Evaluation of YouTube Bariatric Surgery Videos in the Context of Medical Tourism.

Introduction The increasing prevalence of obesity has led to the popularity of bariatric and metabolic surgery, often sought through medical tourism due to constraints within public healthcare systems. This study aimed to examine the quality and impact of YouTube videos related to bariatric surgery within the context of medical tourism. Materials and methods In June 2023, a YouTube search for "Bariatric Surgery Medical Tourism" and "Obesity Surgery Medical Tourism" yielded the top 200 videos, from which 33 were chosen after applying exclusion criteria. These videos underwent further screening based on source, duration, and content. Quality was assessed using established scales, including the Journal of American Medical Association (JAMA) criteria, the Global Quality Scale (GQS), and modified DISCERN score. Results Thirty-three videos were chosen for comprehensive analysis. Among the videos, 48.5% portrayed patient experiences in the context of medical tourism bariatric surgery, providing valuable insights. The videos had varying durations and engagement metrics, with an average GQS score of 2.09, JAMA score of 2.57, and DISCERN score of 3.06. Notably, videos depicting patient experiences had distinct characteristics and higher evaluation scores, emphasizing their significance within the study. Conclusion This study assessed YouTube videos related to bariatric surgery within the realm of medical tourism. The research illuminated diverse facets of medical tourism concerning obesity surgery and the quality of information disseminated on YouTube. Although patient experience videos received higher quality ratings, the overall reliability and content diversity underscored the potential and challenges of utilizing YouTube as an information source for medical tourism.

Ultrasonography Guided Modified BRILMA (Blocking the Cutaneous Branches of Intercostal Nerves in the Middle Axillary Line) Block in Bariatric Surgery.

Background: Postoperative pain is one of the major problems after laparoscopic sleeve gastrectomy besides complications. Management of pain control is still unclear in the obese population. Modified BRILMA (blocking the cutaneous branches of intercostal nerves in the middle axillary line) is a new analgesia technique which is performed by ultrasonography guided through the way between eighth and ninth rib level. This study is to evaluate the efficiency of modified BRILMA in bariatric patients while comparing with trocar site infiltration. Materials and Methods: This is a prospective designed retrospective data analysis study. Patients undergoing laparoscopic sleeve gastrectomy between June 2019 and January 2020 were divided into two groups. One group underwent BRILMA block; the other group used traditional trocar site injection. Postoperative pain was followed by using visual analogue scale (VAS) (at 1, 3, 6, 12, 24, 36, 48 hours postoperatively). Results: Thirty patients were included in the study. Twenty-four (80%) of the patients were women, and 6 (20%) of the patients were men. Mean body mass index of patients were 39.83 ± 4.02 kg/m2. Mean operational time was calculated 86.16 ± 19.94 minutes. When the patients' VAS was compared, 12th hour VAS value was statistically less in the BRILMA group. There were no significant differences in other hours' VAS between two groups. When compared with the use of opioid amount, there were no statistically significant difference between the two groups (P = .66), but BRILMA group had less amount. Conclusion: Modified BRILMA is an alternative technique to the use of trocar site bupivacain injection in bariatric surgery. It is new technique that is tried in bariatric population, which is also cost-effective and has less opioid consumption.

The Efficacy of Omentopexy During Laparoscopic Sleeve Gastrectomy: Comparative Analysis of Surgical Outcomes, Complications, and Quality of Life.

