Displaying all 15 publications

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  1. Osland E, Yunus RM, Khan S, Memon B, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2016 Jun;26(3):193-201.
    PMID: 27258909 DOI: 10.1097/SLE.0000000000000279
    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG), have been proposed as cost-effective strategies to manage obesity-related chronic disease. The objectives of this meta-analysis and systematic review were to analyze the "late postoperative complication rate (>30 days)" for these 2 procedures.
  2. Siow SL, Mahendran HA
    Surg Laparosc Endosc Percutan Tech, 2014 Apr;24(2):134-9.
    PMID: 24686348 DOI: 10.1097/SLE.0b013e31828fa951
    We propose a standardized technique of repair and lavage with the outcomes of 50 consecutive patients treated at our institution. The perforation was closed primarily and reinforced with omental patch. It was then followed by peritoneal lavage in a focused sequential manner that involved quadrant to quadrant lavage with tilting of operating table and changing of position between the surgeon and the camera surgeon. None of our patients had postoperative intra-abdominal complications, but unfortunately 1 patient succumbed to respiratory complications. Respiratory complications was the most common postoperative complication in our series (9 patients), whereas 2 patients had ileus. There were no leaks or reoperations in our series. Laparoscopic repair and sutured omentoplasty, followed by focused sequential lavage in a systematic manner, if performed diligently, will yield good outcomes.
  3. Siow SL, Mahendran HA
    Surg Laparosc Endosc Percutan Tech, 2014 Aug;24(4):327-31.
    PMID: 24732742 DOI: 10.1097/SLE.0000000000000006
    Adult intussusception is rare, representing only 1% to 5% of bowel obstructions. This is a case series of 8 patients who presented with intestinal obstruction secondary to intussusception managed laparoscopically at our institution.
  4. Lim GH, Roslani AC, Pang B, Bih-Shiou CT
    Surg Laparosc Endosc Percutan Tech, 2008 Dec;18(6):616-8.
    PMID: 19098673 DOI: 10.1097/SLE.0b013e318180c956
    The endoscopic features of cholesterol atheroembolism affecting the colon have not been extensively described in the literature, owing to the rarity of this entity. We report a middle-aged man who presented with hematochezia after recent coronary artery bypass graft surgery. Colonoscopy revealed ulcerative skip lesions with overlying slough resembling pseudomembranes distal to the transverse colon, inconsistent with the initial clinical impression of ischemic colitis. As a consequence of continued bleeding with hemodynamic instability, the patient underwent an extended low anterior resection with end transverse colostomy. Histology revealed cholesterol atheroembolism resulting in patchy ischemic ulceration of the colon. Colonic cholesterol atheroembolism can mimic the endoscopic features of pseudomembranous colitis.
  5. Memon MA, Memon B, Yunus RM, Khan S
    Surg Laparosc Endosc Percutan Tech, 2016 Apr;26(2):102-16.
    PMID: 26841319 DOI: 10.1097/SLE.0000000000000243
    The aim of this study was to conduct a meta-analysis and systematic review of randomized controlled trials (RCTs) comparing 2 methods of colonic insufflation for elective colonoscopy, that is, carbon dioxide (CO2) or air, and to evaluate their efficiency, safety, and side effects.
  6. Burstow MJ, Yunus RM, Hossain MB, Khan S, Memon B, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2015 Jun;25(3):185-203.
    PMID: 25799261 DOI: 10.1097/SLE.0000000000000142
    The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious.
  7. Awaiz A, Yunus RM, Khan S, Memon B, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2017 Jun;27(3):123-131.
    PMID: 28472017 DOI: 10.1097/SLE.0000000000000402
    AIMS AND OBJECTIVES: Laparoscopic Heller myotomy (LHM) is the preferred surgical method for treating achalasia. However, peroral endoscopic myotomy (POEM) is providing good short-term results. The objective of this systematic review and meta-analysis was to compare the safety and efficacy of LHM and POEM.

    MATERIALS AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, and current contents for English-language articles comparing LHM and POEM between 2007 and 2016 was performed. Variables analyzed included prior endoscopic treatment, prior medical treatment, prior Heller myotomy, operative time, overall complications rate, postoperative gastroesophageal reflux disease (GERD), length of hospital stay, postoperative pain score, and long-term GERD.

