Mohammed Alokl

Background Anastomotic leak after one-anastomosis gastric bypass (OAGB) remains a serious postoperative complication with significant morbidity and mortality. Despite multiple available strategies, no standardized approach exists for managing gastrojejunostomy leaks. This study presents a simple, minimally invasive technique designed to control leakage and promote tract closure. Methods This single-centre case series included five consecutive patients who developed gastrojejunostomy leaks following OAGB between 2020 and 2025. All patients were managed using a novel minimally invasive technique involving placement of a Foley catheter through the leak site to achieve internal sealing, combined with controlled external drainage. Clinical data, postoperative course, and outcomes were recorded. Results Five patients (mean age 44.4 years; mean BMI 55.4 kg/m²) were treated using this technique. All leaks were identified at the gastrojejunostomy, with onset ranging from 2 to 7 days postoperatively. Oral fluid intake was initiated on the second day following clinical improvement. Median postoperative hospital stay was 4 days. The Foley catheter was maintained for a mean duration of 23.8 days before removal. All patients were followed up, with a mean follow-up duration of 4 months. Conclusion This minimally invasive salvage technique appears feasible and safe for managing gastrojejunostomy leaks after OAGB. It offers a straightforward alternative that supports controlled external drainage and facilitates leak closure. Larger studies are needed to validate its reproducibility and broader applicability.

Introduction Obesity and overweight have become a global epidemic, impacting people of all ages and socioeconomic status. Metabolic bariatric surgery remains the most effective and long-lasting way to lose weight and address obesity-related conditions. Effective pain management is crucial for a successful recovery after surgery. This randomized double-blind study aimed to compare the analgesic efficacy of ultrasound-guided trans-muscular quadratus lumborum (QL) block to preperitoneal local anesthetic infiltration during laparoscopic bariatric surgery and in the early postoperative period. Methods Eligible patients undergoing laparoscopic bariatric surgery under general anesthesia were randomly allocated to one of two equal groups receiving either bilateral ultrasound guided QL block or laparoscopic preperitoneal bupivacaine infiltration. The primary outcome was patient-reported pain scores at 1, 2, 4, 6, 12, and 24 h postoperatively. Secondary outcome measure were intraoperative fentanyl requirements, postoperative morphine requirements, and incidence of postoperative nausea and vomiting. Results A total of 44 patients were included and randomized equally into two groups. The QL block group had significantly longer block times and surgical durations compared to the preperitoneal local anesthetic infiltration group (p = 0.001 and p = 0.019, respectively). Intraoperative fentanyl requirements were similar between groups; however, postoperative morphine consumption was significantly lower, and the time to first morphine dose was significantly longer in the quadratus lumborum block group (p = 0.001 and p = 0.002, respectively). Postoperative nausea and vomiting occurred significantly less frequently in the QL block group (p = 0.04), and pain scores were significantly lower in this group during the first 6 h postoperatively (p < 0.01). Conclusion The QL block was associated with reduced postoperative opioid consumption, lower early postoperative pain scores, and prolonged analgesic effect compared to preperitoneal infiltration. Optimizing anesthesia techniques in laparoscopic sleeve gastrectomy is essential for minimizing opioid use, reducing the risk of chronic postsurgical pain, and limiting opioid-related adverse effects. Further studies are warranted to evaluate and compare the efficacy of QL block versus preperitoneal infiltration in other types of metabolic bariatric surgery. Key points 1. The quadratus lumborum block provided stronger early postoperative analgesia, reflected by consistently lower pain scores during the first hours after surgery. 2. Patients who received the quadratus lumborum block required less post operative morphine and had a longer interval before their first opioid dose. 3. The incidence of postoperative nausea and vomiting was lower in the quadratus lumborum block group, supporting its opioid-sparing advantages.

