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Objective: Metabolic syndrome (MetS) affects about one-fourth of the global adult population and is characterized by hyperglycemia, abdominal obesity, low HDL (high-density lipoprotein cholesterol) cholesterol, and high triglycerides and blood pressure. Its emergence in developed nations is linked to energy intake imbalances and sedentary lifestyles. There is a parallel between MetS and conditions marked by glucocorticoid excess, such as Cushing's syndrome (CS), sharing features like central obesity, hypertension, dyslipidemia, and insulin resistance. This study aimed to investigate the association between retroperitoneal fat area (RFA) and MetS components in patients undergoing laparoscopic lateral transabdominal adrenalectomy. While intra-abdominal visceral fat's role in MetS has been studied, the significance of RFA needs further exploration., Patients and Methods: The research involved 88 patients categorized into three groups: adrenal-dependent CS, subclinical CS (SCS), and nonfunctional adrenal incidentaloma (NFA). Parameters, including body mass index (BMI), RFA, waist circumference, blood pressure, lipid profile, and fasting glucose levels, were measured. The study used hormonal hypersecretion assessments, criteria for SCS diagnosis, and biochemical analyses. MetS components were determined based on established criteria, and RFA quantification used advanced imaging software on computed tomography (CT) scans. Previous studies on intra-abdominal fat and MetS were reviewed to contextualize the findings., Results: Patients with MetS had significantly higher BMI, waist circumference, and RFA compared to those without MetS. Positive correlations were observed between BMI, RFA, central obesity, and MetS. ROC curve analysis showed a significant relationship between RFA and MetS, with a cutoff value of 36.6 cm² predicting MetS accurately in 95% of cases. The results were compared with existing literature on visceral fat's impact on MetS., Conclusions: The study findings underscore the associations between anthropometric parameters, specifically RFA and MetS. RFA is a valuable tool for assessing metabolic risk, with implications for refining criteria for adrenalectomy in individuals with adrenal incidentalomas.

Objective: Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by abnormal liver function because of lipid accumulation. NAFLD can range from simple fatty liver, which is usually harmless, to a more severe condition called non-alcoholic steatohepatitis (NASH), which involves inflammation, liver cell damage, cirrhosis, and liver cancer. Liver biopsy is considered the gold standard for diagnosing and staging hepatosteatosis, but it is an invasive and expensive procedure. Non-invasive methods, such as ultrasound, and magnetic resonance imaging (MRI), can provide useful information without the need for an invasive procedure. This study aimed to compare laparoscopic findings of hepatosteatosis with ultrasound data to create a classification that can identify individuals with NASH in operated patients., Patients and Methods: 120 patients who applied to the General Surgery Department of Istinye University Faculty of Medicine between 06/2022 and 12/2022 were included in the study. They were evaluated for hepatosteatosis with preoperative ultrasound. Demographic, physical examination (BMI), laboratory, and radiological findings of the patients were recorded retrospectively. In addition, laparoscopy video recordings were reviewed retrospectively, and the findings were evaluated. Statistical analysis of the findings was made. The p-value was calculated using the Chi-square test; p-value <0.05 was considered statistically significant., Results: The mean age of 120 patients was 39.04 years, the mean BMI was 34.9 kg/m², and 63.3% of them were female patients. Cholecystectomy was performed in 60 of 120 patients, and sleeve gastrectomy in 60 of them. It has been observed that there is a high correlation between the ultrasound grade and the laparoscopic stage of hepatosteatosis (r=0.849) (p<0.05)., Conclusions: Laparoscopy results to be an effective method in the diagnosis and classification of NASH.

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/m2, 77 kg/m2, 74 kg/m2, 72 kg/m2, 68 kg/m2, 65 kg/m2, 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/m2. 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., Key Words: Bariatric surgery, Obesity, Panniculectomy.

Background: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates., Methods: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020., Results: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country., Conclusions: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak., (© 2021. The Author(s).)

Purpose: 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/m 2 (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/m 2 (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., (© 2021. Springer Nature Singapore Pte Ltd.)

2019-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., Key Words: CoVid-19, SARS-CoV-2, Surgery.

Purpose: Wound healing consists of a sequence of complex molecular and cellular events. Collagen is composed mainly of proline and hydroxyproline. Proline and hydroxyproline constitute 1/3 of the amino acids in collagen, which makes up approximately 30% of the proteins within the body. The hydroxylation of proline found in collagen determines the stability of the triple helical structure of collagen. In this study, we examined the effects of local and systemic administration of proline on wound healing. Materials and Methods: 24 female Sprague-Dawley rats were used in the study and divided into three groups. Group 1: The defect created in the backs of the subjects was left to secondary healing. Group 2: 200 µl proline per day was administered topically for 30 days on the defect in the backs of the subjects. Group 3: 200 µl per day was administered intraperitoneally for 30 days on the defect in the backs of the subjects. Results: On day 21, there was a statistically significant difference between the groups in terms of the mean re-epithelialization score. On days 7 and 14, there was a statistically significant difference between the groups in terms of the mean granulation score. On days 7, 14, and 21, there was a statistically significant difference between the groups in terms of the mean collagen accumulation score. On day 30, there was a statistically significant difference between Groups 1 and 3 in terms of the mean E-mode score on mechanical tensile test. Conclusion: Our study confirmed that proline has positive effects on wound healing. However, it revealed that systemic administration of proline is more effective than local administration of proline.