Search

Background: Single incision laparoscopic bariatric surgery has developed over the last few years, with single incision laparoscopic adjustable gastric banding (SILS-AGB) being performed most commonly. However, there are no randomised controlled trials and few matched studies comparing SILS-AGB to conventional laparoscopic multi-port multiport adjustable gastric banding (LAGB). Our aim was to study any differences in outcome and analgesic requirements between two matched groups of gastric band patients (SILS-AGB and LAGB). Methods: Between June 2009 and September 2010, 111 patients underwent SILS-AGB and 99 patients underwent LAGB performed by a single surgeon (AGP). Patients were matched for age, sex, weight, BMI and co-morbidities. Forty six SILS-AGB and LAGB patients were included for analysis. Their outcomes were compared for operating times, conversions, analgesia requirements, morbidity and mortality. Results: Patients characteristics between the SILS-AGB and LAGB groups were similar with no differences in their median age (44 vs 47 years), sex (m:f; 7:39 vs 4:42), body mass index (43.1 vs 44.4 kg/m) or co morbidities respectively. In the SILS-AGB group the median operating time (70 min) was not significantly longer than in LAGB group (61.5 min, p = 0.07). However, SILS-AGB patients used less opiates ( p < 0.01) than the LAGB patients. There was no difference in morbidity, mortality or readmission rates. Conclusion: SILS-AGB is a safe and feasible option and is comparable with LAGB. Post operative demand for analgesia was significantly less in the SILS-AGB group. Further comparisons of post operative pain and long term outcomes are required; however preliminary results are promising. [ABSTRACT FROM AUTHOR]

• Spatial–temporal dimension reduction of rs-fMRI is developed for automatic PD diagnosis. • Both region-specific and patient-specific diagnoses can be achieved with nonlinear manifold learning. • Temporal lobe, partial Parietal lobe, partial Occipital lobe, and motor region have high classifiability for PD diagnosis using rs-fMRI and the proposed method. • Multi-region classification can significantly improve the PD diagnosis accuracy compared with the single region classification (from 87.8% to 96.4%). Parkinson's disease (PD) is one of the leading causes of neurological disability, and its prevalence is expected to increase rapidly in the following few decades. PD diagnosis heavily depends on clinical features using the patient's symptoms. Therefore, an accurate, robust, and non-invasive bio-marker is of critical clinical importance for PD. This study proposes to develop a new bio-marker for PD diagnosis using resting-state functional Magnetic Resonance Imaging (rs-fMRI). Unlike most existing rs-fMRI data analytics using correlational analysis, a Topological Machine Learning approach is proposed to construct the bio-marker. The default functional network is identified first using rs-fMRI. Next, rs-fMRI's high dimensional spatial–temporal data structure is mapped on a Riemann Manifold using topological dimensional reduction. Following the topological dimensional reduction, machine learning is used for classification and sensitivity analysis. The proposed methodology is applied to three open fMRI databases for demonstration and validation. The PD diagnosis accuracy can reach 96.4 % when the proposed methodology is used. Thus, rs-fMRI and topological machine learning provide a quantifiable and verifiable bio-marker for future PD early detection and treatment evaluation. [ABSTRACT FROM AUTHOR]

Obesity increases the risk of progression of chronic kidney disease (CKD) towards kidney failure and may preclude access to kidney transplantation. Weight loss surgery remains relatively novel in obese patients with CKD, with several studies reporting results using Roux-en-Y bypass and adjustable gastric banding. However, in obese patients with CKD, kidney failure after bypass surgery and gastric band erosion after kidney transplantation have been reported. We present the first report of laparoscopic sleeve gastrectomy (LSG) performed for the treatment of obesity in patients with CKD. Weight loss, blood pressure and lipids, estimated kidney function, surgical complications and adverse events were studied. Nine obese patients with CKD (five of whom were undergoing haemodialysis treatment) underwent LSG, with median body mass index decrease of 8.4 kg/m and excess weight loss of 43.0% after 6 months. Four of the five patients on haemodialysis were added to the kidney transplantation waiting list as a result of weight loss achieved with LSG. Adverse events occurred in three patients: myocardial infarction (one patient), acute kidney injury secondary to dehydration (one patient) and compromised dialysis access (one patient). There was one complication-a gastric leak, detected 7 months after LSG, requiring further surgical intervention and nasojejunal feeding, and no mortality. Our preliminary evidence suggests that LSG is an effective treatment for obesity in patients with CKD. However, there may be additional risk associated with the procedure in patients with CKD, requiring further study. [ABSTRACT FROM AUTHOR]

