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Background: Failure of adequate weight loss or weight regain has been reported after laparoscopic greater curve plication (LGCP). The primary aim of this retrospective study is to analyze weight lo...

Surgical therapy for post-bariatric surgery complications is associated with significant morbidity and mortality. Endoscopic options like primarily endoscopically placed fully covered self-expandable metallic stents (SEMS) offer significant benefits for the management of leaks and obstructions or stenosis, and even in case of mega stent failure, further endoscopic techniques could resolve the situation. We conducted a single-centre retrospective study on patients with leakage and stenosis/obstruction after bariatric surgery who were managed primarily by SEMS between January 2015 and January 2019. Clinical success rate was evaluated in terms of the cure of the reason for stenting, the need for other interventions, and the presentation of stent-related complications. There were 58 patients included, (50 with leak, 8 with stenosis/obstruction following bariatric surgery). Mean time to stent placement was 6.82 (±1.64) days for the leak group and 35 (±21.13) days for the stenosis group (p = 0.019). Successful outcomes with SEMS alone were achieved in 42 (72.41%) patients, while 16 patients had failed SEMS treatment, of whom 14 were successfully managed by endoscopic procedures while two cases needed surgical intervention. Of the SEMS-related complications encountered, 25.86% were ulcers; 24.13%, vomiting; 22.41%, gastroesophageal reflux disease (GerdQ≥8); 18.96%, stent migration; and 5.17%, stent intolerance. A mega stent is an effective and safe tool for the early management of post-bariatric surgery leakage and stenosis, and it is associated with acceptable rates of failure that can be managed by further endoscopic techniques in most of the patients.

Several factors including preoperative stomach capacity and sleeve volume impact weight loss after laparoscopic sleeve gastrectomy (LSG). We aimed at measuring these volumes using multidetector computed tomography (MDCT) gastrography and correlating them with postoperative weight losses. Morbidly obese patients prepared for LSG during 2018 were included in the study. MDCT gastrography was performed 1 week before, 6 and 12 months after LSG. Preoperative gastric volume and postoperative sleeve volumes were measured. Correlation with preoperative BMI and postoperative %TWL was performed. The change in sleeve volume at 6 and 12 months was assessed. A total of 98 patients (62 F) were included. Mean preoperative BMI was47 ± 7 kg/m2. Follow-up was achieved in 89 patients (91%) and 82 patients (83%) at 6 and 12 months, respectively. Mean %TWL was 24 ± 3 and 32.8 ± 3 at 6 and 12 months, respectively (p

Background: This study aims to evaluate the incidence of subclinical hypothyroidism (SCH) among studied obese patients. The effects of laparoscopic sleeve gastrectomy (LSG) and loss of weight on th...

Laparoscopic gastric greater curvature plication (LGGCP) is a novel bariatric procedure. Its outcome as a standalone procedure has been studied in the literature. We herein describe a comparative study between LGGCP versus laparoscopic sleeve gastrectomy (LSG). The objective of this study was to analyze %excess weight loss (%EWL), co-morbidity improvement and complication rate in both groups at 1, 3, 6, 12 months follow-up.Retrospective study of 140 patients undergoing LGGCP and LSG between July 2011 and March 2012 at University of Alexandria, Egypt. Data on patient demography, operative time, length of stay, body mass index (BMI) were collected.Baseline characteristics were similar for both groups, except for preoperative BMI that was higher among the LSG group. Follow up rate was 98% (n = LGCCP: 68 - LSG: 69) at 6 months and 81% (n = LGGCP: 54 - LSG: 60) at 1 year. The mean operative time and mean length of stay were longer in the LSG group (P = .03) and (P = .02), respectively. There were 4 (6.5%) readmissions and 2 (3.2%) reoperations in the LGGCP group compared to 3 (3.8%) readmission and 2 (2.6%) reoperations in the LSG group. At 6 months follow-up the mean %EWL for LGGCP and LSG was 40.4±11.9% and 47.1±13.9% (P.001), while at 1 year it was 52.1±15.1% and 68.1±15.8% (P.001), respectively. Both techniques showed similar results in co-morbidity improvement at 1 year.In the short term, both techniques were comparable as regards to co-morbidity resolution. However, LSG appears to have achieved a higher weight loss.

