Laparoscopic sleeve gastrectomy improves excessive daytime sleepiness and sleep quality 6 months following surgery: A prospective Cohort study

Obstructive sleep apnea (OSA) is one of the most important co-morbid conditions related with morbid obesity. Bariatric procedures are associated with significant improvement in OSA. The aim of the current study was to evaluate the effect of bariatric surgery on daytime sleepiness and quality of sleep in patients that had undergone laparoscopic sleeve gastrectomy. Fifty-nine patients were prospectively enrolled in the study. Pre-operative and post-operative (6 months) demographics, medical history, weight, and height of the patients were recorded, and patients were asked to complete Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. OSA screenings were performed using the STOP-Bang questionnaire. The mean age of the patients was 37.1 +/- 1.2 years and 76% were female. Pre-operative and post-operative median (range) BMIs were 47 kg/m(2) (39-67 kg/m(2)) and 35 kg/m(2) (25-44 kg/m(2)), respectively (P < 0.001). The mean +/- standard deviation excess weight loss was 51.6 +/- 13.2%. In univariate analysis, total PSQI, STOP-Bang, and ESS scores were found to significantly improve 6 months after surgery (all P < 0.001). Multivariate mixed-model analysis showed a high correlation between the decrease in BMI and all key predictors. Mixed-model analysis revealed that every 1 kg/m(2) decrease in BMI was associated with a 0.32, 0.13, and 0.26 improvements in PSQI, STOP-Bang, and ESS scores, respectively (all P < 0.001). Laparoscopic sleeve gastrectomy is associated with rapid weight loss and improvements in sleep quality, daytime sleepiness, and the risk of OSA 6 months after surgery

The effect of morphometric and anatomic relationship of gallbladder to the liver on standard laparoscopic cholecystectomies and proposal of a new anatomical classification

OBJECTIVE: Anatomical variations of the extrahepatic biliary tree are frequently seen and may cause challenging conditions for surgeons. We aimed to investigate the morphological variations of the gall-bladder in patients who underwent cholecystectomy and their effects during and after the surgery, by using a new anatomical classification. PATIENTS AND METHODS: Dissection time, perioperative bleeding, perioperative/postoperative complication rates, the difference between preoperative/postoperative hematocrit and leukocyte levels of 164 symptomatic cholelithiasis patients who underwent laparoscopic cholecystectomy were evaluated. The patients' gallbladders were categorized in "seven" different types regarding their anatomical positions and morphometric relations with the liver's acute margin and fossa of the gallbladder. Relations between these gallbladders types and perioperative/postoperative parameters were also examined. RESULTS: The median time to complete the dissection of the gallbladder from the fossa was 375.5 seconds. The mean length of the fossa was 68.06 +/- 15.08 mm, the average size of the gallbladder was 92.10 +/- 18.79 mm. A positive correlation was found between dissection time and length of fossa vesica and also in the size of the gallbladder (p = 0.003, p = 0.034). Moreover, a positive correlation was found between the dissection time and the perioperative perforation risk of the gallbladder (p = 0.005). The most common type of gallbladder was type I and III (23.2%). The least common gallbladder type among the patients assessed as part of the study was type VI (6.7%). When the gallbladder types were compared, the perioperative perforation rate of the gallbladder wall was found to be significantly higher in morphological type V (p = 0.014). CONCLUSIONS: The perioperative perforation rate of the gallbladder wall was found significantly higher in morphological type V. To perform a safe cholecystectomy, surgeons should be aware of anatomical variations of the gallbladder and its relations with the liver parenchyma, which are important for surgical strategies

Spontaneous Gastrosplenic Fistula Resulting From Primary Gastric Lymphoma: Case Report and Review of the Literature

A fistulous tract between the stomach and the spleen is a rare manifestation. Spontaneous gastrosplenic fistula formation resulting from primary gastric lymphoma is extremely rare and should be managed as an emergency. To date, four gastrosplenic fistulas originating from gastric lymphoma have been reported, of which three were spontaneous and one occurred following chemotherapy. We report a case of spontaneous gastrosplenic fistula in a 35 years-old-man with gastric malignant B-cell non-Hodgkin’s lymphoma who was diagnosed by computed tomography and endoscopically, followed by successful treatment with total gastrectomy and splenectomy

