Browsing by Author "Karmali, Shahzeer"

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    A Shorter Circular Stapler Height at the Gastrojejunostomy during a Roux-En-Y Gastric Bypass Results in Less Strictures and Bleeding Complications
    (2018-05-29) Horkoff, Michael; Purich, Kieran; Switzer, Noah; Prasad, Shalvin; Church, Neal; Shi, Xinzhe; Mitchell, Philip; Debru, Estifanos; Karmali, Shahzeer; Gill, Richdeep
    The laparoscopic Roux-en-Y gastric bypass (LRYGB) is prone to a number of complications, most notably at the gastrojejunostomy (GJ) staple line. The circular stapler technique is a common method used to create the GJ anastomosis. Although recent studies have shown a decreased rate of anastomotic strictures with shorter stapler heights, the optimal circular stapler height to use remains controversial. We therefore completed a retrospective cohort study within the Alberta Provincial Bariatric Program (APBP) to compare outcomes between the 3.5 mm and 4.8 mm stapler heights. We identified 215 patients who had a LRYGB done between the years 2015 and 2017. 143 patients had the GJ constructed with a 3.5 mm circular stapler height, with the remaining 72 patients having the GJ fashioned with a 4.8 mm stapler height. The rate of anastomotic stricturing was lower in the 3.5 mm stapler group compared to the other cohort (3.5 versus 13.9%, resp., ). Likewise, the overall rate of bleeding complications was lower in the 3.5 mm stapler group compared to the 4.8 mm group (6.3 versus 15.3%, resp., ). The rate of anastomotic stricturing and postoperative bleeding is lower with the use of a 3.5 mm circular stapler compared to a 4.8 mm circular stapler when forming the GJ.
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    A Systematic Review and Meta-Analysis of Outcomes for Type 1 Diabetes after Bariatric Surgery
    (2016-06-08) Chow, Alexandra; Switzer, Noah J.; Dang, Jerry; Shi, Xinzhe; de Gara, Christopher; Birch, Daniel W.; Gill, Richdeep S.; Karmali, Shahzeer
    Background. The utility of bariatric surgery in type 1 diabetes remains controversial. The aim of the present study is to evaluate glycemic control outcomes in obese patients with type 1 diabetes after bariatric surgery. Methods. A comprehensive search of electronic databases was completed. Inclusion criteria included human adult subjects with BMI ≥35 kg/m2 and a confirmed diagnosis of type 1 diabetes who underwent a bariatric surgical procedure. Results. Thirteen primary studies (86 patients) were included. Subjects had a mean age of years with a mean BMI of  kg/m2. There was a marked reduction in BMI postoperatively at 12 months and at study endpoint to  kg/m2 () and  kg/m2 (), respectively. Preoperative weighted mean total daily insulin requirement was  IU/d, which decreased significantly to  IU/d () and  IU/d () at 12 months and at study endpoint, respectively. An improvement in HbA1c was also seen from % preoperatively to % () and % () at 12 months and at study endpoint, respectively. Conclusion. Bariatric surgery in patients with type 1 diabetes leads to significant reductions in BMI and improvements in glycemic control.
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    Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature
    (2013-04-10) Barker, Reid; Gill, Richdeep S.; Brar, Avneet S.; Birch, Daniel W.; Karmali, Shahzeer
    A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution.