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  • 1.
    Abdelaal, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Abusabeib, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Farghaly, Hanan
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Tabeb, Abdelhakem A. M.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Simultaneous occurrence of follicular and papillary thyroid carcinomas in same thyroid lobe: A case series of six patients from Qatar2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 73, p. 65-70Article in journal (Refereed)
    Abstract [en]

    Background: Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported. Presentation of cases: We report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. Conclusions: We present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety. © 2020 The Author(s)

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  • 2.
    Abdulrazzaq, Sama
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Mohammad, Amjad Salah
    Departments of General Surgery, Hamad General Hospital, Doha, Qatar.
    Sargsyan, Davit
    Department of Metabolic and Bariatric Surgery, Hamad General Hospital, Doha, Qatar / Weill Cornell Medicine-Qatar, Doha, Qatar.
    Bashah, Moataz
    Department of Metabolic and Bariatric Surgery, Hamad General Hospital, Doha, Qatar / Weill Cornell Medicine-Qatar, Doha, Qatar.
    Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?2020In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, p. 1219-1229Article in journal (Refereed)
    Abstract [en]

    Background: Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared to R-RYGB (e.g., post sleeve gastrectomy or gastric banding) are controversial. Methods: Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011 - June 2015) at our center. One hundred and twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension and dyslipidemia in terms of remission, improvement, persistence, relapse and de novo. The current study also assessed mortality and complications rates. Results: There were no significant differences in the baseline characteristics of patients who received P-RYGB with those who received R-RYGB in terms of age, gender and preoperative BMI. However, at 18 months: a) Patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P <0.001), reflected by a higher mean delta BMI (P = 0.02), TWL%(P <0.0001) and EWL%(P < 0.0001); b) No differences were observed between the two patients groups in terms of glycemic parameters, lipid profiles, and control of T2DM, hypertension, and dyslipidemia; and, c) No deaths were reported among both patients groups, and complication rates were comparable. Conclusion: Although R-RYGB effectively addressed inadequate weight loss, weight regain and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared to P-RYGB. There were no significant differences between the two procedures in terms of their clinical control of T2DM, hypertension and dyslipidemia. Both procedures exhibited comparable complication rates. 

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  • 3.
    Abusabeib, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Bhat, Harun
    Weill Cornell Medicine in Qatar, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Right ectopic paraesophageal parathyroid adenoma with refractory hypercalcemia in pregnancy: A case report and review of the literature2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 77, p. 229-234Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus. Presentation of case: A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised. Discussion: Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases. Conclusions: Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy. 

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  • 4.
    Abusabeib, Abdelrahman
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar.
    Mohamed, Sugad
    Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar.
    First case of huge classic papillary thyroid cancer rupturing spontaneously leading to ischemic necrosis, perforation and inflammation of overlying skin: Case report and review of the literature2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 85, article id 106136Article in journal (Refereed)
    Abstract [en]

    Introduction: Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation. Presentation of case: A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI). Discussion: Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%. Conclusion: Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy. 

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  • 5.
    Abusabeib, Alyaa
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Alobaidan, Jassim
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    First Case Report of Fulminant Hepatitis After Laparoscopic Sleeve Gastrectomy Associated with Concomitant Maximal Therapeutic Dose of Acetaminophen Use, Protein Calorie Malnutrition, and Vitamins A and D, Selenium, and Glutathione Deficiencies2021In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 31, no 2, p. 899-903Article in journal (Refereed)
    Abstract [en]

    Nonalcoholic fatty liver disease (NAFLD) is increasingly being linked to obesity. Although laparoscopic sleeve gastrectomy (LSG) is effective for weight loss that can ultimately resolve NAFLD, an initial transient deterioration of liver functions could be observed during the first few months post-operatively, after which a subsequent improvement of the liver functions might occur. Rapid weight loss, nutritional deficiencies, and protein malnutrition can all contribute to hepatic dysfunction and can affect the metabolism of medications such as acetaminophen leading to more insult to a compromised liver. We report acute liver failure after LSG associated with protein calorie malnutrition, multiple nutritional deficiencies in addition to concomitant use of therapeutic doses of acetaminophen. Treatment with N-acetylcysteine, and replacement of deficient multivitamins and trace elements resulted in significant improvement in liver functions. 

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  • 6.
    Abusabeib, Alyaa
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    First Case Report of Acquired Copper Deficiency Following Revisional Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Leading to Severe Pancytopenia with Refractory Anemia2020In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, no 12, p. 5131-5134Article in journal (Refereed)
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  • 7.
    Al Dhaheri, Mahmood
    et al.
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Nada, Mohamed Abu
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Kurer, Mohamed
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Ahmed, Ayman Abdelhafiz
    Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Left iliac fossa mini-incision sigmoidectomy for treatment of sigmoid volvulus: Case series of six patients from Qatar2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 75, p. 534-538Article in journal (Refereed)
    Abstract [en]

    Background: Midline laparotomy is the definitive treatment for sigmoid volvulus after initial colonoscopic detorsion. We successfully adopted another technique at our center on 6 patients, treating sigmoid volvulus by left iliac fossa mini-incision. Presentation of cases: We report our experience of six non-consecutive cases of sigmoid volvulus treated by left iliac fossa mini-incision. The cases were a 33 year old Egyptian female, a 21 year old Bangladeshi male, a 58 year old Qatari male, a 30 year old Ethiopian male, a 36 year old Ugandan male, and a 58 year old Indian male. The six cases are unique in the surgical technique employed in their management. This is possibly the second case series of left iliac fossa mini-incision for sigmoid volvulus in the Middle East and North Africa Region. Discussion: All patients underwent initial colonoscopic detorsion followed by sigmoidectomy and anastomosis. The procedure was successful in treating the volvulus in five patients with no complication or recurrence over a mean follow up of 8 months (range: 1–36 months). One patient required further laparotomy and resection with anastomosis due to incompletely removed sigmoid colon. Conclusions: Left iliac fossa mini-incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.

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  • 8.
    Al Hassan, Mohamed S.
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine – Qatar, Doha, Qatar.
    Alater, Ahmad
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Darweesh, Adham
    Department of Clinical Imaging, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Choroidal metastasis as initial presentation of aggressive medullary thyroid carcinoma with widespread mediastinal, brain, pituitary, bone, lung, and liver metastasis: Case report and literature review2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 87, no October 2021, article id 106419Article in journal (Refereed)
    Abstract [en]

    Introduction: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from the parafollicular C cells of the thyroid gland. MTC can be due to sporadic or hereditary causes due to gain of function germ line mutations in the RET proto-oncogene. MTC presenting as ocular symptoms due to choroidal mass is rare with bad prognosis. Presentation of case: A 38-year-old Sudanese male presented to Hamad General Hospital, complaining of sudden painless decrease of vision of the right eye of 3 weeks duration. After investigations using imaging methods, the patient was discovered to have metastatic MTC that presented as choroidal mass and metastasized to his lung, bone, brain, pituitary, liver and mediastinum. Discussion: In terms of investigations, serum levels of calcitonin have superior diagnostic accuracy. Our patient undertook diagnostic imaging including ultrasonography, fine needle aspiration and computerized tomography (CT) scan and/or MRI imaging. He undertook total thyroidectomy and left neck dissection followed by stereotactic radiosurgery for the right orbit and pituitary. He then received systemic anti-RET therapy (Selpercatinib). At 5 months follow up there was dramatic drop in CEA from 888 μg/L to 164 μg/L, and calcitonin from >585.2 pmol/L to 354 pmol/L. Conclusion: Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.

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  • 9.
    Al Hassan, Mohamed S.
    et al.
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine – Qatar, Doha, Qatar.
    El Baba, Hamzah
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine and Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    What you see might not be what you get: Analysis of 15 prospective cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)2022In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 91, article id 106751Article in journal (Refereed)
    Abstract [en]

    Introduction: Noninvasive follicular thyroid neoplasm with papillary-like nuclear (NIFTP) is a new entity. No previous study reported prospective cases, outlining using many quantitative and qualitative variables. Methods: Retrospective analysis of all (15) prospective NIFTP cases diagnosed between 2017 and 2021 at our institution. Statistical quantitative analysis outlined demographic, history, ultrasound, histopathology and treatment characteristics. Qualitative analysis examined the cases, with details provided on three cases to highlight the different possible presentations and configurations. Results: Mean age was 41.5 ± 9.91 years, 73.3% were females, and mean BMI was 29.49 ± 5.74 kg/m2. About 87% patients were symptomatic; 86.6% had neck swelling. Ultrasound (US) showed multiple nodules in 71.4% of cases. Fine-needle aspiration cytology (FNAC) showed that follicular lesion of undetermined significance (42.8%) was most common, followed by benign nodule (21.3%). Using the Bethesda System for Reporting Thyroid Cytopathology, 7 cases were category III, 3 category IV, 3 category II, and 1 category I. 60% of patients underwent total thyroidectomy. All cases were diagnosed postoperatively, 2 patients had additional papillary microcarcinoma. In 3 cases, the NIFTP site in the histopathology of resected specimen was different than the US-recommended site of the FNAC. Conclusion: We found discrepancies in the site and diagnosis of the preoperative US recommendation for the FNAC vs the postoperative histopathology of the specimen. These suggest that NIFTP might be incidentally and postoperatively diagnosed, irrespective of US or FNAC findings, hence its ‘true’ incidence might remain underestimated. As NIFTP cases higher BMI, Future research could predict preoperative diagnosis of NIFTP and explore associations with BMI. 

