Mustafa Kuşak

Amaç: Laparoskopik sleeve gastrektomi (LSG) ve tek anastomozlu gastrik bypass (OAGB), etkinlikleri kanıtlanmış ve yaygın olarak uygulanan bariatrik cerrahi yöntemlerdir. Ancak bu yöntemlerin orta vadeli etkinlikleri ve beslenme üzerindeki etkileri tartışılmaya devam etmektedir. Bu çalışmada, tek merkezli bir hasta kohortunda OAGB ve LSG sonrası orta vadeli kilo kaybı sonuçları ile ameliyat sonrası beslenme durumunun karşılaştırılması amaçlandı. Gereç ve Yöntem: Ocak 2016–Aralık 2020 tarihleri arasında primer OAGB veya LSG uygulanan hastalar retrospektif olarak değerlendirildi. Standart bariatrik cerrahi endikasyonlarını karşılayan ve ameliyat sonrası takip verileri eksiksiz olan erişkin hastalar çalışmaya dahil edildi. İki grubun demografik özellikleri, antropometrik sonuçları, ameliyat sonrası klinik bulguları ve besin öğesi eksiklikleri uygun istatistiksel yöntemlerle karşılaştırıldı. Bulgular: Çalışmaya 21’i OAGB, 19’u LSG uygulanan toplam 40 hasta dahil edildi. OAGB grubundaki hastaların yaşları anlamlı olarak daha yüksek, diabetes mellitus ve hipertansiyon sıklıkları daha fazlaydı. Başlangıç vücut kitle indeksi ise gruplar arasında benzerdi. OAGB grubunda takip süresi daha kısa olmasına rağmen (42,9±3,5 aya karşı 50,5±10,9 ay; p=0,008), ameliyat sonrası vücut ağırlığı, vücut kitle indeksi, fazla kilo kaybı yüzdesi, toplam kilo kaybı yüzdesi ve vücut kitle indeksindeki azalma açısından gruplar arasında anlamlı fark saptanmadı (tümü için p>0,05). B12 vitamini, D vitamini ve demir eksiklikleri OAGB grubunda anlamlı olarak daha sıktı (her bir karşılaştırmada %28,6’ya karşı %0; p=0,014). Yeni gelişen gastroözofageal reflü ve dumping sendromu oranları gruplar arasında benzerdi. Sonuç: Başlangıçtaki metabolik özelliklerdeki farklılıklara rağmen OAGB ve LSG ile benzer orta vadeli kilo kaybı sonuçları elde edildi. Bununla birlikte, OAGB ameliyat sonrası besin öğesi eksiklikleri açısından anlamlı olarak daha yüksek riskle ilişkiliydi. Bu durum, yapılandırılmış uzun dönem beslenme izleminin gerekliliğini vurgulamaktadır. Bulgular, cerrahi yöntem seçiminde beklenen metabolik yararlar ile uzun dönem beslenme sorunlarının dengelendiği bireyselleştirilmiş bir yaklaşımı desteklemektedir. Anahtar kelimeler: Gastrik bypass, laparoskopik sleeve gastrektomi, obezite.

Aims: The present study aims to evaluate the perioperative safety, postoperative bowel function, and oncological outcomes of stoma-free subtotal colectomy (STC) and total colectomy (TC) with primary anastomosis in patients with obstructed left-sided colon cancer, with particular focus on long-term bowel adaptation and antidiarrheal medication requirement. Methods: This retrospective single-center cohort study included consecutive patients who underwent STC or TC with primary anastomosis for obstructed left-sided colon cancer between June 2016 and August 2024. Patients who required end ileostomy or diverting loop ileostomy were excluded. Demographic, operative, pathological, and postoperative data were reviewed. Results: TC was performed in 41 patients (68.3%) and STC in 19 patients (31.7%). Minor complications occurred in 16 patients (26.7%), major complications in 8 (13.3%), and perioperative mortality in 5 (8.3%). No anastomotic leakage was observed. Follow-up beyond 12 months was available in 51 patients (85.0%). Median daily bowel movements decreased from 7 (range 3-12) at 3 months to 2 (range 2-3) at 12 months. Long-term antidiarrheal medication was required in 14 patients (23.3%) and was significantly more frequent after TC than after STC (31.7% vs. 5.3%, p

