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BACKGROUND: Early diagnosis of anastomotic leakage is the most important factor in reducing its morbidity and mortality. Anastomotic integrity monitoring of the leukocyte count (WBC), C-reactive protein (CRP), and neutrophil-lymphocyte ratio (NLR) are commonly used laboratory parameters. The availability of follow-up presepsin anastomotic integrity was investigated in this study. MATERIALS AND METHODS: This study included patients who had gastrointestinal anastomosis due to major abdominal surgery between January 2016 and February 2017. Blood samples were collected to determine the WBC, CRP, NLR, and presepsin values before the anastomosis was performed and then taken on postoperative days 1, 3, and 5. RESULTS: This is a prospective nonrandomized study with 100 consecutive patients enrolled in the anastomosis group (male/female, 42:58). WBC, CRP, NLR, and presepsin values are based on certain days in the complication group, and the complication group increased with statistical significance. Presepsin had a specificity of 98.63% in determining anastomotic leak. CONCLUSIONS: Presepsin can be used as a supplemental marker with CRP and NLR for anastomotic integrity.
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Fístula Anastomótica/diagnóstico , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Receptores de Lipopolissacarídeos/sangue , Fragmentos de Peptídeos/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/sangue , Fístula Anastomótica/etiologia , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Curva ROC , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: To evaluate and compare the effects of weight lost after sleeve gastrectomy on left ventricular (LV) systolic function using both two-dimensional speckle tracking (2D-STE) and three-dimensional echocardiography (3DE) in men versus women. METHODS: In 53 obese patients referred for sleeve gastrectomy, 2D-STE and 3DE were performed prior to and 6 months after surgery. RESULTS: The study included 53 obese patients (62.3% female; mean age 36.8 ± 10.7 years). Six months after surgery, all patients demonstrated a significant decrease in body mass index, body weight, blood pressure, heart rate, LV end-diastolic dimension, myocardial wall thickness, LV mass, LV mass index, LV mass/height(2.7) , LV end-diastolic volume, LV end-systolic volume, and stroke volume as well as an increase in SV index and ejection fraction. There was no significant difference in measured variables between men and women at baseline or postsurgery, except for baseline LV end-diastolic dimension, and baseline and after surgery LV mass, LV mass index, and LV mass/height(2.7) , which were all significantly higher in men. CONCLUSIONS: Sleeve gastrectomy improves LV systolic function and contributes to reverse LV remodeling in both genders. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:492-499, 2016.
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Ecocardiografia , Gastrectomia , Função Ventricular Esquerda/fisiologia , Redução de Peso/fisiologia , Adulto , Ecocardiografia Tridimensional , Feminino , Seguimentos , Humanos , Masculino , Resultado do TratamentoRESUMO
PURPOSE: The proinflammatory cytokine, interleukin-17 (IL-17) plays a potent role in T-cell mediated angiogenesis and promotes tumorigenicity. The objective of this study was to determine the clinical outcomes of colorectal cancer (CRC) patients in relation to serum IL-17 levels. METHODS: Ninety-six CRC patients were enrolled in this study. Pre-treatment serum IL-17 levels were determined by enzyme- linked immunosorbent assay (ELISA). Thirty age - and sex-matched healthy controls were included in the analysis. RESULTS: The median patient age was 60 years (range: 24-84) and the most frequent localization was colon (N=59;61%). Median follow-up time was 14 months, 27 patients (28%) experienced disease progression, and 20 of the remaining patients (20%) died. The estimated and 1-year progression-free survival (PFS) and 2-year overall survival (OS) rates for the whole patient group were 26.9% (95% confidence interval [CI]=9.9-44.0) and 71% (95% CI=56.0- 85.0), respectively. The number of patients who received neoadjuvant treatment was 25. Of the patients who received palliative treatment, 11 had oxaliplatin whereas 18 and 7 had irinotecan and FU/capecitabine, chemotherapy (CTx). Twenty-four and nine of the patients who received targeted therapy had bevacizumab and cetuximab, respectively. Thirty-three percent of 36 metastatic patients who received palliative CTx were CTx-responsive. The baseline median serum IL-17 levels were significantly lower in patients with CRC than in the healthy control group (p=0.01). Moreover, known clinical variables including older age, poor grade and low albumin levels were found to be correlated with high serum IL-17 concentrations (p=0.02, p=0.02, and p=0.04, respectively). No statistically significant serum IL- 17 concentrations were noted regarding PFS and OS. CONCLUSION: Serum levels of IL-17 may be diagnostic marker in CRC patients. However, no predictive and prognostic values were determined.
