Background and aims: Laparoscopic sleeve gastrectomy (LSG) is a very popular bariatric procedure. Intraperitoneal bleeding, haematoma and staple line leak are the most common postoperative complications of LSG. Many surgeons routinely leave an intraperitoneal drain (IPD) thinking it will help in managing complications. Our aim was to evaluate the role of IPD in diagnosing and treating post-operative complications after sleeve gastrectomy. Patients and methods:We collected the data of patients who underwent primary LSG at our department between February 2016 and March 2018. 120 patients (group A) had LSG with positioning of IPD and 105 patients (group B) had LSG without IPD. All operations were performed by the same operative team and were completed laparoscopically. Inclusion criteria were a body mass index (BMI) greater than 40 kg/m2 or greater than 35 kg/ m2 accompanied with relevant co-morbidities. Exclusion criteria were the inability to undergo general anesthesia, patients with previous bariatric procedures, patients with previous intragastric balloon, patients on anticoagulation and patients older than 60 years. Results:The two groups were not different in their outcome. In Group A, 3(2.5%) patients had bleeding ( only one was evident in the drain) managed conservatively, one(0.8%) of them later on had surgical bed haematoma treated by U/S guided aspiration and pigtail insertion. Also in group A, one case (0.8%) of leakage managed by endoscopic stent and laparoscopic lavage and draining. In Group B, 4 cases (3.8%) had bleeding managed conservatively, 2 of them (1.9%) had haematoma later on managed by U/S guided aspiration and pigtail insertion. No leakage occurred in group B.Conclusions: Insertion of drains does not help in diagnosing or treating post-LSG complications as bleeding, leakage or haematoma.

Background: Laparoscopic repair of inguinal hernias is associated with less postoperative pain and a faster rehabilitation, but its high cost was a changeling matter.Patients and methods: We performed a randomized prospective study in Ain Shams University hospitals form July 2012 and April 2014 in which 50 male patients with primary unilateral or bilateral inguinal hernia were treated by laparoscopic transabdominal preperitoneal repair (TAPP) and mesh fixation through transabdominal polyprolene sutures. We recorded information about operative details, operative time, intraoperative complications, postoperative recovery, postoperative complications, and long term follow-up for one year after surgery.Results: No major intra or postoperative complications had occurred, only 2 patients were converted to open Lichtenstein's repair. Mean operative time was significantly accepted. Hospital stay, recovery period were excellent. Only one patient had unacceptable postoperative pain which decreased over a year during his follow up. After a 1 year follow up period, only in single case of recurrence has been diagnosed.Conclusion: Laparoscopic transabdominal preperitoneal repair (TAPP) and mesh fixation through transabdominal polyprolene stitches when efficiently experienced and mastered is an accepted and excellent surgical choice for inguinal hernia repair because of its cost effectiveness and less incidence of chronic pain syndrome.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure in the world and has overtaken the "gold standard" Roux-en-Y gastric bypass (RYGB) Obesity. The abstraction of the fundus is linked to physiological changes in gastric motility, as the gastric pacemaker is removed. Variable distance of antral resection from the pylorus is present in most cases. This is expected to provoke alterations in gastric emptying.Aim of the Work: to assess the changes in gastric emptying after sleeve gastrectomy and determine the time needed for accommodation. Recommendation of prokinetic therapy was or not reached after this study.Patients and methods: 30 morbidly obese patients who underwent LSG. 99mTc-sulfur colloid GE scintigraphy was performed on all patients pre and post-surgery. All operations were standardized regarding bougie size and distance of antral resection. Results:The mean preoperative body mass index BMI is 44.65±4.26 kg/m2 (range, 40 -53) and the mean preoperative body weight is 123.90±14.79 kg (range, 105 -155). accelerated gastric emptying presented in 24 cases, delayed emptying in 3 cases and normal emptying in 3 cases. The mean preoperative percent of retention at 30 min was 71.83±14.83 (range, 41.6 -92) decreased to 57.88±12.66 (range, 38.1 -80.1) after 3 months, and a mean percent of retention at 30 min was 57.45±21.41 (range, 18.7 -85.2) after 6 months. Conclusion:Gastric emptying was significantly accelerated after sleeve gastrectomy with application of tight bougie (36 French size) and preservation of the antrum. There was strong correlation between delayed gastric emptying and appearance of postprandial symptoms which subsided after prokinetic therapy. However, further studies are required for comparison between tight and wide bougie as regards their effect on gastric emptying and weight regain.

Background Deep venous thrombosis (DVT) is a major cause of morbidity and mortality all-over the world. Complications include pulmonary embolism (PE), post-thrombotic syndrome (PTS), phlegmasia alba dolens, phlegmasia cerulea dolens and venous gangrene. The PTS is the most common cause of long-term morbidity and disability among the previous complications. Aim of the Work The aim of this work is evaluation of the regional catheter-directed thrombolytic therapy versus standard systemic anticoagulant therapy in cases of acute ilio-femoral deep vein thrombosis as regard to efficacy, safety as well as complications. Patients and Methods This study was conducted on 30 patients presented to the vascular surgery unit of Ahmed Maher Teaching Hospital between February, 2019 and August, 2019 with acute iliofemoral deep venous thrombosis (less than two weeks duration). Of the 30 patients, 18 were females and 12 were males. The age of the patients ranged between 22 and 55 years. Results The outcome results of early Follow up of the thrombolytic therapy was complete recanalization in 30.7% of the cases, partial re-canalization in 53.8% of the cases and poor recanalization in the remaining cases15.3%.While the follow up results of anticoagulant therapy was complete re-canalization in 6.7% of the cases, partial re-canalization in 60% of cases and poor recanalization in the remaining cases 33.3% Conclusion Catheter directed thrombolytic therapy using streptokinase, as a lytic agent in the treatment of acute ilio-femoral DVT is a safe and efficient technique.