Venous reconstruction thrombosis after pancreaticoduodenectomy with superior mesenteric/portal vein resection due to pancreatic cancer: an 8 years single institution experience.

BACKGROUND: Superior mesenteric/portal vein reconstruction (SMPVR) thrombosis remains a challenging complication following pancreaticoduodenectomy concomitant with venous resection. In this context, we aimed to present our SMPVR experiences and identify potential clinicopathological factors that increased SMPVR thrombosis. METHODS: A total of 33 patients who underwent SMPVR during pancreaticoduodenectomy were analyzed. Of these, 26 patients who experienced pancreatic head ductal adenocarcinoma met our inclusion criteria. Patients' data were compared as classified by SMPVR type and the development of SMPVR thrombosis. All interposition grafts were Dacron in this cohort. RESULTS: Types of SMPVR included: tangential resection with primary repair (n = 12); segmental resection with splenic vein preservation and either primary anastomosis (n = 8) or 14 mm tubular Dacron grafting (n = 1); segmental resection with splenic vein division either 14 mm tubular Dacron grafting (n = 2) or 14/7 mm 'Y'-shaped Dacron grafting (n = 3). A total of four patients having 14/7 mm 'Y'-shaped (n = 3) and 14 mm tubular Dacron (n = 1) developed SMPVR thrombosis (p = .001). Dacron grafting (p = .001) and splenic vein division (p = .010) were associated with SMPVR thrombosis. The median time to detection of SMPVR thrombosis was 4.3 months (2.5-21.0 months). The median follow-up time was 12.2 months (3.0-45 months). CONCLUSIONS: During pancreaticoduodenectomy for pancreatic head ductal carcinoma, extended venous resection requiring SMPVR with 'Y'-shaped and use of Dacron interposition grafts appeared to be associated with the development of SMPVR thrombosis. This result warrants further investigations.

Clinical outcome of gallstone ileus; a single-centre experience of case series and review of the literature.

BACKGROUND: Gallstone ileus (GI) is a rare entity which is seen in 0.5% of patients with cholelithiasis. In this study, we aimed to share our clinical approach to GI, to present our long-term results and to draw clinicians' attention to this rare entity. MATERIALS AND METHODS: This study included 11 patients with GI whose medical records were evaluated retrospectively. RESULTS: Majority of the 11 patients were female (63.7%, n:7) and the mean age was 71.9 ± 14.10 (range: 50-91). Most common presenting complaints were vomiting (n: 9) and abdominal pain (n: 9). The mean interval from the onset of symptoms to the hospital admission was 3.8 ± 0.75 (range 3-5) days. Rigler triad in abdominal computed tomography (CT) was detected in all cases. Enterolithotomy, one-step procedure and conservative treatment were performed in five (45.4%), four (36.3%) and two (18.1%) patients, respectively. Enterolithotomy group was found to have higher risk according to American Society of Anesthesiologists (ASA) classification, shorter operation time and less intraoperative blood loss. CONCLUSION: Although enterolithotomy is the first choice for patients with GI, one-step procedure should be kept in mind as a more advantageous technique in low-risk patients.

Rectum mucinous adenocarcinoma metastasis to bilateral breast in a male patient: A case report.

A 47-year-old male presented to our clinic with complaints of mass in both breasts. In the patient's history, he had undergone low anterior resection for rectum mucinous adenocarcinoma 2 years ago. The masses in both breasts of the patient were excised. Mucinous adenocarcinoma metastases were reported in the pathologic evaluation of the masses. Metastasis should be considered in patients with bilateral breast mass and previously diagnosed cancer even if the patient is male.

Chest wall metastasis of endometrial cancer: case report and review of the literature.

