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Öğe 30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data(Springer Nature, 2021) Singhal, Rishi; Cardoso, Victor Roth; Wiggins, Tom H.; Super, Jonathan T.; Ludwig, Christian; Sümer, Aziz; Pekşen, Çağhan; Savaş, Osman AnılBackground: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.Öğe Bridged mini gastric bypass: a novel metabolic and bariatric operation(Mary Ann Liebert, Inc, 2019) Sümer, Aziz; Atasoy, Deniz; Barbaros, Umut; Savaş, Osman Anıl; Eren, Eryiğit; Yurdaışık, Işıl; Mercan, SelçukIntroduction: In this article, we aimed to report the first five cases of laparoscopic bridged mini gastric bypass (BMGB) in the treatment of obesity and type II diabetes mellitus (DM). Presentation of Cases: We have performed five cases with a new modified surgical method that we call a BMGB. The patients' recoveries were uneventful. The weight losses of the patients were 15, 13, 14, 11, and 13 kg subsequently and with complete normalization of all metabolic parameters at first month of follow-up. Discussion: The BMGB was modified from the mini gastric bypass and resulted with the same nutritional results, less surgical complications, and a possible advantage of remaining access to the remnant stomach. Conclusion: BMGB may be as effective and possibly an even easier operation to treat obesity and uncontrolled type II DM with possible advantages over currently available metabolic procedures.Öğe Bridged one?anastomosis gastric bypass: technique and preliminary results(Springer Link, 2021) Sümer, Aziz; Mahawar, Kamal; Vartanoğlu Aktokmakyan, Talar; Savaş, Osman Anıl; Pekşen, Çağhan; Barbaros, Umut; Mercan, SelçukPurpose: One-anastomosis gastric bypass (OAGB) is an established bariatric procedure performed worldwide. We developed a modification of OAGB leaving a bridge at the cranial 2 cm of the fundus as a gastro-gastric fistula to allow for endoscopic access to the bypassed stomach. We present the preliminary results of 44 patients who underwent this technique in our hospital. Methods: We analyzed, retrospectively, data collected prospectively on 44 patients who underwent our bridged one-anastomosis gastric bypass (BOAGB) procedure between September, 2018 and November, 2020. Results: The mean age of the patients was 45.2 ± 9.3 years (range 20-66 years). The mean preoperative body mass index (BMI), weight, and HbA1c values were 41.5 ± 6.4 kg/m2 (range 35-59), 116 ± 22.7 kg, and 8.2 ± 2.1%, respectively. After a median follow-up period of 18 months (11-26 months), the mean postoperative BMI was 28.4 ± 3.2 kg/m2 (range 21-38), the mean total weight loss was 35.8 ± 13.5 kg (range 20-80 kg), and the mean percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were 79.8 ± 16.1% (range 47-109) and 30.6 ± 6.9% (range 19-48), respectively. The mean postoperative HbA1c level was 6.3 ± 0.9%. There were two early complications (stenosis and bleeding) and one late complication (marginal ulcer). Conclusion: Patients who underwent BOAGB lost weight similarly to those who underwent OABG as reported in the literature, without an apparent increase in complications related to the technique. Randomized studies with longer term follow-up are needed.Öğe Comparison of magenstrasse and mill gastroplasty and sleeve gastrectomy techniques as an experimental study on rabbits(Edizioni Luigi Pozzi, 2020) Sümer, Aziz; Çelik, Sebahattin; Aktokmakyan, Talar Vartanoğlu; Pekşen, Çağhan; Sancak, Tunahan; Kuşcu, Yağmur; Savaş, Osman Anıl; Eren, EryiğitAIM: Bariatric surgery is an important option when lift-style modification, diet, and medical treatment are inadequate in lose weight. Bariatric surgical methods have gained popularity in recent years. In this paper, we compared the Magenstrasse and Mill(M&M) technique, with performing a simpler and more physiological type of gastroplasty without implanted foreign material such as band and reservoir, to the Sleeve Gastrectomy (SG) technique. This study aimed to determine the effects of the M&M for obesity on the rabbits in comparison with the SG, which is accepted as a standard bariatric technique with creating a gastric tube. MATERIAL AND METHODS: The study was approved by the University of Van Yuzuncu Yil Regional Committee of Ethics (Institutional Animal Care and Use Committee). 20New Zealand Rabbits underwent operations. After prestudy with 2 rabbits, the remaining 18 rabbits were divided into 2 groups; Group 1 (SG) and Group 2 (M&M). RESULTS: Group 1 rabbits were observed to lose weight in all, while Group 2 rabbits; 2 of them died 5 of them lost weight, 2 of them gained weight. When the pre and post-operative weight of the rabbits were compared; preoperative median weight values of 9 rabbits in Group 1 were significantly higher than postoperative values. On the other hand, there was no significant change in the mean weight of Group 2 of 7 rabbits (living up to 8weeks). The mean weight of rabbits undergoing standard SG was significantly lower than the MeM technique. CONCLUSION: We believe that this animal experimental study, which we conducted intending to compare MeM and SG techniques, will contribute to the literature as a pilot study and determine the survey of M&M technique as a pioneer in other studies.