Comparison of short- and long-term outcomes of bariatric surgery methods: A retrospective study.

The present study is intended to retrospectively compare the short- and long-term outcomes of 3 different treatment methods in patients undergoing bariatric surgery and the variances in weight and nutritional parameters during the preoperative and postoperative periods. In this study, 534 patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-En-Y gastric bypass (LRYGB), and laparoscopic one anastomosis gastric bypass (LOAGB) between 2014 and 2021 were included. The sociodemographic and biodemographic characteristics of these patients, their weight losses and nutritional changes in the preoperative and postoperative periods, operative times, hospital stays, complications, and morbidity and mortality rates were retrospectively compared. There was a statistically significant difference between the surgical methods in the percentages of excess weight loss and total weight loss in the 1st and 3rd months. There were significant differences in the homeostasis model assessment of insulin resistance, folic acid, vitamin D, iron, ferritin, and parathyroid hormone levels (P < .05). All 3 techniques were found to be successful in facilitating weight loss at the end of the first year. LRYGB and LOAGB were found to be superior to LSG in terms of remission from diabetes during the first 6 months, whereas LSG was superior to the other methods in terms of nutritional deficiencies. Despite being more advantageous in terms of operative time, LSG and LOAGB were disadvantageous compared with the LRYGB technique because of the higher rates of leakage and mortality in the LSG technique and the higher rate of bile reflux in the LOAGB technique.

Additional gastric resection after one anastomosis gastric bypass-are there benefits?

BACKGROUND: Mini/one anastomosis gastric bypass (MGB-OAGB) is a bariatric surgery procedure that has proved effective for weight loss and the resolution of metabolic disorders. The present study evaluates the effect on postoperative outcomes of resecting the corpus and fundus as an addition to OAGB. METHODS: This retrospective study recorded and evaluated the data of 83 patients who underwent laparoscopic OAGB due to morbid obesity (Body Mass Index-BMI ≥ 40 kg/m2 ) in our clinic between January 2018 and January 2020. The patients were divided into two groups: the first group comprised patients undergoing standard OAGB (n = 49), while the second group included those undergoing OAGB plus (OAGB with additional corpus and fundus resection) (n = 34). The patient data recorded for comparison included demographic characteristics, comorbidities, preoperative and postoperative weight (at 6 and 12 months), body mass index (BMI), excess weight loss% (EWL%), excess BMI loss% (EBL%), and total body weight loss% (TBWL%), hemoglobin, fasting blood glucose (FBG), albumin and HbA1c levels. RESULTS: There was no statistically significant difference between the two groups with regard to age, gender or comorbidities. The operating time, the number of cartridges used during the operation and the length of hospital stay were statistically higher in the OAGB plus group (p = 0.039, p < 0.001, p < 0.001, respectively). No statistically significant difference was seen between the groups regarding weight, BMI, EBL% and TBWL% preoperatively and at 6- and 12-months postsurgery. There was also no statistically significant difference in preoperative and postoperative (at months 6 and 12) levels of hemoglobin, FBG, albumin, and HbA1c between the two groups. DISCUSSION: The addition of resection of the gastric fundus and corpus to an OAGB has no impact on postoperative weight loss or metabolic outcomes.

Impact of the COVID-19 pandemic on operations in general surgery clinics in Turkey.

