Spontaneous decompression of sigmoid volvulus.

Objectives: Spontaneous decompression is an uncommon outcome of sigmoid volvulus (SV). The aim of this study was to evaluate the clinical presentation, diagnosis, treatment, and follow-up of spontaneously decompressed SV. Methods: We utilized the data of our 1,063 SV patients, the most comprehensive monocenter SV series in the world. To obtain the worldwide data on the spontaneous decompression of SV, we researched the last 56-years' literature in Web of Science and PubMed databases. Results: The incidence of the spontaneous decompression was 0.1% (1/1,063) in our SV series, whereas it was 1.5% (8/549) in the worldwide data (Fisher exact test, p = 0.001). By this way, cumulative spontaneous decompression rate was found as 0.6% (9/1,602). In the spontaneously decompressed cases, the main clinical features were abdominal pain/tenderness, distention, and obstipation, which were similar to management-required patients. However, the treatment and follow-up algorithm is still a relatively undefined subject. Conclusion: Spontaneous decompression of SV is a very rare clinical entity. The clinical presentation and diagnosis of the spontaneously decompressed SV look alike the management-required SV. However, as seen in most management-required patients, SV tends to recur in the spontaneously decompressed cases and a recurrence-reducing procedure is required in selected patients.

Comments on "Sigmoid volvulus management, only endoscopic devolvulation?"

We read the paper written by Garcia-Calonge et al. presenting a patient with Lewy body dementia and recurrent sigmoid volvulus (SV) treated with emergency surgery due to gangrenous bowel. Our clinic has 1,063-case experience with SV over 56,5-year period between June 1966 and January 2023, which data signifies the largest monocenter SV series over the world. In the light of this experience, our comments relate to neuropsychiatric diseases-SV comorbidity, endoscopic decompression, and recurrence of SV.

Sigmoid volvulus and diabetes mellitus.

Objectives: Diabetes mellitus (DM) complicates about 15.7% of sigmoid volvulus (SV) cases. However, the pathophysiology of this relation is still unclear. Our objective was to evaluate the association of DM and SV. Methods: The clinical data of 1,051 patients treated in Ataturk University Faculty of Medicine during 56 years between June 1966 and July 2022 were considered. The records of 612 cases (58.2%) were evaluated retrospectively till June 1986, while 439 (41.8%) were investigated prospectively thereafter. To obtain the worldwide data, an electronic search of the last 56-years' literature (from 1967 to date) was performed in Web of Science and PubMed databases. Results: DM was statistically higher in SV patients than of general population (15.7% vs. 8.3%, p<0.001). Conversely, SV and DM co-occurrence was statistically lower in our series than of world-wide data (2.9% vs. 15.7%, p<0.001). In our series, SV and DM comorbidity was statistically higher in elders that that of children (3.9% vs. 0.0%, p<0.05). Although sigmoid gangrene was more common in DM patients when compared with that of total, the difference was not statistically significant (42.9% vs. 27.4%, p>0.05). Conversely, the mortality rate was statistically higher in DM cases than that of no diabetics in SV (28.6% vs. 7.8%, p<0.001). Conclusion: Although the pathophysiology of SV and DM comorbidity is still relatively unexplainable, our study suggests that DM worsens the prognosis of SV. For this reason, early diagnosis and proper treatment have great importance in such patients.

Recurrence-Preventive Role of Flatus Tubes Following Endoscopic Decompression in Sigmoid Volvulus.

BACKGROUND: Sigmoid volvulus may recur following endoscopic decompression. Flatus tubes are traditionally used to prevent an early recurrence. This study aims to evaluate the recurrence-preventive role of the flatus tubes in sigmoid volvulus. METHODS: Sigmoid volvulus recurrence was retrospectively analyzed in prospectively collected clinical data of endoscopically decompressed 60 patients, in whom no tube, rectal tube, or sigmoidal tube was used. RESULTS: Mean pain/discomfort scores were higher in rectal and sigmoidal tube groups than that of no tube group (1.2 ± 0.4, 4.2 ± 0.9, and 3.5 ± 0.9, respectively, P < .001). The early recurrence was seen in 3 patients in the no tube group, while no early recurrence was determined during tube placement in the rectal and sigmoidal tube groups (15.0%, 0.0%, and 0.0%, respectively, P < .05, P < .05, and P > .05). The tubes were removed or spontaneously discharged in 13 (65.0%) and 12 patients (60.0%) in the rectal and sigmoidal tube groups, respectively, and sigmoid volvulus recurred in 2 patients in each group following the removal or spontaneous discharge. There was no statistically significant difference between the early recurrence rates of the no tube, rectal tube, and sigmoidal tube groups following the removal or spontaneous discharge of the tubes (15.0%, 15.4%, 16.7%, respectively, P > .05) and in total (15.0%, 10.0%, and 10.0%, respectively, P > .05). CONCLUSION: Flatus tubes may prevent the early volvulus recurrence during their placement in sigmoid volvulus. Nevertheless, they generally cause pain and discomfort, and they are frequently removed or spontaneously discharged, which suppresses their recurrence- preventive effects.

Factors affecting recurrence in sigmoid volvulus.

