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.

The effect of carbon monoxide releasing molecule-2 (CORM-2) on healing of ischemic colon anastomosis in rats

Background/aim: Ischemia on the colon wall negatively affects healing of anastomosis. We were aimed to evaluate the effects of carbon monoxide releasing molecule-2 (CORM-2) on the healing of anastomosis in a rat model of the ischemic colon. Materials and methods: In this prospective study a total of 60 rats were randomly divided into three groups as colon transection and end-to-end anastomosis (Group I), colon transection, and end-to-end anastomosis following the induction of ischemia (Group II), and colon transection and end-to-end anastomosis following the induction of ischemia and treated with daily intraperitoneal administration of CORM-2 (Group III). Each group was also divided into two equal subgroups as postoperative 3rd and 7th day. Postoperative healing of anastomoses was evaluated by anastomosis burst pressure (ABP), tissue biomarkers including hydroxyproline (HP), malondialdehyde (MDA), glutathione (GSH), and histopathological findings. Results: In the ischemic group treated with CORM-2, lower MDA and higher HP levels were observed in comparison to the untreated ischemic group on the 3rd day. GSH and HP levels were higher and MDA levels was lower in the ischemic rats treated with CORM-2 than in the ischemic untreated rats on the 7th day. In the ischemic group treated with CORM-2, the mucosal epithelial score decreased and the neoangiogenesis score increased compared to the untreated rats on the 7th day. Conclusion: In ischemic colon anastomosis, reduces cell destruction by suppressing the oxidative reaction, and strengthening the antioxidative mechanisms of the cells. It also increases collagen formation, epithelial development, and neoangiogenesis.

Untargeted multi-omic analysis of colorectal cancer-specific exosomes reveals joint pathways of colorectal cancer in both clinical samples and cell culture.

Exosomes are naturally secreted nano-vesicles consisting of biochemical molecules including RNAs, metabolites, lipids, and proteins, that emerge as diagnostic tools and disease-specific reporters. Here we offer a systematic and integrative approach for the simultaneous analysis of altered molecules namely metabolites, lipids, and proteins. These components tend to augment the discovery of low abundance signature components, and assist in explanation of molecular basis of colorectal cancer (CRC). In order to investigate CRC-derived exosomes, we selected mi-R19a, miR-21, miR-92a, and miR-1246 positive exosomes for downstream experiments. The overall multi-omic changes were investigated comparatively in cell culture and serum samples. Following a systematic multi-omic study, 37 (cell culture) and 31 (serum) metabolites; 130 (cell culture) and 56 (serum) lipids; 9 (cell culture) and 13 (serum) proteins were seen to be differentially expressed (p < 0.05), enabling discrimination between CRC and control. By using these enriched components, we demonstrated that the joint pathways mainly involving fatty acid and amino acid metabolism related pathways changed in CRC significantly. We conclude that this study increases our understanding of molecular basis of CRC, and provides potential exosomal biomarkers for the non-invasive detection, and discrimination of CRC.

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.

Vascularity of Intrahepatic Cholangiocarcinoma on Computed Tomography is Predictive of Lymph Node Metastasis.

BACKGROUND: The indications for lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) are controversial. METHODS: Seventy patients with mass-forming dominant ICC underwent hepatectomy with systematic LND or lymph node sampling between 2003 and 2013. We defined the computed tomography (CT) ratio as the CT value (Hounsfield units) of the tumor divided by the CT value (Hounsfield units) of the liver parenchyma in the late arterial phase, and investigated the indications for LND with hepatectomy for ICC. RESULTS: A multivariate analysis identified lymph node metastasis (LNM; n = 19, p = 0.012) and perineural invasion (p = 0.017) as independent predictors of survival. The median survival time and 5-year survival rate in patients exhibiting LNM were 31.1 months and 16.0 %, respectively. In a subgroup analysis of patients without LNM, overall survival was comparable between patients treated with LND and those treated without LND (p = 0.801). A multivariate analysis of the preoperatively measurable parameters revealed that a CT ratio <0.88 and macroscopic periductal infiltration were independently associated with LNM. We developed a score predicting LNM of mass-forming dominant ICC (LMIC score), assigning 1 point for each of these risk factors. The percentages of patients with LNM with an LMIC score of 0, 1, or 2 points were 0, 35, and 58 %, respectively. CONCLUSIONS: The vascularity of ICC is associated with important prognostic factors, LNM, and perineural invasion. LN dissection would be conducted in patients with an LMIC score of one or two points but can be omitted in patients with an LMIC score of zero.

The favorable prognosis after operative resection of hypervascular intrahepatic cholangiocarcinoma: A clinicopathologic and immunohistochemical study.

