The Relationship of Anatomical Localizations of Hiatal Clamp and Oesophagogastric Junction with Body Mass Index / Relación entre las Localizaciones Anatómicas de la Pinza Hiatal y la Unión Esofagogástrica con el Índice de Masa Corporal

SUMMARY: In our study, we aimed to reveal the relationship between the anatomical localizations measured and the Body Mass Index (BMI) in patients scheduled for upper gastrointestinal endoscopy. In this study, anatomical localizations of the hiatal clamp and oesophagogastric junction in 189 female and 137 male patients who applied to the hospital with different gastrointestinal system complaints and underwent esophagogastroduodenoscopy (EGD) were investigated depending on BMI. In addition, the data were compared with the patients' complaints before EGD and the diagnoses they received after EGD. SPSS Statistics 22 (IBM Corp. Turkey) program was used for statistical analysis and p0.05). On the other hand, it was determined that the hiatal clamp distance and the distance of the oesophagogastric junction increased as the height and weight increased (p38. As a result of the study, it can be said that BMI values, hiatal clamp distance and oesophagogastric junction localizations may change in relation to height and weight.

En este estudio, buscamos revelar la relación entre las localizaciones anatómicas y el Índice de Masa Corporal (IMC) en pacientes programados para endoscopía digestiva alta. Se investigaron las localizaciones anatómicas de la pinza hiatal y la unión esofagogástrica en 189 mujeres y 137 hombres que acudieron al hospital con diferentes problemas del sistema gastrointestinal los cuales fueron sometetidos a una esofagogastro- duodenoscopia (EGD) dependiendo del IMC. Además, los datos se compararon con las quejas de los pacientes antes de la EGD y los diagnósticos que recibieron después de la EGD. Se utilizó el programa SPSS Statistics 22 (IBM Corp. Turquía) para el análisis estadístico y el valor de p0,05). Por otro lado, se determinó que la distancia de la pinza hiatal y la unión esofagogástrica aumentaba con la altura y el peso corporal (p38. Como resultado del estudio, se puede decir que los valores de IMC, la distancia de pinzamiento hiatal y las localizaciones de la unión esofagogástrica pueden cambiar en relación con la altura y el peso.

Effect of tumor size on prognosis in colorectal cancer.

AIM: This study aimed to reveal the effect of tumor size on overall survival and disease-free survival. MATERIAL AND METHODS: This study retrospectively evaluated the data of 593 patients who underwent colorectal surgery for colorectal cancer (CRC) between May 2012 and December 2018. The patients were divided into two groups based on their tumor size; those with a tumor size <5 cm were grouped as group 1 and those with a tumor size ≥ 5 cm were grouped as group 2. RESULTS: The present study included 222 patients with colorectal adenocarcinoma. The median follow-up period of the patients was 36.0 (1.4-107.4) months, mean tumor size was 5.1±2.3 cm, and number of patients with a tumor size of ≥5 cm was 117 (52.7%). There were statistically significant differences between the groups in terms of overall survival (Log-Rank = 12.559, p<0.001). DISCUSSION: According to the American Joint Committee on Cancer's Cancer Staging Manual (8th edition), the CRC staging system considers the tumor's depth of invasion of the intestinal wall but not the tumor's size. Moreover, it considers the size of the tumors developing in the parenchymal organs (breasts and lungs) but not tumors developing in luminal organs (stomach, colon, etc.). CONCLUSIONS: Tumor size ≥5 cm was found to be a risk factor for poor prognosis. To a certain extent, we believe that this study will aid in elucidating the link between tumor size in and prognosis of patients with CRC. KEY WORDS: Colorectal cancer, Prognosis, Tumor size.

Comparison of the cystocholedochal angle in patients with choledocholithiasis and only cholelithiasis.

