Saudi Journal of Laparoscopy

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Objectives:

To assess knowledge, attitudes, and practices of physicians regarding medical malpractice at King Khalid University Hospital
To assess the possible factors that affect malpractice knowledge, attitudes, and practices among physicians.

Methods: A cross-sectional questionnaire-based study was conducted in King Khalid University Hospital between November and March 2019. Both medical and surgical physicians were included. A convenience sampling technique was used with a sample size of 336. The questionnaire contains four sections: demographics, knowledge, attitudes, and practices. Results: A total of 293 out of 336 questionnaires were returned giving a response rate of 87.2%. The comparison of the levels of knowledge of the respondents for each form of malpractice showed a statistically significant correlation with gender where female high knowledge score was 73 (62.9%) and male high knowledge score was 50 (35.5%). Another variable that showed statistical significance is specialty where medical specialty doctors scored 81 (54.7%) high knowledge, surgery doctors scored 25 (34.7%) high knowledge, and other specialties scored 17 (45.9%) high knowledge. Other variables showed no statistical significance. About the other two outcome variables, both attitudes and practice showed no statistically significant correlation with all included study variables. Conclusion: The research results show good and bad aspects. The overall knowledge among physicians was good. Moreover, there was no significant difference in knowledge among physicians from different rankings, nor among physicians with different years of experience. Regarding attitude and practice, the results showed no statistical significance. Overall these results can contribute to the quality of healthcare.

Background: Groin hernia surgery is one of the most common procedures performed by surgeons worldwide. With the advent of minimal access surgery, the procedure for repair is now done either by transabdominal preperitoneal approach Transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The advantage of one procedure over the other is still controversial. Objectives: This prospective study was conducted to find out the intraoperative and postoperative outcomes of TEP and TAPP for inguinal hernia repair in terms of operative time, intraoperative complications, conversion to open, visual analog scale (VAS) score, postoperative complications, length of hospital stay, and recurrence of hernia and chronic pain. Materials and Methods: A total of 88 patients of inguinal hernia enrolled prospectively between November 2017 and November 2019 and patients aged 18 years and above admitted in Jawaharlal Nehru Medical College and Hospital were included in this study. Forty-four patients were included in TEP group, while 44 patients were allocated to TAPP group. Results: The statistical analysis was done using Chi-square test and unpaired t-test, respectively. The mean operative time in TEP was 91.14 ± 11.14 min and in TAPP repair was 103.16 ± 6.79 min, which was found to be significantly significant. The mean pain score on VAS score on postoperative day 1 was 5.70 ± 0.95 in laparoscopic TEP group and 5.86 ± 0.97 in laparoscopic TAPP group. The mean pain score on VAS score on postoperative day 2 was 3 ± 1.27 in laparoscopic TEP group and 2.95 ± 1.29 in laparoscopic TAPP group. Similarly, the mean pain score on VAS scale on postoperative day 7 was 0.863 ± 1.26 in laparoscopic TEP group and 0.659 ± 1.21 in laparoscopic TAPP group. No significant difference was observed in VAS between TEP and TAPP groups during follow-up. Both TEP and TAPP mesh techniques were comparable in terms of the intraoperative complications and postoperative complications (seroma [during hospital stay, after 1 week of discharge, after 1 month of follow-up]; hematoma [during hospital stay, after 1 week of discharge]; wound infection) and in conversion to open and length of hospital stay. The difference in mean cost of surgery was found to be statistically significant. Conclusion: Although the mean operative time and cost of surgery were significantly more in TAPP than in TEP group, no significant difference could be found between the intraoperative and postoperative complication rates, conversion to open, and length of hospital stay. Recurrence was observed in one case of TEP groups during follow-up. Our study supports the view that both laparoscopic TEP and TAPP mesh repairs of inguinal hernia are safe and efficacious.

Background: Obesity is a worldwide health problem and is of particular importance in Saudi Arabia, where there is a high incidence of the disease. There are many surgical procedures for its management, including laparoscopic sleeve gastrectomy (LSG). However, this procedure has postoperative complications such as bleeding and leakage. Patients and Methods: This retrospective cohort study included all patients who underwent LSG at King Khalid University Hospital under one surgeon from July 2015 to May 2018. The 146 patients were divided into a clipping group (n = 72) who underwent LSG with clipping of the staple line, and a nonclipping group (n = 74) who underwent LSG without clipping of the staple line. The incidence of postoperative complications, including bleeding and leak, was compared in the two groups. Results: There was no statistically significant difference between the two groups regarding patient demographic criteria or risk factors for postoperative complications. In addition, there was no statistically significant difference between the two groups in postoperative bleeding (P = 1) or leak (P = 0.324). Conclusion: Clipping the staple line in LSG does not affect the rate of postoperative leaking or bleeding.

Advances in minimal access surgery have led to the emergence of single-incision laparoscopic surgery. Single-incision laparoscopic fundoplication for gastroesophageal reflux disease is safe and feasible in experienced hands. However, the main drawback of this technique is the increased cost factors considering the port devices and specialized instrumentation required. We did single-incision, multiple port laparoscopic Nissen fundoplication with conventional trocars and instruments.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer worldwide with high mortality rate, and it most commonly develops in the presence of cirrhosis and chronic liver diseases, most commonly in hepatitis. In some cases, however, it may present in noncirrhotic liver or healthy liver without any chronic disease. Our case is a 60-year-old male with primary HCC with no liver disease and negative hepatitis serology. Presented with multiple liver masses in four different segments. Managed with embolization and staged liver resection.

Online since 8^th June, 2016