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Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 ± 24.4 Kgs and 43.03 ± 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively. The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.

Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstract

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.

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.

Obesity and its associated medical problems increase risk of kidney function decline while prior studies suggest that bariatric surgery may improve kidney outcomes. However, little is known about the comparative effectiveness of different types of bariatric surgery on kidney function. In this study, we compare the effects of laparoscopic one anastomosis gastric bypass (LOAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on kidney function one year after surgery. The patients’ demographic, medical, and surgical data were prospectively collected and retrospectively reviewed. Type 2 diabetes mellitus, hypertension, and dyslipidemia, body mass index (BMI), and kidney function tests were obtained before and one year after surgery. Kidney function was evaluated by estimated glomerular filtration rate (eGFR) and spot urine albumin to creatinine ratio (ACR). Changes in eGFR and ACR were compared between LRYGB vs. LOAGB after adjustment for confounders (age, sex, remission of associated medical problems, preoperative BMI, and percentage of excess BMI loss) using ANCOVA model. Both surgical techniques significantly decreased the post-surgery presence of diabetes, hypertension, and dyslipidemia (p < 0.001 for all paired comparisons). The eGFR level significantly increased and the ACR level significantly decreased in both groups (p < 0.001 for all paired comparisons before and after adjustment). However, eGFR and ACR mean differences between LRYGB and LOAGB were not significantly different after adjustment for confounding variables (p = 0.9 and 0.4, respectively). Both LOAGB and LRYGB improved 1-year eGFR and ACR equally independently from weight loss and other confounders.

The time interval between bariatric surgery and pregnancy is controversial. In this study, we report and compare the outcomes of pregnancy from two groups of bariatric surgery (BS) patients who became pregnant less than 12 months (early) and above 12 months (late) after surgery. For this retrospective study, women of reproductive age who became pregnant after BS between 2010 and 2019 were reviewed, allocated into two groups, and compared. Perinatal care was provided as standards and continued at monthly intervals by a gynecologist. Demographic data, pregnancy-related events, results of any screening tests in each trimester, the reports of all ultrasonographies, and lab data were extracted from their medical documents. Chi-square and t-test were used for analysis. Four hundred seventy-seven out of 1046 participants were of reproductive age. 12 and 37 women were put in early and late pregnancy groups, respectively. No significant difference was observed in the rate of maternal complications, outcomes of pregnancies, and the rate of fetal and neonatal problems in pregnancies conceived during the first vs. second year postbariatric surgery. 91.6% of the patients with early pregnancy had at least one perinatal/neonatal finding. Mean neonatal birth weight was 2610 ± 152 and 2881 ± 315 g in early and late pregnancy groups, respectively. Patients with early pregnancy were not at significantly higher odds for any pregnancy-related or neonatal complications. The rate of maternal, fetal, and neonatal complications in pregnancies conceived during the first vs. second postbariatric year were indifferent.

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.

Laparoscopic one-anastomosis gastric bypass (LOAGB) has to be reverse under some circumstances. This study is aimed to introduce and review a series of LOAGB cases that had to be reversed to normal anatomy due to severe hypoalbuminemia and its related symptoms after a few months. Patients who had LOAGB from 2014 to 2018 and then reversed after some months were included in this study. Their first and second surgical data were collected and reviewed for important and relevant information. From 846 cases of LOAGB, 12 patients reversed after a mean of 12.1 months. All of them were women with mean age of 46 years. All of the gastrojejunostomy anastomosis had been made 200 cm after the Treitz ligament, and all of the patients had at least 250 cm common channel. The mean excess body mass index loss before the reversal surgery was 107.7%. None patients lost or died during the study. Regarding anastomosis, 200 cm from Treitz ligament is not suitable for all of the patients and common channel more than 250 cm cannot prevent hypoalbuminemia. The surgeon should decide as quickly as possible whether his/her patients need reversal surgery or not. Appropriate patients should be selected for LOAGB.

