4^th International Conference and Exhibition on Surgery October 05-07, 2015 Crowne Plaza, Dubai, UAE

Biography:

Kanishka Indraratna is Consultant Anaesthesiologist at Sri Jayewardenepura General Hospital, Sri Lanka. He has also worked as a Consultant Anaesthesiologist in England. His interests are cardiac and neuro anesthesia, critical care and intra operative transoesophageal echocardiography. A review article by him on \"To give or not to give fluid challenges\" was published in Trends in Anesthesia and Critical Care, June 2012.

Abstract:

Biography:

Kanishka Indraratna is Consultant Anaesthesiologist at Sri Jayewardenepura General Hospital, Sri Lanka. He has also worked as a Consultant Anaesthesiologist in England. His interests are cardiac and neuro anesthesia, critical care and intra operative transoesophageal echocardiography. A review article by him on \"To give or not to give fluid challenges\" was published in Trends in Anesthesia and Critical Care, June 2012.

Abstract:

Biography:

Dr Enas Al Alawi Consultant laparoscopic and obesity surgeon Medical degree from the National University of Ireland - Cork - 1996 Fellowship from the Royal College of Surgeons Ireland 2001 Post graduate degree from University Of Wakes 2004 Masters in health care management from the Royal College of Surgeons Ireland 2010 Post graduate diploma from University of Strasbourg France 2015

Abstract:

Endoscopic Gastric botox is a procedure that speeds up weight loss by using botox to temporarily relax the muscles of the stomach. Botox will cause gastric motility to slow down making the person feel full more quickly and for longer than usual, reducing the overall amount of food consumption. Our data of 85 patients between December 2013 and March 2015 shows that this procedure is safe and most successful in obese patients with lower body mass index between 28 and 35.

Biography:

Biography Derick A Mendonca is a British Board Certified Plastic Surgeon, currently Head of the Plastic and Reconstructive Surgery department at Sakra World Hospital, Bangalore. He completed his Specialist Registrar Plastic Surgery training at the prestigious Queen Elizabeth University Hospital, Birmingham, UK. He obtained the MRCS and FRCS (Plastic) qualification from the Royal College of Physicians and Surgeons, Glasgow, and is credentialed with the Certificate of Completion of Training (CCT) in Plastic Surgery. He obtained an advanced fellowship in Craniofacial and Paediatric Plastic Surgery for 1 year at Washington University School of Medicine, St. Louis, USA. He maintains a keen academic interest with over 30 scientific publication prizes and is a frequent speaker at national and international Plastic Surgery conferences. He is particularly proud of two seminal publications: “The Birmingham classification of venous malformations in children”, and “The first biomechanical cadaveric anatomical study on palatal dissection and movement”. He is a reviewer and member of the Cochrane Wounds Group, Oxford and a Craniofacial surgery reviewer for two prestigious Plastic Surgery journals. His area of interest is in complex craniomaxillofacial reconstruction, craniofacial distraction, craniosynostosis (endoscopic & open calvarial remodelling), facial fractures and trauma, cleft lip and palate surgery, paediatric plastic surgery, ear and nose reconstruction, facial palsy reanimation surgery and oculoplastic surgery.

Abstract:

Calvarial vault reconstruction: Technical modifications in an Asian context Derick A Mendonca, Swaroop Gopal and Satish Rudrappa Sakra World Hospital, India Abstract Introduction: Craniosynostosis is a premature fusion of the growing cranial suture resulting in head deformities. Anterior craniosynostosis (metopic/uni/bicoronal) is more common in India, as compared to sagittal suture. Calvarial Vault Reconstruction (CVR) is the standard surgical treatment. The aim of this paper is to investigate and document outcomes of craniosynostosis treatment in a new craniofacial unit in Bangalore, South India. Methods: A prospective study of all craniosynostosis patients treated from Jan 2014 to Jan 2015 was conducted. Pre and post-operative data were collected and analysed. Results: A total of 10 patients were diagnosed with craniosynostosis. Four patients presented late, while 6/10 patients underwent surgery (CVR). The mean age at surgery was 12 months. One patient had isolated metopic, 3 patients had metopic and coronal, 1 patient bicoronal and 1 patient had sagittal synostosis. The mean length of stay in PICU was 1 day. Mean blood loss during surgery was 250 ml. Head circumference increased by 2.5 cm. One patient developed a CSF leak which settled conservatively. Technical variations in an Indian context are presented and discussed. Strategies to create awareness and education of craniosynostosis are offered. Conclusion: Calvarial vault reconstruction can be offered to Indian patients in a safe, reliable and cost effective manner.

Biography:

Muslim Mustaev has completed his medical degree from First Tashkent State Medical Institute, Uzbekistan, and earned his Master of Surgery and PhD degrees from Centre of Surgery, Uzbekistan. He currently works as a Surgical Resident at the Department of General Surgery, Queensland Health, Australia, and has about 30 published works.

Abstract:

A rare case of cytomegalovirus enteritis in an immunocompetent patient Muslim Mustaev, Zainab Naseem and Rasika Hendahewa Caboolture Hospital, Australia Abstract Purpose: Cytomegalovirus (CMV) is predominantly an opportunistic infection in immunocompromised patients. CMV infection, in otherwise immunocompetent individuals, is a rare phenomenon. Amongst CMV’s systemic manifestations, colitis is the most common presentation. CMV enteritis in the immunocompetent is rare and has not been reported in association with small bowel ischemia. Methodology: A 78-year old male presented with diarrhoea and abdominal pain for four days. No immunosuppressive risk factors (HIV, transplant procedures or steroid therapy) were noted. Haematological investigations showed leucocytosis with neutrophilia. Initial CT scan indicated enteritis with thickening of terminal ileum. Diagnostic laparoscopy revealed thickened small bowel which was however viable. Persistent clinical features led to laparotomy, and thickened congested segment of ileum was resected with caecum. Histology showed isolated small bowel ischemia, ulcerative changes with CMV inclusions. Ganciclovir therapy was commenced and the patient had subsequent uneventful recovery. Results: CMV enteritis was the least suspected cause of this presentation. Literature has reported limited number of cases of CMV colitis and its association with enteritis is even rarer. This is perhaps the first case reported where the virus has caused ischemia of the small bowel without evidence of colonic involvement. Even in the elderly patients, small bowel is resilient to ischemic changes because of good blood supply. Isolated ischemic changes sparing colon are unusual and rare especially due to CMV infection. Conclusion: Segmental ileal ischemia caused by CMV in immunocompetent individuals is another facet of this disease. It needs to be investigated further for better understanding to aide timely diagnosis.

Biography:

Abstract:

DWS is hydrocephalus associated with a posterior fossa cyst and dysgenesis of the cerebellum. In USA the incidence of DWS is thought to be between 1 in 25000 – 35000, live births. This is a case of middle aged male patient with large head since birth, which was asymptomatic till 57 yrs of age. After LOC and CT scan he was diagnosed to have DWS. This case was successfully managed with conservative management plan.

Biography:

Dr Gayatri Prakash Tahiliani has worked in the USA for three months in surgical super specialities and prestigious Bombay hospital and Dhirubai Ambani hospital before been practicing as a second year resident in Masters of Surgery at the age of 25 years from MGM Institute of Medical Sciences ,New Bombay ,India .She has published around 5 papers and presentations in reputed journals .

Abstract:

MEDIASTINAL TERATOMA- Quite an Incidentaloma A teratoma is a germ cell tumour derived from pluripotent cells and made up of elements of different types of tissue from one or more of the three germ cell layers. Mature cystic teratomas are rare and account for only about 3 to 12% of the total teratomas. Though benign, they can turn malignant. A surgeon should always remember the significance of diagnosing such teratomas and be vigilant to treat the condition promptly. Any delay can cause worsening of the symptoms of the patient and may be fatal. In this poster an attempt has been made to discuss a case report of a patient with such a lesion and was treated for the same with right lateral thoracotomy with mediastinal mass excision with good outcome of the patient.

Biography:

Robert Caiazzo is professor of Surgery in the Faculty of medicine at the University of Lille II, Lille, France. Member of the department of general and endocrine surgery at Lille University Hospital, he performed bariatric surgery in a dedicated center for the obesity (CIO Lille) part of the largest hospital in north of europe (CHRU – Lille, 4500 beds). Robert Caiazzo also participates to a research group at the University of Lille, INSERM U1190, devoted the clinical development of biotherapies for treating diabetes. U1190 Translational Diabetes Research is a funding member of the LABEX European Genomic Institute for Diabetes (EGID) was classified as “Remarkable” by the CSS5 Inserm in 2014. Pr Caiazzo research is devoted to the surgical treatment of endocrine and metabolic disease and focused on metabolic surgery for type 2 diabetes. Pr Caiazzo has authored or co-authored 25 papers in reputed journals. He is also the principal investigator of several ongoing clinical trials of bariatric surgery in Lille.

Abstract:

The high mortality rate of postoperative leak is a major concern after Laparoscopic Roux en Y Gastric Bypass (LRYGB). We report in this study factors influencing the prognosis of such leaks. Methods: The data of patients after LRYGP has been analyzed from Lille Cohort Obesity Study from 2004 to 2012 for 824 patients. Data from patients initially operated in another centers and secondary transferred in our department for a suspected leak were retrospectively included in the analysis. Results: 36 patients experienced a postoperative leak (4,4%), most in patients operated in the early experience in our institution (6,1% before june 2009, 2,3% after). In the same period, 12 patients were transferred in our institution for treatment of anastomotic leak. Most of leaks were developed from the Gastro entero anastomosis (25/48, 59%), and (42/48, 88%) developed before day 4 post operative (D4PO). Patients with heart rate (HR)<100 bpm D1PO had <1% risk of peritonitis while risk of 50% in case of HR>120 bpm. All early leaks were managed surgically, half of them by full laparoscopic approach (23; 55%); most of late leaks treated by selective nonoperative management (4/6, 67%). No death occured in this study. Hospital stay was 32 ± 30 days, range from 5 to 123 days. Intensive care unit stay was required in 19 cases for multiorgan failure (median= 23 days, range 3-76). Leaks diagnosed and treated after D1PO had higher risk to developed a multiorgan failure (p<0,001). Only a delay of treatment of more than 24 hours for surgery increased the risk of prolonged hospital stay (respectively 18±15 days vs 68 ± 37 days, p<0,001). Hospital stay and ICU stay was correlated to the delay of surgical exploration (>24 hours) when an early leak occurred (both p<0,001, and respectively r=0,67 and r=0,75). Conclusion: The early diagnosis of a leak is essential in the first day after LRYGBP. Easy laparoscopic reexploration for early diagnosis and treatment is an effective option. We assume that a laparoscopic reexamination should be concidered in case of HR>120 bpm in the first day post operative. Selective nonoperative management of leaks should be considered only after D4PO in selected patients.

