Laparoscopic adjustable silicone gastric banding in the treatment of super obesity in the Jeddah area, Saudi Arabia. A preliminary report.

Eighteen morbid and super-obese patients were subjected to laparoscopic adjustable silicone gastric banding (LASGB) of the new prototype which is currently used in Europe. This prospective study was done during a short period of time between October 26, 1995 and January 29, 1996 by one team and in the same hospital. Eleven patients were males, while seven were females. The mean age was 32 years (range 19-55 years), while the mean weight was 138 kg (range 98-191 kg), and the mean Body Mass Index (BMI) was 49.8 kg/m2 (range 36.3-65 kg/m2). Although most of the patients were super obese, no major operative difficulties were encountered and the patients made a good postoperative recovery after this technique. The weight loss during this short period was encouraging. The literatures are reviewed.

Breast reconstruction without implant: experience of 52 cases.

Reconstruction of the breast (BR) after mastectomy without using a prosthetic implant has always presented a challenge for plastic surgeons, allowing them to avoid complications due to foreign body and to provide a more natural reconstructed breast. Out of 66 women who underwent BR using the rectus abdominis musculocutaneous flap, 52 received no implant. Ten upper rectus (ERF) and 42 lower rectus (TRAM) were the two procedures applied. The ERF has been abandoned due to the 9% rate of complete necrosis encountered among the total series of rectus flap regardless of the implant inclusion. Partial necrosis was also the most frequent complication of the TRAM (28% among those not having received an implant), but the reconstruction was nevertheless possible in all the cases. The TRAM technique produced abdominal sequelae in 45% of the no-implant cases, though it also improved the cosmetic aspect of the abdomen in an equal number of cases, particularly in obese women. Overall cosmetic results were also better for the TRAM without implant than for the ERF (72% good vs. 51%). Moreover the BR without implant could be performed in only 48% of the total ERF, as compared to 93% of the total TRAM. The major advantage of such BR without implant is that it provides a reconstructed breast which appears more symmetrical to the contralateral breast and which remains even after several years of follow-up.

[Cancers of the rectum: predictive factors in locoregional recurrence. Multifactorial study]. / Cancers du rectum: facteurs prédictifs de la survenue des récidives loco-régionales. Etude multifactorielle.

Local recurrences (LR) after curative surgery have been analyzed in series of 173 rectal adenocarcinomas treated between 1973 and 1983. LR predictive factors were analyzed by univariate and multivariate (Cox model) studies. Five factors had no predictive value on LR: age, sex, tumor differentiation, tumor size, and number of metastatic nodes. Five factors had a predictive value on LR: severe clinical symptoms (fixation, obstruction and perforation) (p = 0.03), tumors localized within five cm of the anal verge (p less than 0.001), intramural infiltration (p = 0.09), localization of positive nodes (p = 0.02), and tumor emboli inside the vessels (p less than 0.01). The multivariate study underlined the two main predictive factors: the tumor site within 5 cm of the anal verge (p less than 0.001) and involvement of the serosa (p = 0.05). An equation of LR risk is presented and four subgroups of different LR risk patients are defined. This study might provide guidelines for indications and evaluation of major adjuvant treatments in the highest LR risk patients.