INTRODUCTION: The increasing popularity of laparoscopic sleeve gastrectomy (LSG) as a bariatric procedure has been accompanied by concerns about potential complications, including staple line bleeding and leaks. Additionally, postoperative quality of life can be affected by gastroesophageal reflux disease (GERD) and food-related issues. In light of these factors, there is a need to compare the outcomes of standard LSG with LSG with omentopexy. This comparative analysis aims to provide insights into the distinct recovery processes associated with these two approaches. MATERIALS AND METHODS: This retrospective study aimed to compare the outcomes of LSG in two groups: LSG alone and LSG with omentopexy. Data collected from January 2022 to April 2022 included patient characteristics, surgical details, complications, medication usage, and follow-up. Gastrointestinal Quality of Life Index (GIQLI) scores were recorded at postoperative intervals of 15 days, one month, and three months. RESULTS: This study analyzed 29 patients who underwent standard LSG and 36 patients who underwent LSG combined with omentopexy. The two groups exhibited similarities in terms of age, gender, body mass index (BMI), comorbidities, surgical duration, complications, hospitalization duration, and medication requirements (p > 0.005). Telephone consultations were significantly higher in the LSG with omentopexy group (p < 0.001). Nausea (p = 0.486) and vomiting (p = 0.603) rates did not significantly differ, but the constipation rate at one month was higher in LSG with omentopexy (p = 0.244). The flatulence rate at one month was significantly higher in LSG with omentopexy (p < 0.007). GIQLI scores were significantly lower in LSG with omentopexy at 15 days (p < 0.001) and one month (p < 0.001), but not at three months (p = 0.884). CONCLUSION: This study demonstrates that LSG and LSG with omentopexy have similar surgical outcomes and short-term complications. However, differences exist in postoperative symptoms and quality of life experiences.

An Assessment of the Quality and Reliability of Gastric Botox Information Videos on YouTube.

Background and objective Intragastric botulinum toxin (Botox) applications have emerged as a novel endoscopic intervention method to treat obesity. YouTube stands out as one of the primary online platforms frequently utilized for accessing health-related information. In light of this, this study aimed to evaluate the accuracy and reliability of informational videos about gastric Botox on YouTube. Materials and methods In July 2023, a comprehensive evaluation of gastric Botox information videos on YouTube was conducted by querying "Gastric Botox" on YouTube. A total of 70 videos were initially reviewed and 48 videos were meticulously analyzed by a general surgeon. Videos were categorized based on their sources and attributes and evaluated using standard scales like the Journal of the American Medical Association (JAMA) score, modified DISCERN, and the Global Quality Scale (GQS). Results A total of 48 videos were assessed. Of these, 2.1% originated from academic institutions, 20.8% from private hospitals/organizations, and 52.1% from physicians. Videos by other healthcare professionals accounted for 2.1%, health information websites 12.5%, and independent users 10.4%. Video durations varied significantly across sources (p<0.001). Independent user videos had the highest likes/views. JAMA scores (p=0.009) and DISCERN scores (p=0.045) showed significant differences among sources. Academic institution videos had a median JAMA score of 4; independent users scored 1. As for DISCERN, academic videos scored the highest at 5, while independent users scored the lowest at 1.8. Conclusions YouTube is filled with healthcare information videos today. Although the quality and reliability scores based on conventional assessment methods might be moderate, we advise utilizing videos from academic institutions and reputable health information websites as primary sources to educate patients about gastric Botox.

Assessment of Surgical and Quality-of-Life Outcomes Between Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients.

Introduction: Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients. Methods: We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates. Results: A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery. Conclusion: Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients.

Prognostic Nutritional Index in Short-term Postoperative Outcomes in Hepaticojejunostomy.

OBJECTIVE: To investigate the utility of prognostic nutritional index (PNI) on short-term complications, biliary fistula, mortality, and morbidity in patients undergoing hepaticojejunostomy (HJ) procedure. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Tepecik Training and Research Hospital, Izmir, Turkey, between January 2018 and January 2020. METHODOLOGY: Patients who underwent elective HJ for benign and malignant reasons were scanned retrospectively using the hospital digital record system. Many data such as chronic diseases and PNI values of patients, postoperative 30-day mortality and morbidity, days of hospital stay (HS), postoperative complications, and data of surgery were analyzed. RESULTS: A total of 81 patients, of whom 42 (52%) were males and 39 (48%) were females, were included in the study. The mean age of the patients was 65.8 ±11.3. In 53 patients (65.4%), surgeries were performed due to malignancy. In 19 (23.4%) patients, grade 3 and 4 complications according to Clavien-Dindo Classification were observed in 12 patients (14.8%), and postoperative 30-day mortality was observed. The rate of grade 3 and 4 complications increased in patients with a PNI below 45, it was not statistically significant (p=0.165). The mortality rate was 4.5% in patients with PNI>45, and 18.6% in patients with PNI<45 but this difference was not significant (p=0.165). The mean HS was significantly shorter in patients with PNI>45 (p=0.02). CONCLUSION: At PNI>45, many complications and hospital stay become markedly shorter. Large multi-centre randomised future studies are required to confirm these findings. KEY WORDS: Prognostic nutritional index, Hepatic duct, Biliary tract, Biliary fistula.

