Investigating the Impact of Bariatric Surgery on Macular and Peripapillary Vessel Density in Obese Individuals Without Metabolic Disease.

INTRODUCTION: It is well-established that microvascular structures are affected in obese people with metabolic disease. We aimed to evaluate the effect on microvascular structures by examining macular and peripapillary vessel density with optical coherence tomography angiography (OCTA) after bariatric surgery in obese individuals without metabolic disease. METHODS: This prospective study included 96 eyes of 48 obese patients. Body mass index (BMI), macular vessel density in the superficial, intermediate, and deep capillary plexus, and peripapillary vessel density were measured before and 6 months after bariatric surgery. RESULTS: BMI decreased significantly to 43.75±4.4 kg/m2 postoperatively compared to 55.31±5.1 kg/m2 preoperatively (p<0.05). A significant increase was observed in macular vessel density in the deep capillary plexus postoperatively (p<0.01). However, no significant postoperative increase occurred in macular vascular density in the superficial and intermediate capillary plexus (p >0.05). Moreover, there was no change in peripapillary vascular density (p>0.05). Postoperative thickening of the foveal, parafoveal, and perifoveal retinal layers was significant (p < 0.001). No significant correlation was detected between BMI change and macular and peripapillary vessel density changes (p>0.05). CONCLUSION: An increase in macular vascular density, particularly in the deep capillary plexus, and retinal layer thickness has been observed following bariatric surgery performed on obese individuals without metabolic disease. This increase may indicate that microvascular structures are affected even in the absence of metabolic disease and that microperfusion improves with surgery.

A Troublesome Complication of Hydatid Cysts; Intra-Abdominal Rupture: A 10-Year Study from a High-Volume Center.

Background: Hydatid cyst is a parasitic infection, often caused by Echinococcus granulosus. Although it is classified as a benign disease, cyst ruptures in the abdomen can be fatal. Ruptures occur spontaneously or after trauma. We aimed to report data from patients who underwent emergency surgery due to spontaneous intra-abdominal hydatid cyst rupture. Methods: Upon a retrospective review of the records at Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey, we found that 34 cases were operated on due to hydatid cyst rupture between January 2012 and October 2022. All patients were operated on in an emergency, and partial cystectomy, intra-abdominal irrigation, and drainage were performed using laparotomy. The patients were evaluated in terms of age, sex, symptoms, radiological findings, laboratory results, intraoperative findings, and postoperative follow-ups. Results: Twenty-two (64.7%) female and 12 (35.3%) male patients were enrolled. The mean age was 39.1 (±17.58) years. All patients experienced spontaneous rupture. The ruptured cyst was found in the liver in 32 patients (94%), the spleen in 1 patient (3%), and the pelvis in 1 patient (3%). The diagnosis was determined using ultrasonography in 12 (35.3%) patients, computed tomography in 21 (61.8%) patients, and magnetic resonance imaging in 1 (2.9%) patient. All patients exhibited acute abdomen and leukocytosis. The average length of hospital stay was 5.14 (±1.37) days. Conclusion: Hydatid cyst rupture should be considered in cases of acute abdomen, particularly in regions where the disease is endemic, as in our region. The ruptured hydatid cyst was primarily observed in the liver (94.11% of cases).

Does Central Fat Distribution Reduction After Bariatric Surgery Induce Ocular Refraction Change Independent of Body Mass Index?

