Impact of Ursodeoxycholic Acid on Gall Stone Formation Post Bariatric Surgery

Introduction: Bariatric surgery is identified as highly effective therapy for obesity and help to loss wight that is become important public health priority because it increases the risk of condition including diabetes, cardiovascular disease, and several types of cancer whether by accomplishing mini-gastric bypass, Gastric bypass (Roux-en-Y) and sleeve gastrectomy [1] rapid weight loss increased incidence risk of gall stone formation [2]. Ursodeoxycholic acid is a bile acid which affect a reduction in cholesterol in biliary fluid primary by dispersing the cholesterol and forming a liquid-crystal phase [2], it’s can play a significant role in preventing of gall stone formation. Objective: Study potential effect of Ursodeoxycholic acid (UDCA) on gall stone formation after bariatric surgery. Methods: This study Cross-sectional Trials, review of all patient underwent bariatric surgery November 2021-Jun 2022, Taif Military Hospital in the department of surgery, the sample of study will be around 143 participants or more, data collection all patient underwent bariatric surgery. Results: A Total of 160 patients underwent bariatric surgery in Taif Armed Forces Hospitals from 2015 to 2021. Of these, 53 were male (33.1%) and 107 were female (66.9%). only 33 patients (20.6%) received Ursodeoxycholic acid, and 127 patients (79.4%) weren’t proscribed for them. However, 40 patients (25%) develop gall stone and underwent cholecystectomy, three of them were on Ursodeoxycholic acid (9%) and 37 patients weren’t on Ursodeoxycholic acid (29%). which shows that Ursodeoxycholic acid remarkable reduce the risk of gall stone formation post wight reduction surgery. Conclusion: In conclusion, bariatric procedures come with the risk of leading to the formation of gallstones. This is especially in the stage when a patient experiences rapid loss of weight. This is why a preventive measure is necessary and UDCA have been considered for this purpose. This study has shown that patients who use UDCA are less bound to have gallstone formations.

Laparoscopic Sleeve Gastrectomy Outcomes

Introduction: Sleeve gastrectomy was first defined in 1990 as a part of the duodenal switch procedure with the formation of a narrow stomach tube along the small curvature of the stomach. Later, researchers proposed that Laparoscopic leave gastrectomy (LSG) reduced the risk profile of the duodenal switch procedure in high risk patients. Additionally, LSG was accepted as a rapid single bariatric surgical procedure due to its simplicity and efficacy. The aim of this study was to describe the outcomes of LSG at a single bariatric unit in King Salman North West Armed Forced Hospital (KSAFH), Tabuk, Saudi Arabia. Objective: To compare outcomes of primary LSG regarding pre and post operative sleep apnea, diabetes mellitus (DM), arterial hypertension (HTN), bronchial asthma, female urinary incontinence, infertility, and gastroesophageal reflux (GERD). We will assess our complications according to the Clavein-Dindo classification. We reviewed the medical records of patients who underwent LSG in King Salman Armed Forces Hospital from 1/1/2015 till 31/6/2017. Methods: This retrospective comparative study is performed in the Department of Surgery, KSAFH. All patients are instructed for follow-up at 1 week and 1, 3, 6, 12, 18, 24 months postoperatively. Laboratory tests are requested every 6 months post op. Improvement of Comorbidities assessed post-operatively. Surgical Complications reported according to the Clavein-Dindo classification. Our results were compared with international studies. Inclusion criteria (more than 14 years, morbid obese with BMI > 40 and obese class 11 with comorbidities). Exclusion criteria (less than 14 years, BMI < 35 and BMI < 40 with no medical illness, revisional cases). Results: A total of 127 patients underwent LSG at King Salman Armed Forces Hospital from 1/1/2015 till 31/5/2017. Of these, 40 were male (31.5%) and 87 were female (68.5%). The mean age was 35 years. Comorbidities included diabetes 31 (24.4%),