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  • 10.
    Al Hassan, Mohamed S.
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Elshafeey, Abdallah
    Weill Cornell Medicine – Qatar, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    First bilateral non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) co-occurring with bilateral papillary thyroid microcarcinoma: Case report and literature review2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 78, p. 411-416Article in journal (Refereed)
    Abstract [en]

    Introduction: Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management. Presentation of case: A 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as ‘follicular lesion of undetermined significance’ (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas. Discussion: Management of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence. Conclusion: Although rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis. © 2020 The Author(s)

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  • 11.
    Al Zoubi, Mohammad
    et al.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Al Moudaris, Ahmed A.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Largest case series of giant gallstones ever reported, and review of the literature2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 72, p. 454-459Article in journal (Refereed)
    Abstract [en]

    Introduction: Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. Presentation of cases: Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone. Conclusions: Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties. © 2020 The Author(s)

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  • 12.
    Aleter, Ammar
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Toffaha, Ali
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Ammar, Adham
    Department of Laboratory Medicine and Pathology, Hamad General Hospital, Doha, Qatar.
    Shahid, Fakhar
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience2021In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 64, article id 102199Article in journal (Refereed)
    Abstract [en]

    Background: Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. Method: Retrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results: 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant. Conclusion: AMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence. 

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  • 13.
    Almirón Santa-Bárbara, Rafael
    et al.
    Department of Orthopaedic Surgery and Traumatology, Hospital de Antequera, Malaga, Spain ; School of Medicine, Universidad de Málaga, Spain.
    García Rivera, Francisco
    University of Skövde, School of Engineering Science. University of Skövde, Virtual Engineering Research Environment.
    Lamb, Maurice
    University of Skövde, School of Informatics. University of Skövde, Informatics Research Environment. University of Skövde, School of Engineering Science. University of Skövde, Virtual Engineering Research Environment.
    Víquez Da-Silva, Rodrigo
    Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
    Gutiérrez Bedmar, Mario
    Preventive Medicine and Public Health Department, School of Medicine, University of Málaga, Spain ; Biomedical Research Institute of Malaga-IBIMA, Spain ; CIBERCV Cardiovascular Diseases, Carlos III Health Institute, Madrid, Spain.
    New technologies for the classification of proximal humeral fractures: Comparison between Virtual Reality and 3D printed models—a randomised controlled trial2023In: Virtual Reality, ISSN 1359-4338, E-ISSN 1434-9957, Vol. 27, no 3, p. 1623-1634Article in journal (Refereed)
    Abstract [en]

    Correct classification of fractures according to their patterns is critical for developing a treatment plan in orthopaedic surgery. Unfortunately, for proximal humeral fractures (PHF), methods for proper classification have remained a jigsaw puzzle that has not yet been fully solved despite numerous proposed classifications and diagnostic methods. Recently, many studies have suggested that three-dimensional printed models (3DPM) can improve the interobserver agreement on PHF classifications. Moreover, Virtual Reality (VR) has not been properly studied for classification of shoulder injuries. The current study investigates the PHF classification accuracy relative to an expert committee when using either 3DPM or equivalent models displayed in VR among 36 orthopaedic surgery residents from different hospitals. We designed a multicentric randomised controlled trial in which we created two groups: a group exposed to a total of 34 3DPM and another exposed to VR equivalents. Association between classification accuracy and group assignment (VR/3DPM) was assessed using mixed effects logistic regression models. The results showed VR can be considered a non-inferior technology for classifying PHF when compared to 3DPM. Moreover, VR may be preferable when considering possible time and resource savings along with potential uses of VR for presurgical planning in orthopaedics. 

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  • 14.
    Alnadhari, Ibrahim
    et al.
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Sampige, Venkata Ramana Pai
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdeljaleel, Osama
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Ali, Omar
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Salah, Morshed
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Shamsodini, Ahmad
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities2020In: Therapeutic advances in urology, ISSN 1756-2872, Vol. 12, p. 1-8, article id 1756287220930627Article in journal (Refereed)
    Abstract [en]

    Purpose:

    The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).

    The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.

    Methods:

    We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.

    Results:

    A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.

    The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.

    Conclusion:

    Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

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  • 15.
    Alobaidy, Abdulqadir
    et al.
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Ibrahim, Tarek
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Corporation, Doha ; College of Medicine, Qatar University, Doha, Qatar.
    Tawfik, Hosam
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Naimi, Abdulla
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Hussain, Salam
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Ansari, Abdulla
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Grooved vs smooth ureteric stent before extracorporeal shockwave lithotripsy: Single-blind randomised clinical trial2022In: Arab Journal of Urology, ISSN 2090-598X, Vol. 20, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

    Objective: No study compared the grooved stent to the widely used standard smooth (nongrooved) stent in humans. We compared stone clearance, complications, and patient tolerance of the grooved stent vs standard JJ stent. Patients and Methods: Single-blinded randomised trial among patients planned for pre-extracorporeal shockwave lithotripsy (ESWL) stenting. Adult patients with unilateral ureteric/ renal stones planned for ESWL were randomly assigned to receive (Percuflex) smooth ureteric stent or (Visiostar) grooved lithotripsy stent and blinded to the stent type. We collected and compared the baseline data and outcomes (stone-free rate, complications, and stent-related symptoms) of both patient groups. Results: A total of 96 adults were included (48 per arm). There were no significant differences between the groups at baseline in terms of demographics, body mass index, comorbidities, renal function, number of ESWL sessions, and stone characteristics, including pre-ESWL stone volume (mean [SD] smooth 310.2 [301.6] vs grooved 270.7 [278.6] mm3, P = 0.5). Stone clearance was statistically insignificant between the groups, although clinically relevant (smooth stent 70.8% vs grooved stent 81.2%, P = 0.2). Grooved-stent patients reported comparable urinary symptoms score (P = 0.05) and operative complications (P = 0.6), but significantly more urinary tract infections (UTIs) not requiring hospitalisation (P = 0.003). Conclusions: Although statistically insignificant, the grooved stent exhibited higher stone clearance compared to the smooth stent, with similar complication rates excpet that patients with grooved stents reported more UTIs. A re-visit to the size of the outer diameter of the grooved stent could enhance its stone clearance properties, and further development of its coating material could lead to better patient satisfaction.

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  • 16.
    Al-Yahri, Omer
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Farghaly, Hanan
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Murshed, Khaled
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Zirie, Mahmoud A.
    Department of Endocrinology, Hamad General Hospital, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    First ever case report of co-occurrence of hobnail variant of papillary thyroid carcinoma and intrathyroid parathyroid adenoma in the same thyroid lobe2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 70, p. 40-52Article in journal (Refereed)
    Abstract [en]

    Introduction: The hobnail variant of papillary thyroid cancer (PTC) is rare. Intrathyroid parathyroid adenoma (ITPA) is also rare. Co-ocurrence of PTC and ITPA in the same thyroid lobe is extremely rare. Likewise, primary hyperparathyroidism with such non-medullary thyroid carcinoma is rare. The specific molecular profile of hobnail PTC (HPTC) is different from the classic, poorly differentiated and anaplastic variants and may contribute to its aggressive behavior. HPTC's genetic profile remains unclear. Presentation of case: A 61-year-old woman presented to our endocrine clinic with generalized aches, bone pain, polyuria, and right neck swelling of a few months’ duration. Laboratory findings revealed hypercalcemia and hyperparathyroidism. Ultrasound of the neck showed 4.6 cm complex nodule within the right thyroid lobe. Sestamibi scan suggested parathyroid adenoma in the right thyroid lobe. Fine-needle aspiration (FNA) revealed atypical follicular lesion of undetermined significance. She underwent right lobectomy, which normalized the intraoperative intact parathyroid hormone levels. Final pathology with immunohistochemical stains demonstrated HPTC and IPTA (2 cm each). Next-generation sequencing investigated the mutation spectrum of HPTC and detected BRAFV600E mutation. Conclusions: A parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma. Thyroid evaluation is needed for patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers. Cytomorphologic features to distinguish thyroid from parathyroid cells on FNA cytology must be considered. Immunohistochemical stains are important. BRAFV600E is the most common mutation in HPTC. This is possibly the first reported case of HPTC and ITPA co-occurring within the same thyroid lobe. Studies that define other molecular abnormalities may be useful as therapeutic targets. © 2020 The Author(s)

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  • 17.
    Andersson, Henrik
    et al.
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Axelsson, Christer
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Larsson, Anna
    Ambulance Department, South Älvsborg's Hospital, Borås, Sweden.
    Bremer, Anders
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economy and IT, Trollhättan, Sweden.
    Bång, Angela
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Infection Disease Department, Skövde, Sweden.
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 36, no 12, p. 2211-2218Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.

    METHODS: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

    RESULTS: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).

    CONCLUSION: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

  • 18.
    Andersson, John
    et al.
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden ; Department of Surgery, Alingsås Hospital, Alingsås, Sweden.
    Abis, G
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Gellerstedt, Martin
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Angenete, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Angerås, Ulf
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Cuesta, M. A.
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Jess, P
    Roskilde Hospital, Roskilde, Denmark.
    Rosenberg, Jakob
    Herlev Hospital, Copenhagen University, Copenhagen, Denmark.
    Bonjer, H. J.
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Haglind, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II)2014In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, no 10, p. 1272-1279Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer.

    METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms.

    RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences between laparoscopic and open approaches. An improvement in sexual dysfunction was seen in the first year, but some male sexual problems persisted. Before operation 64·5 per cent of men in the laparoscopic group and 55·6 per cent in the open group reported some degree of erectile dysfunction. This increased to 81·1 and 80·5 per cent respectively 4 weeks after surgery, and 76·3 versus 75·5 per cent at 12 months, with no significant differences between groups. Micturition symptoms were less affected than sexual function and gradually improved to preoperative levels by 6 months. Adjusting for confounders, including radiotherapy, did not change these results.

    CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this.

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  • 19.
    Angenete, Eva
    et al.
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Anders
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Gellerstedt, Martin
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Haglind, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Effect of Laparoscopy on the Risk of Small-Bowel Obstruction: A Population-Based Register Study2012In: Archives of surgery (Chicago. 1960), ISSN 0004-0010, E-ISSN 1538-3644, Vol. 147, no 4, p. 359-365Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures.

    Design: A population-based retrospective register study.

    Setting: Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated.

    Patients: The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected.

    Main Outcome Measures: Episodes of hospital stay and surgery for SBO within 5 years after the index surgery.

    Results: A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures.

    Conclusions: Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance

  • 20.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Qatar / College of Medicine, Qatar University, Qatar.
    El-Ansari, Kareem
    Volunteer, Hamad General Hospital, Hamad Medical Corporation, Qatar.
    Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery: Refining the evidence base2020In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 59, p. 264-273Article, review/survey (Refereed)
    Abstract [en]

    Background: Venous thromboembolic events (VTE) post-bariatric surgery (BS) lead to morbidity and mortality.

    Methods: This scoping review assessed whether reported VTE post-BS could be under/over-estimated; suggested a possible number of VTE post-BS; appraised whether VTE are likely to decrease/increase; examined BS as risk/protective factor for VTE; and mapped the gaps, proposing potential solutions.

    Results: VTE appears under-estimated due to: identification/coding of BS and VTE; reporting of exposure (BS); and reporting of outcomes (VTE). The review proposes a hypothetical calculation of VTE post-BS. VTE are unlikely to decrease soon. BS represents risk and protection for VTE. Better appreciation of VTE-BS relationships requires longer-term strategies.

    Conclusion: VTE are underestimated. Actions are required for understanding the VTE-BS relationships to in order to crease VTE by better-informed prevention strategy/ies.

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  • 21.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Qatar / College of Medicine, Qatar University, Qatar.
    El-Ansari, Kareem
    Hamad General Hospital, Hamad Medical Corporation, Qatar.
    Missing Something? Comparisons of Effectiveness and Outcomes of Bariatric Surgery Procedures and Their Preferred Reporting: Refining the Evidence Base2020In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, no 8, p. 3167-3177Article, review/survey (Refereed)
    Abstract [en]

    Comparisons of effectiveness of bariatric surgery (BS) procedures encompass weight loss, metabolic/clinical outcomes, and improvements or worsening of comorbidities. Post-operative physical activity (PA) and diet influence such outcomes but are frequently not included in comparisons of effectiveness. We assessed the value and necessity of including post-operative PA/diet data when comparing effectiveness of BS. Including post-operative PA/diet data has significant benefits for BS and patients. The paper proposes an explicit preferred reporting system (Preferred REporting of post-operative PHYsical activity and Diet data in comparisons of BS effectiveness: PRE-PHYD Bariatric). Including post-operative PA/diet data could result in more accurate appraisals of effectiveness of BS procedures. This could translate into better 'individualized' BS by achieving a better 'fit' between patient and procedure.

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  • 22.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine-Qatar, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar.
    Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study2022In: Metabolic Syndrome and Related Disorders, ISSN 1540-4196, E-ISSN 1557-8518, Vol. 20, no 6, p. 360-366Article in journal (Refereed)
    Abstract [en]

    Background: Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. Materials and Methods: We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample t-tests compared the observed and predicted BMI at 1 year. Results: The model comprised preoperative BMI (β = 0.757, P = 0.026) + age (β = 0.142, P < 0.0001) with adjusted R2 of 0.581 (P < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m2) +0.106 × age (years). For validation, the equation exhibited an adjusted R2 0.550 (P < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m2, P = 0.225). Conclusions: This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.

  • 23.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps—a Scoping Review2021In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 31, no 4, p. 1755-1766Article, review/survey (Refereed)
    Abstract [en]

    Some patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric surgery (BS). We undertook a scoping review of WR and IWL after BS. We searched electronic databases for studies addressing the definitions, prevalence, mechanisms, clinical significance, preoperative predictors, and preventive and treatment approaches including behavioral, pharmacological, and surgical management strategies of WR and IWL. Many definitions exist for WR, less so for IWL, resulting in inconsistencies in the reported prevalence of these two conditions. Mechanisms and preoperative predictors contributing to WR are complex and multifactorial. A range of the current knowledge gaps are identified and questions that need to be addressed are outlined. Therefore, there is an urgent need to address these knowledge gaps for a better evidence base that would guide patient counseling, selection, and lead to improved outcomes. 

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  • 24.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar / College of Medicine, Qatar University, Doha 2713, Qatar .
    El-Menyar, Ayman
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar / Clinical Medicine, Weill Cornell Medical School, Doha 24144, Qatar.
    Is routine preoperative esophagogastroduodenscopy prior to bariatric surgery mandatory?: Protocol for a systematic review and meta-analysis2020In: International Journal of Surgery Protocols, ISSN 2468-3574, Vol. 22, p. 1-5Article in journal (Refereed)
    Abstract [en]

    Introduction: Routine preoperative esophagogastroduodenscopy (p-EGD) prior to bariatric surgery (BS) is currently widely undertaken, and hence an important issue with many clinical and financial repercussions. Yet, the true extent of why p-EGD is routinely undertaken for all bariatric patients remains not well understood. Methods and analysis: To address this, we will undertake a systematic review and meta-analysis of routine p-EGD prior to BS from around the world. This protocol describes the methodological approach to be adopted and outlines the search strategies and eligibility criteria that will be employed to identify and select studies, and the way by which data from the selected studies will be extracted for analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, Cochrane Library, MEDLINE, Scopus, clinicaltrials.gov and Google scholar will be searched from 01 January 2000 to 30 April 2019 for original studies written in English that provided prevalence estimates of the outcomes of routine p-EGD prior to BS. STROBE criteria will assess the methodological quality of the selected studies. The use of fixed or random effects model will depend on the results of statistical tests for heterogeneity. Publication bias will be visually estimated by assessing funnel plots. Pooled estimates will be calculated. This protocol conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and has been submitted for registration at the PROSPERO International Prospective Register of systematic reviews. No ethical clearance is required for this study. This review will be published in a peer- reviewed journal and will be presented at various national and international conferences. © 2020 The Author(s)

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  • 25.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    El-Menyar, Ayman
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar / Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
    Sathian, Brijesh
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
    Al-Thani, Hassan
    Department of Surgery, Trauma and Vascular Surgery Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Kuwari, Mohammed
    Department of Bariatric Surgery, Hamad Medical Corporation, Doha, Qatar.
    Al-Ansari, Abdulla
    Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
    Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory?: Systematic Review and Meta-analysis of 10,685 Patients2020In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, no 8, p. 3073-3083Article in journal (Refereed)
    Abstract [en]

    Background: This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). Methods: Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000–30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. Results: Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45–67%); Group 1, 2064 patients (26%, 95% CI: 23–50%); Group 2, 1351 patients (16%, 95% CI: 11–21%); and Group 3 included 31 patients (0.4%, 95% CI: 0–1%). Conclusion: For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to “necessary” substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required. 

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  • 26.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Sathian, Brijesh
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
    El-Menyar, Ayman
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar / Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
    Venous thromboembolic events after bariatric surgery: Protocol for a systematic review and meta-analysis2020In: International Journal of Surgery Protocols, ISSN 2468-3574, Vol. 22, p. 10-14Article in journal (Refereed)
    Abstract [en]

    Introduction: Considerably large numbers of bariatric surgery (BS) procedures are undertaken globally, and are projected to increase with the obesity epidemic. Venous thromboembolic events (VTE) comprise an important cause of postoperative morbidity and mortality after BS and an important issue with wide clinical and financial repercussions. Yet, a precise extent of the prevalence of VTE after BS for obesity and its mortality remains uncertain. Methods and analysis: In order to respond to this knowledge gap, we will conduct a systematic review and meta-analysis of the prevalence of and mortality associated with VTE after BS. This protocol outlines the methodology that will be used and the search strategies and eligibility criteria that will be utilized to identify and select studies, as well as the method by which data from the selected studies will be extracted for analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, Cochrane Library, MEDLINE, Scopus, clinicaltrials.gov and Google scholar will be searched from 01 January 1990 through 10th April 2020, for original studies written in English that provided prevalence estimates of VTE after BS. Articles will also be searched for mortality estimates of VTE after BS. STROCSS (Strengthening the Reporting of Cohort Studies in Surgery) criteria will evaluate the methodological quality of the selected studies. The use of fixed effect or random effects model will be subject to the findings of the statistical tests for heterogeneity. Publication bias will be visually estimated by inspecting the funnel plots. Pooled estimates will be computed. Th current protocol conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and has been submitted to the PROSPERO International Prospective Register of systematic reviews. No ethical clearance is required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal and presented at national and international conferences. © 2020 The Author(s)

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  • 27.
    El Baba, Hamizah
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Al Moudaris, Ahmed
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Samra, Hayan Abo
    Department of Laboratory Medicine and Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Alateeg, Layth
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Al-Yaseen, Mohammed
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine–Qatar, Doha, Qatar.
    First case of chronic cell leukemia discovered incidentally in extra-saccular inguinal lymph node during laparoscopic bilateral inguinal hernia repair: Case report and literature review2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 88, article id 106558Article in journal (Refereed)
    Abstract [en]

    Introduction: Chronic cell leukemia discovered incidentally in extra-saccular inguinal lymph node during laparoscopic bilateral inguinal hernia repair is extremely rare. Presentation of case: 62-year-old Romanian male presented at the outpatient general surgery clinic in April 2019 complaining of bilateral inguinal swelling that gradually increased in size mainly on right side and was diagnosed with bilateral inguinal hernia. During the laparoscopic repair of the hernia, a large lymph node in the left femoral canal was incidentally observed. Histopathologic, immunohistochemical, and flowcytometric evaluation of the excised specimen confirmed chronic lymphocytic leukemia/small lymphocytic lymphoma. Discussion: Whole body CT showed supra and infra-diaphragmatic lymphadenopathy, and few small subsolid pulmonary nodules, possibly metastatic. Splenomegaly and pancreatomegaly were also noted, suggesting lymphomatoid infiltration. Conclusion: There is need for cautious inspection and meticulous palpation of the inguinal area for any lymphadenopathy during routine inguinal hernia repair.

