Comparison of short- and long-term outcomes of bariatric surgery methods: A retrospective study.

The present study is intended to retrospectively compare the short- and long-term outcomes of 3 different treatment methods in patients undergoing bariatric surgery and the variances in weight and nutritional parameters during the preoperative and postoperative periods. In this study, 534 patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-En-Y gastric bypass (LRYGB), and laparoscopic one anastomosis gastric bypass (LOAGB) between 2014 and 2021 were included. The sociodemographic and biodemographic characteristics of these patients, their weight losses and nutritional changes in the preoperative and postoperative periods, operative times, hospital stays, complications, and morbidity and mortality rates were retrospectively compared. There was a statistically significant difference between the surgical methods in the percentages of excess weight loss and total weight loss in the 1st and 3rd months. There were significant differences in the homeostasis model assessment of insulin resistance, folic acid, vitamin D, iron, ferritin, and parathyroid hormone levels (P < .05). All 3 techniques were found to be successful in facilitating weight loss at the end of the first year. LRYGB and LOAGB were found to be superior to LSG in terms of remission from diabetes during the first 6 months, whereas LSG was superior to the other methods in terms of nutritional deficiencies. Despite being more advantageous in terms of operative time, LSG and LOAGB were disadvantageous compared with the LRYGB technique because of the higher rates of leakage and mortality in the LSG technique and the higher rate of bile reflux in the LOAGB technique.

Investigation of serum and adipose tissue levels of asprosin in patients with severe obesity undergoing sleeve gastrectomy.

OBJECTIVE: This study aimed to reveal the relationship between obesity and asprosin (fibrillin-1) in patients undergoing bariatric surgery and to investigate the role of asprosin in obesity etiopathogenesis. METHODS: The study included 37 patients who underwent laparoscopic sleeve gastrectomy for severe obesity and 37 patients who underwent laparoscopic cholecystectomy for cholelithiasis in the study and control groups, respectively. Blood samples were collected from the patients in the preoperative period to measure biochemical parameters. Blood samples were collected at 6 months postoperatively from the patients in the study group to compare their pre- and postoperative serum asprosin levels. RESULTS: A significant intergroup difference in terms of mean asprosin levels in adipose tissue was noted (p = 0.001). A comparison of preoperative and postoperative 6-month serum asprosin levels in the study group showed significant differences (p = 0.021). The area under the curve of asprosin tissue levels was 78.1%, and the cutoff value was 217.34 ng/g of protein, with a sensitivity and specificity of 73.0%. Tissue levels of asprosin were found to increase the risk of obesity by a factor of 1.018 (odds ratio; 95% CI: 1.008-1.027). CONCLUSIONS: Serum asprosin levels decreased significantly at 6 months after bariatric surgery. Adipose tissue of patients with obesity showed high asprosin levels and immunoreactivity. In conclusion, asprosin levels in adipose tissue were considered a potential independent risk factor in obesity etiopathogenesis.

What Is the Effect of Inguinal Hernia Operations on Sexual Functions?

OBJECTIVE: The study aimed to evaluate sexual function before and after inguinal hernia surgery using a standard, internationally approved, patient-administered questionnaire. METHODS: 57 male inguinal hernia cases operated with the Lichtenstein hernioplasty technique were prospectively included in the study. Patients who agreed to participate in the study had the IIEF (International Index of Erectile Function) scoring system form consisting of 15 questions filled in preoperatively, during the first and sixth months after surgery. Patients' age, BMI, comorbidity, employment status, hernia type, hernia size, and single or bilateral hernia were recorded. The relationship between these variables was evaluated by statistical analysis. RESULTS: A statistically significant difference was found in terms of erectile function, sexual desire, intercourse function, and overall satisfaction, when the preop-postop first month, preop-postop sixth month, and postoperative first month-postop six-month scores were compared (p < 0.05). CONCLUSIONS: Pain and swelling due to an inguinal hernia can negatively affect the sexual functions of the patient, and most of the patients benefit from this after the surgery. Sexual dysfunction may be one of the indications for an inguinal hernia operation.

Comparison of the Algan Hemostatic Agent with Floseal in Rat Liver Laceration Bleeding Model.

