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Since 1987, when EA Wickham coined the term “minimally invasive procedure” in British Medical Journal (1), it was clear that the efforts of IbnSina, who used candles and sunlight in surgical operations from the beginning of 6th century (2), have advanced in a new direction to create a new approach to surgery. A minimally invasive procedure is distinct from a noninvasive procedure. These procedures may result in a shorter hospital stay or allow outpatient treatment. When there is minimal damage to biological tissues at the point of entry of instrument(s), the procedure is called minimally invasive. A minimally invasive surgery (MIS) typically involves the use of endoscopic devices, remote-controlled instruments, indirect observation of the operative field through an endoscope, or the use of similar devices, and is performed through the skin or through anatomical openings.We searched medical databases like Pubmed and ISI web of sciences using the terms “endoscopic surgery” or “minimally invasive” and found 36,484 published articles. We calculated that the number of papers published between 2006 and 2011, was about four times the number of papers published before 2000 (n = 7456 vs. n = 25478). These statistics indicate the importance and evolution of this new field of science. They also underline the increase in the number of scientists and researchers in the field of minimally invasive surgical sciences (3). However, the Journal Citation Report in the ISI web of knowledge showed that in 2010, there were 187 indexed journals on MIS. Thus, there is a major gap between the number of researchers in this field and the published journals. Considering the necessity of establishing new journals for researchers, we proposed to establish and publish our journal titled, “Minimally Invasive Surgical Sciences”. This journal is the official journal of the Mediterranean and Middle Eastern Endoscopic Surgery Association (MMESA) and MIS research center of Tehran University of Medical Sciences. MMESA connects scientists in the Mediterranean and Middle Eastern countries while the MIS research center attempts to connect scientists from Iran and countries bordering the Caspian Sea. MMESA connects surgeons in European countries with Middle Eastern and North African MIS surgeons and was been established by Prof. J. Melloti in 1990. This organization is a non-profit, non-governmental body that aims to connect researchers in this field and promote MIS scientists from the above-mentioned regions. Scientific productivity is increasing in different regions of the world,and the scientific productivity of the Islamic Republic of Iran is one of the highest among all countries of the Middle East region. Due to the important role of planning in achieving the top position in this region, we aimed to establish a unique research center for MIS scientists. Thus, the MIS research center was established in 2009 that Supports journal as well. The journal of Minimally Invasive Surgical Sciences (MinSurgery) is a clinical journal officially published by the MMESA and the MIS Research Center of Tehran University of Medical Sciences, and it targets all clinicians active in the field of MIS. This journal was founded in 2011 by “Professor Abdolreza Pazouki” and “Professor Jose M. Schiappa”. The Journal is a peer-review compilation of interdisciplinary findings and global research on MIS and includes original manuscripts, meta-analyses and reviews, health economic papers, debates, and consensus statements of clinical relevance in MIS. In addition, consensus evidential reports not only highlight new observations, original studies, results accompanied by innovative treatments, and all other relevant topics, but also include elucidation of disease mechanisms, important clinical observations, and letters on articles published in the journal. The journal welcomes all types of manuscripts and other scientific communications, including original manuscripts, meta-analyses and reviews, health economic papers, debates, and consensus statements of clinical relevance in MIS (4). To ensure that both surgical and non-surgical procedures are addressed equally, the scope of this journal includes surgical sciences as well as non-surgical methods. Articles from streams such as cardiology, pain and anesthesiology, gastroenterology, pulmonology can be submitted to the journal. In the last decade, all surgical techniques have been modified to use the MIS approach, primarily because of the less invasive procedures and fewer complications. Gynecologists, general surgeons, urologists, orthopedists, neurosurgeons, and ENT specialists use MIS methods in their routine operations. We invite all clinical practitioners, researchers, and surgeons who are active in the field of MIS to submit their valuable papers through our online submission system and provide solutions for the various issues in this field.

