LSG vs OAGB: 7-Year Follow-up Data of a Randomised Control Trial and Comparative Outcome Based on BAROS Score.

BACKGROUND: This study aims to evaluate and compare long-term results of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) based on bariatric analysis reporting and outcome system (BAROS) score. MATERIALS AND METHODS: Patients operated for morbid obesity between 2013 and 2015 were randomised to LSG and OAGB groups. Based on inclusion and exclusion criteria, 201 patients (100 LSG and 101 OAGB) were analysed for changes in total body weight (TBW), body mass index (BMI), percent excess weight loss (%EWL), percent total weight loss (%TWL), QoL (quality of life) scores, comorbidity resolution and outcome based on BAROS at 7 years. RESULTS: Sixty-six LSG and 64 OAGB patients were followed up at 7 years. Mean pre-operative TBW and BMI were 119 ± 28.2 and 44.87 ± 7.71 for LSG group and 113.25 ± 23.74 and 44.71 ± 8.75 for OAGB group respectively. At 7 years after surgery, there was significant drop in mean TBW and BMI in both groups. Mean %EWL for LSG and OAGB patients was 50.78 ± 28.48 and 59.99 ± 23.32 and mean %TWL for LSG and OAGB patients was 23.22 ± 12.66 and 27.71 ± 12.27 respectively. Mean QoL scores at 7 years were significantly higher than the pre-operative scores and most of the patients in both groups had remission or improvement in their comorbidities. 68.76% OAGB patients had very good or excellent outcome on BAROS score while only 36.37% LSG patients had similar outcome. CONCLUSIONS: LSG and OAGB are successful bariatric procedures over the long term. OAGB outperforms LSG and has significantly higher %EWL and %TWL over the long term.

Mitochondrial sourcing of interferogenic ligands and an autoantigen in human obesity-associated metaflammation.

OBJECTIVE: Visceral adipose tissue (VAT) inflammation contributes to metabolic dysregulation in obesity. VAT recruitment and activation of plasmacytoid dendritic cells (pDCs) through toll-like receptor 9 (TLR9) recognition of self-DNA, leading to induction of type I interferons, are crucial innate triggers for this VAT inflammation. It was hypothesized that mitochondrial DNA (mtDNA) can contribute to TLR9 activation in VAT-recruited pDCs in obesity, and this study aimed to identify the carrier protein for ligand access to TLR9 and to explore whether this also provides for a source of autoantigens in this context. METHODS: VAT samples, used for gene expression studies as well as adipose explant cultures, were collected from patients with obesity (n = 54) and lean patients (n = 10). Supernatants from human pDC cultures, treated with adipose explant culture supernatants, were used for interferon α ELISA. Venous plasma, from patients with (n = 114) and without (n = 45) obesity, was used for an ELISA for autoantibodies. RESULTS: MtDNA from VAT in obesity, in complex with mitochondrial transcription factor A protein (TFAM), acts as interferogenic ligands for pDCs. Humoral autoreactivity against TFAM is also induced in obesity. CONCLUSIONS: Interferogenic ligands and an autoantigen can be sourced from dysfunctional mitochondria in VAT of humans with obesity. Further therapeutic and prognostic potential for this immune mechanism in obesity warrants exploration.

Tailored one anastomosis gastric bypass - Subgroup analysis of a randomised control trial based on bilio-pancreatic limb length with long-term results of 101 patients.

Background: : Ideal bilio-pancreatic limb (BPL) length is a highly debatable issue in one anastomosis gastric bypass (OAGB). Whether to use a tailored BPL or a fixed-length BPL needs to be answered. Materials and Methods: : One-hundred and one patients who have undergone tailored OAGB based on basal metabolic index (BMI) and type 2 diabetes mellitus (T2DM) were analysed. Sixty-three patients had BPL of 150 cm and 38 patients had BPL of 180 cm. Mean pre-operative BMI of BPL 150 and 180 cm groups were 39.73 and 51.92 kg/m2, respectively. Results: There was a significant drop in mean total body weight, BMI and excess body weight of both the groups at 1 year which persisted for 5 years post-operatively. The mean BMI of BPL 150 and BPL 180 cm group at 5 years was 29.17 and 32.88 kg/m2, respectively. Although mean percentage excess weight loss (%EWL) and percentage of excess BMI loss in the two groups was similar, the mean percentage total weight loss (%TWL) was significantly higher for the BPL 180 cm group. There was no difference between the two groups in the number of patients who had >50% EWL and >20% TWL. At 5 years of follow-up, the mean serum iron level was significantly low in BPL 180 cm group. There was a significant drop in mean haemoglobin A1c values postoperatively, with no difference between the two groups. Conclusions: Tailored BPL of 150 and 180 cm do not show any difference in the number of patients achieving >50% EWL or >20% TWL and so increasing limb length may not increase the number of good responders for weight loss. Although the resolution of T2DM and improvement of QoL score do not change significantly with increase in BPL length, mean serum iron levels may be lower with longer BPL.

