Laparoscopic gastric bypass for the treatment of morbid obesity

Many authors consider Roux-en-Y gastric bypass [RYGBP] to be the "gold standard" in surgery for morbid obesity. However, laparoscopic RYGBP is arguably the most challenging minimally invasive procedure in general surgery and its learning curve is steep and difficult. The aim of this study was to study the feasibility, safety, and effectiveness of laparoscopic Roux-en-Y gastric bypass [LRGBP] in the treatment of morbid obesity. This study included 30 consecutive morbidly obese patients that underwent attempted laparoscopic RYGBP. Only patients who had a previous open upper abdominal surgery and/or BMI> 60 kg / m[2] were excluded. A prospective analysis was performed identifying the technical success, operative times, complications, length of hospital stay, and weight loss. Open conversion was required in one patient [3.3%]. There were no leaks at the gastrojejunal anastomosis, but one patient died because of gastrointestinal leak from a traumatic perforation. The mean operative time was 215 minutes. The average hospital stay was 3.4 days. One patient required endoscopic balloon dilation for stenosis at the gastrojejunostomy. Another patient required surgery for internal hernia. Patients were followed up for a mean of 21.3 months. Average excessive weight loss was 74.8%. Laparoscopic RYGBP is feasible, but it is a very complex operation. Our data showed adequate short-term weight loss and marked correction of co-morbidities. The complication rates are acceptable in the very beginning of our experience, which includes our learning curve for the procedure

Open preperitoneal mesh repair of recurrent inguinal hernia

Recurrent inguinal hernia still remains a significant clinical problem and accounts for 8% to 17% of all inguinal hernia repairs with a higher risk of re-recurrence and testicular complications. The aim of this prospective cohort study was to determine the outcome of open preperitoneal mesh repair of recurrent inguinal hernia. Forty-five consecutive male patients with unilateral recurrent inguinal hernias were repaired. Preperitoneal space was entered through a transverse lower abdominal incision. A polypropylene mesh [15x15cm] was anchored using 2/0 polypropylene interrupted sutures. The mean age was 44 years. The mean postoperative hospital stay was 1.3 days. All post-operative complications were minor. There were 2 superficial wound infections, 1 seroma, 2 hematomas and 2 cases of urine retention. The mean time for return to work was 2.8 weeks. Follow-up was completed for all patients for a mean of 31.3 +/- 10.8 months [range, 13-49 months]. No recurrences were found. One patient developed hydrocele of the distal hernial sac. None of the patients developed testicular atrophy, vaginal hydrocele, or chronic residual neuralgia. Open preperitoneal mesh repair for recurrent inguinal hernia has a low complication rate and is highly effective in preventing re-recurrence. It is easy to learn and should be the general surgeons' procedure of choice for recurrent inguinal hernia repair