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Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Interleucina-17/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Progressão da Doença , Intervalo Livre de Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Turquia , Regulação para Cima , Adulto JovemRESUMO
PURPOSE: Leptin is a highly pleiotropic adipokine. Pancreatic adenocarcinoma (PA) and leptin relationship is important. Our aim was to investigate the serum levels of leptin in patients with PA, the relationship of leptin with tumor progression and known prognostic parameters and its diagnostic, predictive and prognostic role. METHODS: Thirty-three patients with PA were investigated. Serum samples were obtained on first admission before treatment and follow-up. Both serum leptin levels were determined using enzyme-linked immunosorbent assay (ELISA). Age, sex, and body mass index (BMI) matched to 20 healthy controls were included in the analysis. RESULTS: The median patient age at diagnosis was 59 years (range 32-84) and 20 (61%) patients were men. The tumor was located in the head of pancreas in 21 (63%) patients. The most common metastatic site was liver in 23 patients with metastasis (N=19; 83%). The median follow-up time was 26.0 weeks (range 1.0-184.0). At the end of the observation period, 32 patients (97%) had died. The baseline serum leptin levels were significantly higher in patients with PA than in the control group (p=0.02). Thirty-nine percent of 23 metastatic patients who received palliative gemcitabine-based chemotherapy (gCTx) were gCTx-responsive. Serum leptin levels were significantly higher in the gCTx-unresponsive patients compared with gCTx -responsive (median 5.32 vs 1.16 ng/mL, p=0.004). Conversely, serum leptin concentration was found to have no prognostic role on survival (p=0.20). CONCLUSION: Serum leptin levels may be a good diagnostic and predictive tool on the response to gCTx in PA patients.
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Adenocarcinoma/sangue , Adenocarcinoma/tratamento farmacológico , Biomarcadores Tumorais/sangue , Desoxicitidina/análogos & derivados , Leptina/sangue , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/tratamento farmacológico , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desoxicitidina/uso terapêutico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Prognóstico , GencitabinaRESUMO
OBJECTIVE: Robotic adrenalectomy is one of the minimally invasive surgical methods gaining wide acceptance due to the three-dimensional imaging system and ergonomics of the equipment. We aimed to present the early data on patients who underwent robotic adrenalectomy due to adrenal masses in our hospital. MATERIAL AND METHODS: The records of eight cases, in which a unilateral robotic trans-peritoneal adrenalectomy was conducted due to an adrenal mass between 2011 and 2013, have been evaluated. Demographic characteristics of cases, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative diagnosis, diameter and localization of the adrenal mass, operative time, blood loss, conversion rate to open surgery, morbidity and mortality rates, length of hospital stay, total hospital charges and postoperative pathologic results were considered. RESULTS: The female to male ratio was 6:2, the median age was 49.5 (26-71) and the median BMI was 29.7 (21.7-38.5). An adrenalectomy was performed in six cases for a right adrenal mass and in two cases for a left adrenal mass. The mean tumor diameter was 53.6 mm (20-90). The average surgical time (including docking) was 98 min. (55-175 min.) and the average blood loss was 50 mL. The only complication was a diaphragm injury which was repaired robotically. There were no conversions to traditional laparoscopic or open surgery and there have not been any mortality in the series. The median length of hospital stay was 4.1 days (range 2-11) and the average cost was 3617.12 TL ($1808.56). CONCLUSION: Robotic adrenalectomy is an effective and safe surgical alternative to laparoscopic adrenalectomy. However its high cost has emerged as its main disadvantage.
