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1Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases显示文摘AIM: To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method. METHODS: A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived fi les. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years). RESULTS: After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms(4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometeric changes after band ligation. CONCLUSION: RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with signifi cant improvement in quality of life. RBL doesn't alter ano-rectal functions.Ayman M El Nakeeb Amir A Fikry Waleed H Omar Elyamani M Fouda Tito A El Metwally Hosam E Ghazy Sabry A Badr Mohmed Y Abu Elkhar Salih M Elawady Hisham H Abd Elmoniam Waiel W Khafagy Mosaad M Morshed Ramadan E El Lithy Mohamed E Farid 2008World Journal of Gastroenterology2008,14,42:24
2Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases显示文摘AIM To evaluate the evolution, trends in surgical approaches a n d r e c o n s t r u c t i o n t e c h n i q u e s, a n d i m p o r t a n t lessons learned from performing 1000 consecutive pancreaticoduodenectomies(PDs) for periampullary tumors.METHODS This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period(1993-2002), middle period(2003-2012), and late period(2013-2017).RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.CONCLUSION Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.ayman el nakeeb waleed askar ehab atef ehab el hanafy ahmad m sultan tarek salah ahmed shehta mohamed el sorogy emad hamdy mohamed el hemly ahmed a el-geidi tharwat kandil mohamed el shobari talaat abd allah amgad fouad mostafa abu zeid ahmed abu el eneen nabil gad el-hak gamal el ebidy omar fathy ahmed sultan mohamed abdel wahab 2017World Journal of Gastroenterology2017,23,38:15
3Clinicopathological features and surgical outcome of patients with fibrolamellar hepatocellular carcinoma(experience with 22 patients over a 15-year period)显示文摘AIM To evaluate the clinicopathological features and the surgical outcomes of patients with fibrolamellar hepato-cellular carcinoma(FL-HCC)over a 15-year period. METHODS This is a retrospective study including 22 patients with a pathologic diagnosis of FL-HCC who underwent hepatectomy over a 15-year period. Tumor characteristics,survival and recurrence were evaluated. RESULTS There were 11 male and 11 female with a median age of 29 years(range from 21 to 58 years). Two(9%)patients had hepatitis C viral infection and only 2(9%)patients had alpha-fetoprotein level > 200 ng/m L. The median size of the tumors was 12 cm(range from 5-20 cm). Vascular invasion was detected in 5(23%)patients. Four(18%)patients had lymph node metastases. The median follow up period was 42 mo and the 5-year survival was 65%. Five(23%)patients had a recurrent disease,4 of them had a second surgery with 36 mo median time interval. Vascular invasion is the only significant negative prognostic factor CONCLUSION FL-HCC has a favorable prognosis than common HCC and should be suspected in young patients with non cirrhotic liver. Aggressive surgical resection should be done for all patients. Repeated hepatectomy should be considered for these patients as it has a relatively indolent course.Mohamed Abdel Wahab Ehab El Hanafy Ayman El Nakeeb Mahmoud Abdelwahab Ali 2017World Journal of Gastrointestinal Surgery2017,9,2:12
4Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma:A retrospective study of 5-year survivors显示文摘AIM:To determine predictors of long term survival after resection of hilar cholangiocarcinoma(HC) by comparing patients surviving > 5 years with those who survived < 5 years.METHODS:This is a retrospective study of patients with pathologically proven HC who underwent surgical resection at the Gastroenterology Surgical Center,Mansoura University,Egypt between January 2002 and April 2013.All data of the patients were collected from the medical records.patients were divided into two groups according to their survival:patients surviving less than 5 years and those who survived > 5 years.RESULTS:There were 34(14%) long term survivors(5 year survivors) among the 243 patients.Fiveyear survivors were younger at diagnosis than those surviving less than 5 years(mean age,50.47 ± 4.45 vs 54.59 ± 4.98,p = 0.001).Gender,clinical presentation,preoperative drainage,preoperative serum bilirubin,albumin and serum glutamic-pyruvic transaminase were similar between the two groups.The level of CA 19-9 was significantly higher in patients surviving < 5 years(395.71 ± 31.43 vs 254.06 ± 42.19,p = 0.0001).Univariate analysis demonstrated nine variables to be significantly associated with survival > 5 year,includingyoung age(p = 0.001),serum CA19-9(p = 0.0001),non-cirrhotic liver(p = 0.02),major hepatic resection(p = 0.001),caudate lobe resection(p = 0.006),well differentiated tumour(p = 0.03),lymph node status(0.008),R0 resection margin(p = 0.0001) and early postoperative liver cell failure(p = 0.02).CONCLUSION:Liver status,resection of caudate lobe,lymph node status,R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.Mohamed Abd El Wahab Ayman El Nakeeb Ehab El Hanafy Ahmad M Sultan Ahmed Elghawalby Waleed Askr Mahmoud Ali Mohamed Abd El Gawad Tarek Salah 2016World Journal of Gastrointestinal Surgery2016,8,6:10
5Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity显示文摘AIM To detect risk factors for post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) and investigate the predictors of its severity.METHODS This is a prospective cohort study of all patients who underwent ERCP.Pre-ERCP data,intraoperative data,and post-ERCP data were collected.RESULTS The study population consisted of 996 patients.Their mean age at presentation was 58.42(± 14.72) years,and there were 454 male and 442 female patients.Overall,PEP occurred in 102(10.2%) patients of the study population; eighty(78.4%) cases were of mild to moderate degree,while severe pancreatitis occurred in 22(21.6%) patients.No hospital mortality was reported for any of PEP patients during the study duration.Age less than 35 years(P = 0.001,OR = 0.035),narrower common bile duct(CBD) diameter(P = 0.0001) and increased number of pancreatic cannulations(P = 0.0001) were independent risk factors for the occurrence of PEP.CONCLUSION PEP is the most frequent and devastating complication after ERCP.Age less than 35 years,narrower median CBD diameter and increased number of pancreaticcannulations are independent risk factors for the occurrence of PEP.Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.Ayman El Nakeeb Ehab El Hanafy Tarek Salah Ehab Atef Hosam Hamed Ahmad M Sultan Emad Hamdy Mohamed Said Ahmed A El Geidie Tharwat Kandil Mohamed El Shobari Gamal El Ebidy 2016World Journal of Gastrointestinal Endoscopy2016,8,19:10
6Efficacy of octreotide in the prevention of complications after pancreaticoduodenectomy in patients with soft pancreas and non-dilated pancreatic duct: A prospective randomized trial显示文摘Background: The efficacy of octreotide to prevent postoperative pancreatic fistula(POPF) of pancreaticoduodenectomy(PD) is still controversial. This study aimed to evaluate the effect of postoperative use of octreotide on the outcomes after PD.Methods: This is a prospective randomized controlled trial for postoperative use of octreotide in patients undergoing PD. Patients with soft pancreas and pancreatic duct < 3 mm were randomized to 2 groups.Group I did not receive postoperative octreotide. Group II received postoperative octreotide. The primary end of the study is to compare the rate of POPF.Results: A total of 104 patients were included in the study and were divided into two randomized groups.There were no significant difference in overall complications and its severity. POPF occurred in 11 patients(21.2%) in group I and 10(19.2%) in group II, without statistical significance(P = 0.807). Also, there was no significant differences between both groups regarding the incidence of biliary leakage(P = 0.083), delayed gastric emptying(P = 0.472), and early postoperative mortality(P = 0.727).Conclusions: Octreotide did not reduce postoperative morbidities, reoperation and mortality rate. Also, it did not affect the incidence of POPF and its clinically relevant variants.Ayman El Nakeeb Ahmed El Gawalby Mahmoud A.Ali Ahmed Shehta Hosam Hamed Mohamed El Refea Ahmed Moneer Ahmed Abd El Rafee 2018Hepatobiliary & Pancreatic Diseases International2018,17,1:7
7Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: A retrospective study of 5-year survivors显示文摘Background: Pancreaticoduodenectomy(PD) is the standard curative treatment for periampullary tumors. The aim of this study is to report the incidence and predictors of long-term survival( ≥ 5 years) after PD. Methods: This study included patients who underwent PD for pathologically proven periampullary adenocarcinomas. Patients were divided into 2 groups: group(I) patients who survived less than 5 years and group(II) patients who survived ≥ 5 years. Results: There were 47(20.6%) long-term survivors( ≥ 5 years) among 228 patients underwent PD for periampullary adenocarcinoma. Patients with ampullary adenocarcinoma represented 31(66.0%) of the long-term survivors. Primary analysis showed that favourable factors for long-term survival include age < 60 years old, serum CEA < 5 ng/mL, serum CA 19-9 < 37 U/mL, non-cirrhotic liver, tumor size < 2 cm, site of primary tumor, postoperative pancreatic fistula, R0 resection, postoperative chemotherapy, and no recurrence. Multivariate analysis demonstrated that CA 19-9 < 37 U/mL [OR(95% CI) = 1.712(1.24 8–2.34 8), P = 0.001], smaller tumor size [OR(95% CI) = 1.335(1.032–1.726), P = 0.028] and R0 resection [OR(95% CI) = 3.098(2.095–4.582), P < 0.001] were independent factors for survival ≥ 5 years. The prognosis was best for ampullary adenocarcinoma, for which the median survival was 54 months and 5-year survival rate was 39.0%, and the poorest was pancreatic head adenocarcinoma, for which the median survival was 27 months and 5-year survival rate was 7%. Conclusions: The majority of long-term survivors after PD for periampullary adenocarcinoma are patients with ampullary tumor. CA 19-9 < 37 U/mL, smaller tumor size, and R0 resection were found to be independent factors for long-term survival ≥ 5 years.Ayman El Nakeeb Mohamed El Sorogy Helmy Ezzat Rami Said Mohamed El Dosoky Mohamed Abd El Gawad Ahmed M Elsabagh Ehab El Hanafy 2018Hepatobiliary & Pancreatic Diseases International2018,17,5:6
8Intraoperative endoscopic retrograde cholangiopancreatography: A useful tool in the hands of the hepatobiliary surgeon显示文摘AIM: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography(ERCP) combined with laparoscopic cholecystectomy(LC) forpatients with gall bladder stones(GS) and common bile duct stones(CBDS).METHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram(TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven CBDS.RESULTS: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases(84.2%) where removal of stones were successful; passed stones in 6 cases(7.9%); short lower end stricture with small stones present in two cases(2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case(1.3%) which was treated by open hepaticojejunostomy; and one case(1.3%) was proved to be ampullary carcinoma and whipple's operation was scheduled. CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.Ayman El Nakeeb Ahmad M Sultan Emad Hamdy Ehab El Hanafy Ehab Atef Tarek Salah Ahmed A El Geidie Tharwat Kandil Mohamed El Shobari Gamal El Ebidy 2015World Journal of Gastroenterology2015,21,2:6
9Impact of referral pattern and timing of repair on surgical outcome after reconstruction of post-cholecystectomy bile duct injury:A multicenter study显示文摘Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of BDI.Methods:We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020.The patients were divided into three groups based on the time of BDI reconstruction.Group 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3.Favorable outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).Multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group 3.Transected BDI and level E4 BDI were independent factors of unfavorable outcome.Conclusions:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI.Complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.Ayman El Nakeeb Ahmad Sultan Helmy Ezzat Mohamed Attia Mohamed Abd ElWahab Taha Kayed Ayman Hassanen Ahmad AlMalki Ahmed Alqarni Mohammed M Mohammed 2021Hepatobiliary & Pancreatic Diseases International2021,20,1:4
10Biliary leakage following pancreaticoduodenectomy:Prevalence,risk factors and management显示文摘Background: Few studies investigated biliary leakage after pancreaticoduodenectomy(PD) especially when compared to postoperative pancreatic fistula(POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. Methods: We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, Mansoura University, Egypt. According to occurrence of postoperative biliary leakage, patients were divided into two groups. Group(1) included patients who developed biliary leakage and group(2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed. Results: The study included 555 patients. Forty-four patients(7.9%) developed biliary leakage. Ten patients(1.8%) had concomitant POPF. Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography(ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients(90.9%). Only 4 patients(9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group(6.8% vs 3.9%, P = 0.05). Conclusions: Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. However, biliary leakage can be conservatively managed in majority of cases.Ayman El Nakeeb Mohamed El Sorogy Hosam Hamed Rami Said Mohamad Elrefai Helmy Ezzat Waleed Askar Ahmed M Elsabbagh 2019Hepatobiliary & Pancreatic Diseases International2019,18,1:4
11Pancreatic Anastomotic Leakage after Pancreaticoduodenectomy. Risk factors, Clinical predictors, and Management (Single Center Experience)显示文摘Ayman El Nakeeb Tarek Salah Ahmad Sultan Mohamed El Hemaly Waleed Askr Helmy Ezzat Emad Hamdy Ehab Atef Ehab El Hanafy Ahmed El-Geidie Mohamed Abdel Wahab Talaat Abdallah 2013World Journal of Surgery2013,,6:4
12Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy显示文摘AIM:To elucidate surgical outcomes of pancreaticoduodenectomy(PD)in patients with liver cirrhosis.METHODS:We studied retrospectively all patients who underwent PD in our centre between January 2002and December 2011.Group A comprised patients with cirrhotic livers,and Group B comprised patients with non-cirrhotic livers.The cirrhotic patients had ChildPugh classes A and B(patient’s score less than 8).Preoperative demographic data,intra-operative data and postoperative details were collected.The primary outcome measure was hospital mortality rate.Secondary outcomes analysed included duration of the operation,postoperative hospital stay,postoperative morbidity and survival rate.RESULTS:Only 67/442 patients(15.2%)had cirrhotic livers.Intraoperative blood loss and blood transfusion were significantly higher in group A(P=0.0001).The mean surgical time in group A was significantly longer than that in group B(P=0.0001).Wound complications(P=0.02),internal haemorrhage(P=0.05),pancreatic fistula(P=0.02)and hospital mortality(P=0.0001)were significantly higher in the cirrhotic patients.Postoperative stay was significantly longer in group A(P=0.03).The median survival was 19 mo in group A and 24 mo in group B.Portal hypertension(PHT)was present in 16/67 cases of cirrhosis(23.9%).The intraoperative blood loss and blood transfusion were significantly higher in patients with PHT(P=0.001).Postoperative morbidity(0.07)and hospital mortality(P=0.007)were higher in cirrhotic patients with PHT.CONCLUSION:Patients with periampullary tumours and well-compensated chronic liver disease should be routinely considered for PD at high volume centres with available expertise to manage liver cirrhosis.PD is associated with an increased risk of postoperative morbidity in patients with liver cirrhosis;therefore,it is only recommended in patients with Child A cirrhosis without portal hypertension.Ayman El Nakeeb Ahmad M Sultan Tarek Salah Mohamed El Hemaly Emad Hamdy Ali Salem Ahmed Moneer Rami Said Ahmed AbuEleneen Mostafa Abu Zeid Talaat Abdallah Mohamed Abdel Wahab 2013World Journal of Gastroenterology2013,19,41:3
13Renal cell carcinoma metastatic to the pancreas: Results of surgical management显示文摘Taylor A. Sohn M.D. Charles J. Yeo M.D. John L. Cameron M.D. Attila Nakeeb M.D. Keith D. Lillemoe M.D 2001Journal of Gastrointestinal Surgery2001,,4:3
14Cholangiocarcinoma: A Spectrum of Intrahepatic, Perihilar, and Distal Tumors显示文摘Attila Nakeeb Henry A. Pitt Taylor A. Sohn JoAnn Coleman Ross A. Abrams Steven Piantadosi Ralph H. Hruban Keith D. Lillemoe Charles J. Yeo John L. Cameron 1996Annals of Surgery1996,,4:3
15Outcomes of pancreaticoduodenectomy in elderly patients显示文摘BACKGROUND: Although the mortality and morbidity of pancreaticoduodenectomy(PD) have improved significantly over the past years, the concerns for elderly patients undergoing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly patients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly patients.METHODS: We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age: group I(patients aged <60 years), group II(those aged 60 to 69 years) and group III(those aged ≥70 years). The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival rate.RESULTS: A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579(69.9%) patients in group I, 201(24.3%) in group II, and 48(5.8%) in group III. The overall incidence of complications was higher in elderly patients(25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006). There were more patients complicated with delayed gastric emptying in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital mortality.CONCLUSIONS: PD can be performed safely in selected elderly patients. Advanced age alone should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of associated comorbidities.Ayman El Nakeeb Ehab Atef Ehab El Hanafy Ali Salem Waleed Askar Helmy Ezzat Ahmed Shehta Mohamed Abdel Wahab 2016Hepatobiliary & Pancreatic Diseases International2016,15,4:2
16Left-sided Pancreatectomy: A Multicenter Comparison of Laparoscopic and Open Approaches显示文摘David A. Kooby Theresa Gillespie David Bentrem Attila Nakeeb Max c. Schmidt Nipun B. Merchant Alex A. Parikh Robert C. G. Martin Charles R. Scoggins Syed Ahmad Hong Jin Kim Jaemin Park Fabian Johnston Matthew J. Strouch Alex Menze Jennifer Rymer Rebecca M 2008Annals of Surgery2008,,3:2
17Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes显示文摘C. Max Schmidt Jennifer Choi Emilie S. Powell Constantin T. Yiannoutsos Nicholas J. Zyromski Attila Nakeeb Henry A. Pitt Eric A. Wiebke James A. Madura Keith D. Lillemoe William Jarnagin 2009HPB Surgery2009,,:2
18Cholangiocarcinoma: a spectrum of intrahepatic, perihilar, and distal tumors 显示文摘Nakeeb A Pitt HA Sohn TA 1996Ann Surg1996,224,46:1
19Biliary carcinoembryonic antigen level are a marker for cholangicarcinoma显示文摘 Lipsett PA Lillemoe K 1996Am J Surg1996,171,3:1
20Early detection of anastomotic leakage after elective low anterior resection 显示文摘Fouda E Nakeeb EA Magdy A 2011J Gastrointest Surg2011,15,1:1
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