Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: a case-matched multicenter study.

BACKGROUND: The present study aimed to compare the outcome of single anastomosis sleeve ileal (SASI) bypass and sleeve gastrectomy (SG) in regards weight loss, improvement in comorbidities at 12 months of follow-up, and postoperative complications. METHODS: This was a case-matched, multicenter analysis of the outcome of patients who underwent SG or SASI bypass. Patients who underwent SASI bypass were matched with an equal number of patients who underwent SG in terms of age, sex, BMI, and comorbidities. The main outcome measures were excess weight loss (EWL) at 6 and 12 months after surgery, improvement in medical comorbidities, and complications. RESULTS: A total of 116 patients (97 female) of a mean age of 35.8 years were included. Fifty-eight patients underwent SASI bypass and an equal number underwent SG. %EWL at 6 months postoperatively was similar between the two groups. SASI bypass conferred significantly higher %EWL at 12 months than SG (72.6 Vs 60.4, p < 0.0001). Improvement in type 2 diabetes mellitus (T2DM) and gastroesophageal reflux disease (GERD) after SASI bypass was better than SG (95.8% Vs 70% and 85.7% Vs 18.2%, respectively). SASI bypass required longer operation time than SG (108.7 Vs 92.8 min, p < 0.0001). Complications occurred in 12 (20.7%) patients after SG and 4 (6.9%) patients after SASI bypass (p = 0.056). CONCLUSION: The %EWL at 12 months after SASI bypass was significantly higher than after SG. SASI bypass conferred better improvement in T2DM and GERD than SG. Both procedures had similar weight loss at 6 months postoperatively and comparable complication rates.

Short-term Outcome of Single-Anastomosis Plication Ileal Bypass (SAPI) in Treatment of Morbid Obesity.

PURPOSE: This prospective study aimed to report the short-term outcome of the single-anastomosis plication ileal (SAPI) bypass in the treatment of morbid obesity. METHODS: Adult patients with morbid obesity who underwent SAPI procedure were recruited to this prospective study. SAPI procedure involved plication of the greater curvature of the stomach in two rows then performing a stapled side-to-side anastomosis between an ileal loop and the gastric antrum. Body mass index (BMI), percentage excess weight loss (%EWL), percentage total weight loss (%TWL), and improvement in comorbidities were recorded at 6 and 12 months postoperatively. RESULTS: The present study included 56 patients (48 female) of a mean age of 37.3 years. There was a significant decrease in BMI at 6 months (37.2 ± 9.3) and 12 months (31.5 ± 7.8) as compared with the baseline BMI (47.9 ± 5.7). The %EWL at 12 months was 72.5 ± 16.2, significantly higher than its value at 6 months (50.1 ± 15.6). The %TWL at 12 months was 36.4 ± 6.4, significantly higher than its value at 6 months (24.9 ± 6.3). All patients with DM showed remission or improvement in their diabetic state. Improvement in hyperlipidemia and hypertension was recorded in 81.8% and 77.8% of patients, respectively. Postoperative complications were recorded in five (8.9%) patients. CONCLUSION: SAPI procedure achieved significant reduction in body weight and BMI, significant %EWL, and satisfactory improvement in comorbidities at 12 months after surgery. Longer follow-up of patients is needed to reach more solid conclusions on the efficacy and safety of this new technique.

A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection.

