leak after double-stapled technique was less than 8%; however, it showed a wide range from less than 1% to approximately 25%. This wide variation might be related to additional risk factors of anastomotic leak, namely low tumor location and multiple stapler firings. Several techniques were described to modify the double-stapled technique to try to reduce the incidence of anastomotic leak.
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http://dx.doi.org/10.1016/j.surg.2022.02.019DOI Listing
August 2022

Fournier's gangrene in a COVID-19 patient with multiple comorbidities: Combatting the triple threat.

Colorectal Dis 2022 Apr 7. Epub 2022 Apr 7.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.

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http://dx.doi.org/10.1111/codi.16139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111850PMC
April 2022

An updated review of the methods, guidelines of, and controversies on screening for colorectal cancer.

Am J Surg 2022 07 25;224(1 Pt B):339-347. Epub 2022 Mar 25.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address:

Background: Screening for early detection of colorectal cancer (CRC), adenomatous polyps, and precancerous lesions can reduce mortality. This review aimed to illustrate methods, guidelines, and clinical utility of CRC screening programs.

Methods: Literature search of PubMed and Scopus electronic databases was independently performed by two authors in September 2021. Articles discussing CRC screening methods and updated guidelines were reviewed.

Results: After reviewing the full text of 55 studies, it was found that the screening tests for CRC are divided into stool-based, endoscopic, and molecular. All CRC screening guidelines recommend screening starting at age 45-50, but vary regarding screening methods, frequency, and timing of screening discontinuation. Controversies include clinical benefits of screening the elderly and discontinuation of screening. Effective screening barriers involve patient- and healthcare-related factors.

Conclusion: Overall, screening should start at age 45-50 for average-risk individuals. Colonoscopy and FIT tests are standard modalities recommended for regular screening. Increasing public awareness of the importance of screening and implementing mass national screening programs can detect early CRC and decrease related mortality.
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http://dx.doi.org/10.1016/j.amjsurg.2022.03.034DOI Listing
July 2022

Extended Right-Sided Colon Resection Does Not Reduce the Risk of Colon Cancer Local-Regional Recurrence: Nationwide Population-Based Study from Danish Colorectal Cancer Group Database.

Dis Colon Rectum 2022 Mar 10. Epub 2022 Mar 10.

Research Unit for Surgery, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark.

Background: It is controversial whether extensive resection of right-sided colon cancer confer oncological benefits.

Objectives: The aim of this study was to examine short- and long-term outcomes of extended surgical removal of mesocolon compared to conventional approach.

Setting: This was a retrospective population-based study based on a prospectively maintained Danish Colorectal Cancer Group database.

Main Outcome Measures: Primary outcome measure was local-regional recurrence in patients who underwent curative resection for right-sided colon cancer and secondary outcome measures was 30-day postoperative complications. Distant metastasis, unplanned intraoperative adverse events, and 30- and 90-day postoperative mortality were also investigated. Patients who had palliative or compromised resection, emergency surgery and neoadjuvant chemotherapy were excluded.

Results: Of the 12,855 patients with resection of right-sided colon cancer retrieved, 1,151 underwent extended right hemicolectomy. Patients who had extended right hemicolectomy were younger males with lower ASA scores, operated by colorectal surgeons, using laparoscopic approach, and had a significantly higher number of harvested lymph nodes. The rate of local-regional recurrence was 1.1% (136/12,855) with no difference between conventional right hemicolectomy and extended right hemicolectomy (OR 1.7 CI 95% 0.63-2.18). Postoperative medical complications were significantly higher in extended right hemicolectomy even after adjusting for age, comorbidity, access to abdomen and other covariates (OR 1.26 CI 95% 1.01-1.58). No significant difference was noticed between conventional right hemicolectomy and extended right hemicolectomy in the rates of distant metastasis, unplanned intraoperative adverse event, and mortality.

Limitations: It is a register-based study, therefore, under reporting cannot be excluded. Extended right hemicolectomy as defined in this study does not reflect the extent of lymphatic dissection done during the surgery.