Introduction: Endometrial cancer is the fourth most common female cancer and also distant metastases to the chest wall associated with these tumors are seen less common. Surgical treatment options for metastases of endometrial cancer are limited. Case: A 57-year-old patient who underwent total abdominal hysterectomy + bilateral salpingo oophorectomy and received adjuvant chemotherapy for endometrioid-type adenocarcinoma of the endometrium and tuba is presented. The patient initially presented with pleural effusion 8 years ago and the tumor was detected while during etiologic screening. The patient had no problems after adjuvant chemotherapy and had been living in another city when she presented with a mass on the chest wall measuring 20 × 15 × 12 cm 8 years after the initial diagnosis and distant organ metastasis due to the first surgery was detected. The mass was first thought to be a sarcoma and the tru-cut biopsy revealed a metastatic lesion that was immunohistochemically similar to the first surgical specimen. The mass was resected with a wide radical excision and 'no touch' technique. The patient was then discharged with no postoperative complications. Conclusion: Here in, a case with a distant organ metastasis due to an endometrioid-type adenocarcinoma is presented accompanied by literature data.

Topical Steroids Are Effective in the Treatment of Idiopathic Granulomatous Mastitis.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic disease of the breast. Despite the various treatment approaches described for this disease, a gold standard treatment modality has not yet been defined. In this study, the effect of topical steroids was reviewed and assessed in patients with IGM. METHODS: The records of patients with IGM who were treated only with topical steroids were retrospectively reviewed. Patients were grouped as "completely healed," "inadequately healed," "stable," "worsened," or "recurred" if they had once healed but their symptoms returned. Patients whose skin changes were completely ameliorated were considered "completely healed." RESULTS: All of the patients were women, and the average patient age was 35.7 years (range 24-48 years). During the average follow-up of 37.2 months (range 12-72 months) in patients who received only topical steroid treatment, recurrence was observed in three patients (3/28, 10.7 %), and no side effects or steroid-related complications occurred. CONCLUSIONS: Topical steroids seem to be effective in the treatment of IGM characterized by skin changes. Prospective clinical studies would be useful in determining the clinical efficacy of topical steroids in the treatment of IGM.

Carcinoembryonic antigen in the diagnosis, treatment, and follow-up of focal liver lesions.

In this editorial review, we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery. Carcinoembryonic antigen (CEA) is a fetal glycoprotein and can be secreted in very small amounts from healthy adults after birth. CEA is widely used not only for diagnostic tumor markers but also importantly for the management of some gastrointestinal tumors. The most common clinical use is surveillance for the monitoring of colorectal carcinoma. However, CEA can become elevated in several malign or benign characterized pathologies. Serum CEA level may vary depending on the location of the lesion, whether it metastasizes or not, and its histopathological characteristics. It has been determined that cases with high preoperative CEA have a more aggressive course and the risk of metastasis to the lymph tissue and liver increases. In this editorial review, we focused on evaluating the role of CEA in clinical practice with a holistic approach, including the diagnostic and prognostic significance of CEA in patients with focal liver lesions, the role of CEA in follow-up after definitive surgery, and also hepatic resection for metastasis, and the management of all patients with raised CEA.

CT findings of patients with small bowel obstruction due to bezoar: a descriptive study.

PURPOSE. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types. MATERIALS AND METHODS. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. RESULTS. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum (n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. CONCLUSIONS. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis.

Role of contrast-enhanced serial/spot abdominal X-rays in perioperative follow-up of patients undergoing abdominal surgery: An observational clinical study.

BACKGROUND: Many imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging, and endoscopy are used to identify the problems or complications that occur in the perioperative period and to determine the appropriate therapeutic approach. Specialists at surgical clinics and intensive care units sometimes need diagnostic procedures that can give quick results or reveal unexpected results. In particular, rapid on-site evaluation of patients followed under intensive care conditions has several advantages. AIM: To determine the problems developing in patients in the perioperative period by contrast-enhanced abdominal X-ray (CE-AXR), revealing their current status or defining the effectiveness of CE-AXR. METHODS: The files of the patients who underwent hepatopancreatobiliary or upper gastrointestinal surgery, whose CE-AXR film was taken, were reviewed retrospectively. Abdominal X-ray radiographs taken after ingestion of a water-soluble contrast agent (iohexol, 300 mg, 50 cc vial) and its application in a drain, nasogastric tube, or stent were evaluated. The contribution of the data obtained in patients who underwent CE-AXR to the diagnosis, follow-up, and treatment processes and the effectiveness of the application were investigated. RESULTS: CE-AXR was applied to 131 patients in our clinic, most of whom underwent hepatopancreatobiliary or upper gastrointestinal surgery. It was determined that the data obtained from CE-AXR films taken in 98 (74.8%) of the patients contributed to the diagnosis, treatment, and follow-up expectations and positively affected the clinical processes. CONCLUSION: CE-AXR is a simple procedure that can be applied anywhere, especially in intensive care patients and at bedside, with a portable X-ray device. The simplicity of the procedure, less radiation exposure for the patients, less time wastage, reduction in the CT and endoscopy procedure burden and costs, quick results, rapid assessment of the situation, and enabling the monitoring of processes with repetitive procedures are important advantages. X-rays taken will be useful in terms of being a reference value during the follow-up period of the patient and determining the situation in medicolegal processes.

