Background: Pain after laparoscopic bariatric surgeries has negative effects on patients' recovery. Objective: To evaluate efficacy and safety of adding intraperitoneal dexamethasone to bupivacaine for postoperative pain relief after laparoscopic bariatric surgeries. Patients and Methods: Sixty patients were randomly allocated into 3 groups as follows: Group B (n=20): bupivacaine 100 ml 0.25% + 5 ml normal saline. Group BD4 (n=20): bupivacaine 100 ml 0.25% + 4 mg dexamethasone (1 ml) + saline 4 ml, and Group BD8: (n=20) bupivacaine 100 ml 0.25% + 8 mg dexamethasone (2 ml) + saline 3 ml. Postoperatively ketorolac IV 30 mg/6 hours + Paracetamol IV 1 g/8 hours were given± nalbuphine. Results: Pain was lower in Group BD8. Sedation was deeper in Group B. Time to first supplementary analgesia was longer in Group BD8 than Groups B or BD4, and longer in Group BD4 compared to Group B. Patients requiring supplementary analgesia were less in Group BD8 than Groups B or BD4. Total postoperative consumption of nalbuphine in the first postoperative day (POD 1) was less in Group BD8 than Groups B or BD4, and less in Group BD4 than Group B. Time for independent ambulation was shorter in Group BD8 than Groups B or BD4, and shorter in Group BD4 than Group B. Postoperative nausea and vomiting (PONV) was higher in Group B compared to other groups. Conclusion: Intraperitoneal administration of either 4 mg or 8 mg dexamethasone to bupivacaine (0.25%) resulted in better recovery and pain relief after bariatric surgeries. Dexamethasone 8 mg is superior to 4 mg.

Background: Although awareness via cancer screenings and the knowledge of therapy modalities has increased, the burden of colorectal cancer (CRC) is much more pronounced in developing countries. Objective: This study was aimed to estimate serum carcinoembryonic antigen (CEA) levels in preoperative CRC patients and to determine the associations between serum CEA levels and tumor node metastasis (TNM) stage. Patients and methods: This cross-sectional study included 36 patients with CRC (stages IV) attending at Department of General Surgery, Zagazig University Hospitals. Patients scheduled preoperatively for sigmoidoscopy were prepared by an enema and examined by using standard video endoscopes. The CEA levels were estimated preoperatively for all patients. Results: CEA level among the studied cases ranged from 0 to 23 ng/dl with mean 6.39 ng/dl and median 4.5ng/ml. Also 58.3% had CEA level ≤ 5 ng/ml. There were no statistical significance relations between the CEA and age or sex distribution. But there was a statistical significance increase in frequency of smoking among cases had CEA level >5 ng/ml. There was no statistical significance relation between site and diameter of lesions and CEA level among the studied cases. Conclusions: It could be concluded that there is a meaningful link between TNM stage and CEA level. However, normal levels of CEA will not rule out CRC diagnosis, and these patients should be investigated in detail.

Background: colon cancer is one of the most common cancers all over the world. There are many methods for surgical removal of the cancer as open conventional colectomy and laparoscopic colectomy. The aim of this study is to compare between the two methods to establish the advantages and disadvantages of laparoscopic colectomy in comparison to open colectomy. Methods: Patients were divided into 2 groups according to type of surgical interference. Group 1: included "15 patients" comprised those who had colonic carcinoma with laparoscopic intervention. Group 2: included "15 patients" comprised those who had colonic carcinoma with open surgical intervention. This study included patients with colonic carcinoma were admitted to Zagazig University Hospitals. Patients were collected in the period from December 2016 to December 2018. Results: the results showed that there are no significant differences between laparoscopic colectomy and open colectomy. Laparoscopic colectomy showed advantages over open colectomy in terms of short hospital stay (P=0.02), rapid recovery, early return to work and good oncological outcomes. Conclusion: Laparoscopic colectomy can be performed with good technical efficiency, quick recovery of bowel function, and mild disability, less operative blood loss, less operative trauma and shorter hospital stay. The short-term oncologic results of laparoscopic colectomy seem to be acceptable and comparable with conventional methods. We recommend using Laparoscopic colectomy in colonic carcinoma as a gold standard in our hospital to get the aforementioned advantages.

Background: Midline laparotomies are accompanied by severe postoperative pain that is mainly related to abdominal wall incision. Objective: This study aimed to find if the analgesia provided through rectus sheath catheters can be safe and effective as thoracic epidural analgesia for early postoperative pain relief after midline laparotomies. Patients and Method: 50 patients were randomly allocated into 2 groups: Group TEA (n=25): on wound closure 20 mL of 0.25% bupivacaine + 40 μg fentanyl were injected into epidural catheter. Thereafter, every 6 h, 20 mL 0.125% bupivacaine + 40 μg Fentanyl for 48 h were injected into the catheter. Group RSB (n=25): bilateral rectus sheaths catheters were surgically placed during wound closure. On each side, 20 mL bupivacaine 0.125% + 20 μg fentanyl were injected. Then, every 6 h, 10 mL 0.125% bupivacaine + 20 μg fentanyl were given through each catheter for 48 h. In both groups, IV 1 gm paracetamol/8h was given. If visual analogue scale (VAS) score became ≥ 4. Also, IV fentanyl was given. Results: intraoperative and postoperative fentanyl consumption, time to first analgesia, VAS and sedation levels were comparable between groups. Time for first oral intake was shorter in group TEA. Time for independent ambulation was shorter in group RSB. Post-operative nausea and vomiting (PONV) and pruritus were higher in group TEA. Patients' satisfaction was higher in group RSB. Conclusion: Analgesia through surgically placed rectus sheath catheters is a safe and effective alternative to thoracic epidural analgesia in midline laparotomies. Clinical trials registration number: NCT04262622.