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

Study of both ghrelin hormone and serum TNF-alpha in patients with inflammatory bowel disease; their relation to degree of disease activity

Crohn's disease and ulcerative colitis, both defined as inflammatory bowel diseases [IBD], are idiopathic inflammatory disorders of gut mucosa of unknown etiology. The clinical course of both diseases can differ from a mild form to a severe form. TNF- alpha is a key pro-inflammatory cytokine in IBD and in other chronic inflammatory conditions. A substantial amount of research has been conducted concerning TNF- alpha and anti-TNF- alpha therapies. Ghrelin, a hormone secreted from the stomach with orexigenic, adipogenic, and somatotropic properties, functions through the stimulation of its receptor, the growth hormone secretagogue receptor [GHS-R], leading to release of growth hormone. Although GHS-R and ghrelin are expressed in human T lymphocytes and monocytes, yet its role in regulation of immune responses remains undefined. was to study both ghrelin hormone and serum TNF-alpha in inflammatory bowel disease and their relation to degree of activity. The study included twenty patients with inflammatory bowel disease in varying degrees of activity and ten healthy volunteers were taken as control. All patients had undergone thorough clinical examination, calculation of body mass index, Ileocolonoscopy and biopsy, calculation of degree of disease activity, and measurement of serum Ghrelin hormone and serum TNF- alpha. The mean serum Ghrelin in IBD patients was significantly higher than in control group [802.4 +/- 51.14 versus 227.25 +/- 39.45 pg/ml respectively p=0.000]. Moreover, the mean serum ghrelin level in patients with moderate to severe activity was significantly higher than inatients with mild activity [828.89 +/- 32.48 versus778.91 +/- 55.11 pg/ml respectively] [p=0.012]. Also, Ghrelin hormone correlates positively with C-reactive protein. The mean serum TNF-alpha level was significantly higher in patients than in control group [60.20 +/- 59.86 versus 22.2 +/- 15.70 ng /ml respectively p=0.007]. The mean TNF- alpha level for patients with mild activity was 53.36 +/- 52.27 and was 68.56 +/- 70.37 for patients with moderate to severe activity, with no statistically significant difference between the two groups [p=0.299]. Serum ghrelin hormone increases significantly in IBD than in control group and correlates positively with the degree of IBD activity, while serum TNF-alpha,although significantly increased in patients with IBD yet it doesn't correlate statistically with disease activity

Laparoscopic totally extra peritoneal [TEP] repair for inguinal hernia: a new horizon

The laparoscopic repair of inguinal hernia is a fairly recent technique. Although the laparoscopic approach to a hernia repair procedure is associated with less pain and faster recovery than open repair3 many surgeons are not familiar with this technique owing to technical demands and a long learning curve. Systematic review of randomized, controlled trials comparing laparoscopic repairs with open techniques has shown benefits of the minimally invasive approach to be less postoperative pain and morbidity and earlier recovery. Patients and during 6 moths period all patients admitted to Alexandria Main University Hospital, Hepatpbiliary surgical unit were included, with exclusion of huge irreducible inguino-scrotal hernia. They were subjected to laparoscopic totally extraperitoneal hernia repair without fixation of the mesh. 32 inguinal hernias in 28 patients as four patients was complaining of bilateral inguinal hernias. All the patients were males, the age ranged from 18 to 65 years. All the hernias were primary. The procedure was completed laparoscopkally in 26 patients [92.86%]. In only two patients [7.14%] we converted to open surgery. Operative time in the cases that completed laparoscopically ranged from 35 mm to 90 mm in unilateral cases [mean=54.42 +/- 12.83] and up to 120 mm in bilateral cases [mean=105 +/- 12.9]. Hospital stay was less than 48h in all patients except the patient who complained from early post operative recurrence, he stayed for 3 days. Resumption to usually daily activity among all patients ranging from 4 to 7 days [mean=5.2 +/- 1.2]. TEP without fixation of the mesh is a safe and effective method for repair of inguinal hernia with shorter and more comfortable post operative course and minimum add to the cost