Factors affecting complications and clinical outcome in patients with Mirizzi syndrome. Single center experience.

Mirizzi syndrome (MS) is a syndrome that causes chronic destructive and fibrotic changes because of compression and inflammation in the main biliary tract. MS remains to be a serious problem due to its high morbidity. In this study, it is aimed to evaluate the diagnostic tools, risk factors and clinical output data we apply to our patients with MS in the light of the literature. We retrospectively analyzed the data of patients treated for MS in the last decade in our hospital, where an average of 1350 cholecystectomies are performed annually. Clinical, laboratory and imaging data obtained from patients' files were evaluated. We identified 76 patients with MS and classified them as type 1-5 according to the Csendes classification. Abdominal pain, fever and jaundice were the most common symptoms. 42 patients had type 1 and 2 MS. Mirizzi syndrome was diagnosed with preoperative radiological imaging methods in 24 of the patients. In 41 of the patients, the surgery first started laparoscopically, and then turned to laparotomy in 39 patients. Other 35 patients were operated with conventional methods. In 11 cases, subtotal cholecystectomy was performed Early diagnosis and surgical treatment of symptomatic cholelithiasis decrease the frequency of MS. Inflammation criteria can be used as an indicative biomarker. The patient's history, USG, ERCP and MRCP findings are currently the most important diagnostic tools. Releasing the gallbladder with the "fundus first" approach can reduce the risk of trauma. In cases where MS is suspected, a stent placed with ERCP decrease bile duct trauma. KEY WORDS: Complication, Diagnosis, Mirizzi's syndrome, Prediction, Treatment.

Management of hepatic artery trauma during hepato-pancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review.

BACKGROUND: One of the most feared complications of surgeons dealing with hepato-pancreato-biliary (HPB) surgery is hepatic artery (HA) injury. Here, we aimed to evaluate our clinical experience (laceration, transection, ligation, and resection) related to HA traumas, which have serious morbidity and mortality risks, in the light of literature data and the rapidly evolving management methods in recent years. METHODS: The files of 615 patients who were operated on for HPB pathologies in the last decade, in our hospital, were retrospectively reviewed. Clinical, laboratory, and imaging data obtained from patients' files were evaluated. RESULTS: A total of 13 HA traumas were detected, eight of them had HA injury and five had planned HA resection. During the post-operative follow-up period, liver abscess, anastomotic leakage, and late biliary stricture were detected. CONCLUSION: Complications and deaths due to HA injury or ligation are less common today. The risk of complications increases in patients with hemodynamically unstable, jaundice, cholangitis, and sepsis. Revealing the variations in the pre-operative radiological evaluation and determining the appropriate approach plan will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to be maintained with primary anastomosis, arterial transpositions, or grafts.

[Investigation of Helicobacter pylori iceA1 and iceA2 genes in patients with chronic gastritis and gastric cancer]. / Kronik Gastrit ve Gastrik Kanserli Hastalarda Helicobacter pylori iceA1 ve iceA2 Genlerinin Arastirilmasi