BACKGROUND: The aim of this study was to clarify the clinicopathologic characteristics of hypervascular intrahepatic cholangiocarcinoma (ICC). METHODS: Seventy patients with a mass-forming type ICC underwent hepatectomy between 2003 and 2013. These patients were divided into 2 groups and compared based on findings during the late arterial phase of computed tomography: hypervascular ICC (the mean computed tomography value of the tumor ≥ that of the nontumorous liver parenchyma, n = 21), and hypovascular ICC (n = 49). RESULTS: The overall survival of the hypervascular group was better than that of the hypovascular group (5-year survival: 63% vs 35%, respectively, P = .046). Pathologic examinations showed less lymph node metastasis (0% vs 39%), lymphatic invasion (14% vs 57%), mucin secretion (19% vs 61%), tumor necrosis (24% vs 57%), and combined periductal infiltration (0% vs 27%), P ≤ .01 each, in the hypervascular group. The microscopic bile ductular feature was more frequent in the hypervascular group (57% vs 29%, P = .023). Immunohistochemical analysis revealed that the hypervascular group had greater immunoreactivity to neural cell adhesion molecule (71% vs 37%, P = .008) and a lesser S100P immunoreactivity (33% vs 73%, P = .002). Multivariate analysis revealed that neural cell adhesion molecule reactivity (P = .018) was independently associated with the hypervascular group. CONCLUSION: Tumor vascularity predicts the aggressiveness of ICC. In most patients with hypervascular ICC, the tumor has a less invasive nature. Furthermore, the prognosis after resection in patients with hypervascular ICC is significantly better than in patients with hypovascular ICC.

Nebivolol Ameliorates Hepatic Ischemia/Reperfusion Injury on Liver But Not on Distant Organs.

INTRODUCTION: Hepatic ischemia/reperfusion injury may occur after large tumor resection and liver transplantation procedures. Nitric oxide was shown to have protective effects on ischemia/reperfusion injury. Nebivolol is a compound that has been reported to improve nitric oxide release. We evaluated the effects of nebivolol in a rat liver ischemia/reperfusion model. METHODS: A total of 40 rats were randomly divided into four groups (n = 10 each). Group I underwent only laparotomy, Group II was administered nebivolol and then underwent laparotomy, Group III underwent laparotomy and hepatic ischemia/reperfusion, and Group IV was administered nebivolol and then underwent laparotomy and hepatic ischemia/reperfusion. Serum AST, ALT, urea, and creatinine levels, and TAS and TOS levels of liver, lung, and kidney tissues were determined. Histopathological determination was also performed. RESULTS: Nebivolol significantly reduced liver function tests in group IV, but it did not improve renal functions. Oxidative stress and abnormal histopathological findings were found to be reduced in liver tissue in group IV. Although the oxidative stress was increased after hepatic ischemia/reperfusion, nebivolol could not reduce the oxidative stress in kidney tissue. There were no significant differences between group III and group IV in terms of the histopathological changes in kidney tissue. There were no significant differences in lung tissue between the groups. CONCLUSIONS: The results of this study suggest that nebivolol has protective effects on liver but not on distant organs in a hepatic ischemia/reperfusion injury model. These experimental findings indicate that nebivolol may be useful in the treatment of hepatic ischemia/reperfusion injury.

Evaluating mean platelet volume as a new indicator for confirming the diagnosis of necrotizing pancreatitis.

BACKGROUND: The aim of the present study is to discuss the possible role of mean platelet volume as a new predictor in the diagnosis of necrotizing pancreatitis. METHODS: Study subjects are arranged in three different groups: Group I; control group (n= 40), Group II; acute pancreatitis (n= 40), Group III; necrotizing pancreatitis (n= 36). Demographic data and mean platelet volume values are recorded retrospectively. RESULTS: Mean platelet volume of patients in Group II was 7.9±0.53, while in Group III patients it was 7.2±0.52 (p<0.001). When we compared the study groups with ROC analysis, results demonstrated that cut off value of necrotizing pancreatitis patients as 7,8 (area under curve: 0.857), sensitivity as 86.1% and specificity as 72.5%. CONCLUSION: The current study shows that mean platelet volume in necrotizing pancreatitis patients is significantly reduced compared to that of patients in the control and acute pancreatitis group.

Incidental midgut malrotation detected during second laparotomy: Case report and literature review.