This study aims to evaluate the relation between the cystocholedochal angle (SCA) and choledocholithiasis. The data of 3.350 patients were reviewed retrospectively and a total of 628 patients who met the criteria were included in the study. The patients included in the study were divided into three groups as patients with choledocholithiasis (Group I), patients with only cholelithiasis (Group II), and patients without gallstones as control group (Group III). Measurements of SCA, cystic, bile, and common hepatic ducts (CHDs) were made on magnetic resonance cholangiopancreatography (MRCP) images. Laboratory findings and demographic characteristics of the patients were also recorded. Of the patients included in the study 64.2% were female, 35.8% were male, and their age ranged from 18 to 93 (mean 53.37 ± 18.87 years). While the mean SCA values of all patient groups were 35.44° ± 10.44°, the mean length of cystic, bile and CHDs were 28.91 ± 9.30, 40.28 ± 12.91, 27.09 ± 9.68 mm respectively. All measurements were higher in Group I in comparison to other groups, whereas all measurements of Group II were higher than those of Group III (p < 0.001). Statistical analysis suggests that a SCA of 33.5° and above is an important criterion for diagnosis of choledocholithiasis. Increase of SCA raises the likelihood of choledocholithiasis, as it facilitates the passage of stones from gallbladder into the bile ducts. This is the first study to compare SCA in patients with choledocholithiasis and those with only cholelithiasis. Therefore, we think that this study is important and will be a guide for clinical evaluation.

Impact of COVID-19 pandemic on colonoscopy results - an overview.

<b>Aim:</b> Colorectal cancers are common cancers. Colonoscopy procedure, which is applied in the early diagnosis and treatment of this disease, has a very important role. In this study, we aimed to examine the effect of the COVID-19 pandemic period on our colonoscopic procedures. </br></br> <b> Material and methods:</b> In this observational study, the data of the patients who underwent colonoscopy in our General Surgery Endoscopy Unit, between March 11, 2019 and March 12, 2021 were scanned retrospectively. Patients under 18 years of age were excluded. The patients were divided into 2 groups. 1. Group patients between 11 March 2019-11 March 2020; patients in the pre-COVID-19 period, Group 2, on March 12, 2020-March 12, 2021; Grouped as the COVID-19 era. </br></br> <b>Results:</b> Data of 8285 patients were analyzed. A total of 4889 patients in Group 1 and 3396 patients in Group 2 were included in the study. The detection of precancerous polyps between the groups was found to be significantly higher in group 1 (p < 0.05) (4.3% vs 2.1). Similarly, the presence of precancerous polyps over the age of 65 was found to be significantly higher in the pre-covid group. In group 1, no significant difference was found in the evaluation of cancer patients according to gender (p > 0.05) (F/M: 1.2%/1.6%). In group 2, cancer patients were found to be significantly higher in males. </br></br> <b>Conclusions:</b> The COVID-19 pandemic has had negative effects in many areas, as well as on our colonoscopic procedures. Experienced centers continue to work to minimize these negative effects.

Extrahepatic Biliary Tract Variations is an Effect for Acute Calculous Cholecystitis.

OBJECTIVE: To evaluate the anatomy of the extrahepatic bile duct and to reveal its importance in the formation of acute calculous cholecystitis (ACC). STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of General Surgery and Radiology, Kanuni Sultan Suleyman Training and Research Hospital of the University of Health Sciences, Turkey, between January 2016 and December 2021. METHODOLOGY: The data of the patients treated with ACC were analysed on MRCP by an experienced radiologist. The patients were divided into two groups; asymptomatic gallstones (AsGS, control group) and ACC. The cystic duct, common hepatic duct, and common bile duct lengths and variations in cystic duct opening were measured. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value and compared categorical results of the two groups by Mann-Whitney U test. RESULTS: One-hundred and seventy-three patients were analysed, one-hundred and seven were females, and 66 were males. The median age was 46 years in the AsGS group and 53 years in the ACC group. It was statistically significant that ACC had a higher median age value than AsGS (p=0.014). In the analysis of extrahepatic variations, cystic duct, common hepatic duct, and common bile duct length, were statistically longer in the calculous cholecystitis group (p<0.001, p=0.022, and p=0.019 respectively). ROC analysis was performed for cystic, common hepatic, and common bile duct length, respectively. Cut-off values ​​were 30.5 mm, 36.5 mm, and 42.5 mm. CONCLUSION: Extrahepatic bile duct variations are of critical importance in ACC surgery. In the data, as the cystic duct and common bile duct lengthens, the possibility of ACC increases. There is need for studies with larger samples. KEY WORDS: Acute calculous cholecystitis, Extrahepatic biliary tract, Anatomical variations, Cholelithiasis.

