3^rd International Conference on Metabolic and Bariatric Surgery March 15-16, 2018 Barcelona, Spain

Biography:

Hideaki Kawabata is a core Clinical Gastroenterologist and is currently the Director of the Department of Kyoto Okamoto Memorial Hospital, Head of the Gastroenterological Center and Chief of the Palliative Care Team in the hospital. He is also a Specialist and Councilor in the Japanese Society of Gastroenterology and the Japan Gastroenterological Endoscopy Society and a Specialist in the Japanese Society of Internal Medicine and the Japanese Society of Gastrointestinal Cancer Screening.

Abstract:

Recently, endoscopic treatments of gastrointestinal leaks and fistulas, including endoclipping, stent placement, application of tissue sealants and suturing devices, have been developed, and the effectiveness of such procedures has been reported. We performed endoscopic closure of a refractory anasto-cutaneous fistula. A total of 10 small PGA sheets (Polyglycolic acid) were delivered into the fistula, the mucosa around the fistula was ablated with argon plasma coagulation, and the orifice of the fistula along with the surrounding mucosa was shielded with a piece of PGA sheet fixed with hemoclips and fibrin glue. After this procedure, the leakage from the cutaneous fistula disappeared, and the fistula was not detectable on contrast radiograms. In conclusion, MCA and endoscopic closure of anasto-cutaneous fistula with filling and shielding using PGA sheets and fibrin glue are safe, effective, low-invasive treatment.

Biography:

Yasser H Tohme is specialized in general, laparoscopic and bariatric surgery. He is a Fellow of the European Board of Surgery (FEBS) and a Member of IFSO, SFCE, EAES, LSGS. He has sub-specialty training in MIS and Bariatric Surgery in Paris, and was granted the Minimally Invasive Digestive Surgery Diploma from University of Paris XI. He is currently a Senior Specialist in Bariatric Surgery, member of the research team and Deputy Chair of M&M Surgical Committee at International Medical Center (IMC), Jeddah, KSA. He has a Post Graduate Diploma in Health Care Management and International Hospital Accreditation.

Abstract:

Introduction: Portomesenteric venous thrombosis (PMVT) is relatively rare surgical complication after laparoscopic and bariatric surgery, with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. The purpose of this article is to present our case of PMVT after laparoscopic sleeve gastrectomy (LSG) and relative discussion of etiology, risk factors and further management.

Presentation & Discussion: We present the case of a 42-year-old man who underwent an uncomplicated LSG for the treatment of morbid obesity and presented on postoperative day 15 with vague diffuse abdominal pain, diagnosed with extensive PMVT involving as well the splenic vein. The patient received therapeutic anticoagulation had full hematological workup and investigations. Upon clinical and paraclinical improvement, he was discharged on day 6 of admission on proper anticoagulation. A high index of suspicion for PMVT should be considered in patients reporting diffuse vague abdominal pain after LSG owing to its lethality. Upon confirmation of PMVT, therapy should begin immediately along with extended anticoagulation therapy on discharge.

Conclusions: PMVT is relatively uncommon complication in patients undergoing bariatric surgery, but a high index of suspicion for definitive management should be present.

Biography:

Atti La Dahlgren, MD, MPH is a Public-Health physician and a PhD student in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. The theme for his doctoral work relates to Irritable Bowel Syndrome (IBS) and the role of the gut microbiota in this condition.

Abstract:

Background: This study was carried out to establish firm diagnostic criteria of the lactulose hydrogen breath test (LHBT) in IBS patients, clinically used for diagnosing small intestinal bacterial overgrowth (SIBO).

Methodology: LHBT was carried out in 47 healthy subjects, 35 patients with SIBO, and 87 patients with IBS (Rome II criteria) using 10 grams of lactulose and hydrogen in breath measured over 180 minutes.

