The efficacy of liraglutide combined with intragastric balloon on weight loss

OBJECTIVE: Intragastric balloon placement is an effective method for weight reduction. The aim of this study was to evaluate the efficacy of combining liraglutide with intragastric balloon.METHODS: Initially, demographic data of patients such as age, gender, comorbid diseases, adverse events, initial weight, height, body mass index,percent body fat, and waist-hip ratio were collected. Weight, body mass index, percent body fat, and waist-hip ratio were measured in the second, third, fourth, fifth, and sixth months. Then, intragastric balloon was removed and liraglutide was stopped.RESULTS: A total of 50 patients were included in the study, of whom 28 (56%) were in Group A (intragastric balloon) and 22 (44%) were in Group B (plus liraglutide). Weight change at the time of balloon removal was higher in Group B [median weight change 13.8 (7.8 min to 16.8 max) versus 7.9 (4.8 min to 11.8 max); p<0.01]. When the weight, percent body fat, body mass index, and waist-hip ratio changes were compared according to gender, no significant difference was observed in the groups. Comorbid diseases were hypertension in 7 patients (4 in Group A and 3 in Group B) and diabetes in 9 patients (5 in Group A and 4 in Group B). No statistical significance was found.CONCLUSION: Liraglutide has benefits in terms of weight, percent body fat, and body mass index reduction when administered with intragastric balloon

The difficulties encountered in conversion from classic pancreaticoduodenectomy to total laparoscopic pancreaticoduodenectomy

WOS: 000384291900008PubMed ID: 27251830Background: Recently, total laparoscopic pancreatectomy has been performed at many centres as an alternative to open surgery. In this study, we aimed to present the difficulties that we have encountered in converting from classic open pancreaticoduodenectomy to total laparoscopic pancreatectomy. Materials and Methods: Between December 2012 and January 2014, we had 100 open pancreaticoduodenectomies. Subsequently, we tried to perform total laparoscopic pancreaticoduodenectomy (TLPD) in 22 patients. In 17 of these 22 patients, we carried out the total laparoscopic procedure. We analysed the difficulties that we encountered converting to TLPD in three parts: Preoperative, operative and postoperative. Preoperative difficulties involved patient selection, preparation of operative instruments, and planning the operation. Operative difficulties involved the position of the trocars, dissection, and reconstruction problems. The postoperative difficulty involved follow-up of the patient. Results: According to our experiences, the most important problem is the proper selection of patients. Contrary to our previous thoughts, older patients who were in better condition were comparatively more appropriate candidates than younger patients. This is because the younger patients have generally soft pancreatic texture, which complicates the reconstruction. The main operative problems are trocar positions and maintaining the appropriate position of the camera, which requires continuous changes in its angles during the operation. However, postoperative follow-up is not very different from the classic procedure. Conclusion: TLPD is a suitable procedure under appropriate conditions

Placing of the provisional hemodialysis catheters with the guidence of doppler ultrasonography : early and late outcomes