Several virulence factors of Helicobacter pylori play crucial role in the pathogenesis of the infections.H.pylori iceA gene which is induced by the contact with epithelium during the attachment of bacterium to the gastric mucosa, possess two variants (iceA1 and iceA2). Although there are some data indicating the relationship between H.pylori iceA1 and peptic ulcer, this concept is still controversial. The aims of this study were to investigate the presence and prevalence of H.pylori iceA1 and iceA2 gene regions in the tissue samples of patients diagnosed as chronic gastritis and gastric cancer, and to evaluate whether any correlation existed between these genotypes and clinical manifestations. A total of 109 tissue samples obtained from chronic gastritis (n= 55) and gastric cancer (n= 54) patients whose H.pylori infections have been confirmed by histopathologic examination of biopsy samples, were included in the study. The presence of H.pylori in the samples were also confirmed by amplification of the ureA gene region by inhouse polymerase chain reaction (PCR). H.pylori iceA1 and iceA2 genes were directly genotyped with the use of specific primers in the gastric biopsy specimens by PCR. The total positivity rates of iceA1 and ice- A2 genotypes in patients were found as 58% (63/109) and 24% (26/109), respectively. With the special attention to chronic gastritis and gastric cancer patients, the frequencies of iceA1 gene were 51% (28/55) and 65% (35/54), while the frequencies of iceA2 gene were 20% (11/55) and 28% (15/54), respectively. The difference of positivity rates of iceA1 and iceA2 genotypes between the patient groups were not statistically significant (p> 0.05). There was also no statistically significant correlation between the genotypes and clinical manifestation (r> 0.01). As a result, H.pylori iceA1 genotype was predominant (58%) in chronic gastritis and gastric cancer patients in our region, however the prevalence of iceA2 genotype was lower (24%) similar to those data reported in the literature. Our results supported the concept that iceA gene reflects geographical differences rather than determining the clinical picture and virulence. In conclusion, multicenter and large scaled studies are needed for better evaluation of H.pylori iceA gene and disease relationship.

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review.

BACKGROUND: The omentum is an organ that is easily sacrificed during abdominal surgery. The scope of omentectomy and whether a routine omentectomy should be performed are still unknown. AIM: To review the literature in order to determine the physiological functions of the omentum and the roles it plays in pathological events in order to reveal the necessity for removal and preservation of the omentum. METHODS: A clinical review of the English language literature based on the MEDLINE (PubMed) database was conducted using the keywords: "abdomen", "gastrointestinal", "tumor", "inflammation", "omental flap", "metastasis", "omentum", and "omentectomy". In addition, reports were also identified by systematically reviewing all references in retrieved papers. RESULTS: The omentum functions as a natural barrier in areas where pathological processes occur in the abdominal cavity. The omentum limits and controls inflammatory and infectious pathologies that occur in the abdomen. It also aids in treatment due to its cellular functions including lymphatic drainage and phagocytosis. It shows similar behavior in tumors, but it cannot cope with increasing tumor burden. The stage of the disease changes due to the tumor mass it tries to control. Therefore, it is considered an indicator of poor prognosis. Due to this feature, the omentum is one of the first organs to be sacrificed during surgical procedures. However, there are many unknowns regarding the role and efficacy of the omentum in cancer. CONCLUSION: The omentum is a unique organ that limits and controls inflammatory processes, foreign masses, and lesions that develop in the abdominal cavity. Omental flaps can be used in all anatomical areas, including the thorax, abdomen, pelvis, and extremities. The omentum is an organ that deserves the title of the abdominal policeman. It is generally accepted that the omentum should be removed in cases where there is tumor invasion. However, the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.

Dealing with hepatic artery traumas: A clinical literature review.

BACKGROUND: The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood. AIM: To reveal the evolution and recent developments in the management of HA traumas in the light of the literature. METHODS: In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled. RESULTS: The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature. CONCLUSION: In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

The role of portoenterostomy in the treatment of patients with multiple bile duct trauma: Case series and review of the literature.

