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Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

A 44-year-old man presented with an enlarged painful lower anterior neck lump with elevated serum concentrations of free thyroxine (T4) and tri-iodothyronine (T3), alongside the presence of antithyroid peroxidase antibodies. Prior to presentation, the patient was demonstrating recovery from a SARS-CoV-2 infection that required sedation, intubation, and invasive ventilation in the intensive care unit (ICU) for 11 days. Ultrasound examination of the thyroid demonstrated features of De Quervain’s (subacute) thyroiditis. This corresponded to the clinical picture, and continuous thyroid function tests were arranged. Emerging evidence throughout the SARS-CoV-2 pandemic describes the long-term sequelae of the infection, including developing atypical effects on the thyroid gland. This case report emphasises the association of painful subacute thyroiditis with post-viral infection and its manifestation during recovery from severe SARS-CoV-2, suggesting that follow-up thyroid function testing should be considered in patients discharged from the ICU who develop neck discomfort.

Mbarouk Mohammed,1 Frank Bright,1 Alfred Mteta,1 Jasper Mbwambo,1 Bartholomeo Nicholaus Ngowi,1 Orgeness Mbwambo,1 Sidney Yongolo,2 Andrew Mganga3 1Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 2Department of Urology, Faculty of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania; 3Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, TanzaniaCorrespondence: Mbarouk Mohammed Email mbaroukmohd281@gmail.comBackground: Hypospadias is one of the commonest congenital penile abnormalities in newborn males. The external urethral opening can be located anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient’s psychological, emotional and sexual well-being.Aim: To determine the proportion of patients who develop long-term complications after hypospadias repair and its associated risk factors.Methods: This was a hospital-based analytical cross-sectional study, conducted at KCMC Urology Institute from January 2009 to December 2018 and all children were followed up for 1-year post-operatively. A structural data sheet was used to collect information from patients’ files. Study parameters include age, location of hypospadias, surgical technique, surgeon experience, chordee, suture size, materials to assess the association with long-term complications.Results: A total of 254 patients were included in the study, the majority were aged more than 2 years (71.83%) with mean age at operation (SD) of 4.74 ± 2.99 years. Distal types were the most common type of hypospadias (125 patients; 50%), and 51 patients (20%) had severe chordee. Tubularized incised plate (TIP) repair was the most common technique (130 patients; 51.59%). The number of patients with long-term complications following hypospadias repair was 156 (61.60%) and urethrocutaneous fistula(UCF) accounted for 40.5%. The surgeon’s experience, location of hypospadias, surgical technique and associated chordee were significant predictors of long-term complications of hypospadias repair.Conclusion: Tubularized incised plate urethroplasty is a safe and reliable method of hypospadias repair. Proximal hypospadias with severe chordee still remain a challenge.Keywords: hypospadias, long-term complication

Glycogen storage disease type Ia (GSDIa) is caused by defective glucose-6-phosphatase, a key enzyme in carbohydrate metabolism. Affected individuals cannot release glucose during fasting and accumulate excess glycogen and fat in the liver and kidney, putting them at risk of severe hypoglycaemia and secondary metabolic perturbations. Good glycaemic/metabolic control through strict dietary treatment and regular doses of uncooked cornstarch (UCCS) is essential for preventing hypoglycaemia and long-term complications. Dietary treatment has improved the prognosis for patients with GSDIa; however, the disease itself, its management and monitoring have significant physical, psychological and psychosocial burden on individuals and parents/caregivers. Hypoglycaemia risk persists if a single dose of UCCS is delayed/missed or in cases of gastrointestinal intolerance. UCCS therapy is imprecise, does not treat the cause of disease, may trigger secondary metabolic manifestations and may not prevent long-term complications. We review the importance of and challenges associated with achieving good glycaemic/metabolic control in individuals with GSDIa and how this should be balanced with age-specific psychosocial development towards independence, management of anxiety and preservation of quality of life (QoL). The unmet need for treatment strategies that address the cause of disease, restore glucose homeostasis, reduce the risk of hypoglycaemia/secondary metabolic perturbations and improve QoL is also discussed.

Two years since the advent of the COVID-19 pandemic, it is time to discuss the long-term complications post virus infection. We are reporting three autopsy cases from patients who had COVID-19 one to six months before death. All three patients were SARS-CoV-2 negative at admission but expired shortly. At autopsy, the first patient showed subacute diffuse myocardial ischemic injury with microthrombi in pericardial small vessels, whereas the second patient showed catastrophic acute and subacute pulmonary infarctions with hemothorax leading to respiratory failure. The third patient showed subacute severe cerebral infarcts in the left middle cerebral artery region. Our findings suggest the hypercoagulopathy and subsequent vital organ damage may persist beyond the active phase of SARS-CoV-2 infection. It is essential to continue monitoring the COVID-19 patients after recovery, so as to identify those with vital organ injury in a timely manner and to take necessary steps to prevent severe consequences of COVID-19 complications.

Over the last decade, the care of patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) has significantly improved, leading to a decrease in deaths related to allo-HCT as well as improved long-term survival. However, for many patients, long-term survivorship is associated with a substantial burden of chronic morbidities. Indeed, malignant and nonmalignant late complications after allo-HCT are numerous and usually multifactorial, with all organs and tissues a potential target. In many cases, these long-term side effects are associated with the use of high-dose total body irradiation, myeloablative conditioning regimens, and the onset of chronic graft-versus-host disease. It appears to be essential to change the natural history of these late effects. This requires the introduction of improved conditioning regimens and the development of lifelong monitoring controls, patient counseling, and preventative treatment measures. This approach will allow us to pursue our efforts to improve patient outcome.

Objective : This study evaluated the long-term outcome after laparoscopic transabdominal preperitoneal（TAPP）inguinal hernioplasty for young adults cases. The first goal is to measure recurrence rate. The second goals are late symptoms, complication, and patient’s satisfaction rate. Method : Young adults patients who underwent TAPP repairs between １９９５ and ２００４ were requested to fill in a postal questionnaire,１９patients are eligible to this study. Study participants ranged from ２０ to ４０ years, with an average age of ３２ years. One participant was female and eighteen participants were male. Follow up range was ５ to１３years, with a mean of ８．２years. Pt’s satisfaction scales ranging from １（not satisfied）to ５（very satisfied）were used. Participants checked yes or no about late symptoms, complications, and recurrence. Result : Of１９operated patients,１４patients（７３．６％）responded. One patient（７．１％）had symptomatic hernia recurrence. Long-term groin discomfort（occasional）occurred in ４ patients（２８．６％）. But there are no patient feeling groin discomfort interfered with daily activity. Pt’s satisfaction rates were５（very satisfied）：２８．６％,４：５０．０％,３：１４．２％,２：０％,１（very dissatisfied）：７．１％. None of them were required mesh removal. CONCLUSION : TAPP repair is a feasible procedure for young adult with acceptable rate of recurrence, no severe complication, late symptoms, and pt’s satisfaction rate.