Robotic median arcuate ligament release: a video vignette.

Median arcuate ligament syndrome (MALS) poses a rare challenge in diagnosis and management. We present a case of MALS in a 50-year-old male with recurrent epigastric pain, vomiting, and diarrhea. Diagnostic imaging revealed celiac artery stenosis and gastroduodenal artery collateral dilatation. Robotic-assisted median arcuate ligament release successfully alleviated symptoms. Utilizing the da Vinci X system (Intuitive Surgical, Inc.), the procedure involved meticulous dissection of the celiac artery and surrounding tissue. Postoperative duplex ultrasound confirmed improved arterial flow. Literature underscores the diagnostic hurdles of MALS and the advantages of minimally invasive approaches over conventional open surgery. The robotic approach may help smoothen the learning curve associated with this procedure, by providing improved operative flexibility. Patient outcomes are excellent, with long-term symptom relief in most cases.

Sleeve gastrectomy with duodenoileal bipartition using linear magnets: feasibility and safety at 1-year follow-up.

BACKGROUND: Single-anastomosis metabolic/bariatric surgery procedures may lessen the incidence of anastomotic complications. This study aimed to evaluate the feasibility and safety of performing side-to-side duodenoileal (DI) bipartition using magnetic compression anastomosis (MCA). In addition, preliminary efficacy, quality of life (QoL), and distribution of food through the DI bipartition were evaluated. METHODS: Patients with a body mass index (BMI) of ≥35.0 to 50.0 kg/m2 underwent side-to-side DI bipartition with the magnet anastomosis system (MS) with sleeve gastrectomy (SG). By endoscopic positioning, a distal magnet (250 cm proximal to the ileocecal valve) and a proximal magnet (first part of the duodenum) were aligned with laparoscopic assistance to inaugurate MCA. An isotopic study assessed transit through the bipartition. RESULTS: Between March 14, 2022 to June 1, 2022, 10 patients (BMI of 44.2 ± 1.3 kg/m2) underwent side-to-side MS DI. In 9 of 10 patients, an SG was performed concurrently. The median operative time was 161.0 minutes (IQR, 108.0-236.0), and the median hospital stay was 3 days (IQR, 2-40). Paired magnets were expelled at a median of 43 days (IQR, 21-87). There was no device-related serious advanced event within 1 year. All anastomoses were patent with satisfactory diameters after magnet expulsion and at 1 year. Respective BMI, BMI reduction, and total weight loss were 28.9 ± 1.8 kg/m2, 15.2 ± 1.8 kg/m2, and 34.2% ± 4.1%, respectively. Of note, 70.0% of patients reported that they were very satisfied. The isotopic study found a median of 19.0% of the meal transited through the ileal loop. CONCLUSION: Side-to-side MCA DI bipartition with SG in adults with class II to III obesity was feasible, safe, and efficient with good QoL at 1-year follow-up. Moreover, 19% of ingested food passed directly into the ileum.

The Utilisation of Digital Applications for Measuring Patient Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis of Comparative Studies.

In the context of escalating obesity rates, bariatric surgery holds a crucial role in managing severely obese patients. With a demonstrated effectiveness in weight loss and with the advent of ambulatory surgery, bariatric surgery allows for a streamlined care pathway, ideally suited for postoperative surveillance using digital health applications. The aim of this systematic review and meta-analysis is to evaluate the effect of eHealth-delivered health services or support for adults undergoing bariatric surgery. Five studies, encompassing 2210 patients, were analysed. The intervention group showed a 10% increase in total weight reduction and a 22% reduction in excess weight loss. ED visitation rates also trended towards reduction. Despite the absence of clear statistical superiority for DHA, the findings suggest potential benefits of DHA in postoperative monitoring.

Is a giant incisional hernia a contraindication for laparoscopic cholecystectomy?

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures worldwide. A previous abdominal operation is not considered a significant risk factor for conversion to open cholecystectomy. We describe the case of an 80-year-old woman with a surgical history of a giant uncomplicated incisional midline hernia presenting at our department with choledocholithiasis and acute cholangitis. After an ERCP with extraction of common bile duct stones, a LC was planned. The first trocar was inserted in the right midclavicular line, using an open technique and a careful inspection of the abdominal cavity and the hernia sac content. An uncomplicated cholecystectomy was performed and the postoperative course was uneventful.

Presbyopic LASIK using the Supracor algorithm and micromonovision in presbyopic myopic patients: 12-month visual and refractive outcomes.

