The efficacy of liraglutide combined with intragastric balloon on weight loss.

OBJECTIVE: Intragastric balloon placement is an effective method for weight reduction. The aim of this study was to evaluate the efficacy of combining liraglutide with intragastric balloon. METHODS: Initially, demographic data of patients such as age, gender, comorbid diseases, adverse events, initial weight, height, body mass index, percent body fat, and waist-hip ratio were collected. Weight, body mass index, percent body fat, and waist-hip ratio were measured in the second, third, fourth, fifth, and sixth months. Then, intragastric balloon was removed and liraglutide was stopped. RESULTS: A total of 50 patients were included in the study, of whom 28 (56%) were in Group A (intragastric balloon) and 22 (44%) were in Group B (plus liraglutide). Weight change at the time of balloon removal was higher in Group B [median weight change 13.8 (7.8 min to 16.8 max) versus 7.9 (4.8 min to 11.8 max); p<0.01]. When the weight, percent body fat, body mass index, and waist-hip ratio changes were compared according to gender, no significant difference was observed in the groups. Comorbid diseases were hypertension in 7 patients (4 in Group A and 3 in Group B) and diabetes in 9 patients (5 in Group A and 4 in Group B). No statistical significance was found. CONCLUSION: Liraglutide has benefits in terms of weight, percent body fat, and body mass index reduction when administered with intragastric balloon.

Effects of polyurethane membrane on septic colon anastomosis and intra-abdominal adhesions.

BACKGROUND: Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%-8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions. METHODS: This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured. RESULTS: No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3. CONCLUSION: We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.

The effect of Hericium erinaceum on the prevention of chemically induced experimental colitis in rats.

BACKGROUND/AIMS: The aim of this study is to investigate the effects of the Hericium erinaceum on an experimental colitis model. METHODS: Twenty-four Wistar albino were included in this study. Rats were divided into three groups. Group 1 (n = 8) was sham group. Group 2 is the group of chemically induced by intrarectal administration of trinitrobenzene sulfonic acid (TNBS) resulting in colitis. Group 3 (n = 8) is the group that was treated 7 days before and 7 days after with H. erinaceum resulting in colitis. The activity of colitis was evaluated macroscopically and microscopically in rats. In other words, nitric oxide (NO) levels, malondialdehyde (MDA), interleukin 6 (IL-6), nuclear factor-kappa B (NF-κB) and, tumor necrosis factor-α (TNF-α) in addition to the myeloperoxidasem (MPO) activities was determined. RESULTS: The rate of TNBS-induced colitis caused to increase the level of MDA activities meaningfully in the colitis group than the control group. The results indicated that MDA (p = 0.001), NO (p = 0.001), IL-6 (p = 0.001), MPO (p = 0.878), TNF-α (p = 0.001), and NF-κB levels of treatment group decreased in the blood and colon tissues because of the H. erinaceum treatment when compared to the colitis group. H. erinaceum treatment was related to the declining of MDA, NF-κB, NO, IL-6, and TNF-α levels. CONCLUSION: H. erinaceum had a positive effect on the colitis by reducing oxidative damage in blood and tissue.

Early Surgical Repair of Bile Duct Injuries following Laparoscopic Cholecystectomy: The Sooner the Better.

Background We aimed to investigate the outcomes of the immediate surgical repair of bile duct injuries (BDIs) following laparoscopic cholecystectomy. Materials and Methods Between January 2012 and May 2017, patients, who underwent immediate surgical repair (within 72 hours) for postcholecystectomy BDI, by the same surgical team expert in hepatobiliary surgery, were enrolled into the study. Data collection included demographics, type of BDI according to the Strasberg classification, time to diagnosis, surgical procedures, and outcome. Results There were 13 patients with a mean age of 43 ± 12 years. Classification of BDIs were as follows: type E in six patients (46%), type D in three patients (23%), type C in two (15%), and types B and A in one patient each (7.6%). Mean time to diagnosis was 22 ± 15 hours. Surgical procedures included Roux-en-Y hepaticojejunostomy for all six patients with type-E injury, primary repair of common bile duct for three patients with type-D injury, and primary suturing of the fistula orifice was performed in two cases with type-C injury. Other two patients with type-B and -A injury underwent removal of clips which were placed on common bile duct during index operation and replacing of clips on cystic duct where stump bile leakage was observed probably due to dislodging of clips, respectively. Mean hospital stay was 6.6 ± 3 days. Morbidity with a rate of 30% ( n = 4) was observed during a median follow-up period of 35 months (range: 6-56 months). Mortality was nil. Conclusion Immediate surgical repair of postcholecystectomy BDIs in selected patients leads to promising outcome.

The Role of C-Reactive Protein in the Early Prediction of Serious Pancreatic Fistula Development after Pancreaticoduodenectomy.

INTRODUCTION: Despite recent advances in surgical techniques, pancreatic fistulas are common. We aimed to determine the role of C-reactive protein in the prediction of clinically relevant fistula development. MATERIALS AND METHODS: Data from patients who underwent pancreaticoduodenectomy between 2012 and 2015 is collected. Postoperative 1st, 3rd, and 5th day (POD1, POD3, and POD5) C-reactive protein (CRP) levels, postoperative pancreatic fistula (POPF) development, other complications, length of hospital stay, and mortality were recorded. RESULTS: Of 117 patients, 43 patients (36.8%) developed complications (including fistulas). Of the patients developing fistulas, 21 (17.9%) had POPF A, 2 (1.7%) had POPF B, and 7 (6.0%) had POPF C. POD5 CRP and POD3 CRP were shown to be significantly correlated with mortality and development of clinically relevant POPF (p = 0.001 and p = 0.0001, resp.) and with mortality (p = 0.017), respectively. The development of clinically relevant POPFs (B and C) could be predicted with 90% sensitivity and 82.2% specificity by POD5 CRP cut-off level of 19 mg/dL and with 100% sensitivity and 63.6% specificity by the difference between POD5 and POD1 CRP cut-off level of >2.5 mg/dL. CONCLUSION: CRP levels can effectively predict the development of clinically relevant pancreatic fistulas.

Laparoscopic surgery in distal pancreatic tumors.

OBJECTIVE: Laparoscopic distal pancreatectomy is increasingly being used in the surgical treatment of corpus and distal pancreatic tumors. In this study, patients who underwent laparoscopic or open distal pancreatectomy for benign or malignant causes were evaluated in terms of tumor characteristics and perioperative outcomes. MATERIAL AND METHODS: We retrospectively reviewed data from a total of 27 distal pancreatectomy cases performed for benign or malignant causes in the General Surgery Department between January 2013 and December 2015. Groups were compared according to the demographic characteristics of patients, operation type (laparoscopic or open, with splenectomy or spleen preservation), operation time, surgical site infection (superficial, deep wound infection, or intra-abdominal abscess), pancreatic fistula development, and histopathological examination results. RESULTS: Both groups were similar in terms of age, sex, and body mass index (p=0.42). Tumor diameter was similar (p=0.18). The total number of resected lymph nodes was similar in both groups (p=0.6). Pancreatic fistula developed in one patient in each group. Mean hospital stay duration and the amount of intraoperative bleeding were similar in both groups. The laparoscopy group had a markedly lower overall morbidity rate (p=0.08). There was no mortality observed in the study subjects. CONCLUSION: Laparoscopic distal pancreatectomy can be safely performed as a minimally invasive procedure in experienced centers and in selected cases without increasing perioperative complication rates, particularly in benign cases. Although oncological outcomes are acceptable for malignant cases, future prospective controlled studies are necessary for more reliable evaluation.

Effect of Resected Gastric Fundus Fat on Ghrelin Tissue Levels: A Prospective Study.