INTRODUCTION: Intestinal malrotation is defined as intestinal nonrotation or incomplete rotation around superior mesenteric artery (SMA), involving anomalies of intestinal fixation as well. The patients may be recognized incidentally during other surgical procedures or at autopsy. Here in, we present a case of midgut malrotation which was diagnosed incidentally during hepaticojejunostomy procedure for benign biliary stricture. PRESENTATION OF CASE: A 46 years old male patient was referred to our clinic with failed surgery for biliary stricture due to extensive adhesions. Prior to our surgery, intestinal malrotation was not reported and noticed by the diagnostic tools. When the patient underwent relaparotomy, midgut malrotation was observed. DISCUSSION: Distruption in the normal embryological development of bowel is the cause of intestinal malrotation. Various anatomic configurations and anomalies resulting from rotation anomalies of midgut. Adult patients are usually asymptomatic and the anomaly is discovered only at autopsy or incidentally at surgery. The role of additional surgery especially in patients with asymptomatic disease related to malrotation is debated. CONCLUSION: Performing loop hepaticojejunostomy with Braun enteroenterostomy is feasible and acceptable option rather than Roux-N-Y hepaticojejunostomy in case of intestinal malrotation.

An unusual case of primary colonic dedifferentiated liposarcoma.

INTRODUCTION: In this paper, we present a rare case of primary dedifferantiated liposarcoma (DDLS) of the colon, management of which is unclear and difficult to cope with. PRESENTATION OF CASE: 71 year old female patient with complaints of abdominal pain and swelling was referred to our clinic with the diagnosis of intraabdominal mass. 23cm×19cm×18cm tumor starting from the neighborhood of left liver lobe and extending toward pelvic floor was detected on computed tomography. At laparotomy, a multilobulated, soft and yellowish mass was arising from transvers colon and invading greater curvature of stomach. En-bloc removal of the tumor including segmental colon and gastric wedge resection was performed. Postoperative histopathological diagnosis was consistent with dedifferentiated liposarcoma. DISCUSSION: Liposarcomas are rarely encountered in the gastrointestinal tract. Previously, only ten cases of primary liposarcoma of the colon have been reported worldwide and to our knowledge DDLS of transverse colon is the first case reported in the literature. DDLS is a high-grade aggressive tumor carrying the ability to metastasize. Despite complete removal of tumor recurrence is common in DDLS. CONCLUSION: The constellation of findings in our patient demonstrates that liposarcomas which histologically exhibit dedifferentiation are associated with a poor clinical prognosis and advocating surgery alone is not recommended.

An unusual cause of recurrent pancreatitis: A gastric duplication cyst with an accessory pancreatic lobe.

Congenital anomalies of pancreas and its ductal drainage are uncommon but in general surgically correctable causes of recurrent pancreatitis. A gastric duplication cyst communicated with an accessory pancreatic lobe is an extremely rare cause of recurrent pancreatitis, but an early and accurate diagnosis of this anomaly is important because suitable surgical treatment may lead to a satisfactory outcome. Herein, we presented multidetector computed tomography and magnetic resonance imaging findings of a gastric duplication cyst communicating with an accessory pancreatic lobe via an aberrant duct in a 29-year-old woman with recurrent acute pancreatitis and also reviewed other similar cases reported in the literature.

Multidetector computed tomography diagnosis of adenomyomatosis of the gallbladder.

The differentiation of gallbladder adenomyomatosis from gallbladder carcinoma is important as both conditions may present with thickening of the gallbladder wall or as a focal mass. Identification of Rokitansky-Aschoff sinuses is the key feature in making an accurate diagnosis of gallbladder adenomyomatosis on imaging studies. The diagnosis of gallbladder adenomyomatosis can be made with accurately by multidetector computed tomography when the presence of Rokitansky-Aschoff sinuses (small cystic spaces within the thickened gallbladder wall) are noted. Herein we present multidetector computed tomography findings of a 27-year-old patient with gallbladder adenomyomatosis.

Congenital variants and anomalies of the pancreas and pancreatic duct: imaging by magnetic resonance cholangiopancreaticography and multidetector computed tomography.

Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.

Preoperative staging of colorectal cancer: accuracy of single portal venous phase multidetector computed tomography.

In this study, we aimed to investigate the accuracy of single portal venous phase multidetector computed tomography (MDCT) in preoperative staging of colorectal cancer. MDCT, surgery, and pathological results of 159 patients with pathologically proven colorectal adenocarcinoma were evaluated retrospectively. In T staging, the accuracy was 96% for ≤ T2 tumors, 92% for T3 tumors, and 96% for T4 tumors. In N staging, the accuracy was 68% for N0 tumors, 74% for N1 tumors, and 71% for N2 tumors. In conclusion, the accuracy of single portal venous phase MDCT is reasonably high in T staging, but it is not sufficiently high enough in N staging.