Salman, M. A., H. S. E. Omar, H. M. S. Mikhail, M. Tourky, M. El-Ghobary, H. Elkassar, M. G. Omar, M. Matter, A. M. Elbasiouny, A. M. Farag, et al., "Sarcopenia increases 1-year mortality after surgical resection of hepatocellular carcinoma.", ANZ journal of surgery, 2020. Abstract

BACKGROUND: Liver resection is a well-recognized modality for hepatocellular carcinoma. Cirrhotic patients are more prone to adverse consequences after liver resection. This work assesses the prognostic significance of sarcopenic hepatocellular carcinoma cases for whom surgical resection was performed.

METHODS: The present prospective work included 52 cirrhotic cases. Computed tomography scans were used to determine the skeletal muscle index (SMI) at the plane of the third lumbar vertebra (L3). L3 SMI was used for the definition of sarcopenia. The primary outcome measure was the predictive value of sarcopenia for 1-year post-hepatectomy mortality.

RESULTS: Sarcopenia was diagnosed in 27 patients (51.9%). All patients had a Child-Turcotte-Pugh score A. At a 1-year follow-up, 20 cases died; that is the 1-year mortality rate was 38.5%. Sarcopenia was more commonly associated with older age and non-viral causes of cirrhosis. The risk of 1-year mortality is 7.6 times higher in sarcopenic patients with a risk ratio of 3.7 (95% confidence interval 1.4-9.6).

CONCLUSION: Sarcopenia diagnosed using L3 SMI is an independent prognostic factor for 1-year deaths in cases with hepatic malignancy with Child-Turcotte-Pugh score A undergoing surgical resection.

Salman, M. A., A. Abdallah, H. M. S. Mikhail, A. Abdelsalam, A. H. Ibrahim, A. A. E. A. Sultan, M. El-Ghobary, A. A. M. Ismail, T. E. Abouelregal, M. G. Omar, et al., "Long-term Impact of Mini-Gastric Bypass on Inflammatory Cytokines in Cohort of Morbidly Obese Patients: a Prospective Study.", Obesity surgery, 2020. Abstract

PURPOSE: One anastomosis gastric bypass (OAGB) is a promising bariatric procedure. We performed this study to evaluate the changes in a group of inflammatory cytokines 12 months after OAGB.

METHODS: A single-arm prospective study was conducted on obese patients who underwent OAGB. The serum levels of the following adipocytokines were monitored pre- and 12 months postoperatively: adiponectin, leptin, interleukin 6 (IL-6), interleukin 8 (IL-8) levels, tumor necrosis factor-alpha (TNF-α), serum amyloid A (SAA), high-sensitivity C-reactive protein (hs-CRP), and monocyte chemotactic protein 1 (MCP-1).

RESULTS: A total of 62 patients were included with a mean age of 43.9 ± 6.8 years old. The serum adiponectin increased significantly from 7.64 ± 0.29 to 8.76 ± 0.42 μg/mL 12 months after the operation (p < 0.001). hs-CRP and IL-6 decreased significantly 12 months after the OAGB from 3323.35 ± 643.4 ng/mL and 3.72 ± 7.7 pg/mL to 1376.81 ± 609.4 ng/mL and 3.64 ± 6.9 pg/mL, respectively (p < 0.001). The MCP-1 showed significant increase in its level after OAGB as well (p = 0.014). In contrary, there were no significant changes in serum levels of IL-8 (p = 0.12) and TNF-α (p = 0.84) 12 months after the operation. The correlation analysis showed significant correlations between initial body mass index (BMI) with serum adiponectin, IL-8, and serum SAA.

CONCLUSION: OAGB can significantly impact the inflammatory cytokine profile in obese patients with possible subsequent protection from obesity-related comorbidities such as insulin resistance, cardiovascular diseases, and certain cancers.

