Posterior fixation of gastric tube with fibrin sealant in laparoscopic sleeve gastrectomy: a promising method to prevent revision surgeries.

BACKGROUND: We aim to assess the effects of gastric posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy in aspects of 12th-month body mass index and gastric volume. METHODS: The patients who underwent laparoscopic sleeve gastrectomy between January 2019 and February 2021 were divided into two groups preoperatively. The first 75 patients were appointed to the posterior fixation group, and the second 75 were to the control group. Changes in gastric volume and body mass index were assessed in the postoperative 12th month. RESULTS: There were 110 patients in the final analysis. Fifty-four patients had posterior fixation, and 56 had only laparoscopic sleeve gastrectomy. The posterior fixation group was superior in terms of total weight loss rate (39.1% vs. 34.5%, p<0.001) and less gastric volume increase rate (39.8% vs. 164.7%, p<0.001) in the postoperative 12th month. CONCLUSION: Our study suggests that posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy is a promising method for preventing weight regain and creating a need for revision surgery.

Current Status and Surgical Technique for Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis

Restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) is the procedure of choice for patients with ulcerative colitis (UC), some patients with colonic Crohn's disease (CD), and those with familial adenomatous polyposis (FAP); albeit, owing to its complexity, it should be performed by experienced professionals. RP/IPAA is the recommended surgical treatment for UC when the standard medical therapy is ineffective. This procedure has been demonstrated to provide patients with a good quality of life, such as in FAP patients with extensive disease in the rectum. The CD has been associated with higher rates of perianal involvement and disease recurrence, but some patients with CD limited to the large intestine and minimal perianal or ileal disease may also be considered for this operation. First, all patients undergo a detailed preoperative evaluation that includes a review of previous imaging, pathology, and colonoscopy findings, a perianal examination, an evaluation of the anorectal functions, mechanical bowel preparation, and prophylaxis against deep venous thrombosis and infectious complications. A staged approach is the most commonly preferred technique for RP/IPAA, which can be performed in 2 or 3 stages. The IPAA can be performed by laparoscopic, robotic, or open approach. The type of approach is determined based on the patient's condition, medication used, elective or emergency setting, and the surgeon's expertise level. A successful IPAA requires tension-free pouch anastomosis. The most common IPAA pouch types are the J or S pouches; alternatively, an H pouch may be created, which is mainly used in redo pouches. In experienced centers, > 95% of the patients become stoma-free in 10 years. IPAA is a complex procedure, and the complications after pouch surgery are pouchitis, pelvic sepsis, pouch failure, or anastomotic stricture. The majority of long-term complications can be prevented in such cases with a comprehensive preoperative evaluation and through the use of appropriate surgical techniques and postoperative care conducted at experienced centers. The techniques for performing RP/IPAA with their long-term outcomes have been reviewed in this article.

Retrospective analysis of pelvic and retroperitoneal sarcomas. Single center's experience.

BACKGROUND: Retroperitoneal sarcoma (RPS) is a surgically manageable condition that can recur locally after complete macroscopical resection. Managing patients at high-volume specialized healthcare centers has positive effects on treatment outcome. The present study aimed to preoperatively, perioperatively, and postoperatively assess patients who underwent surgery for RPS. METHODS: Consecutive surgical resections of RPS performed at a single healthcare center between January 2011 and December 2018 were investigated retrospectively. Histological, radiological, and clinical data were collected. In addition to local recurrence rate of patients with complex tumor resection, existing symptoms, adjuvant treatment type, and 5- year overall and disease-free survival rates were recorded and analyzed. RESULTS: Extensive complete tumor resection was performed in 25 (%100) patients operated in our clinic for retroperitoneal sarcoma between 2011-2018. The mean survival time in patients undergoing R0 resection was found to be significantly higher than that in patients undergoing R1 resection(p=0.001). No statistically significant difference was found between histological grading and histological types in terms of mean survival (p=0.63 p=0.36). There was no statistically significant difference in terms of mean survival between patients who did not receive additional therapy, received adjuvant chemotherapy, and those who received adjuvant chemotherapy and radiotherapy. (p = 0.342) CONCLUSION: Although extensive complete resection is the gold standard in the treatment of retroperitoneal sarcoma, the effect of adjuvant chemotherapy and radiation therapy is still under discussion. In our study, high mean survival rates were determined due to R0 resection, and the effect of tumor grade and histological subtype on survival was not observed. KEY WORDS: Adjuvant therapy, Overall survival, Retroperitoneal sarcoma, Surgical resection.