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Patients suffering from complex regional pain syndrome (CRPS) often experience debilitating symptoms that significantly impact their quality of life. At Burjeel Day Surgery Center, specialists are employing advanced interventional pain management techniques to provide relief for these challenging cases.

Understanding Complex Regional Pain Syndrome

CRPS is a disabling condition that typically affects limbs following an injury or surgery. The condition manifests through severe pain, swelling, limited range of motion, temperature changes, and skin discoloration. While the definitive pathology remains incompletely understood, current evidence suggests CRPS involves immune system disruption affecting the nervous system.

Dr. Shailendra Chauhan, Consultant Anesthesia and Pain Management at Burjeel Day Surgery Center, explains: “CRPS is categorized into two types: Type 1 (Reflex Sympathetic Dystrophy) when there is no obvious nerve injury, and Type 2 (Causalgia) when there is a clear nerve injury. Both types present with overlapping symptoms but differ in their underlying mechanisms.”

Diagnosis relies on clinical criteria such as the Budapest Criteria, which evaluates sensory, vasomotor, sudomotor/edema, and motor/trophic changes to establish the presence of CRPS.

Targeted Intervention

A lumbar sympathetic block is a minimally invasive pain procedure designed to disrupt nerve signals from the sympathetic chain to the lower extremities. This intervention is particularly valuable for various painful conditions, including CRPS, phantom limb pain, hyperhidrosis, vascular insufficiencies, and herpes zoster.

“The densest portion of the lumbar sympathetic ganglia is located at the L2 and L3 vertebral levels,” notes Dr. Chauhan. “For optimal results, we typically perform the initial diagnostic block at the L3 level using only local anesthetic. If significant relief is achieved, we proceed with radiofrequency ablation at L2, L3, and L4 levels for longer-lasting benefit.”

Case Study: Post-Surgical CRPS

A young male patient was referred from the orthopedic department after developing CRPS following right knee surgery three months prior. His presentation included:

• Elevated skin temperature around the knee
• Moderate to severe pain (VAS 7/10)
• Mild swelling
• Hypoesthesia (decreased sensation) along the lateral aspect of the limb
• Allodynia (pain from normally non-painful stimuli) along the anterior aspect

Conservative management had failed to provide adequate relief, prompting consideration of interventional techniques.

After thorough counseling and informed consent, the patient underwent a lumbar sympathetic diagnostic block at the right L3 level. The procedure was performed under fluoroscopic guidance to ensure precise needle placement.

Remarkable Results

Following the diagnostic block, the patient experienced immediate pain relief and demonstrated improved range of motion in the affected knee. This dramatic response confirmed the sympathetic nervous system’s involvement in his pain condition and established him as an excellent candidate for radiofrequency ablation.

The patient was subsequently scheduled for radiofrequency ablation, which involves creating controlled lesions to interrupt pain signals for a longer duration than temporary nerve blocks allow. This comprehensive treatment plan will continue at Burjeel Day Surgery Center, Al Reem.

“While CRPS typically doesn’t have a definitive cure, timely interventions like lumbar sympathetic blocks can significantly slow disease progression and provide crucial pain relief, helping patients maintain daily function and quality of life,” Dr. Chauhan emphasizes.

This case highlights the importance of a multidisciplinary approach to chronic pain conditions and the value of specialized interventional techniques in managing complex pain syndromes refractory to conventional medical management.

Experts

In a remarkable surgical achievement, specialists at Burjeel Hospital have successfully treated a rare vascular condition that affects only a tiny fraction of the population worldwide. The patient presented with debilitating symptoms that were successfully resolved through an innovative surgical approach.

Extremely Rare Diagnosis

A young male patient arrived at Burjeel Hospital with short-distance claudication – severe pain that occurred after walking only brief distances. This symptom significantly limited his mobility and quality of life, prompting a thorough diagnostic investigation.

CT angiogram and MRI examinations of the right knee revealed an unusual finding: cystic adventitial disease affecting the popliteal artery. This exceedingly rare vascular disorder involves cystic degeneration in the wall of an artery, most commonly occurring in the popliteal artery behind the knee.

