Laparoscopically placed adjustable gastric band for the management of morbid obesity

In this study, 30 patients [21 females and 9 males] were scheduled for laparoscopic placement of adjustable silicone gastric band. The technique was described and evaluated. Patients were followed up initially after four weeks and then at 4-8 weeks interval for weight and body mass index evaluation as well as adjustment of the band. Patients' symptoms and complications were recorded. The results have shown that the mean operative time was 110 min and the mean hospital slay was 3.7 days. One patient had conversion to laparotomy, one patient had obstruction by the band which resolved on conservative measures and another patient had infection at the reservoir site. In spite of being costly, laparoscopic adjustable gastric band is a safe and reliable procedure for weight reduction in morbidly obese patients. Its complications are relatively minor and it provides a continuous control over the degree of gastric restriction

Jejunal pouch reconstruction after total gastrectomy for gastric cancer

The overall outcome of the jejunal pouch Roux-en-Y reconstruction after total gastrectomy is evaluated in terms of pouch reservoir function, postprandial symptoms and nutritional outcome. This study included 19 patients having total gastrectomy with jejunal pouch Roux- en-Y reconstruction. The technique was described and the range of resection was demonstrated. Postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters and barium meal studies are evaluated. The incidence of postprandial symptoms ranged from 0 to 15.8%, they disappeared within six months after surgery with the exception of three patient who retrained to suffer from bile reflux esophagitis, early satiety and postprandial fullness. The results of this study have shown that the jejunal pouch Roux-en-Y reconstruction is associated with minimal postprandial symptoms and good postoperative nutritional status and should be considered after total gastrectomy for potentially curable resection

Comparative study between laparoscopic Nissen fundoplication and Toupet fundoplication

This study was carried out on 27 patients to compare the postoperative symptoms of the laparoscopic Nissen fundoplication with those of the laparoscopic Toupet fundoplication. Preoperative assessment has showed that both groups were comparable regarding age, sex, preoperative symptoms, endoscopic grading, duration of symptoms and medications used. The follow-up period ranged from 6-45 months [mean 21 months]. The operative time of Toupet fundoplication was slightly higher but this was not significant. Both procedures were comparable in the operative and the early postoperative complications. In conclusion, the Toupet fundoplication controls reflux equally well as the Nissen fundoplication with less postoperative symptoms, however, its durability has to be tested over a longer follow up period

Differences between colorectal cancer in Egypt and the Western prototype

This study aimed to review patients with colorectal cancer presented to a general surgery unit with special interest in coloproctology in Ain-Shams University concentrating on the differences between the pattern of the disease in Egypt and western countries. The study is a six-year retrospective review of one hundred and fifty-five patients with colorectal cancer. The results showed that 38% of the tumors occurred in patients less than 40 years and only 15% of patients were above 60 years of age. 3% of the tumors were Dukes A and 58% were Dukes C. 6% of the tumors were irresectable, 36% of the resections were palliative and 29% of curative operations entailed massive resection of nearby organ or tissue. Synchronous adenomas were present in 5.2% of patients and bilharziasis in 3.2%. At a mean follow up of 52 months, 58% of curative resection patients had recurrence, 38% died of their disease or secondary to its treatment and 42% were alive and disease free

prognostic value of serum albumin level in severe intra-abdominal sepsis

This study investigated the relation between the degree of hypo-albuminaemia and mortality in septic patients as well as the effect of surgical drainage on serum albumin level. Eighty three patients with severe intra-abdominal sepsis were studied, 27 of them died from uncontrolled sepsis and multiple organ failure. The mortality rate of intra-abdominal sepsis was positively related to the degree of hypo-albuminaemia. Mortality rate was significantly higher [P<0.001] when the albumin level dropped below 2.5 gm/dl during the management. The mean value of serum albumin level was significantly higher [p<0.001] when sepsis was cleared than during the presence of sepsis. Serum albumin was found to be a good prognostic indicator of the severity of sepsis and effectiveness of it 's management. The presence of clinical suspicion of an intra-abdominal abscess together with continuous hypo-albuminaemia should always initiate an active search for the presence of pus before multiple organ failure becomes manifested