6^th Global Gastroenterologists Meeting August 11-12, 2016 Birmingham, UK

Biography:

C Rajkumar Vinayak has completed MBBS from JIPMER, India, MS, Gen. Surg. from Osmania University, India. He completed fellowship in Advanced Lap. & Bariatric Surgery from LOC Pune, India. He is currently practising as Consultant General & Bariatric Surgeon at General Hospital Taiping, Malaysia. He has established bariatric services in Northern region, Malaysia since 2007. He is Principle Investigator in clinical reasearch project: “Identification of Novel Biomarkers in Morbid Obese Patients Undergoing Bariatric Surgery” – in conjuction with Research Councils, UK & Univ Malaya, Malaysia. He is Pioneer in Stapleless Bariatric Surgery in Malaysia. Currently he is Faculty for Asia Pacific Metabolic & Bariatric Surgery Society, College of Surgeons, Malaysia and Malaysian Metabolic & Bariatric Surgery Society-2016.

Abstract:

Single Incision Laparoscopic Sleeve Gastrectomy (SILS) involves a single incision and specialized port platforms to facilitate surgery. SILS is unique and challenging in bariatric surgery due to the thickness of the patient’s abdominal wall. Here we present a video demonstration of a SILS sleeve gastrectomy using the Gelpoint platform with incorporation of needleoscopic-like instruments. Inclusion criteria for our cohort are as per standard NICE guidelines for the asian population. Patients with excessive android habitus, large livers and the super obese (BMI>50) were excluded. A total of 121 bariatric procedures were performed at our centre from may 2015 to may 2016. 5 patients out of 56 sleeve gastrectomies performed requested for SILS. All 5 patients were discharged well by post op day 2-3. Benefits from SILS involve a less invasive approach and minimum visible scarring (achieving close to the scarless effect). Disadvantages include loss of triangulation and cluttering of instruments. Also, surgeons will need to familiarize themselves with the learning curve and demanding techniques. As innovations occur in the SILS platform, a difficult intervention can be made relatively easy, safe and cost effective. In conclusion SILS is a surgical modality, which if performed correctly, brings about results comparable with standard laparoscopy bariatric surgery with the addition of cosmesis and cost-effectiveness.

Biography:

Muhammad S Niam is General Surgeon, Consultant in Digestive Surgery, Endoscopic and Laparoscopic Surgeon. He is also a Lecturer and Medical Staff of Saiful Anwar General Hospital, Brawijaya University School of Medicine, Malang, Indonesia. Apart from these, he is Chairman of Indonesian Society of General Surgery of Malang Region, National Faculty Member of Indonesian Society of Endo-laparoscopic Surgery and National Faculty Member of Indonesian Society of Coloproctology, and Committee of Asian Society of Colorectal Surgery.

Abstract:

Background: Gastric perforation is around 25–30% of acute abdomen cases presented in emergency department, with highly mortality and morbidity rate. Traditionally, laparotomy is believed as a gold standard. However, patients with ASA status ≥3 and Boey score ≥2 still had poor outcome. This research presented peritoneal drainage as an alternative to laparotomy for poor prognostic patients.

Objective: To determine the success rate of the peritoneal drainage procedure in the poor prognostic patients of gastric perforation cases in Saiful Anwar General Hospital Malang.

Method: Observational descriptive study was made in gastric perforation patients with the poor prognostics, determined by Boey score ≥2 and ASA score ≥3, who underwent laparotomy and peritoneal drainage procedure in RS Syaiful Anwar Malang in 2013. Using SPSS 17.0, the mortality in 30 days after each procedure was presented in crosstabulation and analyzed in crossectional method.

Results: 42 gastric perforation patients were in the poor prognostics, 18 patients underwent peritoneal drainage (42.85%), of them, 11 patients survived in for 30 days after the procedure (mortality rate = 38.89%). While of 24 patients who underwent laparotomy (57.14%), only 5 patients survived (mortality rate = 79.16 %). The mortality rate in laparotomy group was greater than peritoneal drainage group (OR: 5.971, CI :95).

Conclusion: In gastric perforation, patients with poor prognostics and peritoneal drainage have a better end result as compared with laparotomy procedure.

Biography:

Eslam Ahmed Habba is an Assistant Lecturer of Hepatology, Gastroenterology and Infectious Diseases at Tropical Medicine department, Faculty of Medicine, Tanta University Hospitals, Egypt. He is an active member of European Association for the Study of Liver (EASL). Also, he is a member of American Association for Study of Liver Diseases (AASLD) and a member of Liver Tumors Committee at new Tanta University Teaching Hospital. He has some published papers in the field of Hepatology and Infections. Recently, he had a published book about Hepatocellular Carcinoma.

Abstract:

Radiofrequency ablation (RFA) is the treatment of choice for patients with an early-stage Hepatocellular Carcinoma (HCC) who are not candidates for surgical management; however, it is associated with a recurrence rate as high as 15–30% after one year. The aim of this study was to analyze the risk factors for HCC recurrence in Egyptian patients after RFA. This study was conducted on 45 HCC patients presented at two large referral centers for management of HCC in Egypt. Only patients with an early-stage HCC, eligible for RFA, were included in the analysis and were followed up for a period of one year and grouped into 2 groups: Group I which included patients with HCC recurrence during follow-up (n=30) and Group II with patients who did not show any recurrence during follow-up (n=15). The risk factors associated with recurrence included smoking (70% in Group I vs. 40% in Group II), hepatomegaly (50% in Group I vs. 40% in Group II), splenomegaly (90% in Group I vs. 53.3% in Group II), heterogeneous liver (30% in Group I vs. 6.66% in Group II), bilobar involvement (20% in Group I vs. 6.66% in Group II), and tumors in contact with hepatic capsule (20% in Group I vs. 6.66% in Group II). Hepatomegaly, liver heterogeneity, and splenomegaly (a sign of portal hypertension) together with the tumor factors such as large size, bilobar involvement, and proximity to liver capsule were the factors that showed a significant association with tumor recurrence in this study.

