Artificial Intelligence entails simulation of human intelligence by machines. The capacity for systems to generate big data coupled with the increasing affordable computational power has enabled progress from machine learning to deep learning. Artificial intelligence(AI) solutions could be applied in in the preoperative, intraoperative and postoperative laparoscopic care of patients as well as in the training of surgeons. Its potential for reproducibility and consistency is a drive for conditional autonomy in robotic laparoscopic systems. However issues of bias, privacy concerns and explainability of deep learning algorithms are challenges in the faster deployment of AI systems.
Gallbladder polyp in the pediatric population is a rare entity. Only 20 cases have been reported thus far in the English medical literature. We report this case of an 11-year-old female, presenting with acute cholecystitis clinically. Ultrasound confirmed a gallbladder polyp of size 1.6 cm × 1.1 cm. Laparoscopic cholecystectomy was done and provided complete symptomatic relief. As the pathologic spectrum of gallbladder polyp in children is different from that in adults, cholecystectomy and thorough histopathological study would be recommended with such a presentation in a symptomatic child. Incidental asymptomatic cases should be under ultrasound surveillance if polyp size is <1 cm, as long-term effects are unknown with limited information in the English literature. Cholecystectomy is recommended for polyp more than 1 cm.
Introduction: Hernia repair has been an ever-evolving field of surgery. Laparoscopic hernia repair techniques and the use of a mesh in the primary inguinal hernia repair is a standard treatment associated with significantly less postoperative pain and an earlier return to normal work compared with open hernia repair. As mesh-related complications have increased in the past decade, there has been an evolution in the type of meshes being used. As a consequence, today, two major mesh concepts are distinguished: the classical concept including heavyweight (HW) meshes with small pores and the new concept including lightweight (LW) meshes with large pores. Objective: The objective of the study was to compare the postoperative outcomes and patient satisfaction, after the use of HW meshes (HWMs) versus LW meshes (LWMs) in laparoscopic inguinal hernia repair by analyzing infection, seroma formation, ileus, foreign-body sensation, groin stiffness, delayed urinary retention, and testicular atrophy among male patients, early postoperative pain on day 1, 2, and 7, chronic pain on follow-up 3 rd and 6 th months, duration of hospital stay, duration to start work, quality of life after surgery (7-point Likert scale), and recurrence. Materials and Methods: This hospital-based prospective study enrolled 91 patients presenting with inguinal hernias to compare the utilisation of heavy-weight and light-weight mesh. The patient cohort was stratified into two groups and evaluated for an array of post-operative outcomes, including pain assessment, complications, and quality of life metrics. The study employed Prolene heavy-weight mesh and Ultrapro light-weight mesh, and patients were monitored for six months following surgical intervention. Data were collected and subsequently analysed utilizing SPSS software, and the results were deemed statistically significant if the p-value was less than 0.05 Results: This was a hospital-based, unicentric, prospective study. A total of 91 patients with inguinal hernia enrolled prospectively between November 2019 and June 2021, aged more than 13 years, admitted in JNMCH Hospital were included in this study. All patients were divided into the two groups by manual random selection technique. Fifty-four patients were included in the HWM group, whereas 37 patients were allocated to the LWM group. The LWM repair was found to have better than HWM repair in terms of duration of hospital stay and quality of life score with P = 0.0054 and P = 0.0372, respectively. Postoperative complications (infection, seroma, recurrence, foreign-body sensation, groin stiffness, delayed urinary obstruction, and testicular atrophy among male patients), postoperative pain (day 1, 2, and 7; 3rd and 6th months), and duration of return to work did not show a statistically significant difference between LWM and HWM repair, with P values of 0.15271, 0.770335, 0.15271, 0.629837, 0.629837, 0, 0, 0, 0.626, 0.7704, 0, 0, 0, and 0.1888, respectively. Our study showed no statistical difference between the LWM repair and HWM repair in terms of postoperative complications (infection, seroma, recurrence, foreign-body sensation, groin stiffness, delayed urinary obstruction, and testicular atrophy among male patients), postoperative pain (early and chronic), and duration of return to work. Conclusion: The use of mesh in the laparoscopic approach for inguinal hernia repair is widely adopted now. In our study, the use of LWMs is associated with the less duration of hospital stay and better quality of life score with P = 0.0054 and P = 0.0372, respectively, with no increased incidence of postoperative complications in comparison with the HWMs. We recommend the use of LWMs over HWMs to be used in laparoscopic inguinal hernia repair for a relatively better outcome.