“Since its first description in 1947, only about 300 cases have been reported worldwide,” explains Dr. Moatasiem Bukhari, Consultant Vascular Surgeon at Burjeel Hospital. “This makes it one of the rarest vascular conditions we encounter in clinical practice.”

Tissue biopsy confirmed the diagnosis, and the case was thoroughly reviewed in Burjeel’s Vascular Multidisciplinary Team meeting, where specialists concurred on the optimal approach to treatment.

Surgical Management Challenges

The consensus was to perform an open surgical procedure using a posterior approach to access the affected area. This challenging operation was further complicated by several factors:

1. The rarity of the condition, with minimal precedent cases for reference
2. Severe inflammatory changes affecting both the artery itself and surrounding tissues
3. The compact anatomical space of the popliteal fossa where the affected artery was located
4. This was the first such case to be treated within the Burjeel Holdings hospital network

The surgical team successfully performed an interposition graft procedure, using the patient’s own long saphenous vein from the same leg to create a bypass around the affected arterial segment. This approach preserves blood flow while eliminating the diseased portion of the vessel.

Excellent Patient Outcome

Following surgery, the patient remained in the hospital for five days for observation and recovery before being discharged in good health. The procedure restored normal blood flow to the lower extremity, alleviating the painful claudication symptoms and allowing the patient to resume normal daily activities.

This case exemplifies the specialized expertise available at Burjeel Hospital for treating even the most uncommon vascular conditions. The successful outcome resulted from meticulous diagnosis, careful surgical planning, and the precise execution of a complex vascular procedure.

The case underscores the importance of considering rare vascular disorders in the differential diagnosis of patients with atypical claudication symptoms, particularly in younger individuals without traditional risk factors for peripheral arterial disease.

Experts

A remarkable case of a forgotten double J stent retained for six years presented unique challenges for urologists at LLH Hospital, who successfully removed the heavily encrusted stent through a combination of innovative techniques.

Case Background

A 35-year-old female patient presented to LLH Hospital with right flank pain and burning during urination. Her medical history revealed that she had undergone ureteroscopy with double J stent placement six years prior while working outside the UAE. Due to various circumstances, the stent—which is typically removed after 4-6 weeks—had never been extracted.

“Double J stents are essential tools in urological practice, providing effective drainage from kidney to bladder in various conditions,” explains Dr. Jai Pal Paryani, Specialist Urologist at LLH Hospital. “However, when forgotten or neglected, these temporary devices can create serious complications including stone formation, infection, and renal impairment.”

Diagnostic Findings

Initial ultrasound and X-ray KUB (kidney, ureter, bladder) examinations revealed a heavily encrusted double J stent with a large bladder stone measuring approximately 6 cm. CT scan confirmed the findings, showing calculus deposits along the entire length of the stent, with particular concentration around the upper coil in the kidney.

Laboratory tests revealed slightly elevated creatinine levels and a urinary tract infection with Staphylococcus aureus. This case represented one of the longest-retained stents with the highest stone burden documented in the UAE.

Treatment Approach

The management strategy developed by Dr. Paryani and Dr. Jana Kalyan Vijaya Kumar involved a multi-step approach:

1. Initial Antibiotic Treatment: The patient received appropriate antibiotics to address the urinary infection before surgical intervention.
2. Extracorporeal Shock Wave Lithotripsy: An initial attempt to break up the stones around the upper coil of the stent using ESWL proved unsuccessful in releasing it from the renal pelvis mucosa.
3. Combined Endourological Procedure:
   • Introduction of a 20 Fr nephroscope sheath to remove the large bladder stone using pneumatic lithotripsy
   • Deployment of a 6 Fr ureteroscope alongside the encrusted stent within the ureter
   • Careful internal lithotripsy to fragment stone formations throughout the ureter
   • Delicate freeing of the upper coil from renal pelvis mucosa where it had become embedded
   • Successful removal of the entire stent with all fragmented stones

Technical Excellence

The case presented extraordinary technical challenges. The stent had become an integrated part of the urinary tract after six years, with significant encrustations throughout its length. The bladder stone alone was substantial, while the embedded nature of the upper coil required exceptional care to avoid renal injury.

