Unreported rare but serious complication: Major vascular injuries during bariatric surgery.

BACKGROUND: The aim of this study was to investigate the incidence, risk factors, clinical presentation, and management of major vascular injuries during bariatric surgery, with a specific focus on the role of different access methods in abdominal cavity entry. METHODS: A nationwide survey was conducted among bariatric surgeons to assess the prevalence of major vascular injuries. A questionnaire was distributed to 365 surgeons through WhatsApp groups of two national bariatric surgery societies, with 76 surgeons completing the survey. The study population included general surgeons practicing bariatric surgery, and the questionnaire consisted of 12 questions. RESULTS: Among the participants, 16.9% reported experiencing a major vascular injury during bariatric surgery. The majority of injuries (75%) occurred at the trocar entrance, with the remaining cases during the dissection phase. Notably, 66.7% of surgeons used optical trocars for access, while 27.8% employed the Veress needle technique. Early detection varied, with 45% identifying the injury immediately and 30% recognizing it within three minutes. Most injuries (52.4%) were repaired laparoscopically, and only three surgeons sought assistance from cardiovascular surgeons. CONCLUSION: Vascular injuries are infrequent but potentially serious complications in laparoscopic bariatric surgery. Understand-ing their incidence, timely recognition, and proper management are crucial to minimize adverse effects. The findings of this study shed light on the patterns of vascular injuries and the potential role of specific access methods, providing valuable insights for enhancing patient safety in bariatric surgery.

Panniculectomy with bariatric surgery in super morbid obesity patients.

OBJECTIVE: Panniculitis is an inflammation of the subcutaneous fat common in patients defined as super-super obese (>60 kg/m2). Poor hygiene and skin infections are common in the super morbidly obese group due to impaired metabolism of subcutaneous fat tissue, especially at abdominal folding. In our study, we will discuss the short-term results of panniculitis that develops as a result of these, simultaneously with bariatric surgery. MATERIAL AND METHODS: In our study, six super morbid obese patients with Body Mass Index (BMI) of 80 kg/m2, 77 kg/m2, 74 kg/m2, 72 kg/m2, 68 kg/m2, 65 kg/m2, respectively, and sub umbilical skin tissue panniculitis were evaluated. These patients underwent bariatric surgery as a result of the obesity council decision. In the preoperative evaluation of the patients, it was observed that the blood supply to the subcutaneous fat tissues under the umbilicus was impaired, and the dermis/epidermis was hypertrophied. RESULTS: Mean BMI of patients 73 kg/m2. Sleeve Gastrectomy (SG) was performed in 4 patients, Mini Gastric Bypass (MGB) was performed in 1 patient, and modified transit bipartition was performed in 1 patient. Infected erythematous lesions were detected on the skin secondary to ischemia, especially in some areas. After the patients performed the operations, a panniculectomy of approximately 70x30x20 cm was performed from under the umbilicus to the transverse line and up to the fascia. CONCLUSION: Panniculectomy and bariatric surgery are recommended in the appropriate patient group. Extensive prospective studies are required to define further the burden of infectious morbidity and mortality conferred by obesity. KEY WORDS: Bariatric surgery, Obesity, Panniculectomy.

Bridged one-anastomosis gastric bypass: technique and preliminary results.

PURPOSE: One-anastomosis gastric bypass (OAGB) is an established bariatric procedure performed worldwide. We developed a modification of OAGB leaving a bridge at the cranial 2 cm of the fundus as a gastro-gastric fistula to allow for endoscopic access to the bypassed stomach. We present the preliminary results of 44 patients who underwent this technique in our hospital. METHODS: We analyzed, retrospectively, data collected prospectively on 44 patients who underwent our bridged one-anastomosis gastric bypass (BOAGB) procedure between September, 2018 and November, 2020. RESULTS: The mean age of the patients was 45.2 ± 9.3 years (range 20-66 years). The mean preoperative body mass index (BMI), weight, and HbA1c values were 41.5 ± 6.4 kg/m2 (range 35-59), 116 ± 22.7 kg, and 8.2 ± 2.1%, respectively. After a median follow-up period of 18 months (11-26 months), the mean postoperative BMI was 28.4 ± 3.2 kg/m2 (range 21-38), the mean total weight loss was 35.8 ± 13.5 kg (range 20-80 kg), and the mean percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were 79.8 ± 16.1% (range 47-109) and 30.6 ± 6.9% (range 19-48), respectively. The mean postoperative HbA1c level was 6.3 ± 0.9%. There were two early complications (stenosis and bleeding) and one late complication (marginal ulcer). CONCLUSION: Patients who underwent BOAGB lost weight similarly to those who underwent OABG as reported in the literature, without an apparent increase in complications related to the technique. Randomized studies with longer term follow-up are needed.

Recommendations for bariatric and metabolic surgical operations during the COVID-19 pandemic in Turkey.

