Search

The world has been struggling with the COVID-19 virus since December 2019. Turkey has also been battling with the virus since March 2019. While struggling with this unknown virus, we have postponed our new bariatric surgeries like most elective surgery. However, curfew and quarantine period (increase in food intake and decreased physical activity) increases risks for morbidity and mortality because of obesity and diabetes. When the pandemic decreases and disappears, many obesity patients will seek treatment for obesity and the workload of surgeons will increase. Before bariatric and metabolic surgery operations, which is the most effective treatment of obesity and related comorbidities, necessary precautions must be determined and implemented to protect patients and healthcare workers before and during surgery. In this review, it was aimed to determine the pre-peri and postoperative periods of bariatric surgical requirements. This review has been written on behalf of the Turkish Society for Metabolic and Bariatric Surgery as an initiative in order to answer some questions about bariatric and metabolic surgery during the COVID-19 pandemic.

Introduction: In this study, we aimed to compare the surgical outcomes between elderly and young patients undergoing surgery for gallstone disease and determine variations in patient characteristics, if any.

Aim: The aim of this study was to compare the results of patients who underwent primary excision of the pilonidal sinus with open excision (GE), wide excision primary closure (PC) and flap application (F). Materials and Methods: The data of 249 patients were evaluated retrospectively. Twelve of these patients were excluded because of recurrent disease. 101 patients had GE, 68 had PK and 68 had F. Demographic characteristics, duration of symptoms, characteristics of gluteal cleft, perioperative complications, duration of surgery and hospital stay, drain use and dressing status, pathological volume, distance to anus, and recurrence of the disease were recorded. Results: Mean operative time was 32.62 ± 9.65 in the GE group; 53.23 ± 15.40 in the PK group; In the F group, it was 76.69 ± 17.00 minutes (p

Amac: Bu calismada, morbid obezite tanili hastalarda tedavi amaciyla uygulanan LSG’nin kilo kaybi ve yandas hastaliklarin tedavisinin yani sira metabolik ve hormonal mekanizmalar uzerindeki etkinliginin, operasyon oncesi ve operasyon sonrasi donemdeki hormon duzeyleri karsilastirilarak irdelenmesi amaclandi. Gerec ve Yontemler: Mayis 2013-Mayis 2014 tarihleri arasinda, LSG uygulanan 38 hasta calismaya dahil edildi. Prospektif olan bu calismada hastalarin demografik verileri, yandas hastaliklari, takipte kilo kaybi, morbidite ve mortalite oranlari, operasyon oncesi ve sonrasi insulin duzeyleri ile operasyon oncesi ve operasyon sonrasi sekizinci haftadaki leptin ve grelin hormonlarinin duzeyleri irdelenerek karsilastirildi. Bulgular: Calismaya dahil edilen 38 hastadan 32’si (%84.2) kadin, altisi (%15.8) ise erkekti. Operasyon oncesi alinan kandaki leptin duzeylerinin ortalamasi 11.16 ng/mL iken, operasyon sonrasi sekizinci haftadaki hormon seviyesi 4.39 ng/mL olarak belirlendi. Grelin duzeylerine bakildiginda ise; operasyon oncesi ortalama 25.72 pg/mL iken, operasyon sonrasi sekizinci haftadaki hormon seviyesi 14.16 pg/mL olarak belirlendi. Operasyon oncesi ortalama vucut kitle indeksi (VKI) 44.3, operasyon sonrasi sekizinci haftada ise 36.6 olarak belirlendi. Hicbir hastada mortalite gerceklesmedi. Sonuc: LSG, gunumuzde mukemmel kilo kaybi saglamasi ve kabul edilebilir oranlarda dusuk komplikasyon riskleri nedeniyle morbid obezite tedavisinde tek basina uygulanan bir cerrahi teknik haline gelmistir. Calismamizin sonuclarina baktigimiz zaman; bu ameliyat tekniginin sadece restriktif degil, ayni zamanda metabolik degisikliklere neden olarak da kilo kaybindaki devamliligi sagladigi kanaatindeyiz.

Fournier gangrene is described as necrotizing fasciitis involving the genital, perineal, and perianal area. Early surgical debridement of necrotic tissues, topical therapy, and antibiotics are fundamental in the treatment of Fournier gangrene. We aimed to compare the effects of Dakin solution and povidone iodine solution on patient outcomes by using the Fournier gangrene severity index (FGSI). The demographic data, comorbid diseases, local therapeutic interventions, FGSI, necessity of diverting colostomy or orchiectomy, hospitalization time, number of debridements, complications, and outcomes of 57 patients with Fournier gangrene were retrospectively analyzed. A total of 47 of 57 patients (82.5%) were male, and 10 patients (17.5%) were female, with a mean age of 62.3 ± 13.8 years (range, 27–85 years). The survivors were significantly younger than the nonsurvivors. The mean FGSI score was 4 (range, 1–9) in survivors, and mean FGSI score was 9 (range, 6–10) in nonsurvivors. FGSI score was significantly higher in the mortality group. The median hospital stay was 13 days (range, 3–34 days) in the Dakin solution group and 20 days (range, 1–41 days) in the povidone iodine group. Overall mortality rate was 17.5%. Advanced age had a statistically significant effect on mortality. The hospitalization time was significantly shorter in the Dakin solution group, and use of Dakin solution decreased the number of debridements. Dakin solution has favorable effects on hospital stay and the necessity of multiple debridements. Dakin solution seems to be a good and cost-effective choice for treatment in local wound healing.

