Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier's procedure).

Perineal procedures have higher recurrence and lower mortality rates than abdominal alternatives for the treatment of rectal prolapse. Presence of incarceration and strangulation also influences treatment choice. Perineal rectosigmoidectomy is one of the treatment options in patients with incarceration and strangulation, with low mortality and acceptable recurrence rates. This operation can be performed especially to avoid general anesthesia in old patients with co-morbidities. We aimed to present perineal rectosigmoidectomy and diverting loop colostomy in a patient with neurological disability due to spinal trauma and incarcerated rectal prolapse.

Laparoscopic Sleeve Gastrectomy With Transit Loop Bipartition and Transit Bipartition in Type 2 Diabetic Patients With Obesity: A Retrospective Analysis.

AIM: We aimed to compare 1-year postoperative results of patients with obesity and type 2 diabetes mellitus (T2DM) who underwent laparoscopic sleeve gastrectomy with transit bipartition (LSG-TB) and transit loop bipartition (LSG-TLB) and mini gastric bypass (MGB). PATIENTS AND METHODS: This is a retrospective comparison of 2 novel bariatric surgery techniques with MGB. Primary outcome measure of the study was a rate of T2DM remission. Secondary outcomes included excess body mass index (BMI) loss, improvement in hepatosteatosis, and duration of operation. Revision surgery needs were also assessed. RESULTS: Overall, 32 patients underwent the LSG-TLB, 15 underwent LSG-TB, and 50 underwent MGB. Mean age and sex distribution were comparable for all groups. Presurgical BMI was similar in MGB and LSG + TB groups, whereas LSG + TLB group had significantly lower BMI values compared with the MGB group. In both groups, BMI values reduced significantly compared with respective baseline values. Excess BMI loss was significantly higher in patients who underwent LSG-TLB compared with patients treated with LSG-TB and MGB. Bariatric surgery procedures lasted shorter in LSG-TLB than in LSG-TB. However, the shortest of all was MGB. The remission of T2DM rates were 71% and 73.3% in LSG-TLB and LSG-TB groups, respectively ( P > 9.999). The rate of revision surgeries was comparable in both groups. CONCLUSION: In conclusion, LSG-TLB took less time and provided significantly higher excess BMI loss compared with LSG-TB. T2DM remission and improvement rates were similar in both groups. LSG-TLB seemed like a promising bariatric surgery technique in patients with obesity and T2DM.

The Evaluation of Serum Endocan, Interleukin-6, and CRP Levels Following Sleeve Gastrectomy.

Background: The excessive accumulation of fat tissue in obesity is the source of chronic low-level inflammation and causes future dysmetabolic and cardiovascular disorders. Removal of this excessive fat tissue with the aid of bariatric surgery (BS) techniques, such as sleeve gastrectomy, may reverse adverse inflammatory outcomes. The aim of this study is to investigate the impact of sleeve gastrectomy on inflammatory markers, specifically endocan, IL-6, and CRP, in individuals with obesity. Methods: Thirty-two patients with class 3 obesity and class 2 obesity + comorbidities were enrolled in the study. Clinical characteristics including age, comorbidity, body mass index (BMI), waist, and hip circumferences of the participants were noted before and 3 months after sleeve gastrectomy. Blood samples were collected during those periods to assess biochemical features such as serum endocan, interleukin-6 (IL-6), C-reactive peptide, fasting insulin, glycosylated hemoglobin A1c levels, and lipid panel. A statistical package program was used for the analysis of those parameters, and p<0.05 was accepted as significant at a 95.0% confidence interval. Results: BMI reduced from 43.55±6.78 to 36.16±6.14 kg/m2 within 3 months following BS (p<0.001). Preoperative serum endocan, IL-6, and CRP levels were correlated with BMI, and in line with BMI reduction, their serum levels decreased after BS (p<0.05). HOMA-IR also reduced after BS, and both in the pre and post-BS periods correlated with BMI, IL-6, endocan, and CRP levels (p<0.05). The mean total body weight loss was 20.4% within 3 months post-BS. Conclusion: BS techniques are effective in weight loss and reversing the inflammatory processes caused by obesity. Serum endocan, IL-6, and CRP levels are promising markers for describing obesity-related inflammation and objectively checking the alleviation of inflammation following BS.