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Background: Familial adenomatous polyposis (FAP) is a well-known entity for specialist
and it has near 100% chance of malignant changes if does not managed surgically. In order
to reduce the disadvantages of laparatomy and diverting ileostomy we present our
results of laparoscopic total proctocolectomy without diverting ileostomy.
Objectives: The aim of this study was to present the results of laparoscopic total proctocolectomy
and J pouch ileoanal anastomosis without diverting ileostomy in managing
patients with familial adenomatous polyposis (FAP).
Patients and Methods: Hospital records of 19 patients who were diagnosed with FAP and underwent
laparoscopic restorative proctocolectomy without ileostomy were retrospectively
evaluated in this study. Early complications and demographic data were considered.
Results: The mean age of patients was 34 years, with a standard deviation of 4.3 years. The
most common presenting symptom was rectal bleeding. Two weeks after the operation,
no leakage was detected at the site of anastomosis, but some patients experienced temporary
diarrhea and fecal incontinence.
Conclusions: Laparoscopic total proctocolectomy and J Pouch ileoanal anastomosis without
diverting loop ileostomy seems to be a safe procedure in the management of FAP.

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Background: Female genital tuberculosis is an important cause of secondary amenorrhea
and infertility in developing countries where tuberculosis is endemic.
Objectives: We present three cases in which endometrial tuberculosis was a cause of secondary
amenorrhea and infertility.
Patients and Methods: In a retrospective study from January 2007 to June 2010, we conducted
1010 laparoscopies for infertile patients. Among these patients, three had secondary
amenorrhea and infertility; therefore, they underwent hysteroscopy and endometrial
biopsy.
Results: The laparoscopic findings showed normal uterus and ovaries in all three patients;
although the fallopian tubes were patent in one patient, they blocked in the other two. Hysteroscopy
findings revealed that the endometrial layer was atrophied in all three patients,
and biopsy results revealed the presence of acid-fast bacilli using Zeihl-Neelsen stain.
Conclusions: Patients with genital tuberculosis may have no documented history of tuberculosis
or may have evidence of tuberculosis lesions elsewhere in the body. Histopathological
evidence from biopsies of premenstrual endometrial tissue or demonstration of tubercle
bacilli in cultures of menstrual blood or endometrial curetting is necessary to reach
a conclusive diagnosis of the disease. When our patients were treated with antituberculosis
treatment for 1 year they regained their menstruation but did not achieve pregnancy.
Of note, if a patient conceives after genital tuberculosis infection, there is an increased
chance of an ectopic pregnancy as a consequence of chronic salpingitis and tubal damage.
Gynecologists in developing countries must consider genital tuberculosis as an important
cause of tubal blockage and secondary amenorrhea that leads to infertility

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Background: Postoperative nausea and vomiting (PONV) is a frequent and unpleasant adverse
event associated with surgery. The reported incidence of PONV after laparoscopic
cholecystectomy (LC) is quite high. Despite the use of different drugs to prevent or relieve
PONV, it continues to be undermanaged. Recently, studies have been undertaken to determine
if gabapentin can be useful for the prevention of PONV.
Objectives: We assessed the effect of perioperative gabapentin administration on PONV
after LC.
Patients and Methods: We enrolled 92 patients scheduled to undergo LC for a randomized
double-blind placebo-controlled study. Patients were divided into two groups of 46 patients.
The intervention group received two doses of 600 mg gabapentin: one dose two hours before
surgery and one dose six hours after surgery. Similarly Control group received capsules
in the same size and shape as gabapentin capsules. All Patients were observed for PONV and
adverse effects of the drug for 24 h. Metoclopramid (10 mg) was used as the antiemetic in
patients with severe PONV in necessary circumstances. Total metoclopramid consumption
were recorded.
Results: There were no demographic differences between the 2 study groups. Within 24 h
of LC, 12 patients who received gabapentin (26.1%) and 30 patients who received a placebo
(65.2%) experienced nausea (P < 0.001), while 10 patients in the intervention group (21.7%)
and 24 patients in the control group (52.3%) vomited (P = 0.002). Metoclopramid was used
to control PONV in 11 intervention patients (23.9%) and 29 control patients (63%; P = 0.001).
Conclusions: Perioperative administration of gabapentin significantly decreases the incidence
of PONV and the requirement for postoperative antiemetic treatment following LC.

