Effect of sleeve gastrectomy on thyroid-stimulating hormone levels in morbidly obese patients with normal thyroid function

OBJECTIVE

There are many studies, which demonstrate that morbid obesity is associated with an increase in Thyroid Stimulating Hormone (TSH) levels. However, the effect of Laparoscopic Sleeve Gastrectomy (LSG) procedure on postoperative TSH levels is not clear. This study aims to evaluate the effect of weight loss after LSG procedure on TSH levels in euthyroid patients with morbid obesity.

PATIENTS AND METHODS

159 Euthyroid patients who applied for an LSG procedure (93.7% female, with a mean age of 34.18±10.01 years, BMI 43.2±6.82 kg/m2) were retrospectively analyzed for the study. The parameters used in the analysis were their serum free T3 levels (fT3), free T4 levels (fT4), and TSH levels preoperatively and at 6 months after surgery. The postoperative correlation between TSH and BMI (Body Mass Index), % EWL (Percent Excess Weight Loss), and % TWL (Total Weight Loss) levels were evaluated.

RESULTS

Mean BMI change from 43.2±6.82 kg/m2 to 30.48±5.63 kg/m2 (p<0.001), 6 months after LSG, was associated with a mean reduction in the TSH from 2.27±1.09 µU/dL to 1.61±0.99 µU/dL; p<0.001). Serum fT3 levels (3.23±0.42 ng/dL at baseline and 3.21±0.48 ng/dL at 6 months after surgery; p=0.409) remained steady. Serum fT4 levels (1.21±0.18 µU/dL at baseline and 1.43±0.20 µU/dL at 6 months after LSG; p<0.001) increased. Change in TSH was significantly correlated with change in BMI at 6 months after surgery (r=0.200, p=0.015). However, the decrease in TSH following LSG procedure did not correlate with % EWL (r=-0.114, p=0.159) and % TWL (r=-0.100, p=0.209).

CONCLUSIONS

After the LSG procedure, there was a significant decrease in TSH levels and a significant increase in fT4 levels, but no change was seen in fT3 levels. While this decrease in TSH levels showed a positive correlation with BMI, no statistically significant correlation was found with % EWL and % TWL.

The Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Diastolic Function, Aortic Elasticity, and Atrial Electromechanics Delay

BACKGROUND

Obesity is a well-known risk factor for cardiovascular diseases. The aim of this study was to prospectively investigate the short-term effects of laparoscopic sleeve gastrectomy (LSG) on cardiac functions.

METHODS

Forty-four morbidly obese patients who underwent LSG were included in the study. The aortic systolic and diastolic diameters, left ventricular (LV) diameter, LV cardiac output and cardiac index, LV ejection fraction, LV septal and lateral wall velocities, deceleration time of the E wave, the LA volume index and atrial mechanic functions, and atrial conduction times were evaluated.

RESULTS

The patients' aortic stiffness index showed a significant improvement at postoperative control: 3.23 ± 0.58, 2.49 ± 0.36; p<0.001 for preoperative and postoperative aortic stiffness index, respectively. A significant reduction was observed in the LV mass and relative wall thickness (RWT) of the patients: 182.41 ± 36.87 g, 154.85 ± 24.32 g; p<0.001 and 0.42 ± 0.07, 0.39 ± 0.05; p=0.010 for the preoperative and postoperative LV mass and RWT, respectively. A statistically significant decrease was observed in total atrial conduction time and interatrial and intraatrial conduction time in the postoperative period: 120.95 ± 22.27 ms, 106.57 ± 20.46 ms; p=0.001; 13.82 ± 8.21 ms, 10.66 ± 6.78 ms; p=0.038, and 29.64 ± 14.18 ms, 24.09 ± 10.95 ms; p=0.047 for preoperative and postoperative total atrial conduction time, intraatrial electromechanical delay, and interatrial electromechanical delay, respectively.

CONCLUSIONS

Weight loss reduced aortic stiffness, IVS and posterior wall thickness, LAV, LAVi, LA passive emptying fraction, and atrial electromechanical delays in morbidly obese patients.

Randomised controlled study of seroma rates after mastectomy with and without quilting the skin flap to pectoralis muscle

Aims

The aim of this study was to determine whether seroma formation was affected by reduction of the potential dead space with the flap fixation method and obliteration of the axillary region in patients with breast cancer who underwent either mastectomy and axillary lymph node dissection or sentinel lymph node biopsy. A total of 105 patients with breast cancer were divided into two groups according to wound closure patterns.

Patients and Methods

The operating time, postoperative pain and complications, time to drain removal, seroma formation, amount of fluid aspirated and number of aspirations were recorded prospectively.

