Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience

Ashraf Imam,Harbi Khalayleh,Guy Pines,Deeb Khoury,Eli Mavor,Arie Pelta 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.2

Purpose: This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure). Methods: The records of all the patients who underwent pilonidal sinus excision between November 2013 and August 2017 were reviewed. Inclusion criteria included either pilonidal pits excision or the Bascom cleft lift procedure. All procedures were performed by a single surgeon. Perioperative complications and recurrence rates were reviewed. Results: Fifty-three patients met the inclusion criteria. Male/female ratio was 36/17, with a mean age of 23.4 ± 7 years. In this study, 21 patients underwent the Bascom cleft lift (skin flap) procedure and 32 underwent the Gips-style operation. The mean follow-up was 3.5 months. Twenty-eight patients (52.8%) underwent prior drainage of pilonidal abscess. Eleven patients had a previous wide local excision with recurrent disease. A higher rate of recurrence was observed among patients who underwent pits picking following failure of a previous wide local excision (80% vs. 0%, P = 0.02). Minor wound dehiscence developed in 8 patients; all of which were in the Bascom flap group (40% vs. 0%, P < 0.005). All of these wounds healed completely between 3 and 6 weeks. Conclusion: The Gips procedure is the recommended treatment for simple pilonidal disease. For recurrent pilonidal disease, the Bascom cleft lift (flap) procedure is an excellent option since it demonstrates a short wound healing time and a good success rate. This calls into question the continued use of the wide excision technique used by most surgeons in this country and abroad.

Laparoscopic cystectomy for pancreatic echinococcosis

Ashraf Imam,Tawfik Khoury,Dani Weis,Harbi Khalayleh,Muhammad Adeleh,Abed Khalaileh 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.1

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with the Echinococcus granulosus tapeworm. Following ingestion of eggs, hydatid cysts develop, most frequently in the liver and lungs, but occasionally in other organs. Infection of the pancreas by hydatid cysts is very rare, even in endemic areas. Most cases of pancreatic hydatid cysts reported in the literature were treated surgically using traditional open laparotomy. There are only few case reports describing laparoscopic treatment for this disease. Herein, we report on an eighteen-year-old female patient who was referred to our institution with a hydated pancreatic tail cyst. After a course of treatment with Albendazole, we successfully performed laparoscopic splenic-sparing distal pancreatectomy to remove the cyst with an uneventful intra- and post-operative course.

The effect of atrophied pancreas as shown in the preoperative imaging on the leakage rate after pancreaticoduodenectomy

Ashraf Imam,Harbi Khalayleh,Meni Brakha,Ariel A. Benson,Naama Lev-Cohain,Gidon Zamir,Abed Khalaileh 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.2

Backgrounds/Aims: The soft texture of the pancreas parenchyma may influence the incidence of pancreatic leakage after pancreaticoduodenectomy (PD). One possible method to assess pancreatic texture and atrophy, is via computed tomography (CT) scan of the abdomen. The purpose of our study was to evaluate the relation between the preoperative CT scan and the incidence of pancreatic fistula after PD. Methods: A retrospective single-center study including patients who underwent PD for a benign and malignant tumor of the periampullary region between the years 2000 and 2016. Demographic and imaging data were analysed and a correlation with the post-operative leak was evaluated. Results: Pancreatic leak was documented in 34 out of 154 (22.1%) patients. All the leakage cases occurred in the preserved pancreas group (33.1% of the total preserved pancreas group alone). No leak was documented in the atrophic pancreas group. This difference between the two groups was found to be statistically significant (p ≤ 0.00001). Conclusions: Atrophic pancreas in the preoperative CT scan may be protective against leakage after PD. These findings may help the surgeon to risk stratify patients accordingly. In addition, the findings suggest that patients with a preserved pancreas may require more protective methods to prevent leakage.

Rupture of an Idiopathic Aneurysm of the Inferior Pancreaticoduodenal Artery Leading to an Intra-Abdominal Bleeding

Riham Imam,Harbi Khalayleh,Deeb Khoury,Guy Lin,Ashraf Imam 대한외상중환자외과학회 2020 Journal of Acute Care Surgery Vol.10 No.1

Aneurysm of the pancreaticoduodenal artery is a rare finding that can be divided into true and false aneurysm. True aneurysm of the pancreaticoduodenal artery is more common and is usually due to atherosclerosis or celiac stenosis. Herein we present a rare case of a 59-year-old male patient with a spontaneous rupture of an idiopathic aneurysm of the inferior pancreaticoduodenal artery who was successfully treated with angiographic coil embolization