“Managing forgotten stents requires a careful, individualized approach,” notes Dr. Vijaya Kumar. “In this case, we utilized multiple techniques across several specialties, including endourology, lithotripsy, and minimally invasive approaches to achieve complete removal with minimal trauma.”

Preventive Strategies

This case underscores the importance of proper stent management systems in urological practice. Key preventive measures include:

• Comprehensive patient education about temporary nature of stents
• Clear follow-up protocols with reminder systems
• Maintenance of stent registries in hospitals
• Patient tracking mechanisms for those relocating between healthcare systems

The successful management of this complex case highlights the sophisticated urological capabilities available at LLH Hospital and serves as an important reminder about the potential complications of medical device oversight.

A two-year-old boy’s life was saved through the swift and coordinated efforts of a multidisciplinary medical team at Burjeel Specialty Hospital in Sharjah, after he had swallowed 17 small magnetic pieces that posed a significant risk to his digestive system.

Critical Presentation

The toddler was brought to the hospital after experiencing nausea and refusing food for approximately 72 hours. His parents, unaware of what might be causing these symptoms, sought medical attention when the refusal to eat persisted. An abdominal X-ray revealed the alarming presence of 17 magnetic pieces that had been ingested at least 72-96 hours prior, according to parental estimates.

By the time of presentation, the child had not passed stool for 48 hours and was showing signs of discomfort, irritability, and anxiety. Clinical examination revealed sluggish bowel sounds, suggesting developing intestinal obstruction—a potentially life-threatening complication.

Immediate Intervention

“Foreign body ingestion in children is a relatively common occurrence, but multiple magnetic pieces represent a particularly dangerous scenario,” explains Dr. Mohamed El Sayed Eraki Ibrahium, Medical Director and Consultant of General & Laparoscopic Surgery at Burjeel Specialty Hospital Sharjah. “When multiple magnets are swallowed, they can attract each other through intestinal walls, leading to pressure necrosis, perforation, and peritonitis.”

The medical team devised a two-phase approach:

Phase 1: Endoscopic Retrieval Under general anesthesia, Dr. Mehreen Zamanr, Specialist Gastroenterologist, performed an emergency gastroscopy. The procedure revealed multiple magnet pieces in the stomach body and antrum, with some impacted at the pylorus—the stomach’s exit point.

Using specialized endoscopic tools including rat-tooth forceps and snares, the team successfully retrieved 13 magnetic pieces over a two-hour period. The remarkable challenge during this phase was the powerful magnetic force between the pieces, which caused them to resist separation and required exceptional technical skill to overcome.

Phase 2: Surgical Intervention Fluoroscopic imaging during gastroscopy revealed that four remaining magnetic pieces had already passed into the distal intestine, likely stuck at the ileocecal junction. An immediate colonoscopy attempt proved unsuccessful due to stool impaction.

After consultation with general surgeons Dr. Eraki and Dr. Saima Asrar, the decision was made to proceed with a laparotomy to retrieve the remaining magnets. During surgery, all four magnets were located in the ileum and successfully removed through a small enterotomy. Significantly, the team observed early ulceration of the intestinal wall where the magnets had lodged—confirming the urgency of intervention before perforation could occur.

Technical Challenges

“This case presented unique challenges due to the magnetic properties of the foreign bodies,” notes Dr. Saima Asrar. “When attempting to remove one piece endoscopically, if it slipped from the forceps, it would immediately be drawn back to the remaining stack by magnetic forces. Additionally, the duration of impaction had begun to cause superficial necrosis of the stomach lining where some pieces had been stationed.”

The successful outcome was achieved through seamless coordination between gastroenterology and surgical teams, along with rapid decision-making when initial approaches required modification.

Public Health Importance

This case highlights the critical importance of keeping small magnetic objects away from young children. Parents and caregivers should be vigilant about magnetic toys, decorative items, and household objects that could pose ingestion risks.

