The Effect of Bariatric Surgery on Menstrual Abnormalities in Saudi Women: A Cross-Sectional Study.

BACKGROUND: Adults in Saudi Arabia are more likely to be obese, which has negative effects on reproductive health, especially for women. While bariatric surgery (BS) provides a sustainable approach, little is known about how it affects menstrual health and requires a study among the Saudi demographic. METHODS: The current investigation is a cross-sectional study conducted in Saudi Arabia. Data were collected using an online questionnaire to assess the impact of BS on menstrual abnormalities in women. Data were cleaned in Excel and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 24.0, Armonk, NY). RESULTS: This study included 516 Saudi women who underwent various BS procedures, with 37.2% aged 18-30 years and 97.9% residing in Saudi Arabia. Approximately 85.9% underwent sleeve gastrectomy (SG), experiencing a mean weight loss of 54.2 kg. Co-morbidities included polycystic ovary syndrome (PCOS) (12.4%), hypothyroidism or hyperthyroidism (11%), uterine fibroids (4.7%), and hormonal imbalances (2.5%). Post-surgery, 18% encountered BS complications from BS, while 8.3% used antidepressants. Moderate sports participation ranged from 12.2% (five or more days) to 36.2% (one to three days). In particular, no significant associations were found between complications and various parameters, except a marginal association with educational level (p=0.071). The number of menstruations per year did not change statistically significantly, remaining constant at 10.6±4.8 before surgery and 10.6±4.9 after surgery (p = 0.859). However, there was a mild decrease in the amount and duration of menstruation, reported by 23.3% and 27.3% of the participants preoperatively and post-operatively, respectively. CONCLUSION: The study demonstrates the impact of BS on menstrual abnormalities in Saudi women. Despite a significant weight reduction, we found mild improvement in the amount and duration of menstruation with no substantial effect observed on the menstrual cycle frequency. Psychological support after surgery is crucial, considering the increased use of antidepressants.

Umbilical pilonidal sinus.

Pilonidal sinuses are commonly encountered, but their occurrence in the umbilical area is rare. The author presents one such case of an umbilical pilonidal sinus in an obese male patient that presented with recurrent episodes of umbilical discharge. The condition was treated with sinus excision and umbilical reconstruction. There was no recurrence of the disease until one year of follow up.

Using simulation to improve the cognitive and psychomotor skills of novice students in advanced laparoscopic surgery: a meta-analysis.

Advances in simulation technologies have enhanced the ability to introduce the teaching and learning of laparoscopic surgical skills to novice students. In this meta-analysis, a total of 18 randomized controlled studies were identified that specifically looked at training novices in comparison with a control group as it pertains to knowledge retention, time to completion and suturing and knotting skills. The combined random-effect sizes (ESs) showed that novice students who trained on laparoscopic simulators have considerably developed better laparoscopic suturing and knot tying skills (d = 1.96, p < 0.01), conducted fewer errors (d = 2.13, p < 0.01), retained more knowledge (d = 1.57, p < 0.01) than their respective control groups, and were significantly faster on time to completion (d = 1.98, p < 0.01). As illustrated in corresponding Forest plots, the majority of the primary study outcomes included in this meta-analysis show statistically significant support (p < 0.05) for the use of laparoscopic simulators for novice student training on both knowledge and advanced surgical skill development (28 of 35 outcomes, 80%). The findings of this meta-analysis support strongly the use of simulators for teaching laparoscopic surgery skills to novice students in surgical residency programs.

The effect of simulation in improving students' performance in laparoscopic surgery: a meta-analysis.

