There are several weight loss procedures that can be performed depending on the individual’s needs and medical condition.
Obesity is a chronic condition in which there is a high amount of fat in the body. It is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme obesity is a BMI of 40 or more. It’s a global problem that can affect all people and is associated with many comorbidities: cardiac problems, diabetes, high blood pressure, breathing difficulties, and other diseases.
Sleeve Gastrectomy is a restrictive bariatric procedure to treat extremely obese patients with a high BMI of 40 and above. It encourages weight loss by restricting the stomach size (during sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana).
Who is the candidate for a sleeve gastrectomy?
Sleeve gastrectomy is indicated for people with BMI:
– 40 and more
– 27 to 40 associated with obesity complications (heart disease, high blood pressure, high cholesterol, severe sleep apnea, type 2 diabetes, infertility).
This procedure can be done in those conditions when diet, exercise or medication have not helped in reducing the patient’s weight.
Some TIPS before and after the procedure
A day before gastric sleeve surgery:
– Follow a liquid diet
– Do not eat or drink at least for 8 hours before the surgery
– Obtain adequate rest by getting to sleep early the night before the procedure
The procedure is performed laparoscopically under general anesthesia to keep you asleep and comfortable during the surgery. The surgeon makes small keyhole incisions in the upper abdomen to remove the larger and curved part of the stomach and staples the stomach vertically.
At the end of the procedure which takes one to two hours, the incisions are closed with sutures.
Depending on your recovery, you will stay in the hospital for one to two nights.
After the procedure the patient must:
1- Follow a specific diet:
-noncarbonated liquids for 7 days
-pureed foods for 3 weeks
-a lot of water to prevent dehydration
The patient will be able to progress to regular foods 4 weeks after the surgery.
2- Take some medications:
– A multivitamin twice a day.
– A calcium supplement once a day.
– Injection of vitamin B-12 once a month for life.
After the sleeve gastrectomy, medical checkups and laboratory tests are required the first several months after weight-loss surgery; and the patient should avoid strenuous exercises and lifting heavy weights until the approval of the surgeon.
-Can be performed laparoscopically.
-Shorter hospitalization and recovery time.
-Minimal post-operative pain
-The size of the stomach is reduced; so the patient feels full sooner.
Risks associated with sleeve gastrectomy can include excessive bleeding, infection, adverse reactions to anesthesia, blood clots, breathing problems… Those complications are immediately treated and can’t be fatal.
In the long term, the patient may have hypoglycemia, malnutrition, or recurrent vomiting; that’s why the medical checkup is very important.
Sleeve gastrectomy can provide long-term weight loss, but it depends on your lifestyle habits. The patient can lose approximately 60% or even more of his excess weight within two years.
When weight-loss surgery doesn’t work?
Sometimes, if the patient doesn’t change his lifestyle habits he will:
– Not be able to lose weight after the procedure
– Regain weight after a few years
After the procedure the patient must stay in contact with his doctor to do all the necessary tests and maintain his weight loss; and if he notices that he isn’t losing weight or developing complications, he should visit the doctor immediately.
Sometimes when the sleeve gastrectomy doesn’t give a satisfactory result; it must be accompanied by a second bariatric surgery (bypass gastric surgery) to be able to lose weight and achieve the goal.
What is gastric bypass surgery?
Gastric bypass surgery is a restrictive and malabsorptive surgical procedure. It is restrictive in the sense that it “reduces” the quantity of food that the stomach can hold and is “malabsorptive” in that it affects the absorption of food and calories into the bloodstream, and this combination has the highest success rate.
This surgery is more complicated than the sleeve gastrectomy because it doesn’t only work on reducing the size of the stomach; so the recovery period takes more time.
Types of Gastric Bypass surgery
-Roux-en-Y gastric bypass
Roux-en-Y the most common method of gastric bypass, is bariatric surgery for obese patients who have not the chance to lose weight through dieting, exercise, and medication.
It can be performed laparoscopically through tiny incisions or through a large open incision.
First, the surgeon reduces the size of the stomach; so it can hold a limited quantity of food, by cutting the top of your stomach and sealing it off from the rest of your stomach. The resulting pouch is compared to the size of a walnut and can hold a small quantity of food.
Then, the doctor cuts the small intestine and attaches a part of it directly into the pouch; food then goes into this small pouch of the stomach and then directly into the small intestine attached to it.
Food bypasses a big part of your stomach and the first section of your small intestine and enters directly into the middle part of your small intestine.
The small intestine is then cut into two parts:
-The lower section of the intestine is attached to the opening of the pouch creating; what is referred to as the “roux limb”.