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  • 28.
    Elgenaied, Isra
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Elsherif, Mohamed Aly
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdulrazzaq, Sama
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Qabbani, Amjad Salah
    Department of Surgery, Hamad General Hospital, Doha, Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy2020In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 16, no 10, p. 1521-1530Article in journal (Refereed)
    Abstract [en]

    Background: Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown. Objectives: We assessed patients’ characteristics associated with T2D remission 1 year post SG. Setting: University hospital. Methods: Retrospective study of 230 T2D patients (18–64 yr) who underwent SG at our institution. We examined pre- and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre- and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve. Results: A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 ± 8.84 years. Mean preoperative weight and body mass index were 115.69 ± 20.76 kg and 43.53 ± 6.98 kg/m2, respectively. Approximately two thirds (64.4%) of the sample had diabetes for &gt;5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on ≥2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 ± 6.09 kg/m2, percent excess weight loss (%EWL) was 62.29 ± 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration + pre-HbA1C + %EWL + insulin therapy + age + OHA (area under the curve = .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration). Conclusion: SG results in significant weight reduction and various extents of T2D remission. HbA1C, %EWL, insulin therapy, age, and OHA were independent predictors of complete remission. Assessing these factors before bariatric surgery is important to identify any modifiable characteristics that can be altered to increase the likelihood of remission. © 2020 American Society for Bariatric Surgery

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  • 29.
    Elhag, Wahiba
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Durability of Cardiometabolic Outcomes Among Adolescents After Sleeve Gastrectomy: First Study with 9-Year Follow-up2021In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 31, no 7, p. 2869-2877Article in journal (Refereed)
    Abstract [en]

    Background: Long-term durability of weight loss and comorbidity resolution beyond 7 years after laparoscopic sleeve gastrectomy (LSG) among adolescents is completely lacking. Methods: Retrospective review of adolescents aged ≤ 18 years who underwent primary LSG at our institution between 2011 and 2015 (N = 146). We assessed anthropometric and cardiometabolic outcomes at 1, 3, 5, 7, and 9 years. Results: Follow-up rates were 57.53%, 82.87%, 85.24%, 83.92%, and 83.33% at the five time points. The preoperative mean body mass index (BMI) (45.60 ± 6.50 kg/m2) decreased at year 1 (30.04 ± 4.96 kg/m2, P=0.001) and was maintained up to 9 years (30.20 ± 3.92 kg/m2, P = 0.001). Remission rates were triglycerides, 100% (11/11) at 5 years, and 100% (1/1) at 9 years; high density lipoprotein, 89.4% (17/19) at 5 years, and 100% (3/3) at 7 years; low density lipoprotein, 71.4% (11/14) and 100% (3/3) at 5 and 7 years; total cholesterol, 70% (7/10) at 5 years, and 100% (2/2) at 9 years; uric acid, 100% (3/3) at 5 years. Remission of liver enzymes was 84.6–100% (22/26–2/2) at 5–9 years. Prediabetes remission was 87.5% (14/16 and 7/8) at 5 and 7 years and 100% (3/3) at year 9. Type 2 diabetes complete remission was 50% (3/6, 1/2) at years 5 and 7, with all cases resolved at 9 years. The only case of hypertension completely resolved. Conclusions: LSG achieved substantial weight loss and remission of cardiometabolic risk factors that were sustained on the long term. This is the first study among adolescents to assess such outcomes beyond 7 years. Graphical abstract: [Figure not available: see fulltext.]. 

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  • 30.
    Elhag, Wahiba
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Qatar ; Weill Cornell Medicine-Qatar, Doha, Qatar.
    Effectiveness and Safety of Liraglutide in Managing Inadequate Weight Loss and Weight Regain after Primary and Revisional Bariatric Surgery: Anthropometric and Cardiometabolic Outcomes2022In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 32, no 4, p. 1005-1015Article in journal (Refereed)
    Abstract [en]

    Background: No study appraised the effectiveness and safety of liraglutide in managing inadequate weight loss or weight regain (IWL/ WR) after primary versus revisional bariatric surgery (BS). Methods: Retrospective study of all eligible adults who completed liraglutide 3 mg therapy for IWL/WR after primary or revisional BS at our institution between May 2016 and June 2019 (N = 145; 119 primary, 82%; 26 revisional, 18%). Changes in anthropometric and cardiometabolic parameters were assessed before the start of liraglutide and at 6 and 12 months after treatment. Results: The mean age was 43.32 ± 10.49 years, and 83% were females. Patients received liraglutide at a mean of 54.10 ± 31.75 months after their BS, for WR (74.3%) or IWL (25.6%). Liraglutide significantly reduced weight and BMI among primary and revisional patients (P < 0.0001 for all) and was equally effective in these reductions for both groups. Primary patients achieved total weight loss percentage (TWL%) of 5.97% and 6.93% at 6 and 12 months. Additionally, 52.3% and 60% of the patients lost ≥ 5% of their total weight (TW) at 6 and 12 months after primary BS. Revisional patients achieved TWL% of 6.41% and 4.99% at 6 and 12 months, and 60% and 48% of patients lost ≥ 5% TW at the two time points. Liraglutide did not improve cardiometabolic outcome for primary patients; for revisional patients, only the systolic blood pressure decreased after treatment. Liraglutide was well tolerated, and the most common side effect was nausea. Conclusions: Liraglutide is useful as an adjunct weight loss medication for patients achieving unsatisfactory outcomes with BS. Graphical abstract: [Figure not available: see fulltext.] 

  • 31.
    Elhag, Wahiba
    et al.
    Department of Bariatric Surgery and Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine–Qatar, Doha, Qatar.
    Multiple nutritional deficiencies among adolescents undergoing bariatric surgery: who is at risk?2022In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 18, no 3, p. 413-424Article in journal (Refereed)
    Abstract [en]

    Background: Nutritional deficiencies among adolescents undergoing bariatric surgery (BS) have not been evaluated a in relation to patient's sex. Objectives: We compared the preoperative nutritional profile of adolescents characterized by sex and single versus multiple deficiencies. Setting: University hospital. Methods: Cross-sectional retrospective chart review of 415 eligible adolescents who underwent primary BS between 2011 and 2020. Data included preoperative demographic, anthropometric information as well as three sets of nutritional variables: anemia-related, calcium-related, and other nutritional variables. Results: The sample comprised 247 males (59.5%) with a mean age of 15.89 ± 1.03 years and a mean body mass index (BMI) of 47.80 ± 6.57 kg/m2. Most common deficiencies were vitamin D (92.3%), albumin (51.8%), anemia (15.9%), zinc (11.1%), and vitamin B12 (8%); 21.7% had hyperparathyroidism. Females exhibited a significantly higher prevalence of low hemoglobin, low hematocrit, and iron deficiency. Multiple deficiencies were present among 97.6%, 73.2%, 23.6%, 15%, and 12.6% of adolescents, who had vitamin D, albumin, hemoglobin, zinc, and vitamin B12 deficiencies, respectively. Univariate analysis revealed that adolescents with a BMI of ≥50 kg/m2 were 1.24 times more likely to have multiple deficiencies (P = .004). Using multivariate log-binomial regression, BMI of ≥50 kg/m2 was a significant predictor of multiple nutritional deficiencies (P = .005, adjusted risk ratio = 1.23, 95% CI 1.06–1.42). Age and sex were not independent predictors of multiple nutritional deficiencies. Conclusion: To our knowledge, this study is the first to appraise single and multiple nutritional deficiencies in adolescents undergoing BS by sex. Multiple deficiencies were common. Females are at higher risk of anemia-related deficiencies. A BMI of ≥50 kg/m2 independently and significantly predicted multiple nutritional deficiencies. Correction before and monitoring after surgery are important. © 2021 American Society for Bariatric Surgery

  • 32.
    Elhag, Wahiba
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine-Qatar, Doha, Qatar.
    Nutritional Deficiencies Among Adolescents Before and After Sleeve Gastrectomy: First Study with 9-Year Follow-up2022In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 32, no 2, p. 284-294Article in journal (Refereed)
    Abstract [en]

    Background: Globally, only two studies appraised the long-term nutritional status of adolescents after laparoscopic sleeve gastrectomy (LSG). Methods: Retrospective chart review of all adolescents aged ≤ 18 years who underwent LSG with ≥ 5 years follow-up and had no subsequent revisional surgery (N = 146). We assessed 15 nutritional parameters preoperatively and at 1, 3, 5, 7, and 9 years post surgery. Results: Mean age was 16.51 ± 1.29 years, 51% were males. We identified three patterns:1) Significant worsening of preoperative deficiencies: 4.7% and 0.8% of the sample exhibited zinc and vitamin B12 deficiencies, worsening to 20.8% and 12.8% at 1 year, respectively. Likewise, 0.7% of the sample had low total protein, worsening to 8.3% at year 3. A total of 32.4% of females had preoperative low hemoglobin worsening to 57.9% at year 5.2) Significant improvement: the percentage of males with preoperative low hemoglobin (5.6%) was reduced to 4.1% and 5.1% at years 1 and 3, respectively.3) Persistent deficiency: all (100%) of adolescents had preoperative vitamin D deficiency that persisted through years 3 and 9 at 90.5% and 100%, respectively. The most common complications were food intolerance (51%), vomiting (47.5%), gastritis/ esophagitis (35.7%), and gastroesophageal reflux disease (20.3%). We observed one case of Wernicke’s encephalopathy. Across the 9 years, 15.4% of the adolescents underwent intra-abdominal surgeries where 12.6% had cholecystectomy and one patient had appendectomy. Conclusion: Adolescents had several preoperative nutritional deficiencies, most of which worsened or persisted on the long term. This is the first study among adolescents to assess such deficiencies beyond 5 years. Graphical Abstract: [Figure not available: see fulltext.]. 