Amaç: Böbrek yetmezlikli hastalarda hemodiyaliz amaçlı geçici kateter uygulaması sık kullanılan bir yöntemdir. Makalemizde; Doppler ultrasonografi (USG) eşliğinde uygulanan hemodiyaliz amaçlı geçici kateter deneyimlerimizi sunmayı amaçladık. Gereç ve Yöntem: Kap-Damar Cerrahisi Kliniğimizde Ocak 2010-Ocak 2012 tarihleri arasında hemodiyaliz amaçlı geçici kateter uygulanan 270 hasta yaş, cinsiyet, kateter endikasyonu, uygulama yeri, çıkartılma sebepleri ve komplikasyonları açısından retrospektif olarak incelendi. Bulgular: Böbrek yetmezlikli 270 hastaya toplam 320 defa geçici hemodiyaliz kateteri takıldı. En sık giriş yeri 240 olguda sağ internal juguler vendi (İJV). 11 olguda erken dönemde, 30 olguda ise geç dönemde komplikasyon gelişti. En sık görülen komplikasyon kateter disfonksiyonu idi. Sonuç: Geçici hemodiyaliz kateterlerinin kullanımı erken ve geç dönemde yüksek komplikasyon oranları ile beraberdir. Erken dönem koplikasyonların azaltılmasında Doppler USG eşliğinde kateterizasyon önem kazanırken, geç dönem komplikasyonların azaltılmasında en önemli faktör kronik böbrek yetmezlikli hemodiyaliz gerektiren hastalarda en kısa zamanda kalıcı vasküler erişim yolunun oluşturulmasıdır.Objective: Placing of the temporary hemodialysis catheters in the patients with renal failure disease is a commonly used practice. In this study, we aimed to present our experiences on placing of temporary hemodialysis catheters with the guidance of doppler ultrasonography. Material and Methods: In our cardiovascular surgery clinic, between January 2010 and January 2012, 270 patients who were inserted temporary hemodyalysis catheter, were screened retrospectively for their age, sex, catheter insertion indication, insertion site, removing reasons and complications. Results: Temporary hemodyalysis catheters were used in 270 patients with renal failure disease at 320 times. Right internal jugular vein (IJV) was the most common insertion site as in 240 patients. In 11 cases, early complications were developed and in 30 cases, late complications were seen. The most commonly seen complication was catheter dys- function. Conclusion: Usage of temporary hemodyalysis catheters may result in increased rate of some early and late complications. Insertion, guided with doppler ultrasonography has gained importance in preventing early complications. On the other hand, in patients with renal failure disease requiring hemodyalysis, early creation of permanent vascular access site is the most important issue for preventing late complications

A reliable pancreaticojejunal anastomosis with V-Loc 180 wound closure device for soft pancreatic stump

WOS: 000335085400046PubMed ID: 24901167Background/Aims: Although mortality rates decreased in recent years, pancreaticoduodenectomy is still associated with high morbidity rates. Pancreatic fistula is the leading cause of morbidity after pancreaticojejunal anastomosis and commonly occurs in soft pancreas. The objective of this study is to compare outcomes of conventional modified invaginated end to side pancreaticojejunostomy with a new practical method using V-Loc (TM) 180 wound closure device in soft pancreas. Methodology: Between December 2011 and August 2013, a total of 90 pancreaticoduodenectomy procedures were performed in our hospital. 28 of them were defined as soft pancreas according to attending surgeon and included in this study. Patients were divided into two groups consecutively and analysed for postoperative pancreatic fistula (POPF) rate, length of stay, operation time, cost and particular duration of anastomosis. Pancreatic fistulas were classified according to International Study Group on Pancreatic Fistula (ISGPF) definition. Results: 1 grade A and 2 grade B fistulas appeared in V-Loc group (Group 1), whereas 1 grade A, 2 grade B and 1 grade C fistulas appeared in conventional anastomosis group (Group 2). Conclusions: Pancreaticojejunostomy with V-Loc suture is a convenient method in soft pancreas and can be performed safely

Placing of the provisional hemodialysis catheters with the guidence of doppler ultrasonography: Early and late outcomes

