Papers by Ibrahim ElSayaad
International Journal of Medical Arts (Print), Oct 1, 2021
Background: Cardiac surgery became more common. This led to increased redo-surgeries with expecte... more Background: Cardiac surgery became more common. This led to increased redo-surgeries with expected increase of overall complications after the redo. The used approach could affect overall outcome. However, this is not addressed well in literature. Aim of the work: To examine the overall outcome of patients underwent redo-mitral valve replacement [redo-MVR]. Patients and methods: This study is a retrospective comparative study that was conducted in Cardiothoracic Surgery Department, Al-Hussein University Hospital in the last three years [from January, 1st, 2017 to the end of December 2019]. Collected data included patient demographics, surgical approach and overall short-term outcome. Results: The current study included 37 patients; the mean age was 45.19±9.16 years. The most common indication for redo was pannus formation [48.6%], followed by thrombosis [45.9%]. There was no significant difference between preoperative and postoperative heart rhythm. Redo sternotomy was the commonest, reported in all patients, and femoral bypass done for 3 patients. Trans-atrial approach reported in 24 patients [64.86%] while Trans-septal approach reported in 13 patients [35.14%]. No significant difference between preoperative and postoperative echo data [Ejection Friction, left atrial dimension or left ventricle end diastolic dimension]. However, there was significant reduction of left ventricle end-systolic dimension [LVESD], pulmonary artery systolic pressure [PASP] and pressure gradient [PG] cross mitral valve after operation. Reoperation for bleeding was not reported in any cases, while need for new pacemaker reported in 2 patients [5.41%], new postoperative neurological dysfunction reported in new heart failure or need to dialysis in two patients [5.41%]. The postoperative arrhythmia was reported in 7 patients [18.9%] and mortality was occurred in three patients [10.8%]. Conclusion: The results of the current study showed that, both transseptal and transatrial approaches are comparable and no one is superior to the other.
Al-Azhar Medical Journal, 2018
Background: Cryptorchidism is a common male genital anomaly discovered at birth. Orchiopexy is th... more Background: Cryptorchidism is a common male genital anomaly discovered at birth. Orchiopexy is the sole curative option. However, hormonal treatment has its potential role. The type and regimen of hormonal treatment is widely different. Objective: To evaluate the effect of the use of human chorionic gonadotrophin (hCG) as an adjunctive therapy after orchiopexy. Patients and Methods: The study included 60 boys presented with unilateral palpable undescended testis. Their ages at presentation ranged between 10 months and 6 years. All patients were subjected to history taking, clinical and radiological examination and orchiopexy. Patients were randomized into two equal groups. Randomization was done by a closed envelope that opened 2 weeks postoperatively by a nurse not included in the study. Group A received supportive hCG injection, two weeks after operation by single intramuscular injection weekly for 4 consecutive weeks. The dose was adjusted according to patient weight (< 10kg received 500 IU/week; 10-20 kg received 1000 IU/week and above 20 kg received 1500 IU/week). Group B received orchiopexy without postoperative hormonal support. Results: About 88.4% of studied children were underwent orchiopexy in the first two years of life. Both groups were comparable as regard to pre-intervention hormonal profile, and testicular volume before intervention, while after the intervention, volume significantly increased in group A with good blood supply. Conclusion: hCG postoperative supplementation for children with unilateral palpable undescended testis appears to be beneficial in subsequent outcome as expressed by increase in the size and vascularity of the testis.
