Bayram Çolak

Novel capsules for potential theranostics of obscure gastrointestinal bleedings.

Obscure gastrointestinal (GI) bleeding is identified as persistent or repeated bleeding from the gastrointestinal tract which could not be defined by conventional gastrointestinal endoscopy and radiological examinations. These GI bleedings are assessed through invasive diagnostic and treatment methods including enteroscopy, angiography and endoscopy. In addition, video capsule endoscopy (VCE) is a non-invasive method used to determine the location of the bleeding, however, this does not provide any treatment. Despite of these successful but invasive methods, an effective non-invasive treatment is desperately needed. Herein, we prepare non-invasive theranostic capsules to cure obscure GI bleeding. An effective theranostic capsule containing endothelin as the targeting agent, thrombin-fibrinogen or fibrin as the treating agent, and fluorescein dye as the diagnostic tool is suggested. These theranostic capsules can be administered orally in a simple and non-invasive manner without a risk of complication. By using these novel capsules, one can diagnose obscure GI bleeding with having a possibility of curing.

The comparison of pulmonary functions After the bariatric surgery In Morbid obeses Versus Super Obeses

Objective: Nowadays, The increase in incidence of morbid obesity is one of the most common health problems in the world. Bariatric surgery has performed as a curative procedure for morbid obesity. It has give rise to lose excess weight, heal comorbidities and to improve pulmonary functions in obeses.. Our aim was to compare postoperative respiratory outcomes in morbidly obese patients who have underwent Laparoscopic sleeve gastrectomy. Material and Methods: Consecutive 124 morbid obese patients who were underwent Laparoscopic sleeve gastrectomy was followed up 6 months between the years of march 2014 to july 2016 retrospectively. Patients were divided into two groups A and B. Group A patients who have BMI between 40-45kg/m2 and group B patients who have BMI between 45-50kg/m2. FEV1, FVC, FEV1/FVC, MSV, DV/VO2, DV/VCO2, VO2peak results, body mass index, postoperative oxygen saturation and comorbidites, were compared between both groups. Students t test,chi-square test was used for the variables and homogeneity in the patient group. Preoperative and postoperative values between the groups were compared with the ANOVA test. Results: The mean age values, respiratory function values in both groups were similar in preoperatively. In our postoperative results, there was a significant difference in the FEV1, FVC, FEV1/FVC, MSV, DV/VO2, DV/VCO2, VO2 peak ratios and also identified significant difference in resolution and improvement of comorbidities. Conclusions: The results of the patients who underwent bariatric surgery and whose body mass index (BMI) was 4045kg / m2 were statistically significant compared to those with body mass index between 45-50kg / m2. The improvement in pulmonary functions and the effect of correction of comorbidities are higher in the morbidly obese group with laparoscopic sleeve gastrectomy.

Reply to the Letter to the Editor on “A New Algorithm to Reduce the Incidence of Gastroesophageal Reflux Symptoms after Laparoscopic Sleeve Gastrectomy”

Thank you very much for your kind attention to our manuscript. This study does not constitute our first experience with this topic. We fully understand that gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy is a serious complication of this surgical technique. Therefore, we developed a new algorithm to overcome this problem. In the literature, most reports of GERD are based on subjective observations. We aimed to evaluate the preoperative risk of GERD objectively and to highlight our methods of prevention. Insufficient dissection of retrogastric tissue and creation of a large sleeve pouch are not closely associated with GERD symptoms. Large sleeve gastrectomy is often related to weight regain and poor weight loss. Therefore, we do not need to explain the technical details of surgery. Many techniques for adjusting the final volume of the sleeve have already been described in the literature; some of these references were cited in our article. For this study, most of the bariatric operations were performed by a senior laparoscopic surgeon (H. Yilmaz) who has experience with over 500 laparoscopic sleeve gastrectomies, over 200 laparoscopic Roux-en-Y gastric bypasses, over 30 laparoscopic diverted sleeve gastrectomies with ileal transposition, over 20 laparoscopic pancreaticoduodenectomies, over 50 bariatric revisional surgeries, and over 500 single-incision laparoscopic surgeries of various types. Over the last 3 years, we have performed preoperative and postoperative gastric volumetric measurements for each patient using 3-D CT scans. These data are the subject of a separate ongoing study. The postoperative gastric volume of our patients is similar to that reported in the literature [1]. Some authors claim that the great majority of hiatal hernias are asymptomatic but that most of them can be detected during surgery. Therefore, these authors advocate the dissection of both diaphragmatic pillars to identify a missed hiatal hernia [2]. However, we think that the routine exploration of both pillars can be a possible cause of postoperative GERD, due to the division of the posterior ligaments of the gastroesophageal junction. Thus, we do not recommend the destruction of the ligaments around the abdominal esophagus (Fig. 1). In an attempt to avoid staple line leak, some surgeons inadvertently leave too much fundus during the operation. This phenomenon, called neofundus, was first described by Himpens et al. [3]. Residual fundus, or neofundus, is associated with the release of larger amounts of ghrelin, increased appetite of patients, and weight regain or insufficient weight loss after surgery. In our study group, only 4.9% of 402 patients required a revisional surgery due to weight regain or poor weight loss. Fundus dilation was detected in only three of these patients. Furthermore, we know that the embryonic rotation of the stomach creates a diverticulum on the posterior aspect of the stomach; we checked this area during resection and found no residual fundus. Because the stomach is extensible, we do not think that it is suitable to measure it with a tie. Insufficient tension on the tie can affect the measurements. At this point in the procedure, the experience and capability of the surgeon become more * Ilhan Ece ilhanece@yahoo.com

