Effect of Corrective Exercise on Static Balance, Food Consumption, and Body Composition in the Early Period After Bariatric Surgery.

PURPOSE: To determine the impact of corrective exercise program applied during the period of rapid weight loss following bariatric surgery on static balance, dietary intake, and body composition. MATERIALS AND METHODS: Participants who had undergone Sleeve Gastrectomy (SG) surgery were divided into as Corrective Exercise Group (CEG), and Control Group (CG). CEG underwent a 12-week supervised corrective exercise program. Body composition and static balance of all participants were assessed before and after the study. Their physical activity levels and dietary intake were also evaluated. RESULTS: Following of the corrective exercise program, both groups exhibited significant reductions in body weight, BMI, fat mass, fat percentage, muscle mass, waist circumference-to-height ratio, and visceral adiposity values (p < 0.05). Additionally, the CEG showed increase in lean body mass percentage (p < 0.001). In measurements related to static balance, values for eyes-closed perimeter (p = 0.015), eyes-closed (p = 0.006), eyes-open (p = 0.028) ellipses area, average F-B speed, and eyes-open center of pressure in the X-axis (C.O.P.X.) sway distance significantly decreased in both groups (p = 0.025). However, the difference in eyes-open C.O.P.X. sway distance was found to be higher in the CG (mean difference = 8.67; p = 0.034). Postoperatively, there were significant decreases in energy, protein, fat, CHO (carbohydrate), CHO percentage, fiber, and iron values, while protein percentage (p < 0.001), vitamin D (p = 0.003), and B12 (p < 0.001) values increased. CONCLUSION: It has been observed that the corrective exercise program implemented in the early postoperative period following SG surgery had a positive impact on eyes-open static balance.

Effect of laparoscopic sleeve gastrectomy on platelet count and mean platelet volume.

Objective: Several studies have reported an increase in platelet (PLT) count with chronic inflammation in the presence of obesity. Mean platelet volume (MPV) is an important marker for PLT activity. Our study aims to demonstrate if laparoscopic sleeve gastrectomy (LSG) has any effect on PLT, MPV and white blood cells (WBCs). Methods: A total of 202 patients undergoing LSG for morbid obesity between January 2019 and March 2020 who completed at least 1 year of follow-up were included in the study. Patients' characteristics and laboratory parameters were recorded preoperatively and were compared in the 6th and 12th months. Results: Two hundred and two patients (50% - female) with a mean age of 37.5 ± 12.2 years and mean pre-operative body mass index (BMI) of 43 (34.1-62.5) kg/m2 underwent LSG. BMI regressed to 28.2 ± 4.5 kg/m2 at 1 year after LSG (P < 0.001). The mean PLT count, MPV and WBC during the pre-operative period were 293.2 ± 70.3 103 cells/µL, 10.22 ± 0.9 fL and 7.8 ± 1.9 103 cells/µL, respectively. A significant decrease was seen in mean PLT count, with 257.3 ± 54.2 103cell/µL (P < 0.001) at 1 year post-LSG. The mean MPV was increased at 6 months 10.5 ± 1.2 fL (P < 0.001) and remained unchanged at 1 year 10.3 ± 1.3 fL (P = 0.9). The mean WBC levels were significantly decreased with 6.5 ± 1.7 103 cells/µL (P < 0.001) at 1 year. At the end of the follow-up, weight loss showed no correlation with PLT and MPV (P = 0.42, P = 0.32). Conclusion: Our study has shown a significant decrease in circulating PLT and WBC levels while MPV remained unchanged after LSG.

Menetrier's disease in a morbid obese patient undergoing bariatric surgery: A case report.

INTRODUCTION AND IMPORTANCE: Menetrier's disease is a rare type of hypertrophic gastropathy characterized by the atrophy of the gastric parietal cells and dilatation of mucus releasing glands. Hereby, we present a morbid obese patient who has undergone laparoscopic sleeve gastrectomy (LSG) and he has also diagnosed with Menetrier's disease. CASE PRESENTATION: A 67-year-old male patient whose body mass index (BMI) was 39 kg/m2. Preoperative endoscopy was done. There were no pathologies except increased gastric mucosal folds. LSG was done. During the surgery it was noticed that gastric tissue was abnormally thick. After LSG completed, it was observed that there was an abnormal bleeding from the staple line. The staple line was oversewed with 3.0 V-Loc™ and bleeding was stopped. Pathology report was compatible with menetrier's disease. CLINICAL DISCUSSION: Hypoalbuminemia and H. pylori take an important place in diagnosis of Menetrier's disease, but H. pylori was not detected and albumin level was normal in our patient. For certain diagnosis full-thickness gastric biopsy is needed. The routine use of preoperative endoscopy in patients scheduled for bariatric surgery was still controversial until recently. CONCLUSION: This is the first case with menetrier's disease that has undergone LSG. Preoperative endoscopic evaluation before bariatric surgery is crucial. As in this case, it will be effective in terms performing additional intraoperative precautions when necessary and preventing possible complications.

