Ahmed Elhoofy - Academia.edu (original) (raw)
Papers by Ahmed Elhoofy
The Egyptian Journal of Surgery
The Egyptian Journal of Surgery, 2019
Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-ri... more Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-risk procedure and can be reversed. Patients and methods Between June 2014 and September 2018, 310 morbidly obese patients have undergone LOAGB surgery. Results The mean operating room time was 69 min. Median postoperative length of stay was 2.1 days. The;Deg;BM;Deg;I has decreased from 49.3±9.9 to 38.8±9.7 kg/m2, 33.7±4.7 and 28.8 kg/m2 at 6, 12, and 24 months postoperatively, respectively. The percentage of excess weight loss is, respectively, 50±26, 62±25, and 72±18% at 6, 12, and 24 months postoperatively.. Major complications have occurred in a total of 11 (3.5%) patients. One patient has suffered from postoperative gastrojejunal anastomotic leakage. Five patients have suffered from massive postoperative bleeding. Two patients have intractable bile reflux after minigastric bypass. Omega loop gastric bypass was converted to Roux-en-Y gastric bypass in these two patients. One anastomoti...
Surgery for Obesity and Related Diseases, 2016
Background Although the vertical banded gastroplasty (VBG) is effective in achieving weight loss ... more Background Although the vertical banded gastroplasty (VBG) is effective in achieving weight loss without metabolic side effects during the first few years, late failures cause weight regain in about 20% of the patients. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the procedure of choice to convert a failed VBG. Materials and Methods Between August 2014 and June 2016, 37 patients (23 females and 14 males) underwent revisional LRYGBs after failed VBGs. Thirty-four patients had open VBGs and two patients had laparoscopic butterfly gastroplasties. These patients completed follow-ups of at least 1 year. Results The median operating time was 164 min (range 132-246), and the mean length of the hospital stay was 2.4 days (range 2-7). The mean body mass index (BMI) of the study group was 42.5 kg/m 2 , while the mean BMI and the percentage of excess body weight loss (%EBWL) for the patients 6 months after the operation were 31.7 kg/m 2 and 52.1%, respectively. The mean BMI and %EBWL for the patients 1 year after the operation were 29.5 kg/m 2 and 67.7%, respectively. There were neither intraoperative complications nor postoperative mortalities, but the overall complication rate was 22% (eight patients). Conclusion An LRYGB following a VBG is technically challenging, but safe, with low morbidity and mortality rates. Moreover, a revisional LRYGB provides excellent weight loss results.
Minimally Invasive Surgery
Background. Superior mesenteric artery (SMA) syndrome is a rare disorder that may be managed surg... more Background. Superior mesenteric artery (SMA) syndrome is a rare disorder that may be managed surgically if conservative management fails. Different surgical techniques have been described, division of the ligament of Treitz, gastrojejunostomy, and duodenojejunostomy. The aim of this case series is to show that laparoscopic duodenojejunostomy is a safe and technically feasible management for superior mesenteric artery syndrome. Methods. In this case series, we retrospectively identified all patients who underwent laparoscopic duodenojejunostomy for SMA syndrome in our tertiary university center between December 2016 and July 2019. Data collected included demographics, presenting symptoms, comorbidities, pre and postoperative body mass index (BMI), operative approach, operative blood loss, operative duration, clinical and radiological results, in hospital/30-day complications, mortality, and postoperative follow-up outcomes. Results. We identified eleven patients, 10 females and 1 mal...
Ain Shams Journal of Surgery, Jul 1, 2018
Background: The surgical technique of sleeve gastrectomy has not been fully standardized and, the... more Background: The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. Resection of the antrum is one of these debatable issues. Aim: The study aims at assessing the difference in long and short term weight loss between both antral resection laparoscopic sleeve gastrectomy & antral preservation laparoscopic sleeve gastrectomy. Patients and methods: Is a prospective randomized control study including 100 patients with BMI exceeding 35, fifty of them will undergo antral preservation in laparoscopic sleeve gastrectomy (group A), and the other fifty patients will undergo antral resection in laparoscopic sleeve gastrectomy (group B). Results: Weight loss and BMI reduction after 6 months in the antral resection group were more than the antral preservation group with mean weight 92.25 kg in antral resection group compared to 99.46 kg in antral preservation group and mean BMI 34.48 in antral resection group compared to 39.29 in antral preservation group. Also weight loss and BMI reduction after 12 months in the antral resection group were more than the antral preservation group with mean weight 71.60 kg in antral resection group compared to 77.20 kg in antral preservation group and mean BMI 26.41 in antral resection group compared to 30.71 in antral preservation group. Conclusion: Antral resection in LSG safely potentiates the restrictive effect achieved and may result in greater and better maintained weight loss.
