The effect of rs9939609 FTO gene polymorphism on weight loss after laparoscopic sleeve gastrectomy.

PURPOSE: Remarkable differences in weight loss have been observed in obese patients undergoing laparoscopic sleeve gastrectomy (LSG). These high variations might be partly explained by genetic factors. The rs9939609 fat mass and obesity-associated gene (FTO) polymorphism has been implicated in the susceptibility of obesity. We aimed to explore the effects of the rs9939609 FTO gene polymorphism on weight loss among severely obese patients applying for LSG. MATERIALS AND METHODS: All individuals were analyzed for the FTO rs9939609 gene polymorphism. A total of 74 morbid obese patients (20 male, 54 female) were operated. Body weight and body mass index (BMI) were measured at before LSG and after surgery at the sixth month. RESULTS: Twenty-eight patients (37.8%) had genotype TT (wild-type allel), 36 patients (48.6%) had genotype TA, and 10 patients (13.5%) had genotype AA. In both wild-type group and mutant group, BMI and weight levels decreased at the sixth month after surgery. Percent of excess weight loss (EWL) at 6 months of follow-up was similar in both groups. There were no differences between the mutant and wild-type groups percent of EWL at the sixth month after applying LSG. CONCLUSION: Our data showed that the rs9939609 FTO gene polymorphism is not a useful genetic test prior to LSG to help clinicians predicting the weight loss for severely obese patients in short-term follow-up.

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.

Loss of tight junction proteins (Claudin 1, 4, and 7) correlates with aggressive behavior in colorectal carcinoma.

BACKGROUND: Tight junction proteins in the cell organize paracellular permeability and they play a critical role in apical cell-to-cell adhesion and epithelial polarity. Claudins are major integral membrane proteins of tight junctions, especially Claudin 1, 4, and 7, which are known as the impermeability Claudins. In this study, we investigated the importance of loss of Claudin 1, 4, and 7 expression, and their relation to tumor progression in colorectal cancer patients. MATERIAL/METHODS: Loss of Claudin 1, 4, and 7 expression was examined by immunohistochemical method in 70 patients diagnosed with colorectal cancer. Cases with loss of Claudin expression in <1/3 of tumor cells were classified as mild loss, whereas cases with loss of Claudin expression ³1/3 of tumor cells were classified as moderate-to-marked loss in order to evaluate the relation between loss of Claudin 1, 4, and 7 expression and clinicopathologic data. RESULTS: The severe suppression of Claudin 1, 4, and 7 expression was found to be significantly related to the depth of tumor invasion, positive regional lymph nodes, histological grade, lymphovascular invasion, perineural invasion, and lymphocytic response. Additionally, severity of loss in Claudin 4 expression was found to have a relation with distant metastasis. CONCLUSIONS: Claudin 1, 4, and 7 are important building blocks of paracellular adhesion molecules. Their decreased expression in colorectal cancer seems to have critical effects on cell proliferation, motility, invasion, and immune response against the tumor.

The role of high mobility group box 1 (HMGB1) in colorectal cancer.

BACKGROUND: HMGB1, the most important member of the high mobility group box protein family, is a nuclear protein with different functions in the cell; it has a role in cancer progression, angiogenesis, invasion, and metastasis development. We studied the expression of HMGB1 and whether it is a prognostic factor in colorectal carcinoma. MATERIAL AND METHODS: The study included 110 cases that were histopathologically diagnosed with colorectal carcinoma from the tissue samples acquired by surgical resection and biopsy in Antalya Education and Research Hospital between 2008 and 2012. HMGB1 expression was examined via immunohistochemical method. RESULTS: HMGB1 expression was evaluated as negative in 32 (44.4%) of the patients and as positive in 40 (55.6%) patients. There was no relation between the HMGB1 expression and sex, age, tumor invasion depth, and histological type. However, a significant relation was detected between the HMGB1 expression and lymph node status, metastasis status, and stage (p:<0.001, p:<0.001, p:<0.001, respectively). Similar results were obtained for the relations between the HMGB1 and histological grade, perineural invasion, lymphovascular invasion, and lymphocytic response (p<0.001, p<0.001, p<0.001, and p<0.001, respectively). CONCLUSIONS: The results of our study demonstrate that HMGB1 overexpression has a significant role in tumor progression (especially migration of tumor cells) and tumor ability to metastasize in colorectal cancers; thus, it corroborates the idea that it might be an important prognostic factor.

