The Incidence of Gastrointestinal Stromal Tumors in Obese Patients—A Large Single Center Experience

Background and Objectives: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms located mainly in the fundus (60–70%). The incidence of GIST is approximately 10 per million population per year in Europe, with a peak incidence at the age of 63. Recent studies suggest that morbidly obese patients have a higher incidence of GIST than the general population. The aim of this study was to analyze the incidence of GIST in patients undergoing laparoscopic sleeve gastrectomy (LSG) in our department. Materials and Methods: this paper present the retrospective study of prospectively collected data of 1564 patients who underwent LSG in a single large bariatric center from October 2013 to September 2021. After surgery, each sample of the resected stomach was sent for histopathological examination. For the analysis, we included patients diagnosed with GIST intraoperatively or postoperatively. Results: GISTs were found in five patients (0.31%). There were three men and two women. The mean age was 50.2 (range 32–63 ± 11.8) and the mean preoperative body mass index was 43.3 kg/m2 (40–49.4 ± 3.2). In four cases, GISTs were found in the fundus (80%), and in one in the pylorus (20%). None of the tumors were larger than 7 mm in diameter and all were diagnosed as a very low-risk category. No adjuvant treatment was required. All patients achieved good or satisfactory bariatric and metabolic results. Conclusions: The incidence of GIST in our study was estimated at 0.31%. All patients had a very low-risk GIST and no recurrence until follow-up. Recent literature suggests that the risk of GIST is higher in the obese population, and therefore surgeons should be aware of the risk of incidental GIST during LSG.

Extirpation of the stump of the operated stomach for cancer

The issue of cancer of the stump of a previously resected stomach is insufficiently covered in the literature, and operations on this matter are performed very rarely. So, according to A. V. Melnikov (1960), out of 22 operations performed by domestic surgeons in this regard, there were 18 extirpations of the stump. The nature of the 4 operations is not specified.

SIMULTANEOUS SURGICAL TREATMENT OF STOMACH CANCER AND JEJUNAL DIVERTICULOSIS

The article presents a case of a combination of stomach cancer and jejunal diverticulosis in a 71-year-old female patient. Stomach cancer was diagnosed preoperatively both clinically and by instrumental (endoscopic and radiological) and pathomorphological methods. During the surgery, jejunal diverticulosis was accidentally revealed. Considering the stomach cancer resectability and the presence of diffuse intestinal diverticulosis, resection of the proximal jejunum, distal subtotal gastrectomy, Roux-en-Y gastroenteroanastomosis, and D2 lymphadenectomy were performed. The immediate postoperative period was complicated by perforation of the anterior wall of the resected stomach, and defect was urgently sutured. Control X-ray examination showed that both the stomach and gastroenteroanastomosis were normal, the passage of contrast through the jejunum was satisfactory. The patient was discharged home on the 12th day in satisfactory condition.

The bacterial association with oral cavity and intra-abdominal abscess after gastrectomy

Background Perioperative oral management has been reported to be effective for preventing postoperative infectious complications. In addition, severe periodontal disease was identified as the significant risk factor for complications after gastrointestinal surgery. We investigated the bacteriological association between the periodontal pocket, stomach mucosa and drainage fluid to determine whether oral bacteria directly cause intra-abdominal infection after gastrectomy. Methods Patients who were scheduled to undergo surgery for gastric cancer were prospectively enrolled. We evaluated the similarity of bacterial strains in periodontal pocket, stomach mucosa and fluid from drainage tube. Gingival crevicular fluid and dental plaque were collected from the periodontal pocket and cultured to detect bacteria. Specimens from the resected stomach were collected and used for bacterial culturing. Drainage fluid from the abdominal cavity was also cultured. Results All of 52 patients were enrolled. In the periodontal pocket, α-Streptococcus spp., Neisseria sp., and Prevotella sp. were mainly detected. Bacterial cultures in the stomach mucosa were positive in 26 cases. In 20 cases (76.9%), the detected strains were the same as those in the periodontal pocket. Six patients had the postoperative intra-abdominal infection after gastrectomy, and the same bacterial strains was detected in both of drainage fluid and periodontal pocket in two patients with severe periodontal disease. Conclusions We found the bacteriological association that same strain detected in periodontal pocket, stomach and in intra-abdominal drainage fluid after gastrectomy in patients with periodontal disease.

