Most cases of blunt hepatic trauma are treated nowadays non-operatively. This type of conservative treatment has resulted in increased complication rate. Delayed complications occur in cases that didn't require surgical intervention during the first 24 hours. The most common late complication is hemorrhage. We report a case of two weeks delayed hemorrhage after blunt hepatic trauma in an adult. We describe the diagnostic procedures, the surgical treatment and review the relevant literature.

Background: As bariatric surgery evolves and gains popularity, statistical analysis of its outcomes could improve the process of decision-making and risk assessment. This study aimed to evaluate the influence of age and other factors on bariatric surgery outcomes in order to improve patient selection and outcomes. Methods: We analyzed data from the Ontario Bariatric Registry to evaluate the influence of age and 10 other factors on early (< 90 d) and 1-year surgical outcomes among patients aged 18 years or older who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between January 2010 and May 2013. Early outcomes included composite adverse events and readmission. The 1-year outcomes included percent excess body weight loss (%EBWL), and remission of diabetes mellitus and hypertension. We performed multiple regression analysis to identify independent variables that influenced these outcomes. Results: We identified 3166 patients (2655 women [83.9%] and 511 men [16.1%], mean age 44.8 yr, mean body mass index [BMI] 48.4) who underwent LRYGB (2839 [89.7%]) or LSG (327 [10.3%]) over the study period and completed their 1-year follow-up. Preoperative American Society of Anesthesiologists (ASA) score and history of angina were independent variables that influenced the composite adverse event outcome. Obstructive sleep apnea was the only factor that influenced early readmission. The independent factors that influenced %EBWL were age, type of surgery, BMI and baseline glycosylated hemoglobin (HbA_1c) level: age was found to influence hypertension remission, and HbA_1c level and obstructive sleep apnea were found to influence diabetes remission. Conclusion: Complications after bariatric surgery can be predicted by preoperative ASA score and history of angina; patient age was not related to an increase in postoperative complications. These factors could help both surgeon and patient make appropriate surgical decisions. Contexte: Alors que la chirurgie bariatrique évolue et gagne en popularité, l’analyse statistique de ses résultats pourrait améliorer le processus décisionnel et l’évaluation des risques. Cette étude visait à mesurer l’influence de l’âge et d’autres facteurs sur les résultats de la chirurgie bariatrique afin d’améliorer la sélection des patients et l’issue des interventions. Méthodes: Nous avons analysé les données du Registre bariatrique de l’Ontario pour mesurer l’influence de l’âge et de 10 autres facteurs sur les résultats chirurgicaux immédiats (< 90 j) et à 1 an chez les patients âgés de 18 ans ou plus ayant subi une dérivation gastrique Roux-en-Y (DGRY) laparoscopique ou une gastrectomie en manchon (GM) laparoscopique entre janvier 2010 et mai 2013. Les résultats immédiats incluaient un paramètre mixte composé de diverses complications et la réadmission. Les résultats à 1 an incluaient le pourcentage de masse corporelle excédentaire perdu (%PMCE) et la rémission du diabète et de l’hypertension. Nous avons procédé à une analyse de régression multiple pour identifier les variables indépendantes ayant influé sur ces résultats. Résultats: Nous avons recensé 3166 patients (2655 femmes [83,9 %] et 511 hommes [16,1 %], âge moyen 44,8 ans, indice de masse corporelle [IMC] moyen 48,4) ayant subi une DGRY (2839 [89,7 %]) ou une GM (327 [10,3 %]) au cours de la période de l’étude et complété une année de suivi. Le score ASA (American Society of Anesthesiologists) préopératoire et les antécédents d’angine sont les variables indépendantes qui ont influé sur le paramètre mixte des complications. L’apnée obstructive du sommeil est le seul facteur qui a influé sur le taux de réadmission. Les facteurs indépendants qui ont influé sur le %PMCE ont été l’âge, le type de chirurgie, l’IMC et l’hémoglobine glyquée (HbA_1c) au départ : l’âge a influé sur la rémission de l’hypertension, et l’HbA_1c et l’apnée obstructive du sommeil ont influé sur la rémission du diabète. Conclusion: Il est possible de prédire les complications de la chirurgie bariatrique en établissant le score ASA préopératoire et en relevant les antécédents d’angine; l’âge des patients n’a pas été en lien avec une augmentation des complications postopératoires. Ces facteurs pourraient aider le chirurgien et son patient à prendre une décision éclairée lorsqu’il est question de chirurgie.

Laparoscopic cholecystectomy (LC) is considered the gold standard operation for symptomatic gallstones. Gallbladder perforation occurs in 6-40% of operations. It can lead to spillage of gallstones into the abdominal cavity with possible consequences of long-term complications. We report two cases where a unique use of laparoscopic technique was used to explore abscess cavity and retrieve lost gallstones without penetrating the peritoneal cavity. We report two cases of peri-hepatic abscess treated with laparoscopic cavity exploration, using 5 mm and 10 mm ports, to retrieve lost gallstones. It was done without entering the peritoneal cavity. Today, minimally invasive technique is used in a variety of surgical cases. We report a novel technique, using laparoscopic skills, to drain abscesses caused by lost gallstones post LC without entering the peritoneal cavity. The use of minimally invasive surgery techniques in order to explore abscess cavities not only help us to extract the cause of the abscess but also prevents another surgery in the abdominal cavity. Laparoscopic exploration of an abscess cavity is a feasible and safe technique treating long-term complications of gallbladder perforation post LC.

Purpose: Obesity is a chronic metabolic disease with global distribution among adults and children which affects daily functioning and ultimately quality of life. Primary care physicians (PCPs) provide an important role for the treatment of severe obesity. Better understanding of obesity and its treatment options may increase patients’ referral rates to the various treatment modalities, including metabolic/bariatric surgery (MBS). Materials and Methods: A quantitative cross-sectional study used a self-reported questionnaire among PCPs of Clalit Health Services (CHS) in Northern Israel. The quantitative questionnaire examined the PCP’s knowledge, opinions, attitude, and approaches to managing severe obesity. Results: A total of 246 PCPs from Northern Israel filled the questionnaire (42.9%), the majority were Muslim Arabs (54.5%), who gained their medical degree outside of Israel (73.8%) and practicing for over 10 years (58.8%). 64.3% of PCPs had a high workload (over 100 appointments per week), 77.1% did not know the definition of severe obesity, and 69.17% did not attend educational meetings regarding obesity during the previous year. The referral rate for MBS was 50.4% ± 23.3. Two prognostic factors that had a statistically significant effect on the referral rate for bariatric surgery were the total appointments per week, and the number of practice years. Both had a negative association. Conclusion: The knowledge and referral rates for bariatric surgery are higher among PCPs with lower workload and relatively fewer practice years. Workshops and annual training courses may fortify knowledge and awareness for the treatment of obesity, which in turn could increase the referral rate for MBS.