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Ataya K, El Bourji H, Bsat A, Al Ayoubi A, Al Jaafreh AM, Abi Saad G. Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis. J Minim Invasive Surg 2023; 26:198-207. [PMID: 38098353 PMCID: PMC10728689 DOI: 10.7602/jmis.2023.26.4.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/06/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
Purpose In recent years, the need for revisional bariatric surgery (RBS) procedures has experienced a noteworthy surge to confront complexities and weight recidivism. Despite being a subject of controversy for many, the utilization of the Da Vinci robotic platform (Intuitive Surgical, Inc.) may present benefits in RBS. This study aimed to evaluate the outcomes of robotic RBS in comparison to Laparoscopic RBS. Methods A meticulous and thorough analysis was ensured through a comprehensive exploration of the literature, which included PubMed, Medline, Scopus, and Cochrane. This exploration was conducted in adherence to the directives outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale was used for quality assessment. Results A total of 11 studies were included in this meta-analysis, comprising 55,889 in the laparoscopic group and 5,809 in the robotic group. No significant differences were observed in the leak, bleeding, operative time, or length of stay across both groups. However, the robotic group showed higher rates of conversion to open surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53-0.79; p < 0.0001; I2 = 0%), reoperation (OR, 0.70; 95% CI, 0.57-0.87; p = 0.0009; I2 = 6%), and readmission (higher rate of readmission in the robotic group; OR, 0.76; 95% CI, 0.62-0.92; p = 0.005; I2 = 30%). Conclusion Robotic-assisted bariatric surgery has no significant advantage over conventional laparoscopic surgery. Further research is warranted to explore and evaluate surgeons' methodology and proficiency differences.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, King’s College Hospital, London, UK
| | - Hussein El Bourji
- Department of General Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ayman Bsat
- Department of General Surgery, American University of Beirut, Beirut, Lebanon
| | - Amir Al Ayoubi
- Department of General Surgery, Lebanese University, Beirut, Lebanon
| | | | - George Abi Saad
- Department of General Surgery, American University of Beirut, Beirut, Lebanon
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Ataya K, Al Jaafreh AM, El Bourji H, Bsat A, Nassar H, Al Ayoubi A, Abi Saad G. Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as Revisional Surgery After Failed Sleeve Gastrectomy: A Systematic Review and Meta-analysis. J Metab Bariatr Surg 2023; 12:57-66. [PMID: 38196783 PMCID: PMC10771971 DOI: 10.17476/jmbs.2023.12.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024]
Abstract
Purpose This study aimed to assess the outcomes of revisional procedures, namely Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) following unsuccessful laparoscopic sleeve gastrectomy. Materials and Methods This systematic review and meta-analysis included 817 patients (404 in OAGB group, 413 in RYGB group) from seven retrospective comparative studies. Data on sample size, demographics, perioperative complications, operative time, pre- and post-revisional body mass index, total weight loss, and global weight loss over follow-up were extracted. Results The mean operative time was 98.2-201 minutes for RYGB versus 78.7-168 minutes for OAGB. Despite classical RYGB gastric bypass taking longer, mini gastric bypass resulted in greater weight loss than RYGB, with a mean difference of -5.84 (95% confidence interval [CI], -6.74 to -4.94; P<0.00001; I2=0%), greater total weight loss, and a higher diabetes remission rate (odds ratio [OR], 0.32; 95% CI, 0.14 to 0.71). However, OAGB was associated with a significantly higher incidence of postoperative gastroesophageal reflux than RYGB (52 vs. 31: OR, 0.40; 95% CI, 0.24 to 0.67; P=0.0005; I2=0%). Conclusion OAGB was performed more quickly and boasted greater total weight loss and higher diabetes remission rates compared to RYGB after failed sleeve gastrectomy. However, OAGB also demonstrated a higher incidence of postoperative gastroesophageal reflux disease. Thus, careful patient selection is essential when considering OAGB. Trial Registration PROSPERO Identifier: CRD42023474966.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, Kings College Hospital London, London, UK
| | | | - Hussein El Bourji
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayman Bsat
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Department of Surgery, The Royal London Hospital, London, UK
| | - Amir Al Ayoubi
- Lebanese University Faculty of Medical Sciences, Hadath, Lebanon
| | - George Abi Saad
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Ataya K, Bsat A, Al Tannir AH, Al Jaafareh AM, Rabih Al A, Abi Saad G. Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis. J Metab Bariatr Surg 2023; 12:35-43. [PMID: 38196784 PMCID: PMC10771976 DOI: 10.17476/jmbs.2023.12.2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 01/11/2024]
Abstract
