Comparison of surgical outcomes of three different stump closure techniques during distal pancreatectomy.

BACKGROUND: To find the appropriate method of pancreatic transection during distal pancreatectomy (DP), we retrospectively compared post-operative complications including postoperative pancreatic fistula (POPF) according to the different types of pancreatic transection. METHODS: This study included 169 patients who underwent pancreatic transection using an ultrasonic activated device (USAD) with transfixion of the pancreatic duct (DP-TF group, n = 89), USAD followed by pancreaticogastrostomy (DP-PG group, n = 44), and a reinforced linear tristapler (DP-ST, n = 36). RESULTS: Overall and POPF-related complications in DP-PG group, and delayed gastric emptying (DGE) in DP-ST group were significantly lower than DP-TF group. There were no significant difference in overall complication, length of hospitalization and operative costs between DP-PG and DP-ST groups. Operative time was significantly longer in DP-PG group than others. CONCLUSION: Both DP-PG and DP-ST are associated with better surgical outcomes. Regarding ease of surgical technique, shorter operative times, and similar medical costs, DP with a reinforced linear tristapler is a good choice during DP.

Portomesenteric venous gas does not always mean intestinal necrosis: report of a case.

Portomesenteric venous gas is a rare condition most commonly caused by mesenteric ischaemia. Mesenteric ischemia, can be life-threatining and requires immediate surgical intervention with a poor prognosis. During the laparotomy, intestinal necrosis and perforation are most common findings although some patients reveal no surgical pathology. In this report we present a case of portomesenteric venous gas which is secondary to acute intramural intestinal haematoma.

Is familial Mediterranean fever (FMF) common in patients with negative appendectomy?

OBJECTIVES: Familial Mediterranean fever (FMF) is an autosomal-recessive disease characterized by recurrent attacks of fever with serositis. Differential diagnosis of a FMF abdominal attack with acute abdomen is difficult. Acute appendicitis is the most common cause of acute abdominal pain that requires surgical treatment. The aim of this study was to investigate frequency of FMF in patients with negative appendectomy. METHODS: We assessed 278 patients (female/male 127/151) who were operated with preoperative diagnosis of acute appendicitis. In 250 of the patients, definitive diagnosis of acute appendicitis was established by histo-pathological examination. Patients with negative appendectomy were assessed for FMF by rheumatologist. RESULTS: Negative appendectomy was detected in 28 patients (M/F 5/23, mean age 25.3 ± 8.4 years). Negative appendectomy ratio was 10.1 %. Among 28 patients two had FMF (7.7 %). CONCLUSIONS: FMF were established in 7.7 % of patients with negative appendectomy. Our study suggests patients having negative appendectomy should be evaluated for FMF. Further large sample studies are needed to define the real prevalence of FMF among negative appendectomy patients.

The outcome of concomitant cholecystectomy with bariatric surgery: a retrospective cohort study.

Gallstones are more common in obese individuals than in healthy individuals. They are diagnosed during the preoperative evaluation for bariatric surgery (BS). However, simultaneous cholecystectomy with BS is still controversial in patients with asymptomatic gallstones in the same session. In this study, the authors aimed to present an analysis of these operations performed with BS in the hospital. Materials and Methods: The records of 396 patients who underwent BS at Samsun VM Medicalpark Hospital between September 2017 and October 2021 were retrospectively reviewed. The length of hospital stay, operation time, complications, and safety of patients who underwent simultaneous cholecystectomy and BS only were examined. Results: Of 396 patients, 262 (66.1%) underwent laparoscopic sleeve gastrectomy and 134 (33.8%) underwent laparoscopic gastric bypass surgery. Gallstones were detected during the preoperative examination in 72 (18.1%) of the 396 patients who underwent BS. It was observed that 11 of them had symptoms. No major complications occurred during or after surgery in patients who underwent simultaneous cholecystectomy and only in those who underwent BS. Conclusion: Simultaneous cholecystectomy with BS does not burden the patient, and complication rates are very low. The procedure is also cost-effective, as patients do not require a second surgery.

Does Neutrophil-Lymphocyte Ratio Correlate with the Improvement of Hepatosteatosis after Laparoscopic Sleeve Gastrectomy?

