Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood.

BACKGROUND: Childhood obesity is associated with a variety of complications that see their light throughout adulthood. Due to the serious side effects of these morbidities, early intervention is essential. Laparoscopic sleeve gastrectomy (SG) is a safe and effective procedure for the treatment of obesity, however, the long-term data on its use in adolescents is lacking in the literature. METHODS: A retrospective analysis was conducted on all patients that underwent SG aged between 12 and 21 years old at a public hospital in Kuwait. Data on their weight and comorbidities was collected and analyzed. RESULTS: 164 adolescent patients with a mean age of 19 underwent SG. 71% of the patients were female, while the mean weight at surgery was 128.6 kg, corresponding to a BMI of 47.8 Kg/m2. 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60. The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%. On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. 21 patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op. CONCLUSION: It is of ample importance to tackle obesity during childhood before complications ensue later in life. Bariatric surgery, specifically SG, has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities.

Long-term outcomes after laparoscopic sleeve gastrectomy in Kuwait.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been established as an effective means of weight loss. Multiple studies report LSG as a cost-effective procedure with few perioperative complications. OBJECTIVES: Report long-term weight changes after LSG in a single center in Kuwait. DESIGN: Retrospective analysis of data collected 5-8 years after surgery. SETTING: A single medical center. PATIENTS AND METHODS: All patients that had undergone LSG between December 2008 and December 2011. MAIN OUTCOME MEASURES: Weight changes, short-term complications following surgery (within one month). SAMPLE SIZE: 187. RESULTS: The mean age at the time of the surgery was 36.5 (10.3) years. Females composed 71.6% of this study population.Two patients (1.1%) presented with a leak within 30 days of the surgery. Twenty-one (11.2%) patients underwent revisional bariatric surgery after LSG. Mean (SD) BMI decreased from 47.1 (8.3) kg/m2 before surgery to 34.3 (7) kg/m2 5-8 years after surgery. Mean (SD) body weight decreased from 126.3 (25.3) kg to 91.6 (19.9) kg 5-8 years following LSG. The mean excess body weight loss was 58.8% (29.2%). CONCLUSION: LSG is a bariatric procedure with low complications and mortality in relation to other forms of bariatric surgery. It is associated with a significant improvement in weight loss in the long term. LIMITATIONS: Recall bias due to the nature of collecting the data, small sample size. CONFLICT OF INTEREST: None.

Repair of a giant diaphragmatic hernia using the dual approach.

Bochdalek hernias are diaphragmatic defects seen in pediatrics. About 5-25% of the cases are diagnosed in adulthood, and present with symptoms of chest and abdominal problems. This is a case of an 18-year-old male who presented to the emergency department with epigastric pain, vomiting and dyspnea. Most of the left-sided organs had herniated to the left chest cavity. Immediate surgery was performed. The stomach, spleen and colon were reduced into the abdominal cavity. The diaphragm defect was repaired laparoscopically, but there were limitations due to inadequate space, leading to difficult visualization of the posterior diaphragmatic leaflet. A thoracoscopic approach was taken where we saw the left kidney herniated through the repair site posteriorly. It was reduced and the defect was closed. The early diagnosis of Bochdalek hernias is important to prevent stomach/intestinal strangulation. Laparoscopic surgeons need to be prepared for a thoracic approach in giant congenital diaphragmatic hernias.

The aftermath of the Kuwait mosque bombing: A retrospective cohort analysis and lessons learned.

INTRODUCTION: The occurrence of terrorist attacks are still recurrent incidents plaguing the middle east region. However, Kuwait has been mostly spared from these attacks over the years. Therefore, when the bombing of the mosque in 2015 happened, it shocked a country that is not prepared for such disasters. Our aim was to present the incident that occurred on that day and on the lessons learned from it. METHODS: A collaborative effort among the hospitals in Kuwait examined the details and outcomes of the initial response to the bombing. The centers reported their retrospective data, which was analyzed to determine prehospital and intra-hospital management and assess the medical response to the terrorist bombing. RESULTS: A total of 239 victims were involved in the explosion, of which 18 were pronounced dead on site. 147 (67%) were transferred to the hospital for care 22 min after the explosion occurred. The injuries seen were not localized to one region of the body, but afflicted various organ systems. 86 patients were admitted to the hospital, for which five required urgent surgical intervention. Total mortality (on-site and in-hospital) reported after the bombing was 11.2%. CONCLUSION: Rapid response after a mass casualty is of utmost importance for the adequate management of the victims of such tragedies, and could ensure excellent outcomes if performed precisely. However, many lessons can be learned from this shocking event, especially that it exposed the gaps currently present in our disaster plan systems and the importance of looking into addressing them.