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OBJECTIVE: Laparoscopy is gaining more importance in emergency abdominal surgery. Peptic ulcer perforation (PUP) constitutes a significant portion of surgical emergencies. The aim of this study was to evaluate the methods and results of patients who underwent surgery due to PUP in our department. MATERIAL AND METHODS: Patients who were admitted to the hospital in the early period and received Graham-patch (GP) repair due to PUP from January 2009 to January 2013 were divided into two groups as laparoscopic (group L) or open (group O) surgery. Demographic data of the patients, duration of the operation, conversion to open surgery, length of hospital stay, secondary interventions, re-admissions, morbidity and mortality rates were retrospectively evaluated. Patients with conversion to open surgery were included in Group O. RESULTS: Two hundred and nineteen patients were included in the study, 148 of which were in Group O (including the 47 patients with conversion), and 71 in group L. In patients with early admission, the rate of laparoscopically completed GP was 19.6% in the first year of the study, whereas this rate was 61.8% in the fourth year (p<0.001). The rate of conversion to open surgery was 50% in 2009, and 24.4% in 2012 (p=0.028). Length of hospital stay was shorter in group L (p=0.35). The complication rate was 4.2% in patients who had laparoscopic procedures, and was 6.1% in patients who underwent open surgery (p=0.57). Seventy-three percent (n=11) of re-hospitalized patients in the perioperative period (n=15) were treated conservatively. When costs related to secondary interventions and re-hospitalization were included, there was no significant difference between laparoscopic and open surgery groups in terms of cost (p=0.06). CONCLUSION: Laparoscopic surgery for PUP is a reliable method and has been used increasingly over the years in our department. The operative time is longer, the length of hospital stay is shorter, the complication rates are less than open surgery, and the conversion rate is significantly reduced. Laparoscopic GP is feasible in early-admitted patients with PUP, due to the above-mentioned advantages. We believe the rate of conversion to open surgery decreases with increasing experience in laparoscopy.
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BACKGROUND: Despite advancements in technology and expertise, ERCP carries risks of significant complications, such as pancreatitis, bleeding, and perforation. Post-ERCP pancreatitis is the most common and important complication following ERCP. In our study, we aimed to examine the relationship between patient and procedure-related parameters and the development of pancreatitis. METHODS: Four hundred patients who underwent ERCP between January 1, 2019 and December 31, 2020, at the General Surgery Clinic of the Bakirköy Dr. Sadi Konuk Health Application and Research Center of the University of Health Sciences Faculty of Medicine were retrospectively evaluated. Patient and procedure-related factors were analyzed statistically through univariate and multivariate analyses. RESULTS: Age, urgent indication, ERCP history, cholangitis, precut sphincterotomy, common bile duct diameter, pancreatic cannulation, pancreatic stent, and bleeding were statistically significant risk factors for post-ERCP pancreatitis (+). In multivariate analysis, the effects of urgent indication, ERCP history, cholangitis, precut sphincterotomy, common bile duct diameter, and pancreatic cannulation on post-ERCP pancreatitis were statistically significant risk factors ( P <0.05). DISCUSSION: This study demonstrates that emergency indication, ERCP history, cholangitis, precut sphincterotomy, and pancreatic cannulation are significant risk factors for the development of post- ERCP pancreatitis. One notable contribution of our study to the existing literature is the unique analysis of post-sphincterotomy bleeding as an independent factor.
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Colangite , Pancreatite , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Estudos Retrospectivos , Pancreatite/epidemiologia , Pancreatite/etiologia , Fatores de Risco , Esfinterotomia Endoscópica/efeitos adversos , Colangite/complicaçõesRESUMO
BACKGROUND: Congenital and traumatic diaphragmatic hernias (DH) can lead to respiratory and gastrointestinal complications that can be the cause of serious morbidity and mortality. In this study, we aimed to share our experience with the surgical repair of complicated or non-complicated DH. METHODS: Patients who were operated on under emergency or elective conditions with the diagnosis of DH between 2009 and 2023 were analyzed retrospectively. Demographic characteristics, histories, symptoms, etiology of DH, computed tomography find-ings, surgical techniques, and postoperative outcomes of the patients were recorded. RESULTS: The mean age of the cases was 51.5±18.5, and 29 were female and 41 were male. Hernia etiology was found to be con-genital (40%), traumatic (32.8%), spontaneous (14.3%), and iatrogenic (12.8%), respectively. The mean diameter of the defects was 7.3±2.76 cm (range: 3-15 cm), and 84% of the defects were on the left side. Sixty percent of the cases were treated by laparoscopic surgery and 11.4% by laparotomy. The conversion rate from laparoscopic to open was 24.3%. Dual mesh was used in 48% of the pa-tients, and primary suturing was applied in 34%. The postoperative mortality rate was 7.1%. CONCLUSION: DH is an important cause of morbidity and mortality due to abdominal organ strangulation and pulmonary and cardiac complications. When a DH is diagnosed, laparoscopic or open surgery is the treatment that should be preferred.