INTRODUCTION: The Covid-19 pandemic spread rapidly throughout Turkey from March 2020 onward, and despite modified working conditions in the surgical clinics of our hospitals, some surgical patients became infected with the coronavirus during their perioperative period. AIM: The present study investigates the impact of the novel coronavirus on patients undergoing general surgical operations in our clinics during the Covid-19 pandemic. METHODS: A retrospective analysis was conducted of all surgeries performed in the general surgery clinics of two 'pandemic hospitals' between March 19 and April 30, 2020 - a period when all elective surgeries were suspended in hospitals within Turkey. Demographic data, comorbidities, choice of anesthesia method, blood parameters, duration of stay in hospital and the intensive care unit and mortality rates were compared statistically with the frequency of postoperative Covid-19 positivity in these patients. RESULTS: A total of 275 surgical operations were performed during this period. Covid-19 was identified in seven patients during the postoperative period, and was more commonly diagnosed in those who were elderly and those with comorbidities. (p=0.02, p=0.02). Statistically significant correlations were found between a Covid-19 diagnosis and admission to the intensive care unit, the length of hospital stay and the length of stay in intensive care (p<0.001, p<0.001, p=0.01). Mortality was observed in two patients who developed Covid-19 postoperatively (p= 0.03). CONCLUSIONS: The Covid-19 pandemic has had a significant impact on patients undergoing operations in our general surgery clinics. Precautionary measures taken during postoperative care should be maximized for high-risk patients. KEY WORDS: Covid-19 pandemic, General surgery clinics, Novel coronavirus, Gastrointestinal system surgery.

Intestinal Metaplasia Influencing the Density of Ghrelin Expressing Cells in Morbid Obese Patients.

PURPOSE: The aim was to compare the density of ghrelin-expressing cells (GECs) in morbid obese patients with or without intestinal metaplasia (IM). MATERIALS AND METHODS: The study included 48 patients out of 244 who underwent laparoscopic sleeve gastrectomy between 2015 and 2019. IM was detected in the sleeve gastrectomy specimens of 24 of these 244 patients. The study group consisted of all of the patients with IM. It was a case matched study. Matching factors were age and gender. Ghrelin was stained with a Leica semiautomatic immunohistochemical-staining machine. Stained preparations with ghrelin were subjected to light microscopic examination. RESULTS: The number of GECs in cases with IM was significantly lower than the cases without IM (p = 0.001). The number of GECs was significantly higher in cases with chronic inactive superficial gastritis than cases with chronic active superficial gastritis (p = 0.033). CONCLUSION: We found that there was a decrease in the number of GECs in the corpus and fundus of the stomach in cases with gastric IM as a contribution to the literature. IM cause a decrease in the number of GECs in the gastric oxyntic glands. In addition, chronic active superficial gastritis is also associated with a decrease in the number of GECs. We can say that the common feature of all of these factors may be gastric mucosal damage. Consequently, damage to the gastric mucosa appears to reduce the number of GECs.

Relationship between health literacy and quality of colonoscopy bowel preparation.

BACKGROUND/AIMS: There are a variety of factors that affect the quality of colonoscopy bowel preparations, although the relationship between the level of health literacy (HL) and the quality of bowel preparations has yet to be clarified. The present study evaluated the effect of HL on the quality of bowel preparation prior to a colonoscopy. MATERIALS AND METHODS: The data of 150 patients who underwent a colonoscopy for colorectal cancer screening and in whom the quality of bowel preparation was scored during the colonoscopy were recorded prospectively. The European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to evaluate HL prior to the colonoscopy, and the Boston bowel preparation scale was used to evaluate the quality of the bowel preparation during the colonoscopy. The demographic characteristics of the patients, the presence of comorbidities, socioeconomic characteristics (marital status, income level, and educational level), HLS-EU-Q47 questionnaire, and Boston bowel preparation scale scores were recorded and evaluated. RESULTS: A significant linear relationship was identified between the general HL index score, the cleanliness of the colonic segments (right, transverse, and left colon) and the total Boston bowel preparation scale score (p=0.013, p=0.010, p=0.008, p=0.001, respectively). In a HL subgroup analysis, a significant linear relationship was noted between disease prevention and health promotion index, the cleanliness of the colonic segments (right, transverse, and left colon), and the total Boston bowel preparation scale score. It was observed that an increase in the health care index resulted in an increase in the cleanliness of the relevant colonic segments and the total Boston bowel preparation scale score. No relationship was found between the right, transverse, and left colon and the total Boston bowel preparation scale scores and gender, age, Body Mass Index (BMI), comorbidity, marital status, level of income, or educational level. CONCLUSION: The level of HL affects the quality of colonoscopy bowel preparations.

What Can be Done for Large and Multiple Choledochal Stones?

