Potential associations between alterations in gut microbiome and obesity-related traits after the bariatric surgery.

BACKGROUND: This study aimed to examine the effects of both obesity and bariatric surgery on gut microbiome, dietary intake, as well as metabolic and inflammatory parameters. METHODS: All participants (15 with morbid obesity who had bariatric surgery, 8 with morbid obesity and 11 non-obese) were followed up for a 6-month period with interviews at baseline (M0), at the end of 3 (M3) and 6 months (M6). Dietary assessment was done, and blood and faecal samples were collected. RESULTS: Dietary energy and nutrient intakes as well as serum glucose levels, total cholesterol, low-density lipoprotein (LDL)-cholesterol and high sensitivity C-reactive protein (hs-CRP) levels decreased after surgery (p < 0.05, for each). Participants with morbid obesity had higher levels of Firmicutes and lower levels of Bacteroidetes at M0 compared to non-obese participants. The abundances of Bacteroidetes increased (p = 0.02), whereas that of Firmicutes decreased (p > 0.05) after the surgery, leading to a significant decrease in Firmicutes/Bacteroidetes ratio (p = 0.01). At sub-phylum level, the abundances of Lactobacillus and Bifidobacterium decreased, whereas those of Akkermansia increased after the surgery (p < 0.01, for each). Although participants who were morbidly obese had a distinct profile according to ß-diversity indices at M0, it became similar with the profile of non-obese participants (p > 0.05) at M3 and M6. Similarly, α-diversity indices were lower in subjects with morbid obesity at M0, but became similar to levels in non-obese controls at M6. CONCLUSION: This study confirmed that bariatric surgery has substantial impacts on gut microbiome's composition and diversity, as well as anthropometrical measurements and biochemical parameters, which were associated with the alterations in dietary intake patterns.

Single Port vs. Four Port Cholecystectomy--Randomized Trial on Quality of Life.

BACKGROUND: Classical laparoscopic cholecystectomy involves four ports while most novel 'single port' technique only requires one incision on the abdominal wall. This technique is thought to decrease surgical trauma and improve cosmesis although there are reports pointing out that classical laparoscopic cholecystectomy is also feasible in terms of cosmesis. OBJECTIVES: In this study we tried to determine if there are certain advantages in quality of life after single port surgery which would justify its utilization instead of classical laparoscopic cholecystectomy. MATERIAL AND METHODS: This is a prospective randomized study which enrolled 30 patients randomized either into classical laparoscopic cholecystectomy or single port surgery. The primary endpoint was patient satisfaction after surgery. This was assessed with short form 36 and gastrointestinal quality of life index (first preoperatively and then 3 months postoperatively) and a visual analogue scale on the first and seventh days. RESULTS: There was not a statistically significant difference between groups in the emotional role, social functions, mental health, vitality and general health subscales of short form 36. At the end of 12 weeks, both groups demonstrated increases in the gastrointestinal and social subscales of the gastrointestinal quality of life index. There was not a statistically significant difference between groups when the visual analogue scale scores on first and seventh days were compared. CONCLUSIONS: The equal length of hospitalization, patient quality of life and pain perception and the longer operative times, high likelihood of incisional hernia and surgical site infection call into question the utilization of single port surgery, as it does not seem to confer an advantage over classical laparoscopic cholecystectomy.

Giant Extra-Adrenal Retroperitoneal Myelolipoma With Incidental Gastric Mesenchymal Neoplasias.

Extra-adrenal myelolipomas are rare, benign tumors composed of adipose tissue and hematopoietic cells. Almost all myelolipomas occur within the adrenal gland. Only 50 cases of myelolipomas were described in literature and none of these were associated with gastric mesenchymal neoplasia. A 72-year-old male patient presented to a family medicine outpatient clinic with dyspnea and urinary urgency. His abdominal sonography revealed a 9-cm intra-abdominal mass. An incidental finding was 2 separate masses 1 cm each on the serosal surface of the stomach. The pathology specimen of the retroperitoneal mass revealed myelolipoma histopathology while gastric masses were reported as spindle cell mesenchymal neoplasias. The association of gastric spindle cell tumor and myelolipoma was not reported before in medical literature. Extra-adrenal myelolipomas are rare lesions, but should be considered in the differential diagnosis of fat containing retroperitoneal masses that are well circumscribed.

Utility of endoscopy for diagnosis of barrett in a non-Western society: endoscopic and histopathologic correlation.