Biography:

Abstract:

FEES or functional Endoscopic Surgery of sinuses: Better understanding of the pathophysiology of recurrent and chronic sinusitis and the fact that most of the changes are revarsable if proper drainage and ventilation is provided to the sinuses has in more recent years. led to the development of Endoscopic Surgery of the sinuses. This has further been made possible by advances in technology such as development of: 1 . rigid fiber optic Endoscopic which provide better illumination and magnification and permit visualization and structure situated at different angles. 2 . micro surgical instruments. Which permit percise and limited Surgery directed specific sites to remove obstruction to sinuses ostia. Endoscope can pass through a cannula in to the maxillary sinuse to visualize it\'s interoir and take accurate biopsy or deal with certain pathological conditions such as small cysts and polyps.

Biography:

Hashem Shemshadi has completed his B.Sc.,from the USA and M.D from Shiraz Medical School, Iran at the age of 28. He has received his General Surgery Board Certified as second national rank recognition from the Shiraz Medical School, Iran. Subsequently, he completed his 3 years Subspecialty Clinical Fellow in Plastic and Reconstructive Surgery from South Western Medical School, Dallas, USA. At the present, he is serving as an attending Full Professor of Plastic and Reconstructive Surgery at the Rofeida Rehabilitation Hospital, a teaching hospital linked to the University of Social Welfare and Rehabilitation Science in Tehran, Iran.

Abstract:

Patients undergoing any type of nasal surgery may experience degrees of postoperative olfactory dysfunction. We sought to investigate \\\"when\\\" the olfactory function recovers to its preoperative levels. In this cohort design, 40 of 65 esthetic open rhinoplasty candidates with equal gender distribution, who met the inclusion criteria, were assessed for their olfactory function using the Smell Identification Test (SIT) with 40 familiar odors in sniffing bottles. All the patients were evaluated for the SIT scores preoperatively and postoperatively (at week 1, week 6, and month 6). At postoperative week one, 87.5% of the patients had anosmia, and the rest exhibited at least moderate levels of hyposmia. The anosmia, which was the dominant pattern at postoperative week 1, resolved and converted to various levels of hyposmia, so that no one at postoperative week 6 showed any such complaint. At postoperative week six, 85% of the subjects experienced degrees of hyposmia, almost all being mild to moderate. At postoperative six months, the olfactory function had already reverted to the preoperative levels: no anosmia or moderate to severe hyposmia. A repeated ANOVA was indicative of significant differences in the olfactory function at the different time points. According to our post hoc Benfronney, the preoperative scores had a significant difference with those at postoperative week 1, week 6, but not with the ones at month 6. Esthetic open rhinoplasty may be accompanied by some degrees of postoperative olfactory dysfunction. Patients need a time interval of 6 weeks to 6 months to fully recover their baseline olfactory function.

Biography:

MBBS from university of khartoum 2015 and now he is student in master of human anatomy at Elneelin university. Intersted in syrgery and human anatomy.

Abstract:

Acute appendicitis is the most common cause of an acute abdomen in young adult with a life time risk of about 6% (1) and appendectomy is the most frequently performed urgent abdominal operation. The diagnosis of acute appendicitis is essentially clinical however. The most widely used is the Alvarado score also known by the acronym MANTRELS Measure the diagnostic accuracy of Alvarado score as rule in score at cut point of 7 and Assessment of the rule of application of the score in reduction of negative appendectomy This study is designed as descriptive cross sectional and includes 84 patients from Khartoum teaching hospital in July-august 2013. The data is collected using questionnaire but with direct interview with each patient. Datais analysed using SPSS and score is precoded to each patient. Verbal consent from emergency department unit was taken. Negative appendectomy was found in 7.1% of patients , all were Alvarado score below 7. 37% of overall patients had complicated appendix. At cut point 3 of the score no inflamed appendix was found and at cut of point 7 no normal appendix was found. Elevated temperature was found negative in 43.6% of positively inflamed appendix Diagnostic accuracy of Alvarado score is 100% at cut point of 7, because all patients at or above 7 have positive surgical appendicitis. 43% of those with positive appendicitis have no fever. Alvarado score must be applied to decrease negative appendectomy.Alvarado score require revision and modification to include only high sensitive and specific clinical symptoms and signs and also it includes left shift of Neutrophil maturation, which is not routinely done in many laboratories.Health education is required to improve and ensure early detection of appendicitis and decrease the high percentage of complicated appendix.

Biography:

Iam dr hayan besmar ,general and laparoscopic surgeon at PMAH ,fellow of American college of surgeon.fellow of international college of surgery FICS, prior ASSISTANT PROFESSOR college of medicine ,king saud university.

Abstract:

For the last two decades ; The laparoscopic cholecystectomy LC had become a standard procedure for cholecystectomy world wild, Due to smooth post-op recovery , less pain, early return to work in comparison to open cholecystectomy. The incidence of bile duct injury BDI during LC was higher at the “learning curve “ phase ,then droped to almost similar and even less than its rate in open cholecystectomy , The BDI is a serious complication of LC ,lead to prolonged hospitalization ,increase the infectious morbidity ,and need a major surgery for its repair (hepaticojejunostomy) wish has got its own complication as well The average incidence of BDI now a days range between 0.4 to 0.8 % During LC , the maximum care should be undertaken to avoid such complication, My lecture aim to identify the risk factors leading to BDI, and discuss the technical aspects in order to avoid such injury.

Biography:

A-W Meshikhes graduated from the Royal College of Surgeons in Ireland, Dublin in 1984. He did his pre-surgical fellowship training in Manchester, UK before obtaining his fellowship 1989. He is currently working as consultant surgeon and section head, section of general and minimally invasive surgery at King Fahad Specialist Hospital, Dammam, Saudi Arabia. He has many publications in peer-reviewed national and international journals. He is also a memebr of the editorial board of several international journals and regular surgical reviewer to many others.

Abstract:

Animal studies demonstrated that intraperitoneal CO2 insufflation during laparoscopic surgery increases the intraabdominal pressure and may adversely affect the oxygenation of the colon. Bowel ischaemia has been reported after various laparoscopic procedures including cholecystectomy, Nissen funduplication, incisional and inguinal hernia repair. This serious complication can also occur after minimally invasive colorectal procedures. Its occurrence is associated with high mortality rate and hence surgeons should exercise a high index of suspicion and be on the alert for this complication after laparoscopic colorectal resection. However, the question that needs to be answered is whether laparoscopic colorectal surgery is associated with higher incidence of colon ischaemia than open surgery. The following steps have been suggested to minimize its occurrence in laparoscopic procedures: 1) Avoidance of intraoperative and postoperative haemorrhage, dehydration and hypotension; 2) Avoidance of prolonged traction on the bowel during extracorporeal resection and anastomosis and hence intracorporeal resection and anastomosis is recommended; 3) Use of the lowest acceptable intraabdominal pressure as high pressure pneumoperitoneum (more than 15 mmHg) significantly impairs the intestinal tissue oxygen pressure and this may predispose to ischaemia; 4) Intermittent decompression and deflation during prolonged laparoscopic procedures and 5) Special care and precautions are taken in the elderly with cardiovascular disease. Although the incidence of this complication is rare, further studies to either confirm or refute the assumption that this complication is associated with laparoscopic more than open colorectal procedures are needed.

Biography:

Basant Kumar has completed his MS (General Surgery) from King George Medical University, Lucknow, India in 2005 and MCh (Pediatric Surgery) from Sir Padampat Mother & Child Health Institute, SMS Medical College, Jaipur, Rajasthan, India in 2008. He is working as Associate Professor in the Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. He has published more than 30 papers in reputed journals and had been served as Executive Member of State Association of Pediatric Surgeons of India

Abstract:

Gastrointestinal tuberculosis is a major problem in the developing world and has rising trend in developed countries. It is characterized by long-lasting abdominal symptoms, which are usually confused with other conditions, and the diagnosis is usually delayed; mostly diagnosed after its complications. Surgical intervention is usually indicated for the treatment of complications and for obtaining a specimen for histopathological diagnosis. During a 4-year period, we treated 11 cases of abdominal TB in children presented as acute abdomen. Data was collected retrospectively including age, sex, clinical presentations, diagnostic investigations, treatment, outcome, etc., and analyzed. Diagnosis was confirmed on the basis of isolation of acid fast bacilli or pathognomonic histology, or positive PCR/raised ADA level and on classical operative findings. There were 5 female and 6 male patients. The median age of presentation was 12 years. Ten patients were operated while one female patient needed intervention for tissue diagnosis. There was no mortality. Contact history was traced in 5 patients. The most common clinical presentations included fever (11/11), abdominal pain (11/11), and weight loss (10/11). 3 patients operated elsewhere in which 2 patients presented as fecal fistula and one with adhesive bowel obstruction. Two patients were explored but abdominal cavity could not be accessed because of plastered dense bowel adhesions but they responded well with empirical anti-tubercular drugs. The diagnosis of abdominal TB was suspected initially in only 6 patients; the others were not diagnosed until 6-38 days (mean=19 days) after hospitalization. Abdominal tuberculosis has non-specific presentation and no single laboratory investigation is pathognomonic. Diagnosis is often delayed till acute crisis. Surgery is temporary measure in acute crisis and full course of ATT is definitive. An algorithmic approach is needed. Prompt surgical intervention; vigilant postoperative care and early ATT are required for success.