LSG vs MGB-OAGB: 5-Year Follow-up Data and Comparative Outcome of the Two Procedures over Long Term-Results of a Randomised Control Trial.

BACKGROUND: Bariatric surgery is a durable and effective way for the management of obesity and resolution of related comorbidities. The aim of this study is to evaluate the outcome of laparoscopic sleeve gastrectomy (LSG) and one-anastomosis gastric bypass (OAGB) over long term in a South Asian population. MATERIALS AND METHODS: This is a prospective randomised trial comparing the outcome of 100 and 101 LSG and OAGB patients respectively after 5-year follow-up. This study is in continuity with previous published papers with 1- and 3-year follow-up. 71 LSG and 73 OAGB patients followed at 5 years. The results of these patients were analysed and compared in terms of %EWL, comorbidity resolution and quality of life (QoL) at 5 years. Bariatric analysis reporting and outcome system (BAROS) was used to assess the outcome of patients. RESULTS: At 5-year follow-up, both LSG and OAGB patients performed well and patients had significant improvement in BMI (kg/m2). The mean preoperative BMI of LSG and OAGB patients was 44.89 ± 7.94 and 45.32 ± 8.24, and their mean BMI at 5 years was 33.41 ± 6.02, 30.80 ± 3.40 respectively. At 5 years, %EWL was 55.95 ± 27.01 and 65.28 ± 13.98 for LSG and OAGB patients respectively. The QoL score of LSG and OAGB patients was 1.86 ± 0.56 and 2.35 ± 0.41 while comorbidity score was 1.84 ± 0.68 and 2.24 ± 0.62 respectively at 5 years. CONCLUSIONS: Both LSG and OAGB are effective bariatric procedures over long term with respect to weight loss, comorbidity resolution and improvement in QoL. OAGB is significantly better than LSG in all the three parameters at 5 years.

MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution.

INTRODUCTION: Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB) has been approved as a mainstream metabolic/bariatric procedure by IFSO. Still there are lots of concerns regarding nutritional deficiency after MGB-OAGB. The purpose of this retrospective analysis is to evaluate the effect of biliopancreatic limb (BPL) length on weight loss, comorbidity resolution, and nutritional deficiencies in patients 1 year after MGB-OAGB and to find suitable BPL length. MATERIAL AND METHODS: One hundred and one patients who underwent MGB-OAGB were divided into three groups of 150 cm, 180 cm, and 250 cm depending on the length of BPL bypassed. The nutritional parameters (vitamin D3, vitamin B12, serum iron, serum ferritin, total protein, serum albumin, serum globulin), anthropometric measurements (weight, BMI), and comorbidity resolution (T2DM, hypertension) were compared between the three groups at 1-year follow-up. RESULTS: There was statistically significant difference in number of patients having deficiencies in all the nutritional parameters except globulin between 150 cm and 250 cm groups (P < 0.05). While on comparing 180- and 250-cm group, a statistically significant difference was present in vitamin D3, vitamin B12, and total protein (P < 0.05) only. The difference was statistically insignificant between the three groups on T2DM, hypertension resolution, and %EWL but TWL between 150 cm vs 180 cm and 150 cm vs 250 cm showed significant difference. CONCLUSION: A 150-cm BPL length is adequate with very minimal nutritional complications and good results. A 180-cm BPL can be used in super obese while a 250-cm BPL should be used with utmost care as it results in significant nutritional deficiencies.

LSG vs MGB-OAGB-3 Year Follow-up Data: a Randomised Control Trial.