Obesity and its associated morbidities have become a significant concern all over the world. Bariatric surgery, regardless of its type, is the most effective approach for treating morbid obesity. Single-anastomosis sleeve jejunal (SASJ) bypass is a novel bariatric surgery technique and can be considered for patients with former background of severe gastroesophageal symptoms. The purpose of this research was to compare SASJ bypass outcomes with other techniques during a 6-month follow-up. This is a non-randomized clinical trial conducted on 100 patients, who underwent four types of bariatric surgery (classic Roux-en-Y bypass, SASJ bypass, omega gastric bypass, and sleeve gastrectomy), and each one of these types contained 25 cases, during the time period of 2 years from 2016 to 2018. Patients’ information including age, gender, height, basal weight, body mass index (BMI), serum albumin, and hemoglobin A1C were recorded, within 1, 3, and 6 months after their surgery, and also were compared with each other. Members of the four groups were similar due to their age, gender distribution, height, baseline BMI, hemoglobin A1C, albumin, and also excess weight (P value > 0.05); however, the sleeve gastrectomy group baseline weight was significantly higher compared with the other three groups (P value = 0.013). All of the groups significantly lost weight during this 6-month period, but the comparison between them indicated no statistical difference regarding excess weight loss, BMI, hemoglobin A1C, and albumin (P value > 0.05). The excess weight loss mean during 6 months in SASJ bypass was 34.2 ± 5.4%, which was comparable with other groups. The weight loss trend after the SASJ bypass was similar to that of older techniques; consequently this technique can be considered for cases with particular indications due to the reversibility and also more accessible gastric follow-up studies in the SASJ approach. Further researches with longer follow-ups are strongly recommended.

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: Although laparoscopic cholecystectomy (LC) is the gold standard approach for gallbladder diseases, this sometimes may face difficulties and require conversion to open surgery. The preoperative ultrasonographic study may provide information about the probability of difficult LC, but the data in this term are uncertain. We assessed the value of preoperative ultrasonographic findings for the prediction of LC's difficulty. Materials and Methods: The current prospective clinical trial was conducted on 150 patients who were candidates for LC due to symptomatic gallstone. All of the patients underwent ultrasonography study preoperatively, and then, LC was performed. The surgeon completed a checklist regarding the easy or difficult surgical criteria. Finally, the values of ultrasonographic findings for the prediction of LC difficulty were evaluated. Results: Among the 150 included patients, 80 had easy LC and 70 had difficult LC. Statistically significant differences were found between the two groups of easy and difficult LC regarding gallbladder wall thickness (P = 0.008), stone impaction (P = 0.009), and gallbladder flow (P = 0.04). The area under the curve (standard error [SE]) for the thickness of the gallbladder wall, flow in the gallbladder wall, and stone impaction was 0.598 ± 0.048, 0.543 ± 0.047, and 0.554 ± 0.047, respectively (P < 0.05). The highest specificity was for gallbladder wall flow (100%). Binary logistic regression showed that stone impaction had predictive value for determining difficult LC (odds ratio = 3.10; 95% confidence interval: 1.03–9.30; P = 0.04). Conclusion: Although a significant difference was observed between two groups in terms of impacted stone, flow in the gallbladder wall, and thickness of the gallbladder wall, only stone impaction had predictive value for determining difficult LC.

Objective Peritoneal adhesions may develop after every abdominopelvic surgery. Many agents and technical modifications have been investigated to minimize adhesions. Punica granatum (pomegranate) flower has some anti-inflammatory and antioxidative effects that would reduce the formation of peritoneal adhesions. In the present study, the effects of different doses of oral Punica granatum flower extract on postoperative peritoneal adhesions were evaluated in a rat model. Study design Thirty-two female Wistar rats were divided into four groups: one control group (CG) and three experimental groups, treated with 100 (EG100), 200 (EG200), and 400 (EG400) mg/kg/day Punica granatum extract orally for eight days. Induction of peritoneal adhesions was done in all groups using the same method. Two weeks after the first surgery, all rats re-operated and adhesions were evaluated via both macroscopic and microscopic changes. Results We observed that rats in the control group had statistically higher adhesion area and more severe adhesions when compared to all experimental groups. Besides, those in the EG-400 group had a significantly lower rate of foreign body reaction in serosal layer when compared to the other three study groups. Other microscopic findings were comparable between the four groups. Conclusion Administration of the oral Punica granatum flower extract was associated with a decreased quantity and quality of the adhesions in the animal model of rat in this study. This therapy might be an effective and safe strategy to reduce intraperitoneal adhesion after abdominal surgeries in animal models.

