Day 1 :
Keynote Forum
Ahmed Moustafa Kamel Zaid Nawar
Benha University Hospital, Egypt
Keynote: Outcome of pedicled thoracodorsal artery perforator flap in the surgical treatment of stage II and III hidradenitis suppurativa of axilla
Time : 10:00-10:45
Biography:
Ahmed Moustafa Kamel Zaid Nawar is a Professor in General Surgery and Surgical Oncology at Faculty of Medicine, Benha University. He is also a Consultant of General Surgery and Surgical Oncology at Benha University Hospital, Egypt.
Abstract:
Background & Aim: Hidradenitis Suppurativa (HS) is a chronic, inflammatory disease affecting the apocrine glands of the axillary, groin and mammary regions with significant physical and psychosocial sequela. Surgical excision of the affected tissue is the criterion standard treatment. Advanced cases of axillary HS are associated with high rates of recurrence and require extensive surgical resection with challenging reconstruction associated with risk of postoperative complications. The most effective method for reconstruction of the axilla after excision of HS is yet to be identified. The aim of the study was to evaluate the results of the use of pedicled Thoraco Dorsal Artery Perforator (TDAP) flap as a method of reconstruction for axillary effect result from wide surgical excision as a line of treatment for stage II and III HS of the axilla.
Method: The study included 20 patients with stage II and III (Hurley Staging system) HS of the axilla, 18 male and 2 women treated by wide local excision and reconstruction by rotational TDAP flap. At the end of follow-up, outcome is judged by complete remission of disease, comparing preoperative shoulder function (using Constant-Murley shoulder outcome score) and quality of life (using dermatology life quality index) with postoperative results after 1 year, plus durability of reconstruction, donor site morbidity, overall aesthetic outcome and patient's satisfaction.
Result: The mean±SD follow-up period was 30±5.2 months (range=12-60 months). Four patients (20%) were treated for their right side, 8 patients (40%) for their left side and 8 patients (40%) were treated bilaterally, so we perform 28 operations for 20 patients. The treated patients with stage II disease were 16 (57.14%) and with stage III disease were 12 (42.85%). The size of the defects was usually approximately 10×15 cm. By the end of follow-up period, all patient showed complete remission of the disease with improvement in both shoulder function and quality of life, whereas 1 flap (3.57%) was complicated by bleeding treated by reoperation, 2 flaps (7.14%) complicated by wound infection that was treated conservatively, 3 other flaps (10.71%) showed wide scare at insight of the flaps and 1 flap (3.57%) developed hypertrophic scare at donor site of the flap.
Conclusion: Surgical treatment of stage II and III HS of axilla and reconstruction by rotational TDAP flap provides good aesthetic and functional results with 100% success rate in eradicating and complete remission of the disease during follow-up period and accepted complication rate.
Keynote Forum
Neil Lowrie
University of Otago, New Zealand
Keynote: Enhanced recovery after surgery pathways in emergency general surgery: Summary of a systematic review
Time : 10:45-11:30
Biography:
Neil Lowrie is currently the Senior Resident in General Surgery at Southland Hospital and the University of Otago, New Zealand. Following completion of Primary Surgical Fellowships, he has obtained a Master of Surgery degree from the Royal College of Surgeons and Edinburgh University. Having gained experience in trauma surgery at Waikato Hospital in New Zealand, his experience and areas of interest are in trauma and acute care surgery. His Master’s dissertation examines the utility and possible benefits of enhanced recovery protocols following emergency surgery.
Abstract:
Aim: The aim of this review is to assess the strength of the available literature regarding the use of ERAS in ES and to identify areas in which improved outcomes have been reported.
Method: A comprehensive literature search was performed to identify existing published literature in addition to trials and research currently being undertaken. Databases searched included MEDLINE/PubMed; EMBASE and the Cochrane CENTRAL; ANZ Controlled Trials Registry; the Clinical Trials Database; the National Research Register; Current Controlled Trials and the NHS Centre for Reviews and Dissemination database. The four studies selected for inclusion in comparative outcome measurement all detailed assessment of the background details of their patient populations, with no significant differences in demographics being reported. No significant differences were reported in physiological assessment techniques performed on the patient groups. These techniques included: American Society of Anesthesiologists (ASA) grade, presence of major co-morbidity, Injury Severity Score (ISS) and Penetrating Abdominal Trauma Index (PATI) score.