Barrett esophagus is metaplastic transformation of esophageal squamous epithelium to columnar cells. A total of 1370 patients who had undergone upper endoscopy because of dyspeptic complaints were enrolled in the study. Age, sex, alcohol and smoking habits, body mass index, type and duration of symptoms (heartburn, epigastric pain, nausea, vomiting), and use of proton pump inhibitors were evaluated in all patients and recorded on standardized forms. Patients were grouped as normal esophagogastric junction, long-segment Barrett esophagus, and short-segment Barrett. Biopsies were taken from at least 6 points and examined histopathologically. Of the 1370 patients involved in the study, 748 (54.6%) were female and 622 (45.4%) were male. Mean age was 47.2 ± 15.30 years. Short-segment Barrett esophagus was detected in 16 patients, and long-segment Barrett was detected in 11 patients. Although Barrett esophagus was detected in 11 cases that were suspected to have Barrett during endoscopy, histopathology was negative in all cases that were not suspected to have Barrett. Barrett esophagus prevalence was significantly higher in people who used alcohol and tobacco and who had hiatal hernia. Although Barrett esophagus was detected in 40% of cases that were suspected to have Barrett during endoscopy, histopathology was negative in all cases that were not suspected to have Barrett. Barrett was detected in 40.7% of cases that were suspected to have Barrett during endoscopy; histopathology was negative in all cases that were not suspected to have Barrett. Senstivity of endoscopy is questionable in detection of short-segment Barrett.

Nephron-saving surgery for abscess of renal allograft using radiofrequency bipolar sealer.

Thousands of patients with renal disease are on waiting lists for kidney transplant. Survival and quality of life on hemodialysis are much lower than that after renal transplantation. Renal allografts are extremely valuable and worth saving at all costs. Many complications can be seen after organ transplants on short and long term as rejection, vascular compromise, and infection. There are various reports on partial nephrectomy after renal transplant secondary to de novo masses in the renal allograft. Here, we present a case where we used radiofrequency bipolar sealer for partial nephrectomy for necrotic abscess of the renal allograft. We successfully saved the allograft with partial nephrectomy despite parenchymal infection and necrosis.

Long term efficacy of laparoscopic adjustable gastric banding--retrospective analysis.

BACKGROUND: Laparoscopic procedures have emerged over the past decade for treatment of obesity. Laparoscopic adjustable gastric banding is the easiest surgical technique for morbid obesity. OBJECTIVES: The authors analyzed the long term results of laparoscopic adjustable gastric banding in their center. MATERIAL AND METHODS: A total of 172 consecutive patients who had undergone laparoscopic adjustable gastric banding between May 2005 and February 2011 in authors clinic were contacted for evaluation. The main outcome measures were complications, secondary operations, percent excess weight loss, mortality, patient satisfaction and band removal rate. RESULTS: The follow-up rate was 62.2%. Mean age of patients was 30.6 years. Mean body mass index of patients was 48.47 +/- 7.8 kg/m2. Median follow-up interval was 36 months (min 8, max 81) and band removal rate was 19.1%. There was one mortality. Of all patients, 33 had band removal. The band was removed laparoscopically in 21 patients. The main reason for band removal was slippage followed by band erosion. After band removal, 4 patients had re-banding, 5 had Roux-en-Y gastric bypass. Overall, the mean percent excess weight loss was 50.6 +/- 7.8% (range, 5-100%). Mean percent excess weight loss for those who had band removal was 27.8 +/- 5.78% (range 12.5-34.1%). Overall satisfaction index was rated as "good" for 42% of patients. CONCLUSIONS: Despite a low satisfaction index, considerable mean percent excess weight loss and vast improvement in co-morbidities is achieved after laparoscopic adjustable gastric banding. The authors conclude that laparoscopic adjustable gastric banding can be utilized as the initial surgical procedure in morbid obesity.

Controversies in periampullary tumors.

Periampullary tumors are one of the most common tumors of the gastrointestinal tract. Despite the increase of 1-5% in five year life expectancy in periampullary tumors prognosis is still poor. The controversies in diagnosis, surgical and adjuvant treatment will be discussed in this article.

Two unusual presentations of appendiceal masses.

Appendix is one of the most common organs harboring intra-abdominal pathologies both in acute and chronic settings. Appendiceal diseases in elderly population is hard to differentiate owing to the age related changes and wide spectrum of differential diagnosis. Even uncomplicated diseases of the appendix can have features mimicking a neoplasm. Here we present two cases of appendiceal masses. First case presented with symptoms and findings of an invasive neoplasm and the second case had findings of a pelvic mass. Both cases were treated successfully.