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Yayın Correlation of the endoscopic esophagogastric junction integrity with symptomatic gerd in patients undergoing work-up for metabolic and bariatric surgery(Springer, 2025) Şişik, Abdullah; Dalkılıç, Muhammed Said; Gençtürk, Mehmet; Yılmaz, Merih; Erdem, Hasan; Nguyen, Ninh T.BackgroundGastroesophageal reflux disease (GERD) is a common adverse effect after metabolic and bariatric surgery (MBS). Identifying patients with preexisting GERD is critical for preoperative planning. The American Foregut Society (AFS) recently proposed a new endoscopic classification system for objective assessment of the esophagogastric junction (EGJ) integrity, building upon the Hill classification. Grade 1 represents an intact EGJ, while grades 2, 3, and 4 represent partial, moderate, and complete disruption of the ARB. Unlike Hill classification, the AFS classification includes objective measurement of hiatal axial length and aperture diameter. The study aimed to evaluate the ability of the AFS hiatus classification to predict GERD severity using symptom questionnaires.MethodsWe performed a prospective study of obese patients who underwent endoscopy as work-up for MBS. The endoscopy was evaluated for esophagitis, Barrett's esophagus, and AFS grade. All patients were also surveyed preoperatively with the GERD-HRQL, GerdQ, and RSI. The correlation between AFS grades and questionnaire scores was analyzed using Spearman's test.ResultsA total of 393 patients were included in the study. There were 81% female, with a mean age of 36 +/- 10.7 years and a mean BMI of 41.7 +/- 7.2 kg/m2. The AFS grades were distributed as follows: 11 (2.8%) patients had grade 1; 137 (34.9%) had grade 2; 162 (41.2%) had grade 3; and 83 (21.1%) had grade 4. There was a positive but weak correlation between AFS grades and all scoring systems, including GERD-HRQL (r = 0.201), heartburn (r = 0.203), regurgitation (r = 0.212), RSI (r = 0.110), and GerdQ scores (r = 0.202). However, the proportion of patients with esophagitis increased progressively with increasing grades (0% in grade 1, 2.2% in grade 2, 9.9% in grade 3, and 32.5% in grade 4, p = 0.01).ConclusionThe AFS hiatus classification can stratify the population with obesity based on rate of esophagitis and symptom scores. This study supports the practical utility of the AFS classification as an adjunct in the detection of patients who are at risk for GERD after MBS. Further validation studies with pH testing are needed.Yayın How long can an intragastric balloon remain in the stomach safely? a rare case report on 5.5 years of asymptomatic retention(Springer, 2025) Gençtürk, Mehmet; Dalkılıç, Muhammed Said; Erdem, Hasan; Şişik, AbdullahIntragastric balloons (IGBs) are widely used as a minimally invasive weight loss intervention for patients with obesity. While the recommended implantation period for most IGBs is 6 to 12 months, exceeding this duration is associated with an increased risk of complications such as deflation, migration, obstruction, and gastric perforation. However, the long-term safety of retained IGBs remains inadequately studied. We report a rare case of an asymptomatic 5.5-year retention of a Spatz3 IGB in a 29-year-old male patient. Initially implanted for obesity management with a body mass index (BMI) of 38 kg/m2, the patient experienced an initial 15 kg weight loss, followed by partial weight regain. Despite multiple attempts to schedule removal, the patient postponed the procedure due to personal reasons and was lost to follow-up. Upon returning 5.5 years later, he remained asymptomatic with a BMI of 37.3 kg/m2. Endoscopic examination revealed an intact gastric mucosa and a fully inflated balloon without evidence of degradation or leakage. The balloon was successfully removed endoscopically under sedation, and the postoperative course was uneventful. This case highlights that, under certain conditions, IGBs may remain intact beyond their recommended duration without causing immediate complications. However, this should not be interpreted as evidence of safety, as prolonged retention poses significant risks. Regular patient education, adherence to follow-up schedules, and improved tracking systems are crucial to prevent unintended long-term IGB retention and its associated complications.Yayın Integrating anti-migratory strategies with hiatal repair in sleeve gastrectomy(Springer, 2025) Dalkılıç, Muhammed Said; Şişik, Abdullah; Oumar, Mahamat Bechır Saleh; Erdem, HasanWe read with great interest the recently published articles by Abdallah and Alawadi, titled “Fixation of the Esophagus to Diaphragmatic Hiatus as a Routine Step in Hiatal Her nia