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Öğe The association between psoas muscle area index and morbidity/mortality in laparoscopic gastric cancer surgery(2022) Turgut, Emre; Zengin, Akile; Bağ, Yusuf Murat; Kaplan, Kuntay; Güneş, Orgun; Karatoprak, Sinan; Sümer, FatihAs advanced gastric cancer often leads to obstruction or cancer-related cachexia, gastric cancer seems to have a closer association with sarcopenia than other types of cancer. Our study aim was to investigate the relationship between the psoas muscle area (PSMA) and morbidity and mortality in patients undergoing gastric cancer surgery. The data of patients who underwent laparoscopic gastric resection between November 2014 and April 2020 were analyzed retrospectively. The intervertebral disc space was verified at L3-4 in the sagittal plane. The PSMA on the right and left sides were measured separately and then added to obtain the total PSMA. This value was then divided by the patient's height (m2) to calculate the psoas muscle area index (PSMAI) (mm2/m2). The mean PSMAI of men (741.1 mm2/m2) was significantly higher than that of women (502.1 mm2/m2) (p<0.001). While there was a positive correlation between the PSMAI and BMI (r:0.352, p:0.019 in women; r:0.447, p<0.001 in men), the correlation between PSMAI and age was negative (r: -0.369, p:0.014 in women; r:-0.349, p<0.001 in men). PSMAI was statistically lower in patients with attendant morbidity (p:0.035). There was no significant relationship between PSMAI and the first 30-day mortality rate (p:0.096); however, the association between PSMAI and both the 90-day mortality rate (p:0.023) and the total mortality rate (p:0.046) were significant. In our opinion, assessing gastric cancer patients for sarcopenia and supporting them with the necessary nutrition and exercise program prior to surgery can help predict and lower postoperative morbidity and mortality rates.Öğe Can revision of RYGB to sleeve gastrectomy be a solution to inadequate weight loss treatment?(Mexican Acad Surgery, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Sumer, Fatih; Kayaalp, CuneytWe aimed to discuss the weight loss success of the revision of RYGB to sleeve gastrectomy (SG). Between January 2019 and June 2020, four patients' files were analyzed retrospectively. Post-RYGB mean minimal BMI was 27.4 +/- 9.47 kg/m2, be-fore SG the mean BMI was 43.41 +/- 4.16 kg/m2. Post-operative gastric fistula developed in two patients. The mean follow-up time after revision surgery was 17.25 +/- 6.89 months, mean excess weight loss (EWL) was 74.77 +/- 8.94%, and mean BMI was 32.65 +/- 2.9 kg/m2. Despite high rate of major complications, revision of RYGB to SG is successful in weight loss and resolving certain complications of RYGB.Öğe The Effects of Laparoscopic Sleeve Gastrectomy on Metabolic Syndrome(Mary Ann Liebert, Inc, 2019) Turgut, Emre; Aydin, Cengiz; Ugurlu, LeventPurpose: Obesity is an important component of metabolic syndrome. In this study, we aim to research the effect of laparoscopic sleeve gastrectomy (LSG) on metabolic syndrome. Methods: A total of 164 patients who had undergone LSG between January 2013 and August 2016 were included in the study. Data collected from preoperative examinations and follow-ups until the 12th month postoperation were retrospectively analyzed. Results: A total of 86.6% of patients were female and 13.4% were male. The average age was 36.6 years and average body mass index was 45.5 kg/m(2). Excess weight loss was 48.5% in month 3, 67% in month 6, and 83.7% in month 12. The number of patients diagnosed with metabolic syndrome preoperatively was 118; this number dropped to 29 by the 6th month and to 11 by the 12th month. Conclusions: LSG is a very effective procedure for treating metabolic syndrome, which is considered an important cause of mortality and morbidity.Öğe Helicobacter pylori Increases Gastric Compliance on Resected Stomach After Laparoscopic Sleeve Gastrectomy(Springer, 2021) Kaplan, Kuntay; Turgut, Emre; Okut, Gokalp; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytBackground The relationship between high body mass index (BMI) and Helicobacter pylori (HP) was reported previously. But the mechanism is not clear. We aimed to evaluate the effect of HP on gastric compliance and volumes in obese patients. Materials and Methods One hundred fifty-nine patients who underwent sleeve gastrectomy due to morbid obesity were enrolled in the study and were divided into two groups as HP+ (n = 86) and HP- (n = 73) according to the HP status in