Saleh M. Aldaqal

Prevalence and Desire for Body Contouring Surgery in Postbariatric Patients in Saudi Arabia

Background: Morbid obesity has become a common problem worldwide and as a result the demand for bariatric surgery has increased as well. Most patients develop skin redundancy and sagging at many body parts after major weight loss procedures which increased the demand for body contouring procedures. Aims: The study was to address the prevalence and patients desire for body contouring procedures. Materials and Methods: A cross-sectional study targeting the postbariatric patients from April 2011 to October 2011 was conducted at our hospital. Questionnaire was administered in order to measure frequency and patients desire to undergo body contouring surgery after massive weight loss. Results: The total number of patients was 128 patients. The mean age of our patients was 37-year old (range 18-56 year). The percentage of the desire for body contouring surgery after bariatric surgery was 78.1%. There was very pronounced desire to body contouring surgery after those who underwent gastric bypass surgery with P-value 0.001. Only 18 patients (14%) have underwent body contouring surgery, with a total of 29 procedures, in which abdominoplasty considered the most commonly procedure performed (57%). Conclusion: With the increasing number of weight loss surgery, there is higher number of patients that desire a body contouring surgery, which create huge disparity between demand and accessibility.

Post‑Bariatric Surgery Satisfaction and Body‑Contouring Consideration after Massive Weight Loss

Background: Following a bariatric surgery and massive weight-loss, the outcome is usually sullied by consequences on the bodys contour and redundant skin. Aims: We aimed to record the frequency of contour irregularities and quantify patients’ satisfaction with appearance and anticipations from body contouring surgery. Materials and Methods: The ethical committee at King Abdulaziz University Hospital approved the study, and patients were consented. A cross-sectional study targeting the post-bariatric patients from May 2011 to April 2012 was conducted at our hospital. We used post-massive weight loss Satisfaction Questionnaire. Results: The total numbers of patients were 64 (51 women and 13 men), of which 57 patients (89.2%) developed sagging skin. Most patients were dissatisfied with their appearance after weight loss. The most common zones were the upper arms (50%) and abdomen (45%). Considerably more women (36.2%) than men (24%) were dissatisfied with certain body areas. The most noticeable expectation of patients from body contouring surgery was improved cosmetic appearance (65.6%) and self-confidence (64.1%). More women (70.58%) than men (46.15%) expected a better cosmetic appearance after body contouring (P = 0.003). Conclusion: After bariatric surgery, sagging excess skin is an unsatisfactory problem. Therefore, body contouring surgery must be included in morbid obesity management.

Self-esteem and quality of life in adolescents with extreme obesity in Saudi Arabia: the effect of weight loss after laparoscopic sleeve gastrectomy

OBJECTIVES To evaluate the self-esteem and quality of life in adolescents with extreme obesity before and one year after laparoscopic sleeve gastrectomy as obesity is a major challenging medical problem, not only in adults but also in children and adolescents in Saudi Arabia. METHODS In a prospective cohort study, 32 adolescents (aged 13-17 years) with extreme obesity (Group 1) presenting for laparoscopic sleeve gastrectomy (LSG) were compared with 32 matched, healthy, nonobese adolescents (aged 14-17 years) (Group 2) with regards to self-esteem and quality of life. Assessment was done using the Rosenberg Self-Esteem Scale and Pediatric Quality of Life Inventory version 4.0 (self- and parent report), respectively. Body mass index (BMI) Z scores were calculated for both groups. RESULTS We found significantly poor self-esteem and impairment in all domains of quality of life (self- and parent report) in Group 1 compared with Group 2 (P<.001). Self esteem and quality of life (self- and parent reports) significantly improved 1 year after LSG (P<.001), and the weight loss induced by LSG, reflected by a decrease in BMI Z scores, was a significant predictor for the improvement in self-esteem (R2=0.28 and P=.003) and quality of life (R(2)=0.67 and P<.001). CONCLUSION LSG was found to be a safe and effective operation in adolescents with extreme obesity: LSG leads to weight loss, with subsequent improvement in self-esteem and quality of life.

The attitude and perception of breast reconstruction by general surgeons in Saudi Arabia.

