Percutaneous gas decompression can ease endoscopic derotation in sigmoid volvulus.

Sigmoid volvulus is a disease of elderly and debilitated patients. In sigmoid volvulus patients, colonoscopic derotation is the most commonly applied approach as the first line treatment. However, colonoscopic derotation sometimes fail and then urgent surgery is required in these frail patients with high morbidity and mortality. Percutaneous colonic gas decompression has been described to sigmoid volvulus. In case of life-threating increase intraabdominal pressure and as a primary attempt before colonoscopy. However, this technique did not find wide acceptance in the literature. Here, we aimed to present a 78-year-old male with sigmoid volvulus in whom colonoscopic derotation failed and following percutaneous gas decompression, endoscopic derotation could be done successfully. Evacuation of percutaneous colon gas in the sigmoid volvulus may facilitate endoscopic derotation when the first colonoscopic attempt failed.

Balance performance measured by posturography in mild-moderate Alzheimer's Disease: An undervalued assessment.

PURPOSE: The aim of the study was to compare balance performance in mild-moderate stage Alzheimer's disease (AD) patients and healthy peers using clinical balance tests and computerized posturography. METHODS: We recruited 95 patients and divided them into two groups; 51 patients (62 % (n=32) female) in AD group and 44 patients in healthy controls group (50 % (n=22) female). Berg Balance Scale (BBS) and Timed Up & Go (TUG) test were performed. Computerized posturography was performed. RESULTS: The mean age was 77.2±5.5 years in the AD group and 73.8±4.4 years in the control group (p<0.001). Sensory organization test composite equilibrium score (60[30-81], p<0.001), step quick turn-sway velocity (69.2 [38.2-95.8], p<0.001) and step quick turn-time (3.8 [1.6-8.4], p<0.001) were significantly impaired in mild-moderate stage AD patients. Berg Balance Scale (50 [32-56], p<0.001) and TUG test (13.0 [7.0-25.7], p<0.001) results were worse in AD. CONCLUSIONS: Computerized posturography measures were impaired in mild-moderate AD patients. The results highlight importance of early screening for balance and fall risk in AD patients. The study provides multi-dimensional and holistic assessment of balance performance in early-stage AD patients. Alzheimer's disease patients at earlier stages are prone to fall risk and should be evaluated accordingly.

Incidental cancer in colectomy specimens from patients with familial adenomatous polyposis: single centre experience and literature review.

BACKGROUND: Since cancer development is inevitable in patients with familial adenomatous polyposis (FAP), we aimed to determine the incidence of incidental malignancy in prophylactic colectomy specimens. METHODS: The files of patients who underwent prophylactic surgery for FAP between 2010 and 2020 were retrospectively reviewed. The incidence of incidental malignancy in histopathological specimens was examined and a comprehensive literature review was made. RESULTS: Fifty-five patients were included in the study, of whom 30 patients had a diagnosis of primary malignancy. Prophylactic colectomy was performed on 25 patients. The pathology results indicated that the specimens were benign in 12 patients (48%) and revealed carcinoma in situ in 11 patients (44%). Incidental malignancy was detected in 2 patients (8%). In the literature review, there were 243 patients who underwent prophylactic colectomy and incidental cancer was detected in 25 patients (10.3%) with the stages of 1 (7.4%), 2 (2.1%), and 3 (0.8%), respectively. CONCLUSIONS: Incidental cancer is not rare in patients who have undergone prophylactic colectomy for FAP. Hopefully. they are usually at early stages and unexpected advanced cancers are seen rarely.

Total 102 natural orifice specimen extraction following laparoscopic colorectal resections.