Nutritional Deficiencies in Morbid Obese Patients Before and After Laparoscopic Sleeve Gastrectomy.

BACKGROUND: This study aims to assess the prevalence of preoperative and postoperative nutritional deficiencies and associated factors in patients who are eligible for laparoscopic sleeve gastrectomy. METHODS: Patients who underwent primary laparoscopic sleeve gastrectomy between December 2018 and April 2020 were included in the study. All patients were screened by detailed laboratory tests pre- and post-laparoscopic sleeve gastrectomy 6th and 12th months. Patients' data, which were recorded prospectively, were analyzed retrospectively. RESULTS: A total of 228 patients were included in the study. The mean age was 39 ± 11.5 (60% female), and the mean body mass index was 41.2 ± 6.3 kg/m2. In the preoperative period, anemia was detected in 20 female patients (9%), low ferritin levels were detected in 25%, B12 and folic acid deficiencies were detected in 2.6% and 12.3%, respectively, and vitamin D deficiency was detected in 76% of the patients. During the postoperative follow-up, 77% of the patients received multivitamin supplements regularly. Mean body mass index regressed to 27.1 ± 4.2 kg/m2 in the first year. Incidence of anemia was found at 4.8%, low ferritin levels were 14%, folate deficiency was 5.3%, B12 deficiency was 5.3%, and vitamin D deficiency was 25% in the 12th month. Vitamin A, zinc, biotin, and thiamine deficiencies were 8.8%, 6.6%, 11%, and 2.2% in the 12th month, respectively. CONCLUSION: In the preoperative period, we detected significant deficiencies in some vitamins. The incidence of de novo vitamin deficiency during post-laparoscopic sleeve gastrectomy follow-up was low. Regular multivitamin-multimineral use may have an effect on this.

Effect of pre-operative weight loss on patients' outcomes undergoing laparoscopic sleeve gastrectomy.

Background: The study aims to demonstrate whether weight loss with a low-calorie diet before laparoscopic sleeve gastrectomy (LSG) may affect the outcomes. Materials and Methods: A total of 305 patients undergoing primary LSG were included in the study. Each patient adopted a low-calorie diet (1000 calories) before LSG. The patients were stratified into two groups. Group A: Those who lost 3% or more of their total body weight loss (TBWL), Group B: Those who lost <3% of their TBWL. Two groups were compared in terms of operative time, length of hospital stay, complications and weight loss outcomes. Results: One hundred and five patients (35%) were in Group A and 200 patients were in Group B. Median weight loss was 4 kg (3-20 kg). Pre-operative mean body mass index (BMI) was 40 ± 7.4 kg/m2 in Group A and 41 ± 5.9 kg/m2 in Group B (P = 0.06). At 1 year after the surgery, BMI regressed to 29.7 ± 4.9 kg/m2 in Group A and to 27 ± 4.2 kg/m2 in Group B (P < 0.001). One hundred and twenty-nine patients who completed 2 years of follow-up, mean BMI regressed to 29.4 ± 4.1 kg/m2 in Group A (n = 46) and to 27.2 ± 4.5 kg/m2 in Group B (n = 83) (P < 0.001). In Group B, one patient experienced post-operative bleeding. No other complications were observed in the study. There was no significant difference between the groups in terms of operative time (P = 0.53) and length of hospital stay (P = 0.9). Conclusion: Weight loss before LSG does not improve post-operative weight loss.

Gastric Botulinum Toxin-A Application for Weight Loss Therapy.

