Background:The anterior abdominal wall is one of the most common regions affected in penetrating stab wound injuries. Tradionally, wound exploration and exploratory laparotomy are used as a diagnostic and therapeutic modality in the management of such injuries. Recently, laparoscopy has gained popularity in the management of such cases with favorable results in carefully selected patients. The aim of the present study was to assess the role of laparoscopy in the diagnosis and management of patients with stab wounds of the anterior abdominal wall.Patients and methods: 52 hemodynamically stable patients with stab wound of the anterior abdominal wall were included in this study at the emergency department of Ain Shams University Hospitals. Patients were selectively subjected to, physical examinations, focused abdominal sonography in trauma (FAST), computed tomography (CT), exploratory laparotomy, diagnostic and therapeutic laparoscopy.Results: Out of 39 patients that underwent laparoscopy, the laparoscopy succeeded to rule out visceral injury in 14 patients (35.9%) and was nontherapeutic in 5 patients (12.8%). 17 patients (43.6%) needed therapeutic management through laparoscopy and conversion to open laparotomy was done in 3 patients (7.7%). One case of missed injury with laparoscopy was recorded (accuracy 97.4%). Conclusion:Laparoscopy is a feasible and useful modality for evaluating and managing hemodynamically stable patients with abdominal stab wounds. Increased use of laparoscopy will help to decrease the rate of negative and nontherapeutic laparotomies, thus lowering morbidity and decreasing length of hospitalization.

Background: There are currently two different treatment modalities available for treatment of achalsia; pneumatic dilation (PD) and Heller myotomy (HM). Both of them are focused on decreasing the LES resting pressure thereby allowing the distal esophagus to empty with the aid of gravity. Ideally, the choice between the 2 treatment options should be based upon prospective, randomized and comparative studies. Studies comparing pneumatic dilatation with rigiflex balloon and laparoscopic Heller myotomy have recently been reported. This study aims to compare the results of pneumatic dilatation versus laparoscopic Heller's myotomy combined with Dor fundoplication in cases of achalasia of the cardia to consider which group of patients should be subjected to either methods for better management.Methods: This study is a prospective randomized clinical trial conducted in Ain Shams University Hospitals during the period from June 2012 till October 2014. Thirty patients who were diagnosed as having achalsia were randomized into 2 groups: group A included 15 patients who underwent pneumatic dilatation and group B included 15 patients who underwent laparoscopic Heller's myotomy.Results: The mean operative time was significantly longer in Heller's myotomy group [99 (80-120min)] than pneumatic dilatation group [46.6(40-60min)] (P < 0.001). The mean hospital stay was significantly longer in the HM group 2.1 days than the PD group 1.1 day (P< 0.001). There was no need for conversion to open Heller's in the HM. There was no significant difference in the incidence of intraoperative complications between both groups. There was a statistically significant lower symptom scoring in the HM group than PD group (P<0.001). Postoperative complications in the form of reflux symptoms and recurrence of achalasia symptoms were significantly lower in the HM group than the PD group (P<0.001).Conclusion: Laparoscopic cardiomyotomy was found to be superior to an endoscopic balloon dilatation strategy in the treatment of achalasia when studied during the first 12 month after treatment with special care must be taken in the future studies to laparoscopic myotomy alone as it is thought to be the best way for the management of achalasia in the future.

Background: Hepatic hydatid cyst has been traditionally managed by the open approach. Laparoscopy has provided an alternative approach for the open technique in many procedures. The aim of this study was to evaluate the role of the laparoscopic approach versus the open approach in the management of the hepatic hydatid cyst.Patients and methods: A prospective study was conducted over three years including 30 patients suffering from hepatic hydatidosis. They were divided into two groups each 15 patients. One group was treated by open approach while the other laparoscopically. The two groups were compared in relation to the intraoperative bleeding, anaphylactic reaction, operative time, postoperative bile leak, infection and length of the hospital stay.Results: The mean time of the open approach (group I) was 111.33 minutes while in the laparoscopic approach was 96.73 minutes. One patient suffered from bleeding and another patient from reaction in the laparoscopic group. One patient suffered from bile leak and 3 patients suffered from postoperative wound infection in the open group. The length of the hospital stay was significantly shorter in the laparoscopic group than the open group. Conclusion:The laparoscopic approach is safe and effective in the management of the hepatic hydatid cyst with less morbidity and shorter hospital stay.

Background: There are currently two different treatment modalities available for treatment of achalsia; pneumatic dilation (PD) and Heller myotomy (HM). Both of them are focused on decreasing the LES resting pressure thereby allowing the distal esophagus to empty with the aid of gravity. Ideally, the choice between the 2 treatment options should be based upon prospective, randomized and comparative studies. Studies comparing pneumatic dilatation with rigiflex balloon and laparoscopic Heller myotomy have recently been reported. This study aims to compare the results of pneumatic dilatation versus laparoscopic Heller's myotomy combined with Dor fundoplication in cases of achalasia of the cardia to consider which group of patients should be subjected to either methods for better management.Methods: This study is a prospective randomized clinical trial conducted in Ain Shams University Hospitals during the period from June 2012 till October 2014. Thirty patients who were diagnosed as having achalsia were randomized into 2 groups: group A included 15 patients who underwent pneumatic dilatation and group B included 15 patients who underwent laparoscopic Heller's myotomy.Results: The mean operative time was significantly longer in Heller's myotomy group [99 (80-120min)] than pneumatic dilatation group [46.6(40-60min)] (P < 0.001). The mean hospital stay was significantly longer in the HM group 2.1 days than the PD group 1.1 day (P< 0.001). There was no need for conversion to open Heller's in the HM. There was no significant difference in the incidence of intraoperative complications between both groups. There was a statistically significant lower symptom scoring in the HM group than PD group (P<0.001). Postoperative complications in the form of reflux symptoms and recurrence of achalasia symptoms were significantly lower in the HM group than the PD group (P<0.001).Conclusion: Laparoscopic cardiomyotomy was found to be superior to an endoscopic balloon dilatation strategy in the treatment of achalasia when studied during the first 12 month after treatment with special care must be taken in the future studies to laparoscopic myotomy alone as it is thought to be the best way for the management of achalasia in the future.