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BACKGROUND: Data are lacking on trends in bariatric surgery and the frequency of incidental findings in Saudi Arabia. OBJECTIVE: Report on trends in bariatric surgery as well as our experience in incidental findings along with a literature review (mainly on gastrointestinal stromal tumor). DESIGN: Retrospective chart and literature review. SETTINGS: Academic tertiary care center. PATIENTS AND METHODS: We conducted a retrospective study at King Khalid University Hospital and analyzed the data collected from 2009 to 2019. We collected data on age, body mass index (BMI), H pylori infection, type of bariatric surgery performed, and type and location of incidental findings. MAIN OUTCOME MEASURES: Incidental findings during or after bariatric surgery (in pathology specimen). SAMPLE SIZE: 3052 bariatric surgeries, 46 patients with incidentalomas. RESULTS: The mean and standard deviation for the age of the 46 patients with incidentalomas was 42.1 (13.9) years and the mean (SD) preoperative BMI was 43.4 (6.4) kg/m 2 . Of 3052 bariatric surgeries performed, the most common type was sleeve gastrectomy (93.9%), followed by gastric bypass surgery (4.58%) and gastric banding (1.47%). The total frequency of incidentalomas was 1.5%; 10.8% of patients had gastrointestinal stromal tumors (GIST), with the stomach being the commonest site for incidental findings. Eighty percent of the patients with GIST were positive for H pylori ( P =.01 vs negative patients). CONCLUSION: The number of incidentalomas and other findings were consistent with other reports. All these findings suggest that bariatric surgeons should take special care before, during, and after a laparoscopic operation in obese patients. LIMITATIONS: Since this is a single-center, retrospective study, we did not collect data on important variables such as gender, socioeconomic status of the patient, and family history of obesity, and we did not perform a preoperative esophagogastroduodenoscopy. CONFLICT OF INTEREST: None.

Background: Spontaneous CSF leaks are rare, their diagnosis is often delayed, and they can precipitate meningitis. Craniotomy and intracranial approach is the historical "gold standard" repair for these leaks [1] . Anendonasal endoscopic approach offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success [2] . Recurrence of these leaks is not uncommon. One of the most important factors of this recurrence is inadequate support of the flaps or grafts or loose cooptation of raw surfaces which may be unable to resist the normotensive CSF leak. Maintaining adequate continuous low grade pressure intraoperativelyand two weeks postoperatively may optimize the best chance for raw areas to heal properly with minimal recurrence. Aim of Study:The aim of this study is to identify and discuss the pivotal role of intraoperative packing and its technique to obtain a successful repair of CSF rhinorrhea. Patients and Methods:A prospective randomized study conducted on 14 patients suffering spontaneous CSF rhinorrhea, from March 2018 to April 2020 in Hearing and Speech Institute. The 14 patients have been divided into two equal groups 7 patients each, group A and group B. In group A, traditional nasal packing was done, whoever, in group B, the special packing was done in the form two packs, the first pack over the grafted area was two layered composed of 1mm thickness silasticsheet over the graft and raw area and a piece of Merocel 1 by 1.5cmms supporting the silastic sheet. The second pack was placed in the nasal cavity. The first pack has been changed weekly to two or three weeks then removed finally.Results: All patients were doing well throughout the follow-up period. In group A, there was recurrence in fourpatients, two after six months and two after one year. In group B there was one recurrence after one year of follow-up.