Although it is well known that obesity increases the risk of atherosclerosis in carotid arteries, it is not clear whether this risk changes after obesity surgery. The aim of this study was to investigate whether weight reduction with a laparoscopic sleeve gastrectomy (LSG) has any effect on distensibility and elasticity which show subclinical atherosclerosis in the carotid arteries of obese individuals. This prospective study included 130 patients (body mass index (BMI) 48.21 ± 6.97 kg/m2) who underwent LSG. The patients were followed up for 1 year. Comparisons were made of the distensibiliy and elasticity values calculated preoperatively and at 1, 3, 6, and 12 months, postoperatively. There was a statistically significant increase in distensibility and elasticity values from baseline to 1, 3, 6, and 12 months postoperatively (p

Background: The aim of our study was to determine the optimization of the change in epicardial fat thickness in obese patients who underwent bariatric surgery with Central Composite (CCD) and Box-Behnken Experimental design (BBD). Methods: Response Surface Methods are used to see the sensitivity of the assessment criterion to changes in design variables, and even to obtain the necessary correlations experimentally. Response surface methods are evaluated in two different ways as CCD and BBD design. In this study, 33 experimental designs were designed. The study data consisted of 40 obese patients who lost weight by bariatric surgery between February 2015 and December 2016. Body Mass Index (BMI), Age and HOMA values were evaluated in 3 categories and 3 levels, and response variable was the change in Epicardial Fat Thickness (ΔEFT). Results: As a result of CCD analysis, Age = 30.52, BMI = 45.30, HOMA = 34.62, the optimum ΔEFT = 2.571. As a result of BBD analysis, Age = 38.36, BMI = 63.18, HOMA = 14.95, the optimum ΔEFT = 3.756. Optimum ΔEFT is modeled with Contour and Response surface graphics. Conclusion: According to the results of the analysis, it was found that BBD analysis for optimum ΔEFT was more positive than CCD and optimum age, BMI and HOMA combinations were determined to reach maximum ΔEFT.

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is now being performed in increasing frequency and getting more and more attention. TOETVA is carried out through three incisions in the oral vestibular area. Thyroidectomy is performed endoscopically using conventional laparoscopic instruments, an energy based device and neuromonitoring instruments. Intraoperative neuromonitoring is one of the tools of utmost importance, used for navigation and confirmation of the functional integrity of the recurrent nerve during TOETVA. The aim of this study is to give information about the standards and technique of intraoperative neuromonitoring of the recurrent laryngeal nerves during TOETVA procedures. TOETVA is a safe technique with no visible scarring and hence resulting in an excellent cosmetic effect. We believe that neuromonitoring of the recurrent laryngeal nerves also minimizes the risk of nerve damage and is an essential safety component in this technique.

Apendiks intussepsiyonu nadir gorulse de cerrahlarin ister ameliyat oncesi ister ameliyat sirasinda karsilastiklarinda cerrahi islem basamaklarini degistirebilecek bir durumdur. Bu nedenle akut apandisit tanisi alan her hastada karslasilabileceginin bilincinde olunmasi ayni zamanda tekrarlayan bulanti kusma ve kronik karin agrili hastalarda intussepsiyonun da akla getirilmesi onemlidir.

Aim: The aim of this study was to determine whether minimally invasive parathyroid surgery has any positive impact on cosmesis.Materials and Methods: This case control study included 28 parathyroidectomized patients, who had been operated between January 2006 – December 2008. All patients were called back for at least 8 months after surgery. Demographics were recorded. Minimally invasive parathyroidectomy versus conventional parathyroidectomy were compared by means of skin features (using Fitzpatrick’s classification), results of patient and independent observer scar assessment scales and photographic scar analysis by the blinded plastic surgeon.Results: There were no differences in demographics and Fitzpatrick’s classification between both groups. As expected, incision length of the minimal invasive group was significantly shorter (2.6 ± 0.5cm vs. 4.9±1.0 cm, p=0.02). Meanwhile, no significant difference in objective outcomes of patients between groups was recorded. There was also no significant difference in photographic scar analysis between groups, while independent observer scar assessment scale scores were better in the minimal invasive group (p=0.03). Conclusion: Although superior results of an independent observer, assessment of cosmesis by the plastic surgeon and the patient him/herself revealed no superiority of the minimally invasive approach, when compared to conventional parathyroid surgery.

Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis.Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (β = 153, p = 0.001).Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.

Background The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery. Method In this study, 33 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board (Approval number: KA16/281). The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT). Results As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots. Conclusion Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention.

Purpose. The purpose of this study was to assess how frequently thyroid cancer is located only in the non-dominant nodules. Methods. A total of 111 thyroid patients, whose primary operation were carried out at our institute and were confirmed to have thyroid cancer, were evaluated. Tumor characteristics were recorded in a retrospective database. Variables analyzed included patients’ age and sex, nodule and tumor size, ultrasound features of nodules, fine needle aspiration biopsy result and the presence of multifocality of malignancy. Results. There were 91 females and 20 males. Mean age was 48±12 years (range 16-80 years). Mean dominant nodule size was 2.1±1.3 cm, while mean malignant tumor size was 1.4±1.4 cm (range 0.1-7 cm). Carcinomas were located in the dominant nodule in 61 (55%) cases, while it was present in the non-dominant nodules – without a neoplastic focus in the dominant nodule – in 50 (45%) cases. In 20 (18%) cases the carcinoma was found in both the dominant and the non-dominant nodule. Multifocality of the malignant tumor was present in 64/111 (58%) cases. Conclusions. Risk of malignancy in the non-dominant thyroid nodule should be kept in mind before carrying out a biopsy from the dominant nodule. Assessment of multinodular goiter should not be restricted to the dominant nodule.

OBJECTIVE Fine needle aspiration biopsy provides one of the most important data that determines the treatment algorithm of thyroid nodules. Nevertheless, the reliability of fine needle aspiration biopsy is controversial in large nodules. The aim of this study was to evaluate the adequacy of fine needle aspiration biopsy in thyroid nodules that are four cm or greater. MATERIAL AND METHODS We retrospectively examined 219 patients files who underwent thyroidectomy for thyroid nodules that were greater than four centimeter between May 2007 and December 2012. Seventy-four patients with hyperthyroidism, and 18 patients without preoperative fine needle aspiration cytology were excluded from the study. Histopathologic results after thyroidectomy were compared with preoperative cytology results, and sensitivity and specificity rates were calculated. RESULTS False-negativity, sensitivity and specificity rates of fine needle aspiration biopsy of thyroid nodules were found to be 9.7%, 55.5%, and 85%, respectively. Within any nodule of the 127 patients, 28 (22.0%) had thyroid cancer. However, when only nodules of at least 4 cm were evaluated, thyroid cancer was detected in 22 (17.3%) patients. CONCLUSION In this study, fine needle aspiration biopsy of large thyroid nodules was found to have a high false-negativity rate. The limitations of fine-needle aspiration biopsy should be taken into consideration in treatment planning of thyroid nodules larger than four centimeters.

Sentinel lymph node biopsy is the standard application for evaluating the axilla in patients with breast cancer. The Z0011 trial conducted by The American College of Surgeons Oncology Group (ACOSOG) revealed that axillary dissection may be redundant in selected patients with positive sentinel node. This raises questions regarding the application of this result to ultrasound-positive patients. This research therefore aimed to evaluate how accurate an ultrasound scan is for axillary node status in early–stage breast carcinoma. The study included 156 newly diagnosed clinical T1–T2, N0 breast cancer patients attending our breast clinic between January 2010 and February 2016. Sentinel lymph node biopsy and axillary lymph node clearance in the presence of sentinel lymph node metastasis was performed on all the breast cancer patients. Axillary ultrasound reports were reviewed retrospectively and the results compared with surgical pathology results. The sensitivity and specificity of axillary ultrasound for detecting axillary lymph node disease was 69.2% and 98%, respectively, with a negative predictive value of 86.4% and positive predictive value of 94.7%. Given the high sensitivity and specificity, and high positive predictive value and negative predictive value demonstrated in the present study, axillary ultrasound represents a potential alternative to sentinel lymph node biopsy for staging of the axilla in early breast cancer. Subsequent trials (SOUND) comparing axillary ultrasound alone with sentinel lymph node biopsy in early breast cancer patients will provide additional information about the subject.

We aimed to investigate whether simvastatin had any impact on the prevention of adhesion formation after thyroidectomy in a rat model.This study was performed in 66 Wistar albino rats randomized into three experimental groups. A right hemithyroidectomy was carried out in all the rats. Simvastatin was administered locally at a dose of 0.5 mg/kg and 0.8 mg/kg. Control rats received a saline solution only. Changes during the 1st week, 1st month and 3rd month were evaluated. Efficacy of the treatment was assessed by using a scoring system.The severity of adhesions in low-dose simvastatin group was significantly less than the control and high-dose groups during the 1st and 3rd month (p .05). In addition, adhesions were less in the high dose group during the 3rd month, when compared to the control group (p .05). Moreover, fibrosis and fibroblast scores, which represent adhesions, were significantly lower in low-dose and high-dose groups at 3rd month, compared to controls (p .05).We investigated the influence of simvastatin application on post-thyroidectomy adhesion formation in rats. Whether adhesions, causing technical difficulties during neck redo surgery, can be reduced by the use of simvastatin in human, needs to be studied.

