There are numerous studies over
the past few decades that reiterate
the positive points of Obesity and
Metabolic Surgery. It’s ability to
provide a relatively more sustainable
weight loss over a longer period of
time, improvement in quality of life
and weight-related comorbidities
namely Type 2 Diabetes Mellitus are
among a few to boast. However, as
with any invasive procedure, Obesity
and Metabolic Surgery is not free of
possible complication risks, the main
reason for which there has been a major
push for improvements in efficacy and
innovation for better and safer surgical
weight loss options. In the era of
“healthcare at your fingertips”, a simple
Google search will be able to enlighten
just anyone on the available options
making it possible for an individual
to “negotiate” or “bargain” with their
surgeon before making a final decision.
The four most well researched and
documented weight loss procedures
are Laparoscopic Sleeve Gastrectomy
(LSG), Laparoscopic Roux-En-Y gastric
Bypass (LRYGB), Biliopancreatic
Diversion (BPD) and Laparoscopic
Adjustable Gastric Banding (LAGB)
(Buchwald et al. 2004). Look a little
closer and you will not be able to turn
away from being a tad bit curious about
a few “new kids on the block” such
as Laparoscopic Mini Gastric Bypass,
Laparoscopic Sleeve Gastrectomy with
Proximal Jejunal Bypass, Laparoscopic
Banded Roux-En-Y Gastric Bypass and
some of the less invasive endoluminal
procedures including a recent FDA
approved percutaneous aspiration
device called Aspire Assist that has
garnered much interest as well as
criticism at the same time (Lee et
al. 2014; Kumar 2016; Forssell &
Norén 2015). Surgeons from all over
the world, their institutions, and the
supporting industry laud the excitement
surrounding innovation in Obesity and
Metabolic Surgery. A sentiment shared
by consumers who perceive “new” as
synonymous with improved.
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.
Keywords: bariatric, cosmetic, laparoscopy, obesity, sleeve gastrectomy
Breast augmentation using silicone implant is a common and popular aesthetic procedure with a high safety profile. Infection of silicone breast implants is a rare clinical entity, with skin commensal organisms often implicated as causative pathogen. Surgical treatment often involves removal of the implant with salvage procedures limited to selected cases. This case highlights a delayed presentation of an infected silicone breast implant presenting as a chest wall abscess 15 years after initial surgery.
Rectus sheath hematoma (RSH) is a rare clinical entity that has been associated with the use of injectable anticoagulant therapy. Although low molecular weight heparin (LMWH) was proven to have a better safety profile than its predecessor, it is not without its own risk of bleeding. The increase in use of self-injectable LMWH in both in-patient as well as out-patient basis warrants greater awareness among health care providers, patients and caregivers regarding the potential risks and identification of possible complications. We present a fatal case of rectus sheath hematoma in an elderly man that occurred following erroneous technique of Dalteparin injection.
The presence of thrombus within the inferior vena cava (IVC) is often a sign of advance hepatocellular carcinoma (HCC). Various treatment methods have been described with variable and inconclusive results. Now, the advancement of endovascular approach offers new possibility as a potential treatment modality. We discuss the removal of tumour thrombus with catheter directed mechanical thrombectomy. IVC tumour secondary HCC was removed by AngioJet® rheolytic system (Possis Medical, Minneapolis, MN, USA) with good result. Further work should be encouraged to explore the prospect of this technique with other treatment modalities.
Right iliac fossa pain can often be misdiagnosed as something sinister or benevolent despite assistance with state of the art imaging techniques. This is particularly more challenging in the female gender whereby the error of managing a right iliac fossa pain may approach forty percent. A 66-year-old lady, ten years post-menopause, presented with a week history of progressively worsening right iliac fossa pain. Malignancy was suspected with a palpable abdominal mass. Computed tomography was suggestive of an abscess collection, but a needle aspirate produced brown faecal material suggestive of a diverticulitis. An exploratory appendisectomy revealed a non malignant appendicular abscess. In conclusion, when clinical and imaging assessments are inconclusive, an exploratory laparotomy for a surgical excision is warranted primarily if malignancy is suspected.
Gastro-peritoneal fistula is a rare but serious complication of laparoscopic sleeve gastrectomy with significant morbidity and mortality. We present the case of a 42-year-old man who underwent laparoscopic sleeve gastrectomy for morbid obesity and presented later with a history of chronic epigastric pain and severe reflux. Upper gastrointestinal series showed the presence of a communicating fistula between the stomach and the left hemi-diaphragm and peri-splenic area.
The diagnosis of aortic dissection in a young adult in the absence of atherosclerosis or prior history of trauma is extremely rare. The presence of more than one arterial dissection site in such a patient is even more unheard of. We highlight a case of spontaneous multiple acute arterial dissections occurring in a 32-year-old male. Stanford B aortic dissection and a separate dissection extending from the bifurcation of the right common iliac artery to the right common femoral artery was noted on computed tomographic angiography (CTA). A small aneurysm of the right subclavian artery was also noted. A two-stage hybrid procedure involving a combination of open and endovascular surgery was employed. The rarity and lethality of this condition warrants a high index of suspicion for early diagnosis and prompt intervention.
Introduction: Laparoscopic fundoplication is performed for the management of symptomatic hiatus hernias and gastro-oesophageal reflux disease (GORD) refractory to medical therapy. We adopted the use of Gore Bio-A® for selected laparoscopic hiatus hernia repairs in 2011 and with this case series aimed to establish whether mesh augmentation affects symptomatic outcomes. Methods: A retrospective review of prospectively collected data from all laparoscopic fundoplications performed by a single surgeon between October 2011 and January 2013 was performed. Patient specific data were entered into a proforma and analysed using Microsoft ExcelTM. Patient reported outcomes were assessed with a system specific quality of life questionnaire (GORD-HRQL) both pre and post-operatively. Results: Twenty-three patients underwent laparoscopic fundoplication during the study period. Gore Bio-A® re-enforcement of the hiatal repair was used in 14 patients and was the preferred option for those with pre-operative evidence of a large hiatus hernia. Whilst overall there was a statistically significant difference between pre and post-operative scores (21 vs 0, p=
Patient positioning is a vital in ensuring patient comfort, dignity and good access to
the operative site. Accurate positioning helps in minimising the risk of injury to the
patient. An in-house airbag made from recyclable medical supplies can be used
to replace the conventional sandbag for head and neck surgeries. It involves the
use of an empty irrigation bottle, a valve and suction tubing. Its shape and volume
is readily adjustable by altering the volume of inflated air. Moreover, compressible
air moulds the bag to the curvature of the patient’s external surface reducing the
risk of pressure sores in prolonged surgery. Ultimately this serves as an innovative technique which is financially savvy with the use of recyclable items.