Gastrointestinal Surgery Unit Research Articles

A single institution experience in the treatment of fistula in ano using diode laser (fistula laser closure): short-term outcomes

Introduction Management of the perianal fistula has been always a challenge for colorectal surgeons especially when the external sphincter is involved. Several minimally invasive procedures emerged as an alternative to the traditional surgical approach as fibrin glue injection, ligation of the intershpincteric track (LIFT) and injection of platelet-rich plasma (PRP). Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and sealing of the fistulous track that depends on the power and the duration of laser light application. Patients and methods This study was carried out on 69 patients with perianal fistula in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period from February 2021 to December 2022. Patients underwent fistula laser closure (FILAC) using a diode laser, radial fibers, wavelength 1470 nm, and 10 watts of power. Results Sixty nine patients underwent fistula laser closure. The success rate was 74%. There was significance between recurrence and posterior position of the fistulous track of the intersphincteric type. Also, there was significance between recurrence and cases who had a caliber track more than 7 mm but there was no significance between recurrence and length of the track. The procedure was associated with minimal postoperative pain, long period of postoperative discharge, short hospital stay, and early return to normal activities. Conclusion Diode laser is a safe minimally invasive and effective procedure for the treatment of straight non branched short track fistula with some considerations as the caliber track should not exceed 7 mm and the posterior intersphincteric fistula should be treated by lay open fistulotomy. The procedure is also associated with less postoperative pain, early return to normal activities, and minimal recurrence rate but high cost remains a limitation.

Outcomes of diode laser haemorrhoidoplasty in treatment of second, third and fourth grades of haemorrhoids. a retrospective study

Introduction Management of hemorrhoidal disease had been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and degeneration that depend on the power and the duration of laser light application. It is also associated with minimal postoperative pain, bleeding, discharge and short hospital stay. Patients and methods This prospective study was carried out on 104 patients with second, third and fourth grades of hemorrhoids in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (18 months, from February 2021 to August 2022). All patients underwent laser hemorrhoidoplasty lasotronix device, bare fibers, wavelength 1470 nm and 8 watts of power. Mucopexy was added in 28 patients with grade 4 hemorrhoids. Results Postoperative pain was evaluated using VAS score, in the first 6 h VAS ranged from 4-9 with mean of 5.81±1.23 SD, after 12 h ranged from 1 to 7 with mean of 4.19±1.70 SD. There was significant relation between the grade of hemorrhoid and postoperative edema (P value was less than 0.001) as all of the 24 patients who developed edema, they were grade 4 hemorrhoids. Also, there was relation between grade 4 hemorrhoid and the development of other postoperative complications but P value was not significant (0.066 in infection and 0.260 in recurrence). There was no incontinence or stenosis in all of the 104 patients and recurrence occurred only in 4 cases (3.8%) and underwent conventional hemorrhoidectomy after six months of follow up. Conclusion Diode laser is a safe minimally invasive procedure for the treatment of second, third and fourth grades of hemorrhoids with less postoperative pain and early return to normal activities but high cost remains the only limitation.

The impact of the COVID-19 pandemic on elective laparoscopic cholecystectomy: A retrospective Cohort study.

The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on elective surgery for benign disease. We examined the effects of COVID-19 related delays on the outcomes of patients undergoing elective laparoscopic cholecystectomy (LC) in an upper gastrointestinal surgery unit in the UK. We have analysed data retrospectively of patients undergoing elective LC between 01/03/2019 to 01/05/2019 and 01/04/2021 to 11/06/2021. Demographics, waiting time to surgery, intra-operative details and outcome data were compared between the two cohorts. Indications for surgery were grouped as inflammatory (acute cholecystitis, gallstone pancreatitis, CBD stone with cholangitis) or non-inflammatory (biliary colic, gallbladder polyps, CBD stone without cholangitis). A p value of <0.05 was used for statistical significance. Out of the 159 patients included, 106 were operated pre-pandemic and 53 during the pandemic recovery phase. Both groups had similar age, gender, ASA-grades and BMI. In the pre-pandemic group, 68 (64.2%) were operated for a non-inflammatory pathology compared to 19 (35.8%) from the recovery phase cohort (p < 0.001). The waiting time to surgery was significantly higher amongst patients operated during the recovery phase (p = 0000.1). Less patients had complete cholecystectomy during the pandemic recovery phase (p = 0.04). There were no differences in intraoperative times and patient outcomes. These results demonstrate the impact of COVID-19 related delays to our cohort, however due to the retrospective nature of this study, the current results need to be backed up by higher evidence in order for strong recommendations to be made.

