BACKGROUND:The primary aim of this study was to evaluate the effectiveness of patient positioning prior to trocar entry in laparoscopic sleeve gastrectomy. MATERIAL AND METHODS:The records of 300 patients that had a laparoscopic sleeve gastrectomy su...

Background/Objectives: Isolated cecum necrosis (ICN) is a rare disease and there are few reports on it in the literature. We retrospectively analyzed the patients with acute abdomen who had ICN, in terms of etiology, demographic findings, surgery, and prognosis to determine the best treatment approach. Methods: Seven patients with per-operative diagnosis of isolated cecal necrosis were included in the study. Age, gender, comorbidities, symptoms, laboratory data, imaging modalities, time from symptoms to surgery, surgical procedure, hospital stay, morbidity, and mortality were retrospectively analyzed. Results: The median age of the patients and the F/M ratio were 61 years and 2/5, respectively. The most common comorbidity was chronic renal failure, followed by hypertension, diabetes mellitus, and coronary artery disease. The median time from symptom onset to surgery was 1 day. The ileocolic anastomosis was performed in 4 patients and terminal ileostomy in three patients. The morbidity and mortality rates were 28.5% and 14.3%, respectively. The median length of hospital stay was 12 days. Conclusions: ICN should be suspected in elderly patients with comorbidities presenting to the emergency department with an acute abdomen. Computed tomography is an important diagnostic tool. Diagnostic laparoscopy is a good option for definitive diagnosis and end ileostomy is better than anastomosis in patients with bleeding tendency or hypotensive patients with chronic renal failure on dialysis, coronary artery disease, and in the presence of purulent peritonitis to reduce morbidity and mortality.

Background: Sump syndrome is one of the rare long-term complications of side-to-side choledochoduodenostomy (CD) leading to attacks of cholangitis due to accumulation of food and debris in the common bile duct distal to the anastomosis is one of the rare long-term complications after CD. Methods: Fifteen patients treated with the Sump syndrome in our institution between 1996 and 2023 were retrospectively evaluated for long-term outcome. Results: Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and bile duct clearance was done in 11 patients, while four were subjected to revisional surgery in the form of a Roux-en-Y hepaticojejunostomy. No complications were recorded. There were 5 (38%) recurrences in a median follow-up period of 8 years (10 months-23 years). Of those, 3 patients were treated surgically and two with repeat ERCP. None of the patients developed any cholangiocarcinoma during follow-up. Conclusion: We conclude that although a high recurrence rate was observed, endoscopic treatment may be a valid approach in the treatment of Sump syndrome, with revisional surgery in the form of a Roux-en-Y hepaticojejunostomy as salvage therapy in recurrences.

Background: Signet-ring cell colorectal cancer (SRCC) and colorectal cancer with a signet-ring cell component (SRC) are rare histological subtypes associated with poor prognosis. Although these entities are classified separately based on pathological criteria, it remains unclear whether they differ in clinical behavior and survival outcomes. This study aimed to compare the clinicopathological characteristics and survival of patients with SRCC and SRC. Methods: Patients who underwent surgery for colorectal cancer (CRC) between January 2012 and December 2019 and were diagnosed with SRCC or SRC on histopathological examination were retrospectively included. Demographic, clinical, and survival data were analyzed and compared between the two groups. Results: A total of 32 patients (22 males, 10 females) with SRCC or SRC were included, representing 2.6% (32/1253) of all CRC cases operated at our center. Seven patients (five with SRCC and two with SRC) had synchronous distant metastases, including liver-only metastases (9%), diffuse intra-abdominal seeding (9%), and ovarian metastasis (3%). The mean disease-free survival was 19.2 ± 3.3 months overall, and 17.18 ± 3.61 months for SRCC and 19.3 ± 9 months for SRC. The mean overall survival was 70.9 ± 10.18 months overall, and 65.95 ± 13.77 months for SRCC and 79.20 ± 15.03 months for SRC. No statistically significant difference in overall survival was observed between the groups (p = 0.534). Conclusions: SRCC and SRC demonstrate broadly similar clinicopathological features, with younger age at diagnosis observed in SRCC patients. However, given the limited sample size, the absence of statistically significant differences in survival outcomes should be interpreted with caution and does not imply equivalence. Distant metastasis remains the most important prognostic factor in both groups.