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   Table of Contents - Current issue
January-December 2020
Volume 5 | Issue 1
Page Nos. 1-42

Online since Saturday, October 3, 2020

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Bariatric surgeries' complications in Saudi Arabia Highly accessed article p. 1
Sultan Ali Alwajeeh, Rawan Saeed Alasmari, Ibtihal Mohammed Alattas, Razan Aiydh Abu Hassan, Raged Ibrahim Alrawaji
As obesity is becoming a global epidemic, many solutions have been proposed to patients from medical to psychological to surgical. Recently, with the advances of laparoscopic surgery and the safety of the anesthesia, bariatric surgeries are expanding, particularly in the countries affected by obesity the most. Saudi Arabia is one of the highest countries with an obesity rate. This study aims to explore the complications of various bariatric surgeries (gastric banding, gastric bypass, and vertical sleeve gastrectomy) by reviewing the literature that has been published in Saudi Arabia. The findings from this study would enlighten the clinicians and patients about the prevalence of these complications in this geographical area and allow a thoughtful comparison between the complication rate among different countries and practice types.
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Cystic duct identification in laparoscopic cholecystectomy review articles p. 6
Raafat R Ahmed Alturfi, Ahmed A Hilmi
Postcholecystectomy bile duct injury (BDI) is a life-threatening complication; it associated with increased morbidity and mortality in addition to the medicolegal consequences. The most common cause of serious biliary injury is misidentification of cystic duct-common bile duct relationship. Many techniques had been tested by surgeons to avoid the misidentification injury, this include infundibular technique, critical view of safety, retrograde laparoscopic cholecystectomy, operative cholangiography, fluorescence cholangiography, and biliary navigation surgery using endoscopic nasobiliary drainage. Among these methods, critical view of safety (CVS) has been found most reliable and safe method for cystic duct identification. Moreover, it is easy applicable, fast to learn, and not required special equipment. If the CVS cannot be achieved safely, there are others alternative methods to avoid BDI according to SAGES recommendations.
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Establishment of research units: A perspectives/proposal towards enhancing the prospective research studies among general surgery trainees p. 12
Mohammed Yousef Aldossary, Mohammed Saad Alqahtani
Background: Education, clinical care, and research are the three main foundations of academic health centers in the world. The research environment has always been riddled with ebbs and flows, depending on the availability of funding resources. Prospective research studies are limited for the residents in Saudi Arabia because most of them are doing rotations outside the center or changing the surgical unit after 1–3 months and joining another team. Objectives: This article discusses the creation of research units to provide research support in prospective studies and presents the advantages and disadvantages of these units. The project is based on the acknowledged importance of establishing research facilities in general surgery training centers of the kingdom with the aim of helping regions move in the same pace with the rest of the world. Conclusion: This project proposes establishing research units and development of prospective research studies in all general surgical centers in the Kingdom of Saudi Arabia. The goal of the project is to provide data and research materials to general surgery residents so that they can improve their performance and also increase their satisfaction in the field.
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Comparison of laparoscopic sleeve gastrectomy outcomes between elderly and young patients p. 18
Saad Althuwaini, Fahad Bamehriz, Abdullah Aldohayan, Maram A Alaqel, Rasha Abdulelah Bassas, Rana A AlJunidel
Background and Aim: There are conflicting results in the literature regarding the percentage of excess weight loss (%EWL) and the resolution of comorbidities postlaparoscopic sleeve gastrectomy between the young and elderly patients. We compared the resolution of comorbidities and the %EWL and investigated for significant complications after surgery between the young and elderly patients. Methods: This was a retrospective case–control study which used the data collected from the electronic medical records at the Center of Excellence of Bariatric Surgery in King Saud University Medical City, Riyadh, Saudi Arabia, from 2011 to 2017. The variables collected included; length of hospital stay, resolution of comorbidities at 1, 6, and 12 months, complications postsurgery, and the %EWL. Results: We included 56 patients (35 males and 21 females) with a mean age of 58.8 years (55 to 75 years) and mean body mass index of 39.5 kg/m2 (42–60 kg/m2). The length of stay was significantly longer in the elderly group compared to the younger group (3.14 vs. 2.33 days). The proportion of comorbidities in the older population was higher compared to the younger population. The resolution of the comorbidities was significantly higher at the last patient's follow-up in both older and younger population. The %EWL was above 50% in both age groups. There was one incidence of bleeding in the elderly group. Conclusion: Bariatric surgery is relatively safe and effective in reducing the incidence of comorbid conditions even among elderly patients aged 60 years old and above. Therefore, we suggest that the age should not be a major impediment when considering bariatric surgery, particularly for the elderly patients. However, a meticulous assessment of other patient risk factors should also be considered prior to bariatric surgery.