463. OESOPHAGEAL PERFORATIONS: CAUSES, MANAGEMENT, AND OUTCOMES AT A SPECIALIST UPPER GASTROINTESTINAL UNIT OVER A TEN-YEAR PERIOD

Abstract Perforation of the oesophagus is a relatively rare but life-threatening condition, which requires early laparoscopic or surgical intervention. The aim of this work was to describe the causes, management and outcomes of emergency patients treated at a single high volume upper gastrointestinal specialist unit in the United Kingdom. In this retrospective case series, we identified all patients who presented to a tertiary upper gastrointestinal surgery unit with a spontaneous or iatrogenic oesophageal perforation. Patient demographics, clinical management, and outcomes were identified by hand review of the medical notes. Between March 2011 to July 2020, 58 patients were identified. The median age was 71 years (interquartile range 52 years to 83 years) and 64% were male. A total of 83% of patients had benign perforations, the rest being malignant. Management of all patients was supportive in 41%, endoscopic in 19% and surgical in 40%. In total 63% of spontaneous benign perforations were managed surgically, and only 6% endoscopically. The median length of hospital stay for all patients that survived more than 90 days was 13 days. The 90-day mortality rate for all patients was 42%. Oesophageal perforations are a relatively rare but lethal disease, carrying a mortality. Whilst surgery has historically been the most common management of benign spontaneous perforations, endoscopic treatments are likely to become increasingly common in the future.

Laparoscopic one anastomosis gastric bypass: A revisional procedure for failed laparoscopic sleeve gastrectomy

AbstractBACKGROUNDThe indications for bariatric surgery revision are weight loss failure, complications or weight regain so laparoscopic one anastomosis gastric bypass (LOAGB) is a promising revisional bariatric procedure for failed laparoscopic sleeve gastrectomy (LSG).AIM OF STUDYThe aim was to evaluate LOAGB as a revisional bariatric procedure for failed LSG regarding weight loss, improvement in comorbidities and complications.PATIENTS AND METHODSThis prospective study was carried out at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, between Jan 2018 and June 2019. It included 40 patients who underwent LOAGB as a revisional bariatric procedure for failed LSG.RESULTSThe study population included 32 females and 8 males with a mean age of 28.20 ± 7.22 years. The mean preoperative body mass index (BMI) was 45.54 ± 5.24 kg/m2. The mean operative time was 80.59 ± 35.42 min and the mean postoperative hospital stay was 3.35 days. Neither conversion to open or to other bariatric procedures, nor mortality occurred. Revisional surgery was performed 45 ± 10.5 months after primary LSG Concomitant procedures were cholecystectomy in 4 patients (10%) and re‐sleeve for wide proximal pouch occurred in 15 patients (37.5%). Early complications were encountered in 4 patients (10%), intraluminal bleeding was recorded in 1 patient (2.5%). Late complications included 8 patients (20%). The mean postoperative excess body weight loss percent achieved was 45.23 ± 12.35 at 1 year, 58.85 ± 14.60 at 2 years. The mean BMI achieved was 34.52 ± 4.26 at 1 year, 29.37 ± 6.95 at 2 years.CONCLUSIONLaparoscopic one anastomosis gastric bypass is an easy, safe and effective revisional bariatric procedure for failed LSG producing satisfactory weight loss and improvement or resolution of comorbidities with low perioperative complications.

A Prospective Review of Preoperative Nutritional Status and Its Influence on the Outcome of Abdominal Surgery.