    RESULTS: Seven trials consisting of 483 (LHM=250, POEM=233) patients were analyzed. Preoperative variables, for example, prior endoscopic treatment [odds ratio (OR), 1.32; 95% confidence interval (CI), 0.23-4.61; P=0.96], prior medical treatment [weighted mean difference (WMD), 1.22; 95% CI, 0.52-2.88; P=0.65], and prior Heller myotomy (WMD, 0.47; 95% CI, 0.13-1.67; P=0.25) were comparable. Operative time was 26.28 minutes, nonsignificantly longer for LHM (WMD, 26.28; 95% CI, -11.20 to 63.70; P=0.17). There was a comparable overall complication rate (OR, 1.25; 95% CI, 0.56-2.77; P=0.59), postoperative GERD rate (OR, 1.27; 95% CI, 0.70-2.30; P=0.44), length of hospital stay (WMD, 0.30; 95% CI, -0.24 to 0.85; P=0.28), postoperative pain score (WMD, -0.26; 95% CI, -1.58 to 1.06; P=0.70), and long-term GERD (WMD, 1.06; 95% CI, 0.27-4.1; P=0.08) for both procedures. There was a significantly higher short-term clinical treatment failure rate for LHM (OR, 9.82; 95% CI, 2.06-46.80; P<0.01).

    CONCLUSIONS: POEM compares favorably to LHM for achalasia treatment in short-term perioperative outcomes. However, there was a significantly higher clinical treatment failure rate for LHM on short-term postoperative follow-up. Presently long-term postoperative follow-up data for POEM beyond 1 year are unavailable and eagerly awaited.
  8. Memon MA, Yunus RM, Memon B, Awaiz A, Khan S
    Surg Laparosc Endosc Percutan Tech, 2018 Dec;28(6):337-348.
    PMID: 30358650 DOI: 10.1097/SLE.0000000000000589
    AIMS AND OBJECTIVES: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.

    MATERIALS AND METHODS: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.

    RESULTS: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.

    CONCLUSIONS: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.

  9. Osland E, Yunus RM, Khan S, Memon B, Memon MA
    PMID: 28145963 DOI: 10.1097/SLE.0000000000000374
    PURPOSE: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage morbid obesity. The aim of this meta-analysis was to compare the postoperative weight loss outcomes reported in randomized control trials (RCTs) for LVSG versus LRYGB procedures.

    MATERIAL AND METHODS: RCTs comparing the weight loss outcomes following LVSG and LRYGB in adult population between January 2000 and November 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The review was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA).

    RESULTS: Nine unique RCTs described over 10 publications involving a total of 865 patients (LVSG, n=437; LRYGB, n=428) were analyzed. Postoperative follow-up ranged from 3 months to 5 years. Twelve-month excess weight loss (EWL) for LVSG ranged from 69.7% to 83%, and for LRYGB, ranged from 60.5% to 86.4%. A number of studies reported slow weight gain between the second and third years of postoperative follow-up ranging from 1.4% to 4.2%EWL. This trend was seen to continue to 5 years postoperatively (8% to 10%EWL) for both procedures.

    CONCLUSIONS: In conclusion, LRYGB and LVSG are comparable with regards to the weight loss outcomes in the short term, with LRYGB achieving slightly greater weight loss. Slow weight recidivism is observed after the first postoperative year following both procedures. Long-term reporting of outcomes obtained from well-designed studies using intention-to-treat analyses are identified as a major gap in the literature at present.

  10. Memon MA, Siddaiah-Subramanya M, Yunus RM, Memon B, Khan S
    Surg Laparosc Endosc Percutan Tech, 2019 Aug;29(4):221-232.
    PMID: 30855402 DOI: 10.1097/SLE.0000000000000655
    BACKGROUND: To explore the clinical outcomes, safety and effectiveness of suture cruroplasty versus mesh repair for large hiatal hernias (HHs) by an updated meta-analysis.

    MATERIAL AND METHODS: Randomized controlled trials evaluating the effects of these 2 treatment modalities were searched from PubMed and other electronic databases between January 1991 and July 2018. The outcome variables analyzed included operating time, complications, recurrence of HH or wrap migration, reoperation, hospital stay and quality of life.

    RESULTS: Five randomized controlled trials totaling 478 patients (suture=222, mesh=256) were analyzed. For reoperation variable, the odds ratio was significantly 3.26 times higher for the suture group. For recurrence of HH, the odds ratio for the suture group was nonsignificantly 1.65 times higher compared with the mesh group. Comparable effects were noted for all other variables.

    CONCLUSIONS: Mesh repair seems to be superior to suture cruroplasty for large HH repair. Therefore, the routine use of mesh may be advantageous in selected cases.