Background: An increasing number of techniques are emerging in the literature describing single-incision laparoscopic cholecystectomy (SILC). The advent of a new surgical approach is a reminder of the increase in bile duct injuries in the past when laparoscopic cholecystectomy was first introduced. With this in mind, the authors describe a safe and reproducible approach to SILC. Methods: Between August 2008 and August 2009, 20 patients with symptomatic gallbladder disease underwent SILC using a totally transumbilical fundus-first approach with an intraoperative cholangiogram. Data including pain scores were collected prospectively. Results: In this initial series, the median operative time was 103 min (range, 55-177 min), including the time for two patients undergoing additional procedures at the time of surgery. Intraoperative cholangiograms were completed for 18 of 19 patients. Additional ports were required in four patients for safe completion of the procedure. The mean pain score 12 h postoperatively was 2.5 on a visual analogue scale with a range of 0-10. There was no morbidity or mortality. Conclusion: According to the findings, SILC with an intraoperative cholangiogram can be performed safely using a fundus-first approach. However, for SILC to become the operation of choice for the treatment of gallbladder disease, evidence is required to demonstrate its advantage over laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Obesity is a major risk factor for the development of endothelial dysfunction. We explored the effect of different degrees of body mass on endothelial function, lipids, systemic inflammation and glucose homeostasis and the effect of surgically-induced weight loss on endothelial function in severely obese humans. Methods: A cross-sectional study of healthy subjects across a wide range of body fatness was performed to characterize the effect of obesity on flow-mediated dilatation (FMD), systemic inflammation, blood pressure and insulin sensitivity. A longitudinal study was performed to assess the effect of bariatric surgery induced weight loss on these parameters. 73 healthy subjects across a wide range of body mass were recruited; of these, 8 underwent bariatric surgery (median BMI 52.2 kg/m2, interquartile range 50.355.9). Endothelial dependent vasodilatation was measured using the brachial artery vasodilatory response to forearm hyperemia assessed using highresolution ultrasonography. Results: Obese subjects were characterised by a complex collection of abnormalities, with hypertension, impaired glucose homeostasis, systemic inflammation and reduced FMD. BMI ≤25 kg/m2 (median FMD 9.7%, interquartile range 6.8-12.2), BMI >30 kg/m2 (median FMD 6.7% 4.8-7.5), P=0.01 comparing FMD in lean and obese subjects. A mean reduction in weight of 23.4 (4.6) kg produced an improvement in FMD from 5.3% (3.87.0) to 10.2% (7.6-13.3), P=0.01. Conclusions: Even moderate obesity leads to endothelial dysfunction. In severely obese subjects, FMD is normalized by weight loss. This improvement in FMD is associated with a decline in inflammatory markers, blood pressure and insulin. The improvement in FMD occurred despite patients remaining significantly obese. These results suggest that an integrated approach to improving endothelial function in obese humans may be necessary. [ABSTRACT FROM AUTHOR]

Background: Obesity surgery has been shown to result not only in sustained weight loss, but also in improvements in psychological morbidity and quality of life. The present study aimed to explore the mechanisms behind the success of surgery and to examine how it might bring about such changes in patients' health status. Methods: Both quantitative and qualitative methods were used. A questionnaire was completed by patients who had undergone bariatric surgery in the past 4 years (n=22) and a matched-group of waiting list controls (n=39). In depth interviews were then carried out with 15 surgical patients. Results: The quantitative study showed that the surgical group weighed less, had more negative experiences of eating and yet reported improved subjective health status using a range of validated tools. The qualitative study provided some insights into this improved health status, with the surgical patients reporting improved energy and self-esteem. The patients also reported a fundamental shift in their relationship with food. In particular, they described changes in their eating behavior and stated that they had a new experience of fullness and a reduction in their hunger. Furthermore, they described how food now had a reduced role in their lives and that the operation had made them feel more in control of their food intake. Conclusion: Post-surgical improvements in health status may not only be a result of the non-specific consequences of surgery brought about by weight loss, but also a result of the specific impact of the surgical procedure itself. By enforcing a reduction in the amount of food that can be eaten, restrictive surgery seems to generate changes in the individuals' relationship to food and may help to re-establish a perception of control over eating behavior. [ABSTRACT FROM AUTHOR]

