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AlSabah S, Al Haddad E. Bariatric Surgery and Malpractice: an Extensive Review of Demographics, Complications, Litigation, and Proactive Mitigation Strategies. Obes Surg 2023; 33:3611-3620. [PMID: 37770777 DOI: 10.1007/s11695-023-06837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
The rising prevalence of severe obesity has led to a parallel increase in bariatric surgeries, raising a complex array of medicolegal issues. This review aims to analyze and synthesize literature on bariatric surgery malpractice, focusing on patient demographics, surgical complications, litigation costs, and the nature of malpractice cases. A systematic search was conducted across multiple databases for relevant studies published up to May 2023. Our review endeavors to provide insights into these medicolegal challenges and their implications and foster an informed dialogue on strategies for their effective management. By doing so, we hope to enhance ethical and legally sound bariatric practices, safeguarding both patient welfare and surgical practitioners from legal repercussions.
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Al Sabah S, Haddad EA, Shuaibi S, Qadhi I, Al-Saidan L, Khayat A. Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood. BMC Surg 2023; 23:103. [PMID: 37118797 PMCID: PMC10148482 DOI: 10.1186/s12893-023-02006-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Childhood obesity is associated with a variety of complications that see their light throughout adulthood. Due to the serious side effects of these morbidities, early intervention is essential. Laparoscopic sleeve gastrectomy (SG) is a safe and effective procedure for the treatment of obesity, however, the long-term data on its use in adolescents is lacking in the literature. METHODS A retrospective analysis was conducted on all patients that underwent SG aged between 12 and 21 years old at a public hospital in Kuwait. Data on their weight and comorbidities was collected and analyzed. RESULTS 164 adolescent patients with a mean age of 19 underwent SG. 71% of the patients were female, while the mean weight at surgery was 128.6 kg, corresponding to a BMI of 47.8 Kg/m2. 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60. The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%. On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. 21 patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op. CONCLUSION It is of ample importance to tackle obesity during childhood before complications ensue later in life. Bariatric surgery, specifically SG, has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities.
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Affiliation(s)
- Salman Al Sabah
- Department of Surgery, Kuwait University, Kuwait City, Kuwait.
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AlSabah S, Al Haddad E, Al-Subaie S, Ekrouf S, Almulla A, Alhaddad M, Aljabal MS, Alenezi K. Long-term outcomes of revisional one anastomosis gastric bypass post laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2023; 408:43. [PMID: 36656465 DOI: 10.1007/s00423-023-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Revisional bariatric surgeries following laparoscopic sleeve gastrectomy (LSG) have demonstrated a dramatic increase worldwide. Recently, one-anastomosis gastric bypass (OAGB) has become a contender as an appropriate revisional procedure; however, no long-term data currently exist on the effectiveness of it as a revisional surgery post-LSG. METHODS A retrospective analysis was performed on all patients who underwent LSG at a public hospital in Kuwait from 2008 to 2017. A list was obtained of those who underwent revisional OAGB surgery after initial LSG, after which a phone survey was performed and demographics were analyzed. RESULTS A total of 29 patients underwent revisional OAGB post-initial LSG, of which 89.7% were female. Prior to LSG, the mean weight of the patients was 127.5 kg, and the mean BMI was 49.0 kg/m2. The mean weight loss after initial LSG was 43.8 kg, while the average duration until patients underwent revisional OAGB was 5.3 years. The cause for revision was weight regain (86.2%) or inadequate weight loss (13.8%). Prior to undergoing revisional OAGB, the weight and BMI of the patients was 110.9 kg and 42.4 kg/m2, respectively. Revisional OAGB demonstrated a %excess weight loss of 14.5%, 31.9%, 48.0%, 56.3%, 57.2%, and 54.7% at 2 weeks, 3 months, 6 months, 1 year, 4 years, and 5 years, respectively. Twelve morbidities were reported during the follow-up period. CONCLUSION Revisional bariatric surgery is technically demanding and may be associated with a high complication rate. However, OAGB as a revisional procedure has proven to be safe and effective in the long-term outcomes of revisional OAGB patients post-LSG.
