Laparoscopic bariatric surgery though growing rapidly in the past two decades has a high degree of immediate postoperative complications. We present three emergent complications in our series of first 100 cases in a private hospital in Oman which were tackled appropriately by our team of professionals. These complications were one staple line hemorrhage in laparoscopic sleeve gastrectomy, twist of gastric pouch in mini gastric bypass and leakage of gastrojejunal anastomosis in Roux-en-Y gastric bypass. In all the three cases, thorough postoperative vigil has been stressed upon as an important factor in postoperative bariatric surgical care. In the gastric bypass case, despite the absence of definite findings in the radiological investigations, patient was taken to the operating room on high degree of clinical suspicion as a part of diagnostic algorithm.

Introduction: Trauma is a major health problem in Saudi Arabia and the number one cause of mortality. Tremendous effort is needed to improve the quality of care to decrease the burden of this health problem on national hospitals. To be able to establish a new trauma system, we need to have a better insight into the current level of care and practice. This study aims to shed light on trauma patients presenting to the largest emergency department (ED) in Makkah, Saudi Arabia, and determine the length of stay (LOS) for all trauma patients. Methodology: During the 31-day study period, 1984 trauma visits in Alnoor Specialist Hospital in Makkah have been analyzed. The LOS of all the patients presented to ED is calculated and then compared to the LOS of all nontrauma patients. Results: The analysis showed a significant increase in LOS of trauma patients. Several factors have been identified as the major causes of prolonged stay. A priceless insight of the current care provided to trauma patients is described in this study. Further efforts should be focused on the need of advanced trauma care to improve patient's care.

Background and Objective: Surgical residents are at high risk of sustaining sharp injuries. Our aim is to identify predisposing factors of sustaining sharp injuries in operating rooms among surgical residents and their attitudes and behaviors in dealing with sharp injuries. Methods: In this cross-sectional study, a random sampling technique was adopted to recruit a representative sample of surgical residents who were involved in operative procedures in King Abdulaziz University Hospital. Data were collected between September and December 2016 by completing a self-administered questionnaire on attitude toward the most recent sharp injuries, predisposing factors for sharp injuries, and practice of universal precautions during the surgical procedures. Results: Among the 78 recruited residents, 46 (58.9%) had sharp injuries during surgical procedures. Most of the injuries (60%) were self-induced, and (72.9%) of the injuries took place while suturing. Twenty (43.5%) of those who had injuries did not report any injury, 15 (32.6%) reported some, and 11 (23.9%) claim that they reported all their sharp injuries. 44.9% of the participants are fully aware of sharp injuries local policy and procedures in the hospital. Most of the injured participants during surgeries did not follow each step of the local sharp injury policy. The perceived causes of sharp injuries among the participants were due to rushed (61.1%), fatigue (43%), lack of skills (19.4%), lack of assistance (15.3%), lack of sleep (13.9%) and (16.7%) though it is not preventable. 55.1% of all participants have never participated in any sharp-related safety training. 10.2% practiced all three universal precautions of double-gloving, face shields, and hands-free technique. Conclusions: Sharp injuries are common among the surgical residents but are not reported by most of them. Target training about sharp injuries during residency may improve their attitude and behavior toward prevention of sharp injuries in the operative room.

Background: Malignant obstruction due to left-sided colonic malignant lesions is an acute emergent situation which is always dealt with by emergent celiotomy and colostomy for salvage of patient life. Colostomy is considered life-saving in such situations, yet it is of undesirable psychological feedback impressions for patients. The aim of this work is to describe our experience with the use of colonic stent in left-sided malignant obstruction, as a good step to relieve the obstruction, and hence to proceed for one-step resection anastomosis with primary repair without the need for colostomy, which is in itself of good impact for psychological satisfaction and salvage of patient. Patients and Methods: Out of 20 patients with left-sided colonic obstruction, 9 patients were dealt with colonic stent, of them 7 patients had one-step procedure with either left hemicolectomy or sigmoidectomy, and 11 had emergent surgical interference with colostomy. Results: Seven of nine patients had a successful laparoscopic colonic stent, and followed by a successful one-step surgical procedure, two of nine patients had unsuccessful laparoscopic stent with emergent exploration and colostomy. Conclusion: Colonic stent for the left malignant obstruction represents a valuable procedure for one-step resection and primary anastomosis without the need for colostomy.

While acute appendicitis and acute calculous cholecystitis are both common, acute acalculous cholecystitis (AAC) is traditionally rare and usually encountered in the elderly or critically ill patients. Here, we reported a case of simultaneous AAC and acute suppurative appendicitis occurring in a young female that was managed by open cholecystectomy and appendectomy at the same time.

Thymoma is the most common primary mediastinal neoplasm. It is well known to have a strong association with autoimmune diseases, but associated cutaneous disorders are considerably rare presentation of thymoma as paraneoplastic manifestation. Thymectomy is an optional treatment in some autoimmune diseases such as myasthenia gravis. We describe a 51-year-old male with a history of thymoma for 6 years accompanied by generalized severe purpuric rash, which was completely resolved after thymectomy.