Laparoscopic approach in the management of diaphragmatic eventration in adults: gastrointestinal surgical perspective

The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the role of laparoscopy in managing DE patients presenting mainly with gastrointestinal symptoms. We retrospectively reviewed the data of 20 patients who underwent laparoscopic diaphragmatic plication between January 2010 and December 2018. Postoperative outcomes and quality of life were assessed. Most DEs were left sided (95%). Laparoscopic diaphragmatic plication was possible in all patients, along with correcting all associated gastrointestinal and diaphragmatic problems. The former included gastric volvulus (60%), reflux esophagitis (25%), cholelithiasis (5%), and pyloric obstruction (5%), while the latter included diaphragmatic and hiatus hernia (10% and 15%, respectively).The average operative time was 142 min. All patients had a regular (reviewer #1) postoperative course except for one who developed hydro-pneumothorax. At a median follow-up of 48 months, midterm outcomes were satisfactory, with an improvement (reviewer #1) in gastrointestinal symptoms. Three patients (reviewer #1) developed radiological recurrence without significant clinical symptoms. Patient's quality of life, including all parameters, significantly improved after the laparoscopic procedure compared to the preoperative values. Laparoscopic approach is safe and effective for managing adult diaphragmatic eventration (reviewer #1).

Helicobacter pylori infection in migraine headache: a true association or an innocent bystander?

Much concern was directed towards the relationship between migraine and Helicobacter pylori (H. pylori) infection. Some researchers reported a strong association. Meanwhile, others have indicated totally negative results. The aim of this work was to clarify the association between migraine headaches and both H. pylori infection and Gastrointestinal (GIT) symptoms and to study their impact on the frequency and severity of migraine headache attacks.

This is a case control study conducted on 77 migraine patients and 77 healthy controls. History was taken from the included patients regarding the frequency of migraine headache attacks/month and GIT symptoms including dyspepsia, flatulence, weight loss, and epigastric pain. Migraine Disability Assessment Test (MIDAS) and Visual Analogue Scale (VAS) were used for assessment of migraine severity. Helicobacter pylori was detected in the stool of the included patients and controls.

There was a significantly higher prevalence of infection with H. pylori in migraine patients [77.9% (n = 60)] than control group [50.6% (n = 39)] (P-value˂ 0.001, Odds ratio= 3.439, 95% CI =1.708 - 6.923). The prevalence of dyspepsia, flatulence, and epigastric pain. was significantly higher in migraine patients in comparison to control group (P-value= 0.003, 0.017, 0.006 respectively). There was no effect of infection with H. pylori or presence of GIT symptoms on frequency of migraine attacks, MIDAS or VAS scores.

GIT symptoms and H. pylori infection are more prevalent in patients with migraine compared to controls, however, they might not have an impact on the frequency or severity of migraine headache attacks.