Dr. Eraki emphasizes: “Immediate medical attention is crucial if magnetic ingestion is suspected or witnessed. The window for non-surgical intervention narrows significantly after 48-72 hours, and delays can lead to serious complications including intestinal perforation, peritonitis, and sepsis.”

Thanks to the coordinated efforts of the medical team at Burjeel Specialty Hospital Sharjah, this young patient made a full recovery from a potentially life-threatening situation.

Experts

In a remarkable feat of surgical expertise, a multidisciplinary team at Burjeel Hospital successfully removed a massive retroperitoneal liposarcoma weighing over 16 kilograms, dramatically improving a patient’s quality of life after years of increasingly debilitating symptoms.

Patient Journey

A 63-year-old man presented to the Outpatient Department at Burjeel Hospital with progressive abdominal distension that had begun approximately eight years prior. While the growth had been relatively slow initially, it had accelerated dramatically over the previous six months, causing severe discomfort and significantly impacting his daily activities.

The patient, who described himself as having avoided medical attention due to fear of hospitals and surgical procedures, was experiencing severe challenges with mobility, difficulty sleeping, lower extremity swelling, and chronic back pain. Basic activities like bending had become impossible.

Comprehensive Assessment

Upon examination, the medical team discovered an extraordinarily large abdominal mass measuring approximately 50 x 50 x 40 centimeters, occupying all quadrants of the patient’s abdomen. The mass had caused significant physical changes including umbilical stretching, abdominal wall edema, and bilateral lower extremity swelling extending to the thighs.

Dr. Mohammed Basheeruddin Inamdar, Consultant Surgical Oncologist, explains: “Cases of this magnitude are exceedingly rare in modern healthcare settings. Most patients seek intervention long before a tumor reaches such proportions.”

Diagnostic imaging was vital to surgical planning:

• CT scans revealed a heterogeneous mass with fatty, solid, and calcified components occupying most of the abdomen and pelvis
• The mass had displaced bowel loops superiorly and compressed vital structures including the urinary bladder, aorta, and inferior vena cava
• PET-CT confirmed the absence of metastatic disease
• All tumor markers (AFP, Beta HCG, LDH, CEA, CA 19-9) were within normal limits

Multidisciplinary Approach

The case was comprehensively reviewed by Burjeel Hospital’s Oncology Multidisciplinary Team, including medical oncologists, surgical oncologists, radiation oncologists, radiologists, and nuclear medicine specialists. After thorough evaluation, the team recommended surgical intervention as the primary treatment.

The surgical plan included:

1. Bilateral ureteric catheterization to protect the ureters during dissection
2. Laparotomy with careful dissection around major blood vessels
3. Complete resection of the retroperitoneal tumor

Surgical Challenges

The 5-hour procedure presented several significant technical challenges:

• The tumor’s massive size and weight (16.2 kg) required careful handling to prevent vascular injury
• Severely dilated blood vessels throughout the tumor bed increased bleeding risk
• Compression of major vessels (IVC, aorta, iliac vessels) had distorted normal anatomy
• The extensive adhesions and large surgical field required meticulous dissection

Despite these challenges, Dr. Inamdar and the surgical team successfully completed the procedure with minimal blood loss. Postoperative recovery was smooth, and the patient was discharged on the sixth postoperative day.

Life-Changing Outcome

“Retroperitoneal sarcomas of this magnitude severely compromise quality of life,” notes Dr. Inamdar. “Before surgery, this patient was barely able to walk and had bilateral pitting pedal edema to the knee joint. These slow-growing tumors can reach massive proportions if neglected.”

The patient expressed profound gratitude for the life-changing results following recovery. With the massive tumor burden removed, he could return to normal activities and experience significant relief from his symptoms.

This case highlights the importance of seeking timely medical attention for unusual symptoms and showcases the exceptional surgical capabilities available at Burjeel Hospital, where complex oncological procedures are performed with excellent outcomes.

The multidisciplinary team involved in this case included Prof. Dr. Humaid Obaid bin Harmal Al Shamsi (Consultant Oncologist), Dr. Mehdi Afrit (Specialist Oncologist), Dr. Mohammed Eid Ali (Consultant Anesthesiologist), and Dr. Omar Hnaidi (Consultant Urologist).