Conclusion: This large population-based registry study showed no difference in local-regional recurrence of right-sided colon cancer between conventional and extended right hemicolectomy with mesenteric resection and ligation of the middle colic vessels. Extended resection was associated with higher rates of postoperative complications. http://links.lww.com/DCR/B907.
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http://dx.doi.org/10.1097/DCR.0000000000002358DOI Listing
March 2022

Outcome of laparotomy and conservative treatment of patients with acute mesenteric venous ischemia with viable bowel.

Eur J Trauma Emerg Surg 2022 Mar 9. Epub 2022 Mar 9.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.

Background: Acute mesenteric ischemia (AMI) is one of the most serious abdominal emergencies. Predicting the onset of bowel necrosis that warrants surgical intervention is of paramount importance in AMI. The present study aimed to investigate the outcome of patients with AMI secondary to mesenteric venous occlusion (MVO) and the consequence of non-therapeutic exploratory laparotomy.

Methods: The records of 132 patients with AMI were retrospectively reviewed. The outcome of patients with acute mesenteric venous ischemia (AMVI) and viable bowel was analyzed based on the method of treatment: conservative versus surgical. The impact of non-therapeutic laparotomy on the outcome of patients with AMVI in terms of morbidity, readmission, and mortality was analyzed.

Results: Forty-seven patients (34 male) with AMVI had viable bowel. Of the 47 patients with viable bowel, 8 (17%) had an exploratory non-therapeutic laparotomy, whereas 39 patients were treated conservatively. Patients who had non-therapeutic laparotomy had significantly higher complication (50 vs 5.1%, p = 0.005) and readmission rates (37.5 vs 5.1%, p = 0.03) and longer hospital stay (8.5 vs 7 days, p = 0.02) than those treated conservatively. Patients with bowel necrosis who had a therapeutic laparotomy had slightly lower rates of morbidity and mortality as compared to patients with viable bowel who underwent a non-therapeutic laparotomy.

Conclusion: Careful assessment and informed decision-making in patients with AMVI are crucial to avoid unnecessary surgical intervention that can result in higher rates of complications and readmission and extended hospital stay.
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http://dx.doi.org/10.1007/s00068-022-01924-zDOI Listing
March 2022

Pancreatic injuries following laparoscopic splenic flexure mobilization.

Int J Colorectal Dis 2022 Apr 18;37(4):967-971. Epub 2022 Feb 18.

Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, United States.

Purpose: To call awareness to pancreatic injury occurring following laparoscopic splenic flexure mobilization (LSFM) and to discuss the mechanisms which led to such an injury.

Methods: Retrospective review of patients who underwent LSFM as part of their colectomy procedure and sustained pancreatic injuries at a colorectal surgery referral center during 2014-2021.

Results: Of 1022 (0.6%) LSFM performed during the study period, six (0.6%) patients were identified in which clinically significant injuries to the pancreas occurred. Two patients had partial transection of the tail of the pancreas and underwent laparoscopic distal pancreatectomy during the index operation. Three patients developed a post-operative pancreatic fistula after their pancreatic injury went undiagnosed during surgery and required percutaneous drainage, one of whom eventually required a distal pancreatectomy for a persistent pancreatic fistula. Another patient developed a peripancreatic fluid collection which resolved with conservative treatment.

Conclusions: Pancreatic injury is rare and a potentially major complication of LSFM. Anatomical misperception, retroperitoneal bleeding, a large bulky splenic flexure tumor, and a "difficult flexure" were recognized as possible mechanisms of such injury.
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http://dx.doi.org/10.1007/s00384-022-04112-yDOI Listing
April 2022

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East-a multicentre prospective cohort study.

Int J Colorectal Dis 2022 Apr 13;37(4):777-789. Epub 2022 Feb 13.

Minia University Hospital, Minya, Egypt.

Background: The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East.

Methods: This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared.

Results: Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001).

Conclusion: During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.
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http://dx.doi.org/10.1007/s00384-022-04108-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853311PMC
April 2022

A pilot randomized controlled trial on ligation of intersphincteric fistula tract (LIFT) versus modified parks technique and two-stage seton in treatment of complex anal fistula.