  • 33.
    Elhag, Wahiba
    et al.
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Razaq, Sama
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Elsherif, Mohamed
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qata.
    Mustafa, Isra
    Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qata.
    Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: Anthropometric, glycemic, lipid, safety and cost outcomes2019In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 45, p. 75-81Article in journal (Refereed)
    Abstract [en]

    Background: To evaluate effectiveness, safety, and costs of Lorcaserin vs. phentermine among obese non–surgical and surgical patients (post bariatric surgery). Methods: This retrospective study retrieved charts of all patients (January 2013–June 2016) who received Lorcaserin or phentermine for 3 months. The study assessed anthropometric, glycemic, and lipid changes, as well as side effects and cost of medications among overweight and obese non-surgical (n = 83) and surgical patients (n = 46). These two patient groups were compared using Chi-square (χ2) and unpaired‘t’ test for qualitative and quantitative variables respectively. Results: At 3 months, among the non-surgical group, Phentermine patients had greater percentage of total weight loss (TWL%) (7.65 ± 8.26 vs. 2.99 ± 3.72%, P = 0.003), and greater BMI reduction (−3.16 ± 3.63 vs. −1.15 ± 1.53 kg/m2, P = 0.003) than Lorcaserin. Within the surgical group, Lorcaserin patients had significantly smaller TWL% (1.86 ± 5.06 vs. 7.62 ± 9.80%, P = 0.012), and smaller BMI reduction (−0.74 ± 1.80 vs. −3.06 ± 4.08 kg/m2, P = 0.012) than Phentermine. Lorcaserin exhibited significant total cholesterol and LDL improvements only among surgical patients with significant weight reduction (≥5% TW). Both medications were not associated with glycemic improvements among non-surgical and surgical groups. Phentermine had slightly more side effects but was less expensive. Conclusions: Among both patient groups, phentermine was more effective in achieving weight loss. Lorcaserin showed dyslipidemia improvements only among surgical patients who achieved significant weight reduction. Anti-obesity medications as part of weight management programs can result in weight loss among non-surgical and surgical patients, or halt weight regain among surgical patients. This is the first study to evaluate the effectiveness and safety of two anti-obesity medications (lorcaserin vs. phentermine) among two distinct obese patient groups, non-surgical and surgical patients. 

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  • 34.
    Erichsen Andersson, Annette
    et al.
    University of Gothenburg.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Karlsson, Jón
    University of Gothenburg.
    Eriksson, Bengt I.
    University of Gothenburg.
    Nilsson, Kerstin
    University of Gothenburg.
    Traffic flow in the operating room: An explorative and descriptive study on air quality during orthopedic trauma implant surgery2012In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 40, no 8, p. 750-755Article in journal (Refereed)
    Abstract [en]

    Background:Understanding the protective potential of operating room (OR) ventilation under different conditions is crucial to optimizing the surgical environment. This study investigated the air quality, expressed as colony-forming units (CFU)/m³, during orthopedic trauma surgery in a displacementventilated OR; explored how traffic flow and the number of persons present in the OR affects the air contamination rate in the vicinity of surgical wounds; and identified reasons for door openings in the OR.

    Methods:Data collection, consisting of active air sampling and observations, was performed during 30 orthopedic procedures.

    Results:In 52 of the 91 air samples collected (57%), the CFU/m³ values exceeded the recommended level of <10 CFU/m³. In addition, the data showed a strongly positive correlation between the total CFU/m³ per operation and total traffic flow per operation (r=0.74;P=.001; n=24), after controlling for duration of surgery. A weaker, yet still positive correlation between CFU/m³ and the number of persons present in the OR (r=0.22;P=.04; n=82) was also found. Traffic flow, number of persons present, and duration of surgery explained 68% of the variance in total CFU/m³ (P=.001).

    Conclusions:Traffic flow has a strong negative impact on the OR environment. The results of this study support interventions aimed at preventing surgical site infections by reducing traffic flow in the OR.

  • 35.
    Granath, Carl
    et al.
    Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Noren, Hunter
    Cell Therapy Institute, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA.
    Björck, Hanna
    Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Simon, Nancy
    Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Olesen, Kim
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden / Department of Chemistry, Ångström Laboratory, Uppsala University, Sweden.
    Rodin, Sergey
    Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden / Division of Cardiothoracic Surgery and Anesthesiology, Department of Surgical Sciences, Uppsala University, Akademiska University Hospital, Uppsala, Sweden.
    Grinnemo, Karl-Henrik
    Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden / Division of Cardiothoracic Surgery and Anesthesiology, Department of Surgical Sciences, Uppsala University, Akademiska University Hospital, Uppsala, Sweden.
    Österholm, Cecilia
    Division of Clinical Genetics, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Characterization of Laminins in Healthy Human Aortic Valves and a Modified Decellularized Rat Scaffold2020In: BioResearch Open Access, ISSN 2164-7844, E-ISSN 2164-7860, Vol. 9, no 1, p. 269-278Article in journal (Refereed)
    Abstract [en]

    Aortic valve stenosis is one of the most common cardiovascular diseases in western countries and can only be treated by replacement with a prosthetic valve. Tissue engineering is an emerging and promising treatment option, but in-depth knowledge about the microstructure of native heart valves is lacking, making the development of tissue-engineered heart valves challenging. Specifically, the basement membrane (BM) of heart valves remains incompletely characterized, and decellularization protocols that preserve BM components are necessary to advance the field. This study aims to characterize laminin isoforms expressed in healthy human aortic valves and establish a small animal decellularized aortic valve scaffold for future studies of the BM in tissue engineering. Laminin isoforms were assessed by immunohistochemistry with antibodies specific for individual alpha, beta, and gamma chains. The results indicated that LN-411, LN-421, LN-511, and LN-521 are expressed in human aortic valves (n = 3), forming a continuous monolayer in the endothelial BM, whereas sparsely found in the interstitium. Similar results were seen in rat aortic valves (n = 3). Retention of laminin and other BM components, concomitantly with effective removal of cells and residual DNA, was achieved through 3 h exposure to 1% sodium dodecyl sulfate and 30 min exposure to 1% Triton X-100, followed by nuclease processing in rat aortic valves (n = 3). Our results provide crucial data on the microenvironment of valvular cells relevant for research in both tissue engineering and heart valve biology. We also describe a decellularized rat aortic valve scaffold useful for mechanistic studies on the role of the BM in heart valve regeneration.

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  • 36.
    Haljamäe, Ulla
    et al.
    Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
    Nyberg, Gudrun
    Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences. Institute of Health Care Pedagogics, Göteborg University, Sweden.
    Remaining experiences of living kidney donors more than 3 yr after early recipient graft loss2003In: Clinical Transplantation, ISSN 0902-0063, E-ISSN 1399-0012, Vol. 17, no 6, p. 503-510Article in journal (Refereed)
    Abstract [en]

    Living kidney donor programs, based on willingness among family members and close relatives to donate, have made it possible to perform a satisfactory number of kidney transplantations. Early graft loss in the recipient may occur and it is not known if such an event will result mainly in acute, rather transient, emotional reactions or if long-lasting reactions may be evoked in the living kidney donor. The aim of the present study was to assess and describe the remaining experiences of donors (n = 10) more than 3 yr after early recipient graft loss or death of the recipient. A phenomenographic, interview-based research approach was used. Five different fields or domains were identified: (i) the decision to donate; (ii) the information provided; (iii) care received at the time of donation; (iv) responses at graft failure; and (v) concerns remaining at the time of the interview. All donors expressed that they had volunteered to donate and that no stress had been put on them. The information given prior to and in connection with the donation procedure was deemed insufficient but all donors were satisfied with the medical care provided in connection with the nephrectomy and in the immediate post-operative period. Graft failure was immediately accepted on the intellectual level by nine of 10 donors but still evoked emotional reactions and responses included a wish that continuing contact with the transplant staff had been provided. The present interview-based study shows that it is of importance that the donor is thoroughly informed about all donor as well as recipient-related factors including the potential risk of recipient graft failure. In case of graft failure, or the death of the recipient, the transplant unit staff members should offer contact for discussions of medical matters as well as for psychosocial support. In individual cases it may be necessary to maintain such a supportive contact channel for a prolonged period of time.