AIM: The objective of this study is to compare 3-year follow-up results of one anastomosis gastric bypass (MGB-OAGB) and laparoscopic sleeve gastrectomy (LSG) in terms of weight loss, complications, resolution of comorbidities and quality of life. MATERIALS AND METHODS: A prospective randomised study of results between 100 LSG patients and 101 MGB-OAGB patients was done from 2012 to 2015. The results were compared regarding operative outcomes, percentage of excess weight loss (%EWL), complications, resolution of comorbidities and quality of life (BAROS score) at 3 years follow-up. RESULTS: Follow-up was achieved in 93 MGB-OAGB vs 92 LSG patients for 3-year period. The average %EWL for MGB-OAGB vs LSG was 66.48 vs 61.15% at the end of 3 years respectively, which was statistically insignificant. Diabetes remission was seen in 89.13% of MGB-OAGB patients and 81.82% of LSG patients. Remission of hypertension was seen in 74% of MGB-OAGB patients and 72.22% of LSG patients. Bariatric analysis reporting and outcome system (BAROS) with comorbidity in LSG patients and MGB-OAGB patients was 6.03 and 6.96 respectively, whereas in patients without comorbidity, BAROS score was 3.86 in LSG group and 4.34 in MGB-OAGB group. CONCLUSIONS: In our study, at 36 months follow up, there was no significant difference between LSG and MGB-OAGB in %EWL and remission of HTN. Type 2 diabetes mellitus (T2DM) remission rates were higher after MGB-OAGB as compared to LSG but the difference was statistically insignificant. MGB-OAGB patients with comorbidities have a better quality of life and BAROS score compared to LSG patients.

Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores.

BACKGROUND: Obesity is one of the major causes for development of T2DM. Metabolic surgery has been proved to be a successful and cost-effective treatment modality for managing the patients with obesity and T2DM. Many scoring systems and models have been described in literature to predict the outcome of T2DM after metabolic surgery. The aim of this study is to compare the efficacy of Diarem, DRS, and ABCD score in predicting the T2DM remission. METHODS: A total number of 102 diabetic patients, who underwent LMGB/LOAGB, were selected for this study. A retrospective analysis of the three scoring systems when applied to these patients and their predictive abilities were analyzed. RESULTS: At 1 year after surgery, 72 (70.59%) patients achieved remission of T2DM. Though the pairwise comparisons between AUC on ROC analysis of ABCD, Diarem, and DRS scores does not show statistically significant difference between them, Diarem score has the maximum relative area under ROC curves. By multivariate analysis, it was found that factors significantly associated with T2DM remission were duration of T2DM, C-peptide, and Pre-Op HbA1c. CONCLUSIONS: Among the three scoring systems, though DiaRem score has the best sensitivity and specificity and maximum AUC, no statistically significant difference was found in their diabetes remission predicting abilities. A shorter duration of T2DM, a lower HbA1C, and higher levels of C-peptide were significantly associated with a higher chance of T2DM remission.

LSG vs OAGB-1 Year Follow-up Data-a Randomized Control Trial.

OBJECTIVES: Laparoscopic sleeve gastrectomy (LSG) is one of the most popular bariatric procedure. One anastomosis gastric bypass (OAGB) is rapidly emerging as a safe and effective metabolic procedure. This study aims at comparing the 1-year follow-up results of OAGB and LSG in terms of excess weight loss, complications, resolution of comorbidities, and quality of life. METHODS: A prospective randomized study of results between 100 LSG and 101 OAGB patients was done from 2012 to 2015. The results were compared regarding operative outcomes, percentage of excess weight loss, complications, resolution of comorbidities, and quality of life (BAROS score). RESULTS: The mean BMI for the OAGB and LSG group was 44.31 and 43.75 kg/m2, respectively. Percentage of excess weight loss (%EWL) for OAGB vs LSG was 66.87 ± 10.87 vs 63.97 ± 13.24 at 1 year (p > 0.05), respectively. Diabetes remission was 83.63 % in OAGB patients and 76.58 % in LSG patients. Remission of hypertension is 64.15 % in OAGB patients and 66.07 % in LSG patients. Bariatric Analysis Reporting and Outcome System (BAROS) was 3.71 in LSG and 3.96 in OAGB. CONCLUSIONS: In our study, there was no significant difference between LSG and OAGB in outcome at 1 year follow-up in % excess weight loss, remission of HTN, and quality of life. OAGB has marginally better outcome in T2 DM remission. However, a longer follow-up is required to establish a correct comparative result.

