Self-fixing parietex progrip versus the standard sutured prolene mesh in tension-free repair of inguinal hernia: effect on testicular volume and testicular blood flow.

Our study was conducted to compare self-fixing lightweight polyester mesh (group I) to the standard heavy weight polypropylene mesh (group II) using tension-free Lichtenstein hernioplasty as regard to the effect of mesh implantation and perimesh fibrosis on testicular blood flow. 80 patients with uncomplicated inguinal hernia were divided in two groups. Doppler ultrasonography measured testicular volume, testicular artery velocity preoperative and 3rd month post operative. Blood flow in the testicles was represented by resistive index (RI). No case of testicular atrophy occurred in either group, however, in both groups a significant postoperative decrease in testicular volume (p = 0.001 in group I and p < 0.001 in group II) was accompanied by a significant increase in RI as compared to their pre-operative values (p < 0.001 in group I and p = 0.009 in group II). Comparing the two groups, patients in group I showed higher values of decrease in testicular volume accompanied by more increase in RI values postoperatively compared to group II patients, but these values did not reach a significant value (p = 0.107, p = 0.136). There was a significant increase in the number of post-operative varicocele and hydrocele in group I compared to group II. Mesh implantation has an effect on testicular size and blood flow by decreasing the testicular size and increasing the RI. This effect was more obvious in the parietex progrip. Although there is an indirect relation between RI and the sperm count, testicular blood flow alone is not enough to judge fertility.

Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy.

BACKGROUND: The relation between the resected gastric volume and the weight loss after laparoscopic sleeve gastrectomy appears conflicting in the literature. Both the residual and the resected volumes represent the total gastric volume, and if the weight loss is related to one of the two volumes, it should be related to the other. While some reports indicate that the weight loss is related to the resected gastric volume, others state that the weight loss is not related to the residual volume. The aim is to investigate the influence of the resected gastric volume on the weight loss after surgery. METHODS: The study included 287 consecutive patients. Gastrectomy was performed encroaching over a 38-Fr calibrating tube all the way to the angle of His. Filling volume of the resected stomach, with tap water, was measured. Patients were analyzed into group 1 with BMI ≤50 kg/m(2) and group 2 >50 kg/m(2). RESULTS: Females represented 74 % of cases. Mean age was 32.9 ± 9.5 years; preoperative BMI = 48.7 ± 7.9 kg/m(2). The mean resected gastric volume was 1525 ± 408 ml, and it was significantly lower in females compared to that in males (1443 ± 311 vs 1824 ± 502 ml, p < 0.001). Data were analyzed in two groups: group 1 with BMI ≤5050 kg/m(2) and group 2 >50 kg/m(2). Both groups were similar in preoperative BMI (p = 0.399) and excess weight percent (EW%) (p = 0.33). Group 2 had a resected gastric volume (1663 ± 424.7 ml) greater than that of group 1 (1440 ± 347 ml; p < 0.001). The percentage of excess weight loss (EWL%) was 57.9 ± 14.5 % at 6 months (62.7 ± 13.5 % vs 48.34 ± 11.29 %, p < 0.001), 77 ± 19 % at 12 months (84 ± 19.6 % vs 68 ± 14.2 %, p = 0.001), 76.6 ± 7.4 % at 18 months (79.7 ± 4.8 vs 74.7 ± 8.2 %, p = 0.5), and 75.8 ± 11.5 % at 24 months (81.7 ± 11.17 vs 70 ± 11 %, p = 0.8) (group 1 vs group 2, respectively). At 12 months, 86 % patients achieved more than 50 % EWL% (100 % of group 1 vs 60 % of group 2). Preoperative BMI correlated with resected gastric volume (r = 0.239, p = 0.004). In multiple regression, the initial BMI was a predictor of EWL% at 6 and 12 months (r partial = -0.65, p < 0.0001) while the resected gastric volume was not. CONCLUSIONS: The resected gastric volume is related to the total gastric volume when the technique is standardized and the residual volume is calibrated using a consistent technique. It is not in itself a predictor of weight loss, but it is related to the initial BMI which predicts the weight loss.

Donor safety in live donor laparoscopic liver procurement: systematic review and meta-analysis.