Journal of Taibah University Medical Sciences, Aug 1, 2013
Objectives: The aim of this study is to compare between the modified Koyanagi and Snodgrass techn... more Objectives: The aim of this study is to compare between the modified Koyanagi and Snodgrass techniques in the management of proximal types of hypospadias as regards operative time, hospital stay, success rate, postoperative complications and cosmetic results. Methods: Fifty male patients with different types of proximal hypospadias (the urethral meatus is proximal penile, penoscrotal or scrotal) were enrolled in the present study; these patients underwent surgical repair using the tubularized incised plate urethroplastyand Modified Koyanagi repair. They were studied during the period between 2010 and 2012 at Pediatric Surgical Units, Al-Azhar University Hospitals (Cairo & Damietta). All patients were subjected to: detailed history taking, full clinical examination, both general and local. Fifty patients were randomized into two groups; A; (n = 30) patients underwent TIPU; B; (n = 20) patients underwent MK technique. The range of follow up period is 4 to 8 months with a mean of 6 months. Results: Operative time was significantly decreased in group A in comparison to group B (83.30 ± 6.51 vs. 158.25 ± 22.78 min respectively). Duration of hospital stay was significantly shortened in group A in comparison to group B (9.56 ± 1.73 vs. 17.80 ± 2.26 days respectively). The success rate in group A was 70.0% compared to 60.0% in group B. The fistula was more in group A than B and meatal stenosis was more in group A than B, while disruption was equal in both groups. Conclusions: TIP and Modified Koyanagi repair techniques could be considered as acceptable and as effective as each other for hypospadias repair, provided that a good selection of cases for each type of repair was achieved. The tubularized incised plate (TIP) urethroplasty is a reliable one stage procedure in dealing with proximal hypospadias either without or with a mild degree of chordee if the urethral plate is supple and wide enough for tubularization, while MK is a reliable one stage procedure in severe degree of chordee, small sized penis or with narrow urethral plate.
Trends in Medical Research, Mar 1, 2011
International Journal of Medical Arts (Print), Jun 2, 2020
Background: Hypospadias is a congenital condition characterized by tissue hypoplasia of the ventr... more Background: Hypospadias is a congenital condition characterized by tissue hypoplasia of the ventral aspect of the penis, with incidence of one in 300 males (0.3%). There is an increase incidence in those with first-degree relatives having hypospadias to about 13 times more than those without family history. Aim of the work: To compare between the meatal-based flap "Mathieu" technique and tubularized incised plate (TIP) "Snodgrass urethroplasty in treatment of distal hypospadias. Patients and Methods: This study was carried out at the Department of Surgery, Al-Azhar university hospital [Damietta], Egypt., The study consists of forty male children, suffering from distal penile hypospadias. Patients were blindly assigned into two groups;20 patients underwent Mathieu technique and another 20 patients underwent "Snodgrass urethroplasty". Results: Both groups were comparable regarding patient age, consanguinity, maternal drug intake, urethral plate characteristics and duration of hospital study. However, Snodgrass urethroplasty is associated with significant increase of operative time (80.0±16.1 vs 60.0±9.6 minutes), significant lower complication rate (10% vs 30.0%), significantly good cosmetic appearance of the penis (100% excellent versus 40% excellent, 40% good, and 20% torsion of the shaft) and 100% slit like and vertically oriented meatus. Conclusion: Snodgrass and modified Mathieu repair are safe, and the choice of one of the techniques will depend on the surgeon's decision. Its procedure had its own advantages and disadvantages and final decision should be attributed to surgeon preferences.
Hernia, May 25, 2019
Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants... more Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extracorporeal knotting and burying the knot subcutaneously. This may result in many drawbacks. The aim of this multicenter study is to introduce a new technique for pediatric inguinal hernia repair using only needles without any laparoscopic instruments. Patients and methods This is a multicenter study which was conducted at Pediatric Surgical Departments of Al-Azhar, Mansoura, Alexandria and Tanta Universities during the period from January 2015 to June 2017. 314 patients with CIH underwent Needlescopic Assisted Internal Ring Suturing (NAIRS) after cauterization of the hernia sac at its neck. The main outcome measures were: feasibility, safety of the technique, operative time, recurrence rate, hydrocele and cosmetic results. Results A total of 314 patients with CIH were corrected by NAIRS. They were 232 males and 82 females. The mean age was 28.12 ± 1.3 months (range 6-120 months). The mean operative time was 12.6 ± 1.7 min (range 8-15 min) for unilateral cases and 18.6 ± 1.7 min (range 14-20 min) for the bilateral repairs. All cases were completed laparoscopically without major intraoperative complications. No recurrence was detected in this study. No wound complications or umbilical hernias developed. Hydrocele occurred in five males (2.16%), without detection of testicular atrophy or iatrogenic ascent of the testis. Conclusion This preliminary study showed that NAIRS after cauterization of the neck of the hernia sac in infants and children is safe, feasible, reproducible with excellent cosmetic results.