Biography:

Sandeep C Mutha has done his graduation (MBBS) from B J Medical College, Pune, India. Then he completed his Post-graduation in Anaesthesiology from Pune University in 1994 and Diplomate of National Board (DNB) in Anaesthesia in the year 1995. After gaining experience in Anaesthesia and Intensive Care from Bombay Hospital for one year, he became a Consultant Anaesthesiologist in Pune. He is the Director of Pune Anaesthesia and Criti-care Private Limited, a Post-graduate Teacher in Anaesthesia and Intensive Care, and President of Indian Association of Cardio-vascular and Thoracic Anaesthesia Maharashtra branch, Anaesthesia society of obesity India. He has presented lectures in many regional, state, national and inter-national conferences. 

Abstract:

The incidence of obesity is increasing like epidemic; 65% of adults in USA are obese and approximately 5.2-37% in India. One out of five children is obese (COED - Organization of economic co-operation and development) and the rate of obese females is three times that of male. We as clinicians and anaesthesiologists have to deal with this problem more and more day by day. Obesity is a major health problem affecting almost all organ systems. Most affected systems are cardiovascular, respiratory, endocrine, airway, OSA, hepatic, renal, musculoskeletal, etc. Obese patients have higher rate of post-operative complications like myocardial infarct, neuropathy, infection, DVT, pulmonary embolism, etc. Morbidly obese are with BMI more than 40 Kg/sq.m or super-obese with BMI more than 50 Kg/sq.m are to be preoperatively prepared for better perioperative outcome. Pre-operative workup aims at controlling systemic diseases, optimizing cardio-respiratory status, stabilizing endocrinal abnormalities and improving nutrition, effort tolerance and psychological state of mind of the patient. Minimum of 10% weight reduction preoperatively with improved effort tolerance and cardiorespiratory status decreases perioperative complications and hospital stay and cost. In super obese patients pre-operative preparation may require 6-8 weeks of controlled diet, exercises and medical treatment.

Biography:

Rahul Mahadar has completed his Graduation & Post Graduation – Master’s of Surgery (MS) from Governent Medical Collage, Miraj, Maharashtra, India. He is Director of Jeevanshree Hospital, Minimal Access Surgery Center from Dombivali, Mumbai, India. He is also a Member of ASGE. He has published 4 papers in national as well as international conferences.

Abstract:

Gastro- esophageal reflux disease being very common condition in day to day practice of Gastroenterology, one should know when the Surgical Intervention is necessary and what type of surgery is required for the particular patient. In deciding this, Esophageal Manometry, pH metry and impedence pHmetry plays an important role as many motility disorders are associated with GERD. Surgery is indicated in GERD with Chronic strictures, Barrett’s esophagus, Volume reflux, Large Anatomical defects i.e., with Hiatal Hernia and in young patients with long term medical tratment. After excluding motility disorders, patients are operated Laparoscopically either Nisson’s 360 degree floopy wrap or Partial 270 degree posterior wrap and choice of operation decided according to result of Esophageal manometry tests.

Biography:

Ubaldo Pimentel has finished his Medical grade at age of 26 years old from Universidade Regional del sureste and postgraduated studies from Benemerita Universidad de Puebla. He currently Works as General surgeon in Instituto Mexicano del Seguro Social.

Abstract:

Many therapies are avaible for patients with inflammatory bowel disease (IBD). Medical therapies include aminoslicylates drugs such as sulfasalazine, olsalazine, balsalazide, and various formulations of mesalamine; antibiotics; corticosteroids; immunosuppresive medications as azathiprine, 6-mercaptopurine (6-MP), methotrexate, and cyclosporine; and biotechnology medications such as anti-tumor necrosis factor (TNF) agents and newer agents with different mechanisms of action. Many surgical therapies also are used in patients with IBD. Some of the treatments are designed to deliver medication to specific areas of the bowel, while others act systemically. A thorough understanding of the anatomical distribution og inflammation is required in order to choose the optimal drug for a given patient. Ulcerative colitis can be divided into ulcerative proctitis, ulcerative proctosigmoiditis, left- sided ulcerative colitis, and extensive colitis or pancolitis. Crohn disease can be divided into ileitis, colitis, and ileocolitis.

Biography:

I have been graduated from Ankara University Medical Faculty in 2000. I have been working as anaesthesiology specialist at Marmara Univ. Training Hospital. I have attended academic meetings nationally and internationally. My academic interest includes microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia.

