Comparison of short- and long-term outcomes of bariatric surgery methods: A retrospective study.

The present study is intended to retrospectively compare the short- and long-term outcomes of 3 different treatment methods in patients undergoing bariatric surgery and the variances in weight and nutritional parameters during the preoperative and postoperative periods. In this study, 534 patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-En-Y gastric bypass (LRYGB), and laparoscopic one anastomosis gastric bypass (LOAGB) between 2014 and 2021 were included. The sociodemographic and biodemographic characteristics of these patients, their weight losses and nutritional changes in the preoperative and postoperative periods, operative times, hospital stays, complications, and morbidity and mortality rates were retrospectively compared. There was a statistically significant difference between the surgical methods in the percentages of excess weight loss and total weight loss in the 1st and 3rd months. There were significant differences in the homeostasis model assessment of insulin resistance, folic acid, vitamin D, iron, ferritin, and parathyroid hormone levels (P < .05). All 3 techniques were found to be successful in facilitating weight loss at the end of the first year. LRYGB and LOAGB were found to be superior to LSG in terms of remission from diabetes during the first 6 months, whereas LSG was superior to the other methods in terms of nutritional deficiencies. Despite being more advantageous in terms of operative time, LSG and LOAGB were disadvantageous compared with the LRYGB technique because of the higher rates of leakage and mortality in the LSG technique and the higher rate of bile reflux in the LOAGB technique.

Impact of the COVID-19 pandemic on operations in general surgery clinics in Turkey.

INTRODUCTION: The Covid-19 pandemic spread rapidly throughout Turkey from March 2020 onward, and despite modified working conditions in the surgical clinics of our hospitals, some surgical patients became infected with the coronavirus during their perioperative period. AIM: The present study investigates the impact of the novel coronavirus on patients undergoing general surgical operations in our clinics during the Covid-19 pandemic. METHODS: A retrospective analysis was conducted of all surgeries performed in the general surgery clinics of two 'pandemic hospitals' between March 19 and April 30, 2020 - a period when all elective surgeries were suspended in hospitals within Turkey. Demographic data, comorbidities, choice of anesthesia method, blood parameters, duration of stay in hospital and the intensive care unit and mortality rates were compared statistically with the frequency of postoperative Covid-19 positivity in these patients. RESULTS: A total of 275 surgical operations were performed during this period. Covid-19 was identified in seven patients during the postoperative period, and was more commonly diagnosed in those who were elderly and those with comorbidities. (p=0.02, p=0.02). Statistically significant correlations were found between a Covid-19 diagnosis and admission to the intensive care unit, the length of hospital stay and the length of stay in intensive care (p<0.001, p<0.001, p=0.01). Mortality was observed in two patients who developed Covid-19 postoperatively (p= 0.03). CONCLUSIONS: The Covid-19 pandemic has had a significant impact on patients undergoing operations in our general surgery clinics. Precautionary measures taken during postoperative care should be maximized for high-risk patients. KEY WORDS: Covid-19 pandemic, General surgery clinics, Novel coronavirus, Gastrointestinal system surgery.

Prospective multi-center study of surgeon's assessment of the gallbladder compared to histopathological examination to detect incidental malignancy.

PURPOSE: Routine histopathological examination after cholecystectomy for gallstones is performed despite the low rates of incidental findings of malignancy. The aim of this study was to assess predictive values of macroscopic examination of cholecystectomy specimens by surgeons in gallstone disease. METHODS: A prospective multi-center diagnostic study was carried out between December 2015 and March 2017 at four different centers. All patients undergoing cholecystectomy for gallstone disease were consecutively screened for eligibility. Patients whose ages are 18 to 80 years, and preoperative imaging findings without any pathology except cholelithiasis were included. The gallbladder was first evaluated macroscopically ex situ by two operating surgeons and rated as macroscopically benign (group S1), suspicious for a benign diagnosis (group S2), and suspicious for malignancy (group S3). Thereafter, a pathologist made a final histopathological examination whose results are grouped as chronic cholecystitis (group P1), benign or precancerous lesions in which only cholecystectomy is the adequate treatment modality (group P2), and carcinoma (group P3). Diagnostic accuracy of the surgeon's assessment to the histopathological examination was evaluated using sensitivity, specificity, positive and negative predictive values, and accuracy, and correlated by a kappa agreement coefficient. RESULTS: A total of 1112 patients were included in this trial. The specificity rates were 96.5%, 100%, and 98.7% for group S1-group S2, group S1-group S3, and group S2-group S3, respectively. Accuracy rates to detect malignancy were 100% and 95. 2% for group S1 and group S2, respectively. Kappa coefficient values were 1.0 and 0.64 for group S1-group S3 and group S2-group S3, respectively (p < 0.001 for both). CONCLUSION: Assessment of the gallbladder specimen and selective histopathological examination may be adequate after cholecystectomy for gallstone diseases. Such a procedure would have the potential to reduce costs and prevent unnecessary loss of labor productivity without affecting patients' safety. However, higher number of patients in more centers is needed to confirm this hypothesis.

Midgut malrotation causing intermittent intestinal obstruction in a young adult.

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.