Early predictive factors and risk assessment for anastomotic leakage in patients undergoing low anterior resection for rectal cancer.

OBJECTIVE: Anastomotic leakage is a complication that creates significant concern in terms of postoperative morbidity and mortality after colorectal surgery. This study aimed to identify variables for detecting anastomotic leakage in those who had open, laparoscopic, or robotic low anterior resection for cancer and to explore their relationships. PATIENTS AND METHODS: A total of 283 patients who were diagnosed with rectal cancer and underwent low anterior resection were divided into two groups: those with and without anastomotic leakage. Demographic and clinical data were analyzed. Anastomotic leakage was detected in 23 of 283 patients who underwent low anterior resection. RESULTS: The postoperative analysis of the biochemical data of the patients showed statistically significant differences between the two groups in terms of C-reactive protein (Crp), albumin, lymphocytes, leukocytes, neutrophils, and their ratio. The performance of these parameters in predicting anastomotic leakage was statistically analyzed in the patient group with anastomotic leakage, and nomogram results were acquired. Immune system components and biomarkers were statistically tested, and nomogram results were obtained in rectal cancer patients. CONCLUSIONS: These parameters can be used together as a potential marker in anastomotic leakage. Further development of these variables has the potential to facilitate the timely detection and treatment of anastomotic leakage.

The effect of alpha-lipoic acid on oxidative parameters, SCUBE-1 and SCUBE-2 in hepatic ischemia-reperfusion injury in cholestatic rats.

OBJECTIVE: The aim of the study was to evaluate the protective effects of alpha-lipoic acid (ALA) on the liver, oxidative parameters, and signal peptide-CUB-epidermal growth factor-like domain-containing proteins 1 and 2 (SCUBE-1 and -2) in an experimental cholestatic hepatic ischemia-reperfusion (IR) model. MATERIALS AND METHODS: Twenty-four female rats were included in the study and divided into four groups of six rats each. Group 1 was the control group, in which only laparotomy was performed; Group 2 underwent laparotomy and received alpha-lipoic acid (ALA) on a daily basis; bile duct ligation was performed in Group 3; bile duct ligation was performed, and ALA was administered to Group 4. All rats underwent relaparotomy on the seventh day, followed by 30 minutes of hepatic ischemia and 60 minutes of reperfusion in Groups 3 and 4. Liver tissue and blood samples were taken for histopathological and biochemical examinations. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), albumin, ischemia modified albumin (IMA), SCUBE-1, SCUBE-2, total antioxidant status (TAS) and total oxidant status (TOS) levels were also examined. RESULTS: The SCUBE-1 and SCUBE-2 values in Group 4 were lower than in Group 3, but no significant difference was observed between all the groups. The AST, TBIL, and DBIL levels were significantly higher in Groups 3 and 4 than in Groups 1 and 2 (p<0.0001). Although TOS was the highest in Group 3, the measurements were similar across the groups (p=0.464). IMA and TAS were similar between Groups 3 and 4 but significantly higher in these groups than in Groups 1 and 2 (p=0.001). The hepatic injury observed in Groups 3 and 4 was significantly higher than that observed in Groups 1 and 2 (p<0.0001). In the histopathological examination, neutrophilic infiltration and bile duct proliferation were less commonly detected in the portal areas in Group 4 than in Group 3, and necrotic foci were not observed due to the administration of ALA. CONCLUSIONS: The promising effects of ALA, known for its powerful antioxidant properties, on the IR injury of the liver can allow it to enter clinical practice in the future.

Comparison of robotic-assisted resection alone and with natural orifice specimen extraction for rectal cancer by using Da Vinci Xi.

