RESEARCH ARTICLE | |
1. | Laparoscopic adrenalectomy by transabdominal lateral approach: Should we be afraid of getting started? First 5 years of experience Muhammet Kadri Çolakoğlu, Ali Demir, Ali Özdemir, Suleyman Kalcan, Gökhan Demiral, Ahmet Pergel, Uğur Avcı doi: 10.14744/less.2019.90692 Pages 149 - 155 INTRODUCTION: A laparoscopic approach has become the standard procedure for removing adrenal masses. However, the need for experience with the technique continues to be emphasized. The aim of this study was to retrospectively review the first 5 years of data of patients who had an adrenal mass and underwent laparoscopic surgery with a transabdominal lateral approach. METHODS: All of the patients at a single institution who were operated on for an adrenal mass using a laparoscopic transabdominal lateral approach between January 2014 and January 2019 were included. The demographic data, any history of other abdominal surgery, American Society of Anesthesiologists score, preoperative diagnosis, hormonal characteristics of the tumor, intraoperative parameters, intra- and postoperative complications, and the histological diagnosis were analyzed. RESULTS: A total of 42 laparoscopic adrenalectomy procedures were performed. The mean age of the patients was 50.64±13.22 years. The lesion was located on the right side in 52.3% of the patients. Nine patients (21.4%) had previously undergone abdominal surgery for various reasons. The majority of the adrenal masses were a secretory adenoma or hyperplasia of the gland. Four patients were operated on for metastasis of other malignancies and others were non-secreting tumors. The mean size of the adrenal lesions was 29.4±12.7 mm. The mean operative time was 140.45 minutes and the mean blood loss was 62.9 mL. Intraoperative complications occurred in 3 cases (7.1%). Complications were observed postoperatively in 9 patients (21.4%). The mean length of hospitalization was 3.8±2.1 days. DISCUSSION AND CONCLUSION: A laparoscopic adrenalectomy proved to be a safe and feasible method, even in cases in which it was the operator’s first experience with the procedure. The results of a first application were similar to those reported in the literature. However, we strongly believe that other prior laparoscopic experience is required to achieve these results. |
2. | Robotic versus laparoscopic sleeve gastrectomy in the treatment of morbid obesity Afag Aghayeva, Ismail Ahmet Bilgin doi: 10.14744/less.2019.53386 Pages 156 - 160 INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has become the preferred procedure in the surgical management of morbid obesity. However, there are as yet few studies that include results of robotic sleeve gastrectomy (RSG). The purpose of this retrospective study was to compare the outcomes of RSG with those of the LSG technique. METHODS: The records of all patients who underwent LSG or RSG between December 2015 and April 2018 were retrieved retrospectively from the prospectively maintained registry of a single institution. The demographic details of the patients and the perioperative parameters and postoperative short-term outcomes were compared. RESULTS: A total of 41 patients were included (20 RSG patients vs. 21 LSG patients). There was no statistically significant difference in the demographic details, with the exception of age. The patients in the RSG group were younger than those in the LSG group (p=0.038). The mean operating time was significantly lower in the LSG group (120±34.57 minutes vs. 154±41.41 minutes; p=0.001). The mean estimated intraoperative blood loss was significantly lower in the RSG group (13±14.18 mL vs. 28±16.30 mL, p=0.003). There were no significant differences in the number of postoperative complications, reoperation rate, or the length of hospital stay between groups. DISCUSSION AND CONCLUSION: According to the results of this study, the robotic approach had comparable results to the laparoscopic approach in sleeve gastrectomy. Further prospective comparative studies are needed. |
3. | Postoperative first-month biochemical parameters in laparoscopic sleeve gastrectomy patients Zuhal Karaca Karagöz, Burhan Hakan Kanat, Nurullah Aksoy, Nizamettin Kutluer, Mehmet Buğra Bozan, Sinan Irtegün, Selim Sözen, Ali Aksu doi: 10.14744/less.2020.68442 Pages 161 - 164 INTRODUCTION: Sleeve gastrectomy (SG), which was first described as a part of the duodenal switch procedure, has become the most commonly used type of metabolic surgery in Turkey and the world. This study is an evaluation of the effects of SG surgery on the levels of glucose metabolism, liver enzymes, and thyroid hormones in the first postoperative month, according to age and gender. METHODS: A total of 124 consecutive patients who underwent SG at a single center between January 2018 and September 2019 were retrospectively evaluated for enrollment. The biochemical parameters of the patients measured at the first postoperative month were evaluated and any differences between female and male patients were analyzed. RESULTS: Twenty-five patients were excluded from the study due to insufficient data and the study was performed using the records of 99 patients. Of the group, 70 (70.7%) were female and 29 (29.3%) were