Al-Azhar Medical Journal, 2017
Background: Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Imagi... more Background: Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Imaging methods, such as ultrasonography (US) and computed tomography (CT), aimed at avoiding a misdiagnosis and facilitating earlier surgery, when necessary, have become increasingly important for decreasing the morbidity of the disease. Objective: This study aimed to compare the accuracy of US and CT in the diagnosis of AA. Patients and Methods: After local ethical approval and written consent taken, 107 patients with signs and symptoms suggesting AA, selected from emergency department of Al-Azhar University Hospital, New Damietta during the period from March, 2016 to April 2017. They were 63 males and 44 females, mean age was 17.09±3.02 years. 90 (84.11%) underwent surgery, and 17 patients (15.9%) were hospitalized for clinical observation after imaging (12 patients (11.2%) were dismissed from the hospital while 5 cases (4.7%) presented with positive CT findings underwent surgery). After history taking, full clinical examination and laboratory investigations, all patients were subjected to US and CT examination. All patients were reevaluated clinically, and a correlation was made between both sets of results. Accordingly, final decision was made. Accuracy was ascertained intra-operatively for those underwent appendectomy, and the results were compared with those found by radiological examination. The results were correlated with surgical and histopathologic findings. Results: Males affected more than females, and abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were found to be 91.7 %, 77.8 %, 94.3%, 70.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 98.8 %, 88.9 %, 98.8%, 88.9% and 97.8 % respectively. Conclusion: US should be the first-line imaging modality. As US sensitivity is limited, and non-confirmed US examinations, diagnostic strategies and algorithms should focus on clinical reassessment and CT examination.
Advances in Urology
Background. Proximal hypospadias, with significant curvature, is one of the most challenging anom... more Background. Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett’s procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett’s procedure. Results. No significant difference was identi...
International Journal of Medical Arts, 2021
Background: Cardiac surgery became more common. This led to increased redo-surgeries with expecte... more Background: Cardiac surgery became more common. This led to increased redo-surgeries with expected increase of overall complications after the redo. The used approach could affect overall outcome. However, this is not addressed well in literature. : To examine the overall outcome of patients underwent redo-mitral valve replacement [redo-MVR]. Patients and methods: This study is a retrospective comparative study that was conducted in Cardiothoracic Surgery Department, Al-Hussein University Hospital in the last three years [from January, 1st, 2017 to the end of December 2019]. Collected data included patient demographics, surgical approach and overall short-term outcome. Results: The current study included 37 patients; the mean age was 45.19±9.16 years. The most common indication for redo was pannus formation [48.6%], followed by thrombosis [45.9%]. There was no significant difference between preoperative and postoperative heart rhythm. Redo sternotomy was the commonest, reported in all patients, and femoral bypass done for 3 patients. Trans-atrial approach reported in 24 patients [64.86%] while Trans-septal approach reported in 13 patients [35.14%]. No significant difference between preoperative and postoperative echo data [Ejection Friction, left atrial dimension or left ventricle end diastolic dimension]. However, there was significant reduction of left ventricle end-systolic dimension [LVESD], pulmonary artery systolic pressure [PASP] and pressure gradient [PG] cross mitral valve after operation. Reoperation for bleeding was not reported in any cases, while need for new pacemaker reported in 2 patients [5.41%], new postoperative neurological dysfunction reported in new heart failure or need to dialysis in two patients [5.41%]. The postoperative arrhythmia was reported in 7 patients [18.9%] and mortality was occurred in three patients [10.8%]. The results of the current study showed that, both transseptal and transatrial approaches are comparable and no one is superior to the other.
