Background: One of the major global health burdens is type 2 diabetes mellitus (T2DM). Laparoscopic sleeve gastrectomy (LSG) has recently been shown to be effective and safe for T2DM management. Laparoscopic mini-gastric bypass (LMGB) was introduced as a simple (one anastomosis) operation combining both restrictive and malabsorptive functions thus suitable for obese patients with metabolic derangements like T2DM. This study aims to compare the effect of LSG and LMGB on T2DM in obese patients. Materials and methods: A cohort study was carried out on obese patients with T2DM submitted for LSG or LMGB in the department of surgery at Suez Canal university hospital and Suez Canal authority hospital, Egypt, from June 2018 to September 2020. The patients were followed up for 12 months. Results: A total of 20 patients were allocated to each group. The change in the mean body mass index (BMI) was significantly higher in the LSG, compared to the LMGB group ( p < 0.05). Both groups exhibited a significant reduction in the HbA1c at the end of follow-up 12 months after surgery; however, the reduction was significantly higher in the LMGB group ( p < 0.05).Among the LSG group, 75 % of the cases showed complete diabetic remission, 15 % showed partial remission, and 10 % showed improvement in their glycemic control at the end of follow-up. Among the LMGB group, 85 % of the cases showed complete diabetic remission and 10 % showed partial remission. The difference between the study groups was statistically significant. Conclusion: The study showed good improvement for T2DM and a great response in losing weight with a significant superiority of LMGB over the LSG.
A bstrAct Aim and objective: The aim and objective of this article was to focus on long-term complications after bariatric surgery, which are usually managed by general surgeons in the emergency department. Background: Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed bariatric techniques in the world. Gastric remnant complications after this procedure are infrequent and poorly known. Furthermore, the diagnosis of this pathology may be challenging. Case description: We present the case of a 54-year-old woman with intense epigastric pain and history of uncomplicated laparoscopic RYGBP 18 years ago. After clinical, laboratory, and radiological examinations, the patient was diagnosed with a gastric remnant perforation. Laparoscopic surgery was performed, and the perforation was successfully repaired with primary suture and omental patch. Conclusion: Gastric remnant perforation after bariatric surgery is not frequent and usually appears several years after the procedure. This type of pathology is presented without specific clinical manifestations and with few analytical alterations. Complementary radiological studies, such as computed tomography (CT) scan, should be performed. However, pneumoperitoneum and extravasation of oral contrast are usually absent. Depending on the size of the defect, primary suture or gastric remnant resection may be performed. Nevertheless, surgical treatment should not be delayed. Clinical significance: Long-term complications after bariatric surgery are in many circumstances managed by general practitioner surgeons. The low incidence and scarce manifestations make the diagnosis of this pathology challenging. Furthermore, bariatric surgery is progressively increasing its presence all over the world. Complications after this procedure must be known and kept in mind because an early diagnosis is crucial to give a proper treatment and reduce morbidity and mortality.
A bstrAct Background: The gold standard for gallbladder (GB) surgery worldwide is laparoscopic cholecystectomy. At the same time, complications that may arise from performing cholecystectomy can be horrifying. This is because in some cases, the complex anatomy can predispose the patient to the dangerous arteriovenous and biliary injuries. A subtotal cholecystectomy (STC) can, thus, obviate these complications. Aim: To examine the clinical spectrum of STC and the postoperative turnout of this procedure. Materials and methods: Our health management information system was used to collate our 10-year data (January 2010–January 2020) from the secondary and tertiary health facilities owned by Ondo State of Nigeria. Information on patients’ biodata, indication for surgery, surgical approach, laboratory evaluation, and radiological assessment was entered into a spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) version 20 (OBM Incorporation). STC occurs when there is a remnant of the GB after GB surgery exclusive of the cystic duct. Results: A total of 60 (15 % ) out of 400 patients underwent laparoscopic STC. Closely compacted, complexly crowded constituents and adhesions at the Calot’s triangle were the main indications for STC. Ten patients (16.7 % ) had bile leakage after surgery. There were no biliovascular injuries, and 1-month mortality was zero. There was no case of surgical site infection. Over a consistent follow-up of 1 year, clinical examination, liver function test, and ultrasonography revealed no abnormality in any of the patients. Conclusion: STC is a rescue mission during difficult GB surgery. Early consideration for STC before conversion to open surgery is more acceptable. Intraoperative injuries are obviated, and the postoperative outcomes are satisfactory.
We have observed that the falciform ligament can appear prominently as a vertical lucent artifact making cholangiography difficult during laparoscopic cholecystectomy.Our suspicion is that this is due to the pneumoperitoneum, and once the pneumoperitoneum is released, this artifact disappears.We have presented images displaying this phenomenon that we feel would be useful for general surgeons operating on the gallbladder.
Background: In today’s era of minimally invasive surgery, early postoperative pain reduction, early recovery, and return to normal activities are also important aspects. This study has been designed to analyze and compare the effect of laparoscopically administered transversus abdominis plane (TAP) block with port-site infiltration of long-acting local anesthetic agent (0.25 % bupivacaine) in cases of elective laparoscopic cholecystectomy. Materials and methods: This is a comparative study carried out at St Joseph Hospital, Ghaziabad, from September 2019 to March 2020 on 154 patients who underwent standard four-port laparoscopic cholecystectomy. Seventy-seven patients in group I received TAP block with 0.25 % bupivacaine and seventy-seven patients in group II received 20 mL of 0.25 % bupivacaine infiltration over port sites, including 10 mL each at epigastric and umbilical port and 5 mL each at midclavicular line and anterior axillary line ports, respectively. Various parameters were assessed during the intraoperative and postoperative periods. The pain was analyzed using visual analog scoring (VAS) for the first 24 hours at an interval of 3, 6, 12, and 24 hours. A note was made of any additional analgesic requirement. Results: Postoperative pain at 3, 6, and 12 hours was significantly reduced in group I who received TAP block as compared to those who received port-site infiltration. Hospital stay duration was significantly shorter in group I. Conclusion: Laparoscopic-assisted TAP block significantly reduces early postoperative pain, shortens hospital stay after elective laparoscopic cholecystectomy, and is a safe and cost-effective method without any extra requirement of specialized equipment and skills.
