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Midgut malrotation is a congenital anomaly of intestinal rotation and fixation that is generally seen in neonatal population. Adult cases are rarely reported. Early diagnosis is crucial to avoid life threatening complications. Here, we present an adulthood case of midgut volvulus as a rare cause of acute abdomen. more...

Amaç: Perianal fistül tedavisinde LIFT (ligation of intersphincteric fistula tract) görece yeni bir tedavi yöntemidir. İntersfinkterik alanda sfinkterlerin korunarak fistül traktının bağlanıp kesilmesi olarak tanımlanır. Bu çalışmanın amacı standart fistülotomi yöntemi ile LIFT tekniğinin cerrahi etkinlik ve anal inkontinans üzerine olan etkisinin karşılaştırılmasıdır.Hastalar ve Yöntem: Aralık 2012- Nisan 2014 arasında Bezmialem Vakıf Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı Kliniğinde intersfinkterik veya alçak transsfinkterik perianal fistül hastalığı nedeniyle operasyon planlanan 30 hasta (18 erkek, 12 kadın, erkek/kadın oranı: 3/2, yaş aralığı: 24-72, ortalama yaş: 42.7) iki eşit gruba ayrıldı. Çalışmaya 18 yaşın üstünde olan, cerrahi operasyona engel ek patolojisi ve nüks hastalığı olmayanlar dahil edildi. Eş zamanlı inflamatuar barsak hastalığı, malignite, garnülomatöz hastalık ve tüberküloz hastalığı olanlar çalışmaya alınmadı. Birinci gruba standart fistülotomi ,ikinci gruba LIFT uygulandı.Standart fistülotomi grubunda ortalama takip süresi 4-19 ay (ortalama 12.3 ay), LIFT grubunda ise 4-21 ay (ortalama 14.9 ay) idi. Fistül tipinin belirlenmesinde preoperatif anorektal endosonografi (EUS) ve/veya MR görüntülemeleri ile fizik muayene bulguları kullanıldı. Çalışmadaki hastaların 25'i intersfinkterik, 5'i alçak transsfinkterik fistül tipinde idi. Standart fistülotomi grubunda 13 intersfinkterik, 2 transsfinkterik fistül, LIFT grubunda ise 12 intersfinkterik ve 3 transsfinkterik tipte fistül vardı. Hastalara preoperatif dönemde ve postoperatif üçüncü aylarında anorektal manometri ve Wexner klinik skorlaması yapılarak anal inkontinans değerlendirildi. Yara iyileşme süreleri, yara yeri enfeksiyonu ve nüks oranları karşılaştırıldı.Sonuçlar: İntraoperatif komplikasyon gözlenmedi. Standart fistülotomi uygulanan grubta nüks izlenmedi. LIFT grubunda 2 hastada (%13.4) nüks gelişti. Standart fistülotomi grubunda 1, LIFT grubunda 2 hastada yara yeri enfeksiyonu gelişti. Standart fistülotomi grubunda bir hastada anal inkontinans gelişti. Standart fistülotomi uygulanan hastalarda preoperatif ortalama Wexner skoru 1.00 ±1.13, postoperative 3. ay sonrası yapılan ortalama Wexner skoru 1.87 ±1.77 olarak bulundu. LIFT yapılan hastaların preoperative ortalama Wexner skoru 0.53 ±0.74, postoperatif üçüncü ay sonrası yapılan ortalama Wexner skoru 0.60 ±0.63 olarak bulundu. İki grup arasında operasyon öncesi ve sonrası Wexner skorları arasında anlamlı fark bulunmadı (Preop. Wexner p değeri: 0.275, Postop. Wexner p değeri: 0.072). Yara yeri iyileşme süresi standart fistülotomi grubunda ortalama 27.4 ±2.77 gün, LIFT grubunda 14.87 ±1.13 gün olarak bulundu. LIFT grubunda yara iyileşme süresi istatistiksel olarak anlamlı olacak şekilde düşük saptandı (p 0.05). Tartışma: LIFT komplike olmayan perianal fistüllerde standart fistülotomi kadar başarılı olup benzer nüks oranına sahiptir. Preoperatif Wexner