Purpose Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications. Materials and Methods A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library. The analysis encompassed 14 studies, involving 1,066 patients. We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates. Results SADI as a salvage procedure following SG yielded positive outcomes. Mean operative time was 125.98 minutes (95% CI 102.50-149.46, I2=99%). Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38-57%, I2=44%), dyslipidemia in 55% (95% CI 40-69%, I2=30%), and diabetes in 63% (95% CI 53-72%, I2=30%) of patients. Post-operative diarrhea incidence was relatively low at 2% (95% CI 1-9%, I2=75%). In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86-57.61, I2=95%) at six months, 59.39% (95% CI 51.18-67.61, I2=95%) at twelve months, and 23.84% (95% CI 5.76-41.92, I2=100%). At twenty-four months. Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0-5%, I2=80%) of cases. Conclusion SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness. It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks. Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, Kings College Hospital London, London, UK
| | - Ayman Bsat
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Hafiz Al Tannir
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Amir Rabih Al
- Lebanese University Faculty of Medical Sciences, Beirut, Lebanon
| | - George Abi Saad
- Department of General Surgery, American University of Beirut, Beirut, Lebanon
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El Charif MH, Tarhini H, Dushfunian D, Al Harake H, Khasawneh H, Abi Saad G, Khalife M, Sbaity E. Retroperitoneal desmoid-type fibromatosis: a case report. Ann Med Surg (Lond) 2023; 85:1258-1261. [PMID: 37113969 PMCID: PMC10129236 DOI: 10.1097/ms9.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023] Open
Abstract
Desmoid-type fibromatosis (DF) is a rare subtype of soft tissue sarcomas that most commonly occurs in the anterior abdominal wall. When occurring in the retroperitoneum, DF is usually part of familial syndromes while only rarely sporadic. This makes it imperative to report any instance of experience with DF and the oncological outcomes of the different approaches to management. We report two cases of sporadic and severe DF occurring in the retroperitoneum at our institution. Case presentation The first case is a male that presented with urinary obstruction symptoms and underwent surgical resection of the tumor that extended into the left kidney. The second case is a female with a history of recurrent desmoid tumors of the thigh and was incidentally diagnosed with retroperitoneal DF on imaging. She underwent tumor resection and radiotherapy; however, the tumor recurred with urinary obstruction symptoms that required another surgical resection. Histopathological characteristics and radiological imaging of both cases are described below. Clinical discussion Desmoid tumors often recur, thus significantly influencing the quality of life which is reflected in one of our cases. Surgery remains a mainstay treatment, and both cases presented in this report required surgical resection of the tumors as symptomatic and curative measures. Conclusion Retroperitoneal DF is a rare entity, and our cases add to the scarce literature available on the topic, which may well contribute to the formulation of practice-changing recommendations and guidelines focused on this rare variant of DF.
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Affiliation(s)
| | | | | | | | - Hala Khasawneh
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Eman Sbaity
- Department of Surgery
- Corresponding author. Address: Riad El Solh, Beirut 1107 2020, Lebanon. Tel.: +961 377 1917. E-mail address: (E. Sbaity)
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Ghaziri D, Dehaini H, Msheik M, Bahmad M, Zorkot M, Saad GA. Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol. BMC Pharmacol Toxicol 2023; 24:2. [PMID: 36639796 PMCID: PMC9837750 DOI: 10.1186/s40360-023-00643-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The literature recommends against the use of fondaparinux in patients with kidney failure and dialysis as it may, with repeated dosing, accumulate and put patients at risk of bleeding. The management of patients with thrombosis in the presence of heparin-induced thrombocytopenia HIT requires the introduction of an alternative anticoagulant like bivalirudin or argatroban. When these drugs are not available, fondaparinux, remains the only alternative. In similar scenarios, there are few studies addressing how to administer it. METHODS: We developed a protocol for fondaparinux in patients with renal failure where pharmacokinetic parameters are altered, and levels changed only after hemodialysis or in cases of residual renal activity. Patients received a full first dose except for high risk of bleeding. We targeted a peak anti-factor Xa activity level of 0.6-1.3 units/ml and changed the subsequent dose accordingly. Furthermore, we monitored the patients for signs of bleeding, a drop in hemoglobin level, or clinical signs of thrombosis. DISCUSSION: We described 10 patients with kidney failure and suspected HIT taking fondaparinux. All the patients achieved therapeutic anti-factor Xa activity levels. However, one developed new-onset venous thromboembolism (VTE) despite therapeutic anti-factor Xa levels. Another patient experienced a bleeding episode. We believe that these two patients developed complications due to their medical conditions rather than the use of fondaparinux. CONCLUSION Fondaparinux can be safely used in kidney failure using our protocol. However, despite its safety profile and relative success, this case series was small. More robust studies need to be conducted prior to drawing conclusions.