Background: Laparoscopic Cholecystectomy (LC) provides a safe and effective treatment for most pa... more Background: Laparoscopic Cholecystectomy (LC) provides a safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients and with development of the traditional technique and with seeking of the surgeons and patients to less scaring, the SPLC developed. Objective: comparison between single port and traditional multiple ports LC and explain if single port can be an alternative to multi-port or not. Patients and methods: Forty patients presented to the outpatient clinic during the duration between January 2015 and January 2017. These patients were randomly divided into two equal groups: group (A) was subjected to TLC, and group (B) was subjected to SPLC. All patients were submitted to preoperative assessment (history taking, physical examination, laboratory investigations, imaging studies, cardiopulmonary assessment), abdominal ultrasonography (U/S), magnetic resonance cholangiopancreatography (MRCP) if needed and pre...
International Journal of Medical Arts, 2021
Background: Diagnosis of acute appendicitis depends mainly on clinical diagnosis. However, the hi... more Background: Diagnosis of acute appendicitis depends mainly on clinical diagnosis. However, the high negative rate remains a challenge and different aids for diagnosis had been proposed. The aim of the work: The current work aimed to assess the sensitivity of Modified Alvarado Score [MAS] in diagnosis of acute appendicitis. Patients and Methods: One hundred children with clinical manifestations of acute appendicitis were included. Patients were categorized into two groups according to MAS: [group A] included 50 patients with [MAS] ≥ 7 regardless of sonography results. The second group [group B] included another 50 patients with MAS <7 and abdominal ultrasound study suggestive for appendicitis. Intraoperative diagnosis had been performed for 100 patients with postoperative histopathological study for all cases. Results: Tenderness in right iliac fossa was the most frequent sign in the study population [98%]. Histopathology revealed positive results among 49 patients [47 in group A and 2 in group B] with significant difference between groups A and B. The overall sensitivity and specificity of ultrasonography were 89.4% and 33.3% respectively and were 96.0% and 20.0% respectively of MAS score. Conclusion: In acute appendicitis, MAS is a good diagnostic [sensitive] tool. Sensitivity increased when combined with ultrasound, as the number of negative appendectomies was reduced.
Al-Azhar Assiut Medical Journal, 2017
Background Intussusception is the main reason of intestinal obstruction in pediatrics. Hydrostati... more Background Intussusception is the main reason of intestinal obstruction in pediatrics. Hydrostatic reduction (HR) is the cornerstone in its treatment. However, surgical treatment is indicated in case of failure of HR. Fixation of terminal ileum (ileopexy) has been used to reduce or even prevent recurrence of intussusception, but its outcome has not been well studied. Aim The aim was to investigate the effect of fixation of terminal ileum on recurrence rate after surgical reduction of intussusception in pediatric age group. Patients and methods A total of 80 children scheduled for surgical reduction of intussusception were included and randomly assigned to fixation of terminal ileum (group A; n=40) or no fixation (group B; n=40). All were assessed clinically, and laboratory investigations were done. Patient’s demographics and surgical outcome were documented and compared between both groups. Results Both groups were comparable regarding demographic data, clinical presentation, duration of symptoms before admission, surgical indication, and duration of hospital stay. In addition, the recurrence rate was nonsignificantly reduced in group A when compared with group B (5.0 vs. 15.0%, respectively). In addition, HR was successful in one and failed in the other recurrent case in group A (50.0% of success) compared with only one (16.7%) of six in group B. Conclusion Fixation of terminal ileum during surgical reduction of intussusception is safe, feasible, and simple technique. It results in reduction of the recurrence rate. However, the difference was statistically nonsignificant.