klinik skoru yüksek olan hastalara standart fistülotomi yöntemi uygulanması halinde Wexner skorunda artış olmaktadır. LIFT grubunda yara iyileşme süresi standart fistülotomiye göre yaklaşık %50 daha kısadır. Objective: Ligation of intersphincteric fistula tract is a relatively new method for treatment of perianal fistula. It is defined as ligation and cutting the fistula tract while protecting the sphincters in the intersphincteric field. The aim of this study is to compare the standard fistulotomy with the LIFT about the surgical activity and the effect on anal incontinence. Patients and methods: The records of 30 patients (18 male, 12 female, male/female: 3/2, age range: 24-72, mean age: 42.7), who are planned an operation for intersphincteric or low transsphincteric perianal fistula between December 2012 and April 2014 in Bezmialem Vakıf University General Surgery Clinic, devided into two equal groups. Patients older than 18 years of age with primary perianal fistula were included in the study. Patients with inflammatory bowel disease, gastrointestinal malignancy, granulomatous disease and tuberculosis were excluded. Standard fistulotomy is performed for the first group and LIFT is performed for the second group. The duration of follow-up is 4-19 months (mean 12,3 months) for the standard fistulotomy group and 4-21 months (mean 14,9 months) for the LIFT group. Preoperative anorectal endosonography (EUS) and/or MRI and physical examination are used for determine the type of fistula. 25 of the patients in this study was intersphincteric, 5 was low transsphincteric fistula. There was 13 intersphincteric, 2 transsphincteric fistula in standard fistulotomy group and 12 intersphincteric, 3 transsphincteric fistula in LIFT group. Anal incontinence is evaluated with anorectal manometry and Wexner clinic scoring system preoperative period and postoperative third month. Period of wound healing, enfection of wound and the rate of recurrence is compared.Results: There were no intraoperative complications. Although two recurrences (%13.4) developed in LIFT group, in standard fistulotomy group there was recurrence. Wound infection detected in one (%6.6) and two patients (%13.4) in standard fistulotomy and LIFT groups, respectively. Anal incontinance developed in one patient (%6.6) in standard fistulotomy group.In standard fistulotomy group the mean preoperative Wexner score was 1.00 ±1.13 and the postoperative third month score was 1.87 ±1.77. In LIFT group the mean preoperative Wexner score was 0.53 ±0.74 and the postoperative third month score was 0.60 ±0.63.There was no significant difference between the preoperative and postoperative Wexner scores (Preoperative Wexner p: 0.275, Postoperative Wexner p: 0.072).The mean wound healing was 27.4 ±2.77 days in standard fistulotomy group and 14.87 ±1.13 days in LIFT group. The period of wound healing was significantly low in LIFT group (p 0.05).Conclusions: In uncomplicated perianal fıstulas, LIFT technique has similar success rate as standard fistulotomy and both have similar recurrence rates. Standard fistulotomy causes an additional increase in Wexner clinic scores in patients with higher preoperative scores. In the LIFT group, the wound healing time is approximately 50% shorter than that of standard fistulotomy group. 61 more...

