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Multivisceral resection (MVR) with open approach is the standard surgical treatment for locally advanced colorectal cancer. However, the medical literature concerning the practice of minimally invasive MVR in order to reduce postoperative complications and hospital stay has been growing exponentially over the last years. The present study aimed to examine our experience and to provide a systematic review about the results and complications of minimally invasive MVR.Data of patients that underwent minimally invasive MVR for locally advanced colorectal cancer from 2015 to 2021 were retrospectively reviewed. The literature was searched for studies concerning minimally invasive MVR for colorectal cancer.A total of 39 laparoscopic MVR were performed in our department. Complications occurred in 14 patients (35.9%) with major complications in five patients (18.82%) according to Clavien-Dindo classification. Conversion was required in one case (2.56%) with subsequent mortality (2.56%). Pathologic adjacent organs or structures invasion was observed in 30 patients (76.9%) and positive resection margin occurred in two cases (5.2%). Twenty-two studies including 1055 patients were identified after literature search. In these studies, laparoscopic surgery and robotic surgery were performed in 90.15% and 9.85% of the patients, respectively. R0 resection was established in 95% of cases, conversion rate varied between 0% and 41.7%, and postoperative mortality ranged between 0% and 7.7% in the included articles.Minimally invasive approach may be a safe option for patients requiring MVR for locally advanced colorectal cancer, with equivalent oncological results and could result in better early postoperative outcomes to open approach. However, further studies on this topic are needed to confirm the results of the current study.

The prevalence of obesity in the Eastern Mediterranean is increasing significantly up to 20.8% in 2016. Therefore, a higher percentage of colorectal cancer (CRC) patients are expected to be obese. Laparoscopic colorectal cancer surgery (LCRCS) is regarded as a safe and feasible procedure as laparoscopic approach is becoming the gold standard in CRC surgery, especially in the early stages of disease. However, LCRCS is correlated with a higher risk of short-term post-operative complications in obese patients (body mass index [BMI] ≥30 Kg/mA retrospective study was conducted. Clinical data of case and control patients were extracted from medical records. These patients underwent LCRCS between January 2018 and June 2021 at Hôtel-Dieu de France Hospital, Beirut-Lebanon. Patients were divided into two groups: obese and non-obese. BMI ≥30 Kg/mWe identified 107 patients who underwent LCRCS during this study period at our institution. Among the patients, 23 were obese (21.49%). At 30 days post-operative, 26 patients were reported to having at least one complication. Non-significant differences were found between the two groups regarding the early post-operative complications rate (obese 26.1% and non-obese 23.8% with P = 0.821). Obesity was not demonstrated as a stratification risk by severity of the early post-operative complications (P = 0.92).Obesity, which was defined as BMI ≥30 Kg/m

Introduction. Obesity is increasing worldwide and in Lebanon with a negative impact on the quality of life. The primary objective of this study is to measure the quality of life in obese subjects before and after bariatric surgery, depending on age, sex, and degree of weight loss. A secondary objective is to determine the impact of bariatric surgery on comorbidities associated with obesity. Materials and methods. Patients undergoing laparoscopic sleeve gastrectomy for BMI ≥ 30 kg/m2 between August 2016 and April 2017 were included. Participants completed the Moorehead-Ardelt Quality of Life Questionnaire II (MA II) prior to operation and one year after. Statistical analysis was carried out using SPSS statistics version 20.0. Results. 75 patients participated in the study. The majority were women (75%), and the mean age was 36.3 years. The mean weight loss was 36.57 kg (16–76). Initially, the total MA II score was −0.33 ± 0.93. Postoperatively, it increased to 1.68 ± 0.62 (p≤0.001). All MA II parameters improved after surgery (p≤0.001), but this improvement was independent of age and sex. Improvement in self-esteem, physical activity, work performance, and sexual pleasure was influenced by the degree of weight loss (p≤0.001). All comorbidities associated with obesity regressed significantly after sleeve gastrectomy (p<0.05) with the exception of gastroesophageal reflux and varicose veins of the lower limbs. Conclusion. Sleeve gastrectomy improves quality of life and allows reduction of comorbidities.

Patient: Female, 58-year-old Final Diagnosis: Gastric perforation Symptoms: Abdominal pain • peritonitis Medication: — Clinical Procedure: Jejunostomy tube placement • laparoscopic surgery • open surgery Specialty: Surgery Objective: Unusual clinical course Background: Invasive lobular carcinoma and ductal carcinoma of the breast can metastasize to all sites in the body, including the gastrointestinal tract. Late presentation of metastases of lobular carcinoma of the breast to the gastrointestinal tract have previously been reported, but late metastasis of ductal carcinoma of the breast to the gastric mucosa is rare. This report is of a 58-year-old Lebanese woman who presented with acute gastric perforation due to metastatic ductal carcinoma,18 years following bilateral mastectomy for invasive ductal carcinoma of the breast. Case Report: We present the case of a 58-year-old woman who underwent a right modified mastectomy for an invasive ductal carcinoma in 2002 combined with a contralateral prophylactic mastectomy for cosmetic purposes. She presented a secondary gastric lesion 18 years later. The clinical presentation resembled perforated ulcer. The choice of gastrectomy was denied due to retrogastric and pancreatic invasion by the tumor. A laparoscopic gastric closure failed to heal the perforation. A supraumbilical laparotomy incision was performed for the placement of a Pezzer tube in the gastric perforation and the installation of a feeding jejunostomy. Conclusions: This report is of a rare presentation of metastatic ductal carcinoma of the breast to the gastric mucosa associated with gastric perforation that presented 18 years after bilateral mastectomy. This case highlights the importance of obtaining a full past medical history to identify previous primary malignancy, and also is a reminder that ductal carcinoma of the breast can present with metastatic involvement in the gastrointestinal tract several months, or even years, following mastectomy.

Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy (LSG). Clinical presentation includes fever, leucocystosis, and abdominal pain. CT SCAN is a must for diagnosis. The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy. We report the thirteen case of a splenic abscess after LSG. In our patient, the abscess occurred three weeks after LSG in a 21-year-old man, and it was successfully treated conservatively.

Laparoscopic sleeve gastrectomy (LSG) is currently the leading bariatric procedure and targets, among other obesity classes, patients with BMI 30–35 kg/m2, which are reaching alarming proportions. Between February 2010 and August 2015, data on 541 consecutive patients with BMI 30–35 kg/m2 undergoing LSG were prospectively collected and analyzed. Mean age was 32 ± 8 years (13–65) and 419 (77.4 %) were women. Preoperative weight was 92.0 ± 8.8 kg (65–121) and BMI was 32.6 ± 1.5 kg/m2 (30–35). Comorbidities were detected in 210 (39 %) patients. Operative time was 74 ± 12 min (40–110) and postoperative stay was 1.7 ± 0.22 days (1–3). There were no deaths, leaks, abscesses or strictures and the rate of hemorrhage was 1.2 %. At 1 year, 98 % were followed and BMI decreased to 24.7 ± 1.6, the percentage of total weight loss (% TWL) was 24.1 ± 4.7 while the percentage of excess BMI loss (%EBMIL) reached 106.1 ± 24.1. At 5 years, 76 % of followed patients achieved a ≥50 % EBMIL. With appropriate surgical expertise, LSG in patients with BMI 30–35 kg/m2 achieved excellent outcomes with a zero fistula rate.

Background. Revisional surgery is becoming a common and challenging practice in bariatric centers. The aim of this study was to evaluate resectional one anastomosis gastric bypass/mini gastric bypass (R-OAGB/MGB) as a revisional procedure. Methods. From January 2016 to February 2017, data on 21 consecutive patients undergoing R-OAGB/MGB for weight loss failure after primary restrictive procedures were prospectively collected and analysed. Results. Mean age was 39 ± 12 years (18–65), and 11 (52.3%) were women. The mean operative time was 96.4 ± 20.9 min (range, 122–80), and the mean postoperative stay was 47.8 ± 7.4 hours (range, 36–73). There were no deaths and no procedure-related complications. The mean body mass index (BMI) decreased from 42.9 ± 6.5 at the time of R-OAGB/MGB to 28.5 ± 4 at the 12-month follow-up. At that time point, the mean percentage of BMI loss (%EBL) and the mean percentage of total body weight loss (%TWL) reached 81.6 ± 0.17% and 35 ± 0.01%, respectively. Conclusion. R-OAGB/MGB was technically straightforward, effective, and safe in this at-surgical risk population. R-OAGB/MGB should be added to the armamentarium of revisional bariatric procedures considering its technical aspects and the potential advantage on weight loss.

Laparoscopic sleeve gastrectomy is known to be associated with a risk of gastric staple line leak. We report on our experience with endoscopic stenting of the anomalous leaking tract. Three cases of post sleeve gastric leak confirmed by computed tomography scan were treated by endoscopic stenting of their leak with a plastic endoprosthesis under fluoroscopic and endoscopic guidance. Endoscopic stenting by means of biliary or pancreatic endoprosthesis was successful in the three patients. The median number of endoscopy procedures per patient was 1.3. Stents were extracted 6 to 10 weeks after their placement. Neither morbidity nor recurrence was noticed on follow-up. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy proved to be an efficacious technique for leak healing.