Background: Repair of ventral and incisional hernias repair (VIHR) is a standard procedure; newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. Indeed the data of Phasix resorption started to occur postmaturation of the wound tissue. However, data on the use of slowly resorbable mesh materials remain scarce, and this study aims to evaluate the use of Phasix ST in the laparoscopic repair of VIHR. Methods: This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a Phasix ST mesh. Perioperative characteristics and clinical outcomes were collected. Results: In total, 26 patients, including 19 females and 7 males, underwent laparoscopic VIHR using Phasix ST from April 2016 to January 2023. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6 years, and the mean body mass index was 35.5. All patients had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in the clinic with a median follow-up of 48 months. We observed four wound seromas, no wound infections, and three recurrences during the 5-year follow-up period. All occurred in the center of the mesh with severe adhesions to the mesh and tacker. Conclusion: Five years of follow-ups showed 11% recurrence in the same site note, which needs to be reviewed. Further, 10 years of follow-up results need to be assessed.
Introduction: Achalasia is a rare neurological disorder, in which the esophagus fails to relax. The esophagus also has a marked absence of peristalsis. In <50% of patients, the lower esophageal sphincter is hypertensive. This condition causes a functional obstruction at the gastroesophageal junction. Background: Treatment is to ease the symptoms of achalasia by decreasing the outflow resistance caused by a nonrelaxing and hypertensive lower esophageal sphincter. Surgical options are laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy. The recommended step for reducing pressure across the lower esophageal sphincter is surgical myotomy, which can be done laparoscopically. This procedure will cut the circular muscle fibers running across the lower esophageal sphincter, leading to relaxation. LHM can potentially cause uncontrolled gastroesophageal reflux, so it typically pairs with an antireflux procedure such as Nissen, the posterior (Toupet), or the anterior (Dor) partial fundoplication. The anterior fundoplication is the more common choice. LHM with partial fundoplication is the surgical procedure of choice. The important thing is that the fundoplication is partial, not complete, so as not to cause postoperative dysphagia, which is more severe with Nissen fundoplication. The clinical success rate of LHM is high (76%–100%) at 35 months, with a low mortality rate of 0.1%. Disease progression after 5 years subsequently reduces the success rate. Methods: Video demonstration of case of achalasia treated with Heller myotomy. Results: Video demonstration of case of achalasia treated with Heller myotomy. Discussion: Video demonstration of case of achalasia treated with Heller myotomy. Conclusion: Video demonstration of case of achalasia treated with Heller myotomy.
Background: Lymphangiomas are rare benign vascular malformations of the lymphatic system. It is usually located in the head, neck, and axilla and is typically present during the first 2 years of life. A few cases of inguinal lymphangioma have been reported in adults. Methods: Case report. Discussion: Lymphangioma rarely occurs in the inguinal region, presenting a diagnostic challenge as it mimics various inguinal conditions. Differential diagnoses include inguinal hernia, hydrocele of the cord, lymphadenopathy, or hematoma. Imaging is used to determine the size, invasion, relation to surrounding structures, and extension to the abdominal cavity. Magnetic resonance imaging is the diagnostic modality of choice in nonemergency settings. Complete surgical excision is the gold standard for the management with the lowest risk of recurrence. Alternative non-surgical treatment options have been used successfully in poor surgical candidates. Different sclerosing agents have been used with low complications and rates of recurrence. Ethanol is a widely available sclerosing agent, and it was used with no recurrence or side effects during the follow-up period. Conclusion: Surgeons should have a high index of suspicion when investigating any inguinal mass, considering such a rare presentation as part of the differential. Sclerotherapy is an effective treatment for lymphangioma and should be considered as an alternative modality in nonsurgical candidates.