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Affiliation(s)
- Dania Ghaziri
- grid.411654.30000 0004 0581 3406Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hassan Dehaini
- grid.239578.20000 0001 0675 4725Departments of Vascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - Mayyas Msheik
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Bahmad
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Zorkot
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - George Abi Saad
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Bsat S, Moussalem C, Kawtharani S, El Houshiemy MN, Halaoui A, Saba T, Najjar M, Assi H, Baajour J, El-Houcheimi I, Saad GA, Darwish H. Neurosurgical Experience of Beirut Blast in the Era of Coronavirus Disease 2019 (COVID-19) from a Tertiary Referral Center. World Neurosurg 2022; 162:e659-e663. [PMID: 35367645 PMCID: PMC8969293 DOI: 10.1016/j.wneu.2022.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022]
Abstract
Background In this paper, we shed the light on Beirut’s blast that took place in the coronavirus disease 2019 (COVID-19) era. An explosion that ripped the heart of Beirut, it produced a destructive shock wave that left thousands of casualties and people homeless. This explosion, which had a mushroom-like cloud appearance similar to that of Hiroshima and Nagasaki, was described as the third-biggest explosion in human history. It was a blast that not only destroyed lives but also fell as a heavy burden on the shoulders of a country that was suffering from unprecedented economic crisis on top of the COVID-19 pandemic. Facing all this, health care providers were the first line of defense in what looked like an impossible mission. Objective We seek to share with the medical community our experience and the challenges we faced, as a neurosurgery team, during this event, particularly that we were short of basic medical equipment as well as intensive care unit beds since we were in the middle of an economic crisis and the peak of the COVID-19 pandemic. This prohibited us from delivering proper care, whether in the triage of patients or in the operating room, as well as postoperative care. Now, 1 year after this sad event, we revisit the whole situation and examine all the pitfalls that could have been avoided. Thus, we discuss the importance of initiating a disaster response, in particular the neurosurgical emergency response, to be better prepared to face future potential events. Conclusions The rate-limiting step in such disasters is definitely a well-prepared trained team with a prompt and fast response. And, since time is brain, then what saves the brain is proper timing.