BACKGROUND AND AIMS Minimally invasive surgery of the adrenal gland is widespread. Although reports demonstrate the safety and feasibility of robot-assisted adrenalectomy, the objective benefits are still unclear, compared to those of conventional laparoscopy. Recently, robot-assisted approach has also become possible for pheochromocytoma resection. Since cardiopulmonary changes during robot-assisted dissection of the pheochromocytoma patient has not been studied in detail, we aimed to assess these concerns, compared to the routine laparoscopic technique. METHODS In this case-control study, 19 consecutive robot-assisted adrenal resections were compared with a control group consisting of 14 conventional laparoscopic adrenalectomy. Patient characteristics and intraoperative hemodynamic and respiratory parameters were assessed. Groups were compared using the χ2 test for categorical variables and Student's t-test for continuous variables. Significance was considered p < 0.05. RESULTS The robot-assisted procedure was performed successfully in all patients, except one. The duration of the robot-assisted procedure, compared to the conventional laparoscopy group, was significantly longer (p < 0.05). Intraoperative blood loss was significantly less in the robot-assisted group (p < 0.05). Dissection of pheochromocytoma showed a significant difference between the groups, according to the incidence of intraoperative blood pressure fluctuations (p < 0.05). The robot-assisted approach resulted in less incidents. Other hemodynamic and respiratory parameters did not differ between groups significantly. There were no perioperative deaths. Complication rates and postoperative hospital stays were not significantly different. CONCLUSION Robot-assisted adrenalectomy is a safe and technically feasible procedure for a pheochromocytoma patient. Robot-assisted resection of pheochromocytoma minimized the occurrence of intraoperative blood pressure fluctuations and blood loss.

Background/aim We compared the effects of volume-controlled equal ratio ventilation (VC-ERV) and volume-controlled conventional ratio ventilation (VC-CRV) on oxygenation, ventilation, respiratory mechanics, and hemodynamic status during mechanical ventilation with recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic sleeve gastrectomy. Materials and methods A total of 111 patients scheduled for laparoscopic sleeve gastrectomy were randomized to ventilation with inspiratory to expiratory ratio of 1:1 (Group VC-ERV) or 1:2 (Group VC-CRV) following tracheal intubation. RM (40 cmH2O, 15 s) and PEEP (10 cmH2O) were administered to all patients. Arterial blood gas samples were taken and peak airway pressure (Ppeak), mean airway pressure (Pmean), dynamic compliance (Cdyn), mean arterial pressure, heart rate, SpO2, and EtCO2 were recorded at 4 time points. Postoperative respiratory complications were recorded. Results Oxygenation, ventilation, Pmean levels, and hemodynamic variables were similar in both groups. VC-ERV significantly decreased Ppeak and increased Cdyn compared to VC-CRV at all time points of the operation (P < 0.05). No pulmonary complication was observed in any patients. Conclusion VC-ERV provides significantly lower Ppeak and higher Cdyn with similar oxygenation, ventilation, hemodynamic parameters, and Pmean levels when compared to VC-CRV during mechanical ventilation with RM and PEEP in laparoscopic sleeve gastrectomy.

Aim: Elevated red blood cell distribution width (RDW) and mean platelet volume (MPV) levels which are closely associated with chronic inflammation and platelet aggregation are suggested as independent predictors of obesity and cardiovascular diseases. However influence of significant weight loss following bariatric surgery on these parameters is unknown. Therefore we aimed to find out the effect of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on RDW and MPV levels. Methods: The medical data of 98 morbid obese subjects (25 male, 73 female) who were operated between February 2015 and June 2017 according to indications of bariatric surgery in current guidelines including body mass index (BMI) >40 kg/m 2 or BMI= 35-40 kg/ m 2 with additional comorbidities were recorded. The difference between baseline and values at one year was expressed as a delta (Δ). Results: The mean age of our study population was 41.89±11.99 years and mean weight loss in one year after LSG was 45.41±13.13 kg (36.5%). BMI decreased from 46.60±7.11 kg/m 2 to 29.58±4.63 kg/m 2 . Compared to the baseline, significant decreases in RDW (14.61±1.69 % vs. 13.71±2.10 %; p

