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Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 23 (1)
Volume: 23  Issue: 1 - 2016
RESEARCH ARTICLE
1.Operational cost of obesity surgery in Turkey
Güvenç Koçkaya, Fatma Betül Yenilmez, Gülpembe Ergin, Kağan Atikeler, Mehtap Tatar, M. Mahir Özmen, Mehmet Görgün, Halil Coşkun, Halil Alış, Mustafa Şahin, Ali Yağız Üresin, Bilgehan Karadayı, Adem Ünal, Olgun Şener, Mustafa Taşkın
doi: 10.14744/less.2014.57966  Pages 1 - 5
INTRODUCTION: Obesity and its comorbidities are among the primary challenges faced by health systems globally. Obesity is rapidly becoming a problem in Turkey, as well. Real cost of obesity surgery differs from country to country, largely due to differences in costs of health care services, medical devices, and medicines. The objective of this study was to determine operational cost of obesity surgery in Turkey.
METHODS: Expert panel was primary source of data in the study. Following literature review of costs of obesity surgery, questionnaire was designed for expert panel. Form was sent to the experts in advance of panel discussion held to reach consensus. After consensus-building phase, cost of surgical treatment of obesity was estimated based on public reimbursement and auction price.
RESULTS: Laparoscopic by-pass surgery had highest cost among obesity surgeries in both operational and postoperative costs, while laparoscopic sleeve operation had highest preoperative cost. Package payment included all costs and services from preoperative period through 15 days after operation. Based on analysis, package reimbursement prices were below actual costs for all surgical methods.
DISCUSSION AND CONCLUSION: Social Security Institution reimburses cost of obesity surgery at fixed amount of 4500 TL, 3100 TL, and 2250 TL for by-pass, sleeve, and banding surgeries, respectively. This fixed amount includes preoperative, operative, and postoperative periods. It was observed that fixed amount provided is lower than real cost of the practice of obesity surgery. As a result, hospital management may avoid performing obesity surgery or reduce the quality of surgical treatment to reduce losses. Decision makers may need to evaluate results of the study to understand accurate picture and take action in order to improve obesity surgery reimbursement.

2.Evaluation of treatment, approach, and surgical instrument preferences among surgeons: A survey
Göksin Özel, Güvenç Koçkaya, Sultan Özcan, Hülya Tiner, Hakan Karadağ, Ruhi Kadaifci, Yıldırım Gülhan
doi: 10.14744/less.2013.35220  Pages 6 - 14
INTRODUCTION: The aim of this study was to evaluate daily practice among a population of surgeons.
METHODS: A questionnaire was distributed to randomly selected general surgeons, gynecologists, urologists, and thoracic surgeons from the following 12 cities: Adana, Ankara, Antalya, Bursa, Diyarbakir, Erzurum, Istanbul, Izmir, Kayseri, Manisa, Mersin, and Samsun.
RESULTS: Surgeons administer deep vein thrombosis prophylaxis in 65% of their patients. Laparoscopic surgery is the most frequently performed procedure for cholelithiasis and antireflux treatment. The dominant factor in the selection of new surgical device is cost-effectiveness. There is an increasing preference for single-port laparoscopy. The impact of surgeons on purchase of new surgical device is at most 50%.
DISCUSSION AND CONCLUSION: his is the first survey performed in Turkey that evaluated preferences and practices of surgeons among a population that reflects practices countrywide.

REVIEW
3.Endoscopy-assisted percutaneous repair of Achilles tendon rupture
Mahmut Nedim Doral, Gazi Huri, Egemen Turhan, Defne Kaya, Gürhan Dönmez, Kadir Büyükdoğan, Mustafa Sargon
doi: 10.14744/less.2014.46855  Pages 15 - 18
While the Achilles tendon (AT) is the strongest and thickest tendon in the human body, it is also the most common tendon to rupture. It begins near the middle of the calf and is the conjoint tendon of the gastrocnemius and soleus muscles. Though numerous non-operative and operative methods have been described, there is no universal agreement about optimal management strategy of acute, total AT rupture. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon, which is important in the biological healing of the AT, this technique is a reasonable treatment option in AT rupture. Aim of this review was to discuss details of endoscopy-assisted percutaneous repair of Achilles tendon rupture and present experience.

4.Laparoscopic myomectomy in a patient with laparoscopic vaginoplasty (modified Davydov) and a review of the literature
Esengül Türkyılmaz, Mesut Öktem, Ahmet Erdem
doi: 10.14744/less.2014.43043  Pages 19 - 22
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital absence of the uterus and vagina, or uterus may be rudimentary. Coexistence of myoma uteri with MRKH syndrome is possible. The case presented in this study is the 18th report in the literature. Moreover, it is the first with coexistent skeletal system anomalies, left pelvic renal ectopia, and leiomyoma of the rudimentary uterus. Review of English-language medical literature revealed that coexistence of uterine leiomyoma and MRKH syndrome is very rare. However, if a patient with MRKH syndrome presents with a pelvic mass, the possibility of leiomyoma should be considered.

HOW TO
5.Repair of rectal perforation during robotic prostatectomy
Jameson Loyal, Roberto Bergamaschi
doi: 10.14744/less.2014.35744  Pages 23 - 24
Abstract | Full Text PDF

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