Kamran Samakar

Erratum to: The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese

Background The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG.

Asymptomatic ruptured giant popliteal aneurysm

An 84-year-old male presented with two large masses on the left leg and a large mass on the right leg. The patient reported that the two masses on the left leg had been there for approximately 2 years. He did not report any significant symptoms related to the masses on lower extremities other than dislike for the size and concern for “impending rupture.” On examination of the left leg, the patient had two large, nonpulsatile masses on the medial aspect (A). Masses were soft, nontender, and had no Doppler signal. His pulse examination demonstrated a left femoral pulse with no distal pulses. There were biphasic Doppler signals in the left dorsal pedal and posterior tibial positions with an ankle-brachial index of 0.8. The right leg had a large, pulsatile mass on the medial thigh. There were palpable femoral and popliteal pulses with an anklebrachial index of 0.9. Computed tomography angiogram of the left lower extremity showed a multilobulated mass (21.7 18 40 cm) extending from mid-thigh to mid-calf, consistent with a contained rupture of a giant popliteal artery aneurysm with thrombosis. On the right, there was a giant popliteal artery aneurysm (8.5 9.7 16.6 cm) with significant intraluminal thrombus with patent outflow vessels (B). Angiogram of the left leg showed reconstitution of the distal popliteal artery and two-vessel runoff to the left foot (C). Exploration of the left leg was performed, and both masses were consistent with old hematomas within a pseudocapsule (D). The masses were evacuated, and revascularization was not necessary due to adequate collateral blood flow. Seven days after his initial surgery, he was returned to the operating room for ligation and bypass of his right popliteal artery aneurysm with nonreversed greater saphenous vein. Popliteal artery aneurysms are defined as dilation of the popliteal artery over 2 cm in diameter. Popliteal artery aneurysms are most commonly symptomatic secondary to a thromboembolic event, acute rupture, or compression of adjacent structures. This case is unusual in that the patient was relatively asymptomatic upon presentation and did not require revascularization of the left leg. Only one similar case has been reported in the literature.

Gastric cancer in the young: An advanced disease with poor prognostic features

Gastric cancer in young patients is rare. We analyzed the clinicopathological features and prognosis of early‐onset gastric carcinoma.

Inguinal Hernia Repair: Laparoscopic

Abstract Symptomatic inguinal hernias are a commonly encountered surgical problem. Repair can be performed with an open or minimally invasive approach. Laparoscopic inguinal hernia repair is now widely performed, especially in the setting of bilateral or recurrent inguinal hernias. This chapter reviews the anatomy, benefits, and possible complications of laparoscopic inguinal hernia repair. Laparoscopic inguinal hernia repair is also compared with the traditional anterior approach, and the operative techniques of both the transabdominal preperitoneal repair and the totally extraperitoneal repair are reviewed. The outcomes of these two procedures are also examined.

Routine esophageal manometry is not useful in patients with normal videoesophagram

BackgroundVideoesophagram (VEG) and esophageal manometry (EM) are components of the preoperative evaluation for foregut surgery. EM is able to identify motility disorders and diminished contractility that may alter surgical planning. However, there are no clearly defined criteria to guide this. Reliable manometry is not always easily obtained, and therefore its necessity in routine preoperative evaluation is unclear. We hypothesized that if a patient has normal videoesophagram, manometry does not reveal clinically significant esophageal dysfunction.MethodsWe reviewed patients who underwent protocolized videoesophagram and manometry at our institution. Measures of esophageal motility including the mean distal contractile integral (DCI), mean wave amplitude (MWA), and percent of peristaltic swallows (PPS) were analyzed. The Chicago Classification was used for diagnostic criteria of motility disorders. Normal VEG was defined as stasis of liquid barium on less than three of five swallows.ResultsThere were 418 patients included. 231 patients (55%) had a normal VEG, and 187 patients (45%) had an abnormal VEG. In the normal VEG group, only 2/231 (0.9%) patients had both abnormal DCI and PPS, 1/231 (0.4%) patients had both abnormal DCI and MWA and no patients had both abnormal MWA and PPS. There were no patients with achalasia or absent contractility and 1 patient with ineffective esophageal motility (IEM) in the normal VEG group. This was significantly different from the abnormal VEG group which included 4 patients with achalasia, 1 with absent contractility and 22 with IEM (p < 0.0001). The negative predictive value of VEG was 99.6% and the sensitivity was 96.4%.ConclusionsA normal videoesophagram reliably excluded the presence of clinically significant esophageal dysmotility that would alter surgical planning. Routine manometry is not warranted in patients with normal videoesophagram, and should be reserved for patients with abnormal VEG.