Papers by Dr. Ahmed Marzouk
ABSTRACT Background: To determine and review of the importance for the Coloproctology surgeon to ... more ABSTRACT Background: To determine and review of the importance for the Coloproctology surgeon to be familiar and do trans-anal ultrasound (TAUS) for patients with various anal disorders. Methods: A review of 100 cases for whom two and three dimensional TAUS for various reasons (anal suppurative diseases- Abscesses and fistulae - 65 cases, vague anal pain 10 cases, anal incontinence 20, and 5 cases of anal masses) was done by the colorectal unit of surgery department, Faculty of medicine Cairo University, all findings were confirmed by clinical assessment, complimentary MRI and surgical intervention. Results: Among the 100 cases there were four main groups of patients; Vague anal pain group (10 cases) a PR examination were done and directed the TAUS to detect 6 cases of deep and supralevator collections. Suppurative anal conditions group (anal abscesses 13 cases and fistulae 52 cases) combined clinical examination and TAUS had truly delineated (13/13) cases of abscesses, and with injection of H2o2 through the external opening of anal fistulae have correctly localized 49 of 52 internal opening site, with detection of low intersphincteric and transsphincteric fistulae in (31/31) cases, complex fistulae with horse-shoe extension in (13/13) cases, high transsphincteric tracts and high supralevator extrasphincteric tracts (5/8) cases. Anal Incontinence group (20 cases) TAUS has determined an anatomical muscular defects in 12/20 cases due to previous anal operations and post obstetric injuries, while in 8/20 cases no defects were detected and proved to have a neurogenic cause by complimentary investigations. Anal masses group in 2 cases there were signs of infiltration of anal mucosa and anal sphincters and they were pathologically proved to be anal carcinomas and the other 3 cases there were no local infiltration and were excised surgically and proved to be benign anal polyp (1/3) and thrombosed internal piles(2/3). Conclusions: Two and three dimensional TAUS is an effective and important tool to investigate anal lesions, being a bedside test together with clinical assessment provide an accurate, non invasive, cost effective, and non lengthy assessment of various anal conditions compared with other investigations.
British Journal of Surgery
Background Acute pancreatitis is a common disease requiring admissions under surgical and critica... more Background Acute pancreatitis is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. COVID-19 pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, primary aim was to ascertain incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30 day mortality, outcomes and management of acute pancreatitis patients from Altnagelvin Area Hospital from 1st March, 2020 till 30th August, 2020. Methods A retrospective observational review of all patients admitted under General Surgical team from March 2020 till September 2020 was performed. Information regarding demographics, severity of acute pancreatitis (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected ...
British Journal of Surgery
Background Perforated peptic ulcer disease is one of the most common causes of acute peritonitis.... more Background Perforated peptic ulcer disease is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in presentation of patients with perforated ulcers. Here we present this study from a Northern Irish perspective on perforated peptic ulcers. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with incidence of perforated peptic ulcers. Follow-up data was also collected. Seasons were defined as per UK Met Office. Results Results: A total of 50 patients presented with perforated PUD. Male:female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common mo...
Background and study aims Adequate lymphadenectomy is crucial to ensure accuracy in staging and t... more Background and study aims Adequate lymphadenectomy is crucial to ensure accuracy in staging and treatment of colorectal cancer. Endoscopic preoperative tattooing to mark the location of the tumor has recently been proposed to promote the recovery of lymph nodes in colorectal specimens. The purpose of the study was to evaluate the role of preoperative endoscopic tumor tattooing in improving the retrieval of lymph nodes in colorectal resections. Patients and methods The study was conducted on 100 candidates randomized into two groups. The first group included 50 patients who were injected with black eye dye by colonoscopy done 3–10 days before surgery (tattooed group), and the 50 other patients in the second group (control group) did not have preoperative tattooing. All patients underwent the standard resection under National Comprehensive Cancer Network Colorectal Cancers Guideline. Results The tattooed group showed higher number of lymph nodes retrieved compared with the control gro...