BACKGROUND/AIMS: The aim of this study is to share the results of gastric botulinum toxin (BTX) application in individuals who are overweight or type 1 obese without comorbidity. MATERIALS AND METHODS: In this study, 13 patients were included who were enrolled for gastric BTX application for the first time. A total of 300 U of BTX-A (Allergan Botox ®1 vial 100 U) was diluted with 8 mL of 0.9% NaCl saline, and antrum (100 U to 8 spots), corpus (100 U to 8 spots), and fundus (100 U to 8 spots) regions were injected intramuscularly. Patients were given a 1200-calorie low-carb diet and this was followed for 6 months. RESULTS: Gastric BTX application was applied to 13 patients with a mean age of 40.9 ± 5.2 (85% female), a mean body mass index (BMI) of 28.41 ± 1.4 kg/m2 (26-31.6) and a mean excess weight of 10.1 ± 3.6 kg. As a result of the 6-month follow-up, only four patients (30.8%) were able to lose more than 50% of their excess weight (6-15 kg). Six patients (46.2%) could not lose any weight. There was an average decrease of 3.3 kg in the weight of patients before and after BTX application (P = .03). A mean decrease of BMI was detected, 1.17 kg/m2 (P = .032). CONCLUSION: It was concluded that the application of gastric BTX for weight loss does not provide effective results.

Porto-mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. A case report.

INTRODUCTION AND IMPORTANCE: Porta-mesenteric vein thrombosis (PMVT) is a rare but fatal complication in patients who are undergoing bariatric surgery. In this report, we present a rare case of a PMVT after laparoscopic sleeve gastrectomy (LSG). CASE PRESENTATION: A 52-year-old male patient with a body mass index of 42 kg/m2 was admitted to our clinic for morbid obesity. Standart LSG was performed with 5 trocar technique. 15 days after LSG, the patient admitted to the emergency department with complaints of abdominal pain, nausea and vomiting. The patient was dehydrated. His C-reactive protein level was 138 mg/L. Abdominal computerized tomography with contrast was performed and showed thickening of a part of small bowel wall in 10 cm length. Also, major trombosis were detected in the superior mesenteric vein branches and portal vein. The patient was hospitalized and 2 × 10,000 IU/1.0 mL high dosage low moleculer weight heparin (LMWH) therapy was initiated. The patient's clinical signs recovered rapidly following treatment. CLINICAL DISCUSSION: In LSG, if the gastroepiploic venous arcus, which runs along the greater curvatura, and has a direct connection to the portal circulation is damaged, a local thrombus may form and move towards the portal system over time. Dehydration is another significant predisposing factor for PMVT. Some patients may develop life-threatening intestinal ischemia. Abdominal tomography with contrast plays a major role in diagnosis. CONCLUSION: PMVT should be considered as a serious complication after LSG in patients with abdominal pain. With early diagnosis and anticoagulant therapy, patients's clinical symptoms may improve quicly.

Screening Esophagogastroduodenoscopy Before Laparoscopic Sleeve Gastrectomy: Results in 819 Patients.

Aim: The routine use of esophagogastroduodenoscopy (EGD) during the preoperative evaluation of surgical weight loss candidates is controversial. The aim of this study is to evaluate the findings of preoperative EGD in patients who are scheduled for a primary laparoscopic sleeve gastrectomy (LSG). The probable effect of these findings on the medical and surgical strategy that was followed is assessed. Methods: Findings of EGD obtained from consecutive LSG candidates and all data were prospectively recorded and retrieved from the database. Results: A total of 819 patients underwent EGD successfully. Mean age and body mass index were 38 ± 11.3 and 43.17 ± 7.2 kg/m2, respectively. Fifty-eight percent were female. EGD of 263 (32.1%) patients was normal and 687 (84%) patients were asymptomatic. At least one abnormal finding was detected in 65% of the asymptomatic patients. Abnormal findings that did not change the surgical strategy were found in 550 patients (67.2%). Findings such as gastritis or duodenitis that changed the medical management before surgery were found in 309 patients (38.2%). Helicobacter pylori was positive in 218 (26.6%) patients but eradication treatment was not applied in the preoperative period. No pathology was detected that would create absolute contraindication or change the type of surgery in any patient. Only technical modifications were required in 13% due to hiatal hernia. The timing of the planned surgery has changed in only 6 patients (0.74%) (early stage neuroendocrine tumor, leiomyoma, severe ulcer). Conclusions: Routine EGD performed before LSG did not change the planned bariatric option in any patient, but led to 13% rate of technical modifications due to the presence of hiatal hernia. At least one abnormal finding was detected in 65% of asymptomatic patients. Due to endoscopic findings, the rate of patients who started medical acid-suppression treatment in the preoperative period was 38%.

