GİRİŞ ve AMAÇ: Laparoskopik Apendektomi de apandiks güdüğünün kapatılmasında (CAS) kullanmış olduğumuz değişik teknikleri ve bunların güvenliğini tartışmak.
YÖNTEM ve GEREÇLER: Kliniğimizde laparoskopik apendektomi işlemi uygulanan 232 hastanın ameliyat ve ameliyat sonrası bulgularını irdeledik.
BULGULAR: Yapılan 232 laparoskopik apandektominin yaş ortalaması 31 (16-72) ve %42.6 sı kadın %57.4 ü erkek idi. Toplam 183 apandiks güdüğü kapatılmasında (CAS) sadece endo-loop kullanıldı, 32 hastada sadece hem-o-lok kullanıldı ve 14 hasta da ise hem endo-loop hemde hem-o-lok klip beraber kullanıldı. Kalan 3 hastada ise apandiks güdüğünde ki enflamasyondan dolayı ve cerrahın kararına istinaden endo-stapler ile güdük kapatıldı.
TARTIŞMA ve SONUÇ: Laparoskopik apandektomi de güdük kapatılması (CAS) endo-looplar, endo-staplerler veya hem-o-lok klipler ile hafif ve orta derecede enflame güdüklerde güvenli olarak yapılabilinir. Ancak genişlemiş ve ileri derece de enflame olan apandiks güdüklerinde herangi bir güdük kaçağının engellenmesi için endo-stapler kullanımı daha güvenli bir seçenek olabilmektedir.

INTRODUCTION: The aim of the present study was to compare different techniques for the closure of an appendiceal stump (CAS) with respect to safety.
METHODS: A retrospective review of the records of 232 patients who underwent a successful laparoscopic operation for acute appendicitis was conducted.
RESULTS: In the 232 laparoscopic appendectomies (LA) performed in the clinic, the median age of the patient was 31 years (range: 16–72 years). The female/male ratio was 42.6%/57.4%. Of all the cases, CAS was performed with an Endoloop (Ethicon, Inc., Somerville, NJ, USA) in 183, Hem-o-lok clips (Teleflex, Inc., Wayne, PA, USA) were used in 32, and both items were used in 14 cases, according to the intra-operative decision of the surgeon. In 3 cases the CAS was achieved using a laparoscopic stapler due to inflammation in the stump of the appendix.
DISCUSSION AND CONCLUSION: CAS in LA can be performed safely using an Endoloop, Hem-o-lok clips, or a stapler in patients with a mild to moderately inflamed appendix base. In cases of enlarged and severely inflamed, or wide appendix stump, a stapler is a safe option to prevent any stump leakage.

GİRİŞ ve AMAÇ: Giriş: Laparoskopik kolesistektomi günümüzde safra kesesi hastalıklarının tedavisinde altın standarttır. Ancak açığa geçme bazen operasyonun güvenli sonlandırılabilmesi için kaçınılmaz olabilmektedir.
Amaç: Ameliyat öncesinde sıklıkla kullandığımız bazı laboratuvar bulgularının Laparoskopik kolesistektomilerde açığa dönüş ile ilişkisini değerlendirmeyi amaçladık