male, with a mean age of 35.42±11.47 years (range: 18–68 years). Preoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) values were found to be significantly higher in male patients (p<0.05). No significant difference was observed between the male and female patients in terms of free-T4 and thyroid-stimulating hormone values, (p>0.05) whereas there was a significant difference between the genders in terms of free-T3 (fT3) thyroid hormone (p<0.05). There was no significant difference between the female and male patients in terms of glucose, glycated hemoglobin (HbA1c), or age. DISCUSSION AND CONCLUSION: SG was found not only to have mechanical effects but also to cause many metabolic changes. There are currently too few studies in the literature examining how these metabolic changes alter the biochemical parameters. According to the results of a small number of studies, SG significantly reduces body mass index, and the levels of AST, triglycerides, and HbA1c. The results of this study indicated that AST, ALT, GGT, and fT3 levels were higher in men after SG than in women. |
4. | Emergency laparoscopic colorectal surgery Emrah Şahin, Ersin Gündoğan, Cüneyt Kayaalp doi: 10.14744/less.2019.39306 Pages 165 - 169 INTRODUCTION: The laparoscopic technique is increasingly used in colorectal surgery. However, in emergency cases, the use of the laparoscopic method is still limited. This was a study of the outcomes of laparoscopic surgery in emergency cases of colorectal disease at a single center. METHODS: The demographic data and perioperative findings of patients who underwent emergency laparoscopic colorectal surgery between July 2013 and January 2019 were retrospectively analyzed. RESULTS: An emergency laparoscopy was performed on a total of 14 of 658 (2.1%) patients who underwent colorectal surgery. Eight (57.1%) were male and the mean age was 55.2±21.6 years. Conversion to open surgery was required in 5 cases (35.7%). The mean number of lymph nodes removed from the patients operated on for tumors was 22.5±17.5. DISCUSSION AND CONCLUSION: The results of this study suggest that the laparoscopic approach can be applied in emergency cases of colorectal disease in certain circumstances. However, the rate of conversion to open surgery was greater than for non-emergency laparoscopic surgery. Laparoscopy was most useful for colonoscopy perforations and some colonic obstructions. |
5. | The experience of a single center using laparoscopic surgery for traumatic diaphragmatic injuries Uğur Topal, Muhammet Akyüz, Mustafa Gök, Abdullah Bahadır Öz, Türkmen Bahadır Arıkan, Merve Hamurcu, Erdoğan Mütevelli Sözüer doi: 10.14744/less.2019.25633 Pages 170 - 174 INTRODUCTION: Diaphragmatic injuries are rare and occur in about 3% of all abdominal injuries. While 5% are caused by motor vehicle accidents, 10%–15% are caused by penetrating trauma. Diaphragmatic injury develops in 0.8%–7% of blunt trauma cases and 10%–15% of penetrating trauma cases. The aim of this study was to present a report of patients from a single center who underwent laparoscopic repair with the diagnosis of traumatic diaphragmatic injury during a 2-year period. METHODS: Patients who underwent laparoscopic surgery at the study center due to traumatic diaphragmatic injury between May 2017 and November 2018 were included in the study. The demographic characteristics of the patients, cause of injury, additional injured organs, anatomical localization of the injury, surgical procedure, quantity of intraoperative hemorrhage, rate of conversion to open surgery, duration of hospitalization, morbidity and mortality rates, and 30-day readmission rate were retrospectively reviewed using hospital files and electronic records. RESULTS: Of the patients enrolled in the study, 3 were female and 1 was male. The mean age was 47.25 years (range: 36–66 years). The injury etiology was penetrating injury for 3 patients and in-vehicle traffic accident for 1 patient. Two patients had a hemopneumothorax, which was treated with a chest tube. One patient displayed hematoma in the liver and spleen. The injury to the left diaphragm was 1–4 cm in diameter in all of the study patients. A primary repair was performed in all cases. The mean quantity of intra-abdominal bleeding was 212 mL (range: 100–300 mL) and the mean postoperative hospital stay was 7.5 days (range: 5–13 days). A postoperative intra-abdominal abscess developed in 1 patient. There was no instance of mortality and no patient was re-admitted in the 30-day period after discharge. DISCUSSION AND CONCLUSION: It has been reported in the literature that laparoscopic approaches can be used safely in selected cases of abdominal injury, and can potentially have the benefits of laparoscopy. The results of this study also suggest that laparoscopy can be used safely in cases of traumatic diaphragmatic injury in the appropriate patients. |