The Egyptian Journal of Hospital Medicine, 2021
Background: The inguinal method is utilized for treating hydrocele in the pediatric populace. Whi... more Background: The inguinal method is utilized for treating hydrocele in the pediatric populace. While, investigations on scrotal orchiopexy have declared herniation or hydrocele repairing via the same scrotal cut as a portion of an orchiopexy operation, there are a few researches investigating the treatments of separated communication hydrocele via a scrotal incision. Objective: To compare between scrotal and inguinal surgery for repair of communicating hydrocele in kids with assessment of surgical period, intraoperative complications, hospitalization, and postoperative complication.
Al-Azhar Medical Journal, 2017
Background: Hemangioma is one of the most common benign infantile vascular tumors. Corticosteroid... more Background: Hemangioma is one of the most common benign infantile vascular tumors. Corticosteroids were used for a long time for treatment. However, it was associated with many complications. Thus, propranolol was introduced and become the first line of treatment. Initially, it was used orally, and then the topical use gained a wide acceptance. However, no study compared the effectiveness and safety profile of topical when compared to systemic propranolol therapy. Objective: Comparison between systemic and topical propranolol in treatment of infantile hemangioma (IHs). The study was carried out at Al-Azhar University Hospitals (Pediatric Surgery Unit) during the period from May 2015 to February 2016. Forty infants with hemangioma were included, and divided into two equal groups: The first group received systemic propranolol therapy; while the second group received topical propranolol therapy. Patients were evaluated before starting the treatment by full history taking and clinical examination. The treatment started in systemic group by 1mg/kg/day divided into three doses; then increased and maintained on 2mg/kg/day till the fifth month, then gradually withdrawn by the end of the sixth month. In topical group, 1mg/kg/day was prepared in an oily base received in daily two divided doses till the end of the sixth month. Outcome was compared between both groups. Results: Topical propranolol therapy was effective as the systemic therapy with low side effects and even better effectiveness. However, the difference was statistically non-significant. In addition, both groups were comparable as regards patient demographics and hemangioma characteristics. Topical propranolol was effective and safe as that or even better than systemic propranolol therapy. However, the small number of the studied subjects prevented the globalization of our results.
Al-Azhar Assiut Medical Journal, 2017
Background Intussusception is the main reason of intestinal obstruction in pediatrics. Hydrostati... more Background Intussusception is the main reason of intestinal obstruction in pediatrics. Hydrostatic reduction (HR) is the cornerstone in its treatment. However, surgical treatment is indicated in case of failure of HR. Fixation of terminal ileum (ileopexy) has been used to reduce or even prevent recurrence of intussusception, but its outcome has not been well studied. Aim The aim was to investigate the effect of fixation of terminal ileum on recurrence rate after surgical reduction of intussusception in pediatric age group. Patients and methods A total of 80 children scheduled for surgical reduction of intussusception were included and randomly assigned to fixation of terminal ileum (group A; n=40) or no fixation (group B; n=40). All were assessed clinically, and laboratory investigations were done. Patient’s demographics and surgical outcome were documented and compared between both groups. Results Both groups were comparable regarding demographic data, clinical presentation, duration of symptoms before admission, surgical indication, and duration of hospital stay. In addition, the recurrence rate was nonsignificantly reduced in group A when compared with group B (5.0 vs. 15.0%, respectively). In addition, HR was successful in one and failed in the other recurrent case in group A (50.0% of success) compared with only one (16.7%) of six in group B. Conclusion Fixation of terminal ileum during surgical reduction of intussusception is safe, feasible, and simple technique. It results in reduction of the recurrence rate. However, the difference was statistically nonsignificant.
