Background: Laparoscopic sleeve gastrectomy (LSG)is derived from the biliopancreatic diversion with duodenal switch operation(BPD-DS). Specific and potentially severe complications of LSG are bleeding from the staple line and staple line leakage (SLL). A staple line leak may result in severe morbidity with potential sepsis and multi- organ failure.Objectives: To review our experience with the definitive surgical management of staple line leak Post sleeve gastrectomy and its outcomes.Patients and methods: retrospective review of patients who underwent definitive surgical treatment of staple line leak post sleeve gastrectomy from May 2014 till June 2016 at Saint Raphael center of morbid obesity, Primary surgery was laparoscopic sleeve gastrectomy in all patients. Staple line leak was diagnosed at the gastroesophageal junction in all patients.Results: Six female patients were treated with definitive surgical management, mean body mass index was 42.7±4.0(range from 35.3-51.2 kg/m2 ), all patient had no associated co-morbidities related to obesity, the mean age of the patients was 36(range from 29-43 years), The leak was at the Gastroesophageal junction in all patients.All patients were fully recovered after definitive surgical treatment of leak, no signs of persist leak during the follow up period, with no mortalityConclusions: Definitive surgical repair with conversion to Roux-en-Y gastric bypass, is safe and very effective and should be done when the general condition of the patient is optimized whenever possible.
Background: Thyroid surgery has undergone many changes during the past 2 decades, including the introduction of new surgical techniques such as endoscopic or video-assisted approaches, anesthesia care, intraoperative nerve monitoring and new hemostatic toolsObjectives: to assess the efficacy and safety of Harmonic Focus shears in total thyroidectomy compared with conventional surgical technique.Patients and methods: prospective study conducted from October 2011 till January 2016, two handers and nine patients with benign and malignant thyroid diseases, scheduled for total thyroidectomy in a governor and private hospitals were enrolled randomly into 2 groups, group A consists of 105 patient who undergone a total thyroidectomy using a harmonic FOCUSTM , and group B consists of 104 patients who underwent total thyroidectomy with conventional surgical technique.Results: Eleven patients had papillary thyroid carcinoma: 6 (5.7%) of them in group A and 5(4.8%) in group B. Eighty seven (82.9%) patients in group A had non toxic MNG, and 12(11.4%) patients had toxic MNG, 90 (86.5%) patients in group B had non toxic MNG while the other 9 (8.7%) had toxic MNG. Mean operative time was significantly lower in group A compared to Group B (100+/- 34 vs. 119+/- 30mins, respectively). In group A mean calcium level at first post-operative day was 8.36 +/- 0.54 mg/dl. In group B mean value was 8.12+/- 0.56 mg/dl. This difference was not statistically significant. There were no significant difference between the two groups concerning transient hypocalcemia requiring calcium and Vitamin D therapy: 11(10.5%) patients in group A versus 12(11.5%) in group B. No permanent hypocalcemia was found in both groups. Two patients had transient vocal cord palsy in group A(1.9%) versus 3 patients in group B (2.8%)Conclusions: The HF is a reliable, comfortable and safe instrument alternative to knot tying technique, very suitable hand-piece for total thyroidectomy. It creates a clean, bloodless surgical field, and there is an advantage for the surgeon to use a single tool for both dissection and hemostasis. Moreover, the HF is a time-saving option, allowing for a significant reduction of operative time, without affecting parathyroid function, need for medical therapy, and hemostasis in the early post-operative period.