Abstract:

Sedation outside operating room for children has increasing importance. Paediatric patients with end stage liver disease are of great importance for various and frequent procedures including gastrointestinal endoscopy, magnetic resonance imaging, computerized tomography, brachytherapy, catheterisation, interventional radiology. Anaesthesia plan plays critical role for the success of these procedures. Patient safety, ventilation, hemodynamic responses, side effects of anesthetics on liver, periprocedural analgesia are the main topics of attention. Informed consent, silent environment are needed. Airway management tools may help because of edema and ascites pushing diaphragm upwards resulting in lung atelectasis. Nasal capnography enables monitoring spontaneous ventilation. Enlargement of extravascular extracellular fluid and dysproteinemia effects drug behaviours. Drug elimination half-time as well as context sensitive half-time have to be taken into account and designed individually. The pressure above vena cava inferior results in preload decrease, thus reduction in cardiac output. Pulse wave variation monitoring helps for estimating circulating fluid status. Tendency for bleeding can be anticipated with fresh frozen plasma. Patient-controlled analgesia may be a choice of favour but close monitoring required for repeated iv. analgesics. Children's Hospital of Eastern Ontario Pain Scale would be a good monitoring tool for pain.

Biography:

Mona El-Amir has completed her Msc at the age of 29 years,MD at age of 33 years from Cairo University School of Medicine. She is a Professor of Internal Medicine Cairo University .She is a member of Europian Association for Study of Liver (EASL) since 2010 as well as a member of Asian Pacific Association for study of Liver (APASL) since 2007.She is working as an active member of Liver Transplant Center ,Medical School of Cairo University since 2005.

Abstract:

In the absence of cadaveric donor liver transplantation ,living-donor liver transplantation (LDLT) is an alternative option for patients with end-stage liver disease .LDLT continues to be a life-saving option in counteries without satisfactory cadaveric donation.In our country the cadaveric donation is still limited by religious and cultural beliefs ,as in Japan ,Korea and India. We report the outcome of 120 adult LDLTs at Cairo University Trasplant Center.Patients records were retrospectively reviewed between 2006 and 2014 for recipient survival and complications.Trasplant recipients consisted of 110 men and 10 women (ages 19 to 62 years).The main indication for LDLT was hepatitis C cirrohsis , 110 patients ( 61.9 %). All procedures were right lobe hepatectomy without middle hepatic vein..All donors survived the procedure..Sixty four of 120 LDLT recipients are alive. Thirty patients died in the early(1st 3 months) postopeerative period ( 25%) because of (infections ,vascular complications, biliary complications, CVA , pulmonary embolism ). One-year survival is 64%%. HCV recurrence occured in 61 patients ( 50.8%) .Biliary complications developed in 47 recipients (39% ) ,most of them was treated by interventional teqniques.Vascular complications occured im 12 patients (10%).Thirty eight patients suffered from infections ( 31.6%).Acute rejection occured in 21 patients (17.5%) while chronic rejection developed in 7 patients (5.8%). Our results indicate that LDLT is with rather satisfactory outcome in absence of cadaveric donation.

Biography:

Manish Madnani has completed his Super Specialty in Surgical Gastroenterology from National Board of Examinations of India. He is a Consultant Surgical Gastroenterologist, Hepatobiliary and Pancreatic Surgeon at Narayana Multispeciality Hospital, Ahmedabad, India. He has published 3 papers in reputed journals, wrote a chapter in textbook, an article in local medical association’s magazine. He has been serving as an Editorial Board Member of reputed medical journals. 

Abstract:

Introduction: Laparoscopic cholecystectomy is considered as a gold standard for the surgical treatment of gallstone disease, which results in less post-operative pain, better cosmesis and shorter hospital stay than open cholecystectomy. In 1997, Navarra et al. described a single-incision laparoscopic cholecystectomy as a possible alternative procedure to the four port laparoscopic cholecystectomy. The present study is to compare Standard 4 Port Laparoscopic Cholecystectomy (S4PLC) and Single Incision Laparoscopic Cholecystectomy (SILC), in terms of safety, surgeon comfort, pain scores and final cosmetic appearance of scar.

Patients & Methods: At three different centers of India, total 372 patients were operated for laparoscopic cholecystectomy during July 2013 to December 2014. Patients who met exclusion criteria were not followed up for further data collection. Total 53 patients in SILC and 61 patients in S4PLC group were studied prospectively without randomization (patient autonomy was preserved). All the acquired data was filled in SPSS IBM 20.0 version and statistical analysis was done. Chi square test for qualitative data, Student’s ‘t’ Test for quantitative data, Mann Whitney U test for non-parametric data and ANOVA/MANOVA (multivariate analysis) tests for distribution of variances were used.

Results: Young patients selected SILC over S4PLC when given options of both. Mean age in SILC group was 39.87 (range 19-70), while it was 50.43 in S4PLC group (range 26-78). There were 35 (66%) females and 18 (34%) males in SILC group while in S4PLC group there were 33 (54%) females and 28 (46%) males, though this difference was not statistically different. SILC and S4PLC were comparable in incidence of intra-operative (11.3% vs. 9.8%) (p>0.05), immediate (1.9% vs. 4.9%) (p>0.05) and late post-operative complications (5.7% vs. 3.5%) (p>0.05), with a same follow up duration. It was observed that SILC and S4PLC both had no difference in post-operative pain (2.94±1.56 vs. 2.9±1.58) and analgesic requirement (28.3% vs. 27.6%). Dissection during surgery in Calot’s triangle was not felt to be difficult by the operating surgeon in both types of surgery, as difficulty was encountered in 7.54% in SILC while in 9.83% in S4PLC group (p=0.764). Though surgeons’ physical comfort and ergonomics were better with S4PLC than with SILC (p=0.001). Use of additional ports was required in more number of cases in SILC than in S4PLC (22.64% vs. 6.55%, p=0.044). Duration of surgery was longer in SILC than in S4PLC (70.26±44.8 vs. 58.64± 45.76, p=0.002). Post-operative hospital stay (31.21±15.91 vs. 33.59±14.21, p=0.094) and day of suture removal (7.21±1.34 vs. 7.31±1.39, p=0.426) was same with both procedures. Cosmetic appearance of scar is significantly better with SILC than with S4PLC (3.4±1.2 vs. 2.51±1.53, p<0.0001), which has impact on overall patient satisfaction (happy or very happy: 94.3% vs. 78.7%, p=0.001).