Introduction: Obesity is currently an important health problem that is rapidly increasing worldwide. In recent years, the number of obesity-related surgeries has increased. The most common type of obesity-related surgery is laparoscopic sleeve gastrectomy (LSG). The aim of this study was to compare the genetic expression of the hormone ghrelin in different parts of the stomach. Materials and Methods: Nineteen obese patients who underwent LSG were examined in this study. Fat tissue from two different parts of the stomach, the fundus and the upper part of the fundus, were analysed by enzyme-linked immunosorbent assay (ELISA). The ribonucleic acid (RNA) isolation, complementary DNA (cDNA) and real-time quantitative polymerase chain reaction (RQ-PCR) techniques were applied. Additionally, a human ghrelin ELISA kit was used to measure ghrelin in obese patients. The ghrelin levels of fat tissue from the fundus and upper part of the fundus were statistically compared. Results: In all 19 patients, the average ghrelin level in the fundus was greater than 30. The average ghrelin level of the fat pad, which is located in the upper part of the fundus, was greater than 30 for 4 patients; the average level was approximately 5 in the remaining patients. A statistically significant difference in the ghrelin level was found between the fundus and the fundus fat tissue. CONCLUSION: Collection of fundus fat tissue is not routinely performed during LSG. However, ghrelin hormone elevation in this tissue may require collection of fundus tissue during surgery.

The difficulties encountered in conversion from classic pancreaticoduodenectomy to total laparoscopic pancreaticoduodenectomy.

BACKGROUND: Recently, total laparoscopic pancreatectomy has been performed at many centres as an alternative to open surgery. In this study, we aimed to present the difficulties that we have encountered in converting from classic open pancreaticoduodenectomy to total laparoscopic pancreatectomy. MATERIALS AND METHODS: Between December 2012 and January 2014, we had 100 open pancreaticoduodenectomies. Subsequently, we tried to perform total laparoscopic pancreaticoduodenectomy (TLPD) in 22 patients. In 17 of these 22 patients, we carried out the total laparoscopic procedure. We analysed the difficulties that we encountered converting to TLPD in three parts: Preoperative, operative and postoperative. Preoperative difficulties involved patient selection, preparation of operative instruments, and planning the operation. Operative difficulties involved the position of the trocars, dissection, and reconstruction problems. The postoperative difficulty involved follow-up of the patient. RESULTS: According to our experiences, the most important problem is the proper selection of patients. Contrary to our previous thoughts, older patients who were in better condition were comparatively more appropriate candidates than younger patients. This is because the younger patients have generally soft pancreatic texture, which complicates the reconstruction. The main operative problems are trocar positions and maintaining the appropriate position of the camera, which requires continuous changes in its angles during the operation. However, postoperative follow-up is not very different from the classic procedure. CONCLUSION: TLPD is a suitable procedure under appropriate conditions.

Serum and biliary MMP-9 and TIMP-1 concentrations in the diagnosis of cholangiocarcinoma.

AIM: Cholangiocarcinoma is generally detected late in the course of disease, and current diagnostic techniques often fail to differentiate benign from malignant disease. Ongoing biomarker studies for early diagnosis of cholangiocarcinoma are still continues. By this study, we analyzed the roles of serum and biliary MMP-9 and TIMP-1 concentrations in the diagnosis of cholangiocarcinoma. MATERIALS AND METHODS: The 113 patients (55 males, 58 females) were included; 33 diagnosed with cholangiocarcinoma (malignant group) and 80 diagnosed with choledocholithiasis (benign group). MMP-9 and TIMP-1 concentrations were analyzed in serum and bile and compared in the malignant and benign groups. Results were evaluated statistically. RESULTS: Biliary MMP-9 concentrations were significantly higher (576 ± 209 vs. 403 ± 140 ng/ml, p < 0.01) and biliary TIMP-1 concentrations were significantly lower (22.4 ± 4.9 vs. 29.4 ± 6.1 ng/ml, p < 0.01) in the malignant than in the benign group. In contrast, serum MMP-9 and TIMP-1 concentrations were similar in the two groups. Receiver operating curve analysis revealed that the areas under the curve of bile MMP-9 and TIMP-1 were significantly higher than 0.5 (p < 0.001). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and accuracy were 0.94, 0.32, 0.36, 0.93, 1.40, 0.19 and 0.5 for biliary MMP-9, respectively, and 0.97, 0.36, 0.39, 0.97, 1.5, 0.08 and 0.54 for biliary TIMP-1, respectively. CONCLUSION: Serum and biliary MMP-9 and TIMP-1 tests do not appear to be useful in the diagnosis of cholangiocarcinoma.

Impact of GLP-1 analogue on oxidative damage and hepatic regeneration in experimental 70% hepatectomy model.

BACKGROUND/AIMS: The purpose of our study is researching into impact of glucagon like peptide 1 (GLP 1) analogue on liver regeneration after major hepatectomy. METHODOLOGY: 24 wistar albino rats were consecutively divided into 3 groups. Group 1: Control (sham) group day 14 (n = 8), Group 2: Liver resection group day 14 (n = 8); 70% Liver resection was performed, Group 3: Study group day 14 (n = 8); Subsequent to performing 70% liver resection, GLP-1 analogue was administered 2 times a day. (10 µgr/70 kg x 2 times). After 14 day, rats were sacrificed. Oxi- dative stress and antioxidant enzymes and mitochon- drial permeability transition, cytochrome-c, Bax, Bcl- 2, caspase-3, caspase-8 and caspase-3 activity were examined. RESULTS: 70% Liver resection induced oxi- dative stress of liver tissue was ameliorated by GLP-1 induction. Administration of GLP increased Bcl-2 ex- pression. Decreased expression of cytochrome-c was accompanied by a decrease caspase-3, caspase-8, and Bax expression and caspase-3 activity. CONCLUSIONS: Glp 1 induction plays a regenerative role in the major hepatectomy. This effect is dependent on modulation of the antiapoptotic and antioxidative pathways by GLP 1 expression.

Metachronous metastatic paraganglioma in jejunum as a rare entity: A case report.

Pheochromocytomas and paragangliomas are neuroendocrine tumors that arise from chromaffin cells of adrenal medulla and extra-adrenal paraganglia, respectively. The recurrence of these neuroendocrine tumors as a jejunal mass causing obstruction in the small intestine is an exceptional entity. The present study reports the case of a 70-year-old male who presented to the Emergency Department of Bezmialem Vakif University Hospital with abdominal pain and vomiting. The patient possessed a history of left nephrectomy due to malignant pheochromocytoma that had invaded into the left kidney eight months prior to presentation. Bowel obstruction was diagnosed and the patient underwent a laparoscopic procedure. Partial resection of the jejunum was performed and immunohistochemical studies revealed the lesion to be malignant paraganglioma. The majority of paragangliomas are chemo- and radioresistant. Surgical excision remains the primary treatment. Metachronous paraganglioma arising from the small intestine is an extremely rare entity and may be a relevant consideration in patients presenting with bowel obstruction.

An unusual liver mass: primary malignant mesothelioma of the liver : CT and MRI findings and literature review.

Primary malignant mesothelioma of the liver is extremely rare, and radiologic features have been defined in only one case. We present radiologic findings of two cases which are pathologically proven as primary malignant mesothelioma of the liver. Malignant mesothelioma of the liver may be included in a differential diagnosis list if there is a heterogeneous, hemorrhagic and necrotic lesion in the liver, with peripheral serpiginous vascular structures and increasing septal enhancement in post-contrast images.

Cholangiocarcinoma presenting with hypercalcemia and thrombocytopenia.

Malignant hypercalcemia and thrombocytopenia may result from bone metastasis of cholangiocarcinoma (CC). Our case was 53-year-old man admitted to emergency department with symptoms of anorexia, weight loss, nausea, vomiting, and general fatigue in February 2012. His laboratory findings showed hypercalcemia and thrombocytopenia. CT showed a large multinodular mass in the right lobe and, extending through left lobe of the liver. We considered the diagnosis of hypercalcemia of malignancy with elevated calcium levels and suppressed PTH level with the existence of skeletal bone metastasis and the absence of parathyroid gland pathology. Treatment of hypercalcemia with IV saline, furosemide, and calcitonin improved the patient symptoms. After the 8th day of admission, calcium level, thrombocytopenia, and other symptoms were normalized. Patient was sustained surgically inoperable and transferred to medical oncology department for the purpose of palliative chemotherapy and intended radiotherapy for bone metastasis. Hypercalcemia relapsed 4 weeks after discharge and patient died at the 5th month after admission due to disseminated metastasis. We should be aware of CC with symptomatic hypercalcemia and rarely low platelet count. The correction of hypercalcemia provides symptomatic relief and stability of patients.

A novel sutureless colonic anastomosis with self-gripping mesh: an experimental model.

INTRODUCTION: Anastomotic leakage is one of the most feared complications of colorectal surgery. High morbidity and mortality rates are related to this complication and several studies had been performed to test new techniques which are suggested to reduce leakage rates. The aim of our study was to evaluate the safety and effectiveness of a novel technique sutureless anastomosis with self-gripping mesh in an animal model by examining wound healing process in anastomosis. METHODS: In this study sixteen Norwegian Wistar Albino female rats were used. The rats' weights ranged from 250 to 300 g. The rats were divided into control and study groups. The control group underwent a colocolic anastomosis using the conventional method of hand-sewing with single-layer interrupted nonabsorbable sutures. The study group underwent a colocolic anastomosis using self-gripping mesh without sutures. These rats were sacrificed on the 10th postoperative day. The sample pieces obtained from the groups were subjected to anastomotic bursting pressure tests, to a test for hydroxyproline levels in the tissue and to histopathological examinations. The tissue was evaluated in terms of quantity of inflammatory cells, fibroblasts, neovascularization level and collagen content and classified according to the Ehrlich-Hunt model. Statistical analysis was done by using Mann-Whitney U test. RESULTS: The burst pressure mean ± range of control and study groups were 162 ± 78 and 123 ± 35, respectively (P = 0.049). The mean peritoneal adhesion grades were 3.2 ± 0.7 in the study group and 2.3 ± 0.7 in the control group (P = 0.036). The operative time was significantly shorter in the study group. The difference between the groups by mean of hydroxyproline levels was found to be significant (P = 0.001). According to histopathological examinations by means of the Ehrlich-Hunt model, the fibroblast activation and collagen fiber ratio were higher in the study group and the difference between these measurements was statistically significant (P = 0.006; P = 0.028). CONCLUSION: This study showed that use of self-gripping meshes for colocolic anastomosis in rats is a safe and feasible method. It is suggested that the most important advantage of this technique is the shorter operative time.

Midgut malrotation causing intermittent intestinal obstruction in a young adult.

Midgut malrotation is a congenital anomaly of intestinal rotation and fixation that is generally seen in neonatal population. Adult cases are rarely reported. Early diagnosis is crucial to avoid life threatening complications. Here, we present an adulthood case of midgut volvulus as a rare cause of acute abdomen.

A rare tumor in a patient with hepatic hydatic cyst: adrenal hepatoid adenocarcinoma.

Hepatoid adenocarcinoma (HAC) is a very rare type of extrahepatic adenocarcinoma which has a clinicopathologic and morphologic similarity to hepatocellular carcinoma (HCC). Although it is not common, it can be seen in organs other than the liver. The correct diagnosis can be a challenge because of its clinically similarity to HCC and the diagnosis is usually achieved by pathological examination following the surgery. We present a 48-year-old woman who was following with the diagnosis of stage 5 hepatic hydatic cyst. In her routine blood examinations, her alpha feta protein level was found higher than normal and her abdominal computed tomography and magnetic resonance findings did not reveal any pathological findings rather than hepatic hydatic cysts. There was a high activity of FDG on PET CT in the hepatic region so we performed a right lateral hepatectomy to the patient and final pathology was adrenal hepatoid adenocarcinoma. In this paper we aimed to present a rare case of hepatoid carcinoma of the adrenal gland.

Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods.

BACKGROUND: Fiberoptic ductoscopy is a practical and direct approach that allows the visualization of intraductal breast disease. The aim of this study was to assess the efficacy of ductoscopy in the diagnosis and management of intraductal lesions. METHODS: Data on 357 ductoscopic investigations from patients with nipple discharge were collected prospectively. Seventy-five patients were diagnosed as having intraductal papillary lesions and these cases were evaluated by final histopathology (55 solitary, 14 multiple papillomatosis, 6 premalignant or malignant lesions). Results of classical diagnostic studies using ultrasonography, mammography, and galactography were compared with those of ductoscopy and pathology. RESULTS: The sensitivities of investigation methods for papillomas in this study were 72 % in ultrasonography, 62.9 % in mammography, 81.4 % in galactography, and 86.6 % in ductoscopy. With ductoscopic papillomectomy (DP), almost 30 % of patient with solitary papilloma did not require further extensive surgery. CONCLUSION: Since there is an increased risk of malignancy, surgical excision is recommended for multiple, larger papillomas and for papillomas with atypia and in addition for papillomas where diagnostic tools produce suspicious findings. On the other hand DP is a minimally invasive intervention and can aid in the follow-up of lesions proven to have no atypia.

Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy safe?

BACKGROUND/AIMS: To study the effect of selective concomitant cholecystectomy (SCC) on laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: A retrospective case-control study of 16 morbidly obese patients treated with concomitant LSG as the primary bariatric surgery and SCC for proven gallbladder (GB) pathology (Group A) between November 2010 and February 2013 was performed. Randomly selected 32 patients who underwent laparoscopic sleeve gastrectomy was the control group (Group B). RESULTS: A total of 48 patients with a mean age of 35.5±10.7 years were included. Demographic data of groups were similar except that there were more female patients in the Group A (p=0.036). Mean body mass index (kg/m2) was 51.1±5.6 and 50.9±5.4 in Groups A and B, respectively (p=0.894). The mean operative time for patients with and without cholecystectomy was 157.2±40 and 95.72±6.2 min, respectively (p=0.001). Cholecystectomy resulted in an additional mean operative time of 49.1±27.9 min without any specific complication. There was no statistical difference with regard to overall morbidity (p=0.316) and the length of hospital stay (p=0.528) between groups. CONCLUSION: Although an increase in operative time may be an important issue, SCC can be performed on all patients with proven GB pathology during LSG without an increase in morbidity or length of hospital stay.

Acute intestinal obstruction secondary to left paraduodenal hernia: a case report.

Paraduodenal hernia, the most common type of internal herniation, is rare in the etiology of intestinal obstruction. Delayed diagnosis and surgical intervention may result in significant morbidity and mortality risk. This report presents a case of left paraduodenal hernia resulting in acute intestinal obstruction. A 43-year old male patient was admitted with a diagnosis of acute intestinal obstruction. A left paraduodenal hernia was identified by computed tomography findings of an encapsulated cluster of dilated small bowel loops occupying the left upper quadrant between the stomach and pancreas, and the presence of an engorged and displaced vascular pedicle at the orifice of the hernia. Upon further investigation, the dilated proximal jejunal segments were found in the left paraduodenal fossa, enclosed in a hernia sac. After reducing the intestinal segments to the abdominal cavity, the orifice of the hernia sac was closed by suturing to the retroperitoneum. Paraduodenal hernia should be considered as a possible etiology in cases of acute intestinal obstruction with unremarkable presentations. Physicians should be familiar with the demonstrative imaging findings of computed tomography of a paraduodenal hernia. Early surgical intervention is critical to prevent the significant morbidity and mortality associated with this condition.

Laparoscopic management of totally intra-thoracic stomach with chronic volvulus.

AIM: To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus (IGV) and to assess the preoperative work-up. METHODS: A retrospective review of a prospectively collected database of patient medical records identified 14 patients who underwent a laparoscopic repair of IGV. The procedure included reduction of the stomach into the abdomen, total sac excision, reinforced hiatoplasty with mesh and construction of a partial fundoplication. All perioperative data, operative details and complications were recorded. All patients had at least 6 mo of follow-up. RESULTS: There were 4 male and 10 female patients. The mean age and the mean body mass index were 66 years and 28.7 kg/m(2), respectively. All patients presented with epigastric discomfort and early satiety. There was no mortality, and none of the cases were converted to an open procedure. The mean operative time was 235 min, and the mean length of hospitalization was 2 d. There were no intraoperative complications. Four minor complications occurred in 3 patients including pleural effusion, subcutaneous emphysema, dysphagia and delayed gastric emptying. All minor complications resolved spontaneously without any intervention. During the mean follow-up of 29 mo, one patient had a radiological wrap herniation without volvulus. She remains symptom free with daily medication. CONCLUSION: The laparoscopic management of IGV is a safe but technically demanding procedure. The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.