Additional gastric resection after one anastomosis gastric bypass-are there benefits?

BACKGROUND: Mini/one anastomosis gastric bypass (MGB-OAGB) is a bariatric surgery procedure that has proved effective for weight loss and the resolution of metabolic disorders. The present study evaluates the effect on postoperative outcomes of resecting the corpus and fundus as an addition to OAGB. METHODS: This retrospective study recorded and evaluated the data of 83 patients who underwent laparoscopic OAGB due to morbid obesity (Body Mass Index-BMI ≥ 40 kg/m2 ) in our clinic between January 2018 and January 2020. The patients were divided into two groups: the first group comprised patients undergoing standard OAGB (n = 49), while the second group included those undergoing OAGB plus (OAGB with additional corpus and fundus resection) (n = 34). The patient data recorded for comparison included demographic characteristics, comorbidities, preoperative and postoperative weight (at 6 and 12 months), body mass index (BMI), excess weight loss% (EWL%), excess BMI loss% (EBL%), and total body weight loss% (TBWL%), hemoglobin, fasting blood glucose (FBG), albumin and HbA1c levels. RESULTS: There was no statistically significant difference between the two groups with regard to age, gender or comorbidities. The operating time, the number of cartridges used during the operation and the length of hospital stay were statistically higher in the OAGB plus group (p = 0.039, p < 0.001, p < 0.001, respectively). No statistically significant difference was seen between the groups regarding weight, BMI, EBL% and TBWL% preoperatively and at 6- and 12-months postsurgery. There was also no statistically significant difference in preoperative and postoperative (at months 6 and 12) levels of hemoglobin, FBG, albumin, and HbA1c between the two groups. DISCUSSION: The addition of resection of the gastric fundus and corpus to an OAGB has no impact on postoperative weight loss or metabolic outcomes.

An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery.

Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation.

Determination of Factors Affecting Human Transmission of Echinococcus granulosus Parasite: A Case-control Study, Turkey

Objective: Through this study we aimed to determine the risk factors affecting the transmission of Echinococcus granulosus to humans. Methods: This case-control study included a study group comprising of 107 people who underwent surgery for hydatid cyst and a control group comprising of 107 people. Place of living, age, and sex were taken as matching factors. A chi-square analysis was used for paired comparisons in the study. The variables that were significantly related in paired comparisons were included in the logistic regression analysis. Results: Hydatid cyst disease was seen 3.661 [confidence interval (CI) =1.650-8.123] times more often in individuals with an education period of 11 years or less compared to those with 12 years or above, 3.427 (CI=1.470-7.991) times more in those with a toilet outside the house compared to those with a toilet inside the house, and 5.540 (CI=2.088-14.697) times more in individuals who took a shower 8 times a month or less compared to those who take a shower 9 times or more. Conclusion: Individuals with a low level of education and who do not pay attention to environmental and personal hygiene are at risk for hydatid cyst disease.

Factors Affecting the Choice of Treatment in Hepatic Hydatid Cyst Surgery.

OBJECTIVE: We aimed to determine the effective factors in the selection of treatment methods for patients with hepatic hydatid cyst undergoing surgery and the variables effective when performing postoperative endoscopic retrograde cholangiopancreatography (ERCP). In addition, we aimed to reveal the factors affecting the recurrence, postoperative complications, and length of stay of these patients. MATERIALS AND METHODS: A total of 107 patients diagnosed with hepatic hydatid cysts were treated surgically. Data were obtained from the records of these patients. Chi-square test was used for the analysis. The variables that were found to be significant in the chi-square analysis were included in the logistic regression (Backward: LR) analysis. RESULTS: Of all patients, 6.5% underwent the puncture, aspiration, injection, and reaspiration (PAIR) technique, 67.3% underwent conservative surgery, and 26.2% underwent radical surgical treatment. In paired comparisons, a significant difference was found among the ultrasonographic size of the cyst (p = 0.033), the radiological classification of the cyst (0.006), and history of previous surgery and treatment methods for the cyst. The risk of performing ERCP was 25.710 [95% confidence interval (CI): 1.721-284.013] folds higher for cysts located in the left lobe, whereas it was 19.992 (95% CI: 2.004-199.488) folds higher for cysts located in both right and left lobes. When the radical surgical treatment method was taken as a reference, the status of ERCP implementation was 29.785 (95% CI: 1.844-480.996) folds higher for PAIR and 3.628 (95% CI: 0.355-37.103) folds higher for conservative surgery. CONCLUSION: In conclusion, radical surgery is a significant treatment for hepatic hydatid cyst as its ultrasonographic cyst size increases with time. The location and treatment method of the cyst increases the complication of biliary fistula and requires ERCP.

Prevalence of perianal diseases and associated factors in primigravida women: A hospital-based cross-sectional study.

