Laparoscopic crural repair with simultaneous sleeve gastrectomy: a way in gastroesophageal reflux disease treatment associated with morbid obesity

Laparoscopic sleeve gastrectomy [LSG] has become popular both as a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease [GERD] is a common co-morbid disease in bariatric patients. The aim of this study was to evaluate the efficacy of LSG and hiatal hernia repair [HHR] to treat obesity, complicated by hiatus hernia [HH]. The participants in the study were twenty patients, 14 women and 6 men, with a mean body mass index of 43.4 +/- 1.9 kg/m[2] and mean age of 47 years. All the subjects were eligible for LSG and eight were found to have esophagitis at pre-operative endoscopy. Patients with Barrett's esophagus were excluded. GERD symptom questionnaire, 24-hour esophageal pH-metry, and manometry were employed as Pre-and post-procedure assessments. The mean follow-up period was eight months. Clinical outcomes were also evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence. Symptomatic HH was diagnosed preoperatively in 18 patients. In the other two patients, HH was asymptomatic and was diagnosed intra-operatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with an HH > 5 cm. Mortality was nil and no complications occurred. After a mean follow-up of seven months, GERD symptoms resolution occurred in nine patients, while the other patients reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m[2]. A laparoscopic hiatal repair with or without commercially available onlay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time, was successful in controlling the reflux symptoms and reducing body weight

Effect of bioentric intragastric balloon [bib] on weight reduction in morbidly obese patients

Bioentric Intragastric Balloon [BIB] System in association with restricted diet has been used for the short-term treatment of morbid obesity. Aim of this prospective study was to evaluate the short term efficacy of the BIB for weight reduction in morbidly obese patients. Thirty two patients were included in this study from January 2005 to May 2006. After patients' selection, all endoscopic procedures were performed under unconscious intravenous sedation and topically applied anesthesia. The bioenteric ballon [Inamed Health; Santa Barbara, CA, USA] was filled by using saline [600 ml] and methylene blue [10 ml]. Patients were discharged with omeprazole therapy and diet regimen [1000 kcal]. Patients were followed up regularly for six months; mortality, complications, BMI and BMI reduction were recorded. A total of 32 patients were selected for the study [17 males and 15 females; mean age: 27 +/- 5.6 years, range 21-45 years; mean BMI 45.1 +/- 1.1 kg/m[2], range 41-54 kg/m[2]. All patients completed the study. Mortality was absent. Complications related to endoscopy, balloon placement and removal were absent. Mean time of BIB positioning was 18 +/- 3 minutes, range 15-25 min. After six months the mean BMI significantly lowered from 45.1 +/- 1.1 to 38.0 +/- 2.6 kg/m[2]. The results of this study showed that treatment of morbidly obese patients with BIB is a safe and effective procedure; in association with appropriate diet it is significantly effective in short term weight reduction

Laparoscopic appendectomy by ultrasonically activated scalpel: a prospective study

Aim: laparoscopic appendectomy [LA] is increasingly being used in treating acute appendicitis. New instruments such ultrasonically activated scalpel as have been introduced for most laparoscopic procedures as a hemostatic too. This study was done to evaluate the feasibility and effectiveness of ultrasonically activated scalpel during LA, as the role of this instrument in LA remains to be defined

Patients and Methods: between January 2004 and April 2005, fifty patients with clinical diagnosis of acute appendicitis were included in this study. Once the diagnosis of acute appendicitis was established, laparoscopic appendectomy was performed using the ultrasonically activated scalpel for coagulation and cuffing of the mesoappendix

Results: the mean operative time was 45.6 minutes +/- 11.6 in one patient conversion to open appendectomy was needed. There were no complications related to the ultrasonically activated scalpel for control of the vascular pedicle. No electrosurgical coagulation, clips, loops or endostapler were used in any patient to control the mesoappendix

Conclusion: use of ultrasonically activated scalpel during laparoscopic appendectomy is feasible. It makes dissection of the appendix easier, helping to reduce the mean operative time

Non-ligation of the hernial sac during repair of indirect inguinal hernia

The present study was designed to study the effect of. non-ligation of the hernial sac of indirect inguinal hernia during repair. As ligation of the hernial sac has been considered mandatory for a successful repair and essential for preventing recurrence, the recent studies found that non-ligation of the hernial sac has no effect on recurrence rate and may decrease post operative pain, so we can recommend that it is not necessary to ligate the hernial sac during inguinal hernia repair, as ligation of the hernial sac is a hallowed and time consuming concept and result in increase post operative pain, however, this concept has been contested in recent studies. We conducted a prospective study on sixty patients of indirect inguinal hernia repair. In thirty cases the sac was ligated at the neck and excised [control group] in the other thirty cases the sac was not ligated at all, and either inverted or excised without ligation [test group]. The chosen type of repair was Lichtenstein's repair. Post-operative pain was significantly less in those cases where hernial sac was not ligated as it is recorded by pain score. Also there were no recurrence in either groups at one year follow up. Ligation of the hernial sac during inguinal hernia surgery is not only unnecessary and time consuming but also may increase post-operative pain. And has no effect on recurrence rate

Rhomboid flap versus fasciocutaneous V-Y advancement flap in treatment of pilonidal sinus

Pilonidal sinus of the natal cleft is one of the common surgical problems and represents a challenge to many surgeons, because the high incidence of recurrence and long postoperative morbidity course. Although many methods of surgical and non surgical approaches have been proposed to overcome these problems, an optimal treatment modality has not been achieved yet. Evaluation of two different types of surgical procedures for surgical treatment of Sacrococcygeal pilonidal sinus; Rhomboid flap technique and V-Y advancement flap technique, comparing the results of each one separately. 30 patients with chronic pilonidal sinus disease were admitted to surgical department in Ain Shams University hospital during the period from December 2002 to August 2003. The patients were divided into two groups. Group [A]. 15 patients, 13 of them were classic cases while 2 cases were recurrent cases. This group was treated by excision of the sinus and closure the wound by Rhomboid flap technique. Group [B] 15 patients, 12 of them were classic cases while 3 cases were recurrent cases. This group was treated by excision of the sinus, and closure the wound by V-Y advancement flap technique. In group [A], mean hospital stay was 5 days, mean healing time was 15 days, and only 2 cases developed wound infection, while in group [B], mean hospital stay was 7 days, mean healing time was 17 days, and only one case of wound infection. No recurrence detected in both groups during the whole period of follow up [12 months]. Treatment of chronic pilonidal sinus of the natal cleft can be efficient using one of the both techniques mentioned above, as both techniques having the same principles [flattening of the natal cleft and keeping the scar away from the midline]. We advise the use of one of both techniques for the treatment of chronic pilonidal sinus disease, specially the V-Y flap advancement for treatment of recurrent complex cases allowing removal of all pathological tissues, and rhomboid flap for simple classic cases