Repair During Bariatric Surgery” [1], and by Nguyen et al. on Flap Valve-Preserving Vertical Sleeve Gastrectomy (fvpVSG) [2]. We commend both groups for presenting innovative approaches to mitigate two of the most chal lenging sequelae of sleeve gastrectomy (SG): postoperative gastroesophageal reflux disease (GERD) and intrathoracic sleeve migration (SM).Yayın Minimizing omental bleeding risk following sleeve gastrectomy: assessing the double-line sealing technique(Lippincott Williams and Wilkins, 2025) Dalkılıç, Muhammed Said; Gençtürk, Mehmet; Yılmaz, Merih; Erdem, Hasan; Şişik, AbdullahObjective:Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric procedure due to its technical simplicity and effectiveness. While stapler line reinforcement has significantly reduced hemorrhagic complications, postoperative bleeding remains a concern, particularly from omentum or unidentified sources. The LigaSure device, known for sealing vessels successfully up to 7 mm in diameter, may face challenges in obese patients due to excessive omental fat. This study introduces a double-sealing technique as a simple solution aimed at reducing postoperative bleeding related to patient-specific factors.Methods:This study conducts a retrospective analysis to evaluate the double-line omental sealing technique in LSG, an intervention aimed at reducing the incidence of postoperative bleeding. We compared outcomes from 222 patients using the double-line sealing (DLS) technique and 297 patients with standard dissection. DLS technique involves creating 2 adjacent rows of seals on the omentum during dissection, aiming to minimize bleeding risks. Patient demographics, including age, sex, body mass index, and comorbidities, were examined, alongside operative time, length of hospital stay, and instances of reoperation. Special attention was given to identifying cases of severe postoperative bleeding, primarily determined by the need for blood transfusion.Results:No demographic differences emerged between the groups. The study group, which utilized DLS, demonstrated a significantly lower incidence of intraperitoneal severe bleeding (0.45%) compared with the control group (3%). Reoperations were significantly reduced, with only 2 cases (0.67%) in the control group and none in the DLS group. It also correlates with reduced length of hospital stay but increased operative time.Conclusions:DLS in LSG shows promise in reducing severe postoperative bleeding. Despite these positive initial findings, further studies with larger sample sizes are recommended to fully ascertain the efficacy and safety of this technique.Yayın The effect of prophylactic intraoperative tranexamic acid use on bleeding after laparoscopic sleeve gastrectomy with omentopexy: a prospective cohort study(SAGE Publications Inc., 2025) Dalkılıç, Muhammed Said; Şişik, Abdullah; Gençtürk, Mehmet; Yılmaz, Merih; Erdem, Hasan; Parmar, ChetanBackground Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric procedure. While advancements like staple line reinforcement (SLR) have reduced hemorrhagic complications, bleeding risks persist. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating bleeding risks in various surgical disciplines, but its efficacy in LSG with SLR remains unexplored. This study aims to evaluate the effect of intraoperative TXA administration on postoperative bleeding outcomes in patients undergoing LSG with oversewing and omentopexy.Methods This prospective observational cohort study included 233 patients undergoing LSG with oversewing and omentopexy. Patients were divided into 2 groups: 1 received 1 g of TXA intraoperatively, while the other did not. Hemoglobin differences at 24 and 48 hours postoperatively were the primary outcomes. Secondary outcomes included blood transfusion necessity, re-intervention rates, and 30-day surgical complications.Results There was no statistically significant difference in hemoglobin changes at 24 hours (TXA group: 0.8 +/- 0.7 g/dL, 95% CI: 0.67-0.93; control group: 0.9 +/- 0.9 g/dL, 95% CI: 0.74-1.06; P = 0.125) or at 48 hours (TXA group: 1.4 +/- 1.5 g/dL, 95% CI: 1.12-1.68; control group: 1.5 +/- 1.4 g/dL, 95% CI: 1.25-1.75; P = 0.167) between the groups. No patients required transfusions or re-interventions. Five patients in the control group exhibited hemorrhagic drainage exceeding 150 mL, while none in the TXA group experienced similar complications. Length of hospital stay and operative time were similar between the groups (P = 0.124 and 0.746, respectively).Conclusions Tranexamic acid may not significantly impact major bleeding complications following LSG with oversewing and omentopexy but appears to reduce minor hemorrhagic events.
