Laparoscopic Sleeve Gastrectomy: Impact on Body Mass Index and Thyroid Hormones in Euthyroid Obese Patients.

BACKGROUND Obesity is still a major global public health problem and its incidence is increasing. Obesity leads to deterioration in thyroid functions. Even when they are within normal ranges, high normal levels of thyroid-stimulating hormone (TSH) increase morbidity and mortality. This study aimed to evaluate the body mass index (BMI) and TSH levels in 300 euthyroid patients with obesity before and after laparoscopic sleeve gastrectomy (LSG). MATERIAL AND METHODS A total of 300 euthyroid patients who underwent LSG between 2019 and 2021 were included in the study. Body mass index (BMI), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT) 3 and tetraiodothyronine (FT4) levels were recorded before surgery and at 6 and 12 months after surgery and subsequently analyzed. RESULTS Mean BMI values were significantly lower at 6 and 12 months after surgery (P<0.001). There was a significant difference between mean TSH and FT4 levels before surgery and those at 6 and 12 months after surgery (P<0.001). However, mean FT3 levels remained unchanged 1 year after surgery (P=0.005). CONCLUSIONS LSG is not only effective in terms of weight loss, but also exhibits improving effects on thyroid hormone homeostasis in obese patients and provides protection against further adverse effects of TSH.

The Efficacy of Hemoglobin, Albumin, Lymphocytes, and Platelets as a Prognostic Marker for Survival in Octogenarians and Nonagenarians Undergoing Colorectal Cancer Surgery.

Objectives: With the aging population worldwide, the octogenarians are becoming a substantial group and since cancer incidence increases by age, this group of patients is becoming more affected. However, no distinct treatment algorithm has been established for elderly patients with cancer. The present study aimed to determine the prognostic value of several inflammatory parameters by comparing octogenarian patients treated surgically for colorectal cancer with their younger counterparts, as well as to predict and prevent age-related complications in this frail group of patients. Methods: The demographic and clinical data were collected from octogenarians and older people as case group (51 patients) and from a nonelderly control group of patients 65 years old or younger (88 patients). Results: The results showed that Hemoglobin, Albumin, Lymphocytes, and Platelets (HALP) values were statistically different between case and control groups. Based on the results of the receiver operating characteristic analysis performed, there was a positive correlation between HALP and survival. HALP had a significant discrimination power at the good level [AUC = 0.775 (0.696-0.854); p < 0.001]. The multivariate model showed that age groups and HALP scores were significant factors for patient survival. Conclusions: HALP biomarker was associated with the prognosis of patients treated surgically for colorectal cancer with curative intent. Furthermore, HALP score was significantly different in octogenarians compared to their younger counterparts. The newly formulated Hemoglobin, Albumin, Lymphocytes, Platelets, and Age (HALPA) appeared to be a promising biomarker of survival for elderly patients scheduled for colorectal cancer surgery.

Association between Shoulder Range of Motion and Pain Catastrophizing Scale in Breast Cancer Patients after Surgery.

BACKGROUND: Prolonged survival period as a result of early diagnosis and treatment in breast cancer has increased the importance of postoperative morbidities. The aim of the present study was to investigate the association of pain ca-tastrophizing with shoulder pain in patients with decreased shoulder range of motion in the postoperative period. PATIENTS AND METHODS: The present study included 53 patients who underwent surgery due to breast cancer. Patients who had bilateral mastectomy, distant metastases, cervical-cranial originated lesions, patients with problems involving one of the shoulders or upper extremities before the operation, and patients with cognitive impairment, heart failure, or low albumin levels (liver parenchyma disease or renal failure) were excluded. Shoulder range of motion was measured in the postoperative period, and two study groups were established: one with a limited shoulder range of motion level and the other with a normal level. Effects of pain catastrophizing and shoulder pain severity on shoulder range of motion limitation were compared between the two groups. RESULTS: The average age of 53 female patients who had breast surgery was 52.3 ± 10.5 years. In the group with limited shoulder range of motion, the median pain catastrophizing scale value was 27 (range 5-32) and the shoulder pain severity score was 4 (range 0-8), while in the group with normal shoulder range of motion these values were 11 (range 3-39) and 2 (range 0-6), respectively (p < 0.05). In addition, it was found that factors such as surgical treatment modality and postoperative radiotherapy did not significantly affect shoulder range of motion limitation. CONCLUSION: Determining the pain catastrophizing scale of patients and controlling pain in the early postoperative period could have positive effects on shoulder range of motion.

