Asian Journal of Research in Surgery https://journalajrs.com/index.php/AJRS <p style="text-align: justify;"><strong>Asian Journal of Research in Surgery</strong>&nbsp;aims to publish&nbsp;high-quality&nbsp;papers (<a href="/index.php/AJRS/general-guideline-for-authors">Click here for Types of paper</a>) in all aspects of&nbsp;‘Surgery’. By not excluding papers based on novelty, this journal facilitates the research and wishes to publish papers as long as they are technically correct and scientifically motivated. The journal also encourages the submission of useful reports of negative results. This is a quality controlled, OPEN peer-reviewed, open-access INTERNATIONAL journal.</p> Asian Journal of Research in Surgery en-US Asian Journal of Research in Surgery Inguinal Hernia: Diagnostic Trap https://journalajrs.com/index.php/AJRS/article/view/30202 <p>Hernia is the most common parietal complication in cirrhotic patients. In the latter, it is ascites that explains why its prevalence is higher than in the general population. When a surgical treatment of the hernia is decided, control of the ascites is necessary and is essentially based on repeated punctures, Although the treatment of Hernia was long reserved for symptomatic forms, it is currently recommended to treat paucisymptomatic forms due to serious complications that could occur (rupture or strangulation) including, Emergency surgical treatment is accompanied by a high morbidity and mortality rate in cirrhotic patients. During repair, it is necessary to excise all necrotic tissue.</p> <p>It is possible to use prosthetic material if the neck is wide without increasing the risk of secondary infection, provided sterile ascites is present. The advantage of the laparoscopic approach is to avoid dissection of superinfected skin. In case of small neck, a cure under local anesthesia is possible.</p> A. Bachar A. Fatine Y. Eddaoudi T. Elabassi M. R. Lefriyekh ##submission.copyrightStatement## 2022-07-23 2022-07-23 58 61 A Prospective Comparative Clinical Trial of Onlay versus Sublay Mesh Repair for Treatment of Ventral Hernia https://journalajrs.com/index.php/AJRS/article/view/30198 <p><strong>Introduction: </strong>This randomized clinical study was done at Sharda Hospital on patients admitted to the Surgery ward with Ventral hernias after taking an Informed consent. Patients were investigated as a part of the pre-operative evaluation and Hernia Repair surgery is done as planned.</p> <p><strong>Aims &amp; Objective: </strong>To compare the onlay vs sublay mesh repair techniques for ventral hernias in patients coming to Sharda hospital for 1) post-operative pain (vas) 2) Duration of hospital stay, 3) Time required to return to work 4) Complications (Seroma, Hematoma, Wound Infection, Recurrence.)</p> <p><strong>Materials and Methods:</strong> Patients reporting to General surgery OPD of SMS&amp;R, S. hospital, G. N. with Ventral hernia were included in the study. Patients will be randomized into two groups: -group A, patients operated upon by Onlay mesh repair, and group B, patients by Sublay component separation repair. Patients followed up for- 1) post-operative pain (day 2, day 7, 1 month, and 3 months) using VAS, 2) mean hospital stay (in days), 3) return to basic activity (in days), and 4) complications including Seroma, Hematoma, SSI and recurrence.</p> <p><strong>Result: </strong>Data collected and entered in the proforma, tabulated and analyzed using software package for statistical analysis (SPSS2015). Seroma, hematoma, superficial skin necrosis, SSI, hospital stay, &amp; return to normal activities was more in onlay than in sublay repair.</p> <p><strong>Conclusion:</strong> Sublay mesh repair was found to be excellent in terms of short-term results with minimal morbidity. It resulted in fewer complications and no recurrence was noted. Seroma, hematoma, superficial skin necrosis, SSI, hospital stay, &amp; return to normal activities was relatively more in onlay mesh repair than sublay mesh repair.