Experts

Burjeel Medical City has successfully implemented an innovative, minimally invasive approach to treating cerebral cavernous malformations, offering new hope for patients with this challenging neurological condition.

Understanding the Patient’s Journey

A 23-year-old male patient presented with a history of cerebral cavernous malformation diagnosed approximately one year prior. His condition was initially discovered following a seizure episode with loss of consciousness that required ICU admission. Initial MRI revealed a left frontal hematoma, which was managed conservatively with anti-epileptic medications.

Two weeks prior to his presentation at Burjeel Medical City, the patient experienced a recurrence of symptoms following an episode of hypertension. Upon examination, he was fully conscious with no neurological deficits, but required a comprehensive evaluation to prevent further episodes.

Sophisticated Diagnostic Approach

High-resolution MRI performed at Burjeel Medical City revealed:

• Focal cortical-based altered signal intensity areas in the left temporal and left frontal lobes with enhancement measuring approximately 2.1 and 1.8 cm respectively, classified as type II Zabramski
• Multiple small centimeter to subcentimeter foci throughout the supratentorial brain parenchyma
• Additional tiny dot-like foci in the pons and left cerebellar hemisphere, classified as type IV Zabramski

These findings confirmed the diagnosis of multiple cavernous vascular malformations, with the larger lesions posing a significant risk for future bleeding events.

Multidisciplinary Treatment Approach

The neurosurgical team at Burjeel Medical City, led by Dr. Mohamed A. Elzoghby and Dr. Essam Elgamal, carefully assessed the patient’s condition in collaboration with radiology, oncology, and radiation oncology specialists through the CNS tumor board.

After thorough evaluation, the team recommended surgical intervention for the two larger lesions in the left frontal and temporal lobes. The surgical plan incorporated several advanced techniques:

1. Minimally invasive craniotomies (3 cm each) precisely targeted to each malformation
2. Neuronavigation guidance for pinpoint accuracy
3. Continuous electrophysiological monitoring to protect critical brain functions
4. Intraoperative MRI for real-time confirmation of complete resection

Surgical Challenges and Innovations

The procedure presented several unique challenges:

Critical Location: The lesions were located near the motor area in the dominant hemisphere, requiring exceptional precision to avoid permanent neurological deficits. One particularly delicate aspect involved a cortical artery running directly over one of the malformations, which required careful dissection and preservation.

Pathology Considerations: Cavernous malformations contain abnormally thin-walled blood vessels prone to bleeding. The surgeons utilized microsurgical techniques to meticulously remove the lesions while minimizing the risk of intraoperative hemorrhage.

During the procedure, frozen section analysis confirmed the diagnosis, and intraoperative MRI verified complete resection of both lesions without residual malformation or vascular complications.

Advancing Neurosurgical Excellence

This case exemplifies the significant advantages of combining minimally invasive surgical approaches with advanced intraoperative imaging and monitoring technologies. For patients with cavernous malformations in critical brain regions, this approach offers:

• Reduced surgical trauma
• Lower risk of neurological deficits
• Confirmation of complete resection before closure
• Improved recovery and outcomes

The multidisciplinary team also included Dr. King Jee Dhar (Anesthesiologist), Dr. Rawia Mubarak Mohamed (Anatomic Pathology), and Dr. Mohsin Saleem Basade (Radiology), highlighting Burjeel Medical City’s comprehensive approach to complex neurological conditions.

Experts

In a landmark surgical achievement, a team at Burjeel Medical City (BMC) successfully performed a totally robotic Whipple pancreatoduodenectomy, showcasing the hospital’s cutting-edge technical capabilities and specialized expertise in complex surgical interventions.

Patient Journey

The patient, an Emirati woman with previous breast cancer history, presented with abnormal liver function tests during routine follow-up. Comprehensive diagnostic imaging—including abdominal ultrasound, CT scan, MRI, and endoscopy—revealed a blocked biliary system causing jaundice. The blockage was located at the lower end of her bilio-pancreatic ductal system, specifically at the ampulla region.