Background: The aim of this study was to describe the clinical presentation and out- comes of treatment in patients who develop gastrointestinal leaks after different bariatric surgeries. Methods: Retrospective review of 632 consecutive bariatric surgical procedures performed from 1999-2009 in Alexandria University Hospital, Egypt. Results: Leakage occurred in 10 patients. Symptoms and signs included tachycardia, fever, tachyp- nea, left shoulder pain, abdominal pain, chest pain, and/or change in the nature of the drain efflu- ent. The earliest signs of presentation were tachycardia and unilateral decrease in air entry in all patients. The average time to diagnosis was 3.9 ± 2.6 days. In four patients contrast study was neg- ative (40%). Six leaks occurred after laparoscopic sleeve gastrectomy (6.3%), 2 after laparoscopic gastric bypass (3.6%), one after open gastric bypass (2.3%), and 1 after laparoscopic vertical banded gastroplasty (2.4%). The most common leak location was at the esophagogastric junction (70%). Four patients (40%) required reoperations. A percutaneous abdominal drainage was placed in five patients (50%). In 2 patients (20%), the prophylactic drain was maintained in situ till cessa- tion of leakage. Two patients (20%) died. Mean hospital length of stay was 13.9 ± 7.8 days. Conclusions: Tachycardia and unequal breath sound in the early postoperative course are worrisome signs that warrant laparoscopic exploration even if contrast studies were negative. Patients with signs of sepsis or hemodynamic instability require emergent exploration. Leaks that are more insidious may be treated successfully with percutaneous drainage or maintenance of prophylactic drains. a 2012 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. All rights reserved.

Background: Varicocele is an abnormal dilation of the pampiniform plexus that constitutes the primary drainage of the testis. It is found approximately in 15% of male adolescents with a left sided predominance. Laparoscopic varicocelectomy has been proposed as an alternative surgical procedure for the repair of varicocele with reported benefits of better convalescence, minimal invasiveness and less analgesic requirement postoperatively Patients and methods: The study was done in ElFayoum UniversityHospitalfromNovember 2011 till November 2012 and it included twenty cases with varicocele. The patients were divided into two groups: The first group (10 patients) was subjected to laparoscopic staple interruption for treatment of varicocele with cutting the gonadal vein or veins in between the clips, the second group (10 patients) was subjected to laparoscopic staple interruption for treatment of varicocele without cutting inbetween the clips. Results: All the procedures in the two groups were completed satisfactorily, with no intraoperative complications. No significant difference was found in the operative time between the two groups (25.5±3.12minutes and 26.2±4.23 minutes for group I and II respectively) (p=0.889). Most patients in the two groups had moderate pain, with no significant difference between the two groups (p=0.801). The hospital stay was not significantly different among the patients of the two study groups (1.7±0.82 days in group I and 1.5±0.68 days in group II) (p=0.870). There were no post operative complications, only one patient in the 2nd group experienced recurrence symptoms of varicocele. Conclusion: In conclusion, laparoscopic staple interruption for treatment of varicocele without cutting inbetween the clips is more superior to traditional laparoscopic staple interruption with cutting the gonadal vein or veins inbetween the clips for treatment of varicocele regarding the lower risk to cut the vas deference or spermatic artery. The spermatic count was the same as well as the spermatic motility and abnormal forms.

Intussusception is a rare cause of intestinal obstruction in adults and is usually secondary to malignant neoplasms as the pathologic leading point. We present a case of ileocolic intussusception in an adult caused by a large pedunculated cecal lipoma and mobile cecum. The patient was a 45-year-old woman with 3 weeks’ history of colicky abdominal pain, hematochezia, and alternating bowel habits. Computed tomography of the abdomen revealed ileocolic intussusception with 7×5 cm low-density mass in the cecum. Right hemicolectomy was performed, and histopathological examination of the specimen confirmed the diagnosis of a subserosal cecal lipoma.

Ultrasonically activated devices have been used for gallbladder dissection in laparoscopic cholecystectomy (LC) with encouraging results. The aim of the present study was to compare the surgical outcome of LC performed by the harmonic shears to that performed by the conventional diathermy in patients with cirrhosis.In this prospective randomized study, 40 cirrhotic Child-Pugh's classes A and B patients with symptomatic uncomplicated gallstones disease were randomly assigned to either the Harmonic scalpel LC group (20 patients) or the conventional diathermy LC group (20 patients).The use of the harmonic shears was associated with a statistically significant shorter median operative time (55 vs. 82.5 minutes, P = .000), less median estimated intraoperative blood loss (50 vs. 120 mL, P = .000), and lower incidence of gallbladder perforation (10% vs. 70%, P = .000). In the Harmonic scalpel LC group, Laparoscopic subtotal cholecystectomy was resorted to in eight patients (40%) compared with six patients (30%) in the conventional diathermy LC group. No statistically significant difference was found between both groups as regards the conversion rate, the median hospital stay, and the incidence of postoperative complications. Neither bile leaks nor Bile duct injuries were encountered in either group. Similarly, no mortalities were encountered in the present study.The Harmonic shears achieved complete hemobiliary stasis. Further, it provided a superior alternative to the conventional diathermy in terms of shorter operative time, less intraoperative blood loss, and lower incidence of gallbladder perforation partly through facilitating the performance of laparoscopic subtotal cholecystectomy.