One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) Versus a 200-cm BPL, a Systematic Review and Meta-analysis.

This is a systematic review and meta-analysis that assessed the impact of performing OAGB with a 150-cm BPL versus a 200-cm BPL concerning weight loss, comorbidities remission, and adverse nutritional effects. The analysis included studies that compared patients who underwent OAGB with a 150-cm BPL and 200-cm BPL. Eight studies were eligible for this review after searching in the EMBASE, PubMed central database, and Google scholar. The pooled analysis revealed favoring the 200-cm BPL limb length for weight loss, with a highly significant difference in the TWL% (p=0.009). Both groups showed comparable comorbidities remission. Significantly higher ferritin and folate deficiency rates were found in the 200-cm BPL group. Considering a 200-cm BPL when performing OAGB delivers a better weight loss outcome than a 150-cm BPL, which is at the expense of a more severe nutritional deficiency. No significant differences were found regarding the comorbidities' remission.

Nissen Versus Toupet Fundoplication For Gastro-oesophageal Reflux Disease, Short And Long-term Outcomes. A Systematic Review And Meta-analysis.

BACKGROUND: Gastroesophageal reflux disease (GERD) remains one of the most commonly encountered gastrointestinal disorders. Proton pump inhibitors still show an inadequate effect on about 10% to 40% of the patients. Laparoscopic antireflux surgery is the surgical alternative for managing GERD in patients who are not responding to proton pump inhibitors. AIM OF THE STUDY: This study objected at comparing laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication (LTF) concerning the short-term and long-term outcomes. PATIENTS AND METHODS: This is a systematic review and meta-analysis that evaluated the studies comparing between Nissen fundoplication and LTF for the treatment of GERD. Studies were obtained by searching on the EMBASE, the Cochrane Central Register of Controlled Trials, and PubMed central database. RESULTS: The LTF group showed significantly longer operation time, less postoperative dysphagia and gas bloating, less pressure on the lower esophageal sphincter, and higher Demeester scores. No statistically significant differences were found between the 2 groups in the perioperative complications, the recurrence of GERD, the reoperation rate, the quality of life, or the reoperation rate. CONCLUSION: LTF is favored for the surgical treatment of GERD being of lower postoperative dysphagia and gas bloating rates. These benefits were not at the expense of significantly additional perioperative complications or surgery failure.

Three-Dimensional Multi-detector Computed Tomography (3D-MDCT) Gastric Volumetry in Patients with obesity and Normal-Weight Individuals.

BACKGROUND: Obesity is a widely prevalent medical and socioeconomic problem. Bariatric surgery is indicated for patients with clinically severe obesity. Reduction of gastric volume is an important factor that contributes to weight loss after laparscopic sleeve gastrectomy (LSG). The impact of the gastric volume on weight after LSG has been studied. AIM OF THE STUDY: This study was designed to assess the gastric volume in patients with obesity prior to LSG and in the normal-weight patients, using three-dimensional multi-detector computer tomography (3D-MDCT), and to evaluate the potential correlation of the gastric volume with body mass index (BMI). PATIENTS AND METHODS: A total of 100 patients were equally enrolled in two groups: one group for patients with obesity scheduled for LSG and another one for normal-weight patients scheduled for non-bariatric surgery. The study patients underwent 3D-MDCT gastric volumetry. RESULTS: The gastric volume ranged from 525 to 1170 mL in patients with obesity and from 312 to 676 mL in the normal-weight group. Statistically significant difference was found between the two groups. Age, weight, and BMI were found to be predictors for the gastric volume in normal-weight patients only. CONCLUSION: MDCT gastric volumetry is a feasible method to assess the stomach volume. Higher volumes were evident in patients with obesity. Age, weight, and BMI are predictors for the gastric volume in normal-weight patients with linear regression equations that could help during the preoperative planning of bariatric surgeries.

Initial Experience With Trans-anal Minimally Invasive Surgery (TAMIS) for Rectal Polyps and Early Colorectal Cancers at Cumberland Infirmary, Carlisle.

INTRODUCTION: Bowel cancer is the fourth most common type of cancer in the United Kingdom in 2019. Total mesorectal excision is the standard procedure for the removal of rectal tumors, however, it comes with serious side effects. Therefore, less invasive procedures and sphincter preservation techniques have been developed, like conventional trans-anal excision, and trans-anal endoscopic microsurgery (TEM). In 2010, trans-anal minimally invasive surgery (TAMIS) was introduced as an alternative to TEM, which offers the same benefits as TEM but at a lower cost and without the need for specialized instrumentation. This study aims to assess the practicability and safety of this technique and to report its findings.  Methods: Retrospective data of all patients who underwent TAMIS at Cumberland Infirmary (Carlisle, UK) from July 2017 to July 2022 for large benign rectal polyps or early rectal cancer were collected. Variables collected included patients' age, gender, number of procedures per year, perioperative outcome, and histopathology outcome. The SPSS version 21 (IBM Corp., Armonk, NY, USA) was used for both descriptive and inferential analyses of the data. RESULTS: During a five-year period, 42 patients underwent TAMIS at Cumberland Infirmary. The primary indication for TAMIS was distal rectal lesions, large rectal polyps up to 120 mm, and early rectal cancer (T1). The median age of the assessed patients at the time of surgery was 71 years with 64.29% (27) male and 35.71% (15) female. The mean operating time was 123 minutes (range 45 to 240 minutes). The surgical and pathological outcome included a mean polyp size of 6 cm (+/- 0.8 cm), a rate of specimen fragmentation at 19.04% (n=8), and a rate of positive margins at 04.76% (n=2), whereas histology of 73.81% (n=31) was tubulovillous adenoma and 11.91% (n=5) was adenocarcinoma. There was no 30-day postoperative mortality, however, the 30-day re-operation rate was 02.39% (n=1) and the recurrence rate which needed further intervention was 26.19% (n=11). CONCLUSION: Our findings suggest that TAMIS produces positive results. The size of the lesions removed, and the effect of an early learning curve are reflected in the rate of specimen fragmentation and polyp recurrence. Nonetheless, TAMIS is a safe and effective alternative to total mesorectal excision for certain types of rectal lesions and should be used for more proximal and complex rectal lesions.