Background: Pulmonary metastasis (PM) from colorectal cancer (CRC) is a rare and incompletely understood entity which affects 10% of CRC patients. The 5-year overall survival (OS) of Stage IV CRC is 11.3% and in pulmonary metastatectomy range from 40% to 69.7%. This study aims to evaluate the overall 5-year survival of PM from CRC and identify potential independent risk factors affecting the OS. Methods: A retrospective study was conducted in a tertiary care center (Royal Hospital). The study included all patients diagnosed with Stage IV CRC with PM aged >18 years between 2008 and 2015. Patients with no follow-up and missed data were excluded. Data were retrieved from the electronic record system (Al-Shifaa) and analyzed using SPSS software. Results: The prevalence of PM in the overall CRC cases was 15.2% (84/554 patients). Seventy-one patients were included in this study after the application of exclusion criteria with the mean age of patients was 60.35 ± 16.4 years; majority male gender 64.8% (46) and most of them with no comorbidities 57.7% (42). The most common location of primary tumor is sigmoid 31% (22) and diagnosed with T3 40.8% (29) status and N2 32.4% (23) status with high CEA > 5 at presentation and diagnosis. The majority of cases presented with synchronous PM 74.6% (53) and following metastasis features bilateral lung side 69.0% (49), =>10 nodules 42.3% (30), <1 cm size 66.2% (47), and no lymph involvement 57.7% (41). Five-year OS rate is 15.3%, and the median OS time is 15 months. There was a statistically significant difference in the OS distribution between those who received surgery and those who did not receive surgery (Log-rank test, P = 0.004) and 5-year OS rate in the surgical group is 55.6% versus 8.3% in nonsurgical. Median survival time was 71 months versus 13 months, respectively. Several factors were found to be associated with a favorable OS, which include the middle age group (P = 0.007), absence of perineural invasion (P = 0.015), and isolated PM (P = 0.003). In addition, multivariate Cox regression showed OS relatively poor in females (P0.001), metachronous (0.003), T4 (0.005), and normal CEA at diagnosis (0.011). Conclusion: The present study showed 5-year OS rate is 15.3%, and the median OS time is 15 months for Stage IV CRC with pulmonary metastasis. Surgical management, middle age group (40–59 years), absence of perineural invasion, and isolated pulmonary metastasis at diagnosis may be associated with improved survival. Female gender, tumor status T4, Carcinoembryonic <=5 at diagnosis, and metachronous lung mts were associated with poorer survival outcomes. Despite the study’s limitations of retrospective design with a small sample size, the results can be considered as part of MDT-based decision-making. These findings will require future large multicenter studies.
Background: Seroma formation is one of the most common events following ventral hernia repair. When mesh is used for the repair of larger and more complex incisional hernias, the risk of seroma formation increases. The mesh onlay technique, which requires more extensive dissection, is associated with an even greater incidence of seroma formation. Treatment options for postoperative seromas include observation for spontaneous resolution, percutaneous aspiration, closed suction drainage, abdominal binders, and sclerosant. Methods: The aim of this report is to present a definitive management of a very challenging case of abdominal wall chronic complex seroma following herniorrhaphy with mesh approached by open capsulectomy and scarification of the remnant pseudocapsule. Results: Our patient is a 60 years-old male a status post low anterior resection with covering loop ileostomy for rectal cancer. His diverting stoma was taken off after completing the adjuvant chemotherapy treatment. Seven months later, the patient has developed an enlarging midline incisional hernia. This hernia was subsequently repaired by primary fascial closure with suprafascial onlay polypropylene mesh. Postoperatively, he developed a subcutaneous seroma which was initially treated with an abdominal binder without success. Over the following 3 months of observation, seroma was increasing in size. Discussion: Having recovered his acute condition, surgical intervention was planned. The patient underwent an excision and evacuation of the complex seroma and pseudocapsule. A 12-cm midline incision was made in line with the previous incision used for the hernia repair. The pseudocapsule of the seroma was encountered when the subcutaneous tissue was incised. The incision was carried superior, inferior, and laterally, and the capsule was exposed. The seroma opening sinus was expanded and fluid was evacuated. There were some fibrous dead tissues and coagulated dark blood. The anterior and lateral aspects of the pseudo capsule were excised. Furthermore, the posterior aspect was cleaned carefully using the curettage instrument without affecting the integrity of the mesh which was looking healthy and intact and without causing injury to the intraabdominal contents. Argon beam coagulator was used to scarify the remaining posterior aspect attaching to the mesh. Hemostasis was secured, and the wound was closed over a Jackson–Pratt drain. A pressure dressing and abdominal binder were applied. Conclusion: Factors leading to seroma following incisional herniorrhaphy are poorly understood. Many options are available for treating complicated abdominal wall seroms. capsulectomy and scarification of the remnant pseudocapsule were good option for the treatment of persistence complex seroma.
Introduction and Background: The past decade has witnessed a paradigm shift in surgical interventions, with minimally invasive surgery is superior to the traditional open approach for several conditions, including the management of benign gallbladder diseases. The widespread acceptance and popularity of laparoscopic cholecystectomy, in fact, can be explained by the significant reduction in associated morbidity and faster recovery to daily activities, in comparison to the classic open approach. The current systematic review is the first to provide comparative outcomes by summarizing the previously published systematic reviews in a comprehensive and objective pattern. It aims to illustrate evidence regarding the intra- and postoperative outcomes of each laparoscopic cholecystectomy approach, as most of the previous publications have only briefly touched upon one or two of them. Methods: The current systematic review is the first to provide comparative outcomes by summarizing the previously published systematic reviews in a comprehensive and objective pattern. It aims to illustrate evidence regarding the intra- and postoperative outcomes of each laparoscopic cholecystectomy approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. Results: The analysis of our primary and secondary outcomes revealed a statistically significant improvement in esthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Discussion: Since the introduction of SILC by Navarra et al . in 1997, extensive efforts have been made to prove its safety and feasibility to replace the conventional method of laparoscopic cholecystectomy. Previous surgeries involving the abdomen and signs of acute cholecystitis were identified as factors predicting failure of SILC, with success rate limited to 59% in association with acute cholecystitis, as suggested by Antoniou et al . in his systematic review addressing the limitations of the single-incision approach. The associated increase in the length of operative time can be partly explained by the surgeon learning curve as applied to any surgical procedure. Conclusion: Careful selection of candidates undergoing SILC should be present to minimize technical difficulties and prevent related complications both intraoperatively and shortly after the procedure.