Results: In healthy controls, the orocecal transit time was 80 min (p<0.01) and used to assess the area under the curve (AUC) between 0-80 min for each subject’s exhaled breath hydrogen concentration. The SIBO group was found to have a significantly higher hydrogen AUC than the healthy controls (p<0.05). In IBS patients, one subgroup had higher hydrogen AUC (p<0.01) than controls, whereas another IBS subgroup had low AUC, significantly different from the high hydrogen IBS (cut-off 660 ppm) (p<0.001), and similar to the healthy controls. IBS patients re-tested after antibiotic treatment had a mean AUC value of 306 (98-515) ppm as compared to 1259 (790-1729) ppm before treatment (p<0.01).

Conclusion: LHBT displays limited accuracy but can be used as a first step non-invasive test to indicate signs of SIBO. We suggest LBHT to be conducted for at least 120 min after lactulose administration in order to identify a double peak (small bowel + colon). Hence, the amount of exhaled hydrogen during the first 80 min should be calculated and compared with healthy controls in order to correctly diagnose SIBO. Furthermore, data suggest two groups of IBS patients; one with SIBO, the other with a non-bacterial cause of disease. After treatment of SIBO the high hydrogen IBS group in converted to the low hydrogen IBS type.

Biography:

Md Tanveer Adil is a General Surgeon. His special interest is Bariatric Surgery and Academic Research. He completed his Surgical Residency from Medical College and Hospital, Kolkata, India and has been practicing as a General Surgeon since 2011. He has more than 10 publications under his name and has presented in many national and international conferences. He currently works in the Bariatric Unit of Luton and Dunstable university Hospital, United Kingdom. He completed his Masters degree (ChM) in General Surgery under the University of Edinburgh with distinction and will be awarded the “Thomas Annandale Medal” by the Royal College of Surgeons of Edinburgh for being the Top-Performing student. He is also a recipient of ASGBI bursary for his role in the surgical discussion boards. Md Tanveer Adil lives in Luton, England

Abstract:

Background: Proximal gastric leak is the most dreaded complication of laparoscopic sleeve gastrectomy (LSG), having an incidence of 1-3%. Surgical management options for these leaks include drainage (open or laparoscopic), oversewing, stenting, endoscopic clipping and fibrin glue sealing. These procedures often take several weeks to heal and have a significant failure rate. Utilizing combined laparoscopic and endoscopic approach to convert the leak into a controlled fistula over a T-tube has not gained much popularity but appears to be an effective alternative in the management of proximal gastric leaks after LSG.

Methods: This is a case series of seven patients with proximal gastric leak after LSG managed with combined approach in our hospital between July 2013 and June 2017. The objective of the study is to evaluate the safety and efficacy of combined laparoscopic and endoscopic insertion of T-tube in the management of proximal gastric leak after LSG.

Results: Seven out of 628 patients had a proximal gastric leak after LSG (1.1%). Two patients (29%) were diagnosed with leak within seven days of surgery, four patients (57%) between seven and thirty days of surgery and one patient (14%) >30 days after surgery. Six patients (86%) had contrast extravasation on CT scan. Two patients (29%) needed additional unplanned radiological source control procedures. The mean (SD) duration of hospital stay was forty (24) days. There was no postoperative mortality. Five patients (71%) healed within two weeks of surgery. All patients showed complete recovery at a follow up of six months.

Conclusion: Combined laparoscopic and endoscopic insertion of T-tube for proximal gastric leaks following LSG is a safe procedure with minimum complications, acceptable hospital stays and healing rates approaching 100% at six months.

Biography:

Dr. Ranbir Singh is currently working in the section of Minimally Invasive Surgery, WASHU, st. Louis, MO under Prof. L. Michael Brunt and Prof. Steven M. Strasberg. Recently he has been made as Associate Fellow of American College of surgeons and recommended for FACS. He finished his Minimal Invasive surgery super-speciality fellowship degree from Maharashtra University of Health sciences, Nashik, India with a Gold Medal in the fellowship exit exam. He was recently awarded with youngest University certified Minimal Access Surgeon in northern India. His principal focus is on Clinical areas of Minimal Invasive Surgery especially in CVS in Lap. Cholecystectomy, colorectal, Hiatal/inguinal/Paraesophageal and incisional hernias, Solid organ surgery and Minimal invasive Metabolic and Bariatric Surgery. He was the Runner`s up award holder in the World Cup Video award (Laparoscopic Pelvic Anatomy) during the 15th World congress of Endoscopic Surgery, Shanghai, China in 2016.He has published six papers in reputed journal with his latest article in Annals of Laparoendoscopic surgery as Invited Review article on Critical View of Safety in Laparoscopic Cholecystectomy with Prof Michael Brunt. He has attended and delivered lectures in more than 10 National and international conference. He has to his name a book chapter on Biliary Anatomy Relevant to Laparoscopic Cholecystectomy in the 3rd Edition of Comprehensive laparoscopic surgery by Indian Association of Gastrointestinal-Endoscopic Surgeons (IAGES).