Laparoscopic versus Open Appendectomy Outcomes

Background: Appendicitis is one of the most common surgical emergencies requiring an appendectomy, with a life-time risk of 6%. The overall mortality rate for open appendectomy (OA) is around 0.3% and morbidity is about 11%. Objective: To compare laparoscopic vs open appendectomy with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission. Methods: This prospective comparative study is performed in the Department of Surgery, North West Aramed Forced Hospital, Tabuk, Kingdom of Saudi Arabia. All patients between 13 and 60 years of age admitted through the accident and emergency (A&E) department with a clinical diagnosis of acute appendicitis and those who completed follow-up are included in the study. All those patients in whom a clinical diagnosis of acute appendicitis was not established or have a palpable mass in the right lower quadrant, suggesting an appendiceal abscess and those who does not give consent are excluded from the study. We reviewed the medical records of all patients who underwent a laparoscopic and open appendectomy in King Salman Armed Forces Hospital, Saudi Arabia from 1/1/2012 to 31/12/2015. Result: A total of 502 patients underwent Appendectomy at King Salman Armed Forces Hospital from 1/1/2012 till 31/12/2015. Of these, 203 were male (40.4%) and 299 were female (59.6%). The mean age was 18 years. Alvarado Score more than 7 in 93% of patients diagnosed with appendicitis. Comorbidities included diabetes 21 (5.56%) and hypertension 7 (1.39%). The mean Body Mass Index (BMI) was 20 kg/m2. 328 patients (65.3%) underwent Open Appendectomy (OA). None of Laproscopic appendectomy(LA) had a conversion. The mean operative time was 76 minutes (44 minutes and 50 minutes for OA and LA, respectively). Mean hospital stay in OA 2 days and one day LA. Eight cases (1.6%) developed seroma (6 cases in OA and 2 cases in LA with rates of 1.2% and 0.4% respectively). Nine patients (1.6%) had wound infection, 8 in OA and one in LA with rate of 1.5% and 0.2% respectively). Four patients (0.8%) develop the hematoma (3 cases in OA and one case in LA with rates of 0.6% and 0.2% respectively). Seven cases of reported appendectomy develop the pelvic abscess (1.4%) (5 cases in OA and 2 cases in LA with rates of 1% and 0.4% respectively). Conclusion: Alvarado Score carries high significance in the diagnosis of acute appendicitis. Laparoscopic appendectomy has improved diagnostic accuracy along with advantages in terms of fewer seroma, hematoma, wound infections, faster recovery, and earlier retention to normal activity but longer operative time.

Parathyroid Surgery Outcome at King Salman Armed Forces Hospital

Introduction: The aim of this study is to review the surgical outcome of parathyroidectomy at one institution over nine years in form of methods of diagnosis, type of surgery, postoperative complications and histopathology findings. Methods: This is a retrospective study from a single institution (King Salman North West Armed Forced Hospital (KSAFH), Tabuk, Saudi Arabia). All cases underwent parathyroidectomy from 1/1/2010 until 31/12/2018 were retrieved from the archives of the department of surgery. Data were extracted from the patients’ charts. They included demographical data, presence of comorbidities, laboratory and radiological investigations, type of surgery, postoperative complications and histopathology findings. Inclusion criteria include patients older than 13 years old. Exclusion criteria include patients younger than 13 years old, hyperparathyroidism cured with medication, patients unwilling to give informed consent and patients with serious underlying medical conditions that restrict diagnostic testing or therapy such as congestive cardiac failure. Results: A total of 30 patients underwent parathyroidectomy at KSAFH. 20 out of 30 patients were female (66.7%). The mean age was 35 - 45 years old. Diabetes mellitus was found in 5 patients (16.7%), while hypertension was seen in 10 patients (33.3%). 6 patients (20%) had end stage renal disease (ESRD). The data showed 24 patients with primary hyperparathyroidism (80%), 5 patients with secondary hyperparathyroisim (16.7%) and one patient with tertiary hyperparathyroidism (3.3%). Our study demonstrated that 23 patients underwent partial parathyroidectomy (76.6%), while 7 patients underwent total parathyroidectomy (23.3%). According to the method used for diagnosis of hyperparathyroidism, blood tests were used in 27 patients (90%), Sestamibi parathyroid scan in 26 patients (86.6%), ultrasound scanning in 28 patients (93.3%) and bone scan in 9 patients (30%). Sensitivity of Sestamibi scan in primary hyperparathyroidism (91.7%) and (66%) for secondary hyperparathyroidism. Mean operative time was 79 minutes. Mean hospital stay was 4 days. Postoperative ccomplications included hypocalcemia in 9 patients (30%), wound infection was (0%), hematoma formation in 2 patients (6.67%), seroma formation in 1 patient (3.33%), vascular injury (0%) and recurrence rate in 2 patients (6.67%). Histopathology findings included parathyroid adenoma in 22 patients (73.3%), parathyroid hyperplasia in 6 patients (20%) and parathyroid carcinoma in 2 patients (6.7%). Rate of cure was 93.3%. Conclusions: Hyper-parathyroidism is more common in female patients than male patients. High sensitivity for sestamibi scan in primary hyperparathyroidism. ESRD is the most common cause of secondary hyperparathyroidism. Most common complication is hypocalcemia. High rate of cure following parathyroid surgery.