An analysis of 77 cases of pancreatic injuries at a level one trauma center: Outcomes of conservative and surgical treatments

Harbi Khalayleh,Ashraf Imam,Oded Cohen-Arazi,Pikkel Yoav,Brigitte Helou,Bala Miklosh,Alon J. Pikarsky,Abed Khalaileh 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.2

Backgrounds/Aims: Traumatic pancreatic injury (TPI) is rare as an isolated injury. There is a trend to perform conservative treatment even in patients with complete duct dissection and successful treatment. This study reviewed our 20 years of experience in the management of TPI and assessed patient outcomes according to age group and treatment strategy. Methods: A retrospective analysis of patients diagnosed and treated with TPI at a level-I trauma center from 2000–2019. Patients were divided into two groups: adults and pediatrics. Conservative treatment cases were subjected to subgroup analysis. Level of evidence: IV. Results: Of a total of 77 patients, the mean age was 24.89 ± 15.88 years. Fifty-six (72.7%) patients had blunt trauma with motor vehicle accident. Blunt trauma was the predominant mechanism in 42 (54.5%) patients. Overall, 38 (49.4%) cases had grade I or II injury, 24 (31.2%) had grade III injury, and 15 (19.5%) had grade IV injury. A total of 30 cases had non-operative management (NOM). Successful NOM was observed in 16 (20.8%) cases, including eight (32.0%) pediatric cases and eight (15.4%) adult cases. Higher American association for the surgery of trauma (AAST) grade of injury was associated with NOM failure (16.7% for grade I/II, 100% for grade III, and 66.7% for grade IV injury; p = 0.001). An independent factor for NOM failure was female sex (69.2% in females vs. 29.4% in males; p = 0.03). Conclusions: High AAST grade TPI is associated with a high rate of NOM failure in both pediatric and adults.

Cost Behaviors and Cost Structure of Public Hospitals in India: Analysis from the Perspective of Congestion Costs

Nidhish Kumar MISHRA,Ijaz ALI,Nabil Ahmed Mareai SENAN,Moin UDDIN,Asif BAIG,Asma KHATOON,Ashraf IMAM,Imran Ahmad KHAN 한국유통과학회 2022 The Journal of Asian Finance, Economics and Busine Vol.9 No.4

The goal of this study is to understand better the relationship between hospital bed occupancy rate and cost rigidity as a proxy for the degree of hospital bed congestion, as well as the relationship between the risk of changes in hospital bed occupancy rate and congestion cost, targeting public hospitals. As public hospitals for analysis, we selected hospital projects from the Public Enterprises Survey Reports published by the Department of Public Enterprises, Ministry of Finance, and obtained unbalanced panel data consisting of 1,505 hospitals and 15 years, totaling 12,595 hospitals and years. The analysis revealed that the risk of changes in the bed occupancy rate increases the degree of cost rigidity and leads to a decrease in the variable cost ratio; furthermore, an increase in the bed occupancy rate decreases the degree of cost rigidity and leads to an increase in the variable cost ratio. These findings suggest that although public hospitals are taking managerial actions to avoid congestion costs, congestion costs resulting from higher bed occupancy rates have not been eliminated. The regression analysis results show that even if congestion costs arise as the occupancy rate increases, they are covered by the increase in revenue associated with the increase in the occupancy rate.

The Effect of Departmental Accounting Practices on Organizational Performance: Empirical Evidence from the Hospital Sector in India

Nidhish Kumar MISHRA,Ijaz ALI,Nabil Ahmed Mareai SENAN,Moin UDDIN,Asif BAIG,Asma KHATOON,Ashraf IMAM,Imran Ahmad KHAN 한국유통과학회 2022 The Journal of Asian Finance, Economics and Busine Vol.9 No.4

Using data from a departmental profit and loss management questionnaire survey conducted for a group of hospitals consisting of various establishment entities, this study evaluates the effectiveness of departmental profit and loss management practices, such as break-even analysis, based on objective performance data. The study also examines whether the implementation of departmental profit and loss accounting is still effective in improving profitability in the financial year 2021 and whether the effectiveness of the implementation of departmental profit and loss accounting is robust. This study reconfirmed that the implementation of departmental profit-and-loss accounting has a positive effect on objective financial performance in hospitals and that the effect of improving profitability can be enhanced by implementing it monthly with high frequency and regularity and by using the accounting results more actively. It was also found that the department’s implementation of break-even analysis had a positive impact on financial performance, which was enhanced by more active use of the data. Given the current economic climate, a hospital organization’s active participation in income statement management, not only for the hospital as a whole but also for each department, would be an effective management activity.