The Egyptian Journal of Surgery, 2019
© 2019 The Egyptian Journal of Surgery | Published by Background Obesity has become a worldwide p... more © 2019 The Egyptian Journal of Surgery | Published by Background Obesity has become a worldwide pandemic health problem, and morbid obesity leads to high rate of complications associated with metabolic syndrome, including type 2 diabetes mellitus (DM), hypertension, and hyperlipidemia. Bariatric procedures have become a main therapeutic option allowing improved diabetes, hypertension, and hyperlipidemia control in most patients Patients and methods A prospective study which was done between December 2015 and December 2017, this randomized study included 120 obese patients with metabolic syndrome whowere divided into two groups: group 1 included 60 patients who were treated by laparoscopic sleeve gastrectomy (SG). Group 2 included 60 patients who were treated by laparoscopic minigastric bypass (MGB). The outcome for weight loss, DM control, blood pressure control, and hyperlipidemia were assessed and compared. Results A total of 120 patients were included in the study. The average ag...
Ain Shams Journal of Surgery, 2017
Background: Porto-mesenteric venous thrombosis (PMVT) is a rare but severe surgical complication ... more Background: Porto-mesenteric venous thrombosis (PMVT) is a rare but severe surgical complication developing in patients who underwent laparoscopic bariatric surgery; with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. Its clinical presentation, management, and sequelae remain poorly understood. We aimed to describe the incidence, clinical features, management and outcome, in patients with PMVT after laparoscopic bariatric surgery. Patients and methods: This was a retrospective analysis of patients who underwent laparoscopic bariatric surgery for morbid obesity between October 2014 and September 2016 who developed PMVT. Age, sex, body mass index(BMI), personal risk factors for thrombosis, family history of thrombosis, surgical technique, thrombo-embolic prophylaxis, primary surgery outcomes, clinical features and long term postoperative follow up findings were analyzed in this study. The diagnosis was established with an abdominal computed tomography (CT) scan as well as duplex ultrasound of the portal venous system. All patients received longterm anticoagulation. Results: Of 1434 patients who underwent laparoscopic bariatric surgery; 947 patients underwent laparoscope sleeve gastrectomy (LSG) while 487 underwent laparoscopic mini-gastric bypass (LMGBP). 4 patients of those who underwent LSG (0.42%) developed PMVT. On the other hand no patients experienced PMVT following LMGBP. Three patients were males, the mean age was 34 years, and the mean body mass index was 43 kg/m 2. The time of onset of symptoms was within one to two weeks post operatively in 3 cases while one case (the female patient) presented late after 86 days and the presentation was atypical and rapidly progressive and the patient died within two weeks. New-onset epigastric pain was present in all patients, while other signs and symptoms were variable. Ultrasonography and computed tomography scan were performed and were diagnostic in all cases. The decision regarding the type of drug and the duration of anticoagulation therapy was based on hematology consultant assessment as regards patients' clinical course, result of thrombophilic evaluation, presence of other thrombotic risk factors and follow-up Doppler studies. One patient underwent surgical intervention: laparotomy with splenectomy and necrotic small-bowl resection. One patient died. Conclusion: PMVT is a rare but serious complication after LSG. Familiarity with this dangerous entity is important. It requires early diagnosis and management as these cases carry significant morbidity and mortality. Prompt diagnosis and anti-coagulation therapy led to favorable outcomes in most cases. Significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation.
