Amnon Ovnat

Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery.

Fifteen morbidly obese patients with Sleep Apnea Syndrome (SAS) were studied during nocturnal sleep before and between 2 to 4 months after a weight reduction surgery. Six patients were also recorded between 4 to 8 months after surgery. Postoperative recordings revealed a dramatic reduction in the sleep apnea index and an improvement in sleep motility and daytime vigilance levels. A further decrease in apneas and sleep motility was seen in the late post-treatment recording. These results indicate that weight reduction surgery is an effective definitive treatment for obesity associated SAS.

A new approach to rectal anastomotic stricture

A technique is presented that can serve as a solution for localized postoperative rectal stricture. This procedure was used after the failure of manual and instrumental dilatations. It consisted of cutting the prominent plication of the stricture, using the EEATM stapler. Five patients successfully underwent this operation without morbidity or mortality, three after very low anterior resection and two after total colectomy, mucosal proctectomy, and ileoanal anastomosis.

Sigmoid perforation in patients with chronic constipation.

From 1976 to 1982, seven cases of free perforation of the sigmoid colon were treated at the Soroka University Hospital. None of the patients suffered any known underlying disease of the affected bowel such as malignancy, diverticulosis, stercoral ulcer, colitis, or trauma. The only feature common to all seven patients was a long history of chronic constipation. All patients were treated surgically with no mortality and with minimal morbidity. We believe that severe untreated chronic constipation may, on rare occasions, cause free perforation of the sigmoid colon.

The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.

BackgroundTo evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience.MethodsA retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database.ResultsNine hundred eighty-four LSG cases were performed by three surgeons. Seventy-eight complications were observed (7.9%): 44 mild (4.5%) and 34 severe (3.4%). Over-sewing of staple line was performed in 689 cases (76.2%), and no SLR in 217 cases (24.0%) without significant impact on mild or severe early morbidity. Bougie size 36 Fr or smaller was used in 635 cases (73.0%) without significant differences in early complications compared to 235 cases (27.0%) with larger bougie. LSG, as revision bariatric surgery, was performed in 273 cases (27.7%). Concomitant removal of a gastric band was performed in 199 of these cases (72.9%). History of silastic ring vertical gastroplasty (SRVG) was recorded in 10 cases (1.0%). Previous bariatric surgery was a significant risk factor for early mild complications (ORxa0=xa01.14, p valuexa0=xa00.02), but not for severe ones (ORxa0=xa00.79, p valuexa0=xa00.09). Concomitant removal of gastric band did not affect this result. The risk for mild complication was significantly reduced with surgeon experience achieving 100 cases.ConclusionsSLR or bougie size is not affecting LSG morbidity, but previous bariatric history and surgeon experience are significant factors for early mild complications.