Conclusion: SILC is a method of laparoscopic cholecystectomy with better cosmetic advantage than conventional laparoscopic cholecystectomy. But this advantage comes at the cost of longer duration of surgery, difficult posturing, ergonomics for surgeon and other technical difficulties. Hence, SILC should only be offered to patients in whom it is anticipated to be smooth, who have greater concern for cosmesis and only by the surgeon who has enough experience of performing this procedure. 

Biography:

Anil Sanganeria has completed Master of Surgery (MS) 32 years ago from a reputed Indian Medical College, and did a Fellowship from International College of Oncology. He is currently invoved with treating patients with Gastrointestinal Tract (GIT) cancers from over 3 decades at various premier hospitals at Mumbai, India.

Abstract:

Background: Cancers of stomach, colon and rectum form a significant sum to total cancer burden of Indian population. With intense propaganda and anti tobacco drive, life style factors correction, awareness for early diagnosis and primary prevention, the risk and rate of GIT Cancers have gone down significantly in last decade. With availability of diagnosis tools, more endoscopies, biopsies at primary, secondary medical centers, the early diagnosis of cancer of GIT is fast emerging. Almost whole spectrum of Innovative treatment modalities, from limited conservative resections to radical resections by endolaproscopic, and open methods are available and being employed widely and commonly. This talk pertaining to cancers of GIT in pretext to Indian subcontinent population will highlight the emerging scenario, the Indian Medical Fraternity is in fast forward mode to match, adopt and apply the most innovative methods for primary prevention and the best treatment modalities for the cancer of stomach, colon and rectum. 

Biography:

Hector Martinez is one of the most important neonatologists in Colombia to be a pioneer in the implementation of the Mother Kangaroo Method in 1979 with Dr. Edgar Rey Sanabria (deceased) and Dr. Luis Navarrete who is currently faithful collaborator Dr. Martinez, who thanks to his work has been awarded by the President of the Republic José Celestino Mutis with prize award followed by SASACAGUA the World Health Organization, currently Dr. Martinez is Head of the Department of Pediatrics clinical CAFAM who explained to us what this methodology has been helpful for the survival of many premature babies that do not exceed 2.500go 37 weeks post conceptional age as previously occurred when these cases the use of a was necessary incubator to regulate the baby's weight at the risk of acquiring a hospital acquired infection. Besides the little contact that the premature baby had the first few days with his mother.

Abstract:

Biography:

Pallavi Nitin Shah has completed her degree in Naturopathy and has done her Post-graduation in Psychological Counseling (PGDPC). She has done her Post-graduation in Hospital Management (PGDHHM), Certificate course in Nutrition (CNN). She has done her dissertation in setting up bariatric clinic. Being one of the Founder Members of LOC (Laparo obese centre) founded by renowned Bariatric Surgeon Dr. Shashank Shah, she performs various roles like counseling, nutritionist, taking protocol of patients, pre- and post-surgery diet plans, awareness programs in various institutes and organizing patient support group. She has taken a special training, related to Bariatric under Father of Obesity Surgery, Dr. Nikola Scopinaro, Italy. She has attended various national and international conferences in India and abroad. She was also a faculty for Boston University affiliated training program. She is also a member of Executive committee of All India Advancing Research Obesity (AIAARO). Currently, she is working as a Bariatric coordinator in Laparo Obeso Centre, India.

Abstract:

Bariatric surgery is a treatment for weight loss and metabolic syndrome and an effective tool for resolution of co morbidities. As patients need diet modification, physical activity and life style modification, this is not the only surgeon’s job. He needs team of Physician, Endocrinologist, Anesthetist, Intensivist, Nutritionist, Physiotherapist, Psychologist, and Bariatric coordinator. Pre- and post-operative role includes: Evaluation of comorbidities, control of comorbidities, pre-anesthetic work up, nutritional assessment, psychological counseling and coordination of formalities and facilities. A pre- and post-operative role for a Surgeon is to perform surgery, Anesthetist for the administration of anesthesia, Intensivist to manage patient, Physiotherapist and Physician to manage post-operative recovery and comorbidities. The safety and success of bariatric surgery is depending upon the multidisciplinary approach of bariatric practice

Biography:

Trans-abdominal sonography of the stomach & duodenum can reveal many diseases like gastritis & duodenitis, acid gastritis, ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer & post-healing fibrosis & struicture. polyps & diverticulum, benign intra-mural tumours, intra-mural haematoma, duodenal outlet obstruction due to annular pancreas, gastro-duodenal ascariasis,  pancreatic or biliary stents, foreign body, necrotizing gastro-duodenitis, tuberculosis, lesions of ampulla of vater like prolapsed, benign & infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature with enlargement of the involved segment. Shouldering effect at the ends of stricture is most common feature. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-ampullary malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant gastro-intestinal tract lesions, so should be the investigation of choice.