Analysis of upper gastrointestinal endoscopy results during the Covid-19 pandemic. A high-volume single-Center experience.

PURPOSE: The histopathological effects of the COVID-19 period on the upper gastrointestinal system are not clearly known. This study is the first in the literature to compare the results of upper endoscopic biopsy before and during the COVID- 19 period. METHODS: Data of 10510 patients who underwent upper endoscopy with a given biopsy sample during the procedure between March 2019 and March 2021 were retrospectively scanned. Patients are divided into two groups as the prepandemic period patients and the COVID-19 pandemic period patients. The pathological data of these patients were statistically analyzed according to the Sydney classification. RESULTS: Group 1 comprised of 6,787 patients with 3,915 females and 2872 males (F:M=1.3:1), while Group 2 with 1,734 females and 1,455 males (F:M=1.2:1), and this gender difference between the two groups was statistically significant (p=0.002). A comparison of the patient groups in terms of the inflammation, activation, intestinal metaplasia, and presence of H. pylori revealed a significant difference, with higher rates recorded in the COVID-19 period than in the pre-pandemic period (p < 0.05). CONCLUSION: In the pandemic period, the results of the upper endoscopic biopsy are adversely affected by various factors compared to the pre-pandemic period. KEY WORDS: Biopsy, COVID-19, Sydney classification, Upper endoscopy.

Laparoscopic repair of the left paraduodenal hernia: A rare case of an internal hernia.

Paraduodenal hernia (PDH) is a rare congenital anomaly, the most common cause of internal hernia. The left-sided PDHs (LPDHs) are more common than the right-sided and are common in male patients at the 4th and 6th years of life. LPDH is been often clinically asymptomatic and often detected by chance in surgical patients. Abdominal computed tomography is the gold standard in diagnosis. PDH can cause ischemia with the high mortality rates due to intestinal obstruction. Therefore, surgical repair should be done as soon as possible after diagnosis. Here, we present a case of LPDH that was laparoscopically diagnosed and repaired early.

Incidentally Detected Gastrointestinal Wall Thickness on Abdominal Computed Tomography; What Does it Mean for Endoscopy?

BACKGROUND: The clinical significance of gastrointestinal wall thickening (GWT) on abdominal computed tomography (CT) is not certain, yet. Despite the need for clinical guidelines describing the importance and evaluation of GWT on a CT scan, there have been few studies evaluating these incidental imaging abnormalities. The aim of this study is to endoscopically evaluate certain etiologies that cause incidental GWT found on CT. METHODS: This retrospective cohort study was carried out with patients who had incidentally detected GWT on a CT scan at the Kanuni Sultan Süleyman Training and Research Hospital between February 2016 and December 2018. RESULTS: A total of 129 patients (62 males and 67 females; mean age 57.5 years, range: 26-87 years) were included in the study. Abnormalities observed during endoscopy at the exact site of the GWT noted on a CT image were found in 114 patients (99%): upper endoscopy revealed malignancy in 33 (29%), gastritis in 63 (52%), hiatal hernia in 19 (16%), a gastric ulcer in 7 (6%), and alkaline gastritis in 3 (2%). Colonoscopy revealed malignancy in 4 (33%), benign polyps in 5 (35%), colonic ulcer in 2 (16%), and 2 patients (16%) had normal findings. Malignancy was detected more frequently in the cardioesophageal region compared with the antrum (P=0.020). CONCLUSION: In this study, detection of GWT on CT often indicated pathologies which were subsequently confirmed endoscopically. Pathological findings were detected in 83% of these patients, with approximately 30% determined to be malignant. Endoscopic evaluation is recommended when GWT is reported on a CT scan.

Percutaneous cholecystostomy instead of laparoscopy to treat acute cholecystitis during the COVID-19 pandemic period: single center experience.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital. METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period. RESULTS: The mean age of the pandemic period patients was 53 years (range: 26-78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant. CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.

