British Journal Of Surgical Science

How I do it Afferent loop obstruction (ALO) with hyper-amylasemia and deranged liver function test , are we going to see this complication more frequently again? Emergency conversion of One anastomosis gastric bypass (OAGB) to a Roux-en-Y Gastric bypass (

2023-11-25T11:39:38-08:00

Abstract

Afferent loop syndrome is a known complication of gastric surgery specifically after Billroth II and to a lesser extent a Roux –en-Y reconstruction. However the incidence decreased over the years proportionally with the decrease in the number of gastric surgery.

Afferent loop syndrome can be either acute or chronic with different presentation and treatment options. The acute type can occur early post operatively or it could be delayed presentation. Acute ALS is associated with complete closed loop obstruction and considered a surgical emergency, whereas chronic ALS is mostly related to partial obstruction of the afferent loop.

This rare complication can occur after the single anastomosis gastric bypass (Omega loop bypass) as it is a type of Billroth II reconstruction of gastric pouch –jejunostomy.

With the increase in the number of SAGB performed all over the world as weight reduction surgery for morbidly obese patient s surgeons should be aware of this complication and the treatment options.

One Anastomosis Gastric Bypass is an acceptable version of Gastric Bypass

2023-12-28T03:46:16-08:00

The Roux-en-Y gastric bypass (RYGB) has been considered a gold standard procedure in bariatric surgery for many years and yet there is no definite standardisation¹.

RYGB has a small gastric pouch, different biliopancreatic limb lengths, Roux limb [alimentary limb] and the common channel. Standardization of the procedure is suggested in the 2019 Bhandari et al study². It suggested <30mls gastric pouch capacity, the total length of BPL and the Roux limb is 200cm with each limb could be 50-150cm. There was no mention of the common channel length.

The proximal RYGB with short BPL is expected to be associated with an increasing risk of failure, weight regain and relapse of the comorbidities, while the distal type is associated with severe hypoproteinaemia, malnutrition, liver failure and increasing risk of mortality, but superior efficacy³. The adjustment of the BPL and bypassed intestinal length is the safety and efficacy key factor for both OAGB and RYGB.

A pragmatic study of Porcine Acellular Dermal Matrix Mesh in Ventral and Parastomal Hernia repairs. Evaluation of outcomes from a tertiary centre.

2023-07-14T11:11:33-07:00

Aims and Objectives: Incidence of complex ventral hernias and those with contamination are increasing. Synthetic meshes are not favoured due to increased risk of wound complications. Biologic meshes are used as an alternative given their biocompatible safety, but, there is lack of strong evidence to recommend its routine use. Hence, it is up to institutions to evaluate the safety and efficacy to support its continuing usage, which is the basis of this study.

Methods: A retrospective review of a prospectively maintained PADM mesh database was performed focussing on midline and parastomal hernias. Demographic data, surgical techniques and short- and long-term complications were reviewed.

Results: 71cases, (acute/elective 10/61) were included. The median age group, sex ratio in the acute and elective groups were 67 years (36-83yrs) and 62years (25-93yrs), 2:1 and 4:3 respectively. Mean ASA score was 3.4 in acute and 2.4 in elective group. Midline hernias constituted 37/ 61 (60%) and Parastomal hernias, 40% (24/61). Component separation was performed in 29 cases, which includes bilateral anterior component separation in 16, unilateral anterior component in 11 and posterior component separation in 2. Median length of stay was 11days (1-180d) and 15 days (1-159d) in the elective and acute groups respectively. Median length of follow up was 18 months (12 -72 months). There were 5 deaths within 90 days. Recurrences were noted in 6/37 (16%) midline repairs and 8/24 (33%) parastomal hernias.

Conclusion: Our limited PADM series showed acceptable results in comparison with available studies. As such we find it a useful adjunct in the repair of complex ventral hernias.

The Biliary Drainage For Sepsis Control In Acute Cholangitis: A Case Report

2023-08-10T21:50:14-07:00

Acute cholangitis leading to sepsis is a common occurrence, especially in populations with a high
prevalence of gallstones. Unfortunately, the mortality rate related to this issue is high. Recently,
we had a case involving an elderly woman who initially had mild acute cholangitis, but it progressed
into a severe case. Respiratory and hematological issues developed, along with worsening septic
parameters and liver functions. As a result, she was intubated, ventilated, and monitored in the
intensive care unit (ICU). Urgent ERCP failed, but PTBD and percutaneous cholecystostomy were
inserted to aid in biliary decompression and sepsis control. Currently, she is recovering from
sepsis and plans for early ERCP and cholangiogram before definitive surgical intervention. To
handle obstructed biliary sepsis, early biliary drainage is crucial for urgent biliary decompression
and sepsis control, alongside fluid resuscitation, intravenous antibiotics, and intensive care.

The Unfortunate Event - Extramedullary Myeloma Of The Urinary Tract

2023-04-24T06:53:02-07:00

Extramedullary disease is an uncommon manifestation of multiple myeloma (MM). It can present de-novo or develop as a result of disease progression or relapse. We present a rare case of extramedullary myeloma (EMM) of the urinary tract in a 65-year-old gentleman.

The incidence of EMM is ~13% of the MM population with a higher predilection for males in the fifth decade. The common sites for EMM were lymph nodes, skin, and soft tissue, however, involvement of the urinary tract is exceedingly rare. Despite the combination of chemotherapy, radiotherapy, the novel agents of immunomodulators, proteosome inhibitors, and consolidative autologous hematopoietic stem cell transplantation, the relapse rate is relatively high. In conclusion, the prognosis of patients with EMM is poor and currently, the optimal treatment strategy for this subset of patients is still debatable.