Search

Background: There is not any consensus on concomitant cholecystectomy for asymptomatic gallbladder stones during laparoscopic sleeve gastrectomy (LSG). The aim of this study was to evaluate the surveillance results of the LSG patients who have asymptomatic gallbladder stones and did not undergo cholecystectomy. Methods: Patients who underwent laparoscopic sleeve gastrectomy with preoperatively detected gallbladder stones and completed at least 6 months follow-up were included in the study. Concomitant cholecystectomy was performed for symptomatic patients while it was not performed for asymptomatic subjects. At the end of the follow-up time, symptoms and signs related to gallbladder disease were recorded. Clinical and demographic characteristics were compared between symptomatic and asymptomatic patients. Results: Between February 2012 and October 2016, 312 laparoscopic sleeve gastrectomies were performed. Among the patients, 24 were regarded as asymptomatic cholelithiasis, and cholecystectomy was not performed. The mean follow-up period was 27 (6-58) months. The mean preoperative BMI was 50.0 ± 7.6 kg/m, and at the end of the follow-up time, it decreased to 35.6 ± 8.8 kg/m. Five (20.8%) patients experienced biliary colic. Acute cholecystitis or obstructive jaundice was not observed in any of the patients. Characteristics of patients who developed symptomatic gallbladder disease ( n = 5) were not significantly different from those of patients who remained asymptomatic ( n = 19). Conclusions: The risk of becoming symptomatic for asymptomatic cholelithiasis is very close to the healthy population after sleeve gastrectomy. Although further studies with a high number of cases are needed, we suggest only observation for asymptomatic gallbladder stones in patients who will undergo sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy of combined treatment with anti-tumor necrosis factor (TNF) agents, and setons for perianal fistulas in Crohn's disease. Patients and Methods: Study included 27 consecutive patients with perianal fistulizing Crohn's disease, requiring seton drainage and anti-TNF therapy in our center from January 2013 to November 2014. All patients underwent a standardized pelvic magnetic resonance imaging (MRI) examination. Patient characteristics, follow up time, findings of pelvic MRI, colonoscopy and examination under anesthesia findings were recorded. Response to treatment was evaluated at the end of the follow up. Results: The median follow-up after treatment was 17 months (6-32). The fistula was complex in 24 (89%) of the 27 patients. Colonoscopy revealed ileitis in 16 (59.3%) patients and active proctitis in 9 (33.3%) patients. Perianal abscess was observed in 12 (44.4%) patients. Complete response was obtained in 17 (63%) patients. Only 3 (11.1%) patients experienced recurrence abscess during the study period. We could not find any factor, which was associated with complete response. Conclusion: Complete response was achieved in 63% of the patients, with perianal fistula formation associated with Crohn's disease, with combined seton drainage and anti-TNF therapy. [ABSTRACT FROM AUTHOR]

Background: Perianal disease is reported more widely in pediatric Crohn patients than in the past, and has been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn's disease (fpCD) in the pediatric age group., Methods: A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled., Results: Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients had a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infliximab., Conclusion: Fistulising perianal Crohn's disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.