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Affiliation(s)
- Shadi Bsat
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Kawtharani
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Nabih El Houshiemy
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adham Halaoui
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tatiana Saba
- NeuroICU Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Najjar
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem Assi
- Neuro-Oncology Division, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Baajour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - George Abi Saad
- NeuroICU Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Houssein Darwish
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Gebran A, Abou Khalil E, El Moheb M, Albaini O, El Warea M, Ibrahim R, Karam K, El Helou MO, Ramly EP, El Hechi M, Matar A, Zeineddine J, Dabar G, Al Hajj A, Abi Saad G, Hoballah J, Safadi B, Kaafarani HMA. The Beirut Port Explosion Injuries and Lessons Learned: Results of the Beirut Blast Assessment for Surgical Services (BASS) Multicenter Study. Ann Surg 2022; 275:398-405. [PMID: 34967201 DOI: 10.1097/sla.0000000000005322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This multicenter study aims to describe the injury patterns, emergency management and outcomes of the blast victims, recognize the gaps in hospital disaster preparedness, and identify lessons to be learned. SUMMARY BACKGROUND DATA On August 4th, 2020, the city of Beirut, Lebanon suffered the largest urban explosion since Hiroshima and Nagasaki, resulting in hundreds of deaths and thousands of injuries. METHODS All injured patients admitted to four of the largest Beirut hospitals within 72 hours of the blast, including those who died on arrival or in the emergency department (ED), were included. Medical records were systematically reviewed for: patient demographics and comorbidities; injury severity and characteristics; prehospital, ED, operative, and inpatient interventions; and outcomes at hospital discharge. Lessons learned are also shared. RESULTS An estimated total of 1818 patients were included, of which 30 died on arrival or in the ED and 315 were admitted to the hospital. Among admitted patients, the mean age was 44.7 years (range: 1 week-93 years), 44.4% were female, and the median injury severity score (ISS) was 10 (5, 17). ISS was inversely related to the distance from the blast epicenter (r = --0.18, P = 0.035). Most injuries involved the upper extremities (53.7%), face (42.2%), and head (40.3%). Mildly injured (ISS <9) patients overwhelmed the ED in the first 2 hours; from hour 2 to hour 8 post-injury, the number of moderately, severely, and profoundly injured patients increased by 127%, 25% and 17%, respectively. A total of 475 operative procedures were performed in 239 patients, most commonly soft tissue debridement or repair (119 patients, 49.8%), limb fracture fixation (107, 44.8%), and tendon repair (56, 23.4%). A total of 11 patients (3.5%) died during the hospitalization, 56 (17.8%) developed at least 1 complication, and 51 (16.2%) were discharged with documented long-term disability. Main lessons learned included: the importance of having key hospital functions (eg, laboratory, operating room) underground; the nonadaptability of electronic medical records to disasters; the ED overwhelming with mild injuries, delay in arrival of the severely injured; and the need for realistic disaster drills. CONCLUSIONS We, therefore, describe the injury patterns, emergency flow and trauma outcome of patients injured in the Beirut port explosion. The clinical and system-level lessons learned can help prepare for the next disaster.
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Affiliation(s)
- Anthony Gebran
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
| | - Elissa Abou Khalil
- Division of Pulmonary and Critical Care, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Mohamad El Moheb
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
| | - Obey Albaini
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | | | - Rand Ibrahim
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karin Karam
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Mohamad Othman El Helou
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Elie P Ramly
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Majed El Hechi
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
| | - Ayah Matar
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Zeineddine
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - George Dabar
- Division of Pulmonary and Critical Care, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | | | - George Abi Saad
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal Hoballah
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Safadi
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
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Hallal A, Andraos R, Saad GA, Boyajian T, Hoballah J. Corrigendum to ' Mass casualty management during a pandemic surge: The American University of Beirut Medical Center experience' [Seminars in Vascular Surgery Volume 34, Issue 2 (2021) 51-59/Article Number]. Semin Vasc Surg 2021; 34:152-154. [PMID: 34642035 DOI: 10.1053/j.semvascsurg.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ali Hallal
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Rebecca Andraos
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - George Abi Saad
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Talar Boyajian
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Jamal Hoballah
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Hallal A, Andraos R, Saad GA, Boyajian T, Hoballah J. Mass casualty management during a pandemic surge: The American University of Beirut Medical Center experience. Semin Vasc Surg 2021; 34:51-59. [PMID: 34144748 DOI: 10.1053/j.semvascsurg.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 01/24/2023]
Abstract
Mass casualty incidents can be devastating events associated with a large number of fatalities, morbidities, and long-lasting sequelae. The negative outcomes can be further amplified if the incident occurred during a pandemic surge, such as what occurred in Beirut, Lebanon with the August 4, 2020 Beirut Port explosion. To decrease the mortality and morbidity and avoid inefficiency, management depends on having an established coordinated multidisciplinary approach from transport and triage to emergency department care and in-hospital management. In this article, the mass casualty management and the impact of the coronavirus disease 2019 pandemic will be discussed based on the American University of Beirut Medical Center experience.