INTRODUCTION: Teaching is one of the most important needs of human societies, and selecting the best method of teaching is so important to improve the teaching as well as learning of students. The purpose of this study was to determine the effect of case-based teaching (CBT) and flipped classroom methods in comparison with lecture method on students' learning and satisfaction at internship of Department of General Surgery, Isfahan University of Medical Sciences. MATERIALS AND METHODS: This experimental study was performed on fifty medical surgery internship students in Isfahan University of Medical Sciences in 2017. Students were randomly divided into two groups of control group and intervention group. The data were collected by a posttest after holding every class and a researcher-made form for evaluating students' satisfaction after the end of the project. The results of this study were analyzed by SPSS 21 software using descriptive statistical methods (mean and standard deviation) and paired t-test. RESULTS: The comparison of the mean posttest scores in the three classes showed that the mean scores of the students in the intervention group in the first and second sessions unlike the third session were higher than that in the control group; this difference was statistically significant in the first session (P = 005) and the third session (P = 0.002). Students' satisfaction with case-based learning method (4.03 ± 0.87) was higher than that of lecture method (2.88 ± 0.78). CONCLUSION: In CBT and flipped classroom, students' learning and the quality of teaching were improved. In addition, students were more satisfied with this method in comparison with the lecture method. However, it should be noted that the success of using this teaching method depends on choosing the appropriate subject.

One of the most acceptable procedures in bariatric surgery is laparoscopic gastric bypass. Laparoscopic Roux-en-Y gastric bypass (RYGB) is a common technique used in bariatric surgery. Recently, one anastomosis gastric bypass (OAGB) has been suggested as a simple, fast, and effective technique for obesity treatment. This study aims to compare the frequency of histologically proven bile reflux in OAGB and RYGB among patients with morbid obesity. This prospective cohort study was performed from 2015 to 2017 in the Department of Bariatric Surgery of Isfahan University of Medical Sciences, Isfahan, Iran. Patients who had undergone RYGB or OAGB surgery were enrolled. Patients who had undergone revisional surgery were excluded. Data on demographics, symptoms, fasting blood sugar, lipid profile, endoscopic, and histologic findings (based on the Sydney bile reflux index) of bile reflux and postoperative complications were collected and compared for the two techniques. A total of 122 obese patients (22 males) who had undergone RYGB or OAGB surgery were included. The Sydney bile reflux index showed no statistically significant difference between RYGB and OAGB groups. Similarly, no statistically significant difference was found in the self-reported history of bile reflux–related symptoms, bile reflux markers in esophagogastroduodenoscopy, and postoperative complications between groups. OAGB and RYGB appear to be equal with respect to postoperative complications, bile reflux frequency, bile reflux index, and the Sydney system score.

The effect of bariatric surgery on non-alcoholic fatty liver disease is still controversial. In most cases, bariatric surgery results in hepatic improvement, but sometimes it can lead to impairment. We systematically reviewed the English literature for reports of stunting or deterioration of hepatic histology following bariatric surgeries through sequential liver biopsies to show the possibility of this negative occurrence by gathering all the reports regarding this event until March 2018. Underlying mechanisms, patient characteristics, possible risk factors, preventative strategies, presenting signs and symptoms, and available management options are discussed. This paper concludes that although rare, hepatic decompensation following bariatric surgeries can occur. Therefore, bariatric surgeons should be aware of the ways to prevent, monitor, and manage hepatic impacts.

