The therapeutic outcomes of EPLBD for removal of large bile duct stones are better than those of ES with comparable complication rate. EPLBD is also recommended for removal of large CBD stone in patients with an underlying coagulopathy or need for anticoagulation following endoscopic retrograde cholangiopancreaticography.

Background: Perforated appendicitis is one of the common surgical emergencies which need immediate surgical intervention.For many years, the classic open appendectomy still seems to be the routine treatment of perforated appendicitis. The improvement of technology and an increase in laparoscopic experience have been central to the development of laparoscopic surgery.The aim of this study is to compare outcome of laparoscopic versus open surgery for surgical management of perforated appendicitis in our locality. Patients and Methods:This is a prospective study that included 40 patients with perforated appendicitis admitted at general surgery department in Qena university hospital "between April 2018 to April 2019", 20 patients underwent open appendectomy and 20 had laparoscopic surgery. All patients subjected to: full clinical evaluation, diagnostic modalities as: laboratory investigation, plain X-ray erect and abdominal sonography.Results:All cases were completed successfully.A20 patient underwent open conventional surgery their mean age 29.80±7.32 years. While those underwent laparoscopic surgery were 20 patients and their mean of age 28.80±7.37 years. There were statistically significant differences between studied groups regarding operative time,time to return to a normal diet, length of hospital stayand postoperative complications. Conclusion:Laparoscopicsurgery for perforated appendicitisis safe and carries many advantages of minimallyinvasivetechniques. So, it should beused selectively, reservingthe traditionalopen approach.

Background:The rising global incidence and prevalence of type II diabetes (T2DM) has paralleled the rise in obesity. Bariatric surgery is currently the most effective treatment for obesity compared to maximal medical and lifestyle management. Objectives: This work aimed to compare the efficacy and safety of LSG (group 1), (LRYGB) (group 2) and (MGB) (group 3) for T2DM obese patients. Patients and Methods: A randomized prospective clinical study for 225 patients with morbid obesity (BMI 35 kg/m 2 or more with T2DM) treated by laparoscopic sleeve gastrectomy (LSG),laparoscopic Roux-en-Y gastric bypass(LRYGB) and mini gastric bypass (MGB),(75 patients in each group) conducted in Qena and Alexandria university hospitals from March 2019 to September 2020.The primary outcome was complete remission of type 2 diabetes with hyperglycemia control, (HbA1c <6 %). The secondary outcome was weight loss is by calculating the percentage of excess weight loss (% EWL) Results: There was statistically significant difference between the three studied groups regarding time of surgery (96.5 ± 17.6, 107.3 ± 19.4, and 106.6 ± 15.8 among group 1, 2, and 3respectively; P-value < 0.05). There was no statistically significant difference between the three studied groups regarding hospital staying duration and postoperative complication. There was no statistically significant difference between the three studied groups regarding HbA1C postoperative. Conclusion: Metabolic surgery has emerged as the single most effective treatment option for T2DM and obesity. There is a potential superiority of the LRYGB and MGB over the LSG in obtaining diabetes remission.

The problem of obesity become epidemic proportions not only in Western countries but also all over the world (Flegal, 2010). Bariatric surgery now considered efficiently producing long-term weight loss, improving comorbidities and improving quality of life for the morbidly obese patient, currently; there is much interest in restrictive procedures with theirlower operative and nutritional risks compared to mixed and mal-absorptive procedures (Brunault, 2011).

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