Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review.

INTRODUCTION: In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS: A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS: A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION: IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.

The risk of recurrence of Pilonidal disease after surgical management.

OBJECTIVES: To estimate the rate of the Pilonidal disease (PND) recurrence and to evaluate the associated predictors of the recurrence. Methods: This is a retrospective study, conducted at King Fahd Hospital of the University in Alkhobar, Kingdom of Saudi Arabia over a period of 10 years from January 2003 until December 2013.  Results: A study of 366 with PND, 19 of those were identified as secondary cases and excluded. Most involved 347 patients were Saudi (82.1%), single (87%), and men (93.1%). The mean age of the sample was 23 ± 8 years, and the mean body mass index (BMI) was 29.7 ± 6 Kg/m2. Overall recurrence rate after the surgical management was found in 25 patients (7.2%). By logistic regression to the recurrence group, young age group, prolong sitting and BMI may increase the likelihood of the disease recurrence. Conclusion: Pilonidal disease still has challenges in its management. Treatment should depend on the extent and severity of the disease. The recurrence rate in this study is approximately 7.2%. The most predominate factors associated with recurrence were prolong sitting job, young age group, and high BMI.