Can Simple Parameters such as Neutrophil-to-Lymphocyte Ratio and Neutrophil Count Predict the Nature of Adrenal Masses?

BACKGROUND: The immune system responds to many diseases by triggering an inflammatory response, which in turn produces changes in the formulation of blood elements in the circulation. Certain parameters derived from the complete blood count, mainly the neutrophil/lymphocyte ratio (NLR), have been used as biomarkers in the diagnosis and prognosis of solid tumors. METHODS: A total of 66 patients who underwent surgery for adrenal lesions were analyzed. Complete blood countderived parameters obtained preoperatively were studied according to the nature of the definitive pathology report. RESULTS: As a result of ROC analysis, neutrophil and NLR parameters were found to be significant diagnostic biomarkers in differentiating benign from malignant lesions (AUC = 0.853 (0.760 - 0.947); p < 0.001, AUC = 0.702 (0.557 - 0.848); p = 0.025, respectively). Other blood parameters were similar between the groups (p > 0.05). The discrimination power of NLR was significantly more successful than neutrophil count. The cutoff point for the NLR was found to be 4.36. Concerning tumor diameters of all study groups, the malignant group was found to be statistically different from the others (p < 0.001). A positive significant correlation was observed between tumor diameter and NLR (r = 0.435, p < 0.001). CONCLUSIONS: The systemic inflammatory response to adrenal lesions may be evaluated by means of NLR, an elevated NLR value in combination with a large lesion may be predictive of malignancy rather than benignity.

Transrectal vacuum treatment for low colorectal anastomotic leaks.

BACKGROUND: Anastomotic leakage after rectal resection is a major complication which increases the rates of morbidity and mortality. A small number of patients with generalised peritonitis need radical surgical treatments. Stable patients with local peritonitis can be treated conservatively. The aim of this study is to evaluate the effects of transrectal vacuum treatment on the healing of low colorectal anastomotic leaks. METHODS: Medical records of fourteen patients managed conservatively with transrectal vacuum treatment for anastomotic leakage after rectal resection between September 2015 and September 2018, were retrospectively reviewed. Anastomotic leakage was documented and evaluated with computerised tomography and rectosigmoidoscopy. RESULTS: 10 of 14 patients had successful closure of the perianastomotic abscess cavity after a mean of 19 days of vacuum treatment. 2 patients in this group had stricture on the anastomotic site as a late complication which was successfully treated with repeated dilatations. 4 of 14 patients had eventually a permanent sigmoid colostomy. CONCLUSION: Our results suggest that transrectal vacuum treatment can be safely used to all stable patients without generalised peritonitis in the management of low colorectal anastomotic leakages. KEY WORDS: Anastomotic leakage, Rectosigmoidoscopy, Vacuum treatment, VAC.

The Efficiency of Laparoscopic Common Bile Duct Exploration in Endoscopic Retrograde-Cholangiopancreatography-Limited Setting in a Peripheral University Hospital.