Comparison of mid-term clinical outcomes of laparoscopic partial cystectomy versus conventional partial cystectomy for the treatment of hepatic hydatid cyst

Background: The aim of this study was to compare the mid-term outcomes of open and laparoscopic partial cystectomy (LPC). Methods: The medical records of patients who underwent conventional partial cystectomy (CPC) and LPC for liver hydatid cyst from May 2010 to February 2015 were retrospectively reviewed. Operative time, blood loss, length of hospital stay, post-operative morbidity, mortality and mid-term follow-up outcomes were evaluated. Results: Amongst 130 patients, 38 patients were underwent LPC and 92 underwent CPC. Blood loss and post-operative complications were similar in both groups. The mean operative time in the LPC and the CPC groups was, respectively, 95.4 ± 13.1 and 63.5 ± 15.6 min, which showed a significant difference between the both groups. The mean length of hospital stay in CPC group was significantly longer when compared the LPC group. The mean diameter of cyst in LPC group was 6.1 ± 1.1 cm and 7.8 ± 2.1 cm in CPC group with a significant difference. The overall complication rates were 13.1% in LPC group and 17.3% in CPC group without significant difference. The most common complication was biliary leakage and surgical site infection. Conclusion: LPC for the surgical treatment of liver hydatid cyst appears to be safe and effective method with low morbidity rates in selected patients.

Çok arterli böbrek nakilleri: Erken dönem sonuçlarımız

GIRIŞ Bobrek nakli, basarili cerrahi teknikler, ilerleyen immunsupresif tedavi yontemleri ve yogun bakim sartlarindaki gelismeler sayesinde son donem bobrek yetmezligi olan hastalarin tedavisinde en etkili yontem olmustur. Bu gelismeler sayesinde hastalarin hem yasam suresi hem de yasam kalitesi artmistir (1). Bobrek nakli icin kullanilan organlarda en sik rastlanan anomali renal arterin sayisal anomalileridir. Bir veya her iki bobrekte birden fazla sayida renal arter bulunmasi orani %20-35’dir. Renal ven anomalileri ise arter anomalilerinden daha az gorulmektedir. Damar anomalisi olan bobregin cikartilmasi ve nakil edilmesi normal bobrege gore daha zor olmasi nedeniyle soguk ve sicak iskemi sureleri uzayabilmekte ve bu durum gecikmis greft fonksiyonuna neden olmaktadir (2, 3).

Foliküler adenom ile papiller karsinom ilişkisi

GIRIŞ Tiroidin en sik gorulen selim tumoru folikuler adenomlardir. Adenomda histopatolojik olarak selim ve kapsullu bir dokunun buyumesi soz konusudur. Folikuler adenomlar iyi sinirli tek lezyon seklinde olup adenomu normal tiroid dokusundan ayiran kapsulleri vardir. Genellikle genc eriskinlerde gorulurler ve siklikla 3 cm’den daha kucuk soliter lezyonlardir. Mikroskopik olarak folikuler adenomlar kolloid, embriyonal, fetal ve Hurtle hucreli varyant olarak siniflandirilabilir (1).