PURPOSE: To evaluate the visual and refractive outcomes for presbyopia and myopia treatment using the Teneo 317 M2 platform and the myopic Supracor algorithm. SETTING: Percy Military Hospital and Private Laser Victor Hugo Center, Paris, France. DESIGN: Observational retrospective nonrandomized study. METHODS: 50 eyes (25 patients) treated with bilateral myopic Supracor and micromonovision using the Teneo 317 M2 platform and followed up for 12 months. Study outcomes included binocular and monocular visual acuities (without correction for distance and near vision), the spherical equivalent, predictability, stability, safety, optical aberrations, and complications. RESULTS: The mean age was 50.6 ± 2.7 years, and the mean preoperative spherical equivalent was -2.6 ± 1.4 diopters. At 12 months postoperatively, the mean binocular uncorrected distance visual acuity was 0.02 ± 0.03 logMAR, and 24 patients (96%) achieved an acuity of 20/25 or better. The binocular uncorrected near visual acuity was equal to Jaeger 1 in 18 patients (72%) and Jaeger 2 or better in 23 patients (92%). 12 eyes (24%) had lost 1 Snellen line, and 1 eye (2%) had lost 2 Snellen lines of monocular corrected distance visual acuity. No cases required retreatment; however, 1 eye (2%) underwent revision surgery because of diffuse lamellar keratitis. CONCLUSIONS: This study suggests that Supracor using the Teneo 317 M2 platform is a safe and effective technique for myopia and presbyopia treatment. Supracor is therefore a viable alternative to monovision for presbyopia and myopia. However, a careful patient selection is essential to satisfy realistic expectations.

SURGICAL TREATMENT OF VITREORETINAL COMPLICATIONS DURING DISSEMINATED INTRAVASCULAR COAGULATION SECONDARY TO MENINGOCOCCEMIA.

PURPOSE: To report a case of the surgical management of vitreoretinal complications during disseminated intravascular coagulation secondary to meningococcemia. METHODS: A case report. RESULTS: A 25-year-old man presented with loss of vision due to retinal and vitreous hemorrhages during disseminated intravascular coagulation secondary to meningococcemia. Examination revealed the visual acuity to be counting fingers in the right eye and light perception in the left eye. Bilateral vitreous hemorrhages were found on fundus examination. A dome-shaped lesion overlying the macula consistent with a subinternal limiting membrane hemorrhage was seen on optical coherence tomography. Bilateral vitrectomy was performed. Multiple subinternal limiting membrane hemorrhages were evident in the posterior pole. A membrane forceps was used to peel the internal limiting membrane and remove the fibrin under it. The internal limiting membrane and vitreous samples were sent for anatomopathological examination confirming our hypothesis. The peripheral retina revealed bilateral multiple ischemic areas, and argon laser photocoagulation was performed on it. Both eyes were filled with silicone oil. Eight months after surgery, his vision improved to 70 and 65 on the early diabetic retinopathy study scale in the right and left eyes, respectively. CONCLUSION: Published cases of retinal and vitreous hemorrhages during disseminated intravascular coagulation secondary to meningococcemia are few. There is no specific and codified management of these ocular complications. This case is the first reporting positive visual recovery after surgical treatment. Surgical procedure seems to be effective to treat multiple vitreoretinal hemorrhages secondary to meningococcemia.

Impact of the COVID-19 Pandemic and Lockdown on Gastric Bypass Results at 1-Year Follow-up.

PURPOSE: The COVID-19 pandemic caused a lockdown in many countries, which induced negative dietary habits and sedentary behavior. Studies suggest that weight loss of patients undergoing bariatric surgery was equally affected. The aim was to evaluate the impact of COVID-19 on weight loss, obesity-related comorbidities, and nutritional status at 1-year follow-up after gastric bypass (GB). METHODS: Retrospective observational case-control study of patients undergoing primary GB in a tertiary referral Belgian center. COVID-19 period group was composed by those whose 1-year postoperative period was affected by the COVID-19 pandemic and lockdown: from October 1, 2019, to March 31, 2020. The control group was composed of patients operated from October 1, 2018, to March 31, 2019. Electronic clinical records were reviewed searching: baseline characteristics, weight and comorbidities evolution, and biochemical values. RESULTS: A total of 47 patients in the COVID-19 period group and 66 in the non-COVID-19 period group were analyzed. There were no significant differences in baseline characteristics. A reduced weight loss was observed at 1-year follow-up, in terms of percentage of excess weight loss (%EWL) (82.4% [SD: 21.6] vs. 82.4% [SD: 21.6]; p: 0.043) and body mass index (BMI) (27.8 kg/m2 [IQR: 25.8-30.0] vs. 26.2 kg/m2 [IQR: 24.6-28.6]; p: 0.029) for COVID-19 period group vs. non-COVID-19 period group, respectively. There was a similar reduction of obesity-related comorbidities, without clinically significant differences in the nutritional follow-up. CONCLUSION: The COVID-19 pandemic and lockdown had an impact on weight loss at 1-year follow-up after gastric bypass.

Validity and reliability of the reflux symptom score.