Biography:

Abstract:

A total of twelve (12) rabbits randomly assigned into three groups (I, II, and III) of 4 rabbits each were used. A 6 cm long paralumber skin incision was aseptically performed in groups I and II using xylazine (0.5mg/kg) and ketamine (22mg/kg) as pre-medicant and anesthetic respectively. The incised skins in group I rabbits were apposed with conventional silk suture while the incised skins in the group II rabbits were approximated with CHT. Group III served as a control (no surgery). The hematological and serum biochemistry responses following the use of these sutures were evaluated. Packed cell volume (PCV), red blood cell (RBC) count, total and differential white blood cell (WBC) counts, total protein, albumin and globulin levels were determined using standard methods at pre-surgery (day 0) and on post-operative days 1, 3, 7, 10, 14 and 21 in all the groups. Hematological and serum biochemistry parameters were analyzed using one-way analysis of variance (ANOVA). The means of packed cell volume (PCV) and red blood cells (RBC) in rabbits in groups I, II and III showed no significant variations (P > 0.05) throughout the study. The total white blood cells (WBC) count increased significantly (P < 0.05) in group I compared to groups II and III on post-surgery day 3. The means of differential leucocytes such as the hetrophils, monocytes, eosinophils and basiophils in the three groups (I, II and III) were statistically not significant (p > 0.05) throughout the study. However, at day 3 post-surgery the means of lymphocytes in rabbits in groups I and II increased significantly (p < 0.05) compared with group III, the control. At day 21 post-surgery, the means of lymphocytes in group I and II were statistically not significant (p > 0.05) but they vary significantly higher (p < 0.05) with group III. Total protein, albumin and globulin in the three groups (I, II and III) showed no significant difference (p > 0.05) throughout the study. Cotton Hair Thread elicited insignificant haematological and serum biochemical changes compared to the conventional silk suture material.

Biography:

Abstract:

We present results of the first year of our bowel cancer screening program (BCSP), which was initiated and backed by the Right Honourable Minister for Health, Dr. John Cortes, in Gibraltar in March 2014. The Gibraltar bowel cancer screening program is offered by immunochemical faecal occult blood testing (iFOBt) to the population between 60 and 74 years every 2 years. All FOB positive and double inconclusive patients are invited for a screening colonoscopy. Any patient with positive findings ranging from anal fissure, to haemorrhoids, colon polyps and colo-rectal cancer are referred to the colo-rectal surgery service for treatment and follow-up. All negative colonoscopy patients are referred back to the BCSP, for repeat iFOBt every 2 years. In April 2014, 1980 iFOBt kits were sent out to patients. Compliance was 62% with 1228 kits returned. With a higher sensitivity threshold for the iFOBt, 104 patients tested positive or were double inconclusive (8.46%). All these patients were offered colonoscopy. 56 patients underwent colonoscopy, with a completion rate of 91.1% (51 colonoscopy). Completion was established by CT colonography in 5 patients. 21 patients had polyps (37.5%), 6 had cancer (10.7%). All polyps were adenomatous, and 5 cancers were T1 No Mo, with one cancer T2 N1 Mo. In conclusion, a population based bowel cancer screening program is an excellent pathway for early detection of colorectal cancer and pre-cancerous lesions.

Biography:

Marcella Akemi Haruno de Vilhena is currently pursuing medicine graduation course at the Centro Universitário Serra dos Órgãos (UNIFESO). She/He is a participant of the study group formed by Dr. Flavio Antonio Sa Ribeiro and Camila Toledo Turano

Abstract:

Neuroendocrine (NE) tumours (NETs) of the gastroenteropancreatic system have slow growth and indolent evolution; usually at diagnosis they already present metastasis. It is difficult to quantify the real incidence of NETs whereas there is a difference in the cancer registries; however the estimate is 1 to 7 per 100,000 population per year, representing 0.49% of all cancers. NETs are characterized by the secretion of active peptides, like somatostatin, which may cause physiologic effects, such as carcinoid syndrome. The most common primary sites are small bowel, large bowel and pancreas, but with less frequency other parts of the body are affected. At diagnosis, 65-90% of patients already have synchronic neuroendocrine liver metastases (NELM). Those with metastasis have a 5-year survival 13-54% vs. 75-99% from those who doesn\'t have it. The treatment is controversy, but the ressection surgery of the primary tumour and the liver metastasis is the only potential treatment for cure. However, in case of unresectability of hepatic metastases, the therapeutic approach will be chosen among radio frequency ablation, ases ablation, transarterial embolisation or liver transplantation. Therefore the objective of the present study is to discuss a case report of a NELM including its surgery treatment, showing a comparison with other results.

Biography:

Dr. Adam Hamawy is board certified by the American Board of Plastic Surgery, specializing in both aesthetic and reconstructive procedures. Trained in general surgery at New York Presbyterian Hospital in New York City and in Plastic Surgery at the University of Texas’ Southwestern Medical Center in Dallas. Dr. Hamawy subsequently served in the U.S. Army. A tour of duty in Iraq and several years in Washington at the Madigan Army Medical Center afforded him the opportunity to treat a wide variety of patients. He left the military after achieving the rank of Lieutenant Colonel and currently works in private practice in Princeton, NJ. Dr. Hamawy is currently the Chief of Microsurgery at St. Joseph’s Regional Medical Center. He has authored peer reviewed journal articles and book chapters. He is an editorial reviewer for the Journal of Plastic and Reconstructive Surgery. His clinical interests are migraine reduction surgeries, aesthetic facial restoration and aesthetic breast reconstruction.

Abstract:

There are many variables that must be considered when making decisions for breast reconstruction. Consideration of the patient and oncologic variables is becoming increasingly appreciated when selecting the surgical team and technique as a predictor of good outcomes following mastectomy and reconstruction. This discussion is structured to review the variables that are relevant when deciding upon a particular reconstructive option for a particular patient.

Biography:

Derick A Mendonca is a British Board Certified Plastic Surgeon, currently Head of the Plastic and Reconstructive Surgery department at Sakra World Hospital, Bangalore. He completed his Specialist Registrar Plastic Surgery training at the prestigious Queen Elizabeth University Hospital, Birmingham, UK. He obtained the MRCS and FRCS (Plastic) qualifi cation from the Royal College of Physicians and Surgeons, Glasgow and is credentialed with the Certifi cate of Completion of Training (CCT) in Plastic Surgery. He obtained an advanced fellowship in Craniofacial and Paediatric Plastic Surgery for 1 year at Washington University School of Medicine, St. Louis, USA. He maintains a keen academic interest with over 30 scientifi c publication prizes and is a frequent speaker at national and international Plastic Surgery conferences. He is particularly proud of two seminal publications: “The Birmingham classifi cation of venous malformations in children”, and “The fi rst biomechanical cadaveric anatomical study on palatal dissection and movement”. He is a reviewer and member of the Cochrane Wounds Group, Oxford and a Craniofacial surgery reviewer for two prestigious Plastic Surgery journals. His area of interest is in complex craniomaxillofacial reconstruction, craniofacial distraction, craniosynostosis (endoscopic & open calvarial remodelling), facial fractures and trauma, cleft lip and palate surgery, paediatric plastic surgery, ear and nose reconstruction, facial palsy reanimation surgery and oculoplastic surgery.

Abstract:

Introduction: Craniosynostosis is a premature fusion of the growing cranial suture resulting in head deformities. Anterior craniosynostosis (metopic/uni/bicoronal) is more common in India, as compared to sagittal suture. Calvarial Vault Reconstruction (CVR) is the standard surgical treatment. Th e aim of this paper is to investigate and document outcomes of craniosynostosis treatment in a new craniofacial unit in Bangalore, South India. Methods: A prospective study of all craniosynostosis patients treated from Jan 2014 to Jan 2015 was conducted. Pre and postoperative data were collected and analysed. Results: A total of 10 patients were diagnosed with craniosynostosis. Four patients presented late, while 6/10 patients underwent surgery (CVR). Th e mean age at surgery was 12 months. One patient had isolated metopic, 3 patients had metopic and coronal, 1 patient bicoronal and 1 patient had sagittal synostosis. Th e mean length of stay in PICU was 1 day. Mean blood loss during surgery was 250 ml. Head circumference increased by 2.5 cm. One patient developed a CSF leak which settled conservatively. Technical variations in an Indian context are presented and discussed. Strategies to create awareness and education of craniosynostosis are off ered.

Biography:

Enas Al Alawi is Consultant Laparoscopic and Obesity Surgeon. He obtained his Medical degree from the National University of Ireland - Cork in 1996 and also received Fellowship from the Royal College of Surgeons Ireland in 2001. He obtained Post-graduate degree from University of Wakes in 2004 and Masters in Health Care Management from the Royal College of Surgeons Ireland in 2010. He also received Post-graduate diploma from University of Strasbourg France in 2015.

Abstract:

Endoscopic Gastric botox is a procedure that speeds up weight loss by using botox to temporarily relax the muscles of the stomach. Botox will cause gastric motility to slow down making the person feel full more quickly and for longer than usual, reducing the overall amount of food consumption. Our data of 85 patients between December 2013 and March 2015 shows that this procedure is safe and most successful in obese patients with lower body mass index between 28 and 35.

Biography:

Flavio Antonio de Sa Ribeiro is Headman Surgery Professor of Universidade Fundacao Serra dos Orgaos, Research Headman and Surgeon of Hospital Federal de Bonsucesso/Ministerio da Saude-Governo Federal. He is an entitled member of Colegio Brasileiro de Cirurgioes, Doctorated in Surgery by the Universidade Federal do Rio de Janeiro, Associated Surgery Professor of Universidade Gama Filho.

Abstract:

An increasing number of elderly patients are undergoing ambulatory surgery. We studied 4,184 patients with age above 60 years, outpatient’s surgical procedures in ambulatory surgical center from UERJ (Policlinica Piquet Carneiro), in Rio de Janeiro, in the last fi ve years (January 2010 to January 2015); in the studied group, the elderly patient was 90 years and the median was 72 years. No deaths in this group, neither hospital admittance nor major complication.

Biography:

Rajeev Kumar Singh and K Singh is a consultant surgeon at Burhar Central Hospital, India. His research interests include General surgery, Abdominal surgery.

Abstract:

Background: Acute appendicitis is the most common surgical condition of the acute abdomen. Approximately 7% of the population will have appendicitis in their life time. Th e diagnosis of appendicitis is still based primarily on clinical history & examination. Prompt diagnosis and surgical intervention may reduce the risk and prevent complications. Objectives: To evaluate the efficacy of Modifi ed Alvarado Score and USG abdomen in diagnosis of acute appendicitis as well to reduce the rate of negative appendicectomy. Methods: Patient came to Dept. of Surgery, PCMS, Bhopal during duration of study with acute abdomen. Th e study includes 60 patients between 5-60 yrs of age. Th ey were prospectively evaluated on admission using the modifi ed Alvarado Score to determine whether or not they had acute appendicitis and all equivocal cases were subjected to ultrasonography examination. Th e score was correlated with the operative and histological fi ndings. Results: All 60 patients underwent surgery. Th e sensitivity of the modifi ed Alvarado score was 89.65% and sensitivity of USG was 91.37%, out of 60 cases of acute appendicitis, male were 36 and remaining 24 cases were of female. So it showed sex ratio of 36:24, 3:2 which co relate with literature and old studies. With the use of both MASS and USG as diagnostic tool, out of 60 cases, 57 cases were positive and with the help of histopath it was confi rmed in 58 cases. Conclusion: Th e modifi ed Alvarado scoring system is a good diagnostic indicator for acute appendicitis. It helps in minimizing the rates of negative appendicectomy. It can be used as an adjunct to surgical decision-making along with ultrasonography in doubtful cases. Combining modifi ed Alvarado score and ultrasonography together can work very eff ectively in diagnosing acute appendicitis correctly and in reducing the number of negative appendicectomy

Biography:

Fred Peyerl is a Partner with Boston Strategic Partners, Inc., a dedicated life science and healthcare consulting fi rm. Dr. Peyerl holds a PhD in Virology from Harvard University Medical School, and an MBA from the University of Colorado. Dr. Peyerl has authored over 20 peer-reviewed scientifi c articles, including articles in the fi eld of health economics and outcomes research (HEOR).