We report a rare silent migration of a fishbone into the liver and review the relevant literature. A 56-year-old man presented with a 2-day history of dull epigastric pain and raised inflammatory markers. Computerized tomography scan revealed a 4-cm abscess in the left lobe of the liver, with a linear radio-dense foreign body within the collection. At laparoscopy the hepatogastric fistula was disconnected. The fishbone was retrieved from the liver. Gastrostomy was closed with an omental patch. The patient had an uneventful recovery. Fifty-two cases of liver abscess secondary to enterohepatic fishbone migration were reported with over two-thirds presenting with a left-lobe abscess. There was marked variability in the management of liver abscess in the setting of fishbone migration-summarized in table. We believe that laparoscopic drainage of the abscess and extraction of the foreign body offer control of the source of sepsis and diminishes recurrence, whilst having a low-risk profile. [ABSTRACT FROM AUTHOR]

Background: Research implicates inflammation in the vicious cycle between depression and obesity, yet few longitudinal studies exist. The rapid weight loss induced by bariatric surgery is known to improve depressive symptoms dramatically, but preoperative depression diagnosis may also increase the risk for poor weight loss. Therefore, we investigated longitudinal associations between depression and inflammatory markers and their effect on weight loss and clinical outcomes in bariatric patients. Methods: This longitudinal observational study of 85 patients with obesity undergoing bariatric surgery included 41 cases with depression and 44 controls. Before and 6 months after surgery, we assessed depression by clinical interview and measured serum high-sensitivity C-reactive protein (hsCRP) and inflammatory cytokines, including interleukin (IL)-6 and IL-10. Results: Before surgery, depression diagnosis was associated with significantly higher serum hsCRP, IL-6, and IL-6/10 ratio levels after controlling for confounders. Six months after surgery, patients with pre-existing depression still had significantly higher inflammation despite demonstrating similar weight loss to controls. Hierarchical regression showed higher baseline hsCRP levels predicted poorer weight loss (β = −0.28, p = 0.01) but had no effect on depression severity at follow-up (β = −0.02, p = 0.9). Instead, more severe baseline depressive symptoms and childhood emotional abuse predicted greater depression severity after surgery (β = 0.81, p < 0.001; and β = 0.31, p = 0.001, respectively). Conclusions: Depression was significantly associated with higher inflammation beyond the effect of obesity and other confounders. Higher inflammation at baseline predicted poorer weight loss 6 months after surgery, regardless of depression diagnosis. Increased inflammation, rather than depression, may drive poor weight loss outcomes among bariatric patients. [ABSTRACT FROM AUTHOR]