AimTo assess the incidence of malnutrition in a surgical gastroenterology unit and analyze its impact on postoperative complication rates.MethodData were prospectively accrued from patients admitted for emergency or elective surgery to the gastrointestinal surgery unit at Jaslok Hospital between May 2013 and May 2014. The nutritional status was preoperatively assessed by using anthropometric parameters like body mass index (BMI), midarm circumference (MAC), and tissue skinfold thickness (TSFT). In addition, a subjective global assessment scale (SGA), serum albumin, and absolute lymphocyte count (ALC) were used. Patients with BMI <18.5, MAC <24 cm in males and <22 cm in females, and TSFT <10 mm were considered malnourished. Patients with serum albumin between 3 and 3.5 g/dl were considered mild, 2.4-2.9 g/dl was moderate, and <2.4 g/dl were severely malnourished. Patients with ALC between 1200 and 2000/cm were labelled mild, between 800 and 1199/cm were moderate, and <800/cm were severely malnourished. As per SGA, well-nourished had less than 5% weight loss or if more than 5%, with recent gain and improved appetite, mild/moderately malnourished had 5% to 10% weight loss with no gain, mild subcutaneous fat loss, and those severely malnourished had more than 10% weight loss, severe subcutaneous fat loss, and muscle wasting. Postoperative complications were graded as per the Clavien-Dindo classification. Patients with grades 1 and 2 complications were labelled as minor and the rest as major.ResultMen in the age group of 40-60 years comprised the majority of the study population. The most frequent reason for admission was cholelithiasis. The overall incidence of malnutrition was 22.16%. Out of the 96 patients who had complications, 45 had minor and 41 had significant complications. Amongst the well-nourished, the incidence of complications was 26.62% of which the majority were minor complications. Severely malnourished patients had a high complication rate (63.38%); 32% out of the 63.38% developed significant complications. The majority of the patients suffering from severe malnutrition belonged to the sub-group with chronic pancreatitis and carcinoma of the pancreas. According to the chi-square analysis of the data, ALC, serum albumin, and SGA correlate with the postoperative complication rate with a p-value <0.05 as significant. On the contrary, BMI, MAC, and TSFT did not correlate with postoperative complications.ConclusionPreoperative malnutrition is common among patients undergoing abdominal surgeries in the urban private health care sector. Although there have been studies that have analyzed the incidence of malnutrition in patients undergoing oncological surgeries, there is limited literature on malnutrition among patients subjected to gastrointestinal surgeries. We conclude that simple bedside nutritional assessment tools like serum albumin, absolute lymphocyte count, and SGA can accurately identify malnourished patients preoperatively and are good predictors of postoperative complications. Hence, it is imperative to assess and attempt to improve the nutritional status of the patients preoperatively.

EVALUATION OF THE ROLE OF LAPAROSCOPIC TRUNCAL VAGOTOMY AND GASTRO-JEJUNOSTOMY FOR CICATRIZED DUODENAL ULCER:A PROSPECTIVE STUDY

INTRODUCTIONPeptic ulcer affects about 5% of the global population. About 70-90% of patients with gastric ulcer and 80-95% with duodenal ulcers are infected with H. pylori.After the era of proton-pump inhibitor, management of peptic ulcer disease has changed dramaticallyand manifested by early satiety and fullness after meals and repeated vomiting. endoscopic balloon dilatation of pylorus followed by long term H2-receptor antagonists was suggested that surgery could be avoided in up to 80% of the patients,with longer follow up.Over50% will require ulcer surgery within two years of dilatation. In addition, the dilatation carries a risk of perforation rate up to 10%. Balloon dilatation is only reserved for those patients who are too high a risk surgery.AIM OF THE WORKThis study is designed to assess the role of laparoscopic truncal vagotomy and laparoscopic gastro-jujenostomy in the treatment of patient with gastric outlet obstruction due to cicatrized duodenal ulcer.Subjects and methodsAfter approval of local ethics committee, all patients included in the study will be informed about the procedure and will sign an informed written consent before carrying the procedureThis study will be concerned on 15 patients, in the upper gastrointestinal surgery unit, Alexandria main University Hospital presenting with gastric outletobstruction due to cicatrized duodenal ulcer confirmed by upper GI endoscope and C.T gastrography

Eliminating Hospital-Acquired Pressure Injuries Caused by Graduated Compression Stockings.