[Evaluation of a hospital outbreak related to carbapenem-resistant Pseudomonas aeruginosa]. / Karbapeneme Dirençli Pseudomonas aeruginosa'ya Bagli Bir Hastane Enfeksiyonu Salgininin Incelenmesi.

Pseudomonas aeruginosa is an important nosocomial pathogen that causes opportunistic infections and hospital outbreaks. During October 2012, carbapenem-resistant P.aeruginosa strains with similar antibiotic resistance patterns, were isolated from specimens sent from the intensive care and plastic surgery units in our hospital. Thus a hospital outbreak was suspected. The microbiology laboratory database was retrospectively searched and all strains of P.aeruginosa isolated during the four month period, starting with the initial carbapenem-resistant strain in August 2012, was evaluated as a hospital outbreak. The aim of this study was to define the outbreak by investigating the clonal relationship between the strains, to detect the potential environmental sources and to evaluate the period of the outbreak, risk factors and the efficiency of infection control measures. The study was conducted between August-November 2012. Twenty patients with carbapenem-resistant P.aeruginosa (CRPA) positive cultures were included in the study. The control group consisted of 22 patients with carbapenem-susceptible P.aeruginosa (CSPA) positive cultures. The clonal relationship between 26 CRPA strains was studied by pulsed-field gel electrophoresis (PFGE). The PFGE results indicated that CRPA strains in our hospital were not related to a single clone, however, there were four major clones composed of four to eight strains. Logistic regression analysis indicated that the risk increased 15.7 fold (95% CI: 1.19-207.76) by the use of carbapenem, 76.8 fold (95% CI: 2.03-2901.30) by surgical procedures and 0.787 fold (95% CI: 0.63-0.97) by the duration of hospital stay. Surveillance cultures from health-care personel and the environment performed in course of the outbreak, yielded no growth of a strain with the similar antibiotic resistance pattern. The spread of CRPA has been controlled by the use of effective precautionary measures, regressing the isolate number to 0-1 strain/month. Since CRPA infections have high mortality and lack therapeutic alternatives, they should be regarded among the priorities of the infection control programmes. This study has enabled to test the effectiveness of the infection control program, to make plans for the possible future outbreaks and to train the staff.

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.

Prognostic value of preoperative CEA and CA 19-9 levels in patients with colorectal cancer.

AIMS: This study evaluated the prognostic value of the preoperative CEA and CA 19-9 levels on the survival time and TNM staging in patients with colorectal cancer. METHODOLOGY: We retrospectively analyzed 172 patients who underwent potentially curative resection of colorectal cancer (TNM I-III) between 2002 and 2007. Clinical data were obtained from medical charts, including age, gender, tumor location, TNM stage, mortality, follow-up duration, and preoperative CEA and CA 19-9 levels. A CEA > or = 5ng/mL was defined as abnormal (CEA+), while the cutoff for the CA19-9 was set at 37U/mL (CA19-9+). Patients were categorized into Groups I-IV according to the preoperative serum CEA and CA 19-9 levels [CEA/ CA 19-9: (-/-), (+/-), (-/+), and (+/+)]. RESULTS: Follow-up was longest for Group I (p<0.001). Mortality rates were higher in Groups V (p<0.001) and II (p<0.008). On comparing patients according to CEA levels, survival was longer in the CEA-negative group (p=0.0001). On comparison according to CA 19-9 levels, survival was greater in the CA 19-9-negative group (p=0.0001). While CEA (p<0.016) and CA 19-9 (p<0.001) were independent prognostic factors according to the logistic regression analysis, TNM (p=0.002), CEA (p<0.001), and CA 19-9 (p<0.001) were prognostic factors in the ROC curve analysis. CONCLUSIONS: Colorectal cancer patients with elevated levels of both CEA and CA 19-9 have a significantly poorer prognosis than those with normal levels of these tumor markers.