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The role of protective ileostomy for restorative proctocolectomy
has been debated. Although anastomotic complications
can be minimized with protective stoma (1),
several authors have reported good outcomes in patients
who have undergone restorative proctocolectomy without
ileostomy (2-5). A previous report has suggested the
possibility of rectal cancer development from the rectal
mucosa remnants resulting from ileal pouch–anal anastomosis
(IPAA) performed using the stapling technique (6).
Therefore, some authors have suggested the selective use
of this technique, particularly in patients with familial adenomatous
polyposis with rectal sparing; while in other
cases, rectal mucosectomy and hand-sewn IPAA have been
recommended (7), because the functional or manometric
outcome of staple and hand-sewn IPAA is not significantly
different (7, 8). However, lifelong surveillance of the IPAA is
essential in all patients.
The key factor to a successful operation is tension-free
anastomosis with good blood supply to the ileal pouch.
Therefore, ileal pouch elongation is a crucial step, particularly
in patients with hand-sewn IPAA, where an additional
ileal length of 3–4 cm may be required. Several techniques
for ileal pouch elongation have been reported, e.g., selective
division of branches of the superior mesenteric artery or division
of the ileocolic artery. Some authors have advocated
preserving the middle colic artery as an additional blood
supply route (9). We have proposed the technique of dividing
the submesenteric arcades and preserving 3 or 4 of the
innermost arcades of the distal ileum as well as both the

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Background: Obesity has emerged as one of the most serious public health concerns in
the 21st century. The consequences of this chronic disorder are serious. Bariatric surgery
has been shown to eliminate comorbid conditions associated with obesity. Currently it
is considered to be the only successful, long-term therapy for morbidly obese subjects.
Objectives: The aim of this study was to evaluate the effect of weight reduction following
laparoscopic total gastric vertical plication on anthropometric indices, lipid profile and
insulin resistance in morbidly obese patients.
Patients and Methods: 15 severely obese patients aged 32.4 ± 10 yr were enrolled in this prospective
study. Body mass index (BMI), waist circumference, high-density lipoprotein cholesterol
(HDL-c), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), triglycerides
(TG), fasting glucose, fasting insulin and insulin sensitivity were measured before and 6
weeks after laparoscopic total gastric vertical plication (LTGVP). Insulin-sensitivity was estimated
using the homeostasis model assessment of insulin-resistance (HOMA-IR).
Results: Anthropometric indices decreased significantly during the 6 week period after
LTGVP. TG, LDL-c, fasting insulin, HOMA-IR and QUIKI also decreased but the changes in
HDL-c, TC and fasting glucose were not significant. At baseline, we found a direct correlation
between weight and TC, weight and fasting glucose, waist to hip ratio and TG and a
negative correlation between waist to hip ratios and HDL-c.
Conclusions: LTGVP results in significant weight loss among morbidly obese subjects,
and following weight reduction, lipid profile and insulin resistance improved.

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Introduction: Epidermoid tumors comprise 1% of intracranial tumors. Although reported,
intraosseous epidermoid tumors are even more rare. Cystic lesions of the petrous apex
are uncommon and surgically challenging; the most rare pathology is presumed to be
epidermoid.
Case Presentation: This is a case of a 61-year-old woman with a large skull-base tumor extending
inferiorly from the C1-C2 articulation and superiorly to the tuberculum sella.
The lesion replaced the left-sided petrous apex, and the lateral extension of the tumor
reached the styloid process. The tumor displayed intradural invasion medial to the internal
auditory meatus, producing an intra-axial mass at the level of the upper pons.
The patient presented with a 4-month history of headache and total unilateral deafness.
Under image guidance, an endoscopic endonasal approach was used to totally resect the
tumor. By following the tumor’s dural defect, the intra-axial part of the tumor was safely
resected, and the dural defect was successfully repaired.
Conclusions: Image-guided endoscopic endonasal surgery is a versatile approach that
can safely and easily address a large epidermoid tumor in this challenging region, obviating
the need for demanding and sophisticated transcranial surgery.

