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    Acute Liver Failure following Sleeve Gastrectomy with Jejuno-Ileal Bypass
    (Elsevier Sci Ltd, 2021) Aktas, Aydin; Gokler, Cihan; Sansal, Mufit; Karadag, Nese; Kayaalp, Cuneyt
    Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric surgery in recent years, and some modifications have emerged to improve its efficacy. Melissas has described SG plus jejuno-ileal bypass (JIB), which has reported good results in a few studies. We performed this procedure in 21 cases and in one case, we observed acute liver failure (ALF) that has not been reported before. Case presentation: A 38-year-old female (BMI: 56.1 kg/m(2)) underwent laparoscopic SG plus JIB. There was no sign of diarrhea, malnutrition or liver failure for eight months and her BMI was 43.0 kg/m(2). At the 9th month, she was hospitalized for abdominal pain, jaundice and ALF. The patient was treated by plasmapheresis and molecular absorptive recirculation system. She was planned to undergo liver transplantation but died of multiorgan failure on the 40th day of hospitalization. Conclusion: ALF can be observed following SG plus JIB. JIB reversal before compromising liver functions should be taken into consideration. (C) 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
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    Influence of Drain Placement on Postoperative Pain Following Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: Randomized Controlled Trial
    (Springer, 2018) Gundogan, Ersin; Kayaalp, Cuneyt; Aktas, Aydin; Saglam, Kutay; Sansal, Mufit; Gokler, Cihan; Cicek, Egemen
    There is currently no evidence to support the routine use of an abdominal drain following laparoscopic Roux-en-Y gastric bypass (RYGB). Our aim was to investigate drain use in laparoscopic RYGB and its effects on postoperative pain. Sixty-six patients were randomly divided into two groups as no-drain (n = 36) and with-drain (n = 30). Intraoperative (time, blood loss, complications) and postoperative outcomes (morbidities, pain scores, hospital stay) were compared. Demographics of both groups were comparable. Three patients in the no-drain group required a drain (8.3%). Median visual analog scale scores for days 1-3 for with-drain and no-drain groups were 4.5 (2-9) vs. 3 (0-8) (p = 0.02), 3 (0-7) vs. 2 (0-7) (p = 0.10), and 2 (0-7) vs. 0 (0-4) (p = 0.0004), respectively. There was no difference between the groups in terms of complications and length of hospital stay. Drain use increased the postoperative pain following laparoscopic RYGB. Drain placement following laparoscopic RYGB should be selective instead of a routine application.
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    Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass
    (Elsevier Science Bv, 2018) Gundogan, Ersin; Kayaalp, Cuneyt; Aktas, Aydin; Saglam, Kutay; Sansal, Mufit; Uylas, Ufuk; Gokler, Cihan
    Background: Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. Objectives: The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. Setting: University hospital. Methods: A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. Results: A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. Conclusions: In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.
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    Recurrent Gastric Bezoar after Roux-en-Y Gastric Bypass for Morbid Obesity
    (Springer India, 2019) Aktas, Aydin; Sansal, Mufit; Saglam, Kutay; Sumer, Fatih; Kayaalp, Cuneyt
    In this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A 66-year-old patient, who had diabetes mellitus (DM) and hypertension (HT) and had LRYGB operation 3years ago, underwent the first endoscopic bezoar evacuation 26months after the operation due to the diagnosis of gastric bezoar following the examination due to the nausea-vomiting and inability to eat. The patient applied again 36months after LRYGB with similar complaints. A 3-cm gastric bezoar, which was detected with the endoscopic examination at the anastomosis site, was evacuated after disintegration. The possibility of a bezoar formation should be kept in mind in patients with Roux-en-Y gastric bypass, who complain of nausea and vomiting. The removal of the bezoar leads to a dramatic improvement in the complications. These patients should follow strictly their diets, chew their food thoroughly, take vitamin supplements, and solve their psychological problems in the postoperative period. Otherwise, gastric bezoar may recur.
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    Transanal specimen extraction following combined laparoscopic colectomy and liver resection
    (Mexican Acad Surgery, 2020) Gundogan, Ersin; Kayaalp, Cuneyt; Sansal, Mufit; Saglam, Kutay; Sumer, Fatih
    A 47-year-old woman admitted with constipation and a sigmoid colon adenocarcinoma and liver metastasis was diagnosed. Synchronous laparoscopic anterior resection and liver metastasectomy were done and transanal specimen extractions were performed for both resection materials. No recurrence or procedure-related problem was found in the follow-up of the 14th months, and her esthetic score was determined as 9/10. Transanal specimen extraction can be a viable method for patients with left-sided colon cancer with liver metastasis. It avoids additional abdominal incision, and as far as we know, this is the first liver specimen removed through the anus.