Analysis of the Factors Affecting Survival in the Patients who Underwent Curative-Intent Gastrectomy due to Gastric Adenocarcinoma.

OBJECTIVES: Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related deaths in the world. In this study, we aimed to evaluate the impact of clinicopathological factors on overall survival in the patients who underwent curative-intent gastrectomy due to gastric adenocarcinoma. METHODS: The medical records of 644 patients who underwent gastrectomy between January 2007 and January 2017 in our clinic were retrospectively reviewed. Among these patients, 359 patients were included in this study. The impact of several prognostic factors on survival was investigated. RESULTS: The mean age was 59.2±11.6 (29-83). Male/female ratio was 2.12. The median follow-up time was 19 months (CI=10.1-31.1). Median overall survival was 23±2.3 months (CI=18.3-27.6). Splenectomy, R1 (microscopically incomplete) resection, and advanced stage were independent risk factors for poor prognosis. CONCLUSION: R1 resection, splenectomy, and advanced TNM stage were associated with poor prognosis in gastric cancer. Splenectomy should be avoided in the absence of direct invasion of the tumour or metastasis of lymph nodes on splenic hilum to prevent postoperative infectious complication-related mortality.

The factors that affect the mortality of emergency operated ASA 3 colon cancer patients.

INTRODUCTION: colorectal cancers take third place among cancer-related deaths and 10-28% of these patients are admitted with the necessity of emergency surgical intervention. The main propose of this study was to investigate the factors affecting mortality in ASA 3 colorectal cancer patients who undergo emergency surgery. METHODS: between 2010 and 2017 ASA 3 patients who underwent emergency colon cancer surgery were included in the study. All of the study group was evaluated within the first 30-day time-frame. The results were obtained by a statistical comparison of the data of patients with and without mortality. RESULTS: one hundred and twenty eight patients included in the study. There was no statistical difference in the demographic data of the groups and the indications of the operation. The differences and durations of surgery also did not make any statistical difference. The complication rate was the same according to the Clavien-Dindo classification. CONCLUSION: despite the screening programs applied in colorectal cancers, applications to emergency services and procedures performed under emergency conditions are still at high levels. Surgical operations, which have to be performed in patients with impaired metabolic status, carry major risks for patients, but their outcomes are also satisfactory for them.

[Our experience in the cases with penetrating colonic injuries]. / Penetran kolon yaralanmali olgulardaki deneyimlerimiz.

BACKGROUND: In this study, the factors that effect the morbidity and mortality in patients with penetrating colonic injuries were evaluated. METHODS: Fourty-two patients (37 males, 5 females; mean age 30,1; range 14 to 63 years) with penetrating colonic trauma were evaluated according to age, gender, type of penetrating trauma, location and severity of the colonic injury, associated injury, interval between the trauma and the definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality. RESULTS: Type of the penetrating trauma was stab injury in twenty-eight (67%) patients, and gunshot injury in fourteen (33%) patients. The mean Colon Injury Severity Score was 2,1. The mean Abdominal Trauma Index (ATI) was 17,2 and it was over than 25 in eight (19%) patients. The symptoms of shock were present in eleven (26%) patients at admission. Blood transfusions were applied in sixteen (38%) patients. In twenty-one patients intraabdominal bleeding was observed and it was more than 500 mL in eleven (26%) patients. Primary repair was performed in 36 (86%) of the 42 patients and colostomy was performed in six (14%) patients. Morbidity and mortality rates were 41% and 10% respectively. CONCLUSION: It was found that morbidity rates were increased in patients with ATI score higher than 25, and mortality rates were increased in patients presenting shock at admission, with the amount of intraabdominal blood more than 500 mL, and who needed three or more units of blood transfusion. The primary repair of the penetrating colon trauma can be performed confidently in the hemodynamically stable patients with ATI score less than 25.

Case Report of the Descending Colon Located Completely in the Right Extraperitoneal Cavity and Sigmoid Colon Located in the Right Quadrant in a Patient with a Splenic Flexure Tumor: a Rare Anomaly.

Cases in which congenital anomalies of the colon and colon tumors are observed together are very rare. The aim of this article is to present a splenic flexure tumor case, which possessed the anomaly of the descending colon in the right extraperitoneal space and the sigmoid colon located in the right quadrant. Similar findings have previously been reported in two cases in cadaveric studies.

Adjustable gastric banding in a multicenter study in Turkey.

BACKGROUND: Adjustable gastric banding (AGB) is a minimally-invasive approach which allows adjustment of gastric restriction. METHODS: The AGB was evaluated retrospectively in a consecutive series at 3 centers. From October 1998 to October 2001, 70 patients (49 women), mean age 34.3 years (18-59) with morbid obesity (preoperative mean BMI 45.2 kg/m(2)) underwent AGB The open approach was employed in the first 35 patients. Laparoscopic placement was used in the second 35 patients. Complete follow-up has been obtained in all patients. RESULTS: Mean postoperative follow-up has been 18 months (12-39). Mean operative time was 120 minutes in the open approach and 150 minutes in the laparoscopic AGB. Mean hospital stay was 5 days after the open approach and 1.7 days after the laparoscopic surgery. The excess weight loss after 18 months was 59%. Incidence of early postoperative complications was 27.1%, including nausea and vomiting in 8 patients (5 in open approach, 3 in laparoscopic placement), wound infection in 10 patients (all 10 in open approach), and Wernicke's encephalopathy in 1 patient (open approach). Incidence of late complications was 28.5%, and included band migration in 2 patients (both by laparoscopic placement), pouch dilatation in 10 patients (6 in open approach, 4 in laparoscopic placement), incisional hernias in 4 patients (all by open approach), and port infections in 4 patients (all 4 in open approach). CONCLUSION: AGB has been effective in achieving good weight loss to 3 years follow-up. The ability to adjust the degree of gastric restriction has enabled progressive weight loss.