Endoscopic evaluation identified a small tumor in the periampullary region, with biopsy confirming periampullary cancer blocking both bile and pancreatic ducts. Further workup confirmed the absence of metastatic spread, making her an ideal candidate for surgical intervention.

Advanced Surgical Approach

“The Whipple procedure is the most complex surgery of the gastrointestinal system,” explains Dr. Ali Iyoob, Consultant & HOD of Gastro-intestinal Surgery at Burjeel Medical City. “Using the technically most demanding robot for this type of surgery is the real challenge.”

Following evaluation at BMC’s multidisciplinary tumor board, the surgical team recommended a minimally invasive approach using the da Vinci Xi Robotic System—a significant advancement over traditional open surgery techniques.

The procedure involves removing:

• Bile duct
• Gallbladder
• Portion of the pancreas
• Duodenum
• Part of the stomach
• Part of the small intestine
• Regional lymph nodes

Following removal, the surgical team meticulously reconstructs the digestive pathway to restore normal function.

Technical Innovations

What distinguishes this procedure is that it was performed entirely using the da Vinci Xi Robot, making it a truly unique surgical achievement. Very few medical centers worldwide have the capability to perform a totally robotic Whipple procedure.

The robotic approach offers significant advantages over both traditional open surgery and laparoscopic techniques:

• Enhanced 3D magnification for surgeons
• Superior dexterity and precision
• Finer tissue manipulation
• Better cancer clearance
• Enhanced lymph node harvesting
• Reduced complications

Successful Outcome

The surgical procedure lasted approximately 500 minutes and proceeded without complications. Postoperative recovery was remarkably smooth, with the patient being able to begin oral nutrition after just 24 hours. She was discharged after 9 days with excellent wound healing and has since returned to a normal diet.

“The reconstruction and joining of pancreas and bile duct to the digestive pathway is the most challenging aspect of this surgery,” notes Dr. Iyoob. “Using the da Vinci Robot, this can be accomplished with minimal risk of leakage complications.”

The surgical team included Dr. Bipin Thomas Prasad, Specialist in General Surgery, and Dr. Murali Shankar, Consultant Anesthesiologist, highlighting the multidisciplinary approach essential for such complex procedures.

This case demonstrates Burjeel Medical City’s position at the forefront of adopting advanced robotic surgical techniques, offering patients in the UAE and Gulf region access to world-class minimally invasive surgical options for even the most complex conditions.

Expert

Pancreatic cancer remains one of the most challenging oncological conditions to treat, often requiring complex surgical interventions. A recent case at Burjeel Hospital Abu Dhabi demonstrates how advanced laparoscopic techniques are transforming outcomes for patients requiring pancreaticoduodenectomy, commonly known as the Whipple procedure.

The Patient’s Journey

A 72-year-old woman was referred to Burjeel Hospital after presenting with epigastric pain lasting one month and experiencing a 3kg weight loss. Having previously undergone right mastectomy for breast cancer in 2002, the patient’s medical history prompted thorough evaluation.

Prior to referral, the patient had undergone ERCP (Endoscopic Retrograde Cholangiopancreatography) with placement of a biliary metal stent. Diagnostic imaging revealed concerning findings that required expert surgical intervention.

Comprehensive Diagnostic Workup

The patient underwent an extensive diagnostic assessment including:

• CT scan of the abdomen revealing a 13mm pancreatic head mass with significant dilation of both the pancreatic duct (10mm) and bile duct (22mm)
• CT chest confirming no metastatic disease
• Elevated tumor marker CA19-9 at 76 (normal range <37)
• Endoscopic ultrasound showing a 2.5cm pancreatic head mass with biopsy indicating potential malignancy

The case was presented at the hospital’s Oncology Multidisciplinary Team meeting, where specialists collectively recommended proceeding with Whipple’s resection based on the highly suspicious imaging appearances indicative of pancreatic head cancer.

Pioneering Surgical Approach

Prof. Dr. Basil Ammori, Consultant Laparoscopic Bariatric, Gastrointestinal, Hepatobiliary and Pancreatic Surgeon at Burjeel Hospital, performed a complete laparoscopic Whipple procedure—a technically demanding operation rarely performed using minimally invasive techniques.

