Covering sleeve gastrectomy cut surface area with acellular amniotic membrane matrix results better healing. Moreover, acellular amniotic membrane matrix provides safe healing even in incomplete sutured area.

Survival outcomes in resectable GCs are affected by the experience of the surgeon and patient-related factors at the time of surgery, including tumor size, T stage, and presence of metastatic lymph nodes.

The chyle duct (CD) lies close to the spine behind the right renal vein and vena cava. Forces capable of tearing the CD may also injure other adjacent structures or organs. Cases of isolated chylous injury are rarely reported in the literature. Our aim was to report a case of isolated chylous injury due to blunt abdominal trauma that was successfully treated non-operatively. A 54-year-old man was involved in a deceleration-type traffic accident. His physical examinations, radiologic evaluations, paracentesis, and laboratory findings revealed isolated chylous injury resulting from intra-and retroperitoneal chylous fluid collection. The patient was treated via percutaneous drainage and medical therapy. This condition is generally self-limited and resolves without the necessity of any surgical interventions. However, if medical treatment is unsuccessful, the decision of diagnostic laparoscopy or exploratory laparotomy becomes inevitable. Keywords: Abdominal trauma, chylous ascites, chyloretroperitoneum INTRODUCTIONThe cisterna chyli is an important structure because it receives the lymphatic drainage from the intestinal trunk, the right and left lumbar lymphatic trunks, and small lymph vessels that descend from the lower part of the thorax. Injury to the cisterna chyli is rare and eventful. It may manifest with chylous ascites and chyloretroperitoneum (1, 2).Chylous ascites is the accumulation of a milk-like peritoneal fluid that is rich in triglycerides, due to the presence of thoracic or intestinal lymph in the abdominal cavity. It develops when there is a disruption of the lymphatic system due to traumatic injury or obstruction (from benign or malignant causes) (3).Many pathological conditions can result in chylous ascites. These conditions include congenital defects of the lymphatic system; nonspecific bacterial, parasitic, and tuberculous peritoneal infections; liver cirrhosis; malignant neoplasm; surgical injury; and blunt abdominal trauma. However, the most common cause in adults is believed to be abdominal malignancy, while congenital lymphatic abnormalities is the most common cause in the pediatric population. The incidence of chylous ascites seems to be increasing because of more aggressive thoracic and retroperitoneal surgeries and with the prolonged survival of patients with cancer (4). Examples for surgical procedures that may be associated with chylous ascites are abdominal aortic aneurysm repair, retroperitoneal lymph node dissection, pancreaticoduodenectomy, liver transplantation, catheter placement for peritoneal dialysis, distal splenorenal shunt, inferior vena cava resection, and laparoscopic Nissen fundoplication (3).Progressive and painless abdominal distention is the major clinical manifestation of chylous ascites, which occurs over the course of weeks to months, depending upon the underlying cause. Acute onset of symptoms may be observed in patients who have undergone either an abdominal or thoracic surgical intervention or had a major traumatic injury.Blunt abdominal trauma resulting in inte...

In this retrospective study of real-life data, we aimed to determine the diagnostic accuracy in patients with choledocholithiasis of some current imaging modalities, including ultrasonography (US), computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). This study utilized a database of imaging records from 86 consecutive patients with ERCP-proven choledocholithiasis in a single-center outpatient clinic. Features of the stones found, namely number, size, localization, choledochal dilation and cholestasis, were determined using various imaging modalities and liver function tests (LFTs). Our study focused on a total of 86 patients (43 female; 43 male) who underwent the ERCP procedure. Hepatobiliary ultrasound was performed in 71 (82.6%); MRCP in 59 (68.6%); and CT in 13 (15.1%) patients. All 86 patients had choledocholithiasis: 59 (68.6%) with multiple stones and 21 (24.4%) with stones over 10 mm in diameter. Sensitivity for the presence of choledocholithiasis was 40.8% for US, 76.9% for CT, and 86.4% for MRCP, where ERCP was taken as the reference method. Even though US, CT, and MRCP are widely used as noninvasive imaging modalities for CL, in our real-life data their sensitivity for choledocholithiasis was lower than expected. MRCP is preferred when a nontherapeutic but only diagnostic evaluation is aimed for; however, while highly competent in establishing the level of choledochal dilation, it had a low yield in differentiating the localization, size, and number of the stone(s).

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...