Additional gastric resection after one anastomosis gastric bypass-are there benefits?

BACKGROUND: Mini/one anastomosis gastric bypass (MGB-OAGB) is a bariatric surgery procedure that has proved effective for weight loss and the resolution of metabolic disorders. The present study evaluates the effect on postoperative outcomes of resecting the corpus and fundus as an addition to OAGB. METHODS: This retrospective study recorded and evaluated the data of 83 patients who underwent laparoscopic OAGB due to morbid obesity (Body Mass Index-BMI ≥ 40 kg/m2 ) in our clinic between January 2018 and January 2020. The patients were divided into two groups: the first group comprised patients undergoing standard OAGB (n = 49), while the second group included those undergoing OAGB plus (OAGB with additional corpus and fundus resection) (n = 34). The patient data recorded for comparison included demographic characteristics, comorbidities, preoperative and postoperative weight (at 6 and 12 months), body mass index (BMI), excess weight loss% (EWL%), excess BMI loss% (EBL%), and total body weight loss% (TBWL%), hemoglobin, fasting blood glucose (FBG), albumin and HbA1c levels. RESULTS: There was no statistically significant difference between the two groups with regard to age, gender or comorbidities. The operating time, the number of cartridges used during the operation and the length of hospital stay were statistically higher in the OAGB plus group (p = 0.039, p < 0.001, p < 0.001, respectively). No statistically significant difference was seen between the groups regarding weight, BMI, EBL% and TBWL% preoperatively and at 6- and 12-months postsurgery. There was also no statistically significant difference in preoperative and postoperative (at months 6 and 12) levels of hemoglobin, FBG, albumin, and HbA1c between the two groups. DISCUSSION: The addition of resection of the gastric fundus and corpus to an OAGB has no impact on postoperative weight loss or metabolic outcomes.

Intestinal Metaplasia Influencing the Density of Ghrelin Expressing Cells in Morbid Obese Patients.

PURPOSE: The aim was to compare the density of ghrelin-expressing cells (GECs) in morbid obese patients with or without intestinal metaplasia (IM). MATERIALS AND METHODS: The study included 48 patients out of 244 who underwent laparoscopic sleeve gastrectomy between 2015 and 2019. IM was detected in the sleeve gastrectomy specimens of 24 of these 244 patients. The study group consisted of all of the patients with IM. It was a case matched study. Matching factors were age and gender. Ghrelin was stained with a Leica semiautomatic immunohistochemical-staining machine. Stained preparations with ghrelin were subjected to light microscopic examination. RESULTS: The number of GECs in cases with IM was significantly lower than the cases without IM (p = 0.001). The number of GECs was significantly higher in cases with chronic inactive superficial gastritis than cases with chronic active superficial gastritis (p = 0.033). CONCLUSION: We found that there was a decrease in the number of GECs in the corpus and fundus of the stomach in cases with gastric IM as a contribution to the literature. IM cause a decrease in the number of GECs in the gastric oxyntic glands. In addition, chronic active superficial gastritis is also associated with a decrease in the number of GECs. We can say that the common feature of all of these factors may be gastric mucosal damage. Consequently, damage to the gastric mucosa appears to reduce the number of GECs.

Impact of the COVID-19 pandemic on operations in general surgery clinics in Turkey.

INTRODUCTION: The Covid-19 pandemic spread rapidly throughout Turkey from March 2020 onward, and despite modified working conditions in the surgical clinics of our hospitals, some surgical patients became infected with the coronavirus during their perioperative period. AIM: The present study investigates the impact of the novel coronavirus on patients undergoing general surgical operations in our clinics during the Covid-19 pandemic. METHODS: A retrospective analysis was conducted of all surgeries performed in the general surgery clinics of two 'pandemic hospitals' between March 19 and April 30, 2020 - a period when all elective surgeries were suspended in hospitals within Turkey. Demographic data, comorbidities, choice of anesthesia method, blood parameters, duration of stay in hospital and the intensive care unit and mortality rates were compared statistically with the frequency of postoperative Covid-19 positivity in these patients. RESULTS: A total of 275 surgical operations were performed during this period. Covid-19 was identified in seven patients during the postoperative period, and was more commonly diagnosed in those who were elderly and those with comorbidities. (p=0.02, p=0.02). Statistically significant correlations were found between a Covid-19 diagnosis and admission to the intensive care unit, the length of hospital stay and the length of stay in intensive care (p<0.001, p<0.001, p=0.01). Mortality was observed in two patients who developed Covid-19 postoperatively (p= 0.03). CONCLUSIONS: The Covid-19 pandemic has had a significant impact on patients undergoing operations in our general surgery clinics. Precautionary measures taken during postoperative care should be maximized for high-risk patients. KEY WORDS: Covid-19 pandemic, General surgery clinics, Novel coronavirus, Gastrointestinal system surgery.

Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?

Background: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infection (SSI) on the one hand and irrational use of antibiotics on the other. The aim of this study was to determine the need/rationale for antibiotic prophylaxis in patients undergoing laparoscopic bariatric surgery, especially low-risk patients. Methods: This retrospective analysis involved 313 morbidly obese patients (body Mass Index [BMI] ≥40) who underwent laparoscopic BS at three medical centers between September 2018 and June 2019. During the trial, no inducement was given to use antibiotics, and the centers had chosen whether to use prophylaxis. The U.S. Centers for Disease Control and Prevention (CDC)-2016 criteria were used for the diagnosis of SSI. Results: Antibiotic prophylaxis was given to 181 patients, and the SSI rate in the entire series was 4.5% (14/313). There was no significant difference in SSI between the group who received antibiotics and that who did not (2.8% versus 6.8%, respectively; p = 0.09). Post-operative intra-abdominal complications were the main independent determinant for SSIs (p < 0.001). Antibiotic prophylaxis did not have any significant effect on the rate of SSI caused by these complications (2.2% versus 3.8%, respectively; p = 0.50). The second independent factor was the rate of SSI in patients with super-obesity (BMI ≥60), particularly incisional SSIs (p < 0.001). Antibiotic prophylaxis did not produce any significant decrease in the rate of SSI in patients with a BMI < 60 (2.8% versus 5.5%, respectively; p = 0.24). When these two independent factors were excluded, there were no patients with SSI in the no-antibiotics group, and only one in the antibiotic prophylaxis group (0.5%) (p = 1.00). Conclusions: Routine antibiotic prophylaxis should be questioned in laparoscopic BS. Prophylaxis may reduce incisional SSI in patients with a BMI of ≥60. In other cases, antibiotic prophylaxis does not provide a decrease in SSI.

Relationship between health literacy and quality of colonoscopy bowel preparation.

BACKGROUND/AIMS: There are a variety of factors that affect the quality of colonoscopy bowel preparations, although the relationship between the level of health literacy (HL) and the quality of bowel preparations has yet to be clarified. The present study evaluated the effect of HL on the quality of bowel preparation prior to a colonoscopy. MATERIALS AND METHODS: The data of 150 patients who underwent a colonoscopy for colorectal cancer screening and in whom the quality of bowel preparation was scored during the colonoscopy were recorded prospectively. The European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to evaluate HL prior to the colonoscopy, and the Boston bowel preparation scale was used to evaluate the quality of the bowel preparation during the colonoscopy. The demographic characteristics of the patients, the presence of comorbidities, socioeconomic characteristics (marital status, income level, and educational level), HLS-EU-Q47 questionnaire, and Boston bowel preparation scale scores were recorded and evaluated. RESULTS: A significant linear relationship was identified between the general HL index score, the cleanliness of the colonic segments (right, transverse, and left colon) and the total Boston bowel preparation scale score (p=0.013, p=0.010, p=0.008, p=0.001, respectively). In a HL subgroup analysis, a significant linear relationship was noted between disease prevention and health promotion index, the cleanliness of the colonic segments (right, transverse, and left colon), and the total Boston bowel preparation scale score. It was observed that an increase in the health care index resulted in an increase in the cleanliness of the relevant colonic segments and the total Boston bowel preparation scale score. No relationship was found between the right, transverse, and left colon and the total Boston bowel preparation scale scores and gender, age, Body Mass Index (BMI), comorbidity, marital status, level of income, or educational level. CONCLUSION: The level of HL affects the quality of colonoscopy bowel preparations.

What Can be Done for Large and Multiple Choledochal Stones?