  • 37.
    Labori, Knut Jørgen
    et al.
    Department of Hepato Pancreato Biliary Surgery, Oslo University Hospital ; Institute of Clinical Medicine, University of Oslo, Norway.
    Bratlie, Svein Olav
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden ; Department of Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Andersson, Bodil
    Department of Clinical Sciences Lund, Surgery, Lund University, Sweden ; Skåne University Hospital, Lund, Sweden.
    Angelsen, Jon-Helge
    Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Medicine, University of Bergen, Norway.
    Biörserud, Christina
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden ; Department of Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Björnsson, Bergthor
    Department of Surgery in Linköping, Linköping University, Sweden ; Department of Biomedical and Clinical Sciences, Linköping University, Sweden.
    Bringeland, Erling Audun
    Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Norway ; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
    Elander, Nils
    Department of Biomedical and Clinical Sciences, Linköping University, Sweden ; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
    Garresori, Herish
    Department of Hematology and Oncology, Stavanger University Hospital, Norway.
    Grønbech, Jon Erik
    Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Norway ; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
    Haux, Johan
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Oncology, Skaraborg Hospital Skövde, Sweden.
    Hemmingsson, Oskar
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden ; Wallenberg Centre for Molecular Medicine, Umeå University, Sweden.
    Gustafsson Liljefors, Maria
    Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Myklebust, Tor Åge
    Department of Registration, Cancer Registry of Norway, Oslo, Norway ; Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
    Nymo, Linn Såve
    Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway ; Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
    Peltola, Katriina
    Comprehensive Cancer Center, Helsinki University Hospital, Finland.
    Pfeiffer, Per
    Department of Medical Oncology, Odense University Hospital, Denmark.
    Sallinen, Ville
    Gastroenterological Surgery/ Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Finland.
    Sandström, Per
    Department of Surgery in Linköping, Linköping University, Sweden ; Department of Biomedical and Clinical Sciences, Linköping University, Sweden.
    Sparrelid, Ernesto
    Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Stenvold, Helge
    Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
    Søreide, Kjetil
    Department of Clinical Medicine, University of Bergen, Norway ; Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway.
    Tingstedt, Bobby
    Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
    Verbeke, Caroline
    Department of Pathology, Oslo University Hospital, Norway ; Institute of Clinical Medicine, University of Oslo, Norway.
    Öhlund, Daniel
    Wallenberg Centre for Molecular Medicine, Umeå University, Sweden ; Department of Radiation Sciences, Umeå University, Sweden.
    Klint, Leif
    Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden ; Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Dueland, Svein
    Department of Oncology, Oslo University Hospital, Norway.
    Lassen, Kristoffer
    Department of Hepato Pancreato Biliary Surgery, Oslo University Hospital, Norway ; Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
    Aahlin, Eirik Kjus
    Bratthäll, Charlotte
    Halimi, Asif
    Hatlevoll, Ingunn
    Heby, Margareta
    Kokkola, Arto
    Kordes, Maximilian
    Lindblad, Stina
    Lundgren, Linda
    Mortensen, Michael Bau
    Mortensen, Kim Erlend
    Persson, Jan
    Rangelova, Elena
    Rønne, Elin
    Sandvik, Oddvar Mathias
    Søreide, Jon Arne
    Vilhav, Caroline
    Waardal, Kim
    Wennerblom, Johanna
    Williamsson, Caroline
    Yaqub, Sheraz
    Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORPACT-1): a multicentre, randomised, phase 2 trial2024In: The Lancet Gastroenterology & Hepatology, ISSN 2468-1253, Vol. 9, no 3, p. 205-217Article in journal (Refereed)
    Abstract [en]

    Background

    In patients undergoing resection for pancreatic cancer, adjuvant modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) improves overall survival compared with alternative chemotherapy regimens. We aimed to compare the efficacy and safety of neoadjuvant FOLFIRINOX with the standard strategy of upfront surgery in patients with resectable pancreatic ductal adenocarcinoma.

    Methods

    NORPACT-1 was a multicentre, randomised, phase 2 trial done in 12 hospitals in Denmark, Finland, Norway, and Sweden. Eligible patients were aged 18 years or older, with a WHO performance status of 0 or 1, and had a resectable tumour of the pancreatic head radiologically strongly suspected to be pancreatic adenocarcinoma. Participants were randomly assigned (3:2 before October, 2018, and 1:1 after) to the neoadjuvant FOLFIRINOX group or upfront surgery group. Patients in the neoadjuvant FOLFIRINOX group received four neoadjuvant cycles of FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and fluorouracil 400 mg/m2 bolus then 2400 mg/m2 over 46 h on day 1 of each 14-day cycle), followed by surgery and adjuvant chemotherapy. Patients in the upfront surgery group underwent surgery and then received adjuvant chemotherapy. Initially, adjuvant chemotherapy was gemcitabine plus capecitabine (gemcitabine 1000 mg/m2 over 30 min on days 1, 8, and 15 of each 28-day cycle and capecitabine 830 mg/m2 twice daily for 3 weeks with 1 week of rest in each 28-day cycle; four cycles in the neoadjuvant FOLFIRINOX group, six cycles in the upfront surgery group). A protocol amendment was subsequently made to permit use of adjuvant modified FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2 over 46 h on day 1 of each 14-day cycle; eight cycles in the neoadjuvant FOLFIRINOX group, 12 cycles in the upfront surgery group). Randomisation was performed with a computerised algorithm that stratified for each participating centre and used a concealed block size of two to six. Patients, investigators, and study team members were not masked to treatment allocation. The primary endpoint was overall survival at 18 months. Analyses were done in the intention-to-treat (ITT) and per-protocol populations. Safety was assessed in all patients who were randomly assigned and received at least one cycle of neoadjuvant or adjuvant therapy. This trial is registered with ClinicalTrials.gov, NCT02919787, and EudraCT, 2015-001635-21, and is ongoing.

    Findings

    Between Feb 8, 2017, and April 21, 2021, 77 patients were randomly assigned to receive neoadjuvant FOLFIRINOX and 63 to undergo upfront surgery. All patients were included in the ITT analysis. For the per-protocol analysis, 17 (22%) patients were excluded from the neoadjuvant FOLFIRINOX group (ten did not receive neoadjuvant therapy, four did not have pancreatic ductal adenocarcinoma, and three received another neoadjuvant regimen), and eight (13%) were excluded from the upfront surgery group (seven did not have pancreatic ductal adenocarcinoma and one did not undergo surgical exploration). 61 (79%) of 77 patients in the neoadjuvant FOLFIRINOX group received neoadjuvant therapy. The proportion of patients alive at 18 months by ITT was 60% (95% CI 49–71) in the neoadjuvant FOLFIRINOX group versus 73% (62–84) in the upfront surgery group (p=0·032), and median overall survival by ITT was 25·1 months (95% CI 17·2–34·9) versus 38·5 months (27·6–not reached; hazard ratio [HR] 1·52 [95% CI 1·00–2·33], log-rank p=0·050). The proportion of patients alive at 18 months in per-protocol analysis was 57% (95% CI 46–67) in the neoadjuvant FOLFIRINOX group versus 70% (55–83) in the upfront surgery group (p=0·14), and median overall survival in per-protocol population was 23·0 months (95% CI 16·2–34·9) versus 34·4 months (19·4–not reached; HR 1·46 [95% CI 0·99–2·17], log-rank p=0·058). In the safety population, 42 (58%) of 73 patients in the neoadjuvant FOLFIRINOX group and 19 (40%) of 47 patients in the upfront surgery group had at least one grade 3 or worse adverse event. 63 (82%) of 77 patients in the neoadjuvant group and 56 (89%) of 63 patients in the upfront surgery group had resection (p=0·24). One sudden death of unknown cause and one COVID-19-related death occurred after the first cycle of neoadjuvant FOLFIRINOX. Adjuvant chemotherapy was initiated in 51 (86%) of 59 patients with resected pancreatic ductal adenocarcinoma in the neoadjuvant FOLFIRINOX group and 44 (90%) of 49 patients with resected pancreatic ductal adenocarcinoma in the upfront surgery group (p=0·56). Adjuvant modified FOLFIRINOX was given to 13 (25%) patients in the neoadjuvant FOLFIRINOX group and 19 (43%) patients in the upfront surgery group. During adjuvant chemotherapy, neutropenia (11 [22%] patients in the neoadjuvant FOLFIRINOX group and five [11%] in the upfront surgery group) was the most common grade 3 or worse adverse event.

    Interpretation

    This phase 2 trial did not show a survival benefit from neoadjuvant FOLFIRINOX in resectable pancreatic ductal adenocarcinoma compared with upfront surgery. Implementation of neoadjuvant FOLFIRINOX was challenging. Future trials on treatment sequencing in resectable pancreatic ductal adenocarcinoma should be biomarker driven.

