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    The effect of fundectomy on histopathological findings and metabolic hormones in rats
    (Edizioni Luigi Pozzi, 2023) Bugdayci, Nihat; Aktokmakyan, Talar Vartanoglu; Tokocin, Merve; Meric, Serhat; Ercan, Gulcin; Kirankaya, Aysegul; Cay, Tugce
    The effect of fundectomy on histopathological findings and metabolic hormones in rats AIM: Fundectomy, shown as an alternative to restrictive techniques, causes absorption restriction and metabolic changes. This study aimed to examine the histopathological changes caused by the fundectomy as a technique applied to rats by hormones that affect stomach and obesity metabolism and its effect on weight loss. MATERIAL AND METHODS: 2randomly selected Winstar-Hannover rat groups were evaluated by measuring their pre-and postoperative weights and biochemically measuring Gastrin, Ghrelin, and Leptin levels on day 30. After sacrifi cation, the stomachs were taken for histopathological examination. RESULTS: Significant weight loss was observed in the fundectomy group in the 1stmonth postoperatively. Biochemically, Gastrin means in the fundectomy group were statistically significantly higher than in the control group. The mean Ghrelin and Leptin levels of the Fundectomy Group were statistically significantly lower (p=0.005). Immunohistochemically, Gastrin means TMat the antrum and proximal stomach parts of the Fundectomy Group were significantly higher than in the control group. As Ghrelin, a significant decrease was observed in all 3regions of the Fundectomy Group compared to the control group. Leptin results were significantly lower at the antrum and proximal stomach parts of the Fundectomy Group. Histopathologically, in the Fundectomy Group, cystic glandular hyperplasia was moderate at the proximal stomach, foveolar hyperplasia was mild at the antrum, fibrosis was moderate at the antrum and corpus, and high at the proximal stomach. CONCLUSION: Fundectomy is an effective method in terms of weight loss. This animal experiment, conducted as a pilot study, will be an essential step in elucidating metabolic and histopathological changes.
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    The Effect of Single Anastomosis Duodenoileal Bypass plus Sleeve Gastrectomy on Histopathological Findings and Metabolic Hormones in Obese Rats
    (Mary Ann Liebert, Inc, 2023) Tokocin, Merve; Aktokmakyan, Talar Vartanoglu; Tokocin, Onur; Bugdayci, Nihat; Cay, Tugce; Gunes, Aysegul; Solmaz, Ali
    Purpose: Single anastomosis duodenoileal bypass+sleeve gastrectomy (SADI-S) is one of the techniques with the effect of both restrictive and absorption reduction and a more up-to-date and safer modification of this highly effective surgery. In the SADI-S model performed on rats, we aim to identify mediators in obesity and stomach metabolism, histopathologic data, and the weight loss rate.Methods: Obese rats were divided into two groups, eight of them in the SADI-S group and eight in the control group. Both groups were measured for gastrin, ghrelin, and leptin levels before and 30 days after surgery and histopathologically examined.Results: In the SADI-S group, the decrease in blood ghrelin and leptin levels was statistically significant compared with the control group (p = 0.012 and p = 0.008). The blood gastrin level was found to increase significantly compared with the control group (p = 0.012). The decrease in levels of ghrelin and leptin, determined histopathologically, in the SADI-S group was statistically significant compared with the control group (p = 0.015 and p = 0.003). The increase in gastrin level was found to be statistically significant compared with the control group (p = 0.001). Histopathological examination revealed a statistically significant increase in foveolar hyperplasia (FH) and cystic glandular dilation (CGD) in the SADI-S group (p = 0.003 and p = 0).Conclusions: In our experimental model, SADI-S was found to be a more effective method for weight loss, compared with the control group, and development of CGD, which has the potential for coexistence with gastric cancer, was detected with FH.
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    Is the Presence of 2 Renal Allograft Arteries Associated with Adverse Outcomes in Live Donor Kidney Transplantation?