OBJECTIVE: Major vascular injury is one of the most important causes of death after trauma. The effective and speedy control of the hemorrhage is crucial in reducing deaths. Many products are used for this purpose. Today, however, an ideal product has not yet been produced and there is a strong demand for such effective hemostatic products. The aim of this study is to compare the efficacy of Algan hemostatic agent with Floseal in the liver laceration model in rats. MATERIALS AND METHODS: A total of 28 rats were used in the study. Rats were divided into 4 groups, each consisting of 7 rats. Experimental liver laceration was established. In the control group, saline-impregnated gauze was applied. Algan hemostatic agent-impregnated sponge, Algan hemostatic agent powder, and Floseal gel were applied to the experimental groups. RESULTS: There was no difference in bleeding control among the Algan hemostatic agent powder, Algan hemostatic agent-impregnated sponge, and Floseal. When compared to the control group, Algan hemostatic agent powder, Algan hemostatic agent-impregnated sponge, and Floseal were found to be very effective in bleeding control, respectively (P=.001, .012, and .002), in the experimental groups. CONCLUSION: This study showed that the properties of both Algan hemostatic agent powder and Algan hemostatic agent-impregnated sponge for controlling bleeding are similar to Floseal. Considering other characteristics such as Algan hemostatic agent's naturalness, easy applicability, and low cost, Algan hemostatic agent has been a promising effective hemostatic agent.

Evaluation of the response to vitamin B12 supplementation in patients with atrophy in sleeve gastrectomy materials.

OBJECTIVE: Vitamin B12 deficiency can be seen in the cases with sleeve gastrectomy. Because the chief factor in vitamin B12 deficiency is gastric atrophy, we aimed to evaluate the effect of atrophy on postoperative vitamin B12 levels in patients who underwent sleeve gastrectomy. MATERIAL AND METHODS: Sixty patients were included in this study. Vitamin B12 levels were compared with presence of atrophy before the operation and after vitamin B12 supplementation. RESULTS: Atrophy was observed in 37 (61.7%) of the cases; 23 (38.3%) patients had no atrophy. There was a statistically significant difference between the presence of atrophy and vitamin B12 levels (p = 0.024). Despite vitamin B12 support, there were statistically significant low vitamin B12 levels after the operation in female patients having atrophy (p = 0.023). The same significance was not observed in males (p = 0.480). CONCLUSION: Vitamin B12 deficiency following obesity surgery is a condition that must be monitored and prevented. We found that histopathologically confirmed atrophy had an adverse effect on postoperative vitamin B12 levels. These findings can be a guide for the clinicians in the management of these cases.

OBJETIVO: La deficiencia de vitamina B12 se puede observar en los casos de gastrectomía en manga. Debido a que el factor principal en la deficiencia de vitamina B12 es la atrofia gástrica, nuestro objetivo fue evaluar el efecto de la atrofia en los niveles posoperatorios de vitamina B12 en pacientes que se sometieron a gastrectomía en manga. MATERIAL Y MÉTODOS: se incluyeron 60 pacientes en este estudio. Los niveles de vitamina B12 se compararon con la presencia de atrofia antes de la operación y después de la suplementación con vitamina B12. RESULTADOS: Se observó atrofia en 37(61.7%) de los casos; 23 (38.3%) pacientes no presentaron atrofia. Hubo una diferencia estadísticamente significativa entre la presencia de atrofia y los niveles de vitamina B12 (p = 0.024). A pesar del apoyo de vitamina B12, hubo niveles bajos de vitamina B12 estadísticamente significativos después de la operación en pacientes femeninas con atrofia (p = 0.023). No se observó la misma significación en los hombres (p = 0.480). CONCLUSIONES: La deficiencia de vitamina B12 luego de una cirugía de obesidad es una condición que debe ser monitoreada y prevenida. Encontramos que la atrofia confirmada histopatológicamente tuvo un efecto adverso sobre los niveles posoperatorios de vitamina B12. Estos hallazgos pueden ser una guía para los médicos en el manejo de estos casos.

The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery.

