One-year follow-up of the oxidative stress profile of patients after laparoscopic sleeve gastrectomy.

OBJECTIVE: Obesity is a major risk factor for developing a number of serious diseases, such as cardiometabolic changes and cancer. An increase in adipose tissue and a decrease in antioxidant capacity both contribute to the etiopathogenesis of these comorbidities. The most effective method in the treatment of morbid obesity is bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is the most preferred method in bariatric surgery today. In this study, the potential improvement effect of laparoscopic sleeve gastrectomy (LSG) surgery in the restoration of weight loss and endocrine and tissue-based deterioration was obtained by evaluating changes in oxidative stress, antioxidant agents, and lipid oxidation levels. PATIENTS AND METHODS: Fifty patients who had LSG surgery were chosen, along with 50 healthy volunteers who were the same age and gender as these patients. Serum total antioxidant capacity measurement, total oxidant capacity measurement, malondialdehyde (MDA) for the measurement of lipid peroxidation degree, and superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels for the measurement of antioxidant levels were measured colorimetrically with the help of a commercial kit. RESULTS: Oxidative stress indices, MDA levels, and GPx levels of patients with morbid obesity treated with LSG were observed to decrease significantly compared to the preoperative period, while no significant changes were observed in SOD levels. CONCLUSIONS: In patients with morbidly obese conditions, the weight control achieved by sleeve gastrectomy, which is a restrictive method and thus causes a decrease in adipose tissue, causes a decrease in oxidative stress and an increase in the antioxidant response.

Investigation of time-dependent alterations in adipokine levels and endoplasmic reticulum stress markers in obese patients with laparoscopic sleeve gastrectomy.

BACKGROUND AND AIMS: We aimed to investigate the time-dependent alterations of serum, adipose tissue WISP1, Nrg4, asprosin, SPX adipokines and serum ER stress markers GRP78, XBP1, ATF6, CHOP in obese patients who underwent laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Morbidly obese patients (n = 19) and normal-weight individuals (n = 19) were compared. Preoperative (control, obese) and postoperative 1st, 3rd and 6th month (obese) follow-up measurements were obtained. Levels of adipokines, ER stress markers were measured with commercial kits. RESULTS: Body mass index (BMI), total fat, trunk fat mass, fat percentage of obese patients decreased after LSG. Postoperative serum glucose, insulin, HOMA-IR, triglyceride levels of obese patients decreased, HDL increased. In obese patients, preoperative LDL and total cholesterol, which were not different from control, were higher in the postoperative 6th month measurements. Omentum WISP1, subcutaneous adipose tissue WISP1 and SPX, and serum WISP1, asprosin, CHOP levels were higher, Nrg4 lower in obese patients. Serum Nrg4 was still lower in the postoperative 1st month measurements, while WISP1 was higher in the 3rd and asprosin in the 3rd, 6th months compared to control. 1st and 3rd month ATF6 and 3rd month CHOP concentrations were lower than preoperative values. Serum CHOP measured at the 6th month was significantly higher than control. Negative correlations were observed between serum Nrg4 and fat percentage, TG concentration. CHOP was negatively correlated with fat percentage. CONCLUSION: The correlations between changes in serum Nrg4, CHOP and fat percentage highlight the roles of Nrg4 and CHOP in the fat loss following LSG.

Ultrasound-guided wire localization biopsy in non-palpable breast lesions: predictive factors for malignancy.