Laparoscopic cholecystectomy in patients aged 80 years and older: an analysis of 111 patients.

INTRODUCTION: The incidence of cholelithiasis increases with age. More octogenarian (≥80 y) patients are undergoing laparoscopic cholecystectomy (LC) operation throughout the world. PATIENTS AND METHODS: A retrospective study was conducted on patients older than 80 years (group 1: 111 patients) and those in the 18 to 79 years age group (group 2: 185 patients), who underwent LC between July 2005 and October 2009. The variables analyzed were the presentation, demographics, comorbid illnesses, American Society of Anaesthesiology (ASA) scores, history of previous abdominal surgery, the operative time, postoperative morbidity and mortality, and the length of hospital stay. A comparison was made between the two groups. Data was evaluated by using the χ and the Fisher exact test. P<0.005 was considered significant. RESULTS: The difference in both groups in the mean age and ASA scores were significant. The indication for LC was gallstone disease in 87 (78.4%) patients, acute cholecystitis in 16 (14.4%), and gallstone pancreatitis in 8 (7.2%) of group 1 patients. The conversion rate was not statistically significant. The mean operative time was 77 minutes in group 1 patients, and this was significantly longer than that of group 2 patients. The postoperative oral intake within 24 hours of surgery was significantly earlier in group 2 patients. Other parameters were not significantly different between the 2 groups. CONCLUSIONS: LC in octogenarians is a relatively safe procedure that can be performed with low morbidity and mortality rates. The comorbidities and higher ASA scale are major risk factors for postoperative complications in this age group of patients.

Comparison of results of laparoscopic gastric banding and consecutive intragastric balloon application at 18 months: a clinical prospective study.

BACKGROUND: Obesity is a serious health problem that leads to serious physical and psychological problems. The methods used in treating obesity include diet and behavioral changes, pharmacotherapy, and surgery. Laparoscopic adjustable gastric banding (LAGB) and intragastric balloon (IGB) applications are two of the methods used to treat obesity. The aim of this study was to compare the effects of LAGB with those of two consecutive IGB applications in weight loss management of obese patients. METHODS: Thirty-two patients (F/M:24/8) admitted in the study were divided into two groups. In the first group of 16 patients, LAGB was performed, and in the other group two consecutive IGBs were applied. Total weight loss, body mass index (BMI), excess weight loss percent (EWL %), and excess body mass index loss percent (EBMIL %) were recorded at months 6, 12, and 18 for both groups. RESULTS: At the end of the 6th month, BMI values of LAGB and IGB groups were 36.0 and 30.6 kg/m(2), EWL % were 32.3% and 39.3%, and EBMIL % were 36.3% and 47.1%, respectively. The results were similar. At the end of 12 months, median BMI was 36.6 kg/m(2) for LAGB and 27.5 kg/m(2) for IGB (P<.05). The EWL % and EBMIL % at the end of the 12th month were 57% and 70%, which is significant in favor of IGB. The last evaluation was made at the 18th month of applications, and the three parameters for two applications were found to be similar. CONCLUSIONS: The achieved weight losses at the 6th month were similar for both groups. However, at the 12th month, two consecutive IGB applications were more effective. At the end of the 18th month, the results were again similar. Two consecutive IGB applications may be offered to obese patients who do not feel ready for surgery.

Intragastric balloon treatment for obesity: prospective single-center study findings.

BACKGROUND: The intragastric balloon (IGB) procedure is an obesity treatment. METHODS: A BioEnteric IGB was used in 33 patients between February 2006 and February 2009. RESULTS: Of the 31 patients, 19 were female (61.3%). Mean age was 35.48 +/- 9.31 years. Following intravenous sedation, the balloon was inserted and inflated under direct vision by using saline (600 ml) and methylene blue (10 ml) solution. Average weight and mean BMI scores were as follows: 119.34 +/- 22.64 (range 80-170) kg and 41.84 +/- 8.28 (range 30-63.2) kg/m(2). Mean weight and BMI were measured as 104.31 +/- 21.33 (range 64-151) kg and 36.43 +/- 7.36 (range 26-52) kg/m(2) 6 months after the index procedure. Percent of excess weight loss (%EWL) and percent of excess body mass index loss (%EBMIL) were as follows: 29.16 +/- 15.99% (range 0.00-56.91%) and 35.45 +/- 19.46% (0-75.2%), respectively. All patients lost weight constantly for the 6-month period. Patients showed statistically significant weight and BMI losses for the first 3-month period but these decrements reached a plateau between the 4th and 6th month. Weight loss was not statistically significant during the second 3-month period. Few patients had mild complaints following balloon insertion; there was no balloon intolerance. CONCLUSIONS: IGB is safe and effective for short-term weight reduction in obese patients. Weight reduction during the second half of the treatment period needs closer follow-up.

Jejunogastric intussusception, a rare complication of gastric surgery: report of two cases.

Jejunogastric intussusception is a rare complication of gastric surgery. It usually presents with abdominal pain, nausea, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate diagnosis. An early diagnosis and urgent surgical intervention is mandatory. We herein report two cases of patients with jejunogastric intussusception who presented with acute abdomen and hematemesis.