Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery.

Background/aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT). Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively) because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery.

First Virtual Live Conference in Healthcare.

Background: Conferences and meetings bring together thousands of doctors from diverse locations. However, the traveling, accommodation, and arrangement of venues for conferences and meetings are expensive and a lot of time needs to be devoted to these logistics. The purpose of this article was to present our own virtual live conference experience using web conferencing and to briefly outline the basics and advantages of this technology in organization of healthcare conferences.

Predictors of outcome after reconstructive hepatico-jejunostomy for post cholecystectomy bile duct injuries.

Introduction: Reconstructive hepatico-jejunostomy is recommended for major bile duct injuries (BDIs) during cholecystectomy. Complications of biliary leak, cholangitis, bleeding, anastomotic strictures and biliary cirrhosis remain a major concern affecting a patient's outcome after surgery. The aim of this study was to analyse the results of surgical repair of major BDIs at our institution and identify predictors for the development of major complications.

Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years.

Introduction: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure.

Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed 'standalone' bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution.

Preliminary Evaluation of Acoustic Radiation Force Impulse Shear Wave Imaging to Detect Hepatic Fibrosis in Morbidly Obese Patients Before Bariatric Surgery.

Background And Aims: Acoustic Radiation Force Impulse (ARFI) shear wave imaging is a noninvasive method of assessment of the liver to detect fibrosis in patients with chronic hepatitis and nonalcoholic fatty liver disease (NAFLD). The aim of this retrospective study was to investigate whether noninvasive measurement of shear wave velocity (SWV) by ARFI shear wave imaging has a potential usefulness for detection of fibrosis secondary to NAFLD in patients with morbid obesity.

Methods: Twenty-eight morbidly obese patients were included in this study.

Unexpected benign histopathology after pancreatoduodenectomy for presumed malignancy: accepting the inevitable.

Background: Differentiating malignant and benign disease in the pancreatic head and periampullary region is difficult. The aim of this retrospective study was to analyze patients with unexpected "benign" disease after pancreatoduodenectomy (PD) to evaluate the incidence, possible discriminating factors, and outcome. The role of preoperative pathology interpretation in diagnosing malignancy was also assessed.

Laparoscopic Undo of Fundoplication with Roux-en-Y Gastric Bypass in a Morbidly Obese Patient with Prior Nissen's Fundoplication: A Video Report.

Background: Roux-en-Y gastric bypass (RYGB) may be a better option for morbidly obese patients with gastroesophageal reflux (GERD) for long-term reflux control. It is recommended after fundoplication if a patient is morbidly obese with GERD with failed fundoplication or if bariatric surgery is planned with a prior successful fundoplication (Kim et al., Am Surg 80(7):696-703, 2014; Kambiz Zainabadi, Surg Endosc.

Management of Type 1 Late Sleeve Leak with Gastrobronchial Fistula by Laparoscopic Suturing and Conversion to Roux-en-Y Gastric Bypass: Video Report.

Background: Gastrobronchial fistula (GBF) is a rare but serious complication after laparoscopic sleeve gastrectomy (LSG). It commonly appears sometime after the primary LSG. (Alharbi Ann Thorac Med.

Concomitant Bariatric Surgery with Laparoscopic Intra-peritoneal Onlay Mesh Repair for Recurrent Ventral Hernias in Morbidly Obese Patients: an Evolving Standard of Care.

Background And Aims: Repair of recurrent ventral hernias (RVHs) has a high failure rate more so in the presence of obesity. The chronic increase in intra-abdominal pressure (IAP) associated with obesity might, in part, be an important implicating factor that needs to be addressed in these patients. Laparoscopic ventral hernia repair (LVHR) done with concomitant bariatric surgery in morbidly obese patients with RVHs may avoid multiple failures.

Management of Type 2 Late Sleeve Leak by Laparoscopic Suturing and Conversion to Roux-en-Y Gastric Bypass: Video Report.

Background: Laparoscopic sleeve forming gastrectomy (SFG) is a commonly performed bariatric procedure for the surgical management of morbid obesity. Staple line gastric leaks occur infrequently but are the most feared complication causing prolonged morbidity (Burgos et al., Obes Surg 19(12):1672-7, 2009; Márquez et al.

The effect of surgically induced weight loss on nonalcoholic fatty liver disease in morbidly obese Indians: "NASHOST" prospective observational trial.

Background: Surgically induced weight loss improves nonalcoholic fatty liver disease (NAFLD) in morbidly obese Caucasian patients. Similar data are lacking from India.

Objective: To compare the histologic features of NAFLD in morbidly obese Indian patients before and 6 months after bariatric surgery.

Role of intraoperative frozen section for assessing distal resection margin after anterior resection.

Background And Aims: The use of neoadjuvant long-course chemoradiotherapy (LCRT), shorter distal safety margins (DSMs) and stapled or intersphincteric resections has increased sphincter preservation rates. While intraoperative frozen section (IOFS) is not mandatory, it helps achieve negative distal resection margins (DRMs). Our aim was to audit the role of IOFS for DRM assessment while performing sphincter-saving rectal surgery and to identify those subgroups that would benefit the most from IOFS analysis.

Diagnostic Yield and Clinical Implications of Preoperative Upper Gastrointestinal Endoscopy in Morbidly Obese Patients Undergoing Bariatric Surgery.

Background And Aims: Upper gastrointestinal (UGI) endoscopy in patients undergoing bariatric surgery is controversial. It is recommended routinely by some authors to detect benign or malignant pathology that mostly remains asymptomatic. Others recommend selective use, suggesting not much impact on surgical management of detected pathology, especially in asymptomatic patients.

Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery.

Background: Numerous studies worldwide have identified a high prevalence of non-alcoholic fatty liver disease (NAFLD) among morbidly obese subjects. Several predictors have been found to be associated with NAFLD and its histological high-risk components. Similar data from India is lacking.

Sporadic giant mesenteric fibromatosis.

Mesenteric fibromatosis is an uncommon tumour which is locally aggressive without any metastatic potential and can occur as a sporadic event or in association with familial adenomatous polyposis syndrome. Giant mesenteric fibromatosis is very rare and is a diagnostic and therapeutic challenge. This is a case report of a rare presentation of deep fibromatosis as a sporadic giant intrabdominal mesenteric tumour in a 29 year old male managed by surgical excision and definitive diagnosis made on the basis of immunohistochemical findings.

Implantation metastasis from adenocarcinoma of the sigmoid colon into a perianal fistula: a case report.

Implantation metastasis from a colorectal cancer into a perianal fistula is very rare. Such lesions are commonly mistaken as benign perianal abscesses or fistulas and diagnosed only after pathological analysis of surgically excised fistulas. Once diagnosed, the management of this condition remains controversial.

Torsion of pedunculated accessory liver lobe with acute acalculous cholecystitis.

Accessory lobes of the liver are very uncommon and rarely symptomatic. We report the occurrence of torsion and infarction of a pedunculated accessory lobe of the liver with acute cholecystitis. The speculated possibilities of the coexistent pathologies and its management are discussed.

Three level risk assessment for pancreatic fistula formation after distal pancreatectomy with a strategy for prevention.

Background: Distal pancreatectomy (DP) has a high post-operative morbidity predominantly due to pancreatic fistula though the mortality is very low. Data on distal pancreatectomy was reviewed to analyse the risk factors that contribute to this morbidity.

Methods: Thirty three patients underwent distal pancreatectomy with sutured closure of the remnant, over a 5-year period between May 2006 and April 2011.