Day 1 :
Keynote Forum
Kanishka Indraratna
Sri Jayewardenepura General Hospital, Sri Lanka
Keynote: THE USE OF TRANSOESOPHAGEAL ECHOCARDIOGRAPHY TO PREVENT PERIOPERATIVE CARDIAC FAILURE
Time : 09:30-09:55
Biography:
Kanishka Indraratna is Consultant Anaesthesiologist at Sri Jayewardenepura General Hospital, Sri Lanka. He has also worked as a Consultant Anaesthesiologist in England. His interests are cardiac and neuro anesthesia, critical care and intra operative transoesophageal echocardiography. A review article by him on \\\"To give or not to give fluid challenges\\\" was published in Trends in Anesthesia and Critical Care, June 2012.
Abstract:
Peri operative cardiac failure carries a high morbidity and mortality and its occurrence can spell catastrophe for allrnconcerned. Peri operative cardiac failure can occur due to decompensation of existing cardiac dysfunction, acute ischaemicevent, or overloading of fl uid or an increase in the aft erload. During anaesthesia any of these can occur particularly if the heart function is already compromised. It may occur due to myocardial depression, an imbalance in the coronary oxygenrnsupply, inappropriate transfusion of fl uid or vasoconstriction. Th e traditional methods used for evaluating optimum cardiacfunction intra and peri operatively were measurements such as the cvp and pcwp whose value has been questioned. To preventrnand manage peri operative heart failure , there should be methods of assessing cardiac function and to monitor whetherrntherapeutic manipulations have the desired eff etc. It is important to monitor the volume status, whether giving fl uid challengesrnis safe, whether the contractility of the myocardium is satisfactory, whether it is deteriorating, whether it needs inotropes. Isthe heart dilated, and does it need to be overloaded? Would a vasoconstrictor or vasodilator help. Th is presentation , shows how transoesophageal echocardiography can be used to obtain this required information and thereby help in preventing andmanaging peri operative cardiac failure.
Keynote Forum
Dr. Ayşe karcı
Dokuz Eylül University School of Medicine,Turkey
Keynote: PERÄ°OPERATÄ°VE GLYCEMÄ°C CONTROL Ä°N GENERAL SURGÄ°CAL PATÄ°ENTS
Time : 09:55-10:20
Biography:
Ayse Karci has completed her medical education at Ege University, Turkey and was specialized in Anesthesiology in Dokuz Eylul University School of Medicine. She is still working in the same hospital as an Associate Professor. She has worked in the Department of Obstetrics and Labor Unit as Anesthesiologist and was also the Director of School of Anesthesia Technicians for six years. She has 16 publications in reputed journals and 29 Turkish papers in the field of Anesthesia.
Abstract:
Perfusion index as a predictor of successful neuraxial anesthesiarnAyse KarcirnDokuz Eylul University, Turkeyrnrn Abstractrnrn Background & Aim: Traditionally evaluation of adequacy of the neuraxial anesthesia depends on the loss of response to the sensations of cold and pinprick which requires patient cooperation. Objective assessment of clinical signs of sympathectomy do not appear fast enough to confirm surgical anesthesia. We hypothesized that increases in the pulse oximeter perfusion index (PI) may provide earlier and clearer objective evidence for sympathectomy compared to traditional responsed to sensory stimulation. rnrnMaterials & Methods: After approval was obtained from the Ethics Committee of University of Dokuz Eylül, Medical School, Ä°zmir, patients between 18-65 years of age who were categorized as American Society of Anesthesiology physical status I-III were included. A spinal block using 0.5% bupivacaine was performed with the patient in the sitting position. No external heating device was used. The upper sensory block level was checked 2 min after the spinal injection by assessing the loss of cold sensation from alcohol swabs. Systolic blood pressure (SAP), heart rate and PI were recorded at 2 min intervals in the first 10 min and then at 5 min intervals. Skin temperature was recorded at the same times. The PI value is generated by pulse oximetry placed on the second toe. rnrnResults & Discussion: Compared to basal values, sympathectomy caused a significant decrease in SAP and an increase in PI values following spinal anesthesia. The incresase in skin temperature was significant after the 8th min. The increase in the PI value and sensory block level were parallel in 15 min following spinal anesthesia and both stayed at a plateau afterwards. In one patient in whom the spinal block was not successful, PI did not significantly change compared to baseline. rn
