Global 30-Day Morbidity and Mortality of Primary Bariatric Surgery Combined with Another Procedure: The BLEND Study.

BACKGROUND: No robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures. OBJECTIVES: The objective of this study is to collect a 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair. SETTING: This is as an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures. METHODS: The audit took place from January 1 to June 30, 2022. A descriptive analysis was conducted. A propensity score matching analysis compared the BLEND study patients with those from the GENEVA cohort to obtain objective evaluation between combined procedures and primary BMS alone. RESULTS: A total of 75 centers submitted data on 1036 patients. Sleeve gastrectomy was the most commonly primary BMS (N = 653, 63%), and hiatal hernia repair was the most commonly concomitant procedure (N = 447, 43.1%). RYGB accounted for the highest percentage (20.6%) of a 30-day morbidity, followed by SG (10.5%). More than one combined procedures had the highest morbidities among all combinations (17.1%). Out of overall 134 complications, 129 (96.2%) were Clavien-Dindo I-III, and 4 were CD V. Patients who underwent a primary bariatric surgery combined with another procedure had a pronounced increase in a 30-day complication rate compared with patients who underwent only BMS (12.7% vs. 7.1%). CONCLUSION: Combining BMS with another procedure increases the risk of complications, but most are minor and require no further treatment. Combined procedures with primary BMS is a viable option to consider in selected patients following multi-disciplinary discussion.

Is the Anal Component of the Anogenital HPV-Related Disease Overlooked During the Surveillance of Patients Treated for Cervical Intraepithelial Neoplasia?

AIM: To investigate the anal component of the anogenital Human Papillomavirus (HPV) related disease during surveillance of patients treated for cervical intraepithelial neoplasia (CIN). METHODS: Patients were analyzed within two groups according to the histopathological examination of the cervical biopsies: Low-Grade Squamous Intraepithelial Lesion (LSIL) and High-Grade Squamous Intraepithelial Lesion (HSIL) groups. Anal specimens were also collected in the first-year follow-up visit. RESULTS: All patients had cervical high-risk HPV (HR HPV) infection at admission. At the first-year follow-up, positive HR HPVs were found in 47% of cervical samples. Despite this clearance, the anal HPV infection rate after the first year was 42.5% and 39.6% in LSIL and HSIL groups. Amongst the HSIL group, anal HR HPV positivity was observed in 29.6% of cases without any cervical HPV infection. CONCLUSION: A group of women cured of high-grade lesions have ongoing anal HPV infection. It is reasonable to propose that detecting anal HPV could impact the patient's treatment process. Therefore, prospective studies are needed to investigate this group of women's clinical outcomes and define the clearance rate of cervical HPV infection when anal HPV persists.

Might simple peripheral blood parameters be an early indicator in the prediction of severity and morbidity of cholecystitis?

Purpose: The aim of this study is to examine the effectiveness of the neutrophil-lymphocyte ratio (NLR) and CRP/albumin ratio (CAR) in evaluating disease severity and predicting clinical outcomes in patients diagnosed with acute cholecystitis (AC). Methods: A total of 186 patients with AC were evaluated retrospectively. NLR, CAR, Mannheim Peritonitis Index (MPI), and P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scores were compared with AC severity grade. Results: The rates of the grade 1 patients (group 1) and the grade 2-3 patients (group 2) were 57.5% (n = 107) and 42.5% (n = 79) according to the disease severity according to Tokyo Guidelines criteria (TG) 18/TG13, respectively. The morbidity rates determined in groups 1 and 2 were 26.7% (n = 28) and 51.9% (n = 41), respectively. No mortality was found in group 1, whereas the mortality rate in group 2 was 6.3% (n = 5). According to multivariate analysis, CAR (odds ratio [OR], 1.234; P < 0.001) and MPI (OR, 1.175; P = 0.001) were found to be associated with moderate-severe disease while CAR (OR, 1.109; P = 0.035) and P-POSSUM morbidity (OR, 1.063; P = 0.007) variables were found to be associated with the presence of morbidity. Conclusion: We have demonstrated that CAR can be used in predicting severity of AC and that CAR is an alternative simple parameter of P-POSSUM morbidity score in prediction of morbidity in these cases. In addition to other assessment methods, these scores can provide valuable and complementary information in assessment of disease severity and prognosis in AC.

The Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Diastolic Function, Aortic Elasticity, and Atrial Electromechanics Delay.

BACKGROUND: Obesity is a well-known risk factor for cardiovascular diseases. The aim of this study was to prospectively investigate the short-term effects of laparoscopic sleeve gastrectomy (LSG) on cardiac functions. METHODS: Forty-four morbidly obese patients who underwent LSG were included in the study. The aortic systolic and diastolic diameters, left ventricular (LV) diameter, LV cardiac output and cardiac index, LV ejection fraction, LV septal and lateral wall velocities, deceleration time of the E wave, the LA volume index and atrial mechanic functions, and atrial conduction times were evaluated. RESULTS: The patients' aortic stiffness index showed a significant improvement at postoperative control: 3.23 ± 0.58, 2.49 ± 0.36; p<0.001 for preoperative and postoperative aortic stiffness index, respectively. A significant reduction was observed in the LV mass and relative wall thickness (RWT) of the patients: 182.41 ± 36.87 g, 154.85 ± 24.32 g; p<0.001 and 0.42 ± 0.07, 0.39 ± 0.05; p=0.010 for the preoperative and postoperative LV mass and RWT, respectively. A statistically significant decrease was observed in total atrial conduction time and interatrial and intraatrial conduction time in the postoperative period: 120.95 ± 22.27 ms, 106.57 ± 20.46 ms; p=0.001; 13.82 ± 8.21 ms, 10.66 ± 6.78 ms; p=0.038, and 29.64 ± 14.18 ms, 24.09 ± 10.95 ms; p=0.047 for preoperative and postoperative total atrial conduction time, intraatrial electromechanical delay, and interatrial electromechanical delay, respectively. CONCLUSIONS: Weight loss reduced aortic stiffness, IVS and posterior wall thickness, LAV, LAVi, LA passive emptying fraction, and atrial electromechanical delays in morbidly obese patients.

