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Patient management after bariatric surgery is important in controlling patients' diabetes and recurrence prevention. This study aimed to meet the medical managements of patients with diabetes 6 months after the bariatric surgery.This cross-sectional study was performed on 77 type 2 diabetes patients' candidates for bariatric surgery (Roux-en-Y [RYGP] and Omega). Postoperative implementation protocol was one-third of insulin for patients taking long-term insulin and the discontinuation of medications for patients of oral antidiabetic agents. Blood glucose (BG) level was checked regularly by the patients at home and the necessary medical management was applied. The weight, BG and HbA1C levels, and use of oral antidiabetic agents and insulin were assessed and recorded before 1, 3, and 6 months after the surgery.BG levels and HbA1C percentage in the 1The long-term management and support of the patients by the implementation of a standard protocol after surgery are of great significance in obtaining the optimal outcome after bariatric surgery.

Background Laparoscopic sleeve gastrectomy(LSG) is the most popular bariatric surgery worldwide. Postoperative de-novo acid reflux is one of the major common complications of the procedure. Different additive anti-reflux surgical techniques have been tried to decrease the complication although no favorable outcome is obtained. This study was conducted to evaluate effects of concurrent cruroplasty during LSG on postoperative de-novo acid reflux incidence rate. Methods In current participant-blinded randomised controlled trial total of 80 subjects who were candidate for LSG were enrolled from the September 2018 to the December 2019. Following matching patients by gender and age, simple randomization method was held to allocate participants to LSG alone and LSG + cruroplasty groups with equal 40 members in each. Demographic data, length of hospital stay, and operation time was registered. Presence of acid reflux was looked by using gastroesophageal reflux disease-health related quality of life(GERD-HRQL) questionnaire prior and 6 months after surgery in follow-up visit. Results Finally 12/28 and 14/26 male/females with 38.5 ± 10.7 and 39.7 ± 8.2 years of age were recruited in LSG alone and LSG + cruroplasty, respectively.(p > 0.05) The length of operative time was significantly shorter in LSG alone(p 0.05). Conclusion Equipping LSG with concurrent cruroplasty to diminish postoperative de-novo gastroesophageal acid reflux is not effective and not recommended in absence of other indications., Highlights • Data of incidence and reinforcement of diaphragmatic crura to inhibit de-novo GERD after LSG is varied and insufficient. • Adding cruroplasty to LSG for preventing de-novo gastroesophageal reflux is not advised. • It is recommended to focus researches on details of surgical technique for LSG to prevent postoperative reflux.

Background Obesity, which has various complications and co-morbidities, is an epidemic issue worldwide. Vitamin D deficiency (VDD) is a well-known metabolic disorder among patients with severe obesity. While they are good candidates for bariatric surgery, this deficiency can affect the outcome of surgery negatively. Objectives The aim of this study was to compare 3 different VDD treatment strategies for use before bariatric surgery and compare serum vitamin D levels after 7 weeks. Settings University hospital, Isfahan, Iran. Methods This was a single-blinded, randomized clinical trial on 100 patients who were referred for bariatric surgery from 2016 to 2018. Vitamin D (VitD) level was checked before surgery for the patients included in the study, if their VitD level was Results No case was lost during the follow-up time. No significant differences were found among the 3 groups in terms of their age (P = .654), body mass index (P = .434), sex (P = .799), initial 25(OH) VitD level (P = .273), and history of supplement use (P = .45). Mean serum VitD levels were 15.21, 13.16, and 13.37 ng/mL, respectively, before the surgery and reached 32.91, 24.74, and 29.49 ng/mL after 7 weeks of treatment in oral, injection, and combined groups, respectively. Finally, the 7-week oral treatment option had significantly higher levels of VitD (P value=.034). Conclusion VDD treatment with 50,000 units VitD3 capsule every week for 7 weeks before bariatric surgery yields a higher level of VitD. Based on our findings, injectable supplements are not recommended for VDD treatment.