Ain Shams Journal of Surgery, Jul 1, 2018
Aim: Reduced Port laparoscopic Surgery (RPLS) involves fewer ports or narrower ports than standar... more Aim: Reduced Port laparoscopic Surgery (RPLS) involves fewer ports or narrower ports than standard laparoscopic surgery. It has the potential to cause reduced postoperative pain, reduce abdominal wall trauma and increase the aesthetic result without compromising the outcome. This review describes the feasibility, present situation and challenges faced as well as standardized procedures and the future prospects of reduced port laparoscopic gastrectomy for various bariatric procedure. Materials and methods: From December 2015 to January 2017, 251 patients were enrolled in our trial all of which underwent the procedure using the three port technique. All patients had morbid obesity with history of failure of conservative treatment. The aim was to assess and evaluate postoperative pain and patients' satisfaction with the aesthetic results as well as to define the features of early post-operative complications of patients in comparison to the conventional five ports technique. Results: 251 patients were enrolled in our trial. The analyzed population included 185 women and 66 men. Mean age and BMI were 41 ± 23 and 53 ±18, respectively. Mean operative time was 47 ± 20 min for sleeve gastrectomy, 65±13 min for mini-gastric bypass and 133±25 min for revisional surgeries. Mortality was nil. Overall morbidity rate was recorded. Median duration of hospital stay was 1.5 days (range, 1-2) for sleeve gastrectomy and gastric bypass and 2.5 days (2-4 days) for revisional surgeries. Conclusion: Three ports technique for bariatric surgery is a safe and effective surgical option in patients with morbid obesity without additional early surgical complications or increase in operative time, and with a greater patient aesthetic satisfaction.
British Journal of Surgery, 2021
Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when... more Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when conservative management fails. We present a case series of six patients who underwent laparoscopic duodenojejunostomy in our tertiary centre for treatment of SMA Syndrome. The aim of our case series is to assess and present our outcomes in comparison to the limited available literature on the topic. Retrospectively, we identified all patients who underwent laparoscopic duodenojejunostomy for SMA Syndrome in our tertiary university centre’s surgical database between December 2016 and July 2019. Data collected included demographics, presenting symptoms, co-morbidities, pre and post-operative Body Mass Index (BMI), operative approach, operative blood loss, operative duration, length of hospital stay, clinical and radiological results, in hospital/30 day complications, mortality and post operative follow up outcomes. We identified six patients, 1:5 male to female ratio, with a median age 18...
The Egyptian Journal of Surgery
The Egyptian Journal of Surgery, 2019
Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-ri... more Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-risk procedure and can be reversed. Patients and methods Between June 2014 and September 2018, 310 morbidly obese patients have undergone LOAGB surgery. Results The mean operating room time was 69 min. Median postoperative length of stay was 2.1 days. The;Deg;BM;Deg;I has decreased from 49.3±9.9 to 38.8±9.7 kg/m2, 33.7±4.7 and 28.8 kg/m2 at 6, 12, and 24 months postoperatively, respectively. The percentage of excess weight loss is, respectively, 50±26, 62±25, and 72±18% at 6, 12, and 24 months postoperatively.. Major complications have occurred in a total of 11 (3.5%) patients. One patient has suffered from postoperative gastrojejunal anastomotic leakage. Five patients have suffered from massive postoperative bleeding. Two patients have intractable bile reflux after minigastric bypass. Omega loop gastric bypass was converted to Roux-en-Y gastric bypass in these two patients. One anastomoti...
Surgery for Obesity and Related Diseases, 2016
Background Although the vertical banded gastroplasty (VBG) is effective in achieving weight loss ... more Background Although the vertical banded gastroplasty (VBG) is effective in achieving weight loss without metabolic side effects during the first few years, late failures cause weight regain in about 20% of the patients. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the procedure of choice to convert a failed VBG. Materials and Methods Between August 2014 and June 2016, 37 patients (23 females and 14 males) underwent revisional LRYGBs after failed VBGs. Thirty-four patients had open VBGs and two patients had laparoscopic butterfly gastroplasties. These patients completed follow-ups of at least 1 year. Results The median operating time was 164 min (range 132-246), and the mean length of the hospital stay was 2.4 days (range 2-7). The mean body mass index (BMI) of the study group was 42.5 kg/m 2 , while the mean BMI and the percentage of excess body weight loss (%EBWL) for the patients 6 months after the operation were 31.7 kg/m 2 and 52.1%, respectively. The mean BMI and %EBWL for the patients 1 year after the operation were 29.5 kg/m 2 and 67.7%, respectively. There were neither intraoperative complications nor postoperative mortalities, but the overall complication rate was 22% (eight patients). Conclusion An LRYGB following a VBG is technically challenging, but safe, with low morbidity and mortality rates. Moreover, a revisional LRYGB provides excellent weight loss results.