Objective: In the present study, we aimed to retrospectively evaluate the preoperative characteristics, intraoperative and postoperative results of patients who underwent laparoscopic obesity surgeries. Methods: After obtaining the approval of the Ethics Committee, records of patients who underwent laparoscopic obesity surgery from January 2013 to December 2016 were reviewed. Demographic characteristics, medications used in anaesthesia and analgesia, the duration of recovery unit/hospital stay, intensive care unit/mechanical ventilation requirements and complications were recorded. Results: A total of 329 ASA II-III patients over a 3-year period were operated. Thiopental and propofol were administered at induction, sevoflurane, isoflurane and desflurane were administered for the maintenance, and vecuronium and rocuronium were administered to aid in neuromuscular blockage. The mean durations of recovery unit and hospital stays were 30.80 +/- 6.01 minutes and 4.27 +/- 1.68 days, respectively. The hypnotic agent, muscle relaxant or inhalation anaesthetics used did not have a significant effect on the duration of recovery unit and hospital stay. Mask ventilation and intubation were noted to be difficult in 5.5% and 8.5% of the cases, respectively. The presence of obstructive sleep apnoea syndrome and high body mass index and Mallampati scores significantly increased difficult mask ventilation and difficult intubation rates. Four patients were transferred to intensive care unit for close monitoring. Two patients were re-operated on, two patients had rhabdomyolysis, one patient had Wernicke's encephalopathy and two patients had peripheral neuropathy. Perioperative mortality did not occur in any patient. Conclusion: We believe that appropriate patient selection, the use of well-designed anaesthesia and surgical protocols play important roles in increasing the success rate of patient outcomes and early and late complications in laparoscopic obesity surgery.

Background: This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity on serum lipid levels of dyslipidemic and normolipidemic patients.Methods: 141 patients who underwent LSG between September 2014 and January 2016 were included in the study.Results: The patients’ mean body mass index was 46.27 ± 6.79 kg/m2 preoperatively, 31.60 ± 5.37 kg/m2 in the 6th month postoperatively and 27.80 ± 4.25 kg/m2 in the 12th month (p

In this presentation, medical literature regarding this topic was reviewed along with the evaluation of treatment methods used in two specific cases during which leakages occurred along the staple line after laparoscopic sleeve gastrectomy (LSG). One of the two patients who developed a leakage after LSG was a 26-year-old female (case 1) and the other was a 20-year-old female (case 2). Case 1 was explored, when a leakage was diagnosed through clinical and screening procedures on day 3 after the surgery. After determining the leakage, the defect was primarily sutured and a feeding jejunostomy was placed. Case 1 developed leakage again on the fourth day after the second surgery, an esophagogastric stent was performed three times whose drainage was cut off from the leakage line, and the patient was discharged with full recovery. However, case 2 then developed leakage on the 14th day after surgery. Next an esophagogastric stent was placed in the patient, and a computer tomography (CT)-guided percutaneous drainage was placed to drain the collections inside the abdomen. Four weeks after this procedure, the stent was removed and after specifying that the leakage had closed, the patient was discharged with full recovery. The treatment methods of gastric leakages after LSG are also variable, and the treatment method is designated depending on the dimension of the leakage, the extent of the abdominal contamination, and the location of the leakage. J Curr Surg. 2015;5(2-3):175-178 doi: http://dx.doi.org/10.14740/jcs269w

The association of obesity with atrial fibrillation (AF) and with ventricular arrhythmias is well documented. The aim of this study was to investigate whether weight reduction by a laparoscopic sleeve gastrectomy has any effect on P wave dispersion (PWD), a predictor of AF, and corrected QT interval dispersion (CQTD), a marker of ventricular arrhythmias, in obese individuals. In a prospective study, a total of 114 patients (79 females, 35 males) who underwent laparoscopic sleeve gastrectomy were examined. The patients were followed 1 year. PWD and CQTD values before and 3rd, 6th, and 12th months after the surgery were calculated and compared. There was a statistically significant decline in body mass index (BMI), PWD, and CQTD values among baseline, 3rd, 6th, and 12th months (p

INTRODUCTION Metastatic tumors of the pancreas are uncommon and rarely detectable clinically. Metastases to the pancreas are rare. We present a patient with pancreatic metastases from a leiomyosarcoma of the uterus and review the literature about the clinical features of pancreatic metastasis and its surgical management. PRESENTATION OF CASE A 40-year-old woman, who underwent hysterectomy, left oophorectomy, omentectomy and lymp node dissection for leiomyosarcoma of the uterus. At the follow up, the patient complained of non-specific abdominal discomfort. Preoperative diagnosis were pancreatic pseudocyst, cystadenoma or cystadenocarcinoma. At laparotomy, a cystic mass was found in the tail of the pancreas which was invased to the transverse colon mesenterium and the spleen. Distal pancreatectomy with splenectomy and transverse colon resection was performed. Histologically, the tumor was evaluated as poorly differentiated leiomyosarcoma. DISCUSSION Metastatic lesions of the pancreas are uncommon and less than 2% of all pancreatic malignancies. However a few cases of leiomyosarcoma with metastases to the pancreas have been reported in the literature. Before deciding that the lesion in the pancreas was metastasis, primary leiomyosarcoma of the pancreas had to be ruled out. Histologically, leiomyosarcoma of the pancreas contains interlacing spindle cells with varying degrees of atypia and pleomorphism. The surgical approach to the pancreatic metastases must be aimed complete excision of the tumor with a wide negative margin of clear tissue and maximum preservation of pancreatic remnant if possible. CONCLUSION In the absence of widespread metastatic disease, aggressive surgical approach with negative margins must be aimed.