In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection. more...

While intestinal tumors are rare, small intestinal lipomas are even more uncommon benign neoplasms. They are usually asymptomatic, but lipomas larger than 2 cm may become symptomatic due to obstruction, bleeding, or intussusception. In this paper, US and CT findings of a lipoma located in the terminal ileum and causing ileocecal intussusception were discussed. We report a case of small bowel lipoma that became symptomatic due to intermittent obstruction episodes and ileocecal intussuception. If the diagnosis of intestinal lipoma had been made absolutely as in our case, they should be removed surgically in elective conditions. more...

AMAÇ: Günümüzde obezite yaşlı popülasyonda da (≥60 yaş) artan bir sorun haline gelmiştir (1,2). Yeni metaanalizlere göre yaşlı popülasyonun obezite tedavisinde önceki yılların aksine genç popülasyonla karşılaştırıldığında; kabul edilebilir komorbidite (%2,545,84) ve mortalite (%0,14-0,89) oranları ile uygulanabilirliği desteklenmiştir (1). Literatürde yaşlıların obezite cerrahisinde sleeve gastrektomi veya gastrik bypass tekniklerinden hangisinin tercih edilmesi gerektiği ile ilgili tartışmalar devam etmektedir (3,4). Çalışmamızda yaşlı popülasyonda uyguladığımız laparoskopik sleeve gastrektomi (LSG) ve laparoskopik tek anastomozlu gastrik by-pass (LTAGB) tekniklerinin sonuçlarını karşılaştırmayı amaçladık. YÖNTEM: Retrospektif kohort olarak tasarlanan çalışmada; 2018-2021 yılları arasında Bezmialem Vakıf Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda bariatrik ve metabolik cerrahi uygulanan 634 hastadan; 60 yaş ve üzerinde obezite ve/veya ilişkili hastalıklar nedeniyle başvuran (VKİ≥ 40kg/m2 veya VKİ≥35 kg/m2 olup obezite ile ilişkili hastalıkları olanlar) 25 hasta çalışmaya dahil edildi. Hastalara LSG (grup-1) ve LTAGB (grup-2) teknikleri uygulandı. Revizyon cerrahisi olan hastalar çalışma dışı bırakıldı. Hastaların yaş, cins, ek hastalık, beden kitle indeksi, komorbid hastalıkları, ilaç kullanım öyküsü gibi demografik bulguları kaydedildi. Postoperatif dönemde erken dönem komplikasyonları, yeniden yatış oranları, komorbid hastalıkların remisyon durumları ve fazla kilo kaybı oranları (%EWL) değerlendirildi ve karşılaştırıldı. BULGULAR: Çalışmaya 25 hasta (grup-1: n:17, grup-2: n:8) dahil edildi. Hastaların 16’sı (%64) kadın ve 9’u (%36) erkek, ortalama yaşı 64,8±4,7 yıl idi. Preoperatif ortalama vücut kitle indeksi (VKİ) 48,4±10,24 kg/m2 idi. Hastaların 24’ünde (%96) obezite ile ilişkili komorbid hastalık (Tip 2 diyabet 19 kişide (%76), hipertansiyon 18 kişide (%72), obstrüktif uyku apne sendromu 9 kişide (%36), hiperlipidemi 13 kişide (%52)) mevcut idi. Ameliyat süresi grup-1 de istatistiksel olarak anlamlı olacak şekilde daha kısa bulundu (Grup-1:82,3±8,5 dk, Grup-2: 110,9±10 dk, p more...

AMAÇ: Çocukluk çağı morbid obezitesi özellikle gelişmiş ve gelişmekte olan ülkelerde son iki dekatta iki kat artış göstermiş olup tedavide bariatrik cerrahi etkili bir yöntem olarak uygulanmaktadır (1). Laparoskopik sleeve gastrektomi (LSG) günümüzde en sık uygulanan bariatrik cerrahi yöntemidir (1,2). Adölesan çağı obezitesinin tedavi yönetimi multidisipliner yaklaşım gerektirmektedir (3). Çalışmamızda, adölesan çağı obezitesinde uyguladığımız bariatrik cerrahi sonuçlarımızı göstermeyi amaçladık. YÖNTEM: Retrospektif olarak 2018-2021 yılları arasında Bezmialem Vakıf Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’na bariatrik ve metabolik cerrahi uygulanan 634 hastadan; adölesan çağında (≤18 yaş) morbid obezite nedeniyle (VKİ≥40kg/m2), çocuk endokrinoloji ve çocuk psikiyatristi tarafından yönlendirilen ve LSG uygulanan 32 hasta çalışmaya dahil edildi. Hastaların demografik verileri (yaş, cins, ek hastalık, vücut kitle indeksi (VKİ), komorbid hastalıkları, ilaç kullanım öyküsü) incelendi. Postoperatif dönemde komplikasyon, fazla kilo kaybı oranları, komorbid hastalıkların remisyon durumu değerlendirildi. BULGULAR: Çalışmadaki toplam 32 hastanın ortalama yaşı 16,1±1,07 yıl idi. Hastaların 24’ü (%75) kız ve 8’i (%25) erkek idi. Preoperatif ortalama VKİ 47,4±7,56 kg/m2 idi. Hastaların 22’sinde (%66,6) tip 2 diyabet, 7’sinde (%21,8) hipertansiyon ve 4’ünde (%12,5) obstrüktif uyku apne sendromu vardı. Tüm hastalara LSG uygulandı. Ortalama ameliyat süresi 71,2±17,3 dakika ve yatış süresi 4,3±0,7 gün idi. Peroperatif ve postoperatif herhangi bir komplikasyon izlenmedi. Mortalite izlenmedi. Postoperatif takiplerinde ortalama % EWL değerleri 3.ayda %27,7, 6.ayda %48,05 ve 12.ayda %72,1 idi. Komorbid hastalıklardaki remisyon oranların tip 2 diyabet için %86,3, hipertansiyon için %71,4 ve obstrüktif uyku apne sendromu için %100 olarak saptandı. SONUÇ: Adölesan çağı obezitesinde endikasyona uygun olarak seçilmiş hastalarda LSG tekniği güvenli ve etkili bir tedavi yöntemidir. Anahtar Kelimeler: Adölesan, Obezite, Sleve Gastrektomi more...

