Objective This study aimed to reveal the relationship between obesity and asprosin (fibrillin‐1) in patients undergoing bariatric surgery and to investigate the role of asprosin in obesity etiopathogenesis. Methods The study included 37 patients who underwent laparoscopic sleeve gastrectomy for severe obesity and 37 patients who underwent laparoscopic cholecystectomy for cholelithiasis in the study and control groups, respectively. Blood samples were collected from the patients in the preoperative period to measure biochemical parameters. Blood samples were collected at 6 months postoperatively from the patients in the study group to compare their pre‐ and postoperative serum asprosin levels. Results A significant intergroup difference in terms of mean asprosin levels in adipose tissue was noted (p = 0.001). A comparison of preoperative and postoperative 6‐month serum asprosin levels in the study group showed significant differences (p = 0.021). The area under the curve of asprosin tissue levels was 78.1%, and the cutoff value was 217.34 ng/g of protein, with a sensitivity and specificity of 73.0%. Tissue levels of asprosin were found to increase the risk of obesity by a factor of 1.018 (odds ratio; 95% CI: 1.008‐1.027). Conclusions Serum asprosin levels decreased significantly at 6 months after bariatric surgery. Adipose tissue of patients with obesity showed high asprosin levels and immunoreactivity. In conclusion, asprosin levels in adipose tissue were considered a potential independent risk factor in obesity etiopathogenesis.

Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation.

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akademik gastroenteroloji dergisi 2017; 16(1): 06-11 tarama programında olmamasına rağmen mide kanseri; kadın hastalarda meme kanseri, erkek hastalarda akciğer kanserinden sonra ikinci sırada görülmektedir (3). Genel olarak, erkekler kadınlara göre iki kat daha sıklıkla etkilenir ve ortalama görülme yaşı 60-70 yaş arasındadır (4).Helicobacter pylori enfeksiyonu, tütsülenmiş veya tuzlu gıdalar, pernisiyöz anemi, daha önceden geçirilmiş mide cerrahisi, kronik atrofik gastrit, intestinal metaplazi, ge- GİRİŞMide kanseri dünya genelinde dördüncü sıklıkta görülen kanser tipi olup, kanserle ilişkili ölümlerde üçüncü sırada yer almaktadır (1). Dünya genelinde yeni tanı alan kanserlerin %8'i ve kanser nedeniyle olan ölümlerin %10'u mide kanserine bağlı olmaktadır (2). Olguların 3 / 4 'ü gelişmiş ülkelerde özellikle uzak doğu ülkelerinde (Kore, Japonya ve Çin) görülürken özellikle ABD ve Batı Avrupa'da mide kanserinin görülme insidansı giderek azalmaktadır ve Doğu Asya'nın insidansının sadece altıda biridir. Ülkemiz kanser Giriş ve Amaç: Mide kanserinin erken tanınması tedavide daha sınırlı rezeksiyonların yapılmasına ve sağ kalımın iyileşmesine olanak sağlar. Amacımız mide kanserli hastalarımızın semptomları, endoskopik bulguları ve ameliyat piyeslerini değerlendirerek hangi evrelerde başvurduklarını saptamaktır. Gereç ve Yöntem: Mide kanseri nedeniyle elektif opere edilen 77 hastanın verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, ko-morbiditeleri, tümör lokalizasyonları, pasaj geçişinin olup olmadığı, semptomlar ve süreleri, endoskopik patoloji sonuçları, Amerikan Anesteziyoloji Derneği sınıflaması, uygulanan rezeksiyon tipleri, patolojik evreler, tümör büyüklüğü, çıkarılan ortalama lenf nodu ve metastatik lenf nodu sayısı ve evreleri değerlendirildi. Bulgular: Çalışmamızda, olguların 55'i (%71,4) erkek, 22'si (%28,6) kadın idi. Olguların 46'sına (%59,8) total gastrektomi,16'sına (%20.8) subtotal gastrektomi ve 15'ine de (%19,4) eksploratif laparotomi uygulandı. Laparoskopik yaklaşımla 2 (%2,6) olguya total gastrektomi, 2 (%2,6) olguya subtotal gastrektomi yapıldı. Olguların 9'unda (%11,68) ek organ rezeksiyonu yapıldı. Morbidite 9 (%11,6) olguda görüldü. Mortalite 3 (%3,9) olguda görüldü. En sık saptanan T patolojik evresi pT3 ve pT4 idi (sırasıyla %18,2 ve %55,8). Olgularımızın büyük çoğunluğunun Evre 3 (%61) oldukları görüldü. Sonuç: Mide kanseri nedeniyle ile ameliyat edilen hastalarımız tanı sırasında genellikle ileri evrede olup, bu hastalara geniş çaplı mide rezeksiyonları ve lenf nodu diseksiyonları yapılmaktadır. Minimal cerrahi girişimlerin veya endoskopik girişimlerin uygulanabilmesi için tarama programları ile olguların erken evrede saptanması gereklidir.Anahtar kelimeler: Mide kanseri, cerrahi, evre, endoskopik tarama Background and Aims: Early diagnosis of gastric cancer allows for limited resection and improved survival. Our aim is to evaluate the symptoms, endoscopic findings and surgical procedures of our patients with stomach cancer and to determine at which stage they ar...

- BACKGROUND: Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing. AIM: The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats. METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount. RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05). CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.

Objectives. The aim of this study was to evaluate the efficiency and safety of resection for colorectal malignancy in elderly patients, by comparing the data from octogenarian (80+ years) patients with other patients of different ages undergoing this procedure. Methods. Data from 80 patients who underwent elective surgery for colorectal malignancy,by a single surgeon in the same center between the dates of May 2013 and May 2015, were evaluated retrospectively. For comparison purposes, patients were classified into three age groups: 65 years and under; between the ages of 66 and 79; and 80+ years old. Demographic features; the presence of comorbidity; colon tumor location; permeation features during colonoscopy; resection type and method; morbidity and mortality; lymph node metastasis and stage of the disease; follow-up period; recurrence during follow-up; and survival data of the patients were recorded and evaluated. Results. Statistically, no significant difference was detected between the three age groups in terms of demographic features; presence of comorbidity; colon tumor location; permeation features in colonoscopy; resection type and method; morbidity and mortality; lymph node metastasis and stage of the disease; follow-up period; recurrence during followup;or survival data. Conclusion. Curative resections for colorectal cancer can be safely carried out in octogenarian patients.

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323Pancreas cancer is an important cause of mortality worldwide. It has no particular symptoms, and may cause different complaints according to tumor diameter and localization. Local invasion may develop in the short term and distant metastasis may occur in vascular structures in its neighborhood. That's why, resectability rates are low at the time of diagnosis with a negative effect on survival rates. Minimally invasive surgery is being increasingly implemented in pancreas lesions owing to the positive short-term oncologic results of the technique in many other procedures. Traditionally, conventional open surgery is performed in pancreatic head tumors. As laparoscopic resection of pancreatic head cancer has serious technical difficulties and requires advanced laparoscopic experience, minimal invasive attempts in this field have not yet reached sufficient acceptance worldwide. Besides the fact that laparoscopic pancreaticoduodenectomy may provide sufficient short-term oncologic results that are comparative with open surgery, it can be implemented in selected patients in centers with advanced laparoscopic resection capacity. In this case series, we aimed to present our experience of laparoscopic pancreaticoduodenectomy in pancreatic head cancer patients.