- General Surgery and its specialties
Session Introduction
Derick A Mendonca
Sakra World Hospital, India
Title: Calvarial vault reconstruction: Technical modifi cations in an Asian context
Biography:
Derick A Mendonca is a British Board Certified Plastic Surgeon, currently Head of the Plastic and Reconstructive Surgery department at Sakra World Hospital, Bangalore. He completed his Specialist Registrar Plastic Surgery training at the prestigious Queen Elizabeth University Hospital, Birmingham, UK. He obtained the MRCS and FRCS (Plastic) qualifi cation from the Royal College of Physicians and Surgeons, Glasgow and is credentialed with the Certifi cate of Completion of Training (CCT) in Plastic Surgery. He obtained an advanced fellowship in Craniofacial and Paediatric Plastic Surgery for 1 year at Washington University School of Medicine, St. Louis, USA. He maintains a keen academic interest with over 30 scientifi c publication prizes and is a frequent speaker at national and international Plastic Surgery conferences. He is particularly proud of two seminal publications: “The Birmingham classifi cation of venous malformations in children”, and “The fi rst biomechanical cadaveric anatomical study on palatal dissection and movement”. He is a reviewer and member of the Cochrane Wounds Group, Oxford and a Craniofacial surgery reviewer for two prestigious Plastic Surgery journals. His area of interest is in complex craniomaxillofacial reconstruction, craniofacial distraction, craniosynostosis (endoscopic & open calvarial remodelling), facial fractures and trauma, cleft lip and palate surgery, paediatric plastic surgery, ear and nose reconstruction, facial palsy reanimation surgery and oculoplastic surgery.
Abstract:
Introduction: Craniosynostosis is a premature fusion of the growing cranial suture resulting in head deformities. Anterior craniosynostosis (metopic/uni/bicoronal) is more common in India, as compared to sagittal suture. Calvarial Vault Reconstruction (CVR) is the standard surgical treatment. Th e aim of this paper is to investigate and document outcomes of craniosynostosis treatment in a new craniofacial unit in Bangalore, South India. Methods: A prospective study of all craniosynostosis patients treated from Jan 2014 to Jan 2015 was conducted. Pre and postoperative data were collected and analysed. Results: A total of 10 patients were diagnosed with craniosynostosis. Four patients presented late, while 6/10 patients underwent surgery (CVR). Th e mean age at surgery was 12 months. One patient had isolated metopic, 3 patients had metopic and coronal, 1 patient bicoronal and 1 patient had sagittal synostosis. Th e mean length of stay in PICU was 1 day. Mean blood loss during surgery was 250 ml. Head circumference increased by 2.5 cm. One patient developed a CSF leak which settled conservatively. Technical variations in an Indian context are presented and discussed. Strategies to create awareness and education of craniosynostosis are off ered.
Biography:
Enas Al Alawi is Consultant Laparoscopic and Obesity Surgeon. He obtained his Medical degree from the National University of Ireland - Cork in 1996 and also received Fellowship from the Royal College of Surgeons Ireland in 2001. He obtained Post-graduate degree from University of Wakes in 2004 and Masters in Health Care Management from the Royal College of Surgeons Ireland in 2010. He also received Post-graduate diploma from University of Strasbourg France in 2015.
Abstract:
Endoscopic Gastric botox is a procedure that speeds up weight loss by using botox to temporarily relax the muscles of the stomach. Botox will cause gastric motility to slow down making the person feel full more quickly and for longer than usual, reducing the overall amount of food consumption. Our data of 85 patients between December 2013 and March 2015 shows that this procedure is safe and most successful in obese patients with lower body mass index between 28 and 35.
Flavio Antonio de Sá Ribeiro and Ivan Mathias
Universidade do Estado do Rio de Janeiro, Brazil
Title: Ambulatory surgery in elderly patients
Biography:
Flavio Antonio de Sa Ribeiro is Headman Surgery Professor of Universidade Fundacao Serra dos Orgaos, Research Headman and Surgeon of Hospital Federal de Bonsucesso/Ministerio da Saude-Governo Federal. He is an entitled member of Colegio Brasileiro de Cirurgioes, Doctorated in Surgery by the Universidade Federal do Rio de Janeiro, Associated Surgery Professor of Universidade Gama Filho.
