Impact of biliary drainage prior to pancreatectomy.

BACKGROUND: There is still a lack of clarity about the benefits of preoperative biliary drainage (PBD), which was introduced to improve the perioperative outcome in patients with obstructive jaundice caused by a periampullary tumour. The aim of this study was to determine whether operative and postoperative complications increase in patients undergoing PBD during pancreatoduodenectomy (PD). MATERIAL AND METHODS: Retrospective examination was made of patients who underwent PBD for a periampullary tumour in our hospital between 2006 and 2014. From these, the patients were identified who had PBD with endoscopic retrograde cholangiopancreatography and these patients were further separated into two groups, as one group of patients with plastic stents and the other group of patients with metallic stents. Patients with pancreas head cancer were also separated into two groups as those who were and were not applied with PBD. The preoperative, intraoperative and postoperative characteristics of the patients were evaluated. RESULTS: A total of 123 patients were retrospectively reviewed. Biliary stent placement with PBD was applied to 48 patients, of whom 31 had metallic stents and 17 had plastic stents. In general, there was no difference between the PBD and the non-PBD groups in respect of the preoperative, operative and postoperative results. When patients with tumour of the pancreas head only were examined, the rate of wound infection was higher in the PBD group and there was no difference in the other parameters. Moreover, there was no difference between the patients with metallic stents and those with plastic stents in respect of outcomes. CONCLUSIONS: With the exception of wound site infection, although no difference was observed between the PBD and the non-PBD groups based on intraoperative and postoperative complications, because of the distinctive inherent complications of PBD it is essential to manage such patients properly and to carefully select the patients for the PBD procedure.

Presentation and Follow-up of Familial Adenomatous Polyposis: Differences Between APC and MUTYH Mutations. / Presentación y seguimiento de poliposis adenomatosa familiar (PAF): diferencias entre las mutaciones APC y MUTYH.

BACKGROUND: Familial adenomatous polyposis is described as one of the common two types of genetic disorders: APC and MUTYH gene associated polyposis syndrome and the clinical differences between the two can sometimes be unclear. MATERIALS AND METHODS: A retrospective analysis and comparison was made of clinical, surgical, and histological criteria, mutation types and the long-term results of patients who underwent genetic analysis which resulted in the diagnosis of Familial Adenomatous Polyposis between 1984 and 2018. RESULTS: Of the total 71 patients included in the study, 14 were identified with the MUTYH gene, and 57 with the APC mutation. In patients with the APC mutation, 63% had duodenal adenoma, 61% gastric polyp and 54% had desmoid tumor. Of the patients with the MUTYH mutation, 21% had duodenal adenoma and 21% were diagnosed with gastric polyps. In 21% of the patients with APC mutation, the polyp count was <100, and 64% of those with the MUTYH mutation had >100 polyps in the colon No statistical difference was determined between the groups in respect of the proportion of patients with >100 polyps. CONCLUSION: The pre-operative genetic testing of patients with polyposis coli will be useful in determining the future clinical outcome and helpful in guiding an informed decision as to whether to apply surgical treatment. It is useful to determine the colonic and extra-colonic involvement of genetic mutation diseases in patients with Familial adenomatous polyposis.

Therapeutic effects of vitamin D on acetic acid-induced colitis in rats.

PURPOSE: To analyze the effect of calcitriol treatment on acute colitis in an experimental rat model. METHODS: A total of 24 adult Sprague Dawley albino rats were randomly separated into 3 equal groups: control group (n:8), colitis group (n:8), calcitriol administered group (n:8). A single dose of acetic acid (1 ml of 4% solution) was administered intrarectally to induce colitis. Group 1 was given 1 ml/kg 0.9% NaCl intraperitoneally; rats belonging to Group 2 were administered calcitriol 1 µg/kg for 5 days. RESULTS: Plasma tumor necrosis factor alpha, Pentraxin 3, and malondialdehyde levels were significantly lower in the calcitriol administered colitis group than in the standard colitis group (p<0.01). In the Calcitriol group, there was a significant histological improvement in hyperemia, hemorrhage and necrotic areas in the epithelium compared to the placebo group (p <0.000). CONCLUSION: The findings suggest that calcitriol may be an agent that could be used in acute colitis treatment.

Laparoscopic Conversion from Single Anastomosis Duodeno-Jejunal Bypass with Sleeve Gastrectomy (SADJ-S) to Roux-en-Y Gastric Bypass (GBP): Improving Unsatisfactory Outcomes.

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) can be considered as either a primary procedure or second stage procedure. Malnutrition is rare but could lead to a reversal of the SADI-S. The aim of this manuscript is to present the management and technique of weight regain after proximalization of a SADI-S by converting it to a gastric bypass.