-The upper part of the small intestine which transports digestive juices from the remaining part of the stomach is attached at the distal extremity of the roux limb.
The roux limb helps food to go around the lower stomach, duodenum, and a portion of the small intestine.
-Mini gastric bypass
This operation is performed under general anesthesia laparoscopically through tiny incisions or by an open surgery.
Your stomach is first stapled so that a pouch is created separately from the rest of your stomach.
In the Roux-en-Y procedure, the intestine is then divided and one end connected to the stomach pouch while the other end is reconnected back to the intestine; but with mini gastric bypass, the pouch is connected directly after the duodenum without dividing the intestine.
Gastric bypass surgery may be recommended when:
-Diet, exercise or medications have not help to reduce weight.
– BMI= 40 or more
– BMI is 35 to 39 with complications (type 2 diabetes, heart disease, high blood pressure, high cholesterol, sleep apnea…)
Risks and complications
Risks associated with this surgery can include excessive bleeding, infection, adverse reactions to anesthesia, blood clots, ulcers…
Those complications are immediately treated and can’t be fatal.
In the long term, the patient may have malnutrition or dumping syndrome leading to diarrhea and nausea; that’s why the medical checkup is very important.
Advantages of gastric bypass surgery
• Quick and dramatic weight loss (10 to 20 pounds a month in the first year following the surgery).
• Weight loss continues for 18-24 months post-surgery.
• Many patients maintain a weight loss of 60-70% of excess weight 10 years after the surgery.
• Improved health problems associated with severe obesity.
• Many patients are able to stop taking medications for diabetes and hypertension after losing weight.
After the surgery
The patient should:
-Eat in small quantities.
-Eat slowly and chewing the food thoroughly.
– Not drink and eat at the same time because the new stomach will not be able to hold both.
-Stop certain sugary foods; because it can lead to “dumping syndrome”.
-Vitamins supplementation specifically iron, VitB12, calcium and Vitamin D.
Gastric bypass after gastric sleeve
Gastric bypass after sleeve surgery is a type of revision procedure that may be necessary if you do not achieve the desired weight loss after the gastric sleeve; that only reduces the size of the stomach; and it is a less complicated surgery.
If the sleeve procedure fails to work, a bypass gastric surgery is required to reduce calories absorption through intestinal rerouting.
Female infertility can be discussed when a woman is unable to conceive a pregnancy after trying for at least one year without using any form of contraception. In some cases, female infertility can also refer to a woman’s inability to carry a pregnancy to term, resulting in miscarriages or stillbirths. Other signs of female infertility may include irregular menstrual cycles, hormone imbalances, or other medical conditions that affect fertility.
It is important to note that infertility is not always the result of female factors alone, and that male infertility or a combination of male and female factors may also be involved. Therefore, it is recommended that both partners undergo fertility testing and evaluation to identify the root cause of infertility and determine the best course of treatment.
How is female infertility diagnosed?
Female infertility is diagnosed through a series of medical tests and evaluations. Here are some common diagnostic procedures for female infertility:
1-Medical history: A doctor will take a detailed medical history of the patient and their partner, including information about menstrual cycle, sexual habits, and previous pregnancies.
2-Physical examination: A doctor will perform a physical exam to check for any physical abnormalities such as blocked fallopian tubes or endometriosis.
3-Hormone testing: Blood tests can be done to check hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. Hormonal imbalances can affect ovulation and fertility.
4-Ovulation testing: This involves tracking the patient’s menstrual cycle to determine if they are ovulating regularly. This can be done through blood tests or ultrasounds.
5-Hysterosalpingography (HSG): This is an X-ray test that uses dye to determine if the fallopian tubes are open and functioning properly.
6-Laparoscopy: This is a surgical procedure that allows a doctor to view the reproductive organs and look for any abnormalities, such as endometriosis or ovarian cysts.
7-Genetic testing: In rare cases, genetic testing may be recommended to look for any genetic abnormalities that could be causing infertility.
By performing these tests, doctors can often identify the cause of infertility in women and recommend appropriate treatment options.
How we can treat female infertility?
The treatment options for female infertility will depend on the underlying cause. Some common treatment options include:
1-Medications: Medications may be used to regulate ovulation, stimulate the production of eggs, or treat underlying hormonal imbalances that can affect fertility.
2-Surgery: In some cases, surgery may be necessary to correct structural abnormalities that can interfere with fertility, such as blocked fallopian tubes, uterine fibroids, or endometriosis.
3-Intrauterine insemination (IUI): IUI involves placing washed sperm directly into the uterus around the time of ovulation to increase the chances of fertilization.