OBJECTIVE: The aim of the study was to evaluate the results of ultrasound-guided excisional biopsy in patients with nonpalpable breast lesions and examine factors associated with malignancy. PATIENTS AND METHODS: A total of 380 patients who underwent ultrasound-guided excisional biopsy for suspected nonpalpable breast masses, between May 2012 and 2018, were retrospectively examined. Histopathological results of the patients were compared regarding age, ultrasound findings, ultrasonographic and mammographic Breast Imaging Reporting and Data System (BI-RADS) categories and factors predicting malignancy were determined. RESULTS: The mean age of the patients was 48.35 ± 11.23 (17-86) years. There was a history of breast cancer in the families of 22 (5.8%) patients, and 187 (49.2%) patients were in menopause. The complication rate was found to be 6.6%. Malignant lesions were detected in 76 (20%) patients and benign lesions were detected in 304 (79.99%) patients. Some benign lesions were high-risk lesions (16.8%). Most of the patients with malignant lesions had early-stage breast cancer (83.3%). In univariate analyzes, ultrasonographic BI-RADS, mammographic BI-RADS and age variables were found to be associated with malignancy (p = 0.0001). In the multiple logistic regression analysis, ultrasonographic and mammographic BI-RADS values were found to be risk factors for malignancy (p = 0.0001). CONCLUSIONS: BI-RADS scoring was used to determine risk factors in predicting malignancy in the evaluation of suspected nonpalpable lesions. The ultrasound-guided wire localization biopsy is a useful method in nonpalpable breast lesions with suspected malignancy that cannot be diagnosed by core/vacuum biopsy or in cases where incompatibility between pathology and radiology results exists.

Randomised controlled study of seroma rates after mastectomy with and without quilting the skin flap to pectoralis muscle.

AIMS: The aim of this study was to determine whether seroma formation was affected by reduction of the potential dead space with the flap fixation method and obliteration of the axillary region in patients with breast cancer who underwent either mastectomy and axillary lymph node dissection or sentinel lymph node biopsy. A total of 105 patients with breast cancer were divided into two groups according to wound closure patterns. PATIENTS AND METHODS: The operating time, postoperative pain and complications, time to drain removal, seroma formation, amount of fluid aspirated and number of aspirations were recorded prospectively. RESULTS: No significant difference was found between groups in the rates of seroma development (P = 0.7), complication rates (P = 0.6), time to drain removal (P = 0.5), length of hospital stay (P = 0.3) or numbers of aspiration (P = 0.7). The operating time for fixation was determined to be longer than that of the classic procedure (P = 0.02). CONCLUSIONS: Reducing potential dead space with flap fixation and obliteration of the axillary region may be useful in decreasing the development of seroma in patients who have undergone mastectomy because of breast cancer. However, surgical technique must be careful, and appropriate patient follow-up must be conducted.

Effect of sleeve gastrectomy on thyroid-stimulating hormone levels in morbidly obese patients with normal thyroid function.

OBJECTIVE: There are many studies, which demonstrate that morbid obesity is associated with an increase in Thyroid Stimulating Hormone (TSH) levels. However, the effect of Laparoscopic Sleeve Gastrectomy (LSG) procedure on postoperative TSH levels is not clear. This study aims to evaluate the effect of weight loss after LSG procedure on TSH levels in euthyroid patients with morbid obesity. PATIENTS AND METHODS: 159 Euthyroid patients who applied for an LSG procedure (93.7% female, with a mean age of 34.18±10.01 years, BMI 43.2±6.82 kg/m2) were retrospectively analyzed for the study. The parameters used in the analysis were their serum free T3 levels (fT3), free T4 levels (fT4), and TSH levels preoperatively and at 6 months after surgery. The postoperative correlation between TSH and BMI (Body Mass Index), % EWL (Percent Excess Weight Loss), and % TWL (Total Weight Loss) levels were evaluated. RESULTS: Mean BMI change from 43.2±6.82 kg/m2 to 30.48±5.63 kg/m2 (p<0.001), 6 months after LSG, was associated with a mean reduction in the TSH from 2.27±1.09 µU/dL to 1.61±0.99 µU/dL; p<0.001). Serum fT3 levels (3.23±0.42 ng/dL at baseline and 3.21±0.48 ng/dL at 6 months after surgery; p=0.409) remained steady. Serum fT4 levels (1.21±0.18 µU/dL at baseline and 1.43±0.20 µU/dL at 6 months after LSG; p<0.001) increased. Change in TSH was significantly correlated with change in BMI at 6 months after surgery (r=0.200, p=0.015). However, the decrease in TSH following LSG procedure did not correlate with % EWL (r=-0.114, p=0.159) and % TWL (r=-0.100, p=0.209). CONCLUSIONS: After the LSG procedure, there was a significant decrease in TSH levels and a significant increase in fT4 levels, but no change was seen in fT3 levels. While this decrease in TSH levels showed a positive correlation with BMI, no statistically significant correlation was found with % EWL and % TWL.