BACKGROUND: Surgical site infection (SSI) is one of the most common complications after abdominal surgery. The present trial examined the efficacy of saline irrigation of open appendectomy wound with or without topical antibiotics in prevention of SSI. METHODS: This was a double-blind randomized trial on patients with acute appendicitis who underwent open appendectomy. Patients were randomly allocated to one of three equal groups; group I had layer-by-layer wound irrigation with gentamicin-saline solution, group II had wound irrigation with saline solution, and group III received no irrigation (Control group). The main outcome measures were the incidence of incisional SSI, surgical site occurrence (SSO), other complications, operation time, postoperative pain, and patients' satisfaction. RESULTS: 205 patients (113 female) of a mean age of 27.9 years were included. The average hospital stay and pain scores were similar in the three groups. Groups I and II had significantly lower rates of incisional SSI (4.3% Vs 2.9%; Vs 17.4%, p = 0.005) and SSO (24.6% Vs 13.4% Vs 43.5%; p = 0.0003) as compared to group III. Groups I and II had comparable rates of SSI and SSO. The three groups had similar rates of wound seroma, hematoma, and dehiscence. Groups I and II had significantly higher satisfaction with the procedure than group III. CONCLUSIONS: Layer-by-layer irrigation of open appendectomy wound decreased the rates of incisional SSI and SSO significantly compared to the no-irrigation group. Adding gentamicin to saline solution was useless to improve the outcome and did not decrease rates of SSI or other complications.

Topical 5% minoxidil versus topical 0.2% glyceryl trinitrate in treatment of chronic anal fissure: A randomized clinical trial.

BACKGROUND: Chronic anal fissure (CAF) is a common painful anal condition. Medical treatment of CAF involves the use of agents that induce chemical sphincterotomy. The present trial aimed to compare the efficacy and safety of topical minoxidil and glyceryl trinitrate (GTN) preparations in treatment of CAF. METHODS: Adult patients with CAF were randomly assigned to one of two equal groups; group I received topical 5% minoxidil gel and group II received topical 0.2% GTN cream. The main outcome measures were healing of anal fissure, duration to healing, relief of symptoms, and adverse effects. RESULTS: 62 patients (36 female and 26 male) were included to the study. Group I comprised 30 patients and group II comprised 32 patients. Healing of anal fissure was achieved in 23 (76.7%) patients in group I and 15 (46.9%) patients in group II (p = 0.03). The average duration to healing in group I was significantly shorter than group II (4.1 ± 1.9 vs 5.3 ± 2.7 weeks, p = 0.048). Adverse effects were recorded in 2 (6.6%) patients in group I and 13 (40.6%) patients in group II. The post-treatment pain score in the GTN group was significantly lower than the Minoxidil group. CONCLUSION: Topical 5% minoxidil gel achieved greater and quicker healing of CAF and fewer adverse effects than topical 0.2% GTN cream. Post-treatment pain scores after GTN were significantly lower than minoxidil. TRIAL REGISTRATION NUMBER: NCT03528772.

Identifying Patients at High Risk of Having Pulmonary Dysfunction Before Laparoscopic Bariatric Surgery and Its Impact on Postoperative Pulmonary Complications.

Background: Morbid obesity is associated with variable degrees of pulmonary dysfunction that may predispose to postoperative complications. This study aimed to identify high risk patients to have pulmonary dysfunction before bariatric surgery in terms of age, sex, and body mass index (BMI) and the impact of pulmonary dysfunction on postoperative pulmonary complications. Methods: Prospective database of patients with morbid obesity who underwent bariatric surgery was reviewed. Data on patients' demographics, parameters of pulmonary function tests, and postoperative pulmonary complications were collected. The correlation between patients' age, sex and BMI, and pulmonary function was investigated using Pearson's correlation coefficient test. Results: Ninety-seven patients (82 female) with morbid obesity were included in the study. Twenty-eight (28.9%) patients had pulmonary dysfunction. Patients >40 years had higher odds of pulmonary dysfunction than patients ≤40 years (odds ratio [OR]: 2.54, P = .05). Male patients had significantly higher odds of pulmonary dysfunction than female patients (OR: 2.5, P = .03). Patients with BMI >50 had significantly higher odds of pulmonary dysfunction than patients with BMI <50 (OR: 4.9, P = .002). Patients with pulmonary dysfunction had significantly higher odds of developing pulmonary complications than patients with normal spirometry (OR: 9.13, P = .009). Conclusion: Around 30% of patients undergoing bariatric surgery had pulmonary dysfunction. Pulmonary dysfunction in preoperative spirometry was able to predict postoperative pulmonary complications. Men, patients older than 40 years, and superobese individuals had higher odds of having pulmonary dysfunction and are at higher risk to develop pulmonary complications after bariatric surgery.