Minimal invasive surgical approach with standard laparoscopic ınstruments for type I liver hydatid cyst patients

Hayvancılığın yaygın olduğu coğrafyalarda sık görülen ve Echinococcus granulosus’un etken olduğu hidatik kistinde antiparaziter ilaçlar kullanılsa da, en etkili tedavi minimal perkütan girişimlerden açık cerrahiye kadar uzanan invazif yaklaşımlardır. Çalışmamızda tip 1 karaciğer kist hidatik hastalarında standart laparoskopik el aletleriyle uygulanan minimal invazif cerrahinin etkinliğini araştırdık. Kliniğimizde 2013-2014 arasında on tane tip I (CE 1 – pür kistik) karaciğer kist hidatik hastasına uyguladığımız laparoskopik cerrahi girişimin verileri, literatür bilgileri ışığında değerlendirildi. Hastaların 5’i kadın 5’i erkekti. Hastaların ortalama yaşı 44 idi. Ortalama kist çapı 82.6 mm idi. Kistlerin en sık yerleşim yeri segment 2-3 idi. On hastanın sadece birinde indirekt hemaglitunasyon testi pozitif bulundu. Tüm hastalarda tanı histopatolojik olarak doğrulandı. Hastaların tamamına standart laparoskopik el aletleri kullanılarak laparoskopik unroofing+total kistektomi+drenaj uygulandı. Ortalama ameliyat süresi 95 dakika, hastaların ortanca yatış süresi 4 (2-18) gün, ortalama takip süreleri 13 aydı. Poliklinikten takip edilen hastalarda nüks saptanmadı. Günümüzde deneyimli merkezlerde seçilmiş hastalarda laparoskopik cerrahi girişimler karaciğer kist hidatik hastalığının tedavisinde etkin ve güvenli bir alternatif olarak tedavi algoritmasında yerini almaktadır ve düşük komplikasyon oranlarıyla uygulanabilmektedir. Özellikle pür kistik ekinokokkozların cerrahisinde özelleşmiş laparoskopik aletlere gerek olmadığını düşünmekteyizDespite antiparasite-drug-regimen, most effective treatment modality in hydatid disease – that is common in the husbandry regions and caused by Echinococcus granulosus – is still invasive in a spectrum of percutaneous techniques to major surgery. We evaluated the efficacy of minimal invasive surgery with standart laparoscopy instruments for type I hydatid cyst patients. Data of patients between 2013-2014 undergone laparoscopic surgery for liver type I (pure cystic) hydatid cyst were evaluated and discussed with literature data. There were 5 male, 5 female patients. Mean age was 44. Mean diameter of cysts was 82.6 mm. Most common locations for cysts in liver were segments 2 and 3. Only one patient had positive indirect hemagglutination test result. All diagnosis confirmed by histopathology. All patients had undergone laparoscopic procedure of unroofing+total cystectomy+drainage performed with standart instruments. Mean operative duration was 95 minutes. Median hospital stay value was 4 (2-18) days. Mean follow-up period was 13 months; no recurrence during follow-up. Laparoscopy take place as an effective and safe alternative in treatment algorythm of hydatid disease and can be performed with low rate of complications. We suggest that special laparoscopic instruments aren’t necessary for pure cystic echinococcosis’ surgery

Low educational status and childhood obesity associated with ınsufficient mid-term weight loss after sleeve gastrectomy: A retrospective observational cohort study

Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG). This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: =%50EWL (successful WL) in the sixth month. The independent predictors for insufficient weight loss six months after SG were analyzed. In the sixth post-operative month, their mean %EWL and percentage of excess body mass index loss (%EBMIL) were 50 +/- 15.4 and 58.2 +/- 19.3, respectively. In univariate analysis, group 1 patients were found to be significantly older when compared to group 2 patients while the education level of group 2 patients was significantly higher when compared to group 1. A tertiary educational level at a university or higher was associated with a nearly fourfold increased success in weight loss (AOR 3.772, p = 0.03) 6 months after SG. Multivariate analysis showed that patients with a history of childhood obesity were more likely to have insufficient weight loss (AOR 0.390, p = 0.045). Childhood obesity and a lower level of education are associated with insufficient weight loss 6 months after SG. However, prospective external validation is warranted, with a long-term follow-up of a large bariatric surgery population