The purpose of this evidence-based practice project was to reduce the incidence of pressure injuries (PIs) from the use of graduated compression stockings in patients on a gastrointestinal (GI) sarcoma surgery unit. Before this project, the standard of care for preventing deep vein thrombosis (DVT) included the use of graduated compression stockings, anticoagulation therapy, and intermittent pneumatic compression devices. We sought to examine the impact on PI and DVT risk of using only anticoagulation therapy and intermittent pneumatic compression devices. The pilot phase of the project began in June 2017 when nurses on the GI sarcoma surgery unit initiated a practice change in which graduated compression stockings were removed during the 7 AM shift change and put back on the patient before bedtime. Data on the incidence of DVTs and PIs were already being collected in our institution's electronic health record and safety intelligence reporting system. The project team monitored the incidence of PIs and DVTs throughout the project. After the pilot project concluded in August 2017, the GI sarcoma surgery unit staff continued the practice of taking off graduated compression stockings during the day, until on June 2018 the use of graduated compression stockings was formally discontinued for all surgical patients, both during the day and night. Data collected during the pilot phase revealed that no PIs or DVTs occurred among the 497 study patients on the GI sarcoma surgery unit. From June to October 2017, the unit cared for a total of 856 patients and PI and DVT rates remained at zero. From the start of the pilot project in June 2017 to October 2018 (five months after the discontinuation of graduated compression stockings on all surgical units) the unit cared for 3,141 patients-an average of 174 patients per month-and had a zero rate of PIs and DVTs. We found that the use of graduated compression stockings confers more risks than benefits for patients. Our findings prompted the discontinuation of graduated compression stockings use in postoperative patients throughout our institution. In the 17 months after the pilot project was initiated, no PIs occurred among patients in the GI sarcoma surgery unit, which also maintained a zero rate of DVTs.

Laparoscopic one anastomosis gastric bypass: a revisional procedure for failed open vertical banded gastroplasty in treatment of morbid obesity: a prospective study

Background The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications, so laparoscopic one anastomosis gastric bypass (LOAGB) is a promising bariatric procedure used as a revisional procedure for failed open vertical banded gastroplasty (VBG). Aim The aim was to evaluate LOAGB as a revisional bariatric procedure for failed open VBG regarding technical feasibility, weight loss, improvement in comorbidities, and complications. Patients and methods This prospective cohort study was carried out at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, between October 2017 and October 2018. It included 20 patients who underwent LOAGB as a revisional bariatric procedure for failed open VBG. Results The study population included 17 females and three males, with a mean age of 38.25±5.36 years. The mean preoperative BMI was 48.15±4.35 kg/m2. The mean operative time was 145.36±25.19 min, and the mean postoperative hospital stay was 3.12 days. Neither conversion to open technique or to other bariatric procedures nor mortality occurred. Early complications were encountered in 3 patients (15%). Late complications included four (20%) patients. Severe biliary gastritis occurred in one (5%) patient, who was managed by side-to-side jejunojejunostomy. The mean postoperative excess body weight loss percent (EBWL%) achieved was 47.14±15.24 at 1 year and 60.85±12.17 at 2 years. The mean BMI achieved was 32.72±5.46 at 1 year and 28.14±4.45 at 2 years. Conclusion LOAGB surgery as a revisional procedure for failed open VBG is an effective bariatric surgical procedure producing significant weight loss and resolution or improvement of comorbidities with low perioperative complications.

Short-term outcomes of laparoscopic sleeve gastrectomy for super-obese egyptian patients − a single-center experience

Background Owing to its simplicity, low morbidity and mortality, and efficacy in achieving sustained weight loss, laparoscopic sleeve gastrectomy (LSG) became increasingly popular as a primary procedure. Aim To report short-term outcomes of LSG in super-obese (SO) Egyptian patients with BMI more than 50–60, taking in consideration, the safety, feasibility, and efficacy of the technique. Patients and methods This was a prospective study performed on 50 SO patients in the Gastrointestinal Surgery Unit, Department of General Surgery, Tanta University Hospital, during the period from January 2017 to January 2019. The patients’ characteristics, including preoperative weight, BMI, preoperative comorbidities, postoperative complications, the resolution of comorbidities, and percentage of excess weight loss, at different follow-up periods were prospectively analyzed. Results A total of 50 SO patients were subjected to LSG in our department during the study period. Mean patients’ BMI was 53.42±2.95 kg/m2 (range, 50–60 kg/m2). Mean age was 34.58±9.93 years, with 12 males and 38 females. Mean operative time was 76.66±14.94 min. Mean percentage of excess weight loss achieved was 22.25±3.20, 35.07±5.67, 47.89±8.57, 57.80±7.65, 59.08±13.01, and 55.11±8.93 at 1, 3, 6, 12, 24, 48, and 36 months, respectively. There was no mortality, whereas total morbidity occurred in 15 patients. Conclusion In SO patients, LSG is a safe and feasible technique and is associated with acceptable and satisfactory weight loss results; moreover, there is improvement of obesity-related comorbidities on short-term follow-up.