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Blitzer D, Bouhout I, Al Haddad E, Lewis M, Farooqi K, Shah A, Zemer-Wassercug N, Singh H, Anderson B, Bacha E, Kalfa D. Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases. JTCVS Open 2022; 11:351-362. [PMID: 36172453 PMCID: PMC9510886 DOI: 10.1016/j.xjon.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/25/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- David Blitzer
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Ismail Bouhout
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Eliana Al Haddad
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Matthew Lewis
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Kanwal Farooqi
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Amee Shah
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Noa Zemer-Wassercug
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Harsimran Singh
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Brett Anderson
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Emile Bacha
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - David Kalfa
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
- Address for reprints: David Kalfa, MD, PhD, Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN-274, New York, NY 10032.
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Dada S, Ellis SLS, Wood C, Nohara LL, Dreier C, Garcia NH, Saranchova I, Munro L, Pfeifer CG, Eyford BA, Kari S, Garrovillas E, Caspani G, Al Haddad E, Gray PW, Morova T, Lack NA, Andersen RJ, Tjoelker L, Jefferies WA. Specific cannabinoids revive adaptive immunity by reversing immune evasion mechanisms in metastatic tumours. Front Immunol 2022; 13:982082. [PMID: 36923728 PMCID: PMC10010394 DOI: 10.3389/fimmu.2022.982082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023] Open
Abstract
Emerging cancers are sculpted by neo-Darwinian selection for superior growth and survival but minimal immunogenicity; consequently, metastatic cancers often evolve common genetic and epigenetic signatures to elude immune surveillance. Immune subversion by metastatic tumours can be achieved through several mechanisms; one of the most frequently observed involves the loss of expression or mutation of genes composing the MHC-I antigen presentation machinery (APM) that yields tumours invisible to Cytotoxic T lymphocytes, the key component of the adaptive cellular immune response. Fascinating ethnographic and experimental findings indicate that cannabinoids inhibit the growth and progression of several categories of cancer; however, the mechanisms underlying these observations remain clouded in uncertainty. Here, we screened a library of cannabinoid compounds and found molecular selectivity amongst specific cannabinoids, where related molecules such as Δ9-tetrahydrocannabinol, cannabidiol, and cannabigerol can reverse the metastatic immune escape phenotype in vitro by inducing MHC-I cell surface expression in a wide variety of metastatic tumours that subsequently sensitizing tumours to T lymphocyte recognition. Remarkably, H3K27Ac ChIPseq analysis established that cannabigerol and gamma interferon induce overlapping epigenetic signatures and key gene pathways in metastatic tumours related to cellular senescence, as well as APM genes involved in revealing metastatic tumours to the adaptive immune response. Overall, the data suggest that specific cannabinoids may have utility in cancer immunotherapy regimens by overcoming immune escape and augmenting cancer immune surveillance in metastatic disease. Finally, the fundamental discovery of the ability of cannabinoids to alter epigenetic programs may help elucidate many of the pleiotropic medicinal effects of cannabinoids on human physiology.
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Affiliation(s)
- Sarah Dada
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Samantha L S Ellis
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Christi Wood
- Biotechnology - Biomedical Science and Technology (BST), University of Applied Sciences, Mannheim, Germany
| | - Lilian L Nohara
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Carola Dreier
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada.,Biotechnology - Biomedical Science and Technology (BST), University of Applied Sciences, Mannheim, Germany
| | | | - Iryna Saranchova
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Lonna Munro
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Cheryl G Pfeifer
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Brett A Eyford
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Suresh Kari
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Emmanuel Garrovillas
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Giorgia Caspani
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Eliana Al Haddad
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | - Tunc Morova
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Nathan A Lack
- Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Medicine, Koç University, Istanbul, Türkiye
| | - Raymond J Andersen
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
| | | | - Wilfred A Jefferies
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.,The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Department of Zoology, University of British Columbia, Vancouver, BC, Canada.,Department of Urological Science, University of British Columbia, Vancouver, BC, Canada
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Al Sabah S, AlWazzan A, AlGhanim K, AlAbdulrazzaq HA, Al Haddad E. Does Laparoscopic Sleeve Gastrectomy lead to Barrett's esophagus, 5-year esophagogastroduodenoscopy findings: A retrospective cohort study. Ann Med Surg (Lond) 2021; 62:446-449. [PMID: 33643643 PMCID: PMC7889435 DOI: 10.1016/j.amsu.2021.01.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Laparoscopic Sleeve Gastrectomy (LSG) is one of the most prevalent approaches to tackle obesity and its co-morbidities. The main complication following the LSG is Gastro-esophageal reflux disease (GERD), with most patients developing worsening symptoms of GERD, and a small number progressing to Barrett's esophagus. This retrospective analysis aims to assess the rate of GERD pre- and post- LSG as well as the rate of progression to Barrett's. Methods Data was collected from 1639 patients. 92 patients fit our inclusion criteria. Data was then analyzed and summarized against similar literature. Results Of 64 (69.6%) patients who had normal EGD findings pre-LSG, only 28 patients (30.4%) had the same results 5 years post-LSG (p= < 0.05). The number of patients who had Grade A GERD almost quadrupled post-LSG, increasing from 3 patients (3.3%) to 14 (15.2%). Patients with esophagitis/gastritis/duodenitis increased from 20 (21.7%) to 32 patients (34.8%). Patients with hiatal hernias increased from 4 (4.4%) to 10 patients (10.9%). The most significant result is that 2 out of 92 patients developed Barrett's Esophagus (2.2%), while 7 other patients developed further serious complications. Conclusion LSG is a very effective and safe bariatric procedure. However, the major downslide is that it can lead to the aggravation of GERD symptoms. This paper and the included literature demonstrate that LSG does lead to a substantial increase in the rate of GERD, however, the percentages of Barrett's Esophagus are markedly low. Performing an EGD pre- and post- LSG is an important protocol that aids in the diagnosis and management of LSG related GERD. The main complication post-LSG is Gastro-esophageal reflux disease (GERD), with some progressing to Barrett’s esophagus. We assessed Esophagogastroduodenoscopy (EGD) results pre-LSG and 5 yrs post-op to determine the development of Barrett’s. This paper and the included literature demonstrate that LSG does lead to the development of Barrett’s Esophagus. Performing an EGD pre- and post-LSG is an important protocol that aids in the diagnosis and management of LSG related GERD.
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Al Sabah S, Al Haddad E, Jumaa T, Al Abbad J, Salam F, Abbas M, Al Kandari M, Al Ozairi A. Results from the first Kuwait National Bariatric Surgery Report. BMC Surg 2020; 20:292. [PMID: 33228620 PMCID: PMC7685619 DOI: 10.1186/s12893-020-00946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, more than 30% of the population in the gulf demonstrate a body mass index (BMI) exceeding 30. This burden of obesity has proven to take a toll on the population; therefore, we created the first Kuwait National Bariatric Surgery Database to report on bariatric surgeries performed in Kuwait. METHODS Data was collected from the six public hospitals in Kuwait. This data was then submitted to a merged National Registry. Data web portal were used to upload, merge, and analyze the data. RESULTS The average age for participants was 32.6 years. The average preoperative BMI was 45.9 kg/m2 for males and 43.3 kg/m2 for females. 16.4% of males and 12.3% of females presented with type 2 diabetes, while the most prevalent obesity related disease was a poor functional status in both males and females (90.8% and 90.5%, respectively). Most procedures performed in Kuwait are sleeve gastrectomy. The most encountered in-hospital complication after primary bariatric surgery was bleeding (1.5%), with Roux-en-Y gastric bypass (RYGB) having the highest recorded rate of post-operative complications (3.6% bleeding). The overall rate of operative complications was 2.6%, which was most prevalent post-RYGB (10.3%) and lowest post-sleeve gastrectomy (2.5%). CONCLUSION The importance of tracking and documenting the journey and change in the rates of obesity and effectiveness of bariatric procedures in individual countries with significantly high obesity rates is imperative to be able to create a plan of action to tackle this worldwide epidemic. This report will be able to provide the population with an accurate accounting that demonstrates further the safety of bariatric/metabolic surgery.