6. | Three-port versus standard four-port laparoscopic cholecystectomy: A clinical trial Tamer Akay, Serhat Örün, Metin Leblebici doi: 10.14744/less.2020.93764 Pages 175 - 180 INTRODUCTION: After the first laparoscopic cholecystectomy was performed in 1987, the 4-port operation technique became the standard worldwide. This study is a comparison of the intraoperative complications observed using 3-port and 4-port methods, and an examination of the reliability of the 3-port method. METHODS: The files of 400 patients who underwent a laparoscopic cholecystectomy due to gallbladder disease between 2014 and 2019 were analyzed. The patients were divided into 2 groups according to the use of a 3-port or a 4-port method, and the intraoperative complications of the groups were compared. RESULTS: A total of 400 patient files were reviewed and the only significant difference between the 2 groups among the parameters of age, gender, and weight was the female-male ratio. Of the 3-port cases, 13.5% were male, and 86.5% were female. Of the 4-port cases, 23.5% were male and 76.5% were female (p=0.010). A significant difference was not seen between the 2 groups with respect to the mean operation time (p=0.548) or operation success (p=0.253). The average hospitalization period was longer in the 3-port group (1.98 days vs 1.18 days, respectively; p<0.001). No significant difference was found in the number of intraoperative complications: gallbladder perforation (p=0.215), liver laver hemorrhage (p=0.481), entry of the gallstone into the abdomen (p=0.760), and choledoch injury (p=0.522). DISCUSSION AND CONCLUSION: The success rate of a laparoscopic cholecystectomy was similar in the 3-port and 4-port groups. The mean length of hospitalization was longer in the 3-port group compared with the 4-port group. Analysis suggested that the greater number of intraoperative complications in the 3-port group had an effect on the hospitalization period. There were no instances of further complications developing after the 3-port procedure. |
7. | Staple line bleeding control with monopolar cautery in laparoscopic sleeve gastrectomy Kutay Sağlam, Cüneyt Kayaalp, Ersin Gündoğan, Mufit Sansal, Aydın Aktaş, Cihan Gökler, Fatih Sümer doi: 10.14744/less.2019.82335 Pages 181 - 184 INTRODUCTION: During a sleeve gastrectomy, cauterization of the staple line for bleeding control is not recommended due to the worry of weakening the staple line. This study is an evaluation of sleeve gastrectomy outcomes in a cohort where all staple line bleeding control was achieved using monopolar cautery. METHODS: Between July 2014 and February 2019, monopolar cautery was used as the only method of staple line bleeding control following 187 sleeve gastrectomies. The rate of staple line leaks as well as intra-abdominal and intraluminal (gastrointestinal) bleeding was examined. RESULTS: A total of 144 women and 43 men were enrolled in this study (mean age: 34.1 years; mean body mass index: 43.6 kg/m2). There were 5 leaks from the staple line (2.6%) and 7 cases of gastrointestinal bleeding (3.7%). There was no instance of mortality. DISCUSSION AND CONCLUSION: Staple line bleeding control with monopolar cautery during sleeve gastrectomy is a feasible, simple, inexpensive, and relatively safe method. Randomized trials are needed to compare monopolar cautery with other staple line bleeding control methods. |
8. | Risk factors for trocar site hernia following laparoscopic cholecystectomy Muhammet Fikri Kündeş, Metin Kement doi: 10.14744/less.2019.58561 Pages 185 - 188 INTRODUCTION: Laparoscopic cholecystectomy (LC) remains the gold standard surgical method for cholelithiasis. The objective of this study was to evaluate risk factors for the development of a trocar site hernia following an LC. METHODS: All of the patients who underwent an LC between 2014 and 2017 at the Kartal Research and Education Hospital were included in the study. Clinical data were collected retrospectively and possible causes of a trocar site hernia were analyzed. Age, gender, the method of suturing trocar sites, open or closed trocar insertion technique, body mass index (BMI), surgical site infection occurrence, associated diseases, and follow-up times were recorded. RESULTS: A total of 340 patients were included in this study. In the group, 254 were female (74%). The mean age was 48.4±14 years (range: 19-90 years). The mean follow-up time was 31.9±12.7 days. A trocar site hernia developed in 20 (5.9%) patients, and the mean age was 62.5±12.8 years (p=0.0001). Six (35.2%) of 17 patients with a postoperative surgical site infection developed a hernia (p=0.0001). In all, 35 patients had diabetes and 6 diabetic patients (17.1%) developed a hernia (p=0.003). The mean BMI was 31.2±6.1 kg/m2 in the presence of a hernia and 27.9±4 kg/m2 in the absence of a hernia (p=0.001). DISCUSSION AND CONCLUSION: This study examined age, BMI, diabetes, surgical site infection, trocar insertion method, and the technique used for the closure of fascia as possible risk factors in the development of trocar site hernia. Multivariate analysis revealed that only age, diabetes, BMI, and wound site infection were significant. |
