The Effect of Yoga on Early Clinical Outcomes and Pulmonary Functions in Patients Scheduled for Bariatric Surgery: a Randomized Controlled Study.

PURPOSE: The present research was undertaken to investigate the effect of yoga on pulmonary function and early clinical outcomes in patients scheduled for bariatric surgery. MATERIALS AND METHODS: This research with a randomized control group was performed on patients scheduled for bariatric surgery between October 2021 and June 2022 in the General Surgery Clinic of a University Hospital in Eastern Turkey. The sample consists of 100 randomized patients who received yoga breathing exercises and routine care. Pulmonary function test (PFT), posteroanterior chest X-rays (CXR), 6-min walk test, and oxygen saturation (SpO2) were applied as a pretest. The researcher practiced yoga for 40 min every day of the week. Post-test measurements were performed at the end of the yoga practice. Control group patients underwent the tests at the same intervals without any modifications to the standard clinical protocol. RESULTS: The difference between the control and experimental groups was significant in terms of post-test PFT measurements (p < 0.001). In the CXR of the patients, a statistically significant improvement was determined in 61.5% of the patients with yoga breathing practice (p < 0.001). Also, there was a significant increase in the 6-min walk test and SpO2 values in the experimental group (p < 0.05). CONCLUSION: Yoga practice positively affected the pulmonary function values of the patients.

Comparison of the ABCD Score's Accuracy in Predicting Remission of Type 2 Diabetes Mellitus One Year After Sleeve Gastrectomy, One Anastomosis Gastric Bypass, and Sleeve Gastrectomy with Transit Bipartition.

PURPOSE: ABCD score is one of the scoring systems that predicts the probability of T2DM remission after bariatric surgery. Its success in determining T2DM remission after sleeve gastrectomy with transit bipartition (TB) has not yet been validated. The aim of this study was to evaluate the predictive value of ABCD score in TB. MATERIALS AND METHODS: Of 438 patients with T2DM, 191 underwent sleeve gastrectomy (SG), 136 underwent one anastomosis gastric bypass (OAGB), and 111 underwent TB. Retrospective analysis of ABCD scores, 1-year postoperative remission rates, and the predictive accuracy of ABCD scores for these were conducted. RESULTS: In the SG, OAGB, and TB groups, respectively, median ABCD scores were 7, 6, and 4, while complete remission rates were 95.3%, 84.6%, and 76.6% (p < 0.001). The area under curves (AUCs) for SG, OAGB, and TB were 0.829 (95% CI = 0.768 to 0.879, p < 0.0001), 0.801 (95% CI = 0.724 to 0.865, p < 0.0001), and 0.840 (95% CI = 0.758 to 0.902, p < 0.0001), respectively. There was no statistically significant difference between AUCs. CONCLUSION: ABCD score predicts the probability of remission at 1-year follow-up in T2DM patients undergoing TB as accurately as in patients receiving SG or OAGB.

Effects of sildenafil citrate on pancreatic and lung complications in an experimental L-arginine-induced acute pancreatitis model.

AIM: In this study, we aimed to investigate the effects of sildenafil citrate on acute pancreatitis and pulmonary complications of the disease. MATERIAL AND METHODS: In this study, we used 21 male Wistar-Albino rats weighing between 185 and 230 g. The rats were divided into 3 groups. Group 1 rats (control group, n = 7) were administered intraperitoneal 0.9% NaCl injection. Group 2 (study group, n = 7) and Group 3 (treatment group, n = 7) rats were given 100 mg/100 gr L-arginine twice, with an interval of 1 h to create acute pancreatitis. Group 3 was also administered intraperitoneal 10 mg/kg/day sildenafil citrate in 2 equal doses, 30 min and 12 h after creation of AP. The pancreas and lungs of all rats were stained with haematoxylin and eosin and examined histopathologically. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), interleukin (IL) 1α (IL-1α), IL-6, tumor necrosis factor α (TNF-α), nitric oxide (NO) and ADMA levels were measured in blood samples. RESULTS: In the treatment group, levels of amylase, AST, ALT, LDH, IL-1, IL-6, TNF-α, and NO were lower. In addition, pancreas and lung oedema, and perivascular inflammation were significantly less on histopathological examination when compared to the study group (p < 0.001). The ADMA level was significantly higher in the treatment group when compared to the control and study groups. There was no acinar cell necrosis or haemorrhage in the treatment group. However, the difference was not regarded as statistically significant because sufficient acinar cell necrosis and haemorrhage could not be created in the study group. CONCLUSIONS: Sildenafil citrate significantly decreases various biochemical and histopathological changes in the early phase of acute pancreatitis and protects pancreatic tissue.

Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?

Background: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infection (SSI) on the one hand and irrational use of antibiotics on the other. The aim of this study was to determine the need/rationale for antibiotic prophylaxis in patients undergoing laparoscopic bariatric surgery, especially low-risk patients. Methods: This retrospective analysis involved 313 morbidly obese patients (body Mass Index [BMI] ≥40) who underwent laparoscopic BS at three medical centers between September 2018 and June 2019. During the trial, no inducement was given to use antibiotics, and the centers had chosen whether to use prophylaxis. The U.S. Centers for Disease Control and Prevention (CDC)-2016 criteria were used for the diagnosis of SSI. Results: Antibiotic prophylaxis was given to 181 patients, and the SSI rate in the entire series was 4.5% (14/313). There was no significant difference in SSI between the group who received antibiotics and that who did not (2.8% versus 6.8%, respectively; p = 0.09). Post-operative intra-abdominal complications were the main independent determinant for SSIs (p < 0.001). Antibiotic prophylaxis did not have any significant effect on the rate of SSI caused by these complications (2.2% versus 3.8%, respectively; p = 0.50). The second independent factor was the rate of SSI in patients with super-obesity (BMI ≥60), particularly incisional SSIs (p < 0.001). Antibiotic prophylaxis did not produce any significant decrease in the rate of SSI in patients with a BMI < 60 (2.8% versus 5.5%, respectively; p = 0.24). When these two independent factors were excluded, there were no patients with SSI in the no-antibiotics group, and only one in the antibiotic prophylaxis group (0.5%) (p = 1.00). Conclusions: Routine antibiotic prophylaxis should be questioned in laparoscopic BS. Prophylaxis may reduce incisional SSI in patients with a BMI of ≥60. In other cases, antibiotic prophylaxis does not provide a decrease in SSI.

Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center.

BACKGROUND: The aim of this study was to evaluate the protective effects of staple line reinforcement with omentopexy during laparoscopic sleeve gastrectomy on postoperative complications. MATERIALS AND METHODS: A total of 3942 laparoscopic sleeve gastrectomy cases were included in the study. All the patients were divided into 3 groups: No reinforcement (NoSLR), staple line reinforcement with fibrin glue (SLR-FG), and staple line reinforcement with omentopexy (SLR-O). Demographic data and perioperative characteristics of the groups were analyzed retrospectively. Among these, age, sex, preoperative comorbidities, American Society of Anesthesiologists scores, body mass index, duration of operation, reoperation, complications, and Clavien-Dindo classification scores were recorded. RESULTS: Age, sex, body mass index, comorbid diseases, American Society of Anesthesiologists, and Clavien-Dindo Classification scores were similar in all the groups. The overall complication rate was 3.0%. The overall minor and major complication rates were 1.7% and 1.3%, respectively. The mortality rate was 0.1% (4 patients). The most common postoperative complications were bleeding (0.9%) and leakage (0.5%). The incidence of leakage, bleeding, and twisted gastric sleeve rates were similar when compared between SLR-FG and NoSLR. In the SLR-O patients, the incidence of leakage, hemorrhage, and twist were significantly lower and the operation time was significantly longer when compared with the other groups. CONCLUSIONS: The SLR-O technique, especially when performed by experienced surgeons, is a promising method for the prevention of postoperative leakage, bleeding, and twist complications with an acceptable increase in the duration of operation. Considering the limited effects of the SLR-FG technique, it was predicted that it would lose its popularity over time.

The results of surgical decompression in the treatment of foot drop due to peroneal nerve entrapment after bariatric surgery.