OBJECTIVES: To investigate the effects of low-flow anesthesia on hemodynamic parameters and recovery from anesthesia in obese individuals undergoing laparoscopic surgery. METHODS: This randomized-controlled and prospective study included 44 obese patients who underwent laparoscopic sleeve gastrectomy operation. The patients were randomly allocated into 2 groups as low-flow and high-flow anesthesia. Further, the groups compared in terms of hemodynamic parameters, anesthesia recovery times, operation times, and arterial blood gas parameters. RESULTS: The groups were similar with respect to demographic data. Heart rate, peripheral oxygen saturation, arterial blood pressure measurements, end-tidal, and CO2, lactate levels measurements were similar in both groups during the entire procedure. There was also no statistically significant difference in terms of arterial blood gas parameters or anesthesia recovery periods. CONCLUSION: Low-flow anesthesia in laparoscopic obesity surgery seems to be safer compared to high-flow anesthesia in terms of the adequacy of tissue perfusion, depth of anesthesia, and postoperative recovery.

The Relationship Between Histopathologic Findings and Body Mass Index in Sleeve Gastrectomy Materials.

OBJECTIVE: For treatment of obesity, which is one of the important health problems of the present time, lifestyle modification, pharmacotherapy, behavioral treatment methods, and surgical procedures are commonly used. Sleeve gastrectomy is widely used among surgical procedures. We aimed to investigate the relationship between histopathologic findings and body mass indices (BMIs) of cases with sleeve gastrectomy in our study. METHODS: Thirty-seven patients were included in our study who underwent sleeve gastrectomy and whose operation materials were examined histopathologically in our hospital. Two pathologists re-evaluated all gastrectomy materials. The relationship between BMI and the presence of gastritis, atrophy, intestinal metaplasia (IM), Helicobacter pylori (HPL), and other histopathological findings was investigated. RESULTS: The mean age of patients included in the study was 34.7 + 9.3 years. Of patients, 70.3% were female and 29.7% were male. There was a statistically significant difference between BMI and IM among the evaluated histopathologic parameters. Moreover, IM was significantly more present in patients with type 2 diabetes. CONCLUSIONS: There is no previous study investigating the relationship between gastric histopathological findings and BMI in sleeve gastrectomy patients. We think that the statistically significant difference between BMI and IM that we found in our study may shed light on studies to be performed in the future.

Propofol attenuates cytokine-mediated upregulation of expression of inducible nitric oxide synthase and apoptosis during regeneration post-partial hepatectomy.

PURPOSE:: To determine the effects of propofol and ketamine anesthesia on liver regeneration in rats after partial hepatectomy (PHT). METHODS:: Male Wistar albino rats were assigned randomly to four groups of 10. Anesthesia was induced and maintained with propofol in groups 1 and 2, and with ketamine in groups 3 and 4. PHT was undertaken in groups 1 and 3. Rats in groups 2 and 4 (control groups) underwent an identical surgical procedure, but without PHT. At postoperative day-5, rats were killed. Regenerated liver was removed, weighed, and evaluated (by immunohistochemical means) for expression of inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS), apoptosis protease-activating factor (APAF)-1, and proliferating cell nuclear antigen (PCNA). Also, blood samples were collected for measurement of levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6. RESULTS:: Between groups 2 and 4, there were no differences in tissue levels of iNOS, eNOS, and APAF-1 or plasma levels of TNF-α and IL-6. eNOS expression was similar in group 1 and group 3. Expression of iNOS and APAF-1 was mild-to-moderate in group 1, but significantly higher in group 3. Groups 1 and 3 showed an increase in PCNA expression, but expression in both groups was comparable. Plasma levels of TNF-α and IL-6 increased to a lesser degree in group 1 than in group 3. CONCLUSION:: Propofol, as an anesthetic agent, may attenuate cytokine-mediated upregulation of iNOS expression and apoptosis in an animal model of liver regeneration after partial hepatectomy.

Propofol attenuates cytokine-mediated upregulation of expression of inducible nitric oxide synthase and apoptosis during regeneration post-partial hepatectomy

Abstract Purpose: To determine the effects of propofol and ketamine anesthesia on liver regeneration in rats after partial hepatectomy (PHT). Methods: Male Wistar albino rats were assigned randomly to four groups of 10. Anesthesia was induced and maintained with propofol in groups 1 and 2, and with ketamine in groups 3 and 4. PHT was undertaken in groups 1 and 3. Rats in groups 2 and 4 (control groups) underwent an identical surgical procedure, but without PHT. At postoperative day-5, rats were killed. Regenerated liver was removed, weighed, and evaluated (by immunohistochemical means) for expression of inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS), apoptosis protease-activating factor (APAF)-1, and proliferating cell nuclear antigen (PCNA). Also, blood samples were collected for measurement of levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6. Results: Between groups 2 and 4, there were no differences in tissue levels of iNOS, eNOS, and APAF-1 or plasma levels of TNF-α and IL-6. eNOS expression was similar in group 1 and group 3. Expression of iNOS and APAF-1 was mild-to-moderate in group 1, but significantly higher in group 3. Groups 1 and 3 showed an increase in PCNA expression, but expression in both groups was comparable. Plasma levels of TNF-α and IL-6 increased to a lesser degree in group 1 than in group 3. Conclusion: Propofol, as an anesthetic agent, may attenuate cytokine-mediated upregulation of iNOS expression and apoptosis in an animal model of liver regeneration after partial hepatectomy.