resection materials. Demographics, pathological data, specimen sizes, volume, and compliance were retrospectively analyzed. Results The median age of the study group was 34 years (17-64 years) while the median BMI was 43 kg/m(2) (35-64, 3 kg/m(2)). Most of the patients (n = 134, 84.3%) were female. The median diameter of the widest point of the specimen was 22.5 cm (14-32 cm), and the median volume of the specimen was 790 cc (330-1920 cc). Both the diameter of the widest point and the volume of the specimens were significantly increased in the HP+ group compared to the HP- group (p < 0.001 and p = 0.017, respectively). In addition, the median compliance was 52.6 cc/mmHg, and the compliance was significantly higher (p < 0.001) in the HP+ group. There were no significant differences in specimen sizes between the two groups. Conclusion This is the first study showing that HP increases gastric compliance in obese patients who underwent LSG. The etiology and the effects of this increase in compliance have not been fully clarified yet. Further studies are needed to shed light on these effects.Öğe The impact of splenectomy on human lipid metabolism(Upsala Med Soc, 2022) Gunes, Orgun; Turgut, Emre; Bag, Yusuf Murat; Gundogan, Ersin; Gunes, Ajda; Sumer, FatihBackground: Splenectomy impacts hematological, immunological, and metabolic functions of the patient. Since our understanding of its metabolic effects, in particular effects on lipid metabolism, is limited, this study aims to investigate the effects of splenectomy on lipid metabolism. Methods: The data from 316 patients undergoing splenectomy between 2009 and 2019 were retrospectively analyzed. Thirty- eight patients whose serum lipid values were measured both preoperatively and 1 year after surgery were included in this study. Results: Significantly higher levels of total cholesterol, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) lipid profile were found in the postsplenectomy measurements. However, no significant differences were recorded in levels of triglyceride, HDL, or very-LDL. Conclusion: We determined that splenectomy does impact lipid metabolism, and that the metabolic effects of splenectomy should further be investigated.Öğe Is It Possible to Estimate the Liver Left Lobe Volume Using Preoperative Data Before Bariatric Surgery?(Springer, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytY Purpose Retraction of the left lobe of the liver (LLL) is an important step in bariatric surgical procedures. A good liver retraction will both facilitate the operation and reduce complications. The aim of the study is to identify patients with large LLL with preoperative anthropometric and laboratory data, and to reveal complications due to large LLL. Materials and Methods The data of 245 patients who underwent bariatric surgery in our department between April 2019 and March 2021 were retrospectively analyzed. The patients were divided into two groups according to the visibility of the caudate lobe of the liver, the left diaphragmatic artery-vein, and the fat pad on the esophagus after liver retraction. Results Univariate analyses revealed significant differences in BMI, waist and hip circumferences, TG, DM, and HbA1c values, but only BMI (p = 0.001) and the presence of DM (p = 0.017) were found to be independent predictors of LLL size. BMI >= 42.1 kg/m(2) indicates the size of LLL with 83% sensitivity and 49% specificity. Retractor-related complications were significantly higher in the large LLL group (p = 0.036). There was no difference between the two groups in terms of complications related to trocar insertion (p = 0.014) and postoperative liver enzyme levels (p = 0.714). The operation time (laparoscopic sleeve gastrectomy [LSG]; p = 0.021) (laparoscopic Roux-N-Y gastric bypass [LRYGB]; p = 0.020) and the amount of bleeding (LSG; p < 0.001) (LRYGB; p = 0.011) are higher in patients with large LLL. Conclusion Large LLL can be predicted and complications may be reduced with the help of preoperative data.Öğe Is Previous Abdominal Surgery an Obstacle to Laparoscopic Bariatric Surgery?