9. | Comparison of laparoscopic and open appendectomy in the treatment of acute appendicitis Tolga Canbak, Hüseyin Kerem Tolan, Aylin Acar doi: 10.14744/less.2020.45467 Pages 189 - 191 INTRODUCTION: The laparoscopic method of performing an appendectomy is increasingly used due to advantages such as a faster recovery, decreased length of hospital stay, and minimal scarring. The objective of this study was to compare laparoscopic and open appendectomy methods performed as a result of acute appendicitis. METHODS: The records of patients who underwent an appendectomy between January 2014 and January 2015 at a single center were retrospectively evaluated. Patients who underwent a laparoscopic appendectomy were assigned to Group 1 and those who underwent an open appendectomy were classified as Group 2. Cases of a laparoscopic procedure that was converted to the open method were included in Group 2. Chi-square and Fisher exact tests were used to compare the 2 groups. P<0.05 values were considered statistically significant. RESULTS: A total of 608 patients were included in the study. Seven patients who underwent a conversion appendectomy were included in Group 2. There were 160 patients in Group 1 and 448 patients in Group 2. There were 92 male and 68 female patients in Group 1, and 279 male and 169 female patients in Group 2 (p=0.29). The mean age was 27.8±11.1 years in Group 1 and 32.7±12.3 years in Group 2. The laparoscopic appendectomy patients were younger (p<0.0001; t=15.00). The median duration of hospitalization was 2 days (range: 1–4 days) in the laparoscopic appendectomy group and 2 days (range: 1–8 days) in the open appendectomy group. No significant difference was found between the groups (p=0.607). In Group 1, 1 patient developed a wound site infection and 1 patient an intra-abdominal abscess, while in Group 2, 6 patients developed a wound site infection and 2 an intra-abdominal abscess. No statistically significant difference was found between the groups in terms of postoperative complications. DISCUSSION AND CONCLUSION: The results of this study suggest that a laparoscopic appendectomy can be performed as safely as open appendectomy. |
CASE REPORT | |
10. | Use of stapling devices to repair full-thickness rectal prolapse Bülent Kaya doi: 10.14744/less.2020.76983 Pages 192 - 194 Rectal prolapse is a chronic condition with important morbidity. Several surgical techniques, such as the Altemeier and Delorme procedures, have been used to treat the condition, but thus far, there is no gold standard surgical procedure. Recurrence and unsuccessful operations are not uncommon. Perineal stapled prolapse resection is a relatively new surgical technique for treating rectal prolapse. This is a report of the use of this simple procedure to repair rectal prolapse perineally using a stapling device under spinal anesthesia. The operation was successful, and there was no recurrence 4 months after surgery. |
11. | Biliary cancer risk should be kept in mind in laparoscopic surgery for adult choledochal cyst Ersin Gündoğan, Fatih Sümer, Aydın Aktaş, Mehmet Can Aydın, Cüneyt Kayaalp doi: 10.14744/less.2019.66487 Pages 195 - 198 Choledochal cysts are a congenital pathology with a malignant potential that increases with age. The preferred treatment is surgical excision in all age groups, and is now often performed laparoscopically. The aim of this case report was to emphasize the importance of biliary tumor risk when laparoscopic excision of a choledochal cyst is performed in adults. A 46-year-old woman was referred to the clinic for a type 1 choledochal cyst with an accompanying gallbladder polyp with regular margins. She had not had previous abdominal surgery and there were no co-morbidities. The patient underwent a laparoscopic cyst excision, cholecystectomy, and hepaticojejunostomy. The hepaticojejunostomy failed and the procedure was completed by converting to open surgery. The gallbladder and choledochal cysts were removed through an abdominal incision. A specimen pathology report indicated gallbladder cancer (T2N0M0). One month later, a gallbladder bed resection and perihilar lymph node dissection were performed. No malignancy was detected in the second pathology specimen. Follow-up at the postoperative 16th month revealed no difficulties. A literature review of 231 adult laparoscopic choledochal cyst excisions yielded a 2.6% risk for biliary cancers. Especially in adults, biliary tumors are more commonly associated with choledochal cysts. The cancer risk should not be forgotten during laparoscopic surgery for congenital choledochal cysts. |
12. | Quadriparesis after bariatric surgery: Case report Cem Dönmez, Ezgi Dönmez, Sercan Subasi doi: 10.14744/less.2019.82698 Pages 199 - 201 Obesity is one of the most significant public health concerns of the 21st century. The number of surgeries performed due to obesity continues to increase. Laparoscopic sleeve gastrectomy is the most commonly performed laparoscopic bariatric surgery and nutritional deficiencies after bariatric surgery are common. In weight-loss surgery patients with a nutritional deficiency, it should be kept in mind that the patient may have multiple vitamin deficiencies. Lifetime nutritional status follow-up is necessary. An appropriately detailed preoperative evaluation and postoperative care, as well as patient education, are essential to follow-up. There are guidelines available that recommend routine nutritional supplementation for the treatment and prevention of deficiencies. The aim of this manuscript was to describe the clinical impact of the current evidence. |