Laparoscopic sleeve gastrectomy (LSG) is currently the leading bariatric procedure and targets, among other obesity classes, patients with BMI 30-35 kg/mBetween February 2010 and August 2015, data on 541 consecutive patients with BMI 30-35 kg/mMean age was 32 ± 8 years (13-65) and 419 (77.4 %) were women. Preoperative weight was 92.0 ± 8.8 kg (65-121) and BMI was 32.6 ± 1.5 kg/mWith appropriate surgical expertise, LSG in patients with BMI 30-35 kg/m

International audience; Lipophilic pollutants can accumulate in human white adipose tissue (WAT), and the consequences of this accumulation are still poorly understood. Cytochromes P450 (P450s) have recently been found in rat WAT and shown to be inducible through mechanisms similar to those in the liver. The aim of our study was to describe the cytochrome P450 pattern and their induction mechanisms in human WAT. Explants of subcutaneous and visceral WAT and primary culture of subcutaneous adipocytes were used as WAT models, and liver biopsies and primary culture of hepatocytes were used as liver models to characterize P450 expression in both tissues. The WAT and liver models were then treated with typical P450 inducers (rifampicin, phenobarbital, and 2,3,7,8-tetrachlorodibenzo-p-dioxin) and lipophilic pollutants (lindane, prochloraz, and chlorpyrifos), and the effects on P450 expression were studied. P450 expression was considerably lower in WAT than in the liver, except for CYP1B1 and CYP2U1, which were the most highly expressed adipose P450s in all individuals. 2,3,7,8-Tetrachlorodibenzo-p-dioxin and prochloraz induced CYP1A1 and CYP1B1 expression in both tissues. The aryl hydrocarbon receptor was also present in WAT. In contrast, neither phenobarbital nor rifampicin treatment induced CYP2 or CYP3 mRNA in WAT, and constitutive androstane receptor and pregnane X receptor were almost undetectable. These results suggest that the mechanisms by which P450s of family 1 are regulated in the liver are also functional in human WAT, but those regulating CYP2 and CYP3 expression are not.

The treatment of acutely obstructed carcinoma of the left colon and sigmoid still represents a matter of controversy. The aim of this study was to assess retrospectively the results of its management by emergency subtotal or total colectomy with primary anastomosis.Sixty-seven patients were reviewed. There were 42 males and 25 females. The mean age was 70.5 years (range: 26-87 years). Mean operative time was 210 minutes. There were five synchronous colon carcinomas (7.5%) and 23 (343%) synchronous tubulous and tubulo-villous adenomas. No death was noted in the series. Ten postoperative complications (15%) occurred in nine patients including one postoperative peritonitis without evidence of anastomotic leak, one alithiasic cholecystitis, one evisceration and two intra-abdominal abscesses. The mean hospital stay was 11.4 days. Fifty-eight patients were assessed at three and twelve months for functional results. No fecal incontinence was encountered. The mean number of bowel movements per 24 hours was 3.2 at three months and 2 at twelve months. All patients were satisfied with their quality of life. Twelve patients (20.7%) occasionally needed anti-diarrheic medications.Urgent subtotal or total colectomy with primary anastomosis is a safe and efficient procedure in the management of acutely obstructed neoplasm of the left colon. It allows to treat in one stage the cancer and the obstruction, bearing no mortality, acceptable morbidity and satisfactory postoperative functional results.

Since 2002, we have performed 350 laparoscopic Roux-en-Y gastric bypasses (LRYGB). We decided to evaluate the laparoscopic mini-gastric bypass (LMGB), an operation reported as effective, yet simpler than LRYGB. It consisted of a long lesser curvature tube with a terminolateral gastroenterostomy, 200 cm distal to the Treitz ligament.From October 2006 to November 2007, 100 patients (23 men and 77 women) underwent LMGB. The mean age was 40.9 +/- 11.5 years (17.5-62.4), the preoperative mean body weight was 131 +/- 23.1 kg (82-203) and the mean BMI was 46.9 +/- 7.4 kg/m(2) (32.8-72.4). Twenty-four patients had prior restrictive procedure: 20 LAGB of which nine were already removed and four VBG (two laparoscopic and two by open surgery). In preoperative gastric endoscopy Helicobacter pylorii was present in 26 patients and eradicated.All procedures were completed laparoscopically by six different surgeons. Mean operative time was 129 +/- 37 min. There was no death. Seven patients (7%) presented major early complications: three reoperations for incarcerated herniation of small bowel in the trocar wound, one peritonitis due to a traumatic injury of the biliary limb, one perianastomotic abscess, one intraabdominal bleeding requiring splenectomy, and one endoscopic haemostasis for anastomotic bleeding. One patient presented anastomotic stenosis that required endoscopic dilatation 2 months postoperatively. Mean BMI at 3 months was 38.7 kg/m(2) (31.2-60.9) and at 6 months 35.1 (23.6-53.0). Nine patients complained of diarrhea that resolved 3 months postoperatively and, significantly, only two patients complained of biliary reflux.Pending long-term evaluation, LMBG seems a good alternative to LRYGB, giving the same results with a more simple and reproductible technique.

The barium enema examination (BEE) is an important diagnostic study and considered to be safe without adverse effects. Perforation of the bowel is rare but is the most frequent complication of BEE and can be life-threatening.We report four cases of barium extravasation due to BEE treated at our institution, three rectal perforations and one perforation in the descending colon.The four patients underwent surgery because signs of peritonitis developed. Two of them recovered and two died from multiple organ failure.Perforation of the colon and rectum during BEE constitutes a surgical emergency in most cases. Prompt recognition and management are vital in decreasing morbidity and mortality.