Abstract:

Trans-abdominal sonography of the stomach & duodenum can reveal many diseases like gastritis & duodenitis, acid gastritis, ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer & post-healing fibrosis & struicture. polyps & diverticulum, benign intra-mural tumours, intra-mural haematoma, duodenal outlet obstruction due to annular pancreas, gastro-duodenal ascariasis,  pancreatic or biliary stents, foreign body, necrotizing gastro-duodenitis, tuberculosis, lesions of ampulla of vater like prolapsed, benign & infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature with enlargement of the involved segment. Shouldering effect at the ends of stricture is most common feature. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-ampullary malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant gastro-intestinal tract lesions, so should be the investigation of choice.

Biography:

Maria Paula Carlini has completed his PhD from Federal University of Parana, Brazil. She is a Nutritionist at Clínica Dr. Giorgio Baretta. She is a member of scientific Commission of Brazilian Society for Bariatric and Metabolic Surgery (SBCBM). She has published papers in reputed journals and has been serving as an Editorial Board Member of repute. 

Abstract:

The obesity per se can be the cause of numerous nutritional deficiencies. In nutritional assessment, in the preoperative period the deficiencies of vitamins C, B12 and D are common and occur in up to 90% of patients. Bariatric surgery in their technical variants provides weight loss and improves the quality of life of the patients. The restrictive, mal-absorptive and hormonal components promote weight control over time. There is absolute need for change in lifestyle, food quality, frequent physical activity and use of nutritional supplements permanently. Nutritional deficiencies after bariatric surgery are common and must be monitored by a multidisciplinary team. The most important shortcomings are: Vitamin B, fat-soluble vitamins, iron, calcium, zinc and protein. Anemia is common complication and should be treated individually; it could be due to iron deficiency, megaloblastic anemia and pernicious anemia. Nutritional needs vary according to gender. According to the guidelines, there is no need to use a daily multivitamin as that reaches at least 2/3 of all optimal micronutrient for an adult. Minerals like iron can be supplied with iron 27 mg in the form of fumarate and in women of reproductive age can take up to 100 mg daily iron; calcium with 1500 to 2400 mg/day. Vitamins like Folic acids can be taken up to 240 mcg per day. Whereas vitamin B12, daily requirement is 350 to 500 mcg orally, vitamin A daily requirement is 10.000 UI and vitamin D is 2000 UI per day. Therefore, all operated patients need to maintain a specialized nutritional monitoring to prevent and treat these possible nutritional deficiencies.

Biography:

He is Director and Chairman of Gateway Clinics and Hospital. He is renowed Gastroenterologist of the country and have vast experience in the field of advanced laparoscopic surgery. He has various presentation and publication national and international on his name.

Abstract:

Introduction: In Egypt, the situation is very critical. Hepatitis C virus constitutes an epidemic in Egypt which is having the highest prevalence in the world. In all other countries, the prevalence of HCV constitutes 1% to 2% of the population. There are a few exceptions where the prevalence of HCV is 3%. In Egypt however, the prevalence of HCV is 14.7%. The association between HCV infection and Coronary Artery Diseases (CAD) is less clear with different studies showing conflicting results, a small number of studies have reported no association between HCV infection and CAD. On the other hand other studies have reported an increased risk of CAD in HCV patients.

Aim: The aim is to study the relation and severity of CAD in patients with chronic HCV infection.

Methods: This cross sectional study was conducted during the period from June 2013 to September 2015 in Medical Specialized Hospital (MSH), Mansoura University, Egypt. The study included 200 patients with chronic HCV who attended hepatitis virology clinic and were referred to cardiology clinic for evaluation of their cardiac complaint. An informed consent was obtained from all patients and the protocol was approved from the Ethical Committee of Faculty of Medicine, Mansoura University. Chronic HCV was defined by the presence of anti-HCV antibodies and measurable serum HCV-RNA by PCR >15 IU/ml for 6 months, according to FibroScan, F0-F1: Absent or minimal liver fibrosis; F2: Significant liver fibrosis has occurred and spread inside the areas of the liver including blood vessels; F3: Severe liver fibrosis which is spreading and connecting to other liver areas that contain fibrosis; F4: Cirrhosis or advanced liver fibrosis. Based on the result of the previous coronary angiography and revascularization procedure it was reviewed that, the severity of CAD is based on the severity of coronary lesion and the location of this lesion according to the Gensini score. Score (1): for lesions 1%–25% stenosis; Score (2): for lesions 26%–50% stenosis; Score (4): for lesions 51%–75% stenosis; Score (8): for lesions 76%–90% stenosis; Score (16): for lesions 91%–99% stenosis and Score (32): for total occlusion.

Results: Data were analyzed by SPSS version 21. ANOVA test was used to compare mean of more than 2 groups; while Kruskal Wallis H Test was used for comparison of median of more than two groups. Patients were classified into 3 groups according to severity of liver fibrosis assessed by FibroScan, Group 1 (34 patients) constitutes 17% of the studied group, Group 2 (59 patients) constitutes 29.5% of the studied group and Group 3 (107 patients) constitutes 53.5% of the studied group. Patients with non-significant lesions were 21 patients representing (28.4%), while patients with significant lesion were 53 patients representing (71.6%). According to the number of vessels affected with significant lesions, patients who showed single vessel disease were 20 patients, with double vessel disease were 18 patients, and with triple vessel disease were 15 patients. Patients in Group 2 and Group 3 had statistically more severe atherosclerosis regards to Gensini Score (p: 0.006)

Biography:

Appendectomy is the commonest abdominal operation in the world. There are many miss concepts in the technique of this procedure that needs to be understood and rectified. Major problems are post-operative pain, nausea, vomiting, and delayed wound healing which jeopardize the patients’ routine life. There are many sites of pain in appendectomy that need to be known and addressed especially ligation of appendix’s stump under cover of local anesthesia. Further appendectomy needs locoregional anesthesia with SSS (short sound sleep), not general anesthesia. We are continuously doing research on this and now have found a cure to it. Patients go back to normal life immediately from Operation Theater and can do heavy work as well. There is no need of post-operative hospitalization, so there will be no burden on hospital and its staff. It will be proved to be a big economical breakthrough with saving a lot of time and work. 