Sleeve gastrectomy in class 1 obesity: Assessment of operative outcomes.

BACKGROUND: The risk/benefit ratio of sleeve gastrectomy (SG), especially in patients without type 2 diabetes (T2D), is unknown for patients with class 1 obesity. OBJECTIVES: Assessment of operative outcomes of SG in class 1 obesity. SETTING: Private practice. METHODS: Candidates for a primary SG with body mass index 30-35 kg/m2 after 5 years of unsuccessful dieting were included after informed consent was obtained. Participants who did not complete 3-month follow-up and those who underwent modified SGs were excluded. Data and complications were recorded prospectively. Patients were followed up at 3, 6, and 12 months and yearly thereafter. Definition of presence and remission of T2D and insulin resistance were set according to guidelines. Effects on weight loss parameters were evaluated with Wilcoxon signed-rank test. RESULTS: Between 2012 and 2020, 143 consecutive SGs were performed in patients with class 1 obesity without conversion, leak, mortality, or a venous event. Two were lost to follow-up. In 141 participants, 2 bleedings and 1 colon perforation occurred (2.1% rate for acute life-threatening events). During a mean follow-up of 25.9 months; 1 case of functional stenosis and 4 cases of de novo symptomatic cholelithiasis clinically became evident in different patients, all requiring reoperation. Therefore a 5.6% rate of major complications were identified at 2 years. The benefit on weight loss was immediate and permanent (P < .001). T2D and insulin resistance were in remission in 100% and 98.1% of participants at 1 year, respectively. CONCLUSION: The 5.6% major complication rate reflects a minimum because more de novo symptomatic gallstones and stenosis are yet to occur or overlooked. Additionally, this excludes patients with de novo reflux and malnutrition, dissatisfaction issues, or recidivism. Caution is required to freely operate on patients with class 1 obesity with no co-morbidity. Evidence-based outcome data are lacking to balance the reported risks.

Hair Loss After Sleeve Gastrectomy and Effect of Biotin Supplements.

Aim: In this study, we aimed to determine the incidence of hair loss in patients who underwent laparoscopic sleeve gastrectomy (LSG), and to observe whether use of Biotin has an impact on hair loss. Methods: This study included 156 female patients who underwent LSG for obesity and completed a 1-year follow-up. All patients with vitamin deficiency were screened in the pre- and postoperative period. Hair loss was defined as the subjective perception of the women of losing a higher amount of hair when compared with normal situation. Results: Hair loss was observed in 72% of the patients after LSG (n = 112). Seventy-nine percent of the patients reported hair loss between the third and fourth-month interval, and continued for an average of 5.5 ± 2.6 months. Permanent alopecia was not observed in any of the patients. Patients who experienced hair loss and Biotin deficiency after LSG were prescribed 1000 mcg/day of Biotin for 3 months. Of these 22 patients; only 5 (23%) patients reported a remarkable decline in hair loss. In addition, 29 patients were found to take 1000 mcg/day of Biotin for average 2.5 months after onset of hair loss by their own initiative, despite optimal blood Biotin levels. Eleven (38%) patients reported a remarkable decline in hair loss. The effect of biotin use on hair loss in patients with and without biotin deficiency was compared. There was no significant difference (P = .2). Conclusion: Temporary hair loss after LSG is common. It was found that biotin supplementation used to prevent hair loss does provide low efficacy.

Combined partial posterior fundoplication with laparoscopic sleeve gastrectomy for morbid obese patients with symptomatic GERD. Video case report.

INTRODUCTION: Gastroesophageal reflux disease (GERD), which can be seen in up to 30% in postoperative series, is perhaps the most important complication of sleeve gastrectomy(SG). The general trend for patients who are planning to have bariatric surgery and have symptomatic GERD, Roux-en-Y gastric bypass is the most common choice. CASE PRESENTATION AND MANAGEMENT: A 42-year-old female patient with a body mass index of 36 kg/m2 presented to our clinic with obesity and symptomatic GERD. She had been using proton pump inhibitör (PPI) regularly for 1 year. Preoperative endoscopy showed hiatal hernia but no esophagitis. The patient underwent ambulatory pH study and GERD was confirmed. The patient was scheduled to have laparoscopic hiatal hernia repair plus combined partial posterior fundoplication and sleeve gastrectomy. Hiatal hernia was repaired, gastric fundus was passed behind the esophagus and partial posterior fundoplication was performed, and than SG was completed. She stopped using PPI in the early postoperative period and her reflux symptoms disappeared completely. The patient lost 20 kg in the 3rd month (%40 ewl) and underwent controlled ambulatory pH moniterization and no reflux was detected. CONCLUSION: In some cases this technique can be proposed to obese patients with GERD as a primary treatment modality. High numbers of patients and longer follow up care are needed to assess the long term efficacy and safety of this technique.