Updates Surg 2022 Apr 17;74(2):657-666. Epub 2022 Jan 17.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, 35516, Dakahlia, Egypt.

Complex anal fistula (CAF) is a challenging condition for surgeons. This randomized trial aimed to compare ligation of the intersphincteric fistula tract (LIFT), modified Parks technique, and two-stage seton in the treatment of complex anal fistula in terms of the success of treatment and complications. This was a pilot randomized trial conducted in the period of January 2019 to December 2019 on adult patients with CAF who were allocated to one of three groups: LIFT, modified Parks technique, and two-stage seton. The main outcome measures were healing rates, time to healing, complications, operation time, and quality of life. Sixty-six patients (75.7% males) of a mean age of 45.2 years were included. Mean operation time of LIFT was significantly shorter than the other two procedures (p < 0.0001). There was a significant difference between the three groups in terms of success rate (p = 0.04) but not in regard to complications (p = 0.59). The modified Parks technique had a significantly higher success rate than LIFT (95.2% vs 68.1%, p = 0.045) whereas the success rates of two-stage seton and LIFT were not significantly different (86.9% vs 68.1%, p = 0.16). The average time to healing after LIFT was significantly shorter than the other two procedures. The quality-of-life scores were comparable among the three groups. There was a significant difference in healing rates after the three procedures as the modified Parks technique achieved the highest success rate followed by two-stage seton and then the LIFT procedure. Time to complete healing after LIFT was significantly shorter than the other two procedures. The three procedures achieved similar quality of life and complication rates.
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http://dx.doi.org/10.1007/s13304-022-01240-6DOI Listing
April 2022

Transanal total mesorectal excision (TaTME) with delayed coloanal anastomosis versus TaTME with immediate coloanal anastomosis and temporary diversion in middle and low rectal cancer.

J Surg Oncol 2022 Apr 15;125(5):865-871. Epub 2022 Jan 15.

Department of Surgery, Section of Colon & Rectal Surgery, University of Alexandria, Alexandria, Egypt.

Background: Transanal total mesorectal excision (TaTME) avoids the difficulty of laparoscopic dissection of the lower part of the rectum. The need for stoma is associated with many stoma-related complications. The objective was to compare TaTME with immediate coloanal anastomosis and protective ileostomy (TaTME-IA) versus Turnbull-Cutait delayed coloanal anastomosis (TaTME-TC).

Methods: A retrospective cohort study included patients with low rectal cancer at least 1 cm above the top of the anal sphincter. Patients had either TaTME-IA or TaTME-TC. Primary outcome measures were anastomotic and stoma-related complications. Secondary outcomes included rate of permanent stomas, local recurrence, continence, and quality of life (QOL).

Results: TaTME-IA was done in 25 patients versus 20 who had TaTME-TC. TaTME-IA had significantly longer mean operative time (p = 0.04) and shorter length of stay (LOS) (4.5 vs. 11.4 days; p = 0.0001) compared to TaTME-TC. Anastomotic leak was reported in two patients of TaTME-IA versus one patient of TaTME-TC (p = 0.77). Anastomotic stenosis was reported in one patient in each group. No significant difference between groups as regard continence, local recurrence, and QOL.

Conclusion: TaTME-TC is a safe option that can be offered for patients with low rectal cancer who refuse or are not amenable to a temporary stoma. Anastomotic complications were similar in both groups. LOS was much longer in TaTME-TC, however, it avoids stoma complications. Both groups had similar functional oncologic outcomes and QOL.
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http://dx.doi.org/10.1002/jso.26795DOI Listing
April 2022

Impact of change in the surgical plan based on indocyanine green fluorescence angiography on the rates of colorectal anastomotic leak: a systematic review and meta-analysis.

Surg Endosc 2022 04 13;36(4):2245-2257. Epub 2022 Jan 13.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.

Background: In the present study, patients with colorectal anastomoses that were assessed with indocyanine green (ICG) fluorescence angiography (FA) were compared to patients who had only white light visual inspection of their anastomosis. The impact of change in surgical plan guided by ICG-FA on anastomotic leak (AL) rates was assessed.

