Hepatic artery (HA) reconstruction is a crucial step in living donor liver transplantation (LDLT). However, many important aspects specific to this challenging step are still inadequately documented. From August 2001 through March 2007, we performed a total of 133 cases of LDLT at Dar El-Fouad Hospital. The magnifying loupe was used for performing microanastomoses in the first 31 cases, and the operating microscope was used for 98 cases. There were 128 adult and five pediatric patients. One hundred twenty-five patients received right lobe grafts, and seven patients received left lobe grafts. One patient died intraoperatively and was excluded from analysis. Arterial complications occurred in four patients of the first group (4/30, 13%) in the form of early thrombosis. One patient underwent successful interventional thromboembolectomy, two patients underwent surgical reexploration with revision of anastomoses; these three patients survived. The fourth patient died from fulminant liver failure. Regarding the second group, all arterial anastomoses were patent after reconstruction. Signal problems occurred in the form of intraoperative intermittent flow and postoperative no diastole phenomenon. Our overall arterial complication rate was 4.5%; however, we lost only one patient due to HA thrombosis (0.8%). Microsurgical reconstruction of the HA carries its own challenges. The use of operating microscope reduces the risk of complications, and aggressive interference including salvage surgery maximizes the success of HA reconstruction.

Objectives: In middle hepatic vein dominant livers, the anterior segment of the right lobe of the liver (segments V and VIII) drains mainly into the middle hepatic vein. In these donors, when right lobe grafts are procured without the middle hepatic vein, the graft may harbor large segment V and/or VIII veins that need reconstruction to avoid graft congestion and subsequent graft dysfunction. Draining these middle hepatic vein tributaries using autologous or cryopreserved vessels is a solution, despite the possible difficulties of their preparation. However, these vessels are not always available. Our objective was to evaluate the effectiveness and safety of using a synthetic vascular graft. Materials and Methods: Between January 2012 and October 2013, eighteen adult recipients underwent living-donor liver transplant using right lobe grafts without the middle hepatic vein at Dar Al Fouad Hospital, 6th of October City, Egypt. All grafts had a large tributary of the middle hepatic vein. Eight-mm ringed expanded polytetrafluoroethylene vascular grafts were used to drain 15 segment V vein tributaries and 3 segment VIII vein tributaries directly to the inferior vena cava. Follow-up was done using duplex ultrasound to evaluate the patency of the vascular graft and the liver congestion and the liver function tests including liver enzymes. Results:Intraoperative Duplex ultrasound confirmed patency and absent segmental congestion in all 18 recipients. The vascular graft patency was 17/18 at 1 week (94.4%) and 15/18 at 1 month (83.3%). No recipients developed graft infection at 1 month. Conclusions: Synthetic vascular expanded polytetrafluoroethylene grafts could be used effectively and safely in middle hepatic vein tributary reconstruction to overcome the unavailability of autologous or cryopreserved vessel grafts or just to avoid the additional burden of recovering autologous grafts thus simplifying the procedure.

Aim of the study: The aim of the study is to compare between two techniques of mesh placement in uncomplicated ventral hernias, onlay versus sublay,comparing the operative technique,length of operation , the postoperative complications and recurrence.Methods: Thirty patients with a defect size ranging from 3.5 to 15 cm were prospectively randomized into 2 groups: Group A (n = 15) was operated upon using the onlay mesh repair technique and group B (n = 15) was operated upon by means of the sublay mesh repair technique. The operative time, postoperative complications and short-term recurrence were reported.Results: In this study, onlay placement of the mesh significantly reduced the operative time (which was longer in the sublay mesh group; P = 0.007). Fewer incidences of seroma formation in the sublay group after drain removal (which was higher in the onlay mesh group) with no statistical significance ( P = 0.7). There were 3 events of Superficial surgical site infection (SSI) in the onlay group compared to only one event in the sublay group. Also one event of retro-rectus haematoma in the sublay group, skin flap necrosis occurred in one case of the onlay group with no statistical significance. Conclusion:Both sublay and onlay mesh placement techniques for ventral hernia repairs in low-risk adults are safe, efficient and are associated with comparable complications rate. Additional studies are needed to determine the long term benefits of both approaches with respect to mesh infection rates and hernia recurrence rates.

Recentstudies have shown hyperbilirubinaemia to be a useful predictor of appendicular perforation. An elevated Serum Total Bilirubin (STB) that is not explained by liver disease or biliary obstruction can be observed in many patients with acute appendicitis. However there is no confirmatory laboratory marker for the pre-operative diagnosis of acute appendicitis and appendicular perforation. Recently, elevation in serum bilirubin was reported, but the importance of the raised total bilirubin has not been stressed in appendicitis.

To assess the applicability of intraoperative recurrent laryngeal nerve (RLN) identification during thyroidectomy. Recurrent laryngeal nerve injury is one of the most serious complications of surgery in the neck. Numerous studies have demonstrated the utility of intraoperative monitoring of the RLN in adult thyroid surgery to prevent such injury. Patient and methods: It is a prospective study which included 50 patients undergoing thyroidectomy. During surgical excision, intraoperative RLN identification was performed with use of methylene blue. True vocal fold mobility was examined by postoperative flexible laryngoscopy. Results: Intraoperative RLN identification was performed successfully for all patients and we avoided postoperative RLN paresis in all cases. Conclusion: Intraoperative RLN identification with methylene blue can be a useful tool during thyroidectomy and it is a safe and reliable technique.