Effect of laparoscopic sleeve gastrectomy on platelet count and mean platelet volume.

Objective: Several studies have reported an increase in platelet (PLT) count with chronic inflammation in the presence of obesity. Mean platelet volume (MPV) is an important marker for PLT activity. Our study aims to demonstrate if laparoscopic sleeve gastrectomy (LSG) has any effect on PLT, MPV and white blood cells (WBCs). Methods: A total of 202 patients undergoing LSG for morbid obesity between January 2019 and March 2020 who completed at least 1 year of follow-up were included in the study. Patients' characteristics and laboratory parameters were recorded preoperatively and were compared in the 6th and 12th months. Results: Two hundred and two patients (50% - female) with a mean age of 37.5 ± 12.2 years and mean pre-operative body mass index (BMI) of 43 (34.1-62.5) kg/m2 underwent LSG. BMI regressed to 28.2 ± 4.5 kg/m2 at 1 year after LSG (P < 0.001). The mean PLT count, MPV and WBC during the pre-operative period were 293.2 ± 70.3 103 cells/µL, 10.22 ± 0.9 fL and 7.8 ± 1.9 103 cells/µL, respectively. A significant decrease was seen in mean PLT count, with 257.3 ± 54.2 103cell/µL (P < 0.001) at 1 year post-LSG. The mean MPV was increased at 6 months 10.5 ± 1.2 fL (P < 0.001) and remained unchanged at 1 year 10.3 ± 1.3 fL (P = 0.9). The mean WBC levels were significantly decreased with 6.5 ± 1.7 103 cells/µL (P < 0.001) at 1 year. At the end of the follow-up, weight loss showed no correlation with PLT and MPV (P = 0.42, P = 0.32). Conclusion: Our study has shown a significant decrease in circulating PLT and WBC levels while MPV remained unchanged after LSG.

A Review on the Concepts for Initially Unresectable Liver Tumors - Bridge to Surgery.

Surgical treatments of advanced tumors have expanded in the last two decades as a result of ad-vances in surgical techniques, advanced interventional radiology methods, improved intensive care unit settings and increased overall life expectancy. Advanced liver tumors represent a broad category from various malignancies such as liver metastasis or native liver tumors. Not uncom-monly these tumors are not amenable to curative treatment and require down-staging, or local control at the initial diagnosis. Herein we discuss the portal vein embolization (PVE), transarterial radioembolization (TARE) with Yttrium-90 (Y-90), and surgical options namely, two-staged hepatectomy (TSH), and associating liver partition and portal vein ligation for staged hepatecto-my (ALPPS) as bridging strategies for definitive surgical treatment.

The Effect of Laparoscopic Sleeve Gastrectomy With Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease.

AIM: The aim of this study is to reveal incidence of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) and to determine the effect of LSG with hiatal hernia repair on GERD. METHODS: A total of 440 patients, 395 of them underwent primary LSG (group A) and 45 of them underwent LSG with concomitant hiatal hernia repair (group B) between March 2018 and September 2020 were included in the study. Presence of hiatal hernia was evaluated with endoscopy and confirmed intraoperatively. Patients were evaluated for GERD symptoms in the pre and postoperative period. Two groups' data were compared. RESULTS: Mean age of the 440 patients was 38.4±11 years (56% female) and mean body mass index was 44.2±7 kg/m 2 . Symptomatic GERD was detected in 103 (23.4%) and hiatal hernia was detected in 45 (10.2%) patients. In the preoperative assessment there was no difference with regard to demographics and symptomatic GERD between the 2 groups. Mean duration of follow-up was 17±5.7 (12 to 28) months in the overall study population. Mean body mass index decreased to 28.3±4.9 kg/m 2 at 12 months after LSG. Excess weight loss ratio was found to be 81±20.4%. The rate of symptomatic GERD after LSG in group A was found to be 20% (n=79/395). Of these patients, 46 (11.6%) had de novo GERD and 33 (38%) had persistent GERD. GERD resolved completely in 54 (62%) patients. In the group B, the rate of symptomatic GERD was detected as 33% (n=15/45) ( P =0.04). The rate of de novo GERD (20%) was also higher in group B ( P =0.03). The rate of persistent GERD (37%) and GERD resolution (62%) were similar in both groups. CONCLUSION: In our study, symptomatic and de novo GERD rates were detected to be higher in the LSG+HH group than LSG alone.

Does Fixation of Gastric Sleeve Prevent Functional Stenosis in Sleeve Gastrectomy Patients?

