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   Table of Contents - Current issue
January-June 2019
Volume 7 | Issue 1
Page Nos. 1-37

Online since Tuesday, August 2, 2022

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Portomesenteric thrombosis after bariatric surgery in the Pan-Arab region p. 1
Ahmad Bashir, Ahmed Maasher, Mousa Khoursheed, Mohammad Alnaami, Alaa Alhazmi, Hayssam Fawal, Aayed Alqahtani, Emad Abdallah, Ayman El-Nakeeb, Ramzi Alami, Bassem Safadi, Mohammed Alkuwwari, Moataz Bashah, Davit Sargasyan, Ahmed Abdelwahid, Safwan Taha, Fuad Ahmed, Ra’ed Fayez, Ashraf Moghraby, Ali Al-Montashery, Mohammad Haddad, Abdelrahman Nimeri
Background: Bariatric surgery has been shown to be the most effective method to treat morbid obesity and obesity-related comorbidities compared to intensive medical therapy. However, bariatric surgery is not without complications. Some rare complications after bariatric surgery are underestimated. One of these rare complications is portomesenteric thrombosis (PMT). We herein examine the prevalence of PMT after bariatric surgery in the Pan-Arab region. Methods: We sent a questionnaire to the members of the Pan-Arab Bariatric Society for Metabolic and Bariatric Surgery in 2014. This is a group that started on social media in 2012, that represents surgeons practicing in the following countries: United Arab Emirates (UAE), Kingdom of Saudi Arabia (KSA), Qatar, Bahrain, Oman, Kuwait, Egypt, Iraq, Palestine, Jordan, and Lebanon. The questionnaires were sent by email and placed on a link on the Facebook page of the group, and reminders were sent through social media to the members of the group and in our monthly Tele-video conference meeting. All data of procedures carried out in the Pan-Arab region were included. Any procedures performed outside the region were excluded. Results: We sent 77 and received back 18 completed questionnaires (23.4%). The data represent 21 surgeons from 13 hospitals in 9 countries (Iraq, Palestine, UAE, Qatar, Lebanon, Jordan, KSA, Egypt, Kuwait). Data for patients operated in Austria and in the United States were excluded. We received no responses from Bahrain, Iraq, or Oman. The total number of cases performed was 13,274, 9% laparoscopic adjustable gastric banding, 68% laparoscopic sleeve gastrectomy (LSG), 17% laparoscopic Roux-en-Y gastric bypass, 3% one anastomosis gastric bypass/mini gastric bypass, 1% laparoscopic greater curvature plication, 1% biliopancreatic diversion, and 2% others. Our surgeons encountered 30 PMT cases (0.23%). PMT was in both the portal and mesenteric veins in 57% of patients. The rest was observed in either the portal or mesenteric veins. History of travel was found to be associated with PMT in 7/30 [23%]. PMT cases were observed after all procedures, however, mostly after LSG 25/30 (83%). Our practice of deep vein thrombosis prophylaxis is quite variable before and after surgery in different countries. However, most patients with PMT received anticoagulation for less than a week (1–6 days and most of them were on unfractionated heparin 2–3 times/day, or low molecular weight heparin 40 mg once daily during their hospital stay). All patients with PMT complained of abdominal pain in the first 1 to 4 weeks after surgery. Computed tomography scan detected PMT in all except one patient, who was diagnosed by abdominal ultrasound. Two patients required surgical resection of the small bowel and all others were treated medically with anticoagulation. There were no mortalities. Conclusion: PMT is an uncommon complication after bariatric surgery. However, a high index of suspicion is needed to detect this complication. It is most commonly observed after LSG outcome with appropriate intervention is favorable. Majority of patients can be treated without surgical intervention.
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Perception of body image and weight status in Algerian adult population: A wrong self-evaluation p. 8
Chaima Boudaoud, Rabiâa Karoune, Wassila Adjali, Corinne C Dahel
Background: Overweight and obesity is increasing among Algerian adults with a prevalence of 55.6% in 2017. Numerous studies demonstrate that obesity is associated with the misperception of body weight. The latter causes in the individual dissatisfaction with his or her body, which could affect his or her behavior with regard to weight control and self-esteem. Aim: The objective of this study is to describe the body image perception of Algerian adults according to their body size. Settings and Design: A cross-sectional survey by a questionnaire was conducted at the city of Constantine (Eastern Algeria) from January 13 to July 31, 2019. Materials and Methods: A survey was carried among 405 adults (25–65 years old). Body mass index has been classified according to the World Health Organization references (2000). The Figure Rating Scale of Stunkard et al. (1983) was used to evaluate the body image. Statistical Analysis: Data were analyzed using Epi-Info 7 software. We used the Student’s t test, the chi-squared test, and the analysis of variance for, respectively, the comparison between two means, the comparison between two percentages, and the comparison of several means. Statistical significance was set at 0.05. Results: Between all adults, 25.9% were (n = 105) obese, and they were the most likely to underestimate their weight. About 70.5% of them (n = 74) chose an ideal overweight body, and 88.6% (n = 93) had a wrong perception of their body weight. Among the participants, 60.6% of men (n = 175) and 68.1% of women (n = 79) were dissatisfied with their body image. Conclusion: The ideal body image for the majority of women and men was represented by a large figure. The wrong self-evaluation of adults’ current figure could significantly influence their eating behavior. The evaluation of body image and self-esteem of Algerians seems necessary to develop effective strategies for obesity prevention.