Objectives: Recurrence is a relatively common outcome following endoscopic decompression in sigmoid volvulus (SV). This study aims to evaluate the factors affecting recurrence in SV. Methods: In 434 patients with SV treated between June 1986 and January 2022, probable recurrence-affecting factors including age, age of SV onset, gender, dietary habit, defecation habit, altitude of living area, and SV attack count were analyzed in prospectively collected data. Results: Of 434 patients, 111 (25.6%) had recurrent SV with mean 1.6 ± 2.3 of volvulus episodes (range: 1-21 attacks). SV recurrence demonstrated a significant linear increase with age (14.3%, 17.1%, 21.5%, and 29.9%, respectively, in young, middle aged, mature, and elderly patients, p < 0.001). Recurrent SV was also significantly higher in male gender (28.5% vs 12.7%, p = 0.004), high-fiber diet habit (32.9% vs 17.7%, p < 0.001), and living at high altitude (26.9% vs 12.5%, p = 0.047). Although SV recurrence was higher in patients with chronic constipation, the difference was not significant (36.7% vs. 20.3%, p = 0.594). When compared with that of the patients with mature onset or elderly onset patients, SV attack count was significantly higher in young-onset cases (1.3 ± 0.9 and 1.1 ± 0.3 vs 4.6 ± 6.9, p < 0.001). Conclusion: Elderliness, early-onset, maleness, high-fiber diet habit, high altitude, and most likely chronic constipation may be the practical clinical parameters of recurrent SV. These parameters, as well as the presence of previous SV episode history, must be considered in the decision-making process in the elective treatment of SV.

The effect of biliary stents implanted before pancreaticoduodenectomy in periampullary tumors on postoperative results: a retrospective analysis of 106 consecutive cases at a single medical center.

PURPOSE: The present study evaluated the potential effects of biliary drainage before pancreaticoduodenectomy on postoperative outcomes and presented the details of a surgeon's 6 years of experience. METHODS: All consecutive pancreatoduodenectomies performed from 2015 to 2021 were retrospectively analyzed. The study population was divided into two groups: the stented group (Group I) and the nonstented group (Group II). Patient demographic data and clinical characteristics were compared between the two groups. RESULTS: This study comprised 106 individuals who underwent pancreaticoduodenectomy for periampullary tumors. The median age of the patients was 64.41 ± 11.67 years, and 65 (61.3%) were males. Sixty-seven patients (63.2%) received biliary drains (stented group), and 39 (36.8%) patients did not (nonstented group). Total bilirubin values (6.39 mg/dl) were higher in the nonstented patient group than in the stented group. The rate of total complications was significantly higher in the stented group than in the nonstented group [please check this carefully] (p < 0.05). The length of stay, operation time and pancreatic fistula were found to be higher in the stented group than in the nonstented group. CONCLUSIONS: Although the total bilirubin value was higher in the nonstented patient group than in the stented group, preoperative biliary drainage increased postoperative complication rates, operation time, and hospital stay. An advanced age and the presence of stents were independent risk factors influencing morbidity development according to the multivariate analysis.

Diagnostic value of serum levels of galanin and obestatin in patients with gastric cancer.

OBJECTIVE: Gastric cancer ranks the third among the cancer-related deaths. It is diagnosed at advanced stage in many patients due to malignant proliferation and has a poor prognosis. Currently, no instrument or biomarker has been proven to diagnose the disease before the advanced stages. This study aimed to measure the serum levels of galanin and obestatin, which were examined in various studies including cancer studies, and to discuss their diagnostic value in gastric cancers. METHODS: In this study, 30 adult patients with gastric cancer and 30 healthy adults in the control group were examined prospectively. The demographic characteristics and serum levels of galanin and obestatin in the patient and control groups were recorded. RESULTS: The mean serum level of galanin in the patient and control groups was 19.73±5.04 and 35.59±10.94 pg/mL, respectively. The mean serum level of obestatin in the patient and control groups was 40.21±5.82 and 15.15±3.32 ng/mL, respectively. A significant difference was found between the groups (p<0.001). CONCLUSION: Serum levels of galanin were lower and serum levels of obestatin were higher in patients with gastric cancer compared to the healthy individuals. Serum levels of obestatin and galanin can be used as potential biomarkers in the diagnosis of gastric cancer.

Giant Incisional Hernia Repair Using Open Intraperitoneal Dual Mesh.

Aim Giant incisional herniae are larger than 15 cm and are typically treated with an open approach. Our aim was to highlight the outcomes of treating giant incisional hernia using open intraperitoneal dual mesh. Methods Between January 2015 and December 2021, 25 patients with giant incisional hernias, where fascial defects were 15-30 cm, were evaluated retrospectively. Intraperitoneal dual mesh was used in all patients. The patients were evaluated in terms of age, gender, body mass index (BMI), previous abdominal surgeries, defect diameter, anesthesia method, length of hospital stay, drain application, complications, and recurrence. Results Eleven of the patients were male and 14 were female. The mean age was 62±13.5 years (29-82 years). The average BMI was 32 kg/m2 (20-52 kg/m2). The mean size of the fascial defect was 22±5.5 cm (15-30). The mean operation time was 90 minutes (70-130 minutes). Six patients had type I and II complications according to the Clavien-Dindo classification, specifically superficial skin infections, skin erosion, subcutaneous bleeding, and temporary ileus due to intestinal adhesion. During the average follow-up period of 36 months (6-70 months), no major complications were observed related to the recurrence and use of dual mesh. Conclusion In the treatment of giant incisional hernia, open intraperitoneal dual mesh application should be kept in mind as an effective treatment option with low complication and recurrence rates.