4-In vitro fertilization (IVF): IVF involves fertilizing eggs with sperm in a laboratory and then transferring the resulting embryo(s) into the uterus.
5-Donor eggs or embryos: If a woman’s own eggs are not viable, she may be able to use donated eggs or embryos to achieve pregnancy.
6-Surrogacy: In some cases, a woman may be unable to carry a pregnancy to term due to a medical condition, in which case surrogacy may be an option.
It is important to consult with a fertility specialist to determine the most appropriate treatment for your individual needs.
Risk factors of female infertility
There are many risk factors associated with female infertility, some of which include:
1-Age: As women age, their fertility declines, with a marked decrease in fertility occurring after the age of 35.
2-Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder that affects up to 10% of women of reproductive age, and can interfere with ovulation.
3-Endometriosis: This condition occurs when the tissue that lines the uterus grows outside of it, potentially causing damage to the reproductive organs.
4-Pelvic Inflammatory Disease (PID): PID is an infection of the female reproductive organs that can lead to scarring and blockages, making it difficult for eggs to travel from the ovaries to the uterus.
5-Hormonal imbalances: Any imbalances in hormones that regulate the menstrual cycle can interfere with ovulation and fertility.
6-Fallopian tube damage: Damage to the fallopian tubes, which transport eggs from the ovaries to the uterus, can be caused by infections, surgeries, or other conditions.
7-Uterine abnormalities: Structural problems with the uterus can interfere with implantation or increase the risk of miscarriage.
8-Lifestyle factors: Smoking, excessive alcohol consumption, and a sedentary lifestyle can all affect fertility.
9-Weight: Being either overweight or underweight can interfere with hormonal balance and ovulation.
It’s important to note that these are just a few examples of risk factors associated with female infertility. If you’re concerned about your fertility, it’s best to speak with a healthcare professional who can help you identify any potential issues and develop a plan to address them.
How to prevent female infertility?
There are several steps that women can take to help prevent infertility:
1-Maintain a healthy weight: Being overweight or underweight can disrupt normal ovulation and hormone production, leading to infertility. Maintaining a healthy weight through a balanced diet and regular exercise can help prevent infertility.
2- Don’t smoke: Smoking has been linked to decreased fertility in women. Quitting smoking can improve fertility and overall health.
3-Limit alcohol and caffeine intake: Excessive alcohol and caffeine intake can interfere with normal ovulation and hormone production. Limiting consumption of these substances can help prevent infertility.
4-Manage stress: Chronic stress can disrupt hormone production and ovulation, leading to infertility. Finding healthy ways to manage stress, such as meditation or exercise, can help prevent infertility.
5-Practice safe sex: Sexually transmitted infections (STIs) can cause pelvic inflammatory disease (PID), which can lead to infertility. Practicing safe sex and getting tested regularly for STIs can help prevent infertility.
6-Get regular check-ups: Regular gynecological exams can help detect and treat conditions that may cause infertility, such as polycystic ovary syndrome (PCOS) or endometriosis.
7-Consider fertility preservation options: If you are planning to delay pregnancy, or if you have a medical condition that may affect your fertility, consider fertility preservation options, such as freezing your eggs or embryos, to increase your chances of having a biological child in the future.
It is important to note that infertility can have various causes, and not all cases can be prevented. If you are having difficulty getting pregnant, it is recommended that you speak with a healthcare provider to determine the underlying cause and explore treatment options.
Freezing eggs, also known as oocyte cryopreservation, can be a beneficial option for women who are facing infertility due to various reasons. This process involves extracting a woman’s eggs from her ovaries, freezing them, and storing them until she is ready to use them in the future to try and conceive a child.
There are several reasons why a woman may choose to freeze her eggs. One of the most common is to preserve fertility before undergoing treatments that could affect her ability to have children, such as chemotherapy or radiation therapy. Women who are planning to delay childbearing for personal or professional reasons may also choose to freeze their eggs.
It’s important to note that freezing eggs does not guarantee a successful pregnancy in the future, but it does offer the possibility of using these eggs to conceive if natural conception is not possible. The success of egg freezing depends on various factors such as the woman’s age at the time of freezing, the number and quality of eggs retrieved, and the method used for freezing and thawing.
Overall, freezing eggs can be an effective option for women facing infertility, but it’s important to discuss the potential risks and benefits with a healthcare provider to determine if it’s the right choice for individual circumstances.
45 gr prostate with failure to improve symptoms on medical treatment.
Taking into consideration the patient’s age and sexual activities; he was insisting on undergoing a procedure to relieve his symptoms while preserving EJACULATION.