OBJECTIVE: The aim of our study is to compare the results of robotic surgery-assisted Low Anterior Resection (LAR) and Natural Orifice Specimen Extraction (NOSE) for Rectal Cancer (RC). PATIENTS AND METHODS: From November 2015 to June 2021, patients receiving robotic NOSES and robotic surgery assisted resection (RSAR) were retrospectively enrolled in the study. All robotic-assisted LAR of the rectum, NOSE, colorectal anastomosis and loop ileostomies were performed using the Da Vinci Xi system. RESULTS: A total of 57 patients with robotic NOSES and 93 with robotic RC resection were enrolled. Total mesorectal excision of the rectum, trans-anal or transvaginal specimen extraction (TVSE), anastomoses and protective ileostomy were conducted in all patients. ASA, BMI, tumor histology, stage, nodal stage, mean operative time, estimated blood loss, tumor size, lymph nodes removal, hospital stay morbidity and mortality were evaluated. No patient required conversion to conventional surgery. NOSE has less morbidity and significantly reduces postoperative pain and hospital stay (5.0 vs. 5.5). The two groups were similar in long-term survival. CONCLUSIONS: According to our literature search, this is the first study to compare RSAR and NOSE for RC using the Da Vinci Xi system. NOSE can be performed safely and successfully on selected patients, providing excellent good results.

Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy.

OBJECTIVE: In this study, we aimed to describe the findings associated with gastric pathology and to identify the prevalence of Helicobacter pylori (H. pylori) in patients undergoing laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: Gastric specimens of a total of 291 patients (225 females, 66 males; mean age: 42 years; range: 18 to 60 years) who underwent LSG for the treatment of morbid obesity were analyzed. Histopathologic diagnoses and their relation with body mass index (BMI), age and gender were evaluated. RESULTS: In the histopathological examination of sleeve specimens, 58 patients (19.93%) had chronic gastritis, 102 patients (35.05%) had chronic active gastritis, 27 patients (9.27%) had follicular gastritis, 47 patients (16.15%) had active follicular gastritis, one patient (0.34%) had a glomus tumor, and one patient (0.34%) had a gastrointestinal stromal tumor. The gastric mucosa was normal in 55 patients (18.90%). Intestinal metaplasia was detected in eight patients (2.74%). The H. pylori test result was positive in 126 patients (43.29%). There was no statistically significant difference between the pathological diagnoses and age and sex of the patient. CONCLUSIONS: Our study results suggest that the prevalence of chronic active gastritis and H. pylori positivity is high in morbidly obese Turkish patient population. No significant difference was found between the pathological diagnosis in obese patients with LSG operation in terms of age and sex.

The impact of laparoscopic sleeve gastrectomy on plasma obestatin and ghrelin levels.

OBJECTIVE: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on the levels of obestatin and ghrelin hormones and body mass index (BMI) in morbidly obese patients. PATIENTS AND METHODS: The study included 30 morbidly obese patients who had LSG. Five cc blood samples were taken from the patients preoperatively and at postoperative months 3 and 6. After serum extraction, the levels of obestatin and ghrelin hormones and the levels of fasting insulin and glucose were studied using the enzyme-linked immunosorbent assay (ELISA) method. The homeostatic model assessment of insulin resistance (HOMA-IR) score was calculated. Preoperative and postoperative 3- and 6-month BMI were calculated. Kruskal-Wallis Analysis of Variance, Bonferroni-Dunn Test, Spearman's correlation test, and Pearson's correlation test were used for statistical analysis. RESULTS: BMI of the patients were statistically significantly reduced at postoperative months 3 and 6 compared to preoperative values, and at postoperative month 3 compared to month 6 values (p < 0.001). Ghrelin values were higher at postoperative month 6 compared to the preoperative and postoperative month 3 values (p < 0.001). Obestatin values of the patients were lower at postoperative month 6 compared to the preoperative and postoperative month3 values (p < 0.001). Insulin and glucose values were statistically significantly lower at postoperative months 3 and 6 compared to preoperative values (p < 0.001), whereas there was no difference between months 3 and 6. HOMA-IR score was significantly lower at postoperative month 3 compared to preoperative values (p < 0.001). CONCLUSIONS: LSG enables effective weight loss and glucose regulation in obese patients. LSG has also effects on obestatin and ghrelin hormones, which are coded by the same gene and have opposing effects, and the associated mechanisms of which are still controversial. Obestatin produces a feeling of satiety, whereas ghrelin initiates eating by producing a feeling of hunger. The patients were observed to have increased ghrelin and reduced obestatin postoperatively due to a negative energy balance.