Objective. We aim to evaluate the effect of peritoneal closure on postoperative pain and life quality associated with open appendectomy operations. Methods. This is a single-center, prospective, randomized, and double-blinded study. Here, 18–65-year-old patients who underwent open appendectomy for acute appendicitis were included. Demographic data of the patients, operation time, length of hospital stay, pain scores using a 10 cm visual analogue scale (VAS) on the first postoperative day, quality of life assessment using the EuroQol-5D-5L questionnaire on postoperative 10th day, deep wound dehiscence, bowel obstruction, and mortality data were recorded. Results. In total, 112 patients were included in the study. The demographic data showed no significant difference between the groups. The median VAS score was lower in the group with open peritoneum, but this difference was not statistically significant (3 vs. 4, p=0.134). The duration of surgery was significantly shorter in the peritoneal nonclosure group (31.0 ± 15.1 vs. 38.5 ± 17.5 minutes, p=0.016). Overall complication rates and life quality test (EuroQol-5D-5L) results were similar between groups. Conclusion. Nonclosure of the peritoneum seems to shorten the duration of surgery without increasing complications during open appendectomy. Postoperative pain and life quality measures were not affected by nonclosure of the peritoneum. This trial is registered with NCT02803463. more...

Aim: In this study, we aimed to investigate the early effect of probiotic supplementation after Laparoscopic Sleeve Gastrectomy (LSG) on constipation and gastrointestinal quality of life compared to control group.Methods: This study was a prospective, randomized clinical trial. Participants were recruited to Bariatriklab Obesity and Metabolic Surgery Center for LSG. All patients were divided into 2 groups as probiotic and control by using simple randomization. The probiotic group consumed Bifidobacterium animalis lactis BB-12 strain as a probiotic supplement during 6 weeks after LSG. Gastrointestinal Symptom Rating Scale (GSRS), Constipation Severity Instrument (CSI), Patient Assessment of Constipation Quality of Life Scale (PAC-QOL), Bristol Stool Form Scale (BSFS), Gastrointestinal Quality of Life Index (GIQLI) of the patients were recorded before LSG and at the 2nd, 4th, 6th weeks after LSG. Results: The probiotic group had an average age of 37.00±8.92 years (18 female, 12 male), the control group had an average age of 41.03±11.29 years (23 female, 7 male). CSI (16.50 ± 14.76 vs. 31.37 ± 15.34), PAC-QOL (58.53 ± 12.59 vs 72.30 ± 19.70), GSRS (26.83 ± 9.14 vs. 37.93 ± 16.59) and total score mean were lower compared to the control group, GIQLI total score average (147.50 ± 11.79 vs 136.87 ± 18.98) was found higher (p, Amaç: Bu çalışmada, Laparoskopik Sleeve Gastrektomi (LSG) sonrası probiyotik takviyesinin, konstipasyon ve gastrointestinal yaşam kalitesi üzerine erken dönem etkisinin araştırılması amaçlanmıştır.Yöntemler: Bu çalışma, prospektif, randomize klinik çalışmadır. Katılımcıları Bariatriklab Obezite ve Metabolik Cerrahi Merkezi’ne LSG için başvuran bireyler oluşturmaktadır. Tüm hastalar, basit randomizasyon kullanılarak randomize örnekleme ile probiyotik ve kontrol olmak üzere 2 gruba ayrıldı. Probiyotik grubu, LSG sonrası 6 hafta boyunca probiyotik takviyesi olarak Bifidobacterium animalis lactis BB-12 suşunu kullandı. Hastaların, LSG öncesi ve sonrası 2.hafta, 4.hafta, 6.haftanın sonunda Gastrointestinal Semptom Derecelendirme Ölçeği (GSRS), Konstipasyon Ciddiyet Ölçeği (CSI), Konstipasyon Yaşam Kalitesi Ölçeği (PAC-QOL), Bristol Dışkı Formu Skalası (BSFS), Gastrointestinal Yaşam Kalitesi İndeksi (GIQLI) kaydedildi.Bulgular: Probiyotik grubun yaş ortalaması 37,00±8,92 (18 kadın, 12 erkek), kontrol grubunun yaş ortalaması 41,03±11,29 (23 kadın, 7 erkek) idi. CSI (16,50 ± 14,76 ile 31,37 ± 15,34), PAC-QOL (58,53 ± 12,59 ile 72,30 ± 19,70), GSRS (26,83 ± 9,14 ile 37,93 ± 16,59) ve toplam puan ortalaması kontrol grubuna göre daha düşük, GIQLI toplam puan ortalaması (147,50 ± 11,79 ile 136,87 ± 18,98) daha yüksek bulundu (p more...