Background: The aim of this study is to evaluate complications and costs in patients treated with laparoscopic and open method for common bile duct (CBD) stones. Secondary aim is to compare the effectiveness, safety, and outcomes of these methods. In addition, it is aimed to review the feasibility of laparoscopic method in rural areas. Methods: Seventy-one patients were analyzed retrospectively. Patients were divided into two groups as open and laparoscopic surgical method. These groups were analyzed comparatively in terms of complications and costs. Subgroups were formed from patients who underwent T-tube drainage, primary closure, and biliary anastomosis as choledochotomy management. As a secondary outcome, these three subgroups were investigated in terms of complications and cost. Results: The cost was lower in open method compared to laparoscopic method (484$, 707$, P = .002). There was no significant difference in postoperative complications between groups (P = .257). While the mean hospital stay was longer in the open group, the operation time was shorter (P = .002, P = .03). The mean length of hospital stay in the T-tube group was significantly higher than the primary closure (P = .001). The cost in the T-tube group was significantly higher than the primary closure and biliary anastomosis groups. Conclusion: Laparoscopic CBD exploration by experienced surgeons in endoscopic retrograde-cholangiopancreatography-limited settings is an effective and safe method in the treatment of choledocholithiasis. This procedure should not be limited to reference centers and should be performed safely in rural areas by well-trained surgeons.

Reply to "Comment on the Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis".

We would like to thank Akbulut and his colleague for reading our article with interest, and for their valuable comments and criticisms [...].

Does a selective surgical approach to malignant bowel obstruction help in palliative care patients?

BACKGROUND: Malignant bowel obstruction (MBO) is a condition secondary to intra-abdominal metastatic spread of advanced-stage tumors. There is no consensus for the treatment approach of MBO. This study aims to present the results of medical treatment and palliative surgery in patients diagnosed with MBO. METHODS: The patients who were treated for advanced-stage tumors between 2010 and 2017 and for whom consultation was requested from the surgical clinic for MBO symptoms were identified. A selective approach together with palliative care for the indication of surgery was instituted. The patients with surgical treatment and medical treatment were compared concerning survival, oral food intake and symptom relief. RESULTS: Seventy-six patients (30 female, 46 male) aged 60.5±12.8 years (range: 27-88) were included in this study. Forty-eight of the patients (64.9%) underwent surgical treatment, while 28 (35.1%) had medical treatment. Although the patients with surgery had longer duration of stay in the hospital (median 16 days vs. 4 days) (p<0.001) and higher complication rates (27.1% vs. 3.5%) compared to medically treated patients; the restoring oral food intake was better (97.9% vs. 78.6%) (p=0.005) and the survival was longer (105 days vs. 43 days). CONCLUSION: This study revealed that surgical treatment resulted in better outcomes for life quality parameters in highly selected patients with malignant bowel obstruction evaluated by multidisciplinary team, including palliative care.

Can Simple Tests Prior to Endoscopy Predict the OLGA Stage of Gastritis?

Gastritis is a progressive disease that evolves from a non-atrophic to atrophic state and progresses through intestinal metaplasia, with some cases leading eventually to gastric cancer. Since gastritis by definition is an inflammatory process of the mucosal lining of the stomach and is usually associated with pain, we aimed to identify any association between the severity of gastritis and pain and a simple inflammatory marker derived from a complete blood count (CBC). This was a prospective cross-sectional study which enrolled 155 consecutive adult patients who underwent an upper endoscopy. Prior to the endoscopy, all patients were given a questionnaire, numerical rating scale (NRS) and complete blood count evaluation. The biopsy was obtained from the gastric mucosa according to the modified Sydney classification and scored with the Operative Link for Gastritis Assessment (OLGA) scoring system. The results showed a significant correlation between NRS and intestinal metaplasia (p < 0.01); moreover, a correlation was also found between the NRS and OLGA stage (r = 0.469, p < 0.001). A nonlinear curve was constructed for OLGA stage estimation according to NRS scores (r2 was found to be 0.442, with p < 0.001). The results also showed a correlation between the neutrophil to the lymphocyte ratio (NLR) and OLGA stage (p < 0.01). No correlation was found between the other gastric parameters and NLR (p > 0.05). Helicobacter pylori positivity did not correlate with NRS and NLR. As a conclusion, pain measured by NRS and NLR, which are simply calculated from the CBC prior to endoscopy, may be used to predict OLGA stages and estimate the severity of gastritis in endoscopy patients.