Amaç: Böbrek yetmezlikli hastalarda hemodiyaliz amaçlı geçici kateter uygulaması sık kullanılan bir yöntemdir. Makalemizde; Doppler ultrasonografi (USG) eşliğinde uygulanan hemodiyaliz amaçlı geçici kateter deneyimlerimizi sunmayı amaçladık. Gereç ve Yöntem: Kap-Damar Cerrahisi Kliniğimizde Ocak 2010-Ocak 2012 tarihleri arasında hemodiyaliz amaçlı geçici kateter uygulanan 270 hasta yaş, cinsiyet, kateter endikasyonu, uygulama yeri, çıkartılma sebepleri ve komplikasyonları açısından retrospektif olarak incelendi. Bulgular: Böbrek yetmezlikli 270 hastaya toplam 320 defa geçici hemodiyaliz kateteri takıldı. En sık giriş yeri 240 olguda sağ internal juguler vendi (İJV). 11 olguda erken dönemde, 30 olguda ise geç dönemde komplikasyon gelişti. En sık görülen komplikasyon kateter disfonksiyonu idi. Sonuç: Geçici hemodiyaliz kateterlerinin kullanımı erken ve geç dönemde yüksek komplikasyon oranları ile beraberdir. Erken dönem koplikasyonların azaltılmasında Doppler USG eşliğinde kateterizasyon önem kazanırken, geç dönem komplikasyonların azaltılmasında en önemli faktör kronik böbrek yetmezlikli hemodiyaliz gerektiren hastalarda en kısa zamanda kalıcı vasküler erişim yolunun oluşturulması- dır.Objective: Placing of the temporary hemodialysis catheters in the patients with renal failure disease is a commonly used practice. In this study, we aimed to present our experiences on placing of temporary hemodialysis catheters with the guidance of doppler ultrasonography. Material and Methods: In our cardiovascular surgery clinic, between January 2010 and January 2012, 270 patients who were inserted temporary hemodyalysis catheter, were screened retrospectively for their age, sex, catheter insertion indication, insertion site, removing reasons and complications. Results: Temporary hemodyalysis catheters were used in 270 patients with renal failure disease at 320 times. Right internal jugular vein (IJV) was the most common insertion site as in 240 patients. In 11 cases, early complications were developed and in 30 cases, late complications were seen. The most commonly seen complication was catheter dysfunction. Conclusion: Usage of temporary hemodyalysis catheters may result in increased rate of some early and late complications. Insertion, guided with doppler ultrasonography has gained importance in preventing early complications. On the other hand, in patients with renal failure disease requiring hemodyalysis, early creation of permanent vascular access site is the most important issue for preventing late complications

Poliüretan membranın karıniçi adezyonlar ve septik kolon anastomuzu üzerine etkileri

BACKGROUND: Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%-8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions. METHODS: This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured. RESULTS: No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3. CONCLUSION: We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.AMAÇ: Gastrointestinal sistem cerrahisinden sonra görülen anastomoz kaçağı ve adezyonlar hala önemli bir morbidite ve mortalite nedenidir.Anastomoz kaçağı oranı %3–8 iken, kaçağa bağlı mortalite oranı %30’un üzerindedir. Karıniçi sepsis anastomoz kaçağının iyi bilinen bir nedenidir. Ayrıca, karıniçi adezyon hastane başvurularının ve morbidite ve mortalite ile ilişkili reoperasyonların önemli bir nedenidir. Bu çalışmada, bir poliüretan membranın anastomoz iyileşmesi ve karıniçi yapışıklıklar üzerine etkileri araştırıldı.GEREÇ VE YÖNTEM: Bu çalışma için dört gruba ayrılmış 32 Wistar Albino sıçan kullanıldı. Çekal ligasyon ve perforasyon oluşturulduktan sonraperitoneal refleksiyonun 2 cm yukarısından standart sol kolon rezeksiyonu ve anastomozu yapıldı. Kontrol gruplarına (1, 3) herhangi bir tedavi verilmedi. Deney grubunda (2, 4) ise kolon anastomozunun etrafına poliüretan membran sarıldı. Patlama basıncı, hidroksiprolin, IL-6 (interlökin 6),NO (nitrik oksit), TPA (doku plazminojen aktivatörü), TNF-α (Tümör nekroz faktörü alfa) seviyeleri ölçüldü ve relaparotomi sonrası anastomozun histopatolojik özellikleri analiz edildi. Ayrıca adezyon skorları ölçüldü. BULGULAR: Üçüncü ve beşinci günler arasında sakrifiye edilen hayvanlar arasındaki ortalama patlama basıncı değerlerinde istatistiksel olarak anlamlı bir fark yoktu (p=0.259, p=0.177). Tüm gruplar karşılaştırıldığında, hidroksiprolin, NO, IL-6 seviyeleri arasında anlamlı bir fark gözlenmedi(p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). Bununla birlikte, grup 2 ve grup 4’te, TPA seviyeleri poliüretan membran tedavisi ile anlamlı olarak yüksekti (p=0.001, p=0.003) ve adezyon skorlarına göre istatistiksel olarak anlamlı bir fark vardı (p<0.035). Grup 2 ve grup 4, grup1 ve grup 3’ten daha düşük adezyon skorlarına sahipti. TARTIŞMA: Biz deneysel septik kolon anastomoz modelinde poliüretan membranın histopatolojik ve biyokimyasal iyileşme üzerinde pozitif veya negatif bir etkisi olmadığını bulduk. Ancak, poliüretan membranın anastomoz çevresine uygulanması intraabdominal adezyonları etkili bir şekilde azaltmaktadır