Amaç : Çalışmamızda intersfinterik fistül trakt ligasyonu (LIFT) ile fistülotomi yöntemlerininperianal fistül tedavisindeki postoperatif sonuçlarının karşılaştırılması amaçlandı.Yöntem : Aralık 2012 ile Nisan 2016 yılları arasında Bezmialem Vakıf Üniversitesi TıpFakültesi Hastanesi Genel Cerrahi bölümüne başvuran, intersfinkterik veya alçaktranssfinkterik perianal fistül tanısıyla operasyon planlanan 42 hasta,https://www.randomizer.org internet adresinde başvuru sıralarına göre LIFT (grup-1) vefistülotomi (grup-2) uygulanacak gruplar olarak rastgele ikiye ayrıldı. Fistül tipininbelirlenmesinde preoperatif rektal endosonografi (R-EUS) ve/veya manyetik rezonans (MR)görüntüleme yöntemleri ile fizik muayene bulguları kullanıldı. Hastalara preoperatif dönemdeve postoperatif üçüncü aylarında anorektal manometri yapılarak sfinkterlerin maksimumsıkma basıncı (MSP) ve maksimum istirahat basınçları (MİP) bakıldı. Preoperatif vepostoperatif üçüncü aylarında Wexner klinik skorlaması yapılarak anal inkontinans durumlarıdeğerlendirildi ve gruplar arasında karşılaştırıldı. Hastaların postoperatif ikinci aylarına kadarhaftalık ve sonrasında üç ayda bir perianal muayeneleri yapılarak postoperatif iyileşmezamanı, yara yeri enfeksiyonu ve rekürrensler değerlendirildi ve gruplar arasındakarşılaştırıldı.Bulgular : İntersfinkterik (n=32) veya alçak transsfinkterik (n=10) perianal fistülü olanhastalar randomize edilerek 2 gruba ayrıldı. 42 hastanın 25’i (%57.1) erkek ve ortalama yaş43.8±9.9 yıl idi. İntraoperatif herhangi bir komplikasyon tespit edilmedi. Yara yeri enfeksiyonugrup-1’de %14.2 (n=3) iken, grup-2’de %9.5 (n=2) idi. İyileşme zamanı grup-1’de daha kısaidi (26.5±3.35 vs. 15.0 ±1.24 gün, p 0.05). Grup-1 ve grup-2’deki rekürrens oranları sırasıyla %14.2 (n=3) ve %4.7(n=1) idi.Sonuç : LIFT, standart fistülotomiye benzer nüks ve komplikasyon oranları ile intersfinkterikve alçak transsfinkterik perianal fistül tedavisinde etkili ve güvenilir bir tedavi seçeneği olarakuygulanabilir.Anahtar Kelimeler: Anal fistül, Anal inkontinans, Fistülotomi, LIFT more...

Amaç: Primer ve revizyonel bariatrik cerrahide kaçak tanısı için uygulanan intraoperatif metilen mavisi testi ile postoperatif üst gastrointestinal sistem kontrastlı grafilerin etkinliklerini ve sonuçlarını değerlendirmeyi amaçladık.Yöntemler: Primer ve revizyonel cerrahi uygulanan, kaçak tespiti için rutin olarak intraoperatif metilen mavisi testi ile postoperatif üst gastrointestinal kontrastlı grafi yapılan 287 hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, komorbid hastalıkları, hastanede yatış süresi, ameliyat süresi, intraoperatif ve postoperatif komplikasyonlar retrospektif olarak incelendi.Bulgular: Çalışmamızdaki 287 hastanın 256’sına (%89,1) primer cerrahi uygulandı ve hastaların 221’i (%75,7) kadın, ortalama yaş38.4±11.9yıl ve ortalama beden kitle indeksi 44.3±7.6 kg /m2idi. Daha önce abdominal cerrahi geçiren ve komorbid hastalığı olan hasta sayıları sırasıyla 108(%37,6) ve 149 (%51,9) idi.Bir (% 0,3) tek-anastomozlu gastrik bypass olgusunda metilen mavisi testinde kaçak tespit edildi. Revizyon cerrahisi uygulanan 1 (%3,2) olguda, metilen mavisi testinde kaçak tespit edilmeyip, postoperatif 1. gün klinik bulgulara göre kaçak tespit edildi. Postoperatif kontrastlı grafi sonuçlarında hiçbir hastada kaçak tespit edilmedi. Primer ve revizyonel cerrahi uygulanan olgular arasında görülen kaçaklarda istatistiksel olarak anlamlı fark tespit edilmedi (p=0,230). Mortalite yok idi.Sonuç: Primer ve revizyonel bariatrik cerrahide postoperatif gastrointestinal kontrast çalışmalarının kullanılmasına gerek olmayabilir, ancak kaçak tespitindeki pozitif sonuçları nedeniyle intraoperatif metilen mavisi testinin rutin olarak uygulanması düşünülebilir more...