PURPOSE: The effect of body mass index (BMI) and central fat distribution (CFD) reduction after bariatric surgery on ocular refraction is not well established. We assessed association between anthropometric parameters and refraction errors with other ocular and metabolic parameters 1 year after the surgery. MATERIALS AND METHODS: This was a retrospective study with patients underwent bariatric surgery and had at least 1 year follow-up. Data were extracted from the bariatric and ophthalmology outpatient clinic records of the participants. Measurements of metabolic, anthropometric, and ocular parameters including BMI, CFD, refraction status, visual acuity, intraocular pressure (IOP), optic coherence tomography (OCT), and biometry test of the eyes were evaluated. RESULTS: Seventy-four eyes of 37 patients had a mean follow-up of 14.4 ± 1.7 months after the surgery. Mean BMI and percentage of CFD decreased from 47.5 ± 6.7 to 33.1 ± 5.2 kg/m2 (p < 0.01) and 28.5 ± 5.74 to 17.8 ± 4.64 (p < 0.001) after 1 year, respectively. Mean refractive errors of the right and left eyes changed from - 0.62 ± 1.23 D to - 0.17 ± 1.36 D and from - 0.79 ± 1.39 to - 0.34 ± 1.56 after 1 year of the surgery (p < 0.001). Mean IOP was significantly reduced (p < 0.001). Unlike BMI, reduction in CFD was significantly correlated with refraction change in both eyes (right eyes; r = 0.783, left eyes; r = 0.791, p < 0.001) after 1 year. No significant differences were found in the other parameters. CONCLUSION: Bariatric surgery induced significant refractive change in eyes, which is significantly associated with CFD reduction after 1 year. Bariatric surgery should be considered as a risk factor in patients with unexpected refractive error changes.

Impact of Laparoscopic Sleeve Gastrectomy on Thrombomodulin Concentration and Early Markers of Atherosclerosis.

Background: Thrombomodulin, an integral membrane protein functioning as a cofactor in the anticoagulant pathways, has recently emerged as a marker of endothelial dysfunction. This study aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on thrombomodulin concentration and early markers of atherosclerosis. Methods: Forty-four subjects undergoing LSG were prospectively examined. The change in thrombomodulin concentration from baseline (preoperative) to the sixth postoperative month following the LSG and the relationship between the change in thrombomodulin concentration and BMI, CIMT, ABI, and blood lipids were examined. Results: The medical records were available for 44 patients (mean age: 37.2 ± 10.9 years, 65.9% male). LSG led to significant reductions in total body weight and body mass index (BMI) at postoperative six months (37.0 ± 5.6 kg/m2 vs. 47.1 ± 5.8 kg/m2, p < 0.001). Markers of early atherosclerotic events, including carotid intima-media thickness (CIMT) and ABI, improved. The change in thrombomodulin concentration (Δ TMD) was significantly correlated with the change in Δ BMI (r = 0.500, p=0.011), Δ LDL (r = 0.389, p=0.032), Δ systolic blood pressure (r = 0.384, p=0.012), and Δ CIMT (r = 0.327, p=0.012) and was negatively correlated with Δ HDL (r = -0.344, p=0.020) and Δ ABI (r = -0.357, p=0.020). Conclusion: LSG leads to significant improvements in blood lipids, systolic and diastolic blood pressure, and in surrogate markers of atherosclerotic burden and endothelial function, including thrombomodulin, ABI, and CIMT, at postoperative six months. LSG might prevent or reduce atherogenesis in the early stages by stopping endothelial dysfunction.

The Effect of Laparoscopic Sleeve Gastrectomy on Subclinical Atherosclerosis in Patients with Severe Obesity.