Five-year outcomes of laparoscopic sleeve gastrectomy in the treatment of morbid obesity: a retrospective analysis

Background Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical technique that is gaining popularity among bariatric surgeons owing to its surgical simplicity with encouraging results. Aim A retrospective analysis of 5-year outcomes of LSG performed for treatment of morbid obesity was done regarding weight loss, improvement in comorbidities, complications, and quality of life. Patient and methods LSG was performed for the treatment of morbid obesity between May 2012 and January 2015 on 200 patients who completed 5-year follow-up postoperatively at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, Egypt. Results The study population included 165 females and 35 males, with a mean age of 30.17±8.90 years. The mean preoperative BMI was 51.76±7.36 kg/m2. The mean operative time was 90.83±29.43 min, and the mean postoperative hospital stay was 3.54 days. Conversion to open surgery occurred in one (0.5%) case. Early complications were encountered in 15 (7.5%) patients. Staple line leakage at the gastroesophageal junction was recorded in two (1%) cases detected by gastrografin study on the fifth postoperative day. Late complications included 20/199 (10.1%) patients. The mean postoperative excess body weight loss percent achieved was 59.47±15.20 at 1 year, 66.45±13.8 at 2 years, 70.09±14.3 at 3 years, 65.72±10.14 at 4 years, and 60.20±11.25 at 5 years, The mean BMI achieved was 35.40±5.81 at 1 year, 31.60±5.41 at 2 years, 28.20±7.25 at 3 years, 30.48±6.71 at 4 years, and 34.20±5.45 at 5 years. Conclusion LSG surgery is an easy, safe, and effective bariatric surgical procedure producing significant weight loss, resolution or improvement of comorbidities, and improvement of quality of life with low perioperative complications.

Ilioinguinal nerve preservation vs prophylactic neurectomy in Lichtenstein tension-free mesh hernioplasty of inguinal hernia: a prospective comparative study

Introduction Chronic groin pain is a significant morbidity following open mesh hernioplasty for inguinal hernia. Although the pain is often mild in nature, different studies have shown that chronic pain, irrespective of severity, can significantly interfere with normal daily activities. Identification and division of the ilioinguinal nerve (IIN) can reduce chronic postoperative inguinal pain as suggested by many authors, yet controversies persist. Patients and methods This prospective study was carried out on 240 patients with primary inguinal hernias categorized into two equal groups. Group A patients underwent prophylactic ilioinguinal neurectomy, whereas nerve preservation was done in group B patients during Lichtenstein tension-free mesh hernioplasty for inguinal hernia in the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (24 months, from January 2017 to December 2018). Follow-up of postoperative groin pain was done on first postoperative day, seventh postoperative day, and after 1, 3, and 6 months using visual analog scale. Results The difference between both groups regarding postoperative pain after 6 months at rest was statistically insignificant. However, after minor exercises like coughing 10 times, walking up three flights of stairs, or cycling for 10 min, there was a statistically significant difference, as no pain occurred in group A patients, whereas 30% of group B patients experienced pain (P 0.05). Conclusion Prophylactic ilioinguinal neurectomy may be beneficial in minimizing inguinal neuralgia after mesh hernioplasty of inguinal hernia.

Management of Inflammatory Pancreatic Fluid Collections and Walled-off Pancreatic Necrosis: A Retrospective Study Over Five Years

Background and objective: Acute pancreatitis (AP) is an inflammatory process of the pancreas, with variable involvement of peri-pancreatic tissues and remote organ systems. In this study we discuss surgical and conservative management of acute pancreatitis and its local complication. Methods: This retrospective study was carried out on 128 patients, who were admitted to Gastrointestinal Surgery Unit, Main Alexandria University Hospital, Alexandria University, and who were complaining of acute pancreatitis with fluid collections and sequels (PP, ANC and walled-off pancreatic necrosis (WOPN). Medical information was retrieved retrospectively from patient’s files recorded in Main Alexandria University Hospital and from computerized data system in Gastrointestinal Surgery Department, between October 2013 – October 2018. Results: Forty-five patients with acute edematous pancreatitis with free collection were managed conservatively successfully. Thirty-two patients with PP underwent drainage, endoscopic (n=17), or open (n=15) approach. Twentythree patients with WON underwent drainage and debridement whether by open (n=11), endoscopic (n=9), or PCD (n=3) approaches. Twenty-eight patients with necrotizing pancreatitis, 16 patients were managed conservatively, 12 patients needed intervention either, PCD (n=9) or open surgical necrosectomy (n=3). Conclusions: The operative management of acute pancreatitis is focused on managing the acute complications, and the long-term sequelae. However, the evolution of videoscopic and endoscopic techniques have greatly expanded the tools available.