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Background: Surgeon’s depend to a large degree on the amount of blood loss and a clear
view of the surgical field, when conducting endoscopic procedures in order to achieve
satisfactory outcomes. The anesthesiologist’s choice of method for the induction and
maintenance of anesthesia plays a major role in achieving this goal.
Objectives: This study was performed in order to compare the two most well-known
methods in this regard; total intravenous anesthesia (TIVA) and venous inhalational
mixed anesthesia (VIMA).
Patients and Methods: This study included the endoscopic management of 89 patients
with cerebrospinal leakage (CSF leakage) covering a period of nine years (1999-2008) for
whom a subarachnoid injection of fluorescein was first administered, and afterwards
they were maintained under general anesthesia using two distinct methods; propofolremifentanil
versus isoflurane–remifentanil (inhalational or intravenous). During the
operation, hemodynamic indices, blood loss, and surgeon’s satisfaction, were assessed
and compared between the two groups.
Results: Endoscopic management and autografts were successful in repairing anterior
skull defects in 90% of cases. Regarding the surgeon’s satisfaction level, and hemodynamic
stability no significant difference between the two groups was observed (P > 0.01).
Conclusions: Both isoflurane and propofol in combination with remifentanil afford optimal
surgical conditions with regard to hemodynamic parameters and the satisfaction
of the surgeon with the surgical field.

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Background: There are several methods for the ligation of structures during minimally invasive
operations. The hem-o-lok clip is a nonabsorbable polymer clip with a lock engagement
feature. There are few reports about its use in minimally invasive general surgical procedures.
Objectives: In this report, we describe our experience with the hem-o-lok clip during basic,
minimally invasive, general surgery procedures and the adverse events during application
of the hem-o-lok.
Patients and Methods: We retrospectively reviewed all laparoscopic appendectomies (LAs),
cholecystectomies (LCs), and splenectomies (LSs), performed by 6 general surgeons at a
university-affiliated hospital over 4 years. Clip failure was defined as intraoperative or postoperative
bleeding due to clip malfunction that necessitated placement of another clip, conversion
to an open procedure, or postoperative re-exploration. Leakage from the cystic duct
and appendiceal stump was also considered clip failure. A search of the US Food and Drug
Administration Manufacturer and User Facility Device Experience (MAUDE) database using
the appropriate keywords was performed on July 7, 2011. This online resource contains reports
of adverse events involving medical devices.
Results: Over a 4-year period, 856 laparoscopic operations, comprising 770 LC, 55 LS, and 31
LA, were performed. We did not observe any incidence of clip failure. There were 22 reports of
hem-o-lok clip failure in the MAUDA database. Eighty-two percent (n = 18) of clip failures were
reported during laparoscopic nephrectomy. There was no report of failure after LA. There
were 2 reported clip failures after LC (with bile leakage) and 1 after LS (tearing of splenic vessels
with intraoperative bleeding). There was also a report of migration of the hem-o-lok clip
into the common bile duct, which occurred 4 years after a complicated LC.
Conclusions: Hem-o-lok clips that are properly applied during basic laparoscopic procedures
are a secure option for the ligation of the structures. Surgeons must be educated regarding
the proper application technique.

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Appendicitis after age 40 is unusual, and appendicitis two days after laparoscopic hysterectomy
is very rare and has not been reported to date. We describe a 44-year-old woman
who had abdominal pain two days after laparoscopic hysterectomy. The pathology
report indicated early appendicitis and the pain disappeared after appendectomy. In our
opinion, the cause of appendicitis may have been related to the use of monopolar and
bipolar coagulation during laparoscopic hysterectomy, although the coincidence of appendicitis
and laparoscopic surgery may be accidental.