The present study evaluated the effect of internal mesh fixation and external fixation (inguinal hernia truss) on postoperative complications in patients with inguinal hernia.This randomized clinical trial was performed on 64 patients that were candidates for inguinal hernia repair by laparoscopic method following the totally extraperitoneal procedure. These patients were randomly divided into two groups. In the first group, the mesh was fixed with a maximum of three absorbable tacks. In the second group, the inguinal hernia truss was used as the external fixation for 6 weeks immediately after the surgery.The results revealed that seroma, neuralgia, and recurrence were observed with the values of 6.4%, 19.4%, and 3.2% in Group A and 3.3%, 13.3%, and 3.3% in Group B (The mentioned findings can trigger the use of external fixation and an inguinal hernia truss as a support for the abdominal wall to make the dream of not using a foreign body in the human body come true.

Background Recently the performance rate of one anastomosis gastric bypass (OAGB) bariatric surgery has increased. Bile reflux is on of common considered complication of OAGB challenging surgeon. Methods We searched English full text with keyword “bile reflux” AND “OAGB” OR “one anastomosis gastric bypass” OR “SAGB” OR “single anastomosis gastric bypass” that published from January 1st, 2000 to December 31st, 2020 in PubMed, EMBASE, Google scholar and Cochrane Library. We included prospective or retrospective systematic review, review, clinical, and meta-analysis human article that its full text was available and focused on bile reflux after OAGB/SAGB as the fundamental performed bariatric surgery. Results A total of 1259 articles were analyzed, of which 5 were included. Analysis of number articles by year revealed that 2019 and 2020 was the highest number of published articles (n = 232; 68%). Study type analysis revealed that review studies and clinical research (n = 62; 18.2%) were the most frequent study types. Reported data on bile reflux after OAGB had diversity. Implicitly, postoperative incidence of bile reflux differed from 7.8 to 55.5%. General consensus was not existed among authors to consider the OAGB as the first suspect leading to postoperative bile reflux among other bariatric surgery types. Conclusion Although surgeons prefer to conduct OAGB procedure because of its easier surgical approach needing just one anastomosis formation it is not virtually clear that is the procedure costly benefitted regarding bile reflux outcomes., Highlights • Review of the literature shows bile reflux is a not well understood complication after OAGB. • Regarding current data incidence of bile reflux after OAGB varied from 8 to over 55%. • It seems current surgical technique is not influenced on incidence of bile reflux after OAGB.

Introduction. Obesity is among the newest health matters that human beings are struggling with. Length of bypassed intestine is important in achievement of most weight loss and least nutritional and absorptive disorders. This study has aimed to assess short-term metabolic and nutritional effects of laparoscopic mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) with a loop bypass length of 180 centimeters (cm) and compare these factors among patients with a body mass index (BMI) of 40–45 and 45–50 kilograms per square meter (kg/m2). Methods. 25 patients were put in group 1 (BMI = 40–45 kg/m2) and 25 patients in group 2 (BMI = 45–50 kg/m2). Patients’ BMI, postoperative weight, excess weight loss, and laboratory tests including fasting blood sugar (FBS), lipid profile, serum iron (Fe), ferritin, total iron-binding capacity (TIBC), 25-OH vitamin D, vitamin B12, liver function tests, and albumin were recorded preoperatively and within 3- and 6-month follow-up. Results. Weight loss and BMI reduction was significantly more in patients with higher BMI level (P=0.007), and excess weight loss was higher in patients with lower preoperative BMI level (P=0.007). Six-month follow-up showed statistically significant reduction in total cholesterol, total triglyceride, Fe, and vitamin B12 among patients with higher BMI level (P value Conclusion. Based on this study, 180-cm intestinal bypassed length works for patients with a BMI level of 40–45 and 45–50 kg/m2, according to their significant decrease in weight, BMI, and improving glycolipid profile.

Introduction Percutaneous endoscopic gastrostomy (PEG) is the most common way of inserting a gastrostomy tube. If PEG is not appropriate for a patient, then the laparoscopic or open technique should be used. Here, we introduce a new laparoscopic technique for inserting a gastrostomy tube. Material and surgical technique We used this new laparoscopic approach in 21 patients for whom PEG was not suitable. After marking on the abdominal skin and inserting the trocars, two 2-0 silk sutures were passed. Two stitches were placed 2 cm apart in the stomach with one hand. Each suture was pulled out with the fascia closure, the stomach was pulled out with a Babcock, and a purse-string suture using a round 2-0 silk suture was placed outside the stomach, creating a mushroom-retained gastrostomy. Conclusion This new laparoscopic technique is minimally invasive. It provides full control through only two trocars and required smaller incisions than common laparoscopic approaches. This method can be used to insert a gastrostomy tube in indicated patients when PEG placement is not suitable.