Result: The studies selected three reported LoS data according to mean values with standard deviation figures, while a single study reported only a median figure without ranges. Combined means and standard deviation calculations were performed. Hedges’ g formula was used to calculate effect size allowing for weighting according to the relative size of the sample populations. Effect size was calculated to be 0.89 for the combined LoS data (showing a large size of effect for this outcome). A single variable z-score calculation was then performed using the CC combined mean and standard deviation values as the background population figures. After calculating the background population variance figure the z-score and p-value were calculated for this outcome.
Conclusion: There remains a relative paucity of literature to support the use of ERAS protocols in ES despite their widespread utilization in the elective surgery setting. The current literature uses a variety of non-standardized outcome measures, with only M&M and LoS being consistent throughout the selected papers. Current evidence would support the benefit of reduced LoS, without any negative effect on M&M, for the use of ERAS protocols over conventional care in the ES setting.
Keynote Forum
Ahmed Abdelrahim Shoulah
Banha University, Egypt
Keynote: Reconstruction of soft tissue defects of the heel with free flap
Time : 11:55-12:40
Biography:
Ahmed Abdelrahim Shoulah is a Lecturer in Plastic and Reconstructive Surgery at Benha University, Faculty of Medicine.
Abstract:
Aim: The study aims to present a case series of reconstruction of soft tissue defects of the heel using Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) free flaps with microsurgical techniques.
Method: The study included 25 patients with soft tissue defect of the heel treated in the Department of General Surgery, Banha University Hospital from June 2015 to September 2017. 11 patients were treated by RFFF and 14 by ALT. Postoperatively, patients received antibiotics and the antiplatelet Clopidogrel with avoidance of weight bearing and walking for 8 to 10 weeks. At the end of follow-up, sensation and foot function were assessed in addition to patient satisfaction.
Result: The median follow-up period was 17 months (range: 15-27 months). The causes of defect were trauma (n=14), neuropathic ulcer (n=8) and neoplastic (n=3). The size of the defect ranged from 5×6 cm to 14×24 cm. Four patients (16%) had calcaneal fracture. By the end of follow up period, 21 cases (84%) showed complete success, while 2 flaps (8%) failed; two in each flap type and 2 other flaps (8%) showed partial loss of the edges (ALT flaps). Failure was due to venous congestion (n=1) and ischemia (n=1). 20 patients (80%) were satisfied with the aesthetic appearance and flap sensation.
Conclusion: Reconstruction of large heel defects using the radial forearm and anterolateral thigh free flaps provides good aesthetic and functional results with 80% success rate and no major complications. Flaps failure was due to venous congestion and ischemia.
- General Surgery and its Specialties | Cardiac Surgery | Orthopaedic Surgery | Surgeons and Physicians
Location: Meeting Room
Chair
Neil Lowrie
University of Otago, New Zealand
Session Introduction
Devid Ruru
Brawijaya University, Indonesia
Title: Gastroschisis: Experience in RSSA during the period of 2015-2016: Descriptive study
Time : 12:40-13:10
Biography:
Devid Ruru is a Resident of General Surgery Department at Brawijaya University, Indonesia.