INTRODUCTION: Obesity is a disease that shortens life expectancy and predisposes to many diseases such as severe hepatosteatosis. Hepatosteatosis is characterized by inflammatory infiltration of the portal space. Bariatric surgery has improvement effect on hepatosteatosis and degree of inflammation. Laparoscopic sleeve gastrectomy is an effective and most common therapeutic option for obesity. Neutrophil-lymphocyte ratio is a parameter associated with inflammatory disease. This study aimed to investigate if there is any correlation between improvements in hepatosteatosis and biochemical parameters especially neutrophil-lymphocyte ratio and ultrasonographic findings 1 year after the laparoscopic sleeve gastrectomy. METHODS: The files of 66 patients who underwent laparoscopic sleeve gastrectomy between May 2017 and April 2020 were retrospectively reviewed. Preoperative and postoperative 1-year demographic data, biochemical and inflammatory parameters, and ultrasonographic reports of the liver were reviewed. RESULTS: A statistically significant improvement in hepatosteatosis was demonstrated by ultrasonography 1 year after laparoscopic sleeve gastrectomy. A significant decrease was also observed in neutrophil-lymphocyte ratio. No correlation was found between the decrease of neutrophil-lymphocyte ratio and improvement in hepatosteatosis. There was also significant difference between the preoperative and postoperative BMI, biochemical and inflammatory parameters. CONCLUSION: However, we found laparoscopic sleeve gastrectomy is associated with significant improvement in hepatosteatosis and inflammatory parameters; no correlation between the improvement in hepatosteatosis and NLR was seen at 1 year.

Three-year outcome after anterior component separation repair of giant ventral hernias: A retrospective analysis of the original technique without mesh.

INTRODUCTION: In this study we presented our results with anterior component separation technique utilized in the repair of giant ventral hernias. Our primary endpoints were the rates of surgical site occurrences and recurrence at three years. Besides we investigated the impact of components separation repair on abdominal wall functions. METHODS: We retrospectively analyzed the prospectively-collected data of 40 patients that were operated on between April 2004 and February 2012 for their median ventral hernias sizing larger than 15 cm in width. Our inclusion criteria for component separation program excellently corresponded today's "giant ventral hernia" standards. The method used for components separation was identical to the original Ramirez technique, and did not comprise of any mesh reinforcement. The ICU stays, prolonged intubation, early and late complications, mortality and recurrences at three years were recorded. We used a curl-up test to demonstrate the amelioration of the abdominal wall functions postoperatively. RESULTS: The older age and larger defect size were the significant risk factors necessitating prolonged intensive care. Surgical site occurrences were recorded in 18 patients (45.0%). A total of 7 recurrences (17.5%) were detected at three years. Patients showed a significant improvement in raising their trunks after repair (p < 0.001). CONCLUSIONS: Our findings demonstrated that components separation technique in the original form caused excessive wound complications including skin necrosis which in turn caused delayed discharge from the hospital. The 17.5% recurrence rate seemed higher than those of more recent papers. The already-established newer modifications should be integrated in the repair method. The components separation repair clearly improves abdominal wall functions.

Long-term kidney transplant outcome in obese patients in a predominantly African American population.

The impact of obesity on long-term kidney transplant outcome has largely been studied in non-African American patients. This study seeks to determine differences in outcome between obese and non-obese patients after kidney transplantation, in a predominantly African American population. We reviewed 642 adult renal transplant recipients who received their transplants at SUNY Downstate Medical Center between 1998 and 2007. Sixty-six percent of the patients studied were African American. The patients were divided into five groups according to their BMI status: underweight <20, normal 20-24.9, overweight 25-29.9, obese 30-34.9, and morbidly obese ≥35. There were no differences in race, gender, cytomegalovirus infection, type of transplant, panel-reactive antibody, retransplant status, flow cytometry cross-match results, mycophenolate mofetil therapy, and total HLA mismatch status. The mean discharge serum creatinine in the morbidly obese group was significantly higher than in other groups (p < 0.001). The difference in creatinine level disappeared at six wk and six months (p > 0.5), respectively. Acute rejection rates, delayed graft function, graft survival, and patient survival were not different between the groups. The findings from this large single-center study suggest that obese and morbidly obese patients had similar outcomes compared to other weight groups. Obese and morbidly obese African American patients should not be excluded from kidney transplantation on the basis of weight alone.