Aim: Obesity is a disease that reduces the quality and duration of life and its prevalence is also increasing in the elderly population.In this study, we aimed to investigate the results of early and midterm weight loss and treatment of concomitant diseases and evaluate the safety and efficacy of bariatric surgery in patients aged 60 years and older who underwent Laparoscopic Sleeve Gastrectomy (LSG) in our clinic. Material and Methods: We retrospectively evaluated 28 morbid obese patients ≥60 years oldwho underwent LSG between September 2014 and January 2018.Data reviewed included age, sex, preoperative weight and body mass index (BMI), comorbid conditions, early or delayed complications, mortality, length of follow-up, weight lost, BMI points lost, and effects on obesity-related comorbid conditions. Results: Of 28 patients included in the study there were 22 (78.6%) females and 6 (21.4%) males. The average age of patients was 63.4±3.39.Preoperative mean BMI was 48.4±7.0kg/m2.Average follow-up period 20.67 month. Postoperative median BMI was,36.24kg/m2 in the 6th month, 33.47kg/m2 in the 1st year and 31.17kg/m2 in the 2nd year.Present comorbid conditions included 23 (82.1%) hypertension, 16 (57.1%) diabetes mellitus and 3 (10.7%) obstructive sleep apnea. All of patients reported resolution or improvement in comorbid conditions.No mortality was observed in patients. Conclusion: Outcomes and complication rates of bariatric surgery in patients aged 60 years and older are low and acceptable. The results of our study support bariatric surgery in elderly patients. However, detailed information should be provided about the slightly increased risks and the possibility of less satisfactory outcome.

Objective: This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel’s diverticulum at our clinics. Material and Methods: This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel’s diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012. Results: Fourteen patients with a diagnosis of Meckel’s diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel’s diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel’s diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). Conclusion: Meckel’s diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel’s diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel’s diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel’s diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.

Peutz-Jeghers syndrome (PJS) is an autosomally dominant inherited disease which is responsible for mucocutaneous pigmentation and gastrointestinal polyps. Round, oval or irregular patches of brown pigmentation 1-5 mm in diameter, distributed over the oral mucosa, gums, hard palate and lips are observed. Most of the polyps reside in the jejunum, it may also ocur in ileum, stomach, duodenum and/or colon. There is a higher risk of intestinal and extraintestinal cancers in those patients. Herein we present a 44-year-old male patient having intermittent episodes of bloating and abdominal pain without a particular localization, as well as mild iron deficiency anemia for ten years. Physical examination revealed pigmented lesions on oral mucosa and fingertips, palpable mass on abdominal left upper quadrant, and colonoscopy showed multiple hamartomatous polyps. At the operation performed for the mesenteric mass, it was detected that 2 of 8 small intestinal polyps have intramucosal carsinoma and the mesenteric mass was reported as signet ring cell carsinoma. Patients with PJS should be regularly and closely monitored, because of the increased risk of cancer., Peutz-Jeghers sendromu (PJS), otozomal dominant geçiş gösteren, mukokutanöz pigmentasyon ve gastrointestinal poliplerin görüldüğü bir hastalıktır. Yuvarlak, oval, düzgün olmayan, 1-5 mm çapındaki kahverengi pigmentasyonlar oral mukoza, diş eti, damak ve dudaklarda yerleşim gösterir. Polipler genellikle jejunumda olmakla birlikte, ileum, mide, duodenum ve/veya kolonda yerleşim gösterebilir. İntestinal ve ekstraintestinal kanser gelişme riski artmıştır. Olgu sunumumuz 44 yaşında, 10 sene önce başlayan lokalize olmayan yaygın karın ağrısı ve demir eksikliği anemisi nedeni ile tetkik edilmeye başlayan erkek hastamız ile ilgilidir. Fizik muayenesinde parmak uçları ve oral mukozadaki pigmente lezyonların yanı sıra batın sol üst kadranda kitle palpe edildi ve kolonoskopide multiple sayıda hamartomatoz polip olduğu görüldü. Mezenterik kitle nedeni ile opere edilen hastada, 8 adet ince barsak polibinin ikisinde tübülovillöz adenom zemininde intramukozal karsinom tespit edilirken, mezenterik kitlenin taşlı yüzük hücreli karsinom olduğu rapor edildi. PJS olan hastalar, gelişebilecek malignite ihtimaline karşı yakın takip edilmelidir.