Salman, A. A. A., A. A. E. A. Sultan, A. Abdallah, A. Abdelsalam, H. M. S. Mikhail, M. Tourky, M. G. Omar, A. Youssef, R. A. Ahmed, H. Elkassar, et al., "Effect of weight loss induced by laparoscopic sleeve gastrectomy on liver histology and serum adipokine levels.", Journal of gastroenterology and hepatology, 2020. Abstract

BACKGROUND & AIM: Bariatric surgery is a valid treatment option for persons with non-alcoholic fatty liver disease. This study prospectively examined the impact of laparoscopic sleeve gastrectomy (LSG) on liver histopathology, and blood levels of adiponectin, leptin, resistin, and pre-B cell enhancing factor/Nampt/visfatin.

PATIENTS & METHODS: In 81 patients with non-alcoholic fatty liver disease who underwent LSG, paired liver biopsies and blood specimens were obtained before and 18 months after LSG. Differences between preoperative and 18 months postoperative data were tested by paired Student's t-test or Wilcoxon rank test as appropriate.

RESULTS: At follow up, there was a significant improvement in biochemical markers for glucose homeostasis, including fasting glucose, HbA1c, insulin levels, and homeostatic model assessment index. Postoperative liver function tests, namely serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase level, showed a significant improvement compared to before weight loss. The number of patients who had definite, borderline, or no non-alcoholic steatohepatitis was 43 (53%), 27 (33%), and 11 (14%), respectively, at baseline, and 9 (11%), 32 (40%), and 40 (49%) at 18-month post-surgery follow up. A significant reduction in steatosis, liver fibrosis, lobular inflammation, and hepatocyte ballooning was observed in the postoperative biopsies (P < 0.001 each). In addition, at the follow-up assessment, there was a significant increase in serum adiponectin levels and significant decline in serum levels of leptin, resisitin, and pre-B cell enhancing factor/Nampt/visfatin.

CONCLUSION: Weight loss after sleeve gastrectomy was associated with a significant improvement in several metabolic parameters, liver enzyme levels, liver histopathology, and changes in serum adipokine levels towards antidiabetic and anti-inflammatory profiles.

Salman, M. A., H. M. S. Mikhail, M. A. Nafea, A. A. E. A. Sultan, H. E. Elshafey, M. Tourky, A. Awad, T. E. Abouelregal, R. A. Ahmed, O. Ashoush, et al., "Impact of laparoscopic sleeve gastrectomy on fibrosis stage in patients with child-A NASH-related cirrhosis.", Surgical endoscopy, 2020. Abstract

PURPOSE: Bariatric surgery can improve non-alcoholic fatty liver disease (NAFLD). Yet data on the effect on fibrosis are insufficient and controversial. This work endeavored to evaluate the safety of laparoscopic sleeve gastrectomy (LSG) in cases that have compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and its impact on fibrosis stage.

METHODS: The current prospective work involved 132 cases with Child-A NASH-related cirrhosis suffering from morbid obesity scheduled for LSG. They were subjected to preoperative assessment, wedge biopsy, and ultrasound-guided true-cut liver biopsy after 30 months. Patients were included if proved to have F4 fibrosis initially. The liver condition was assessed based on the NALFD Activity Score (NAS). The primary outcome measure was the impact of LSG on fibrosis stage and its relation to weight loss.

RESULTS: The analysis included only 71 patients who completed the 30-month follow-up period. By the end of the follow-up interval, there was a substantial weight loss with a reasonable resolution of comorbidities. The median NAS decreased significantly from 6 (1-8) to 3 (0-6) after surgery. Fibrosis score regressed to F2 in 19 patients (26.8%) and F3 in 29 (40.8%). Patients with improved scores had a significantly higher amount of weight loss (p < 0.001). Improvement was more frequent in males (p = 0.007). By 30 months after treatment, 53.8% of cases with borderline NASH and 36.8% of those with probable NASH showed complete resolution, and 44.7% of patients with NASH showed improvement. Steatosis improved in 74.6% of patients (p < 0.001).

CONCLUSION: In patients with NASH-related liver cirrhosis of Child class A, LSG may be a secure approach for the management of morbid obesity. It has a long-term benefit for both obesity and liver condition with significant improvement of steatosis, steatohepatitis, and fibrosis.