Abstract:

Appendectomy is the commonest abdominal operation in the world. There are many miss concepts in the technique of this procedure that needs to be understood and rectified. Major problems are post-operative pain, nausea, vomiting, and delayed wound healing which jeopardize the patients’ routine life. There are many sites of pain in appendectomy that need to be known and addressed especially ligation of appendix’s stump under cover of local anesthesia. Further appendectomy needs locoregional anesthesia with SSS (short sound sleep), not general anesthesia. We are continuously doing research on this and now have found a cure to it. Patients go back to normal life immediately from Operation Theater and can do heavy work as well. There is no need of post-operative hospitalization, so there will be no burden on hospital and its staff. It will be proved to be a big economical breakthrough with saving a lot of time and work. 

Biography:

Irfan Ahmed Nadeem is a renowned General Surgeon of Pakistan with a vast experience in Government and Private sectors. In 2008 Kashmir’s earthquake he faced the challenges to deal with the patients without the aid of modern investigations and operation theatre facilities. He came up to the challenge and the experience gained at that time proved to be valuable in life later on. In March 2016, he presented ‘One hole cholecystectomy’ at the 18^th International Congress of the Egyptian Hepatic Pancreatic-Biliary Society. He always worked towards the goal to make the operations simple, comfortable and safe in fields of general surgery, orthopedic, ENT, gynecology and obstetrics and many others.

Abstract:

Abdominal wall hernias are very common starting from the very first day of life to death. The only curable treatment is surgical repair after which the patients take a long time to recover and perform their normal activities. Sometimes, they are permanently disabled, not allowed to lift weight or put strain and hence they may be forced to use abdominal belt for the rest of their life.  Hernias need to be operated under locoregional anesthesia with SSS (short sound sleep). Ugly scars of operations also matter in the majority of patients which we have especially looked after. Recurrences are itself a reality and have many miss concepts that need to be rectified. There is a lot of time wasted in hernia repair which needs to be addressed. Our institutes have found comprehensive solution to all these problems and have removed the miss concepts. We desire to share it with you for the beauty and comfort of humanity. Now patients can come back immediately to their normal activities right from Operation Theater and can even carry out the hard work without any bed rest. All of this is quite economical as well. 

Biography:

Irfan Ahmed Nadeem is a renowned General Surgeon of Pakistan with a vast experience in Government and Private sectors. In 2008 Kashmir’s earthquake, he faced the challenges to deal with the patients without the aid of modern investigations and operation theatre facilities. He came up to the challenge and the experience gained at that time proved to be valuable in life later on. In March 2016, he presented ‘One Hole Cholecystectomy’ at the 18^th International Congress of the Egyptian Hepatic Pancreatic-Biliary Society. He always worked towards the goal to make the operations simple, comfortable and safe in fields of general surgery, orthopedic, ENT, gynecology and obstetrics and many others.

Abstract:

This concept is absolutely new but is practicable and time tested. These techniques are different and may lead to many queries. These can be addressed through explanations and detailed discussions to eliminate the confusion so that the uprising surgeons can well appreciate them and bring them into their practice. This concept has to be addressed at many sites, among many are: 1) Maximum accuracy of operation under direct vision without any doubt. (Camera vision is not a direct vision); 2) Performing procedures under loco regional anesthesia and SSS (Short Sound Sleep) instead of general anesthesia; 3) The operation must be free from nausea, vomiting and pain without postoperative discomfort as well; 4) Understanding these concepts and practicing them will lead to patient’s comfort, saving time, opportunity cost, stress on hospital resources and reshaping health budget; and 5) This is the need of today’s busy committed life, especially of developed countries, and resource constraint countries as well. 

Biography:

Irfan Ahmed Nadeem is a renowned General Surgeon of Pakistan with a vast experience in Government and Private sectors. In 2008 Kashmir’s earthquake he faced the challenges to deal with the patients without the aid of modern investigations and operation theatre facilities. He came up to the challenge and the experience gained at that time proved to be valuable in life later on. In March 2016, he presented ‘One Hole Cholecystectomy’ at the 18^th International Congress of the Egyptian Hepatic Pancreatic-Biliary Society. He always worked towards the goal to make the operations simple, comfortable and safe in fields of general surgery, orthopedic, ENT, gynecology and obstetrics and many others.

Abstract:

The only treatment for cholelithiasis is cholecystectomy. There are many ways to accomplish it; but with One Hole Cholecystectomy (OHC), we have achieved the above mentioned claims. After performing thousands of cholecystectomies we have come to the conclusion that major breakthrough lies in understanding the concept of ligation of cystic duct under-cover of local anesthesia to reduce the post-operative pain maximally. Furthermore, OHC technique has an advantage of being minimally invasive, least traumatic, most economical, very well localized and a safe procedure done under locoregional anesthesia with SSS (short sound sleep) within 10 to 15 minutes. Most importantly, it is under direct vision, giving us the advantage of seeing the actual size and pathology. We can even palpate cystic duct for stones through it. The beauty of OHC is the speedy return of patient to normal life without any delay or need of medications. This is the prime requirement of today’s hectic life. This saves millions of medical budget and opportunity cost spent on hospital stay.