Cholelithiasis After Sleeve Gastrectomy and Effectiveness of Ursodeoxycholic Acid Treatment.

Aim: Few adverse effects may occur after bariatric surgery, one being the formation of gallstones. The aim of this study is to determine the incidence of cholelithiasis after laparoscopic sleeve gastrectomy (LSG) and whether ursodeoxycholic acid (UDCA) treatment reduces gallstone formation. Materials and Methods: Gall bladders of all patients planned for LSG were preoperatively checked by ultrasonography (USG). Patients who had no documented gallbladder pathology before LSG and who had USG at 12th month and 2 years follow-up after LSG were included in the study. The incidences of newly developed cholelithiasis, cholecystectomy, and endoscopic retrograde cholangiopancreatography (ERCP) requirement in patients who did not receive any UDCA treatment (pre-2015 protocol, n = 128) was compared with the corresponding numbers in patients who regularly used 500 mg/day oral UDCA for 6 months after the LSG (post-2015 protocol, n = 152). Results: Between January 2012 and October 2018, 717 LSGs were performed in two centers and after exclusions, 280 patients were eligible for evaluation. Sixty-four of 280 (23%) patients developed cholelithiasis after LSG and cholecystectomy was performed in 24 patients (8.6%) for symptomatic cholelithiasis. In the non-UDCA group, 48 patients developed cholelithiasis (n = 48/128, 37.5%) compared with 16 patients in the UDCA group (n = 16/152, 10.5%) (P < .001). Compared with 5 patients in the UDCA group, 19 patients underwent cholecystectomy (39.6%) in the non-UDCA group due to symptomatic cholelithiasis (P = .55) and 5 of these patients also required an ERCP. No ERCP became necessary in the UDCA group (P = .2). Conclusions: An almost fourfold decrease in the rate of new gall stone formation with 500 mg daily UDCA treatment was impressive and may suggest routine UDCA treatment after LSG. Given the rate of exclusions and follow-up differences among the groups, certainly, randomized trials, with less exclusion are needed to provide conclusive evidence.

Finding carcinoid tumor before bariatric surgery. Is preoperative endoscopy necessary? Case report.

INTRODUCTION: Carcinoid tumors are endocrine system-related lesions and 4% of the gastrointestinal tract's neuroendocrine tumors (NET) originate from stomach. In recent years, gastric carcinoid tumors have been reported at increasing rates on endoscopies. In this article, we will present a case of gastric carcinoid tumor detected at the upper gastrointestinal (GI) endoscopy during preoperative bariatric surgery workup. CASE PRESENTATION: A 55 years old male patient with body mass index (BMI) 46 kg/m2 was scheduled for bariatric surgery. Upper GI endoscopy revealed 2 separate 4-5 mm nodular lesions at gastric corpus and antrum. Biopsies were taken and both lesions were reported as neuroendocrine tumors. It was decided that the Laparoscopic sleeve gastrectomy (LSG) operation would be performed because both lesion areas would remain in the extracted part of stomach. DISCUSSION: The routine use of upper GI endoscopy in preoperative evaluation of bariatric surgery patients still remains controversial. CONCLUSION: Upper GI endoscopy is very important in determining various gastric pathologies and determining the most appropriate surgical method before bariatric surgery.

Sleeve gastrectomy in patients with previous antireflux surgery. Preliminary results of the "no-touch to posterior wrap" technique.