Natural orifice surgery has been used with increasing frequency in colon surgeries since the early 2000's. Our aim was to examine the patients retrospectively who underwent Natural Orifice Specimen Excision (NOSE) following laparoscopic colorectal resection. A total of 102 patients 2013 and 2018 were evaluated. The demographic characteristics, intra-operative and post-operative findings, pathology results, pain, incontinence, sexual dysfunction and cosmetic scores were examined. Mean age was 57.0 ± 14 and 52 of them (51%) were female. Specimen extraction was transanal in 72 (70%) (eventration technique in 10 patients) and transvaginal in the remaining 30 patients. The mean operating time was 272 ± 108 (median 240, range 120-540) minutes, and the mean blood loss was 92 ± 87 ml (median 54, range 5-400). The mean hospital stay was 7.0 ± 4.7 days (median 6, range 3-30). The main pain scores (visual analog score) on days 1-2-3 were 3.9 ± 2.0 (median 4, range 1-9), 3.1 ± 1.7 (median 3, range 0-8), 1.9 ± 1.5 (median 1.5, range 0-7), respectively. The mean cosmetic scores were 9.1 ± 1.5 (median 10, range 3-10). The median Wexner Incontinence score was 0 (0-9). Hospital mortality was 1% and unrelated with the NOSE. The 5-year overall survival and disease-free survival rates for cancer patients were 77.2-63.3%, respectively. NOSE has advantages in laparoscopic colorectal resections. It increases patient comfort and decreases incision related complications. CLINICAL TRIALS: www.clinicaltrials.gov (NCT04394988).

Management of the staple line bleeding in laparoscopic sleeve gastrectomy: monopolar cautery versus oversewing.

OBJECTIVE: Staple line bleeding control (SLBC) after laparoscopic sleeve gastrectomy (LSG) is a serious problem. Cauterization alone is generally not preferred because of concerns about weakening the staple line. The aim of this study was to compare the suturing and monopolar cauterization methods for SLBC in LSG. METHODS: 212 patients were divided into two groups as cautery and suture groups. Demographic characteristics, intraoperative, and post-operative results were analyzed. RESULTS: Post-operative complications were seen in seven patients, four of them staple line bleeding (three patients were in the cautery group and one patient was in the suture group), and three of them leakage (all patients were in the suture group) from the staple line. There was no significant difference between the groups in terms of staple line bleeding (p = 0.35), staple line leakage (p = 0.09), blood loss (p = 0.12), intraoperative complications (p = 0.16), post-operative hemoglobin decrease (p = 0.63), and length of hospital stay (p = 0.35), but the operation time was longer in the suture group. CONCLUSION: This is the first study in literature comparing monopolar cauterization with another technique. Monopolar cauterization can be used for SLBC in LSG. It is a safe and efficient method as well as inexpensive.

OBJETIVO: El control del sangrado de la línea de grapas (SLBC) después de la gastrectomía en manga laparoscópica(LSG) es un problema grave. Generalmente, no se prefiere la cauterización sola debido a preocupaciones sobre el debilitamiento de la línea de grapas. El objetivo de este estudio fue comparar los métodos de sutura y cauterización monopolar para SLBC en LSG. MÉTODOS: 212 pacientes fueron divididos en 2 grupos de cauterización y sutura. Se analizaron las características demográficas, los resultados intraoperatorios y posoperatorios. RESULTADOS: Se observaron complicaciones posoperatorias en siete pacientes, cuatro de ellos sangrado en la línea de grapas (tres pacientes estaban en el grupo de cauterización, un paciente en el grupo de sutura) y tres de ellos fuga (todos los pacientes estaban en el grupo de sutura) del línea de grapas. No hubo diferencia significativa entre los grupos en términos de sangrado de la línea de grapas (p = 0.35), fuga dela línea de grapas (p = 0.09), pérdida de sangre (p = 0.12), complicaciones intraoperatorias (p = 0.16), disminución de hemoglobina postoperatoria (p = 0.63), duración dela estancia hospitalaria (p = 0.35), pero el tiempo de operación fue mayor en el grupo de sutura. CONCLUSIÓN: Este es el primer estudio que compara la cauterización monopolar con otra técnica. La cauterización monopolar se puede utilizar para SLBC en LSG. Es un método seguro, eficaz y económico.

Can revision of RYGB to sleeve gastrectomy be a solution to inadequate weight loss treatment?

We aimed to discuss the weight loss success of the revision of RYGB to sleeve gastrectomy (SG). Between January 2019 and June 2020, four patients' files were analyzed retrospectively. Post-RYGB mean minimal BMI was 27.4 ± 9.47 kg/m², before SG the mean BMI was 43.41 ± 4.16 kg/m2. Post-operative gastric fistula developed in two patients. The mean follow-up time after revision surgery was 17.25 ± 6.89 months, mean excess weight loss (EWL) was 74.77 ± 8.94%, and mean BMI was 32.65 ± 2.9 kg/m2. Despite high rate of major complications, revision of RYGB to SG is successful in weight loss and resolving certain complications of RYGB.

