sina safamanesh

Weight regain following bariatric surgery is a significant challenge for this obesity treatment method. This study aimed to identify factors associated with weight regain after bariatric surgeries in obese patients in Gorgan, Iran.

This longitudinal study included 143 obese individuals (125 women and 18 men) with a mean age of 43.13±9.83 years who underwent bariatric surgery in Gorgan, Iran during 2013-19. Participants were invited to join the study via phone calls. Research variables (type of surgery, blood group, pre-surgery weight, and body mass index [BMI]) were extracted from patient records, and their current weight and waist circumference were measured and recorded. Weight regain was determined based on one of three different criteria: (1) regaining more than 25% of the maximum weight lost post-surgery, (2) regaining more than 10 kg from the minimum weight post-surgery, or (3) an increase of more than 5 BMI units from the lowest BMI post-surgery.

Overall, 33% of individuals experienced weight regain, with 26.6% according to the first definition, 29.4% according to the second definition, and 18.2% according to the third definition. Men had a higher rate of weight regain (P<0.05). Additionally, 93.6% (44 cases) of those with weight regain had abdominal obesity. On average, 79.7% of participants who were 48 months post-bariatric surgery experienced some degree of weight regain. Individuals with a pre-surgery BMI of 50 or higher had a 2.69 times greater chance of weight regain compared to those with BMI lower 50 (P<0.05). The mean weight loss after surgery was significantly higher in individuals who experienced weight regain than those who did not (P<0.05). There was no significant statistical association between weight regain and the type of surgery, age, education level, marital status, or blood group.

Weight regain over time is a reality after bariatric surgery, indicating that this method is not a definitive cure for obesity. Therefore, long-term follow-up for weight control is crucial, especially for individuals with a pre-surgery BMI of 50 or higher or those who experienced significant weight loss post-surgery.

The current study aimed to evaluate EGD findings effects on laparoscopic Roux-en-Y gastric bypass (RYGB) plan and time in areas with a high prevalence of Helicobacter pylori infection.

Esophagogastroduodenoscopy (EGD) and Helicobacter pylori testing are routine parts of preoperative assessment of bariatric surgery at many centers

This was a cross-sectional study of all patients underwent EGD and histopathological examination before laparoscopic RYGB in three gastroenterology centers in Iran between January 2018 and December 2020.

Results: 

In total, 637 patients (52.4% female) were enrolled, of which 46.8% had no abnormal mucosal appearance. In 1.7%, surgery was canceled (gastric adenocarcinoma, gastric intestinal metaplasia, GIST, and esophageal varices). The prevalence of H. pylori was 61.5%, and there was no statistical difference between groups of normal and abnormal EGD; however, surgery was postponed after H. pylori eradication in both groups. Overall, 44.4% of patients with esophagitis (any grade), peptic ulcer disease, erosive and non-erosive gastritis/duodenitis, and short segment Barret’s esophagus needed medical management. Small- or medium-sized sliding hiatal hernias were seen in 18.7% of patients with no effect on surgery. Moreover, 88.8% of patients with normal mucosal appearance were asymptomatic, but 92.6% in the group with abnormal EGD were symptomatic (p=0.01). Changes in surgical plan and time occurred in 63.6%, but after eliminating H. pylori eradication, it was 15.4%.

Considering gastric cancer and the high prevalence of H. pylori in Iran, using EGD and histopathological examination as an investigation in the preoperative assessment would have a significant impact on patients undergoing RYGB surgery.

Since 1996 with improvement of endoscopic instrumentation several novel minimally invasive techniques have been developed to perform thyroid operations. The advantages of endoscopic procedure includes better magnification of anatomy, improved illumination of the operation field, earlier recovery, better pain control, and better cosmetic results. Yet it’s performed rarely and only by few surgeons around the world, as it has some limitations like the size of the nodule.. We herein present a patient with right-sided thyroid cold nodule and follicular presentation on fine needle aspiration (FNA), which successfully underwent endoscopic thyroidectomy through an axillary incision in Hazrat Rasul Akram hospital and tolerated the procedure well without any complications and was discharged with a very good condition.. If the indications and contraindications of minimally invasive thyroidectomy are taken into account, it seems to be a safe procedure and regarding the benefits of this procedure, it''s recommended that surgeons pay more attention to this newly developed technique..

Distal pancreatectomy has been a standard technique for pancreatic body and tail lesions for years ago. Recently, it is being performed laparoscopically in a perfect manner. There are two common methods for this procedure. One is distal pancreatectomy with splenectomy and the other is distal pancreatectomy with spleen preservation. In patients with splenic vessels involvement, it is not recommended to save the spleen, because of existing chance of splenic ischemia. On the other hand, after splenectomy there is great chance of immune system problems and fatal infections. This report, presents a patient who underwent laparoscopic distal pancreatectomy due to cystic tumor of pancreatic body with splenic vessels involvement and ligation of them was necessary and the spleen was saved successfully with no following complications..

Distal pancreatectomy has been a standard technique for pancreatic body and tail lesions for years ago. Recently, it is being performed laparoscopically in a perfect manner. There are two common methods for this procedure. One is distal pancreatectomy with splenectomy and the other is distal pancreatectomy with spleen preservation. In patients with splenic vessels involvement, it is not recommended to save the spleen, because of existing chance of splenic ischemia. On the other hand, after splenectomy there is great chance of immune system problems and fatal infections. This report, presents a patient who underwent laparoscopic distal pancreatectomy due to cystic tumor of pancreatic body with splenic vessels involvement and ligation of them was necessary and the spleen was saved successfully with no following complications..

Small bowel obstruction is one of the most common surgical emergencies and main causes of hospital admissions. Diatrizoate Meglumine Gastrografin, a hyperosmolar water-soluble contrast agent, has been used to triage patients with small bowel obstruction for an operative or a non-operative management. It can also have a therapeutic effect by increasing the pressure gradient across obstructive sites that may result in resolving the obstruction.. The aim of this study was to test the gastrografin effect in the resolution of small bowel obstruction..Patients and In this cross sectional–descriptive study, gastrografin was given to patients diagnosed with small bowel obstruction in clinical and radiological grounds. The contrast passage was assessed by serial X-rays. If the contrast remained in the small bowel, a decision was made as to whether proceed to surgical intervention, based on clinical condition. The patients were divided into two groups: A, who finally required surgery, and B, who were resolved by gastrografin administration.. Forty six patients were entered into the study. Thirty seven of the patients (80%) received a non-operative course in whom the contrast was observed in the large bowel. They had a mean hospital stay of 4.6 days. Nine patients (20%) required operative intervention. These patients had a mean hospital stay of 8 days.. This study has demonstrated that gastrografin was highly effective in the management of adhesive small bowel obstruction resulting in a decreased need for surgery and hospital stay.