BACKGROUND: The loss of the fat pad surrounding the fibular head after rapid and excessive weight loss after bariatric surgery can lead to foot drop symptoms due to peroneal nerve entrapment (PNE). Conservative and surgical approaches have been described for the treatment of this condition, but there is some controversy over the effectiveness of the treatment modalities. OBJECTIVE: We aimed to investigate the causes and frequency of foot drop due to PNE after bariatric surgery and to investigate the effects of peroneal nerve decompression (PND) as a surgical treatment for PNE. SETTING: Single center, university surgical department. METHODS: We retrospectively evaluated a series of 2607 patients in terms of neurologic complications after bariatric surgery. Patients' age, sex, co-morbid diseases, vitamin and electrolyte levels, body mass index and postoperative excess weight loss, affected limb, duration of symptoms, and muscle strength scores (according to the Medical Research Council scale) were recorded. RESULTS: A total of 14 (.5%) patients had foot drop symptoms due to PNE. Of these patients, 9 underwent PND. The mean excess weight loss of PND patients at postoperative months 6 and 12 were 68.8 ± 13.5 and 100.9 ± 10.8, respectively. Foot drop symptoms became evident 5 to 11 months after bariatric surgery, affecting only a unilateral lower extremity in all patients. In laboratory analysis, there were no signs of nutritional and vitamin deficiency or insufficiency in any of the PND cases. Muscular strength was Medical Research Council grade 0 in all patients. The median duration of symptoms was 9 days, and the median complete recovery time was 40 days after PND. Patients who had a duration of symptoms for a maximum of 12 days were completely healed 30 days after PND. CONCLUSION: PND should be the first-choice treatment procedure for acute foot drop due to PNE after bariatric surgery.

Enhanced recovery after surgery (ERAS) in one-anastomosis gastric bypass surgery: a matched-cohort study.

BACKGROUND: One-anastomosis gastric bypass (OAGB) is considered new from the bariatric standpoint. OBJECTIVES: To assess the effectiveness and safety of the enhanced recovery after surgery protocol compared with the conventional approach in perioperative care of OAGB patients. SETTING: Turkey. METHODS: The prospectively collected data of 92 patients managed with standard care (group 1) were compared with 216 patients managed by the enhanced recovery after surgery pathway (group 2). All patients underwent OAGB by the same surgeon. The groups were compared in terms of mean postoperative length of stay; costs for surgery and recovery; and rates of complications, emergency room visits, and readmissions. RESULTS: Length of stay was always 5 days in group 1 and had a mean of 1.2 ± 1.3 days in group 2 (P < .001). The mean total cost for surgery and recovery was 858.6 ± 33.1 USD in group 1 and 625.2 ± 289.1 USD in group 2 (P < .001). Specific complications (Clavien-Dindo IIIa) occurred in 1 patient (1.1%) in group 1 and in 3 patients (1.4 %) in group 2 (P = 1.000). Fifty-seven patients (61.9%) in group 1 and 45 (20.9%) in group 2 visited the emergency room within 1 month of being discharged (P < .001). Two patients (.9%) in group 2 needed hospital readmission; there was no need for rehospitalization in group 1 (P < .001). CONCLUSION: The enhanced recovery after surgery pathway significantly reduces length of stay and cost after OAGB, with no significant difference in terms of surgical outcomes. It also reduces postdischarge resource utilization.

QUALITY OF LIFE AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY USING BAROS SYSTEM.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). AIM: To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. METHODS: Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. RESULTS: Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. CONCLUSION: LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.

Quality of life after laparoscopic sleeve gastrectomy using baros system / Qualidade de vida após gastrectomia vertical laparoscópica usando o sistema baros

ABSTRACT Background: Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). Aim: To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. Methods: Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. Results: Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. Conclusion: LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.