(Springer India, 2021) Turgut, Emre; Kaplan, Kuntay; Okut, Gokalp; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytIt is generally considered that a previous history of abdominal surgery can negatively impact the patient's perioperative course. But the effects of it on laparoscopic bariatric surgery have not been sufficiently documented. Therefore, our study aims to analyse the impact of previous abdominal surgery on patients undergoing bariatric surgery. Data from patients who underwent surgery between January 2011 and November 2019 was analysed retrospectively. The study population was divided into the following four groups: those with no history of previous abdominal surgery (group A), those who had previously undergone lower abdominal (group B), upper abdominal (group C) and those who had both lower and upper abdominal surgery (group D). Patients' demographic data, type of surgical procedure, operative time, length of hospitalization, perioperative and postoperative complications were recorded for each patient in the database. In the case of 4 (0.3%) patients, conversion to open surgery from a laparoscopic intervention was required. No significant difference was found between the groups with previous abdominal surgery in terms of intraoperative complications (p: 0.551). The rate of postoperative complications was higher in patients who had previously undergone upper abdominal surgery; however, the difference in this rate compared to the other groups was found to be statistically insignificant (p: 0.189). We believe that during the decision-making process, neither patients nor surgeons should see previous abdominal surgery as an obstacle to laparoscopic bariatric surgery, thus permitting more freedom in selecting the most appropriate type of surgery for the patient.Öğe Is Sleeve Gastrectomy or Roux-en-Y Gastric Bypass Better in Terms of Quality of Life?(Mary Ann Liebert, Inc, 2021) Turgut, Emre; Okut, Gokalp; Kaplan, Kuntay; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytIntroduction: Obesity has increased in frequency over recent years. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used technique worldwide, followed by the laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aims to compare the effects of these two techniques, LSG and LRYGB, on the patients' quality of life. Material and Methods: All patients who underwent surgery or postoperative checkups at our obesity clinic between December 2018 and December 2019 completed two face-to-face questionnaires: the Short Form 36 Health Survey and the Obesity-related Problems Scale. Information on each patient such as demographic data, American Society of Anesthesiologists scores, any previous surgeries, preoperative and/or postoperative complications, the type of surgery, and time elapsed since surgery was compared, retrospectively. Results: No significant statistical differences were found between the two procedures. A significant improvement in the postoperative quality of life was observed in all patients. Scores for female patients were observed to be lower than for male patients. No significant statistical difference was observed between the two age groups (50 years and older or <50 years) for either the LSG or LRYGB patients. Higher body mass index levels have prolonged hospital stay and score lower on many of the parameters.Öğe Management of the staple line bleeding in laparoscopic sleeve gastrectomy: monopolar cautery versus oversewing(Mexican Acad Surgery, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Karahan, Mehmet; Bag, Yusuf M.; Sumer, Fatih; Kayaalp, CuneytObjective: Staple line bleeding control (SLBC) after laparoscopic sleeve gastrectomy (LSG) is a serious problem. Cauterization alone is generally not preferred because of concerns about weakening the staple line. The aim of this study was to compare the suturing and monopolar cauterization methods for SLBC in LSG. Methods: 212 patients were divided into two groups as cautery and suture groups. Demographic characteristics, intraoperative, and post-operative results were analyzed. Results: Post-operative complications were seen in seven patients, four of them staple line bleeding (three patients were in the cautery group and one patient was in the suture group), and three of them leakage (all patients were in the suture group) from the staple line. There was no significant difference between the groups in terms of staple line bleeding (p = 0.35), staple line leakage (p = 0.09), blood loss (p = 0.12), intraoperative complications (p = 0.16), post-operative hemoglobin decrease (p = 0.63), and length of hospital stay (p = 0.35), but the operation time was longer in the suture group. Conclusion: This is the first study in literature comparing monopolar cauterization with another technique. Monopolar cauterization can be used for SLBC in LSG. It is a safe and efficient method as well as inexpensive.