Nuestro objetivo era discutir el éxito en la pérdida de peso de la revisión de BGYR a gastrectomía en manga (SG). Entre enero de 2019 y junio de 2020, se analizaron retrospectivamente los archivos de cuatro pacientes. El IMC mínimo medio post BGYR fue 27.4 ± 9.47 kg/m², antes de SG el IMC medio fue 43.41 ± 4.16 kg/m2. En dos pacientes se desarrolló una fístula gástrica posoperatoria. El tiempo medio de seguimiento después de la cirugía de revisión fue de 17.25 ± 6.89 meses, la pérdida media de exceso de peso (PEP) fue de 74.77 ± 8.94% y el IMC medio fue de 32.65 ± 2.9 kg/m2. A pesar de la alta tasa de complicaciones mayores, la revisión de BGYR a SG tiene éxito en la pérdida de peso y la resolución de ciertas complicaciones de BGYR.

The impact of splenectomy on human lipid metabolism.

Background: Splenectomy impacts hematological, immunological, and metabolic functions of the patient. Since our understanding of its metabolic effects, in particular effects on lipid metabolism, is limited, this study aims to investigate the effects of splenectomy on lipid metabolism. Methods: The data from 316 patients undergoing splenectomy between 2009 and 2019 were retrospectively analyzed. Thirty-eight patients whose serum lipid values were measured both preoperatively and 1 year after surgery were included in this study. Results: Significantly higher levels of total cholesterol, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) lipid profile were found in the postsplenectomy measurements. However, no significant differences were recorded in levels of triglyceride, HDL, or very-LDL. Conclusion: We determined that splenectomy does impact lipid metabolism, and that the metabolic effects of splenectomy should further be investigated.

Is It Possible to Estimate the Liver Left Lobe Volume Using Preoperative Data Before Bariatric Surgery?

PURPOSE: Retraction of the left lobe of the liver (LLL) is an important step in bariatric surgical procedures. A good liver retraction will both facilitate the operation and reduce complications. The aim of the study is to identify patients with large LLL with preoperative anthropometric and laboratory data, and to reveal complications due to large LLL. MATERIALS AND METHODS: The data of 245 patients who underwent bariatric surgery in our department between April 2019 and March 2021 were retrospectively analyzed. The patients were divided into two groups according to the visibility of the caudate lobe of the liver, the left diaphragmatic artery-vein, and the fat pad on the esophagus after liver retraction. RESULTS: Univariate analyses revealed significant differences in BMI, waist and hip circumferences, TG, DM, and HbA1c values, but only BMI (p = 0.001) and the presence of DM (p = 0.017) were found to be independent predictors of LLL size. BMI ≥ 42.1 kg/m2 indicates the size of LLL with 83% sensitivity and 49% specificity. Retractor-related complications were significantly higher in the large LLL group (p = 0.036). There was no difference between the two groups in terms of complications related to trocar insertion (p = 0.014) and postoperative liver enzyme levels (p = 0.714). The operation time (laparoscopic sleeve gastrectomy [LSG]; p = 0.021) (laparoscopic Roux-N-Y gastric bypass [LRYGB]; p = 0.020) and the amount of bleeding (LSG; p < 0.001) (LRYGB; p = 0.011) are higher in patients with large LLL. CONCLUSION: Large LLL can be predicted and complications may be reduced with the help of preoperative data.

Isolated Roux loop versus conventional pancreaticojejunostomy following pancreaticoduodenectomy.

