Background: Volume replacement oncoplastic breast techniques have become one of the standard lines in the treatment of early breast cancer. They have better cosmetic outcome and patient satisfaction. Latissimus dorsi (LD) flap is one of the most commonly used flaps for these techniques. Although it shows satisfactory surgical outcomes, postoperative shoulder dysfunction is an obvious drawback. The aim of this study was to compare LD flap with thoracodorsal artery perforator (TDAP) flap after breast-conserving surgery regarding surgical outcomes, patient satisfaction, and impact on shoulder function. Methods: The study included 42 adult female patients with early breast cancer who were eligible for conservative breast surgery and immediate breast reconstruction. Patients were divided into 2 equal groups: group A where patients underwent immediate reconstruction using LD flap and group B where patients underwent reconstruction using TDAP flap. Follow-up was designed for 12 months for early outcome, patient satisfaction, and shoulder functions. Results: The mean age of the included patients in group A and group B was 40.95 ± 5.06 and 40.33± 5.25 years, respectively. There was no significant difference in flap dimensions, postoperative complications, or cosmetic outcome in both groups. However, significantly less shoulder dysfunction was documented in cases of TDAP compared to LD flap at 3, 6, and 12 months postoperatively. Conclusions: TDAP flap is as reliable a technique as LD flap regarding the feasibility, postoperative complications, and the cosmetic outcome with significantly better functional outcome of the shoulder.

Background. Malignant involvement of circumferential resection margin (CRM) and longitudinal resection margin (LRM) after surgical resection of colorectal cancer (CRC) are associated with higher rates of recurrence and development of distant metastasis. This can influence the overall patient’s prognosis. The aim of the current study was to identify pathological factors as predictors for the involvement of resection margins in early T3 CRC.Patients and Methods.Fifty patients radiologically diagnosed to have cT3a/b (CRC) were included in the study. After resection, the pathological examination was performed to identify patients with positive CRM and/or LRM. Relations between the different pathological parameters and the CMR and LRM involvements were assessed.Results. Positive CRM was present in 17 cases (34%), while positive LRM was found in 6 cases (12%). The involvement of both margins was significantly associated with rectal tumors and tumors with infiltrative gross appearance, grade III, deeper invasion, and positive lymph node metastases. Also, there was a significant association between both margins’ positivity and other pathological parameters as signet ring carcinoma, tumor budding, perineural and vascular invasion, high microvessel density (MVD), and sinusoidal vascular pattern, while the presence of necrosis and infiltrative advancing tumor front was significantly associated with CRM involvement only. The depth of tumor invasion and signet ring carcinoma were identified as independent predictor factors for positive CRM and LRM, respectively.Conclusion. Preoperative identification of these pathological parameters can be a guide to tailor the management plan accordingly.

Background: The accuracy of different scores of acute appendicitis (AA) is extremely variable and sometimes unsatisfactory in different ethnic communities. The validity of the RIPSA score among the Eastern Mediterranean population is still questionable. Objective: This study aims at evaluating The RIPASA diagnostic accuracy for AA among Egyptians. Patients and methods: The current prospective study included 123 patients suffering from AA attending the Emergency Surgery Department. All items of the RIPASA score were fulfilled. The diagnostic cut-off score for AA by RIPASA was 7.5. Histopathological assessment for the appendix was done for all included patients and correlated to the RIPASA score. Results: The mean age of the included patients was 31.85 (SD 8.7) years, and 76 (61.8%) of patients were 40 years old. RIPASA score sensitivity for AA was 96.4% while the specificity was 75%. The positive predictive value was 97.27 %, while the negative predictive value was 69.23 %. The diagnostic accuracy was 94.3 %. Conclusion: RIPASA is a reliable and feasible score for AA with high sensitivity, positive predictive value, and diagnostic accuracy.

Arda technique for the treatment of complicated inguinal hernias. Patients and methods The present study included 52 patients who were recruited and operated on for emergency inguinal hernia and repaired by the Desarda technique. The mean operative time and hospital stay were reported together with intraoperative and postoperative complications. Return-to-normal activities and recurrence were also reported throughout the 18-month follow-up. Results The mean age of the eligible patients was 39.6±14.9 years. The mean operative time was 69.5±4.3 min, with a mean hospital stay of 3.7±1.9 days. Seroma and surgical site infection were the most reported complications and presented in six (11.5%) patients. The return to basal, home, and work activities was 1.8±1.31, 6.8±2.1, and 19.7±3.1 days, respectively. There was a statistically significant increase in recurrence throughout the follow-up time, where it was reported in four (7.7%) patients at 18-month follow-up, whereas only one patient (1.9%) reported recurrence after 6 and 12 months. Conclusion According to the current results, Desarda tension-free repair is an easy, feasible, reliable, applicable, and effective technique for the treatment of complicated inguinal hernia, with acceptable rates of postoperative complications and a low recurrence rate....