PURPOSE: Cardiovascular diseases (CVD) are one of the leading causes of mortality in obese patients. In this study, we investigated the effects of laparoscopic sleeve gastrectomy (LSG) operation on carotid intima-media thickness (CIMT), epicardial fat thickness (EFT), and serum endocan levels, which are independent predictors of subclinical atherosclerosis. MATERIALS AND METHODS: A total of 47 patients (35 females and 12 males) with a mean age of 38 ± 10.48 with standard indications for LSG were prospectively included in the study. Mean CIMT values with B-mode duplex ultrasound, EFT measurements with standard transthoracic 2D echocardiography, and serum endocan levels were measured before the operation and 6 months after the operation. Delta (Δ) values were obtained by subtracting sixth month values from baseline values. RESULTS: Body mass index (BMI) decreased significantly from an average of 47.31 ± 6.10 to 37.25 ± 5.61 kg/m2 in the sixth month after LSG (p < 0.001). EFT, CIMT, and serum endocan values decreased significantly in the sixth month after surgery (0.67 ± 0.15 vs. 0.60 ± 0.14 mm, p < 0.001; 1.07 ± 0.05 vs. 1.00 ± 0.14 mm, p < 0.001; and 89.18 ± 66.22 vs. 37.74 ± 15.37, p < 0.001, respectively). There were mild-moderate positive relationships between Δ-BMI and the values of EFT and CIMT (r = 0.386, p = 0.007 and r = 0.314, p = 0.024, respectively). We also found weak linear relationships between Δ-BMI and Δ-endocan (r = 0.267, p = 0.036), and between Δ-EFT and Δ-CIMT (r: 0.221; p: 0.046). CONCLUSION: LSG can lead to reduction in the risk of cardiovascular disease by providing improvements in CIMT, EFT, and serum endocan values, which reflect early structural atherosclerotic changes in patients with severe obesity.

Changes in the sexual functions of male patients and their partners after obesity surgery.

Sexual functionality significantly contributes to health-related quality of life and can decrease with obesity. In this study, we aimed to prospectively evaluate the changes that occur in the erection function, sexual function and testosterone level of male patients scheduled to undergo bariatric surgery, as well as the changes in the sexual function of their partner. A total of 40 patients and their partners were included. International Index of Erectile Function-5 (IIEF-5) questionnaire and the Arizona Sexual Experience Scale (ASEX) were filled before and 6 months after surgery by the male patients. The ASEX form was also completed by the partners before and 6 months after the procedure. The height and weight measurements and testosterone values were measured before and after surgery. A statistically significant difference was found between the preoperative and post-operative IIEF-5 scores of the patients (p = 0.000 < 0.01). There was also a statistically significant difference between the patients and their partners' preoperative and post-operative ASEX scores. We can conclude that the partners of men with preoperative erection complaints also experience sexual dysfunction, and with the post-operative decrease in or disappearance of erection complaints, the sexual function of both male patients and their partners improves.

Impact of Weight Loss with Laparoscopic Sleeve Gastrectomy on Left Ventricular Diastolic Function: a Prospective Study.

PURPOSE: The present study purposed to investigate the effects of weight loss with LSG on echocardiographic parameters of diastolic dysfunction in subjects with morbid obesity. METHODS: Sixty-one subjects undergoing LSG for standard indications were enrolled. All subjects underwent a physical examination, electrocardiography, and transthoracic echocardiography before and 6 months after the LSG. Peak early diastolic velocity (E), deceleration time (DT), and peak late diastolic velocity (A) were measured from the transmitral flow signal. Peak early (e') diastolic mitral annular velocity was measured at the two acquisition sites (basal septal and basal lateral) using the tissue Doppler recordings. RESULTS: A significant improvement was observed in echocardiographic measures of the diastolic function including E/A ratio, E/e' ratio, DT, and isovolumic relaxation time (IVRT) from baseline to the postoperative 6 months. Left atrial volume index (LAVI) reduced from 30.3 ± 3.9 ml/m2 to 28.0 ± 3.3 ml/m2 (p < 0.001). In addition, interventricular septum diameter (IVSD) significantly decreased from 11.3 ± 1.3 mm to 10.2 ± 1.1 mm (p < 0.001). The change in BMI was significantly correlated with the improvements in DT (r = 0.334, p = 0.012), E/e' (r = 0.440, p = 0.001), E/A (r = - 0.317, p = 0.017), and IVRT (r = 0.348, p = 0.008). CONCLUSION: LSG leads to a significant improvement in echocardiographic measures of the left ventricular diastolic function in subjects with obesity. Our findings also show that LSG leads to a reverse remodeling indicated by the decrease in interventricular septum thickness and left atrial volume index in this population.

The impact of weight loss after laparoscopic sleeve gastrectomy on early markers of atherosclerotic vascular disease: a prospective study.