Results

No significant difference was found between groups in the rates of seroma development (P = 0.7), complication rates (P = 0.6), time to drain removal (P = 0.5), length of hospital stay (P = 0.3) or numbers of aspiration (P = 0.7). The operating time for fixation was determined to be longer than that of the classic procedure (P = 0.02).

Conclusions

Reducing potential dead space with flap fixation and obliteration of the axillary region may be useful in decreasing the development of seroma in patients who have undergone mastectomy because of breast cancer. However, surgical technique must be careful, and appropriate patient follow-up must be conducted.

Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant

Orthotopic liver transplantation is a life-saving procedure for patients with end-stage liver failure. However, Acinetobacter baumannii infections and acute rejection are important causes of morbidity and mortality following transplants. Here we present a case report of a cadaveric donor liver transplantation with infectious complications detected after transplantation. The patient was a 64-year-old female. Because of non-alcoholic steatohepatitis due to hepatic insufficiency (model for end-stage liver disease (MELD): 12; Child-Pugh: 9B), liver transplantation from a cadaveric donor was performed. Following the transplantation, the patient developed a blood stream infection, urinary tract infection (UTI) and postoperative wound infection from biliary leakage. A. baumannii was isolated from blood, urine and wound cultures. Imipenem (4×500 mg), tigecycline (2×50 mg) and phosphomycin (4×4 g) were administered intravenously (IV). On the 14th day of treatment, the bile fistula closed and there was no bacterial growth in blood and urine cultures. The patient was discharged with full recovery. The duration of a transplant patient's hospital stay, intensive care unit stay, invasive interventions, blood transfusions and immunosuppressive treatments cause an increased risk of extensively drug-resistant (XDR) A. baumannii infections, and a high mortality rate is seen despite antibiotic treatment. Phosphomycin, used in combination therapy, may be an alternative in the treatment of XDR pathogens in organ transplant patients, due to its low side effect profile and lack of interaction with immunosuppressives.

Investigation of time-dependent alterations in adipokine levels and endoplasmic reticulum stress markers in obese patients with laparoscopic sleeve gastrectomy

BACKGROUND AND AIMS

We aimed to investigate the time-dependent alterations of serum, adipose tissue WISP1, Nrg4, asprosin, SPX adipokines and serum ER stress markers GRP78, XBP1, ATF6, CHOP in obese patients who underwent laparoscopic sleeve gastrectomy (LSG).

MATERIALS AND METHODS

Morbidly obese patients (n = 19) and normal-weight individuals (n = 19) were compared. Preoperative (control, obese) and postoperative 1st, 3rd and 6th month (obese) follow-up measurements were obtained. Levels of adipokines, ER stress markers were measured with commercial kits.

RESULTS

Body mass index (BMI), total fat, trunk fat mass, fat percentage of obese patients decreased after LSG. Postoperative serum glucose, insulin, HOMA-IR, triglyceride levels of obese patients decreased, HDL increased. In obese patients, preoperative LDL and total cholesterol, which were not different from control, were higher in the postoperative 6th month measurements. Omentum WISP1, subcutaneous adipose tissue WISP1 and SPX, and serum WISP1, asprosin, CHOP levels were higher, Nrg4 lower in obese patients. Serum Nrg4 was still lower in the postoperative 1st month measurements, while WISP1 was higher in the 3rd and asprosin in the 3rd, 6th months compared to control. 1st and 3rd month ATF6 and 3rd month CHOP concentrations were lower than preoperative values. Serum CHOP measured at the 6th month was significantly higher than control. Negative correlations were observed between serum Nrg4 and fat percentage, TG concentration. CHOP was negatively correlated with fat percentage.

CONCLUSION

The correlations between changes in serum Nrg4, CHOP and fat percentage highlight the roles of Nrg4 and CHOP in the fat loss following LSG.

Phyllodes Tumors of the Breast: A Single-Center Experience

Objective

We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT).

Materials and Methods

The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed.

Results

Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis.

Conclusion

PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.

Impact of Laparoscopic Sleeve Gastrectomy on Pulmonary Arterial Stiffness and Right Ventricular Function in Obese Patients

INTRODUCTION

Pulmonary hypertension (PH) is a serious condition associated with high morbidity and mortality, with obesity identified as a significant risk factor. Pulmonary arterial stiffness (PAS) is an early marker of PH, often preceding clinical symptoms. While laparoscopic sleeve gastrectomy (LSG) has been shown to improve various cardiac parameters in obese patients, its impact on PAS and right ventricular (RV) function in the absence of PH remains unclear. This study investigates the effects of LSG on PAS and RV function in obese patients without pre-existing PH.