Endoscopic retrograde cholangiopancreatography may fail to extract large and multiple choledochal stones in a single session, necessitating a repeat procedure. This paper presents the case of a 68-year female patient who underwent stone extraction following endoscopic retrograde cholangiopancreatography and a subsequent biliary stenting procedure for multiple choledochal stones. Cholelithiasis and choledocholithiasis were detected in the above patient presenting with abdominal pain and jaundice. Conventional endoscopic retrograde cholangiopancreatography techniques failed to extract the stones, and the patient subsequently underwent a sequential insertion of multiple biliary stents. The procedure was used to facilitate the downsizing and fragmentation of the stones. The duct was then cleared using the balloon/basket technique. No problem occurred within the follow-up period and the patient underwent a successful cholecystectomy four weeks after the procedure. Multiple stenting is one treatment method that can be performed in selected patients with large and multiple choledochal stones.   Key Words: Choledocholithiasis, Endoscopic retrograde cholangiopancreatography (ERCP), Biliary stenting.

Foreign bodies in the rectum: 2 Case reports.

Encountering a foreign object in the rectum is rare; however, the incidence has greatly increased in recent years. Treatment of these patients requires a multidisciplinary approach because this condition may have serious complications. Presently described is management of 2 cases of rectal foreign body treated in the clinic.

Anaesthesia for infant with Jarcho Levin syndrome: case report / Anestesia em criança com síndrome de Jarcho-Levin: relato de caso

ABSTRACTJarcho Levin syndrome is a rare disorder. There are various vertebral and costal anomalies. Severe deformities and abnormal fusion of ribs and vertebrae cause respiratory insufficiency and pneumonia. We present anaesthesia in a patient with Jarcho Levin syndrome for vesicoureteral reflux.

RESUMOA síndrome de Jarcho-Levin é um distúrbio raro que apresenta várias anomalias vertebrais e costais. Deformidades graves e fusões anormais das costelas e vértebras causam insuficiência respiratória e pneumonia. Apresentamos um caso de anestesia em paciente com síndrome de Jarcho-Levin para refluxo vesicuretral.

[Anaesthesia for infant with Jarcho Levin syndrome: case report]. / Anestesia em criança com síndrome de Jarcho-Levin: relato de caso.

Jarcho Levin syndrome is a rare disorder. There are various vertebral and costal anomalies. Severe deformities and abnormal fusion of ribs and vertebrae cause respiratory insufficiency and pneumonia. We present anaesthesia in a patient with Jarcho Levin syndrome for vesicoureteral reflux.

Anaesthesia for infant with Jarcho Levin syndrome: case report.

Jarcho Levin syndrome is a rare disorder. There are various vertebral and costal anomalies. Severe deformities and abnormal fusion of ribs and vertebrae cause respiratory insufficiency and pneumonia. We present anaesthesia in a patient with Jarcho Levin syndrome for vesicoureteral reflux.

Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction.

The patient presented in this study was a 54-year-old woman complaining of nausea and vomiting, onset preceding four days, with no significant past medical history and an unremarkable surgical history. The patient was afebrile and hypertensive. Physical examination revealed a non-tender abdomen, and initial laboratory evaluation revealed elevated blood glucose level, ketonuria, leukocytosis, elevated C-reactive protein, gamma glutamyl transferase, lactate dehydrogenase, and total bilirubin. The patient was admitted to the internal medicine ward due to new onset of diabetes mellitus. Due to persistent nausea and vomiting, gastroscopy revealed a healed duodenal ulcer, and abdominal ultrasonography revealed cholelithiasis. The medical condition of the patient deteriorated further in the internal medicine ward, with impending hypotension, tachycardia, leukocytosis, and acute renal failure, and she was admitted to the intensive care unit due to septic shock. A computerized tomography was obtained, which revealed an impacted gallstone in the distal duodenum. The patient was taken to the operating room. The gallstone was encountered in proximal jejunum immediately distal to the ligament of Treitz. A longitudinal enterotomy was made, and the stone was extracted. Her drains were cleared on postoperative day 5, and gastrointestinal function returned to normal. Unfortunately, the patient developed an overwhelming sepsis due to bacteremia and fungemia, and died on post-operative day 19.