Quality of Life Following Surgical Treatment of Post Cholecystectomy Bile Duct Injury.

The Roux-en-Y hepaticojejunostomy surgery provides the mainstay of treatment in cases of bile duct injury following cholecystectomy.The aim of this study is to assess the quality of life in patients who underwent surgical repair of bile duct injury following cholecystectomy. The prospective cross sectional study was conducted in Gastrointestinal Surgery Unit, Bir Hospital, National Academy of Medical Sciences. The cases of bile duct injury following cholecystectomy who underwent surgical repair from April 2013 to March 2018 were included. The data collection was done using SF-36 quality of life questionnaire tool.The study was conducted after ethical clearance from Institutional Review Board of National Academy of Medical Sciences. There were 26 cases of referred bile duct injury admitted in gastrointestinal surgery department from 2013 April till 2018 March out of which 19 (73%) were included in the study.More than half of the patients had limitations in carrying out vigorous activities (as running or lifting heavy objects) and 5.2% had a lot of limitations in carrying our moderate activities (as moving a table).63.1% of the patients did not have any interference with social activities with family, friends, neighbors or social groups because of their physical health or emotional problems. The surgical repair of bile duct injury following laparoscopic cholecystectomy has an impact on ability to perform work or daily activities as a result of physical health. However, it has little impact on patient's perception of general health and social activities.

Outcomes of laparoscopic one-anastomosis gastric bypass in treatment of morbid obesity: a retrospective analysis

Background Laparoscopic one-anastomosis gastric bypass (OAGB) is a promising bariatric procedure with multiple apparent benefits. However, concerns have been expressed about reported complication rates and the extent of follow-up, with recommendations to establish a registry of complications and revisional procedures. Aim of study To retrospectively analyze outcomes of OAGB performed for treatment of morbid obesity regarding weight loss, improvement in comorbid conditions, complications, and quality of life. Patients and methods OAGB was performed for the treatment of morbid obesity in 60 patients, and they completed at least 1 year of follow-up postoperatively at the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University, Egypt. Results The study population included 60 patients, with a mean age of 33.52±8 years. The mean preoperative;Deg;BM;Deg;I was 53.29±6.91 kg/m2. Early complications were encountered in eight (13.3%) patients. Late complications occurred in 21 (35%) patients: nutritional sequelae developed in eight (13.4%) patients, four (6.7%) patients developed gall stones, gastritis owing to biliary reflux occurred in eight (13.4%) patients, and severe malnutrition developed in one (1.7%) patient. Preoperative obesity-related comorbidities were hypertension in 11 cases and diabetes mellitus in seven cases. The mean;Deg;BM;Deg;I 24 months after surgery was 34.14±4.17 kg/m2. Most of the comorbidities improved or resolved; 81.8% for hypertension and 85.6% for diabetes mellitus. Conclusion OAGB surgery is an easy, safe, and effective bariatric surgical technique for the treatment of morbidly obese patients producing significant weight loss, resolution or improvement of comorbidities, and improvement of patient quality of life. Strict postoperative follow-up with surveillance for vitamins, protein, and minerals deficiencies is essential, and endoscopic examination when indicated is recommended.

Comparative Study Between Appendiceal Base Ligation with Hand-Made Endoloop Knot Pusher Versus Standard Endoloop in Laparoscopic Appendectomy