BACKGROUND: Considering the emerging role of aortic propagation velocity (APV) in determining the burden of the coronary artery disease, we hypothesized that laparoscopic sleeve gastrectomy (LSG) could improve APV in morbidly obese patients. AIMS: The aim of this study was to investigate the impact of LSG on surrogate markers of atherosclerotic vascular disease such as APV, carotid intima­media thickness (CIMT), epicardial fat thickness (EFT), and ankle­brachial index (ABI) in patients with morbid obesity. METHODS: We prospectively enrolled 71 patients who were scheduled for LSG for standard indications between December 2018 and June 2019 with accordance to the international guidelines. All patients underwent transthoracic echocardiography and carotid ultrasonography. Differences in the variables measured (Δ) were calculated by subtracting 6­month follow-up results from the baseline results. RESULTS: Laparoscopic sleeve gastrectomy led to a significant reduction in body weight, and at 6­month follow­up, there was a reduction in systolic and diastolic blood pressure as well as in levels of triglycerides and low­density lipoprotein cholesterol. Moreover, a reduction in EFT and CIMT as well as an increase in ABI and APV were noted at 6­month follow­up compared with the baseline measurements. The change in APV at 6-month follow-up was correlated with systolic blood pressure, diastolic blood pressure, EFT, ABI, and CIMT. CONCLUSIONS: LSG leads to a significant improvement in BMI as well as CIMT, EFT, ABI, and APV, which are the surrogate markers of atherosclerotic vascular disease, in morbidly obese patients at 6­month follow­up after the procedure. The improvement in APV is correlated with the improvement in BMI, CIMT, EFT, and ABI.

The prognostic value of pro-calcitonin, CRP and thyroid hormones in secondary peritonitis: a single-center prospective study.

BACKGROUND: Infections and sepsis remain the leading cause of morbidity and mortality in secondary peritonitis. Clinicians are still challenged with the task of finding an early and reliable diagnosis of septic complications. The role of inflammatory markers (Procalcitonin (PCT), C-reactive Protein (CRP) and thyroid hormones in determining the severity of secondary peritonitis was evaluated in this study. METHODS: On the preoperative and first, third, fifth, seventh, and fourteenth postoperative days, PCT, CRP, and thyroid hormone concentrations were measured in serum taken from eighty-four consecutive patients who were operated on for secondary peritonitis between January 2008 and January 2010. All data was entered and analyzed using the Statistical Package for Social Sciences, version 15.0 and clinical parameters were compared using the student's t-test. RESULTS: For the groups diagnosed with perforated viscus, PCT concentrations were significantly low in contrast to high thyroid hormone levels in patients who developed postoperative complications or died when compared to patients whose postoperative course was uneventful or discharged. The PCT concentration significantly correlated with the CRP concentration and WBC count. CONCLUSION: In the absence of postoperative complications, PCT is a better predictor of outcome than CRP in secondary peritonitis. Our study showed that a low thyroid hormone level can serve as an important prognostic parameter of disease severity in secondary peritonitis.

[Evaluation of an acute mechanic intestinal obstruction case secondary to diaphragm rupture due to a blunt trauma]. / Künt travmaya bagli diyafram yirtigina sekonder akut mekanik intestinal obstrüksiyon olgusu.

Rupture of the diaphragm after blunt trauma is uncommon. In this report, a 24-year-old male with intestinal obstruction who underwent laparotomy is presented; he had been involved in a traffic accident three years prior to presentation to our emergency service. We conclude that diaphragma ruptures may cause herniation of abdominal organs and intestinal obstruction, and thus should be repaired when diagnosed.

[Primary omental torsion as a cause of acute abdomen: case report]. / Akut karina neden olan primer omentum torsiyonu: Olgu sunumu.

Torsion of the omentum is a rare pathology that was described 100 years ago. The characteristic appearance of omental torsion and a review of the literature are presented with respect to a case of primary omental torsion that was causing acute abdomen. Excision of the ischemic omentum is the proper treatment for omental torsion.