Cureus
Background Perforated peptic ulcer disease (PUD) is one of the most common causes of acute perito... more Background Perforated peptic ulcer disease (PUD) is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in the presentation of patients with perforated ulcers. Here we present this study from our experience in a Northern Irish acute district hospital. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with the incidence of perforated peptic ulcers. Follow-up data were also collected. Seasons were defined as per UK Met Office. Results A total of 50 patients presented with perforated PUD. Male to female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. Fourteen patients (28%) were either very frail or had contained perforations and were conservatively managed. Three deaths were noted (6%). Thirteen patients (26%) required ICU admission at some stage in their management. Conclusion Slight seasonal variation was noted in the presentation of perforated peptic ulcers in our study with a higher incidence in the winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.
Cureus
Background Acute pancreatitis (AP) is a common disease requiring admissions under surgical and cr... more Background Acute pancreatitis (AP) is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, the primary aim was to ascertain the incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30-day mortality, outcomes and management of acute pancreatitis patients from 1st March, 2020 till 31st August, 2020. Methods A retrospective observational review of all patients admitted under the General Surgical team was performed. Information regarding demographics, severity of AP (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on data collection tool used by COVID-PAN study and results were compared to outcomes results of COVID-PAN study. Results Forty-three (43) patients were admitted with AP. Only one patient (2.3%) was diagnosed with COVID-19 at the time of pancreatitis. Gallstones were noted to be the most common cause of AP in our population. Mortality was 7% (3 patients). Five patients (11%) needed ITU admission due to organ dysfunction. Three patients (7%) developed ARDS. Conclusion The overall incidence of COVID-19 in pancreatitis in our population of the study was low. The incidence of COVID-19 during the first wave in Derry/Londonderry area was low and this may explain why the incidence was low in our study as well. Patients with AP in our target population were mostly elderly, one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As observed in other centres globally, urgent cholecystectomy for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy within six months of index admission for gallstone pancreatitis in our centre.
Gut
ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infecti... more ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Una...
The Surgery Journal
Background Morbid obesity is a serious chronic condition with, among other symptoms, increased in... more Background Morbid obesity is a serious chronic condition with, among other symptoms, increased intra-abdominal pressure and subsequent abdominal wall hernias. The optimal management of these manifestations is still controversial. The objective of this study was to assess the early postoperative outcomes of a surgical approach combining laparoscopic ventral hernia repair (LVHR) with sleeve gastrectomy in morbidly obese patients. Methods In this retrospective study, we reviewed the files of patients who are obese with a primary ventral hernia of less than 10 cm in diameter who received simultaneous laparoscopic sleeve gastrectomy and LVHR at our institution between February 2016 and July 2018. LVHR was performed using an intraperitoneal only mesh. The individual mesh size was chosen based on the number and size of the defects. Clinical and radiological follow-ups were performed between 9 and 15 months. Results A total of 15 patients were included. Five of them were males. The mean bod...
Indian Journal of Public Health Research & Development
Enhanced recovery after surgery (ERAS) protocols were created to improve patient recovery and to ... more Enhanced recovery after surgery (ERAS) protocols were created to improve patient recovery and to reduce the postoperative hospital stay and comorbidities. Temporary postoperative gastrointestinal dysfunction, as nausea, vomiting, or abdominal distension, is a common morbidity after abdominal surgery that largely determines clinical recovery and hospital stay. Currently, the diagnoses of temporary postoperative GI.dysfunction and paralytic ileus are based on subjective reporting of clinical symptoms. In our study an objective assessment tool to identify temporary postoperative GI. dysfunction and paralytic ileus, as well as their resolution was used and the results showed that ERAS combined with abdominal ultrasound used for the care of patients undergoing colorectal surgery is improving standards of care by reducing postoperative hospital stay, attempting to improve the overall quality of recovery, decrease the percentage of postoperative vomiting, cost saving, and patient satisfaction.
International Surgery Journal
Background: Patients presented with unilateral inguinal hernia are at risk for the possibility of... more Background: Patients presented with unilateral inguinal hernia are at risk for the possibility of contra-lateral occult hernias; small early-developed hernias may be difficult to be elicited by clinical, imaging assessment and during open repair. This study to evaluate laparoscopic identification of contra-lateral occult hernia with regard to the pre-operative clinical and imaging study.Methods: Retrospective analysis of patients presented in the period of March to December 2015 with unilateral inguinal hernia for which medical and ultrasound imaging assessment were done. Laparoscopic trans abdominal pre-peritoneal (TAPP) approach was done with intraoperative evaluation of the presence of contra-lateral occult hernias.Results: During the study period (27) patients (25 Males and 2 females) presented with unilateral inguinal hernia were clinically evaluated, 18 (66.6%) patients had right sided hernia, 9 (33.33%) had left sided, In all the studied patients routine ultrasound assessment...