Delayed presentation of post-traumatic diaphragmatic hernia with gastric volvulus: a case report.

Post-traumatic diaphragmatic hernia complicated by gastric volvulus may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia with gastric volvulus is relatively unusual. We report a 28-year-old male patient who admitted with gastric volvulus due to traumatic diaphragmatic hernia after sustaining a knife wound to the left lower chest one year before presentation. The patient has been followed without any symptom for two years since the diaphragmatic hernia was repaired by primary suture plication.

Early Results of Laparoscopic Sleeve Gastrectomy With Loop Bipartition.

PURPOSE: We evaluated early results of this new procedure of transit loop bipartition with sleeve gastrectomy (TLB-SG), making a comparison with transit bipartition with sleeve gastrectomy. MATERIALS AND METHODS: Between January 2017 and September 2017, 22 patients have undergone transit bipartition with sleeve gastrectomy or TLB-SG surgery in our clinic. Patients' body mass index, excess body mass index loss, and HOMA-IR were calculated before and after the surgical operation. The values of c-peptide, HgA1C, insulin, blood sugar, albumin, Hg, urea, creatinine, calcium, total cholesterol, 25-hydroxy vitamin D, and vitamin B12 were evaluated retrospectively. RESULTS: Vitamin and mineral deficiency, malnutrition, and anemia were not observed in both groups during the follow-up process. The operation time was shorter in the TLB-SG operation. Both groups were found to be effective at the expected level in terms of weight loss, diabetes remission, and improvement. CONCLUSIONS: TLB-SG is a more effective and simpler method, becoming a candidate for being the most frequently performed surgical operation, in the field of metabolic surgery.

Effects and Results of Omentopexy During Laparoscopic Sleeve Gastrectomy.

PURPOSE: The aim of this study was to demonstrate that gastric volvulus can be prevented by omentopexy and sleeve gastrectomy without increasing other complication rates. MATERIALS AND METHODS: A total of 1385 patients who underwent omentopexy and sleeve gastrectomy between April 2013 and September 2017 were included this study. Body mass index, age, sex, comorbidities, and postoperative complications of the patients were recorded as data. RESULTS: A total of 1385 patients underwent sleeve gastrectomy and omentopexy. There were 999 female and 386 male patients. The mean age of the patients was 36 years (14 to 71 y). The mean body mass index was 42.74 kg/m (35 to 73 kg/m). Twenty-one patients had previously undergone gastric banding and the other 80 patients had previous abdominal operation. The number of patients undergoing simultaneous cholecystectomy was 98. Three patients had hemorrhage due to hypertension and anticoagulant treatment in the postoperative period and the patients were treated medically. One staple-line leakage was observed. Twist, and stricture were not observed and no mortalities were noted. CONCLUSIONS: Sleeve gastrectomy and omentopexy can prevent the gastric twist, which is a functional cause of gastric stenosis, by stabilizing the posterior stomach wall.

Comparison between direct trocar and Veress needle insertion in laparoscopic cholecystectomy.

Although the Veress needle (VN) is widely used for insufflation of the peritoneum, direct trocar (DT) insertion is going to be more popular. A lot of complications have been reported because of the use of VN. We designed a prospective, nonrandomized study for the comparison of VN and DT insertion techniques. A pneumoperitoneum was created using the VN in 135 patients and using DT insertion technique in 148 patients during a 3-year period. Although no major complication was seen in the DT group, three major complications were seen in the VN group, but there was no statistically significant difference between both groups. More frequent minor complications were seen in the VN group, but it was statistically insignificant. Surgical skill and experience of the surgeon with the entry technique who is using it is an important factor for the selection of the abdominal insufflation technique.

Intussusception of the bowel in adults: two different cases.

Intussusception in adults is considered an unusual condition accounting for 5% of all cases of intussusceptions and almost 1%-5% of all cases of bowel obstruction. We present two cases of patients with a complaint of abdominal discomfort and concomitant vomiting who are 43 and 44 years old. Ileocecal intussusception was diagnosed by computed tomography. One patient underwent open whereas the other underwent laparoscopic right hemicolectomy and ileotransversostomy. A histopathological study revealed lipoma in the first case and adenocarcinoma in the second. We described the diagnosis and treatment of intestinal intussusception in adults.