BACKGROUND AND OBJECTIVES Post-mastectomy breast reconstruction surgery had always been integral part in the approach to a patient with breast cancer. It is our aim of this study to report in a simplistic manner the variability in the perception and practice by surgeons surrounding breast reconstruction. DESIGN AND SETTINGS This is a descriptive cross-sectional survey targeting a sample of general surgeons in 6 tertiary hospitals in Saudi Arabia from April 2012 to October 2012. METHODS A questionnaire adopted from the one designed by Spyrou et al was distributed to our sample of surgeons. It primarily focused on the surgeon’s attitude and perception of breast reconstruction surgery after mastectomy. RESULTS A total of 51 general surgeons were included in the study. Most of them, 24 (47.1%), worked in teaching hospitals. Thirty-six (70.6%) surgeons had a special interest in breast cancer management. Eighteen of them (35.5%) referred their patients for breast reconstruction. We observed that the surgeons of high-referral tendency were generally females (P=.016). More than half (33 [64.7%]), thought that a general surgeon is the one responsible for counseling patients. The majority (47%), disagreed with the notion that breast reconstruction can interfere with host defenses. Yet, (76.5 %) were concerned about masking local recurrence of the cancer, and 21 (41.2%) reported that patients refused such type of surgery. Forty-eight (94.1%) agreed that breast reconstruction has psychological benefits. CONCLUSION In Saudi Arabia, general surgeons have a high concern about masking local recurrence of the cancer despite the lack of evidence in the published reports. Nevertheless, less than half of the surgeons referred their cases for breast reconstruction. We recommend establishing national efforts to educate on the benefits of breast reconstruction and establish a tumor conference protocol on breast reconstruction including all involved specialties (oncologists and general and plastic surgeons).

Recurrent intestinal perforations as a presentation of antiphospholipid syndrome.

Ann Saudi Med 2006;26(1):52-55 Antiphospholipid syndrome (APS) is a rare but important cause of thrombosis. It is suspected in patients who present with recurrent thrombosis or thrombosis in an unusual site. Gastrointestinal involvement is rare in this syndrome. Moreover, intestinal perforation in APS is very rare. We report a 19-year-old female patient who developed recurrent spontaneous intestinal perforations in which repeated laparotomies were undertaken and different diagnoses were entertained. The patient had received different treatments but without improvement. Antiphospholipid syndrome (APS) was suspected and diagnosed, and subsequently anticoagulant therapy was started. To our knowledge, this is a first report describing recurrent small intestinal perforation in a patient with APS.

Abnormal Anatomical Variations of Extra-Hepatic Biliary Tract, and Their Relation to Biliary Tract Injuries and Stones Formation

Background To determine the most common abnormal anatomical variations of extra-hepatic biliary tract (EHBT), and their relation to biliary tract injuries and stones formation. Methods This is a retrospective review of 120 patients, who underwent endoscopic retrograde cholangiopancreaticography (ERCP) and/or magnetic resonance cholangiopancreaticography (MRCP), between July 2011 and June 2013. The patients’ ERCP and MRCP images were reviewed and evaluated for the anatomy of EHBT; the medical records were reviewed for demographic data, biliary tracts injuries and stones formation. Results Out of 120 patients, 50 were males (41.7%) and 70 were females (58.3%). The mean age was 54 years old (range 20 - 88). Abnormal anatomy was reported in 30% (n = 36). Short cystic duct (CD) was found in 20% (n = 24), left CD insertion in 5% (n = 6), CD inserted into the right hepatic duct (RHD) in 1.7% (n = 2), duct of Luschka in 3.33% (n = 4) and accessory hepatic duct in also 3.33% (n = 4). Biliary tract injuries were reported in 15% (n = 18) and stones in 71.7% (n = 86). Biliary tract injuries were higher in abnormal anatomy (P = 0.04), but there was no relation between abnormal anatomy and stones formation. Conclusion Abnormal anatomy of EHBT was found to be 30%. The most common abnormality is short CD followed by left CD insertion. Surgeons should be aware of these common abnormalities in our patients, hence avoiding injuries to the biliary tract during surgery. The abnormal anatomy was associated with high incidence of biliary tract injury but has no relation to biliary stone formation.

Effect of Bougie Size and Level of Gastric Resection on Weight Loss Post Laparoscopic Sleeve Gastrectomy

Objectives: To study the effect of bougie size and level of gastric resection on the outcome of laparoscopic sleeve gastrectomy (LSG) in morbid obese patients. Methods: A prospective randomized trial on 90 patients with morbid obesity who underwent LSG between February 2010 and April 2012. The Patients were prospectively randomized into two groups, the first group in which a bougie size of 34 French was used and resection of the stomach was performed 4 cm from pylorus. In the second group, a bougie size of 36 French was used, and resection of the stomach was performed 6 cm from the pylorus. A comparison between the two groups was carried out by assessing percentage of excess weight loss (%EWL), mean body mass index changes (mean BMI) at 6 months and one year post-operative, and complications of surgery . Results: Out of 45 patients in first group, 15 were males (33.3%) and 30 were females (66.7%), mean age was 31.3 years and mean BMI 46.1 kg/m2 (range 40-55.6). out of 45 patients in second group, 14 were males (31.2%) and 31were females (68.8%) with mean age of 32.3 years and mean BMI 45.4 kg/m2 (range 40-56). Six months after LSG, the %EWL in first group was 79% while in second group was 68% (P-value=0.011), and the mean BMI change was 10.1 kg/m2 (range 5-11) and 8.3 kg/m2 (range 4-9) respectively (P-value=0.009). One year after LSG, the %EWL in first group was 84% while in second group was 76 % (P-value=0.015), and the mean BMI change was 14.3 kg/m2 (range 7-15) and 11.2 kg/m2 (range 5-13) respectively (P-value=0.012). In both groups, the duration of operative time, bleeding, gastric leak, Intensive care unit admission, and hospital stay were similar in which statistically insignificant (p-value>0.05). Conclusion: Using bougie size 34fr and gastric resection at 4cm from the pylorus is safe and results in greater weight loss and higher change in BMI.

