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Oral Presentation

January-December 2016, 1(1):31-36
  2,102 62 -
Revisional bariatric surgery: A review of the current recommendations
Muhammad Ghanem, Gustavo Fernandez Ranvier
January-December 2016, 1(1):5-8
Revisional bariatric surgery is increasingly becoming popular as the number of primary procedures for the treatment of obesity gains popularity. It is estimated that about 10% of patients who underwent a bariatric procedure will need revisional surgery. The most common indications for revisional bariatric surgery are inadequate weight loss (<25% of excess body weight loss) and weight regain (gain of more than 10 kg based on the nadir weight); however, procedure-specific complications are also indication of the need for revisional surgery. In this article, we review the current most common bariatric procedures with its complications, indications for revision, alternative procedures, and outcomes.
  2,037 121 -
Laparoscopy and anesthesia: A clinical review
Ramyavel Thangavelu
January-December 2018, 3(1):6-15
Laparoscopy has evolved since as early as 1950 to the present state of being the standard approach for most common surgical procedures. It has gained popularity in clinical practice in view of better cosmetics, lesser postoperative pain, shorter hospitalization, and faster recovery. However, the creation of pneumoperitoneum with laparoscopy is associated with various pathophysiological changes, especially involving the cardiovascular and respiratory systems. Electronic databases were searched to obtain the relevant literature with keywords related to laparoscopy from 1985 to 2016. Ninety-three papers were reviewed. Bibliographies were cross-checked and relevant literature was included. The pneumoperitoneum associated with laparoscopy is found to cause a decrease in cardiac output with an increase in pulmonary and systemic vascular resistance. These changes are mainly due to the increase in abdominal pressure which causes elevation of diaphragm with compression of small and big blood vessels. In the lungs, it causes a decrease in functional residual capacity with impaired pulmonary ventilation and perfusion. Increase in intra-abdominal pressure also perils the splanchnic circulation with a decrease in blood flow to the major abdominal organs. Preoperative assessment requires special attention, especially in high-risk patients. General anesthesia with controlled ventilation has proven to the ideal technique. Various pharmacological agents are used with varying success to attenuate the hemodynamic responses to laparoscopy. This article discusses the various consequences of laparoscopy as well as strategies to counteract them. It is essential for the anesthesiologists to have a good understanding of these changes and intervene at appropriate levels in terms of optimization in the preoperative period and management of hemodynamic changes in the perioperative period for a good surgical and patient outcome.
  1,750 370 -
Peroneal palsy after bariatric surgery
CAC Zhen, T Bautista, A Shabbir
January-December 2016, 1(1):9-12
The rise in popularity of bariatric surgery has been accompanied by a considerable increase in complications observed. Foot drop is a rare, but recognized complication after bariatric surgery. Early studies suggested the combination of rapid weight loss in the setting of postural compression of the nerve as main contributory factors. However, further research has also emphasized the role of postbariatric malnutrition and inflammation in the development of this neuropathy. The cause of this neuropathy is likely to be multifactorial, and understanding these mechanisms will assist multidisciplinary specialists in providing care to postbariatric patients suffering from this condition.
  1,967 69 -
Laparoscopic versus open inguinal hernia repair: A patient's perspective
Varun Hathiramani, Vinod Raj, Swathi Chigicherla, Rajesh Nathani
January-December 2017, 2(1):12-14
Background: The optimal method of hernia repair in children is still debatable in spite of a large number of clinical trials comparing open and laparoscopic repairs. Aim: The aim of this study is to compare laparoscopic versus open herniotomy with regard to a patient's perspective in terms of immediate postoperative recovery and comfort and long-term satisfaction with the procedure. Settings and Designs: This is a retrospective study from January 2014 to 2016 conducted at a tertiary care center. Materials and Methods: A total of eighty consecutive patients (forty open and forty laparoscopic) who underwent inguinal hernia repair were included in this study. Postoperatively on follow-up, which ranged from 6 to 20 months, the patient and/or parent were interviewed by a questionnaire. This included documentation of postoperative pain which was assessed by visual analog scales and face, legs, activity, cry, consolability scoring system according to the age of the child, time of discharge from hospital, postoperative complications and time taken to return to normal activities, recurrence of hernia or hernia on the opposite side, cosmesis, and problems associated with scars. Results and Conclusions: Patients in the laparoscopic group fared better than the open group in terms of postoperative pain, return to routine activities, and cosmesis. However, there was one recurrence on the same side in this group. No recurrences on the operated side were observed in the open group; however, three contralateral hernias were operated in this group.