Abstract:

Electronic health record (EHR) databases represent an increasingly valuable resource for biomedical researchers seeking to identify best perioperative practices via retrospective analysis of real-world patient data. EHR databases provide a unique source of aggregated point-of-care data covering all aspects of the patient encounter, thus allowing researchers to investigate clinical and administrative outcomes during and subsequent to the surgical visit. In-depth comparative eff ectiveness studies comparing two or more interventions are facilitated by the availability of admission/discharge, diagnosis, procedure, laboratory, medication, and clinical assessment data. In addition, a wealth of patient demographic and facility data allows investigators to stratify patients into relevant risk groups. A range of validated statistical approaches support quantitative comparisons between interventions. Recently, the Boston Strategic Partners team used data from a large de-identifi ed US EHR database to conduct a retrospective comparative eff ectiveness study examining the impact of intravenous fl uid choice on postoperative outcomes in patients undergoing on-pump coronary artery bypass graft (CABG) and/or valve procedures. Outcomes examined included clinical complications such as pneumonia, acute kidney injury, and electrolyte imbalances, as well as key administrative outcomes such as readmissions following surgery. Th is study identified significant diff erences in outcome rates based on intravenousfluid choice. In light of these outcome diff erences, an economic model was subsequently developed to examine the economic implications of fl uid choice (5% albumin plus crystalloids versus crystalloids alone) in this patient population. Th e results of this comparative eff ectiveness study reveal a key application of EHR databases for the identification of best perioperative practices.

Biography:

Robert Caiazzo is professor of Surgery in the Faculty of medicine at the University of Lille II, Lille, France. Member of the department of general and endocrine surgery at Lille University Hospital, he performed bariatric surgery in a dedicated center for the obesity (CIO Lille) part of the largest hospital in north of europe (CHRU – Lille, 4500 beds). Robert Caiazzo also participates to a research group at the University of Lille, INSERM U1190, devoted the clinical development of biotherapies for treating diabetes. U1190 Translational Diabetes Research is a funding member of the LABEX European Genomic Institute for Diabetes (EGID) was classifi ed as “Remarkable” by the CSS5 Inserm in 2014. Pr Caiazzo research is devoted to the surgical treatment of endocrine and metabolic disease and focused on metabolic surgery for type2 diabetes. Pr Caiazzo has authored or co-authored 25 papers in reputed journals. He is also the principal investigator of several ongoing clinical trials of bariatric surgery in Lille

Abstract:

Background: Th e high mortality rate of postoperative leak is a major concern aft er Laparoscopic Roux en Y Gastric Bypass (LRYGB). We report in this study factors infl uencing the prognosis of such leaks. Methods: Th e data of patients aft er LRYGP has been analyzed from Lille Cohort Obesity Study from 2004 to 2012 for 824 patients. Data from patients initially operated in another centers and secondary transferred in our department for a suspected leak were retrospectively included in the analysis. Results: 36 patients experienced a postoperative leak (4,4%), most in patients operated in the early experience in our institution (6,1% before june 2009, 2,3% aft er). In the same period, 12 patients were transferred in our institution for treatment of anastomotic leak. Most of leaks were developed from the Gastro entero anastomosis (25/48, 59%), and (42/48, 88%) developed before day 4 post operative (D4PO). Patients with heart rate (HR)<100 bpm D1PO had <1% risk of peritonitis while risk of 50% in case of HR>120 bpm. All early leaks were managed surgically, half of them by full laparoscopic approach (23; 55%); most of late leaks treated by selective nonoperative management (4/6, 67%). No death occured in this study. Hospital stay was 32 ± 30 days, range from 5 to 123 days. Intensive care unit stay was required in 19 cases for multiorgan failure (median= 23 days, range 3-76). Leaks diagnosed and treated aft er D1PO had higher risk to developed a multiorgan failure (p<0,001). Only a delay oftreatment of more than 24 hours for surgery increased the risk of prolonged hospital stay (respectively 18±15 days vs 68 ± 37days, p<0,001). Hospital stay and ICU stay was correlated to the delay of surgical exploration (>24 hours) when an early leak occurred (both p<0,001, and respectively r=0,67 and r=0,75). Conclusion: Th e early diagnosis of a leak is essential in the fi rst day aft er LRYGBP. Easy laparoscopic reexploration for early diagnosis and treatment is an eff ective option. We assume that a laparoscopic reexamination should be concidered in case ofHR>120 bpm in the fi rst day post operative. Selective nonoperative management of leaks should be considered only aft er D4PO in selected patients.

Biography:

Emilio Trignano has completed his plastic surgery training and PhD from Sapienza University of Rome (Italy). He is a Plastic Surgery Consultant at the University of Sassari, Italy. He has published more than 30 papers in reputed journals.

Abstract:

Background: According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. Th e aim of this study is to assess the degree of microcirculation improvement of foot aft er the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. Patients & Methods: Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suff ering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and aft er tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Th irty-six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve and posterior tibialis nerve. Results: Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mm Hg (29.1±5.4 mmHg). PtcO2 values at one month after surgery (45.8±6.4 mmHg) were signifi cantly higher than the preoperative ones (P=0.01). Conclusions: Th e results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients.

Biography:

Hashem Shemshadi has completed his BSc from USA and MD from Shiraz Medical School, Iran. He has received his General Surgery Board Certifi ed as second national rank recognition from the Shiraz Medical School, Iran. Subsequently, he completed his 3 years Subspecialty Clinical Fellow in Plastic and Reconstructive Surgery from South Western Medical School, Dallas, USA. At present, he is serving as an attending Full Professor of Plastic and Reconstructive Surgery at the Rofeida Rehabilitation Hospital, a teaching hospital linked to the University of Social Welfare and Rehabilitation Science in Tehran, Iran.

Abstract:

Patients undergoing any type of nasal surgery may experience degrees of postoperative olfactory dysfunction. We sought to investigate "when" the olfactory function recovers to its preoperative levels. In this cohort design, 40 of 65 esthetic open rhinoplasty candidates with equal gender distribution, who met the inclusion criteria, were assessed for their olfactory function using the Smell Identifi cation Test (SIT) with 40 familiar odors in sniffi ng bottles. All the patients were evaluated for the SIT scores preoperatively and postoperatively (at week 1, week 6, and month 6). At postoperative week one, 87.5% of the patients had anosmia, and the rest exhibited at least moderate levels of hyposmia. Th e anosmia, which was the dominant pattern at postoperative week 1, resolved and converted to various levels of hyposmia, so that no one at postoperative week 6 showed any such complaint. At postoperative week six, 85% of the subjects experienced degrees of hyposmia, almost all being mild to moderate. At postoperative six months, the olfactory function had already reverted to the preoperative levels: No anosmia or moderate to severe hyposmia. A repeated ANOVA was indicative of signifi cant diff erences in the olfactory function at the diff erent time points. According to our post hoc Benfronney, the preoperative scores had a signifi cant diff erence with those at postoperative week 1, week 6, but not with the ones at month 6. Esthetic open rhinoplasty may be accompanied by some degreesof postoperative olfactory dysfunction. Patients need a time interval of 6 weeks to 6 months to fully recover their baselineolfactory function.

Biography:

Hadeel AlSajjan is currently a medical intern at King Khalid University Hospital, Riyadh, Saudi Arabia. She graduated with a Bachelor of Medicine and Bachelor Surgery (MBBS) with honors in May 2015. She is interested in Plastic and Reconstructive surgery and hopes to become a surgeon, researcher and teacher with the aim of innovating and adding value to the field.

Abstract:

The effect of Islamic rulings concerning plastic surgery on Saudi women’s decision-making and reasons of refusal to undergo cosmetic procedures has been a main concern of the cosmetic surgery field. Th e goal of this study is to identify the association between the religious status of Saudi women and its eff ect on their view of breast cosmetic procedures. Th is study was held in2012, at King Khalid University Hospital (KKUH), located in Riyadh, Saudi Arabia. It is a cross sectional study performed on 612 Saudi muslim women, each of whom fi lled out a questionnaire form. Th e women were classified according to demographic characteristics, educational level and religious commitment. Th e questions were structured in order to assess decision making from a religious point of view. Opinions of Saudi muslim women regarding breast cosmetic procedures were defi nite against breast enhancement, however; they were circumstantial or conditionally approved when it came to breast reduction and mastopexy aft er pregnancy or lactation. For undergoing such procedures, religion, age, educational level, marital status and other predictors defi nitely had a direct impact on the acceptance or refusal of breast plastic surgeries. Th e religious group hadhigh self- esteem, life satisfaction, no depression, low rate of media watching and less likelihood for undergoing breast surgeries as apposed to the non-religious group. To conclude, the nature of the breast cosmetic procedure and reasons behind choosing to undergo one certainly influences Saudi women’s religious view and acceptance of breast cosmetic surgery.

Biography:

Kai-Ping Chang has completed his ENT residency at Linko Medical Center of Chang Gung Memorial Hospital and PhD degree of Clinical Medical Sciences from Chang Gung University. He has been a visiting scholar at Head & Neck Surgery of MD Anderson Cancer Center at Houston, USA. He is now currently the director and professor of Head & Neck Surgery of ENT department of Chang Gung Memorial Hospital. He has published more than 110 papers in the peer-reviewed journals and has been serving as an editorial board member of several reputed journals.