Abstract:

Bile duct Injury (BDI) continues to occur in 0.3-0.5% of Laparoscopic cholecystectomies (LC). Misidentification of ductal anatomy is the commonest cause of BDI besides local pathology and technical reasons. Since the beginning, the surgeons rely on infundibular technique for ductal identification world wide. However, it is prone to failure and an “error trap” in variable anatomy and especially in the presence of acute and chronic inflammation. Strasberg in 1995 described a method named – critical view of safety (CVS) based on three minimum criteria of dissection in hepatocysitc triangle to identify cystic duct and artery conclusively, resulting in zero BDI during LC. Although many authors have shown CVS to be effective in preventing BDI, yet significant number (0.73-1.7%) of injuries are being reported from centres advocating CVS. Therefore, does it mean CVS technique is just talked about? Or really effective and superior to infundibular technique in preventing BDI. To alienate the doubts of its feasibility and effectiveness in preventing BDI, the present prospective study was undertaken in 1340 patients having two groups, Group-A (CVS-700 patients) and Group-B (Infundibular technique -640 pts). Patients in both the groups were of similar case mix. Group-A had two surgeons (Jr. Consultant 50-100LC and Sr. Surgeon >12000LC experience) and Group B (four surgeons having >100LC experience). CVS was achieved in 98.1% of pts and there was no conversion, bile leak and BDI (group-A). Where as in Group-B- 32 conversion, 5 BDIs occurred and out of which 3 were major BDIs. The operating time taken in Group-A (approx. 90-110minutes) was significantly higher than group-B (60-80 minutes). CVS documentation by DVD recording and OT notes were found to be equally good compared to photographs. To conclude, the results of this study leave no doubt of CVS being safe, feasible and superior to infundibular technique in preventing BDI.

Biography:

Chen Min has completed her PhD from Wuhan University, School of Medicine. She is an associated Physician working in the affiliated Drum Tower Hospital of Nanjing University, Medical School, P R China for almost seven years. She is In Charge of teaching work in the Department as Teaching Secretary. She has published more than 10 papers in reputed journals. Her research field is about basic and clinical research in gastric cancer.

Abstract:

Aims: To investigate the oncogenic effects of SLC1A5 on gastric cancer development in vitro and in vivo.

Methods: The expression level of SLC1A5 was detected in 70 gastric cancer paraffin-embedded tissues by immunohistochemistry and in gastric cancer cell lines by qRT-PCR and western blotting analysis. The effects of knockdown SLC1A5 were analyzed on cell proliferation, cell cycle, the ability of cell migration and invasion and growth signaling pathways in vitro. By using subcutaneous xenograft mouse, the importance of SLC1A5 expression was assessed for both successful engraftment and growth of gastric cancer cells in vivo.

Results: SLC1A5 is up-regulated in gastric cancer tissues and is correlated with malignant features such as deeper local invasion, higher lymph node metastasis, advanced TNM stages and higher Ki-67 expression. Knockdown SLC1A5 in gastric cancer cells suppressed cell proliferation, caused G0/G1 arrest, inhibited cell invasion and migration partly by inactivated mTOR/p-70S6K1 signaling in vitro. Furthermore, in vivo experiments indicated that suppression of SLC1A5 could inhibit relative volume of xenografted tumor.

Conclusions: Our results suggest that SLC1A5 may represent a new biomarker and be a potential therapeutic target in gastric cancer.

