The most frequent abdominal pathology requiring emergent surgery is acute appendicitis. Laparoscopic appendectomy has been performed for the treatment of acute appendicitis since 1983. Closure of the appendix stump is vital to prevent severe postoperative complications. Different methods are described for closure such as stapler, endoloop, titanium clips, non-absorbable polymer clips (hem-o-lok clip), handmade loops, transsection by Ligasure or with bipolar cautery. The ideal method should be safe, applicable and cheap. The most appropriate method remains to be controversial. All methods are reported as safe, but some have higher costs, and some prolong the operation. In this article, we reviewed clinical and experimental studies on different methods of stump closure, and we tried to compare the benefit of these methods over others. Keywords INTRODUCTIONThe most common acute abdominal pathology requiring emergency surgery is appendicitis. Open appendectomy is the standard approach for treatment. Semm first defined laparoscopic appendectomy (LA) in 1983 as an alternative approach to open surgery (1). This method has been popularized and recommended as first choice treatment in especially women, the elderly and obese patients (2). Along with reported advantages such as less pain, earlier return to work, better cosmetic results, and shorter hospitalization of LA as compared to open appendectomy, there are negative issues such as high cost, long operation time and the high rate of intra-abdominal abscess (3-5).

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Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%.1–3 As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world.4 Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic),5,6 the ideal anesthesia (general, local, or regional),7,8 and the ideal mesh (standard polypropylene or newer meshes).9,10

IntroductionAcute appendicitis is the most common abdominal pathology requiring emergent surgical procedure. For treatment, laparoscopic surgery is commonly performed. For appendix stump closure different procedures are used.AimEvaluation of the results of patients in whom the stump of the appendix was closed with a hand-made loop during laparoscopic appendectomy (LA).Material and methodsPatients in whom the stump of the appendix was closed with a hand-made loop during LA were included in the study. Reports of patients were collected from patient files retrospectively. Laparoscopic appendectomy was applied through 3 ports. Two loops were placed in the stump of the appendix. Loop was a modification of the Roeder loop that has been described in the literature and has been shown to be safe.ResultsSixty-one patients were included in the study. Twenty-four of them (39%) were female, 37 of them (61%) were male. The age range is from 13 to 60 (average age is 30) years. During the postoperative period, one surgical wound infection and two intraabdominal abscesses were detected. There was no leakage from the stump of the appendix in any patients.ConclusionsOne of the most important components of cost of LA is the technique of closure of the stump. Stapler, endoloop, various clips or a hand-made loop could be used for closure. We recommend using a hand-made loop for closure as an easy, safe and cheap method.

BackgroundThis study aimed to determine early postoperative changes of plasma polyunsaturated fatty acids (PUFAs) following laparoscopic sleeve gastrectomy (LSG).MethodsTen obese patients (mean BMI: 51.10 ± 11.59 kg/m2) underwent LSG and eleven normal weight control patients (mean BMI: 24.37 ± 2.33 kg/m2) underwent laparoscopic abdominal surgery. Fasting blood samples were collected prior to surgery, at day 1 after surgery and after postoperation oral feeding. Plasma levels of arachidonic acid (AA, C20:4n6), dihomo-gamma-linolenic acid (DGLA, C20:3n6), eicosapentaenoic acid (EPA, C20:5n3) and docosahexaenoic acid (DHA, C22:6n3) were determined by an optimized multiple reaction monitoring (MRM) method using ultra fast-liquid chromatography (UFLC) coupled with tandem mass spectrometry (MS/MS). Prostaglandin E2 (PGE2) was measured in serum samples by enzyme immunoassay.ResultsA significant decrease was observed in insulin and HOMA IR levels in sleeve gastrectomy patients after postoperation oral feeding compared to preoperation. Plasma AA levels and AA/EPA ratio were significantly increased in sleeve gastrectomy patients after postoperation oral feeding compared to postoperation day 1. Serum PGE2 levels and AA/DHA ratio was significantly higher in sleeve gastrectomy patients at preoperation, postoperation day 1 and after postoperation oral feeding when compared to control group patients.ConclusionIncreased peripheral insulin sensitivity associated with LSG may play a role in the significant increase of plasma AA levels in sleeve gastrectomy patients following postoperation oral feeding. The significant increase in PGE2 levels and AA/DHA ratio in sleeve gastrectomy group patients also confirms the presence of a proinflammatory state in obesity.

Objective: The citation number of an article gives us information about its quality and contribution to science. In this article, we aimed to find the most frequently cited article in general surgery from Turkey, and evaluate how these articles in general surgery contributed to the world literature. Material and Methods:We used the science citation index expanded database to find the most frequently cited articles in general surgery from Turkey.Results: Among the 52 articles found, the most common subjects were as follows: hydatid cyst (21.1%), pilonidal disease (15.4%), laparoscopic operations (15.4%), breast diseases (11.5%), and inguinal hernia (7.7%). Two articles were cited in more than 100 articles. Furthermore, 48.8% of the articles were published from three major cities. Most articles were published between 2000 and 2004, and 65.4% of articles were case series. Conclusion:Most of the cited articles were about hydatid cyst and pilonidal disease, which are more common in the Turkish population compared with other countries. Evaluation of most cited articles is important to identify the fields in which Turkey contributes to the world literature.

This study aimed to determine early postoperative changes of LDL/HDL subfraction profile and HDL-associated enzymes following laparoscopic sleeve gastrectomy (LSG). Thirteen obese patients (mean body mass index (BMI) 52.74 ± 10.97 kg/m(2)) underwent LSG and normal weight control patients (mean BMI 23.56 ± 1.92 kg/m(2)) underwent laparoscopic abdominal surgery. Fasting blood samples were collected prior to surgery, at day 1 after surgery, and after postoperation oral feeding. LDL and HDL subfraction analysis was done by continuous disk polyacrylamide gel electrophoresis. Plasma levels of cholesteryl ester transfer protein (CETP), lecithin-cholesterol acyltransferase (LCAT), and apolipoprotein A-1 (apoA-I) were determined by enzyme-linked immunosorbent assay. Measurement of CETP and LCAT activity was performed via fluorometric analysis. LDL subfraction profile showed no change in both LSG and control group patients. No significant difference was observed in HDL cholesterol, HDL-subfraction distribution, and apoA-I levels in the control group. LSG patients showed a significant increase in HDL-large and a significant decrease in HDL-small fractions at postoperation day 1 compared to preoperation. HDL cholesterol significantly decreased and apoA-I significantly increased in LSG patients after postoperation oral feeding compared to both preoperation and postoperation day 1. Changes in HDL subfraction profile at postoperation day 1 after LSG were accompanied by a significant decrease in CETP protein, LCAT protein, and LCAT activity as compared to preoperation levels. Early changes in HDL subfraction profile and HDL-associated enzymes following LSG suggest that the surgical procedure, irrespective of changes in body weight, affects reverse cholesterol transport.

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