OBJECTIVES/HYPOTHESIS: To develop and validate the Reflux Symptom Score (RSS), a self-administered patient-reported outcome questionnaire for patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: Prospective controlled study. METHODS: A total of 113 patients with LPR were enrolled and treated with diet and 3 months of pantoprazole, alginate, and/or magaldrate depending on the LPR characteristics (acid, nonacid, or mixed). Eighty asymptomatic individuals completed the study. Patients and controls completed the RSS twice within a 7-day period to assess test-retest reliability. Internal consistency was measured using Cronbach's α for the RSS items in patients and controls. Validity was assessed by comparing the baseline RSS with the Reflux Symptom Index (RSI) and Voice Handicap Index (VHI). Seventy-seven patients completed the RSS at baseline and after 6 and 12 weeks of treatment to assess responsiveness to change. The RSS cutoff for determining the presence and absence of LPR was examined by receiver operating characteristic analysis. RESULTS: Test-retest reliability (rs = 0.921) and internal consistency reliability (α = 0.969) were high. RSS exhibited high external validity indicated by a significant correlation with the RSI (rs = 0.831). Internal validity was excellent based on the higher RSS in patients compared with controls (P = .001). RSS, RSI, and VHI scores significantly improved from pre- to posttreatment, indicating a high responsiveness to change. RSS >13 can be considered suggestive of LPR-related symptoms. RSS was not influenced by the occurrence of gastroesophageal reflux disease, LPR subtypes, or patient characteristics. CONCLUSIONS: RSS is a self-administered patient-reported outcome questionnaire that demonstrates high reliability and excellent criterion-based validity. RSS can be used in diagnosing and monitoring LPR disease. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:E98-E107, 2020.

Surgical Treatment for Laryngopharyngeal Reflux Disease: A Systematic Review.

Importance: Laryngopharyngeal reflux (LPR) is a prevalent disease that is usually treated with diet, lifestyle modifications, and proton pump inhibitor therapy. However, nearly 10% to 30% of patients do not achieve adequate acid suppression even with high doses of proton pump inhibitors. For these patients with resistant disease, fundoplication may be recommended but the success rate of fundoplication surgery on laryngopharyngeal symptoms and findings remains uncertain. Objective: To determine whether fundoplication is associated with control of signs and symptoms in patients with LPR. Evidence Review: A literature search was conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline to identify studies published between 1990 and 2018 about the efficacy of fundoplication on clinical outcomes of LPR. Three investigators screened publications for eligibility and exclusion based on predetermined criteria. Study design, patient characteristics, diagnostic method, exclusion criteria, treatment characteristics, follow-up, and quality of the outcome assessment were evaluated. Findings: Of the 266 studies identified, 34 met the inclusion criteria, accounting for 2190 patients with LPR (1270 women and 920 men; mean [SD] age at the time of surgery, 49.3 [6.3] years). A weighted mean of 83.0% of patients (95% CI, 79.7%-86.3%) experienced improvement and a weighted mean of 67.0% of patients (95% CI, 64.1%-69.9%) experienced a disappearance of symptoms, but there is a high level of methodological heterogeneity among studies according to diagnostic method, exclusion criteria, and outcomes used to assess the efficacy of fundoplication. A pH study without impedance study was used in most studies but with various inclusion criteria. According to results of an a priori assessment, the clinical outcomes used were overall poor, excluding many symptoms and findings associated with LPR. Conclusion and Relevance: The reported studies of fundoplication in LPR disease have important heterogeneity in method of diagnosis, exclusion criteria, symptoms, and signs assessed as therapeutic outcomes; therefore, this systematic review was nonconclusive regarding whether surgery for LPR disease is associated with effective control of sight and symptoms. Otolaryngologists, gastroenterologists, and surgeons must establish a diagnostic criterion standard, clear indications for surgery, and future clinical outcomes to precisely assess the effectiveness of treatment.

Color Vision Tests in Pilots' Medical Assessments.

INTRODUCTION: The aim of this study was to evaluate the ability of eight color vision tests to screen for and accurately measure hereditary color-deficiency in order to improve color vision assessment methods for aircraft pilots. METHODS: This prospective study included 29 color-deficient subjects and 23 healthy subjects. All performed the following tests: Ishihara plates, Farnsworth D15, Lanthony desaturated 15 Hue, Munsell 100 Hue, Beyne and Fletcher-Evans CAM lanterns, Nagel anomaloscope, and the Color Assessment and Diagnosis (CAD) test. The sensitivity and specificity of color-deficiency diagnosis were evaluated for each test, as well as the test's relevance for assessing aircraft pilots. RESULTS: The Ishihara plate test demonstrated a sensitivity of 0.97 and a specificity of 1.00 for color-deficiency screening. The CAD test and anomaloscope showed both a sensitivity and specificity of 1.00. The Beyne lantern, Fletcher lantern, Farnsworth D15, and the Lanthony 15 Hue tests all showed a specificity of 1.00 and sensitivities of, respectively, 0.69, 0.97, 0.58, and 0.79. During aircraft pilot selection tests, the CAD test classified 10% of color-deficient subjects as safe to fly, the anomaloscope 17%, and the Beyne and Fletcher lantern tests, respectively, 31% and 3%. DISCUSSION: The discrepancy in results confirms that current color vision test protocols need to be reassessed. The CAD test could be an interesting alternative to the series of tests used to assess flight crew, but it seems more selective than current tests.Marechal M, Delbarre M, Tesson J, Lacambre C, Lefebvre H, Froussart-Maille F. Color vision tests in pilots' medical assessments. Aerosp Med Hum Perform. 2018; 89(8):737-743.