  1,599 76 -
Adverse events survey in the postanesthetic care unit in a teaching hospital
Mohamed Sayed Hajnour, Patrick S K Tan, Abdelazeem Eldawlatly, Tariq A Alzahrani, Abdulaziz E Ahmed, Rashid Saeed Khokhar
January-December 2016, 1(1):13-16
Background and Objectives: This is a survey study of adverse events in the postanesthesia care unit (PACU) at the University Malaya Medical Center (UMMC). Patients and Methods: After obtaining the hospital ethics committee approval, 2704 patients who were operated and admitted to the PACU at UMMC were included in the survey. The survey period was from July 1, to September 30, 2005. The modified Aldrete score was used in the PACU. If it was <9 on a 10-point scale that was defined as a patient complication. A patient diagnosed with a complication was immediately notified by the recovery nurse to the attended anesthesiologist who managed the case, and a survey report was completed. Results: Nearly 9.7% reported incidents of adverse events included two accidents of cardiac arrests. The majority of which were due to hypothermia and cardiovascular instability. Most incidents were in American Association of Anesthetists 3 and 4 category. General surgery was associated with the highest incidents. Most of the incidents resulted in prolonged PACU stay. Conclusions: This study provides auditing information on adverse incidence in the PACU with issues of care delivery; besides, it highlights a roadmap for quality improvement for a better patient care.
  1,560 88 -
Analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach and little bowel: Review of literature
Gabriele Anania, Nicolò Fabbri, Lucia Scagliarini, Mirco Santini, Giuseppe Resta, Ferdinando Agresta
January-December 2017, 2(1):3-11
Gastrointestinal stromal tumors (GISTs) are rare tumors representing 0.1%–3% of all gastrointestinal cancers with an estimated incidence of 15/million. These tumors are characterized by the overexpression of the tyrosine kinase receptor KIT (CD117). The diagnosis of GIST has dramatically increased since 1992, and survival has greatly improved since 2002 when the Food and Drug Administration approved imatinib mesylate. Surgical treatment is the only chance of cure for patients with primary localized GIST. There is no surgical consensus about laparoscopic or open surgical treatment. However, the role for laparoscopy in the resection of GISTs continues to expand. The laparoscopic approach for gastric GISTs offers significant advantages in terms of postoperative pain, surgical trauma, and hospitalization, with the same oncological results obtained with open surgery while today it is considered the gold standard of treatment only for small gastric GIST. Controversy surrounds the maximum diameter of GIST for laparoscopic resection. We present our experience of 33 cases of GIST at Sant'Anna Hospital (Ferrara) in a period between 1999 and 2017 with a literature review.
  1,568 56 -
Launching of the Saudi Journal of Laparoscopy: A dream comes true
Abdullah Aldohayan
January-December 2016, 1(1):1-2
  1,359 60 -
Abdullah Aldohayan, Abdelazeem Eldawlatly
January-December 2017, 2(1):1-2
  1,270 55 -
Laparoscopic treatment strategies for peritoneal catheter malfunction by ovarian fimbriae
Zeiler Matthias, Santarelli Stefano
January-December 2016, 1(1):3-4
  1,261 61 -
Robotic repair of a Morgagni diaphragmatic hernia
Khayal AlKhayal
January-December 2017, 2(1):15-17
Robotic surgery is a high technology minimally invasive system. Morgagni's hernia is a rare congenital diaphragmatic hernia subtype that occurs in relation to the sternum anteriorly. Classically, symptomatic Morgagni's hernia is repaired by open abdominal approaches to reduce the hernia contents and suture the defect primarily or by patching large defects with a synthetic mesh. Recently, authors advocate the use of laparoscopic surgical techniques to repair such hernias especially the elective ones. This case discusses Morgagni's hernia repair using robotic surgery.
  1,261 56 -
Laparoscopic port cleaning: A technique for better visualization
A Aldohayan, F Alshomer, M Alnaami, O Alobeed, F Bamehriz
January-December 2016, 1(1):17-19
Introduction: Laparoscopic approach had enormously advanced the surgical intervention. Such advancement had its own difficulties. One of this is the visualizations of internal structures by the endoscopic camera. Camera lens condensation or contamination by blood and/or fat obscures such view. Materials and Surgical Technique: Here, we present an additional technique in which the use of sterile surgical strips by its specific absorptive and availability in different widths and lengths to clean the endoscopic entry ports with special focus over 5 mm ports that can be combined to the other well-known anticondensation methods for the overall better visualization. Discussion: Different modalities to clean laparoscopic entry ports have been described but with difficulties and associated risks and limitations. The use of sterile packing strips in cleaning laparoscopic ports avoids the disadvantages descried in other modalities and in the same time being easy, adjustable, and have low cost.