Abstract:

In Taiwan, oral squamous cell carcinoma (OSCC), representing 90% of oral cavity cancers, is rated as the sixth highest cause of cancer deaths in Taiwan, and accounts for 3% of all newly diagnosed cancer cases in which 27% of male OSCC are between 30-50 years old (the 2009 Cancer Registry of Department of Health of Taiwan). Th e overall 5-year survival rate and morbidity for patients with OSCC has not been improved over the past two decades due to lacking suitable markers for early detection. Th e incidence of oral cancer continuously increases and the social and economic impacts on the aff ected populations are huge. In the past few years, head and neck research group collaborated by Chang Gung Memorial Hospital and Chang Gung University has used various basic research platforms including the genomic approach and proteomic approach attempting to search and identify the novel biomarkers and discussing their related mechanisms and pathogenesis for oral cavity squamous cell carcinoma. In this presentation, I’ll share our experience to apply the two basic research platforms, including a multiplexed bead-based platform to simultaneously detect auto-antibodies and comparative secretome profi ling for primary cell cultures derived from OSCC and adjacent noncancerous epithelium, to discover the potential salivary marker for the detection of OSCC. In these works, we have already demonstrated that THBS2 and a combined panel of salivary auto-antibodies could be eff actively useful for OSCC detection.

Biography:

Hayan Besmar is a General and Laparoscopic Surgeon at PMAH and is a Fellow of American College of Surgery and International College of Surgery FICS. Prior, he was Assistant Professor at College of Medicine, King Saud University.

Abstract:

For the last two decades, the laparoscopic cholecystectomy LC had become a standard procedure for cholecystectomy worldwide, due to the smooth post-op recovery, less pain, early return to work in comparison to open cholecystectomy. The incidence of bile duct injury BDI during LC was higher at the “learning curve “phase, then dropped to almost similar and even less than its rate in open cholecystectomy. Th e BDI is a serious complication of LC, lead to prolonged hospitalization, increase the infectious morbidity and need a major surgery for its repair (hepatico jejunostomy) wish has got its own complication as well. Th e average incidence of BDI now-a-days ranges between 0.4 to 0.8%. During LC, the maximum care should be undertakento avoid such complication. My lecture aims to identify the risk factors leading to BDI and discuss the technical aspects in orderto avoid such injury.

Biography:

Mohammed Ghunaim is a Resident in the Deptartment of Surgery Division of Endocrine surgery at University of Lille II School of Medicine, France. His clinical interest includes General surgery, Bariatric surgery, Abdominal surgery.

Abstract:

Introduction: Gastro-gastric fi xation (GGF) during laparoscopic adjustable gastric banding (LAGB) is of great debate while the result of large retrospectives studies showed no increase of slippage rate and easier band removal in case of conversion to another procedure when the band has not been coated, nowadays data are still inadequate to conclude that GGF should be abandoned. Objectives: Th e aim of the study was to show the non-inferiority of LAGB with out GGF. Th e main criteria was the comparison of the reoperation rate at 1 and 3 years. Methods: ANOSEAN study is a controlled prospective randomized single-blind trial (CPP). Seventeen bariatric centers included a total of 706 patients (calculated with power=.8, alpha=.05 and reoperation rate: 24%, delta: 8%). Patients in group 1 received gastric banding with GGF while group 2 with out GGT. Results: Follow-up at 1 year was 89.8%. At baseline, patients were similar regarding sex, age and BMI. GGF increased operative time (43±28 mn vs. 39±25 mn; p<0.001). One early slippage (Day 2) occurred in group 2. At 1 year, reoperation rate in group 1 was 1.5% vs. 4.3% in group 2 (p=0.039). Considering only reoperation for slippage, band removal or repositioning rate was higher in the non-fi xation group at 1 year (2.9% vs. 0%, p=0.002). In multivariate analysis, non-fixation was an independent risk factor of reoperation and slippage (OR:3.2 (95% CI: 1.2-9.1), p<0.001). Conclusion: Preliminary results at 1 year showed that GGF prevents band slippage and reoperation. Benefits of no fixation have to be assessed during band removal and redo surgery to conclude definitely whether surgeon should continue to do GGF.

Biography:

Roberto Bruno is a Faculty at State University of Rio de Janeiro , Brazil. He is the author for many reputed articles. His research interests include General surgery and Otolaryngology.

Abstract:

This work aims to report a rare case of metastatic adenocarcinoma presentation of Ampulla of Vater to the right scapula, as fi rst manifestation of systemic metastatic disease. A 45 year-old male patient was diagnosed with adenocarcinoma of the ampullary region, infi ltrating the duodenal wall, pancreas and peri-pancreatic tissue. Th e patient underwent Whipple surgery (pancreatico duodenectomy) for tumor resection. Th e histopathological study has revealed poorly diff erentiated adenocarcinoma with extensive peri-neural infi ltration, vascular invasion with embolization of tumor cells and regional lymph nodes without neoplastic involvement. Four months aft er surgery for resection of ampullary tumor, the patient had severe pain in the right shoulder, which subsequently evolved with the emergence of a suprascapular lump on the same side. It underwent incisional biopsy that revealed adenocarcinoma on the histo-pathological study. It was chosen for tumor resection surgery. During surgery, a link between tumor and bone tissue of the right scapula was observed, leading to the decision to remove the bone fragment to study. The histo-pathological study defi ned the presence of metastatic adenocarcinoma focally for bone tissue, infi ltrating skin, subcutaneous tissue and adjacent muscle. Subsequently, a bone scintigraphy which revealed a heterogeneous hyper-fi xation of the contrast media in the topography of the right scapula (medial edge) was performed. Unfortunately, aft er these events, the patient developed metastatic systemic dissemination, which led to his death. We conclude that this is a presentation of rare and unusual metastatic disease. In our research, it wasn't found any cases of scapula metastasis from Ampulla of Vater adenocarcinoma.

Biography:

Limael E Rodriguez is a Professor in the Department of surgery St. Luke’s Memorial Hospital-Ponce School of Medicine and Health Sciences, USA. His research interests include General surgery, Otolaryngology

Abstract:

Introduction: In this study, we present our diagnostic and clinical outcomes in patients who were admitted with suspected AC that received diagnostic workup with US ± HIDA. Methods: Between January 2013 to July 2014, 63 patients were admitted through ER with a preliminary diagnosis of AC. All patients received US±HIDA scan aft er admission, and were treated with laparoscopic or open cholecystectomy (all gallbladders were sent to pathology for fi nal diagnosis). Patients with pancreatitis and/or cholangitis (n=3) were excluded from the study. Primary end points included: 1) diagnostic test reliability (i.e. sensitivity, specifi city, etc.) of US and HIDA scan for AC, respectively, and 2) outcome measures (complications, hospital stay, cost eff ectiveness, etc.). Results: Th e mean age at time of fi rst encounter was 48 (15-73) years, with females accounting for 66.7% of the cases. All (100%) of the patients received US at presentation, and 19/60 (31.7%) received US+HIDA. Mean time of admission to HIDA scan was 1.5 (0-4) days. Laparoscopic cholecystectomy was performed in 41/60 (68.3%) and open cholecystectomy in 19/60 (31.7%) of the patients. Of the cases that required an open approach, 11/19 (57.9%) were positive for AC with HIDA scan (p=0.007). Final pathology established acute versus chronic cholecystitis in 28/60 (46.7%) and 32/60 (53.3%) of the patients, respectively. In terms of AC, US had a sensitivity and specifi city of 31% and 83.8%, respectively. HIDA scan had a sensitivity and specifi city of 92.3% and 83.3%, respectively. Admission to surgery time was 3 versus 1.6 days in patients who received US+HIDA versus US alone (p=0.001), and total length of stay (LOS) was 6.4 days versus 3.6 days, respectively (p=0.005). Th e total cost per patient was approximately $4,313 vs. $2,311 for the latter groups, respectively (p=0.004). Conclusion: In our single center review, HIDA scan was superior to US as a diagnostic study, and is indicated when US fi ndings are equivocal and AC cannot be ruled out. Delayed HIDA scanning aft er admission had a signifi cant impact on outcome measures. Th ere was a positive correlation between patients that were diagnosed with acute cholecystitis by HIDA and need foropen cholecystectomy. Early HIDA scan at first encounter in ER may effectively facilitate decision making, and reduce time to surgery, LOS, overall costs, and improve outcomes in the setting of AC.

Biography:

Ahmed Abdel Monem is a consultant surgeon at Alsalama One Day Surgery Center ,Saudi Arabia. His research interests include General and surgery.

Abstract:

Background: Hemorrhoidectomy offers the best chances of permanent cure of symptomatic grades-3 and 4 hemorrhoids. The main drawback of hemorrhoidectomy is the uncomfortable pain in the first postoperative week as this surgical procedure commonly creates three raw areas in the anal region. Performing the procedure that helps in healing these raw areas definitely helps to alleviate postoperative pain and discomfort. Aim: is to evaluate the role of internal sphincterotomy in addition to routine open hemorrhoidectomy. Material and Methods: seven hundreds patients with second, third or fourth degree hemorrhoids, were enrolled in this study divided into two groups. Group I managed by open hemorrhoidectomy and posterior internal sphincterotomy and Group II managed by open hemorrhoidectomy alone without sphincterotomy. Patients were given routine postoperative analgesics and other drugs. Our observation included severity of pain, hospital stay, post-operative complications and return to normal activities. The need of analgesics in the postoperative course was also observed. Results: post-operative pain was significantly improved in Group I than in Group II. Patients in Group I had significant lower rate of post-operative infection and also significant lower No. of doses of pain killer either oral or injectable. There was no significant difference in duration of hospital stay between both groups. Conclusion: Adding internal sphincterotomy along with internal hemorrhoidectomy improved the post-operative pain, also decreased rate of post-operative infection and it was well tolerated by patients.

Biography:

Suzi Demirbag has completed his MD from Gulhane Military Medical School and Post-doctoral studies from same center. He has published more than 36 papers in reputed journals.

Abstract:

Post-operative intra-abdominal adhesions are still one of the most challenging problems of modern surgery and cause chronic pelvic pain, infertility, mechanical bowel obstruction and prolonged reoperation time and increased intraoperative/ postoperative complications. Preventive measures such as avoiding unnecessary trauma to tissues, keeping any foreign body out of the peritoneal cavity, keeping serosal surfaces moisturized, preventing contamination of the peritoneum by intestinal contents and avoiding the application of any kind of irritant solution arequite important to prevent adhesion formation. Despite several precautions, creative efforts and anti-adhesive products, peritoneal adhesions aft er laparotomy have been reported as high as in over 90% of the patients. Peritoneal injury, ischemia and peritoneal infl ammation are the most important causes of postoperative adhesions. Although many methods have been used for the prevention of adhesion formation, no completely satisfactory solution is currently available. Research in adhesion prevention has essentially focused on: (1) mechanical barriers (2) protective polymer solutions and (3) anti-inflammatory and fi brinolytic agents. Barriers used for the prevention of postoperative adhesion formation include both mechanical barriers and viscous solutions. In this presentation we will discuss the postoperative intra abdominal adhesiogenesis and researches in adhesion prevention.