Öğe Mini gastric by-pass and bridged mini gastric by-pass: what is new?(Ame Publ Co, 2020) Sümer, Aziz; Aktokmakyan, Talar Vartanoğlu; Pekşen, ÇağhanMore and more people suffer from morbid obesity in the past several decades. Best treatment option for the obesity is still discussed. However, the accepted gold standard treatment for morbid obesity is bariatric surgery nowadays. To treat morbid obesity the several surgical techniques have been developed so far. Every technique has advantages and disadvantages. One of these techniques is mini gastric bypass (MGB). The bridged mini gastric bypass (BMGB) was modified from the MGB and is believed that has same nutritional outcomes, less surgical complication, and possible advantages of accessing to the remnant stomach. BMGB may be an effective and easier operation to treat obesity and uncontrolled type II diabetes with possible advantages over currently available metabolic procedures. In this article, we aimed to explain MGB and its modification called BMGB.Öğe A new approach in bariatric operations: bridged mini gastric by-pass. Is rabbit model suitable for an experimental study?(2021) Sümer, Aziz; Çelik, Sebahattin; Vartanoğlu Aktokmakyan, Talar; Pekşen, Çağhan; Savaş, Osman Anıl; Talih, Tutkun; Sancak, Tunahan; Kuşcu, YağmurObjectives: Obesity is a global health epidemic with considerable co-morbidities. The increasing demand for bariatric surgery has led to the emergence of new techniques. We modified previously described Mini Gastric By-pass(MGB) technique via leaving a bridge at the most cranial 2 cm of the fundus of the human stomach to the follow-up and treatment of the remnant stomach and duodenum. We would like to entitle this new technique as Bridged MGB and aimed to apply on rabbits as an experimental study. Material and methods: The study was performed in the experimental animal laboratory of university after ethical approval was taken from the local ethics committee. Described new technique was applied to 2.1 and 3.2 kg 2 New Zealand rabbits. Results: As a result of the operations, one of the rabbits died on the day of the operation; the other rabbit was exitus postoperatively on the third day. In autopsies, although no problem was detected at the anastomoses, necrosis was detected in the large curvature of both rabbits. Conclusion: Rabbit, one of the popular experimental animals, has been shown to be different from the human gastrointestinal system in both arterial and topographic aspects and it has been emphasized that it varies according to the species and even the diet and the climate. We believe that our study failed as a result of these differences and that animals more similar to humans should be used in gastrointestinal experimental studies.Öğe Proposal for an index for predicting the success of sleeve gastrectomy: a pilot study(Mary Ann Liebert, Inc, 2019) Çelik, Sebahattin; Sümer, Aziz; Yavuz, Alpaslan; Zarbaliyev, Elbrus; Dündar, İlyasBackground: Determining the relationship between remnant gastric volume (RGV) following laparoscopic sleeve gastrectomy (LSG) and the percentage of excess weight loss (%EWL) remains a challenge. The components of RGV appear to play a much more important role than total RGV. We aimed to determine whether there is an optimal ratio between the components of RGV with respect to %EWL and to develop a statistical model to predict %EWL. Materials and Methods: This was a multicentric prospective observational cross-sectional study conducted between 2014 and 2016 with a minimum of 2 years of follow-up. Two university-affiliated hospitals participated in this study. Patients who underwent LSG as treatment for obesity were enrolled in the study. Those who did not consent to postoperative computed tomography (CT) or whose postoperative CT images were not technically suitable for calculating volumes were excluded. Patients whose follow-up was incomplete were also excluded. Out of a total of 82 patients, 63 completed follow-ups and met the inclusion criteria. By dividing RGV into its components (the antrum and body parts), volumetric measurements were made using a novel CT-based software program. RGV was divided by the antrum volume to yield a ratio that we termed the "Sleeve Coefficient" (SC). Taking SC as an independent variable, nonlinear regression analysis was performed to determine the best model for curve estimation of %EWL. The radiologists who measured the RGV components were blinded to the outcomes. Results: The participants were primarily female (56F/7M), with a mean age of 35.9 (+/- 11.9) and a mean preoperative body mass index of 44.8 (+/- 7.4). The best fitted model for predicting %EWL in the second year was the cubic model. In the second year following LSG, the mean %EWL was 76.1% (+/- 18.2%). There was no significant correlation between total remnant volume and %EWL. Optimal %EWL was obtained when the mean SC was 3.3 +/- 1.5 (95% CI: 2.94-3.72). Conclusions: The ratio between RGV and antral (rather than total remaining stomach) volume appears to be of greater importance and utility in predicting %EWL and in managing LSG candidates. The proposed SC should be validated by further studies.