BACKGROUND: Donor safety is a major concern in live organ donation. Live donor laparoscopic liver procurement is an advanced surgical procedure that is performed in highly specialized centers. Since its first report, not much progress has been endeavored for that procedure. METHODS: We planned to include all the randomized and comparative nonrandomized studies. Patients' population: live donors who are submitted to organ procurement via laparoscopy. RESULTS: Out of 5,636 records retrieved from the literature, only seven nonrandomized studies were included in this review, which encompassed 418 patients, 151 patients of whom underwent laparoscopic procurement. The quality scores for the included studies ranged from 66 to 76 %. The operative time was significantly shorter in the conventional open group (SD = 0.863, 95 % CI 0.107-1.819). Blood loss in the laparoscopic group was comparable with the conventional open approach (SD = -0.307, 95 % CI -0.807 to 0.192). In subgroup analysis, laparoscopy was protective against blood loss in laparoscopic parenchymal dissection (SD = -1.168, 95 % CI -1.758 to -0.577). The hospital stay was equal in both groups. Patients in laparoscopic group consumed fewer analgesics compared with conventional open group (SD = -0.33, 95 % CI -0.63 to -0.03). Analgesics use was lower in the laparoscopic group compared with the conventional approach. The rate of Clavien complications was equal in both groups (OR 0.721, 95 % CI 0.303-1.716). No difference was found between subgroup analysis based on the harvested liver lobe. Funnel plot and statistical methods used revealed low probability of publication BIAS. CONCLUSIONS: Live donor laparoscopic liver procurement could be as safe as the conventional open approach. Lower blood loss and lower consumtion of analgesics might be offered in the laparoscopic approach.

Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis.

BACKGROUND: Identifying factors that influence weight loss after bariatric surgery is one way to predict a successful surgical outcome. Knowledge of the effect of gender on weight loss after bariatric surgery has not been well demonstrated in the literature despite being noted in every day practice. The aim of this study was to find the influence of gender on long-term weight loss after bariatric surgery. METHODS: A retrospective analysis of data retrieved from a prospectively maintained bariatric database was conducted. RESULTS: The study included 640 consecutive patients. Their mean age was 38 ± 10 years, mean preoperative body mass index was 44.9 ± 8.4 kg/m2, and mean preoperative excess weight (EW %) was 108.3 ± 38.4%. The mean of the average excess weight loss (EWL %) was 43.3 ± 42.4%. Three procedures were utilized: Roux-en-Y gastric bypass (RYGB), vertical banded gastroplasty (VBG), and gastric banding (GB). Both VBG and RYGB induced significantly more EWL % than GB (d = 22.1%, p < 0.001 and d = 16, p = 0.02, respectively). In patients who underwent VBG and GB, males had significantly lower preoperative EW % (Student t = -4.86, p < 0.001, and Student t = 4.69, p < 0.001, respectively), and postoperative mean of the average EWL % (Student t = -2.43, p = 0.016, and Student t = -3.33, p = 0.002, respectively) than females. In patients who underwent RYGB, there were no differences in the preoperative EW % (t = -1.03, p = 0.309) or the mean of the average EWL % (t = 0.406, p = 0.688). The simple linear regression model used to explain the variability in EWL %, accounted for by the variability in the preoperative EW %, was significant (F = 180, p < 0.001). Analysis of the residual errors in predicting the EWL % revealed no significant difference between males and females after VBG and after RYGB (t = 0.117, p = 0.907 and t = 1.052, p = 0.3, respectively), while it was significant after GB (t = -2.999, p = 0.003). CONCLUSION: From our experience, we suggest that GB not to be offered as a first choice for obese male patients.

Efficacy of intragastric balloon in obese Egyptian patients and the value of extended liquid diet period in mounting the weight loss.

UNLABELLED: Abstract Background: The surgical management of morbid obesity is faced by several challenges. Alternative therapeutic strategies could have an important role in the perioperative risk reduction. The BioEnterics(®) intragastric balloon (BIB) (Inamed Health, Santa Barbara, CA) has been described as being effective in weight reduction and is used as a bridge before bariatric surgery. This study examined the efficacy of BIB in obese Egyptian patients and the value of the extended low caloric liquid diet program in weight loss. SUBJECTS AND METHODS: A retrospective review of a prospectively maintained bariatric database was conducted. Weight changes and complications data were analyzed. Indications for BIB placement were discussed. RESULTS: Records of 55 patients (11 males and 44 females) were retrieved. The mean initial body mass index (BMI) was 45.3±11 kg/m(2). The mean of excess body weight percentage was 111.96±53.2%. Nausea was reported in 30 patients (54.5%). Epigastric discomfort was reported in 23 patients (41.8 %), and vomiting was reported in 27 patients (49.1%). Six patients (10.9%) had an early removal of the balloon, whereas 4 (7.2%) had delayed removal (more than 6 months). The mean excess weight loss percentage (EWL%) was 17.2%. There was significant reduction in patients' BMI from 45.3 to 38.3 kg/m(2) (P<.001). There was no significant correlation between the EWL% and the gender, age, or initial BMI. Two patients had second balloon insertions without complications. There was no significant difference in the EWL% between the 1-week liquid diet group and the extended (4-week) low caloric diet group. CONCLUSIONS: The BIB is effective and safe in weight reduction in obese Egyptian patients. The impact of extended liquid dieting period is not significant.

Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: The aim of this study was to compare the surgical outcome of day-case laparoscopic cholecystectomy (DCLC) performed with the patient under spinal anesthesia with that performed with the patients under general anesthesia in the management of symptomatic uncomplicated gallstone disease. PATIENTS AND METHODS: One hundred eighty patients were prospectively randomized to either the spinal anesthesia DCLC group (SA-DCLC group) or the general anesthesia DCLC group (GA-DCLC group). Intraoperative events related to spinal anesthesia, postoperative complications, and pain scores were recorded. The incidences of both overnight stay and readmissions were also recorded. Patient satisfaction values as to the anesthetic technique and same-day discharge were assessed by direct questionnaire at the end of the first postoperative week. RESULTS: In both groups, all procedures were completed laparoscopically. In the SA-DCLC group, there were 4 (4.4%) anesthetic conversions due to intolerable right shoulder pain, and those 4 patients were excluded from further analysis. In the SA-DCLC group, all patients were discharged on the same day. Overnight stay was required in 8 patients (8.9%) in the GA-DCLC group (P<.001). The cause of overnight stay was nausea and vomiting in 4 patients (4.4%), inadequate pain control in 3 patients (3.3%), and unexplained hypotension in 1 patient (1.1%). Readmission was required in 1 patient (1.1%) in the GA-DCLC group. The difference in patient satisfaction scores with regard to both anesthetic technique and same-day discharge was not statistically significant between the two groups studied. CONCLUSIONS: DCLC performed with the patient under spinal anesthesia is feasible and safe and is associated with less postoperative pain and lower incidence of postoperative nausea and vomiting and therefore a lower incidence of overnight stay compared with that performed with the patient under general anesthesia.

Laparoscopic-assisted truncal vagotomy and gastro-jejunostomy: trial of simplification.

BACKGROUND: Truncal vagotomy and gastro-jejunostomy is an effective procedure for Gastric Outlet Obstruction. The authors' experience with the procedure is presented and an alternative technique for creating the gastro-jejunostomy is described. METHODS: From January 2005 through June 2007, 18 patients with gastric outlet obstruction secondary to a cicatrizing peptic duodenal ulcer underwent laparoscopic truncal vagotomy and an ante-colic laparoscopic-assisted stapled gastro-jejunostomy. RESULTS: All procedures were completed laparoscopically with a mean operative time of 81.2 +/- 11.1 minutes. Anastomotic leak was encountered in 1 (5.5%) patient and bile vomiting in 2 patients (11%). The mean follow-up duration was 22.8 +/- 9.8 months. None of the patients developed recurrent obstruction. CONCLUSIONS: The procedure is feasible, safe, and provides an effective cure for gastric outlet obstruction. The laparoscopic-assisted stapled gastro-jejunostomy reduces the operative time and may reduce the cost of the procedure.

Low dose BCG regimen in T1 transitional cell carcinoma of the bladder: long term results.

BACKGROUND AND OBJECTIVES: BCG has been used for more than 30 years and is currently the most effective agent for non-muscle invasive bladder cancer therapy after transurethral resection. The high-grade T1 lesion treated by transurethral resection alone is reported to progress to muscle invasion in 30%to 50%of the patients. Until now, optimal treatment schedule and optimal dose have not been defined as the toxicity related to BCG therapy is significant. In this study we tried to evaluate the efficacy and toxicity of 60mg intravesical BCG (Pasteur strain) therapy in patients with T1 transitional cell carcinoma of the bladder. PATIENTS AND METHODS: From January 2000 till December 2007, 74 patients with single T1 transitional cell carcinoma (TCC) of the urinary bladder (grade 3 in 24 patients and grade 2 in 50 patients) were treated by complete transurethral resection followed by a 6-weeks course of 60mg BCG intravesically. Follow-up ranged from 26- 96 months with median of 61 months. RESULTS: Nine patients (12.1%) exhibited recurrence with muscle invasion after 6-18 months (5 with grade 3 tumors and 4 with grade 2), all were subjected to radical cystectomy and urine diversion. Whereas 19 patients (29.2%) showed recurrent T1 tumor after 16-45 months (7 with grade 3 tumors and 12 with grade 2) and were treated by TUR-T followed by a second 6-weeks course of 60mg BCG intravesically. Recurrence index was 0.82/100 patients/month and the median tumor free period was 20 months. Regarding toxicity; irritative symptoms occurred in 24%of patients, fever in 9%, microscopic hematuria in 14%; which appeared to be significantly low when compared with the rates reported for higher doses of BCG. CONCLUSION: Intravesical therapy of 60mg BCG is effective in prophylaxis against recurrence and progression of T1 TCC of the bladder. Decreasing the dose resulted in reducing the side effects significantly without delay or cessation of therapy.