Early start of CAPD with the Seldinger technique.

The ideal method for inserting continuous ambulatory peritoneal dialysis (PD) catheters remains debatable. Minimally invasive techniques are becoming more popular. The routine recommendation for starting PD is 4 - 6 weeks after catheter insertion. We planned a prospective study to evaluate whether this waiting period is necessary. From January 2003 to July 2004, 42 double-cuff Tenckhoff CAPD catheters were inserted into 41 patients. Percutaneous technique was used and PD was started on the sixth day. Only 2 pericatheter leakages (4.8%) were detected. This procedure is comparatively safe, simple, and less costly than surgical and peritoneoscopic placement. The rate of early pericatheter leakage may be lowered with this technique and PD may be started earlier.

Factors Associated with Mammographic Density in Postmenopausal Women.

OBJECTIVES: Breast density increases the risk of breast cancer, but also in the interpretation of mammography is also important. This study examine the risk factors affecting breast density in postmenopausal women. METHODS: Between January 2013 and January 2014, 215 patients admitted to The Clinics of Gynecology and Obstetrics with complaints of menopause were taken. According to the results of mammography, Group I (non-dense, n = 175) and Group II (dense, n = 40) were created. The informations of the caseswere analyzed retrospectively. RESULTS: In Group I, body mass index (BMI), number of pregnancies, parity were significantly higher than group II (P < 0.05). In group II, the withdrawal period of menstruation and progesterone levels were significantly higher (P < 0.05). In logistic regression analysis, BMI for dense breasts and number of pregnancies were found to be an independent risk factor (P < 0.05). CONCLUSION: Increased BMI, pregnancy and parity, result of reduction in density , but longer duration of menopause and increased progesterone cause an increase in density. BMI and the number of pregnancy was found to be independent risk factors for reducing breast density.

The effect of serosal suture reinforcement on burst pressure in sleeve gastrectomy specimens.

PURPOSE: Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of 2 supportive techniques on burst pressures in sleeved gastrectomy specimens. METHODS: A total of 30 patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into 3 groups: group 1 had no extra support in the staple-line, group 2 had interrupted serosal suture on the staple-line, and group 3 had serosal suture on staple-line junction points. The endpoint was the first detectable leakage, at which point the leak pressure and anatomic site of the leakage were recorded. RESULTS: A total of 30 sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences between groups in terms of age, sex, and body mass index. The leak pressure was significantly higher (56.2±6.4 mm Hg) in group 2 (P<0.01). Leaks occurred significantly more frequently in the staple-line than in the staple-line junction points (P<0.01). CONCLUSIONS: Interrupted serosal suture significantly increased the burst pressure. Increases in intraluminal pressure are known to be significant in leak etiology. Thus, we concluded that interrupted serosal suture may be beneficial in the prevention of leaks.

The effect of narrowed segment length on the degree of early postoperative dysphagia in laparoscopic Nissen fundoplication.

BACKGROUND/AIMS: Although laparoscopic Nissen fundoplication is the gold standard in the surgical treatment of gastroesophageal reflux disease, it may cause troublesome complications like dysphagia. In this study, we demonstrated the effect of narrowed segment length on early dysphagia in patients. MATERIALS AND METHODS: Forty-one patients who underwent laparoscopic Nissen fundoplication by a single surgeon between January 2007 and November 2008 were reviewed. Dysphagia scores were assessed by a question in the Gastrointestinal Quality of Life Index questionnaire and recorded preoperatively and at 1 month and 6 months. Barium esophagogram was performed for all patients at 1 month. Narrowed segment length was measured on esophagogram. Patients were divided into two groups (Group 1, ≤30 mm; Group 2, >30 mm). Dysphagia scores preoperatively and at 1 month and 6 months were compared between the two groups. RESULTS: The two groups were homogeneous in age, gender, body mass index, and preoperative dysphagia score. We were unable to demonstrate any difference in preoperative and postoperative dysphagia scores between the two groups. CONCLUSIONS: In this study, we used subjective data for grade of dysphagia and esophagogram for wrap length instead of manometric data. In our opinion, there is no effect of narrowed segment length on the degree of early postoperative dysphagia in patients undergoing laparoscopic Nissen fundoplication.