OBJECTIVES: To define the incidence of anorectal diseases in primigravida women as well as in the first month after delivery and the factors affecting the development of anorectal diseases. METHODS: The sample size was determined as 328 primigravida women. Research data were collected from pregnant women who applied to Gynecology and Obstetrics Polyclinic, Kars Harakani State Hospital Gynecology and General Surgery Polyclinic, Kafkas University, Kars, Turkey, between November 2020 and August 2021.The pregnant women were examined and surveyed 4 times; in the second and third trimesters, on the day after delivery, and in the first month after delivery. Chi-square test was used in the analysis of the data determined by counting. Variables which were statistically significant (p<0.05) in the Chi-square test were included in the backward logistic regression analysis. RESULTS: Perianal disease was observed in 103 (38.6%) of the pregnant women. The incidence of perianal disease was found to be 4.917 times (confidence interval [CI]: [2.134-11.327]) higher in those with perianal disease compared with those without, 2.936 times (CI:[1.584-5.439]) higher in those who did not consume fiber-rich foods compared with those who did, 9.512 times (CI: [4.583-19.742]) higher in those with constipation compared with those without, and 23.721 times (CI: [5.363-104.915]) higher in those whose pushing stage duration was above average compared with that in those whose pushing stage duration was below average. CONCLUSION: In primigravida pregnants, the risk of perianal disease increases in those who have perianal disease before pregnancy, those who do not consume fibrous food, those who have constipation, and those who have a long pushing period.

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.

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.

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.

DIFFERENT SURGICAL METHODS IN COLON ANASTOMOSIS: EXPERIMENTAL STUDY.

AIM: Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing. The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats. METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount. RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05). CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.

Laparoscopic pancreaticoduodenectomy in pancreatic cancer: Our initial experience.

Pancreas cancer is an important cause of mortality worldwide. It has no particular symptoms, and may cause different complaints according to tumor diameter and localization. Local invasion may develop in the short term and distant metastasis may occur in vascular structures in its neighborhood. That's why, resectability rates are low at the time of diagnosis with a negative effect on survival rates. Minimally invasive surgery is being increasingly implemented in pancreas lesions owing to the positive short-term oncologic results of the technique in many other procedures. Traditionally, conventional open surgery is performed in pancreatic head tumors. As laparoscopic resection of pancreatic head cancer has serious technical difficulties and requires advanced laparoscopic experience, minimal invasive attempts in this field have not yet reached sufficient acceptance worldwide. Besides the fact that laparoscopic pancreaticoduodenectomy may provide sufficient short-term oncologic results that are comparative with open surgery, it can be implemented in selected patients in centers with advanced laparoscopic resection capacity. In this case series, we aimed to present our experience of laparoscopic pancreaticoduodenectomy in pancreatic head cancer patients.

Different surgical methods in colon anastomosis: experimental study / Diferentes métodos cirúrgicos em anastomose do cólon: estudo experimental

ABSTRACT - BACKGROUND: Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing. AIM: The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats. METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount. RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05). CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.

RESUMO - RACIONAL: Embora muitos métodos tenham sido definidos para anastomose colônica, a fistula anastomótica ainda permanece importante para o controle da sepse e a cura bem-sucedida. OBJETIVO: comparar os efeitos da sutura convencional, tela de poliglactina 910 e cobertura de retalho omental na cicatrização e extravasamento anastomótico em anastomose colônica experimental em ratos. MÉTODO: estudo realizado em 18 ratos Wistar, sendo os animais divididos em 3 grupos. Grupo 1: Grupo de sutura primária; Grupo 2: sutura primária com malha de poliglactina 910; Grupo 3: Grupo sutura primária com cobertura de retalho omental. Os grupos foram comparados em termos de pressão de ruptura anastomótica, inflamação, atividade fibroblástica, neovascularização e quantidade de colágeno. RESULTADOS: houve diferença estatisticamente significativa na pressão de ruptura da anastomose entre os Grupos 1 e 2 e os Grupos 1 e 3 (p=0,004, p<0.05). Houve uma diferença significativa na atividade fibroblástica entre os Grupos 1 e 3 (p=0,011, p<0.05) e os Grupos 2 e 3 (p=0,030, p<0.05). Houve uma diferença significativa na neovascularização e colágeno entre os Grupos 1 e 2 e entre os Grupos 1 e 3 (p<0,05, p<0.05). CONCLUSÃO: o estudo experimental demonstrou que a tela de poliglactina 910 e a cobertura do retalho omental para anastomoses colocólicas melhoraram a resistência física e a cicatrização da anastomose em comparação com as anastomoses suturadas manualmente convencionais. A poliglactina pode ser uma alternativa segura à tela 910 nos casos em que a cobertura do retalho omental não pode ser utilizada na anastomose colônica.