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Hérnia Diafragmática Traumática , Hérnia Diafragmática , Laparoscopia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Herniorrafia/efeitos adversos , Hérnia Diafragmática/cirurgia , Hérnia Diafragmática Traumática/cirurgia , Laparoscopia/efeitos adversos , Telas Cirúrgicas/efeitos adversosRESUMO
INTRODUCTION: Gastroesophageal reflux is a major problem after sleeve gastrectomy. There is still insufficient understanding of how it occurs and whether it is due to the sphincter length, relaxation, or pressure differences. AIM: This study evaluates the effect on the lower esophageal sphincter of the laparoscopic sleeve gastrectomy (LSG) technique applied in surgery in cases of morbid obesity using ambulatory 24-h pH monitoring (APM) and esophageal manometry (EM). MATERIAL AND METHODS: A retrospective examination was carried out on the APM and EM tests performed preoperatively and postoperatively in cases of LSG. The parameters examined were the body mass index (BMI), amplitude pressure of the esophagus (AP), total length of the lower esophageal segment (LESL), resting pressure of the LES (LESP), residual pressure of the LES (LESR), relaxation time of the LES, intragastric pressure, and the DeMeester score. RESULTS: A total of 62 cases with available data were evaluated. A statistically significant difference was determined between the preoperative values and the 3-month postoperative values of BMI, LESP, and relaxation time of the LES. A statistically significant increase was determined in the DeMeester score, and the increase in the total number of reflux episodes longer than 5 min was found to be the most responsible for this increase. No significant difference was determined in the other parameters. CONCLUSIONS: The LSG was found to cause a reduction in LESP, and an increase in acid reflux causing an extended relaxation time of the LES. This was confirmed by the increase seen in the DeMeester score.
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INTRODUCTION: This study aims to investigate the role of main bile duct drainage and gallbladder transpapillary drainage in the treatment of patients who diagnosed with acute cholecystitis and acute cholangitis because of choledocholithiasis. MATERIALS AND METHODS: Patients who were admitted to the hospital with the diagnosis of acute cholecystitis between January 2018 and December 2019, have hyperbilirubinemia in their laboratory tests, and who were diagnosed with choledochal stone by magnetic resonance imaging and magnetic resonance cholangiopancreatography imaging because of the findings of cholangitis were included in this study. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and choledochus stone extraction procedure and gallbladder drainage with the transpapillary pigtail. The demographic data, success rates, and complications of the patients were evaluated. RESULTS: A total of 19 patients were included in the study. Choledochus was cannulated in all patients, but gallbladder drainage could not be achieved in 2 patients. These 2 patients were recorded under the unsuccessful method use. Although 2 patients could not be operated because of high comorbidity (American Society of Anesthesiologists IV), they underwent percutaneous cholecystostomy because of the development of cholecystitis arising from an obstruction in the pigtail catheter in the 11th and 12th weeks. Treatments of the remaining 15 patients and subsequent cholecystectomy procedures were successful. The mean age of the patients was 54.52 years. Of the patients, 9 were female and 6 were male. In the 6th week of follow-up, 15 patients underwent laparoscopic cholecystectomy with ERCP 1 day after removal of the stent and pigtail catheter. CONCLUSIONS: Transpapillary cholecystectomy with ERCP is a successful method of treatment in patients with acute cholecystitis with the symptoms of cholangitis because of choledochal stone.
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Colangite , Colecistite Aguda , Colecistostomia , Colangite/etiologia , Colangite/cirurgia , Colecistectomia , Colecistite Aguda/complicações , Colecistite Aguda/cirurgia , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND AND OBJECTIVE: Colonic stenting in left-sided tumor is being commonly used. However, placing a stent in the flexure tumors is rare because it is technically more difficult. In this study, we aimed to retrospectively screen patients with flexure tumors admitted to our clinic who were treated using a colonic stent and discuss our findings. METHODS: Patients admitted to the emergency department for obstructive colonic tumors between 2012 and 2017 were retrospectively evaluated, and 21 patients treated using stents were included in the study. The expandable metal stent (Wallflex®, Boston Scientific, Marlborough, MA, USA) was placed at the obstruction through the lead wire. RESULTS: The mean age of the patients was 62 years, and the ratio of females to males was 3:18. Splenic flexure tumors were detected in 18 patients and hepatic flexure tumors in 3 patients. Seven of the patients were stented for palliative purposes. Fourteen of the cases underwent surgery. Three of them underwent laparoscopic surgery and eleven underwent open surgery. CONCLUSIONS: Preoperative stenting in colonic flexura tumors is associated with faster healing, less postoperative complications, lower rates of colostomy, and higher rates of minimally invasive surgery, and can be safely used at experienced centers.