Minimally Invasive Surgery
Background. Superior mesenteric artery (SMA) syndrome is a rare disorder that may be managed surg... more Background. Superior mesenteric artery (SMA) syndrome is a rare disorder that may be managed surgically if conservative management fails. Different surgical techniques have been described, division of the ligament of Treitz, gastrojejunostomy, and duodenojejunostomy. The aim of this case series is to show that laparoscopic duodenojejunostomy is a safe and technically feasible management for superior mesenteric artery syndrome. Methods. In this case series, we retrospectively identified all patients who underwent laparoscopic duodenojejunostomy for SMA syndrome in our tertiary university center between December 2016 and July 2019. Data collected included demographics, presenting symptoms, comorbidities, pre and postoperative body mass index (BMI), operative approach, operative blood loss, operative duration, clinical and radiological results, in hospital/30-day complications, mortality, and postoperative follow-up outcomes. Results. We identified eleven patients, 10 females and 1 mal...
Ain Shams Journal of Surgery, Jul 1, 2018
Background: The surgical technique of sleeve gastrectomy has not been fully standardized and, the... more Background: The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. Resection of the antrum is one of these debatable issues. Aim: The study aims at assessing the difference in long and short term weight loss between both antral resection laparoscopic sleeve gastrectomy & antral preservation laparoscopic sleeve gastrectomy. Patients and methods: Is a prospective randomized control study including 100 patients with BMI exceeding 35, fifty of them will undergo antral preservation in laparoscopic sleeve gastrectomy (group A), and the other fifty patients will undergo antral resection in laparoscopic sleeve gastrectomy (group B). Results: Weight loss and BMI reduction after 6 months in the antral resection group were more than the antral preservation group with mean weight 92.25 kg in antral resection group compared to 99.46 kg in antral preservation group and mean BMI 34.48 in antral resection group compared to 39.29 in antral preservation group. Also weight loss and BMI reduction after 12 months in the antral resection group were more than the antral preservation group with mean weight 71.60 kg in antral resection group compared to 77.20 kg in antral preservation group and mean BMI 26.41 in antral resection group compared to 30.71 in antral preservation group. Conclusion: Antral resection in LSG safely potentiates the restrictive effect achieved and may result in greater and better maintained weight loss.
The Egyptian Journal of Surgery, 2019
© 2019 The Egyptian Journal of Surgery | Published by Background Obesity has become a worldwide p... more © 2019 The Egyptian Journal of Surgery | Published by Background Obesity has become a worldwide pandemic health problem, and morbid obesity leads to high rate of complications associated with metabolic syndrome, including type 2 diabetes mellitus (DM), hypertension, and hyperlipidemia. Bariatric procedures have become a main therapeutic option allowing improved diabetes, hypertension, and hyperlipidemia control in most patients Patients and methods A prospective study which was done between December 2015 and December 2017, this randomized study included 120 obese patients with metabolic syndrome whowere divided into two groups: group 1 included 60 patients who were treated by laparoscopic sleeve gastrectomy (SG). Group 2 included 60 patients who were treated by laparoscopic minigastric bypass (MGB). The outcome for weight loss, DM control, blood pressure control, and hyperlipidemia were assessed and compared. Results A total of 120 patients were included in the study. The average ag...