Background Liver complications are one of the predictable outcomes of chronic obesity and bariatric surgery is one of the best way of diminishing them. This study was designed to compare the Roux-en-Y gastric bypass (RYGB) and Mini-Gastric bypass/One Anastomosis gastric bypass (MGB/OAGB) on non-alcoholic fatty liver disease (NAFLD). Methods In this prospective study, 76 patients were operated with the RYGB or MGB/OAGB from 2016 to 2018. The weight, liver enzymes and liver pathology reports were evaluated at the base line. We asked all of the patients to come for second liver sampling one year after the surgery. All of the data analyzed by SPSS software. Results secondary biopsy was taken from 43.4% of the patients one year after the surgery. According to Brunt system classification, in the RYGB and MGB/OAGB groups, 12.5% and 52.9% of them had no NAFLD respectively and 87.5% and 41.2% of them had Grade 1 NAFLD respectively. One patient (5.9%) in the MGB/OAGB group had Grade II NAFLD. The improvement of NAFLD was significantly better after the MGB/OAGB surgery (P = 0.021). Conclusions Both RYGB and MGB/OAGB methods have predictable beneficial effects on weight loss, however, MGB/OAGB can improve NAFLD better than RYGB in short-term follow-up.

Background and Objectives: Obesity is one of the most health-threatening phenomena. It is estimated that over 1 billion adults have overweight or obesity. The current study aimed at presenting a detailed account of the findings that attempted to predict the severity of fatty liver disease and its sequelae, including non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis, by correlating biopsy results with liver function tests and various metabolic markers of laboratory results in patients with morbid obesity. Methods: A total of 111 subjects participated in the study. The collected data included pathology study of liver biopsy, fasting blood glucose (FBS), liver function test (LFT), and lipid profile. Results: The correlation between fibrosis and steatosis was 0.493 (P = 0.001, 95% confidence interval (CI) and correlation between fibrosis and NASH grade was 0.531 (P = 0.001, 95%CI). There was a significant relationship between aspartate aminotransferase (AST) and triglyceride (TG) with steatosis intensity and a significant positive relationship between AST, cholesterol, and FBS with NASH intensity. Conclusions: Levels of serum AST and TG showed significant relationship with steatosis and fibrosis intensities; AST, FBS, and cholesterol had a significant correlation with NASH intensity. Cholesterol and low-density lipoprotein (LDL) levels had an inverse monotonic relationship with fibrosis intensity.

Introduction: After cessation of smoking, the best way to prevent health-threatening conditions is to treatment of obesity. Also, obesity treatment, cause alleviation or cure of other diseases. Bariatric surgery in selected obese patients is the best option for preventing health-threatening conditions. Despite the health benefits, this method of treatment -just like other surgical procedures- may be associated with various side effects. Case Presentation: A 55-year-old female with BMI of 46.5 underwent laparoscopic Omega Gastric bypass surgery. She was admitted due to dyspnea and pulmonary embolism 14 days later. In conducted surveys, platelet count was less than 25,000. In multiple assessments, no cause found for the thrombocytopenia. Corticosteroids prescribed for her with the diagnosis of ITP; which fully responded to treatment. Conclusions: Thrombocytopenia is a rare complication of gastric bypass surgery. Managements include rule out of other causes of thrombocytopenia and medical treatment.

Objective there is a direct correlation between development of obesity and elevated lipid profile. Restrictive and malabsorptive mechanisms along with stimulating neuroendocrine signals are major components of current bariatric surgeries. Higher weight loss is achieved by a malabsorptive operation compare to other bariatric procedures. In this study, we aim to investigate the early effects of gastroileostomy on weight reduction and lipid profile in rat model. Materials and methods Gastroileostomies with side-to-side anastomosis were performed on 15 male New Zealand rats. Blood samples were obtained at baseline and one week after the surgery. Blood samples were analyzed for lipid profiles. Results The data showed that gastroileostomy leads to a significant decrease in weight (330 ± 15 vs. 240 ± 25 g before and after surgery, respectively; p = 0.04). The levels of triglycerides decreased in plasma (99.21 ± 29.012 mg/dl before and 95.64 ± 48.668 mg/dl after the surgery respectively; p = 0.807). Total cholesterol (71.14 ± 13.416 mg/dl vs. 72.64 ± 22.455 mg/dl; p = 0.813) and LDL (12.96 ± 4.853 mg/dl vs. 15.36 ± 5.665 mg/dl p = 0.121) had no significant changes after the operation. Conclusion Based on the results of this study, gastroileostomy is effective for weight reduction but has no statistically significant change on lipid profiles in a short time. Therefore, this surgery is a promising surgery for weight reduction like other methods of bariatric surgery.