Introduction: Obesity is one of the major lifestyle diseases and is associated with multiple comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea, and neoplasms. Bariatric surgeries are the most effective treatment for obesity. The cost-effectiveness of bariatric surgeries has become a major concern, and there is a shift toward avoiding histological evaluation of surgical specimens during routine procedures. Background: It is assumed that similar to other elective surgery specimens, gastrectomy specimens obtained in bariatric surgery would be normal, except for unexpected incidental findings. Here is a lack of published data on histopathological changes in gastric specimens from patients with morbid obesity. There are conflicting reports about the necessity of histopathological examination of bariatric surgery specimens. In Oman, the practice is to send all surgical specimens resected during sleeve gastrectomy for histopathologic evaluation despite in most of the centers, the practice is not to send in normal sleeve gastrectomy operations. Histopathological data are insufficient to describe the most common histopathological findings in laparoscopic sleeve gastrectomy specimens. Methods: All patients who underwent sleeve gastrectomy in Royal and Nizwa hospitals (tertiary hospitals in Oman) from January 2010 to December 2021 were included in the study. The data were collected from the medical records, and it includes baseline characteristics and histopathological findings. The data will be collected in Excel sheet. The analysis includes age, sex, body mass index (BMI), comorbidities, and the histopathological results. Results: The records of 759 patients were reviewed. 34.3% of the specimens were normal. The remaining of the specimens showed benign pathology. The most common benign pathologies were chronic gastritis 58.2%, H. Pylori-associated chronic gastritis 4.6 and chronic gastritis with metaplasia 1.7%. Discussion: This was a cross-sectional retrospective descriptive study. Statistical Package for the Social Science (SPSS) version 26 was used for analysis. Variables included age in years, sex, BMI, and histopathological findings were calculated as frequencies and percentages. Associations were assessed by t -test. P ≤ 0.05 was considered significant. The sample size was calculated using the n Master 2.0 calculator. Based on the expected common finding of chronic gastritis at 60%, 3.5%precision, and 95% confidence interval, we need to study a minimum of 753. The most prevalent histopathological finding is chronic gastritis 58.2%. This study’s results signify the null occurrence of malignancy in resected gastric specimens. There was no association between Helicobacter pylori and advanced age. There was no association between BMI and suspicious findings P value 0.293. Conclusion: The most prevalent histopathological finding is chronic gastritis. This study’s results signify the null occurrence of malignancy in resected gastric specimens. Routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms is not necessary. Finally, there is no association between BMI, gender, and age with suspicious findings.
Postoperative urinary retention is one of the more common complications following laparoscopic inguinal hernia repair (LIHR). We hypothesized that the oral one adrenergic blocker Tamsulosin, (Flomax, Boehringer Ingelheim) could be used to decrease the incidence of urinary retention after LIHR. Data from all patients undergoing laparoscopic total extraperitoneal (TEP) inguinal hernia repair by a single surgeon from June 2012 through June 2017 were collected prospectively. Patients received Tamsulosin (Flomax) 0.4 mg/day orally for a total of 5 days beginning 2 days before surgery. All TEP procedures were done under general anesthesia without a urinary catheter in place. Patients were discharged home after voiding in the recovery area. Data are expressed as mean ± standard deviation; flomax was administered to 30 of 32 consecutive patients undergoing outpatient TEP inguinal hernia repair. The mean patient age was 51.3 ± 10.5 years (28–72 years). Ten (32.2%) patients were operated on for recurrent inguinal hernias, 14 (45.1%) had bilateral hernias repaired, and 4 (12.9%) had concomitant umbilical hernia repair. The average operative time was 60 ± 24 min. The mean amount of intraoperative fluids given was 998 ± 297 ml. Two patients were excluded from the study because they required a urinary catheter in the operating room for other reasons (one requiring concomitant cystoscopy and one with anticipated complicated repair in patients who had three prior open inguinal hernia repairs and did not take Flomax). None of the patients given Flomax perioperatively developed urinary retention and all were discharged home the same day of surgery. In contrast, the two patients undergoing TEP repairs who did not receive Flomax perioperatively both developed urinary retention that required catheter placement.