A Case Report of Adult Patent Vitellointestinal Duct Sac and Midgut Volvulus

Midgut volvulus is a clinical rare condition which appears as recurrent intermittent abdominal pain after consumption of food with intermittent colicky pain and sometimes with completely asymptomatic period. This gut twist may result in complications such as ischemia, obstruction, hemorrhage, or perforation. In the yolk sac during the third week of intrauterine life, there is normal communication with intraembryonic gut. During development proceeds, this communication gets thinner into a tube known as the vitellointestinal duct. Vitellointestinal duct usually becomes obliterated before eighth week of intrauterine life. In about 2% of people this duct persists and gives rise to a group of anomalies such as Meckel’s diverticulum is the commonest and complete patency of the duct is the rarest. Here we present the case of a 34-year-old male who presented with both conditions.

Outcome of Laparoscopic versus Open Colorectal Cancer Surgery

Introduction: Since the first laparoscopic-assisted colon resection was introduced in 1991 by Jacobs et al., it has gradually become popular. Increasingly more colorectal surgeons admit that the laparoscopic technique leads to quicker functional recovery and improved short-term results when compared with the open approach. However, the laparoscopic technique has not previously been proven to gain significant benefits in colorectal surgeries. Recently, oncologic outcomes of colorectal cancer resection, in terms of lymph node harvest number and excision safety margin lengths, achieved under laparoscopy could be comparable to those obtained using the conventional open technique. However, the curability of colorectal cancer under the laparoscopic technique remains controversial because of the uncertainty about the overall recurrence rate. Objective: To study the outcome of colorectal surgeries in our department in order to compare laparoscopic surgery (LS) versus open surgery (OS) of colorectal cancer procedures in terms of operations duration, blood loss, intra and post-operative complications. Methods: Review of all colorectal cancer patients who underwent open and laparoscopic procedures between January 2014 and January 2020. Excluding patients, those have non-malignant tumors. Included in data collection are the patients’ demographic information, type of surgery, diagnostic test, complications, operative time, and hospital admission period. We will take the information from files of patients and our documentations during clinic visits. Results: A total of 101 patients underwent colorectal cancer surgery at King Salman Armed Forces Hospital from 1/1/2014 till 1/1/2020. Of these, 63 were male (62.3%). Of these colon cancer 68 cases (67%). The mean age was 47.2 years. Comorbidities included diabetes 13 (12%), hypertension 10 (9.9%), IHD 16 (15%), ESRD 4 (3.9%). Of these 41 were smokers (40.5%). Mean Body Mass Index (BMI) was 31.2 kg/m2. Mean hospital stay 7 ± 2 days for OS and 5 ± 2 for LS. Fifty nine patients (58.4%) underwent OS. 7 cases (6.9%) of LR had conversion. Conclusion: LS of colorectal cancer has better short-term results than OS but longer operative time.