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The incidence of obesity has been increasing steadily,
with approximately 10% of the world’s population meeting
the criteria (1). The limited success of lifestyle and
pharmaceutical interventions has resulted in an increased
interest in bariatric surgery, as it is the only proven
modality for achieving sustainable weight loss, and
impacting survival in the clinically severe obese (BMI ≥
40 or ≥ 35 with severe co-morbid disease) (2). In general,
bariatric surgical intervention involves either a restrictive
or mal-absorptive mechanism, to achieve weight loss.
The two most renowned and successful procedures are;
the Roux-en-Y gastric bypass and the biliopancreatic diversion
with duodenal switch, and these use both routes.
However, both of these procedures have potentially life
threatening post-operative complications, mainly entailing
leakage at anastomoses sites, thus making them less
than ideal interventions.
Gastric banding, sleeve gastrectomy and now recently
gastric plication, are other bariatric surgeries that are
essentially restrictive procedures, which are becoming
more popular (3). Of the restrictive procedures, Laparoscopic
Sleeve Gastrectomy (LSG) and Laparoscopic Total
Gastric Vertical Plication (LTGVP) are relatively similar.
Both involve decreasing the greater curvature of the
stomach, and creating a gastric reservoir resembling a
vertical tube (3). In general, LSG accomplishes this goal
with staple lines and removal of a gastric section, while
LTGVP achieves it with suture lines, without the need for
a gastric section. The advantages of both procedures consist
of; not introducing a foreign object into the body, preserving
the stomach’s pylorus, and avoiding dumping
syndrome (2). However, there are some advantages enjoyed
only by plication. Since LTGVP does not involve the
removal of gastric material, it has the ability to be reversible,
which could make it a more ideal surgical procedure
for some patients (4). Another reported benefit of LTGVP
is that it decreases the risk of fistula formation at the gastroesophageal
junction. It is important to recognize that
these stated surgical advantages of LTGVP rely on the operator’s
competency at minimally invasive techniques, in
this case to perform manual laparoscopic suturing (4).
This article highlights the promise that LTGVP has
shown in achieving significant weight loss and reduction
of comorbid conditions. Golpaie et al. have produced a
well-organized study design that involved a multidisciplinary
team. The drawbacks of this study were that; only

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In this study we present successful management of an inflamed branchial cyst by strip-
ping the inner lining thus providing a safe and definitive treatment. We believe that this
is the first report of this technique in the literature.

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Background: Deep Venous Thrombosis (DVT) is a major risk of morbidity and mortality in morbid obese patients underwent bariatric surgery. There are some controversies in different kind of prophylactic strategies for DVT in laparoscopic bariatric surgeries. Unfractionated heparin (UFH) is an available and reversible anticoagulant used for DVT prophylaxis. Objectives: This study aimed to compare clinical results of two different dosage regimes of unfractionated heparin for short term prophylaxis of DVT after bariatric surgery. Patients and Methods: 139 patients with morbid obesity who underwent laparoscopic bariatric surgery (laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding) were evaluated in two groups: group A received 5000 IU unfractionated heparin q12h and group B received the same dose but q8h ( preliminary dose received before induction of anesthesia followed by 2 or 3 times daily). All patients were evaluated by physical examination and Doppler ultra sound for DVT before and 10 days after surgery. Results: There was no statistically significant difference between two groups in venous thrombosis. No thrombotic events were observed before and after operations. There were no heparin induced thrombocytopenia and no meaningful difference between two groups in postoperative bleeding. Conclusions: This study showed that in combination with non-pharmacologic methods for prevention of thromboembolic events, both regimes of UFH prophylaxis had similar clinical effects.

