Reynu Rajan

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.

Metaplastic breast carcinoma with upper limb gangrene

Metaplastic breast carcinomas (MBCs) are rapidly growing tumors with histological heterogeneity, and triple negative receptor status. The aim of this case report is to highlight a case of advanced MBC with axillary artery infiltration leading to gangrene of the ipsilateral upper limb, in a young woman.

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

Laparoendoscopic Transgastric Enucleation of an awkwardly sited Peri-Cardial Gastrointestinal Stromal Tumour (GIST): A Multi- Modal Approach.

In the modern era of surgery, minimally invasive surgery is increasingly applied for excision of gastrointestinal stromal tumors. Site, size and tumor location are important factors that affect the surgical approach and excision. We performed a laparoendoscopic transgastric enucleation of a 4-cm pericardial endophytic gastrointestinal stromal tumor (GIST) using an energy device. The surgery was successful and post-operative recovery uneventful. No tumor recurrence was detected on surveillance gastroscopy. In the safe hands of a well-trained laparoscopic upper gastrointestinal surgeon, pericardial GIST can be enucleated safely by this method. The avoidance of surgical staplers is not only cost-effective, but also reduces the risk of associated complications.