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Affiliation(s)
- Salman Al Sabah
- Kuwait University, Kuwait City, Kuwait. .,Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
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8
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Al-Sabah S, Al Haddad E, Akrof S, Alenezi K, Al-Subaie S. Midterm results of revisional bariatric surgery postsleeve gastrectomy: resleeve versus bypass. Surg Obes Relat Dis 2020; 16:1747-1756. [PMID: 32771425 DOI: 10.1016/j.soard.2020.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bariatric surgery has been shown to produce the most predictable weight loss results, with laparoscopic sleeve gastrectomy (SG) being the most performed procedure as of 2014. However, inadequate weight loss may present the need for a revisional procedure. OBJECTIVES The aim of this study is to compare the efficacy of laparoscopic resleeve gastrectomy (LRSG) and laparoscopic Roux-en-Y gastric bypass in attaining successful weight loss. SETTING Public hospital following SG. METHODS A retrospective analysis was performed on all patients who underwent SG from 2008-2019. A list was obtained of those who underwent revisional bariatric surgery after initial SG, and their demographic characteristics were analyzed. RESULTS A total of 2858 patients underwent SG, of whom 84 patients (3%) underwent either a revisional laparoscopic Roux-en-Y gastric bypass (rLRYGB) or LRSG. A total of 82% of the patients were female. The mean weight and body mass index (BMI) before SG for the LRSG and rLRYGB patients were 136.7 kg and 49.9 kg/m2 and 133.9 kg and 50.5 kg/m2, respectively. The mean BMI showed a drop from 42.0 to 31.7 (P < .001) 1 year post revisional surgery for the LRSG group and 42.7 to 34.5 (P < .001) for the rLRYGB group, correlating to an excess weight loss (EWL) of 61.7% and 48.1%, respectively. At 5 years post revisional surgery, LRSG patients showed an increase in BMI to 33.8 (EWL = 45.3%), while those who underwent rLRYGB showed a decrease to 34.3 (EWL = 49.2%). Completeness of follow-up at 1, 3, and 5 years for rLRYGB and LRSG were 67%, 35%, and 24% and 45%, 21%, and 18%, respectively. CONCLUSIONS Revisional bariatric surgery is a safe and effective method for the management of failed primary SG. LRSG patients tended to do better earlier on; however, it leveled off with those who underwent rLRYGB by 5 years.
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Affiliation(s)
- Salman Al-Sabah
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
| | | | - Shehab Akrof
- Department of Surgery, Al Amiri Hospital, Kuwait City, Kuwait
| | - Khaled Alenezi
- Department of Surgery, Al Amiri Hospital, Kuwait City, Kuwait
| | - Saud Al-Subaie
- Department of Surgery, Al Amiri Hospital, Kuwait City, Kuwait
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Sabah SA, Haddad EA, Vaz JD. Repair of a giant diaphragmatic hernia using the dual approach. J Surg Case Rep 2019; 2019:rjz064. [PMID: 30886697 PMCID: PMC6413371 DOI: 10.1093/jscr/rjz064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/13/2019] [Accepted: 03/01/2019] [Indexed: 11/14/2022] Open
Abstract
Bochdalek hernias are diaphragmatic defects seen in pediatrics. About 5–25% of the cases are diagnosed in adulthood, and present with symptoms of chest and abdominal problems. This is a case of an 18-year-old male who presented to the emergency department with epigastric pain, vomiting and dyspnea. Most of the left-sided organs had herniated to the left chest cavity. Immediate surgery was performed. The stomach, spleen and colon were reduced into the abdominal cavity. The diaphragm defect was repaired laparoscopically, but there were limitations due to inadequate space, leading to difficult visualization of the posterior diaphragmatic leaflet. A thoracoscopic approach was taken where we saw the left kidney herniated through the repair site posteriorly. It was reduced and the defect was closed. The early diagnosis of Bochdalek hernias is important to prevent stomach/intestinal strangulation. Laparoscopic surgeons need to be prepared for a thoracic approach in giant congenital diaphragmatic hernias.