Abstract:
An increasing number of elderly patients are undergoing ambulatory surgery. We studied 4,184 patients with age above 60 years, outpatient’s surgical procedures in ambulatory surgical center from UERJ (Policlinica Piquet Carneiro), in Rio de Janeiro, in the last fi ve years (January 2010 to January 2015); in the studied group, the elderly patient was 90 years and the median was 72 years. No deaths in this group, neither hospital admittance nor major complication.
Rajeev Kumar Singh and K Singh
Burhar Central Hospital, India
Title: Efficacy of modified Alvarado scoring system and USG abdomen in diagnosis of acute appendicitis
Biography:
Rajeev Kumar Singh and K Singh is a consultant surgeon at Burhar Central Hospital, India. His research interests include General surgery, Abdominal surgery.
Abstract:
Background: Acute appendicitis is the most common surgical condition of the acute abdomen. Approximately 7% of the population will have appendicitis in their life time. Th e diagnosis of appendicitis is still based primarily on clinical history & examination. Prompt diagnosis and surgical intervention may reduce the risk and prevent complications. Objectives: To evaluate the efficacy of Modifi ed Alvarado Score and USG abdomen in diagnosis of acute appendicitis as well to reduce the rate of negative appendicectomy. Methods: Patient came to Dept. of Surgery, PCMS, Bhopal during duration of study with acute abdomen. Th e study includes 60 patients between 5-60 yrs of age. Th ey were prospectively evaluated on admission using the modifi ed Alvarado Score to determine whether or not they had acute appendicitis and all equivocal cases were subjected to ultrasonography examination. Th e score was correlated with the operative and histological fi ndings. Results: All 60 patients underwent surgery. Th e sensitivity of the modifi ed Alvarado score was 89.65% and sensitivity of USG was 91.37%, out of 60 cases of acute appendicitis, male were 36 and remaining 24 cases were of female. So it showed sex ratio of 36:24, 3:2 which co relate with literature and old studies. With the use of both MASS and USG as diagnostic tool, out of 60 cases, 57 cases were positive and with the help of histopath it was confi rmed in 58 cases. Conclusion: Th e modifi ed Alvarado scoring system is a good diagnostic indicator for acute appendicitis. It helps in minimizing the rates of negative appendicectomy. It can be used as an adjunct to surgical decision-making along with ultrasonography in doubtful cases. Combining modifi ed Alvarado score and ultrasonography together can work very eff ectively in diagnosing acute appendicitis correctly and in reducing the number of negative appendicectomy
Fred W. Peyerl
Boston Strategic Partners, Inc., Boston, USA
Title: Electronic health record (EHR) database analytics: applications for the identifi cation of best perioperative practices
Biography:
Fred Peyerl is a Partner with Boston Strategic Partners, Inc., a dedicated life science and healthcare consulting fi rm. Dr. Peyerl holds a PhD in Virology from Harvard University Medical School, and an MBA from the University of Colorado. Dr. Peyerl has authored over 20 peer-reviewed scientifi c articles, including articles in the fi eld of health economics and outcomes research (HEOR).
Abstract:
Electronic health record (EHR) databases represent an increasingly valuable resource for biomedical researchers seeking to identify best perioperative practices via retrospective analysis of real-world patient data. EHR databases provide a unique source of aggregated point-of-care data covering all aspects of the patient encounter, thus allowing researchers to investigate clinical and administrative outcomes during and subsequent to the surgical visit. In-depth comparative eff ectiveness studies comparing two or more interventions are facilitated by the availability of admission/discharge, diagnosis, procedure, laboratory, medication, and clinical assessment data. In addition, a wealth of patient demographic and facility data allows investigators to stratify patients into relevant risk groups. A range of validated statistical approaches support quantitative comparisons between interventions. Recently, the Boston Strategic Partners team used data from a large de-identifi ed US EHR database to conduct a retrospective comparative eff ectiveness study examining the impact of intravenous fl uid choice on postoperative outcomes in patients undergoing on-pump coronary artery bypass graft (CABG) and/or valve procedures. Outcomes examined included clinical complications such as pneumonia, acute kidney injury, and electrolyte imbalances, as well as key administrative outcomes such as readmissions following surgery. Th is study identified significant diff erences in outcome rates based on intravenousfluid choice. In light of these outcome diff erences, an economic model was subsequently developed to examine the economic implications of fl uid choice (5% albumin plus crystalloids versus crystalloids alone) in this patient population. Th e results of this comparative eff ectiveness study reveal a key application of EHR databases for the identification of best perioperative practices.