Ain Shams Journal of Surgery, 2017
Background: Porto-mesenteric venous thrombosis (PMVT) is a rare but severe surgical complication ... more Background: Porto-mesenteric venous thrombosis (PMVT) is a rare but severe surgical complication developing in patients who underwent laparoscopic bariatric surgery; with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. Its clinical presentation, management, and sequelae remain poorly understood. We aimed to describe the incidence, clinical features, management and outcome, in patients with PMVT after laparoscopic bariatric surgery. Patients and methods: This was a retrospective analysis of patients who underwent laparoscopic bariatric surgery for morbid obesity between October 2014 and September 2016 who developed PMVT. Age, sex, body mass index(BMI), personal risk factors for thrombosis, family history of thrombosis, surgical technique, thrombo-embolic prophylaxis, primary surgery outcomes, clinical features and long term postoperative follow up findings were analyzed in this study. The diagnosis was established with an abdominal computed tomography (CT) scan as well as duplex ultrasound of the portal venous system. All patients received longterm anticoagulation. Results: Of 1434 patients who underwent laparoscopic bariatric surgery; 947 patients underwent laparoscope sleeve gastrectomy (LSG) while 487 underwent laparoscopic mini-gastric bypass (LMGBP). 4 patients of those who underwent LSG (0.42%) developed PMVT. On the other hand no patients experienced PMVT following LMGBP. Three patients were males, the mean age was 34 years, and the mean body mass index was 43 kg/m 2. The time of onset of symptoms was within one to two weeks post operatively in 3 cases while one case (the female patient) presented late after 86 days and the presentation was atypical and rapidly progressive and the patient died within two weeks. New-onset epigastric pain was present in all patients, while other signs and symptoms were variable. Ultrasonography and computed tomography scan were performed and were diagnostic in all cases. The decision regarding the type of drug and the duration of anticoagulation therapy was based on hematology consultant assessment as regards patients' clinical course, result of thrombophilic evaluation, presence of other thrombotic risk factors and follow-up Doppler studies. One patient underwent surgical intervention: laparotomy with splenectomy and necrotic small-bowl resection. One patient died. Conclusion: PMVT is a rare but serious complication after LSG. Familiarity with this dangerous entity is important. It requires early diagnosis and management as these cases carry significant morbidity and mortality. Prompt diagnosis and anti-coagulation therapy led to favorable outcomes in most cases. Significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation.
Ain Shams Journal of Surgery, Jul 1, 2018
Aim: Reduced Port laparoscopic Surgery (RPLS) involves fewer ports or narrower ports than standar... more Aim: Reduced Port laparoscopic Surgery (RPLS) involves fewer ports or narrower ports than standard laparoscopic surgery. It has the potential to cause reduced postoperative pain, reduce abdominal wall trauma and increase the aesthetic result without compromising the outcome. This review describes the feasibility, present situation and challenges faced as well as standardized procedures and the future prospects of reduced port laparoscopic gastrectomy for various bariatric procedure. Materials and methods: From December 2015 to January 2017, 251 patients were enrolled in our trial all of which underwent the procedure using the three port technique. All patients had morbid obesity with history of failure of conservative treatment. The aim was to assess and evaluate postoperative pain and patients' satisfaction with the aesthetic results as well as to define the features of early post-operative complications of patients in comparison to the conventional five ports technique. Results: 251 patients were enrolled in our trial. The analyzed population included 185 women and 66 men. Mean age and BMI were 41 ± 23 and 53 ±18, respectively. Mean operative time was 47 ± 20 min for sleeve gastrectomy, 65±13 min for mini-gastric bypass and 133±25 min for revisional surgeries. Mortality was nil. Overall morbidity rate was recorded. Median duration of hospital stay was 1.5 days (range, 1-2) for sleeve gastrectomy and gastric bypass and 2.5 days (2-4 days) for revisional surgeries. Conclusion: Three ports technique for bariatric surgery is a safe and effective surgical option in patients with morbid obesity without additional early surgical complications or increase in operative time, and with a greater patient aesthetic satisfaction.
British Journal of Surgery, 2021
Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when... more Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when conservative management fails. We present a case series of six patients who underwent laparoscopic duodenojejunostomy in our tertiary centre for treatment of SMA Syndrome. The aim of our case series is to assess and present our outcomes in comparison to the limited available literature on the topic. Retrospectively, we identified all patients who underwent laparoscopic duodenojejunostomy for SMA Syndrome in our tertiary university centre’s surgical database between December 2016 and July 2019. Data collected included demographics, presenting symptoms, co-morbidities, pre and post-operative Body Mass Index (BMI), operative approach, operative blood loss, operative duration, length of hospital stay, clinical and radiological results, in hospital/30 day complications, mortality and post operative follow up outcomes. We identified six patients, 1:5 male to female ratio, with a median age 18...