Introduction and hypothesis While approximately 225,000 pelvic organ prolapse (POP) surgeries are performed annually in the US, there is no consensus on the optimal route for pelvic support for the initial treatment of uterovaginal prolapse (UVP). Our objective is to compare the outcomes of abdominal sacrocolpopexy (ASC) to vaginal pelvic support (VPS) with either uterosacral ligament suspension (USLS) or sacrospinous ligament fixation (SSF) in combination with hysterectomy for treating apical prolapse. Methods A systematic search was performed through March 2021. Studies comparing ASC with VPS for treatment of UVP were included in the review. The primary outcome was the rate of overall anatomic prolapse failure per studies' definition. Secondary outcomes included evaluating isolated recurrent vaginal wall prolapse, postoperative POP-Q points, total vaginal length (TVL), and Pelvic Floor Distress Inventory (PFDI-20) scores. Random effect analyses were generated utilizing R 4.0.2. Results Out of 4225 total studies, 4 met our inclusion criteria, including 226 patients in the ASC group and 199 patients in the VPS group. ASC was not found to be associated with a higher rate of vaginal wall prolapse recurrence (OR = 0.6; 95% CI = 0.2-2.4; P = 0.33). There was no significant difference between groups for anterior or apical vaginal wall prolapse recurrence (P = 0.58 and P = 0.97, respectively). ASC was associated with significantly longer TVL (mean difference [MD]: 1.01; 95% CI = 0.33-1.70; P = 0.02) and better POP-Q Ba scores [MD = −0.23; 95% CI = −0.37; −0.10; P = 0.01]. Conclusions ASC and vaginal pelvic support (either USLS or SSF) have comparable anatomical outcomes. However, weak evidence of a difference in TVL and Ba was found. The strength of the evidence in this study is based on the small number of observational studies. A large, randomized trial is highly warranted.

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Four-port laparoscopic cholecystectomy (LC) is a standard procedure. Several alternative approaches have been described to make trocar scars invisible. This study describes and was successfully administered as a pilot for feasibility and safety of a bikini line port for better aesthetic results. In patients with symptomatic cholelithiasis undergoing LC between June 2021 and December 2021, bikini line ports were used in 67 patients. With the patient in the supine position, the first trocar (11 mm) was inserted into the abdomen through the umbilicus. The other three trocars were placed in the lower abdomen at the bikini line with the help of the camera. Standard instruments were used to perform the surgery. The mean operative time was 54.66 SD 14.1 min. No intraoperative or postoperative adverse events took place. The median follow-up for this cohort was 24 weeks. Cosmetic results were satisfactory for all patients. The use of one umbilical camera port and the other three ports in the bikini line in the lower abdomen completely hides the scars from the ports’ incision. The technique was quickly adopted by regular laparoscopic surgeons with usual instruments, much to the satisfaction of patients.

Background: Mandible fractures are a frequent injury because of the mandibular prominence and relative lack of support. As with any facial fracture, consideration must be given for the need of emergency treatment. Aim of Study: This study attempts to define current patterns of fracture mandible based on "414" patient demographics and mechanism of injury and variable methods of treatment in Assiut University Hospital in the period from (March 2014 to December 2016). Patients and Methods: This study is a retrospective analysis of medical records available with Trauma Unit Assiut University Hospital. In period from March 2014 to December 2016 "414" patients. Results: There were higher percentage in road accident (69.80%) and (19.80%) fall from height. There were (47.82%) of fracture in body, (3 6.95%) of cases in symphyseal, parasymphyseal. There were (60.86%) of cases had done by open reduction & intend fixation "ORIF" vs. (36.95%) of cases done by closed reduction and (2.2%) of cases treatment conservative. There were (27.77%) of cases have mouth opening normal with (69.0%) have normal occlusion. As regard there were (3.14%) of cases have infection postoperative. Conclusion: As regard there were higher in percentage in function, infection risk of anesthesia and fixation in ORIF group than closed reduction with highly significance difference.