AIM: This study aimed to examine the effects of isolated Roux loop (IP) versus conventional pancreaticojejunostomy (CP) techniques on the rate of postoperative pancreatic fistula and its severity. MATERIAL AND METHODS: This study included retrospectively collected data from 132 patients who underwent pancreaticoduodenectomy in a single institute. Collected data were compared between IP and CP groups. Postoperative pancreatic fistula and its grades were defined according to International Study Group on Pancreatic Fistula (ISGPF) definition. RESULTS: A total of 58 patients had IP and 74 patients had CP. Biochemical leak (IP 20.6% versus CP 14.9%, p=0.38) and grade B/C pancreatic fistula (IP 20.6% versus CP 32.4%, p=0.13) rates of both groups were similar. Durations of hospital stay and intensive care unit stay and 30-day mortality rates of the two groups were similar. CONCLUSION: Isolated Roux loop reconstruction following pancreaticoduodenectomy is not associated with a lower rate of pancreatic fistula but may contribute to reducing the severity of pancreatic fistula. KEY WORDS: Anastomotic leak, Pancreatic fistula, Pancreaticoduodenectomy, Roux en y anastomosis.

Laparoscopic Splenopexy Due to Wandering Spleen: Feasible Technique.

Wandering spleen (WS) is a rare disease caused by the looseness of the splenic ligaments. A 29-year-old female patient presented to the emergency department with complaints of abdominal pain and a palpable mass in the abdomen. A diagnosis of WS was made as a result of preoperative imaging. We performed urgent laparoscopic splenopexy with non-absorbable mesh in a patient with torsioned WS. WS is a disease that must be operated on urgently because it causes ischemia and necrosis in cases where it causes torsion in the splenic pedicle. Many researchers also recommend surgery in asymptomatic patients. While splenectomy was previously recommended for WS, current recommendations advocate for splenopexy. As a result, the only and definite treatment option in the case of WS is surgery. Splenopexy with minimally invasive techniques should be the first choice if possible. Splenopexy with non-absorbable mesh is an inexpensive and feasible method to prevent re-torsion. The use of non-absorbable mesh in laparoscopic splenopexy has not been shared before in the literature.

Splenic surgery: a ten years experience of a tertiary center in Turkey.

AIM: Splenectomy has been performed for various indications. In this study, we aimed to present the experience of a tertiary center on splenic surgery and analyze what has changed in the last 10 years. MATERIAL AND METHODS: Three hundred and sixteen patients who underwent splenic surgery were enrolled in the study. Demographic data, comorbidities, American Society of Anesthesiologists score, indications, operation type, postoperative complications, and mortality were analyzed retrospectively. RESULTS: The most common indication was traumatic splenic injury. Immune thrombocytopenic purpura (ITP) and gastric cancer were the second and third. Splenectomy was performed on 300 (94.9%) patients. Splenorrhaphy, partial splenectomy, and splenopexy were the other procedures performed. Postoperative complications occurred in almost onethird of the patients (n=118, 37.3%). Most of them were grade 5 according to the Clavien-Dindo classification. CONCLUSIONS: Splenectomy has become a less preferred treatment option with the development of non-operative management in splenic trauma, medical treatments for hematological diseases, and a better understanding of the immune, hematological and metabolic functions of the spleen. In the future, minimally invasive and spleen-sparing surgeries will be performed more frequently for patients who need splenectomy even for those with trauma. KEY WORDS: Cyst, Hematology, Laparoscopy, Sepsis, Splenectomy, Trauma.

Is Prognostic Nutritional Index an Indicator for Postoperative 90-Day Mortality in Laparoscopic Gastric Cancer Surgery?

Gastic cancer is a life-threatening malignancy in the world. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a guiding marker for gastric cancer patients with laparoscopic gastrectomy. We retrospectively examined the medical records of 138 gastric cancer patients who had adenocarcinoma pathological diagnosis and operated laparoscopically. Patients were divided into two groups (survived and death) and these groups were compared with clinical and laboratory parameters results. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Logistic regression analyses were performed to identify the risk factors of 90-day mortality. The median age of the study cohort was 62.5 (19-91) years, 98 (71%) were males, and 9 (6.5%) patients died during the 90-day after laparoscopic gastrectomy. The PNI levels were significantly lower in death group compared with survived group 37.5 (25-47.1) to 46.9 (22.8-64.9). The PNI (Odds Ratio = 0.81, 95% Confidence Interval 0.70-0.92, p = 0.003) was found as an independent factor for 90-day mortality in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 45.15 is the best-cutoff value for 90-day mortality after laparoscopic gastrectomy. 90-day mortality rate of PNI > 45.15 was 2.2% and PNI ≤ 45.15 was 13.6% found. Lower PNI is associated with increased 90-day mortality in laparoscopic gastrectomy for gastric cancer. The PNI may be a useful marker for predicting the 90-day mortality of gastric cancer patients after laparoscopic gastrectomy.

Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors.

AIM: The aim was to evaluate the feasibility of transvaginal specimen extraction after laparoscopic gastrectomy for tumors. METHOD: Inclusion criteria were females not planning to deliver a child and an accessible vaginal entry. Exclusion criteria were benign gastric pathologies and emergency cases. RESULTS: There were 24 females with a mean age of 54.5±12.0. Subtotal, total, central, and vertical gastrectomies were implemented in 17, 4, 2, and 1 patients, respectively. There was no conversion to open or conventional laparoscopic surgery. Specimens were removed from the vagina in all cases successfully. Histopathologies were adenocarcinoma in 20, gastrointestinal stromal in 3, neuroendocrine tumors in 2 and high-grade dysplasia in the rest. Mean blood loss and duration of surgery were 122.5±163.4 (range: 10 to 800) ml. and 287.7±95.9 (range: 120 to 440) minutes, respectively. No patient required intraoperative blood transfusions. The median length of hospital stay was 7 days (range: 3 to 22). The mean tumor size was 7.8±6.5 (range: 0.5 to 24) cm. Fourteen of 24 cases were advanced gastric cancers. Mean dissected lymph node numbers in the patients with radical gastrectomy was 35.3±12.9 (range: 18 to 62). There were no early or late complications related to the specimen extraction and no wound-related problems were observed. CONCLUSIONS: In the selected cases, transvaginal specimen extraction was feasible after laparoscopic gastric resections in patients with stomach tumors. As far as we know, this was the largest study on the transvaginal extraction of gastric tumors.

Comparison of stapled versus stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE).

BACKGROUND: Sleeve gastrectomy is a stapler dependent bariatric procedure. A stapleless sleeve gastrectomy can be necessary for certain circumstances. AIMS: Here, we aimed to show whether laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) can be an alternative procedure to stapled sleeve gastrectomy. PATIENTS AND METHODS: In the stapleless group (n = 6), no staplers were used and after vertical resection of the stomach by energy devices, the stomach remnant was closed by two rows of intracorporeal sutures. The resected specimen was removed through the mouth using an endoscopic snare. In the stapler group (n = 7), sleeve gastrectomy was carried out with linear stapler under the guidance of 36 Fr bougie. The specimens were extracted from the left upper quadrant trocar site. RESULTS: A total of 13 patients were compared (stapleless = 6 and stapled group = 7). All the sleeve gastrectomies were completed laparoscopically. The operative time was longer at 200 minutes (range 120-300) versus 120 minutes, (range 90-200) p = 0.07) and the amount of bleeding was higher at 100 ml (range 50-200) versus 30 ml (range 10-50) (p = 0.004) in the stapleless group. Leakage and gastrointestinal bleeding were seen in the stapleless group but no complications were found in the stapler group. No statistically significant difference was found between the metabolic outcomes of the two groups after the operation (p > 0.05). Decrease in BMI at similar rates was observed in 5 postoperative year (stapleless group: 35 kg/m2 (range 31-39) versus stapled group: 36.5 kg/m2 (range 31-39), p > 0.05). CONCLUSION: Laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction has longer procedure time, more blood loss and complications.

Laparoscopic transvaginal ventral hernia repair: a case and review of the literature.

A 52-year-old female underwent laparoscopic repair for recurrent epigastric hernia by hybrid natural orifice transluminal endoscopic surgery. Three 5-mm abdominal trocars and a 15-mm transvaginal trocar were used. The defect was closed by intracorporeal suturing before mesh fixation. She was discharged uneventfully on the 2nd post-operative day. Intracorporeal closing the defect may reduce the bulging of the mesh in laparoscopic ventral hernia repair. This case is the first hybrid transvaginal ventral hernia repair using defect closure technique.