Same-admission laparoscopic cholecystectomy in acute cholecystitis: the importance of 72 hours and oxidative stress markers.

BACKGROUND: This prospective randomized study aims to compare outcomes between immediate laparoscopic cholecystectomy (LC) and same admission delayed LC in patients with acute cholecystitis and also to investigate the relation between oxidative stress markers and complication rates in the patients with AC. METHODS: This study included 64 patients with AC who were randomly divided into two groups. Patients in Group 1 (n=32) were immediately administered LC, while in Group 2 (n=32) patients underwent transient LC following medical treatment. All patients were operated on their first hospitalization. RESULTS: No statistically significant differences were observed between the groups for the comparison of complications, conversion rates, or operation durations (p>0.05). The length of postoperative hospital stay was found to be significantly shorter in group 1 compared to group 2 (1.75 vs 2.93 days; p=0.024). Only the total antioxidant status result was significantly higher in group 1 (p=0.017), but the finding was not correlated with complications. CONCLUSION: LC for AC was performed during the first admission was found to be safe, even beyond 72 hours following symptom onset. Pre-operative oxidative stress markers did not correlate with the complication rates.

A Rare Cause of Inguinal Mass: Round Ligament Cyst.

Round ligament mesothelial cyst is a rare cause of inguinal mass. Round ligament cysts are generally diagnosed during operation in cases who are operated with a pre-diagnosis of inguinal hernia. In this study, we aim to present two cases, who have applied to our clinic with the complaint of a mass in inguinal region and who are diagnosed as round ligament cyst, together with their ultrasound, magnetic resonance images and operation images.

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model.

PURPOSE: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy. METHODS: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure. RESULTS: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041). CONCLUSIONS: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.

Effects of different intraabdominal pressure levels on oxidative stress markers in laparoscopic cholecystectomy.

OBJECTIVE: To evaluate the effect of laparoscopic cholecystectomy performed under different intraabdominal pressure on oxidative stress markers. MATERIAL AND METHODS: This prospective, randomized, controlled study examined 90 consecutive healthy patients who underwent elective laparoscopic cholecystectomy with the diagnosis of symptomatic cholelithiasis. The patients were divided into three groups, 30 patients in each. Group 1 included patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 7 mmHg, Group 2 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 10 mmHg, and Group 3 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 13 mmHg. Blood samples were collected preoperatively, perioperatively, and postoperatively for measurement of the serum levels of ischemia modified albumin and an analysis of total antioxidant status and total oxidant status. Intra-group comparisons were made. RESULTS: Group 1 experienced a significant increase in the postoperative ischemia modified albumin values compared to preoperative ischemia modified albumin values (p=0.013). Group 2 experienced a significant decrease in the perioperative total antioxidant status values compared to preoperative and postoperative total antioxidant status values (p=0.009). Group 3 experienced a significant increase in the perioperative total oxidant status and oxidative stress index values compared to preoperative values (p<0.001). Group 3 experienced a significant increase in the perioperative and postoperative ischemia modified albumin values compared to preoperative values (p<0.001). CONCLUSION: Increased levels of oxidative stress markers were detected in patients who underwent laparoscopic cholecystectomy at a high intraabdominal pressure level.

Effects of obesity on retrobulbar flow hemodynamics: color Doppler ultrasound evaluation.