</p> Amit Kumar Mishra Ravi Kale ##submission.copyrightStatement## 2022-06-25 2022-06-25 1 18 Evaluation of Immediate Reconstruction with Lipofilling Following Breast Conserving Surgery for Early Breast Cancer https://journalajrs.com/index.php/AJRS/article/view/30199 <p><strong>Background: </strong>Early-stage breast cancer is defined as disease confined to the breast with or without regional lymph node involvement, and the absence of distant metastatic disease. In Breast-conserving surgery (BCS), only the tumor (lumpectomy) or maximally the quadrant where the tumor located is removed.</p> <p><strong>Aim of the Work: </strong>to evaluate the cosmetic outcome and oncologic safety of immediate lipofilling in cases of early breast cancer eligible for breast conserving surgery.</p> <p><strong>Methods: </strong>This prospective study was conducted on 40 patients presented with early breast cancer at the Surgical Oncology Unit, General Surgery Department, Tanta University Hospitals. All patients underwent breast conserving surgery by wide local excision of the tumor with free resection margins. Immediate lipofilling was performed by variable volumes of processed fat according to the volumes of the resultant resection defects. The patients were followed up clinically after 15 days, 3 months postoperatively to detect the early and late complications. After 6 months, mammography with complementary ultrasonography were performed to evaluate the graft and detect any complication. FNAC was done to reach the precise diagnosis of any radiological abnormality and exclude any local recurrence. The aesthetic outcome was evaluated objectively and subjectively after 6 months by a scoring system of five items: Asymmetry,breast shape, nipple, skin, wound (ABNSW Score)</p> <p><strong>Results:</strong> The average volume of resection defects was 24.4 cc. The average volume of the grafted fat was 49.7 cc. Fifteen days postoperatively, 28 cases had normal skin, four cases had small hematoma, four cases developed mild cellulitis, and four cases had superficial wound infection. After three months, 38 cases had normal overlying skin and two case still had mild wound infection that improved by treatment. After six months, mammography with complementary ultrasonography revealed architectural distortion in 18 cases, calcified hematoma in 14 cases, oil cyst in 4 cases, and chronic abscess in 4 cases. By FNAC, sixteen cases (40%) had giant cell reaction,ten cases (25%) had chronic inflammation, fat necrosis was diagnosed in 8 cases (20%), normal breast tissue was detected in 4 cases (10%). No local recurrence was recorded in any case<strong>. </strong>Fortunately, 38 cases had good to excellent results by the scoring system ABNSW with the mean total score was 13.2.</p> <p><strong>Conclusion: </strong>Breast conserving surgery with immediate lipofilling offers superior cosmetic outcomes than traditional reconstructive techniques.</p> Mahmoud Dorgham Hossam Moussa Mohamed Mlees Waleed El Sherpiny Mohamed Khedr Ayman Elnemr ##submission.copyrightStatement## 2022-06-25 2022-06-25 19 31 Positive Peritoneal Lavage Cytopathology: Prevalence and Relation to Clinico-Pathological Characteristics of Colonic Adenocarcinoma: A Cohort Study https://journalajrs.com/index.php/AJRS/article/view/30200 <p><strong>Background</strong><strong>:</strong> Positive peritoneal lavage cytopathology (PPLC) is an established poor prog­nostic factor in CRC that has been proven in many studies and was associated with an increase in peritoneal recurrence , overall recurrence and mortality. The incidence of PPLC among CRC patients varied in different studies between 2.1-52%. Similarly, different variables were reported to correlate with peritoneal lavage positivity in published studies. The aim of this trial was to study the prevalence of free intraperitoneal malignant cells at the time of radical resection of colon cancer and to assess its relation to different clinico-pathological characteristics.</p> <p><strong>Patients and methods</strong><strong>: </strong>This cohort study was conducted at the gastrointestinal surgery unit, general surgery department and the emergency hospital at Tanta University during the period from January 2020 ending in December 2020. Forty patients with non-metastatic primary colonic carcinoma were included in the study. Peritoneal lavage fluid was collected before radical resection of the tumour. One hundred milliliters of warm normal saline solution was installed into the peritoneal cavity and at least 80 ml of the lavage fluid was collected for cytopathological examination. After preparation, the sample was stained with Haematoxylin and Eosin and examined under a light microscope by an experienced cytopathologist.</p> <p><strong>Results</strong><strong>:</strong> Eighteen smears (45%) were found positive for malignant cells. Among variables tested, a positive correlation was found between PPLC and a low BMI (&lt; 25 kg/m<sup>2</sup>), the histopathological tumour type, an advanced pT stage, a high lymph node ratio and an advanced overall TNM stage.</p> <p><strong>Conclusion</strong><strong>: </strong>In non-metastatic AJCC stage II and III colon cancer, the prevalence of PPLC detected by conventional cytopathology was found to be 45%. A low BMI &lt;25kg/m<sup>2</sup> , the presence of intraperitoneal free fluid at the time of the operation , a high lymph node ratio, an advanced T stage, histopathological type and an advanced overall TNM stage correlated positively with PPLC.&nbsp;</p> Mohamed A. Abousalama Ahmed I. Swelam Hamdy S. Abdullah Osama H. Elkhadrawy ##submission.copyrightStatement## 2022-07-18 2022-07-18 32 46 Distal Revascularization with Interval ligation (DRIL) – An Extended Indication and Technical Details https://journalajrs.com/index.php/AJRS/article/view/30201 <p><strong>Background: </strong>Mature autogenous arteriovenous fistula(AVF) seems to be the best way to access the circulation for chronic hemodialysis in patients with end stage renal disease(ESRD), but in some cases steal can occur in relation to these fistulas and resulted in distal ischemia manifested as attacks of sever ischemic pain during dialysis sessions (that may mandate discontinuation of the session) which may progresses to digital ischemic rest pain, digital ulcers or gangrene. And in some cases long standing peripheral nerve ischemia can occur and manifests as a progressive atrophy of forearm and hand muscles with progressive weakening of hand grip. Over decades DRIL operation was described as a definitive treatment to cure this ischemic manifestation with preservation of the fistula, but criteria for patient selection, fine technical details and the spectrum of indications were lacking in these previous reports.</p> <p><strong>Aim of the Work</strong>: The aim of this study is to define criteria for selection of cases for whom DRIL operation can be applied with good outcome, test the efficacy of this procedure to treat fistula induced distal ischemic neuropathy and achieving partial or complete nerve recovery. Along with description of the fine technical details during surgery.</p> <p><strong>Materials and Methods: </strong>Twelve patients were enrolled in this study<strong>, </strong>all of them were having mature brachial artery based AVF for chronic hemodialysis with manifestations of distal ischemia caused by steal through the fistula. They were examined clinically and by duplex ultrasound, routine lab. and cardiac investigations were done. Nerve conduction studies were done for cases with suspected ischemic neuropathy. Surgery was planned for all of them where a vein was used as a bypass graft after ligation of the artery just distal to the fistula and patients were followed up over the next six months.</p> <p><strong>Resuls: </strong>DRIL operation was successfully applied to all selected patient with almost complete cure of ischemic manifestations and, surprisingly, a progressive recovery of severely damaged nerves, in cases presented with sever ischemic neuropathy, as the patients regained a near normal muscle mass and hand grip. All grafts were patent at the end of the follow up (100% primary patency).</p> <p><strong>Conclusion:</strong> Beside being an ideal solution for a selected cohort of patients suffering from fistula induced critical hand ischemia, DRIL operation offers an excellent treatment option for those suffering from fistula induced delayed ischemic neuropathy especially in its sever form.</p> Samy R. Zekilah Hosam M. Mokhtar Ahmed Y. Elsabaa Ahmed M. Elshafie ##submission.copyrightStatement## 2022-07-19 2022-07-19 47 57