Nik Ritza Kosai

Laparoscopic preperitoneal mesh repair using a novel self-adhesive mesh

Prosthetic mesh is now used routinely in inguinal hernia repairs, although its fixation is thought to be a potential cause of chronic groin pain. The Parietene ProGrip™ (TYCO Healthcare) mesh, which is semi-resorbable and incorporates self-fixing properties, has been shown to provide satisfactory repair in open surgery. We describe the use of this mesh in TAPP hernia repair, which has not previously been reported in the literature. A prospective study of 29 patients showed a mean operative time to be 47.6 min, with 96% of patients discharged home on the day of surgery or the day after. Visual analog pain scales (out of 10) reduced from 4 preoperatively to 0 at 6 months, and only 1 patient suffered a minor wound complication. The use of this mesh in transabdominal preperitoneal hernia repair is therefore feasible, safe, and may reduce postoperative pain.

Single incision laparoscopic bariatric surgery: challenging the conventional

Sleeve gastrectomy has gained popularity over the years and is commonly performed laparoscopically through multiple small incisions. The arrival of single incision laparoscopic surgery has been a game changer, allowing for sleeve gastrectomy to be performed through a cosmetically more appeasing scar with improved patient satisfaction. In this article, we describe the history, technical challenges, proposed solutions to some of the hurdles faced during single-incision laparoscopic bariatric surgery and highlight our method of performing single incision laparoscopic sleeve gastrectomy purely through a single access device.

Surface Antigen Profiling of Helicobacter pylori-Infected and -Uninfected Gastric Cancer Cells Using Antibody Microarray

Comprehensive immunophenotyping cluster of differentiation (CD) antigens in gastric adenocarcinoma, specifically between Helicobacter pylori‐infected and ‐uninfected gastric cancer patients by using DotScan™ antibody microarray has not been conducted. Current immunophenotyping techniques include flow cytometry and immunohistochemistry are limited to the use of few antibodies for parallel examination. We used DotScan™ antibody microarray consisting 144 CD antibodies to determine the distribution of CD antigens in gastric adenocarcinoma cells and to elucidate the effect of H. pylori infection toward CD antigen expression in gastric cancer.

History and Progress of Bariatric Surgery in Malaysia

Bariatric surgery has become a popular treatment modality for obesity in Malaysia. However, the absence of a standardized national registry has led to paucity of information pertaining to quantity and quality of bariatric surgery in Malaysia. In the absence of a national registry, a nationwide survey was conducted with the aim of establishing a fair estimate of case volume based on type of procedure and to identify the total number of surgeons performing those procedures at their respective centers from 1st January 2010 to 31st December 2016. For this purpose, a questionnaire was designed and distributed to bariatric surgeons throughout Malaysia. The data along with a brief narrative of the history and progress of bariatric surgery in Malaysia is presented in this report.

A randomised controlled trial comparing the use of omega-3 polyunsaturated fatty acid supplements versus very low calorie dietary restriction in obese Malaysian patients awaiting bariatric surgery

Background: A large liver can be a bariatric surgeon’s nightmare as it interferes with the operative field particularly during posterior fundal and hiatal dissection. Various methods have been employed to achieve hepatic volume reduction (HVR) prior to surgery. This study aims to compare the effect of ome-ga-3-polyunsaturated fatty acid (PUFA) supplements and very low calorie diet (VLCD) restriction on hepatic volume. Methods: A total of 52 obese patients were randomized into two groups. For various reasons only 41 patients were included for final analysis; VLCD group (n=20) and omega-3-PUFA group (n=21). MRI vo-lumetry of liver, weight, and serum alanine transaminase (ALT) levels were measured at enrollment and again at 4 weeks. Results: Mean HVR of VLCD group and omega-3-PUFA group at day-30 was 37.10±15.76 and 34.88±9.99 cm3. Comparative analysis of HVR between the two groups showed no statistical dif-ference (P=0.29). Similarly there was no statistical difference in ALT levels of both groups. Significant weight loss (kg) was noted in both VLCD and omega-3-PUFA group, measuring up to 2.21±2.29 and 2.85±4.62, although no sta-tistical difference was noted when compared between the two (P=0.58). Conclusions: Pre-operative hepatic volume and weight reduction were noted in both groups with no superiority of one modality over the other. As dietary restriction is often confronted with non-compliance, omega-3-PUFA does appear to be a more attractive alternative. A larger study including cost effec-tiveness analysis may be able to further ascertain the economic impact and feasibility of pre-bariatric surgery ome-ga-3-PUFA supplementation in a developing economy such as Malaysia.

Platelet changes in healthy male smokers.Scientific views

[No Abstract Available] Saudi Med J 2015; Vol. 36 (12): 1501 doi: 10.15537/smj.2015.12.12885

Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction.

Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)-associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.

A CASE OF CLOSED LOOP SMALL BOWEL OBSTRUCTION WITHIN A STRANGULATED INCISIONAL HERNIA IN ASSOCIATION WITH AN ACUTE GASTRIC VOLVULUS

Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.