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Role of upper gastrointestinal endoscopy before bariatric surgery p. 15
Hadeel S Ashour, Arif Khurshid, Owaid Almalki, Walaa N Al-Harthi, Amer M Al-Nefaie, Atheer M Altalhi
Background: The ultimate purpose of weight management in patients with obesity is to reduce the risk of related comorbidities and improve their health. Bariatric surgery appears to be cost-effective compared with the standard intervention in the management of morbid obesity. However, the role of preoperative esophagogastroduodenoscopy (EGD) remains a controversial topic. The aim of this study is to assess the incidence of abnormal findings in preoperative EGD, to evaluate the correlation between EGD findings and patient risk factors, and to evaluate EGD’s effects on the surgical management plan. Materials and Methods: A retrospective cross-sectional study was conducted on all patients who underwent bariatric surgery at Al-Hada Military Hospital, Taif, Saudi Arabia, by reviewing their medical records. Result: The study population included 227 patients (26% males and 74% females). The incidence of abnormal EGD findings was 78.9% (n = 179), and the most common result was gastritis (n = 86; 37.9%). The prevalence of this abnormal EGD finding was significantly higher in males (n = 53; 89.8%) than in females (n = 126; 75%) (P = 0.016). A multivariate logistic regression analysis showed that male sex (odds ratio [OR] = 3.11 [95% confidence interval (CI) = 1.08–8.93]; P value = 0.036) and hypothyroidism (OR = 2.39 [95% CI = 1.02–5.59]; P value = 0.044) were independent predictive factors for abnormal EGD findings. Conclusion: Almost 80% of patients who underwent EGD before bariatric surgery had abnormal findings including Helicobacter pylori infection, gastritis, hiatal hernia, or duodenitis. Nevertheless, surgical management plans were not significantly impacted by those findings. Accordingly, preoperative EGD should be performed as clinically indicated.
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Prevalence and predictors of dyslipidemia among hypertensive patients attending a secondary healthcare center in southwestern Nigeria p. 21
Ismaheel A Azeez, Akinosun M Olubayo, Kolawole A Adeyemo
Introduction: The prevalence of dyslipidemia is increasing globally with accompanied morbidities and mortalities. There is a paucity of data in Nigeria on the prevalence of dyslipidemia among adult hypertensive patients and this study aimed to assess the serum levels of lipids among hypertensive patients. Materials and Methods: This cross-sectional study of 354 hypertensive patients was conducted at the State Hospital, Oyo, Nigeria. The systematic sampling technique was used to recruit hypertensive patients, and the data were analyzed using SPSS software, version 23. Linear regressions were conducted to determine the predictors of dyslipidemia. Results: Three hundred fifty-four patients who met the criteria for recruitment were interviewed. The mean age of the respondents was 52.60 (SD ± 8.26) years. The prevalence of elevated low-density lipoprotein (LDL) was 43.6% (154), low high-density lipoprotein (HDL) in males was 25.4% (18/71), low HDL in females was 30.7% (87/283), elevated triglycerides was 1.4% (5), and elevated cholesterol was 29.9% (106). For every 1 unit increase in subscapularis skinfold, there was a statistically significant increase in triglyceride by about 0.036 units (95% CI = 0.032–0.040, P = 0.0001). For every 1 unit increase in triceps skinfold, there was a statistically significant increase in LDL by about 0.096 units (95% CI = 0.019–0.172, P = 0.013). For every 1 unit increase in hip circumference, there was a statistically significant decrease in HDL by about 0.007 units (95% CI = −0.009 to 0.013, P = 0.019). Conclusions: This study has facilitated the characterization of this population of hypertensive patients in terms of dyslipidemia, and this would be beneficial in their treatment and future care. Among these hypertensive patients, subscapularis, triceps skinfold thickness, and hip circumference predicted abnormal lipid profile.
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Prevalence of overweight and obesity in the Saudi population: A population-based cross-sectional study p. 29
Aayed R Alqahtani, Mohamed Elahmedi, Awadh Al Qahtani
Background: There is a scarcity of comprehensive data on the epidemiology of overweight /obesity and its association with diet- and activity-related behaviors among the Saudi Arabian adult population. The present study aims to determine prevalence of overweight and obesity and estimates factors that may be associated with obesity in Saudi Arabia. Materials and Methods: A population-based cross-sectional study was conducted with a representative multistage random cluster sample of the Saudi Arabian adult population (n = 12,154; male= 5,523, female = 6631). Measurements included weight, height, body mass index (BMI), screen time, physical activity, and dietary habits (validated questionnaire). Data were analyzed by descriptive statistics; Student’s t-test, Chi-squared tests, ANOVA and logistic regression were employed to examine the associations between obesity and lifestyle factors. Results: Overall, 72.4% of the Saudis who participated in this study suffered from overweight or obesity; (31.9% overweight and 40.5% obese). The prevalence of obesity and overweight increased with age and reached a peak among those aged 50–59 years. Additionally, men were 1.5 times more likely to be overweight or obese than women (crude odds ratio [OR]: 1.54, 95% confidence interval [CI]: 1.42, 1.64). This association did not change after adjusting for other factors such as age, exercise habits, snack habits, educational attainment and co-morbidities. The odds of obesity/overweight was 42% greater for those who never exercised compared to those who exercised daily [adjusted (adj.) OR: 1.42 (1.21, 1.67)]. Conclusion: Age, gender, education attainment, exercise habits and co-morbidities were important factors found to be associated with high BMI among the adult population of Saudi Arabia. The present findings reinforce the importance of reforming public health strategies for effective prevention and management of overweight and obesity in Saudi Arabia.
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