Sequential Extended Thoracoscopic Sympathicotomy for Palmo-Axillo-Plantar Hyperhidrosis.

BACKGROUND: Palmo-axillo-plantar hyperhidrosis (HH) exists in approximately 70% to 100% of patients complaining of HH. Many studies have documented variable effects of thoracoscopic sympathicotomy (TS) on plantar sweating. The present trial evaluated sequential extended thoracoscopic sympathicotomy for the treatment of palmo-axillo-plantar HH regarding its feasibility and outcome on each domain of HH, particularly the plantar domain METHODS: Forty-two patients with severe palmo-axillo-plantar HH underwent sequential extended (T3 to T12) thoracoscopic sympathicotomy. Improvement in HH was assessed using visual analog scale and iodine-starch test, and quality of life was evaluated using the Keller quality of life questionnaire preoperatively and 2 years postoperatively. RESULTS: Included were 16 men and 26 women with a mean age of 24.3 ± 5.3 years. The average preoperative VAS for the palmar, axillary, and plantar HH was 9 ± 0.66, which declined significantly (p < 0.0001) at 24 months of follow-up to a mean of 0.74 ± 0.4 for the palmar and axillary domains and to 1.26 ± 0.7 for plantar HH. Improvement in quality of life was observed in all patients at 24 months of follow-up as the overall median score decreased from 120.5 to 3.5. CONCLUSIONS: Sequential extended thoracoscopic sympathicotomy proved to be an effective method for the treatment of combined HH because it achieved satisfactory and sustained improvement of palmar, axillary, and plantar sweating. Although the benefits of sequential extended thoracoscopic sympathicotomy outweigh its drawbacks and technical difficulties, further prospective studies are required to ascertain the effectiveness of this new technique.

Laparoscopic Sleeve Gastrectomy Then and Now: An Updated Systematic Review of the Progress and Short-term Outcomes Over the Last 5 Years.

INTRODUCTION AND AIM: Laparoscopic sleeve gastrectomy (LSG) is considered one of the most popular bariatric surgeries of the present time. This review aimed to evaluate the progress and short-term outcomes of LSG over the last 5 years. METHODS: The systematic review of electronic databases revealed 27 relevant articles, which were carefully assessed. The data extracted from the studies were analyzed and compared with data reported by a previous review published in 2010. RESULTS: A total of 5218 patients were included in this review with a mean age of 41.1. The average preoperative body mass index (43.8±8) significantly dropped at 12 months to 30.7±3.9. The average percentage of excess weight loss at 1 year was 67.3. The mean rates of remission of diabetes mellitus, hypertension, and dyslipidemia were 81.9%, 66.5%, and 64.1%, respectively. The mean complication rate across the studies was 8.7% and the average mortality rate was 0.3%. A significant drop in postoperative body mass index, higher percentage of excess weight loss, and significantly lower overall complication rate were observed in comparison with the previous systematic review. CONCLUSIONS: LSG continues to achieve satisfactory weight loss and improvement of obesity-related comorbidities with acceptably low morbidity and mortality rates.

Bilateral gluteal advancement flap for treatment of recurrent sacrococcygeal pilonidal disease: A prospective cohort study.

BACKGROUND: There is controversy about the best surgical approach for recurrent pilonidal disease (PND) up till now. This study aims to evaluate the efficacy of bilateral gluteal fascio-myo-cutaneous advancement flap (BGFMCF) in treatment of recurrent PND. PATIENT AND METHODS: Forty patients (35 males, 5 females) with recurrent PND were admitted and treated with BGFMCF. Variables assessed were incidence of recurrence, postoperative complications, patients' satisfaction and quality of life. RESULTS: Patients had a mean age of 25 ± 6.8 years and a mean body mass index of 28.4 ± 2.7. Mean operative time was 87 ± 13 min and mean length of hospital stay was 3 ± 0.7 days. Mean period of follow-up was 15.8 ± 4.9 months. Recurrence was detected in 2 (5%) patients and minor complications occurred in 6 (15%) patients. Thirty eight (95%) patients were satisfied by the procedure at the end of follow-up period. CONCLUSION: BGFMCF is an effective procedure for treatment of recurrent sacrococcygeal PND with low recurrence rate and acceptable morbidity.

Impact of preoperative body mass index on the final outcome after laparoscopic sleeve gastrectomy for morbid obesity.

OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric surgery due to its excellent results and limited morbidity. Our study aims to assess the efficacy of LSG in terms of loss of weight and co-morbidity improvement and to evaluate the impact of preoperative body mass index (BMI) on the final outcome. MATERIAL AND METHODS: The data of 173 patients who underwent LSG were analyzed. Laparoscopic sleeve gastrectomy was indicated only for patients with BMI >40. Mean postoperative BMI, co-morbidity improvement, operative data and complications, length of hospital stay and excess weight loss were evaluated and recorded. RESULTS: This study included 151 females and 22 males with a mean age of 37.6 years. Patients were divided into two groups according to their BMI (group I <50, group II >50). Mean preoperative BMI was 53.8 kg/m2. Mean operative time was 120 minutes. Mean duration of hospital stay was 3.2 days. Mean postoperative BMI decreased to 47.3 kg/m2 at 1 year. Excess weight loss was 43.1% at 6 months, 71.1% at 1 year, and 87.5% at 5 years. Group I showed a significantly shorter length of hospital stay, more improvement of laboratory parameters and more reduction in BMI as compared to group II. There was one mortality and six cases had gastric staple line leakage. CONCLUSION: Laparoscopic sleeve gastrectomy is an efficient treatment to achieve significant weight loss that is maintained up to 5 years of follow up, also it improves some of the obesity related co-morbidities. This beneficial impact of LSG appears to be significantly higher in patients with BMI <50.