Amaç: Çalışmamızda bariatrik cerrahinin obezite ve ilişkili komorbid hastalığı olan bireylerdeki kilo kaybısonuçlarının yanında Tip2 diyabet, hipertansiyon, hiperlipidemi ve uyku apne sendromu üzerine olan etkinliğinideğerlendirmeyi amaçladık. Gereç ve Yöntem: Ocak 2018 ile Eylül 2019 tarihleri arasında BezmialemVakıf Üniversitesi Genel Cerrahi Bölümü’nde bariatrik cerrahi geçiren ve düzenli takipleri yapılan hastalarınverileri retrospektif olarak incelendi ve analiz edildi. Bulgular: Çalışmaya dahil edilen 260 olgunun 198’i(%76,2) kadın, ortalama yaş 38,6±12 yıl, ortalama beden kitle indeksi (BKI) 44,6±7,7 kg/m2 ve ortalama takipsüresi 11±3.6 ay idi. Tip2 diyabet, hipertansiyon, hiperlipidemi ve uyku apne sendromu olan olguların sayısısırasıyla 84, 68, 67 ve 18 idi. Tip2 diyabeti olan olguların preoperatif glukoz ve Hemoglobin A1c (HbA1c)değerleri ortalaması sırasıyla 140,2±60,9 mg/dl ve 6,7±2,6% olup, postoperatif 6,12 ve 18. aylardaki ortalamaglukoz değerleri sırasıyla 101±31, 101,2±56 ve 96,2±21,4 mg/dl idi. Postoperatif 6,12 ve 18. aylardaki ortalamaHbA1c değerleri sırasıyla 5,6±1,0, 6,4±6,5 ve 5,8±1,1% idi. Preoperatif ve postoperatif 12. ayda ortalamaglukoz ve HbA1c değerleri arasında istatistiksel olarak anlamlı fark tespit edildi (p more...

Introduction: Gastroesophageal reflux (GERD) might be occurred after Sleeve Gastrectomy (SG). In this study, we aimed to show the results of preoperative diagnostic tests and laparoscopic double loop gastric bypass (LDLGB) surgery for de novo GERD after SG. Material and Methods: From January 2018 to July 2019, 8 patients who underwent LDLGB for the conversion of SG because of GERD analyzed retrospectively. All patients who suffered from symptomatic and/or resistant reflux after SG underwent esophagogastroduodenoscopy (EGD), 24-hour esophageal pH meter and esophageal manometry. In the LDLGB procedure, sleeved stomach was transected above the incisura angularis via linear stapler to create the gastric pouch. The biliary limb was measured 100 cm distal to the Treitz ligament and gastrojejunostomy was performed using a linear stapler. Starting at this level, the alimentary limb was measured up to 100 cm and fixed by stitching it to the biliary limb. Side-to-side jejunojejunostomy was performed between alimentary and biliary limbs. Finally, the biliary loop and alimentary loop were separated using a linear stapler. Results: The mean preoperative BMI was 32±3.9 kg/m2 . At EGD, class A esophagitis and alkaline reflux(bile) gastritis was found in 75% and 87.5% of cases, respectively. The mean DeMeester score and mean lower esophageal sphincter pressure was 66.3 and 16.4±5.2 mmHg, respectively. The mean operation time was 164±24 minute. There was no complication recorded. The mean BMI was 25.7±1.4 kg/m2 in the follow-up period (mean 12.3±3.2 months). Reflux symptoms completely resolved in all patients. Conclusion: The evaluation of de novo GERD after SG is important and it should be diagnosed by appropriate tests. Conversion of SG to LDLGB is a reliable and feasible technique in the treatment of de novo GERD. more...