Una mujer de 52 años se sometió a reparación laparoscópica por razón de una hernia epigástrica recurrente mediante cirugía endoscópica transluminal de orificio natural híbrido. Se utilizaron tres trócares abdominales de 5 mm y un trócar transvaginal de 15 mm. El defecto se cerró mediante sutura intracorpórea antes de la fijación de la malla. Fue dada de alta sin incidentes. El cierre intracorpóreo del defecto puede reducir el abultamiento de la malla en la reparación laparoscópica de la hernia ventral. Este caso es la primera reparación de hernia ventral transvaginal híbrida que utiliza la técnica de cierre de defectos.

Comparison of open and laparoscopic gastrectomy for gastric cancer: a low volume center experience.

OBJECTIVES: In gastric cancer, laparoscopic gastrectomy is commonly performed in Asian countries. In other regions where tumor incidence is relatively low and patient characteristics are different, developments in this issue have been limited. In this study, we aimed to compare the early results for patients who underwent open or laparoscopic gastrectomy for gastric cancer in a low volume center. MATERIAL AND METHODS: We retrospectively analyzed the data of patients who underwent curative gastric resection (open gastrectomy n: 30; laparoscopic gastrectomy n: 30) by the same surgical team between 2014 and 2019. RESULTS: The tumor was localized in 60% (36/60) of the patients in the proximal and middle 1/3 stomach. In laparoscopic gastrectomy group, the operation time was significantly longer (median, 297.5 vs 180 minutes; p <0.05). In open gastrectomy group, intraoperative blood loss (median 50 vs 150 ml; p <0.05) was significantly higher. Tumor negative surgical margin was achieved in all cases. Although the mean number of lymph nodes harvested in laparoscopic gastrectomy group was higher than the open surgery group, the difference was not statistically significant (28.2 ± 11.48 vs 25.8 ± 9.78, respectively; p= 0.394). The rate of major complications (Clavien-Dindo ≥ grade 3) was less common in the laparoscopic group (6.7% vs 16.7%; p= 0.642). Mortality was observed in four patients (2 patients open, 2 patients laparoscopic). CONCLUSION: In low-volume centers with advanced laparoscopic surgery experience, laparoscopic gastrectomy for gastric cancer can be performed with the risk of morbidity-mortality similar to open gastrectomy.

Laparoscopic gastrectomy in remnant gastric cancer.

OBJECTIVES: Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. MATERIAL AND METHODS: The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. RESULTS: Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. CONCLUSION: Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.

Helicobacter pylori Increases Gastric Compliance on Resected Stomach After Laparoscopic Sleeve Gastrectomy.

BACKGROUND: The relationship between high body mass index (BMI) and Helicobacter pylori (HP) was reported previously. But the mechanism is not clear. We aimed to evaluate the effect of HP on gastric compliance and volumes in obese patients. MATERIALS AND METHODS: One hundred fifty-nine patients who underwent sleeve gastrectomy due to morbid obesity were enrolled in the study and were divided into two groups as HP+ (n = 86) and HP- (n = 73) according to the HP status in resection materials. Demographics, pathological data, specimen sizes, volume, and compliance were retrospectively analyzed. RESULTS: The median age of the study group was 34 years (17-64 years) while the median BMI was 43 kg/m2 (35-64, 3 kg/m2). Most of the patients (n = 134, 84.3%) were female. The median diameter of the widest point of the specimen was 22.5 cm (14-32 cm), and the median volume of the specimen was 790 cc (330-1920 cc). Both the diameter of the widest point and the volume of the specimens were significantly increased in the HP+ group compared to the HP- group (p < 0.001 and p = 0.017, respectively). In addition, the median compliance was 52.6 cc/mmHg, and the compliance was significantly higher (p < 0.001) in the HP+ group. There were no significant differences in specimen sizes between the two groups. CONCLUSION: This is the first study showing that HP increases gastric compliance in obese patients who underwent LSG. The etiology and the effects of this increase in compliance have not been fully clarified yet. Further studies are needed to shed light on these effects.

Natural orifice specimen extraction versus transabdominal extraction in laparoscopic right hemicolectomy.