Acute Mono-appendicitis in a Case of Duplex Appendix: A Rare Finding.

Appendiceal duplication is an extremely rare entity in adulthood. It is usually diagnosed incidentally during laparotomy performed for another indication. Herein, we present a case of double appendicitis in a 31-year male who underwent laparotomy with a preliminary diagnosis of acute appendicitis. Two appendices attached via separate bases to a cecum were identified intraoperatively. One of them was thick-walled, partial 1 perforated from the apex region and the other one was normal looking. Both had their own radices. They were stuck together at their apical parts. Appendicectomy was performed for both of them. Due to the fact that appendicectomy is the most common abdominal surgery procedure, surgeons should always bear in mind this rare anomaly, in order to prevent complications. Key Words: Appendiceal duplication, Cecum, Anatomic variation.

The Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to investigate the efficacy of the complete blood count parameters, C-reactive protein, and Lymphocyte-C-reactive Protein Ratio laboratory tests in the diagnosis of acute appendicitis, as well as their relationship with appendix diameter. We retrospectively examined all patients who underwent appendectomy between 1 January 2012 and 30 June 2019 in the General Surgery Clinic of Gaziosmanpasa University Faculty of Medicine. Laboratory tests, imaging findings, age, and gender were recorded. Lymphoid hyperplasia is considered as normal appendix-in other words, as negative appendicitis. The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤6 and >6 mm) (p < 0.001). We found a significant correlation between appendix diameter and WBC (White blood count), Lymphocyte, Neutrophil, RDW(Red blood cell distribution width), NLR(Neutrophil to lymphocyte ratio), and PLT/L (Platelet to lymphocyte ratio), MPV (Mean platelet volume) and RDW were significantly different in patients with an appendix diameter of ≤6 mm (p = 0.007, p = 0.006, respectively). WBC, Neutrophil, PDW, and NLR values were significantly different between appendicitis and hyperplasia groups in patients with an appendix diameter of >6 mm. The sensitivity of the NLR score (cutoff = 2.6057) in the diagnosis of appendicitis was 86.1% and selectivity was 50% in these patients. Complete blood count parameters evaluation with the clinical findings revealed that NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm. In patients whose pathological results indicated acute appendicitis but who had a diameter of ≤6 mm, we found an elevated MPV and low RDW values.

The Effect of Place of Residence on Treatment Outcomes and Survival in Octogenarian and Nonagenarian Breast Cancer Patients.

Introduction The number of octogenarian invasive breast cancer cases is projected to increase, as there is a significant increase in life expectancy. However, no specific treatment guideline has been established so far for this vulnerable group of patients. The aim of the present study was to evaluate the treatment outcomes of octogenarians diagnosed with early and locally advanced invasive breast cancer, to compare those who underwent surgery with conventional treatment and those who did not, and to reveal the potential social factors that may affect their therapy outcomes. Material and methods A total of 78 patients aged 80 and over were included in the study. There was a significant relationship between a patient's social milieu and treatment status (p < 0.001). The relationship between receiving endocrine therapy or surgical treatment was also significant (p = 0.029). Results The surgical treatment rate was 90.9% in survivors, which was significantly lower in those who passed away (37.8%, p < 0.001). According to the log-rank test results, life expectancy was significantly longer in operated patients than in non-operated ones (p < 0.001). The median survival length was 62 months (range: 33.8-90.2) in operated patients 80 years of age and above and 19 months (range: 16.3-21.7) in non-operated ones. The surgical treatment frequency was 15.30 times (range: 4.86-48.21) higher in patients living with family than in patients living alone or in a nursing home. Conclusion Thus, the social milieu of the patients, especially the place of residence, had a major impact on the treatment of the elderly (octogenarians) patients with breast cancer. Surgery and endocrine therapy as an adjuvant treatment were tolerable and had positive impacts on survival.