Impact of Pyloric Injection of Magnesium Sulfate-Lidocaine Mixture on Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: a Randomized-Controlled Trial.

BACKGROUND: One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG. METHODS: Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24 h postoperatively. RESULTS: Seventy patients (63 female) with a mean age of 34.6 ± 9.9 years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7 mmHg before injection to 13.4 ± 4.1 mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1 mmHg). Of the treatment group patients, 17.1% had significant PONV at 6 h compared to 91.4% of control group patients (p < 0.0001). At 24 h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001). CONCLUSION: Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24 h after LSG without being associated with higher complication rate.

Impact of Ultrasound-Guided Transversus Abdominis Plane Block on Postoperative Pain and Early Outcome After Laparoscopic Bariatric Surgery: a Randomized Double-Blinded Controlled Trial.

BACKGROUND: Based on the promising results of transversus abdominis plane (TAP) block in various abdominal procedures, this study aimed to investigate its effect on postoperative pain and early outcome after laparoscopic bariatric procedures. METHODS: Patients with morbid obesity were randomly assigned to one of two equal groups; group I had US-guided TAP block upon completion of the bariatric procedure and before recovery from general anesthesia and group II did not have TAP block. All procedures were performed laparoscopically with a standardized five-trocar technique. RESULTS: Ninety-two patients of a mean age of 34.7 years and mean BMI of 49.5 kg/m2 were included. The mean pain score in group I was significantly lower than group II at 1 and 6 h postoperatively, whereas no significant differences in pains scores at 12 and 24 h between the two groups were observed. Eight patients in group I required rescue opioid analgesia within the first 24 h postoperatively, compared with 24 patients in group II (P < 0.0001). The postoperative nausea and vomiting (PONV) score at 24 h was significantly lower in group I than group II. Group I required a significantly shorter time to full ambulation and to pass flatus compared with group II. Hospital stay was similar in the two groups. CONCLUSION: Using US-guided TAP block in adjunct with laparoscopic bariatric surgery managed to achieve lower pain scores, lower opioid requirements, lower PONV scores, earlier ambulation, shorter time to pass flatus, and comparable hospital stay and complication rate to the control group.

Outcome of Modified Park's Technique for Treatment of Complex Anal Fistula.

BACKGROUND: Treatment of complex anal fistula (CAF) can be associated with high rates of recurrence and fecal incontinence (FI). Park suggested drainage of the affected intersphincteric anal gland for treatment of cryptoglandular anal fistula; however, recurrence after this technique was high. We modified the original Park's technique by extending the internal sphincterotomy to ensure adequate drainage of the intersphincteric space. The aim of this study was to evaluate the incidence of recurrence and FI after modified Park's technique in treatment of CAF. METHODS: Adult patients of both genders with CAF were evaluated before undergoing modified Park's technique with Wexner continence score, clinical examination, and endoanal ultrasonography or MRI. Postoperatively, patients were examined every 2 wk until complete wound healing. The continence state was evaluated with Wexner continence score, and quality of life was assessed before surgery and at 6 mo postoperatively by Short Form-36 questionnaire. RESULTS: Thirty-two patients (27 male) of a mean age of 38 y were included. Median follow-up was 12 mo. Two patients (6.25%) experienced recurrence and 5 (15.6%) developed complications. One patient (3.1%) developed new-onset FI postoperatively. Twenty-eight (87.5%) patients were completely satisfied with the procedure. Quality of life showed significant improvement at 6 mo postoperatively. CONCLUSIONS: The modified Park's technique is a promising procedure for the treatment of CAF with low recurrence and FI rates, and improved quality of life.