Background: Obesity and its comorbidities remain a priority public health issue, 30% of the Omani population having body mass index (BMI) of more 30. Roux-en-Y gastric bypass (RYGB) remains one of the gold standard procedures for morbid obesity and metabolic disorders in most of the reference centers. One-anastomosis gastric bypass (OAGB), gaining wide acceptance OAGB, was proposed as a simple and effective treatment for morbid obesity. Published data essentially come from retrospective studies, meta-analysis, and few root canal treatment have been reported the value of OAGB remains debated, high-level evidence regarding its efficacy and safety. Methods: A single-institution qualitative retrospective cohort study was conducted in Royal Hospital in the period between 2017 and 2020. Total sample: 45 (28 OAGB and 17 RYGB, the data were collected from the medical record system (Al-Shifa system). Inclusion criteria: all patients who aged 18–65 years with a BMI between 35 and 50 kg/m 2 . Exclusion criteria who have esophagitis, malignancy “Inflammatory bowel disease” Pregnancy, BMI over 50 kg/m 2 , and previous bariatric surgery. Results: The mean BMI at 3 years was 31.9 for OAGB and 32 for RYGB. There was no significant difference in EWL% in the OAGB compared with the RYGB group, P = 0.86; mean HbA1c at 3 years was not statistically different P = 0.49. The mean decrease in HbA1c was significantly greater in the OAGB arm 2.4% than in the RYGB arm 2%. There was a 68% ( n = 15/23) complete type 2 diabetes (T2D) remission rate in the OAGB group versus 31% in the RYGB group. The proportions of T2D remission were not significantly different ( P = 0·722). The incidence of malnutrition, anemia, and vitamin deficiencies at 3 years was not significantly different. Discussion: RYGB was first described in 1967, and an IFSO survey showed that RYGB was the most common bariatric procedure from 2003 to 2013 (11, 28). According to the 2018 IFSO survey results, OAGB was considered the third most popular bariatric surgery. Previous studies have suggested that the OAGB learning curve is shorter than that of RYGB and that the learning curve is closely related to surgical complications. However, there is no consistent confirmation of the effect and comorbid remission rate of the two bariatric surgeries. Many articles have shown that the weight loss effect of OAGB is not as worse as that of RYGB; however, the sample size of the comparison articles is small, the randomized trials are few, and they mainly focused on the comparison of weight loss effect, with less research on postoperative complications. Conclusion: OAGB appeared to be safe, effective, and not inferior to LRYG. OAGB is associated with more weight loss and better resolution of comorbid conditions. No difference between both surgeries in nutritional outcomes. The clinical utility of OAGB needs to be further validated by future prospective RCTS.
Introduction: Mesh has become the preferred method due to its ability to integrate with the host’s tissue, reducing recurrence rates compared to primary suture repairs. While synthetic mesh reduces recurrence rates, it may lead to inflammation and infection. To evaluate its performance, this study aims to assess the short-term outcome following ventral hernia repair with biosynthetic mesh. Background: In Ventral Hernia Working Group Grade 3 hernias, which are often contaminated due to factors like prior wound infections, the presence of a stoma, or gastrointestinal tract violations, the heightened risk of infection poses significant challenges. In such cases, the success of mesh repair is jeopardized by potential contamination, complicating the surgical process; prompting consideration of resorbable or biological meshes despite higher costs. A recent advancement is biosynthetic mesh, notably poly-4-hydroxybutyrate, which offers strength comparable to polypropylene mesh and undergoes resorption. However, it retains only 70% strength after 12 weeks, potentially contributing to recurrence. Its efficacy in contaminated sites requires further exploration. Methods: We conducted a retrospective cohort study to thoroughly assess the potential complications following ventral hernia repair. This study will include all patients whose ages are >16 and underwent either open or laparoscopic ventral hernia repair with a biosynthetic mesh at King Abdulaziz Medical City, Saudi Arabia, Riyadh National Guard Health Affairs. The study period extends from January 2020 to December 2023. The study data were extracted from patients’ medical records through the BestCare system. Results: The mean age of our cohort was 58.65 with body mass index 39.6 when looking at comorbidities diabetes mellitus and HTN were the most common comorbidities with 32% affected with diabetes, and 39% affected with hypertension. The most common hernia type observed in our study was incision hernia accounting for 36% of all hernia types followed by inguinal hernia 24.6%. Complications were assessed at 4 time intervals of 1, 3, and 6 months and 1 year. The majority of the patients with complications presented at the 1 st month with seroma accounting for 2.2% followed by surgical site infection (SSI) 1.8% and only three patients had 1-year postoperative recurrence. Discussion: The long-term effects of using a permanent synthetic mesh have not been fully understood. However, examining the outcomes associated with absorbable mesh can provide a useful framework for discussing potential risks with patients. Reported outcomes include rates of hernia recurrence and various surgical site occurrences requiring intervention, such as SSI, seroma, wound dehiscence, skin necrosis, hematoma, and fistula. It is important to note that this study is a retrospective cohort study with long-term follow-up, rather than a randomized controlled trial. In addition, other peer-reviewed studies have assessed alternative resorbable synthetic or biologic hernia repair materials, including TIGR ® Matrix, Gore ® Bio-A ® , and Strattice™. Conclusion: In short, our results are comparable to the published reports. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report the lasting presence of mesh sensation. Results of the biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations.