Aim. Histology and cytology consultations of thyroid fine needle aspiration biopsy (FNAB) of thyroidectomy specimens can change management of the patient. We aimed to determine compliance rates of pathology results between urban centers and a tertiary institution and its impact on patient management. Methods. This retrospective study includes 101 patients, who were referred to

Crohn’s disease (CD) is an inflammatory bowel disease with the characteristics of idiopathic, granulomatous inflammation which affects any area along the gastrointestinal system from the anus to the oral cavity. We present here an unusual case of a 25-year-old male patient, who consulted us because of abdominal pain for 2 days. The computer tomography showed free fluid at the pelvis, acute appendicitis findings and mural thickening of the terminal ileum, secondary to the appendicitis, were reported, and during the examination together with the acute abdomen findings it was decided to perform surgery on the patient. During surgery free fluid extensive inside the abdomen, at the terminal ileum indigenous for the inflammatory appearance of CD and a perforation of approximately 0.5 cm at the front face of the gastric pylorus, were seen. After the perforation at the stomach was primarily sutured and the inner abdomen was irrigated with physiological saline solution, so the surgery was brought to an end. After postsurgical antibiotherapy and hydration support, the patient was discharged and improved on the seventh day after surgery. Although CD is a chronic inflammatory disease of the gastrointestinal system, it is able to imitate the inner abdominal pathologies during an acute attack (acute appendicitis, hollow organ perforation, etc.). On patients with acute abdomen findings, where the CD diagnosis is not known, a laparotomy must be performed when a differential diagnosis of the inner abdominal pathologies cannot be made radiologically. As it is in this case, even if ileitis due to CD is determined during laparatomy, all inner abdominal organs must be explored carefully, and it should be kept in mind that the other organ pathologies can occur together. In this case the aim was to analyze the association of gastric perforation and acute CD at the terminal ileum of a patient with acute abdomen, where the diagnosis of CD is not known. J Curr Surg. 2014;4(4):124-126 doi: http://dx.doi.org/10.14740/jcs239w

Low grade fibromyxoid sarcoma (LGFS) is a rare tumor that has a tendency to develop in deep soft tissues. Despite its histologically benign appearance it may have an aggressive clinical course with local recurrences and metastasis. It was first described by Evans in 1987. It is more often seen in young adults and especially in male patients. The tumor has a tendency to develop in deep soft tissues and less frequently in the subcutaneous tissues; the most common locations are gluteal region, chest wall, shoulder and lower extremities but rarely it may also occur in the head, cheek, jaw and the retroperitoneal area. In this case report we aimed to determine the diagnosis pathways and treatment modalities of LGFS, with regard to the literature., Düşük dereceli fibromiksoid sarkom (DDFS) derin yumuşak dokularda gelişmeye eğilimli, histolojik olarak benign görünümüne rağmen lokal nüks ve metastaz ile agresif klinik gidiş gösterebilen nadir bir tümördür. İlk kez 1987' de Evans tarafından tanımlanmıştır. Özellikle genç erişkinlerde ve erkeklerde daha sık görülmektedir. Tümör, derin yumuşak dokularda ve daha az sıklıkla da subkutan dokularda yerleşmeye eğilimli olup en sık görülen yerler gluteal bölge, göğüs duvarı, omuz ve alt ekstremiteler olmakla birlikte nadiren baş ve retroperitoneal bölgede de ortaya çıkabilir. Bu olgu sunumunda DDFS'un tanı ve tedavisinin literatür eşliğinde irdelenmesi amaçlandı.

The most common synchronous cancer in gastric cancer patients is colorec-tal cancer, and vice versa. If there are suspicious complaints in the anamne-sis, the patients should be investigated carefully preoperatively. In this case report, we aimed to present the diagnostic and therapeutic methods in a pa-tient with synchronous colon and gastric cancer., Mide kanserli hastalarda en yaygın görülen senkron kanser kolorektal kanser ve kolorektal kanserli hastalarda da en sık görülen senkron kanser mide kanseridir. Anamnezde flüphe edilecek flikayetlerin varlığında preoperatif hastalar ayrıntılı tetkik edilmelidir. Bu sunumumuzda senkron mide ve kolon kanserli bir hastada tanı ve tedavi yöntemini irdelemeyi amaçladık

Highlights • Retroperitoneal paragangliomas are mostly benign with good prognosis. • Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas. • Reactive thrombocytosis is a common cause of thrombocytosis after splenectomy., Introduction Paragangliomas are tumors that arise from extraadrenal chromaffin cells and most of them are asymptomatic presenting with painless mass. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Surgical resection is still the main treatment and necessary for histological assessment. Case report A 41 year old female patient presented with 6 months of loss of appetite, weight loss, weakness and breathlessness on exertion.. The patient’s initial blood examination showed marked anemia, reduced leukocyte count with neutropenia and lymphopenia and a marked reduction in the platelet count. The patient was admitted for evaluation of her pancytopenia. Magnetic resonance imaging revealed a 8 × 7 × 8 cm sized mass closed to the pancreatic tail invading splenic hilum. A large mass was identified retroperitoneally, closed to the tail of pancreas with a splenic hilum invasion. Total mass resection and splenectomy was performed. Discussion Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas as well as for recurrent or metastatic neoplasms. Reactive thrombocytosis is a common cause of thrombocytosis. Splenectomy was found to be one of the main causes of extreme reactive thrombocytosis. Reactive thrombocytosis is a predictable finding after splenectomy and management of the thrombocytosis and prevention of complications should be initiated.

