Pylora of anastomotic leaks after sleeve gastrectomypost-botilinum injection treatment: A rat study

Obesity has become a problem that increases mortality and morbidity, increases health costs, and has negative effects on the country's economy after global smoking and wars. Although it began to be seen as a health problem in the 10th century, it was only discovered in the 19th century. It has also begun to be accepted as a disease. Although physicians all over the world are developing methods to prevent and treat obesity and metabolic diseases, this global epidemic is growing rapidly. Open surgical practices, which started in 1952, have evolved over time and have been replaced by minimally invasive techniques and continue to develop. According to World Health Organization (WHO) data, 16% of adults will be obese and 43% will be overweight in 2022. Its incidence is increasing in both adults and children and adolescents. (1) Obesity, coronary heart disease, cerebrovascular disease, atherosclerosis and some cancers (colorectal, breast, etc.), hypertension, hyperlipidemia, diabetes mellitus, gallbladder disease, cerebrovascular disease, gastroesophageal reflux disease. It causes many diseases such as depression, polycystic ovary disease, sleep apnea syndrome, infertility and osteoporosis. As a result, obesity is one of the important pathologies that shortens life expectancy and increases mortality and morbidity due to diseases. (2) Obesity is the second cause of preventable mortality after smoking. (3) Aim: Techniques to combat obesity remain up-to-date as it is a public health problem that is considered public health all over the world and continues to increase. Treatment algorithms have been created to combat obesity. Although multidisciplinary treatment, increasing physical activity and psychological support, diet regulation and medical treatment are primarily recommended, the inadequacy of these methods has led to surgical treatment being accepted as the first and most effective method in the guidelines. Bariatric surgery methods, which provide the most permanent treatment to solve this growing problem, have begun to be performed more frequently and will probably be performed even more frequently in the coming years. This increase in surgery will naturally lead to an increase in surgical complications. This project focuses on the treatment of anastomotic leaks, which are the most lethal complications of these complications. Material and method: A total of 30 rats, each consisting of 10 male winstar albino rats, were used for the study. xiii Rats were randomly divided into 3 groups (n=10). Group 1 (n:10): Control group. The rats in this group underwent sleeve gastrectomy only with the standard surgical protocol and were designated as the control group. Group 2 (n:10): Surgery group. In this group, sleeve gastrectomy was performed on the rats with a standard surgical protocol and a leak was created in the anastomosis line. Group 3 (n:10): The group that will receive botulinum after surgery. In addition to the procedures in group 2, botulinum toxin was applied to the pylorus of the rats in this group. Standard surgical procedure: After the stomachs of the rats were found, approximately 50% of the stomach volume was resected. For leakage, a standard leak of approximately 1 mm in size was made in the proximal part of the stomach. Application of botulinum A toxin; The pylorus of the subjects in the Botox+leakage group was found and a total of 8 units of Botulinum A toxin, 2 I/U, were applied to each four quadrants. After these three groups were completed, they were followed for 14 days at Van Yüzüncü Yıl University Experimental Medicine Application and Research Center. The death days of the rats were recorded and the 14th postoperative day was considered as full recovery. Rats that died before 14 days were opened and evaluated for intra-abdominal adhesions. On the 14th postoperative day, before the rats were sacrificed, the stomach was inflated with methylene blue by gavage method, and then all rats were sacrificed by giving a high dose of anesthetic agent. As was done for rats that died early, the sacrificed rats were opened and evaluated for methylene blue leakage and intra-abdominal adhesions. No methylene blue extravasation was observed in any subject who completed 14 days. Results: We found that although Botox has positive effects in the treatment of leakage, it is not effective enough to be used as a sole treatment method. Botox; Using primary repairs, endoscopic treatment methods or as a combined treatment method in minimal leaks planned to be followed only with pigtails will increase the success rate of the treatment. However, since our findings were obtained from a rat study, we think that it is not appropriate to interpret them directly clinically and that these results should be supported by clinical studies.