Methods: PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried for eligible studies. Studies included were comparative cohort studies and randomized trials that compared perfusion assessment of colorectal anastomosis with ICG-FA and inspection under white light. Main outcome measures were change in surgical plan guided by ICG-FA and rates of AL. Risk of bias was assessed using RoB-2 and ROBINS-1 tools. Differences between the two groups in categorical and continuous variables were expressed as odds ratio (OR) with 95% confidence interval (CI) and weighted mean difference.

Results: This systematic review included 27 studies comprising 8786 patients (48.5% males). Using ICG-FA was associated with significantly lower odds of AL (OR 0.452; 95% CI 0.366-0.558) and complications (OR 0.747; 95% CI 0.592-0.943) than the control group. The weighted mean rate of change in surgical plan based on ICG-FA was 9.6% (95% CI 7.3-11.8) and varied from 0.64% to 28.75%. A change in surgical plan was associated with significantly higher odds of AL (OR 2.73; 95% CI 1.54-4.82).

Limitations: Technical heterogeneity due to using different dosage of ICG and statistical heterogeneity in operative time and complication rates.

Conclusion: Assessment of colorectal anastomoses with ICG-FA is likely to be associated with lower odds of anastomotic leak than is traditional white light assessment. Change in plan based on ICG-FA may be associated with higher odds of AL. PROSPERO registration number: CRD42021235644.
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http://dx.doi.org/10.1007/s00464-021-08973-2DOI Listing
April 2022

Efficacy and Safety of Non-Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta-Analyses.

World J Surg 2022 05 13;46(5):1022-1038. Epub 2022 Jan 13.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.

Background: Non-operative management (NOM) of uncomplicated acute appendicitis (AA) has been introduced as an alternative to appendectomy. This umbrella review aimed to provide an overview of the efficacy and safety of NOM of uncomplicated AA in the published systematic reviews.

Methods: This umbrella review has been reported in line with the PRISMA guidelines and umbrella review approach. Systematic reviews with and without meta-analyses on the efficacy of NOM of AA were analyzed. The quality of the reviews was assessed with the AMSTAR 2 tool. The main outcomes measures were the treatment failure and complication rates of NOM and hospital stay as compared to appendectomy.

Results: Eighteen systematic reviews were included to this umbrella review. Eight reviews documented higher odds of failure with NOM, whereas two reviews revealed similar odds of failure. Six reviews reported lower odds of complications with NOM, six reported similar odds, and one reported lower odds of complications with surgery. Eight reviews reported similar hospital stay between NOM and appendectomy, one reported longer stay with NOM and another reported shorter stay with NOM. Pooled analyses showed that NOM was associated with higher treatment failure overall, in children-only, adults only, and RCTs-only meta-analyses. NOM was associated with lower complications overall, yet children-only and RCTs-only analyses revealed similar complications to surgery. NOM was associated with shorter stay in the overall and adult-only analysis, but not in the children-only analysis.

Conclusions: NOM of AA is associated with higher treatment failure, marginally lower rate of complications and shorter stay than appendectomy.
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http://dx.doi.org/10.1007/s00268-022-06446-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756749PMC
May 2022

Systematic review and meta-analysis of the outcome of puborectalis division in the treatment of anismus.

Colorectal Dis 2022 04 12;24(4):369-379. Epub 2022 Jan 12.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.

Aim: Anismus is a common cause of obstructed defaecation syndrome (ODS). The aim of the present review is to assess the efficacy and safety of puborectalis muscle (PRM) division in the treatment of anismus.

Method: PubMed, Scopus, Web of Science and the Cochrane Library were searched for studies that assessed the outcome of PRM division in the treatment of anismus. The main outcome measures were subjective improvement in ODS, decrease in the Wexner constipation score and ODS score, and complications, namely faecal incontinence (FI).