- Plastic Surgery
Location: Dubai
Session Introduction
Robert Caiazzo
Lille II University School of Medicine, France
Title: Early diagnosis and treatment of early leak after laparoscopic Roux en Y gastric bypass is the key point to avoid early mortality
Biography:
Robert Caiazzo is professor of Surgery in the Faculty of medicine at the University of Lille II, Lille, France. Member of the department of general and endocrine surgery at Lille University Hospital, he performed bariatric surgery in a dedicated center for the obesity (CIO Lille) part of the largest hospital in north of europe (CHRU – Lille, 4500 beds). Robert Caiazzo also participates to a research group at the University of Lille, INSERM U1190, devoted the clinical development of biotherapies for treating diabetes. U1190 Translational Diabetes Research is a funding member of the LABEX European Genomic Institute for Diabetes (EGID) was classifi ed as “Remarkable” by the CSS5 Inserm in 2014. Pr Caiazzo research is devoted to the surgical treatment of endocrine and metabolic disease and focused on metabolic surgery for type2 diabetes. Pr Caiazzo has authored or co-authored 25 papers in reputed journals. He is also the principal investigator of several ongoing clinical trials of bariatric surgery in Lille
Abstract:
Background: Th e high mortality rate of postoperative leak is a major concern aft er Laparoscopic Roux en Y Gastric Bypass (LRYGB). We report in this study factors infl uencing the prognosis of such leaks. Methods: Th e data of patients aft er LRYGP has been analyzed from Lille Cohort Obesity Study from 2004 to 2012 for 824 patients. Data from patients initially operated in another centers and secondary transferred in our department for a suspected leak were retrospectively included in the analysis. Results: 36 patients experienced a postoperative leak (4,4%), most in patients operated in the early experience in our institution (6,1% before june 2009, 2,3% aft er). In the same period, 12 patients were transferred in our institution for treatment of anastomotic leak. Most of leaks were developed from the Gastro entero anastomosis (25/48, 59%), and (42/48, 88%) developed before day 4 post operative (D4PO). Patients with heart rate (HR)<100 bpm D1PO had <1% risk of peritonitis while risk of 50% in case of HR>120 bpm. All early leaks were managed surgically, half of them by full laparoscopic approach (23; 55%); most of late leaks treated by selective nonoperative management (4/6, 67%). No death occured in this study. Hospital stay was 32 ± 30 days, range from 5 to 123 days. Intensive care unit stay was required in 19 cases for multiorgan failure (median= 23 days, range 3-76). Leaks diagnosed and treated aft er D1PO had higher risk to developed a multiorgan failure (p<0,001). Only a delay oftreatment of more than 24 hours for surgery increased the risk of prolonged hospital stay (respectively 18±15 days vs 68 ± 37days, p<0,001). Hospital stay and ICU stay was correlated to the delay of surgical exploration (>24 hours) when an early leak occurred (both p<0,001, and respectively r=0,67 and r=0,75). Conclusion: Th e early diagnosis of a leak is essential in the fi rst day aft er LRYGBP. Easy laparoscopic reexploration for early diagnosis and treatment is an eff ective option. We assume that a laparoscopic reexamination should be concidered in case ofHR>120 bpm in the fi rst day post operative. Selective nonoperative management of leaks should be considered only aft er D4PO in selected patients.
Biography:
Emilio Trignano has completed his plastic surgery training and PhD from Sapienza University of Rome (Italy). He is a Plastic Surgery Consultant at the University of Sassari, Italy. He has published more than 30 papers in reputed journals.
Abstract:
Background: According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. Th e aim of this study is to assess the degree of microcirculation improvement of foot aft er the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. Patients & Methods: Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suff ering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and aft er tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Th irty-six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve and posterior tibialis nerve. Results: Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mm Hg (29.1±5.4 mmHg). PtcO2 values at one month after surgery (45.8±6.4 mmHg) were signifi cantly higher than the preoperative ones (P=0.01). Conclusions: Th e results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients.