BACKGROUND: Hepaticojejunostomy is a challenging and complex procedure to be administered with the confidence, in conditions which contain a large number of bile duct damaged by benign pathologies or major bile duct trauma. METHODS: Here, our clinical series of portoenterostomy (PE), in which we applied in patients who had aggressive hilar dissection for hilar benign biliary pathologies and major bile duct traumas during laparoscopic cholecystectomies were discussed in the light of the literature. The PE procedure was performed in the presence of three or more bile ducts that could not be merged. The classic Roux-en-Y style hepaticojejunostomy was performed to prevent postoperative ascending cholangitis. The ropeway system was used when sewing. 6-8 stitches were laid on the back or anterior wall and the sutures were tied on the outside. Thin-long silicone stents placed in the small diameter (2 mm) bile ducts coinciding with the anastomosis line were extended into the jejunum. RESULTS: This study included six patients who underwent PE between 2015-2019. Five of the cases were male and one was female and the mean age was 70.33 years. Hepaticojejunostomy was performed in two of the four cases with biliary trauma, but the endoscopic and surgical revision was performed due to developing strictures and bile flow was corrected with stents. In these two cases coming from the external center, PE was applied to multiple bile ducts resulting from aggressive hilar dissection. In two patients who developed major biliary tract trauma (Strasberg-Bismuth-E4) at our hospital underwent PE in the same session. In the other two cases, PE was performed due to a large number of bile ducts caused by benign pathology-related complications (Mirizzi syndrome, Type 4). The mean follow-up period for six patients was 20.1 months (range 11 to 37 months). CONCLUSION: Portoenterostomy can be performed as a salvage procedure in cases where multiple biliary tracts occur and hepaticojejunostomy is inadequate. PE can be safely used in selected cases that had benign pathologies, major bile duct trauma, in the presence of intense fibrosis, inflammation, very thin bile ducts and more fragile tissues in the liver hilum. PE should be performed in centers with surgeons experienced in hepatobiliary surgery. However, to better understand the efficacy of PE, large multicentric clinical series and patient follow-up are required.

Relation of computed tomography features of the pancreatic tissue and development of pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND: Pancreatic density and steatosis detected in pre-operative computed tomography (CT) may be a risk factor for PF development after pancreatoduodenectomy (PD). There is insufficient data available on the relationship between PF and atherosclerosis in pancreatic vasculature of pancreatitis. This study aims to investigate whether PF development in patients undergoing PD can be predicted by preoperative CT findings. MATERIAL-METHOD: Pancreas and spleen densities were measured on non-contrast CT images and pancreatic index (PI) was calculated to detect pancreatic steatosis. Pancreatic density and Wirsung diameter (WD) were measured on portal venous phase. Pancreatic fistulae were identified as biochemical leak (BL), grade B and grade C using ISGPF classification. The findings were compared between the fistula and non-fistula groups and ISGPF subgroups. RESULTS: Of 148 patients, PF was detected on 31 (20.9%). In PF group, mean pancreatic density and PI were significantly lower than non-PF group, while pancreatic steatosis was detected at a higher rate. The WD was significantly narrower in the PF group. No significant relationship was found between the development of PF and the findings of atherosclerosis in the CT and SMA or acute pancreatitis. There was no significant difference between the PF subgroups for pancreas density. CONCLUSION: In preoperative CT examinations, measuring the pancreatic density, PI index and WD can be used as a noninvasive quantitative method to predict the possibility of postoperative PF development.

Clinical Analysis of Pancreaticoduodenectomies for Benign Pathologies.

OBJECTIVE: To evaluate the clinical, laboratory and imaging data of patients who underwent pancreatoduodenectomy (PD) for proven benign pathologies. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Izmir Katip Celebi University, School of Medicine, Turkey between January 2015 and June 2020. METHODOLOGY: All patients who underwent PD, and were found to be benign histopathologically, were included in the study. Patients who had to undergo PD due to trauma during operations performed for other reasons, were also included in the study. The data was collected as per objective. RESULTS: Diagnosis of benign pathologies was made histopathologically in 27 of the 248 patients (10.89%). It was found that 8 of 17 patients, who had biopsy in the preoperative period, were operated with a pre-diagnosis of malignancy, nine were performed PD due to accompanying clinical findings despite the detection of non-diagnostic cytology, and ten patients were taken into surgery; because of the malignancy risk could not be ruled out. CONCLUSION: Patients with benign pathology were found to have better parameters of CRP and total bilirubin. PD was performed in patients with mass in the pancreas; and whose cancer risk could not be ruled out. To reduce PD due to benign causes, patients with undiagnosed lesions should be evaluated with a multidisciplinary approach, and diagnostic tools should be cross-checked. PET/CT may also be useful in the differential diagnosis. Key Words: Benign, Diagnosis, Pancreas, Pancreaticoduodenectomy, Pathology.