Biography:

Amol S Jeur, a Gastrointestinal and Laparoscopic Surgeon, after completing his basic Medical graduation went on to complete his Master’s and Post-graduate training in General Surgery. Due to the keen interest in academic teaching, he remained associated with his Post-graduate University as Lecturer and then as Assistant Professor in the Dept. of Surgery, KIMS, Karad, Maharashtra. He has also trained in skill courses of Minimal Access Surgery and completed Composite Laparoscopic Training and Laparoscopic Skill Courses. He further went on to complete fellowship training in Colo-Rectal Surgery, Anam Hospital, Seoul, Korea. He then worked as Associate Consultant in Apollo Hospital, India. It was here that he developed keen interest in Upper GI/Bariatric, and hence he went on to pursue Fellowship Training in Bariatric Surgery under Guidance of Dr. Shashank Shah, an upper GI/Bariatric Surgeon of repute in India. 

Abstract:

Laparoscopic sleeve gastrectomy (LSG) is becoming popular as a standalone bariatric procedure. The technique has evolved over years towards standardization. Better standardization has minimized complications like leaks, stricture and weight regain. Adequate posterior dissection up to the hiatus and the linear sleeve without a torque can be safely performed. The video presentation refers to the international consensus document on LSG as well as the expert panel consensus summit published in SOARD (Surgery for Obesity and Related Diseases) where our centre’s (Laparo Obeso Centre, Pune) data is shared. The video demonstrates step by step approach to a safe, standardized technique of LSG. 

Biography:

Anjana Vasudevan have completed her MBBS at Chettinad University in the year 2014.  She worked at Apollo Speciality Hospital, Perungudi, Chennai for 9 months and is now doing her Post-graduation at Sri Ramachandra University in the Department of General Surgery. She has been accepted by the ICMR to do MS, PhD intergrated course. She has published one article, participated and presented in several conferences through out India.

Abstract:

Hemangioma is the most common benign liver tumor, and affects 3% to 20% of the general population. These benign tumours can occur in people of all ages, but are more commonly found in young adult females. Hemangioma is usually asymptomatic and diagnosed incidentally. For most patients, the natural history of cavernous hemangiomas in the liver remains uneventful and surgical intervention can be avoided. Here we present a 60 year old post menopausal female who was admitted with complaints of pain in the right hypochondrium for the past one year. USG abdomen was done which showed a mass below the liver. CECT abdomen was also done which revealed a solitary, pedunculated liver haemangioma which was 6 cms in the largest diameter, arising from the 6^th lobe of the liver and blood supply from the right hepatic artery. In view of the patients symptoms, she was taken up for laparoscopic resection of haemangioma and patients subsequent follow ups were uneventful.  

Biography:

Vadiraj G Hunnur is currently in VGM Hospital, Coimbatore, India.  He has published research papers and articles in reputed journals and has various other achievements in the related studies. He has extended his valuable service towards the scientific community with her extensive research work. 

Abstract:

Errors are known to occur in most specializations of the medical field. Most medical errors are managed at the institutional level and seldom are discussed. Few cases, like the present case, are difficult to diagnose and very taxing to the patient as well as to the attending consultant, physically and psychologically. We present a case of laparoscopy assisted retrieval of a surgical sponge in a patient who was presented with chronic abdominal pain and vomiting and had undergone surgery for benign gastric outlet obstruction 6 years prior to presentation. This case is being presented for its uniqueness and to reiterate the importance of sponge count at every step of the procedure.

Biography:

A Aslanyan has completed his MBChB degree in 2014 after which he started working as a Foundation Year 1 Doctor at Scunthorpe General Hospital, UK. He is currently working as a Foundation Year 2 Doctor at Hull Royal Infirmary, UK. His article on this topic was successfully published in EURORAD.

Abstract:

This is a case report of about a 40 year old patient, who was admitted with epigastric pain and vomiting. Two weeks before, the patient was admitted with acute pancreatitis. Unexpected CT finding was the presence of a huge left subscapular splenic haematoma and no evidence of acute pancreatitis. The earlier CT with IV contrast, which was performed when the patient was diagnosed with acute pancreatitis 2 weeks ago, showed the features of acute pancreatitis. Spleen was within normal limits. These findings had resolved on the current CT. This case report aims to remind everyone that splenic complications should be ruled out in any patient with acute abdominal pain who were known to have acute pancreatitis in the recent past. 

Biography:

Amna AL Araimi is a PhD student in College of Medicine and Health Sciences, Department of Biochemistry at Sultan Qaboos University, Sultnate of Oman. Her Doctorate project focuses on pathophysiology of inflammatory bowel disease with focus on hormonal (growth hormone) and herbal therapy. Her work has generated mechanistic understanding of the actions of hormones and also herbal by-products in alleviation of tissue damages and especially fibrotic lesions. This is of greater interest in establishment of proper colonic function during recovery from inflammatory bowel disease.