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Affiliation(s)
- Ali Hallal
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
| | - Rebecca Andraos
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - George Abi Saad
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Talar Boyajian
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Jamal Hoballah
- American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
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Rifai AE, Rifai AE, Ghazal A, Saad GA. Small Bowel Obstruction Due to a Gossypiboma: A Rare and Dreaded Sequel of a Trauma Laparotomy. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.08.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a case report of a 23-year-old male who presented to a hospital in Aleppo with a few months’ history
of abdominal pain and diarrhea associated with progressive weight loss and ultimate cachexia. Patient’s
history is significant for a trauma laparotomy due to a blast injury with management of a colonic and
orthopedic injuries. Three months later he underwent a second laparotomy for reversal of the stoma after
which his symptoms started and gradually became worse. The abdominal pain attacks were so severe
unresponsive to analgesics and he had lost around 30 kg. He underwent CT scan on presentation which
showed small bowel obstruction and was taken down to the operating room (OR) for exploration. In the
operating room a hard mass was palpated in the small bowel and a small enterotomy was done overlying
the mass with retrieval of a large surgical pad, gossypiboma, from the lumen. The enterotomy was closed
primarily and the patient did well postoperatively and was discharged home.
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Abou Heidar NF, Degheili JA, Khauli RB, Abi Saad G. A large bi-lobed classic renal angiomyolipoma with vena caval extension. Radiol Case Rep 2020; 15:353-361. [PMID: 32055259 PMCID: PMC7005504 DOI: 10.1016/j.radcr.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 11/21/2022] Open
Abstract
Renal angiomyolipomas (AMLs) are the most common benign renal tumors encountered, and composed of 3 components: mature adipose tissues, smooth muscles, and blood vessels. Mostly asymptomatic and discovered incidentally, the classic type of AMLs rarely extend to involve great vessels. Radiological confirmation of such lesions is paramount for diagnosis and planned intervention. Management of AMLs is based on clinical presentation and varies from active surveillance to invasive surgical interventions. A case of sizeable classic AML with extension to inferior vena cava is presented here, with successful tumor resection performed after complete liver mobilization. A literature review and a summary of similar cases are also presented. A multidisciplinary approach is required for proper and precise radiological diagnosis to achieve an adequate surgical resection, which might sometimes be complicated and complex, as in this current case.
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Affiliation(s)
- Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Raja B Khauli
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - George Abi Saad
- Division of General Surgery, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
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12
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Halawani HM, Bakkar S, Jamali SF, Khalifeh F, Abi Saad G. Life threatening presentation of thoracic duct injury post thyroid surgery; a case report. Int J Surg Case Rep 2017; 34:40-42. [PMID: 28347925 PMCID: PMC5369858 DOI: 10.1016/j.ijscr.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/26/2022] Open
Abstract
Injury to thoracic duct, and the formation of chyle leak, is a rare complication and carries significant metabolic and immunological consequences. Thoracic duct injury during thyroid surgery is an uncommon event with an incidence rate of 0.5–1.8%. High output chyle leak in a confined space was life threatening. Surgeons must be familiar with thoracic duct anatomy.
Background Injury to thoracic duct is a rare potential complication of time-honored conventional thyroidectomy. Nevertheless, it can be a cause of significant morbidity, and sometimes life-threatening. Patient findings A 78-year-old female patient with a previous surgical history of thyroid lobectomy for nodular disease presented with primary hyperparathyroidism, and a nodule in the remaining thyroid lobe. The patient underwent completion thyroidectomy and parathyroidectomy. Less than 24 h post operatively, the patient developed progressive shortness of breath and neck swelling requiring immediate intubation and re-exploration. A large amount of chyle was drained and an injured thoracic duct was identified and ligated. Summary In experienced hands thyroid surgery is safe. Nevertheless, factors such as the type of pathology and its extent, the level of surgery, and re-operative surgery increase the risk of postoperative complications. Immediate surgical exploration is necessary when patients present with neck swelling and respiratory distress. In our case, a high output chyle leak in a confined space was life threatening. Conclusion Timely re-exploration following thyroid surgery and thorough knowledge of the anatomy of neck structures is crucial in sparing patients potential morbidity and/or mortality.
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Affiliation(s)
- Hamzeh M Halawani
- Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Cairo Street, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan.
| | - Sarah F Jamali
- American University of Beirut Medical Center, Beirut, Lebanon.
| | - Farah Khalifeh
- Department of Immunology and Microbiology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - George Abi Saad
- Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon.