RESUMO Racional: A gastrectomia vertical laparoscópica (LSG) é atualmente o procedimento bariátrico mais frequentemente realizado na Turquia. O objetivo da operação de redução de peso não é apenas diminuir o excesso de peso, mas também melhorar as comorbidades e a qualidade de vida relacionadas à obesidade (QoL). Objetivo: Avaliar o impacto do LSG na qualidade de vida dos pacientes, perda de peso e comorbidades associadas à obesidade mórbida de acordo com os critérios BAROS atualizados. Métodos: Estudo não-randomizado de intervenção comportamental e de saúde pública. Um total de 1138 pacientes adultos foram submetidos a LSG entre janeiro de 2013 e janeiro de 2016. Um questionário (The Bariatric Analysis and Reporting Outcome System - BAROS foi utilizado. Os dados sobre complicações pós-operatórias foram coletados do banco de dados hospitalar. Resultados: Responderam ao questionário 562 (49,4%) pacientes. Seis de 1138 pacientes (0,5%) tiveram deiscência e todos estes responderam a pesquisa. A taxa geral de complicações foi de 7,7%. Após período médio de 7,4±5,3 meses (1-30), a perda média de excesso de peso foi de 71,3±27,1% (10,2-155,4). Os questionados relataram 772 comorbidades. Destes, 162 (30,0%) foram melhorados e 420 (54,4%) foram resolvidos.Os escores médios de QoL foram significativamente aumentados após LSG (p<0,05 a <0,001). Dentre os resultados dos 562 pacientes, 26 (4,6%) foram classificadas como falhas; 86 (15,3%) regular; 196 (34,9%) bom;144 (25,6%) muito bom; e 110 (19,6%) excelente de acordo com para o sistema de pontuação BAROS atualizado. Conclusão: O LSG é procedimento bariátrico altamente efetivo para controle de peso, melhora nas comorbidades e aumento da QoL em curto e meio prazos.

A retrospective analysis of the treatment results of 1557 patients with acute cholecystitis.

OBJECTIVE: To analyse outcomes of variable management strategies for the treatment of Acute Cholecystitis in relation to morbidity, mortality and conversion to open surgery. METHODS: The retrospective study was conducted at Firat University Hospital, Turkey and comprised records of Acute Cholecystitis patients admitted between 2005 and 2011. Patients were divided into subgroups according to admission time as well as American Society of Anaesthesiologists score. The outcomes of early cholecystectomy, interval cholecystectomy, delayed cholecystectomy, 'cooling-off' therapy and percutaneous cholecystostomy were evaluated. Mortality, morbidity, and conversion to open surgery were calculated as measures of success. Data was analysed using SPSS. RESULTS: Of the 1557 patients, 1052(67.6%) were female. The overall mean age was 42.4±14.7 years. Success rates of 'cooling-off' therapy and percutaneous cholecystostomy were 89.3% and 96.3%, respectively. The conversion rate following delayed cholecystectomy was 30%, which was higher than that of both early and interval cholecystectomy (0.2% and 0%, respectively; p<0.001 each). Mortality and morbidity rates of delayed cholecystectomy (57.1% and 7.1%, respectively) were also significantly higher than early and interval cholecystectomy (5% and 0.1%; 5.6 and 0%, respectively). CONCLUSIONS: Early laparoscopic cholecystectomy and interval cholecystectomy shared similar outcomes and rates of efficacy. Percutaneous cholecystostomy was a successful treatment option for high-risk patients, while delayed cholecystostomy correlated to the highest rates of conversion to open surgery, mortality and morbidity.

Long-term results of nonoperative treatment for uncomplicated acute appendicitis.

BACKGROUND/AIMS: This study aimed to assess the long-term (>12 months) efficacy of nonoperative treatment (antibiotic administration) in the management of uncomplicated acute appendicitis (AA). MATERIALS AND METHODS: We surveyed uncomplicated AA patients who elected to undergo nonoperative treatment between 2010 and 2012. A binary logistic regression analysis was performed to identify the critical predictors of recurrence. Age, gender, presence of appendicolith, and white blood cell count on admission were analyzed as possible predictors of recurrence. RESULTS: The median follow-up period of the study was 23 months. Twelve of 118 patients (10.2%) were diagnosed with recurrent appendicitis. Seven were retreated with the same antibiotic protocol and did not show further recurrence. The binary logistic regression analysis revealed statistical significance only for the presence of appendicolith [P=0.001, Exp (B)=0.058, B=-2.845]. Recurrence rate was lower in the presence of appendicolith. CONCLUSION: Nonoperative treatment of uncomplicated AA is an effective option. Recurrence is rare and it can be addressed efficiently with the administration of a second course of antibiotics. The presence of appendicolith should not discourage physicians from prescribing nonoperative treatment for patients with uncomplicated AA.