Background: Malignant colonic obstruction (MCO) occurs in 10%–18% of colorectal cancers. Conventionally, emergency surgery has been the standard treatment modality. However, it is associated with higher morbidity and mortality rates compared to patients undergoing elective surgery. With the advancement of endoscopic techniques, self-expandable metal stent has been advocated as an alternative management. It provides relief of obstructive symptoms, allowing the patient’s general condition to be restored and enabling elective surgery. Furthermore, the ability to complete staging allowed identification and avoidance of unnecessary surgery in patients with advanced disease who need palliative measures. However, various stent-related complications. have been reported in the literature, including perforation (4.5%), migration (11%), and obstruction (12%). Aim: This study aimed to evaluate the technical and clinical success rates and the complication rate of stent placement in patients with MCO. In addition, we compared the rates of laparoscopic surgery, stoma creation, and postoperative outcomes between different subgroups. Methods: We conducted a retrospective cohort study including all patients diagnosed with MCO between March 2015 and September 2021. Patients were divided into groups according to the initial treatment they received, stent versus surgery, and the intent of treatment, and curative versus palliative. Data were collected from medical records. Results: Among 112 patients, 24 had stenting as a bridge to surgery, and 16 underwent palliative stenting. The technical and clinical success rates were 95% and 94.7%, respectively. Stent placement failed in two patients in the curative group due to complete obstruction with the inability to pass the guidewire in one patient and perforation in the other. Clinical failure was encountered in two patients who had persistent symptomatic obstruction beyond 48 h from stenting. The early complication rate following stent insertion was 7.5%. Among curative patients, stenting did not affect surgical resection in terms of laparoscopic approach or need for stoma creation. However, it was associated with longer hospital stay. On long-term follow-up, half the patients who received stent in the palliative group required re-intervention due to re-obstruction with either re-stenting or surgery. The mean stent patency time was 7 months. Conclusion: Management of MCO varies based on the patients’ clinical presentation, tumor site, and surgeon’s preference. Stent placement is an effective and safe management option for selected patients with MCO with reasonable clinical and technical success rates. Complication rates are low, particularly when used as a bridge to surgery. However, long-term patency and the need for re-intervention are an area of concern among palliative patients.
Objective: The objective of the study was to determine whether a short course (within 24 h) of antibiotics is as effective as a long course (5 days) in preventing operative surgical site infection in patients with penetrating abdominal injury. In addition, the secondary outcome is to examine the effect of antibiotic duration on the mortality rate. Data Source: A comprehensive search of electronic databases (PubMed and Embase) until January 2024 comparing a short course (within 24 h) versus a long course (5 days) of antibiotics in preventing postoperative surgical site infection. Study Selection: Inclusion criteria were English-only studies, and the type of studies was restricted to randomized controlled trials. Data Extraction: Two authors independently extracted data from the selected studies, and the data collected were compared to verify agreement. Data Synthesis: Postoperative surgical site infection in patients with penetrating abdominal trauma was the primary outcome evaluated in each study. Studies were weighed by the inverse of the variance of the outcome, and a fixed-effects model was used for all analyses. Conclusion: Based on the available literature on the duration of antibiotics for penetrating abdominal injury with or without associated hollow viscus injury, it can be concluded that a short-course antibiotic (within 24 h) is as effective as a longer course (5 days) to be given for a patient with penetrating abdominal injury to prevent postoperative surgical site infection.
Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus . The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.