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Background: Laparoscopic sleeve gastrectomy (LSG) has become popular both as a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients. Objectives: The aim of this study was to evaluate the efficacy of LSG and hiatal hernia repair (HHR) to treat obesity, complicated by hiatus hernia (HH). Patients and Methods: The participants in the study were twenty patients, 14 women and 6 men, with a mean body mass index of 43.4 ± 1.9 kg/m2 and mean age of 47 years. All the subjects were eligible for LSG and eight were found to have esophagitis at preoperative endoscopy. Patients with Barrett’s esophagus were excluded. GERD symptom questionnaire, 24-hour esophageal pH-metry, and manometry were employed as Preand post-procedure assessments. The mean follow-up period was eight months. Clinical outcomes were also evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence. Results: Symptomatic HH was diagnosed preoperatively in 18 patients. In the other two patients, HH was asymptomatic and was diagnosed intra-operatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with an HH > 5 cm. Mortality was nil and no complications occurred. After a mean follow-up of seven months, GERD symptoms resolution occurred in nine patients, while the other patients reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m2 . Conclusions: A laparoscopic hiatal repair with or without commercially available onlay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time, was successful in controlling the reflux symptoms and reducing body weight.

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Dear Editor,

In recent years bariatric surgery has become very popular in concomitance with the recent epidemic of obesity and the large diffusion of the laparoscopic techniques. Besides, the gastric bypass that has been performed for more than 40 years and remains the gold standard of bariatric surgery while the other techniques, such as the gastric banding and more recently, the sleeve gastrectomy (SG) have been introduced to the technical armamentarium of the bariatric surgeon. The rationale behind the introduction of a new procedure should rely on the possibility of achieving the weight loss with the consequences of improvement in obesity-related comorbid conditions and quality of life while reducing the complexity of surgery and the inherent immediate and long-term complications (1). The SG has been rapidly accepted by the bariatric surgeons worldwide in consideration of the several advantages that it offers over the gastric bypass as it implies an easy surgical technique that does not involve any digestive anastomosis, eliminates the risk of internal hernia, preserves the pylorus, renders the whole digestive tract accessible to endoscopy, eliminates the risk of dumping syndrome and peptic ulcer, and allows normal absorption of nutrients, vitamins, minerals, and drugs with respect to the gastric bypass. On the other hand, the SG carries a risk of leak at the oesogastric junction that varies in the hands of experienced surgeons (> 500 procedures) between 0.6 and 3.9 % (mean 1.06%) (2). The evolution of the staple line leak in the SG may last several months and be very difficult to manage. The laparoscopic total vertical plication (LTVP) of the stomach that Golpaie et al. describes in the article published in the recent issue of the Minimally Invasive Surgical Sciences is a further simplification of the SG that should theoretically reduce the risk of high leak that is the true Achill’s heal of the SG (3). The rationale of the LTVP relies on the vertical plication of the stomach along the greater curvature to restrict the capacity of the stomach. Cost reduction associated with the use of the stapler to cut the stomach as in the SG is a further advantage. Golpaie et al. reports the initial results of the LTVP on weight reduction and consequently, on insulin resistance and lipid profile in a selected series of patients at six weeks after surgery. This study is interesting not only because it deals with a new bariatric procedure but also because it reports data on the component of the metabolic syndrome that, in turn, is associated with an increased risk of mortality (4). The authors found that the LTVP is associated with a significant loss of weight and reduction of the waist circumference reflecting the visceral fat that is known to be the source of proinflammatory cytokines and adipokines implicated in the mechanisms, responsible for the occurrence of insulin resistance (5, 6). Indeed, the latter that is a main determinant of the metabolic syndrome was significantly reduced six weeks after LTVP. The authors also found a significant reduction of the hypertriglyceridemia, while no significant effect on the plasma levels of the HDL cholesterol was recorded. However, analysis of the components of metabolic syndrome is biased in this study by the fact that patients with type 2 diabetes and patients taking lipid-lowering drugs as well as patients with serious comorbidities were not included in the study.