YÖNTEM ve GEREÇLER: Materyal ve Metod: Hastanemizde benign safra kesesi hastalıkları nedeniyle Laparaskopik kolesistektomi(LK) yapılan 173 hastanın kayıtları geriye dönük olarak incelendi. Olgular; yaş, cinsiyet, ameliyat öncesi bulguları, görüntüleme sonuçları, ameliyat öncesi laboratuar değerleri, ameliyat esnasında ve sonrasında ki komplikasyonlar, mevcut semptomları ve hastaların takipleri değerlendirmeye alındı. Olguların ameliyat öncesi laboratuar değerlerinden; Beyaz küre sayısı (WBC) >10,000/ mm3, Alanin amino transferaz (ALT) >55 IU/L, Aspartat amino transferaz (AST) > 35 IU/L, Gama-glutamil transferaz (GGT) >65 IU/L ve Alkalen fosfataz (ALP) >150 IU/Ldeğerleri hastanemiz laboratuar kitlerine göre pozitif olarak kabul edildi.
BULGULAR: Sonuçlar: Çalışmaya alınan 173 hastanın 142 (82.0%)’si kadın, 31 (18.0%)’i erkekti, ortalama yaşları 47,3 (21-81) yıldı. Hastaların 159 (91,9%) ’unda ameliyat laparaskopik tamamlanırken 14 (8.1%)‘nde açığa dönüldü. Laboratuar değerleri yüksek olan bu hastalardan 7 tanesinde açığa dönüldü. LK yapılan hastalardan ameliyat öncesi WBC değeri yüksek olan 20 hastadan 5 (25.0%) ’inde açığa dönüldü ve ameliyat öncesinde bu değerin yüksekliği istatistiksel olarak anlamlı bulundu (p<0,01). WBC değeri yüksek olmayan 153 hastada ise toplam 9 açığa dönüş gerekli oldu (5.8%).
TARTIŞMA ve SONUÇ: Sonuç olarak, elektif laparoskopikkolesistektomi öncesinde WBC değerinin yüksek olması (>10,000/ mm3) açığa dönüş için riskini 4 kat artırmaktadır. Bu durum cerraha tedavinin planlanmasında ve ameliyat öncesi hastayı bilgilendirilme sürecinde yardımcı olacaktır.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard in the treatment of gallbladder diseases. However, open surgery is sometimes inevitable for the procedure to be completed safely. The aim of this study was to evaluate the relationship of some laboratory findings frequently used in the preoperative period to the need to convert to open surgery in LC.
METHODS: The hospital records of 173 patients who underwent LC due to benign gallbladder disease were retrospectively reviewed. Based on preoperative laboratory values, white blood cell count (WBC) >10,000/mm3, alanine aminotransferase >55 IU/L, aspartate aminotransferase >35 IU/L, gamma-glutamyltransferase >65 IU/L, and alkaline phosphatase >150 IU/L were accepted as positive, according to the laboratory kits of the hospital.
RESULTS: Of the 173 patients who were included in the study, 142 (82.0%) were female and 31 (18.0%) were male, and the mean age was 47.3 years (range: 21–81 years). In 159 (91.9%) of the patients, the operation was completed laparoscopically, while in 14 (8.1%) it was converted to open surgery. The most common symptoms seen in the patients were epigastric discomfort and right upper quadrant pain. The preoperative laboratory values of 80 patients were high. Open surgery was preferred in 7 of these patients with high laboratory values. The procedure was converted to open surgery in 5 (25.0%) of the 20 patients with high preoperative WBC value and the level of these preoperative values was found to be statistically significant (p<0.01). A total of 9 conversions to open surgery were required in 153 patients with low WBC score (5.8%).
DISCUSSION AND CONCLUSION: A high WBC value (>10,000/mm3) before elective LC increases the risk of the eventuality of open surgery by 4 times. This finding will help the surgeon to plan the treatment and inform the patient of the possibility before surgery.

INTRODUCTION: The aim of this study was to compare the results of 3 treatment methods for common bile duct (CBD) and gallbladder stones: open, 2-stage endoscopic-laparoscopic, and 1-stage laparoscopic CBD exploration.

METHODS: A total of 229 patients with a median age of 59 years (range: 9–92 years) were enrolled in this study. All of the patients had symptomatic gallbladder stone or CBD stones, which were found preoperatively or intraoperatively using ultrasonography, magnetic resonance-cholangiography, intraoperative contrast cholangiography, or fiberoptic choledochoscopy. Three methods of management of patients were employed. The classic open approach, which consists of laparotomy, cholecystectomy, and CBD exploration was used in 78 patients. The 2-stage laparo-endoscopic approach, which includes pre- or postoperative endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy, was performed in 84 patients. One-stage laparoscopic management consists of laparoscopic cholecystectomy and CBD exploration with intraoperative cholangiography and fiberoptic choledochoscopy, and was performed in 67 patients.

RESULTS: Operation time in open, laparo-endoscopic and one-stage laparoscopic patients was 121 min, 142 min and 123 min, respectively. Stone removal rate were comparable between three groups - 94.8%, 85.7% and 97 % for open, laparo-endoscopic and one-stage laparoscopic patients, respectively. Hospital stay was significantly shorter in one-stage laparoscopic group (2.3 days in one-stage laparoscopic, 6.5 days in laparo-endoscopic and 8.2 days in open). Significant difference was found in complication rate. Total number of complications (19.4%) in one-stage laparoscopic group was significantly (p<0.05) lower than open (52.5%) and laparo-endoscopic (33.3%) groups. Most of complications (92.5%) in one-stage laparoscopic group were minor and did not require interventions.
DISCUSSION AND CONCLUSION: In comparison with the open and 2-stage laparo-endoscopic approaches, 1-stage laparoscopic cholecystectomy and CBD exploration have advantages, including shorter operative time, shorter hospital stay, lower complication rate, and greater stone removal rate, and may be considered the first choice for treatment of gallbladder and CBD stones.

