Waleed Al-Khyatt

Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review

IntroductionAn internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias.MethodsA literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH).ResultsIn Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 – 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH.ConclusionIntestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.

LRYGB: The Hand-Sewn Technique

Laparoscopic Roux-en-Y gastric bypass (LRYGB) results in sustained long-term weight loss and reduced mortality. Several techniques have been described to perform this procedure. In this chapter, the technical steps and tips of performing a supracolic retrocolic hand-sewn LRYGB (LRYGB-HS) approach are described.

Selective oestrogen receptor antagonists inhibit oesophageal cancer cell proliferation in vitro

BackgroundOestrogen receptors (ER) have a well-established role to the initiation, progression and regulation of responses to treatment of breast, prostate, and lung cancers. Previous data indicates altered ER expression in oesophageal cancers (OC). However the role of ER subtypes and ER specific inhibitors in the regulation of OC progression remains unclear. This study sought to assess levels of ERα and ERβ in OC. The effects of highly selective ER antagonists on cell proliferation and apoptosis in two OC adenocarcinoma cell lines was also studied.MethodsERα and ERβ expression profiling in paired normal oesophageal mucosa and tumour tissues (n = 34; adenocarcinoma n = 28; squamous cell carcinoma n = 6) was performed using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Correlation between levels of ER with the clinico-pathological features for OC was determined. The effect of selective ER antagonists on proliferation of OE33 and OE19 OC cell lines was studied.ResultsERα and ERβ mRNA expression was significantly higher (p < 0.05) in tumour tissues relative to their paired normal mucosa and correlated inversely with survival outcome (p < 0.05). Upregulation of ERα mRNA correlated with higher pathological T-stage (p < 0.05) and lymph node metastasis (p < 0.05) while ERβ mRNA upregulation correlated with positive vascular invasion (p < 0.05). A significant concentration-dependent inhibition of proliferation in OE33 and OE19 cell lines was induced by a highly-selective ERα antagonist (MPP) and an ERβ specific antagonist (PHTPP) (p < 0.05). Moreover, anti-oestrogens induced cell death through stimulation of apoptotic caspase activity.ConclusionThese findings indicate that the ER system is involved in OC progression and thus may provide a novel target for the treatment of OC.

Upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease in obese patients

Aim: The marked increase in prevalence of obesity has been associated with an increase in obese patients seeking surgical treatment for refractory gastroesophageal reflux disease (GORD). The management of GORD in such patients remains contentious with no published guidelines. Methods: A snapshot 9-item online survey was undertaken to elicit professional opinions of UK surgeons regarding the surgical management of refractory GORD in obese patients. Results: Eighty-two percent and 51% of surgeons performed more than 10 anti-reflux procedures and more than 10 bariatric procedures per year, respectively. Nearly 80 of responders would consider laparoscopic fundoplication as the preferred option for management of refractory GORD in patients with body mass index (BMI) of 30-34.9 kg/m. In contrast, 58% and 80% would discuss bariatric surgery as an alternative treatment option for refractory GORD in patients with BMI 35-39.9 and ≥ 40 kg/m, respectively. Moreover, a bariatric procedure was considered the preferred option by 74% of respondents for patients with BMI ≥ 40 kg/m with refractory GORD, and by 58% for BMI ≥ 35 patients with refractory GORD and significant comorbidities. Eighty percent of surgeons agreed that laparoscopic Roux en-Y gastric bypass (LRYGB) was the preferred bariatric procedure for the management of obese patients with documented GORD. Conclusion: Our survey demonstrated that amongst UK upper gastrointestinal surgeons, bariatric surgery, specifically LRYGB, was a preferred option for management of patients with a BMI ≥ 35 kg/m and refractory GORD. Updated national guidelines are necessary to inform consensus on the management of GORD in obese patients.

Gastro-Oesophageal Reflux Disease and Obesity: Pathophysiology and Putative Treatment

Both gastro-oesophageal reflux disease (GORD) and obesity have been witnessing a substantial parallel increase in their prevalence over the last few decades. Several epidemiological and pathophysiological studies have reaffirmed the causal association between high Body Mass Index (BMI), especially visceral fat, and GORD and their resulting complications. In this chapter, we discuss the possible underlying pathophysiological mechanisms underlying GORD in obese patients and review available putative treatment.

Predictors of inadequate excess weight loss 12-months after laparoscopic Roux en-Y gastric bypass for morbid obesity.

conducted at seven U.S. sites implants (Dec. 2007 t0 May 2008), and study II included 576 participants at 16 US sites (Aug, 2009 to March, 2011). All were private practices with only 1 practice participating in both studies. At the time of closing out data collection, trial I was complete and 5-year data on all participants available; and for trial II, all had completed 3 years, so only data to 3 years was included. Explants were defined as removing the LB without simultaneous replacement. Results: Yearly explant numbers and rates are presented for both studies for 3 years and study I for years 4 and 5. (See Table) ** Of the 9 in year 5, 7 were from one practice where patients were offered free removal of the LB at the end of the study. All 7 were performed in relation to the study end and several of these in the months following study closure but were planned within the study period. Conclusions: Explant rates in both studies are similar and much lower than the 32.5% safety signal at 5 years. This report reflects the literature from practices using LAGB surgery and mirror the change with time reported in these practices. There have been changes in band design, placement technique and adjustment practices, all of which may have contributed to the major fall in LB explants. UPLOAD-203147-_Laparoscopic adjustable gastric band explanation rates have varied greatly in the literature.pdf