  • 38.
    Mahmoud, Waleed
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Petkar, Mahir
    Department of Laboratory Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Two separate tumours—Concomitant papillary carcinoma in thyroglossal duct cyst and right thyroid lobe: Case report and review of the literature2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 73, p. 257-262Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Malignancy of thyroglossal duct cyst (TGDC) is rare, usually as papillary carcinoma, and less frequently as squamous cell or follicular carcinoma. TGDC carcinoma can present as a mass arising from the neck, with or without compression symptoms. Papillary carcinoma in TGDC concomitant with another papillary carcinoma in the thyroid gland is extremely rare. Presentation of case: : 31 years old female with a neck lump since 2 years, slowly increasing in size, with mild pain while drinking fluids, and no change of voice. No past history of neck irradiation or family history of thyroid cancers. Ultrasonography of the neck showed TGDC and right thyroid nodule. Ultrasound guided fine needle aspiration and cytology of the TGDC showed TGDC papillary carcinoma. The patient underwent Sistrunk's procedure and total thyroidectomy. Discussion: Rare case of classic papillary carcinoma arising in TGDC, concomitant with another papillary carcinoma in the right thyroid nodule. Preoperative work up included US and fine needle aspiration and cytology (FNAC). Post-operative histopathology showed papillary carcinoma in the TGDC; and another in the right thyroid lobe that was a papillary carcinoma with follicular patterns. Conclusions: TGDC carcinoma concurrent with another carcinoma in the right thyroid lobe as two separate tumours are extremely rare. All patients should undergo Sistrunk's procedure, and total thyroidectomy for the thyroid tumour. Follow-up requires thyroxine replacement therapy to treat hypothyroidism and to suppress TSH in order to prevent recurrence; and neck ultrasound and thyroglobulin tumour marker to detect recurrence if present. © 2020 The Authors

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  • 39.
    Mahmoud, Waleed
    et al.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Hassan, Sara
    Department of Breast Surgery, Hamad Medical Corporation, Doha, Qatar.
    Alatasi, Sali
    Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
    Almerekhi, Haya
    Department of Clinical Imaging Service, Hamad Medical Corporation, Doha, Qatar.
    Junejo, Kulsoom
    Department of Breast Surgery, Hamad Medical Corporation, Doha, Qatar.
    Giant mammary hamartoma in a middle aged female: Case report and review of literature of the last 15 years2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 78, p. 145-150Article, review/survey (Refereed)
    Abstract [en]

    Background: Mammary hamartoma is a benign rare tumour occurring in both sexes, with size range mostly between 2–4 cm. Giant breast hamartoma (GMH) is very rare and can reach unexpected sizes in women. Presentation of the case: A 26 year old Egyptian female presented with left breast lump since 3 years, gradually increasing in size, with no other associated complaints. No family history of breast cancer, she did not smoke or consume alcohol, and had no past medical history. Examination revealed a large soft freely mobile mass (12 × 9 cm) in the lower outer quadrant of the left breast at the 3–6 o'clock position. There were no palpable axillary lymph nodes in both sides. Nipples and right breast were normal. Discussion: The diagnosis of GMH can be made by examination and imaging only. The specific features that appear in mammogram and ultrasound can be used to reduce the need for core biopsy in hamartoma. Wide local excision is curative. We include a review of the literature of cases of GMH > 10 cm published during the last 15 years. Conclusion: A non-invasive mammogram and ultrasound provide sufficient evidence of the tumour, hence core biopsy might not be critically required. However, if a breast hamartoma is still clinically suspected but with inconclusive or unequivocal mammographic and ultrasonographic features or if there is suspicion of dysplasia, then invasive core biopsy is justified. Recurrence is low and prognosis is good. 

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  • 40.
    Moghamis, Isam Sami
    et al.
    Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar.
    Abdelsalam, Salahuddeen
    Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Baco, Abdul Moeen
    Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    First case of mechanical compression by methylprednisolone crystals following transforaminal lumbar nerve root block for left sciatic pain leading to hyperesthesia and progressive weakness: A case report2021In: International Journal of Surgery Open, ISSN 2405-8572, Vol. 34, no 100364Article in journal (Refereed)
    Abstract [en]

    Introduction: Lumbosacral nerve root blocks and epidural corticosteroid injections are commonly used for short-term pain relief among patients with degenerative spinal disc disease. Serious complications following these injections are rare, and there are only a few published papers on this subject. It is important that spine surgeons are aware of the potential complications, and the possible factors that contribute to such complications. Presentation of case: 32-year-old Lebanese female presented with progressive weakness and hyperesthesia following a transforaminal lumbar nerve root corticosteroid particulate injection. The case was managed by surgical lumbar decompression. Discussion: Neurological complications following transforaminal/selective nerve root block are the most feared of all possible associated complications with epidurals blocks. It has been hypothesized that such a complication is mainly due to a spinal cord infarct from corticosteroid crystal. However, there are no previous reports that such progressive weakness and hyperesthesia could be due to the mechanical compression caused by corticosteroid particulate crystals themselves as confirmed in the current case. Conclusions: Progressive weakness and hyperesthesia following nerve root block could be due to the effect of the corticosteroid particles used in the injectate. Such complications could be simply avoided by the use of more dilutional volume of the local anaesthetic agent and/or using a non-particulate corticosteroid in order to avoid the adherence of the corticosteroid crystals to the nerve root sheath. This is the first case of post-nerve root block neurological complications due to mechanical compression caused by corticosteroid particulate crystals.

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  • 41.
    Mohamed, Walla
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Weill Cornell Medicine, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Sibira, Rayan M.
    Department of Laboratory Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Abusabeib, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
    Water clear cell ectopic non-iatrogenic giant parathyroid adenoma in sternohyoid muscle with thyroid nodule and asymptomatic hypercalcemia due to primary hyperparathyroidism: Case report and literature review2021In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 86, article id 106295Article in journal (Refereed)
    Abstract [en]

    Background: Ectopic parathyroid gland is not uncommon, and is associated with primary hyperparathyroidism. Giant parathyroid adenoma (PA) and concurrent presence of enlarged thyroid nodule increases the probability of ectopic location. The combination of a giant PA that is ectopic (within the strap muscle) in the neck is very rare, especially in cases with no previous surgery. The rare histopathological findings of the current case, water clear cell parathyroid adenoma (WCCPA), could explain the patient's presentation, since it has low endocrine function. Case presentation: A 56-year-old Qatari female on routine visit to primary health care physician for hypertension, was incidentally discovered to be hypercalcemic and was referred to the emergency department of our institution. Neck ultrasound showed a thyroid nodule on the left side, but 99mTc-sestamibi scintigraphy identified a left PA. FNAC of the thyroid nodule showed that it was a colloid nodule. She underwent left hemithyroidectomy and excision of left PA. Intraoperatively, the PA was giant and in the sternohyoid muscle. Intraoperative monitoring of intact PTH (IOiPTH) confirmed successful excision. Discussion: Ectopic giant parathyroid adenoma is rare especially with the intramuscular location in sternohyoid muscle in the neck without previous neck surgeries. The presence of thyroid nodule could be a precipitating factor for migration of the PA. Preoperative assessment with the radiological image is crucial for diagnosis but sometimes fail to localized the PA. Conclusion: Giant asymptomatic PA with long standing low function before hyperfunctioning should raise the suspicion of WCCPA. If diagnosis is confirmed, metastasis from a clear cell renal cell carcinoma should be ruled out. 

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  • 42.
    Nilsson, Hanna
    et al.
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Angerås, Ulf
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Bock, David
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences and Karolinska University Hospital, Stockholm, Sweden.
    Onerup, Aron
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Fagevik Olsen, Monika
    Department of Gastrosurgical Research and Education, Gothenburg, Sweden.
    Gellerstedt, Martin
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden ; School of Business, Economics and IT, University West, Göteborg, Sweden.
    Haglind, Eva
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Is preoperative physical activity related to post-surgery recovery?: A cohort study of patients with breast cancer2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 1, article id e007997Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery. Design: A prospective cohort study. Setting: Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden. Participants: Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level SaltinGrimby Physical Activity Level Scale (SGPALS). Main outcome measure: Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery. Results: 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks. Conclusions: The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active patients.

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  • 43.
    Onerup, Aron
    et al.
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Angerås, Ulf
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Bock, David
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences and Karolinska University Hospital, Stockholm, Sweden.
    Fagevik Olsén, Monika
    Department of Gastrosurgical Research and Education, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden ; Department of Physical Therapy and Surgery Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gellerstedt, Martin
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden ; School of Business, Economics and IT, University West, Trollhättan, Sweden.
    Haglind, Eva
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Nilsson, Hanna
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy: A cohort study2015In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 19, p. 35-41Article in journal (Refereed)
    Abstract [en]

    Introduction There is an increasing interest in the role of preoperative physical activity for postoperative recovery. The effect of preoperative physical activity and recovery after cholecystectomy is unknown. The aim of this study was to evaluate the association of self-reported leisure-time preoperative physical activity with postoperative recovery and complications after elective cholecystectomy due to gallstone disease. Methods Prospective observational cohort study with 200 patients scheduled to undergo elective cholecystectomy. Level of self-assessed leisure-time physical activity was compared with recovery. Results Regular physical activity was associated with a higher degree of return to work within three weeks post-operatively (relative chance (RC) 1.26, p = 0.040); with a higher chance of leaving hospital within one day post-op (RC 1.23, p = 0.001), as well as with better mental recovery (RC 1.18, p = 0.049), compared to physically inactive. No statistically significant association was seen with return to work within one week or with self-assessed physical recovery. Discussion In clinical practice, evaluating the patients’ level of physical activity is feasible, and may potentially be used to identify patients being more suitable for same-day surgery. Given the study design, the results from this study cannot prove causality. Conclusion The present study shows that the preoperative leisure-time physical activity-level, is positively associated with less sick leave, a shorter hospital stay and with better mental recovery, three weeks post-elective cholecystectomy. We recommend assessing the physical activity-level preoperatively for prognostic reasons. If preoperative/postoperative physical training will increase recovery remains to be shown in a randomized controlled study.

  • 44.
    Rönnberg, Katarina
    et al.
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
    Lind, B.
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
    Zoega, B.
    Department of Orthopaedics, Landspitali University Hospital,Reykjavik, Iceland.
    Gadeholt-Göthlin, G.
    Department of Radiology, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
    Halldin, K.
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
    Gellerstedt, Martin
    Trollhättan/Uddevalla University, Uddevalla, Sweden.
    Brisby, H.
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
    Peridural scar and its relation to clinical outcome: A randomised study on surgically treated lumbar disc herniation patients2008In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 17, no 12, p. 1714-1720Article in journal (Refereed)
    Abstract [en]

    A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Pre- and 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen. 