Sarcina ventriculi: A Rare Case of Life-Threatening Perforated Gastric Ulcer and Review of Literature

Sarcina ventriculi is a gram-positive anaerobic bacterium reported rarely in patients with a history of gastrointestinal surgery and delayed gastric emptying. Sarcina has been implicated in the development of gastric ulcers, emphysematous gastritis, and gastric perforation. So far, less than 30 cases of Sarcina isolated from gastric specimens have been reported, including 3 cases associated with life-threatening illness: emphysematous gastritis and gastric perforation. Herein, we report a case of a 58-yearold woman with history of gastric surgery who presented for evaluation of persistent gastric pain and incurable ulcer. She underwent total gastrectomy, and the resected stomach demonstrated a perforated ulcer with the presence of Sarcina microorganisms. We also report a second case of a 56-year-old woman with history of NSAID use who presented with gastric outlet obstruction. The gastric biopsy identifi ed concurrent Helicobacter pylori and Sarcina. Given Sarcina‘s association with emphysematous gastritis and gastric perforation, its identifi cation on gastric biopsies should be clearly stated in pathology reports and, depending on the clinical scenario, prompt clinicians to add adjunctive antimicrobials to anti-ulcer therapeutic regimens.

Relationship between the resected stomach volume and early postoperative weight loss following laparoscopic sleeve gastrectomy

Background: The aim of the study was evaluation of the effect of the resected gastric volume (RGV) on weight loss after laparoscopic sleeve gastrectomy (LSG).Methods: This prospective study included 40 morbidly obese patients undergoing LSG. Multi Detector Computed Tomography (MDCT) was used to measure preoperative stomach volume and sleeve volume. The actual RGV was measured after surgery. The primary outcome measure was the relation between RGV and percentage of excess body weight loss (%EBWL) after 3 and 6 months. The secondary outcome was early postoperative complications.Results: The mean preoperative BMI was 43.5±4.3 kg/m2. The actual RGV was substantially correlated with that estimated by CT (r=0.996, p<0.001). The former was significantly larger with a mean deviation of 17.6 cc (95%CI: 12.2-23.0 kg). The actual and CT-estimated RGV were positively correlated with% EBWL after 3 months (r=0.361, p=0.022 and r=0.471, p<0.001, respectively) and after 6 months (r=0.466, p=0.002 and r=0.553, p<0.001, respectively). Percentage of volume reduction was positively correlated with weight reduction after 3 and 6 months (r=0.0.525, p=0.001 and r=0.564, p<0.001, respectively).Conclusions: The resected gastric volume during LSG was significantly correlated with weight reduction after 3 and 6 months of surgery. Sleeve volume was not correlated with early weight reduction. MDCT is a reliable method to measure gastric volume before and after surgery.

Operation on Billroth-I in gastric cancer surgery: the evolution of views

In recent years almost all over the world, there is a decrease in the incidence of gastric cancer. Despite that carcinoma of the stomach annually affects on our planet about 1 million people. The prevalence of distal gastric cancer has a tendency to decrease, while the frequency of proximal cancer increases slightly. Early gastric cancer is only 10% of all new cases, and in 64,2% of patients are diagnosed at stages III-IV disease. Over the last 35 years, there has been substantial progress in the diagnosis and treatment of gastric cancer. Surgery that involves complete removal of the tumor remains the only method which gives hope for cure of the patient, despite the significant number of combined and complex treatment methods of this disease. However, many provisions of this concept have changed drastically. After surgery Billroth-I much less frequently and with less severity (than after resection Billroth-II) develops duodenogastric reflux in the absence of duodenostasis and adequate patency of the digestive tract. It is the reflux of bile and pancreatic juice plays an important role in the occurrence of cancer of the stomach stump. The basic cause of cancer is the development of atrophic gastritis as a consequence of denervation of the authority and the reflux of bile into the resected stomach. The choice of the method of restoring the integrity of digestive tract after distal gastrectomy is a topical problem, given the continuous increase in the number of patients undergoing this operation. In the review of literature shows that intervention in the modification of the Billroth-I does not increase the number of postoperative complications, no differences in long-term results of surgical treatment of gastric cancer for two methods of restoring the continuity of the digestive tract after distal resection.