BACKGROUNDWeight regain and inadequate co-morbidity reducti on are the most important problems inthe long-term results aft er laparoscopic sleeve gastrectomy(LSG) and in these conditi onsrevisional surgery is considered.Our aim is to show the importance of total small bowellength and appropriate small bowel loop for determine the lenght of common channel forthe revision of LSG to distal gastric bypass.METHODSData from the pati ents who underwent measurable one-anastomosis distal gastricbypass(MOADGB) in the revision of LSG from May 2017 to January 2019 was retrospecti velyanalyzed.In the surgical technique; all pati ents’ small bowel lenght is measured from theligament of treitz to ileocecal valve and gastroenterostomy anastomosis was performed1/3 distal part of the total small bowel length.RESULTSSeventeen pati ents(female n=10) with a mean age of 41±2.3 years and a mean BMI of39.1±1.7kg/m2 were included in the study.The indicati ons for revisional surgery wereinadequate weight loss (n=5), weight regain (n=11) and inadequate co-morbidity reducti on(n=1).The mean total small bowel length was 10±0.3 meter.The mean operati on ti me was126.2±5.1 minutes.There was no mortality.Only one pati ent had bleeding(5.8%).Leakage wasobserved one pati ent(5.8%). The mean excess weight loss% was 54.1±4.8% aft er the follow-up period (mean 11.2±1.4 months).The mean values of iron,ferriti n,protein,vitaminB12and vitaminD were 59.7±5.6ug/dl, 106.7±25.1ng/ml, 6.8±0.1g/dl, 592±57.2pg/ml and24.9±3.1ng/ml, respecti vely.CONCLUSIONIn the distal gastric bypass procedure which performed in the revisional surgery aft er LSG,determining the common canal length by measuring the total small bowel length mightincerease the effi cacy and decrease the rates of complicati ons such as malnutriti on andvitamin defi ciencies. more...

Recent randomized trials have shown that completion axillary lymph node dissection (ALND) is not required in all patients with a positive sentinel lymph node (SLN) who will receive radiation therapy. Although routine intraoperative pathologic assessment (IPA) becomes unnecessary and less indicated by breast surgeons in the United States and some European countries, it is still widely used all around the world. In this prospective study, the feasibility of intraoperative nodal palpation (INP) as opposed to IPA of the SLN has been analyzed. Between March 2014 and June 2015, 305 patients with clinical T1-2/N0 breast cancer from two different breast clinics (cohort A; [n = 225] and cohort B; [n = 80]) who underwent any breast surgery with sentinel lymph node biopsy (SLNB) were included in this study. Surgeons evaluated the SLNs by manual palpation before sending for IPA, and findings compared with the final pathology. The positive predictive values (PPV) of INP and IPA were 81.8% and 97.9%, respectively, whereas the negative predictive values (NPV) of INP and IPA were 83% and 92.4%. The accuracies of INP and IPA were 82.6% and 94.1%, respectively. If patients with SLNB including micrometastasis were also considered in the final pathologic assessment (FPA) (-) group that would not require a further axillary dissection, the revised NPV of INP and FPA were found to be 92.6% and 98.1%, respectively. The revised accuracy of INP also found to be increase to 86.9%. Our study, which is the only prospective one about palpation of dissected SLNs in the literature, suggests that INP can help to identify patients who do not need ALND, which encourages omitting IPA in cT1-2 N0 breast cancer. more...

Introduction: Esophagogastroduodenoscopy (EGD) is a diagnostic method used in the investigation of upper gastrointestinal system diseases. A high level of anxiety of patients who undergo EGD increases the duration of the procedure and the sedation and analgesic requirements. Sedation is used to increase patient comfort and tolerance by reducing the anxiety and pain associated with endoscopic procedures. Aim: In this study, the effect of anxiety scores on medication doses was investigated in patients who underwent EGD under sedation. Material and methods: A psychiatrist, an endoscopist and an anesthesiologist conducted a prospective observational study blindly to investigate the effect of pre-procedural (before EGD) anxiety level on medication doses for sedation. Patients were divided into two groups, with and without additional medication doses. Results: The study included 210 consecutive patients who underwent EGD under sedation. The average STAI-S score was 40.28 and the average STAI-T score was 40.18. There was no relationship between anxiety scores and gender (p = 0.058, p = 0.869). Statistically significant results were obtained for anxiety scores with additional sedation dosing (p < 0.05). It was observed that an additional dose of medication was affected by age, body mass index and anxiety scores (p < 0.005). Patients who were young, had a low body mass index and had high anxiety scores had significantly higher additional dose requirements. Conclusions: The medications used for sedation during EGD may be inadequate or an additional dose of medication may be needed for patients who have higher anxiety scores, younger age, and lower body mass index. more...