Hashem Shemshadi
University of Social Welfare and Rehabilitation Sciences, Iran
Title: Olfactory function following open rhinoplasty: A 6-month follow-up study
Biography:
Hashem Shemshadi has completed his BSc from USA and MD from Shiraz Medical School, Iran. He has received his General Surgery Board Certifi ed as second national rank recognition from the Shiraz Medical School, Iran. Subsequently, he completed his 3 years Subspecialty Clinical Fellow in Plastic and Reconstructive Surgery from South Western Medical School, Dallas, USA. At present, he is serving as an attending Full Professor of Plastic and Reconstructive Surgery at the Rofeida Rehabilitation Hospital, a teaching hospital linked to the University of Social Welfare and Rehabilitation Science in Tehran, Iran.
Abstract:
Patients undergoing any type of nasal surgery may experience degrees of postoperative olfactory dysfunction. We sought to investigate "when" the olfactory function recovers to its preoperative levels. In this cohort design, 40 of 65 esthetic open rhinoplasty candidates with equal gender distribution, who met the inclusion criteria, were assessed for their olfactory function using the Smell Identifi cation Test (SIT) with 40 familiar odors in sniffi ng bottles. All the patients were evaluated for the SIT scores preoperatively and postoperatively (at week 1, week 6, and month 6). At postoperative week one, 87.5% of the patients had anosmia, and the rest exhibited at least moderate levels of hyposmia. Th e anosmia, which was the dominant pattern at postoperative week 1, resolved and converted to various levels of hyposmia, so that no one at postoperative week 6 showed any such complaint. At postoperative week six, 85% of the subjects experienced degrees of hyposmia, almost all being mild to moderate. At postoperative six months, the olfactory function had already reverted to the preoperative levels: No anosmia or moderate to severe hyposmia. A repeated ANOVA was indicative of signifi cant diff erences in the olfactory function at the diff erent time points. According to our post hoc Benfronney, the preoperative scores had a signifi cant diff erence with those at postoperative week 1, week 6, but not with the ones at month 6. Esthetic open rhinoplasty may be accompanied by some degreesof postoperative olfactory dysfunction. Patients need a time interval of 6 weeks to 6 months to fully recover their baselineolfactory function.
Hadeel AlSajjan and Khalid Jamaan Alzahrani
King Saud Universiy- King Khalid Universiy Hospital, Saudi Arabia
Title: Breast Cosmetic Surgeries among Saudi Muslim Females: A Religious Point of View
Biography:
Hadeel AlSajjan is currently a medical intern at King Khalid University Hospital, Riyadh, Saudi Arabia. She graduated with a Bachelor of Medicine and Bachelor Surgery (MBBS) with honors in May 2015. She is interested in Plastic and Reconstructive surgery and hopes to become a surgeon, researcher and teacher with the aim of innovating and adding value to the field.
Abstract:
The effect of Islamic rulings concerning plastic surgery on Saudi women’s decision-making and reasons of refusal to undergo cosmetic procedures has been a main concern of the cosmetic surgery field. Th e goal of this study is to identify the association between the religious status of Saudi women and its eff ect on their view of breast cosmetic procedures. Th is study was held in2012, at King Khalid University Hospital (KKUH), located in Riyadh, Saudi Arabia. It is a cross sectional study performed on 612 Saudi muslim women, each of whom fi lled out a questionnaire form. Th e women were classified according to demographic characteristics, educational level and religious commitment. Th e questions were structured in order to assess decision making from a religious point of view. Opinions of Saudi muslim women regarding breast cosmetic procedures were defi nite against breast enhancement, however; they were circumstantial or conditionally approved when it came to breast reduction and mastopexy aft er pregnancy or lactation. For undergoing such procedures, religion, age, educational level, marital status and other predictors defi nitely had a direct impact on the acceptance or refusal of breast plastic surgeries. Th e religious group hadhigh self- esteem, life satisfaction, no depression, low rate of media watching and less likelihood for undergoing breast surgeries as apposed to the non-religious group. To conclude, the nature of the breast cosmetic procedure and reasons behind choosing to undergo one certainly influences Saudi women’s religious view and acceptance of breast cosmetic surgery.