With the wide acceptance of Fisher’s theory that breast cancer is a systemic disease from the start and in the light of improvements in adjuvant treatment, the role of surgery in the treatment of cancer was expected to gradually decrease (1). However today’s surgical treatment of breast cancer has developed into oncoplastic and reconstructive surgery (Oncoplastic Breast Surgery (OBS) + Reconstructive Breast Surgery (RBS) = ORBS). Besides establishing ideal regional oncological control, surgeons are often faced with the difficulties of conserving breast aesthetics or achieving optimal results. In a meta-analysis, Losken et al. reported that the rate of surgical margin involvement was 12.3% and 20.6% for patients who underwent OBS and Breast Conserving Surgery (BCS), respectively. In addition, they reported local recurrence rates of 3.6–4.7% and 7% for OBS and BCS, respectively (2). In another study comparing oncological outcomes for BCS and OBS, they reported tumour sizes of 17 mm and 24 mm, surgical margins of 6 mm and 14 mm, and rates of re-excision of 29% and 5.4%, respectively. They suggested that OBS has a positive effect on oncological perspective in breast cancer surgery (3). The Turkish Federation of Breast Disease Societies (TFBDS) made recommendations regarding ORBS at their first Breast Cancer Consensus Meeting in 2006 (4). In Turkey, there is no official Breast Surgery sub-specialization available to general surgeons. However, in certain teaching and research hospitals and university hospitals a small number of general surgeons do concentrate on breast surgery. Despite current publications and national guidelines, there is disparity in surgical approaches to ORBS. This is either due to limited resources in the workplace or the knowledge and experience of the individual surgeon. Our study aims to investigate the experiences, applications and approaches to OBS and RBS taken by general surgeons who focus on breast surgery in Turkey. From our exploration of the available literature (Pubmed; Cohrane Database) we believe this to be a unique study, as it is the first survey of ORBS worldwide and in Turkey to involve such a large cohort of surgeons of this nature.

Miyeloid sarkom ekstramedüller immatür miyeloid hücrelerden kaynaklanan, nadir görülen agresif seyirli bir tümördür. Akut miyeloid lösemili hastaların relapsı olarak karşımıza çıkabilir. Bazen lösemi tanısı olmaksızın solid bir tümör olarak da görülebilmektedir. Mekanik barsak tıkanıklığı semptomları ile başvuran 44 yaşında erkek hasta opere edildi. Operasyonda ince barsak tıkanıklığına neden olan bir tümör saptandı. Tümör rezeke edilerek uç uca anastomoz uygulandı. Patoloji sonucu miyeloid sarkom olarak rapor edildi. Postoperatif dönem sorunsuz seyretti ve hastaya adjuvan tedavi uygulandı. Bu olgu sunumunda ince barsak miyeloid sarkomunun klinik bulguları ve tedavisinin irdelenmesi amaçlandı, Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma.

Introduction. Hydatid disease (HD) is an infestation that is caused by the larval stage ofEchinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst.Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT) revealed a17×11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid.Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR) technique is another nonsurgical option.

Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma.

Objective: In this study, we aimed to determine the significance of the staging systems (EORTC, De Groot, MACIS, and TNM) on the prognosis of well-differentiated thyroid cancer patients who underwent surgery in our clinics. Material and Methods: This retrospective study included 181 patients who were operated between December 1995-December 2007, with a diagnosis of thyroid cancer. In order to obtain data related to cancer staging, a computer program for PDA was developed to facilitate parameter recording. Survival analysis was performed. The findings were compared to the predicted rates by the staging systems. Results: According to the De Groot staging system, stage 1 and stage 2 patients’ results were compatible, but stage 3 and 4 patients’ results were different (stage 3; 87% versus 66.6%, stage 4; 35% versus 100%, p=0.04). In the MACIS staging system, 20-year survival rates are determined and comparison should not be made due to insufficient follow-up period in this study. When compared to the EORTC staging system, stage 3 and stage 4 patients’ results were determined different (stage 3; 51% versus 100%, stage 4; 33% versus 50%, p=0.02). The most consistent results in terms of prognosis was determined in comparison with the TNM staging system (stage 1; 100% versus 97.8%, stage 4; 45.3% versus 50%). Conclusion: Many classification systems are proposed for well-differentiated thyroid cancer, to predict the behavior of the tumor. In this study, we concluded that for determination of prognosis in well-differentiated thyroid cancer, the TNM staging system could best predict prognosis consistent with clinical findings.

Objective: Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma. Material and Methods: Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. Results: Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. Conclusion: Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.