BACKGROUND: Reported morbidity of Roux-en-Y gastric bypass in patients with previous antireflux surgery warrants caution, and data on sleeve gastrectomy (SG) are unexpectedly scarce. OBJECTIVES: To evaluate the safety and efficiency of SG in patients who previously underwent an antireflux procedure. A new technique to preserve intact fundoplication is described. SETTING: Private practice, bariatric center of excellence, Turkey. METHODS: The following data were retrieved from our prospective data base: (1) details of previous repair; (2) clinical/endoscopic reflux status, body mass index (kg/m2), and presence of metabolic syndrome (MetS) and type 2 diabetes (T2D) before SG; (3) duration of SG, length of stay, complications; and (4) percent excess weight loss, MetS/T2D resolution, and reflux status at follow-up. RESULTS: Fifteen consecutive SGs were performed without conversion or major complications. The first case is excluded from the analysis because complete wrap unfolding was abandoned in favor of the described technique. Among 14, 10 had MetS, 4 had T2D, and 1 had a proven reflux recurrence before SG. Mean operating time was 118.5 minutes. All were discharged on the third postoperative day. Apart from 1 functional stenosis, no complications occurred. At 12 months, percent excess weight loss rate was 82.2, MetS resolved in 9 of 10, and T2D was in complete (n = 2) or partial remission (n = 1). No de novo reflux became evident, and absence of reflux was proved by pHmeter in 3. CONCLUSIONS: SG is feasible in patients who previously had antireflux repair with negligible morbidity and percent excess weight loss rates similar to that with regular sleeves. Results in reflux control needs further confirmation.

The effects of sleeve gastrectomy on shoe size one year after surgery.

OBJECTIVE: The aim of this study is to evaluate the effects of sleeve gastrectomy on shoe size one year after the procedure. To our knowledge, no study has yet been conducted addressing this issue. MATERIAL AND METHODS: Patients who were prepared for sleeve gastrectomy were eligible for the study, and all data and preoperative shoe sizes were recorded in our prospective database. At the 12th month of follow-up, each patient's excess weight loss % was calculated, and their shoe sizes were recorded by verbal report. Arbitrary or half-size changes were not taken into consideration. The probability of a change in shoe size and the effects of age, sex, preoperative body mass index, and 12th month excess weight loss % on this change were investigated. p<0.05 was regarded as statistically significant. RESULTS: The subjects of the study were 212 patients who completed their 12-month follow-ups after sleeve gastrectomy between January 2012 and February 2016. The mean shoe size was 41.5; this decreased to 40.5 one year after sleeve gastrectomy (p<0.001). In patients with body mass index (BMI)>50, both the mean decrease (p=0.008) and the percentage of at least two size decreases (p=0.009) were significantly higher than those in patients with BMI<40. Age, sex, and excess weight loss % did not have any significant effects on shoe size. CONCLUSION: Sleeve gastrectomy was clearly associated with decrease in shoe size after 12 months. Only preoperative body mass index was found to be directly associated with this decrease.

Laparoscopic revision surgery for gastroesophageal reflux disease.

Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases.From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated.The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers.

An assessment of the effect of Ginkgo Biloba EGb 761 on ischemia reperfusion injury of intestine.

BACKGROUND/AIMS: The aim of this study was to determine the effect of Ginkgo Biloba (EGb 761) on reperfusion injury of the small bowel. METHODOLOGY: Forty-eight male 200-250 g Spraque-Dawley rats in six groups were used to determine the biochemical and histopathological changes after a 30-min ischemia and 30-min reperfusion. Pre-treatment with 50 mg/kg EGb 761 (Tebofortan, Karlsruhe-Germany) or 10-mL/kg saline was administered intravenously in the treatment and control groups. The superior mesenteric artery was occluded distal to the right colic artery and collateral arcades were ligated to provide complete ischemia. Ischemia was determined by the existence of pulseless or pale color of the small intestine. The return of the pulses and the reestablishment of the pink color were assumed to be the reperfusion of the intestine. Rats that were administered Egb 761 and saline were subjected to laparotomy, ischemia, or ischemia-reperfusion procedures. Mucosal lesions were graded from 0 to 5 in histopathological examination. Malondialdehyde and myeloperoxidase levels of the intestinal mucosa were measured. RESULTS: No significant difference was noted between the control and treatment groups regarding the histopathological changes. Although malonyldialdehyde and myeloperoxidase levels of the reperfusion + EGb 761 group were slightly higher than the laparotomy + saline group, they were significantly lower than the reperfusion + saline group. CONCLUSIONS: We concluded that EGb 761 pre-treatment before ischemia-reperfusion decreased malondialdehyde and myeloperoxidase levels and attenuated the mucosal damage.