GİRİŞ ve AMAÇ: Mirrizzi sendromu(MS) safra kesesi taşının nadir görülen komplikasyonlarından biridir ve tedavi seçimi genellikle laparoskopiden açık cerrahiye konversiyondur.
Bu çalışmada, Mirrizzi sendromlu olgularımızın, klinik prezentasyonu, tanı zorluğunu, cerrahi prosedürlerini ve cerrahi sonuçlarını retrospektif olarak değerlendirdik.

YÖNTEM ve GEREÇLER: Ocak-2014 ile Haziran- 2017 tarihleri arasında semptomatik kolelithiazis nedeni ile opere 768 hastaya operasyon uygulandı. Bu hastalardan 34’ünde MS mevcuttu. 24 hasta kadın ve 10 hasta erkek idi.
BULGULAR: En sık semptom 33 olguda görülen karın ağrısı idi. Hastaların ortalama yaşı 65.53±13.40 idi. Laboratuvar testlerinde 18 hastada tıkanma sarılığı tespit edildi. Cerrahi 30 hastada (% 88,2) gerçekleştirildi ve pre-operatif hastaneye yatıştan cerrahiye kadar geçen ortalama süre 5 gün idi (0-19days). Preoperatif görüntüleme çalışmaları sonucunda hastaların dağılımı sırası ile; Tip I (9 olgu)(% 26.5), tip II (6 olgu) (% 17.6), tip III (6 olgu) (% 17.6), tip IV (5 olgu) (% 14.7) ve son olarak tipV (8olgu) (% 23.5) idi. İki hasta komorbid hastalıkları nedeni ile opere edilemedi. Safra taşı ileusu olan diğer iki hastada medikal tedavi ile ileus hali geriledi ve yine bu hastalarda yandaş komorbid hastallıkları nedeni ile opere edilmedi.
TARTIŞMA ve SONUÇ: MS cerrahlar için tanısı ve tedavisi zor bir hastalıktır. MRCP ve ERCP, ameliyat öncesi doğru tanı ve operatif komplikasyonları azaltmada yararlıdır. Laparoskopik cerrahi, tip I ve seçilen tip II MS hastalarında düşünülmelidir.

INTRODUCTION: Mirizzi syndrome (MS) is a rare complication of cholelithiasis and surgery is the treatment of choice. It usually requires conversion to open surgery. In the present study, a retrospective assessment of experience with MS cases was performed with respect to clinical presentation, diagnostic difficulties, surgical procedures, and outcomes.

METHODS: Between January 2014 and June 2017, 768 patients with symptomatic cholelithiasis were operated on. Of these, 34 patients had MS. In that group, 24 patients (70.5%) were women and 10 patients (29.5%) were men.

RESULTS: The most frequent symptom was abdominal pain, seen in 33 cases (97.1%). The mean age at presentation was 65.53±13.40 years. Obstructive jaundice findings were defined with laboratory tests in 18 patients (52.9%). Surgery was performed in 30 patients (88.2%), and the median time from preoperative hospitalization to surgery was 5 days (range: 0–19 days). The distribution by type of involvment according to preoperative imaging was type I in 9 cases (26.5%), type II in 6 cases (17.6%), type III in 6 cases (17.6%), type IV in 5 cases (14.7%) and, type V in 8 cases (23.5%). Two patients were not operated on as a result of co-morbidities. Furthermore, another 2 patients who had gallstone ileus resolved with medical treatment were not operated on due to co-morbidities.

DISCUSSION AND CONCLUSION: MS is challenging for surgeons. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are useful for an accurate diagnosis and reducing operative complications. Laparoscopic surgery should be considered in patients with type I and in selected cases of type II MS.

Situs inversus totalis is rare embryologic anomaly. The diagnosis is usually made incidentally at a point in life during examinations for other diseases. In such cases, it is usually difficult diagnose cholelithiasis during clinical admission as the pain is usually located in the left hypocondrium. In this paper, we presented a patient who diagnosed symptomatic cholelithiasis with situs inversus totalis.

Situs inversus totalis is rare embryologic anomaly. The diagnosis is usually made incidentally at some point in life during examination for other diseases. In these cases, it is usually difficult diagnose cholelithiasis during clinical admission as the pain is usually located in the left hypocondrium. Presently described is the case of a patient who was diagnosed symptomatic cholelithiasis with situs inversus totalis.

Choledocolithiasis is an important pathology in hepatobiliary surgery. Minimally invasive methods are widely accepted in the management of choledocholithiasis. Laparoscopic and endoscopic approaches can be used. Presently described is the case of an 89-year-old male patient who was treated with laparoscopy and visualization of the common bile duct (CBD) was achieved using a 10-mm laparoscopic camera. Insertion of a laparoscopic camera into the CBD can be performed when the use of choledocoscopy or intraoperative cholangiography is impossible. A 5-mm laparoscopic camera may be even more useful for this purpose.