The outcome of concomitant cholecystectomy with bariatric surgery: a retrospective cohort study.

Gallstones are more common in obese individuals than in healthy individuals. They are diagnosed during the preoperative evaluation for bariatric surgery (BS). However, simultaneous cholecystectomy with BS is still controversial in patients with asymptomatic gallstones in the same session. In this study, the authors aimed to present an analysis of these operations performed with BS in the hospital. Materials and Methods: The records of 396 patients who underwent BS at Samsun VM Medicalpark Hospital between September 2017 and October 2021 were retrospectively reviewed. The length of hospital stay, operation time, complications, and safety of patients who underwent simultaneous cholecystectomy and BS only were examined. Results: Of 396 patients, 262 (66.1%) underwent laparoscopic sleeve gastrectomy and 134 (33.8%) underwent laparoscopic gastric bypass surgery. Gallstones were detected during the preoperative examination in 72 (18.1%) of the 396 patients who underwent BS. It was observed that 11 of them had symptoms. No major complications occurred during or after surgery in patients who underwent simultaneous cholecystectomy and only in those who underwent BS. Conclusion: Simultaneous cholecystectomy with BS does not burden the patient, and complication rates are very low. The procedure is also cost-effective, as patients do not require a second surgery.

Does Neutrophil-Lymphocyte Ratio Correlate with the Improvement of Hepatosteatosis after Laparoscopic Sleeve Gastrectomy?

INTRODUCTION: Obesity is a disease that shortens life expectancy and predisposes to many diseases such as severe hepatosteatosis. Hepatosteatosis is characterized by inflammatory infiltration of the portal space. Bariatric surgery has improvement effect on hepatosteatosis and degree of inflammation. Laparoscopic sleeve gastrectomy is an effective and most common therapeutic option for obesity. Neutrophil-lymphocyte ratio is a parameter associated with inflammatory disease. This study aimed to investigate if there is any correlation between improvements in hepatosteatosis and biochemical parameters especially neutrophil-lymphocyte ratio and ultrasonographic findings 1 year after the laparoscopic sleeve gastrectomy. METHODS: The files of 66 patients who underwent laparoscopic sleeve gastrectomy between May 2017 and April 2020 were retrospectively reviewed. Preoperative and postoperative 1-year demographic data, biochemical and inflammatory parameters, and ultrasonographic reports of the liver were reviewed. RESULTS: A statistically significant improvement in hepatosteatosis was demonstrated by ultrasonography 1 year after laparoscopic sleeve gastrectomy. A significant decrease was also observed in neutrophil-lymphocyte ratio. No correlation was found between the decrease of neutrophil-lymphocyte ratio and improvement in hepatosteatosis. There was also significant difference between the preoperative and postoperative BMI, biochemical and inflammatory parameters. CONCLUSION: However, we found laparoscopic sleeve gastrectomy is associated with significant improvement in hepatosteatosis and inflammatory parameters; no correlation between the improvement in hepatosteatosis and NLR was seen at 1 year.

Hepatic portal venous gas does not show the severity of intestinal.

Hepatic portomesenteric venous gas is a rare condition. Although a CT scan can show hepatic portal vein gas, the intestine's condition can still be misdiagnosed at the very early stage. Accordingly, the decision to operate has to be made based on or after a physicial examnination and laboratory results. In this report, we present a case of portomesenteric venous gas in which the gas was no longer discernible on the control CT scan, even though the patient developed peritonitis.

Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis: Our initial experience and technical details.

OBJECTIVE: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature. MATERIAL AND METHODS: Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. RESULTS: The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence. CONCLUSION: Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

Effects of preoperative conventional and hyperfractionated radiotherapy on the healing of rat colonic anastomoses.

BACKGROUND: One problem associated with end to end anastomoses after preoperative radiotherapy is leakage. The strength of the anastomoses is very important. Fractionation schedules are widely under investigation to achieve higher doses with less toxicity and high curative potential. The aim of this study was to compare preoperative conventional and hyperfractionated radiotherapy effects on anastomoses. MATERIALS AND METHODS: Sixty Wistar albino rats were divided into 3 groups: control, conventional radiotherapy (2 Gy/fraction, total 44 Gy), and hyperfractionated radiotherapy (1.2 Gy/fraction, total 52.8 Gy). 5 weeks after completion of the treatment, the rats underwent end to end anastomoses to the rectum. Following the surgery, the bursting pressure of the anastomoses and the hydroxyproline levels were measured on days 3 and 7. RESULTS: The bursting pressure was lower in both radiotherapy groups on the 3rd day. On day 7, the results of the conventional radiotherapy arm matched those of the control group, but the results of the hyperfractionated group did not (p = 0.001). On day 3, hydroxyproline levels were significantly lower in both radiotherapy groups than in the control group (p = 0.001). On the 7th day, the statistical difference disappeared within the radiotherapy groups. However, the hydroxyproline levels of the 2 radiotherapy arms were still lower than those of the control group (p = 0.001). CONCLUSION: Hyperfractionation strongly inhibits collagen synthesis and is associated with protracted healing.

Should intraoperative ultrasonography be used routinely in hepatic hydatidosis?

BACKGROUND/AIMS: Recurrent or secondary hydatidosis are the most important problems of hepatic hydatidosis in the late postoperative period. The spread of cystic liquid, overlooked centrally located or pericystic satellite cysts that are inconspicuous during operation are the basic reasons for the problem. METHODOLOGY: In order to prevent the risk of recurrent or secondary hydatidosis, 22 liver hydatid cystic patients were taken for a prospective study. Beyond the routine investigations and researches, after the completion of conventional surgical procedures, intraoperative ultrasonography was applied to all patients. RESULTS: In three patients the existence of cysts were not found by conventional research (13.63%), in another patient (4.54%) cysto-biliary communication which had been determined clinically but was invisible due to difficulty in anatomic localization was verified by means of intraoperative ultrasonography. CONCLUSIONS: Intraoperative ultrasonography has been thought to be beneficial to find centrally localized cysts which may be inconspicuous especially in cases of multiple cysts.