The Role of Portoenterostomy with Aggressive Hilar Dissection in Biliary Tract Tumors: Report of Case Series and Review of the Literature.

Hepaticojejunostomy is a challenging and complex procedure to be done with confidence in conditions that contain a large number of segmental bile ducts. Portoenterostomy can be defined as the joining of multiple bile ducts into a single cavity using segmenter bile duct ends, stents, and surrounding connective tissues. During surgery, in cases with advanced stage biliary tract tumors that cannot be performed hepatectomy, after aggressive dissections to provide a negative surgical margin, a large number of segmental bile ducts can be revealed and needs to ensure the continuity of bile flow. Here, our clinical series of portoenterostomy (PE) in which we applied in patients who had aggressive hilar dissection and resection for hilar cholangiocarcinomas and biliary tract tumors were discussed. The study included 15 patients who underwent PE for biliary tract tumors and hilar cholangiocarcinomas between 2015 and 2019. Six of the patients had a tumor-negative surgical margin, with a mean follow-up of 14.4 months (range 2 to 28 months). Nine of the patients had a tumor-positive surgical margin, with a mean follow-up of 7.7 months (range 2 to 17 months). Portoenterostomy instead of hepaticojejunostomy in small and multiple biliary radicles and bile duct cancers has been successfully performed in 15 patients of bile duct cancer and Klatskin tumor. In the presence of active inflammation, fibrosis, major bile duct trauma, and thin bile duct radicles, this method, which is described in detail, provides an excellent salvage surgical procedure with less morbidity.

Is subtotal cholecystectomy safe and feasible? Short- and long-term results.

BACKGROUND: Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak. METHODS: Fifty-seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed. RESULTS: Thirty-three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29-86). All patients had at least one episode of cholecystitis. Forty-seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P < .001). During the average follow-up of 49 months (range: 13-98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively. CONCLUSIONS: Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases.

Analysis of the Factors Affecting Survival in the Patients who Underwent Curative-Intent Gastrectomy due to Gastric Adenocarcinoma.

OBJECTIVES: Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related deaths in the world. In this study, we aimed to evaluate the impact of clinicopathological factors on overall survival in the patients who underwent curative-intent gastrectomy due to gastric adenocarcinoma. METHODS: The medical records of 644 patients who underwent gastrectomy between January 2007 and January 2017 in our clinic were retrospectively reviewed. Among these patients, 359 patients were included in this study. The impact of several prognostic factors on survival was investigated. RESULTS: The mean age was 59.2±11.6 (29-83). Male/female ratio was 2.12. The median follow-up time was 19 months (CI=10.1-31.1). Median overall survival was 23±2.3 months (CI=18.3-27.6). Splenectomy, R1 (microscopically incomplete) resection, and advanced stage were independent risk factors for poor prognosis. CONCLUSION: R1 resection, splenectomy, and advanced TNM stage were associated with poor prognosis in gastric cancer. Splenectomy should be avoided in the absence of direct invasion of the tumour or metastasis of lymph nodes on splenic hilum to prevent postoperative infectious complication-related mortality.

Prevalence of cagA and vacA genotypes of Helicobacter pylori isolated from Turkish patients with active or non-active chronic gastritis.

Several virulence factors of Helicobacter pylori may contribute to gastric mucosal damage. In this study, the prevalence of cagA and vacA genotypes of H. pylori was examined in different patterns of chronic gastritis. Oesophagogastroendoscopy was performed in 147 dyspeptic patients. Antrum biopsies were obtained for isolation of H. pylori and for histopathological assessment. H. pylori vacAs1 and cagA genes were directly genotyped in the gastric biopsy specimens by polymerase chain reaction (PCR). A total of 102 dyspeptic patients, all H. pylori-positive by PCR, were included in the study. Of these, 59 had active chronic gastritis and 37 had non-active chronic gastritis. The prevalence of cagA and vacAs1 was higher among patients with active chronic gastritis than among those with non-active chronic gastritis (45.8% vs 21.6% (p = 0.02) and 78.0% vs 40.5% (p < 0.001), respectively). In conclusion, both cagA and vacAs1 genotypes are associated with the activity of chronic gastritis.