Intussusception after laparoscopic one anastomosis gastric bypass: A rare complication.

INTRODUCTION: Intussusception after one anastomosis gastric bypass is a rare postoperative complication that occurs with bowel obstruction. The diagnosis may be challenging because of long-standing, intermittent, nonspecific symptoms. Our paper describes an unusual case of antegrade intussusception that occurred 28 months after laparoscopic one anastomosis gastric bypass surgery. PRESENTATION: A 30-year-old female known to have diabetes mellitus type 2, who presented with epigastric pain. A computed tomography scan revealed a jejuno-jejunal intussusception. After resection and primary end-to-end hand-sewn anastomosis of the biliary limb, the patient was discharged on the 6th day postoperatively and recovered uneventfully. We belief this is the first report describing a case of intussusception post one anastomosis gastric bypass. DISCUSSION: Gastric bypass surgeries have recently become a popular method for the surgical treatment of morbid obesity worldwide. The reported intussusception incidence after Roux-en-Y gastric bypass (RYGB) is approximately 0.1-0.3%, but not described in one anastomosis gastric bypass surgery. Approximately two-thirds of patients show recurrent chronic and colicky pain. Surgical intervention is essential. CONCLUSION: Clinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.

Weight Loss and Glycemic Control after Sleeve Gastrectomy: Results from a Middle Eastern Center of Excellence.

Obesity and its associated metabolic disorders are strongly linked to both morbidity and mortality. Sleeve gastrectomy (SG) has been established as an effective means of weight loss for obese patients as well as a treatment for type 2 diabetes mellitus (T2DM). This study was designed to examine the short- and midterm outcomes of patients who underwent SG in a Middle Eastern Center of Excellence, a military training teaching hospital. The clinical outcomes of 59 patients with impaired glucose tolerance and T2DM who underwent SG between 2011 and 2014 with at least one and up to four years of follow-up were studied. Data were collected and compared, including the pre- and post-surgery measures of weight, body mass index, glycosylated hemoglobin (HbA1c), and fasting blood glucose. Complete remission was defined as a fasting blood glucose level ≤100 mg/dL, an HbA1c ≤6 mg/dL, without use of antidiabetic medications. All patients showed significant reduction in body mass index following SG. Tight glycemic control was achieved among both diabetic and prediabetic patients. In this study, 88.14 per cent of all patients (diabetic and prediabetic) achieved complete resolution from their impaired glucose tolerance and T2DM and maintained normal blood glucose and HbA1C levels from one to four years postoperatively. SG is beneficial both in terms of short- and midterm weight loss and glucose control in both diabetic and prediabetic obese patients.

Analyzing the Psychometric Properties of the Short Form-36 Quality of Life Questionnaire in Patients with Obesity.

PURPOSE: The Short Form-36 (SF-36) questionnaire is a valuable and easy-to-use tool for the measurement of quality of life in patients with obesity. To become a widely used tool, the questionnaire must be validated in many different contexts. Thus, the present study aimed to evaluate the construct validity and reliability of the SF-36 questionnaire among patients with obesity in Bahrain. METHODOLOGY: The 36-item questionnaire was administered to a study cohort scheduled to undergo bariatric surgery at the Bahrain Defence Force Hospital in Bahrain. Demographic data were extracted. Principal component analysis was used to extract component factors. Factor analysis was used to determine construct validity and fit. The Cronbach's alpha value of the extracted factors was used to determine the internal consistency reliability. Statistical analyses were performed using SPSS version 19.0 and IBM AMOS version 22.0. RESULTS: Most of the participants were female with a mean body mass index (BMI) of 43.24 kg/m2. A six-factor solution explaining 52.31% of variance was generated. The global fit parameter estimates indicated that the suggested model exhibited an acceptable-to-good fit. Overall, the internal consistency reliability estimate of the SF-36 questionnaire was greater than 0.70. CONCLUSION: The identified six-factor model of the SF-36 questionnaire is a valuable tool for the measurement of quality of life among patients with obesity in Bahrain.

Quality of life, food tolerance, and eating disorder behavior after laparoscopic gastric banding and sleeve gastrectomy - results from a middle eastern center of excellence.