Introduction: In laparoscopic colectomy for colorectal cancer, appropriate lymph node dissection and prevention of anastomotic leak are very important. Indocyanine green (ICG) images obtained through the laparoscopic procedure helped visualize lymphatic drainage vessels and inform decision-making to determine the vessels. Intracorporeal anastomosis has advantages such as earlier recovery of postoperative bowel function, shorter length of wound incision, reduction of intestinal mobilization range, and fewer incisional hernias. Background: We report the surgical technique and short-term results of 48 patients who underwent laparoscopic colectomy and intracorporeal anastomosis using the double ICG fluorescence technique from July 2020 to September 2023. Methods: Two injections of ICG (0.75 mg ×2) into the proximal and distal subserosa of the tumor preceded the surgical procedure after pneumoperitoneum. Intraoperative lymph node mapping by the Stryker1588, 1688AIM camera imaging system was visualized. Laparoscopic colectomy was performed according to the Complete Mesocolic Excision and Central Vascular Ligation concepts. Complete intracorporeal anastomosis was performed by a functional end-to-end or overlap or Delta anastomosis. After anastomosis, ICG (12.5 mg) was injected intravenously to check the intestinal blood perfusion at the anastomosis site. Results: Forty-eight patients (Sex; male: 23 and female: 25) (Tumor location; C: 20, A: 11, T: 8, D: 7, S:2) (pStage0:2, I:15, II: 16, III:10, and IV:5) were underwent. The median age was 74. median body mass index was 23. Median number of dissected lymph nodes was 18. The median operative time was 246 min. The median wound length was 3.5 cm. The median postoperative hospital stay was 7 days. Visualization of lymphatic flow was observable in 24 of 28 cases (85.7%). The transection line was changed in 2/48 cases (4.1%) after ICG fluorescence angiography. There were no intraoperative complications, and two patients had postoperative paralytic ileus. Discussion: We introduce a novel technique of double ICG administration during laparoscopic colon resection for colon cancer that enables improved lymphadenectomy and warrants the extent of intestinal resection. It contains the intrinsic solution to the potential risks related to more intense dissection for extended lymphadenectomy. This is an immediate assessment of blood supply to the anastomosed intestinal walls. ICG fluorescence has immanent advantages as a result of its very low toxicity, high sensitivity, fast feedback, and absence of radiation. It is helpful to determine the extent of a bowel resection and can avoid leaving positive lymph nodes behind. It was revealed that ICG accurately evaluates the blood supply to anastomotic sites in real time and can detect organ ischemia before reconstruction is performed. This is particularly useful in laparoscopic surgery, as detection of impaired blood supply is difficult and even more for intracorporeal anastomosis. Lower anastomotic leak and reoperation rates were revealed with the use of ICG in several studies. Lymph nodes’ metastases are the most important prognostic factor in colon cancer, which has a poor prognosis and high recurrence. The use of ICG in the identification of lymph flow and lymphadenectomy basin in colon cancer patients has been previously reported. Lymph drainage of the transverse colon is complicated, and understanding this lymphatic drainage system is difficult, making ICG fluorescence particularly useful in right-sided and splenic flexure colon cancer patients. Conclusion: ICG fluorescence lymphangiography in laparoscopic colectomy for colon cancer allows visualization of lymphatic flow and may complement more reliable lymph node dissection. In addition, the evaluation of intestinal perfusion using ICG contributes to the reduction of anastomotic leakage and enables safer intracorporeal anastomosis.
Introduction: The prevalence of bariatric surgery as a treatment for obesity has brought to light its implications for various health outcomes, including neurological disorders such as seizures and epilepsy. Obesity itself has been linked to neurological health, raising questions about the impact of its treatments, such as bariatric surgery, on neurological outcomes. Background: A study in this domain was conducted; their research investigated the risk of epilepsy following bariatric surgery in comparison to a nonsurgical cohort with an obesity diagnosis. Their results indicated a higher incidence of epilepsy in the postbariatric surgery group. These findings underscore the necessity of this systematic review. The relationship between bariatric surgery and neurological outcomes such as epilepsy remains inadequately explored, with potential long-term risks that warrant further investigation. Therefore, this review aims to synthesize available evidence, evaluate the effects of bariatric surgery on epilepsy risk, and identify potential mechanisms and risk factors. Methods: This review includes eligible case reports and cohort studies on people who developed postbariatric seizure between September 1962 and January 2024, selected from three primary databases: PubMed (NCBI), Embase (OvidSP), and Web of Science. The selection process was based on three phases: title, abstract, and full-text screening, and we included 19 articles. Results: Among the case reports, 14 out of 15 are associated with Roux-en-Y gastric bypass (RYGB) surgery. The causes of postbariatric seizures were diverse, with 56% attributed to hypoglycemia, 19% to hyperammonemia, and the remaining cases linked to hypocalcemia, vitamin deficiency, and postbariatric stroke. Cohort studies assessing postbariatric seizure risk showed significant findings. One study reported HR of 1.45, and another found HRs of 3 and 7.3 for epilepsy and seizures, respectively. These findings underline increased risk after bariatric surgeries. Management varies widely, including surgical and medical treatment. Surgical treatment by RYGB reversal was reported in several cases, with two approaches, including laparoscopic restoration using a Henley-Longmire interposition and distal pancreatectomy. Medical management involved antiepileptic drugs, antihypoglycemic agents, and specific therapy for hyperammonemia and hypocalcemia. Discussion: The results of this review suggest a link between bariatric surgeries and developing seizures. However, the majority of the studies concluded hypoglycemia was primarily associated with these outcomes. Few studies suggest hyperammonemia as a contributing factor; two studies implicate urea cycle disorders. Furthermore, surgical management showed the most effective way to control postbariatric hypoglycemia alongside other specific treatments for certain conditions, such as hyperammonemia. The main limitation of our review is the need for primary studies. Conclusion: Findings from this review highlight the need for continuous monitoring postoperatively to address any risks of seizures following bariatric surgery, as early detection of seizures can prevent adverse outcomes. Moreover, healthcare providers should focus on patients’ education regarding the risk of seizures, enabling them to recognize symptoms and seek medical care. Furthermore, these findings highlight the importance of continuous follow-up to optimize patient safety and improve long-term outcomes for individuals undergoing bariatric surgery.