The diagnostic role of hemogram parameters in pregnant appendicitis.

BACKGROUND: Acute appendicitis is the most frequently encountered non-obstetric disease requiring surgical intervention during pregnancy. Early diagnosis reduces maternal and fetal morbidity / mortality rates. AIM: This study aims to investigate hemogram parameters in the diagnosis of acute appendicitis in pregnant women. MATERIAL AND METHODS: A retrospective case-controlled study was conducted in three groups. Thirty-nine pregnant patients with acute appendicitis (Group A), 39 fertile nonpregnant patients with acute appendicitis (Group B), and 39 healthy pregnant women (Group C) were included in the study. WBC, neutrophil count, lymphocyte count, NLR, PLR, MPV and RDW values were compared. RESULTS: The mean NLR values in group A, group B and group C were 7.39 (1.58-46.6), 5.66 (1-20) and 4.23 (1.54-10.77) respectively, and there was a significant difference in NLR values between the groups (P= 0.002). The mean PLR values in group A, group B and group C were 159.09 (69.1-574), 134.28 (21.5-360) and 120 (68.7-334) and difference was statistically significant (P= 0.019). Cutoff points for WBC count was 14155 106/µL (51,3% sensitivity, 82,1% specificity), for neutrophil count is 10955 106/µL (53,8% sensitivity, 84,6% specificity), for NLR is 9.23 (46,2% sensitivity, 92,3% specificity) and PLR is 157,6 (51,3% sensitivity and 82,1% specificity) NLR had largest area under the curve with 0.667 NLR. CONCLUSION: Neutrophil count, WBC and PLR were found to be the most valuable inflammatory parameters however, RDW, Lymphocyte count, and MPV levels are not found valuable markers in terms of sensitivity and specificity in the diagnosis of acute appendicitis in pregnant patients by this study.

A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method.

BACKGROUND/AIM: The present study aimed to create a decision tree for the identification of clinical, laboratory and radiological data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul. MATERIALS AND METHODS: The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was performed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree. RESULTS: A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%. CONCLUSIONS: There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived.

Spontaneous splenic rupture related to anticoagulant and antiaggregant treatment.

INTRODUCTION: Trauma is the most frequent cause of splenic rupture. In contrast to traumatic rupture of the spleen, spontaneous splenic rupture (SSR) is a rare and life-threatening condition. AIM: To present the cases of patients with SSR, who had no history of trauma, and who had been receiving anticoagulant and/or antiaggregant treatment while hospitalised for cardiac reasons. MATERIAL AND METHODS: The cases of 6 patients with SSR at Gastroenterological Surgery Department, Kartal Kosuyolu High Speciality and Training Hospital were retrospectively evaluated. The clinicodemographic factors and the diagnostic and therapeutic methods utilised for these patients with SSR while hospitalised were investigated as well. RESULTS: Five (83.3%) of the patients were male and 1 (16.6%) was female. The median age of the patients was 71 (61-73) years. Three of the patients had only been receiving antiaggregant treatment, while 2 had only been receiving anticoagulant treatment; only 1 patient had been receiving both anticoagulant and antiaggregant treatments. The decrease in haematocrit (HCT) levels ascertained on the day of SSR diagnosis and the HCT levels ascertained on the day of hospitalisation were statistically significant. All the patients received a blood transfusion. While 5 (83.33%) of the 6 patients had splenectomy, 1 (16.66%) patient received conservative treatment. Mortality was seen in 4 (66.6%) patients. CONCLUSIONS: Spontaneous splenic rupture is a condition that should be taken into consideration in the differential diagnosis of patients hospitalised for cardiac reasons, who are receiving anticoagulant and/or antiaggregant treatment in cases of newly developed abdominal pain and low HCT levels.

Gastric cancer with situs inversus totalis: does it really create difficulties for surgeons?

