Can serum tumor necrosis factor-alpha predict peritoneal adhesions prior to secondary laparoscopic procedures?

AIM OF THE STUDY: This study aimed to investigate the incidence and degree of postoperative intra-abdominal adhesions(POAs) in secondary laparoscopic procedures and assess the power of the preoperative levels of tumor necrosis factor-alpha(TNF-α) and interleukin-1 beta(IL-1ß) and selected peripheral inflammatory biomarkers(PIBs) in the prediction of the development and extent of POA. PATIENTS AND METHODS: This prospective study enrolled 103 patients who had previously undergone at least one or more laparoscopic abdominal or gynecological operations. We examined TNF-α, IL-1ß, and PIBs, namely C-reactive protein, white blood cell count, neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index(SII) according to the presence, location, and score of adhesions determined during secondary laparoscopic procedures. RESULTS: Only age, postoperative adhesion index(PAI) score, NLR, SII, TNF-α, and IL-1ß resulted in a significant difference in the existence of adhesion(P<0.05). The correlation analysis of TNF-α with variables showed that the PAI score and IL 1ß levels had a significantly positive correlation. CONCLUSION: The presence and extent of POA could be predicted by examining the preoperative TNF-α level in patients who had laparoscopic abdominal surgery previously. We could overcome adverse events during secondary laparoscopic procedures by assessing high-risk patients and integrating a personalized surgical approach to managing selected patients.

WEIGHT LOSS AND BEYOND, ASSESSMENT OF QUALITY OF LIFE AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY USING BAROS IN PATIENTS WITH OBESITY IN TURKEY.

Context: Sleeve gastrectomy is an effective method for management of obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a comprehensive and standard system for the assessment of outcomes of weight loss surgery. It is consisted of weight loss, changes in obesity-related comorbidities and quality of life measurements. We investigated results of the sleeve gastrectomy based on the BAROS. Material and Methods: Outcomes of laparoscopic sleeve gastrectomy surgery was studied in 45 patients with obesity (11 male, 34 female), after 45 months in Turkey. Results: Total weight loss was 26.4±0.1% of body weight at 45 months. Weight regain was seen in 97.8% of the patients with an average 14.5 kg and 13.7% body mass index points. The surgery caused 76% decrease in incidence of obstructive sleep apnea, 73% decrease in type 2 diabetes, 63% decrease in hyperlipidemia and 62% decrease in hypertension. Significant improvement is observed in all quality-of-life parameters. The final score of the BAROS was 4.23±1.02. Conclusion: Based on BAROS, sleeve gastrectomy provides significant improvements in weight loss, incidence of medical comorbidities and quality of life after surgery. Future studies should address prevention of weight regain after the surgery.

A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technique.

BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technique today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technique that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas group 2 (n = 16) labels laparoscopic technique combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There are 12 patients in group 1 and 16 patients in group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in six patients for group 1 and in only 1 patient for group 2. Group 1 had 1 patient who suffered from recurrence where group 2 had no recurrence. DISCUSSION: Laparoscopic technique combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias.

Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer.

BACKGROUND: The red blood cell distribution (RDW) is a test measure of erythrocyte variation and the volume level which shows the heterogeneity and it is a proven test in literature for the determination of survival on cardiovascular diseases. The main purpose of this research is to investigate the relationship between the RDW level and postoperative morbidity as well as its stages in diagnosed pancreatic cancer patients. METHODS: In this study we covered 104 diagnosed pancreatic cancer patients who have been operated in 2011-2014. The RDW levels were separated into two groups. Group 1 contains higher level RDW patients (> 14) whereas group 2 contains only lower level RDW patients. We compared both groups in terms of the patients' demographic data, duration of hospitalization, ratio of pancreatic fistula, disease period, and the mortality rates. RESULTS: In group 1 contains 39 patients whereas group 2 contains only 65 patients. We determined the positive correlation between stages of disease with RDW levels as well as the correlation between low level of blood albumin and Ca 19.9 levels (p = 0001). However we did not observe statistically important difference in postoperative morbidity. CONCLUSIONS: Based on this study we report that RDW levels can be use as a marker to show the stages of pancreatic cancer in diagnosed patients.