Duct-to-Mucosa Pancreaticojejunostomy with Less Serosal Stitches: A Different Approach to Well-known Problem.

OBJECTIVE: To describe a new approach (duct-to-mucosa pancreaticojejunostomy with less serosal stiches) for postoperative pancreatic fistula (POPF) in pancreaticoduodenectomy. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Tepecik Training and Research Hospital, Izmir, Turkey, between January 2019 and May 2020. METHODOLOGY: Medical records of 45 patients, who underwent pancreaticoduodenectomy by the same general surgeon between January 2019 and May 2020, were reviewed retrospectively. Pylorus-preserved pancreaticoduodenectomy was performed for all patients. Duct-to-mucosa PJ with less serosal suture technique was used for all patients in reconstruction after pancreaticoduodenectomy. Definition of the ISGPS was used for the POPF and only grade B and C fistulas were accepted as clinically relevant POPF. Here, the descriptive measures were reported. RESULTS: Seventeen (17) of the forty-five (45) patients were females and median age was sixty- six (66) years. The majority of the underlying disease was pancreatic adoneocarcinoma. Hyperbilirunemia was seen in 15 patients. Median operation time was 360 minutes. Number of patients with pancreatic duct size <3 mm was five. Rate of soft pancreas texture was 33.3%. Lastly, the number of patients that underwent vascular resection or additional organ resection were 6 (13.3%) and 8 (17.8%), respectively. Clinically relevant POPF according to ISGPS was seen in 6 patients (grade B:4 and grade C:2). The most prevalent postoperative complication was surgical site infection at a rate of 40%. There was no POPF related mortality. CONCLUSION: Two-layer duct-to-mucosa pancreaticojejunostomy with less serosal stitches technique has acceptable pancreatic fistula rates. This technique could be used by surgeons who are faced with challenges with the duct-to-mucosa anastomosis due to aforementioned causes. Large multi-centre randomised future studies are required to confirm these findings. Key Words: Postoperative pancreatic fistula, Surgical technique, Duct-to-mucosa pancreaticojejunostomy, Less serosal stiches.

Prospective study of sexual dysfunction after proctectomy for rectal cancer.

BACKGROUND: Although rectal cancer is a common malignancy and has an improved cure rate in response to oncological treatment, research on rectal-cancer survivors' sexual function remains limited. OBJECTIVE: The aim of this prospective study is to assess sexual dysfunction after rectal cancer surgery. PATIENTS AND METHODS: Patients undergoing curative rectal cancer surgery were included in the study. Sexual function before and 6 months after the operation was measured using the validated questionnaires. Primary outcome was to determine the rates of Sexual dysfunction after rectal cancer surgery. Furthermore, the factors which can have an impact on sexual function after radical treatment have been assessed. RESULTS: A total of 187 patients [117 (63%) men and 70 (37%) women] with rectal cancer who underwent radical resection were included in the study. Sexual function has significantly decreased after surgery. Among male patients, sexual dysfunction increased from the baseline 4% (n = 5) up to 41% (n = 48) after the operation. Among female patients, sexual dysfunction increased from the baseline 53% (n = 37) up to 77% (n = 54) after the operation. A significant lower rate of laparoscopic surgery has been found in both males and females who reported sexual dysfunction after surgery. The patients who have locally advanced disease and those who received postoperative chemotherapy or radiotherapy have higher rates of sexual dysfunction. CONCLUSION: This study, showed that sexual dysfunction is common in patients with rectal cancer after radical treatment. However, patients who underwent laparoscopic surgery have lower rates of sexual dysfunction than those who underwent open surgery.

Primary Hydatid Cyst of the Small Intestine: A Rare Case Report and Brief Review of the Literature.

Hydatid disease is an endemic disease especially in underdeveloped and developing countries affecting mostly the liver and lungs. The hydatid cysts located in other sites are mostly due to rupture of primary liver or splenic cysts. We present a primary small intestine hydatid cyst resected laparoscopically with the affected intestinal segment. As far as we know, this is the first report of a primary small intestine hydatid disease in the literature.