Introduction: Proton beam therapy (PBT) has the feature of reducing radiation exposure to surrounding organs compared to conventional X-ray irradiation, so PBT for esophageal cancer is gradually spreading. Background: However, there are few reports about salvage esophagectomy after PBT, and its efficacy and safety are unclear. Methods: We reviewed the clinical and surgical outcomes of 5 cases who underwent salvage thoracoscopic esophagectomy after PBT from 2010 to 2023. Results: Four of five cases were males; the median age was 70 years, and all lesions were in the thoracic esophagus. One case was T2 lesion depth before PBT and 4 cases were T3. The median dose of proton beam radiation was 35.2 (26–60) Gy, and the median total (including X-ray) radiation dose was 66 (40–71.2) Gy. For of them were recurrent and one was remnant lesions. All cases were performed through thoracoscopic esophagectomy (one was converted to open surgery). Median thoracic operation time and blood loss were 217 (213–427) min and 10 (6–565) ml, respectively. Two cases with a preoperative diagnosis of T1-2 showed fibrosis comparable to that seen in conventional salvage esophagectomy, and we underwent R0 resection. However, the others had severe fibrosis and Grade IIIb postoperative complications such as thoracic abscess and cardiac tamponade requiring open chest drainage, and percutaneous pericardial drainage was occurred in two cases who underwent R2 resection. Discussion: For the nonlocally advanced cases, the results were comparable to the conventional salvage esophagectomy. However, fibrosis and scarring of the irradiated area were stronger after PBT, especially in advanced lesions, and they were at high risk for non-R0 resection and complications. Conclusion: Because the number of cases was small in this study, it is necessary to conduct further studies on a large number of cases, including multicenter collaboration.
BACKGROUND: The prevalence of inflammatory bowel diseases (IBD), Crohn's (C) and ulcerative colitis (UC) has increased in Saudi Arabia during the past decade. Even though medical treatment is first-line therapy, most patients require surgery during the course of the disease. Stoma creation complications in IBD are underreported in the literature of the Middle East and especially in Saudi Arabia. OBJECTIVES: Report the postoperative, stoma and peristomal complications following stoma creation in (C) versus UC. DESIGN: Retrospective cohort study SETTINGS: Tertiary care center PATIENTS AND METHODS: Patients with IBD who underwent stoma creation for either UC or CD between August 2015 and July 2020 were included. The diseases were compared to assess their characteristics and association to postoperative, stoma and peristomal complications. All complications were reported over a 90-day duration from the surgery. Patients younger than 14 years of age were excluded. MAIN OUTCOME MEASURES: Postoperative complications, stoma and peristomal complications in IBD patients who underwent stoma creation. SAMPLE SIZE: 50 RESULTS: Of 50 IBD patients underwent stoma creation, 32 patients (64%) were diagnosed with CD and 18 patients (36%) with UC. Most of the procedures in both groups were laparoscopic and elective. Low BMI and serum albumin were more prevalent in the CD group. Postoperative complications were higher in the CD patients compared to the UC patients (CD 40.6% vs UC 11.1%, P=.028) with the most common complication being abdominal collection[a]. Stoma complications were comparable between the two groups (UC 16.7% vs CD 15.6%). However, peristomal complications were higher clinically in UC patients in comparison with the CD patients (UC 61.1% vs CD 37.5% P=.095) with the most common complication being skin excoriation (UC 44.4% vs CD 37.5%). CONCLUSIONS: CD has significantly higher postoperative complications compared to UC. Peristomal complications were high in both groups and had a negative impact on quality of life. Therefore, comprehensive stoma education and regular outpatient follow ups are recommended to improve the overall outcomes. LIMITATIONS: Retrospective and conducted in one academic institution with a small sample size.