Results: Ten studies (204 patients, 63.7% male) were included. The weighted mean rate of initial subjective improvement across randomized trials was 97.6% (95% CI 94%-100%) and across nonrandomized studies it was 63.1 (95% CI 39.3%-87%). The weighted mean rate of 12-month improvement across randomized trials was 64.9% (95% CI 53.3%-76.4%) and across nonrandomized studies it was 55.9% (95% CI 30.8%-81%). The weighted mean rate of FI across randomized trials was 12.1% (95% CI 4.2%-20%) and across nonrandomized studies it was 10.4% (95% CI 1.6%-19.3%). Male sex and unilateral PRM division were significantly associated with recurrence of symptoms after PRM division. Bilateral PRM division, posterior division, complete division and concomitant sphincterotomy were significantly associated with FI after PRM division.

Conclusions: The use of PRM division for treatment of anismus was followed by some initial improvement in ODS symptoms which decreased to <60% 12 months after PRM division. The mean rate of FI after PRM division, namely 10%-12%, is a limitation of the technique. Further well-designed trials are needed to verify the outcome of PRM division in the treatment of anismus.
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http://dx.doi.org/10.1111/codi.16040DOI Listing
April 2022

Effect of Altitude Level on Surgical Outcomes of Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity: A Multicentre Prospective Study.

Surg Laparosc Endosc Percutan Tech 2021 Dec 15;32(2):176-181. Epub 2021 Dec 15.

Minia University Hospital, Surgical Department, Minia, Egypt.

Background: This study aimed to evaluate the impact of altitude level on surgical outcomes of laparoscopic sleeve gastrectomy (LSG) for patients with morbid obesity.

Methods: At the normal altitude level, 808 patients underwent LSG, and 467 patients underwent LSG in high-altitude regions. The primary outcome was evaluated based on the postoperative morbidity rate. Secondary outcomes were evaluated based on operating time, mortality, hospital stay, percentage of total weight loss (TWL), and comorbidities improvement.

Results: No significant differences were noted in-hospital stay, time to start oral intake, gastric leakage, overall complications, and hospital mortality between the 2 groups. Deep vein thrombosis, pulmonary embolism, and mesenteric vascular occlusion were significantly higher in high altitude [11 (1.3%) vs. 14 (3%), P=0.04; 8 (0.7%) vs. 11 (2.4%), P=0.01; 4 (0.5%) vs. 8 (1.7%), P=0.03, respectively]. Patients with normal altitude recorded a better %TWL than those at high altitude after 12 months (41±9 vs. 39±9.6, P=0.002) and after 24 months (41±8 vs. 40±9, P=0.009). In both groups, a significant improvement was noted in comorbidity after LSG.

Conclusion: The %TWL significantly achieved with LSG in normal and high altitudes. After 12 and 24 months, the %TWL is significantly higher with LSG at normal altitudes. High altitude is associated with a high incidence of deep vein thrombosis, pulmonary embolism, and superior mesenteric vascular occlusion with LSG.
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http://dx.doi.org/10.1097/SLE.0000000000001030DOI Listing
December 2021

Giant mucocele of the appendix.

Surgery 2022 06 13;171(6):e29-e30. Epub 2021 Dec 13.

General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.

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http://dx.doi.org/10.1016/j.surg.2021.11.015DOI Listing
June 2022

Radical resection of colon cancer: More isn't necessarily better.

Authors:
Sameh Hany Emile

Surgery 2022 02 3;171(2):555. Epub 2021 Nov 3.

General Surgery Department, Mansoura University Hospitals, Mansoura University, Egypt. Electronic address:

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http://dx.doi.org/10.1016/j.surg.2021.10.005DOI Listing
February 2022

Literature review of the outcome of and methods used to improve transperineal repair of rectocele.

World J Gastrointest Surg 2021 Sep;13(9):1063-1078

General Surgery, Mansoura University Faculty of Medicine, Mansoura 35516, Egypt.

Background: Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome (ODS).

Aim: To assess the current literature in regard to the outcome of the classical transperineal repair (TPR) of rectocele and its technical modifications.