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Affiliation(s)
| | | | - Jonathon D Vaz
- Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
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Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been established as an effective means of weight loss. Multiple studies report LSG as a cost-effective procedure with few perioperative complications. OBJECTIVES Report long-term weight changes after LSG in a single center in Kuwait. DESIGN Retrospective analysis of data collected 5-8 years after surgery. SETTING A single medical center. PATIENTS AND METHODS All patients that had undergone LSG between December 2008 and December 2011. MAIN OUTCOME MEASURES Weight changes, short-term complications following surgery (within one month). SAMPLE SIZE 187. RESULTS The mean age at the time of the surgery was 36.5 (10.3) years. Females composed 71.6% of this study population.Two patients (1.1%) presented with a leak within 30 days of the surgery. Twenty-one (11.2%) patients underwent revisional bariatric surgery after LSG. Mean (SD) BMI decreased from 47.1 (8.3) kg/m2 before surgery to 34.3 (7) kg/m2 5-8 years after surgery. Mean (SD) body weight decreased from 126.3 (25.3) kg to 91.6 (19.9) kg 5-8 years following LSG. The mean excess body weight loss was 58.8% (29.2%). CONCLUSION LSG is a bariatric procedure with low complications and mortality in relation to other forms of bariatric surgery. It is associated with a significant improvement in weight loss in the long term. LIMITATIONS Recall bias due to the nature of collecting the data, small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
| | | | | | | | | | | | - Salman AlSabah
- Dr. Salman AlSabah, Department of Surgery,, Kuwait Ministry of Helath,, Kuwait University, Kuwait City, Kuwait, T: +965 66666911, salman.k.alsabah@ gmail.com, ORCID: https://orcid. org/0000-0002-8081-8544
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11
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Al Sabah S, AlHamdan F, Qadhi I, Shuaibi S, Younes S, Al Haddad E. Female Physicians Leading Health Care in the Arab World. Med Princ Pract 2019; 28:315-323. [PMID: 30870857 PMCID: PMC6639578 DOI: 10.1159/000499592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A global trend in female leadership roles in the medical profession is on the rise, and females have been taking up leadership roles in varying and increasing levels. This study aims to identify changes in trends in the medical field in terms of gender in the last decade in Kuwait. METHODS A case study was conducted, in which data on leadership positions in Kuwait's government hospitals were obtained from hospital registries. Demographic data about female to male physicians were collected from statistics published by the Department of Manpower, Statistics and Planning of Kuwait's Ministry of Health. In addition, statistics on medical graduates were obtained from the Faculty of Medicine (FOM), Kuwait University (KU). RESULTS In general, every government hospital in Kuwait has experienced an increase in leadership roles among females; in 2008, among all leadership positions in Kuwait's general hospitals, males occupied a majority of positions (60%); whereas in 2016, the male to female ratio was 1:1. The most change in gender trends was witnessed at Mubarak Al-Kabeer Hospital, where female leaders went from 38% in 2008 to 73% in 2016. The specialties that have the highest number of females in leadership positions across all hospitals from 2008 to 2016 were nuclear medicine, radiology, and laboratory medicine. In KU's FOM, female graduates outweighed male graduates, except in 2005-2006, where females reached a minimum of 48%. The number of female physicians has also increased from its lowest of 31% of the total number of physicians in 2004-2006, to 37% in 2015. CONCLUSION While women make up more than half of medical graduates in Kuwait at present, significant barriers had restricted their entry into formal medical leadership roles in the past. However, it is now seen that females currently occupy more leadership positions in government hospitals in Kuwait.
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Affiliation(s)
- Salman Al Sabah
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait,
| | - Fajer AlHamdan
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Iman Qadhi
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Sameera Shuaibi
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Shaden Younes
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Eliana Al Haddad
- Department of Surgery, Faculty of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
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AlSabah S, Al Haddad E, AlSaleh F. Stop the bleed campaign: A qualitative study from our experience from the middle east. Ann Med Surg (Lond) 2018; 36:67-70. [PMID: 30402222 PMCID: PMC6206322 DOI: 10.1016/j.amsu.2018.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 11/15/2022] Open
Abstract
Background Bleeding due to unintentional injuries are a leading cause of death in the younger population. The immediate involvement of lay bystanders has been proven to be imperative in outcomes, however, there still is less than 30% of out-of-hospital resuscitation attempts initiated by them. Study design The Stop the Bleed campaign was initiated in Kuwait in September-2017, with the aim to raise awareness and train the general public on emergency situations. A survey questionnaire was distributed to a sample of 150 participants to assess their comprehension. Results A total of 1531 participants were trained by the campaign. More than half of the participants have had no previous training of any sort for emergency situations, with the majority (86%) of those queered expressing desire to learn about how to deal with trauma and bleeding cases. After training, most participants were able to demonstrate knowledge of how to deal with unstoppable bleeding, know where and when to place a tourniquet, knew how to respond to epistaxis, and the ability to recognize signs of internal bleeding, with 89% expressing that the 'Stop the Bleed' campaign was useful for promoting health and raising awareness on safety of individuals. Conclusion With the appropriate first-aid training and skill retention, lay members of the public can potentially contribute to a positive and important post-trauma medical response.