AbstractBackground: Using hand-made (endoloop and knot pusher) technique has the same reliability of the other methods in appendiceal base ligation in addition to the significant lower cost in comparison with standard endoloop.Aim of Study: Is to compare between appendiceal base ligation with hand-made Endoloop knot pusher versus standard endoloop in laparoscopic appendectomy.Patients and Methods: This prospective randomized comparative study was carried out in Gastrointestinal, Liver & Laparoscopic Surgery unit of Tanta University Hospitals from May 2017 till May 2018 on 40 patients with acute appendicitis divided into two equal groups; Group I: Were subjected to ligation of the base of the appendix with standard endoloop (commercial) in laparoscopic appendectomy (20 cases). Group II: Were subjected to ligation of the base of the appendix with hand-made endoloop knot pusher in laparoscopic appendectomy (20 cases).Results: The mean age of group I was 29±5.10 years, compared to 29.33±5.39 in-group II, there were 12 males and 8 females in group I, while there were 10 males and 10 females in group II. Statistically significant difference was present in operative time between both groups; group I had operative time mean of 46.07±11.70 minutes compared to 54.73±11.33 minutes in-group II. A highly statistically significant difference in appendiceal base ligation cost between both groups; group I with Mean 69.10±10.41 USD compared to 7.75±1.77 USD in group II. Superficial wound infection developed in one patient in group I and two patients in group II, also each group had only one patient with postoperative ileus, only one patient in group II developed postoperative abscess in the RIF.Conclusion: Using hand-made endoloop knot pusher technique and standard endoloop were proved safe, as both were not associated with major morbidity. Complications rate, hospital stay were average with other studies, Using hand-made endoloop knot pusher technique has significant lower cost in comparison with standard endoloop as it is reusable. However, hand-made endoloop knot pusher technique consuming a longer operative time.

Colorectal Cancer in Young Age Group: Where Do We Stand?

Colorectal cancers in young are in increasing trend. Young patients tend to ignore symptoms and present at advanced stage due to aggressive tumour biology, and also due to traditional dictum of routine screening after &gt;50 years these groups of patients are given less priority. The objective of our study was to estimate the burden of problem among young population and increase awareness among medical personnel and general population of early detection for disease. We conducted retrospective cross sectional study using whole sampling method among patients operated by single gastrointestinal surgery unit. Demographic details, malignancy information, surgical procedure and histopathological examination were studied. All cases admitted as colorectal cancer from 2013 to 2017 at gastrointestinal surgery unit of Shree Birendra Hospital were included. The collected data were entered in SPSS version 16 and analyzed. Likelihood of occurrence of adenocarcinoma was studied using logistic regression model. Among total 104 cases operated, only 99 cases were having complete data with median age: 55 years. Thirty seven percent of the individuals having colorectal malignancies were younger than 50 years. Rectum was the commonest site (52, 52.5%) for occurrence of colorectal malignancy. Males were 1.493 (0.402-5.545) times more likely to have colorectal adenocarcinoma than females. Young age (&lt;50 years) was associated with an increased likelihood of colorectal adenocarcinoma {OR=1.771(0.443-7.233)} than older people. Colorectal cancer in young age is in increasing trends. Increasing awareness among medical personnel and general population is must for early detection.

A Comparison Between the Comprehensive Complication Index and the Clavien-Dindo Grading as a Measure of Postoperative Outcome in Patients Undergoing Gastrointestinal Surgery—A Prospective Study

BackgroundThe Clavien-Dindo (CD) grading system reports the most severe of all the postoperative complications. The comprehensive complication index (CCI) sums up all the complications in postoperative period. We compared the CCI and CD to assess which of the two was a better measure of postoperative outcomes. Materials and methodsBetween June 2015 and December 2016, we recorded the complications using CD grading and CCI in 1000 consecutive patients in our gastrointestinal and hepatopancreaticobiliary surgery unit. The outcome variables studied were postoperative length of hospital stay (LOS), postoperative intensive care unit (ICU) stay, and time to normal activity. The results were expressed as strength of correlation and predictive accuracy of the outcome variables. ResultsThere were 600 males and 400 female patients, with a mean age of 50.3 y. A total of 788 (78.8%) elective and 212(21.2%) emergency procedures were performed. The overall 90-day/in-hospital mortality was 7.9%. Both CD and CCI showed a good correlation with LOS (r = 0.58; P = 0.001, r = 0.57; P = 0.001), ICU stay (r = 0.62; P = 0.002, r = 0.62; P = 0.001), and time to normal activity (r = 0.48; P = 0.01; r = 0.49; P = 0.01). The accuracy of CCI to predict the LOS (area under the curve [AUC] = 0.89; P < 0.001), ICU stay (AUC = 0.85; P < 0.001), and time to normal activity (AUC = 0.76; P < 0.001) was comparable to that of CD (AUC = 0.90; P < 0.001, AUC = 0.87; P < 0.001, AUC = 0.77; P < 0.001). ConclusionsBoth CD and CCI were equally accurate in measuring the postoperative outcomes and in their ability to predict the same in patients undergoing gastrointestinal and hepatopancreaticobiliary surgeries. Considering the relative ease of determination of CD, it remains a more commonly used measure for assessing the severity of complications and outcomes compared to CCI.