Endoscopic retrograde cholangiopancreatography may fail to extract large and multiple choledochal stones in a single session, necessitating a repeat procedure. This paper presents the case of a 68-year female patient who underwent stone extraction following endoscopic retrograde cholangiopancreatography and a subsequent biliary stenting procedure for multiple choledochal stones. Cholelithiasis and choledocholithiasis were detected in the above patient presenting with abdominal pain and jaundice. Conventional endoscopic retrograde cholangiopancreatography techniques failed to extract the stones, and the patient subsequently underwent a sequential insertion of multiple biliary stents. The procedure was used to facilitate the downsizing and fragmentation of the stones. The duct was then cleared using the balloon/basket technique. No problem occurred within the follow-up period and the patient underwent a successful cholecystectomy four weeks after the procedure. Multiple stenting is one treatment method that can be performed in selected patients with large and multiple choledochal stones.   Key Words: Choledocholithiasis, Endoscopic retrograde cholangiopancreatography (ERCP), Biliary stenting.

The Relationship Between Histopathologic Findings and Weight Loss in Laparoscopic Sleeve Gastrectomy.

AIM: The aim of this study was to investigate the correlation between histopathologic findings detected in laparoscopic sleeve gastrectomy (LSG) specimens and excess weight loss percentages (%EWL) and excess BMI decrease percentages (%EBL). METHODS: Patients who underwent LSG in the hospital's Gastroenterological Surgery Department between the years 2013 and 2018 and who completed 1 year of follow-up were involved in the study. Patients whose 6th month and 12th month BMI were unknown were excluded from the study. Clinical and pathologic data of the cases were obtained from the automation system of the hospital. RESULTS: As a result of comparison among diagnosis groups, it was detected in the histopathologic analysis that the 12th month mean %EWL measurement was higher in the inactive stomach diagnosis group. In the comparisons among intestinal metaplasia (IM) groups, it was seen that 6th month %EWL and %EBL and 12th month %EWL and %EBL measurements were higher in the group without IM. Age, baseline BMI and active gastritis incidence in histopathologic analysis have a negative effect on weight loss. CONCLUSIONS: A correlation of histopathologic changes in morbid obese patients with weight loss after bariatric surgery was asserted in this study. Operating on younger patients with lower BMI and inactive gastritis with the LSG method could contribute to achieving more successful results. Prospective research studies are necessary within this context.

Health Literacy and Weight Loss After Bariatric Surgery.

BACKGROUND: There are many factors that affect weight loss after bariatric surgery. The present study evaluated the impact of health literacy on weight loss after bariatric surgery in morbidly obese patients. METHODS: The data of 118 patients who underwent laparoscopic sleeve gastrectomy for morbid obesity (body mass index-BMI ≥ 40 kg/m2) and completed a 1-year follow-up period were recorded and evaluated, prospectively. The Turkish version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to evaluate the health literacy of these patients. Their demographic characteristics, preoperative and postoperative weight (at 6 and 12 months), BMI, the percentage of excess weight loss (% EWL), excess BMI loss (% EBL) and total weight loss (%TWL), comorbidities, socioeconomic characteristics (marital status, income level, educational status, and duration), and HLS-EU-Q47 results were recorded and compared. RESULTS: A significant inverse relationship was identified between preoperative BMI and scores for health promotion health literacy and general health literacy indexes (p = 0.024 and p = 0.032, respectively). A significant positive relationship was noted between % EWL and % EBL at 6 and 12 months, and health promotion health literacy index scores (6 months: p = 0.004, p = 0.006; 12 months: p < 0.001 and p < 0.001, respectively). A similar significant positive relationship was recorded between the % EWL and % EBL at 12 months and the health care health literacy index scores (p = 0.042 and p = 0.036, respectively). There was also a significant positive relationship between general health literacy index scores and % EWL and % EBL at 12 months (p = 0.022 and p = 0.021, respectively). % EWL at 12 months increased by 0.39, with a 1-point increase in health promotion and health literacy index scores. CONCLUSIONS: A high health literacy index score in morbidly obese patients is associated with successful weight loss after bariatric surgery.