INTRODUCCIÓN: La extracción de muestras de orificio natural (NOSE) para resecciones colorrectales, que mejoran aún más las ventajas de la cirugía mínimamente invasiva, se utilizan cada vez con mayor frecuencia. En este estudio, nuestro objetivo fue comparar los métodos de extracción de muestras de nariz y transabdominales en casos de resecciones de colon derecho totalmente laparoscópicas. MÉTODOS: Se incluyeron datos de 52 pacientes que se sometieron a cirugía laparoscópica de colon derecho entre 2013 y 2019. La extracción de muestras transabdominales se realizó en 35 pacientes, mientras que 17 pacientes fueron sometidos a NOSE. Se compararon datos demográficos, hallazgos operativos, resultados patológicos y datos de seguimiento. RESULTADOS: Las mujeres (94% frente a 28%, p = 0,0001), comórbidas (76% frente a 40%, p = 0,01) y antecedentes de cirugía abdominal previa (75% frente a 23%, p = 0,001) fueron más altas en el grupo NOSE . Todas las otras características preoperatorias de los grupos fueron comparables. La pérdida de sangre intraoperatoria, el tiempo de operación y las tasas de complicaciones fueron similares en ambos grupos. La escala VAS postoperatoria (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) y los puntajes cosméticos fueron mejores en el grupo NOSE (10 vs. 7, p = 0.0001). Los resultados oncológicos fueron similares después de un seguimiento medio de 27.4 ± 20.5 (1-77) meses. CONCLUSIÓN: El método NOSE después de la resección laparoscópica del colon derecho fue un método más ventajoso en términos de cosméticos y dolor postoperatorio que la extracción de muestras transabdominales. INTRODUCTION: Natural orifice specimen extraction (NOSE) for colorectal resections, which further enhance the advantages of minimally invasive surgery, are being used increasingly more often. In this study, we aimed to compare NOSE and transabdominal specimen extraction methods in cases of totally laparoscopic right colon resections. METHODS: Data of 52 patients who underwent laparoscopic right colon surgery between 2013 and 2019 were included in the study. Transabdominal specimen removal was done in 35 patients, while 17 patients underwent NOSE. Demographic data, operative findings, pathological results, and follow-up data were compared. RESULTS: Female (94% vs. 28%, p = 0.0001), co-morbid (76% vs. 40%, p = 0.01), and previous abdominal surgery history (75% vs. 23%, p = 0.001) were higher in the NOSE group. All the other pre-operative features of the groups were comparable. Intraoperative blood loss, operation time, and complication rates were similar in both groups. Post-operative visual analog scale (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) and cosmetic scores were better in the NOSE group (10 vs. 7, p = 0.0001). Oncologic results were similar after a mean follow-up of 27.4 ± 20.5 (1-77) months. CONCLUSION: The NOSE method following laparoscopic right colon resection was a more advantageous method in terms of cosmetics and post-operative pain than transabdominal specimen extraction.

Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR).

OBJECTIVES: Masked hypertension, defined as nonelevated clinic blood pressure with elevated out of clinic blood pressure, has been associated with increased cardiovascular events, mortality and cognitive impairment. No evidence exists regarding the effect of treating masked hypertension. In this study, we followed-up the patients in the G-MASH-cog study for 1 year and aimed to examine the effect of the management of masked hypertension on cognitive functions. METHODS: The G-MASH-cog study participants were followed-up for 1 year. In masked hypertensive individuals, lifestyle modification and antihypertensive treatment (perindopril or amlodipine) were initiated for blood pressure control. Measurements of cognitive tests and ambulatory blood pressure monitoring at baseline and at 1-year follow-up were compared. RESULTS: A total of 61 patients (30 in masked hypertension group; 31 in normotensive group) were included. Mean age was 72.3 ± 5.1 and 59% of the participants were female. Compared with baseline ambulatory blood pressure measurement results, patients with masked hypertension had significantly lower ambulatory blood pressure measurement results after 1-year follow-up. The quick mild cognitive impairment test (Q-MCI-TR) score increased with antihypertensive treatment (Q-MCI score at baseline = 41(19-66.5), at 1 year = 45.5 (22-70), P = 0.005) in masked hypertensive patients. In the final model of the mixed-effects analysis, when adjusted for covariates, interaction effect of the masked hypertension treatment with time was only significant in influencing the changes in Q-MCI scores over time in patients aged between 65 and 74 years (P = 0.002). CONCLUSIONS: Treatment of masked hypertension in older adults was associated with improvement in cognitive functions.