  1,217 72 -
De Garengeot's hernia: A case description and surgical approach
Daniela Guevara, Eric Edwards, Gustavo Fernandez Ranvier
January-December 2016, 1(1):23-25
Femoral hernias account for 3% of all hernias and can frequently present with incarceration of omentum, preperitoneal fat, small bowel and colon, and more rarely a Meckel's diverticulum or appendix. De Garengeot's hernia (GH) is a rare type of femoral hernia representing 1% of all femoral hernias and contains the vermiform appendix. The purpose of this report is to present a case of GH with discussion of the clinical findings along with description and details of the surgical technique applied for its repair.
  1,209 61 -
A retrospective study of transfusion practice: Blood crossmatch ordering in obstetrics
Sadaf Malik, Jamil Sharif Anwari, Musaed M Alshahrani, Rashed Ayeidh Alotaibi
January-December 2018, 3(1):21-24
Background: Parturient undergoing elective cesarian delivery (CD) in a busy tertiary care referral hospital often requires blood transfusions. The preoperative ordering for blood crossmatch frequently overshoots the actual need of transfusion. Aims: The primary aim of this study was to audit the local blood ordering practice in obstetric anesthesia and compare with the international guidelines. Materials and Methods: A retrospective analysis of patients who underwent elective CD over a period of 6 months was done. The data collected included patients' age, pretransfusion hemoglobin, timing of transfusion, number of units crossmatched, and number of units transfused. The crossmatch transfusion ratio (CTR), transfusion probability, and transfusion index were calculated from the data. Results: A total of 425 patients underwent CD with mean age 33 (standard deviation 7). Seventy-seven (18%) of them were crossmatched with total 252 units. Thirty-one (7.3%) patients required transfusion and the number of units transfused was 79. CTR in our study was 3.2. Conclusion: CTR for elective CD is higher than the recommended international quality indicator value. There is a need to develop institutional specific blood ordering schedule to bring improvement in transfusion practices.
  1,151 51 -
Laparoscopic oviductal fimbrioplasty for peritoneal dialysis catheter outflow obstruction caused by ovarian fimbriae
A Aldohayan, F Alshomer, M Al-Naami, O Al-Obeed, F Bamehriz, AR Tarakji
January-December 2016, 1(1):20-22
Introduction: The successful maintenance of peritoneal dialysis is the outcome of well functioning of the peritoneal catheter. Catheter outflow obstruction may cripple the usage of the peritoneal catheter. Catheter migration, omental entrapment, and fibrin clots are the usual causes of this failure. Oviduct fimbriae can cause obstruction rarely. Materials and Surgical Technique: We describe a case of a a 65-year-old woman, in whom the obstruction fimbriae was the cause of the obstruction and was managed by cleaning the catheter, and the right  fimbraepexy to the lateral wall of the peritoneal wall in the dependent part with no salpingectomy is required. Discussion: In follow-up of 20 months, the catheter is working; this technique can be used in young patients who need to balance the risk of infertility with the risk of malfunction of peritoneal dialysis catheter. Conclusions: Ovarian fimbria entrapment in the PDC is rarely the cause of dialysis flow obstruction, if occurs, laparoscopic management is ideal way to manage such presentation.
  1,105 67 -
Intraoperative lignocaine infusion achieving earlier discharge criteria among laparoscopic cholecystectomy patients
Shreya Lahiri, Sabyasachi Das, Sekhar Ranjan Basu
January-December 2018, 3(1):16-20
Background: Laparoscopic cholecystectomy (LC), gaining worldwide popularity for being less invasive, enhances earlier recovery. It can be performed on a short stay basis, reducing health care burden, if postoperative pain is adequately addressed. The aim of the present study is to determine the effect of intraoperative infusion of intravenous (IV) lignocaine primarily in terms of time to achieve fast-track eligibility (White Song score 12 out of 14) and postoperative analgesia in patients undergoing LC. Materials and Methods: A total of 120 ASAPS 1 and 2 patients undergoing elective LC were included in this randomized, prospective, placebo-controlled clinical study. Patients were allocated into two groups to receive intraoperative IV lignocaine (Group L) or normal saline (Group C). Lignocaine bolus dose 1.5 mg/kg was administered over a period of 5 min before induction followed by continuous IV infusion 3 mg/kg/h until extubation. Postoperative fentanyl requirement (during the first 6 postoperative hours) and fast-track eligibility (time to reach White Song score 12 out of 14) were recorded. Results: Time to achieve White Song score 12 out of 14 was found to be earlier in Group L (19.9 ± 3.6 min vs. 22.9 ± 2.9 min, P < 0.001). Postoperative requirement of fentanyl was significantly lower (99.3 ± 29.8 μg in Group L compared to 133 ± 35.9 μg in Group C, P < 0.001) in patients of lignocaine group. Conclusion: IV lignocaine effectively improves recovery and reduces postoperative fentanyl requirement, thereby is an inexpensive and safe method of postoperative analgesia.