Effect and Tolerability of Same-Day Repeat Colonoscopy.

Purpose/Aim of the study: The main purpose of the colonoscopy is screening for colorectal cancers and diagnosis of colorectal disease The cost-effectiveness of colonoscopy directly depend on the adequate bowel preparation. Inadequate colonoscopy is recommended to be re-scheduled within 1 year. Re-scheduling is an economic and patient burden. Thus instead of re-scheduling, another strategy may be attempted. The purpose of this study was to examine the usefulness and effect of the same day repeat colonoscopy after administration of an additional laxative dose. Materials and Methods: Patients with inadequate colonoscopy were enrolled in the study. The patients eligible for the enrollment were instructed to consume an additional laxative and scheduled in afternoon. The demographic data of the patient, the details of the index and repeat procedures were obtained by a questionnaire. Results: A total of 60 patients were enrolled in the study. The rate of adequate colonoscopy was 80%. Cecum intubation rate was 83.3%. There were no complications due to colonoscopy itself and additional laxatives. The polyp detection rate was 26.6%. The withdrawal time was 6.7 ± 1.34 min. Conclusion: The results of the present study showed that same day repeat colonoscopy with additional laxative dose can be a safe and effective method for repeat procedure of an inadequate colonoscopy. The patients tolerated and were satisfied with the same day protocol. Quality indicators of colonoscopy such as adenoma detection rate and cecum intubation rate were achieved. Same day bowel cleansing method may be considered as an alternative way rather than re-scheduling inadequate colonoscopy for a later time.

Management of foreign body ingestion and food impaction in adults: A cross-sectional study.

BACKGROUND: The management of food impaction and foreign body ingestion in the upper gastrointestinal tract requires careful evaluation and timely intervention. This study was a retrospective evaluation of the management of adult patients with such a history. METHODS: This study included adult patients admitted to a tertiary medical center with foreign body ingestion or food impaction between January 2012 and January 2018. The demographic and clinical data were recorded pro forma for statistical analysis. RESULTS: Of the 122 patients included in this study, 53.2% were male, and the mean age was 46.68+-18.64 years. In 84 of the patients (68.8%), the ingested object was food. Thirty patients were managed solely through laryngoscopy, while 61 patients (50%) underwent a flexible endoscopy. The patients with a foreign body ingestion were older than those with a food impaction (mean age: 51.3+-17.4 vs. 36.5+-17.4 years; p<0.001) and a plain radiograph showed the ingested material more often in those patients (36.8% vs 10.7%; p<0.001). Two patients underwent surgery due to perforations caused by the impacted material. No mortality was observed. CONCLUSION: The management of a foreign body ingestion or food impaction in an emergency setting requires a stepwise, algorithmic approach.

A rare anal mass: anal leiomyoma presented as perianal fistula.

Leiomyoma of the anal canal originating from the internal anal sphincter is an extremely rare clinical entity. Generally, it does not produce any clinical signs unless it is large enough to cause obstruction, discomfort, bleeding or pain. The diagnosis is often made incidentally during rectal examination due to other perianal disease or check-up. Herein we report a case of internal anal sphincter leiomyoma diagnosed unexpectedly during rectal examination in a patient with perianal fistula, and treated successfully with surgical excision. We present a review of the literature, the diagnostic strategies, differential diagnosis, prognosis and treatment modalities of this lesion.

Recurrent acute pancreatitis in a patient with both gallbladder and cystic duct agenesis and polycystic liver disease.

Agenesis of the gallbladder and cystic duct is a rare congenital anomaly occurring in <0.1% of the population. However, combined gallbladder and cystic duct agenesis (CDA) with polycystic liver disease associated with recurrent acute pancreatitis (RAP) has not been reported earlier. Herein we report a case of a 36-year-old female patient who was admitted to the hospital and successfully treated for acute pancreatitis most probably caused in the background of gallbladder and CDA with polycystic liver disease. In case of non-visualization of gallbladder with the presence of biliary symptoms after repeated ultrasonographic examinations, advanced techniques like MRCP, computed tomography, EUS and even endoscopic retrograde cholangiopancreatography (ERCP) to visualize biliary anatomy must be conducted before any surgical intervention. We present a case of gallbladder and CDA causing RAP by the formation of microlithiasis treated successfully with ERCP and without any unnecessary surgery, its management and review of the literature is assessed.

