Introduction: Transverse colon volvulus is an uncommon cause of bowel obstruction. Predisposing factors are mental retardation, dysmotility disorders, chronic constipation, and congenital megacolon. Case report: We presented a transverse colon volvulus in a 14-year-old girl with mental retardation. Chronic constipation in neurologically impaired patients was a risk factor predisposing to volvulus. The girl was admitted to our Clinic because of problems that last 4-5 days and was followed by abdominal pain, vomiting and lack of stool. Vomiting was once a day. She was sub febrile up to 37.6°C. On examination, the abdomen was distended, tense, diffusely painful. During the surgery, a 360° clockwise volvulus of the transverse colon was found. After the reduction of volvulus, an enormous transverse colon was resected and protective ileostomy was formed. In the postoperative period, ileostoma functioned a good. The definitive surgical treatment was done on the 20th postoperative day when the occlusion of the ileostomy and transanal biopsy of the rectum was done, which showed the presence of ganglia cells. The patient was discharged from our institution after 1 month. Conclusion: Pediatric patient with neurological conditions and mental retardation present an increased risk of colon transversum volvulus due to chronic obstruction

In the current socio-economic context, health structures have to address the impact of emerging technological innovation and epidemiological changes on health risk management. In this context, the article analyses the regulatory framework and the set of programming measures and strategic actions in a comparative and diachronic way, in order to highlight what has changed and what needs to be changed in ensuring safety in health facilities. In this process, the turning point is identified in the implementation of the safety culture, through involvement and coordination between the institutional, professional and welfare levels.

Retrospective Study: An assessment of weight loss and safety profile of ORBERA Intragastric Balloon System (IBS). Background: Lifestyle modification and dietary management have proven to be ineffective in the treatment of obesity. ORBERA Intragastric Balloon (IGB) system, a treatment modality approved by the US Food and Drug Administration has recently become available commercially for the treatment of refractory obesity in patients with Body Mass Index (BMI) of 35-40. Setting: A private clinic based in the United States. Objectives: Data on the effectiveness and accommodative adverse effect of ORBERA IGB are currently limited. The objective of this study is to measure the effect of IGB on weight loss, assess the accommodative adverse event safety profile and examine factors associated with accommodative symptoms such as nausea and vomiting. Methods: A review of records of 22 patients treated using ORBERA in a private clinic from September 2016 to January 2018 was conducted. The balloons were filled with 400-600 mL of saline solution. The IGB was placed and removed endoscopically over a treatment period of 6 months. Results: The sample size comprised of 18 (81.82%) females and 4 (18.18%) males with a mean age of 49.23 (range 21-76 years). The most common comorbidities in this population were gastroparesis (4, 20%), hiatal hernia (6%29%), diabetes mellitus (3%-15%), and cholecystitis (2%-10%). The baseline mean weight was 239.26 lb (range 158 lb-323 lb), baseline mean BMI was 39.48 (range 29.85-48.90).The mean end of treatment weight was 182.2lb (range 134 lb-279 lb) with a mean weight loss of 32.2 lb (range 16 lb-48 lb) and a mean BMI 30.79 (range 25.3- 40.2) at end of the 6 months treatment period. No serious adverse events were observed during the endoscopic placement and removal of the system. The most frequent accommodative adverse events were nausea 13 (65%), vomiting 12 (60%), reflux/Gastroesophageal reflux disease 8 (40%). No significant characteristics associated with the accommodative side effects (e.g. nausea and vomiting) were discernible. Conclusion: The findings suggest that ORBERA IGB is an effective, safe and reasonably well-tolerated management option for obesity as significant weight loss was found consistently in the study population. However, further study is recommended for a better understanding of the accommodative symptoms associated with the IGB system.

Background: A novel technique of posterior component separation using transversus abdominis release has been propagated to recreate the midline (Linea alba) in patients with large midline incisional hernias and provides a large space for placement of an underlay mesh. Another recent technique popularized by minimal access surgeons is the endoscopically assisted anterior Component Separation Technique with laparoscopic intra-abdominal composite mesh repair. Method: In our study, we did open Component separation by the posterior approach for the first fifteen patients and Endoscopic assisted component separation with laparoscopic meshplasty for the next fifteen patients. A minimum component separation index from the data of the first fifteen patients was calculated using pre-operative CECT scans validating the requirement of component separation index the endoscopic group of patients. All the repairs were reinforced using a prolene or composite mesh as a standard practice. Result: The wound complications were more with the open technique while the endoscopic procedure was associated with lesser blood loss and faster post-operative recovery. Improved functional and cosmetic outcomes were observed in both groups. Conclusion: The component separation done by either a posterior open or endoscopic technique results in good functional and cosmetic outcomes for the patients with no reported recurrences.

This study is intended to assess the safety of Laparoscopic surgery in the elderly aged 60 years and older in terms of mortality and morbidity in Manila Doctors Hospital. Since elderly patients are more prone to complications due to the body’s physiological changes and comorbidities. From January 2016 to December 31, 2018, all patients aged 60 years and above who underwent Laparoscopic Cholecystectomy, Laparoscopic Appendectomy and Laparoscopic Hernia Repair were included in the study. Physiologic and operative scores using P-POSSUM and estimates of patient-specific postoperative complications after the surgical procedure using ACS NSQIP risk scoring were used. The overall morbidity and mortality outcome was compared with a choice of international studies. A total of 273 elderly patients underwent laparoscopic surgery. Mostly, 53.1% of the population were 60 to 64 years old who underwent cholecystectomy procedure. The study showed that laparoscopic procedures were safe in the elderly patient despite the challenge that the older population has decreased physiologic reserved and with multiple comorbidities. Among 273 elderly patients, only 3 patients had complications. 2 or 0.74% had pneumonia and 1 or 0.36% died.