- Opthalmic Surgery
Location: Dubai
Session Introduction
Kai-Ping Chang
Chang Gung Memorial Hospital & Chang Gung University, Taiwan
Title: Discovery of salivary biomarkers for detecting oral squamous cell carcinoma by systemic approaches
Biography:
Kai-Ping Chang has completed his ENT residency at Linko Medical Center of Chang Gung Memorial Hospital and PhD degree of Clinical Medical Sciences from Chang Gung University. He has been a visiting scholar at Head & Neck Surgery of MD Anderson Cancer Center at Houston, USA. He is now currently the director and professor of Head & Neck Surgery of ENT department of Chang Gung Memorial Hospital. He has published more than 110 papers in the peer-reviewed journals and has been serving as an editorial board member of several reputed journals.
Abstract:
In Taiwan, oral squamous cell carcinoma (OSCC), representing 90% of oral cavity cancers, is rated as the sixth highest cause of cancer deaths in Taiwan, and accounts for 3% of all newly diagnosed cancer cases in which 27% of male OSCC are between 30-50 years old (the 2009 Cancer Registry of Department of Health of Taiwan). Th e overall 5-year survival rate and morbidity for patients with OSCC has not been improved over the past two decades due to lacking suitable markers for early detection. Th e incidence of oral cancer continuously increases and the social and economic impacts on the aff ected populations are huge. In the past few years, head and neck research group collaborated by Chang Gung Memorial Hospital and Chang Gung University has used various basic research platforms including the genomic approach and proteomic approach attempting to search and identify the novel biomarkers and discussing their related mechanisms and pathogenesis for oral cavity squamous cell carcinoma. In this presentation, I’ll share our experience to apply the two basic research platforms, including a multiplexed bead-based platform to simultaneously detect auto-antibodies and comparative secretome profi ling for primary cell cultures derived from OSCC and adjacent noncancerous epithelium, to discover the potential salivary marker for the detection of OSCC. In these works, we have already demonstrated that THBS2 and a combined panel of salivary auto-antibodies could be eff actively useful for OSCC detection.
Hayan Bismar
PMA Hospital Riyadh, Saudi Arabia
Title: Prevention of bile duct injury during laparoscopic cholecystectomy
Biography:
Hayan Besmar is a General and Laparoscopic Surgeon at PMAH and is a Fellow of American College of Surgery and International College of Surgery FICS. Prior, he was Assistant Professor at College of Medicine, King Saud University.
Abstract:
For the last two decades, the laparoscopic cholecystectomy LC had become a standard procedure for cholecystectomy worldwide, due to the smooth post-op recovery, less pain, early return to work in comparison to open cholecystectomy. The incidence of bile duct injury BDI during LC was higher at the “learning curve “phase, then dropped to almost similar and even less than its rate in open cholecystectomy. Th e BDI is a serious complication of LC, lead to prolonged hospitalization, increase the infectious morbidity and need a major surgery for its repair (hepatico jejunostomy) wish has got its own complication as well. Th e average incidence of BDI now-a-days ranges between 0.4 to 0.8%. During LC, the maximum care should be undertakento avoid such complication. My lecture aims to identify the risk factors leading to BDI and discuss the technical aspects in orderto avoid such injury.
Mohammed Ghunaim
University of Lille II School of Medicine, France
Title: Laparoscopic adjustable gastric banding (LAGB) with out gastro-gastric fi xation cause more complications: One-year results of a prospective, randomized and multicenter trial (ANOSEAN)
Biography:
Mohammed Ghunaim is a Resident in the Deptartment of Surgery Division of Endocrine surgery at University of Lille II School of Medicine, France. His clinical interest includes General surgery, Bariatric surgery, Abdominal surgery.
Abstract:
Introduction: Gastro-gastric fi xation (GGF) during laparoscopic adjustable gastric banding (LAGB) is of great debate while the result of large retrospectives studies showed no increase of slippage rate and easier band removal in case of conversion to another procedure when the band has not been coated, nowadays data are still inadequate to conclude that GGF should be abandoned. Objectives: Th e aim of the study was to show the non-inferiority of LAGB with out GGF. Th e main criteria was the comparison of the reoperation rate at 1 and 3 years. Methods: ANOSEAN study is a controlled prospective randomized single-blind trial (CPP). Seventeen bariatric centers included a total of 706 patients (calculated with power=.8, alpha=.05 and reoperation rate: 24%, delta: 8%). Patients in group 1 received gastric banding with GGF while group 2 with out GGT. Results: Follow-up at 1 year was 89.8%. At baseline, patients were similar regarding sex, age and BMI. GGF increased operative time (43±28 mn vs. 39±25 mn; p<0.001). One early slippage (Day 2) occurred in group 2. At 1 year, reoperation rate in group 1 was 1.5% vs. 4.3% in group 2 (p=0.039). Considering only reoperation for slippage, band removal or repositioning rate was higher in the non-fi xation group at 1 year (2.9% vs. 0%, p=0.002). In multivariate analysis, non-fixation was an independent risk factor of reoperation and slippage (OR:3.2 (95% CI: 1.2-9.1), p<0.001). Conclusion: Preliminary results at 1 year showed that GGF prevents band slippage and reoperation. Benefits of no fixation have to be assessed during band removal and redo surgery to conclude definitely whether surgeon should continue to do GGF.