“The laparoscopic approach to Whipple’s resection is challenging and requires specialized expertise in both laparoscopic and pancreatic surgery,” notes Prof. Ammori. “While the procedure takes longer—approximately 10 hours in this case—the benefits for patient recovery are significant.”

Key advantages of the laparoscopic approach include:

• Minimal blood loss during surgery
• No need for intraoperative or postoperative blood transfusions
• Dramatically shortened hospital stay
• Accelerated return to normal activities
• Earlier initiation of adjuvant chemotherapy when needed

Remarkable Recovery

The patient experienced an uneventful recovery and was discharged just four days after surgery—a dramatic improvement over the typical 10-14 day hospitalization period following traditional open Whipple procedures.

Histopathology revealed an undifferentiated carcinosarcoma of the pancreatic head (pT1CN0) with no involvement of the 16 regional lymph nodes examined (0/16) and clear surgical margins, indicating a potentially curative resection.

At the three-week follow-up appointment, the patient was doing well and was scheduled to begin adjuvant chemotherapy based on the Oncology MDT recommendation.

Advancing Surgical Standards

This case highlights the evolution of complex oncological surgery toward minimally invasive approaches. While traditional open Whipple procedures remain standard at many institutions, the laparoscopic approach offers significant benefits for carefully selected patients.

“The rapid recovery associated with laparoscopic surgery means patients can begin adjuvant chemotherapy sooner, potentially improving long-term prognosis,” explains Prof. Ammori. “This integrated approach to cancer care exemplifies modern multidisciplinary treatment.”

The successful implementation of this advanced procedure at Burjeel Hospital Abu Dhabi demonstrates the institution’s commitment to offering state-of-the-art surgical options for patients with complex conditions.

Experts

In pediatric surgery, minimally invasive techniques are revolutionizing treatment options for even the youngest patients. A recent case at Burjeel Hospital Abu Dhabi highlights how laparoscopic approaches are providing excellent outcomes for neonatal patients with inguinal hernias.

The Case

A four-week-old baby girl presented with large bilateral inguinal swellings that had been increasing in size over the previous week. Upon physical examination, the diagnosis was confirmed as reducible large bilateral inguinal hernias, a condition requiring surgical intervention.

Advanced Surgical Approach

The surgical team, led by Prof. Dr. Amulya Saxena, Consultant Pediatric Surgeon at Burjeel Hospital Abu Dhabi, opted for a laparoscopic approach rather than traditional open surgery.

“Laparoscopic procedures offer significant advantages for neonatal patients, including smaller incisions, reduced pain, and faster recovery times,” explains Prof. Saxena. “However, they present unique challenges in such young patients.”

The surgery utilized specialized equipment tailored for neonatal patients:

• A 5mm 30-degree scope for optimal visualization
• 3mm instruments for precise manipulation in small spaces
• Non-resorbable sutures for secure closure of the internal inguinal rings

Technical Challenges Overcome

The primary challenge in this case was navigating the extremely limited abdominal working space typical in neonatal patients. This required exceptional precision with intracorporeal suturing techniques.

The laparoscopic views captured during the procedure show the meticulous process of:

1. Identifying the open right internal ring
2. Performing purse-string sutures around the inguinal rings
3. Precise intracorporeal knot tying to ensure secure closure

Post-Operative Care

Following the successful procedure, the infant remained in the hospital for a single night for apnea monitoring—a standard precaution for neonatal patients. The follow-up appointment one week later confirmed an uneventful recovery with no complications.

Why This Matters

This case exemplifies the advantages of minimally invasive surgical techniques even for the most vulnerable patients. By utilizing laparoscopic approaches, surgeons can achieve excellent outcomes while minimizing trauma, reducing scarring, and promoting faster recovery—critical considerations for neonatal patients.

The successful implementation of these advanced techniques at Burjeel Hospital demonstrates the institution’s commitment to providing cutting-edge surgical care across all age groups, from newborns to adults.

The surgical team included Dr. Samer Shouman Alkahwaty, Consultant Anesthesiologist, whose expertise was essential in managing the anesthetic challenges specific to neonatal patients.

