Intragastric Migration of Gastric Band Diagnosed During Surgery: A Case Report and Literature

Intragastric band migration (IGBM) is one of the major complications of gastric banding. In this report, we aimed to present a case of IGBM, which was diagnosed intraoperatively, and to review the relevant literature. A 59-year-old male patient was admitted to our outpatient clinic due to epigastric pain persisting for the past three months. The patient had a history of gastric banding surgery owing to obesity with open surgery nine years ago. Postoperative follow-up was not done properly and the patient had started to gain weight in the third postoperative year. Incisional hernia was found in physical examination and operation for gastric band removal and hernia repair was planned. During surgery, the band could not be found around the stomach, therefore, gastroscopy was performed and it was found that the majority of the band was placed in the stomach. The patient was intraoperatively diagnosed with IGBM and the band was removed through gastrotomy, and hernia repair was performed. The patient was discharged at postoperative 6th day without any complication. Although IGBM is rarely seen, it should be considered as a long-term complication in cases with dysfunctional gastric band and in patients who started to gain weight after operation. Treatment is the removal of the band review

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

The Feasibility of Scoring Systems for the Prediction of Mortality in Patient with Fournier’s Gangrene: A retrospective analysis of 53 Patients

Abstract Purpose Fournier's gangrene (FG) is a polymicrobial disease that affects the skin and subcutaneous tissue and is life-threatening. This study aimed to evaluate the feasibility of scoring systems in predicting mortality in FG patients. Material and Method: 53 patients diagnosed with FG and operated between March 2008-August 2020 in our clinic were included. These patients' demographic findings, laboratory values, Fournier's Gangrene Severity Index (FGSI), Uludağ Fournier's Gangrene Severity Indexi (UFGSI), the Sequential Organ Failure Assessment (SOFA), and Age-Adjusted Charlson Comorbidity Index (ACCI) scoring system values were recorded and analyzed regarding how these scoring systems affected mortality. Results 11 (21%) of the 53 patients died, and 42 (79%) survived. The mean age of the patients was 53.64±17.2 years. The mean age of the surviving patients was 49.64±15.26 years, while the mean age of the patients who died was 68.91±15.96 (p=0.002). Of the laboratory parameters, only creatinine elevation was significant in demonstrating mortality (p=0.001). When the impact of scoring systems on mortality was evaluated, it was determined that the increase in FGSI(P=0.000), UFGSI(P=0.000), SOFA(P=0.000), and ACCI(P=0.003) values were directly related to mortality and statistically significant. Conclusion The FGSI, UFGSI, SOFA, and ACCI scoring systems used in our study were correlated with mortality for FG. ACCI had the highest diagnostic confirmation value. This was followed by SOFA, FGSI, and UFGSI, respectively. We recommend that these scoring systems be used to predict mortality for FG.</jats:p

A Massive Colorectal Lipoma Prolapsed with Invagination Through Anal Canal: Case Report

Colorectal lipoma is a rare and generally asymptomatic lesion of the colon. Symptoms emerge as the lipoma grows in size. We here describe our diagnosis and management of a case presenting with abdominal pain, rectal bleeding, and protruding rectal mass for 15 days. A soft mass which had prolapsed through the anus was observed on physical examination. Colonoscopy could not be performed due to the irreducible mass, and urgent surgery was planned. The mass was resected with rectosigmoid resection. The patient developed no complications and was discharged on the 7th postoperative day

External Oblique Intercostal Plane Block Versus Port-Site Infiltration for Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study

Purpose Although laparoscopic sleeve gastrectomy (LSG) is a minimally invasive surgery, postoperative pain is common. A novel block, the external oblique intercostal (EOI) block, can be used as part of multimodal analgesia for upper abdominal surgeries. The aim of our study is to investigate the effectiveness of EOI block in patients undergoing LSG. Materials and Methods Sixty patients were assigned into two groups either EOI or port-site infiltration (PSI). The EOI group received ultrasound-guided 30 ml 0.25% bupivacaine, while the PSI group received 5 ml of 0.25% bupivacaine at each port sites by the surgeon. Data on clinical and demographic were collected and analyzed. Results There were no statistical differences in terms of demographic details (p > 0.05). VAS scores were statistically lower during resting at PACU, 1, 2, 4, 8, and 12 h postoperatively in the EOI group than PSI group (p < 0.05), The VAS scores were also lower during active movement at PACU, 1, 2, 4, and 8 h postoperatively in the EOI group than PSI group (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the EOI than in the PSI group (505.83 +/- 178.56 vs. 880.83 +/- 256.78 mu g, respectively, p < 0.001). Rescue analgesia was higher in PSI group than EOI group (26/30 vs. 14/30, respectively, p = 0.001). Conclusion EOI block can be used as a part of multimodal analgesia due to its simplicity and effective postoperative analgesia in LSG