- Otolaryngology
Location: Dubai
Session Introduction
Roberto Bruno
Universidade do Estado do Rio Janeiro, Brazil
Title: Case report of isolated right scapula metastasis from ampullary adenocarcinoma as initial manifestation of metastatic disease
Biography:
Roberto Bruno is a Faculty at State University of Rio de Janeiro , Brazil. He is the author for many reputed articles. His research interests include General surgery and Otolaryngology.
Abstract:
This work aims to report a rare case of metastatic adenocarcinoma presentation of Ampulla of Vater to the right scapula, as fi rst manifestation of systemic metastatic disease. A 45 year-old male patient was diagnosed with adenocarcinoma of the ampullary region, infi ltrating the duodenal wall, pancreas and peri-pancreatic tissue. Th e patient underwent Whipple surgery (pancreatico duodenectomy) for tumor resection. Th e histopathological study has revealed poorly diff erentiated adenocarcinoma with extensive peri-neural infi ltration, vascular invasion with embolization of tumor cells and regional lymph nodes without neoplastic involvement. Four months aft er surgery for resection of ampullary tumor, the patient had severe pain in the right shoulder, which subsequently evolved with the emergence of a suprascapular lump on the same side. It underwent incisional biopsy that revealed adenocarcinoma on the histo-pathological study. It was chosen for tumor resection surgery. During surgery, a link between tumor and bone tissue of the right scapula was observed, leading to the decision to remove the bone fragment to study. The histo-pathological study defi ned the presence of metastatic adenocarcinoma focally for bone tissue, infi ltrating skin, subcutaneous tissue and adjacent muscle. Subsequently, a bone scintigraphy which revealed a heterogeneous hyper-fi xation of the contrast media in the topography of the right scapula (medial edge) was performed. Unfortunately, aft er these events, the patient developed metastatic systemic dissemination, which led to his death. We conclude that this is a presentation of rare and unusual metastatic disease. In our research, it wasn't found any cases of scapula metastasis from Ampulla of Vater adenocarcinoma.
Limael E Rodriguez
St. Luke’s Memorial Hospital-Ponce School of Medicine and Health Sciences, USA
Title: Clinical implications of HIDA cholescintigraphy and ultrasound in the diagnosis of acute cholecystitis
Biography:
Limael E Rodriguez is a Professor in the Department of surgery St. Luke’s Memorial Hospital-Ponce School of Medicine and Health Sciences, USA. His research interests include General surgery, Otolaryngology
Abstract:
Introduction: In this study, we present our diagnostic and clinical outcomes in patients who were admitted with suspected AC that received diagnostic workup with US ± HIDA. Methods: Between January 2013 to July 2014, 63 patients were admitted through ER with a preliminary diagnosis of AC. All patients received US±HIDA scan aft er admission, and were treated with laparoscopic or open cholecystectomy (all gallbladders were sent to pathology for fi nal diagnosis). Patients with pancreatitis and/or cholangitis (n=3) were excluded from the study. Primary end points included: 1) diagnostic test reliability (i.e. sensitivity, specifi city, etc.) of US and HIDA scan for AC, respectively, and 2) outcome measures (complications, hospital stay, cost eff ectiveness, etc.). Results: Th e mean age at time of fi rst encounter was 48 (15-73) years, with females accounting for 66.7% of the cases. All (100%) of the patients received US at presentation, and 19/60 (31.7%) received US+HIDA. Mean time of admission to HIDA scan was 1.5 (0-4) days. Laparoscopic cholecystectomy was performed in 41/60 (68.3%) and open cholecystectomy in 19/60 (31.7%) of the patients. Of the cases that required an open approach, 11/19 (57.9%) were positive for AC with HIDA scan (p=0.007). Final pathology established acute versus chronic cholecystitis in 28/60 (46.7%) and 32/60 (53.3%) of the patients, respectively. In terms of AC, US had a sensitivity and specifi city of 31% and 83.8%, respectively. HIDA scan had a sensitivity and specifi city of 92.3% and 83.3%, respectively. Admission to surgery time was 3 versus 1.6 days in patients who received US+HIDA versus US alone (p=0.001), and total length of stay (LOS) was 6.4 days versus 3.6 days, respectively (p=0.005). Th e total cost per patient was approximately $4,313 vs. $2,311 for the latter groups, respectively (p=0.004). Conclusion: In our single center review, HIDA scan was superior to US as a diagnostic study, and is indicated when US fi ndings are equivocal and AC cannot be ruled out. Delayed HIDA scanning aft er admission had a signifi cant impact on outcome measures. Th ere was a positive correlation between patients that were diagnosed with acute cholecystitis by HIDA and need foropen cholecystectomy. Early HIDA scan at first encounter in ER may effectively facilitate decision making, and reduce time to surgery, LOS, overall costs, and improve outcomes in the setting of AC.