Therapeutic effects of vitamin D on acetic acid-induced colitis in rats

Abstract Purpose To analyze the effect of calcitriol treatment on acute colitis in an experimental rat model. Methods A total of 24 adult Sprague Dawley albino rats were randomly separated into 3 equal groups: control group (n:8), colitis group (n:8), calcitriol administered group (n:8). A single dose of acetic acid (1 ml of 4% solution) was administered intrarectally to induce colitis. Group 1 was given 1 ml/kg 0.9% NaCl intraperitoneally; rats belonging to Group 2 were administered calcitriol 1 µg/kg for 5 days. Results Plasma tumor necrosis factor alpha, Pentraxin 3, and malondialdehyde levels were significantly lower in the calcitriol administered colitis group than in the standard colitis group (p<0.01). In the Calcitriol group, there was a significant histological improvement in hyperemia, hemorrhage and necrotic areas in the epithelium compared to the placebo group (p <0.000). Conclusion The findings suggest that calcitriol may be an agent that could be used in acute colitis treatment.

Colorectal Cancer Prognosis: The Impact of Signet Ring Cell.

BACKGROUND: The prognosis for patients with colorectal cancer shows variation. The characteristics of colorectal cancer patients with signet-ring cell carcinoma (SRCC) are still not clear. MATERIALS AND METHODS: A retrospective comparison was made of the data of signet-ring cell colorectal carcinoma patients operated on between 2009 and 2018 in respect of clinicopathological and operative results, morbidity, mortality, and long-term survival. RESULTS: The study included a total of 34 patients comprising 26 (76%) males and 8 (24%) females with a mean age of 58 ± 11.7 years. Incidence of SRCC was determined as 1.8%. Lymphovascular invasion was determined in 22 (64%) patients. Tumors were determined as stage T2 in 8 (32%) patients, stage T3 in 9 (36%), and stage T4 in 8 (32%). According to the TNM classification, 5 (14.7%) patients were diagnosed with stage 1, 7 (20.6%) with stage 2, 15 (44.1%) with stage 3, and 7 (20.6%) with stage 4. The mean follow-up period was 40.6 ± 30.4 months, and mean disease-free follow-up was determined as 33.1 ± 36.1 months. Fifteen (44.1%) patients died because of the disease. CONCLUSION: Although SRCC is a poor prognostic factor, it should be kept in mind when determining adjuvant therapies and prognosis of patients determined with advanced-stage SRCC.

Conversion of AspireAssist System® to Sleeve Gastrectomy: Technical Video Description.

PURPOSE: The AspireAssist System® (Aspire Bariatrics, Inc. King of Prussia, PA) is a new endoscopic procedure used to treat obese patients. The aim of this dedicated video is to present a case that required revision surgery due to failure of the AspireAssist System®, and to show how the cannula was removed from the abdomen, and why sleeve gastrectomy (SG) was a good option for revisional surgery in that patient. We aim to discuss technical aspects. PATIENT AND METHODS: A 43-year-old female patient who underwent a placement in 2016. Her initial BMI (body mass index) was 38 kg/m2, with a follow-up period of 26 months. A revisional surgery was performed including dissection of the previous gastric fistula and adhesiolysis from the previous AspireAssist System® placement. A complete dissection of the gastrostomy, including removal of all the system, was done. A decision was made, once the incisura angularis and the placement of a 40 Fch bougie showed that the transection could be performed. SG was done. Patients showed an uneventful postoperative course and 4 months follow-up with 45% EWL. CONCLUSION: In case of having the device in place, the surgeon must be aware to remove intraoperatively or endoscopically, the device. Surgeons should consider endoscopic removal of the AspireAssist System® before conversion to another procedure (SG or GBP) at least 6 months of the removal. Removal of the AspireAssist System® should be performed endoscopically but direct conversion to another bariatric procedure can be considered, either to SG or GBP depending on the technical intraoperative aspects.

Is Segmental Colon Resection an Alternative Treatment for Splenic Flexure Cancer?

Background: Optimal elective surgery for splenic flexure cancer is unclear. Three types of surgical treatment methods are commonly used, subtotal colectomy (STC), left hemicolectomy (LHC), and segmental colon resection (SCR), but consensus is lacking as to which is the optimal method. Materials and Methods: We retrospectively compared clinicopathological and operative results, morbidity, mortality, and long-term survival in patients with splenic flexure cancer who underwent surgery between 1998 and 2018. Results: The study included 124 patients in the study. Following retrospective evaluation of the database, patients were classified into one of three groups according to the surgical approach: (1) STC (n: 41), (2) LHC (n: 55), and (3) SCR (n: 28). No statistically significant differences were found between groups regarding operative results, hospital stay, pathological data, mortality, recurrence, or long-term survival outcomes. Conclusion: Our results suggest that surgical procedures such as STC and LHC have no statistically significant clinical benefits over less aggressive approaches such as SCR. We thus conclude that SCR seems both a safe and effective alternative for splenic flexure tumors.