A New Technique in Management of Pilonidal Sinus, a University Teaching Hospital Experience

This paper evaluates a new technique that can lead to excision of pilonidal sinus with less healing time and low recurrence rate. A prospective randomized double-blind controlled study on 142 patients with pilonidal sinus conducted during the period from September 2008 to March 2012. The patients were prospectively randomized to be operated with one of four surgical techniques, excision and primary closure, or excision after using hydrogen peroxide (H202) and primary closure, or excision without closure, or excision after injection of H202 without closure. The main outcome measures were the healing time and the recurrence rate. Out of 142 patients, 118 patients were males (83%), and 24 were females (17%). The mean age was 24.5 years. The recurrence rate in patients treated with excision after injection of H202 without closure was the lowest (1.8%) with P-value < 0.005, and the mean duration of healing was 30.7 days with P-value < 0.005. We recommend using excision after injection of H202 without closure in management of PNS. Injection of H202 into the pilonidal tracts can give a precise delineation of the affected tracts, which can be excised with minimal amount of surrounding normal tissues and hence lead to a quicker recovery and low recurrence rate.

Management of Postoperative Gastrointestinal Leakage With Autologous Stromal Vascular Fraction

To assess the efficacy of using autologous stromal vascular fraction (SVF) to promote healing of controlled fistula tracts in the management of postoperative upper gastrointestinal leakage. This is an experimental study conducted on 10 experimental rabbits. Animal models were divided into the SVF group which received an autologous SVF and the control group which did not receive the implantation. Surgery was performed on both groups to induce a gastric leak and create a controlled fistula tract between the leakage site in the stomach and the skin. After 2 weeks, surgery was performed on the SVF group to harvest, process and then implant the autologous SVF in the fistula tract. Animal models were followed up and their fistula tracts were evaluated for healing by gross and microscopic examination of the fistula tracts before the SVF implantation and at 24 hours, 1 week, 2 weeks and 3 weeks after implantation. The control group revealed no closure of fistula tracts by the 3(rd) week after implantation and there were no signs of inflammation or drainage. On the other hand, the SVF group showed signs of healing process with progressive closure of the fistula tract to about 95% by the 3(rd) week after implantation. The use of autologous SVF implantation to promote the healing of controlled fistula tracts seems to be a novel, safe and effective method in the management of postoperative upper gastrointestinal leakage. It could prevent reoperation and reduce hospital stay, morbidity and mortality. These results are promising and provide support for further clinical studies.

Prevalence, causes, and outcome of non-diagnostic amylase in acute pancreatitis: A single institution experience

Objectives: To determine the prevalence, common causes, and outcome of non diagnostic amylase in acute pancreatitis. Materials and Methods: The data of 81 patients was looked at retrospectively. This was extracted from the patients records with the diagnosis of acute pancreatitis from June 2010 to June 2012. These patients were admitted to King Abdulaziz University Hospital. The data included demographics, amylase level, causes and outcome. Two groups were devised group 1, non diagnostic amylase, and group 2, diagnostic amylase. Results: Out of 81 patients, 33(41%) were males, and 48(59%) were females. Age ranging from 24-75 years with a mean age of 49. Only 10(12%) of the patients were found to have amylase that is not raised up to the diagnostic level. Gallstones were the commonest cause in both groups, while hyperlipidemia was higher in group 1(20%), than group 2(8.5%). Idiopathic in 40% and 14% in group 1 and 2 respectively. Post ERCP acute pancreatitis was only seen in group 2(8.5%). The outcome was indicated by; pseudocyst which was not present in both groups, necrosis which was only present in group 2 in 4%, Intensive care unit (ICU) admission was seen in 20% of group 1 patients due to delay in diagnosis, and in 4% of group 2 due to necrosis, and mortality was absent in both groups. Conclusion: Prevalence of acute pancreatitis in non diagnostic amylase is found to be 10%. The most common cause after gallstones is idiopathic together with hyperlipidemia. The outcome is usually favorable provided the diagnosis is not delayed.