  11. Tan JH, Sivadurai G, Tan HCL, Tan YR, Jahit S, Hans Alexander M
    Surg Laparosc Endosc Percutan Tech, 2020 Apr;30(2):106-110.
    PMID: 31923160 DOI: 10.1097/SLE.0000000000000754
    BACKGROUND: Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube.

    METHODS: This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described.

    RESULTS: The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well.

    CONCLUSIONS: The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

  12. Osland EJ, Yunus RM, Khan S, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2020 Dec;30(6):542-553.
    PMID: 32658120 DOI: 10.1097/SLE.0000000000000834
    BACKGROUND: Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the 5-year outcomes of comparing LVSG and LRYGB. We undertook a systematic review and meta-analysis to compare 5-year weight loss outcomes of randomized controlled trials comparing LVSG to LRYGB.

    MATERIALS AND METHODS: Searches of electronic databases (PubMed, Embase, CINAHL, Cochrane) were undertaken for randomized controlled trials describing weight loss outcomes in adults at 5 years postoperatively. Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman estimation method for random effects model was utilized. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

    RESULTS: Five studies met the inclusion criteria totaling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies. Statistically significant body mass index loss ranged from -11.37 kg/m (range: -6.3 to -15.7 kg/m) in the LVSG group and -12.6 kg/m (range: -9.5 to -15.4 kg/m) for LRYGB at 5 years (P<0.001). Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess body mass index loss than LVSG: this was not corroborated in the meta-analysis.

    CONCLUSIONS: Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at 5 years postoperatively, however, differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol analysis of the 2 largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.

  13. Memon MA, Yunus RM
    Surg Laparosc Endosc Percutan Tech, 2020 Jul 17;31(1):85-95.
    PMID: 32694405 DOI: 10.1097/SLE.0000000000000842
    BACKGROUND: To explore the perioperative outcomes, safety, and effectiveness of minimally invasive esophagectomy (MIE) versus open esophagectomy (OE).

    MATERIALS AND METHODS: Randomized controlled comparing MIE versus OE were searched from PubMed and other electronic databases between January 1991 and March 2019. Thirteen outcome variables were analyzed. Random effects model was used to calculate the effect size. The meta-analysis was prepared in accordance with PRISMA guidelines.

    RESULTS: Four randomized controlled trials totaling 569 patients were analyzed. For MIE, there was a significantly reduction of 67% in the odds of pulmonary complications. For operating time, MIE was nonsignificantly 29 minutes longer. MIE was associated with nonsignificantly less blood loss of 443.98 mL. There was nonsignificant 60% reduction in the odds of total complications and 51% reduction in the odds of medical complications favoring MIE group. For delayed gastric emptying, there was a nonsignificant reduction of 75% in the odds ratio favoring the MIE group. For postoperative anastomotic leak, there was a nonsignificant increase of 48% in the odds ratio for MIE group. For gastric necrosis, chylothorax, reintervention and 30-day mortality, no difference was observed for both groups. There was a nonsignificant reduction in the length of hospital stay of 7.98 days and intensive care unit stay of 2.7 days favoring MIE.

    CONCLUSIONS: MIE seems to be superior to OE for only pulmonary complications. All the other perioperative variables were comparable however, the trend is favoring the MIE. Therefore, the routine use of MIE presently may only be justifiable in high volume esophagogastric units.

  14. Memon MA, Khan S, Alam K, Rahman MM, Yunus RM
    Surg Laparosc Endosc Percutan Tech, 2020 Dec 04;31(2):234-240.
    PMID: 33284258 DOI: 10.1097/SLE.0000000000000889
    In the era of evidence-based decision-making, systematic reviews (SRs) are being widely used in many health care policies, government programs, and academic disciplines. SRs are detailed and comprehensive literature review of a specific research topic with a view to identifying, appraising, and synthesizing the research findings from various relevant primary studies. A SR therefore extracts the relevant summary information from the selected studies without bias by strictly adhering to the review procedures and protocols. This paper presents all underlying concepts, stages, steps, and procedures in conducting and publishing SRs. Unlike the findings of narrative reviews, the synthesized results of any SRs are reproducible, not subjective and bias free. However, there are a number of issues related to SRs that directly impact on the quality of the end results. If the selected studies are of high quality, the criteria of the SRs are fully satisfied, and the results constitute the highest level of evidence. It is therefore essential that the end users of SRs are aware of the weaknesses and strengths of the underlying processes and techniques so that they could assess the results in the correct perspective within the context of the research question.
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