Background: Prospective studies evaluating outcome of laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia are less in Asian people. Objectives: This study conducted to evaluate the results of laparoscopic cardiomyotomy and partial fundoplication for achalasia. Patients and Methods: Thirty patients who underwent Heller myotomy for achalasia via laparoscopy in Alzahra hospital Isfahan, Iran were recorded prospectively (2009 - 2013). Median follow-up was 18 months. Symptoms including dysphagia, regurgitation, chest pain and weight loss were recorded before and after operation. Also, previous treatment for achalasia such as endoscopic pneumatic dilatations and intrasphincteric injection of botulinum toxin or other component, duration of symptoms and duration and complication of operation was recorded. Results: Among 30 patients, there were 13 (43.3%) females and 17 (56.7%) males, and mean age was 40.8 years (range, 20 - 68 years). The operations were finished laparoscopically in all patients. Mean operative time was 137 ± 36.2 minutes. The patients were symptomatic for at least 30 months before referring for surgery. There are some difficulties in dissection in cases who received Ethanolamine or Botholinum Toxin injection as non-surgical treatment before that. Mean hospital stay was 2.45 days. Regurgitation, chest pain and heartburn relieved significantly in median follow up of 18 months, in 100%, 66.6% and 70%, respectively (P < 0.001, P < 0.01 and P < 0.01, respectively). At that time, except for two (6.6%) patients, all other patients had improvement in dysphagia (P < 0.001) .The mucosa in two (6.6%) of patients was perforated on the gastric end of the xylotomy. The perforations were repaired laparoscopically with single suture without postoperative leak. Conclusions: Our study showed that laparascopic Helermyotomy with Dor fundoplication result in significant relief of dysphagia. Overall clinical symptoms indicate improvement in patient functional status during 18-month follow-up.

Background: The rising prevalence of obesity in today populations has led obese individuals to seek medical interventions. Aside from special diets, routine exercise and in some cases, medical treatment, most of the obese patients, favoring those with morbid or super obesity can benefit from bariatric surgery to lose weight. Laparoscopic sleeve gastrectomy (LSG) is relatively new method to limit the compliance of stomach. The consequent quick satiety during each meal results in gradual weight loss in patients. We investigated the efficacy and safety of this method among a group of our patients. Materials and Methods: This cross-sectional study was conducted in Isfahan, Iran, from January 2012 to January 2013. Thirty-five cases of obesity that had undergone LSG were enrolled and their baseline data of weight, body mass index (BMI), blood sugar, lipid profile, liver function indexes and blood pressure were collected. The patients were followed up for 6 months. The 6-month results were analyzed. Results: There was significant reduction in BMI, weight, blood sugar, blood pressure, liver enzymes and lipid profile components (P < 0.05), except for alkaline phosphatase (ALP) (P = 0.3). The average of excess weight loss percentage after 6 months was 69.2 ± 20.9%. No mortality occurred. Two of the patients had micro anastomotic leaks that were treated with nonoperative management. A case of gross leakage was treated with tube jejunostomy. Conclusion: Our study confirmed the efficacy and safety of LSG as a single surgical intervention for body weight reduction in morbidly and super obese patients.

Introduction: Although thymoma is the most common anterior mediastinal tumor, only 5% of thymoma cases develop pure red cell aplasia (PRCA). Case Presentation: In this article we have reported a 59-year-old man with a large anterior mediastinal mass (diameter of 10 cm) and severe anemia, that thymoma and pure red cell aplasia have been demonstrated by histopathologic and hematological examination. Despite the large mass, a complete video-assisted thoracoscopic surgery (VATS) thymectomy and combinational medical therapy were performed for him successfully. Aplasia remission occurred 6 months after thymectomy and his hemoglobin level reached to 13 g/dL. Conclusions: We believe that a complete resection in combination with medical therapy is necessary to achieve total remission of PRCA symptoms and conclude that VATS thymectomy is an effective and technically feasible procedure for surgery without any contraindications about the size of the thymoma in these patients.