Plasma levels of zinc, copper, and ceruloplasmin in patients after undergoing laparoscopic adjustable gastric banding.

Laparoscopic adjustable gastric banding (LAGB) causes significant weight loss in morbidly obese adults. However, its consequences on nutritional status still remain unclear. There are a few studies determining the nutritional status after LAGB and none have focused on the serum levels of zinc (Zn), copper (Cu), and ceruloplasmin (CP). We aimed to investigate the effects of LAGB surgery on plasma Zn, Cu, and CP levels. Thirty patients with LAGB with morbid obesity were included. Blood samples were collected preooperatively and in the postoperative third month to determine plasma Zn, Cu, and CP levels. The mean preoperative and postoperative body mass indexes (BMI) were 44.9 ± 7.4 kg/m(2) and 44.1 ± 6.5 kg/m(2), respectively. The mean weight loss was 12.9 ± 3.3 kg at the postoperative third month. The postoperative Zn (500 ± 130 ng/ml), Cu (280 ± 80 ng/ml), and CP (23.9 ± 8.8 mg/dl) values were statistically significantly lower than the preooperative Zn (740 ± 230 ng/ml), Cu (370 ± 80 ng/ml) and CP (33.3 ± 15.7 mg/dl) levels (p < 0.05). Decreases in the plasma levels of Zn, Cu, and CP were seen postoperatively following LAGB surgery. The nutritional status of LAGB-applied patients should be monitored and mineral supplementation may be considered.

Direct trocar insertion technique for initial access in morbid obesity surgery: technique and results.

PURPOSE: Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese patients. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. This study assesses the safety and feasibility of the direct trocar insertion technique without pre-existing pneumoperitoneum in patients undergoing laparoscopic bariatric surgery. METHODS: From February 2006 to July 2009, 155 morbidly obese patients underwent laparoscopic adjustable gastric band surgery. There were 128 women (82.6%) and 27 men (17.4%). The mean age was 41 and ranged between 18 and 59 years. RESULTS: All patients met the National Institutes of Health criteria for bariatric surgery. The mean body mass index was 45 kg/m (range 35 to 61). There was no evidence of intestinal or vascular injury during trocar placement. Immediate minor complications were extraperitoneal insufflations in 5 patients, gastric serosal laceration in 1 patient, and left liver lobe laceration in 1 patient. No major complications were associated with this technique. CONCLUSIONS: All complications related to the direct trocar insertion technique were minor and these complications did not affect the success of surgery. We concluded that the direct trocar technique for initial access in laparoscopic bariatric surgery provides safe and quick entry into the peritoneal cavity.

Surgical approach to cases with multiple renal arteries in renal transplantation.

AIM: To evaluate the effect of multiple renal artery (MRA) presence on the success and complication rate of renal allotransplantation. PATIENTS AND METHODS: We retrospectively analyzed 187 cases (128 men and 59 women) who were transplanted in our department from 1997 to 2005. 28 of these cases had MRA. Of MRA kidneys, 6 were obtained from cadavers and 22 from live donors. When the types of anastomoses for MRA cases were examined, 4 cases were anastomosed after being connected to the main polar artery with ex vivo bench surgery; the others had in vivo anastomosis. The patients were divided into two groups as single (group 1) and MRA (group 2) groups. Following the transplantation, creatinine levels, ATN ratios, development of hypertension, patient and graft survivals and vascular and urological complications were compared between the two groups. RESULTS: Patient and graft survival rates were compared between the two groups in the first and third post-operative years. In the first year, graft survival rates for groups 1 and 2 were 94.9 and 92.9% respectively, whereas in the third year these were calculated as 88 and 85.7%. Concerning patient survival, first year results for groups 1 and 2 were 92.5 and 89.2%, for the third year these were found to be 84.9 and 82.1%. Mean creatinine levels of both groups were compared in the first and third years. The results for groups 1 and 2 were 1.41 +/- 0.37 and 1.46 +/- 0.46 mg/dl respectively for the first year. In the third year these were found to be 1.60 +/- 0.43 and 1.69 +/- 0.49 mg/dl and there was no statistically significant difference between the groups. Vascular and urological complications were observed in only 6 out of 187 cases (3.2%). CONCLUSIONS: No significant difference has been observed between single and MRA kidneys considering the success and complication rates of renal allotransplantation.