Öğe Recommendations for bariatric and metabolic surgical operations during the COVID-19 pandemic in Turkey(Bilimsel Tip Yayinevi, 2020) Erol, Varlık; Sümer, Aziz; Savaş, Osman Anıl; Pekşen, Çağhan; Gülay, Hüseyin; Aktimur, Recep; Özmen, Mehmet MahirThe world has been struggling with the COVID-19 virus since December 2019. Turkey has also been battling with the virus since March 2019. While struggling with this unknown virus, we have postponed our new bariatric surgeries like most elective surgery. However, curfew and quarantine period (increase in food intake and decreased physical activity) increases risks for morbidity and mortality because of obesity and diabetes. When the pandemic decreases and disappears, many obesity patients will seek treatment for obesity and the workload of surgeons will increase. Before bariatric and metabolic surgery operations, which is the most effective treatment of obesity and related comorbidities, necessary precautions must be determined and implemented to protect patients and healthcare workers before and during surgery. In this review, it was aimed to determine the pre-peri and postoperative periods of bariatric surgical requirements. This review has been written on behalf of the Turkish Society for Metabolic and Bariatric Surgery as an initiative in order to answer some questions about bariatric and metabolic surgery during the COVID-19 pandemic. © 2020 Bilimsel Tip Yayinevi. All rights reserved.Öğe Retrospective analysis of the first 50 emergency/elective surgical cases in terms of mortality and morbidity in CoVid-19 Pandemic Hospital in Istanbul(EDIZIONI LUIGI POZZI, 2020) Pekşen, Çağhan; Aktokmakyan, Talar Vartanoğlu; Savaş, Osman Anıl; Datlı, Aslı; Nurili, Fuat; Yurdaışık, Işıl; Bozkurtgil, Neşet; Yavuz, Fatime; Sümer, Aziz2019-nCoV currently named SARS-CoV-2 is a highly pathogenic Coronavirus identified in Wuhan China in December 2019. Turkey declared the first case relatively late compared to Asian and European countries on March 11, as the first SARS-CoV-2 infection in Turkey. In this study, we aimed to determine patients' outcomes in 50 surgeries done in the incubation period of SARS-CoV-2 in our hospital. METHODS: We retrospectively analyzed the clinical data of 50 patients who underwent surgeries during the incubation period of CoVid-19 at Istinye University Gaziosmanpasa Medical Park Hospital in Istanbul, from March 2 to April 11, 2020. RESULTS: The age of 50 patients range was 21 to 73, and the median age was 43.32 (64%) patients were women. The median length of hospital stay is 2.6 days (1-21). Operations at various difficulty levels were also performed on patients with co-morbidities. No complication or mortality was observed except for 1 patient, and the ICU requirement of that patient was also due to high energy trauma. CONCLUSION: Although contrary claims have been made in various studies; it is the primary duty of us surgeons to operate CoVid-19 positive/suspicious patients safely and without any contamination, and on the other hand, to continue their operations without victimizing negative patients. In this pilot study, we would like to emphasize with necessary and adequate measures these can be achieved.Öğe A single-center kidney transplantation experience in children with low weight: is low weight a contraindication?(Verduci Editore s.r.l, 2022) Eren, Eryiğit; Tokaç, Mehmet; Özkaya, Ozan; Savaş, Osman Anıl; Sümer, Aziz; Dinçkan, AyhanOBJECTIVE: Kidney transplantation (KT) might be difficult for underweight kids (under 15 kg). Our goal was to convey information on KT in underweight children. PATIENTS AND METHODS: The study’s target population consisted of children (age 18) weighing 15 kg or fewer who received KT at our facility between January 2018 and June 2021. A retrospective analysis was performed on demographic and clinical data, including age, gender, primary disease, pretransplant dialysis status, recipient weight, recipient body mass index (BMI), surgical approach type (intraperitoneal/extraperitoneal), complications, graft status (functioning/failed), patient survival, and immunological data. RESULTS: There were 94 pediatric KTs completed. Thirty-three patients were included when the selection criteria were applied. The mean recipient weight was 11.45 [6.7-15] kg, and the average patient age was 3.36 [1-7]. Three (9.9%) patients had kidney transplants from dead adult donors, whereas thirty (90.1%) patients underwent live donor kidney transplantation (LDKT). While the intraperitoneal (IPA) technique was used in 19 cases, the extraperitoneal (KT) strategy was used on 14 patients (EPA). The donor BMI was 28.24 [19.6-42] kg/m2, and the mean donor weight was 78.13 [55-109] kg. Bridectomy was necessary because five individuals experienced ileus. IPA was performed in each of these patients during LDKT. Following IPA, a 2-year-old patient with a BMI of 16 kg/m2 had renal allograft compartment syndrome and required graft nephrectomy. CONCLUSIONS: Pediatric patients weighing 15 kg or fewer can get kidney transplants successfully. Gastrointestinal problems are relatively uncommon with EPA, even though there is no agreement on the best surgical strategy.