Introduction: Postoperative bradycardia, particularly in the early postoperative phase, is a potential complication following bariatric surgeries such as sleeve gastrectomy (SG). While various types of bradycardias have been documented as complications, early-onset sinus bradycardia has received limited attention. This case series specifically investigates the incidence and progression of early postoperative sinus bradycardia in patients undergoing laparoscopic SG, excluding those with hiatal hernias or cardiovascular comorbidities. Methods: We conducted a retrospective series of patients aged 18 to 50 years with morbid obesity (BMI ≥ 35 kg/m2) who underwent laparoscopic SG from January 2016 to March 2023. All patients were monitored for postoperative bradycardia, defined as heart rates below 60 beats per minute (bpm), and were evaluated with electrocardiograms (ECG) and echocardiograms (ECHO). Data were analyzed using descriptive statistics and R software version 4.3.1. Results: The study included eight patients with a mean age of 34.88 ± 9.05 years and a mean BMI of 44.25 ± 3.62. Postoperative heart rates showed an initial increase to 79.6 ± 4.8 bpm, followed by a gradual decline, reaching 50 ± 3.17 bpm by discharge. Heart rates dropped significantly after 12 h, stabilizing by 24 h. The mean time to return to normal heart rate was 14 ± 4.36 days. All patients had routine preoperative ECG and ECHO, and no significant cardiac abnormalities were noted postoperatively. Conclusion: This case series underscores the occurrence of early postoperative sinus bradycardia in SG patients, a phenomenon that is underexplored in the literature. Future studies should investigate the pathophysiology of this condition and evaluate its clinical implications for postoperative care.

Background: Esophagogastroduodenoscopy (EGD) is crucial in bariatric surgery for detecting gastro-esophageal conditions and incidental pathologies, impacting surgical decisions and outcomes. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommends routine EGD before and after bariatric procedures to identify incidental pathologies. However, global adherence to these guidelines varies, especially in resource-constrained settings where economic limitations often dictate practice patterns. This study adapts a survey by Quake et al. (2022) to the Egyptian context, offering a comprehensive analysis of EGD utilization alongside broader trends in metabolic and bariatric surgery (MBS) practices in Egypt. Methods: A survey adapted from Quake et al. (2022) was tailored to assess trends in metabolic and bariatric surgery (MBS) practices in Egypt. Conducted between April and August 2024 with a response rate of 53.3%, the survey targeted Egyptian bariatric surgeons. It evaluated EGD utilization, surgical expertise, institutional volumes, types of procedures, revisional surgeries, and adherence to the 2020 IFSO position statement. Data was collected through Google Forms and analyzed for trends, challenges, and gaps in practice, focusing on economic constraints and guideline implementation. Results: Among the 80 respondents, 88.8% were consultants, with 73.8% performing over 100 surgeries annually. The volume of bariatric procedures increased from 2021 to 2023, with significant growth in sleeve gastrectomy (SG) and single-anastomosis sleeve ileal (SASI) bypasses/bipartition. Revisional surgeries were most commonly Roux-en-Y gastric bypass (RYGB). Despite this growth, EGD utilization remained limited. Pre-operatively, only 12.5% of surgeons performed EGD routinely for all patients, while 67.5% used it selectively based on patient or procedural factors. Post-operative EGD at one year was routinely offered by just 3.8% of surgeons, with 55% not routinely using it at all. Institutional and economic factors influenced these practices; surgeons in high-volume or private settings were more likely to adopt selective EGD use. Awareness of the 2020 IFSO guidelines showed a minimal impact on EGD practices, suggesting that financial considerations often outweigh clinical recommendations. Conclusions: This study highlights critical trends in bariatric surgery practices in Egypt, including increasing procedural volumes and the limited utilization of EGD. Economic constraints remain the predominant barrier to routine EGD use, despite its potential to improve surgical outcomes by identifying incidental pathologies. Enhancing patient care requires establishing a national registry, upgrading training programs, and implementing observerships to align with international standards are pivotal in advancing bariatric care in Egypt and guaranteeing high-caliber, evidence-based patient care.

Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.