Dr. Keyur Bhatt - Gastrosurgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

Dr Keyur Bhatt- Best GI Surgeon

LAP SPLENECTOMY IN ITP with platelate of 8000^-www.drkeyurbhatt.in*

lap splenectomy video link........

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

Dr. Keyur Bhatt- Best GI Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon

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Thursday, March 3, 2011

Bariatric Surgery^-www.drkeyurbhatt.in*

Long-term Prevention of Mortality in Morbid Obesity Through

Bariatric Surgery. A Systematic Review and Meta-analysis of

Trials Performed With Gastric Banding and Gastric Bypass

Antonio E. Pontiroli, MD, and Alberto Morabito, PhD

(Ann Surg 2011;253:484–487)

Background: Bariatric surgery has been reported to reduce long-term mortality in operated participants in comparison with nonoperated participants.

Methods: We performed a systematic review and meta-analysis of clinical trials published as full articles dealing with cardiovascular (CV) mortality, all-cause mortality (noncardiovascular), and global mortality (sum of CV and all-cause mortality). Pooled-fixed effects of estimates of the risk of mortality in participants undergoing surgery were calculated compared with controls.

Results: Of 44,022 participants from 8 trials (14,052 undergoing surgery and 29,970 controls), death occurred in 3317 participants (400 in surgery, 2917 in controls);when the kind of deathwas specified, 321 CV deaths (118 in surgery, 203 in controls), and 523 all-cause deaths (218 in surgery, 305 in controls) occurred. Compared with controls, surgery was associated with a reduced risk of global mortality (OR = 0.55, CI, 0.49–0.63), of CV mortality (OR = 0.58, CI, 0.46–0.73), and of all-cause mortality (OR = 0.70, CI, 0.59–0.84). Data of all-cause mortality were not heterogeneous; heterogeneity of data of

CV mortality decreased when studies were grouped according to size (large vs small studies). The reduction of risk was smaller in large than in small studies (OR = 0.61 vs 0.21, 0.63 vs 0.16, 0.74 vs 0.35 for global, CV, and all-cause mortality, respectively). The effect of gastric banding and gastric by-pass (3797 vs 10,255 interventions) was similar for global and all-cause mortality (OR = 0.57 vs 0.55, and 0.66 vs 0.70, respectively), different for CV mortality (OR = 0.71 vs 0.48). At meta-regression analysis, a trend for a

decrease of global mortality (Log OR) linked to increasing BMI appeared.

Conclusion: This meta-analysis indicates that (1) bariatric surgery reduces long-termmortality; (2) risk reduction is smaller in large than in small studies; and (3) both gastric banding and gastric by-pass reducemortality with a greater effect of the latter on CV mortality.

Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt - Best Gastro Surgeon

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POST LAP - BILE DUCT INJURY^-www.drkeyurbhatt.in*

Specialist Early and Immediate Repair of Post-laparoscopic

Cholecystectomy Bile Duct Injuries Is Associated With an

Improved Long-term Outcome

(Ann Surg 2011;253:553–560)

The Liver Unit, University Hospital Birmingham, Queen Elizabeth Hospital,

Birmingham, United Kingdom.

Introduction: A majority of bile duct injuries (BDI) sustained during laparoscopic cholecystectomy require formal surgical reconstruction, and traditionally this repair is performed late.We aimed to assess long-term outcomes after repair, focusing on our preferred early approach.

Methods: A total of 200 BDI patients [age 54(20–83); 64 male], followed up for median 60 (5–212) months were assessed for morbidity. Factors contributing to this were analyzed with a univariate and multivariate analysis.

Results: A total of 112 (56%) patients were repaired by specialist hepatobiliary surgeons [timing of repair: immediate, n = 28; early (<21 days), n = 43; and late (>21 days) n = 41], whereas 45 (22%) underwent repair by nonspecialist surgeons before specialist referral [immediate, n = 16; early, n = 26 and late, n = 03]. Outcomes after immediate and early repairs were comparable to late repairs when performed by specialists [recurrent cholangitis:11%, 12%, and 10%; P = 0.96, NS; re-stricture:18%,5%, and 29%; P = 0.01; nonsurgical intervention: 14%, 5%, and 24%; P<0.03; redo surgery: 4%, 2%, and 5%; P = 0.81, NS; overall morbidity: 21%, 14%, and 39%; P<0.02]. On multivariate analysis, immediate and early repairs done by

nonspecialist surgeons were independent risk factors (P < 0.05) for recurrent cholangitis [50% and 27%], re-stricturing (75% and 61%), redo reconstructions (31% and 61%), and overall morbidity (75% and 84%).

Conclusion: Immediate and early repair after BDI results in comparable, if not better long-term outcomes compared to late repair when performed by specialists.