Inguinal Hernia Repair via Application of Mesh in Front of and behind the Fascia Transversalis.

The aim of this study was to compare mesh placement in front of the fascia transversalis and behid the fascia transversalis via inguinal incision. We evaluated the results of 106 inguinal hernia cases treated with polypropylene mesh applied via the anterior approach between December 2004 and January 2010. Using the anterior approach, the mesh was placed preperitoneally behind the fascia transversalis in 51 of the patients, whereas in the other 55 patients the mesh was placed in front of the fascia transversalis. Mean duration of surgery was shorter in the patients in which the mesh was placed behind the fascia transversalis (60 min vs. 75 min) (P < 0.05). In all, 8 patients (7.5%) had postoperative complications, including hematoma (n = 4), seroma (n = 2), scrotal edema (n = 1), and orchitis (n = 1). There weren't any significant differences in the complication rate between the 2 groups of patients (P > 0.05). During a mean 44-month follow-up period (range: 12-72 months), no recurrence was observed. In conclusion, there weren't any significant differences between the 2 methods of inguinal hernia repair, other than the duration of surgery.

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.

The efficiency of various doses of topical isosorbide dinitrate in the treatment of chronic anal fissure and the long-term results: a prospective, randomized and controlled clinical trial.

BACKGROUND/AIMS: In recent years, numerous studies have reported that the application of topical isosorbide dinitrate can cause fissure recovery with the relaxation of the internal anal sphincter. However, there is no consensus about the dose or duration of the drugs to be applied. In addition, long-term results of the patients with chronic anal fissure treated with nitrate-containing compounds are unknown. In this study, the goal was to investigate the effects of various doses of isosorbide dinitrate on chronic anal fissure and their long-term effects. METHODS: Seventy-five sequential patients with chronic anal fissure were divided into three groups. Only symptomatic treatments were applied to patients in the first group (n=15). The patients in second and third groups (n=30 each) were treated with topical isosorbide dinitrate 5% and 10%, respectively. The patients were examined three times at 20-day intervals. Five years later, 44 patients who were responsive to treatment were contacted by telephone. RESULTS: The rate of full response in the 10% isosorbide dinitrate group was statistically higher than of the 5% isosorbide dinitrate group on the 20th day (53.3% vs. 26.7%, p<0.05). However, the rate of full response did not differ between these groups on the 40th and 60th days (63.3% and 70% vs. 56.7% and 63.3%, p>0.05). Five years later, 52.3% of patients who were responsive to treatment had a symptomatic relapse. CONCLUSIONS: Topical isosorbide dinitrate is a good alternative therapy to protect internal anal sphincter in the treatment of chronic anal fissure. However, the recurrence rates are high in the long-term.

Pneumatosis cystoides intestinalis: a single center experience.

AIM: To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI). METHODS: The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed. RESULTS: Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d. CONCLUSION: Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.

The effect of preoperative nutritional supports on patients with gastrointestinal cancer: prospective randomized study.

BACKGROUND/AIMS: Malnutrition adversely affects the postoperative outcome of patients with gastrointestinal cancer. Therefore, the malnourished cancer patients are supported by enteral or parenteral nutrition. In this study, we aimed to investigate the effects of preoperative nutritional supports on total antioxidant capacity (TAC) in malnourished patients with gastrointestinal (GI) cancers. METHODOLOGY: Seventy-five malnourished patients with GI cancers and 25 patients with non-cancer surgical problems were included in the study. The dietary of cancer patients were supported with immune-enhancing enteral solution in group II or standard enteral solution in group III and with parenteral solution in group IV. Plasma TAC levels were measured prior and after nutritional support. Data were expressed as mmol Trolox eq./L. RESULTS: The mean TAC levels of groups before treatment were 1.10±0.17, 0.92±0.19, 0.89±0.17 and 0.92±0.18, respectively. It was significantly higher in group I than others. The mean TAC levels of supported groups after treatment were 1.11±0.20, 1.08±0.21 and 1.09±0.27, respectively. Although there was a statistically significant increase in TAC after treatment in group II and III, it was not statistically significant in group IV. CONCLUSIONS: It was concluded that preoperative nutritional support with standard or immune-enhancing enteral solutions significantly increased TAC levels of malnourished patients with GI cancers.