Nesfatin-1 hormone levels in morbidly obese patients after laparoscopic sleeve gastrectomy.

OBJECTIVE: To investigate changes in body mass index (BMI) and nesfatin-1 levels in patients with morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: Blood samples were collected from, and the BMI calculated of 30 morbidly obese patients pre-surgery and at 3 and 6 months post-surgery. Nesfatin-1 hormone levels were measured using enzyme-linked immunosorbent assay (ELISA). Descriptive statistical analysis of the data was performed using Kruskal-Wallis variance analysis, one-way ANOVA, and the Bonferroni-Dunn test. The correlations between continuous variables not displaying normal distribution and those displaying normal distributions were analyzed using the Spearman correlation test and the Pearson correlation test, respectively. RESULTS: The mean age of the 30 patients was 41.23 ± 10.37 years. The mean BMI values (kg/m2) were 49.30 ± 7.92, 39,48 ± 7.32, and 34.39 ± 7.56 presurgery, three months post-surgery, and six months post-surgery, respectively (p < 0.001). Mean nesfatin-1 levels (ng/ml) were 22.80 ± 14.16, 60.23 ± 52.92, and 96.99 ± 40.20 presurgery, three months post-surgery, and six months post-surgery, respectively (p < 0.001). The postoperative months 3 and 6 BMI values were significantly lower than the preoperative BMI value and the postoperative month 6 BMI value was significantly lower than the postoperative month 3 BMI value (p < 0.001). The postoperative months 3 and 6 nesfatin-1 levels were significantly higher than the preoperative nesfatin-1 levels. A negative correlation was found between age and preoperative nesfatin-1 values (p = 0.001, r = -0.0557). CONCLUSIONS: Observation of significant increases in nesfatin-1 hormone levels in morbidly obese patients who had undergone LSG indicate that nesfatin-1 has important anorexigenic effects post-surgery and may be an important component of future obesity treatments.

The effect of alpha lipoic acid on rat kidneys in methotrexate induced oxidative injury.

OBJECTIVE: The purpose of this study is to determine the antioxidant and anti-inflammatory effects of alpha lipoic acid (ALA) on methotrexate (MTX) induced kidney injury in rats. MATERIALS AND METHODS: Thirty-two rats were equally divided into four groups; control, ALA, MTX and MTX with ALA groups. A single dose of MTX (20 mg/kg) was administered to make kidney injury to groups 3 and 4, intraperitoneally. The ALA was administered intraperitonealy in groups 2 and 4 and the other groups received saline injection for five days. On the sixth day the blood samples and kidney tissues were obtained for the measurement of TNF-α, IL-1ß, malondialdehyde, glutathione, myeloperoxidase and sodium potassium-adenosine triphosphatase levels and histological examination. RESULTS: Administration of MTX caused a decrease in tissue GSH, and Na+, K+-ATPase activity significantly. A significant increase in tissue MDA and MPO activities were also seen. The pro-inflammatory cytokines (TNF-α, IL-ß) were increased in the MTX group significantly. ALA treatment reversed all biochemical indices as well as histopathological alterations induced by MTX administration. CONCLUSIONS: MTX made oxidative damage on kidneys of rat and it was partially prevented by anti-inflammatory and antioxidant effects of ALA treatment.

Ileal J-Pouch Perforation: Case Report.

A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.

Relation between weight loss and age after laparoscopic sleeve gastrectomy.