AIM: The aim of this study is to determine whether gastric sleeve fixation prevents functional stenosis (twist or kink) and to investigate its effects on symptoms such as nausea and vomiting after laparoscopic sleeve gastrectomy (LSG). METHODS: A total of 717 patients who underwent primary LSG for morbid obesity and completed at least 1 year of follow-up between 2012 and 2019 were included in the study. All operations were performed by the same surgical team using the same technique. The patients were divided into 2 groups, that is, group 1: standard LSG and group 2: gastric sleeve fixation with LSG. These 2 groups were compared in terms of demographic characteristics, baseline body mass index, follow-up duration, bleeding, leaks, gastric stenosis, postoperative nausea, vomiting, and the need for antiemetics. In the follow-up period, patients with suspected gastric stenosis underwent endoscopy and upper gastrointestinal series. RESULTS: LSG was performed in 717 patients (55.2% female) with a mean age of 37.8±11.5 years and a median body mass index of 42.2 (30.2 to 74.2) kg/m2. The 241 patients in the first group underwent LSG without fixation, and the 476 patients in the second group with fixation. Functional stenosis was detected in 8 patients, all of whom were in group 1. One patient in group 1 had a leak on the background of functional stenosis. There was bleeding that required transfusion in 2 patients (group 1) and reoperation in 2 patients (group 2). None of the study patients died. During the in-hospital period, 122 (50.6%) patients in group 1 and 159 (33.4%) patients in group 2 had nausea and vomiting that required antiemetic treatment (P<0.001). CONCLUSION: Gastric sleeve fixation in LSG prevents complications that may arise because of improper gastric mobilization. This method is effective in reducing nausea and vomiting in LSG patients.

Sportsman hernia; the review of current diagnosis and treatment modalities.

Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.

The role of suture fixation on mesh contraction after abdominal hernia repair.

Mesh contraction is a threat for hernia repair. Our aim is to analyze the effects of fixation techniques on mesh contraction. Forty-eight rats with abdominal wall defects were equally divided into four groups (G): G1 (control) with no repair, G2 defects were repaired with free polypropylene mesh, and G3 and G4 defects were reinforced with prolene mesh fixed by running and interrupted sutures, respectively. The corners of the defect and prolene mesh were marked with silver clips. The contraction rate was calculated by radiological measurement of distances between corner clips and by measuring the mesh areas after harvesting abdominal wall containing the patch. Host reaction was histhopathologically and biochemically examined by inflammation score, fibroblast count, thickness of the granulation tissue, and tissue hydroxyproline level. Distances between corner clips and mesh area have decreased by 31.5% and 26.4% respectively in G2, while in G3 the decrease was 24.4% (p = .008) and 22% (p = .01), respectively. Granulation tissue thickness was highest in the group with mesh fixed by running suture. The tissue hydroxyproline levels were similar in mesh repair groups. Our study suggests that mesh contraction, which reduces mesh surface, occurs during the wound healing process. In order to decrease the contraction rate, it is important to keep the mesh in place until its incorporation into the surrounding tissue. Our results suggest that mesh contraction is minimized by suture fixation, and running fixation suture, which provides more balanced tension around the mesh, seems more beneficial for decreasing contraction rate.

Multiple perforations along the entire colon as a complication of intestinal Behcet's disease: a rare case.

Colonic complications of Behcet's disease due to intestinal involvement are rarely reported in the literature. Ulcers are the most frequently seen intestinal complications that cause bleeding and perforation predominantly in the ileocecal region. In this article, we report a patient with Behcet's disease who presented with multiple perforations along the entire colon. Postoperative histopathological examination revealed multiple ulcers containing lymphocytic infiltrations in the small peripheral and submucosal venules. Intimal thickening and fresh intraluminal fibrin thrombosis were also seen in these venules.

Accuracy of sentinel lymph node biopsy for the assessment of axillary status in patients with early (T1) breast carcinoma.

OBJECTIVE: To determine the accuracy of SLN biopsy for the assessment of axillary status, and prognostic markers leading to lymphatic metastasis in patients with early (T1) breast cancer. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Surgery, Teaching and Research Hospital. Between January 2000 and August 2004. PATIENTS AND METHODS: SLN mapping by blue dye method was performed on 39 patients with T1 breast carcinoma. SLNs, level 1 and 2 axillary nodes were dissected and excised. The size, pathologic features of the primary tumor, SLNs and other axillary nodes, and hormone receptors were evaluated by histopathologic examination. The rate of SLNs and non-SLNs involvement, and demographic, clinical and pathologic risk factors leading to nodal metastasis were established. The diagnostic accuracy of SLN for axillary status was calculated. RESULTS: SLNs were identified in 37 (95%) patients. The axilla had metastasis in 11 (28%) patients. Malignant cells involved SLNs in 8 patients. Non-SLNs had metastasis in 3 patients without SLN involvement. The sensitivity, specificity and accuracy of SLN biopsy for predicting axillary status was calculated as 73%, 100% and 92% respectively. Four of 5 patients with non-SLN metastasis were pre-menopausal (p=0.03), and hormone receptor negative (p=0.04). All 5 patients had T1c tumors (p=0.14) and lymphovascular invasion (p=0.0004). CONCLUSION: SLN biopsy with high diagnostic accuracy may prevent unnecessary dissection of the axilla in the majority of patients with early (T1) breast carcinoma. Some risk factors as pre-menopausal status, absence of hormone receptors, and presence of lymphovascular invasion must be taken into account as important determinant of non-SLNs metastasis.