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Lakis M, Hanna E, Noujaim MG, Saad GA. Traumatic rupture of a solitary splenic hydatid cyst: A case report. Trauma Case Rep 2015; 1:1-3. [PMID: 30101166 PMCID: PMC6082440 DOI: 10.1016/j.tcr.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2015] [Indexed: 12/03/2022] Open
Abstract
The rupture of an Echinococcus granulosus hydatid cyst in the spleen due to trauma is a rare event. In this case report we describe the case of a 39-year-old Lebanese male victim of a motor vehicle accident with a ruptured solitary splenic hydatid cyst discovered by CT scan and excised during exploratory laparotomy. Echinococcosis or hydatid disease is a parasitic infestation by the Echinococcus genus of tapeworm. The eggs of E. granulosus, a species of Echinococcus, are fecal-orally transmitted to human hosts, most often from dog feces, and manifest as cystic lesions termed hydatid. E. granulosus most commonly affects the liver (75%), lungs (15%), and rarely the spleen (2–5%) [1], [2]. E. granulosus is particularly endemic to cattle rearing areas of the Middle East. Infected patients most commonly present with vague abdominal pain, as a result of mass effect or spontaneous rupture of the cyst. Nevertheless, patient presentation may be due to traumatic rupture of a hydatid cyst; however, this is very rare. Herein we report a case of traumatic rupture of a solitary splenic hydatid cyst in a 39-year-old male following a motor vehicle crash, managed following the Advanced Trauma Life Support (ATLS) protocol.
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Affiliation(s)
- Moustafa Lakis
- American University of Beirut Medical School, Beirut, Lebanon
- Division of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Edith Hanna
- American University of Beirut Medical School, Beirut, Lebanon
| | | | - George Abi Saad
- American University of Beirut Medical School, Beirut, Lebanon
- Division of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- Corresponding author at: Abdel Aziz, Blue Bldg, 4th floor, American, University of Beirut Medical Center, Beirut, Lebanon. Tel.: + 961 1350000x5680.
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14
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El Lakis MA, Rida K, Nakhle R, Abi Saad G. Complex rectal and anal canal injuries secondary to unusual blunt perineal trauma. BMJ Case Rep 2014; 2014:bcr-2014-206060. [PMID: 25352384 DOI: 10.1136/bcr-2014-206060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 27-year-old woman sustained a trauma to her perineal area when she was ejected from a jet ski while riding on water at high speed. The patient presented to the emergency department with blood streaking from her anal canal. Imaging revealed pneumoperitoneum. Surgical intervention showed complex anal canal and rectal injuries. Primary repair of the injuries was performed. Postoperatively the patient did well and was followed up with no evidence of residual symptoms and with a continent anal sphincter.
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Affiliation(s)
| | - Khaled Rida
- Department of Surgery, Habib Medical Group, Riyadh, Saudi Arabia
| | - Ram Nakhle
- Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - George Abi Saad
- Department of Surgery, American University of Beirut, Beirut, Lebanon
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15
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Moustafa MA, Thabet HS, Saad GA, El-Setouhy M, Mehrez M, Hamdy DM. Surveillance of lymphatic filariasis 5 years after stopping mass drug administration in Menoufiya Governorate, Egypt. East Mediterr Health J 2014; 20:295-299. [PMID: 24952286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
The World Health Organization recommends that before lymphatic filariasis elimination in an area can be confirmed, an additional survey should be performed at least 5 years after stopping mass drug administration. The current study aimed to determine the status of lymphatic filariasis 5 years after cessation ofthe mass drug administration in 3 sentinel Egyptian villages in Menoufiya Governorate. The rapid immunochromatographic card test (ICT) and a new commercial antibody detection kit (CELISA®) were used. All 1321 primary-school children aged 6-7 years old were ICT negative but 27 children were antibody positive. All households surveyed in one village with the highest antibody prevalence were ICT negative, indicating an absence of lymphatic filariasis. The CELISA antibody kit needs more standardization and development to be useful under field conditions. We conclude that lymphatic filariasis is no longer a public health problem in these villages and other villages with similar epidemiological conditions.