Experts

Introduction

Burjeel Hospital Abu Dhabi has successfully performed a LINX® device implantation to treat severe gastroesophageal reflux disease (GERD) in a patient with previous bariatric surgery. This case highlights the challenges of managing GERD in post-bariatric surgery patients and demonstrates how innovative medical devices can provide effective symptom relief when traditional surgical approaches are not feasible.

Patient History

A 34-year-old male patient presented with a 4-5 year history of debilitating GERD symptoms, including longstanding heartburn, excessive burping, and dysphagia (difficulty swallowing). Despite previous treatment with proton pump inhibitors (PPIs), his symptoms remained uncontrolled. The patient had a significant surgical history, having undergone laparoscopic butterfly gastroplasty for obesity in 2017.

Diagnostic Workup

A comprehensive evaluation was conducted to assess the severity and physiological basis of the patient’s symptoms:

1. Gastroscopy: The endoscopic examination revealed grade A esophagitis (mild inflammation of the esophageal lining) and a 3cm sliding hiatal hernia.
2. pH Study: A 24-hour pH monitoring confirmed severe gastroesophageal reflux with a DeMeester score of 35 to 306 (normal value <14.72), indicating significant acid exposure in the esophagus. The study also demonstrated a strong correlation (93.9%) between reflux episodes and symptom occurrence.

These findings confirmed the diagnosis of severe GERD that was inadequately controlled with medical therapy, warranting surgical intervention.

Surgical Approach

Prof. Dr. Basil Ammori, Consultant in Laparoscopic, Bariatric, General, Gastrointestinal & Hepatobiliary Surgery at Burjeel Hospital Abu Dhabi, performed a laparoscopic hiatal hernia repair and LINX® sphincter-augmentation device placement. The procedure was performed as a day-case surgery with anesthesia provided by Dr. Samer Shouman Alkahwaty.

The LINX® device consists of a small, flexible band of interlinked titanium beads with magnetic cores. When placed around the lower esophageal sphincter (LES), it provides additional support to prevent reflux while still allowing food and liquid to pass into the stomach. This approach is particularly valuable in post-bariatric surgery patients where traditional anti-reflux procedures like fundoplication may not be anatomically possible.

Surgical Outcome

The procedure was completed successfully in just 51 minutes, with the patient recovering uneventfully and being discharged the same day. Follow-up evaluations at both 1 and 6 weeks post-surgery confirmed that the patient remained entirely symptom-free, indicating an excellent immediate clinical outcome.

Unique Challenges in Post-Bariatric GERD

This case highlights several important considerations in managing GERD after bariatric surgery:

1. Limited Surgical Options: Traditional anti-reflux procedures such as fundoplication are often not feasible in post-bariatric patients due to the altered gastric anatomy.
2. Higher Technical Complexity: Previous abdominal surgery can result in adhesions that increase the technical difficulty of subsequent procedures.
3. Specialized Device Solution: The LINX® device provides an effective mechanical barrier to reflux while accommodating the modified gastrointestinal anatomy following bariatric surgery.

Risk Considerations

While generally safe and effective, LINX® device implantation carries specific considerations that patients should be aware of:

1. Esophageal Erosion: Although rare (1-2%), the device can potentially erode into the esophagus over time.
2. MRI Limitations: Patients with the LINX® device have restrictions regarding MRI procedures due to the magnetic components.
3. Technical Expertise: The procedure requires specialized surgical skills and experience with the device, which is available at specialized centers like Burjeel Hospital.

Conclusion

This case demonstrates Burjeel Hospital Abu Dhabi’s capability to offer innovative solutions for complex gastroesophageal disorders, particularly in patients with previous bariatric surgery. The successful LINX® device implantation as a day-case procedure with excellent symptom resolution highlights the value of this approach for carefully selected patients with severe GERD who cannot undergo traditional anti-reflux procedures. Prof. Dr. Basil Ammori’s expertise in both bariatric and anti-reflux surgery provided the necessary skill set to achieve this excellent outcome in a challenging clinical scenario.

Experts