The changing face of post-transplant lymphoproliferative disease in the era of molecular EBV monitoring.

Pediatric PTLD is often associated with primary EBV infection and immunosuppression. The aim was to retrospectively review the spectrum of histologically documented PTLD for two time intervals differentiated by changes in use of molecular EBV monitoring. Eleven of 146 patients (7.5%) in 2001-2005 (Era A) and 10 of 92 (10.9%) in 1993-1997 (Era B) were diagnosed with PTLD. The median age at liver transplantation (0.8 and 0.9 yr, respectively) and the median duration between liver transplant and diagnosis of PTLD (0.6 and 0.7 yr, respectively) were similar in both eras. However, patients in Era A presented with significantly less advanced histological disease compared to patients in Era B (p=0.03). Specifically, nine patients (82%) in Era A had Pl hyperplasia/polymorphic PTLD, whereas in Era B, six had advanced histological disease (five monomorphic and one unclassified). Three transplant recipients in Era B died secondary to PTLD, whereas there were no PTLD-related deaths in Era A (p=0.03). Heightened awareness of risk for PTLD, alterations in baseline immunosuppression regimens, implementation of molecular EBV monitoring, pre-emptive reduction in immunosuppression and improved therapeutic options may have all contributed to a milder PTLD phenotype and improved clinical outcomes.

Peritoneal tuberculosis in premenopausal patients with elevated serum CA 125.

INTRODUCTION: Peritoneal tuberculosis predominantly involves the omentum, intestinal tract, liver, spleen, and genitourinary tract and occurs in 1-4% of patients with pulmonary tuberculosis. Peritoneal tuberculosis may mimic a pelvic mass in imaging studies and also may increase CA-125 levels. Peritoneal tuberculosis may also produce massive ascites, and intraperitoneal gross appearance might be similar to the peritoneal carcinomatosis. Therefore, peritoneal tuberculosis is often confused with advanced-stage epithelial carcinoma because of similar clinical, radiologic, and laboratory findings and later intraoperative findings. MATERIALS AND METHODS: The pathology records between January 2000 and August 2008 were retrospectively reviewed at 19 Mayis University Hospital. Twenty-two patients were found to have peritoneal caseating necrosis. A total of 13 out of 22 patients were found to have high CA 125 level. RESULTS: Among these 13 patients, 8 patients received/are receiving anti-tuberculous therapy after they were incidentally diagnosed with peritoneal tuberculosis. CONCLUSION: Increased CA 125 levels should be evaluated carefully prior to aggressive surgical approach, especially in premenopausal women and frozen section evaluation should be done before extensive surgical procedure if there is any suspicion.

Single-Port Laparoscopic Liver Resection: Largest Turkish Experience.

Single-port laparoscopic surgery has the advantage of a hidden scar and reduced abdominal wall trauma. Although single-port laparoscopic surgery is widely performed for other organs, its application is very limited for liver resection. Here, we report our experience with nine patients who underwent single-port laparoscopic liver resection. Nine patients underwent single-port laparoscopic liver resection for the indications of hydatid cyst, hepatocellular carcinoma, and colorectal cancer liver metastasis. Nine patients were successfully treated with single-port laparoscopic surgery. The operative time was between 60 and 240 min. The only operative complication was bleeding up to 650 mL in a patient with cirrhosis. No postoperative complications occurred. All patients were discharged earlier than usual. Single-port laparoscopic liver surgery is a challenging surgery. Surgeon with the experience of laparoscopic liver surgery should perform the single-port laparoscopic liver surgery. It is technically feasible with a good outcome in well-selected patients. Initial cases must be benign lesions to avoid jeopardizing oncological safety.

A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma.

Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented.

Intestinal perforation due to miliary tuberculosis in a patient with Behcet's disease.

