Hosam Ghazy Elbanna

Laparoscopic ventral mesh rectopexy versus Delorme's operation in management of complete rectal prolapse: a prospective randomized study

Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delormes operation for complete rectal prolapse.

Novel Approach of Treatment of Pilonidal Sinus Disease With Thrombin Gelatin Matrix as a Sealant.

BACKGROUND: Sacrococcygeal pilonidal sinus disease is a condition caused by insertion of fallen hair shafts into the skin. Different types of operations have been described for the management of pilonidal sinus, yet none of them have proven to be superior to the others. Recently, sealants like fibrin glue have been successfully used. OBJECTIVE: This study aimed to assess the efficacy of thrombin gelatin matrix as a new sealant for pilonidal sinus treatment. DESIGN: This was a prospective study conducted from March 2013 to March 2015. SETTINGS: The study was conducted in private hospitals in Mansoura City. PATIENTS: The study included 36 male patients (72%) and 14 female patients (28%), with a median age of 22 years. INTERVENTIONS: Fifty patients with pilonidal sinus were admitted and treated with thrombin gelatin matrix injection. MAIN OUTCOME MEASURES: Incidence and time of pilonidal sinus recurrence, postoperative pain and complications, duration of hospital stay, healing status, and time to return to work were recorded. RESULTS: The median duration of symptoms was 13 months, median operative time was 18 minutes, and median hospital stay was 6 hours. All of the procedures were conducted as day-case surgeries. Median follow-up duration was 24 months. Three patients (6%) had a breakdown of the sealant, and the wound was managed with daily dressings. Recurrence at 1 year was observed in 2 patients (4%). A total of 96% of patients were satisfied with the outcome of the procedure, and 92% of patients resumed their daily activities within 3 days. LIMITATIONS: Follow-up for a longer duration is required to ascertain the efficacy of this new technique. The cost of this treatment might be challenging for resource-limited communities. CONCLUSIONS: Management of pilonidal sinus using thrombin gelatin matrix, despite being expensive, is an effective, simple treatment that is easy to perform and associated with low recurrence rate, minimal morbidity, and rapid recovery.

Impact of preoperative body mass index on the final outcome after laparoscopic sleeve gastrectomy for morbid obesity

OBJECTIVE Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric surgery due to its excellent results and limited morbidity. Our study aims to assess the efficacy of LSG in terms of loss of weight and co-morbidity improvement and to evaluate the impact of preoperative body mass index (BMI) on the final outcome. MATERIAL AND METHODS The data of 173 patients who underwent LSG were analyzed. Laparoscopic sleeve gastrectomy was indicated only for patients with BMI >40. Mean postoperative BMI, co-morbidity improvement, operative data and complications, length of hospital stay and excess weight loss were evaluated and recorded. RESULTS This study included 151 females and 22 males with a mean age of 37.6 years. Patients were divided into two groups according to their BMI (group I <50, group II >50). Mean preoperative BMI was 53.8 kg/m2. Mean operative time was 120 minutes. Mean duration of hospital stay was 3.2 days. Mean postoperative BMI decreased to 47.3 kg/m2 at 1 year. Excess weight loss was 43.1% at 6 months, 71.1% at 1 year, and 87.5% at 5 years. Group I showed a significantly shorter length of hospital stay, more improvement of laboratory parameters and more reduction in BMI as compared to group II. There was one mortality and six cases had gastric staple line leakage. CONCLUSION Laparoscopic sleeve gastrectomy is an efficient treatment to achieve significant weight loss that is maintained up to 5 years of follow up, also it improves some of the obesity related co-morbidities. This beneficial impact of LSG appears to be significantly higher in patients with BMI <50.