Abstract:
Gastroschisis is among the most common structural birth defects and its cause remains unknown. The phenomenon of increased prevalence has been reported and continues to be a stimulus for epidemiologic evaluation of risk factors, both maternal and environmental. This study seeks to proï¬le infants with gastroschisis admitted to RSSA during the period of January 1st 2015 until December 31st 2016. The design of the study is a descriptive research design with samples of all gastroschisis patients treated at RSSA during the period January 1, 2015 until December 31, 2016 who met the inclusion criteria those patients who undergo therapy to completion. The medical records of samples collected and then do the recording of the variables studied. Results showed patients with gastroschisis occurred in 57% of men, 71% primigravida, 64% of term baby, 79% of low birth weight, average treatment duration of 8 days, the average length of stay of 9 days, the average maternal age 22.3 years, 93% were staged closure, 86% had a combination of antibiotics ampicillin, sulbactam and gentamicin, 93% died of sepsis. The conclusion of this study is gastroschisis patients are predominantly male, young maternal age, primigravida, term baby, have a low birth weight, staged closure performed to almost all patients. The most common antibiotic given was ampicillin sulbactam combined with gentamicin. The mortality rate is 100% with sepsis as the main causes of mortality, mostly cared for less than three days before died and most have a length of survival less than five days. Recommended for women at high risk of doing the ANC to a place with more comprehensive facilities, in addition, it is necessary to do blood cultures in all patients with gastroschisis complicated by sepsis.
- Endocrine Surgery | Vascular Surgery | Cardiothoracic Surgery | Breast Surgery
Location: Meeting Room
Chair
Ahmed Moustafa Kamel Zaid Nawar
Benha University Hospital, Egypt
Session Introduction
Yohko Maki
National Center for Geriatrics and Gerontology, Japan
Title: Care practices for improving social QOL for persons living with dementia
Time : 14:10-14:40
Biography:
Yohko Maki is a researcher at the National Center for Geriatrics and Gerontology (NCGG) and she also currently serves as Chief of Education and Innovation Center at NCGG. Her research is focused on dementia care, dementia rehabilitation, and social participation of persons with dementia to improve social quality of life of persons with dementia and their family members.
Abstract:
Dementia is a life-changing disease, especially for aspects such as relationships with others. As dementia affects independence, maintaining social relationships should be one of the critical issues in dementia care. Thus, for people living with dementia, such support is necessary in order to enhance the quality of their social life within the context of their interpersonal relationships with others, especially family members. Persons with dementia and their family members are inevitably faced with various challenges in their daily life. As the most causative disease of dementia is progressive in nature, living with dementia is a continuous process of coping with such challenges. If they fail to cope with these difficulties in daily living well, their caregiving burdens will increase. Thus, it is necessary to provide them with support to help them manage such challenges, but the most important thing is to ensure that persons with dementia themselves maintain the will to make their lives more meaningful and enjoyable under such circumstances while receiving support and assistance from others. Discussions related to dementia care tend to focus on how to provide care for persons with dementia, but they are not mere care-recipients, and they should be able to decide how to live autonomously. Even in the advanced stages, persons with dementia are capable enough to maintain the will to live well with dementia. If persons with dementia and their family members succeed in feeling and expressing thankfulness for their current relationships, they may find meaning in living with dementia.
Wahyu Purnama Putra
Brawijaya University, Indonesia
Title: Penetrating brain injury: A case report
Time : 14:40-15:10
Biography:
Wahyu Purnama Putra is a General Surgery Resident at Saiful Anwar Malang Hospital. He was trained and registered as a General Practitioner from Brawijaya University in 2014. He currently is the Director of Hayunanto Medical Center Hospital in Malang, Indonesia. His experiences included following training in ATLS, advance surgery skill and other courses in the field of emergency medicine and traumatology.
Abstract:
Background: Penetrating traumatic injury remains one of the most devastating and lethal forms of trauma. Prognosis is generally poor and, for those who survive long enough to make it to the hospital, the management of penetrating brain Injury presents complex challenges to medical and surgical providers in the civilian sector. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high; up to 98.5%. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improves the prognosis and final outcome.
Case Description: A male of 40-year-old came up with low level of unconsciousness after traffic accident bus versus truck with iron penetration in the right eye to left head. Patient with spontaneous and symmetrical breathing, unstable hemodynamic with GCS 123, isochoric pupils and positive light reflex in the left eye, corneal reflex (-/+), local status of this patient is penetration of iron in right orbital region to left parietal, length: 30 cm and diameter 3 cm.
Conclusion: We choose trepanation decompression evacuation because in general, the results of trepanation in this case are excellent and show good progress from clinical pattern.
