Ozgur Firat

Background: Laparoscopic sleeve gastrectomy (LSG) is a frequently performed operation. Leaks are formidable complications; however, the optimal management of these leaks is controversial. Methods: We retrospectively reviewed the medical records of 15 patients referred to our tertiary center between 2012 and 2016 with leaks after LSG. Results: In 12 patients with whom ongoing leaks were identified, stents were inserted with the intent of definitive therapy. In addition to attempts at source control, percutaneous drainage was carried out for intraabdominal collection in 9 patients and pleural effusion in 4 patients. The length of stay in the intensive care unit was significantly shorter in patients referred earlier or in those without any intervention. Conclusion: LSG leaks can be treated nonoperatively in well-organized centers under meticulously designed protocols, depending on the clinical condition of the patient.

Weight regain after bariatric surgery Ozgur Firat

Firat O, et al. Ann Surg Treat Res. 2017 Jul;93(1):1-10. https://doi.org/10.4174/astr.2017.93.1.1

En tr The most common synchronous cancer in gastric cancer patients is colorec-tal cancer, and vice versa. If there are suspicious complaints in the anamne-sis, the patients should be investigated carefully preoperatively. In this case report, we aimed to present the diagnostic and therapeutic methods in a pa-tient with synchronous colon and gastric cancer. Mide kanserli hastalarda en yaygın görülen senkron kanser kolorektal kanser ve kolorektal kanserli hastalarda da en sık görülen senkron kanser mide kanseridir. Anamnezde flüphe edilecek flikayetlerin varlığında preoperatif hastalar ayrıntılı tetkik edilmelidir. Bu sunumumuzda senkron mide ve kolon kanserli bir hastada tanı ve tedavi yöntemini irdelemeyi amaçladık

Turkjgastroenterol, Turkgastro

Because of their effects on the liver parenchyma after surgery, portal hyperperfusion and hepatic venous congestion are challenging problems for hepatobiliary surgeons. However, the effects of those conditions on Kupffer cells have not been established. The aim of this study was to investigate the effects of vascular streams modified by portal hyperperfusion and hepatic venous congestion on Kupffer cell function. Thirty rats were allocated into 3 groups of 10 rats each and were subjected to right portal vein ligation to induce hyperperfusion in the left lobe of the liver (group 1), occlusion of the right hepatic vein to produce venous congestion (group 2), or sham operation (controls; group 3). After 72 hours, the right and left liver lobes of the subjects were submitted separately for scintigraphic and histopathologic evaluation, and the radiocolloid uptake per gram of liver tissue and the number of Kupffer cells per square millimeter were calculated. The mean technetium-99m labeled sulfur colloid uptake values of the liver tissue per gram were 0.126 -/+ 0.038 for group 1, 0.106 -/+ 0.032 for group 2, and 0.110 -/+ 0.031 for group 3. Portal hyperperfusion significantly increased the technetium-99m labeled sulfur colloid uptake of the liver tissue per gram (P = .043). The mean number of Kupffer cells per square millimeter was calculated for each group as follows: 321 -/+ 094 x 10-6 for group 1, 369 -/+ 083 x 10-6 for group 2, and 355 -/+ 096 x 10-6 for group 3. Both vascular streams produced no significant effects on the number of Kupffer cells (P > .05). In this experimental model, portal hyperperfusion affected Kupffer cell function more than did hepatic venous congestion.

Aim: To emphasize the importance of a detailed observation for incidental simultaneous tumoral masses during surgery for gastrointestinal stromal tumors (GISTs) at any location in the gastrointestinal system. Case presentations: Case 1: a 39 years old female patient with an esophageal squamous cell carcinoma and a synchronous small intestinal GIST discovered incidentally during esophagectomy. Case 2: a 73 years old female patient with a gastric GIST and a synchronous colorectal cancer detected incidentally during gastrectomy. In both cases, immunohistochemical examinations of the resected specimens confirmed the coexistences of GISTs and epithelial malignancies. Conclusion: The coexistences of GISTs with epithelial tumors have been increasing in recent years. In any case of a GIST or gastrointestinal adenocarcinoma, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin.

We appreciate the comments of Khalil and Sarkar [1] that they made concerning our paper about traumatic diaphragmatic rupture [2]. We also appreciate the fact that they mentioned the difficulties in the early diagnosis of right-sided diaphragmatic injuries. Meanwhile, we did not understand why they do not agree with our conclusion that a high index of suspicion is of utmost importance for the diagnosis of these patients, since they mentioned that a persistently elevated right hemidiaphragm on routine X-ray must arouse suspicion. Clearly, we reported 11 patients with right-sided injury where 2 of them had late diagnosis. Although the major complaint of these two patients was dyspnea, we agree with Khalil and Sarkar that a high index of suspicion should also be held when dealing with post-trauma patients who complain of persistent right-sided chest discomfort after trauma.