Salman, M. A., H. M. S. Mikhail, A. Abdelsalam, A. Abdallah, H. E. Elshafey, T. E. Abouelregal, M. G. Omar, H. Elkassar, R. A. Ahmed, M. Atallah, et al., "Acceleration of Gastric Emptying and Improvement of GERD Outcome After Laparoscopic Sleeve Gastrectomy in Non-diabetic Obese Patients.", Obesity surgery, 2020. Abstract

PURPOSE: Obesity has become a pandemic nowadays. Bariatric surgery is increasingly performed to manage obesity. Currently, laparoscopic sleeve gastrectomy (LSG) is a widely accepted procedure given its feasibility and efficacy. Previous studies revealed conflicting results regarding the change of gastric emptying following sleeve gastrectomy. The primary aim of the present study is to assess gastric motor function by gastric emptying scintigraphy in a cohort of non-diabetic patients undergoing laparoscopic sleeve gastrectomy (LSG) for treatment of severe obesity.

METHODS: This prospective observational study included 100 obese, non-diabetic patients attending the surgery clinic at Cairo University Hospitals and Al Azhar University Hospitals. LSG was performed following a standardized protocol, with no complications observed. All patients had gastric emptying scintigraphy done through a standard semisolid meal (250 kcal), marked with 0.5 mCiTc 99, pre-operatively and 3 months after LSG.

RESULTS: The mean age was 38.71 years (9.2) and males comprised 57% of the cohort. The body mass index, low-density lipoproteins, and glycated hemoglobin declined significantly at 3-month postsurgery. The scintigraphy study revealed a significantly reduced percent retention at equivalent time points 3 months after LSG. In addition, the percent of patients suffering from GERD decreased significantly after LSG.

CONCLUSION: Gastric emptying becomes faster after LSG in morbidly obese non-diabetic patients. GERD symptoms improve after surgery.

Salman, M. A., M. El-Ghobary, A. Soliman, M. El Sherbiny, T. E. Abouelregal, A. Albitar, A. Abdallah, H. M. S. Mikhail, M. A. Nafea, A. A. E. A. Sultan, et al., "Long-Term Changes in Leptin, Chemerin, and Ghrelin Levels Following Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy.", Obesity surgery, vol. 30, issue 3, pp. 1052-1060, 2020. Abstract

AIM: Published reports showed conflicting results regarding the sustained alterations in leptin, chemerin, and ghrelin concenratios after metabolic surgery. Therefore, we performed the present work to contrast the alterations in leptin, chemerin, and ghrelin levels one year after Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG).

METHODS: The present research is a prospective, comparative one that followed 100 cases for whom RYGB or LSG was done. We assessed the serum values of adiposity-associated mediators, including adipokcytokines (leptin and active chemerin) and gastrointestinal hormones (total ghrelin). The primary outcome in the present study was the alterations in leptin, chemerin, and ghrelin values at 12 months after RYGB and LSG.

RESULTS: The serum leptin level decreased significantly in the LSG group with a mean change of - 170.8 ± 29.4 ng/mL (p < 0.001). Similarly, the serum leptin concentration decreased significantly in the RYGB group, with a mean change of - 165.42 ± 53.4 (p < 0.001). In addition, the mean reduction in baseline chemerin levels 12 months after the operation was considerable in the LSG cohort (- 23.24 ± 9.5 ng/mL) and RYGB group (- 22.12 ± 15.9 ng/mL). The ghrelin values demonstrated a notable reduction in the LSG cohort (- 0.083 ± 0.11 pg/mL) and RYGB group (- 0.068 ± 0.097 pg/mL). However, the changes in the three hormones were not substantially different between both groups (p > 0.05).

CONCLUSION: Both RYGB and LSG result in a considerable, comparable decrease in the postoperative serum concentrations of leptin, chemerin, and ghrelin.

Ahmed F. Ahmed, H. S. E. Omar, A. N. Mashhour, and H. M. S. Mikhail, "Comparison between the accuracy of endoanal ultrasonogrphy and body coil MRI in preoperative assessment of internal opening of perianal fistula complex", Med. J. Cairo uni, vol. 83, issue 2, pp. 289-296, 2015.
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