INTRODUCTIONIn 925 AD the first total thyroidectomy for goiter was reported by Abu al-Qasim Emil Theodore Kocher, was the first to use precise surgical technique and meticulous hemostasis to reduce the mortality rate to 0.5% in more than 5000 thyroidectomies.1 Due to His work in thyroid surgery, he got to a Nobel Prize in 1909. 2The thyroid gland is a highly-vascularized organ, prompt and effective hemostasis is a crucial part of the procedure. Meticulous haemostasis is essential to avoid intraoperative complications and obtaining good visualization of the surgical field and prevent damage to structures such as parathyroid glands or laryngeal nerves. 3Nowadays with the major advent of energy devices such as ultrasonic coagulation (Harmonic Scalpel, Ethicon) and bipolar energy (LigaSure, Valleylab) for cutting and hemostasis introducing new methods of vessel ligation and division without increasing the risk of postoperative complications. 4 The aim of this study was to compare the outcome of the use of the Harmonic® FOCUS and ABSTRACT Background: The thyroid gland is a highly-vascularized organ, prompt and effective hemostasis is a crucial part of the procedure. Nowadays with the major advent of energy devices such as ultrasonic coagulation (Harmonic Scalpel, Ethicon) and bipolar energy (LigaSure, Valleylab) for cutting and hemostasis introducing new methods of vessel ligation and division without increasing the risk of postoperative complications. The aim of this study was to compare the outcome of the use of the Harmonic® FOCUS and conventional suture ligation technique in a prospective comparative study of open total thyroidectomy. Methods: This was prospective comparative study at Sohag University Hospital, Sohag, Egypt. Patients were divided into two groups, the first group included patients who had the Harmonic® FOCUS thyroidectomy group or Sutureless thyroidectomy (S group), and the second group included patients who received Conventional thyroidectomy group (C group). Results: Between September 2014 and September 2016, 69 patients, with thyroid disease were enrolled in this study. 34 patients (49.3%) had a Sutureless total thyroidectomy and 35 patients (50.7%) had a conventional total thyroidectomy, the mean age for Sutureless thyroidectomy was39.85±8.47 years and for conventional group was 43.17±9.69 years. the operative time, intraoperative blood loss, postoperative, drainage volume, transient hypocalcaemia, overall postoperative complications and hospital stay were significantly lower in Sutureless thyroidectomy group. no significant difference between both group as regard recurrent laryngeal nerve function. Conclusions: Sutureless thyroidectomy is the procedure of choice for treatment of thyroid diseases as it had shorter operative time, reduction of overall complications rate and good function results.

Background: One of the most common complications of laparotomy is Incisional hernia, with an estimated incidence of 3-20%. The objective of this study was to compare the outcome of patients after laparoscopic and open incisional hernia repair.Methods: This was a prospective observational comparative study, in Sohag University Hospital, Sohag, Egypt. All adult patients who fulfilled our inclusion criteria underwent laparoscopic or open incisional hernia repair from September 2013 to September 2016 were included in the study. Primary outcome measure of this study was recurrence rate, wound infection. And secondary outcome measure of this study was operative time, postoperative complications and hospital stay.Results: Between September 2013 and September 2016, 60 patients with incisional hernia had fulfilled our inclusion criteria were operated at the general surgery department at Sohag university hospitals, Sohag, Egypt. 31 patients had open incisional hernia repair and 29 had laparoscopic incisional hernia repair. The mean age for laparoscopic repair group was 45.69±7.66 years and for open repair group was46.94±8.08 years p value 0.543. In laparoscopic group male to female ratio 20/9 was while in open group it was16/15 p value 0.197.the mean body mass index for laparoscopic group was29.83±3.56kg/m2 and for open group30.00±3.32kg/m2 p value= 0.873. the most significant finding was hospital stay which was significantly shorter in laparoscopic incisional hernia repair group p value was 0.000 as well as wound infections were significantly lower in laparoscopic incisional hernia repair group p value was 0.05. there was no significant difference between both groups as regard operative time, bowel injury intraoperative complication postoperative complications as well as recurrence rate. The mean follows uptime was 27.24±3.04 months for laparoscopic incisional hernia group and 27.12±3.06 months for open group.Conclusions: Laparoscopic incisional hernia repair is a safe alternative to laparoscopic incisional hernia repair with a shorter hospital stay and a lower wound complication.

Background: Several techniques of circumcision are available such as conventional surgical technique, the device (Gomco, Plastibell), mono and bipolar diathermy and sutureless methods such as fibrin glue. Our knowledge, the first report of using harmonic scalpel in circumcision was published by Peng et al, in the Asian journal of andrology but the study was done on dogs, this one of the little studies describe the use of the harmonic scalpel in male circumcision in humans. Aim was to describe the technique of the harmonic scalpel circumcision and report its outcomes in the term of safety and efficacy.Methods: This was a prospective observational study performed in the general surgery department at Sohag university hospital, Sohag, Egypt from 1st January 2015 to 31 December 2016.Results: 90 male patients were included in this study. Their age ranged between 3 and 18 years. The most common indication was religious circumcision 50%. No intraoperative blood loss or a postoperative bleeding. One case of wound infection and three cases of a postoperative edema respond to conservative treatment. No injury to the surrounding structure.Conclusions: The result of this study determines that the harmonic scalpel circumcision not associated with intraoperative blood loss or postoperative bleeding and a good postoperative cosmetic result, with a minimal complication. So, it is an appropriate alternative to the traditional scalp and suture technique.

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Background: There are many techniques described to decrease the risk of bleeding after circumcision in patients with bleeding diathesis such as monopolar diathermy, bipolar scissors and fibrin glue. Up to our knowledge, no previous study described the use of the harmonic scalpel in patients with bleeding diathesis. Our aim was to evaluate postoperative outcome after harmonic scalpel circumcision in boys with hemophilia.Methods: This was a prospective observational study carried out in Sohag University Hospitals, Sohag, Egypt. The patients were recruited from Outpatient pediatric hematology clinic from January 2014 till January 2017. All procedures were done under general anesthesia. After strict sterilization, the dorsal aspect of the prepuce was incised using harmonic scalpel up to the coronal sulcus, then the whole prepuce was cut circumferentially using the harmonic scalpel. It is a sutureless technique.Results: 26 boys with hemophilia A and 5 with hemophilia B were included. Their median age was 5 and 8 years respectively. The most common indication for circumcision was religious (20/31), the intraoperative blood loss ranged between 0-5 ml, operative time ranged between 3-5 minutes, there was no intraoperative complication, one case of rebleeding managed conservatively by factor administration, two cases of wound infection responded to antibiotic therapy, hospital stay ranged between 1-3 days. It was a sutureless technique.Conclusions: Harmonic scalpel circumcision is a safe technique in children with hemophilia, it decreased the risk of rebleeding, decreased operative time and it is also a sutureless technique and may decrease the cost by reducing the amount of factor replacement.