As benefits of surgery must persist in the long term to validate a bariatric procedure, longer follow-up results of this study are awaited in the foreseeable future to confirm the efficacy of the TLVP on weight loss as well as on the components of the metabolic syndrome. While resection of the gastric fundus that is performed for the SG accounts for the very low plasma levels of ghrelin and the almost absent feeling of hunger that patients experience after a SG it is not clear what is the evolution of plasma levels of ghrelin after the LTVP. It would be interesting to explore the possibility of the pre-prandial plasma ghrelin reduction after LTVP in analogy with what happens after gastric bypass. Indeed, both procedures share the exclusion of the gastric fundus after coming in contact with food.

The issue of postoperative complications in the form of high leak also deserves a particular attention because the plication in two parts of the stomach layer with a compromised vascular supply may not be as safe as it has been concluded from a short series of selected patients as the one, reported by Golpaie et al.

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Background: Omental cysts are rarely intra-abdominal pathology. We report a case of omental cyst successfully resected by laparoscopy using two ports only with excellent outcome. Case Presentation: Our patient was a seven year old girl who presented with complaints of lump in abdomen, in which laparoscopy aided in making a correct final diagnosis and the surgical management. Preoperative diagnostic work-up included Ultrasonography and Computed Tomography scan (CT scan) of abdomen which revealed huge intraabdominal cystic lesion of unknown origin. Extensive diagnostic workup did not reveal the etiology of his problem. Diagnostic laparoscopy led to the correct diagnosis and appropriate surgical treatment with complete relief of his complaint. Histopathology of the excised specimen was suggestive of lymphangioma. Conclusions: On six months of follow up, the patient is doing well and asymptomatic with no evidence of recurrence.

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Background: Catheterization of central veins is a routine technique which is widely used in general hospitals and medical intensive care units. It should be carefully performed and managed to prevent adverse side effects. Case Presentation: In this case report, we describe a case of lost guide wire during central venous catheterization, which was successfully treated with a minimally invasive surgical technique. Conclusions: Inattention is the main cause of the retained guide wires. The interventional angiography is usually successful as the first line therapy.

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Background: Meralgia paresthetica (MP) is a benign clinical syndrome of entrapment of the lateral cutaneous nerve in the thigh. Among the complications of bariatric surgery, neurologic complications are not uncommon and of these complications, MP is a frequent clinical diagnosis. Thus, knowing the clinical risk factors of MP is of great importance as they help with the differential diagnoses of MP from other serious disorders. Objectives: To study the prevalence of MP and its clinical risk factors after bariatric surgery in a sample of Iranian morbid obese patients undergoing surgery for obesity. Patients and Methods: In a cross-sectional study, 163 patients (146 females and 17 males), who underwent bariatric surgery, were called one to 48 months after their surgery. After obtaining their consent, the patients were interviewed and completed a questionnaire containing history and presentation of neuropathy for this study. In addition, some of the variables of the questionnaire were filled using the patient’s medical records. Results: One month after surgery, 32 patients (19.5%) had neurologic signs or symptoms of MP located in their lateral thigh. Diagnosis of MP was made in 21 (17 women and four men) patients (12.8% of all patients), sub-acute polyneuropathy in seven patients (4.3%), and acute polyneuropathy in the remaining four patients (2.4%). No specific treatment was given to the patients with MP. Symptoms of MP were resolved within six months in 15 patients (71.4%). In a univariate analysis of MP, only a history of a neuropathy was significantly correlated with the occurrance of MP after surgery (P = 0.004) with an odds ratio of 4.2 (95% confidence interval: 1.4-12.2). Conclusions: MP is not a common complication after bariatric laparoscopic surgery, however, a history of neuropathy and diabetes should be mentioned to surgeons as risk factors for MP. Additionally, using a belt for fixation could be a an etiologic factor for MP after bariatric surgery