OBJECTIVE: As a bariatric surgery; Laparoscopic Sleeve Gastrectomy (LSG) has gained popularity in recent years. In our study, we aimed to investigate the impact of age on postoperative weight loss at one year after laparoscopic sleeve gastrectomy. PATIENTS AND METHODS: In our clinic between May 2011 and July 2013, 55 patients who underwent LSG with the diagnosis of obesity were included in the study. Patients were divided into two groups below and over an age of 40. Preoperative and postoperative first year Body Mass Index (BMI), percent of Body Mass Index Lost (% BMIL) and Excess Body Mass Index Lost (% EBMIL) were recorded. RESULTS: A total of 55 patients with a mean age of 37.2 ± 8.6 years were included in the study. 37 were women. Patients divided into the age below 40 years old (group 1, n = 29) and over 40 years old (group 2, n = 26). The average age of the groups was 29.9 ± 4.63 and 45.3 ± 7.02, respectively. Characteristics of patients among groups were similar. The preoperative average BMI of groups were 49.34 ± 5.87 kg/m² and 49.73 ± 5.38 kg/m², postoperative first year mean BMI of groups were 30.05 ± 5.78 kg/m² and 36.15 ± 6.64 kg/m², respectively. Percentage loss in BMI was 19.29 ± 3.14% and 13.58 ± 2.96%, respectively; and % EBMIL was 82.95 ± 21.88% and 56.75 ± 15.90%, respectively. CONCLUSIONS: We suggest that age might be as a major determining factor for weight loss and patients over forty years old undergoing LSG for bariatric surgery should be informed about that they will have a lower weight lost.

Is the lateralization distance important in terms in patients undergoing the modified Limberg flap procedure for treatment of pilonidal sinus?

BACKGROUND: The aim of this study was to determine whether the lateralization distance causes differences in the flattening ratio of the natal cleft, early complications, or recurrence rates in patients with sacrococcygeal pilonidal sinus disease undergoing the modified Limberg flap. METHODS: This clinical study was conducted from March 2012 to April 2013. Forty patients with sacrococcygeal pilonidal sinus disease were divided into two groups of 20 patients, each according to the lateralization distance of the lower part of the Limberg flap incision (Group I, 1 cm lateralized; Group II, 2 cm lateralized). Early wound complications, recurrence rates, and the flattening ratio of the natal cleft were evaluated. RESULTS: No statistically significant differences in operating time (mean 42.2 ± 5.7 and 42.3 ± 6.4 min, respectively; p = 0.855), drain removal time [median 3 (range 2-10) and 4 (range 2-14) days, respectively; p = 0.1], or length of hospitalization [median 1 (range 1-3) and 1 (range 1-4) days, respectively; p = 0.775] were found between the groups. The mean follow-up period was 12.8 ± 3.7 months. Recurrence was observed in only one patient of Group II. There were no statistically significant differences in the flattening ratio of the natal cleft, overall wound complications, or recurrence between the two groups. CONCLUSIONS: No statistically significant differences in early complications or recurrence rates were found between the two different lateralization distances in the modified Limberg flap procedure. Therefore, we conclude that 1-cm lateralization of the lower part of the incision is sufficient.

Volvulated paraoesophageal gastric herniation with perforation into bursa omentalis: report of a case.

Although paraoesophageal hernias remain 30% asymptomatic, when diagnosed they have to be operated because of their fatal complications such as ischaemia, bleeding and perforation. The mortality rate increases to twenty times in emergency cases when it is compared with elective ones. Site of gastric perforation may be directed towards bursa omentalis as well as to peritoneal cavity. A case of a volvulated paraoesophageal gastric herniation ruptured to bursa omentalis is discussed with the review of the literature.

Multinodular goitre with thyroid hemiagenesis: a case report and review of the literature.

Thyroid hemiagenesis is a very rare abnormality, in which one thyroid lobe fails to develop. Most of the patients have an associated thyroid disease. The true prevalance of thyroid hemiagenesis is not known, but it is estimated to be 0.02% in normal children. We report a forty-four-year-old female patient with a multinoduler goitre in the right lobe, associated with hemiagenesis of the left lobe.