BACKGROUND: There is increasing interest in using simulators for laparoscopic surgery training, and simulators have rapidly become an integral part of surgical education. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, and Google Scholar for randomized controlled studies that compared the use of different types of simulators. The inclusion criteria were peer-reviewed published randomized clinical trials that compared simulators versus standard apprenticeship surgical training of surgical trainees with little or no prior laparoscopic experience. Of the 551 relevant studies found, 17 trials fulfilled all inclusion criteria. The effect sizes (ES) with 95 % confidence intervals [CI] were calculated for multiple psychometric skill outcome measures. RESULTS: Data were combined by means of both fixed- and random-effects models. Meta-analytic combined effect size estimates showed that novice students who trained on simulators were superior in their performance and skill scores (d = 1.98, 95 % CI: 1.20-2.77; P < 0.01), were more careful in handling various body tissue (d = 1.08, 95 % CI: 0.36-1.80; P < 0.01), and had a higher accuracy score in conducting laparoscopic tasks (d = 1.38, 95 % CI: 0.30-2.47; P < 0.05). CONCLUSION: Simulators have been shown to provide better laparoscopic surgery skills training for trainees than the traditional standard apprenticeship approach to skill development. Surgical residency programs are highly encouraged to adopt the use of simulators in teaching laparoscopic surgery skills to novice students.

Endoscopic treatment of Zenker diverticulum: results of a 7-year experience.

BACKGROUND: Zenker diverticulum (ZD) is a rare disease usually seen in elderly patients who present with symptoms of worsening dysphagia and regurgitation. Although open surgical approach is still the standard management for symptomatic patients, the endoscopic technique has evolved as an alternative approach, especially for highly morbid patients. We are reporting our experience for treating ZD using endoscopic needle-knife papillotome. STUDY DESIGN: A total of 18 patients with a mean age of 80 years (range 68 to 91 years) were included in our prospective cohort study. All patients underwent endoscopic cricopharyngeal myotomy for symptomatic ZD using needle-knife papillotome at Brandon Regional Health Centre during a 7-year period. Mean follow-up was 27.5 months. A dysphagia score system from 0 (no dysphagia) to 4 (severe dysphagia) was used. All patients' baseline characteristics, pre- and postoperative symptoms, operative time, time to oral intake, length of hospital stay, recurrence of symptoms, and complications were analyzed. RESULTS: Dysphagia score and regurgitation symptoms improved substantially after treatment. Mean operative time was 28.4 minutes. Oral intake was resumed within 24 hours in all but 1 patient. Hospital stay for the majority was 24 to 48 hours. Only 1 patient had a microperforation treated conservatively and 2 patients had re-do procedures for persistence of dysphagia. CONCLUSIONS: Endoscopic cricopharyngeal myotomy using needle-knife papillotome is an effective approach to manage ZD for highly morbid patients. It is minimally invasive, decreases anesthetic time, shortens hospital stay, and has a low complication rate.

Resuscitative Long-Bone Sonography for the Clinician: Usefulness and Pitfalls of Focused Clinical Ultrasound to Detect Long-Bone Fractures During Trauma Resuscitation.

Bone has one of the highest acoustic densities (AD) in the human body. Traditionally, bone has been considered to be a hindrance to the use of ultrasound (US), as US waves are reflected by the dense matrix and obscure underlying structures. The intense wave reflection, however, can clearly illustrate the cortical bony anatomy of long bones, making cortical disruption obvious. Ultrasound can be used at the bedside concurrently with the overall trauma resuscitation, and may potentially limit the patient's and treating team's exposure to ionizing radiation, corroborate clinical findings, and augment procedural success. The extended focused assessment with sonography for trauma (EFAST) is an essential tool in the resuscitation of severe torso trauma, frequently demonstrating intra- pericardial and intra-peritoneal fluid, inferring hemo/pneumothoraces, and demonstrating cardiac function. Although it is typically considered as a diagnosis of exclusion, multiple long-bone fractures may be a source of shock and can be quickly confirmed at the bedside with EFAST. Further, the early detection of long-bone fractures can also aid in the early stabilization of severely injured patients. Sonographic evaluation for long-bone fractures may be particularly useful in austere environments where other imaging modalities are limited, such as in the battlefield, developing world, and space. While prospective study has been limited, selected series have demonstrated high accuracy among both physician and para-medical clinicians in detecting long-bone fractures. Pitfalls in this technique include reduced accuracy with the small bones of the hands and feet, as well as great reliance on user experience.