Laparoscopic pancreaticoduodenectomy in pancreatic cancer: Our initial experience.

Pancreas cancer is an important cause of mortality worldwide. It has no particular symptoms, and may cause different complaints according to tumor diameter and localization. Local invasion may develop in the short term and distant metastasis may occur in vascular structures in its neighborhood. That's why, resectability rates are low at the time of diagnosis with a negative effect on survival rates. Minimally invasive surgery is being increasingly implemented in pancreas lesions owing to the positive short-term oncologic results of the technique in many other procedures. Traditionally, conventional open surgery is performed in pancreatic head tumors. As laparoscopic resection of pancreatic head cancer has serious technical difficulties and requires advanced laparoscopic experience, minimal invasive attempts in this field have not yet reached sufficient acceptance worldwide. Besides the fact that laparoscopic pancreaticoduodenectomy may provide sufficient short-term oncologic results that are comparative with open surgery, it can be implemented in selected patients in centers with advanced laparoscopic resection capacity. In this case series, we aimed to present our experience of laparoscopic pancreaticoduodenectomy in pancreatic head cancer patients.

Effect of Health Literacy on Help-seeking Behavior in Morbidly Obese Patients Agreeing to Bariatric Surgery.

BACKGROUND: We aimed to evaluate the effect of health literacy on agreement for bariatric surgery among morbidly obese patients. METHODS: The data of 242 morbidly obese patients (body mass index-BMI ≥ 40 kg/m2) were evaluated in a cross-sectional case-control pattern. The patients were classified into two groups as those who were attending the clinic for the purpose of receiving bariatric surgery (n = 138) and those who did not (n = 104). The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47), consisting of 47 questions, was used for the health literacy evaluation. RESULTS: It was seen that patients who accepted bariatric surgery were younger and had higher weight and BMI values (p < 0.001). HLS-EU-Q47 index results were 33.33 (15.63-50) in the group who agreed to bariatric surgery and 26.04 (8.33:46.88) in the group who did not agree to bariatric surgery, and a statistically significant difference was determined between the two groups (p < 0.001). From the HLS-EU-Q47 questionnaire, an insufficient level (0-25) was found for 2.9% of the group who agreed to bariatric surgery and 45.2% of the group who did not (p < 0.001). The problematic-limited level was similar in the two groups (> 25-33) (respectively, 36.2%, 37.5%, p = 0.840). A sufficient level (> 33-42) and a perfect level were higher in the group who agreed to bariatric surgery (respectively, 42.8%, 18.1%, p < 0.001). CONCLUSION: There is a relationship between health literacy and acceptance of bariatric surgery in morbidly obese patients. The higher the health literacy level, the more the agreement to bariatric surgery increased.

The Factors Affecting Lower Urinary Tract Functions in Patients Undergoing Laparoscopic Sleeve Gastrectomy.

BACKGROUND: We prospectively assessed changes in the lower urinary system functions of women with morbid obesity following laparoscopic sleeve gastrectomy and the factors affecting these changes. METHODS: Data from 40 females who had undergone laparoscopic sleeve gastrectomy due to morbid obesity (body mass index, BMI ≥ 40 kg/m2) between January 2014-2016 at S.B.U. Bursa Yuksek Ihtisas Training and Research Hospital were prospectively evaluated. The presence of comorbidities, onset of obesity, smoking, American Society of Anesthesiologists (ASA) score, pre and 12-month postoperative weights and BMIs, fasting blood glucose (FBG), blood urea nitrogen, creatinine, insulin, homeostatic model assessment-insulin resistance (HOMA-IR) test results, overactive bladder survey (OAB-Q) scores, volume of urination, and Qmax values obtained from uroflowmetry studies were recorded and assessed. RESULTS: Statistically significant differences in weight, BMI, FBG, insulin, HOMA-IR score and creatinine values pre-operation, and the corresponding values obtained at 12 months post-operation were observed (all, p < 0.001). OAB-Q scores were observed to be statistically significantly lower in the postoperative period relative to those in the preoperative period (p < 0.001). Urination volume was statistically significantly higher during the postoperative period (p = 0.048) than during the preoperative period. Non-smoking patients showed a reduction in OAB-Q score and a statistically significant increase in urination volume during the postoperative period (p < 0.001, p = 0.011, respectively); smoking patients indicated a statistically significant reduction in OAB-Q score only during the postoperative period; however, urination volume was not statistically significant between two groups (p = 0.013, p = 0.303). In patients with an ASA score of 1, preoperative OAB-Q scores were statistically significantly lower (p = 0.035) than those obtained post-operation. Patients with childhood-onset obesity showed statistically significantly increased urination volumes during postoperative period in comparison with values obtained pre-operation (p = 0.042). CONCLUSION: Improvements in lower urinary system functions were affected by patient-related factors, such as comorbidity, obesity onset, smoking, ASA score, and weight loss, following laparoscopic sleeve gastrectomy.