Al-Azhar Medical Journal, 2017
Background: Hemangioma is one of the most common benign infantile vascular tumors. Corticosteroid... more Background: Hemangioma is one of the most common benign infantile vascular tumors. Corticosteroids were used for a long time for treatment. However, it was associated with many complications. Thus, propranolol was introduced and become the first line of treatment. Initially, it was used orally, and then the topical use gained a wide acceptance. However, no study compared the effectiveness and safety profile of topical when compared to systemic propranolol therapy. Objective: Comparison between systemic and topical propranolol in treatment of infantile hemangioma (IHs). Patients and Methods: The study was carried out at Al-Azhar University Hospitals (Pediatric Surgery Unit) during the period from May 2015 to February 2016. Forty infants with hemangioma were included, and divided into two equal groups: The first group received systemic propranolol therapy; while the second group received topical propranolol therapy. Patients were evaluated before starting the treatment by full history taking and clinical examination. The treatment started in systemic group by 1mg/kg/day divided into three doses; then increased and maintained on 2mg/kg/day till the fifth month, then gradually withdrawn by the end of the sixth month. In topical group, 1mg/kg/day was prepared in an oily base received in daily two divided doses till the end of the sixth month. Outcome was compared between both groups. Results: Topical propranolol therapy was effective as the systemic therapy with low side effects and even better effectiveness. However, the difference was statistically non-significant. In addition, both groups were comparable as regards patient demographics and hemangioma characteristics. Conclusion: Topical propranolol was effective and safe as that or even better than systemic propranolol therapy. However, the small number of the studied subjects prevented the globalization of our results.
Hernia, 2019
Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants... more Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extracorporeal knotting and burying the knot subcutaneously. This may result in many drawbacks. The aim of this multicenter study is to introduce a new technique for pediatric inguinal hernia repair using only needles without any laparoscopic instruments. Patients and methods This is a multicenter study which was conducted at Pediatric Surgical Departments of Al-Azhar, Mansoura, Alexandria and Tanta Universities during the period from January 2015 to June 2017. 314 patients with CIH underwent Needlescopic Assisted Internal Ring Suturing (NAIRS) after cauterization of the hernia sac at its neck. The main outcome measures were: feasibility, safety of the technique, operative time, recurrence rate, hydrocele and cosmetic results. Results A total of 314 patients with CIH were corrected by NAIRS. They were 232 males and 82 females. The mean age was 28.12 ± 1.3 months (range 6-120 months). The mean operative time was 12.6 ± 1.7 min (range 8-15 min) for unilateral cases and 18.6 ± 1.7 min (range 14-20 min) for the bilateral repairs. All cases were completed laparoscopically without major intraoperative complications. No recurrence was detected in this study. No wound complications or umbilical hernias developed. Hydrocele occurred in five males (2.16%), without detection of testicular atrophy or iatrogenic ascent of the testis. Conclusion This preliminary study showed that NAIRS after cauterization of the neck of the hernia sac in infants and children is safe, feasible, reproducible with excellent cosmetic results.
Hernia, 2019
Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants... more Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extracorporeal knotting and burying the knot subcutaneously. This may result in many drawbacks. The aim of this multicenter study is to introduce a new technique for pediatric inguinal hernia repair using only needles without any laparoscopic instruments. Patients and methods This is a multicenter study which was conducted at Pediatric Surgical Departments of Al-Azhar, Mansoura, Alexandria and Tanta Universities during the period from January 2015 to June 2017. 314 patients with CIH underwent Needlescopic Assisted Internal Ring Suturing (NAIRS) after cauterization of the hernia sac at its neck. The main outcome measures were: feasibility, safety of the technique, operative time, recurrence rate, hydrocele and cosmetic results. Results A total of 314 patients with CIH were corrected by NAIRS. They were 232 males and 82 females. The mean age was 28.12 ± 1.3 months (range 6-120 months). The mean operative time was 12.6 ± 1.7 min (range 8-15 min) for unilateral cases and 18.6 ± 1.7 min (range 14-20 min) for the bilateral repairs. All cases were completed laparoscopically without major intraoperative complications. No recurrence was detected in this study. No wound complications or umbilical hernias developed. Hydrocele occurred in five males (2.16%), without detection of testicular atrophy or iatrogenic ascent of the testis. Conclusion This preliminary study showed that NAIRS after cauterization of the neck of the hernia sac in infants and children is safe, feasible, reproducible with excellent cosmetic results.
Journal of Pediatric Surgery, 2017
Background: Inguinal hernia repair using a percutaneous internal ring suturing technique is an ef... more Background: Inguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the suture and burying the knot subcutaneously. This approach has several drawbacks. The aim of this study is to present a modified technique for single cannula needlescopic assisted hernia repair in children. Patients and Methods: Three-hundred and fifty-seven patients with 397 indirect inguinal hernias underwent a one port needlescopic assisted inguinal hernia repair. The open internal inguinal ring [IIR] was closed using an 18-gauge epidural needle [EN], a 14-gauge venous access cannula [VAC], and a homemade suture device. Saline was injected extraperitoneally around the IIR for hydrodissection. The main outcome measurements were: feasibility, safety of the technique, operative time, recurrence rate, and cosmetic results. Results: This prospective study was conducted on 357 patients at Al-Azhar, Alexandria, and Mansoura University Hospitals during the period from June 2012 to October 2015. There were 286 males and 71 females. The mean age was 2.6 ± 1.3 years (range = 4 months to 6 years). One-hundred and ninety-eight patients presented with a right-sided inguinal hernia, 119 patients with a left-sided hernia, and 40 patients with bilateral inguinal hernia. The mean operative time was 12.6 ± 1.7 minutes (range = 8-15 minutes) for unilateral cases and 18.6 ± 1.7 minutes (range = 14-20 minutes) for the bilateral repairs. No wound complications or umbilical hernias developed. The mean follow-up period was 18.6 ± 1.2 months (range = 11-36 months). During the follow-up period, no recurrence was detected, and the scars were nearly invisible. Conclusion: This preliminary study shows that a single port needlescopic assisted hernia repair in infants and children is a very promising technique to achieve nearly scarless surgery. The procedure is very safe, rapid, easy to learn, and reproducible.
Journal of Pediatric Surgery, 2015
Background: The desire to reduce incision related morbidity and pain while achieving improve cosm... more Background: The desire to reduce incision related morbidity and pain while achieving improve cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES]. Over the last few years, SIPES is increasingly used for a variety of procedures; single incision laparoscopic hernia repair [SILHR] is perhaps its common applications. Intracorporeal suturing and knot tying during SIPES remain one of the most challenging tasks. The aim of this study is to present a novel technique to avoid excessive purposeless movements during SILHR in children. Patients and Methods: One-hundred and fifty patients with 170 hernial defects were subjected to SILHR during the period from June 2009 to October 2011. Extraperitoneal saline was injected around internal inguinal ring [IIR] in males. The opened IIR was closed by percutaneous insertion of purse string suture using Reverdin Needle (RN) with intracorporeal suture tie. The main outcome measurements were; feasibility of the technique, tightness of the suture tie, operative time, postoperative hydrocele formation, recurrence rate, and cosmetic results. Results: Ages ranged between 6 months and 7 years (mean 2±24.2 years). They were 101 males and 49 females. Eighty-four patients presented with right sided inguinal hernia, 46 patients with left sided hernia, and 20 patients with bilateral hernia. The mean operative time was 12.4±1.7 minutes for unilateral cases and 18.6±1.7 minutes for the bilateral cases. On follow-up, there was only 1 case of recurrence and 3 cases of hydrocele and the scar is nearly invisible. Conclusion: The preliminary results of this study showed that our technique is very promising to achieve secure closure of IIR and reduced operative time with excellent cosmetic results.
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Papers by Ibrahim ElSayaad