Background: Obesity is considered as an epidemic globally, which associated with gastroesophageal reflux disease [GERD]. Bariatrics surgery tends to reduce GERD manifestations. However, some reports noticed development of GERD after bariatric surgery; the problem which not addressed well in our community. Aim of the work: To estimate incidence of postoperative GERD after laparoscopic sleeve gastrectomy [SG] in patients with no history of GERD symptoms prior to surgery. Patients and Methods: Fifty morbidly obese patients who were scheduled for laparoscopic SG with no history of preoperative symptoms suggesting GERD and normal upper gastrointestinal endoscopy were included. All were assessed clinically and radiologically and followed-up for clinical or endoscopic GERD manifestations. Results: Females were predominant [76.0%]. Weight, body mass index and waist/hip ratio were significantly reduced after SG. Postoperative complications were leak [2.0%], wound infection [2.0%], bleeding [2.0%], stricture [4.0%] with overall rate of 8.0%. Incidence of GERD was 22.0% [11 patients; 4 grade A, 5 grade B and 2 grade C]. There was significant increase of Waist/hip ratio [both pre-and postoperatively] in patients who developed GERD when compared to those who did not develop GERD. In addition, there was significant increase of sleep related problems and stricture in patients who developed GERD when compared to those did not develop GERD [63.6%, 18.2% vs 17.9%, 0.0% respectively]. Conclusion: The incidence of GERD after SG was 22.0%. It was of mild or moderate nature, which denotes safety of SG. The procedure is also associated with marked weight reduction.

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Background: Recurrence after surgical treatment of inguinal hernia is still a challenge facing surgeons during their daily practice. Aim of the Work:The current trial aims to compare single and double mesh placement in huge inguinal hernia repair.Patients and Methods: 40 cases were involved in the study. They were classified into two equal groups according to the operative technique [A for single mesh and B for double mesh]. The study's candidates were examined and investigated thoroughly regarding their complaint, the presence of a clinically detectable hernia in the inguinal region, its size, characters, onset, duration, and associated symptoms. Then, all were examined clinically and prepared for surgical intervention after lab investigations. Results:The mean ages were 56 and 56.9 years for groups A and B. Both groups were comparable to body mass index, risk factors, type of hernia, hernia side, and intraoperative blood loss. There was a significant decrease in operative time in group A when compared to group B [54.50 ± 8.256 vs. 61.25 ± 6.664 minutes, respectively]. The overall rate of complications was lower in group B when compared to group A [30.0% vs. 50.0%, respectively]. Complications in group A were seroma [10.0%], wound infection [5.0%], scrotal edema [25.0%], and chronic pain [10.0%]; while in group B, seroma [10.0%], scrotal edema [5.0%], chronic pain [15.0%]. Recurrence was confined to group A, and reported to three patients [15.0%]. However, the difference was statistically nonsignificant. Conclusion: Double mesh technique is a safe and efficacious approach for managing huge inguinal hernia. It is associated with lower rate of recurrence than the single mesh approach with comparable operative time, complications, and outcomes.

Background: Acute abdomen is a surgical emergency, that needs early diagnosis and treatment to avoid complications and save patient life. However, accurate diagnosis is crucial to avoid unnecessary surgery. Laparoscopy could represent an optimal solution in these circumstances. The aim of the work:To evaluate the role of laparoscopy in management of doubt cases of acute abdomen. Patients and Methods:It is a prospective study, which held at Al-Azhar University Hospital [Damietta] during the first six months of 2020 and included 30 patients who presented by acute abdominal pain. All were evaluated by full history taking, clinical examination, laboratory and radiological investigations. Then, all underwent diagnostic laparoscopy, which had been continued to therapeutic laparoscopy, or converted to laparoscopy-assisted laparotomy at the same setting. Rate of success, operative diagnosis and postoperative complications were documented. Results:The most common cause of acute abdomen was acute appendicitis [23.33%] followed by acute cholecystitis [13.33%], then perforated peptic ulcer [10.0%]. Negative exploration had been reported in 10%. Therapeutic laparoscopy was successful in [56.7%] while [43.3%] required conversion to laparotomy. Complications were observed in 14 patients [46.7%] and wound infection is the most common [30.0%]. Radiological investigations failed to elaborate diagnosis in 12 patients, and laparoscopy achieved the diagnosis in 9 [75.0%] of them. Conclusion:The laparoscopic approach in doubt acute abdomen is proved to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. It reduces pain, improves recovery, shortens hospitalization and improves cosmetic results.

Although the perception of surgery in space may appear obscure, it is vital to initiate planning early if new frontiers in space travel are to be accomplished. Conditions necessitating surgery in space are rare, but they are challenging in their management. Telemedicine can allow consultation and instruction at the time of surgical intervention. This may permit optimal guidance for conduction of simple surgical maneuvers by non-medical crew members. Robots could be used for more complex interventions in the absence of a trained crew member. Earth-tospace telesurgery is yet to be attained. However, National Aeronautics and Space Administration [NASA] has successfully did several basic procedures at an underwater facility, simulated the space environment. The communication delay between craft and earth is the main potential issue affecting telesurgery. For example a communication delay of radio signals between 4 and 22 minutes is expected between earth and Mars. Thus, available telesurgical capabilities are not suitable for a Mars mission. In addition, to facilitate endogenous repair of injured structures, the use of absorbable nanoparticulate scaffolds could offer temporary structure support, while eluting drugs stimulate endogenous mesenchymal stem cells to differentiate into osteoblasts. Otherwise, direct delivery of extrinsic mesenchymal stem cells to injured sites via nanoparticulate delivery system provide a reasonable alternative. The use of 3D printing allows fabrication of complex surgical tools from a computer-aided design template from a digital database of nearly each instrument. In addition, 3D-printed surgical tools may be disposable, meaning no requirement for space-occupying sterilization appliances.