BACKGROUND Ligation of the left gastric artery (LLGA), which supplies the fundus of the stomach, may reduce the appetite hormone ghrelin, resulting in weight control. The aim of this study was to compare LLGA and sleeve gastrectomy (SG) in terms of postoperative outcomes in a rat model. MATERIAL AND METHODS Fifteen male Wistar albino rats, weighing >350 grams (range 350-525 grams), were enrolled in LLGA (N=5), SG (N=5), and control (N=5) groups. Blood samples were drawn preoperatively and also during the first and fourth week postoperatively to assay ghrelin and leptin hormone levels. Body weight was measured in each group. RESULTS The maximum reduction in ghrelin level (41.5%) was found in the LLGA group. Considerable% total weight loss (TWL) (mean 24.1%) was observed in the SG group, and slight%TWL was noted in the control and LLGA groups (means of 0.1% and 2.1%, respectively). There was no significant difference in mean percent weight change between the LLGA and the SG groups (p=0.08). Blood sample analysis revealed no statistically significant changes in ghrelin or leptin levels between the groups (p=0.9 and p=0.3, respectively). CONCLUSIONS We present evidence that LLGA causes the same reduction in ghrelin hormone levels as SG at 4 weeks after surgery in a rat model. However, LLGA did not cause the same%TWL as SG. The mechanism of weight loss in SG is most likely due to restriction and to the effects of the procedure, rather than due to neurohormonal changes. more...

This study aimed to evaluate the effect of endoscopic marking on the distal surgical margin and ileostomy rates in laparoscopic rectal cancer surgery.Forty patients, who underwent surgery between September 2012 and December 2013 for rectal cancer limited to or with invasion of the upper rectum, were included in the study. The distal tumor margin was marked with purified carbon particles by colonoscopy before surgery in one group (n=20); no marking was performed in the second group (n=20). Patients were assigned randomly to each group. Laparoscopic anterior or low-anterior resection was performed in all patients. Demographic and operative data, pathology results, morbidity, and ileostomy rates were measured.There was no statistically significant difference in the demographic data, the tumor size, the amount of bleeding, the specimen length, the harvested lymph node number, postoperative complications, the length of hospital stay, rehospitalization, and the operation duration between groups 1 and 2, respectively. The distal surgical margin was significantly shorter in the marked group. The protective ileostomy rates were also lower in the marked group; however, the difference did not reach statistical significance.Preoperative endoscopic tattooing decreases distal resection margins and may reduce protective ileostomy rates in laparoscopic rectal surgery. more...

Staple-line leakage and bleeding are worrisome and feared postoperative complications after laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. The purpose of this study was to review clinical evidence following the use of fibrin sealant in standard LSG. Morbidly obese patients who underwent standard technique of LSG with using fibrin sealant were included in the study. Demographics variables [age, gender, body mass index (kg/m2), and comorbid conditions], the re-admission rate, and postoperative early complications, such as bleeding, staple-line leak, twist and stricture, were evaluated at the follow-up during the postoperative first month. In total, 1000 patients [586 female (58.6 %)] with a mean age of 42.6 ± 13.6 years underwent LSG. Fibrin sealant was used in all operations. In total, 186 patients (18.6 %) had previous abdominal surgery. The mean operative time was 72 ± 19 min, and the mean hospital stay was 3.2 ± 1.1 days. Only 3 patients (.3 %) experienced bleeding. Staple-line leakage, twist and stricture were not observed. The re-admission rate was .5 %, and no mortalities were noted. This retrospective study indicates that bariatric surgeons should consider implementing standardized surgical operative technique for reduced postoperative complications in LSG. Fibrin sealant is a reliable and useful tool to reinforce the staple line and may prevent potential twists of the sleeved stomach. more...

Pheochromocytomas and paragangliomas are neuroendocrine tumors that arise from chromaffin cells of adrenal medulla and extra-adrenal paraganglia, respectively. The recurrence of these neuroendocrine tumors as a jejunal mass causing obstruction in the small intestine is an exceptional entity. The present study reports the case of a 70-year-old male who presented to the Emergency Department of Bezmialem Vakif University Hospital with abdominal pain and vomiting. The patient possessed a history of left nephrectomy due to malignant pheochromocytoma that had invaded into the left kidney eight months prior to presentation. Bowel obstruction was diagnosed and the patient underwent a laparoscopic procedure. Partial resection of the jejunum was performed and immunohistochemical studies revealed the lesion to be malignant paraganglioma. The majority of paragangliomas are chemo- and radioresistant. Surgical excision remains the primary treatment. Metachronous paraganglioma arising from the small intestine is an extremely rare entity and may be a relevant consideration in patients presenting with bowel obstruction. more...

While intestinal tumors are rare, small intestinal lipomas are even more uncommon benign neoplasms. They are usually asymptomatic, but lipomas larger than 2 cm may become symptomatic due to obstruction, bleeding, or intussusception. In this paper, US and CT findings of a lipoma located in the terminal ileum and causing ileocecal intussusception were discussed. We report a case of small bowel lipoma that became symptomatic due to intermittent obstruction episodes and ileocecal intussuception. If the diagnosis of intestinal lipoma had been made absolutely as in our case, they should be removed surgically in elective conditions. more...