Trends in bariatric surgery and incidentalomas at a single institution in Saudi Arabia: a retrospective study and literature review.

BACKGROUND: Data are lacking on trends in bariatric surgery and the frequency of incidental findings in Saudi Arabia. OBJECTIVE: Report on trends in bariatric surgery as well as our experience in incidental findings along with a literature review (mainly on gastrointestinal stromal tumor). DESIGN: Retrospective chart and literature review. SETTINGS: Academic tertiary care center. PATIENTS AND METHODS: We conducted a retrospective study at King Khalid University Hospital and analyzed the data collected from 2009 to 2019. We collected data on age, body mass index (BMI), H pylori infection, type of bariatric surgery performed, and type and location of incidental findings. MAIN OUTCOME MEASURES: Incidental findings during or after bariatric surgery (in pathology specimen). SAMPLE SIZE: 3052 bariatric surgeries, 46 patients with incidentalomas. RESULTS: The mean and standard deviation for the age of the 46 patients with incidentalomas was 42.1 (13.9) years and the mean (SD) preoperative BMI was 43.4 (6.4) kg/m2. Of 3052 bariatric surgeries performed, the most common type was sleeve gastrectomy (93.9%), followed by gastric bypass surgery (4.58%) and gastric banding (1.47%). The total frequency of incidentalomas was 1.5%; 10.8% of patients had gastrointestinal stromal tumors (GIST), with the stomach being the commonest site for incidental findings. Eighty percent of the patients with GIST were positive for H pylori (P=.01 vs negative patients). CONCLUSION: The number of incidentalomas and other findings were consistent with other reports. All these findings suggest that bariatric surgeons should take special care before, during, and after a laparoscopic operation in obese patients. LIMITATIONS: Since this is a single-center, retrospective study, we did not collect data on important variables such as gender, socioeconomic status of the patient, and family history of obesity, and we did not perform a preoperative esophagogastroduodenoscopy. CONFLICT OF INTEREST: None.

Incidence of symptomatic cholelithiasis after laparoscopic sleeve gastrectomy and its association with rapid weight loss.

BACKGROUND/AIM: The worldwide prevalence of obesity has increased dramatically over the past years. In the Arab region, 66%-75% of adults and 25%-40% of children are either overweight or obese. Bariatric surgery has become the most effective approach for managing obesity and its co-morbidities. An expected outcome of bariatric surgery is cholelithiasis, which is one of the established risk factors of rapid weight loss. The aim of this study is to detect the incidence of symptomatic cholelithiasis among bariatric patients. PATIENTS AND METHODS: A retrospective cohort study on 711 patients aged between 18 and 60 who underwent laparoscopic sleeve gastrectomy (LSG) was conducted at King Saud University Medical City from January 2016 to January 2018. RESULTS: The postoperative incidence of symptomatic cholelithiasis was 3.5%. The mean duration of symptom development was 12.4 months. The rates of weight loss at 6 and 12 months for patients with symptomatic cholelithiasis were 28.94 ± 4.89% and 38.51 ± 6.84%, respectively (P = 0.002), which were significantly higher than in patients without symptomatic cholelithiasis during the same follow-up period (24.41 ± 6.6% and 32.29 ± 10.28%), respectively; (P = 0.012). CONCLUSION: We found a 3.5% incidence of symptomatic cholelithiasis among post-LSG patients in a period of 2 years. Rapid weight loss was the only risk factor that contributed to the development of post-LSG gallbladder disease. STATISTICAL ANALYSIS USED: Results were expressed as absolute numbers and percentages for categorical variables and as mean and standard deviation for continuous variables. A paired sample t-test was performed to determine significant differences between means at different time stamps. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 23.0.

Chronic Reducible Scapholunate Ligament Dissociation: A Simple Surgical Technique for a Complex Injury.

PURPOSE: Report the outcomes following chondrectomy of scapholunate (SL) joint, temporary stabilization of the SL joint using Kirshner wires and extensor carpi radialis longus (ECRL) transfer to dorsal scaphoid pole to restore normal SL gap and correct dorsal intercalated ligament instability deformity. MATERIALS AND METHODS: Retrospective case series of 11 patients with a mean age of 45 years were treated by the senior author 7 months after SL injury. The SL joint cartilage was removed, the SL joint was stabilized temporarily with 2 Kirshner wires for 8 weeks and ECRL tenodesis to scaphoid dorsally. Visual analog scale, disability of the arm, shoulder, and hand score, wrist flexion and extension range of motion, grip strength, return to work, SL gap, and SL angle were evaluated preoperatively and in last follow-up visit after the procedure. Modified Mayo score and complications were evaluated in the last visit. RESULTS: Average follow-up was 15.6 months. In the last follow-up, the average visual analog scale pain score improved significantly from 6.4 to 1.5. Average postoperative grip strength improved significantly compared with preoperative strength (41 to 56 Ib). Average disability of the arm, shoulder, and hand score improved significantly postoperatively (30 to 18 points). Average Mayo score was satisfactory in the last visit. Average SL gap reduced significantly from 4.1 to 2.8 mm and average SL angle decreased significantly from 82 to 62 degrees. Postoperative extension-flexion arc of motion significantly decreased compared with preoperative measurements. SL advanced collapse developed in 1 case after 15 months follow-up. All patients return to regular work at a mean of 16 weeks. CONCLUSIONS: Chronic reducible SL dissociation can be treated affectively with SL chonderectomy, temporary SL stabilization, and ECRL tenodesis to scaphoid to restore radiologic anatomy without compromising strength or work status. LEVEL OF EVIDENCE: Therapeutic type IV.