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Affiliation(s)
- Salman AlSabah
- Kuwait University, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
- Corresponding author.
| | - Eliana Al Haddad
- Al Amiri Hospital, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
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AlSabah S, Al Haddad E, Khwaja H. The prevalence of musculoskeletal injuries in bariatric surgeons. Surg Endosc 2018; 33:1818-1827. [PMID: 30251136 DOI: 10.1007/s00464-018-6460-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/18/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the prevalence of musculoskeletal (MSK) injuries in bariatric surgeons around the world. BACKGROUND As the popularity of bariatric surgery increases, efforts into improving its patient safety and decreasing its invasiveness have also been on the rise. However, with this shift towards minimal invasiveness, surgeon ergonomic constraints have been imposed, with a recent report showing a 73-88% prevalence of physical complaints in surgeons performing laparoscopic surgeries. METHODS A web-based survey was designed and sent out to bariatric surgeons around the world. Participants were queried about professional background, primary practice setting, and various issues related to bariatric surgeries and MSK injuries. RESULTS There were 113 responses returned from surgeons from 34 countries around the world. 68.5% of the surgeons have had more than 10 years of experience in laparoscopic surgery, 65.8% in open, and 0.9% in robotic surgery. 66% of participants reported that they have experienced some level of discomfort/pain attributed to surgical reasons, causing the case load to decrease in 27.2% of the surgeons. It was seen that the back was the most affected area in those performing open surgery, while shoulders and back were equally as affected in those performing laparoscopic, and the neck for those performing robotic, with 29.4% of the surgeons reporting that this pain has affected their task accuracy/surgical performance. A higher percentage of females than males reported pain in the neck, back, and shoulder area when performing laparoscopic procedures. Supine positioning of patients evoked more discomfort in the wrists, while the French position caused more discomfort in the back region. A higher percentage of surgeons who did not exercise experienced more issues in the neck and back region, while those that exercised more than 3 h a week experienced issues in their shoulders and wrists in both open and laparoscopic approaches. Only 57.7% sought medical treatment for their MSK problem, of which 6.35% had to undergo surgery for their issue, of which 55.6% of those felt that the treatment resolved their problem. CONCLUSION MSK injuries and pain are a common occurrence among the population of bariatric surgeons (66%), and has the ability to hinder performance at work. Therefore, it is of importance to investigate ways in which to improve ergonomics for these surgeons as to improve quality of life.
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Al Haddad E, LaPar DJ, Dayton J, Stephens EH, Bacha E. Complete atrioventricular canal repair with a decellularized porcine small intestinal submucosa patch. CONGENIT HEART DIS 2018; 13:997-1004. [DOI: 10.1111/chd.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Eliana Al Haddad
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Damien J. LaPar
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Jeffrey Dayton
- Division of Pediatric Cardiology; NewYork-Presbyterian/Weill Cornell Medical Center; New York New York
| | - Elizabeth H. Stephens
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Emile Bacha
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
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AlSabah S, Al Haddad E. The pedigree of baraitric surgery: A case series of revisional surgery post laparoscopic sleeve gastrectomy in 3 sisters. Int J Surg Case Rep 2018; 51:302-305. [PMID: 30243264 PMCID: PMC6148839 DOI: 10.1016/j.ijscr.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/04/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Obesity is a complex disease involving multiple factors that play a role in its development, including genetics. Given the high prevalence of obesity in Kuwait, this is of particular interest. Case This is a case of 3 sisters that presented to a single surgeon for morbid obesity with starting body mass indexes (BMI) of 46.9 kg/m2,56 kg/m2,and 51.3 kg/m2. All three elected to undergo a laparoscopic sleeve gastrectomy as an initial procedure. They presented to thier surgeon 5.5 years later with weight regain. The first patient elected to undergo a Laparoscopic Re-Sleeve Gastrectomy, the second Roux-en-Y Gastric Bypass, and the third Single-Anastomosis Gastric Bypass. The patients were followed up for 2-years post-revisional, for which the % EWL was 35.5%, 48.4% and 25.2%, respectively. Conclusion Our study was also able demonstrate how effective revisional surgery is, when genetics are accounted for, with our results showing RYGB as a revisional procedure being superior to the other options.