Laparoscopic Distal Pancreatectomy: Our Experience in a Tertiary Referral Center.

BACKGROUND: Despite an increase in the number of laparoscopic distal pancreatectomy (LDP) procedures being performed, the long-term oncology and operative results are still unclear. The aim of this study was to present the surgical and long-term results of patients undergoing LDP for the treatment of distal pancreatic tumors. MATERIALS AND METHODS: A retrospective review was made of patients who underwent LDP in our clinic, between 2006 and 2018, and who were diagnosed with pancreas tail, neck, and corpus tumors. For the purposes of this study, the data related to the preoperative, operative, and postoperative characteristics of the patients were determined. RESULTS: A total of 46 patients were identified as suitable for inclusion in the study. Of these, 52.1% were female individuals, and the average age of the whole group was 63 years. Previous surgery for malignant diseases was recorded for 54.3% of the patients, due to premalignant diseases in 13% and benign diseases in 32.7%. On average, 10 lymph nodes were removed from patients diagnosed with malignant tumors. The conversion rate was found to be 2.1%. The postoperative pancreatic fistula rate was 26%, and there was 1 complication each of grades III and IV according to the Clavien-Dindo classification. The mortality rate was 0%. CONCLUSIONS: It was concluded that LDP of distal pancreas tumors seems to be both safe and effective in respect of the long-term results in addition to the early results of the operation.

Primary Hydatidosis of the Gluteus Muscle: Report of a Case and Review of the Literature.

Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by Echinococcus granulosus. A 55-year-old woman had no prior surgery for hydatid disease earlier. Total cystopericystectomy was performed without cyst rupture. Albendazole was given postoperatively. Neither systemic or local complications nor recurrences were found after minimum follow-up of 12 months, and the laboratory test results were within the normal ranges. Since primer muscular hydatidosis is a very rare disease, care should be taken in diagnosis of cystic mass of skeletal muscle, especially in endemic areas.

The diagnostic utility of scintigraphy in esophageal burn: a rat model.

BACKGROUND: Corrosive esophageal injury due to accidental ingestion is a serious clinical problem in children particularly in developing countries. The present study was conducted to evaluate the diagnostic utility of technetium-99m-pyrophosphate ((99m)Tc-PYP) scintigraphy in the early stage of esophageal burns by using different concentrations of sodium hydroxide (NaOH) in an experimental rat model. MATERIALS AND METHODS: Twenty-eight male Sprague-Dawley rats, weighing 200-250 g, were used in the study. Esophageal burn model was created in 21 rats by gastrically infusion of various concentrations of NaOH. The rats were divided randomly into three groups: mild-burn group (n = 7) received 15% NaOH, moderate-burn group (n = 7) received 30% NaOH and severe-burn group (n = 7) received 45% NaOH. Seven rats were identified as control group and received normal saline. Three hours after burn injury, 1-mCi (99m)Tc-PYP was administered through tail vein. Two hours after (99m)Tc-PYP administration, static imaging with gamma camera was performed. Then, histopathologic assessment of esophageal samples was achieved properly. RESULTS: All NaOH-applied groups (mild, moderate, and severe) showed a significant higher uptake ratio when compared to control group (P < 0.005). NaOH-applied groups displayed important histologic alterations such as mucosal disintegration, edema, inflammation, and stromal damage when compared to control group. Pearson correlation analysis revealed a significant correlation between the (99m)Tc-PYP uptake ratio and histologic score (P < 0.0005). CONCLUSIONS: The scintigraphic imaging may provide advantages in the early stage of esophageal burns in some patients whom endoscopic procedure is contraindicated because of its high risk of complications such as bleeding and perforation.

Acute nontraumatic torticollis in a patient with right lower quadrant pain: case report.

Right lower quadrant pain is one of the most common symptoms of the emergency patients. For accurate diagnosis and treatment; the patients must be questioned and examined very well. Also accompanying conditions due to right lower quadrant pain may be noticed. In this case presentation, we discussed a patient who was presented with right lower quadrant pain and cervical dystonia. By limiting the usage of metoclopramide the patient was followed seamlessly. In this case presentation we want to accentuate that a patient who with abdominal pain may be presented with rare symptoms such of dystonia. In such conditions a detailed anamnesis and physical examination are the first steps of the evaluation to prevent potential hazardous outcomes. In particular, a surgeon must be always carefully while taking history and examining the patient.