Our preliminary experience and short term results in endovascular treatment of aortic lesions

Amaç: Çalışmamızda, kliniğimizde endovasküler aort tamiri yapılan torasik ve abdominal aort patolojilerinde ilk deneyimlerimizi ve 6 aylık sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: Ocak 2012-Nisan 2013 tarihleri arasında endovasküler aort tamiri yapılan 14 hasta (13 erkek, 1 kadın; ortalama yaş 68,43±9,89 yıl) retrospektif olarak incelendi. On dört hastanın 9’una abdominal endovasküler aort tamiri (EVAR), 5’ine endovasküler torakal aort tamiri (TEVAR) yapılmıştı. Tüm Olguların birinci ve 6. ay kontrol kontrastlı bilgisayarlı tomografileri değerlendirildi. Bulgular: Hastaların komorbidite sebeplerine bakıldığında birinde diabetes mellitus, 5'inde hipertansiyon, ikisinde geçirilmiş aorta koroner bypass greft operasyonu, ikisinde kronik obstruktif akciğer hastalığı, ikisinde malignite, birinde geçirilmiş batın operasyonu, ikisinde kronik böbrek yetmezliği ve 4 hastada sigara kullanımı mevcuttu. İşlemlerin tümünde başarı oranı %100 idi. İşlem sırasında major komplikasyon ve açık cerrahiye gereksinim olmadı. Hiçbir hastada greft enfeksiyonu ya da anevrizma rüptürüne bağlı ölüm gözlenmedi. Sonuç: Endovasküler aortik tamir işlemi açık cerrahi için yüksek riskli olgularda (ileri yaş, komorbidite varlığı, geçirilmiş batın operasyonu) düşük mortalite ve morbidite oranlarına sahip olması, bu hastalarda güvenli bir şekilde uygulanılabilmesi, hastanede kalış süresinin daha az olması ve daha kısa süreli anestezi kullanımının yanı sıra, yüksek teknik başarıya sahip bir yöntem olmasın nedeniyle tercih edilebilir bir uygulama haline gelmiştir. Uygun endikasyonlarda yapıldığında hastayı daha az travmatize eden, hekim açısından ise açık cerrahiye göre daha kolay ve daha az riskli ve işlem süresi kısa olan bir tedavi yöntemi olduğu kanaatindeyiz. Daha kesin sonuçlar için daha büyük serilere ve daha uzun dönem takiplere ihtiyaç duymaktayız.Objective: In this study, we aimed to present our preliminary experience and 6 month follow up results in patients who underwent endovacular aorta repair for thoracic and abdominal aortic pathologies. Material and Methods: Fourteen patients who underwent endovascular aorta repair (13 men, 1 woman; mean age 68.43&plusmn;9.89 years) between January 2012- April 2013 were analyzed retrospectively. Nine of patients had endovascular abdominal aorta repair, 5 of them had endovascular thoracic aorta repair. All patients had computerized tomography with contrast in the first and sixth months. Results: One of the patients had diabetes mellitus, 5 had hypertension, 2 had aorta coronary bypass graft operation, 2 had chronic obstructive lung disease, 2 had malignancy, 1 had abdominal surgery, 2 had chronic renal insufficiency and 4 patients were smokers. The success of intervention was 100%.There were no major complications or need for an open surgery. None of the patients died due to graft infection or aneurysm rupture. Conclusion: Endovascular aortic repair is one of the preferred procedures in high risk cases (advanced age, comorbidities, history of abdominal surgery). This method has low mortality and morbidity ratios, can be performed safely in these patients, has a short hospital stay, short anesthesia duration and high technical success. We suppose that, when performed in correct indications, it causes less harm to the patients, it is easier an less risky for the surgeon compared to open surgery, and it takes a shorter time. For more precise results, a larger study population and a longer follow-up period are needed

Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer

WOS: 000345121000092PubMed ID: 25356183Background: The red blood cell distribution (RDW) is a test measure of erythrocyte variation and the volume level which shows the heterogeneity and it is a proven test in literature for the determination of survival on cardiovascular diseases. The main purpose of this research is to investigate the relationship between the RDW level and postoperative morbidity as well as its stages in diagnosed pancreatic cancer patients. Methods: In this study we covered 104 diagnosed pancreatic cancer patients who have been operated in 2011-2014. The RDW levels were separated into two groups. Group 1 contains higher level RDW patients (> 14) whereas group 2 contains only lower level RDW patients. We compared both groups in terms of the patients' demographic data, duration of hospitalization, ratio of pancreatic fistula, disease period, and the mortality rates. Results: In group 1 contains 39 patients whereas group 2 contains only 65 patients. We determined the positive correlation between stages of disease with RDW levels as well as the correlation between low level of blood albumin and Ca 19.9 levels (p = 0001). However we did not observe statistically important difference in postoperative morbidity. Conclusions: Based on this study we report that RDW levels can be use as a marker to show the stages of pancreatic cancer in diagnosed patients

Placing of the provisional hemodialysis catheters with the guidence of doppler ultrasonography: Early and late outcomes

Amaç: Böbrek yetmezlikli hastalarda hemodiyaliz amaçlı geçici kateter uygulaması sık kullanılan bir yöntemdir. Makalemizde; Doppler ultrasonografi (USG) eşliğinde uygulanan hemodiyaliz amaçlı geçici kateter deneyimlerimizi sunmayı amaçladık. Gereç ve Yöntem: Kap-Damar Cerrahisi Kliniğimizde Ocak 2010-Ocak 2012 tarihleri arasında hemodiyaliz amaçlı geçici kateter uygulanan 270 hasta yaş, cinsiyet, kateter endikasyonu, uygulama yeri, çıkartılma sebepleri ve komplikasyonları açısından retrospektif olarak incelendi. Bulgular: Böbrek yetmezlikli 270 hastaya toplam 320 defa geçici hemodiyaliz kateteri takıldı. En sık giriş yeri 240 olguda sağ internal juguler vendi (İJV). 11 olguda erken dönemde, 30 olguda ise geç dönemde komplikasyon gelişti. En sık görülen komplikasyon kateter disfonksiyonu idi. Sonuç: Geçici hemodiyaliz kateterlerinin kullanımı erken ve geç dönemde yüksek komplikasyon oranları ile beraberdir. Erken dönem koplikasyonların azaltılmasında Doppler USG eşliğinde kateterizasyon önem kazanırken, geç dönem komplikasyonların azaltılmasında en önemli faktör kronik böbrek yetmezlikli hemodiyaliz gerektiren hastalarda en kısa zamanda kalıcı vasküler erişim yolunun oluşturulması- dır.Objective: Placing of the temporary hemodialysis catheters in the patients with renal failure disease is a commonly used practice. In this study, we aimed to present our experiences on placing of temporary hemodialysis catheters with the guidance of doppler ultrasonography. Material and Methods: In our cardiovascular surgery clinic, between January 2010 and January 2012, 270 patients who were inserted temporary hemodyalysis catheter, were screened retrospectively for their age, sex, catheter insertion indication, insertion site, removing reasons and complications. Results: Temporary hemodyalysis catheters were used in 270 patients with renal failure disease at 320 times. Right internal jugular vein (IJV) was the most common insertion site as in 240 patients. In 11 cases, early complications were developed and in 30 cases, late complications were seen. The most commonly seen complication was catheter dysfunction. Conclusion: Usage of temporary hemodyalysis catheters may result in increased rate of some early and late complications. Insertion, guided with doppler ultrasonography has gained importance in preventing early complications. On the other hand, in patients with renal failure disease requiring hemodyalysis, early creation of permanent vascular access site is the most important issue for preventing late complications