Background Sacrococcygeal pilonidal sinus disease (PSD) is an infection of the skin and subcutaneous tissue at the upper part of the natal cleft of the buttocks. Excision and healing by granulation “lay-open” method is still more preferable than other methods of midline closure or using flaps but the healing time is lengthy. The present study was performed to assess the healing promotion effect of platelet-rich plasma (PRP) on the pilonidal sinus wounds treated by the lay-open method. Methods One hundred patients suffering from PSD were randomly divided into two groups, they were treated by the lay-open method, at General surgery department, Kafr El-Sheik University hospital, Egypt, during the period from December 2018 to December 2019. Group (A) was adopted the regular dressing postoperatively, while group (B) was treated with PRP injection into the wound at 4 and 12 postoperative days. Results Accelerated rate of wound healing was detected in group (B) in day 10, with a significant difference detected in days 15, 20, 25 and 30 postoperative, with a mean time of complete healing 45 ± 2.6 days in group B, while it was 57 ± 2.4 days in group A with a p-value of 0.001 which indicates considerable effect in the treated group. Conclusions PRP injection is an effective new technique in accelerating the healing of pilonidal wound after surgery, with a significant decrease in post-operative pain, complications and an early return to work. Trial registration retrospectively registered. Trial registration number: 12/35/1016 issued on December 2018 from the Institution Review Board at Kafr El Sheikh University. ClinicalTrials.gov identifier: NCT04430413

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Background and study aim Bile duct injuries are not infrequently seen during hepatobiliary surgery, particularly after liver transplantation and cholecystectomy. The current study aims to figure out the frequency of postcholecystectomy biliary injuries (PCBI) and the role of early versus late endoscopic retrograde cholangiopancreatography (ERCP) in their management. Patients and methods Totally 960 cases operated by both laparoscopic and open cholecystectomy were evaluated in the current study. In total, 942 cases were operated in our institutes, by both laparoscopic (n = 925) and open (n = 17) cholecystectomy, and the frequency of PCBI among patients operated in our institutes was (9/942) 0.95%. Additional 18 cases of PCBI referred to our centers were included in the study. One patient was treated by repair during the surgery, in the remaining 26 patients, ERCP management was attempted. The full details of the 26 patients regarding ERCP management were discussed. Results The overall success rate of ERCP management was 88.46% (23/26), whereas 11.54% of cases were treated surgically by choledochal-jejunal anastomosis due to complete common bile duct ligation. There were no differences between patients treated by early (first week) versus late (after the first week) ERCP regarding the needed interventions, type of PCBI, type and diameter of the inserted stents, and the overall success. There were no adverse events associated with ERCP management. Conclusions ERCP was valuable in the treatment of 88.46% of injured cases. There were no differences between early and late ERCP in the treatment of PCBI. Furthermore, ERCP management was not associated with adverse events.

Objectives: To determine the incidence of seroma formation after breast cancer surgery, and its association with common risk factors.Method: The correlational study was conducted at the General Surgery department of Kafrelsheikh University Hospital, Egypt, from March 2020 to March 2022 and comprised patients having breast cancer stage I, II or III, as per the Tumour- Node-Metastasis classification, who were scheduled to undergo modified radical mastectomy, breast conserving surgery or reconstructive surgery. Baseline, intraoperative and postoperative data was collected on a proforma. Data was analysed using SPSS 22.Results: Of the 50 female patients with mean age 45±5.20 (range: 20-70 years), 30(60%) were in the elderly group aged >45 years, while 20(40%) were aged <45years. Overall, 12(24%) cases developed seroma; 9(30%) in the elderly group. There were 24(48%) cases of modified radical mastectomy, and 8(33.3%) had seroma. Electrocautery was used for breast dissection in 30(60%) cases, and, among them, seroma developed in 10(33.3%) patients.Conclusion: Age, body weight, afflicted breast side, site, and size of breast mass were not found to be significant predictors of seroma formation following breast cancer surgery.Keywords: Seroma, Breast neoplasms, Neoadjuvant therapy, Electrocoagulation, Wound healing, Lymph nodes, Obesity.

IntroductionPharmacokinetics of mycophenolic acid (MPA) display substantial interpatient variability, with up to 10‐fold difference of exposure in individual patients under a fixed‐dose regimen. MPA trough level (C0) monitoring is common in clinical practice but has not proven sufficiently informative in predicting MPA exposure or patient outcomes, especially in children. No limited sampling strategies (LSSs) have been generated from pediatric heart transplant (HTx) recipients to estimate MPA AUC.MethodsSingle‐center, observational analysis of 135 de novo pediatric HTx recipients ≤21 years old who underwent MPA AUC between 2011 and 2021.ResultsMedian age was 4 years (IQR .6–12.1). Median time from transplant to MPA AUC sampling was 15 days (IQR 11–19). MMF doses (mg or mg/day) had low, negative Pearson correlation coefficients (r) while doses adjusted for weight or body surface area had low correlation with Trapezoidal MPA AUC0–24 h (r = .3 and .383, respectively). MPA C0 had weak association (r = .451) with Trapezoidal MPA AUC0–24 h. LSS with two pharmacokinetic sampling time points at 90 (C3) and 360 (C5) min after MMF administration (estimated AUC0–24 h = 32.82 + 4.12 × C3 + 11.53 × C5) showed strong correlation with Trapezoidal MPA AUC0–24 h (r = .87).ConclusionMMF at fixed or weight‐adjusted doses, as well as MPA trough levels, correlate poorly with MPA AUC0–24 h. We developed novel LSSs to estimate Trapezoidal MPA AUC from a large cohort of pediatric HTx recipients. Validation of our LSSs should be completed in a separate cohort of pediatric HTx recipients.