Laparoscopic appendectomy using our new spiral needle is easy, minimally invasive, and cost effective.

Background Amidst the current worldwide epidemic of type 2 diabetes mellitus (T2DM), the global diabetes health burden is projected to reach 522 million in 2030, with much of this increase occurring in developing countries. Aim of the work to evaluate the role of laparoscopic sleeve gastrectomy with loop bipartition (single anastomosis sleeve ileal bypass) as a bariatric and metabolic procedure in control of type 2 diabetes in obese patients. Patients and methods This prospective cohort study included 20 obese adult patients with type 2 DM recently diagnosed within last 5 years. Some of them have other associated comorbidities. They were recruited at department of surgery Ain Shams University. The follow up was obtained during the first year post-operative. Results In this study, complete remission of diabetes was achieved in 75% of the patients by the 3rd post-operative month and in 95% by the end of the study. This was beside marked weight reduction and improvement of lipid profile without causing micronutrients deficiencies during the study period. Conclusion SASI bypass can be one of the most efficient metabolic procedures and could be associated with less risks. The procedure should be considered under investigations until enough long term data are available. Thus it is worth to be explored in research aiming for more data.

Treatment of primary achalasia includes many modalities. All of these procedures have an associated failure rate. The resulting fibrosis from these methods of treatment (dilation, POEM or Heller's myotomy) makes re-Heller’s more difficult and less effective especially if associated with esophageal body aperistalsis suggesting esophagectomy to be the only surgical option. Cardioplasty whether open or Laparoscopic (LSC) may be an acceptable option after failure of these primary treatment (dilation, POEM or Heller's myotomy). Patients with recurrent achalasia following failed primary treatments, were managed by cardioplasty either open or LSC. All patients were thoroughly investigated by upper endoscopy, dye study and manometry to confirm the failure of primary treatment and the need for redo surgery. Postoperative contrast swallows were done for all patients before discharge as well as manometry. We followed patient clinically and by investigations (dye study and manometry) to check the result of cardioplasty. From May 2019 to April 2022, we operated 23 patients having failed primary achalasia treatment: 3 cases open (13%) and 20 cases (87%) by laparoscopy. Mean operative time was (62 min). Mean hospital stay was 2.6 days. Rapid esophageal emptying by dye studies was noted on all cases. LES pressure decreased in all patients (mean 11 mmhg). No anastomotic leak. During the follow up period, all patients were free from dysphagia. Four patients (17%) had developed heartburn and regurgitation controlled by medical treatment. No mortality recorded. Laparoscopic cardioplasty is a feasible and effective option to treat patients for resistant achalasia with failed primary treatment (dilation, Heller’ myotomy and POEM) avoiding the high morbidity and mortality esophagectomy.

Laparoscopic fundoplication as anti-reflux technique has emerged and widely expanded as a cost effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). Long-term success rate ranges from 80–90% with this procedure, but side effects still exist even with experienced surgeons. Patients with a failed anti-reflux procedure are becoming a more common problem nowadays. Although most of these patients can be managed medically, still some of them will require revisional surgery. Methods We presented our experience from January 2015 to June 2019 facing cases of failed fundoplications. 59 cases with failed fundoplication requiring revision were included in the study. Redo fundoplications were decided preoperatively or intraoperatively to be difficult or unsafe to be done for these cases. Revision surgery for these cases was done using either distal gastrectomy and RY gastro-jejunostomy (22 cases) when the hiatal dissection was not feasible or unsafe due to obscure anatomy or Truncal vagotomy and RY gastro-jejunostomy (37 cases) when the hiatal dissection was easy and feasible. Results Laparoscopy was used in 49 cases and was successfully completed in 42cases (%) and 7conversion (%). Improvement of symptoms: Recurrent reflux or dysphagia was noted in 19 cases (32%) and complete disappeared in 26 cases (44%). One case had leak from the GJ and another one got hematemesis. Both cases were managed conservatively. Nine patient (15%) had bile gastritis with abdominal pain. Five patients (8.5%) complained of dumping symptoms. No mortality was recorded. Conclusion RY gastro-jejunostomy for failed fundoplications is a valid, feasible surgical option when redo fundoplication is difficult to be done or if associated with possible or expected complications.

Subspecialty policy is increasing all over the world aiming to improve the results of heavy esophageal surgeries. Our aim is to define the impact of having surgical specialized esophageal unit on the volume of patients and the results. Methods We reviewed all esophageal cases managed in our esophageal specialized department (from May 2016 to May 2019 Group A) and we compared the results to previous 3 years (from May 2013 to May 2016 Group B) and to the international results. There was 394 cases in group A compared to 104 cases in group B. Results For Gastro esophageal reflux disease (GERD),180 operations were performed in group a (45.7%) compared to 61 cases in group B (68.7%). Forty two (10.7%) modified Heller’s cardiomyotomy (Open and laparoscopic) for achalasia were performed in group A compared to 17 cases (16.3%) in group B. Surgeries for malignant lesions were performed for 122 cases (30.9%) in group A compared to 13 cases (12.5%) in group B. Other Esophageal operations were also done for 50 cases (12.7%) in group A compared to 13 cases (12.5%) in group B. Morbidities and mortalities are reported and compared to the international results. Conclusion Our results in group A are comparable to Hospital mortality rates for patients in medium-volume centers (7.5%). Also we approach the International results for morbidities of benign esophageal disease (5.7–12.7%) for fundoplication. Having a specialized esophageal unit resulted in increase of the volume of patients and improvement of the results.