PURPOSE: To evaluate intraocular pressure (IOP) and extraocular orbital vessels with color Doppler ultrasound (CDU) and investigate the effects of obesity on retrobulbar blood flow. METHODS: Fifty-nine patients were included in this prospective study. Patients were divided into two groups according to body mass index: Group 1 (31 obese patients) and Group 2 (28 non-obese patients). IOP was measured with a Goldmann applanation tonometer, and CDU was used to evaluate the retrobulbar vessels. RESULTS: The mean IOP was 18 ± 6.68 mmHg in the obese group and 13.71 ± 1.60 mmHg in the control group (p<0.001). When the CDU values for the central retinal artery were compared between the groups, the pulsatility index was found to be significantly lower in the obese group than in the control group (p<0.001). When the CDU values for the ophthalmic artery (OA) were compared between the groups, the peak systolic velocity (p<0.001) and end-diastolic velocity (p=0.002) values were found to be significantly lower in the obese group than in the control group. CONCLUSIONS: Obese patients have a higher mean IOP and lower flow velocity than non-obese patients. Increased IOP together with decreased retrobulbar blood flow, particularly in obese individuals, may increase the risk of glaucoma development.

Effects of bariatric surgery on urinary incontinence.

INTRODUCTION: Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI). AIM: One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Obese female patients (n=120), ≥18 years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6 months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values. RESULTS: The mean age of the patients was 39.19 (standard deviation [SD] =9.94) years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6 months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P<0.05). CONCLUSION: LSG results in a clinically significant improvement in most common types of UI, regardless of patient reproductive history, existence of comorbid conditions, and smoking status.

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.

Procalcitonin is a predictive marker for severe acute pancreatitis.

BACKGROUND: Early identification of patients who develop severe acute pancreatitis and those who can benefit from intensive care is important. We studied whether procalcitonin, a marker of systemic inflammation, is important in the differential diagnosis of patients with mild and severe acute pancreatitis. METHODS: Patients were divided into two groups (mild and severe form) prospectively. Procalcitonin levels and the Ranson's and Acute Physiology and Chronic Health Evaluation II scores were determined both at admission and during the follow-up. RESULTS: Of the 65 patients with acute pancreatitis, 46 had mild and 19 had severe pancreatitis. Sensitivity and specificity values for patients calculated using procalcitonin level at 0.5 ng/ml, Ranson's score at 3 and APACHE II score at 8 cut-off levels, were 100%, 84% and 89%; and 84%, 63% and 89% respectively. CONCLUSION: Procalcitonin is a practical, simple parameter that can be used in order to diagnose severe acute pancreatitis earlier and to monitor the clinical prognosis of the disease.

Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy.

Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40) who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT), total macular volume (TMV), and retinal ganglion cell layer (RGCL) were measured by spectral-domain optical coherence tomography (SD-OCT). Subfoveal choroidal thickness (SFCT) was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT). Results. The mean CMT was 237.4 ± 24.5 µm, 239.3 ± 24.1 µm, and 240.4 ± 24.5 µm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean TMV was 9.88 ± 0.52 mm(3), 9.96 ± 0.56 mm(3), and 9.99 ± 0.56 mm(3) preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean RGCL was 81.2 ± 6.5 µm, 82.7 ± 6.6 µm, and 82.9 ± 6.5 µm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean SFCT was 309.8 ± 71.8 µm, 331.0 ± 81.4 µm, and 352.7 ± 81.4 µm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p = 0.34), disc area (p = 0.64), vertical cup/disc ratio (p = 0.39), cup volume (p = 0.08), or retinal nerve fiber layer (p = 0.90). Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

[The effects of melatonin and pentoxiphylline on L-arginine induced acute pancreatitis]. / L-arjinin ile olusturulan akut pankreatit üzerine melatonin ve pentoksifilinin etkileri.