    (Aves, 2023) Eren, Eryigit; Tokac, Mehmet; Uslu, Bora; Sahin, Taylan; Aktokmakyan, Talar Vartanoglu; Dinckan, Ayhan
    Objective: Although it was postulated that renal grafts with multiple arteries could lead to unfavorable recipient outcomes, this subject remains controversial. This study aimed to compare the outcomes of recipients receiving renal allografts with a single artery with those receiving renal grafts with two arteries. Materials and Methods: Adult patients who received live donor kidney transplantation in our center between January 2020 and October 2021 were included. Data including age, gender, body mass index, renal allograft side, pre-kidney transplantation dialysis status, human leukocyte antigen mismatch number, warm ischemia time, the number of renal allograft arteries (single/double), complications, duration of hospitalization, postoperative creatinine levels, glomerular filtration rates, early graft rejection, graft loss, and mortality were collected. Subsequently, patients who received single-artery renal allografts were compared with those who received double-artery renal allografts. Results: Overall, 139 recipients were included. The mean recipient age was 43.73 +/- 13.03 (21-69). While 103 recipients were male, 36 were female. The comparison between the 2 groups revealed that mean ischemia time was significantly longer in the double-artery than in the single-artery group (48.0 vs. 31.2 minutes) (P =.00). In addition, the single-artery group had significantly lower postoperative day 1 and day 30 mean serum creatinine levels. Also, the mean postoperative day 1 glomerular filtration rates were significantly higher in the single-artery group than in the double-artery group. However, the 2 groups were similar concerning the glomerular filtration rates measured at other times. On the other hand, there was no difference between the 2 groups regarding duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates. Conclusion: The presence of 2 renal allograft arteries does not have adverse effects on the postoperative parameters of the kidney transplantation recipients, including graft function, duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates.
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    Panniculectomy with bariatric surgery in super morbid obesity patients
    (Edizioni Luigi Pozzi, 2023) Peksen, Caghan; Aktokmakyan, Talar Vartanoglu; Savas, Osman Anil; Okyay, Ozan; Datli, Asli; Elmali, Necat; Sumer, Aziz
    OBJECTIVE: Panniculitis is an inflammation of the subcutaneous fat common in patients defined as super-super obese (>60 kg/m2). Poor hygiene and skin infections are common in the super morbidly obese group due to impaired metabolism of subcutaneous fat tissue, especially at abdominal folding. In our study, we will discuss the short-term results of panniculitis that develops as a result of these, simultaneously with bariatric surgery. MATERIAL AND METHODS: In our study, six super morbid obese patients with Body Mass Index (BMI) of 80 kg/m(2), 77 kg/m(2), 74 kg/m(2), 72 kg/m(2), 68 kg/m(2), 65 kg/m(2), respectively, and sub umbilical skin tissue panniculitis were evaluated. These patients underwent bariatric surgery as a result of the obesity council decision. In the preoperative evaluation of the patients, it was observed that the blood supply to the subcutaneous fat tissues under the umbilicus was impaired, and the dermis/epidermis was hypertrophied. RESULTS: Mean BMI of patients 73 kg/m(2). Sleeve Gastrectomy (SG) was performed in 4 patients, Mini Gastric Bypass (MGB) was performed in 1 patient, and modified transit bipartition was performed in 1 patient. Infected erythematous lesions were detected on the skin secondary to ischemia, especially in some areas. After the patients performed the operations, a panniculectomy of approximately 70x30x20 cm was performed from under the umbilicus to the transverse line and up to the fascia. CONCLUSION: Panniculectomy and bariatric surgery are recommended in the appropriate patient group. Extensive prospective studies are required to define further the burden of infectious morbidity and mortality conferred by obesity.
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    Unreported rare but serious complication: Major vascular injuries during bariatric surgery
    (Turkish Assoc Trauma Emergency Surgery, 2023) Aktokmakyan, Talar Vartanoglu; Peksen, Caghan; Savas, Osman Anal; Sumer, Aziz
    BACKGROUND: The aim of this study was to investigate the incidence, risk factors, clinical presentation, and management of major vascular injuries during bariatric surgery, with a specific focus on the role of different access methods in abdominal cavity entry. METHODS: A nationwide survey was conducted among bariatric surgeons to assess the prevalence of major vascular injuries. A questionnaire was distributed to 365 surgeons through WhatsApp groups of two national bariatric surgery societies, with 76 surgeons completing the survey. The study population included general surgeons practicing bariatric surgery, and the questionnaire consisted of 12 questions. RESULTS: Among the participants, 16.9% reported experiencing a major vascular injury during bariatric surgery. The majority of injuries (75%) occurred at the trocar entrance, with the remaining cases during the dissection phase. Notably, 66.7% of surgeons used optical trocars for access, while 27.8% employed the Veress needle technique. Early detection varied, with 45% identifying the injury immediately and 30% recognizing it within three minutes. Most injuries (52.4%) were repaired laparoscopically, and only three surgeons sought assistance from cardiovascular surgeons. CONCLUSION: Vascular injuries are infrequent but potentially serious complications in laparoscopic bariatric surgery. Understanding their incidence, timely recognition, and proper management are crucial to minimize adverse effects. The findings of this study shed light on the patterns of vascular injuries and the potential role of specific access methods, providing valuable insights for enhancing patient safety in bariatric surgery.