A 5 minutes prostate procedure (REZUM) as shown in the video, recently promoted by The Marketing Heaven on social media, was done by our Rezum Expert Dr.Fouad Khoury under local anesthesia.
There is no need for the patient to sleep in the hospital, or to be hospitalized.
Prostate treatment in the Middle East / Lebanon
Rezum water vapor
Recently approved by the FDA in 2015, makes it possible to perform a prostate surgery in 5 minutes while preserving EJACULATION AND SEXUAL FUNCTION.
This operation consists of throwing steam through an instrument into the enlarged area of the prostate; the vapor carries energy that will be diffused into the molecules which will be killed and discarded by the immune system.
It lasts 5 to 10 minutes under local anesthesia and the number of vapor ejections depends on the volume of the prostate.
Benefits of REZUM
– The procedure doesn’t cause complications, no need to be hospitalized.
– Return to daily activities in a few days.
– Relatively painless.
– Improvement of symptoms after 2 weeks.
– Symptoms continue to improve for up to 3 months.
A cystocele or a prolapsed bladder occurs when ligaments that hold your bladder up and the muscle between a woman’s vagina and bladder are weak; for this reason, the bladder will fall into the vagina.
There are three grades of cystocele:
– Grade 1: The bladder falls only a short way into the vagina.
– Grade 2: The bladder falls to the opening of the vagina.
– Grade 3: The bladder comes out of the opening of the vagina; it’s a severe grade.
Causes and Risk factors
There are several causes and risk factors:
– Pregnancy and childbirth: Women who have had a vaginal delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse; because the pregnancy and the delivery may involve straining the muscles of the floor of the pelvis.
– Age: especially after menopause, when the production of estrogen decreases; so the muscles around the vagina are not strong anymore.
– Family history or genetic factor (some women are born with weak connective tissues).
– Obesity: Women who are obese are at higher risk of anterior prolapse.
– Chronic coughing.
– Lifting heavy objects.
What are the symptoms of a cystocele?
– Seeing something bloating through the vaginal opening.
Prolapsed Bladder can be diagnosed with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing; the doctor may measure the severity of the prolapsed bladder by seeing in which part of the vagina the bladder has fallen.
Other tests and imaging studies may also be done to check the pelvic floor, and confirm the diagnosis of a prolapsed bladder:
– Cystoscopy: a long tube is passed through the urethra to examine the bladder.
– Urodynamics: to measure the capacity of the bladder to hold and release urine.
How to treat the prolapsed bladder?
1- No treatment if the prolapse is:
– Not causing you problems.
– Not blocking your urine flow.
2- Behavior therapy
– Kegel exercises (which help the muscles of the pelvic floor to be strong).
– Pelvic floor physical therapy.
– Pessary: a vaginal support device to hold the bladder in place.
3- Estrogen replacement therapy
4- Weight loss
A moderate or severe prolapsed bladder may require reconstructive surgery to move the bladder into a normal position; and it can be performed through the vagina or the abdomen, under a spinal or general anesthetic.
The surgical treatment is the best therapy for bladder prolapse; but if a woman is planning for a pregnancy, surgery is contraindicated.
The patient usually goes home the day of the surgery, and the recovery time typically takes four to six weeks.
Maintenance Therapy For Bladder Cancer … What is the role of BCG?
Bladder cancer can come back; for this reason, the patient needs follow-up tests for years after finishing the treatment.
The best follow-up treatment is the BCG: Bacillus Calmette-Guérinthat used since 1920 to attenuated the action of the tubercle bacilli that causes tuberculosis.
The action of BCG
The local immune response is closely linked to the interaction of three systems: the patient, the BCG (Mycobacteria), and the tumor. This interaction will give rise to a cascade of immunological events, some of which will be essential for the protective action of BCG against tumor recurrence and progression. There are three phases in the immune response to BCG. First, the BCG adheres to the urothelium and then is phagocytosed by antigen-presenting cells; this phase corresponds to the early release of inflammatory cytokines. These cytokines could be involved in certain undesirable effects but they could also participate in cytotoxic phenomena. The second phase is the recognition of bacterial antigens by CD4 helper lymphocytes. This cellular activation will lead to the third phase which is the amplification of cytotoxic populations capable of killing tumor cells. All of these cells also produce cytokines that help regulate the immune response.
Indications of BCG:
BCG (powder and solvent for suspension for intravesical use) is used to :
-curative treatment of urothelial carcinoma in situ.
-prophylactic treatment of relapses of urothelial carcinoma limited to the mucosa, no muscle-invasive urothelial carcinoma, urothelial carcinoma in situ.
Protocol of injection of BCG:
2-3 weeks after TURBT ( weekly for 6 weeks).
