high perianal fistula, platelet rich plasma. Background: The main issue involves high perianal fistula management, as fistulotomy would represent an inacceptable risk of incontinence in such patients. Platelet rich plasma (PRP) is defined as a portion of patient own plasma with high concentration platelet and growth factor levels as obtained by centrifugation. Platelets have alpha granules that contain several proteins with multiple actions on the various aspects of tissue repair. Aim of the study was to evaluate the use of autologous platelet rich plasma in the treatment of perianal fistula. Methods: A prospective study including patients with high perianal fistula who presented to General Surgery Department of Zagazig University in the period from September 2016 to February 2019. Result: We had 16 patients with a diagnosis of high perianal fistula, 9 males and 7 females. We had a clinical success rate of 75% (12 patients out of 16 were completely healed with no recurrence throughout the follow up period). Two patients (12.5%) developed postoperative abscess formation and another two patients (12.5%) showed persistent external opening. Conclusion: Platelet rich plasma is promising in the treatment of high perianal fistula without affection of fecal continence.

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Background: Laparoscopic sleeve gastrectomy (LSG) involves resection of a significant portion of the stomach. Laparoscopic gastric plication (LGP) is a relatively alternative procedure similar to LSG, but without the need for gastric resection and low financial coast. Patients and methods: Fifty two patients fulfilled the National Institutes of Health criteria and were assigned randomly to receive either LGP (n = 26)19 women and 7 men; mean age 40.15± 7.35 (21-48) years and a mean BMI 46.96±4.30 kg/m 2 or LSG (n = 26) 17 women and 9 men; mean age 39.73± 8.53 (20-50) years and a mean BMI 46.23±4.21 kg/m 2 by a block randomization method. Patients were studied in terms of postoperative weight loss, complications. Change of HbA1c and hypertension. Results: All procedures were completed laparoscopically. Follow-up was 12 months. The mean hospital stay was 2.5 (3-6) days for both groups. Postoperative complications occurred in 2 cases of minor leak and 3 cases of bleeding were detected after LSG and one case of bleeding and two cases of gastric stenosis following LGP. All patients experienced postoperative excess weight loss which was significantly better in the LSG group in terms of the change in BMI (mean 19.04 compared with 14.72 in LGP) and reduction of HbA1c (mean 1.3 compared with 0.6 in LGP).The improvement in hypertension was not significant. Conclusion: LGP is feasible, safe, inexpensive and effective, but has an inferior weight-loss effect compared to LSG for morbidly obese patients with BMI above 40 kg/m 2 .

Background: Burst abdomen is a continuing problem for the general surgeon as the incidence of such complication may reach 3% with a mortality rate exceeding 25%.Methods: Component separation of all layers of anterior abdominal wall would give an extra length on each side towards medial advancement. 20 patients, 12 men and 8 women aged 35-65 (mean, 48.6) years, with burst abdomen after major gastrointestinal and hepatobiliary surgery whose abdomen could not be closed primarily were managed using this technique. Long term follow up of patients was done for development of complications.Results: One patient died on the fourth postoperative day from pulmonary embolism (mortality 5%), and 2 patients developed subincisional abscesses (10.5%). Skin necrosis occurred in 1 patient (5%). No single case of reburst occurred. Only one patient showed few symptoms of abdominal compartment syndrome. The mean hospital stay was 18.5 days. Long term follow up showed only one case of incisional hernia (5.5%) in a patient with biliary fistula. Conclusion:The component separation technique is a suitable, straightforward and tension free method, with a comparable mortality and morbidity to other conventional methods for closure of burst abdomen.