International Surgery Journal
Background: Fecal incontinence is a difficult and debilitating problem with various nonsurgical a... more Background: Fecal incontinence is a difficult and debilitating problem with various nonsurgical and surgical modes of treatment. Biofeedback is among the most considerable nonoperative strategies. This study is to review of the short-term effectiveness of the use of biofeedback therapy in management of fecal incontinence.Methods: A retrospective review of 14 patients with fecal incontinence were included and completed the planned biofeedback sessions regarding clinical response and change in anorectal manometric parameters.Results: 14 incontinent patients (9 males and 5 females), mean age 38.0 ± 21.4 years, 6 patients (42.8%) showed excellent response (cured), 5 patients (35.7%) showed good response (improved) and 3 patients (21.5%) showed poor response. There were a highly significant decrease in the grade with mean 3.8±1.4 to 2.4±1.7 (P value =0.003) and a score mean 11.8±5.9 to 6.1±7.1 (P value = 0.002). increase in anal resting pressure by mean 33.6±18.1 mmHg (P value = 0.004) a...
Background: To determine and review of the importance for the Coloproctology surgeon to be famili... more Background: To determine and review of the importance for the Coloproctology surgeon to be familiar and do trans-anal ultrasound (TAUS) for patients with various anal disorders. Methods: A review of 100 cases for whom two and three dimensional TAUS for various reasons (anal suppurative diseases- Abscesses and fistulae - 65 cases, vague anal pain 10 cases, anal incontinence 20, and 5 cases of anal masses) was done by the colorectal unit of surgery department, Faculty of medicine Cairo University, all findings were confirmed by clinical assessment, complimentary MRI and surgical intervention. Results: Among the 100 cases there were four main groups of patients; Vague anal pain group (10 cases) a PR examination were done and directed the TAUS to detect 6 cases of deep and supralevator collections. Suppurative anal conditions group (anal abscesses 13 cases and fistulae 52 cases) combined clinical examination and TAUS had truly delineated (13/13) cases of abscesses, and with injection of...
The Egyptian Journal of Surgery, 2015
Background Although anal fistula are encountered commonly in surgical practice and have been stud... more Background Although anal fistula are encountered commonly in surgical practice and have been studied extensively, some complex forms still continue to represent a difficult surgical challenge for many surgeons. The corner stone and the main aim of treatment for an anal fistula is to permanently eliminate abscess formation and achieve healing at the same time preserving anal function and continence. Therefore, precise preoperative assessment of perianal fistulae is crucial to achieving optimal surgical results. Patients and methods In this prospective comparative study, 60 patients were enrolled during the period from December 2012 to June 2014. Endoanal ultrasonography (EAUS) (two-dimensional/three-dimensional) with or without H 2 O 2 enhancement was used for the preoperative assessment of perianal fistulae and abscesses, and the degree of accuracy and its agreement with the surgical findings were estimated. Primary fistulous tract and its relation to the sphincter complex, side tracts, internal opening, and any associated sepsis were determined by EAUS; the reviewers were blinded to the findings of the assessment. Results In classification of the primary tract, there was agreement between EAUS and surgical findings in 47 of the 60 (78.3%) patients. In terms of the presence of an internal opening, the corresponding figures were 53 (88%) cases. In assessment of the secondary (side) tracts by EAUS, 55 (91.7%) patients were diagnosed accurately. In terms of the diagnosis of the presence or absence of abscess cavity or collection in the cases, EAUS diagnosed 53 (88.3%) patients accurately. Conclusion EAUS with its recent innovations of three-dimensional technique and H 2 O 2 enhancement is an excellent modality when planning for fistula surgery, especially with experienced and well-trained operators.
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Papers by Dr. Ahmed Marzouk