BACKGROUND: Obesity is a major health problem in Arab countries. Bariatric surgery can improve the quality of life of an obese individual. However, different types of bariatric surgery result in varying levels of food intolerance as a side effect. Many patients who undergo bariatric surgery are also at risk of subsequently developing eating disorder behaviors. The aim of the study was to compare the quality of life, food tolerance, and behaviors of eating disorders related to laparoscopic sleeve gastrectomy and gastric banding. METHODS: A retrospective review of medical records and a questionnaire-based survey was completed for all patients who had undergone either bariatric sleeve gastrectomy or gastric banding at the Bahrain Defense Force Hospital between 2011 and 2014. Each patient was administered 3 questionnaires to assess the quality of life, food tolerance, and eating disorder behaviors. RESULTS: Forty-eight patients who had undergone sleeve gastrectomy and 36 who had undergone gastric banding participated in the study. Sleeve gastrectomy patients showed better food tolerance (P < 0.001) and better eating behaviors (P = 0.001) post-surgery compared with gastric banding patients. Health-related quality of life (HRQOL) did not differ significantly between the 2 groups. Only sleeve patients had preoperative evaluation of these parameters (HRQOL). However, in the gastric sleeve group, after the surgery, significant improvement was found in all parameters of HRQOL except for mental health status. CONCLUSION: Laparoscopic gastric sleeve surgery patients had superior outcomes in both food tolerance and eating disorder behaviors. The quality of life did not significantly differ between the gastric sleeve and gastric banding surgery groups.

Multisource feedback to assess surgical practice: a systematic review.

BACKGROUND: The assessment, maintenance of competence, and recertification for surgeons have recently received increased attention from many health organizations. Assessment of physicians' competencies with multisource feedback (MSF) has become widespread in recent years. The aim of the present study was to investigate further the use of MSF for assessing surgical practice by conducting a systematic review of the published research. METHODS: A systematic literature review was conducted to identify the use of MSF in surgical settings. The search was conducted using the electronic databases EMBASE, PsycINFO, MEDLINE, PubMed, and CINAHL for articles in English up to August 2012. Studies were included if they reported information about at least 1 out of feasibility, reliability, generalizability, and validity of the MSF. RESULTS: A total of 780 articles were identified with the initial search and 772 articles were excluded based on the exclusion criteria. Eight studies met the inclusion criteria for this systematic review. Reliability (Cronbach α ≥ 0.90) was reported in 4 studies and generalizability (Ep2 ≥ 0.70) was reported in 4 studies. Evidence for content, criterion-related, and construct validity was reported in all 8 studies. CONCLUSION: MSF is a feasible, reliable, and valid method to assess surgical practice, particularly for nontechnical competencies such as communication skills, interpersonal skills, collegiality, humanism, and professionalism. Meanwhile, procedural competence needs to be assessed by different assessment methods. Further implementation for the use of MSF is desirable.

Reduction in weight and BMI and changes in Co-morbidities following laparoscopic adjustable gastric banding procedure for morbidly obese patients in Bahrain: a five year longitudinal study.

BACKGROUND: Obesity and its related illnesses are pan-endemic health problems which require intervention. Laparoscopic Adjustable Gastric Banding (LAGB) is seen as a safe surgical procedure with satisfactory results on weight reduction and improvement in obesity related illness. METHODS: Data were collected in a repeated-measures longitudinal five year study for 143 morbidly obese patients who underwent laparoscopic adjustable gastric banding (LAGB). Follow up was continued from 3 to 60 months post operatively. Patients were assessed for diabetes, hypertension and dyslipidemia. RESULTS: Repeated measures ANOVAs revealed that both men and women lose weight and reduce their BMIs at a consistent rate. At 3, 6 and 9 months post-operative there are no differences in percent weight loss between men and women with mean weight loss at 8.9%, 13.1% and 16.0% respectively of pre-operative weight. At 12, 24 and 60 months post-operatively, however, men significantly increase the percentage of weight loss as well as improve their BMI compared to women (p < .05). At 24 months post-operative, men and women have BMIs of 36.03 and 32.85, both still in the obese range. By 60 months men have achieved a BMI that is slightly under the obese range into the overweight range (30.76) while women (BMI = 36.61) were still in the obese range. At 60 months, men have lost a total of 33.75% of their pre-operative body weight while women have lost a total of 21.50. Diabetes, hypertension and dyslipidemia were significantly reduced in the sample post-operatively (p < .01). CONCLUSION: LAGB is a safe and effective surgical procedure for morbidly obese patients resulting in weight loss, BMI decrease and reduction in co-morbid illnesses.