Mid-term and long-term follow-up of restrictive gastric operations in morbid obese patients

Background Obesity is now recognized as the most prevalent metabolic disease worldwide. Bariatric and metabolic surgeries have grown in popularity in recent years with lower risks and better long-term results. Aim The aim of this study was to evaluate mid-term and long-term efficacy and adverse effects of restrictive gastric operations in morbid obese patients. Patients and methods Retrospective study that was conducted from April 2015 to October 2015 at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospital, on morbidly obese patients who were offered one of the restrictive antiobesity procedures since 2 years or more and were coming in for follow-up or redo surgery because of weight regain. Results This study included 50 obese patients, with 46 females and four males. The mean time elapsed after the restrictive surgery was 48.64±32.37 months. The mean preoperative weight of our patients was 144.5±22.96 kg, whereas the mean weight at the time of the study was 99.28±21.44 kg. The achieved weight loss produced beneficial effects on the associated comorbidities. Endoscopic examination of the patients submitted to sleeve gastrectomy (n=38 patients) revealed gastritis and gastric erosions in 11 cases and dilated pouch in five cases, whereas those of vertical banded gastroplasty (VBG) (n=10 patients) revealed staple line disruption in seven cases and pouchitis in one case. In the two cases of gastric plication, one case showed dilated pouch and the other case showed esophagitis. Barium study of the patients submitted to sleeve gastrectomy (n=38 patients) revealed normal sleeve pouch in 30 cases, dilated pouch in five cases, and retained fundus in two cases, whereas those of VBG (n=10 patients) revealed no abnormality in three cases and staple line disruption in seven cases. Conclusion VBG operation is not very effective in maintaining weight loss in long-term follow-up. Sleeve gastrectomy operation is effective in maintaining weight loss in mid-term follow-up in most cases.

Evaluation of Laparoscopic Combined Sleeve Gastrectomy and Mini-Gastric Bypass in Treatment of Morbid Obesity

AbstractBackground: Combined sleeve gastrectomy and MGB is a modified bariatric procedure composed of the standard procedures of sleeve gastrectomy and MGB that can be performed by laparoscopic technique. This combined procedure is still a novel technique with assumed beneficial effects based on the theory and former experiences with both techniques individually.Aim of Study: Assessment of the efficacy of combined sleeve gastrectomy and MGB in treatment of morbidly obese patient as regard weight reduction and control of co-morbidities.Patient and Methods: From January 2016 to January 2018, laparoscopic combined sleeve gastrectomy and MGB was performed in 20 patients at the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University, Egypt.Results: The study population included 18 females and 2 males with a mean age of 33.13±7 years. The mean pre-operative Body Mass Index (BMI) was 54. 13±60kg/m2. All procedures were completed laparoscopically. Comorbidities: The mean operative time was 153±27.7 minutes and the mean postoperative hospital stay was 6.1±5.8 days. Early compli-cations were encountered in 4 cases (20%) including 3 port site infections (15%), stable line leakage 5 days after operation was recorded in 1 case (5%). Late complications included 6 cases (30%). Pre-operative obesity related co morbidities; hypertension in 2 cases, diabetes mellitus in 3 cases, Dyslip-idaemia in 4 cases and arthrealgia in 7 cases. The mean BMI 18 months after surgery was 29.23±3.4kg/m2, and the EWL% ranged between 51.45% and 98.2% with a mean of 80.68±10.55 18 months after operation. Most of the co-morbidities improved or resolved; 100% for hypertension and diabetes mellitus, 75% for dyslipidemia and 71.4% for artheralgia.Conclusion: Despite the short duration of follow-up for most of the patients, combined SG and MGB can be considered an effective surgical procedure for treatment of morbid obesity in terms of weight reduction and control of co-morbidities. A higher cost is expected for this procedure due to the larger number of cartridges used. Like other bariatric procedures, this novel procedure was attended with post-operative complications mainly staple line leakage, biliary reflux, stomal ulcer, nutritional deficiencies and symptomatic gallbladder stones.