Biography:

Simone Battibugli is an Assistant professor in the Department of cardiothoracic surgery Hospital Santa Marcelina, Brazil. His research interests include General surgery, Cardiovascular surgery, Thoracic surgery.

Abstract:

Introduction: Anterior tibial tendon transfer is a common procedure used to treat a residual forefoot dynamic supination in children with idiopathic clubfoot. Several anterior tibial tendon transfer techniques have been described however; currently there is no general agreement as to the best method of transferred tendon fixation. Th is prospective study of consecutive cases was proposed to assess and compare the results of two techniques pullout or anchor suture fi xation. Methods: Between 2001 and 2009, 78 relapsed clubfoot deformities were initially treated by one of the authors (AFL) with repeating serial casting (Ponseti's method). From those, 25 patients (34 feet) with exclusive residual dynamic forefoot supination were selected and underwent to anterior tibial tendon transfer. Patients were allocated consecutively in two groups discriminating the method of transferred tendon fi xation, as follows: Group I (anchor) which enrolled 13 patients (18 feet) average age 5.1 years (4.2–5.6 years) and Group II (pull-out) which enrolled 12 patients (16 feet) average age 5.54 years (4.3–7.2 years). Surgical procedure was performed similarly to all patients (n=25) by the same author (ALF) using the modifi ed Ponseti and Smoley technique with two dorsal foot incisions; over the anterior tibialis tendon and the other over the third cuneiform. Th e tendon was passed subcutaneously and secured in the third cuneiform. Th e pull-out fi xation involved passing the tendon through a drill hole to the bone with attachment of the tendon fi xation suture on the plantar aspect of the foot which was tensioned while the foot was dorsi-fl exed. Th e anchor fixation technique utilized a metallic suture anchor that was fi xed to the dorsal aspect of third cuneiform in the usual described fashion. Average follow-up Group I was 2.98 years (2–5.2). Group II was 2.37 years (1.2–4.2). Results: Average surgery duration was similar between the two groups; Group I average 32 minutes (24–42). Group II 28 minutes (23–37). Th e clinical results was based on the restoration of muscle balance and correction of dynamic forefoot supination as follows; Group I, there were 15 good (83.4%), 03 regular (16.6%) and no poor results. In group II, there were 14 good (87.5%), 02 regular (12.5%) and no poor results. Th e groups had statistically similar results (p=0.732). No patient in either group had subsequent relapse, failed fixation of the tendon transferred or required additional operative intervention associated with clubfoot deformity during the follow-up period. No major complications were found in both groups. Group I, one patient developed fi brous adhesion dorsal skin, which haven’t required any subsequent intervention. Group II, one patient developed a plantar pressure sore, which improved and healed aft er removing the plantar plastic button. Average procedure cost; anchor fixation U$ 1,400 and pull-out U$ 600. Conclusions: Our study results show that the amount of correction obtained and complications rate were similar between the two methods of fixation (anterior tibial tendon transfer) being the pool-out technique less expensive compared with anchor fixation.

Biography:

DWS is hydrocephalus associated with a posterior fossa cyst and dysgenesis of the cerebellum. In USA the incidence of DWS is thought to be between 1 in 25000 – 35000, live births. Th is is a case of middle aged male patient with large head since birth, which was asymptomatic till 57 yrs of age. Aft er LOC and CT scan he was diagnosed to have DWS. Th is case was successfully managed with conservative management plan.

Abstract:

Biography:

Muhammad Ishaq is the fellow of College of physicians and surgeons of Pakistan, Royal College of Surgeons of Ireland, Royal College of Physicians & surgeons of Glasgow and Royal college of Surgeons of England. He is the examiner to the Royal College of Surgeons in UK. Moreover, he is the Founder Chairman of Jinnah Medical College Peshawar Pakistan. He is a general Surgeon and Head of the Department of surgery of DHQ Hospital and Naseerullah Khan Baber Memorial Hospital. He is also the founder Chairman of Ghulam Yousaf Education System (Pvt. Ltd.) which promotes medical education and allied education in the province in collaboration with the Khyber Medical University and University of Peshawar, Government of Khyberpukhtunkhwa Pakistan. He is also the chairman of Jinnah institute of paramedical sciences and Fatimah Jinnah institute of public health under the auspices of Pakistan nursing council. He is a busy surgeon and has more than 20 publications to his credit in the reputed Journals of the country.

Abstract:

Transuretheral urethrotomy under vision with the Sachse urethrotome is a relatively new surgical procedure for the treatment of urethral strictures. Th e main advantage of the urethrotome is the fact that the surgeon can cut strictures selectively and accurately under clear vision. the procedure is less painful than blind internal urethrotomy. We report on 105 cases with at least 12 months of follow up. In 47(45%) cases the strictures were in membranous and prostatic urethra, in 39(37%) in bulbar urethra and in 19(18%) in penile urethra. the results were considered good in 79(75%) improved in 21(20%) and a failure in 5(5%). Th e-Technique for urethral strictures in described and postoperative treatment is emphasized and discussed. We have found this technique a further improvement in the management of urethral strictures.

Biography:

Ziad Al-Naieb has completed his MB ChB at the age of 24 years from College of medicine at University of Baghdad and postdoctoral studies from Johannes Gutenberg, Mainz Germany MD at urology clinic and Poly-Clinic Mainz Germany and Finished his PhD at the university of Mainz Germany and then completed his Fellowship of the Royal college of Physicians and Surgeons of Glasgow, United Kingdom. He became Full Professor in urology in 1994. Currently, he is the Vice Dean for clinical affairs and Chairman of Surgery at the Arabian Gulf University since 2008 director of Urology Clinics at King Abdulla medical Center and Consultant urologist at Royal Bahrain and Bahrain Specialist Hospital in the Kingdom of Bahrain. He has published more than 33 papers in reputed journals and serving as an editorial board in many national and international medical journals including our reputed journal. His main researches are directed to Stem cell therapy in urology,early detection of Bladder malignancies and photo dynamic therapy of Bladder Cancers.

Abstract:

Background: Th e early detection of carcinoma is very essential for the diagnosis and prognosis of a bladder cancer patient. 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy is a well-documented fact. Th e goal of our study is to assess the infl uence of fl uorescence cystoscopy using 5-AlA as a natural amino acid oral powder with the conventional delta-aminolevulinic acid (ALA) or its derivative, hexaminolevulinate (HAL, Hexvix), installation. Th e oral form of 5- ALA in clearance of other urological malignancies was evaluated. Th e possible apoptotic activities of this substance in the treatment of bladder cancer as a new option and the benefi t of oral form in detecting other urological malignancies during surgery will be outlined. Methods and results: In retrospective and prospective study, 74 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. In 15 patients (group A) the oral form of 5-ALA (5-Aminolevulinic acid (SBI-Pharma-Japan). 20 patients (Group B), we used hexaminolevulinate (HAL, Hexvix). Th irty nine patients (Group C) were taken from records as the medic Germany is not producing the 5 ALA Delta from for intravesical installation any more. Th e patients were followed using standard cystoscopy and urinary cytology. In both groups, white light and blue light were used for comparison. Th e white light DATA was categorized as C I and blue light (visible blue light with wavelength of 420 nm) as C II, Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumours separately. Th e median time to recurrence was 8.05 months in group A and was signifi cantly shorter than 13.54 months in group B (p=0.04, log-rank test). Conclusions: 5-Aminolevulinic acid induced fl uorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma. Th is fl uorescent oral form of 5-ALA, substance can be a useful tool in the treatment of Bladder cancer by inducing apoptosis when exposing the 5-ALA loaded tumour cell to external source of energy. Th is is a new research going on in our centre to study the possible use of external energy source aft er loading the cells with 5- Aminolevulinic acid. Th e patient will take the tablet 4 hours prior to surgery and the bladder will be inspected using white/blue light to stimulate the cell to produce the Protoporphyrin IX from the loaded cells and to explore the hidden or fl at cancer cellssocancer cell will be visible up to 1 mm with this method. Th e oral form opened to us new advantages in using this technology indetecting not only bladder cancers but ureteral renal and even prostatic malignancies in open, laparoscopic or robotic surgeries.

Biography:

Maram Nasser Al Awad is a Professor in the Department of Physiology at Hail university, Saudi Arabia. His research interests include General surgery, Abdominal surgery, Urology and Transplant surgery.

Abstract:

Objective: Cholestasis is one of the most common gastrointestinal disorders requiring hospitalization. While diff erent factors infl uence gallstone formation, these factors are not the same in diff erent cultures or geographical locations. We determined the prevalence of gallbladder disease as assessed by ultrasonography and its complications in Hail City, Saudi Arabia. Methods: Patients who underwent emergency or elective abdominal ultrasonography at King Khalid Hospital, the largest tertiary hospital in the Hail region of Saudi Arabia, between January 2013 and December 2013 were retrospectively analyzed. Results: Of the 4552 patients analyzed, 494 (10.9%) had gallstones. Of these 494 patients, 173 (35%) were male, 321 (65%) were female and 337 (68.2%) were aged >35 years. Th ree hundred twenty-six patients (66%) had multiple stones, whereas 168 patients (34%) had a single stone. Marked and mild wall thickening were found in 180 patients (36.4%) and 155 patients (31.4%), respectively. Common bile duct dilatation was present in 36 patients (7.3%), fatty liver in 106 patients (21.5%), hepatomegaly in 36 patients (7.3%), cirrhosis in 20 patients (4%) and ascites in 21 patients (4.3%). Of the 494 patients, 335 (67.8%) were symptomatic. Saudi females had the highest prevalence of gallbladder disease (60.1%) followed by Saudi males (31.6%), non-Saudi females (4.9%), and non-Saudi males (3.8%). Conclusion: Th e prevalence of gallbladder disease was higher in Hail City compared with other cities in Saudi Arabia.

Biography:

Sibel Akyol and Murat Hanci is an assistant Professor in the Departments of Physiology, at Istanbul University, Istanbul, Turkey. Her research interests include General surgery, Neurosurgery and Transplant surgery.