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Anesthetic technique for elective cesarean section in obese parturients: A cross-sectional study p. 22
Sadaf Malik, Jamil Sharif Anwari, Rashed Ayeidh Alotaibi
Context: A pregnant obese is at an increased risk of several serious adverse outcomes. Anesthesia-related morbidity and mortality are increased in this patient population. Aims: The primary aim of this study was to find the incidence of obesity in parturients presenting for elective cesarean section (CS) and the anesthesia technique offered to these obese parturients. Materials and Methods: A cross-sectional study of patients presenting for elective CS was done over 2 months. The data included patients' age, height, weight at the first antenatal visit and at term, parity, and type of anesthesia. The percentage of obese parturients was determined by calculating the body mass index from the data. Results: Data were calculated from 109 patients. The percentage of obese parturients was 60% and 16.5% were overweight. Spinal anesthesia was employed in 60% of obese parturients for elective CS. Conclusion: The increasing number of obese parturients is alarming and among the highest in the region. The percentage of spinal anesthesia for elective CS is below the recommended international guidelines.
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Prevalence of Helicobacter pylori in gastric specimen following laparoscopic sleeve gastrectomy p. 27
Fahad Yaslam Bamehriz
Background: Laparoscopic sleeve gastrectomy (LSG) for obese patients can give more gastric tissue that can add more precise information about Helicobacter pylori (H. pylori) presence in relation to age, gender, and body mass index (BMI). Methodology: We retrospectively collected the computerized data and the pathology reports for all the patients who underwent LSG for obesity from 2008 to 2018 in King Khalid University Hospital, Riyadh, Saudi Arabia. Results: Of the total 1486 obese patients who underwent LSG, H. pylori was negative in 1025 patients (68.98%) and positive in 461 patients (31.02%). It was found that H. pylori positive was higher in females (53.15%) with lower BMI and was higher in males (58.82%) with higher BMI. H. pylori positive was present highly (45.16%) in the age group of more than 60 years. Conclusions: Data analysis showed that there is a relationship between increased BMI and the incidence of H. pylori. The contradiction of our results with other studies may be related to both small sample size and diagnostic test variability. Furthermore, our study found that maybe there is a relationship between BMI and the presence of H. pylori according to gender.
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Veress needle injury in laparoscopy: A catastrophic complication p. 33
Atul Jain, Nabal Kumar Mishra, Sajid Makbul Nurbhai, Mansoor Banday, Gaurav Patel
Laparoscopy has become popular among surgeons and patients for surgery for various advantages it offers. Still, it has some complications and which can be lethal at times. Majority of injuries occur at the time of entry into the abdomen. Here, we report a case of major vascular injury by Veress needle and its sequelae.
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Fatal intestinal and abdominal wall ischemia post laparoscopic cholecystectomy p. 36
Abdu Hasan Ayoub, Mohammed Ali Fagihi, Gamal Saleh Matar, Mohammed Atiah Albasiouny, Mutaz Faroug Abdelmagid, Alaa El Din Sadek Zidan, Raoom Abdu Ayoub, Yara Eisa Ajaybi, Bushra Ali Meshn
Intestinal ischemia though it is a rare complication postlaparoscopic cholecystectomy but leads to serious devastating and fatal sequelae. Its prognosis depends on high index of suspicion and effective early treatment. Various causes have been described such as splanchnic hypoperfusion, superior mesenteric artery thrombosis, and inferior mesenteric artery thrombosis. Literature review revealed that intestinal ischemia could happen despite of correct operative techniques.
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Surgical considerations of combined laparoscopic cholecystectomy and cesarean delivery p. 40
Khayal Al-Khayal, Anwar Mirza Ahmed Baig, Christos Boustazastal, Shaheen Alaam, Talal Saad Al Mukhlifi
A 32-year-old female, with history of two previous cesarean sections. She was scheduled for an elective cesarean section. The night before surgery, she hada spike of fever and abdominal pain in the epigastrium and felt nauseated. She was brought to the emergency room, and her ultrasound examination revealed edema n the peri- gallbladder area and cholecystitis. A general surgical consult was made, and the opinion was that she needs to be operated urgently. Laparoscopic cholecystectomy was done with initial port placement at Palmer's point with a 5-cm Covidien optical port. Procedure completed with no complication. The obstetric team then made a Pfannenstiel incision to deliver the baby. The delivery was completed in 10 min after the closure of the laparoscopic ports. The patient was in hospital for the next 3 days, and her puerperium was unremarkable. There were no further complications during her stay. The baby was discharged from NICU on the1stpostoperativeday.
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