Evaluation of Weight Reduction, Diabetic State and Satiety Hormones After Laparoscopic Greater Curvature Plication in Morbidly Obese Diabetic Patients

Bariatric surgery proved effective in the treatment of morbid obesity and its associated comorbidities. The aim of this study was to assess weight loss and changes in glucose homeostasis and satiety hormones and to evaluate improvement in diabetic status in morbidly obese patients with type two diabetes mellitus (T2DM) at 6 and 12 months after laparoscopic greater curvature plication (LGCP). Twenty patients with morbid obesity with T2DM were operated upon with LGCP. Weight loss was assessed by the decrease in BMI and percentage of excess weight loss at 6 and 12 months after LGCP. Fasting and postprandial blood glucose levels, HbA1c, fasting serum insulin, serum ghrelin and glucagon-like peptide 1 (GLP-1) levels were measured before and at 6 and 12 months postoperatively. The mean age of patients was 37.6 years. There was significant decrease in BMI from 45.4 to 40.1 at 6 months (p= 0.0008) and then to 36.4 at 12 month (p< 0.0001). The mean fasting blood glucose decreased significantly from 134.8 preoperatively to 120.8 at 6 months (p< 0.0001) and then to 109.5 at 12 months (p< 0.0001). The mean preoperative HbA1c declined from 6.8 before LGCO to 6.3 at 6 months (p< 0.0001) then to 5.9 at 12 months (p< 0.0001). The mean fasting insulin level decreased from 20.5 preoperatively to 17.4 at 6 months (p< 0.0001) then to 16.7 at 12 months (p< 0.0001). The mean baseline ghrelin level decreased significantly from 551.7 preoperatively to 441.5 at 6 months (p< 0.0001) then to 422.5 at 12 months (p< 0.0001). The mean GLP-1 declined from 33.7 before surgery to 33.5 at 6 months (p= 0.76) then to 33.1 at 12 months (p= 0.36). LGCP is an effective bariatric procedure that achieved satisfactory weight loss and significant improvement in the glycemic control as demonstrated by improvement in laboratory markers as serum glucose, insulin, and ghrelin hormone levels.

Functional Assessment of the Esophagogastric Junction After Laparoscopic Sleeve Gastrectomy

The relation between bariatric procedures and gastroesophageal reflux disease (GERD) seems to be quite complex and unclear. The present trial aimed to assess the functional changes that occur in the esophagogastric junction (EGJ) after laparoscopic sleeve gastrectomy (LSG) using objective methods for assessment as esophageal manometry and ambulatory 24-hour pH monitoring in attempt to correlate these changes with either the deterioration or the alleviation of GERD symptoms after LSG. This prospective case series study was conducted on patients with morbid obesity who were treated with LSG in the General Surgery Department, Mansoura University Hospitals. All patients were assessed pre- and postoperatively for the presence of GERD both clinically and with esophagogastrodudenoscopy (EGD). Functional assessment of the EGJ was done before LSG and at six months of follow-up using esophageal manometry and ambulatory 24-hour esophageal pH monitoring. Twenty morbidly obese patients (16 females & 4 males) of a mean age of 29.4 years had underwent functional assessement of the EGJ before and at six months after LSG. The mean BMI at the time of surgery was 51.6 ± 8.7 kg/m². Thirteen patients had no symptoms related to GERD preoperatively, all of these patients remained symptom-free after LSG. Seven (35%) patients had preoperative symptoms of GERD, three reported no change in their symptoms at six months of follow-up, and four reported significant improvement of their symptoms six months after LSG. Overall, no significant changes in the manometric parameters were noticed. However, a significant decrease in the resting LES pressure was noticed after LSG in patients with no preoperative GERD symptoms, but not in patients with symptomatic GERD. Seven (35%) patients had high preoperative DeMeester scores and prolonged total acid reflux time percentage, all of them got normalized postoperatively except two patients. Absolute concordance of the four parameters studied was observed in seven (35%) patients only. Esophageal manometry has a limited utility in the detection or exclusion of GERD postoperatively since the significant decrease in the resting LES pressure observed was not associated with symptoms of GERD. On the other hand, 24-hour pH monitoring was able to detect improvement or persistence of GERD in the patients studied.