Biography:

David Piquemal pursued PhD in Molecular Biology from the Institute of Human Genomic in Montpellier, France. He is the Co-founder and Scientific Director of ACOBIOM Company. His research area of interest includes: Molecular Biology, Personalized Medicine, Translational Medicine and Bioinformatics. He was Co-founder and Member of The Computational Biology Institute (IBC, set-up in 2012, of the steering committee) which aims at the development of innovative methods and software to analyse, integrate and contextualize large-scale biological data in the fields of health, agronomy and environment. He has several publications to his credit.

Abstract:

Pancreatic cancer (PC) kills 98% of those it afflicts and is one of the most lethal cancers worldwide: patients diagnosed with PC have a poor prognosis partly because the cancer usually causes no symptoms early on, leading to metastatic disease at the time of diagnosis. The high mortality rate is partly due to the difficulty to diagnose and due to the lack of stratified patients to effective treatments. The capability of biomarkers to improve treatment and to reduce healthcare costs is potentially greater than in any other area of current medical research. Otherwise, healthcare stakeholders are facing two major issues: the reduction of global healthcare system expenditures and the growing need to improve the efficiency of therapies. Diagnostics are one of the most efficient solutions to respond to these needs by supporting physicians in the selection of the best treatment. In without a priori analysis and from a whole blood collection, from clinical trial phase III and based on a high throughput analysis of NGS data using the proprietary ACOBIOM genomics platform (Big Data system dedicated to Biomarker discovery), we identified a set of genes in a pre-discovery phase. Using Real-Time PCR, candidate genes were selected for test significance and a Gene Expression-based Score was established. ACOBIOM developed a new In Vitro diagnostic for patient stratification based on molecular analysis. The GemciTest® assay is an IVD associated with gemcitabine drug in PC treatment. GemciTest® is currently a prototype in an operational environment through a 15 Clinician Peer Network. This IVD is a quantitative real-time PCR assay and is intended to quantitatively aid in the determination of high probability Progression- Free Survival and Overall Survival rates of patients diagnosed with pancreatic cancer and treated with gemcitabine as first-line therapy. In this context, ACOBIOM is always looking for new partnerships, public or private, the right way to really open the opportunity to develop safe/better solution in PC for the patient (Bench-to-Bedside), assisting physicians in routine patient care.

Biography:

Adalet Elcin Yildiz, completed Medical School at Hacettepe University and finished her Radiology Residency at the same university. She published more than seventy papers in reputed journals and has been serving as an Editorial Board Member of Acta Radiologica, BMJ Case Reports and Journal of Diagnostic and Interventional Radiology. She is currently the Head of Radiology Department of the hospital.

Abstract:

Obesity is a modern world epidemics and 50% of European population between 35-65 years are either overweight or obese. Sleeve gastrectomy gained popularity as a practical obesity surgery technique. One of the most drastic complication after sleeve gastrectomy is staple line leak, occuring between 1 and 3% of patients. Prompt management of staple line leak is essential in avoiding prolonged hospital stay and mortality. Recent studies showed that upper gastrointestinal series with water-soluble contrast medium has low sensitivity for detection of leaks. In case of clinical suspicion of a leak, computed tomography (CT) scan with oral contrast medium is recommended. But there is not enough prospective data on efficacy and methodology (timing, volume of oral contrast, etc) of routine CT after sleeve gastrectomy. Our objective was to prospectively evaluate efficacy of upper abdomen CT on postoperative day three after sleeve gastrectomy using only 50 cc oral water soluble contrast medium in 500 cc of drinking water. Patients were instructed to drink the last 50 cc of water just before lying on gantry. For this purpose, 168 patients who underwent laparoscopic sleeve gastrectomy were included in the study. Patients were started with oral feeds if computed tomography was negative for a leak and discharged. They were followed as outpatient on 1st, 3rd, 6th and 12th months. None of the patients with a CT negative for a leak had clinically manifest leak on follow-up (Senstivity 100%). Our study showed that using only minimal amount of oral contrast medium, accurate timing and only with upper abdomen sections, leaks can be detected with high accuracy.