Discussion: Early recognition and management penetrating brain injury is essential to ensure an optimal outcome. According to the literature, the majority of PBI results from attempted suicides, assaults and accidents. Evaluate corpal, size and mechanism of injury is a key to early diagnose for the patient. During operation, care must be taken not to produce any rocking movement which may be transmitted to the tip of the instrument and removal should retrace the original trajectory of the corpal. The fundamental principles of surgical management include the prevention of early or late infection, thorough debridement of necrotic tissue and hematoma, removal of all accessible bone fragments and foreign body and meticulous closure to prevent cerebrospinal fluid fistula. Operative delay for greater than 48 hours from the time of injury dramatically increases the incidence of infection from 4.6 to 36.5%. The current case is illustrative of the importance of early surgical exploration to avoid delayed infectious, vascular and epileptic complications. The two most common complications of these injuries are infection and secondary hemorrhage.
Erica Dean
Shoalhaven District Memorial Hospital, Australia
Title: Loop and drain technique for ischiorectal abscess: A novel technique for operative management in an adult male
Time : 15:10-15:40
Biography:
Erica Dean is an Australian General Surgical Trainee at Shoalhaven District Memorial Hospital, Australia.
Abstract:
Ischiorectal abscess represents less than 15% of all anorectal disease and affects men three times more than women, possibly owing to the immunosuppressive effects of male sex steroids. It is traditionally treated by incision and drainage. We present the case of a 40-year-old man with a severe ischiorectal abscess, which we treated using a novel surgical technique. He presented with a one-week history of severe perianal pain, fever and tachycardia. On examination, his perineum was diffusely oedematous, erythematous and tender to palpate. He was a heavy smoker, however otherwise fit and well with no history of diabetes mellitus or other immunosuppression, computed tomography scan of the pelvis demonstrated infralevator horseshoe abscess with gas locules. He underwent emergency operation. Incisions were made bilaterally over both arms of the abscess (modified Hanley procedure) a corrugated drain was passed to bridge the horseshoe and a silicon vessel loop seton was placed through the associated fistula-in-ano at the 7 O’ clock position. He was taken back to theatre on day 7 for repeat washout and removal of the drain. At the second operation, two stab incisions were made adjacent to the original incisions through which two silicon vessel loop drains were passed and secured with silk. He had minimal postoperative pain and was discharged home on the third day. The vessel loops were painlessly removed, two at a time at 2 and 6 weeks. At the time of writing there was no recurrence. The Loop and Drain Technique (LDT) was first described in Australia by Gaszynskia, et al. as a safe and effective treatment for subcutaneous abscess. Today it is used around the world and in our hospital is a routine surgical treatment of subcutaneous perianal and pilonidal abscesses, as well as deeply contaminated lacerations. Our case demonstrates that LDT is a safe surgical technique for the treatment of ischiorectal abscess, which should be performed in an operating theatre where optimal lighting, positioning and washout can be achieved. It offers increased comfort and convenience for the patient, negating the need for repeat packing.
- Opthalmic Surgery | Oral and Maxillofacial Sugery | Transplantation Surgery | Gynecological Surgery
Location: Meeting Room
Chair
Ahmed Abdelrahim Shoulah,
Banha University, Egypt
Session Introduction
Novia Nastiti
Semmelweis University, Indonesia
Title: Femoral hernia with incarcerated Meckel's diverticulum using wedge resection technique
Time : 16:05-16:35
Biography:
Novia Nastiti has completed her primary medical qualification at Semmelweis University in Budapest, Hungary. She has completed her Master of Science in Medicine as well as her MD on the importance of the sentinel lymph node biopsy with a particular focus on breast surgery. She is currently an FY2 trainee in the NHS.
Abstract:
Introduction: Littre hernia is defined as a hernia in which hernia sac contains Meckel’s diverticulum. It presented with an irreducible mass in right femoral site diagnose preoperatively as an incarcerated femoral hernia.
Case Study: This case study of a femoral hernia with incarcerated Meckel’s diverticulum happened to 30-year-old male. Case which has been carried us, through tough explaining in critical care condition. The diverticulum was resected using wedge resection technique. Meckel’s diverticulum is an intestinal diverticulum which arises due to the failure of omphalomesenteric duct obliteration in the fifth week of fetal development. The incidence of this disorder is between 2-3% and is the most common congenital anomaly in the gastrointestinal tract. Management of liter hernias must be done surgically. Littre hernia with incarcerated Meckel’s diverticulum in femoral hernia. In this case, the treatment was wedge resection surgery followed by repair of the femoral hernia defect.