BACKGROUND: It has been showed that free oxygen radicals and cytokines contribute to tissue damage and impairment of pancreatic microcirculation in acute pancreatitis. In this study, the effects of melatonin and pentoxiphylline were investigated in rabbits with L-arginine induced acute pancreatitis. METHODS: Rabbits were divided into 5 groups (n=10). Any procedure was not applied for the control group (G1). Acute pancreatitis was induced in one group (G2). Melatonin (G3), pentoxiphylline (G4) and melatonin + pentoxiphylline (G5) were given to other groups after induction of acute pancreatitis. Plasma levels of MDA, amylase, LDH, SGOT, IL-6 and TNF-a were measured at 0, 6, 12, 24 and 48 hours and pancreatic tissue was assessed histopathologically. RESULTS: Melatonin significantly reduced amylase activities at 6, 12, 24, and 48 hours (p<0.025), and all biochemical parameters, (excl. MDA) and edema and necrosis of acinar cells after 48 hours. Although pentoxiphylline reduced abnormally increased parameters in acute pancreatitis (significant for SGOT at 6, 12, 24 and IL-6 at 12, 48 hours), it did not normalized pancreatic abnormalities. CONCLUSION: Melatonin in contrast to pentoxiphylline significantly improved biochemical and histopathological abnormalities due to its powerful antioxidant and free oxygen scavenger properties in acute pancreatitis, and it can be used for patients with pancreatitis.

Esophageal Calibration with Soft Orogasrtric Tube During Laparoscopic Nissen Fundoplication may Reduce Postoperative Transient Dysphagia.

Gastroesophageal reflux is the most common benign disorder of the esophagus and laparoscopic Nissen fundoplication has become the standard surgical treatment for its treatment. In our area, where the use of bougie calibration is debatable, postoperative dysphagia is encountered often after this surgery although it is usually not permanent. The aim of this study was to investigate the effect of using a soft silicone tube 39 F in diameter for esophageal calibration during laparoscopic Nissen fundoplication on the incidence of postoperative dysphagia. We divided cases scheduled to undergo laparoscopic Nissen fundoplication between January 2009 and November 2010 into two groups, each consisting 25 patients. Esophageal calibration with a 39 F silicone orogastric tube was used for the first group while there was no operative calibration in the second group. The surgical duration was recorded; the presence and severity of the postoperative dysphagia was calculated by using a dysphagia severity scoring system during the 1-year postoperative follow-up. The dysphagia severity scores were significantly lower in group 1 than group 2 on the postoperative second day and at the end of the first week and first month. We did not find a significant difference at the end of the 6-month and first year. There was also no significant difference regarding surgery duration. The use of a soft orogastric tube 39 F in diameter for esophagus calibration during laparoscopic Nissen fundoplication has significantly decreased the incidence of postoperative transient dysphagia without affecting the duration of surgery. Although dysphagia gradually resolves in the majority of patients, a safe and easy calibration method for its prevention is worth developing, and we believe that the use of our method in larger series could be beneficial.

The effects of reinforcement methods on burst pressure in resected sleeve gastrectomy specimens.

BACKGROUND: Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of two supportive techniques on burst pressures in sleeved gastrectomy specimens. MATERIALS AND METHODS: Thirty patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into three groups. Group 1 had no extra support in the staple line, Group 2 had oversewing with continuous suture on the staple line, and Group 3 had fibrin sealant (Tisseel(®); Baxter, Deerfield, IL) on the staple line. The end point was the first detectable leakage, at which point leak pressure and the anatomic site of leakage were recorded. RESULTS: Thirty sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences among group in terms of age, sex, and body mass index. The leak pressure was significantly higher (106±10.5 mm Hg) in Group 2 (P<.01). Leaks occurred significantly more frequently in the staple line than in the staple junction points (P=.014). CONCLUSIONS: Oversewing the staple line with 3-0 Vicryl(®) (Ethicon, Somerville, NJ) suture significantly increased the strength of the staple line. Increases in intraluminal pressure are known to be one of the significant risks in leak etiology. Thus, we concluded that oversewing the staple line with 3-0 Vicryl suture can be beneficial in the prevention of leaks. However, further work is necessary in this area of research.