Abstract:

Aim: Th is study aims to provide the infl uence of anesthesia on the expression of natural killer cells and major histo-compatibility complex (MHC) molecules patients who had cerebral digital subtraction angiography (DSA) for either the diagnosis or treatment of intracranial vascular pathologies. Material & Methods: Forty-one male patients who admitted for cerebral DSA were included in this study. Patients were divided into two groups: Group I (n=7) included patients who did not receive anesthesia and group II (n=34) received anesthesia. For the molecules, a venous blood samples from every patient was collected before and aft er cerebral DSA. Results: In the group I, NK cells, NKG2D, MICA/MICB, CD3 and CD8 cytokines were increased signifi cantly aft er the DSA but CD16+56+ and MHC-class I showed no statistical signifi cant diff erence. In the group, NK cells, CD16+56+ and MICA/ MICB levels did not show signifi cant diff erence. On the other hand NKG2D, MHC-class I, CD8+ and CD3+ levels increased signifi cantly aft er the DSA. Comparing the group I and II aft er the DSA showed no signifi cant diff erence regarding CD16+56+ and NKG2D. NK (CD56+), MICA/MICB decreased and MHC-class I, CD8+, and CD3+ levels increased signifi cantly in the group II. Conclusion: Anesthesia combined with surgical stress DSA causes some alterations in the immune status of the patients. More data will lead us to give appropriate agents to the patients in order to strengthen the immune status during the preoperative period for decreasing the morbidity and/or mortality rate.

Biography:

Adam H Hamawy is board certifi ed by the American Board of Plastic Surgery, specializing in both aesthetic and reconstructive procedures. He is trained in General Surgery at New York Presbyterian Hospital in New York City and in Plastic Surgery at the University of Texas’ Southwestern Medical Center in Dallas. He subsequently served in the US Army. He left the military after achieving the rank of Lieutenant Colonel and currently works in private practice in Princeton, NJ. He is currently the Chief of Microsurgery at St. Joseph’s Regional Medical Center. He has authored peer reviewed journal articles and book chapters. He is an Editorial Reviewer for the Journal of Plastic and Reconstructive Surgery. His clinical interests are migraine reduction surgeries, aesthetic facial restoration and aesthetic breast reconstruction.

Abstract:

There are many variables that must be considered when making decisions for breast reconstruction. Consideration of the patient and oncologic variables is becoming increasingly appreciated when selecting the surgical team and technique as a predictor of good outcomes following mastectomy and reconstruction. Th is discussion is structured to review the variables that are relevant when deciding upon a particular reconstructive option for a particular patient.

Biography:

Robert Ryu is a Professor of Radiology and Director of Interventional Radiology at the University of Colorado Anschutz Medical Campus in Denver, CO. He is a Fellow of the Society of Interventional Radiology. He was the Radiology Residency program Director at Northwestern University from 2005-2014, where he was Cofounder of the IVC Filter clinic. He has authored over 100 peer reviewed publications. His areas of clinical and research interests include venous thrombo-embolic disease, interventional oncology and hepatobiliary intervention.

Abstract:

Purpose: Decreased successful retrieval rates have been reported in conjunction with prolonged dwell time of retrievable IVC fi lters (rIVCF). Th e use of adjunctive techniques has improved overall retrieval rates of these devices. Th is study compares the technical successful retrieval rate of rIVCF with prolonged dwell time (defi ned as >6 months), with rIVCF implanted for <6 months. We hypothesize that the technical success rate of rIVCF retrieval is equivalent. We aim to determine and compare technical and clinical factors that impact retrieval success in both cohorts. Materials: All rIVCF retrieval procedures from Jan 2009 to Dec 2014 were identifi ed from a prospectively acquired database. We assessed the technical success of rIVCF retrieval; we recorded fi lter dwell time as <6 months or >6 months for all cases. Th e use of adjunctive retrieval techniques was also recorded. Adjunctive techniques included loop wire, directional sheath use, balloon disruption, endo-bronchial forceps and excimer laser assistance. Statistics were analyzed using the Chi square test, with signifi cance accepted at p<0.05. Results: During the study period, 648 rIVCF retrieval procedures were performed. Th e technical success rate for retrieval procedures performed with rIVCFs in place <6 months was 97.7% (n=596); retrieval technical success rate for rIVCFs in place >6 months was 94.2% (n=52) (p=0.14). Adjunctive techniques were necessary to remove rIVCFs with <6 months dwell time 11% of the time (n=62), and 67% of the time (n=33) for rIVCFs with >6 months dwell time (p<0.001). Overall, complications occurred in 3% (3 major, 15 minor). Conclusions: Th ere is no signifi cant diff erence in the technical success rate for removal of rIVCFs that were implanted >6 months vs. <6 months ago. Retrieval rates for both cohorts exceeded 94%. In patients with prolonged IVC fi lter dwell time, adjunctive techniques are used more frequently to achieve these results.

Biography:

Muslim Mustaev is a Professor in the Department of General Surgery at Caboolture Hospital, Queensland, Australia. His research interests include General surgery, Neurosurgery, Transplant surgery, Urology. He is the author of many reputed articles.

Abstract:

Purpose: Cytomegalovirus (CMV) is predominantly an opportunistic infection in immunocompromised patients. CMV infection, in otherwise immunocompetent individuals, is a rare phenomenon. Amongst CMV’s systemic manifestations, colitis is the most common presentation. CMV enteritis in the immunocompetent is rare and has not been reported in association with small bowel ischemia. Methodology: A 78-year old male presented with diarrhoea and abdominal pain for four days. No immunosuppressive risk factors (HIV, transplant procedures or steroid therapy) were noted. Haematological investigations showed leucocytosis with neutrophilia. Initial CT scan indicated enteritis with thickening of terminal ileum. Diagnostic laparoscopy revealed thickened small bowel which was however viable. Persistent clinical features led to laparotomy, and thickened congested segment of ileum was resected with caecum. Histology showed isolated small bowel ischemia, ulcerative changes with CMV inclusions. Ganciclovir therapy was commenced and the patient had subsequent uneventful recovery. Results: CMV enteritis was the least suspected cause of this presentation. Literature has reported limited number of cases of CMV colitis and its association with enteritis is even rarer. Th is is perhaps the fi rst case reported where the virus has caused ischemia of the small bowel without evidence of colonic involvement. Even in the elderly patients, small bowel is resilient to ischemic changes because of good blood supply. Isolated ischemic changes sparing colon are unusual and rare especially due to CMV infection. Conclusion: Segmental ileal ischemia caused by CMV in immunocompetent individuals is another facet of this disease. It needs to be investigated further for better understanding to aide timely diagnosis.

Biography:

Ahmed abdel monem is a Professor in the Department of General surgery at alsalama one day surgery center ,Saudi Arabia. His Research interests include General surgery, Abdominal surgery, Transplant surgery.

Abstract:

Background ; Chronic abdominal pain is a troublesome dilemma confronting both the medical and surgical care professionals. These patients are submitted to a lot of diagnostic investigations but, regretfully, no precise aetiology of their problem could be elicited. Diagnostic laparoscopy, apart from visualizing a large part of the abdominal cavity , a precise targeted biopsy can be done. Laparoscopy offers also a theraputic solution for a lot of cause of chronic abdominal pain. Patient and Methods: Patient with the inclusion criteria underwent diagnostic laparoscopy for chronic abdominal pain over last two years from January 2012 to December 2013. The patient’s demographic data, length of time with pain, diagnostic studies, intra-operative findings, interventions and follow-up were determined. Statistical methods:descriptive statistics of included patients were summarized graphically and by tabulation . Analytical statistics including associations between qualitative and quantitative variables was done by chi-squared test (for qualitative variables) and Kruskal-Wallis test (for qualitative/quantitative data associations ) . Asignificance level of P<0.05 was set. Results: in this study, 66 patients (45 female and 21male) with an average age of 25 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average duration of pain was 19,5 weeks. Findings included intra-abdominal tuberculousis in 4 patients, internal herniation in 2 patients, significant intra-abdominal adhesions in 12 patients, secondary intessusception in two patients, small intestinal stone in one patients, intestinal lymphoma in one patients, abdominal lymphadenopathy due to lymphoma in 2 patients, ceacal diverticulum in 2 patients and subacute appendicitis in 20 patients. Conclusion: Diagnostic laparoscopy seems to be a simple, rapid and an effective diagnostic tool in evaluating patients with chronic abdominal pain, in whom conventional methods of investigations have failed to elicit a certain cause with the advantages that it is an effective therapeutic tool and accurate and easy tissue sampling.

Biography:

Mohammed Ghunaim is the Chairman of General Surgery, Bariatric and Endocrine Surgery at the University Hospital of Lille, France. He is Professor since 2004. He has published more than 50 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

Introduction: Th e FNA has become essential for the surgical management of thyroid nodule. When cytology indicates a possible malignancy, some teams combine a prophylactic thyroidectomy and lymphadenectomy. Up to date, the risk and benefi t ratio of prophylactic lymphadenectomy has not been evaluated particulary in case of uncertain diagnosis (Bethesda score=3/4). Materials & Methods: Retrospective study was conducted in 227 patients (179 women, 48 men) consecutive operated since July 2010 for a suspected thyroid nodule, isolated or dominant, and who had a preoperative ultrasound and fi ne needle aspiration in an expert single center. Th e intervention consisted of a total thyroidectomy with or without a cervical lymph node dissection (removal of at least 6 nodes). Th e dissection was considered prophylactic in the absence of suspicious lymph nodes identifi ed in the preoperative ultrasound. Results: FNA results were correlated by Bethesda pathological diagnosis of malignancy (B3: 23%, B4: 31%, B5: 73%, B6: 90%). Preoperative ultrasound found no adenopathy in 201 patients (88.6%), including 139 (69% ) underwent a prophylactic lymphadenectomy (≥6 nodes). In this case, the median number of lymph nodes removed was 14 (IQR=9 to 19). Lymph node involvement was found in 0/14 patients B3 (0%), 0/72 B4 patients (0%), 8/72 patients B5 (11%) and 10/42 patients B6 (24%). Th e overall rate of postoperative complications (hypocalcemia, laryngoscopy abnormal, cervical hematoma, surgical site infection) was 49% in cases of prophylactic dissection and 28% in the absence of dissection (p=0.001, Chi 2). Performing dissection signifi cantly increased length of hospital stay (1.5±1.0 vs. 2.2±2.0 days, p<0.001). In multivariate analysis, the implementation of prophylactic lymphadenectomy increased the risk of complications by 47% (OR 2.033, 95% CI: 1.003 to 4.118, p=0.049), regardless of tumor size (p=0.81). Conclusion: 1. During a thyroidectomy for suspicious nodule, prophylactic lymphadenectomy increases postoperative morbidity of 47% and lengthens hospitalization. 2. Role of prophylactic lymph node dissection seems to be questionable when Bethesda’s score is less than 5 regardless of tumor size.