Kristoff Armand E Tan
Chong Hua Hospital, Philippines
Title: The predictive value of the hernia score and other preoperative variables associated with ventral incisional hernia: A retrospective observational study
Time : 16:35-17:05
Biography:
Kristoff Armand E Tan is a young Vascular Surgical Registrar in Australia with an interest in infrainguinal bypass surgery, surgical education and training.
Abstract:
Aim: To determine the predictive value of the hernia score in an external dataset and identify other factors associated with the development of VIH (Ventral Incisional Hernia).
Method: This is a retrospective observational study of patients who underwent an abdominal surgery for gastrointestinal malignancy in a tertiary care hospital from 2013-2017. The overall accuracy and predictive value of the hernia score was computed. To increase predictive value, other preoperative and intraoperative variables associated with the development of VIH were identified.
Result: A total of 447 patients were included in this study and 73 (16.3%) of these patients were diagnosed radiographically to have VIH following an abdominal surgery. The hernia score was found to have an overall accuracy of 48.16% and a positive predictive value of 36.6%. Three other perioperative variables, smoking, (odds ratio-13.43), diabetes mellitus (odds ratio-15.86), previous surgery (odds ratio-9.74) were found to be predictive for the occurrence of VIH.
Conclusion: The overall accuracy of the hernia score in predicting VIH in patients who underwent an abdominal operation for gastrointestinal carcinoma is poor smoking, diabetes mellitus and previous surgery are significant predictors for developing VIH and may be included increase predictive value of the hernia score.
Shenglong Ding
Qingpu Branch of Zhongshan Hospital, China
Title: Modified Internal fixator for anterior pelvic ring fractures versus conventional two-screw fixation
Time : 17:05-17:35
Biography:
Shenglong Ding, a graduate student in orthopedics at Shanghai Medical College, Fudan University, has his expertise in Intervertebral disc degeneration and biomaterials field. He has published articles entitled Salt-assisted toughening of protein hydrogel with controlled degradation for bone regeneration and " Bombyx mori Silk Based Materials with Implication in Skin Repair: Sericin versus Regenerated Silk Fibroin in the field of materials.
Abstract:
Aim: The present study aims to evaluate the short-term clinical effects and complications of modified three-screw fixation and conventional two-screw fixation for treating anterior pelvic ring fractures.
Methods: A retrospective study of 51 patients with type B fractures was performed. 25 patients (modified group) were treated with modified three-screw fixation and the other 26 patients (conventional group) with conventional two-screw fixation. Outcome measures included operation time, intraoperative blood loss, hospital stays, postoperative complications and the Majeed score at postoperatively 2 months, 3 months, 1 year and the time of implant removal.
Results: The mean operative times and mean blood loss for modified three-screw fixation versus conventional two-screw fixation bilateral were 54.8±10.7 min versus 32.3±9.9 min, and 153.3 mL versus 550.0 mL(p<0.001), respectively. However, the Majeed score was better in modified group at postoperatively 2 months (75.6±9.5 vs 69.7±8.3, P=0.008) and 3 months (80.3±10.7 vs. 75.1±11.9, P=0.014). No statistical difference between two groups at the time of implant removal (82.1±9.3 vs 80.9±8.8, P=0.272) and postoperatively 1 year (83.5±7.8 vs 82.6±8.2, P=0.723). No patients experienced surgical wound infection, deep vein thrombosis, delayed union or nonunion, implant loosening or rupture. 1 patient complained of tardive unilateral thigh pain at postoperatively 4 months in conventional group.
Conclusions: Both modified three-screw fixation and conventional two-screw fixation could ultimately afford satisfactory clinical and radiological outcomes with less complication for anterior pelvic ring fractures. The modified three-screw fixation might have better biomechanical strength and faster pelvic rehabilitation.