Phyllodes Tumors of the Breast: A Single-Center Experience.

OBJECTIVE: We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT). MATERIALS AND METHODS: The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed. RESULTS: Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis. CONCLUSION: PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.

Short-term changes and correlations of plasma spexin, kisspeptin, and galanin levels after laparoscopic sleeve gastrectomy.

PURPOSE: To determine the circulating levels of spexin, kisspeptin, galanin, and the correlations between these peptides after laparoscopic sleeve gastrectomy (LSG). METHODS: The plasma levels of the spexin, kisspeptin, and galanin and metabolic parameters (body mass index, weight loss, % excess weight loss, body fat, fasting glucose, HbA1C, and cholesterol levels) were measured (baseline, 1 month, and 3 months) and correlated in thirty adult individuals with obesity (22 female and 8 male) after LSG. RESULTS: The body mass index (BMI), body fat, fasting glucose, total and low-density lipoprotein cholesterol decreased, while high-density lipoprotein cholesterol and % EWL (excess weight loss) increased at 3 months after surgery. The plasma spexin levels increased at 3 months, kisspeptin levels increased at 1 month and stabilized afterward, and galanin levels decreased at 3 months after LSG. Significant correlations were found between metabolic parameters with spexin, kisspeptin, and galanin. In addition, spexin and kisspeptin were negatively correlated with galanin, while spexin was positively correlated with kisspeptin. CONCLUSIONS: The biochemical data reveal evidence that LSG causes an increase in the levels of spexin, and kisspeptin and a decrease in galanin levels. Our findings, therefore, suggest a possible interaction between these novel peptides, which have potential roles in obesity and glucose metabolism.

Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant.

Orthotopic liver transplantation is a life-saving procedure for patients with end-stage liver failure. However, Acinetobacter baumannii infections and acute rejection are important causes of morbidity and mortality following transplants. Here we present a case report of a cadaveric donor liver transplantation with infectious complications detected after transplantation. The patient was a 64-year-old female. Because of non-alcoholic steatohepatitis due to hepatic insufficiency (model for end-stage liver disease (MELD): 12; Child-Pugh: 9B), liver transplantation from a cadaveric donor was performed. Following the transplantation, the patient developed a blood stream infection, urinary tract infection (UTI) and postoperative wound infection from biliary leakage. A. baumannii was isolated from blood, urine and wound cultures. Imipenem (4×500 mg), tigecycline (2×50 mg) and phosphomycin (4×4 g) were administered intravenously (IV). On the 14th day of treatment, the bile fistula closed and there was no bacterial growth in blood and urine cultures. The patient was discharged with full recovery. The duration of a transplant patient's hospital stay, intensive care unit stay, invasive interventions, blood transfusions and immunosuppressive treatments cause an increased risk of extensively drug-resistant (XDR) A. baumannii infections, and a high mortality rate is seen despite antibiotic treatment. Phosphomycin, used in combination therapy, may be an alternative in the treatment of XDR pathogens in organ transplant patients, due to its low side effect profile and lack of interaction with immunosuppressives.

Right iliac bone pathological fracture mimicking acute appendicitis.

Simple bone cyst (SBC) also known as unicameral bone cyst is a benign, radiolucent bone lesion that is seen commonly in childhood. These lesions are usually found incidentally although pain and swelling can be seen. The most common complication is a pathological fracture, and this is often the cause of presentation. Here, we present a 22-year-old male with right lower quadrant pain due to SBC related pathological fracture of right iliac bone which is mimicking acute appendicitis.

Effects of Tempol on Experimental Acute Necrotizing Pancreatitis Model in Rats.

AIM: We aimed to investigate the effects of Tempol on local organ damage in an experimental acute pancreatitis model. METHODS: This experimental study was conducted on 40 male Wistar- albino rats. The animals were randomly allocated into four groups: (i) Sham-operated group, laparotomies and cannulations of the pancreatic duct without acute necrotizing pancreatitis (ANP) (n=10); (ii) Sham + Tempol group, identical to group 1 except for intravenous tempol treatment for 4 hours (n = 10); (iii) ANP group, glycodeoxycholic acid was infused into the pancreatic duct and cerulein was infused intravenously for 6 hours for development of ANP (n=10); and (iv) ANP + Tempol treated group, in addition to the procedure in group 3, rats were administered tempol intravenously for 4 hours (n = 10). Injury of the pancreas was evaluated histopathologically. Malondialdehyde and myeloperoxidase levels of the pancreatic tissue, blood gas analysis, leukocyte and hematocrit levels were measured. Wet/dry weight of pancreatic tissue was also measured. RESULTS: Serum amylase levels, pancreatic tissue malondialdehyde and myeloperoxidase levels, wet/dry weight ratio, pancreatic edema, acinar necrosis, fat necrosis and hemorrhage, inflammation and perivascular infiltration were significantly lower in the ANP + Tempol group compared with the ANP group. CONCLUSION: Tempol infusion reduced local organ damage due to acute necrotizing pancreatitis in this experimental study. These findings demonstrate that tempol has protective effects on local organ damage due to acute necrotizing pancreatitis in rats.