Adipose Recruitment and Activation of Plasmacytoid Dendritic Cells Fuel Metaflammation.

In obese individuals, visceral adipose tissue (VAT) is the seat of chronic low-grade inflammation (metaflammation), but the mechanistic link between increased adiposity and metaflammation largely remains unclear. In obese individuals, deregulation of a specific adipokine, chemerin, contributes to innate initiation of metaflammation by recruiting circulating plasmacytoid dendritic cells (pDCs) into VAT through chemokine-like receptor 1 (CMKLR1). Adipose tissue-derived high-mobility group B1 (HMGB1) protein activates Toll-like receptor 9 (TLR9) in the adipose-recruited pDCs by transporting extracellular DNA through receptor for advanced glycation end products (RAGE) and induces production of type I interferons (IFNs). Type I IFNs in turn help in proinflammatory polarization of adipose-resident macrophages. IFN signature gene expression in VAT correlates with both adipose tissue and systemic insulin resistance (IR) in obese individuals, which is represented by ADIPO-IR and HOMA2-IR, respectively, and defines two subgroups with different susceptibility to IR. Thus, this study reveals a pathway that drives adipose tissue inflammation and consequent IR in obesity.

Is resected stomach volume related to weight loss after laparoscopic sleeve gastrectomy?

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch for the treatment of super-obese or high-risk obese patients but is now most commonly performed as a standalone operation. The aim of this prospective study was to investigate outcomes after LSG according to resected stomach volume. METHODS: Between May 2011 and April 2013, LSG was performed in 102 consecutive patients undergoing bariatric surgery. Two patients were excluded, and data from the remaining 100 patients were analyzed in this study. Patients were divided into three groups according to the following resected stomach volume: 700-1,200 mL (group A, n = 21), 1,200-1,700 mL (group B, n = 62), and >1,700 mL (group C, n = 17). Mean values were compared among the groups by analysis of variance. RESULTS: The mean percentage excess body weight loss (%EBWL) at 3, 6, 12, and 24 months after surgery was 37.68 ± 10.97, 50.97 ± 13.59, 62.35 ± 11.31, and 67.59 ± 9.02 %, respectively. There were no significant differences in mean %EBWL among the three groups. Resected stomach volume was greater in patients with higher preoperative body mass index and was positively associated with resected stomach weight. CONCLUSIONS: Mean %EBWL after LSG was not significantly different among three groups of patients divided according to resected stomach volume. Resected stomach volume was significantly greater in patients with higher preoperative body mass index.

Laparoscopic repair of right sided bochdalek hernia - a case report.

Right-sided Bochdalek hernia in adults is a very rare clinical entity. A case of a 50-year-old female patient is reported, who presented with long history of intermittent breathlessness and right-sided thoracoabdominal pain. The hernia was managed laparoscopically. Contents were colon, omentum, and right kidney. It was successfully repaired using a polypropylene mesh.

An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become very popular nowadays among bariatric surgeons because of its surgical simplicity and good postoperative results. We present our experience on LSG as a single stage primary bariatric procedure for morbid obesity and its 1-3-year follow-up results. METHODS: Between March 2008 and March 2011, a total of 110 patients underwent laparoscopic sleeve gastrectomy. Two patients were excluded from the study and thus the prospectively maintained data of 108 patients were retrospectively reviewed and outcomes were recorded. RESULTS: The mean patient age was 39.3 ± 11.1 years, mean body mass index was 44.5 ± 6.8, mean excess body weight was 54.1 ± 16.3 kg, and the mean American Society of Anesthesiologists score was 3.1 ± 0.57. The mean operative time for the LSG procedure was 64.8 ± 10.6 min. The minimum follow-up duration was 6 months and maximum of 36 months. The mean postoperative percent excess body weight loss achieved was 67.5 ± 13.0 at 1 year, 71.1 ± 13.8 at 2 years, and 66.09 ± 14.3 at 3 years. At the end of 3 years, there was 83.3% resolution in diabetes, 85.7% resolution in hypertension, and 85.71% resolution in dyslipidemia. There were no reports of postoperative hemorrhage, gastric leak, deep venous thrombosis, pulmonary embolism, delayed gastric tube stricture, and operative mortality. CONCLUSIONS: LSG is a safe and effective bariatric procedure with low perioperative complications. Before it is considered as a single stage primary procedure, a long-term prospective comparative study with other bariatric procedures is required.

Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair.

BACKGROUND: Laparoscopic ventral hernia repair is evolving rapidly worldwide to become a standard procedure. The purpose of this study was to compare the benefits, effectiveness, and postoperative outcome of laparoscopic transabdominal preperitoneal (TAPP) and intraperitoneal onlay mesh (IPOM) repair of ventral hernia. PATIENTS AND METHODS: Prospectively collected data of 279 patients who underwent laparoscopic ventral hernia repair between January 2005 and December 2009, of whom 68 underwent TAPP and 211 underwent IPOM repair, were retrospectively reviewed. For each patient demographic, preoperative and postoperative data were studied. Statistical analysis was performed by Student's t-test, Fisher exact test, and chi-square test. RESULTS: The study included a total of 279 patients, of whom 68 underwent TAPP procedure and 211 underwent IPOM procedure. Both the groups were comparable in age, sex, body mass index, American Society of Anesthesiologists score, mean fascial defect size, and mean size of mesh. Although the operating time was longer in TAPP group than IPOM group of patients, the overall cost of surgery in IPOM group ($752.3±355.7) was much higher than TAPP group ($903.6±28.0) of patients. Seroma formation was more common in IPOM group than TAPP group (8.5% versus 5.8%). There were 2 (2.9%) recurrences in TAPP group and 7 (3.3%) in IPOM group of patients. Mean postoperative hospital stay (1.5±0.6 versus 1.4±0.7 days, P=.35) and mean follow-up (22.7±13.4 versus 22.5±11.9 months, P=.90) were similar in both groups of patients. CONCLUSION: Besides the cost-effectiveness of TAPP procedure, it reduces the risk of complication related to intra-abdominal position of mesh and fixating devices. Before we label the TAPP repair of ventral hernia as the first choice, a comparative multicentric prospective trial with IPOM repair is warranted.

Sliding inguinal hernias: scope of laparoscopic repair.

BACKGROUND: Sliding hernias are an uncommon type of inguinal hernia. Very little is published in the literature regarding the outcome of laparoscopic repair of sliding hernia. The present series evaluates the feasibility and outcome of laparoscopic repair of these hernias. METHODS: Retrospective analysis of prospectively maintained data of patients with sliding inguinal hernia undergoing laparoscopic repair from January 2003 to July 2010 was done. The patient demographics, clinical presentations, operative details, and complications were studied. Related literature was reviewed. RESULTS: A total of 1136 patients underwent laparoscopic repair of inguinal hernia, of which 54 patients had sliding inguinal hernia (4.7%). Forty-one patients (76%) had left-sided hernia and 13 patients (24%) had right-sided hernias. Mean age of presentation was 63.5 years. Thirty-five patients (64.8%) presented as complicated hernias (27 irreducible, 7 obstructed, and 1 strangulated). Thirty-nine patients had sigmoid colon, 9 patients had cecum, 3 patients had ascending colon, and 3 patients had urinary bladder as the sliding component. Eight patients underwent Lichtenstein repair, 27 patients transabdominal preperitoneal repair, and 19 patients total extraperitoneal repair. Mean operating time of laparoscopic repair was 53 minutes (40-105 minutes). Five procedures (10.8%) were converted to open repair. Overall morbidity was 44.4%. Median hospital stay was 1.5 days (1-14 days). There were no recurrences in up to 7 years follow-up. CONCLUSION: Laparoscopic repair of sliding inguinal hernia is feasible and safe with good outcome. Laparoscopic transabdominal preperitoneal approach is the preferable method.

Laparoscopic transabdominal preperitoneal repair of ventral hernia: a step towards physiological repair.