Background: Obesity (body mass index >30) is increasing worldwide with an estimated 1.7 billion people currently affected by the disease, Gallstone represent the third most common disease observed among obese patients. Moreover about 30% of the patients who are candidates for bariatric surgery either have undergone a prior cholecystectomy or are found to present gallstones at time of surgery, On the other hand, newly formed gallstones may be diagnosed in 27% to 43% of patients who have undergone bariatric surgery within a very short period of time.Objective: To determine the prevalence of gallstone disease requiring cholecystectomy after laparoscopic sleeve gastrectomy and roux en Y gastric bypass during a one year follow up and to determine the need for prophylactic cholecystectomy in these patients.Patients and methods: prospective study among patients with morbid obesity treated with laparoscopic sleeve gastrectomy and Roux- en- Y Gastric Bypass between 1st of February 2013 till 31st of July 2015 at Saint Raphael hospital and Al-Hayat private hospital, patients with negative abdominal ultrasound preoperatively, patient with at least one year follow up after surgery were included in this study, The patients were divided into two groups for comparison. Group A patients who had laparoscopic sleeve gastrectomy, and group B included the patients who underwent laparoscopic Roux en Y gastric bypass. The primary outcome measure was the formation of symptomatic gallstones or sludge with or without complications.Results: 284 patients in group A(sleeve) and 45 patients in group B(Bypass) were included in the analysis, the mean age of was 34.5 years for group A, and 191(67.3%) of the patients were women, whereas it was 41.5 years for group B and 33 (73.3%) of the patients were women, Symptomatic cholelithiasis subsequently requiring cholecystectomy occurred in 29 (10.2%) of 284 laparoscopic sleeve gastrectomy patients, and 5(11.1%) of 45 Roux en Y gastric bypass patients , symptomatic gallstone developed in a median of 7 months in group A, while the median time to developed symptomatic gallstone in group B was 8 months. No significant difference in symptomatic gallstone disease was found between the patients who underwent laparoscopic gastric bypass and those who had sleeve gastrectomyConclusions: Cholelithiasis was common in our patients before weight reduction surgery. The rate for symptomatic gallstones after surgery was not so high.. Routine prophylactic cholecystectomy should not be recommended for these patients.
Background: Laparoscopic sleeve gastrectomy (LSG)is derived from the biliopancreatic diversion with duodenal switch operation(BPD-DS). Specific and potentially severe complications of LSG are bleeding from the staple line and staple line leakage (SLL). A staple line leak may result in severe morbidity with potential sepsis and multi-organ failure. Objectives: To review our experience with the definitive surgical management of staple line leak Post sleeve gastrectomy and its outcomes. Patients and methods: retrospective review of patients who underwent definitive surgical treatment of staple line leak post sleeve gastrectomy from May 2014 till June 2016 at Saint Raphael center of morbid obesity, Primary surgery was laparoscopic sleeve gastrectomy in all patients. Staple line leak was diagnosed at the gastroesophageal junction in all patients. Results: Six female patients were treated with definitive surgical management, mean body mass index was 42.7±4.0(range from 35.3-51.2 kg/m2), all patient had no associated co-morbidities related to obesity, the mean age of the patients was 36(range from 29-43 years), The leak was at the Gastroesophageal junction in all patients.All patients were fully recovered after definitive surgical treatment of leak, no signs of persist leak during the follow up period, with no mortality Conclusions: Definitive surgical repair with conversion to Roux-en-Y gastric bypass, is safe and very effective and should be done when the general condition of the patient is optimized whenever possible.
Background: Thyroid surgery has undergone many changes during the past 2 decades, including the introduction of new surgical techniques such as endoscopic or video-assisted approaches, anesthesia care, intraoperative nerve monitoring and new hemostatic tools Objectives: to assess the efficacy and safety of Harmonic Focus shears in total thyroidectomy compared with conventional surgical technique. Patients and methods: prospective study conducted from October 2011 till January 2016, two handers and nine patients with benign and malignant thyroid diseases, scheduled for total thyroidectomy in a governor and private hospitals were enrolled randomly into 2 groups, group A consists of 105 patient who undergone a total thyroidectomy using a harmonic FOCUSTM , and group B consists of 104 patients who underwent total thyroidectomy with conventional surgical technique. Results: Eleven patients had papillary thyroid carcinoma: 6 (5.7%) of them in group A and 5(4.8%) in group B. Eighty seven (82.9%) patients in group A had non toxic MNG, and 12(11.4%) patients had toxic MNG, 90 (86.5%) patients in group B had non toxic MNG while the other 9 (8.7%) had toxic MNG. Mean operative time was significantly lower in group A compared to Group B (100+/-34 vs. 119+/-30mins, respectively). In group A mean calcium level at first post-operative day was 8.36 +/-0.54 mg/dl. In group B mean value was 8.12+/-0.56 mg/dl. This difference was not statistically significant. There were no significant difference between the two groups concerning transient hypocalcemia requiring calcium and Vitamin D therapy: 11(10.5%) patients in group A versus 12(11.5%) in group B. No permanent hypocalcemia was found in both groups. Two patients had transient vocal cord palsy in group A(1.9%) versus 3 patients in group B (2.8%) Conclusions: The HF is a reliable, comfortable and safe instrument alternative to knot tying technique, very suitable hand-piece for total thyroidectomy. It creates a clean, bloodless surgical field, and there is an advantage for the surgeon to use a single tool for both dissection and hemostasis. Moreover, the HF is a timesaving option, allowing for a significant reduction of operative time, without affecting parathyroid function, need for medical therapy, and hemostasis in the early post-operative period.
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