Ahmed Abdel Monem
Alsalama One Day Surgery Center ,Saudi Arabia
Title: Internal sphincterotomy patients operated for open hemorrhoidectomy, could it improve the outcome?
Biography:
Ahmed Abdel Monem is a consultant surgeon at Alsalama One Day Surgery Center ,Saudi Arabia. His research interests include General and surgery.
Abstract:
Background: Hemorrhoidectomy offers the best chances of permanent cure of symptomatic grades-3 and 4 hemorrhoids. The main drawback of hemorrhoidectomy is the uncomfortable pain in the first postoperative week as this surgical procedure commonly creates three raw areas in the anal region. Performing the procedure that helps in healing these raw areas definitely helps to alleviate postoperative pain and discomfort. Aim: is to evaluate the role of internal sphincterotomy in addition to routine open hemorrhoidectomy. Material and Methods: seven hundreds patients with second, third or fourth degree hemorrhoids, were enrolled in this study divided into two groups. Group I managed by open hemorrhoidectomy and posterior internal sphincterotomy and Group II managed by open hemorrhoidectomy alone without sphincterotomy. Patients were given routine postoperative analgesics and other drugs. Our observation included severity of pain, hospital stay, post-operative complications and return to normal activities. The need of analgesics in the postoperative course was also observed. Results: post-operative pain was significantly improved in Group I than in Group II. Patients in Group I had significant lower rate of post-operative infection and also significant lower No. of doses of pain killer either oral or injectable. There was no significant difference in duration of hospital stay between both groups. Conclusion: Adding internal sphincterotomy along with internal hemorrhoidectomy improved the post-operative pain, also decreased rate of post-operative infection and it was well tolerated by patients.
Demirbag Suzi
Gulhane Military Medical Academy, Turkey
Title: Postoperative intra-abdominal adhesions
Biography:
Suzi Demirbag has completed his MD from Gulhane Military Medical School and Post-doctoral studies from same center. He has published more than 36 papers in reputed journals.
Abstract:
Post-operative intra-abdominal adhesions are still one of the most challenging problems of modern surgery and cause chronic pelvic pain, infertility, mechanical bowel obstruction and prolonged reoperation time and increased intraoperative/ postoperative complications. Preventive measures such as avoiding unnecessary trauma to tissues, keeping any foreign body out of the peritoneal cavity, keeping serosal surfaces moisturized, preventing contamination of the peritoneum by intestinal contents and avoiding the application of any kind of irritant solution arequite important to prevent adhesion formation. Despite several precautions, creative efforts and anti-adhesive products, peritoneal adhesions aft er laparotomy have been reported as high as in over 90% of the patients. Peritoneal injury, ischemia and peritoneal infl ammation are the most important causes of postoperative adhesions. Although many methods have been used for the prevention of adhesion formation, no completely satisfactory solution is currently available. Research in adhesion prevention has essentially focused on: (1) mechanical barriers (2) protective polymer solutions and (3) anti-inflammatory and fi brinolytic agents. Barriers used for the prevention of postoperative adhesion formation include both mechanical barriers and viscous solutions. In this presentation we will discuss the postoperative intra abdominal adhesiogenesis and researches in adhesion prevention.