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Introduction: Laparoscopic Sleeve Gastrectomy (LSG) has become the most commonly performed bariatric procedure. LSG is known for its safety and effectiveness, shorter operative time, feasibility, and easiness of revision and conversion to a malabsorptive surgery. Surgeons are tailoring different techniques to avoid complications from arising. Twisting of the sleeved gastric tube is one of the causes of sleeve obstruction and persistent nausea and vomiting. This study aims to compare between the postoperative complications in sleeve gastrectomy with and without posterior fixation. Patients and methods:In this prospective comparative cohort study 643 patients were included; divided into two groups according to the surgical technique. Group 1 included 364 LSG operations without fixation and Group 2 included 279 LSG with sleeve fixation. The operations were performed at Ain Shams University Hospitals between June 2017 and June 2021. Fixation of the sleeve was performed by two or three absorbable stitches to the prepancreatic fascia and root of the mesocolon. Incidence of postoperative complications were compared in each group.Results: There were no statistically significant differences in baseline characteristics between the two groups included in the study. Group 2 showed highly significant increase in operative time (p<0.001) the overall incidence of complications was significantly less in the fixation group (p <0.0001). Incidence of vomiting, bleeding, GERD and re-operation was significantly lower in group 2 (p<0.05).Seven patients from group 1 were diagnosed with gastric twist as post operative complication with one patient suffering from leakage compared to three patients in group 2. There were no mortalities in both groups. Conclusion:Adding posterior fixation to LSG ensures decreases incidence of complications. Many randomized controlled trials are needed to draw a solid outcome.

Background: Incisional hernia and wound dehiscence are common complications after abdominal surrgery. The development of minimally invasive surgical techniques has led to a dramatic decrease in these complications. Ten-millimeter and wider ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients, so, laparoscopic surgery may still be followed by trocar site herniation. Various methods have been advocated for its prevention. The aim of this study was to try a new method to prevent trocar site hernia in obese patients. Patients and methods:This prospective interventional non-randomized non-controlled study was conducted in the Department of General Surgery at Ain Shams University hospitals in the period from November 2013 to November 2016 on 150 obese (Body mass index (BMI)>35 kg/m 2 ) patients (50 males and 100 females) who underwent laparoscopic surgery (70 cholecystectomies, 25 gastric bypass surgeries, 35 sleeve gastrectomies and 20 appendectomies). In all patients, the fascial layer of trocar wounds was not closed. Instead, a Surgicel® plug was inserted into the muscle layer of trocar wounds. Informed consent was obtained from all patients included in the study.Results: One case, out of the included 150 obese patients, after laparoscopic gastric bypass developed port site hernia with an incidence of 0.67% (1/150). In both patients, hernia was uncomplicated. No patient in the other groups has been found to develop a hernia. Conclusion:Surgicel® plug is an easy technique with very low incidence of trocar site hernia after laparoscopic procedures in obese patients.

Background: Gastroesophageal reflux disease (GERD) is considered an obesity-related comorbidity. Hiatal hernia (HH) plays a role in the pathophysiology of GERD in the obese population. Roux-en-Y gastric bypass is considered the operation of choice when GERD is diagnosed in these population, the effect of laparoscopic sleeve gastrectomy (LSG) with hiatal hernia repair (HHR) on GERD still debated. Objective: To compare the outcomes of performing LSG with concomitant HHR vs LSG alone in patients with GERD. Patients and Methods: This was a retrospective analysis of maintained data of 241 patients undergoing LSG after refusing to undergo a bypass surgery in the

Background: Acute appendicitis is the most common cause of acute abdomen in young adults. In recent years, studies emerged showing that elevated serum total bilirubin levels could indicate a complicated case of acute appendicitis. An elevated serum total bilirubin that is not explained by liver disease or biliary obstruction can be present in many patients of acute appendicitis. Patients and methods: This is a prospective interventional non-randomized non-controlled study conducted on 175 consecutive cases of acute appendicitis admitted to the emergency unit in the Department of General Surgery at Ain Shams University hospitals, Cairo, Egypt in the period from July 2014 to August 2016. Liver function tests were done as a part of the preoperative investigations. Clinical diagnosis was confirmed postoperatively by histopathological examination. Their clinical and investigative data were analyzed, The level of significance was set at P< 0.05.Results: Serum total bilirubin was found to be significantly elevated in cases of complicated acute appendicitis. Conclusion:Serum total bilirubin is a new important adjunct in the diagnosis of complicated acute appendicitis.