Laparoscopic surgery via a single port is an evolving technique being applied to an increasing variety of operations [1]. Multiple series over the past 3 years have shown single-incision laparoscopic cholecystectomy to be feasible and safe [2]. The ergonomic difficulties of single-port laparoscopy include a loss of instrument triangulation and operation with camera and instruments in parallel. Many different modifications of techniques and equipment have been used to compensate. Single-port techniques have been applied by a few authors to laparoscopic nephrectomy [3], splenectomy [4], and obesity surgery [5, 6]. Laparoscopic liver resection is well established and shown to be safe in multiple series [7]. The laparoscopic approach is accepted as the gold standard for resection of segments 2 and 3 [8]. To the authors' knowledge, no reports of laparoscopic liver resection via a single port have been published. They report the use of their technique for single-incision laparoscopic left lateral segmentectomy in a patient with a solitary segment 2 colorectal liver metastasis. The authors maintained strict oncologic principles and adhered to their standard laparoscopic technique as far as possible. They used a TriPort (Advanced Surgical Concepts, Wicklow, Ireland) placed via a 12-mm incision at the umbilicus. Following diagnostic laparoscopy and intraoperative liver ultrasound, hepatic attachments were divided using electrocautery. Parenchymal transection and vascular control were achieved using an ultrasonic dissector and laparoscopic staplers. Standard straight laparoscopic instruments were used. A number of technical challenges were apparent. Movement of instruments was jerky at times, either because instruments were clashing with one another other or deflecting the camera. The multiport device can be stiff, requiring copious lubrication throughout surgery. Crossing hands facilitates internal triangulation of the operating instruments to allow retraction or to apply tension, for example, during the division of hepatic attachments. Control of minor hemorrhage is possible with judicious and patient application of pressure using small pieces of surgical gauze. An articulating laparoscopic stapler is useful to achieve the ideal angle of staple deployment during transection of vascular pedicles. The specimen was extracted by extending the umbilical incision. No complications occurred. The patient was able to resume an oral diet and full mobility free of opioid analgesia on the first postoperative day. The resection margin was clear. This video demonstrates that the authors' technique is feasible and oncologically safe for selected patients requiring liver resection. [ABSTRACT FROM AUTHOR]

Presents a case study on the laparoscopy of upper gastrointestinal bleeding from a splenic artery pseudoaneurysms. Clinical manifestations of pseudoaneurysm; Distinction between true splenic artery aneurysm and pseudoaneurysm; Effectiveness of embolization of pseudoaneurysms.

Discusses the medical case involving an incidental finding of a horseshoe appendix. Clinical presentation of the condition; Rarity of anomalies of the appendix; Treatment and monitoring.

Background Splenic preservation during a distal pancreatectomy ( SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique ( WT) or splenic vessel preservation ( SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP. Methods A systematic search of medical literature from 1985-2011 was undertaken to identify all comparative studies and case series on SPDP. Non- English papers, series with < 5 patients, technical reports and reviews were excluded. The remaining articles were reviewed considering the study design, surgical technique, outcomes and complications. Results In 23 relevant studies, 356 patients underwent WT and 572 underwent SVP. In WT patients, the mean operating time (160 versus 215 min, P < 0.001), mean estimated blood loss (301 versus 390 ml, P < 0.001) and length of stay (8 versus 11 days, P < 0.001) was significantly less than the SVP patients, respectively. Considering complications, splenic infarction and splenectomy occurred more frequently in WT patients ( P < 0.05). Discussion WT is technically easier to perform than SVP but has a higher incidence of subsequent splenectomies. Surgeons should be able to perform both procedures and tailor the technique according to the patient. [ABSTRACT FROM AUTHOR]

Summary: Women with obesity are at risk of pelvic floor dysfunction with a 3‐fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta‐analysis will assess this recommendation to aid in the counselling of women with obesity‐related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty‐three studies and their outcomes were meta‐analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI‐20, SMD ‐0.774 (95% CI [−1.236, −0.312]). This systematic review and meta‐analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity‐related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity‐related UI are needed to confirm this study's findings. [ABSTRACT FROM AUTHOR]

Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is suggested to play a role in the association between depression and obesity. We investigated differences in cortisol levels in individuals with obesity with and without depression, and the effects of perceived stress and binge eating on cortisol levels. Saliva samples were collected at awakening, 15, 30 and 60 minutes post-awakening from 84 individuals with obesity (44 controls and 41 with major depressive disorder). Salivary cortisol was analysed using ELISA technique. Linear Mixed Model was used for group differences in cortisol awakening response (CAR) with adjustment for confounders and binge eating. Individuals with obesity and depression had lower CAR compared with controls with obesity (B=-0.44;p=0.04). However, after controlling for perceived stress, depression no longer influenced CAR (B=-0.09;p=0.75), but individuals with moderate/high stress had lower CAR compared with those with low stress (B=-0.63;p=0.03). Binge eating did not affect CAR (B=-0.08;p=0.46). Our results suggest that, in our sample, differences in CAR between depressed and controls appear to be due to higher levels of perceived stress in depressed patients. [ABSTRACT FROM AUTHOR]