METHODS

A cohort of 54 patients with obesity who underwent LSG between January and June 2023 at the University hospital was prospectively studied. Patients were evaluated preoperatively and six months postoperatively using comprehensive echocardiographic assessments. Key parameters measured included tricuspid annular systolic velocity (TAS), tricuspid regurgitation velocity (TRV), pulmonary flow acceleration time (PFAT), pulmonary artery velocity, and PAS. Statistical analyses were conducted using paired t-tests and the Wilcoxon signed-rank test.

RESULTS

Significant improvements were observed in several echocardiographic and hemodynamic parameters post-LSG. PAS showed a notable reduction from 2.44 ± 0.68 preoperatively to 1.74 ± 0.32 postoperatively (p < 0.001). Additionally, significant decreases were observed in TRV (2.00 ± 0.30 m/sec to 1.79 ± 0.40 m/sec, p = 0.025) and systolic pulmonary artery pressure (SPAP) (21.28 ± 4.69 mmHg to 18.36 ± 5.28 mmHg, p = 0.025). Improvements in RV function were indicated by an increase in tricuspid annular plane systolic excursion (TAPSE) from 17.68 ± 4.17 mm preoperatively to 21.18 ± 3.53 mm postoperatively (p < 0.001).

CONCLUSIONS

LSG significantly reduces PAS and improves RV function in obese patients, even in the absence of PH. These findings suggest that LSG may offer protective effects on pulmonary vascular health, highlighting its potential as a therapeutic intervention for reducing PH risk in obese patients. Further research is warranted to explore the long-term cardiovascular benefits of LSG in diverse populations.

Global 30-Day Morbidity and Mortality of Primary Bariatric Surgery Combined with Another Procedure: The BLEND Study

BACKGROUND

No robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures.

OBJECTIVES

The objective of this study is to collect a 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair.

SETTING

This is as an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures.

METHODS

The audit took place from January 1 to June 30, 2022. A descriptive analysis was conducted. A propensity score matching analysis compared the BLEND study patients with those from the GENEVA cohort to obtain objective evaluation between combined procedures and primary BMS alone.

RESULTS

A total of 75 centers submitted data on 1036 patients. Sleeve gastrectomy was the most commonly primary BMS (N = 653, 63%), and hiatal hernia repair was the most commonly concomitant procedure (N = 447, 43.1%). RYGB accounted for the highest percentage (20.6%) of a 30-day morbidity, followed by SG (10.5%). More than one combined procedures had the highest morbidities among all combinations (17.1%). Out of overall 134 complications, 129 (96.2%) were Clavien-Dindo I-III, and 4 were CD V. Patients who underwent a primary bariatric surgery combined with another procedure had a pronounced increase in a 30-day complication rate compared with patients who underwent only BMS (12.7% vs. 7.1%).

CONCLUSION

Combining BMS with another procedure increases the risk of complications, but most are minor and require no further treatment. Combined procedures with primary BMS is a viable option to consider in selected patients following multi-disciplinary discussion.

One-year follow-up of the oxidative stress profile of patients after laparoscopic sleeve gastrectomy

OBJECTIVE

Obesity is a major risk factor for developing a number of serious diseases, such as cardiometabolic changes and cancer. An increase in adipose tissue and a decrease in antioxidant capacity both contribute to the etiopathogenesis of these comorbidities. The most effective method in the treatment of morbid obesity is bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is the most preferred method in bariatric surgery today. In this study, the potential improvement effect of laparoscopic sleeve gastrectomy (LSG) surgery in the restoration of weight loss and endocrine and tissue-based deterioration was obtained by evaluating changes in oxidative stress, antioxidant agents, and lipid oxidation levels.

PATIENTS AND METHODS

Fifty patients who had LSG surgery were chosen, along with 50 healthy volunteers who were the same age and gender as these patients. Serum total antioxidant capacity measurement, total oxidant capacity measurement, malondialdehyde (MDA) for the measurement of lipid peroxidation degree, and superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels for the measurement of antioxidant levels were measured colorimetrically with the help of a commercial kit.

RESULTS

Oxidative stress indices, MDA levels, and GPx levels of patients with morbid obesity treated with LSG were observed to decrease significantly compared to the preoperative period, while no significant changes were observed in SOD levels.

CONCLUSIONS

In patients with morbidly obese conditions, the weight control achieved by sleeve gastrectomy, which is a restrictive method and thus causes a decrease in adipose tissue, causes a decrease in oxidative stress and an increase in the antioxidant response.