Öğe Splenic surgery: a ten years experience of a tertiary center in Turkey(Edizioni Luigi Pozzi, 2022) Gunes, Orgun; Bag, Yusuf Murat; Turgut, Emre; Gunes, Ajda; Sumer, Fatih; Kayaalp, CuneytAIM: Splenectomy has been performed for various indications. In this study, we aimed to present the experience of a tertiary center on splenic surgery and analyze what has changed in the last 10 years. MATERIAL AND METHODS: Three hundred and sixteen patients who underwent splenic surgery were enrolled in the study. Demographic data, comorbidities, American Society of Anesthesiologists score, indications, operation type, postoperative complications, and mortality were analyzed retrospectively. RESULTS: The most common indication was traumatic splenic injury. Immune thrombocytopenic purpura (ITP) and gastric cancer were the second and third. Splenectomy was performed on 300 (94.9%) patients. Splenorrhaphy, partial splenectomy, and splenopexy were the other procedures performed. Postoperative complications occurred in almost onethird of the patients (n=118, 37.3%). Most of them were grade 5 according to the Clavien-Dindo classification. CONCLUSIONS: Splenectomy has become a less preferred treatment option with the development of non-operative management in splenic trauma, medical treatments for hematological diseases, and a better understanding of the immune, hematological and metabolic functions of the spleen. In the future, minimally invasive and spleen-sparing surgeries will be performed more frequently for patients who need splenectomy even for those with trauma.Öğe Ten years single center bariatric surgery experience(2021) Turgut, Emre; Kaplan, Kuntay; Okut, Gokalp; Cengiz, Emrah; Kocaaslan, Hüseyin; Baran, Necip Tolga; Karahan, Mehmet; Kayaalp, CuneytIntroduction: Various surgical modalities have been developed to reduce the amount and absorption of nutrients in the fight against obesity. We aimed to share how the single-center experience was affected by the developments in the world and its change over time with the literature. Materials and Methods: The records of patients who underwent laparoscopic bariatric surgery between May 2010 and December 2020 were reviewed retrospectively. Demographic characteristics of the patients, indications for surgery, preparation for surgery, surgical technique, and post-operative follow-up stages were examined in detail. Results: A total of 1422 patients underwent bariatric surgery over a 10-year period. Laparoscopic Roux-n-Y Gastric Bypass (LRYGB) was performed in 946 patients and Laparoscopic Sleeve Gastrectomy (LSG) was performed in 476 patients. The operation time (p<0.001) and the intraoperative blood loss (p<0.001) in LRYGB were significantly higher than LSG. The difference was not significant in terms of length of hospital stay (p=0.149) and drain usage (p=0.782). While intraoperative complications occurred in 49 (5.1%) patients in LRYGB, this number was 5 (1%) in LSG (p<0.001). There was no significant difference in Clavien Dindo class 3 and higher complication rates between the groups (p=0.782). Mortality was seen in only 7 (0.5%) patients. Conclusion: Today, standard techniques are applied in both procedures and the choice is left to the patient. Regardless of the technique applied, laparoscopic bariatric surgery can be applied as an effective and safe method in the treatment of morbid obesity until an alternative treatment is found.Öğe Von Wahl Sign in Sigmoid Volvulus Patient with Cerebrovascular Disease(Gazi Univ, Fac Med, 2021) Uylas, Ufuk; Gundogdu, Ramazan; Turgut, EmreIn addition to radiological imaging, physical examination is also of great importance in the diagnosis of sigmoid volvulus. The presence of a palpable sigmoid colon on abdominal examination is known as the von Wahl sign. A 77-year-old female patient with a history of paraplegia caused by CVD was admitted to the emergency service with abdominal pain and obstipation. Abdominal examination of the patient revealed asymmetric distension in the abdomen in inspection and von Wahl sign in palpation. The coffee bean appearance on the plain radiograph supported the sigmoid volvulus. Successful colonoscopic detorsion was applied to the patient. Six months later, sigmoid volvulus recurrence occurred in the patient who refused elective surgery. Sigmoid colon resection and Hartmann's procedure were performed. The patient, who developed respiratory failure, died on the second postoperative day. In addition to imaging in patients with neurodegenerative disease, findings such as von Wahl sign in the physical examination are supportive in the diagnosis of sigmoid volvulus.
