Evaluation of the outcome of a proposed more physiological bypass surgery technique in morbid obesity: Long term 3 years follows up.

Background: Obesity is a chronic condition that affects millions globally; consequently, bariatric surgery is the key to this serious issue. Bariatric procedures are rapidly expanding in number and methods to address the recognized problems. So, it would make a sense for surgeons and patients if there is a more physiological bypass surgery technique in Morbid obesity. This study aims to evaluate the outcome proposed technique. Patients and methods: The present study is a retrospective analysis on 256 participants subjected to the proposed bypass procedure from December 1999 to January 2017, the participants were followed up for an interval of 3years. Results: The findings of the present study revealed a significant Excess Weight Loss (EWL). In addition, patients experienced decreased calcium, iron, vitamin B12, Hemoglobin, zinc, and Prothrombin Concentration. However, three to six months after surgery, they experienced a significant improvement until they reached normal levels without any supplement by the end of 12,18 months, with a three-year follow-up. Conclusion: This proposed Bypass Operation aims to adequate digestions as well as selective absorption without inducing any vital deficit. Most of study's population showed no elements inadequacies, although few percentages emerged during the interval of maximal weight reduction, and it were transient and minimal. No minerals or vitamins were needed.

Improvement of Coronary Calcium Scores After Bariatric Surgery in People with Severe Obesity.

BACKGROUND: Obesity is an independent risk factor for cardiovascular diseases. Coronary artery calcium (CAC) is a direct measure of coronary atherosclerosis. The study investigated the effect of bariatric surgery on CAC scores in people with severe obesity subjected to laparoscopic sleeve gastrectomy (LSG). METHODS: This prospective study included 129 people with severe obesity in two groups; the LSG group (n=74) subjected to surgery and the diet group (n=55), managed by a diet regimen and lifestyle modification. Cardiovascular risk was assessed by Framingham risk score (FRS) and coronary calcium score (CCS) measured by computed tomography initially and after 3 years. RESULTS: The two groups had a comparable CAD risk before treatment according to FRS or CCS. After treatment, CCS improved significantly in the LSG group (p=0.008) but not in the diet group (p=0.149). There was no correlation between FRS and CCS (r=0.005, p=0.952). Treatment resulted in significant weight reduction and improved fasting blood glucose and lipid profile in the two groups. The change of weight, blood glucose, and HDL, and remission of diabetes mellitus (DM) were significantly higher in the LSG group compared to the diet group. CONCLUSION: LSG may reduce the risk of developing future cardiovascular comorbidities evidenced by reducing CAC scores. Significant weight reduction and improvement of cardiovascular risk factors may recommend LSG as a cardioprotective procedure in people with severe obesity.

Intraoperative Factors Associated With Early Recipient Death After Adult-to-Adult Living Donor Liver Transplant.

OBJECTIVES: Living donor liver transplant is the gold standard therapy for patients with terminal hepatic disorders for whom no alternative therapy is available. The primary aim was to assess different intraoperative factors that may predict early death after adult-to-adult living donor liver transplant. The secondary aim was to assess the effect of small-for-size syndrome on mortality. MATERIALS AND METHODS: This retrospective multicenter cohort study was performed on records from 145 adults with cirrhosis who had received a right lobe living donor liver transplant. Patients were divided according to the occurrence of short-term mortality (death within the first month after transplant). The primary intraoperative parameters included graft weight, surgical duration, mean blood pressure, serum lactate and sodium bicarbonate, transfusions, durations of cold and warm ischemia and anhepatic phase, input and output during surgery, and portal venous pressures. RESULTS: There were statistically significant variations between both cohorts for number of units of packed red blood cells, durations of cold and warm ischemia and anhepatic phase, preclamp and postreperfusion portal venous pressures, average urine output, mean serum lactate, mean blood pressure, and surgical duration (P ⟨ .001). Also, there were significant differences in the number of platelets, units of fresh frozen plasma, and mean sodium bicarbonate (P = .025, .003, and .035, respectively). Of the 25 patients who died within the early postoperative period, 20 had developed small-for-size syndrome (P ⟨ .001). CONCLUSIONS: A variety of intraoperative risk factors may affect early posttransplant mortality, which suggests the high complexity of living donor liver transplants and the need for well-trained experienced teams to perform these surgeries.

Comparison between omentoplasty and partial cystectomy and drainage (PCD) techenques in surgical management of hydatid cysts liver in endemic area (Yemen).

Hydatisosis caused by Echinococcus granulosus is more or less endemic in all sheep raising countries. This study evaluated omentoplasty versus partial cystectomy with drainage in surgical management of hydatid cysts of the liver in endemic area (Yemen). A total of 60 patients with hydatid cyst in the liver was divided into two groups; G1 (32 patients) treated with omentoplasty and G2 (28 patients) treated with partial cystectomy with drainage (PCD). The results showed that the wound sepsis was seen in 6.25%, of Gland in 14.2% of G2, biliary leakage occurred in 3.5% of G2, intra-abdominal abscess formation occurred in 3.5% of G2, atelectasis was in 3.1% of G1 and in 3.5% of G2. The total morbidity was 12.5% in G1 and 32.1% in G2. There was a significant difference between the two groups as regard to the mean post-operative hospital stay, (6.5 days in G1 versus 15.6 days in G2).

Snake bite: clinical presentation, complication and outcome in relation to time of polyvalent snake antivenin in Yemen.

The snakebite envenoming is an important medical emergency. The envenoming is a complex medical emergency involving the site of the bite as well as multiple organ system. The symptoms and signs depend on the type and amount of venom injected, location of bite, victims' age, body size and general health conditions. This study clarified the clinical presentations; factors involved in complications and the outcome in relation to timing of polyvalent snake antivenin administration in 50 Patients were selected from cases admitted to Al-Salam Hospital at Saadah, Republic of Yemen. The manifestations of envenoming and complications were recorded. Treated patients were analyzed to determine the factors involved in complications and the outcomes in relation to the timing of polyvalent snake antivenin administration The bitten patients had envenoming (80%), bitten at night (68%), while walking barefooted (84%), complaining from pain (76%) and limb swelling (56%). The systemic manifestations were common only in severe cases and patients attend to the hospital after six hours from snake bite. All patients had envenoming developed coagulation abnormalities. Two cases (4%) died from cerebral hemorrhage and multi organ failure.