Is the Anal Component of the Anogenital HPV-Related Disease Overlooked During the Surveillance of Patients Treated for Cervical Intraepithelial Neoplasia?

AIM

To investigate the anal component of the anogenital Human Papillomavirus (HPV) related disease during surveillance of patients treated for cervical intraepithelial neoplasia (CIN).

METHODS

Patients were analyzed within two groups according to the histopathological examination of the cervical biopsies: Low-Grade Squamous Intraepithelial Lesion (LSIL) and High-Grade Squamous Intraepithelial Lesion (HSIL) groups. Anal specimens were also collected in the first-year follow-up visit.

RESULTS

All patients had cervical high-risk HPV (HR HPV) infection at admission. At the first-year follow-up, positive HR HPVs were found in 47% of cervical samples. Despite this clearance, the anal HPV infection rate after the first year was 42.5% and 39.6% in LSIL and HSIL groups. Amongst the HSIL group, anal HR HPV positivity was observed in 29.6% of cases without any cervical HPV infection.

CONCLUSION

A group of women cured of high-grade lesions have ongoing anal HPV infection. It is reasonable to propose that detecting anal HPV could impact the patient's treatment process. Therefore, prospective studies are needed to investigate this group of women's clinical outcomes and define the clearance rate of cervical HPV infection when anal HPV persists.

Ultrasound-guided wire localization biopsy in non-palpable breast lesions: predictive factors for malignancy

OBJECTIVE

The aim of the study was to evaluate the results of ultrasound-guided excisional biopsy in patients with nonpalpable breast lesions and examine factors associated with malignancy.

PATIENTS AND METHODS

A total of 380 patients who underwent ultrasound-guided excisional biopsy for suspected nonpalpable breast masses, between May 2012 and 2018, were retrospectively examined. Histopathological results of the patients were compared regarding age, ultrasound findings, ultrasonographic and mammographic Breast Imaging Reporting and Data System (BI-RADS) categories and factors predicting malignancy were determined.

RESULTS

The mean age of the patients was 48.35 ± 11.23 (17-86) years. There was a history of breast cancer in the families of 22 (5.8%) patients, and 187 (49.2%) patients were in menopause. The complication rate was found to be 6.6%. Malignant lesions were detected in 76 (20%) patients and benign lesions were detected in 304 (79.99%) patients. Some benign lesions were high-risk lesions (16.8%). Most of the patients with malignant lesions had early-stage breast cancer (83.3%). In univariate analyzes, ultrasonographic BI-RADS, mammographic BI-RADS and age variables were found to be associated with malignancy (p = 0.0001). In the multiple logistic regression analysis, ultrasonographic and mammographic BI-RADS values were found to be risk factors for malignancy (p = 0.0001).

CONCLUSIONS

BI-RADS scoring was used to determine risk factors in predicting malignancy in the evaluation of suspected nonpalpable lesions. The ultrasound-guided wire localization biopsy is a useful method in nonpalpable breast lesions with suspected malignancy that cannot be diagnosed by core/vacuum biopsy or in cases where incompatibility between pathology and radiology results exists.

Might simple peripheral blood parameters be an early indicator in the prediction of severity and morbidity of cholecystitis?

Purpose

The aim of this study is to examine the effectiveness of the neutrophil-lymphocyte ratio (NLR) and CRP/albumin ratio (CAR) in evaluating disease severity and predicting clinical outcomes in patients diagnosed with acute cholecystitis (AC).

Methods

A total of 186 patients with AC were evaluated retrospectively. NLR, CAR, Mannheim Peritonitis Index (MPI), and P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scores were compared with AC severity grade.

Results

The rates of the grade 1 patients (group 1) and the grade 2-3 patients (group 2) were 57.5% (n = 107) and 42.5% (n = 79) according to the disease severity according to Tokyo Guidelines criteria (TG) 18/TG13, respectively. The morbidity rates determined in groups 1 and 2 were 26.7% (n = 28) and 51.9% (n = 41), respectively. No mortality was found in group 1, whereas the mortality rate in group 2 was 6.3% (n = 5). According to multivariate analysis, CAR (odds ratio [OR], 1.234; P < 0.001) and MPI (OR, 1.175; P = 0.001) were found to be associated with moderate-severe disease while CAR (OR, 1.109; P = 0.035) and P-POSSUM morbidity (OR, 1.063; P = 0.007) variables were found to be associated with the presence of morbidity.

Conclusion

We have demonstrated that CAR can be used in predicting severity of AC and that CAR is an alternative simple parameter of P-POSSUM morbidity score in prediction of morbidity in these cases. In addition to other assessment methods, these scores can provide valuable and complementary information in assessment of disease severity and prognosis in AC.