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Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Obstrução Intestinal/cirurgia , Laparoscopia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND AND OBJECTIVES: Colorectal cancer is the third leading cause of cancer-related death. Excision of premalignant polyps has a significant impact on reducing colorectal cancer mortality and morbidity. Colonoscopy is considered to be the gold standard for the diagnosis and affords an opportunity for treatment of colonic polyps. In recent years, serious debates have taken place because of the biological characteristics of diminutive polyps (DPs), polypectomy complications, and serious costs. There has not yet been a consensus on the management of DPs. The objectives of this study were to demonstrate the real clinical importance of DPs smaller than 5 mm in diameter, which are frequently seen in geriatric patients by new endoscopic techniques, and to help in determining screening and surveillance programs. METHODS: The patients who underwent colonoscopy and were found to have a diminutive colorectal polyp (<5 mm from September 1, 2016 through September 1, 2017), were classified into 3 groups according to the imaging method used: flexible spectral imaging color enhancement (FICE), narrow band imaging (NBI), or I-SCAN. In all groups, demographic data were compared according to Paris classification (morphologic) and Kudo classification (correlation between the prediction of endoscopic diagnosis and final pathological examination) in terms of sensitivity, specificity, and negative and positive predictive values. RESULTS: Two hundred sixty-seven patients were included in the study: 97 in the NBI group, 83 in the FICE group, and 87 in the I-SCAN group. There were no statistically significant differences between NBI, FICE, and I-SCAN in differentiating neoplastic and nonneoplastic polyps, according to the Kruskal-Wallis test (P = .809). CONCLUSIONS: The estimated progression rates of DPs to advanced adenomas or colorectal cancer (CRC) are very low. Missing these polyps or not excising them may lead to failure to diagnose some cancers. There is a need for further comprehensive studies of removing all polyps to determine whether non-high-risk lesions require further pathologic examination and to re-examine routine surveillance programs.
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Neoplasias do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Fatores Etários , Idoso , Neoplasias do Colo/etiologia , Pólipos do Colo/complicações , Pólipos do Colo/patologia , Colonoscopia , Feminino , Humanos , Aumento da Imagem , Masculino , Imagem de Banda Estreita , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND OBJECTIVES: Endoscopic stenting is a minimally invasive treatment modality for patients with various gastrointestinal conditions. We evaluated the safety and efficacy of uncovered biodegradable stents for postoperative leaks and strictures in the upper gastrointestinal tract. METHODS: This was a retrospective study of patients treated endoscopically with biodegradable stents from January 2010 through November 2017. RESULTS: Thirteen patients were enrolled, 7 of whom were men. Their mean age was 46 (range, 21-82) years. The indications for stent placement were postoperative leakage and stricture in 9 and 4 patients, respectively. The primary diagnoses were obesity in 7 patients, gastric cancer in 5, and peptic ulcer in 1. The average time to stent placement after surgery was 35 (range, 17-125) and 166 (range, 153-185) days for patients with postoperative leakage and stricture, respectively. Stent insertion was successful at the first attempt in all patients. Complete resolution of the leak and stricture was achieved after stent application in 11 patients, for a clinical success rate of 85%. The mean follow-up duration was 50 (range, 24-76) months. There were no major complications. CONCLUSIONS: Compared to self-expanding metal and plastic stents, the main advantages of uncovered biodegradable stents are that they do not have to be removed and have a low migration rate. Our results suggest that these stents have promise for management of postoperative gastrointestinal complications. Further randomized trials with larger sample sizes are necessary to determine the role of biodegradable stents in the treatment algorithm.