An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery.

Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation.

Does Weight Gain During the Operation Wait Time Have an Impact on Weight Loss After Laparoscopic Sleeve Gastrectomy?

BACKGROUND: The effect of preoperative weight changes on postoperative outcomes after bariatric surgery remains inconclusive. The aim of the present study was to evaluate the effect of preoperative weight gain on postoperative weight loss outcomes after laparoscopic sleeve gastrectomy (SG). METHODS: Ninety-two morbidly obese patients undergoing SG from January 2014 to April 2016 were separated into two groups according to whether they gained weight or not during the waiting time prior to surgery. RESULTS: Thirty-nine patients (42.4 %) gained weight during the waiting time and 53 patients (57.6 %) did not. The median body mass index (BMI; kg/m2) at surgery was significantly higher in weight-gained patients (47.8 (min-max, 40-62)) compared to patients who had not gained weight (45.10 (min-max, 41-67)), (P = 0.034). No significant difference was found between the two groups regarding the distribution of age, gender, family history of obesity, existence of comorbidity, smoking, weight gain during childhood or adulthood, preoperative Beck depression and Beck anxiety scores, waiting time period, and body weight at the initial visit (P > 0.05). The ASA I score was higher in weight-gained patients whereas ASA II score was higher in those who did not gain, and the difference was significant (P = 0.046). Postoperative % BMI loss and % weight loss were not significantly different between the two groups at the first, third, sixth months, and the end of the first year (P > 0.05). CONCLUSION: Weight gain during waiting time has no negative impact on % weight loss and % BMI loss after SG.

The effects of preoperative immunosuppressive therapy on ischemia and reperfusion (I/R) injury in healthy rats.

PURPOSE: Warm-ischemia-induced injuries might be encountered during renal transplants from cadavers and healthy donors. Toll-like receptors (TLR) in ischemia-reperfusion (I/R) injury are one of the indicators of intracellular injury pathways. The intensity of ischemic injury is directly proportionate to high TLR levels. To minimize the I/R injury, we investigated TLR2 and TLR4 levels on rats, which were pretreated with tacrolimus (FK506) before I/R. METHODS: Eight Wistar albino rats in the study group were administered .01 mg/kg intramuscular tacrolimus. Administration to the study group was performed 24 and 1 h before warm ischemia. Eight rats in the control group were injected with 0.1 c.c. of distilled water. Blood samples were collected from the tail veins of all the rats on the first, second and third days. Expression levels of TLR2 and TLR4 genes were analyzed using the polymerase chain reaction method, to determine any significant difference between the control and study groups on the days when blood was taken. RESULTS: TLR2 (p = 0.045) and TLR4 (p = 0.022) levels in the study group were found to be statistically, and significantly, lower than those in the control group, on the second day following warm-ischemia- and reperfusion-induced injury. CONCLUSIONS: Administration of immunosuppressive drugs to healthy donor rats led to a statistically significant reduction in the expression levels of TLR2 and TLR4 in the early period. In light of the data obtained by this study, we hypothesize that a preoperative therapy on donors might have a role in preventing I/R injury.