The laparoscopic ventral hernia repair with preperitoneal placement of mesh minimizes the complications related to the intraperitoneal position of mesh and fixating devices. It allows safe use of conventional and less expensive polypropylene mesh. The prospectively collected data of 68 patients who underwent laparoscopic transabdominal preperitoneal mesh hernioplasty, for different types of ventral hernias between January 2005 and December 2009 was retrospectively reviewed. The study included 68 patients, 16 males and 52 females with a mean age 51.1 ± 11.1 years (range 23-74 years). Most of the hernias (67.6%) were in the midline position. The mean size of the defect was 30.8 ± 24.4 cm2 (range, 4-144 cm2) and the mean mesh size was 237.8 ± 66.8 cm2 (range, 144-484 cm2). The mean operating time was 96.7 ± 16.7 min (range 70-150 min). All repairs were done with polypropylene mesh. The mean postoperative hospital stay was 1.5 ± 0.6 days (range, 1-4 days). Nineteen patients (27.9%) suffered from postoperative complications. Four patients (5.8%) were detected to have seroma formation. There were two recurrences (2.9%). The mean follow up was 22.7 ± 13.4 months (range, 6-48 months). The laparoscopic preperitoneal ventral hernia repair with polypropylene mesh is cheaper and has acceptable postoperative outcomes. Peritoneal coverage of the mesh not only acts as a barrier between mesh and bowel and thereby prevents adhesions, it also provides an additional security of fixation. This is a safe and feasible option of ventral hernia repair in expert hands. However, for proper validation of these conclusions a long term prospective clinical trial is required.

Laparoscopic splenectomy in patients of ß thalassemia: Our experience.

BACKGROUND: Laparoscopic splenectomy has become a standard treatment of various haematological disorders, but its feasibility in the setting of ß thalassemia has not been established. MATERIALS AND METHODS: Fifty patients of ß thalassemia underwent laparoscopic splenectomy between January 2006 and December 2008. "Anterior approach" method was practiced in all cases, with early ligation of splenic artery and delayed ligation of splenic vein. Specimen was extracted piecemeal via the umbilical port in initial 12 cases, while in 37 cases the specimen was extracted through a 7-8-cm pfannenstiel incision. Twelve patients of ß thalassemia having grade IV splenomegaly with hepatomegaly were electively operated by conventional open method. RESULTS: The procedure was completed in 49 patients. One (2%) patient required conversion to open surgery. Mean operating time in the first 12 cases was 151 minutes (110-210 minutes), while in 37 cases of splenectomy completed laparoscopically it was 124 minutes (80-190 minutes) [P < 0.05]. Mean intra-operative blood loss was 73.8 ml (30-520 ml). No major intra-operative complications occurred. No patient required per-operative blood transfusion. Mean postoperative hospital stay was 4.7 days (2-11 days). Mean preoperative blood transfusion requirement was 11.98 units per patient per year, while mean postoperative blood transfusion requirement was 4.04 units [P< 0.05]. CONCLUSION: Laparoscopic splenectomy is feasible and safe even in patients of ß thalassemia with massive splenomegaly. Removal of specimen via a pfannenstiel incision significantly saves time, carries low morbidity and is a cosmetically acceptable alternative.

Omental torsion and infarction: a diagnostic dilemma and its laparoscopic management.

Vascular disturbances of the omentum, described variously as acute epiploitis, primary omental torsion, idiopathic segmental infarction, etc., is an infrequent cause of acute abdomen, often mimicking acute appendicitis, cholecystitis, or pancreatitis. In this retrospective article, we share our experiences about the incidence, diagnostic dilemma, and management of patients with omental torsion or infarction and discuss the diagnostic and therapeutic role of laparoscopy. From January 2003 to December 2008, 9 patients (7 men and 2 women; median age, 26 years; range, 5-71) with omental gangrene, including omental torsion and infarction, were operated on at our institute. Of these, 8 patients had a preoperative provisional diagnosis of acute appendicitis and 1 patient of acute calculus cholecystitis. During this period, a total of 1502 patients were diagnosed and operated on laparoscopically for acute appendicitis and acute cholecystitis. Of them, 2 patients were intraoperatively diagnosed to have omental torsion and 7 patients had segmental omental infarction. Incidences of omental gangrene presenting as acute cholecystitis and acute appendicitis were 0.11 and 1.1%, respectively. The suspected preoperative pathology was grossly normal, and histopathology of the same was noncontributory to the cause of acute abdomen. All 9 cases were managed laparoscopically, with the gangrenous omentum excised along with appendectomy in 8 patients and cholecystectomy in 1 patient. In conclusion, inspection of the omentum should be a routine part of exploration in suspected acute appendicitis.