  • 45.
    Rönnberg, Katarina
    et al.
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Lind, Bengt
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Zoëga, Björn
    Department of Orthopaedics, Landspitali University Hospital, Reykjavik, Iceland.
    Halldin, Klas
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Gellerstedt, Martin
    Department of Orthopaedics, Trollhätan/Uddevalla University, Sweden.
    Brisby, Helena
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery2007In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 32, no 2, p. 256-261Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN. A prospective study of patients undergoing lumbar disc herniation surgery. OBJECTIVES. To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome. SUMMARY OF BACKGROUND DATA. Patients' expectations on treatment results have been discussed as a predictive factor for postoperative outcome and satisfaction demonstrated to be directly related to patient expectations. METHODS. The study includes 148 patients, 46% women, mean age 40 (range 18-66). Before and 2 years after surgery, questionnaires about given information/care, expected/present work ability, and expectations on/obtained improvement of physical functions/symptoms (leg and back pain, sensibility, and muscle function) were filled in. The visual analog scale leg pain, Zung Depression Scale, and Oswestry Disability Index were used as baseline characteristics. At 2-year follow-up, self-reported and objective outcome was assessed. RESULTS. Satisfaction with given information/care were reported by 46% and 82%, respectively. Zung Depression Scale related to expectations on leg pain recovery (P = 0.022), work ability (P = 0.046), and satisfaction with given information (P = 0.031). Patients who expected to return (76%) and not return (24%) to work, returned in 78% and 26%, respectively (P = 0.021). A high agreement between self-reported outcome and objective outcome were found (P < 0.001). CONCLUSIONS. Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results.

  • 46.
    Saafan, Tamer
    et al.
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health and Education. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar ; College of Medicine, Qatar University, Doha, 2713, Qatar.
    Al-Yahri, Omer
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    Eleter, Ammar
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    Eljohary, Hisham
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    Alfkey, Rashad
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    Hajjar, Mustafa
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    Toffaha, Ali
    Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
    El Osta, Abdelrahman
    Department of Surgery, AlWakra Hospital, AlWakra, Qatar.
    Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study2019In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 42, p. 23-28Article in journal (Refereed)
    Abstract [en]

    Background: /aim: Scores commonly employed to risk stratify perforated peptic ulcer patients include ASA (American Society of Anesthesiologists), Boey and peptic ulcer perforation score (PULP). However, few studies assessed and compared the accuracy indices of these three scores in predicting post PPU repair 30-day morbidity. We assessed accuracy indices of PULP, and compared them to Boey and ASA in predicting post perforated duodenal (PDU) ulcer repair 30-day morbidity. Methods: Retrospective chart review of all PDU patients (perforated duodenal ulcers only) at the largest two hospitals in Qatar (N = 152). Data included demographic, clinical, laboratory, operative, and post repair 30-day morbidity. Area under the Curve (AUC), sensitivity and specificity were computed for each of the 3 scores. Multivariate logistic regression assessed the accuracy indices of each score. Results: All patients were males (M age 37.41 years). Post PDU repair 30-day morbidity was 10.5% (16 morbidities). Older age, higher ASA (≥3), Boey (≥1) or PULP (≥8) scores, shock on admission and preoperative comorbidities; and conversely, lower hemoglobin and albumin were all positively significantly associated with higher post PDU 30-day morbidity. PULP displayed the largest AUC (72%), and was the only score to significantly predict 30-day morbidity. The current study is the first to report the sensitivity and specificity of these three scores for post PDU repair 30-day morbidity; and first to assess accuracy indices for PULP in predicting post PDU repair 30-day morbidity. Conclusion: PULP score had the largest AUC and was the only score to significantly predict post PDU repair 30-day morbidity. © 2019 The Author(s)

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  • 47.
    Salaheldin, Yassmin
    et al.
    Department of Bariatric Surgery/Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Corporation, Doha ; College of Medicine, Qatar University, Doha, Qatar.
    Aljaloudi, Esraa
    Department of Family Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
    Elhag, Wahiba
    Department of Bariatric Surgery/Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
    Third reported case of rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-En-Y gastric bypass: case report and literature review2022In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 27, no 3, p. 1235-1241Article, review/survey (Refereed)
    Abstract [en]

    INTRODUCTION: Obesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency.

    CASE REPORT: We report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy).

    CONCLUSION: Bariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery.

    LEVEL OF EVIDENCE: Level V, case report.

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  • 48.
    Shahid, Fakhar
    et al.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Ben-Gashir, Mohamed
    Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Laparoscopic hydrocelectomy of the canal of Nuck in adult female: Case report and literature review2020In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 66, p. 338-341, article id S2210-2612(19)30674-1Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Among adult females, Hydrocele of Canal of Nuck (HCN) is a very rare condition. The majority of the reported cases of HCN were not conclusively diagnosed until surgery was performed on a suspected inguinal hernia. To the best of our knowledge, this is the first case of laparoscopically operated HCN in adult female in Middle East and North Africa Region, and the fourth such case worldwide.

    PRESENTATION OF CASE: A 36-year-old female presented with a painful small swelling in the right groin of 3 months duration. The swelling extended to the right labia majora while standing, and disappeared when the patient was in prone position. There was no lymph node enlargement, no other masses in the abdomen, and no swelling in the contralateral side. Ultrasonography was undertaken and the patient was admitted electively for laparoscopic exploration and repair of non-complicated right inguinal hernia. She was known to have dyslipidemia on medications. Further history and physical examination were unremarkable. Intraoperatively it was diagnosed to be right-sided HCN which was excised and repaired by mesh fixation using transabdominal preperitoneal (TAPP) approach. Her follow up course was unremarkable.

    CONCLUSIONS: This case expands the clinical and intraoperative potential differential diagnosis of adult female groin masses. Surgeons should consider such cases when they observe such swellings intraoperatively. Laparoscopic TAPP approach in such cases is a superior diagnostic and treatment modality.

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  • 49.
    Toffaha, Ali
    et al.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Elaiwy, Orwa
    Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
    Obaid, Munzir
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Al-Yahri, Omer
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Abdelazim, Sherif
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    First sliding Amyand hernia harbouring appendicular schistosomiasis: Case report2019In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 63, p. 143-146Article in journal (Refereed)
    Abstract [en]

    Introduction: Amyand's hernia (AH) is rare, schistosomiasis of the appendix is very uncommon, and both conditions coexisting together is an extremely rare event. Pre-operative diagnosis of each of the two conditions is usually difficult. To the best of our knowledge, the current paper is first to report both these two conditions in coexistence. Presentation of case: A 31-year old man who had no comorbidities was admitted electively as a day case of non-complicated right indirect inguinal hernia. Further history and physical examination were unremarkable. Intraoperatively the patient was found to have right sliding AH with appendicular schistosomiasis (AS). The patient underwent Lichtenstein repair of the hernia with appendectomy. On follow up he was referred to infectious disease clinic, and the post-operative course was uneventful. Conclusions: Intraoperative identification of non-typical hernia sac before its opening should alert the surgeon to the possibility of sliding hernia and the presence of an organ as a part of the sac. Rare causes of appendicular masses like schistosomiasis granuloma should be considered in endemic areas or immigrants from these areas, despite the difficulty of preoperative diagnosis. Management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present. 

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  • 50.
    Wennström, Berith
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Anaesthesia, Skaraborg Hospital, Skövde, Sweden / Department of Surgery, Skaraborg Hospital, Skövde, Sweden / Research and Development Center, Skaraborg Hospital, Skövde, Sweden.
    Johansson, Anna
    Department of Surgery, Skaraborg Hospital, Skövde, Sweden.
    Kalabic, Sabina
    Department of Surgery, Skaraborg Hospital, Skövde, Sweden.
    E-son Loft, Anna-Lena
    Research and Development Center, Skaraborg Hospital, Skövde, Sweden..
    Skullman, Stefan
    Department of Surgery, Skaraborg Hospital, Skövde, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Patient experience of health and care when undergoing colorectal surgery within the ERAS program2020In: Perioperative Medicine, E-ISSN 2047-0525, Vol. 9, article id 15Article in journal (Refereed)
    Abstract [en]

    Background

    Several studies show that the enhanced recovery after surgery (ERAS) program reduces complications postoperatively and leads to faster recovery and shorter hospital stays. However, little is known about patients’ self-reported health in an enhanced recovery context. The aim of this study was firstly to describe patient experiences of health within the concept of ERAS after colorectal (CR) surgery during a hospital stay and within 2 weeks of discharge. Secondly, to explore whether the ASA classification/co-morbidity, sex, and surgical method affect the patient’s experience of health.

    Methods

    Data were collected through the ERAS-HEALTH questionnaire, including two open-ended questions, and through telephone interviews postoperatively. Qualitative and quantitative analysis was used. Patients undergoing CR surgery (n = 80) were included from October 2016 to June 2018.

    Results

    The patients had mainly positive experiences of their hospital stay as well as most of them felt comfortable coming home. However, experienced state of health is affected by factors like surgical method and co-morbidity. Improvements were desired concerning information, food/food intake, pain management, and environment. At home, the patients experienced a lack of information about food/food intake and ostomy care. Decreased appetite and difficulties with micturition were also described. The most troublesome symptom was postoperative fatigue (POF). Analysis of the ERAS-HEALTH questionnaire showed that patients with higher co-morbidity and those who underwent open surgery have a significantly worse experience of their health compared with patients who underwent laparoscopy. However, it seems that the surgical method affects postoperative health to a greater extent than co-morbidity.

    Conclusions

    The patients reported many positive aspects and challenges when being cared for within the ERAS program. However, several improvements are needed to satisfy patient wishes regarding their care both in hospital and at home. Laparoscopic surgery affects patient state of health positively in several respects compared with open surgery.

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