Abstract:

Ulcerative colitis (UC) is characterized by chronic inflammation of the colonic mucosa, and in advanced stage it may also involve the submucosa layers. Fibrotic damages post-inflammatory phase results disturbed colonic functions associated with poor quality of life. In the present study, the effect of gum arabic (GA) was evaluated in a mouse model of acute experimental colitis induced by dextran sulphate sodium (DSS). Seventy mice were divided into three groups: Control, not treated with GA, a group given GA after colitis induction (post-GA) and a group given GA before induction of colitis (pre-GA). We showed that GA facilitated recovery of pathologic changes in the colon as evidenced by a significant less body weight reduction, decrease of disease activity index and decreased histopathological features of colitis. The GA effect was not explained by changes in systemic and local markers of inflammatory and anti-inflammatory and not by changes in microbiota metabolic markers. Similarly, there were no differences in ultra structures between GA and non-GA treated mice. We observed less colonic structures post-recovery in mice given GA evidenced by less reduction in colon length and also by histological analysis of collagen depositions. GA treated mice showed less expression of alpha-smooth muscle actin, a marker of active pro-fibroblasts and less expression of SMAD 1,2 and TGFBR1 protein levels. Our present findings suggest that GA has both preventive and protective effect on inflammatory damages in colon and have direct effect on fibrotic signaling pathways. Further mechanistic study is needed to study effect of GA on fibroblasts.

Biography:

Gastric lesions in pigs and humans have been associated with Helicobacter suis infection. This study was designed to determine the occurrence of gastric lesions and Helicobacter suis infection in pigs in Nigeria. Stomach from 480 pigs in Southwestern Nigeria was assessed for gastric lesions using a modification of a standard lesion grading method. Mucosa samples from the fundus of 160 pig stomachs from four regions of Nigeria (Lagos, Delta, Enugu and Plateau states) were collected for molecular detection of H. suis. The DNA from samples was extracted with ZR Fungal/Bacterial DNA MiniPrep ^TM Isolation Kit (Zymo research corp. USA). PCR was done using previously published primers. Data obtained were presented as frequency counts and analysed using analysis of variance (ANOVA) and Chi-square techniques. Significance was determined at p≤0.05. Gastric lesions were encountered across the four regions of the stomach with a point prevalence of 57.3%. The prevalence of lesions in the non-glandular region was 32.9%. Helicobacter suis was detected in samples from all regions with frequency of occurrence 8%, 6%, 10% and 14% in Lagos, Delta, Enugu and Plateau states respectively. The gastric lesion distribution across the four regions of the stomach and the occurrence of ulceration in the fundus showed an unusual pattern which is rarely reported in other parts of the world. This is a first report of Helicobacter suis infection of pigs in Nigeria. These findings present the need for further studies to determine its possible role in gastric lesions in pigs and humans in Nigeria.

Abstract:

Gastric lesions in pigs and humans have been associated with Helicobacter suis infection. This study was designed to determine the occurrence of gastric lesions and Helicobacter suis infection in pigs in Nigeria. Stomach from 480 pigs in Southwestern Nigeria was assessed for gastric lesions using a modification of a standard lesion grading method. Mucosa samples from the fundus of 160 pig stomachs from four regions of Nigeria (Lagos, Delta, Enugu and Plateau states) were collected for molecular detection of H. suis. The DNA from samples was extracted with ZR Fungal/Bacterial DNA MiniPrep ^TM Isolation Kit (Zymo research corp. USA). PCR was done using previously published primers. Data obtained were presented as frequency counts and analysed using analysis of variance (ANOVA) and Chi-square techniques. Significance was determined at p≤0.05. Gastric lesions were encountered across the four regions of the stomach with a point prevalence of 57.3%. The prevalence of lesions in the non-glandular region was 32.9%. Helicobacter suis was detected in samples from all regions with frequency of occurrence 8%, 6%, 10% and 14% in Lagos, Delta, Enugu and Plateau states respectively. The gastric lesion distribution across the four regions of the stomach and the occurrence of ulceration in the fundus showed an unusual pattern which is rarely reported in other parts of the world. This is a first report of Helicobacter suis infection of pigs in Nigeria. These findings present the need for further studies to determine its possible role in gastric lesions in pigs and humans in Nigeria.

Biography:

Eslam Ahmed Habba is an Assistant Lecturer of Hepatology, Gastroenterology And Infectious Diseases at Tropical Medicine Department, Faculty of Medicine, Tanta University Hospitals, Egypt. He is an active member of European Association for the Study of the Liver (EASL). Also, he is a Member of American Association for Study of Liver Diseases (AASLD) and a Member of Liver Tumors Committee at New Tanta Universal Teaching Hospitals. He has some published papers in the field of hepatology and infections. Recently, he had a published book about hepatocellular carcinoma available online and everywhere. He was granted an EASL membership for the year 2016 after his research poster was awarded in EASL monothematic conference in Romania in 2015.

Abstract:

Background: Autoimmune hepatitis is seen in all the ages and races. The general principles of diagnosis and management of AIH presenting in childhood are similar to those presented in adult patients with some caveats. More than 50% of children will have evidence of cirrhosis and the milder forms are not usually seen, this justifies initiation of early treatment following diagnosis.

Case: A 4 year old boy was presented with jaundice and abdominal enlargement especially on the right hypochondrium. On physical examination it was found that there was a hepatomegaly about 10 cm below right costal margin and jaundice. CBC, liver function tests, serum markers for HAV, HBV, HCV, AIH, hemochromatosis, Wilson disease and primary biliary cirrhosis were not conclusive except positive HAV IgM lasting for more than a year and rising ALT & AST up to 1113 IU/ml. Biopsy was done which revealed a picture of severe autoimmune hepatitis with incipient cirrhosis. Immunosuppressive therapy was started with marvelous treatment response and resolution of the severe hepatitis.

Conclusion: AIH is a rare liver disease that can be presented aggressively in children. Early treatment can control the hyper immune state and save the liver. 

Biography:

Thiago Patta is currently working in Instituto Vigor-Videocirurgia e Obesidade, Brazil

Abstract: