The Impact of Preoperative Dexamethasone Administration on Quality of Recovery Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study.

INTRODUCTION: Recovery from anesthesia is complex and affected by multiple factors. In patient with obesity, the increased prevalence of anxiety and depressive disorders poses a challenge in achieving optimal patient satisfaction. Therefore, strategies to enhance the quality of recovery are crucial for this population. This study aimed to investigate whether administration of dexamethasone to patients undergoing laparoscopic sleeve gastrectomy (LSG) could improve recovery outcomes. METHODS: This prospective observational study was conducted at a tertiary university hospital in Samsun, Turkey. Thirty patients who received dexamethasone prior to LSG (group D) and 30 patients who did not (group C) were included with convenience sampling method. The quality of recovery was assessed using the Quality of Recovery 40 questionnaire (QoR-40). The primary outcome measure was the QoR-40 score at 24 h postoperatively. RESULTS: The dexamethasone group showed a significant improvement in QoR-40 scores (185.4 ± 6.0 vs. 172.0 ± 8.4, p < 0.001), exhibited reduced morphine consumption (11.8 ± 7.8 vs. 21.8 ± 10.9 mg, p < 0.001), opioid demand count (21.50 [9.50-49.00], p = 0.001), the number of patient used antiemetic drug (1 vs. 22, p < 0.001), and achieved earlier mobilization (3 [3-4] vs. 3 [3-4] h, p < 0.0001). However, no significant differences were observed between the two groups concerning intraoperative complications, postoperative wound infections, or time to discharge. CONCLUSIONS: In patients undergoing laparoscopic sleeve gastrectomy, preoperative dexamethasone administration was associated with improved the recovery quality after discharge and reduced early postoperative need for antiemetic medications.

Comparison of Ketamine, Dexmedetomidine and Lidocaine in Multimodal Analgesia Management Following Sleeve Gastrectomy Surgery: A Randomized Double-Blind Trial.

PURPOSE: The aim of this study was to compare the effects of ketamine, dexmedetomidine, and lidocaine infusions added to the multimodal analgesia regimen on pain scores and analgesic requirement in laparoscopic sleeve gastrectomy. DESIGN: A prospective randomized double-blind trial. Seventy-three patients aged 18 to 65 years (ASA II-III) undergoing laparoscopic sleeve gastrectomy were included. The patients were divided into 3 groups. Intravenous (IV) ketamine (0.5 mg/kg/h), dexmedetomidine (0.5 mcg/kg/h), and lidocaine (2 mg/kg/h) were administered to Groups K, D and L, respectively. Postoperative infusions were continued for 12 hours. METHODS: Visual Analog Scale (VAS) scores (during rest and movement) in the admission to postanesthesia care unit, 1, 3, 6, 12, 24, 48 hours, and on day 15 were assessed postoperatively. Rescue analgesia requirement, the number of patients with nausea, retching, and vomiting, time to mobilization, and hospital length of stay (LOS) were recorded. FINDINGS: VASrest values during all measurements in the first 24 hours, and VASmovement values in the first 6 hours and at 24 hours were lower in Group L when compared to Group K and Group D (P < .001, P < .001, P = .008, respectively). VASrest at 48 hours and VASmovement at 12 and 48 hours were lower in Group L when compared to Group K (P = .044, P = .001 and P = .011, respectively). There was no statistically significant difference between Group D compared to the other two groups at these times (P > .05). The requirement of rescue analgesia on postoperative day 1 was significantly higher in Group K (P < .001). Hospital LOS was shorter in Group L than in the other groups (P = .002). CONCLUSIONS: IV lidocaine added to multimodal analgesia provided better pain control in the early postoperative period compared to dexmedetomidine and ketamine and decreased the hospital LOS.

Assessing the Learning Process of Laparoscopic Sleeve Gastrectomy with Different Approaches.

OBJECTIVE:  To determine the learning curve (LC) of laparoscopic sleeve gastrectomy (LSG) based on an excess weight loss (EWL). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Ondokuz Mayis University, Faculty of Medicine, Department of General Surgery, from December 2012 to April 2018. METHODOLOGY: Data of patients, who were admitted to the general surgery clinic of a tertiary care hospital and underwent LSG, were retrospectively analysed. Three hundred and twenty-five patients, who had completed at least three months of follow-up after their operations, were included in the study. Patients were divided into three groups according to the number of cases in which the lowest expected EWL values were achieved in the postoperative 3, 6, 12 and 24 months as per literature. Comorbidities, complications, duration of surgery and hospital stay were also evaluated in these groups. RESULTS: The groups were homogeneous in terms of age and body mass index. Group 3 had a significantly higher median EWL when compared to the other two groups (p <0.001). There was a statistically significant difference between Group 2 and Group 3 in terms of diabetes mellitus and remission of thyroid function tests (p = 0.013 and p=0.017, respectively). There were 40 minutes difference in operating time and two-day difference in hospital stay between the median values of Group 1 and Group 3 (p <0.001). CONCLUSION: LSG can be safely performed even in centres that have just started bariatric/metabolic surgical operations. Although proficiency seems to require at least 40 cases, more than 80 operations are needed to complete the LC and achieve ideal results. Key Words: Bariatric surgery, Learning curve, Metabolic surgery, Laparoscopic sleeve gastrectomy (LSG).

The impact of the COVID-19 pandemic on emergency general surgery: a retrospective study.

BACKGROUND: The COVID-19 pandemic has affected healthcare systems worldwide. The effect of the pandemic on emergency general surgery patients remains unknown. OBJECTIVE: To reveal the effects of the COVID-19 pandemic on mortality and morbidity among emergency general surgery cases. DESIGN AND SETTING: Data on patients who were admitted to the emergency department of a tertiary hospital in Samsun, Turkey, and had consultations at the general surgery clinic were analyzed retrospectively. METHODS: Our study included comparative analysis on two groups of patients who received emergency general surgery consultations in our hospital: during the COVID-19 pandemic period (Group 2); and on the same dates one year previously (Group 1). RESULTS: There were 195 patients in Group 1 and 132 in Group 2 (P < 0.001). While 113 (58%) of the patients in Group 1 were women, only 58 (44%) were women in Group 2 (P = 0.013). Considering all types of diagnosis, there was no significant difference between the two groups (P = 0.261). The rates of abscess and delayed abdominal emergency diseases were higher in Group 2: one case (0.5%) versus ten cases (8%); P < 0.001. The morbidity rate was higher in Group 2 than in Group 1: three cases (1.5%) versus nine cases (7%); P = 0.016. CONCLUSIONS: The COVID-19 pandemic has decreased the number of unnecessary nonemergency admissions to the emergency department, but has not delayed patients' urgent consultations. The pandemic has led surgeons to deal with more complicated cases and greater numbers of complications.

The impact of the COVID-19 pandemic on emergency general surgery: a retrospective study

ABSTRACT BACKGROUND: The COVID-19 pandemic has affected healthcare systems worldwide. The effect of the pandemic on emergency general surgery patients remains unknown. OBJECTIVE: To reveal the effects of the COVID-19 pandemic on mortality and morbidity among emergency general surgery cases. DESIGN AND SETTING: Data on patients who were admitted to the emergency department of a tertiary hospital in Samsun, Turkey, and had consultations at the general surgery clinic were analyzed retrospectively. METHODS: Our study included comparative analysis on two groups of patients who received emergency general surgery consultations in our hospital: during the COVID-19 pandemic period (Group 2); and on the same dates one year previously (Group 1). RESULTS: There were 195 patients in Group 1 and 132 in Group 2 (P < 0.001). While 113 (58%) of the patients in Group 1 were women, only 58 (44%) were women in Group 2 (P = 0.013). Considering all types of diagnosis, there was no significant difference between the two groups (P = 0.261). The rates of abscess and delayed abdominal emergency diseases were higher in Group 2: one case (0.5%) versus ten cases (8%); P < 0.001. The morbidity rate was higher in Group 2 than in Group 1: three cases (1.5%) versus nine cases (7%); P = 0.016. CONCLUSIONS: The COVID-19 pandemic has decreased the number of unnecessary nonemergency admissions to the emergency department, but has not delayed patients' urgent consultations. The pandemic has led surgeons to deal with more complicated cases and greater numbers of complications.

Comparision of Hem-o-lok polymeric clip and tri-staple in laparoscopic splenectomy.

AIM: This study aimed to compare the hem-o-lok polymeric clip (HC) and tri-staple (TS) methods used in dividing the splenic hilum in terms of results, and to reveal their superiority to each other. MATERIAL AND METHODS: Medical records of patients undergoing elective laparoscopic splenectomy at the Ondokuz Mayis University Faculty of Medicine General Surgery Clinic between March 2011 and March 2020 were retrospectively analyzed. Forty-two laparoscopic splenectomy cases performed using hem-o-lok polymeric clip (HC) or tri-staple (TS) were included in this study. Demographic features, primary diagnoses, splenic size, intraoperative data and postoperative complications, as well as the clip and stapler prices used in the surgery were analyzed. RESULTS: The mean operative time was significantly longer for HC group than TS group (116.7 min vs. 87.6 min, p<0.05). The mean cost of surgical instruments used to divide the splenic hilum was significantly lower for HC group than TS group (34.1 usd vs. 165.4 usd, p<0.05). There was no postoperative mortality, with a morbidity rate 6 (26.1%) for TS group and 4 (21.1%) for HC group (p>0.05). No significant difference existed in the complication rates. CONCLUSIONS: In the HC group, the operation time was longer, but the surgical cost was significantly lower. There was no significant difference when comparing other perioperative results. Although both techniques can be applied safely, we would like to emphasize that hemostasis is the most important factor for good results. KEY WORDS: Hem-o-lok polymeric clip, Laparoscopic splenectomy, Tri-staple.

The effect of cognitive symptoms in binge eating disorder on depression and self-esteem: a cross-sectional study.

PURPOSE: To compare individuals with class II and III obesity with and without binge eating disorder (BED) in terms of sociodemographic characteristics, depressive symptoms, self-esteem, eating behaviors, and cognitive variables thought to be involved in the pathophysiology of the disease. METHODS: The participants were selected from volunteer patients with body mass index ≥ 35 applying to the Ondokuz Mayis University Medical Faculty, Turkey, for bariatric surgery between 01.07.2016 and 31.05.2019. The Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to all participants. RESULTS: Binge eating disorder (BED) was determined in 95 (34%) of the 278 individuals applying for bariatric surgery. The frequency of previous psychiatric diseases was higher in the BED group than in the non-BED group. BDI, RSES, total EDE-Q, weight concern, shape concern, and eating concern EDE-Q subscale scores were also higher in the BED group. Correlation analysis revealed positive low correlation between depression scores and total EDE-Q scores and all subscales scores, with the exception of restraint. Positive low correlation was determined between decreased self-esteem and body weight and shape concern. At multivariate regression analysis, cognitive variables explained 28.6% of variance in depressive symptoms in the BED group, and 21.5% of variance in self-esteem. CONCLUSION: The study results showed elevation in cognitive factors in patients with BED compared to the controls. Among these variables, eating and weight concern were shown to be associated with depressive symptoms, while eating concern was linked to self-esteem. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Laparoscopic resection of retroperitoneal bronchogenic cyst clinically presenting as adrenal cyst.

Bronchogenic cyst localized in the retroperitoneum is a rare clinical entity. It is a congenital malformation generally occurring in the posterior mediastinum due to the abnormal development of the foregut. We report the case of a retroperitoneal cyst presenting as left adrenal cyst. A 38-year-old female presented with left upper abdominal pain. Endocrinological evaluation was done, and no adrenal hormonal secretion was detected. The cyst was removed laparoscopically. Pathologic examination confirmed it as a bronchogenic cyst. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cysts. Laparoscopic resection of retroperitoneal cysts results in favorable outcome.

The Whitehead operation procedure: Is it a useful technique?

OBJECTIVE: Hemorrhoidal disease is a very common entity in the general population; however, the therapeutic approaches to hemorrhoids remain controversial. The choice of treatment method depends on the grade of the hemorrhoid as well as the experience of the surgeon. The Whitehead hemorrhoidectomy procedure is often applied for grade IV hemorrhoids. MATERIAL AND METHODS: We studied 49 patients who underwent surgery between December 1982 and January 2013. The indications for the Whitehead procedure in all patients were grade IV hemorrhoidal disease. The data on these patients were evaluated retrospectively with respect to age, gender, preoperative diagnosis, and postoperative complications. RESULTS: Of the patients included in this study, 34 were male and 15 were female. The mean age of the patients was 41.93±12.42, and the age range was 24-70 years. Complications of the Whitehead procedure included bleeding (6.12%, three cases), stricture (2.04%, one case), urinary retention (16.33%, eight cases), and temporary anal incontinence (2.04%, one case). No patients developed Whitehead deformities, entropion, or infectious complications. All patients were discharged from hospital between the fifth and eighth days post-surgery (6.45±1.00 days). The follow-up period was 1-234 months (70.02±54.89). CONCLUSION: The Whitehead procedure is successful in patients with prevalent peripheral prolapse and/or thrombosed hemorrhoids. With the right indications, and if the surgeon has adequate experience, the morbidity rate of the Whitehead procedure is similar to that of other treatment methods.

A rare cause of acute abdomen in the ED: Chemotherapy-induced pneumatosis intestinalis.

Pneumatosis intestinalis (PI) and portomesenteric venous gas (PVG) refers to the presence of air within the intestinal wall and portomesenteric vessels. Most of the time, it is associated with mesenteric ischemia that requires immediate surgical intervention as it has high mortality rate. It may also be seen secondary to various conditions, including infections, surgeries, and some chemotherapeutic drugs. A 61-year old-male was admitted to our emergency department complaining of abdominal pain after chemotherapy. Radiological evaluation of the patient demonstrated massive PVG and PI. Patient underwent urgent surgery due to the possibility of intestinal ischemia and infarction, but no necrosis was identified Chemotherapeutic drug-induced PI and PVG was the final diagnosis. Although PI and PVG are signs of mesenteric ischemia and intestinal necrosis most the of time, chemotherapeutic drugs may also cause PI and PVG rarely. Recent history of chemotheraphy and absence of any mesenteric vascular occlusion may be the diagnostic clue.

A Pancreatic Fistula after the Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is a popular surgical weight-loss procedure in the treatment of morbid obesity. There are some complications regarding this procedure in the literature. This report presents a pancreatic fistula (PF) case, which has not been previously seen.

Is it possible to use transaminases for deciding on surgical or non-operative treatment for blunt liver trauma?

BACKGROUND: We aimed to research the relation of transaminase levels in blunt liver trauma (BLT) with the intensity of the trauma and the use of transaminase levels for deciding on surgical or non-operative treatment. METHODS: In all, 44 patients with BLT diagnosed by computerized tomography (CT) were involved in this retrospective study. By testing the correlation of the transaminase levels and the grade of liver injury with receiver operator characteristics (ROC), area under the curve (AUC) was calculated; besides, the sensitivity, specificity, and cut-off values of transaminases were calculated separately for the grades. Moreover, same method was repeated for the surgically and non-operatively treated patients. Cut-off value was assessed for surgical and non-operative treatments. The efficiency of transaminases in deciding non-operative treatment was compared with that of other methods using ROC test applied on focused abdominal sonography in trauma (FAST), hemodynamic instability, blood replacement rate, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). RESULTS: It was observed that the AUC, sensitivity, and specificity increased correspondingly with the grade rise of transaminase levels in BLT. In the selection of non-operative treatment/surgery, following values have been confirmed: AUC for AST: 0.851 (sensitivity: 86%, specificity: 73%, cut-off value: 498 U/L), AUC for ALT: 0.880 (sensitivity: 86%, specificity: 81%, cut-off value: 498 U/L), AUC for replacement: 0.948 (sensitivity: 86%, specificity: 94%), AUC for hemodynamic instability: 0.902 (sensitivity: 86%, specificity: 94%), and AUC for FAST: 0.642 (sensitivity: 57%, specificity: 75%). CONCLUSIONS: It was found that in BLT, transaminases can predict the injury rating with higher accuracy as the grade rises, and they outrival FAST in terms of determining the need for laparotomy.

The Effects of Hydrophilic Polyethylene Glycol-Based Adhesion Barrier Use to Prevent Intra-abdominal Adhesions in Intra-abdominal Sepsis Model.

Postoperative adhesion formation is still an important cause of morbidity and mortality. Hydrophilic polyethylene glycol-based adhesion barrier (SprayGel™, Confluent Surgical, Inc., Waltham, MA) is reported to prevent adhesion formation after gynecologic surgery. This study aims to determine the effectiveness of SprayGel™ on adhesion formation after laparotomy in an experimental septic peritonitis model. Wistar albino male rats with weights of 250-350 g were used in this study. Forty rats were grouped into four groups: group I (control), laparotomy and sham operation; group II, laparotomy and cecal ligation puncture (CLP); group III (SprayGel™), laparotomy, sham operation, and SprayGel™; group IV (CLP + SprayGel™), laparotomy, CLP, and SprayGel™. Intra-abdominal sepsis was achieved by perforating the cecum with a 26-gauge needle in selected groups. All animals were sacrificed after 10 days. The results were evaluated according to the score systems of Nair and Knightly. Kruskal-Wallis variance analysis was used for statistical analysis. There were significant differences for the development of adhesion between groups II (CLP) and III-IV (SprayGel™ - CLP + SprayGel™) (p < 0.02). Mortality and wound infection rates were significantly lower in the SprayGel™ treatment groups compared to control groups. Intraperitoneal administration of SprayGel™ significantly decreased the intraperitoneal adhesion formation, and it reduced mortality and wound infection as well.

Is gentamicin-impregnated collagen sponge to be recommended in pilonidal sinus patient treated with marsupialization? A prospective randomized study.

BACKGROUND: The ideal treatment method for pilonidal sinus has always been a matter of debate. Although primary closure or various flap applications offer shorter wound healing times, their infection rates are very high. Secondary recovery involves long recovery period. The aim of this study is to investigate the effects of gentamicin-impregnated collagen sponge on wound healing and infection in patients undergoing marsupialization. PATIENTS AND METHODS: Fifty patients were included in the study. Twenty-five patients in control group (Group 1) underwent excision and marsupialization. Gentamicin-impregnated collagen sponge was used postoperatively in twentyfive patients in group 2. Three-dimensional wound measurements were made on the 0.7 and 15th days and recorded. RESULTS: No significant difference was observed between the groups in terms of development of hemorrhage and infection. Excessive granulation was detected in five patients (two in group 1 and three in group 2). There was no significant difference between the groups with respect to this criterion. Full recovery times were 29.6 and 28.2 days respectively. No statistically significant difference was observed between the groups (p = 0.571). None of the patients developed recurrence at the end of the follow-up period of 6-30 months. CONCLUSION: In accordance with the results obtained in this randomized and controlled study, no significant difference was observed between gentamicin-impregnated collagen sponge group and control group with respect to development of infection, hemorrhage and wound healing times. Therefore, we do not recommend the use of gentamicin-impregnated collagen sponge after marsupialization. KEY WORDS: Gentamicin-impregnated collagen sponge, Marsupialization, Pilonidal sinus.

First-line therapy in Helicobacter pylori eradication therapy: experience of a surgical clinic.

OBJECTIVE: Helicobacter pylori (HP) is the world's most common infectious agent. Despite conventional therapy consisting of proton pump inhibitor (PPI), amoxicillin (AMO) and clarithromycin (CLA), approximately half of the patients remain infected. We compared the PPI-based triple therapy with quadruple treatment (BPMT) including bismuth citrate (BS), PPI, metronidazole (MET) and tetracycline (TET). MATERIAL AND METHODS: Forty-three patients who used triple therapy (LAC) consisting of lansoprazole (L), AMO and CLA and 42 patients who used quadruple therapy (BPMT) for 14 days between May 2008 and November 2013 were included in the study. The LAC group included patients who received 30 mg L 2×1, 1000 mg AMO 2×1, and 500 mg CLA 2×1 for 14 days, whereas the BPMT group was designed from patients who received 600 mg BS 2×1, 40 mg omeprazole (O) 2×1 or 30 mg L 2×1, 500 mg MET 3×1 and 500 mg TET 4×1. RESULTS: Demographic characteristics and endoscopic findings were similar in both groups. The eradication rate was 53.4% in the LAC group and 78.5% in the BPMT group (p<0.05). Compliance problems and side effects were significantly higher in the BPMT group as compared to the LAC group (p<0.05). CONCLUSION: Due to high antibiotic resistance in Turkey, the efficacy of LAC treatment has reduced. The BPMT protocol should be kept in mind in the first line of treatment, since it provides a higher eradication rate.