Primary hydatid cyst localized in soft tissue during pregnancy.

Hydatid cyst in pregnancy is a rare condition. Moreover, it is very rare that it is in the soft tissue other than the liver. In this case, there are no data in the literature on treatment options, but only experience in case presentations. We present a patient who had severe pain during pregnancy due to isolated soft tissue hydatid cyst disease in this case report.

Effect of bevacizumab on acetic acid-induced ulcerative colitis in rats.

BACKGROUND: The aim of this study was to examine the effect of intraperitoneally administered bevacizumab on colitis induced by acetic acid. METHODS: An experimental model of acetic acid-induced colitis was introduced in rats. After the induction of colitis, bevacizumab was administered intraperitoneally at two different daily doses of low (2.5 mg/kg) or high (5 mg/kg) concentration. Control groups were included for colitis and bevacizumab. After 7 d, the rats were sacrificed, and colonic tissues were harvested for macroscopic and microscopic examination of colonic damage. Tumor necrosis factor alpha, interleukin 1 beta (IL-1ß), IL-6, myeloperoxidase, malondialdehyde, glutathione, and superoxidismutase values were measured biochemically. RESULTS: There was no statistically significant macroscopic improvement in damage to the colon tissues (P > 0.05). The severity of inflammation was significantly reduced (0.98 ± 0.22) in the low-dose bevacizumab-treated rat group compared with the control group (P < 0.001). The decrease in the inflammation score in the high-dose bevacizumab-treated rat group was not statistically significant (1.40 ± 0.33). In addition, although there was no significant change in the myeloperoxidase levels biochemically, IL-6 and malondialdehyde levels decreased in the low-dose treatment group (P = 0.014, P = 0.002, respectively). A significant decrease was found at both treatment doses in IL-1ß (P < 0.001, P = 0.010), tumor necrosis factor alpha (P < 0.001, P = 0.015), superoxidismutase (P = 0.046, P = 0.011), and glutathione (P = 0.012 and P < 0.001) levels. CONCLUSIONS: Both treatment doses of bevacizumab were observed to have a protective effect in an experimental colitis model, and the dosage of 2.5 mg/kg bevacizumab was found to have a more prominent effect.

Laparoscopic Removal of Gossypiboma.

Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery.

The fate of suboptimal anastomosis after colon resection: An experimental study.

BACKGROUND: The fate of suboptimal anastomosis is unknown and early detection of anastomotic leakage after colon resection is crucial for the proper management of patients. METHODS: Twenty-six rats were assigned to "Control", "Leakage" and "Suboptimal anastomosis" groups where they underwent either sham laparotomy, cecal ligation, and puncture or anastomosis with four sutures following colon resection, respectively. At the fifth hour and on the third and ninth days; peripheral blood and peritoneal washing samples through relaparotomy were obtained. The abdomen was inspected macroscopically for anastomotic healing. Polymerase chain reaction (PCR) with 16s rRNA and E.coli-specific primers were run on all samples along with aerobic and anaerobic cultures. RESULTS: The sensitivity and specificity of PCR on different bodily fluids with 16s rRNA and E.coli-specific primers were 100% and 78%, respectively. All samples of peritoneal washing fluids on the third and ninth days showed presence of bacteria in both PCR and culture. The inspection of the abdomen revealed signs of anastomotic leakage in eight rats (80%), whereas mortality related with anastomosis was detected in two (20%). CONCLUSION: Anastomotic leakage with suboptimal anastomosis after colon resection is high and the early detection is possible by running PCR on peritoneal samples as early as 72 hours.