Laparascopy Update Dr. Amjad Saeed

Calot triangle dissection; angle of safety

http://www.amedeo.com/p2.php?id=33528666&s=btd&pm=921c99181da7fd1

Open conversion in laparoscopic cholecystectomy and bile duct exploration: subspecialisation safely reduces the conversion rates - PubMed Although open conversion should not be seen as a failure, it carries a high morbidity and should only be performed when other strategies have failed. Subspecialisation and a high emergency case volume together with FFC and subtotal cholecystectomy as salvage strategies can reduce conversion and its....

https://click.mail.medscape.com/?qs=ff1a56ffe8e135da74a8040da78385b163eabf768ba7a560f853b84eef57718ddbc2cec362b95c23f0819027fcd2de0dd96186d5c1e63e4a9e40b9e5a15dfa2d

Keto vs Plant-Based Eating: Is the Carb-Insulin Model Correct? Which is better for weight loss: a low-carb, high-fat ketogenic diet or a low-fat, high-carb plant-based diet? Maybe it's not about the macronutrients, says Dr F. Perry Wilson.

https://www.medscape.com/viewarticle/945098?src=mbl_msp_iphone

Bariatric Surgery Gives 10-Year Cure for Some Advanced Diabetes New trial results will 'convince even the most skeptical of clinicians about the role of metabolic surgery as part of optimal care for their patients with difficult to control type 2 diabetes.'

https://link.springer.com/article/10.1007%2Fs11695-019-04156-0?fbclid=IwAR1CxgRj5hyamkVoosCNEEa6hAybK5rg3n_9FHFeAQR9yW9YQww8rHgneSo

An Extended Pouch in a Roux-En-Y Gastric Bypass Reduces Weight Regain: 3-Year Results of a Randomized Controlled Trial Background Although the Roux-en-Y gastric bypass (RYGB) is considered a standard procedure, many variations exist in the basic design. In order to achieve more pronounced and sustainable results after...

Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients.Review article

Shoar S, et al. Surg Obes Relat Dis. 2018.

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Abstract

BACKGROUND: Portomesenteric and splenic vein thrombosis (PMSVT) is a rare but potentially serious complication after bariatric surgery. No study has systematically analyzed its incidence and risk factors.

OBJECTIVES: To pool the data regarding PMSVT after bariatric surgery and determine its incidence and risk factors.

METHODS: A meta-analysis and systematic review was conducted to retrieve studies on PMSVT after bariatric surgery.

RESULTS: A total of 41 eligible studies including 110 patients with postbariatric PMSVT were enrolled; the estimated incidence rate based on 13 studies was .4%. The use of oral contraception was reported in 35.4% of patients, previous surgery in 61.1%, smoking in 37.2%, and history of coagulopathy in 43%. PMSVT mostly occurred after sleeve gastrectomy (78.9%) and within the first postoperative month (88.9%). Pneumoperitoneum pressure was>15 mm Hg in 6% of patients. The portal vein was the most commonly affected vessel (41.5%). Prothrombin 20210 mutation and protein C/S deficiency were the most common thrombophilic conditions. Unfractionated heparin (59.1%), vitamin K antagonists (50.9%), and low molecular weight heparin (39.1%) were the most common treatments for PMSVT. The morbidity and mortality rates for postbariatric PMSVT were 8.2% and 3.6%, respectively.

CONCLUSION: PMSVT usually occurs within the first postoperative month and is mostly reported after sleeve gastrectomy. The portal vein is the most commonly involved vessel. A previous hypercoagulable state can be an important risk factor. Most patients can be treated with anticoagulation therapy. Further studies with comprehensive data review of patient information are required.

Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients. - PubMed - NCBI Surg Obes Relat Dis. 2018 Jan;14(1):47-59. doi: 10.1016/j.soard.2017.09.512. Epub 2017 Sep 14. Meta-Analysis; Review; Systematic Review