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Implantes Absorvíveis , Endoscopia Gastrointestinal , Gastroenteropatias/terapia , Complicações Pós-Operatórias/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/terapia , Constrição Patológica/etiologia , Constrição Patológica/terapia , Feminino , Seguimentos , Gastroenteropatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Colon perforation during colonoscopy is a rare complication that usually requires surgical intervention. Traditionally, primary repair by laparoscopy, laparotomy, resection, and anastomosis is performed for such perforations. More recently developed minimally invasive endoscopic instruments have also been used in the repair of these perforations; this is becoming increasingly common. An endoscopic over-the-scope clip clamp was used in a 59-year-old male patient who suffered a rectum perforation in connection with a diagnostic colonoscopy. He was referred to our clinic. A colonoscopy was performed in our clinic to assess the rectal perforation caused by a diagnostic colonoscopy 2 h after the initial colonoscopy, with the concurrent therapeutic purpose of repairing the perforation using an endoscopic clamping method. Oral feeding was started 24 h after the procedure. After three days, the patient was discharged. An endoscopic clamping method in appropriate cases can be a safe and appropriate alternative therapy in the management of colonoscopic perforations.
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INTRODUCTION: Initial trocar entry, the first step in laparoscopic surgery, is associated with several complications. In morbidly obese patients, initial trocar placement is associated with a greater number of complications compared to non-obese patients. Materials and Surgical Technique. In this study, we describe our use of an initial trocar entry technique which is direct trocar insertion with elevation of the rectus sheath by a single Backhaus towel clamp and we would like to evaluate the sa fety and efficacy of its administration in bariatric surgery. DISCUSSION: Our results indicate that gaining initial trocar entry using our technique leads to successful laparoscopic bariatric surgery. Our technique is a safe, effective, and reliable first step in successful laparoscopic surgery for almost all patients, and is only contraindicated in patients with severe hepatomegaly.
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Parede Abdominal/cirurgia , Cirurgia Bariátrica/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Esophagogastroduodenoscopy (EGD) is particularly recommended for choosing a surgical method to be used with asymptomatic patients and for the assessment of symptomatic patients prior to sleeve gastrectomy. The presence of hiatal hernia, for instance, is a relative contraindication. EGD is used for malignancy scanning as well as surgical planning, but seems inefficient in determining postoperative complications. OBJECTIVE: Our aim was to investigate the effectiveness of the pathological evaluation of endoscopic biopsies obtained with esophagogastroduodenoscopy (EGD) according to Sydney classification prior to sleeve gastrectomy in identifying the risk of staple line leak, independently of clinical diagnosis. SETTING: Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery. METHODS: Patients who underwent laparoscopic sleeve gastrectomy between January 2014-December 2016 received preoperative EGD as per the clinic's protocol and upon obtaining ethics board approval and patient consent. Biopsies were taken from the patients according to the Sydney protocol. The pathology results were examined retrospectively by considering the exclusion criteria. The results were given in line with the Sydney classification, and patients with and without Staple Line Leak were statistically compared. RESULTS: A total of 630 patients were enrolled in the study. Of these, 71.1% (n = 448) were female and 28.9% (n = 182) were male. Mean age was 38.9 years (17-68), mean body weight was 130.8kg (94-240) and body mass index (BMI) values were 47.4kg/m2 (36-106). In evaluation of median values, no statistically significant relationship was found between staple line leak and H. pylori occurrence grade (P = 0.438; P>0.05), activation grade (P = 0.568; P>0.05) or intestinal metaplasia grade (P = 0.319; P>0.05). Atrophy (P = 0.001; P<0.01) and chronic inflammation grade (P = 0.026; P<0.05) were significantly higher in Staple Line Leak patients. CONCLUSIONS: EGD prior to sleeve gastrectomy and biopsies obtained in line with the Sydney protocol predict Staple Line Leak risk.
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Fístula Anastomótica/etiologia , Endoscopia do Sistema Digestório , Gastrectomia , Hérnia Hiatal/cirurgia , Laparoscopia , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Feminino , Hérnia Hiatal/etiologia , Hérnia Hiatal/patologia , Humanos , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Grampeamento Cirúrgico , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Colonoscopy is the gold standard for detection of polyps and is preventive against colorectal cancers. Flat adenomas are small, superficial lesions and have a high rate of going undetected during conventional white-light endoscopy. This article adds to the scant body of literature in English regarding in vivo detection and diagnosis of flat adenomas using Fujinon intelligent color enhancement (FICE) system. In this study, we investigated the diagnosis of flat lesions via the FICE endoscopy system and in vivo histologic diagnostic estimations of flat lesions. METHODS: This prospective study was conducted in patients who underwent colonoscopy that found flat adenomas. Lesions were classified morphologically with regard to the Paris Classification and sent for histopathologic examination after in vivo histologic diagnostic estimations were made according to Kudo's pit pattern classification. The positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy of in vivo endoscopic diagnostic estimations of flat lesions with the FICE system were analyzed. RESULTS: A total of 217 flat lesions were identified in 137 patients. Of the lesions, 85.7% were Paris type 0-IIa, and 59.4% were Kudo pit pattern type III. When the FICE diagnostic estimations of flat lesions and final pathology results were considered, PPV was 68.5%, NPV value was 89.6%, sensitivity was 94.7%, specificity was 50.9%, and accuracy was 74.2%. CONCLUSIONS: Biologic importance of flat lesions is obscure, as they are usually missed during colonoscopy. The use of novel endoscopic techniques may improve their detection and diagnosis rates.