  1,083 39 -
Poster Presentation

January-December 2016, 1(1):26-30
  1,059 54 -
Laparoscopic resection of a gastric myoepithelial hamartoma mimicked the clinical presentation of a gastrointestinal stromal tumor: Case report and review of literature
Mirco Santini, Nicolo Fabbri, Nicola Tamburini, Giuseppe Resta, Enzo Bianchini, Lucia Scagliarini, Gabriele Anania
January-December 2018, 3(1):1-5
A myoepithelial hamartoma is a very uncommon submucosal tumor of the stomach. The exact pathogenesis and natural history of these lesions are not fully understood, possibly because very few cases have been reported in the literature. Gastrointestinal tract adenomyomas are generally considered to be benign and may present clinically with in part long-standing, but unspecific symptoms, such as pain, nausea, anorexia, and in some patients, they can cause intermittent pyloric obstruction. In an atypical presentation in our case, myoepithelial hamartoma mimicked the clinical presentation of a gastrointestinal stromal tumor.
  1,042 46 -

January-December 2016, 1(1):40-43
  1,006 68 -
Abstracts Presented In The 16TH Annual Surgery Research Day

January-December 2017, 2(1):48-56
  955 43 -
Drain site small bowel hernia following laparoscopic dermoid cyst excision: Known but rare complication of abdominal drains
Udayan Kundu, Shreya Lahiri, Sanjoy Seth
January-December 2017, 2(1):18-20
Laparoscopic surgery, though considered to be an ambulatory procedure, is associated with many unanticipated complications. We encountered a case of drain site hernia in a 40-year-old woman who presented with abdominal distension with pain with features suggestive of intestinal obstruction on the third postoperative day in a case of primary infertility patient admitted for Hysteroscopy and Laparoscopy (Diagnostic and Therapeutic) for left-sided dermoid cyst excision.
  930 42 -
Abstracts presented for the 12th International Symposium on Sympathetic Surgery (ISSS), Fukoka, Japan

January-December 2017, 2(1):21-47
  903 46 -
Video Presentation

January-December 2016, 1(1):37-39
  895 47 -
Bariatric surgery effect on patients with nonalcoholic fatty liver disease and type II diabetes mellitus
Mazen M Hassanain, Nadia A Aljomah, Fahad Y Bamehriz, Hisham M Alkhalidi, Maram M Alkhamash
January-December 2018, 3(1):25-29
Aims: To study the effect of sleeve gastrectomy in patients with type II diabetes mellitus and fatty liver disease. Settings and Design: This is a prospective study that was conducted from September 2016 to 2017 in KSUMC Riyadh, Saudi Arabia. Subjects and Methods: We obtained prospectively collected data from two longitudinal cohort studies at our institution. We included adults who were diagnosed with nonalcoholic fatty liver disease (NAFLD) and diabetes, with a body mass index (BMI) of >30 kg/m2, and who underwent sleeve gastrectomy. Statistical Analysis Used: Data were analyzed using JMP® 13.0.0 for data management and reporting. Continuous data were reported as means and standard deviations if normally distributed or as medians and interquartile ranges otherwise. We also used the paired t-test and Chi-square test. Results: Our population included 32 patients (mean age, 39.5 years). The preoperative and postoperative median BMIs were 42.1 and 34.2 kg/m2, respectively (P = 0.0003). The percentages of macrovascular steatosis pre- and postoperatively were 37.5 and 10, respectively (P = 0.0328). The patients who had complete diabetes mellitus (DM) remission postoperatively had a higher median BMI of 42.05 kg/m2 preoperatively and 35.7 kg/m2 postoperatively than that the patients who did not have remission (P = 0.0003). Regarding the age groups, 46.1% of patients aged <40 years at DM onset, and 34.6% of patients aged >40 years who had complete diabetes remission postoperatively, which was not statistically significant. Conclusions: DM remission was statistically significant postoperatively. Remission occurred more in the higher BMI groups. There was no clear relationship between NAFLD and diabetes remission.
  765 27 -
Portal vein thrombosis occurring after laparoscopic sleeve gastrectomy: A short series and review of literature
Yasmine Shafik, Tariq Jaber
January-December 2018, 3(1):36-40
The prevalence of obesity in Saudi Arabia was 28.7% in 2013, and similar to the west, laparoscopic sleeve gastrectomy (LSG) is nowadays one of the most commonly performed bariatric procedures in Saudi Arabia. Portal vein thrombosis (PVT) was at first thought to be a rare and potentially fatal occurrence postoperatively. Recent data suggest that it is much more prevalent following LSG of all other bariatric procedures, and prognosis is favorable given early diagnosis and treatment. The aim of this article was to describe three cases of PVT post-LSG encountered at our institution and provide a brief review of the literature.
  738 36 -