Gastrointestinal manifestations of both Behçet's disease and intestinal tuberculosis include the signs and symptoms of abdominal pain, weight loss, fever, vomiting, diarrhea and palpable mass in the right lower quadrant. We report the case of a male patient with Behçet's disease who had multiple ileal perforations due to miliary tuberculosis. It was suspected that the perforations were due to intestinal manifestation of Behçet's disease, but the final pathology report and chest X-ray one week after surgery demonstrated the presence of miliary tuberculosis. To our knowledge, this is the first reported case of Behçet's disease with intestinal perforation due to miliary tuberculosis.

Benign splenic epithelial cyst accompanied by elevated Ca 19-9 level: a case report.

We report the case of a 30-year-old woman with a benign epidermoid splenic cyst and a high CA 19-9 serum level (268 U/mL). The patient underwent resection of the cyst and splenectomy. After removal of the cyst, the serum CA 19-9 level decreased to a normal level within 6 weeks. True non-parasitic splenic cysts are rare. Approximately 30 cases of benign true splenic cysts with a high CA 19-9 serum level have been published.

An intraluminal leiomyoma of the small intestine causing invagination and obstruction: a case report.

Leiomyomas are mostly of benign character and are rarely seen in the gastrointestinal (GI) system. They represent one subgroup of a group of tumors known as gastrointestinal stromal tumors (GIST). Although rarely seen, they are symptomatic tumors, and they comprise 20-30 percent of all benign GI tumors. Diagnosis is difficult because of their rarity and the absence of specific symptoms. This is a case report of intestinal leiomyoma in a patient who was suffering with GI obstruction for more than 5 months. The tumor was discovered only after the appearance of intestinal obstruction. The patient underwent laparotomy for ileus of unknown etiology. Leiomyoma was diagnosed by pathologic analysis.

Selective jejunal artery pseudoaneurysm embolization in a patient with massive gastrointestinal bleeding due to intestinal tuberculosis.

Gastrointestinal bleeding is a life-threatening manifestation of intestinal tuberculosis that is generally attributed to oozing of blood from the mucosal ulcers. We report a case of intestinal tuberculosis presenting with massive upper gastrointestinal bleeding from jejunal artery pseudoaneurysm diagnosed with angiography and successfully embolizated by histoacril (glue).

Laparoscopic splenic total cystectomy in a patient with elevated CA 19-9.

True nonparasitic splenic cysts are rare. Reports of approximately 30 cases of benign true splenic cysts producing elevated CA 19-9 serum levels have been published. The traditional treatment of splenic epidermoid cysts is splenectomy. However, with all the advances in laparoscopic surgery, conservative laparoscopic approaches are accepted as the most preferred techniques for this benign disease. Laparoscopic cystectomy with its minimal invasiveness and low morbidity is the ideal technique for properly selected patients. So far, only one case report of laparoscopic cystectomy for splenic epidermoid cyst with elevated CA 19-9 levels has been published. This is the second known report of this procedure being performed to remove a splenic epidermoid cyst in a patient with elevated CA 19-9 levels.

Single port laparoscopic liver surgery: A minireview.

Nowadays, the trend is to perform surgeries with "scarless" incisions. In light of this, the single-port laparoscopic surgery (SPLS) technique is rapidly becoming widespread due to its lack of invasiveness and its cosmetic advantages, as the only entry point is usually hidden in the umbilicus. The interest in "scarless" liver resections did not grow as rapidly as the interest in other scarless surgeries. Hepatopancreatobiliary surgeons are reluctant to operate a malignant lesion through a narrow incision with limited exposure. There are concerns over adverse oncological outcomes for single-port laparoscopic liver resections (SPL-LR) for hepatocellular carcinoma or metastatic colorectal cancer. In addition, getting familiar with using the operating instruments through a narrow incision with limited exposure is very challenging. In this article, we reviewed the published literature to describe history, indications, contraindications, ideal patients for new beginners, technical difficulty, advantages, disadvantages, oncological concern and the future of SPL-LR.

Acute median arcuate ligament syndrome after pancreaticoduodenectomy.

Median arcuate ligament syndrome (MALS) has been reported in 2-7.6 % of patients undergoing pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and treated radiologically or surgically before or during PD. MALS can have an acute postoperative onset after PD even if all preoperative and intraoperative evaluations are normal particularly in young patients.In this report, we present a second case of severe hepatic cytolysis secondary to MALS that developed acutely and the first patient who required acute division of the median arcuate ligament after PD.