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Adenoma/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: Currently, diagnostic laparoscopy (DL) is recommended for the left thoraco-abdominal region penetrating injuries (LTARP). However, organ and diaphragmatic injury may not be detected in all of these patients. Our aim is to focus on this LTARP patient group without any operative findings and to highlight the evaluation of diagnostic tools in the high-tech era for a possible selected conservative treatment. MATERIAL AND METHODS: The patients who were admitted to ED due to LTARP, and who underwent routine DL were evaluated retrospectively in terms of demographic, clinical, radiological, and operative findings of the patients. RESULTS: The current study included 79 patients with LTARP. In 44 of 79 patients, abdominal injury was not detected. In 30 patients an isolated diaphragmatic injury was revealed and in 4 patients a visceral injury was accompanying to diaphragmatic injury. Surgical findings revealed that the diaphragm was the organ most likely to sustain injury. In patients with more than one positive diagnostic findings need for surgery rate was 61.5%, however; in patients with one positive diagnostic finding (n = 53), positive surgical finding rate was only 35.8%, (p = 0.03). Regarding the combined use of all diagnostic tools in these patients; such as physical examination, plain chest X-ray, and computed tomography, when this method was used for pre-operative diagnosis, sensitivity was measured as 82.7%, specificity 84.1%, PPV 77.4% and NPV 88.1%. CONCLUSION: Although DL is reliable for diagnosis of diaphragmatic and visceral injury in patients with LTARP. However, individual decision making for laparoscopic intervention is needed to prevent morbidity of an unnecessary operation under emergent setting due to high rates of negative intraabdominal findings.
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BACKGROUND: Despite improved surgical techniques and materials, anastomotic leakage is a big problem for surgeons. The most frequently used laboratory parameters is leukocyte (white blood cell) and C-reactive protein (CRP). Availability of plasma calprotectin with CRP to detect anastomotic leakage was studied. METHODS: In this prospective study of 41 (male/female 18/23) patients in the anastomosis group, 30 (male/female 20/10) patients were included in the control group. The anastomosis groups viewed in preoperatively day and postoperatively 1st, 3rd, and 5th day of CRP, white blood cell, and plasma calprotectin values. RESULTS: Anastomosis group with complications and without complications were studied. Statistically significant similarities between plasma calprotectin and CRP levels in the postoperative period were observed. CONCLUSION: Plasma calprotectin in monitoring the integrity of the anastomosis can be used with a marker CRP.
Assuntos
Fístula Anastomótica/sangue , Proteína C-Reativa/análise , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complexo Antígeno L1 Leucocitário/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Estudos Prospectivos , Valores de Referência , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The aim of this study was to identify the diagnostic role of plasma calprotectin value for a distinction of presence acute appendicitis and the indifference of uncomplicated from complicated acute appendicitis. METHODS: Plasma calprotectin, white blood cell and C-reactive protein values of 89 patients, who have undergone laparoscopic appendectomy between January 2013 and May 2013 were evaluated. RESULTS: Calprotectin was 91 ng/mL (range 45-538) for acute appendicitis and 47 ng/ml (range 28-205) for the control group. There was a positive, statistically significant relation between calprotectin and C-reactive protein values (r = 0. 292 p = 0. 001, respectively). There was no statistically significant difference was determined between calprotectin and white blood cell values (r = 0. 142 p = 0. 187, respectively). CRP and Cal values were significantly higher in patients with a complicated AA group than in those with uncomplicated AA (p = 0. 014, p = 0. 0001, respectively) whereas white blood cell counts did not differ significantly between two groups (p = 0. 164). CONCLUSION: Plasma calprotectin levels were increased in patients with acute appendicitis and should use in a distinction of uncomplicated from complicated acute appendicitis patients.