Nonoperative management of blunt splenic and liver injuries in adult polytrauma

Background: Isolated splenic or hepatic injuries are present in approximately 30% of all cases of adult abdominal trauma. Most authors quoted above have limited nonoperative management (NOM) to patients with isolated organ injury. Results of NOM following blunt hepatic and splenic trauma in patients with multiple injuries were evaluated in this study. Materials and Methods: Retrospective chart review was performed on multiple injured adults with splenic and liver injures resulting from blunt trauma. Associated injuries, clinical signs at presentation, used diagnostic tools, injury grading, transfusion requirements, morbidity and mortality were documented. Results: Medical records of 275 patients aged from 17 to 81 years with blunt splenic and liver trauma and associated injuries were analyzed. Patients with hemodynamic instability or obvious peritoneal signs were excluded from further study. Surgery was indicated in 106 patients without response or transient response for fluid challenge. 131 of 237(55%) patients were selected for NOM: 78 with splenic, 46 with liver and 7 with injuries to both. 25(19%) patients were older 55 years. The mean injury severity score was 25.2. Injury grade ranged from I-IV and the degree of hemoperitoneum was from mild to severe. 8 patients failed NOM (6%). Mean blood transfusion requirement during first 24 hours at admission was 0.3 units. Morbidity rate was 1.2%. Two patients (1.5%) died following severe head trauma. Conclusion: Nonoperative strategy is the preferred modality for the care of blunt splenic and liver injuries in the hemodynamically stable patients, irrespective of age, grade of injury, associated injuries or degree of hemoperitoneum

The Effect of Bariatric Surgery upon Diabetes Mellitus: A Proof of Concept by Using the Case of the Mid-Term Effect of Lap Adjustable Gastric Banding (LAGB) on Patients with Diabetes

Obesity is a worldwide epidemic, with numbers on the rise in the world. Obesity is strongly correlated with increased morbidity and mortality. One of the major factors affecting this increase is comorbid diseases such as diabetes mellitus (DM), which is strongly associated with and dependent on the degree of obesity. Thus, it is not surprising that when efficient surgical treatments were found to battle obesity, researchers soon found them to be relevant and effective for battling DM as well. Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgical treatment for morbid obesity. LAGB has the potential to improve control of the comorbidities of morbid obesity, primarily diabetes mellitus (DM). Our hypothesis was that patients treated with LAGB would have a long-term improvement in the control of DM and that due to its unique mechanism of action, this can lend us a better understanding of how to battle diabetes in an efficient and effective way. This was a cohort study based on patients who underwent LAGB surgery in our institution 4 to 7 years previously and had DM type 2 at the time of surgery. Data were collected from patient’s charts and a telephone interview-based questionnaire including demographics, health status, and quality-of-life assessment (Bariatric Analysis and Reporting Outcome System [BAROS]). Seventy patients participated in the current study. The average follow-up time was 5.1 ± 0.9 years post-surgery. The average weight prior to surgery was 122.0 ± 20.2 kg, and on the day of the interview it was 87.0 ± 17.6 kg (p < 0.001). The average body mass index before surgery was 43.8 ± 5.1, and on the day of the interview it was 31.2 ± 4.8 (p < 0.001). On the day of the interview, 47.1% of the participants were cured of DM (not receiving treatment, whether dietary or pharmacologic). The sum of ranks for diabetes was lower after the surgery (p < 0.001), as was HTN and its treatment (p < 0.001). We have shown in this study that LAGB is an effective treatment for morbid obesity, as well as two comorbidities that come with it—DM type 2 and Hypertension (HTN)—in a longer period than previously shown, and with a unique look at the underlying mechanism of action of this procedure. There is a need for further studies to consolidate our findings and characterize which patients are more prone to enjoy these remarkable surgical benefits

Abdominal Cocoon as a Rare Cause of Small Bowel Obstruction in an Elderly Man: Report of a Case and Review of the Literature

Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. The cause and pathogenesis of the condition have not been elucidated. It primarily affects adolescent girls living in tropical and subtropical regions. Several earlier cases have been reported in males. We describe an 82-year-old man presenting with small bowel obstruction without history of previous abdominal surgery. He was treated by warfarin following aortic valve replacement. Abdominal cocoon was detected at laparotomy. Excision of membrane and lysis of adhesions led to relief of obstruction. Abdominal cocoon is a rare pathology that may be found in all kinds of populations. It may be a rare form of small bowel obstruction diagnosed during surgery in elderly patients

EAES recommendations on methodology of innovation management in endoscopic surgery.

Under the mandate of the European Association for Endoscopic Surgery (EAES) a guideline on methodology of innovation management in endoscopic surgery has been developed. The primary focus of this guideline is patient safety, efficacy, and effectiveness