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.
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.
Kateter Vena Cenral boleh tercabut dengan senang daripada tubuh badan.
Artikel ini membincang tiga teknik terperinci yang berinovasi untuk mengelakkan
berlakunya insiden kateter tercabut. Penempatan leher kateter kira-kira 1cm dari
tempat kateter keluar pada bahagian kulit dengan jahitan tambahan di bahagian
leher kateter membantu mencegah insiden kateter tercabut.
We discuss a 48-year old, who presented with upper epigastrium pain associated with early satiety and significant weight loss. Physical examination revealed a thickening and darkening of skins around the skin folds, scalp, back and front of abdomen. A diagnosis of gastro-esophageal junction adenocarcinoma was confirmed by oesophagogastroduodenoscopy (OGDS) and biopsy. The biopsy of the skin lesion revealed a diagnosis of acanthosis nigricans, He underwent a total gastrectomy followed by adjuvant chemo-radiotherapy. Recovery is unremarkable. Interestingly, the skin lesions disappear following our therapy. We believe this may be attributed to the treatment of the malignancy. We highlight the interesting association, pathophysiology and therapy.
Acute abdominal pain in pregnancy remains a surgical conundrum. A 25-year-old primigravid at 29 weeks gestation presented with a two-week history of epigastric pain, nausea and vomiting. She had a distended abdomen consistent with a full term gravid uterus; tender at the epigastric and right hypochondrium suggestive of small bowel obstruction or acute appendicitis. Abdominal ultrasound was inconclusive but abdominal Computed Tomography (CT) suggested small bowel volvulus. An exploratory laparotomy revealed a segmental jejunal volvulus and small bowel diverticulum contributing to the volvulus. A short segmental bowel resection was performed. Histopathology confirmed a Meckel's Diverticulum. The patient recovered well but underwent premature labour 10 days later. Small bowel obstruction secondary to Meckel's diverticulum is rare in pregnancy. In an acute gestational abdomen, clinical examination is key. Radiological imaging may be helpful, whilst surgical intervention is confirmatory and therapeutic in the event of an obstructive volvulus.
Obesity has taken the 21st century by storm, posing negative effects on of the various facades of health, healthcare and global economy. With regards to pulmonary performance, numerous studies have proven the detrimental effects of obesity while reinstating the positive effects of weight loss on overall pulmonary function. However, effects of exercise on pulmonary function and correlation between changes in pulmonary function test with weight loss have yet to be described. We performed a prospective interventional study to determine the effects of regular exercise on Pulmonary Function Tests (PFT) and ascertain the relationship between weight loss and change in PFT in obese patients.
The rise in obesity has fuelled the current debate of its classification as a disease. Contrary to just being a medical condition or a risk factor for other diseases, obesity is a complex disease with multifaceted aetiology as well as its own disabling capacities, pathophysiology, and comorbidities. The problem of obesity in Malaysia is serious and calls for active intervention by all stakeholders ranging from government agencies to insurers and healthcare providers. To aid efforts to curb obesity, this consensus statement for bariatric surgery provides a basis for inclusion and exclusion criteria as well as the types of procedures accepted as the norm in Malaysia. This consensus statement was initiated by the Society of Endoscopic and Laparoscopic Surgeons of Malaysia and was collaborated with representatives from the Ministry of Health Malaysia.
Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare entity first described by Cruveilhier in 1835. There are only approximately 200 cases reported in the English literature to date. Histologically, it may be mistaken for spindle cell neoplasms such as gastrointestinal stromal tumour (GIST). Patients with AIHPS usually present with early satiety, abdominal fullness, postprandial vomiting, epigastric pain, and eructations. Adult intussusception is rare and only accounts for 5% of all intussusceptions. Gastroduodenal intussusception is one of the rare types of adult intussusception. This is more likely to occur when a benign or malignant stomach lesion acts as a lead point. We report a case of AIHPS in a 70-year-old lady presenting with gastroduodenal intussusception. An oesophagogastroduodenoscopy (OGDS) was performed, and it revealed a diffusely thickened and narrowed pyloric antrum. A contrasted computed tomography (CECT) of the thorax and abdomen showed a distended stomach with circumferential thickening of the pylorus. The pre-pyloric antrum was intussuscepting into the pylorus, and the apex is seen within the first part of duodenum. She underwent distal gastrectomy with a Roux-en-y reconstruction via laparoscopic approach and was discharged well. AIHPS is a rare condition and should be a differential in adults presenting with gastric outlet obstruction. We believe in cases of AIHPS presenting with gastroduodenal intussusception, a distal gastrectomy with reconstruction is a reasonable approach. A multidisciplinary approach is essential to obtain the best outcome.