INTRODUCTION: Situs inversus totalis (SIT) is a very rare condition that is seen at a rate of one in about 6000-8000 births. AIM: To offer a general view on the coexistence of SIT and gastric cancer, accompanied by a literature review. MATERIAL AND METHODS: Within the scope of this study, the case of a patient with gastric adenocarcinoma and SIT has been presented. Previous research on gastric cancer cases with SIT was reviewed through a comprehensive search of the PubMed, Medline, and Google Scholar databases. The keywords used to conduct this research were "situs inversus totalis and gastric cancer," "situs inversus totalis and gastric malignant," and "situs inversus totalis and gastric resection." The database search covered English studies published between 2000 and 2016. RESULTS: The results of our literature review revealed 20 studies of patients with gastric cancer and SIT, and 21 related cases. Overall, 12 of the patients were male, 9 were female, and their mean age was 61.8 ±10.97 years. The vascular assessment data showed that three out of the 13 mentioned cases had vascular anomalies. Eleven of the patients had laparoscopic resections, and one of the patients that had a surgical procedure exhibiting a postoperative mechanical obstruction. CONCLUSIONS: The coexistence of SIT and gastric cancer is a very rare condition, and a careful preoperative radiological assessment should be conducted because there can be accompanying vascular anomalies. Laparoscopies and robotic surgeries can be performed for suitable patients at experienced centres, consistent with oncological principles.

Does antiaggregant administration lead to early diagnosis in proximal colon cancer?

OBJECTIVE: Cancers of the proximal colon are often diagnosed in advanced stages with iron deficiency anemia and nonspecific symptoms. Aspirin and clopidogrel are commonly used antiaggregant agents for various clinical conditions. The aim of this study was to investigate the effects of antiaggregant medication on the early diagnosis of proximal colon cancer. METHODS: Cases of colon cancer patients who had received curative surgical procedures between January 1, 2013 and July 31, 2016 were retrospectively reviewed. The clinical and pathological results of patients who had used antiaggregant drugs were compared to those who had not. RESULTS: During the studied period, 246 colorectal cancer patients underwent curative surgical procedures. Of the 67 patients with proximal colon cancer who were included in the study, 27 (40.3%) had taken antiaggregant medication. The mean age of the antiaggregant group was 67.1 years (range: 34-88 years), while it was 58.3 years (range: 34-83 years) for the non-antiaggregant group; the difference between the 2 groups was statistically significant (p=0.03). A pathological evaluation revealed that 74.1% of the antiaggregant group was in the early stages (Stage I/II: 7/13), while 42.5% of the non-antiaggregant group was in the early stages (Stage I/II: 2/15); the difference was statistically significant (p=0.011). CONCLUSION: Antiaggregant medication has a positive effect on diagnosing proximal colon cancer at early stages. Patients using aspirin or clopidogrel should undergo a complete colonoscopic evaluation in the presence of gastrointestinal tract bleeding or newly developed anemia.

Spleen-Preserving Surgery in Splenic Artery Aneurysm.

Endovascular interventions are increasingly used in the treatment of a splenic artery aneurysm (SAA), which is a rare and life-threatening clinical disorder. However, in cases of SAA rupture, minimally invasive interventions are unsuitable, and open surgery remains the gold standard method. In open surgery, care should be taken to preserve the spleen and its immune function in cases where an arterial segment of sufficient length allows for reconstruction. An SAA was detected in a 51-year-old woman who presented to our polyclinic with left upper quadrant pain. An endovascular intervention was unsuccessful, and open surgery was performed. Approximately 5 cm of aneurysm in the middle segment of the splenic artery was treated by arterial anastomosis, and the spleen was preserved. The patient experienced no postoperative complications and remained asymptomatic at the seventh month of follow-up. The aim of this case report is to emphasize the importance of splenic sparing surgery in cases of SAAs.

Doppler ultrasound diagnosis of an unusual variant of median arcuate ligament syndrome: concomitant involvement of celiac and superior mesenteric arteries. A case report.

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome is a rare condition characterized by chronic mesenteric ischemia, secondary to the compression of the celiac artery by the median arcuate ligament. Occasionally, in addition to the celiac artery, the superior mesenteric artery may be partially compressed by the median arcuate ligament. We report a case with complaints of chronic abdominal pain from compression of both the celiac artery and the superior mesenteric artery due to MALS, which was primarily detected by Doppler ultrasound. The diagnosis was confirmed with CT-angiography.