Background/Objectives: Adequate bowel preparation is essential for high-quality colonoscopy. The clarity of the final rectal effluent can predict its sufficiency and guide additional preparation if necessary. For an objective and reliable clarity assessment, the stool collection method may be as important as the evaluation itself. This study was designed to compare the sensitivity of clarity assessments of effluent collected using two methods: a disposable cardboard bedpan with a white bag (Group I) and a 50 mL transparent plastic container (Group II). Methods: A prospective, single-center, randomized, comparative study was conducted between August 2024 and January 2025. Based on predefined criteria, 37 of 177 randomized patients were excluded, and 140 were analyzed. Results: Inadequate bowel preparation was correctly identified by a team member in 71% of Group I and 23% of Group II (p = 0.033). In adequate cases, the detection sensitivity was 88% and 85% (Groups I and II, respectively; p = 0.854). Significantly more patients in Group II either withdrew or failed to submit a photograph of the final rectal effluent. Patients’ verbal assessments did not differ significantly between the groups, regardless of bowel preparation quality. Conclusions: Patient self-assessment was an unreliable indicator of bowel cleanliness, highlighting the need for objective, standardized pre-colonoscopy evaluation methods. The use of a disposable cardboard bedpan with a white bag to collect the final rectal effluent may improve the accuracy of predicting inadequate preparation and patient compliance and may allow timely adjustments to bowel cleansing prior to colonoscopy in routine endoscopy practice.

Aim: In spite of the demonstrated advantages, laparoscopic colorectal surgery is not adequately utilised in regional service hospitals. Purpose of the research was to document the findings of patients managed by a gastroenterological surgeon for colorectal neoplasms using laparoscopic surgery at a service hospital of the Central Black Sea Region, Turkey. Material and Method: Every sequential patient having laparoscopic colorectal surgery was registered prospectively and analysed retrospectively. Recorded parameters consisted of demographic characteristics, diagnostic work-up, surgical events, post-surgical morbidity, mortality and outcomes. Results: Seventy-five patients each underwent laparoscopic colorectal surgery for colorectal neoplasm within a period of forty months. Average age was 66.4 years and ratio of males to females was 11:4. Rectal cancer rate was 65.3%. Colon cancer rate was 34.6%. One patient had synchronous colorectal cancer. Mean time of surgery was 276 min and mean volume of haemorrhage was 75 ml. Conversion to open resection rate was 6.6%. Median day of hospitalization was six days. Postoperative complication rate (Clavien–Dindo grade ≥ III) was 8.5%. Two systemic recurrences were observed during the surveillance. Conclusion: Based on our results and those of other studies presented here, a trained surgeon with a high caseload can perform safe and adequate oncological laparoscopic colorectal resections in a regional service hospital of a developing country. The longer operative time is the drawback of the procedure, especially in crowded service hospitals. The results are also valuable in terms of showing the effect of health policies and regional conditions on surgical practices in our city and country. Under the current conditions, surgeons’ dedication and all relevant supports are required.

Background and Objectives: The best way to distinguish complicated acute appendicitis (CAA) from uncomplicated acute appendicitis (UCAA) is still under debate. The aim of this study was to investigate the potential use of the serum sodium (Na⁺) level and the neutrophil-to-lymphocyte ratio (NLR) to distinguish CAA from UCAA and to evaluate whether CAA is more reliably diagnosed using these two variables together. Materials and Methods: This was a retrospective, cross-sectional, two-center study of patients diagnosed with AA between 1 January 2016 and 31 December 2023. The demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. Hyponatremia was defined as a serum Na⁺ level of ≤135 mmol/L. The sensitivity and specificity of the NLR and the serum Na⁺ level in the diagnosis of CAA were determined by assessing the receiver operating characteristic curves. Results: Among the patients who underwent an appendectomy, 3066 histologically confirmed AA cases were identified and included in this study. The registered data revealed that 348 (11.3%) patients had CAA, and the remaining 2718 (88.7%) patients had UCAA. The mean ages were 49.47 ± 18.97 and 38.16 ± 14.50, respectively (p < 0.001). The analysis revealed an exponential correlation between the NLR and the serum Na⁺ level with a moderate degree of agreement with CAA (Cohen’s Kappa: 0.461, p < 0.001). For CAA, using the NLR and the serum Na⁺ level, the areas under the curve and the cutoffs were 0.664, 4.2 with a confidence interval (CI) of 0.647–0.681 and 0.727, 135 mmol/L with a CI of 0.711–0.742, respectively; all these values were significant with a p-value of Conclusions: Although the serum Na⁺ level is a more effective marker than the NLR, using these two variables together can help detect high-risk patients who may benefit from early management by limiting delays in surgery.