The effects of endothelin receptor blockade by bosentan on the healing of a bowel anastomosis in an experimental Crohn's disease model.

OBJECTIVE: It was previously described that endothelins may contribute to the pathogenesis of Crohn's disease. In this study, it was aimed to investigate the effects of endothelin receptor blockade by bosentan on the healing of a bowel anastomosis in an experimental Crohn's disease model. MATERIAL AND METHODS: Twenty-eight Sprague-Dawley rats were divided into four groups. Groups I and II were used as sham-operated and control groups, respectively. Bowel inflammation induced by intrajejunal injection of iodoacetamide in groups III and IV. Rats in group IV were treated with oral preparation of bosentan 60 mg/kg/day. Three days after induction of the inflammation, partial resection of test loop and anastomosis was performed. Re-laparotomy was performed, anastomosis bursting pressures and peritonitis scores were measured, and tissue samples were obtained for the measurements of tissue hydroxylproline level and mucosal damage index 4 days later. RESULTS: The mean mucosal damage index and peritonitis score of group IV were significantly lower, and the mean tissue hydroxyproline level and anastomotic bursting pressure of group IV were significantly higher than those of group III. CONCLUSION: The blockade of endothelin receptors by bosentan decreases the severity of iodoacetamide induced intestinal inflammation, increases the wound healing in the inflamed intestinal tissue, and decreases the severity of peritonitis.

Implementation of a scoring system for assessing difficult cholecystectomies in a single center.

PURPOSE: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis, but sometimes conversion to open cholecystectomy (OC) is necessary. The difficulty of LC or the risk of conversion to OC can be predicted by assessing some preoperative variables. We evaluated the efficacy of the "risk score for conversion from laparoscopic to open cholecystectomy" (RSCLO), which was recently developed by Kama et al. (Am J Surg 2001; 181:520), in a single center. METHODS: We recorded the RSCLO values of 571 patients admitted to undergo LC in the Department of General Surgery, Firat University Hospital, between June 2001 and June 2004. RESULTS: The mean RSCLO score of 19 patients who needed conversion to OC was significantly higher than that of the patients who underwent successful LC, at 16.2 (range, -9 to 41) vs -5.7 (range, -20 to 25) (P < 0.001). The RSCLO was well correlated with conversion to OC. The sensitivity and specificity rates for RSCLO determining the risk of conversion to OC were 100% and 96%, respectively, and its positive and negative predictive values were 43% and 100%, respectively. CONCLUSION: We think that RSCLO could be used to define the term "difficult LC" more accurately and assist in selecting the most appropriate operation.

The results of surgical treatment for hepatic hydatid cysts in an endemic area.

BACKGROUND/AIMS: Hydatid cyst remains an important public health problem in endemic areas. METHODS: This study retrospectively reviewed medical records of 63 patients treated for hepatic cyst hydatidosis in Frat University, Medical School, Department of General Surgery between January 1994 and December 2002. RESULTS: There were 96 cysts in total in 63 patients, with 67 (69%) of them located in the right lobe of the liver. Of 96 hepatic cysts, 41 (45%) were treated with partial cystectomy and drainage, 25 (26%) with partial cystectomy and capitonnage and 15 (15%) with partial cystectomy and omentoplasty. Thirty-two patients (51%) received treatment with albendazole while 31 (49%) received no medical therapy. The postoperative complication rate was 19% and there was no significant difference in the early post-operative complications between surgical procedures (p>0.05). Cysts recurred in 6 patients (11%) and no correlation was found between recurrence of cysts and albendazole use, type of surgical procedure, number and size of the cysts, Gharbi classification as determined by ultrasound examination or the relation of the cyst with the biliary tract (p>0.05). CONCLUSION: It was concluded that there was no significant difference in the rates of complications and recurrences among different surgical procedures when performed with basic rules of the surgical principles.