Methods: An organized literature search for studies that assessed the outcome of TPR of rectocele was performed. PubMed/Medline and Google Scholar were queried in the period of January 1991 through December 2020. The main outcome measures were improvement in ODS symptoms, improvement in sexual functions and continence, changes in manometric parameters, and quality of life.

Results: After screening of 306 studies, 24 articles were found eligible for inclusion to the review. Nine studies (301 patients) assessed the classical TPR of rectocele. The median rate of postoperative improvement in ODS symptoms was 72.7% (range, 45.8%-83.3%) and reduction in rectocele size ranged from 41.4%-95.0%. Modifications of the classical repair entailed omission of levatorplasty, addition of implant, concomitant lateral internal sphincterotomy, changing the direction of plication of rectovaginal septum, and site-specific repair.

Conclusion: The transperineal repair of rectocele is associated with satisfactory, yet variable, improvement in ODS symptoms with parallel increase in quality-of-life score. Several modifications of the classical TPR were described. These modifications include omission of levatorplasty, insertion of implants, performing lateral sphincterotomy, changing the direction of classical plication, and site-specific repair. The indications for these modifications are not yet fully clear and need further prospective studies to help tailor the technique to rectocele patients.
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http://dx.doi.org/10.4240/wjgs.v13.i9.1063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462077PMC
September 2021

Small Bowel Volvulus Secondary to Mesenteric Lipoma.

J Gastrointest Surg 2022 02 4;26(2):507-509. Epub 2021 Oct 4.

General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.

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http://dx.doi.org/10.1007/s11605-021-05167-yDOI Listing
February 2022

Finding a place for non-operative management of acute appendicitis: COVID-19 as an example.

Authors:
Sameh Hany Emile

Am J Surg 2022 03 15;223(3):605-606. Epub 2021 Sep 15.

General Surgery Department, Mansoura University Faculty of Medicine, Mansoura, Egypt. Electronic address:

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http://dx.doi.org/10.1016/j.amjsurg.2021.09.003DOI Listing
March 2022

Artificial Intelligence Compared to Alvarado Scoring System Alone or Combined with Ultrasound Criteria in the Diagnosis of Acute Appendicitis.

J Gastrointest Surg 2022 03 13;26(3):655-658. Epub 2021 Sep 13.

General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.

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http://dx.doi.org/10.1007/s11605-021-05147-2DOI Listing
March 2022

Tumor location and concurrent liver resection, impact survival in T2 gallbladder cancer: a meta-analysis of the literature.

Updates Surg 2021 Oct 23;73(5):1717-1726. Epub 2021 Aug 23.

Dow Medical College, Dow University of Health Sciences, Karachi, Egypt.

Aim of doing this review was to give a uniform consensus on prognostic impact of tumor location (hepatic vs peritoneal), liver resection and adjuvant chemotherapy in gall bladder cancer and, to compare them with previous well-studied factors of survival. We systematically review PubMed, Scopus and Cochrane for relevant articles with no date restrictions, language was restricted to English. Those articles were included that had provided Hazard ratio (HR) of survival for T2 gall bladder cancer. We identified nine retrospective studies published between 2014 and 2020 with 2345 patients. Meta-analysis showed that T2b (hepatic) cancers had higher odds of mortality (HR 3.16 [2.11, 4.74], I = 0%). Liver resection was associated with significantly higher odds of 5-year overall survival only in T2b (2.20 [1.33, 3.63], I = 67%), adjuvant chemotherapy was not associated with any significant decrease in mortality risk (0.98 [0.83-1.16]. I = 20%). Hepatic sided gall bladder tumors carry higher odds for mortality and recurrence. T2a tumors can be managed without hepatic resection. To risk stratify patients we also formulated a scoring system for mortality risk.
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http://dx.doi.org/10.1007/s13304-021-01150-zDOI Listing
October 2021

Axillary breast cancer with lateral orbital metastasis in a male patient.

Surgery 2022 02 24;171(2):e3-e4. Epub 2021 Jul 24.

General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt. Electronic address:

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http://dx.doi.org/10.1016/j.surg.2021.06.049DOI Listing
February 2022
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