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AlSabah SA, AlRuwaished M, Almazeedi S, Al Haddad E, Chouillard E. Portomesenteric Vein Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Case Series and Literature Review. Obes Surg 2018; 27:2360-2369. [PMID: 28281234 DOI: 10.1007/s11695-017-2637-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is today one of the leading procedures in bariatric surgery, and portomesenteric vein thrombosis (PMVT) has been reported as one of its rare complications. The purpose of this study is to determine the prevalence, clinical presentation, and outcomes of PMVT in patients undergoing LSG. METHODS A retrospective study of a database of all post-LSG patients was conducted on the patients who developed PMVT post-LSG from July 2011 to March 2016, at Amiri Hospital, Kuwait. RESULTS A total of 2280 patients underwent LSG during the study period. Nine (0.39%) patients were diagnosed with PMVT post-LSG. Diagnosis was confirmed by CT scan for eight patients, and one had urgent laparotomy. The median age was 34 years (20-50), and there were 7 women and 2 men. Median preoperative body mass index (BMI) was 42 kg/m2 (37.5-74.6), and median operative time was 80 min (60-150). The median post-operative anticoagulation duration was 4 days (2-22). The median onset of diagnosis after the surgery was 28 days (18-453), and two patients had a positive thrombophilia study. All patients were treated medically except one patient who underwent urgent laparotomy for small bowel necrosis and eventually had small bowel transplant. CONCLUSIONS PMVT post-LSG is a rare but possibly dangerous complication. It should be suspected with patients presenting with unresolving abdominal pain. Treatment is mainly conservative and surgical intervention might be needed for small bowel necrosis. Extended anticoagulation prophylaxis is a hypothesis for patients after LSG, and may play a role in preventing PMVT.
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Affiliation(s)
- S Alman AlSabah
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait.
| | - Mohammed AlRuwaished
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait
| | - Sulaiman Almazeedi
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait
| | - Eliana Al Haddad
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait
| | - Elie Chouillard
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Paris, France
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Alsabah S, Al Haddad E, Ekrouf S, Almulla A, Al-Subaie S, Al Kendari M. The safety and efficacy of the procedureless intragastric balloon. Surg Obes Relat Dis 2018; 14:311-317. [DOI: 10.1016/j.soard.2017.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/07/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
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Alsabah A, Al Sabah S, Al-Sabah S, Al-Serri A, Al Haddad E, Renno WM. Investigating Factors Involved in Post Laparoscopic Sleeve Gastrectomy (LSG) Neuropathy. Obes Surg 2017; 27:1271-1276. [PMID: 27889885 DOI: 10.1007/s11695-016-2466-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has gained popularity as the leading bariatric procedure for the treatment of morbid obesity. Due to the rising numbers of bariatric surgeries, neurologic complications have become increasingly recognized. Our aim was to examine biochemical and hormonal factors that are associated with neuropathy post-LSG. METHODS Thirty-two patients were included: 16 patients with neuropathy in the neuropathic group (NG) and 16 patients without neuropathy in the control group (CG). Diagnosis was made by a consultant neurologist, and blood samples were taken to examine vitamin deficiencies and hormones involved in neuropathy. RESULTS There was no significant difference between the BMI (p = 0.1) in both groups as well as excess weight loss percentages post-LSG at 12 months (p = 0.6). B12 levels were within normal range, but higher in NG (p = 0.005). Vitamin B1 and B2 levels were significantly lower in NG; p values are 0.000 and 0.031, respectively. Vitamin B6 levels were significantly higher in NG (p = 0.02) and copper levels were lower in NG (p = 0.009). There was no significant difference in GLP-1 response in both groups. CONCLUSION Our data showed post-LSG neuropathy is associated with lower levels of vitamin B1, B2, and copper, plus patients who are older in age. Vitamin B6 was significantly higher in the NG, which is, at toxic levels, associated with neuropathy. No difference in preoperative BMI, excess weight loss percent at 1 year, and GLP-1 levels was found. Larger data is required to validate our results.