Effects of platelet rich plasma on fascial healing in rats with fecal peritonitis

PURPOSE: To evaluate the effects of platelet rich plasma (PRP) on the healing of fascia wherein peritonitis has been created. METHODS: Twenty eight Wistar Albino rats were divided into four groups. Only a primary fascial repair following laparotomy was performed on Group 1, a primary fascial repair performed and PRP treatment applied following laparotomy on Group 2, and a fecal peritonitis created following laparotomy and a primary fascial repair carried out on Group 3. A fecal peritonitis was created following laparotomy and primary fascial repair and PRP treatment on the fascia was carried out on Group 4. RESULTS: TNF-α was found to be significantly lower in the control group (Group 1). It was detected at the highest level in the group in which fecal peritonitis was created and PRP applied (Group 4). TGF-ß was determined as being significantly higher only in Group 4. Histopathologically, the differences between the groups in terms of cell infiltration and collagen deposition were not found to be significant. CONCLUSION: When platelet rich plasma was given histologically and biochemicaly as wound healing parameters cellular infiltration, collagen accumulation, and tissue hydroxyiproline levels were not increased but neovascularization, fibroblast activation and TNF Alfa levels were increased and PRP accelerated wound healing.

Effects of platelet rich plasma on fascial healing in rats with fecal peritonitis

ABSTRACT PURPOSE : To evaluate the effects of platelet rich plasma (PRP) on the healing of fascia wherein peritonitis has been created. METHODS: Twenty eight Wistar Albino rats were divided into four groups. Only a primary fascial repair following laparotomy was performed on Group 1, a primary fascial repair performed and PRP treatment applied following laparotomy on Group 2, and a fecal peritonitis created following laparotomy and a primary fascial repair carried out on Group 3. A fecal peritonitis was created following laparotomy and primary fascial repair and PRP treatment on the fascia was carried out on Group 4. RESULTS: TNF-α was found to be significantly lower in the control group (Group 1). It was detected at the highest level in the group in which fecal peritonitis was created and PRP applied (Group 4). TGF-β was determined as being significantly higher only in Group 4. Histopathologically, the differences between the groups in terms of cell infiltration and collagen deposition were not found to be significant. CONCLUSION: When platelet rich plasma was given histologically and biochemicaly as wound healing parameters cellular infiltration, collagen accumulation, and tissue hydroxyiproline levels were not increased but neovascularization, fibroblast activation and TNF Alfa levels were increased and PRP accelerated wound healing.

Appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain.

BACKGROUND: Unnecessary hospital admissions and negative appendectomies increase healthcare costs of patients with right lower quadrant (RLQ) pain. This study aimed to evaluate the impact on the cost of treatment of appendicitis scoring systems. METHODS: Charts were reviewed of patients admitted to the general surgery ward of our hospital with RLQ pain within a year. Alvarado and Lintula scores were calculated, and a simulation was performed to determine the treatment charges that would have been generated had the scoring recommendations been used for admission and surgical decision-making. RESULTS: Of the 114 admitted patients, 64 (56%) underwent appendectomy. The rate of negative appendectomy was 17.2%. The overall accuracy rates of the Alvarado and Lintula scores for both 'admit' and 'operate' decision-making were 82.7% and 91.9%, respectively (p=0.102). Total charges for the 114 patients were $39,655. If the Alvarado or Lintula score had been used, the total treatment charges would have been $34,087 and $25,772 (p=0.015 and p=0.000), with negative appendectomy rates of 18.5% and 3.6%, respectively. CONCLUSION: The implementation of Alvarado and Lintula scores for the decision of hospital admission and appendectomy would have reduced overall treatment charges for acute RLQ pain.