Background The optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Making a decision about the right time to operate on a patient with a penetrating abdominal stab wound, especially those who have visceral evisceration, is a continuing challenge. Objectives Until the year 2010, our strategy was emergency laparotomy in patients with penetrating anterior fascia and those with visceral evisceration. This survey was conducted towards evaluating the results of emergency laparotomy. So, better management can be done in patients with penetrating abdominal stab wounds. Patients and Methods This retrospective cross-sectional study was performed on patients with abdominal penetrating trauma who referred to Al- Zahra hospital in Isfahan, Iran from October 2000 to October 2010. It should be noted that patients with abdominal blunt trauma, patients under 14 years old, those with lateral abdomen penetrating trauma and patients who had unstable hemodynamic status were excluded from the study. Medical records of patients were reviewed and demographic and clinical data were collected for all patients including: age, sex, mechanism of trauma and the results of LWE and laparotomy. Data were analyzed with PASW v.20 software. All data were expressed as mean ± SD. The distribution of nominal variables was compared using the Chi-squared test. Also diagnostic index for LWE were calculated. A two-sided P value less than 0.05 was considered to be statistically significant. Results During the 10 year period of the study, 1100 consecutive patients with stab wounds were admitted to Al-Zahra hospital Isfahan, Iran. In total, about 150 cases had penetrating traumas in the anterior abdomen area. Sixty-three (42%) patients were operated immediately due to shock, visceral evisceration or aspiration of blood via a nasogastric tube on admission. Organ injury was seen in 78% of patients with visceral evisceration. Among these 87 cases, 29 patients’ (33.3%) anterior fascia was not penetrated in LWE. So, they were observed for several hours and discharged from the hospital without surgery. While for the remaining 58 patients (66.6%), whose LWE detected penetration of anterior abdominal fascia, laparotomy was performed which showed visceral injuries in 11 (18%) cases. Conclusions All in all, 82 percent of laparotomies in patients with penetrated anterior abdominal fascia without visceral evisceration, who had no signs of peritoneal irritation, were negative. So, we recommended further evaluation in these patients. However, visceral evisceration is an indication for exploratory laparotomy, since in our study; the majority of patients had organ damages.

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.

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.

Mesh fixation is a critical step in TAPP laparoscopic hernia repair because tackers used for this purpose are associated with possible neuralgia. For the present study, 70 patients referred with unilateral inguinal or femoral hernia were divided in two groups for hernia repair. In first group mesh was fixed with titanium tacker. In the second group mesh was fixed with a single suture of Vicryl. Patients in the Vicryl group experienced less postoperative pain and analgesic consumption. Six month follow-up demonstrated no hernia recurrence either. According to results, use of Vicryl suture instead of a titanium tacker is beneficial owing to reduced pain, less analgesic consumption, and lower cost.

Adenosine receptor family especially A1 type is expressed in breast cancer cells in which P53 and caspase genes are wild-type. The aim of this study was to investigate the correlation between A1 receptor and either cell apoptosis or proliferation and also to recognize the relationship between this receptor and P53 and the expression of caspases 3, 8 and 9 in MCF-7 cell line. MCF-7 cells were treated intermittently with A1 receptor agonist N6-Cyclopentyladenosine (CPA) and A1 receptor antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX) in different times to measure the expression of p53, caspase 3, 8 and 9 besides apoptosis and survival rate. Our findings indicated that DPCPX significantly induced apoptosis in MCF-7 cells while the cell viability was reduced specially 72 h after the treatment and the expression of p53 gene and caspase expressions was dramatically up-regulated. On the other hand, CPA increased the cell viability and reduced apoptosis in MCF-7 cells. Our results indicated a significant down-regulation in the MCF-7 mRNA expression of p53 and caspases 3, 8 and 9. Furthermore, DPCPX induced p53 and caspase 3, 8 and 9 expressions that consequently promotes the cell apoptosis in MCF‑7 cells. Therefore, DPCPX can be considered as an anti-cancer drug.