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Affiliation(s)
- M A Moustafa
- Department of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H S Thabet
- Department of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - G A Saad
- Department of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M El-Setouhy
- Department of Public Health, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Mehrez
- General Departmentfor Malaria, Filariasis and Leishmaniasis Control, Endemic Diseases Control Sector, Ministry of Health, Cairo, Egypt
| | - D M Hamdy
- Department of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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16
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Soffar SA, Metwali DM, Abdel-Aziz SS, el-Wakil HS, Saad GA. Evaluation of the effect of a plant alkaloid (berberine derived from Berberis aristata) on Trichomonas vaginalis in vitro. J Egypt Soc Parasitol 2001; 31:893-904 + 1p plate. [PMID: 11775115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Berberine is a quaternary alkaloid derived from the plant Berberis aristata having antibacterial, antiamoebic, antifungal, antihelminthic, leishmanicidal and tuberculostatic properties. The effect of berberine sulphate salt on the growth of Trichomonas vaginalis in vitro was compared to the efficacy of metronidazole as a reference drug. Results showed that berberine sulphate was comparable to metronidazole as regards potency with the advantage of being more safe and possible replacement in metronidazole resistant cases.
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Affiliation(s)
- S A Soffar
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
STUDY OBJECTIVES To examine the incidence and response to treatment of adrenal insufficiency (AI) in high-risk postoperative patients. DESIGN Prospective observational case series. SETTING Large urban tertiary-care surgical ICU (SICU). PARTICIPANTS Adults > 55 years of age who required vasopressor therapy after adequate volume resuscitation in the immediate postoperative period. INTERVENTIONS Each patient underwent a cosyntropin (ACTH) stimulation test; at the discretion of the clinical team, some patients were empirically given hydrocortisone (100 mg IV q8h for three doses) before serum cortisol values became available. MEASUREMENTS Adrenal dysfunction (AD), defined as serum cortisol < 20 microg/dL at all time points, with Delta cortisol (60 min post-ACTH minus baseline) of < or = 9 microg/dL; functional hypoadrenalism (FH), defined as serum cortisol < 30 microg/dL at all time points or Delta cortisol (60 min post-ACTH minus baseline) < or = 9 microg/dL; and AI, as the presence of either AD or FH. RESULTS One hundred four patients were enrolled with a mean age (SD) of 65.2 +/- 16.9 years. AI (AD plus FH) was found in 34 of 104 patients (32.7%): AD was found in 9 patients (8.7%), FH in 25 patients (24%), and normal adrenal function in 70 patients (67.3%). The absolute eosinophil count was significantly higher in the combined AD and FH groups compared with the group with normal adrenal function (p < 0.05). Forty-six of 104 patients (44.2%) received hydrocortisone; 29 (63%) could be weaned from treatment with vasopressors within 24 h. This beneficial effect of hydrocortisone reached statistical significance in the FH group when compared with untreated patients (p < 0.031); a similar trend was seen in the AD group (p = 0.083). Mortality was also lower in the hydrocortisone-treated AI patients (5 of 23 [21%] vs 5 of 11 [45%] in those not receiving hydrocortisone; p < 0.01). CONCLUSION There is a high incidence of AI among SICU patients > 55 years of age with postoperative hypotension requiring vasopressors. There is also a significant association between hydrocortisone replacement therapy, resolution of vasopressor requirements, and improved survival.
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Affiliation(s)
- E P Rivers
- Department of Surgery, Henry Ford Hospital, Case Western Reserve University, Detroit, MI 48202, USA.
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Affiliation(s)
- G A Saad
- Department of Surgery, American University of Beirut, New York, New York 10022-6222, USA
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Abdo F, Massad M, Slim M, Fahl M, Saba M, Najjar F, Saad GA. Wandering intravascular missiles: report of five cases from the Lebanon war. Surgery 1988; 103:376-80. [PMID: 3278406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
From 1980 to 1986, during the Lebanon war, five patients with missile embolization were seen at the American University of Beirut Medical Center. Three had entry in the heart or thoracic aorta with peripheral embolization, and two had entry in the internal carotid artery and inferior vena cava with embolization to the middle cerebral artery and heart, respectively. Embolization was suspected when, in the absence of an exit, routine x-ray films showed the missile in a distant location. Angiography and echocardiography confirmed the diagnosis. Peripheral arterial emboli were extracted while cerebral and venous emboli were kept, as they caused transient symptoms and remained silent.
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Affiliation(s)
- F Abdo
- Department of Surgery, American University of Beirut Medical Center, Lebanon
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