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Affiliation(s)
- Almaha Alsabah
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | | | - Ahmad Al-Serri
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Waleed M Renno
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Abstract
INTRODUCTION Obesity has become an epidemic in the Arabian Gulf, with the prevalence of obesity according to the latest report from the World Health Organization (WHO) showing the gulf region to be countries with the highest incidence of obesity in the 30% plus group. This study aims to examine publications on bariatric surgery and compare them with the other countries with a high incidence of obesity in the world. METHODS A literature review on bariatric surgery published from the earliest detected year of publication up until March 2016 using SCOPUS, PubMed, Ovid, and Google Scholar was conducted. Individual papers were assessed for types of surgery, preoperative measures, names of journals, authors, and outcomes. The data was analyzed using Endnote library and SPSS. Key words used in the search included "Bariatric Surgery," "Arabian Gulf," "Kuwait," "Qatar," "Saudi Arabia," "United Arab Emirates," "Oman," "USA," "Australia," "weight loss surgery," "sleeve gastrectomy," "gastric bypass," "gastric band," "mini-gastric bypass," "biliropancreatic diversion," "duodenal switch," and "intragastric balloon." Original papers, systematic reviews and case reports were included. RESULTS From our review, the gastric sleeve proved to be the most popular published on procedure in the Arabian Gulf, whereas the USA had the highest percentage of gastric bypass surgeries and Australia had equivalent numbers when it came to gastric bypass and band. The numbers of studies from Saudi Arabia, Kuwait, UAE, Bahrain, Qatar, and Oman were 70, 44, 20, 7, 6, and 0, respectively. The mean impact factor of the published articles was 2.53 +/- 1.76 SD. Most of the publications were published in Obesity Surgery (29%), Surgery for Obesity and Related Diseases (5%), and Surgical Endoscopy (5%). CONCLUSION The Arabian Gulf has both the highest percentage of bariatric procedures performed as well as the highest prevalence of obesity. However, they have the lowest number of publications and research when compared to their western counterparts; therefore, more research and publications are needed in the Arabian Gulf region, as well as the possibility of producing a regional registry to be able to have a good overview of bariatric surgery in the region.
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Abstract
INTRODUCTION A BMI of over 35-45kg/m2 is deemed the upper limit for considering a patient for a renal transplant. Voluntary weight loss attempts are a major concern for patients while on hemodialysis, however, bariatric surgeries have opened up a new door to notable weight loss results, even demonstrating significant improvements of patients' diabetic profile and hypertension. CASE REPORT Case of a 52-year-old male with a BMI of 42 in end-stage renal disease, that needed a kidney transplant but was ineligible to be placed on the waiting list due to his weight. A laparoscopic sleeve gastrectomy (LSG) was performed to aid with his weight loss. He also showed major improvements in his hypertension and diabetes profiles. The patient started gaining weight as well as showing deterioration in his diabetic control. He underwent the renal transplant 1.5 years post LSG, after which he showed improvements in his blood results, diabetic and hypertensive control. However, his weight began to increase again, for which he underwent gastric bypass. Since then, the patients' glucose, BUN and creatinine have normalized and his weight continued to drop, reaching a BMI of 31.83kg/m2 2 years post bypass. CONCLUSION Bariatric surgery is a safe and effective procedure to assist renal transplant patients in losing weight. In addition, it has proven to be effective in the management of the co-morbidities that are associated with renal failure. Our study was also able to prove that converting form an SG to a bypass in a transplant patient is a safe and feasible option.
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Job JR, Haddad EA, Hidalgo GS, Furuno DF, da Silva Neto OA, de Araujo CA. [Chronic calculous cholecystitis and fibrotic rudimentary appendix associated with situs inversus totalis]. Arq Gastroenterol 1988; 25:149-51. [PMID: 3255283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A case of calculous cholecystitis and rudimentary appendix in a 45 year old female patient with complete situs inversus is reported. After radiologic and sonographic examination, surgical treatment resulted in symptoms relief. A high index of suspection is imperative for the precise diagnostic and therapeutic approach.
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Affiliation(s)
- J R Job
- Clínico Geral do Hospital Santo Antonio de Votorantim, SP
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