Biography:

Fabio Assis Moreira Fontes is an assistant professor from the State University of Rio de Janeiro , France. His research interest includes General surgery, Obstetrics and Gynaecological Surgery.

Abstract:

Objective: To promote greater integration in knowledge about the surgical techniques currently used in the male / female sex reassignment surgery in Brazil and worldwide. Another secondary aim is to facilitate access to information about the transgender transformation and help in demystifying the subject. Methods: Th ree main databases: PUBMED, LILACS and BVS were used; from which were selected 19 articles published in the last 15 years. Articles with experimental character regarding surgical experience on sex reassignment surgery in specialized services in the world were included. Conclusion: It is not up to the medical doctor to judge the sexual identity or option, and yes, impartially, off er the patients the best care, the best treatment taking into account the individual needs and respect the right of choice of the patient to decide who to be. Discussion: Th e gold standard considered by most bibliographies is the technique that uses the genital retail for the creation of the neovagina. Aft er the usual bilateral orchiectomy, the penis is dissected in its anatomical components: Corpora cavernosa, the glans, urethra, neurovascular bundle and vascularized penile skin. Many modifi cations of this technique have been described, but in general, there are three main groups of such modifi cations: (a) Use of inverted penile skin in the form of an inverted tube skin as the only retail on a abdominal pedicle fl ap; (B) Dividing the penis skin pedicle cylinder to create a rectangular fl ap, which is then increased by a rectangular scrotal skin with a posterior pedicle fl ap to increase the size of neovagina; (C) Th e penile skin fl ap can also be extended with a long and vascularized urethral fl ap, which is harvested and then incorporated into the penile skin fl ap. Th is work is going to review the literature of these and other alternatives and current techniques

Biography:

Robert Caiazzo is Professor of Surgery in the Faculty of Medicine at the University of Lille II, Lille, France. He is the member of the Department of General and Endocrine Surgery at Lille University Hospital. His research is devoted to the surgical treatment of endocrine and metabolic disease and focused on metabolic surgery for type 2 diabetes. He has authored or co-authored 25 papers in reputed journals. He is also the Principal Investigator of several ongoing clinical trials of bariatric surgery in Lille.

Abstract:

Introduction: Th e trans-axillary thyroid surgery robot assisted, developed in South Korea, is an alternative to cervicotomy with great cosmotic benefi t. Its distribution in Europe and US remains limited to a few centers experts, mainly because of its technical difficulty. Most studies are Asian with sometimes confl icting results and no multicenter European study was available. Aim: Our aim was to evaluate the functional results, aesthetic and oncological and identify the specifi c complications of transaxillary robot assisted thyroid surgery. Materials & Methods: Retrospective multicenter study of patients undergoing partial or total thyroidectomy in Lille, Nancy and Geneva with a postoperative follow-up of at least 6 months. Pre- and intraoperative data were extracted from medical records and follow-up data were collected by contacting every patient by phone. Results: 98 interventions were carried out from January 2010 to August 2014, in 93 consecutive patients: 47 lobectomies including 5 totalization of thyroidectomy and 51 total thyroidectomy for suspected thyroid nodules in 69 pateints, 15 toxic nodules or goiter, 8 symptomatic goiter and Graves' disease in 6 patients. Th e operating averaging times were 175±57 minutes for lobectomies and 195±39 minutes for total thyroidectomy. Th e patients evaluated the quality of scar as 7.5 / 10. Th ere was no serious complication, there was 9.2% recurrent paralysis including one defi nitif and 10.2% of hypocalcemia including 1 persistant hypocalcemia. Postoperative pain was moderate with EVA score of less than 4/10 in 58.2% (n=57) and controlled by level I and II of analgesics allowing one day surgery for 4 patients. At 6 months, the rate of mechanical pain was 6.1% (n=6), the rate of cervical adhesions was 19.4% (n=19) and the rate of pre-pectoral dysesthesia was 51% (n=50). Th ese dysesthesia were associated with functional impairment and neuropathic pain in 5.1% (n=5) of patients, necessitating specialized consultation. Th ese symptoms have improved under short treatment by gabapentin and motor physical therapy. Patients whose pathology revealed the presence of cancer, had a mean of follow-up of 25±11 months. Th e patients who received their complementary therapy-I 131, the thyroglobulins were below 1 ng / ml (0.1±0.3 [0 to 0.4]) and all scans of revaluation with 5mCi were normal except two showing an ordinary fi xation without corresponding thyroid ultrasound residue. Conclusion: Th is study shows the results of the trans-axillary thyroid surgery in its learning curve for European patients. Th is approach allows the absence of cervical scar but it is associated with specifi c complications related to subcutaneous dissection path.

Biography:

Leonardo Silva Soares is a Professor of surgery from State University of Rio de Janeiro , Brazil. His research is devoted to the surgical treatment of metabolic syndrome.

Abstract:

Objective: Th is bibliographic review aims to analyze the diff erent surgical therapeutic approaches and their benefi ts before patients with metabolic syndrome and its comorbidities. Methods: We performed literature in MedLine, SciELO, Lilacs and Academic Search from 1998 to 2015 with one exception article published in 1998. I have read 70 articles and selected 29 articles based on keywords. Results: Th e current literature presents several studies with signifi cant results of surgical treatment of comorbidities, which translate the associated metabolic syndrome. Conclusion: The metabolic surgery (bariatric) can eff ectively treat major components of the metabolic syndrome, when it is associated with obesity, leading to their cure. Turning directly and indirectly, and reducing all mortality rates generated by cardiovascular diseases

Biography:

Marcel Henrique Arcuri & Marcella Akemi Haruno de Vilhena is a professor of surgery in the Department of Neurosurgery from The State University of Rio de Janeiro , Brazil. His research interest are Abdominal surgery, Neurosurgery.

Abstract:

Neuro-endocrine (NE) tumors (NETs) of the gastro entero-pancreatic system have slow growth and indolent evolution; usually at diagnosis they already present metastasis. It is difficult to quantify the real incidence of NETs whereas there is a difference in the cancer registries; however the estimate is 1 to 7 per 100,000 populations per year, representing 0.49% of all cancers. NETs are characterized by the secretion of active peptides, like somatostatin, which may cause physiologic eff ects, such as carcinoid syndrome. Th e most common primary sites are small bowel, large bowel and pancreas, but with less frequency other parts of the body are aff ected. At diagnosis, 65-90% of patients already have synchronic neuro-endocrine liver metastases (NELM). Th ose with metastasis have a 5-year survival 13-54% vs. 75-99% from those who doesn't have it. Th e treatment is controversy, but the resection surgery of the primary tumor and the liver metastasis is the only potential treatment for cure. However, in case of unresectability of hepatic metastases, the therapeutic approach will be chosen among radio frequency ablation, ases ablation, trans-arterial embolization or liver transplantation. Th erefore the objective of the present study is to discuss a case report of a NELM including its surgery treatment, showing a comparison with other results.

Biography:

Mathias Antonio Haruno de Vilhena is Professor from State University of Rio de Janeiro , Brazil. His research includes all types of Bone cancers, Orthopeadic surgery, Perioperative surgery.

Abstract:

Chordoma is a rare type of cancer that occurs in the bones of the skull and spine. Th ey are thought to arise from remnants of the embryonic notochord; generally are slow growing, but relentless and tend to recur after treatment. Because of their proximity to critical structures such as the spinal cord, brainstem, nerves and arteries, they are diffi cult to treat and require highly specialized care. Th e annual incidence of chordoma is approximately one new case per million people per year. Nevertheless, chordomas are the most common tumor of the sacrum and cervical spine. With an average overall survival of 7-9 years, the number of people living with chordoma (prevalence) is approximately 8 per million. Th ere is no actual consensus of a second recurrence sacral chordoma best approach. Th erefore, the intention of our study is to present a case report describing the surgical treatment associated with a literature review.

Biography:

Gabriel Nobrega de Arruda, Andre Augusto Torres Prado & Monique Tavares Maia is a Professor of surgery from State University of Rio de Janeiro , Brazil. His research interests include General surgery, Orthopaedic surgery.

Abstract:

Chordoma is a rare type of cancer that occurs in the bones of the skull and spine. Th ey are thought to arise from remnants of the embryonic notochord; generally are slow growing, but relentless and tend to recur after treatment. Because of their proximity to critical structures such as the spinal cord, brainstem, nerves and arteries, they are diffi cult to treat and require highly specialized care. Th e annual incidence of chordoma is approximately one new case per million people per year. Nevertheless, chordomas are the most common tumor of the sacrum and cervical spine. With an average overall survival of 7-9 years, the number of people living with chordoma (prevalence) is approximately 8 per million. Th ere is no actual consensus of a second recurrence sacral chordoma best approach. Therefore, the intention of our study is to present a case report describing the surgical treatment associated with a literature review.

Biography:

Ashjan Mohammed Almuhanna is an assistant professor from the Hail University,Saudi Arabia. His research interests include Abdominal surgey, Perioperative surgery, Gastrointestinal surgery.

Abstract:

Objective: Cholestasis is one of the most common gastrointestinal disorders requiring hospitalization. While diff erent factors infl uence gallstone formation, these factors are not the same in diff erent cultures or geographical locations. We determined the prevalence of gallbladder disease as assessed by ultrasonography and its complications in Hail City, Saudi Arabia. Methods: Patients who underwent emergency or elective abdominal ultrasonography at King Khalid Hospital, the largest tertiary hospital in the Hail region of Saudi Arabia, between January 2013 and December 2013 were retrospectively analyzed. Results: Of the 4552 patients analyzed, 494 (10.9%) had gallstones. Of these 494 patients, 173 (35%) were male, 321 (65%) were female and 337 (68.2%) were aged >35 years. Th ree hundred twenty-six patients (66%) had multiple stones, whereas 168 patients (34%) had a single stone. Marked and mild wall thickening were found in 180 patients (36.4%) and 155 patients (31.4%), respectively. Common bile duct dilatation was present in 36 patients (7.3%), fatty liver in 106 patients (21.5%), hepatomegaly in 36 patients (7.3%), cirrhosis in 20 patients (4%) and ascites in 21 patients (4.3%). Of the 494 patients, 335 (67.8%) were symptomatic. Saudi females had the highest prevalence of gallbladder disease (60.1%) followed by Saudi males (31.6%), non- Saudi females (4.9%), and non-Saudi males (3.8%). Conclusion: Th e prevalence of gallbladder disease was higher in Hail City compared with other cities in Saudi Arabia.