The world has been struggling with the COVID-19 virus since December 2019. Turkey has also been battling with the virus since March 2019. While struggling with this unknown virus, we have postponed our new bariatric surgeries like most elective surgery. However, curfew and quarantine period (increase in food intake and decreased physical activity) increases risks for morbidity and mortality because of obesity and diabetes. When the pandemic decreases and disappears, many obesity patients will seek treatment for obesity and the workload of surgeons will increase. Before bariatric and metabolic surgery operations, which is the most effective treatment of obesity and related comorbidities, necessary precautions must be determined and implemented to protect patients and healthcare workers before and during surgery. In this review, it was aimed to determine the pre-peri and postoperative periods of bariatric surgical requirements. This review has been written on behalf of the Turkish Society for Metabolic and Bariatric Surgery as an initiative in order to answer some questions about bariatric and metabolic surgery during the COVID-19 pandemic.

Comparison of Magenstrasse and Mill gastroplasty and sleeve gastrectomy techniques as an experimental study on rabbits.

AIM: Bariatric surgery is an important option when life-style modification, diet, and medical treatment are inadequate in lose weight. Bariatric surgical methods have gained popularity in recent years. In this paper, we compared the Magenstrasse and Mill(M&M) technique, with performing a simpler and more physiological type of gastroplasty without implanted foreign material such as band and reservoir, to the Sleeve Gastrectomy (SG) technique. This study aimed to determine the effects of the M&M for obesity on the rabbits in comparison with the SG, which is accepted as a standard bariatric technique with creating a gastric tube. MATERIAL AND METHODS: The study was approved by the University of Van Yuzuncu Yil Regional Committee of Ethics (Institutional Animal Care and Use Committee). 20New Zealand Rabbits underwent operations. After prestudy with 2 rabbits, the remaining 18 rabbits were divided into 2 groups; Group 1 (SG) and Group 2 (M&M). RESULTS: Group 1 rabbits were observed to lose weight in all, while Group 2 rabbits; 2 of them died, 5 of them lost weight, 2 of them gained weight. When the pre and post-operative weight of the rabbits were compared; preoperative median weight values of 9 rabbits in Group 1 were significantly higher than postoperative values. On the other hand, there was no significant change in the mean weight of Group 2 of 7 rabbits (living up to 8weeks). The mean weight of rabbits undergoing standard SG was significantly lower than the M&M technique. CONCLUSION: We believe that this animal experimental study, which we conducted intending to compare M&M and SG techniques, will contribute to the literature as a pilot study and determine the survey of M&M technique as a pioneer in other studies. KEY WORDS: Bariatric surgery, Magenstrasse and Mill gastroplasty, Sleeve gastrectomy.

Retrospective analysis of the first 50 emergency/elective surgical cases in terms of mortality and morbidity in CoVid-19 Pandemic Hospital in Istanbul.

2019-nCoV currently named SARS-CoV-2 is a highly pathogenic Coronavirus identified in Wuhan China in December 2019. Turkey declared the first case relatively late compared to Asian and European countries on March 11, as the first SARS-CoV-2 infection in Turkey. In this study, we aimed to determine patients' outcomes in 50 surgeries done in the incubation period of SARS-CoV-2 in our hospital. METHODS: We retrospectively analyzed the clinical data of 50 patients who underwent surgeries during the incubation period of CoVid-19 at Istinye University Gaziosmanpasa Medical Park Hospital in Istanbul, from March 2 to April 11, 2020. RESULTS: The age of 50 patients range was 21 to 73, and the median age was 43.32 (64%) patients were women. The median length of hospital stay is 2.6 days (1-21). Operations at various difficulty levels were also performed on patients with co-morbidities. No complication or mortality was observed except for 1 patient, and the ICU requirement of that patient was also due to high energy trauma. CONCLUSION: Although contrary claims have been made in various studies; it is the primary duty of us surgeons to operate CoVid-19 positive/suspicious patients safely and without any contamination, and on the other hand, to continue their operations without victimizing negative patients. In this pilot study, we would like to emphasize with necessary and adequate measures these can be achieved. KEY WORDS: CoVid-19, SARS-CoV-2, Surgery.

The Effects of Local and Systemic Administration of Proline on Wound Healing in Rats.

Purpose: Wound healing consists of a sequence of complex molecular and cellular events. Collagen is composed mainly of proline and hydroxyproline. Proline and hydroxyproline constitute 1/3 of the amino acids in collagen, which makes up approximately 30% of the proteins within the body. The hydroxylation of proline found in collagen determines the stability of the triple helical structure of collagen. In this study, we examined the effects of local and systemic administration of proline on wound healing. Materials and Methods: 24 female Sprague-Dawley rats were used in the study and divided into three groups. Group 1: The defect created in the backs of the subjects was left to secondary healing. Group 2: 200 µl proline per day was administered topically for 30 days on the defect in the backs of the subjects. Group 3: 200 µl per day was administered intraperitoneally for 30 days on the defect in the backs of the subjects. Results: On day 21, there was a statistically significant difference between the groups in terms of the mean re-epithelialization score. On days 7 and 14, there was a statistically significant difference between the groups in terms of the mean granulation score. On days 7, 14, and 21, there was a statistically significant difference between the groups in terms of the mean collagen accumulation score. On day 30, there was a statistically significant difference between Groups 1 and 3 in terms of the mean E-mode score on mechanical tensile test. Conclusion: Our study confirmed that proline has positive effects on wound healing. However, it revealed that systemic administration of proline is more effective than local administration of proline.