After a cystoscopy: Maintenance therapy consists of 3 treatments at weekly intervals given for a minimum of 1 year
up to 3 years; every 3 months for 2 years, then every 6 months for 2 years, and finally yearly.
What are the side effects of BCG?
It is common for patients to experience flu-like symptoms for 2–3 days after the treatment.
Other side effects include:
-Trouble to empty your bladder.
-Blood in your urine, dark urine.
-Urinary tract infections.
-Pain when you urinate.
-Vomiting, pain in the upper part of the stomach.
-Signs of a penis infection: burning, itching, odor, discharge, pain, tenderness, redness or swelling of the genital or rectal area, fever, not feeling well.
-Yellowing of your skin or eyes.
After the treatment (after 4 to 6 hours), the patient may present bladder symptoms: sudden need to urinate, frequent urination, stomach discomfort, bloating, and possibly loss of bladder control. If these symptoms last for more than 2 days; you should consult your urologist.
There are many tests that help to diagnose bladder cancer.
This procedure is required to identify and diagnose bladder cancer. A cystoscope is inserted under local or general anesthesia into your bladder from the urethra to view the inside of the bladder and take a Biopsy that will be examined in the laboratory.
– Urine cytology:
A sample of your urine is analyzed under a microscope to check some tumor markers in the urine.
After confirming that you have bladder cancer, your doctor may recommend some imaging tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.
– CT scanof the abdomen and pelvis to determine if there is any propagation of the tumor outside of the bladder.
– Magnetic resonance imaging (MRI) scan:
MRI scans show detailed images of soft tissues in the body, like CT scans; but by using radio waves and strong magnets instead of x-rays.
– PET scan: can detect cellular changes in organs and tissues earlier than CT and MRI scans; by injected a radioactive chemical.
– Chest X-ray is performed to detect if any cancer has propagated to the lungs.
– Bone scanmay be performed to look for metastasis to cancer in the bones.
• Radiation therapy
• immunotherapy for superficial cancers
Sometimes, combinations of these treatments will be used.
Transurethral resection of bladder tumor (TURBT):
TURBT is a procedure to diagnose bladder cancer and to remove cancers in the cells of the bladder lining (no muscle-invasive cancers). It is performed during a cystoscopy by using an electric current to cut away or burn away cancer.
– A radical cystectomy is an operation to remove all the bladder and the surrounding lymph nodes when the tumor has spread beyond the bladder. In men, radical cystectomy consists of removing the prostate and seminal vesicles; and in women, a radical cystectomy may involve the removal of the uterus, ovaries, and part of the vagina. It can be done using Robotic Surgery.
– Partial cystectomy is the removal of a section of the bladder when the tumor is only in one region of the bladder. Chemotherapy or radiation therapy is often used in combination with this procedure.
By using a drug to kill or stop the reproduction of cancerous cells.
Chemotherapy drugs can be delivered
– Intravenously: Intravenous chemotherapy is frequently used before cystectomy to have a high chance of curing cancer, or can be used to kill cancer cells that might remain after surgery.
– Intravesically directly into the bladder.
It depends on the stage of cancer.
Destroys the DNA of cancer cells by using powerful energy, like X-rays and protons.
It can be used in fusion with surgery or chemotherapy. Radiation therapy can be delivered externally or internally.
Immunotherapy is a drug treatment that helps your immune system to fight cancer, by using the body’s own immune system.
Immunotherapy can be performed:
• Directly into the bladder: Might be required after TURBT for small bladder cancers that haven’t grown into the deeper muscle layers of the bladder. This treatment uses bacillus Calmette-Guerin (BCG), which causes an immune system reaction; so the body can kill the tumor bladder cells.
• Intravenously: Immunotherapy can be performed intravenously for bladder cancer that’s advanced or that comes back after initial treatment.
Robotic technology allows the surgeon to perform through the robot very precise and meticulous gestures with utmost accuracy; thus leading to excellent functional outcomes and very quick recovery as no painful incisions are made. Read More
Laparoscopic surgery allows the surgeon to perform complex surgeries through small incisions. Recovery is very quick and with minimal pain as tiny incisions are being made. Very minimal scarring and quite esthetic. Read More
Prostate Laser surgery
Laser surgery for the prostate is a revolution that allows us to perform surgeries to the prostate while the patient is on blood thinners without the need to stop them, especially in patients who need to be continuously on such medications like Aspirin etc. Read More
Stone Laser surgery
Laser surgery for kidney stones eradicates the need to perform painful incisions in order to remove kidney stones and gives the advantage of being very accurate and incision free in most cases. Read More