One-anastomosis gastric bypass (OAGB) with fixed bypass of the proximal two meters versus tailored bypass of the proximal one-third of small bowel: short-term outcomes.

BACKGROUND: One-anastomosis gastric bypass (OAGB) is an effective bariatric procedure that confers satisfactory weight loss and improvement in comorbidities. The present study aimed to compare OAGB with fixed bypass of the proximal 200 cm of small bowel and tailored bypass of the proximal 1/3 of bowel. METHODS: Patients with class II/III obesity underwent OAGB with either fixed bypass of the proximal two meters or tailored bypass of the proximal 1/3 of bowel. The main outcomes of the study were weight loss, improvement in comorbidities, complications, and changes in nutritional parameters after each technique. RESULTS: The present study included 80 patients (62 female) of a mean age of 41 years and mean body mass index (BMI) of 50.9 kg/m2. The tailored bypass group was followed by a significantly lower BMI and significantly higher excess weight loss and total weight loss at 6 and 12 months postoperatively. There was no significant difference between the two groups in terms of improvement in comorbidities. The fixed bypass group was associated with a significantly higher complication rate than the tailored bypass group (22.5 vs. 5%, P = 0.04). Both groups were associated with similar changes in the nutritional parameters at 12 months postoperatively, except for the higher serum albumin levels after the tailored bypass than the fixed bypass. CONCLUSIONS: OAGB with tailored bypass of the proximal one-third of bowel was associated with greater weight loss and comparable improvement in comorbidities as compared to fixed bypass of the proximal two meters of intestine.

Operative Outcomes of Single-Incision Laparoscopic Hysterectomy vs Conventional Laparoscopic Total Hysterectomy: A Prospective Randomized Controlled Study.

Background. Over time, there was an emerging need to shift from laparotomy to minimally invasive laparoscopic surgery, with the success of laparoscopic surgery in the last decade in gyne-oncology. Patients and Methods. This is a prospective randomized controlled trial conducted in Surgical Oncology Unit, Oncology Centre, Mansoura University, in the period between February 2016 and October 2019. Fifty female patients planned for total hysterectomy were randomized into two equal groups; the first underwent conventional laparoscopic hysterectomy (CLH), while the second underwent single-incision laparoscopic hysterectomy (SILH). Results. The mean operative time in the SILH group was 120.00 ± 28.72 minutes vs 103.20 ± 23.04 minutes in the CLH group (P= .027). Median hospital stay in the SILH group was 1 day (range: 1-3 days), the same as that in the CLH group, with no statistical significance (P= .384). Postoperative pain assessment using the Visual Analogue Scale (VAS) after 6 hours had a median score of 6 (2-8) in the SILH group and 6 (4-7) in the CLH group with significant increase in experienced pain in the SILH group (P= .004), while no significant difference was noted after 12 hours and 24 hours in both SILH and CLH groups. Conclusion. Single-incision laparoscopic hysterectomy (SILH) has similar outcomes when compared to conventional laparoscopic hysterectomy as regard blood loss, hospital stay, conversion to laparotomy, intraoperative and postoperative complications with the disadvantages of longer operative time, increased surgeon's workload, and relatively more postoperative pain.