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Objective: The preferred treatment for acute cholecystitis (AC) is early cholecystectomy (EC). There are several risk factors increasing the risk of mortality for EC in Tokyo Guideline 2018 (TG18) grade III AC; and therefore, percutaneous cholecystostomy (PC) is recommended in these patients. However, the effect of these risk factors on mortality in patients having undergone EC have not been sufficiently investigated to date. Materials and Methods: In our clinic, 206 patients with AC were treated between 2015 and 2020. Thirty-one adult patients with TG18 grade III AC were included into the study. The patients were divided into two groups as EC group (n=11) and PC group (n=20). Comparisons were made between EC and PC, and the effects of risk factors on mortality were examined. Results: All patients had a score of ≥III according to American Anesthesiologists Association (ASA). The Charlson comorbidity index (CCI) was ≥4 in 72.4% of the patients, and 32.4% of patients had negative predictive factors (NPF: neurological and respiratory dysfunction, and a total bilirubin value of ≥2 mg/dL on admission). Mortality was seen in 12 patients. Compared to patients with PC, higher definitive treatment (p˂0.001), less re-admission (p˂0.001) and less mortality (p=0.01) were seen in patients with EC. Major complications (Clavien-Dindo classification >II) and length of hospital stay were similar in both groups (p=0.60, p=0.39; respectively). Conclusion: This study showed that EC could be performed in patients with TG18 grade III AC who have risk factors. TG18 guidelines should be re-evaluated for risk factors for EC.

Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci XiBetween December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes.Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p = 0.02, p = 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p = 0.052). Operating time in the robotic group was longer (p = 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p = 0.047).Totally robotic technique with the da Vinci Xi

This study contains novel a serie synthesis of N-heterocyclic carbene (NHC) precursors that 2-hydroxyethyl substituted. The NHC precursors have been prepared from 1-(2-hydroxyethyl)benzimidazole and alkyl halides. The novel NHC precursors have been characterized by using H-1 NMR, C-13 NMR, FTIR spectroscopy and elemental analysis techniques. Molecular and crystal structures of 2a, 2d, 2e, 2f and 2g were obtained with single-crystal X-ray diffraction studies. These novel NHC precursor's derivatives effectively inhibited the a-glycosidase, cytosolic carbonic anhydrase I and II isoforms (hCA I and II), butyrylcholinesterase (BChE) and acetylcholinesterase (AChE). Inhibition constant (K-i) were found in the range of 0.30-9.22 nM for alpha-glycosidase, 13.90-41.46 nM for hCA I, 12.82-49.95 nM for hCA II, 145.82-882.01 nM for BChE, and 280.92-1370.01 nM for AChE, respectively. (C) 2017 Elsevier B.V. All rights reserved.

The umbilical region is particularly susceptible for development of incisional hernia after laparoscopic cholecystectomy (LC). To evaluate the effects of port-closure techniques on the complications seen after umbilical port-site closure, we compared closure with Berci's needle and the standard technique of a hand-sutured closure.A hundred patients underwent LC were randomly divided into two groups. We evaluated the required time for closure, the security of techniques and the factors affecting postoperative complications for both closure groups in a prospective manner.Closure of the umbilical port site was performed faster with the Berci's needle compared to standard hand-sutured technique. Postoperative hospital stay and complication rates were not altered significantly depend on the closure technique. Skin dimpling on the trocar site was observed predominantly after closure with Berci's needle. Spontaneous improvement on skin dimpling was observed within the 2 weeks after operation in all patients. During the follow-up period, there was no trocar site hernia observed in the study group.Closure of the umbilical port site with Berci's needle is found as an effective and safe method for laparoscopic cholecystectomy.