E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 27 (3)
Volume: 27  Issue: 3 - 2020
REVIEW
1.Recommendations and measures for minimally invasive surgery and endoscopic interventions during the COVID-19 pandemic
Rumeysa Kevser Liman, Mürşit Dinçer
doi: 10.14744/less.2020.30643  Pages 115 - 121
Çin’in Wuhan eyaletinde 2019 yılının Aralık ayında ortaya çıkan yeni şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2), 2020 Mart ayında pandemi olarak ilan edildi. Dünya genelinde pandemi ile müdacele kapsamında acil olmayan, kanser dışı elektif prosedürler durduruldu. Virüs bulaşının, esas olarak damlacık ve temas yoluyla olmasının yanında aerosol üretici prodesürler sırasında hava ile yayılımının da olabileceği endişesi nedeniyle minimal invaziv cerrahi ve endoskopi gibi işlemler virüs bulaşma riskini taşıyan prosedürler olabileceğine dair endişelere yol açmıştır. Bu makalede minimal invaziv cerrahi ile uğraşan cerrahlara ve endoskopistlere yardımcı olmak adına klinik önerileri ve bilimsel çalışmaları bildirmek amaçlandı.
The new severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), which broke out in Wuhan province of China in December 2019, was declared as a pandemic in March 2020. Within the scope of combatting the pandemic, all non-urgent non-cancer-related elective procedures were halted worldwide. Due to concerns that the virus transmission is primarily via droplets and contact, as well as airborne transmission during aerosol-generating procedures, minimally invasive surgery and endoscopy have led to concerns that there may be procedures that carry the risk of virus transmission. The aim of this article is to report clinical recommendations and scientific studies in order to assist surgeons and endoscopists dealing with minimally invasive surgery.

RESEARCH ARTICLE
2.Comparison between laparoscopic and conventional technique in the surgical treatment of choledocholithiasis
Mehmet Can Aydın, Servet Rüştü Karahan, Emin Kose
doi: 10.14744/less.2020.37929  Pages 122 - 129
GİRİŞ ve AMAÇ: Çalışmanın amacı koledok taşları için uygulanan koledok eksplorasyonunda laparoskopik ve konvansiyonel tekniği etkinlik ve güvenlik açısından karşılaştırmaktır.
YÖNTEM ve GEREÇLER: Ocak 2011 ile Aralık 2016 tarihleri arasında koledok taşı nedeniyle cerrahi tedavi uygulanan 280 hastanın verileri retrospektif olarak incelendi. Bu, 2011 ve 2016 yılları arasında Etik Kurul onaylı retrospektif bir analizdi. Hastalar uygulanan koledok eksplorasyonu tekniğine göre iki gruba ayrıldı: laparoskopik (Grup 1, 164 hasta) ve konvansiyonel (Grup 2, 116 hasta ). İki grup cerrahi bulgular ve kısa dönem sonuçlar açısından karşılaştırıldı.
BULGULAR: Hastaların 170'i (% 60,7) kadındı. Ortalama yaş 61.9 ± 16.9 idi. Klinik sonuçlar Grup 1'de ameliyat süresinin (120 ± 35.9 vs 169 ± 48.4 dakika, p <0.01) ve hastanede kalış süresinin (6.3 ± 3.9 vs 10.9 ± 6.8 gün, p <0.01) daha kısa olduğunu gösterdi. Genel morbidite (% 9 vs % 24, p <0.01) ve mortalite oranları (% 1.2 vs % 6, p <0.03) daha düşüktü. Postoperatif endoskopik sfinkterotomi gereksinimi daha azdı (% 7 vs % 18.1, p <0.01). Ayrıca Grup 1'de, daha düşük yara yeri enfeksiyonu oranıyla (% 0.6 vs % 10.3, p <0.01) daha yüksek bir taş temizliği oranı (% 93.9 vs % 82.8, p <0.01) vardı. Re-operasyon, safra kaçağı veya dren dislokasyonu açısından fark gözlenmedi.
TARTIŞMA ve SONUÇ: Taş temizliği, hastanede kalış süresi, morbidite, mortalite ve komplikasyon oranları açısından laparoskopik koledok eksplorasyonu, konvansiyonel eksplorasyona göre daha güvenli ve daha etkili bir yöntemdir.
INTRODUCTION: The aim of the study is to compare f conventional and laparoscopic techniques in common bile duct exploration in terms of efficacy and safety.
METHODS: The data of 280 patients who underwent surgical procedure for common bile duct stones between January 2011 and December 2016 were retrospectively analyzed. This was an Ethics Committee-approved retrospective analysis of data between 2011 and 2016. The patients were divided into two groups according to the common bile duct exploration technique: laparoscopic (Group 1, 164 patients)
and conventional (Group 2, 116 patients). The two groups were compared in terms of surgical findings and short-term results.
RESULTS: 170 (60.7%) of the patients were women. The mean age was 61.9±16.9 years. Clinical results showed that the operative time (120±35.9 vs 169±48.4 minutes, p<0.01) and hospital stay (6.3±3.9 vs 10.9±6.8 days, p<0.01) were shorter in Group 1; overall morbidity (9% vs 24%, p<0.01) and mortality rates (1.2% vs 6%, p<0.03) were lower. Postoperative endoscopic sphincterotomy requirement was less (7% vs 18.1%, p <0.01). In addition, in Group 1, there was a higher rate of stone clearance (93.9% vs 82.8%, p<0.01) with a lower rate
of wound infection (0.6% vs 10.3%, p<0.01). No difference was observed in terms of re-operation, bile leakage or drain dislocation.
DISCUSSION AND CONCLUSION: In terms of stone clearance, hospital stay, morbidity, mortality and complication rates, laparoscopic common bile duct exploration is a significantly safer and more effective method compared to conventional exploration.

3.Post-operative outcomes of open and laparoscopic gastrectomy for gastric cancer: A single-center experience
Bahri Çakabay
doi: 10.14744/less.2020.43179  Pages 130 - 136
GİRİŞ ve AMAÇ: Laparoskopi yardımlı gastrektomi (LADG) hızla popülerlik kazanmaktadır. Bununla birlikte, onkolojik güvenliğine ilişkin sınırlı kanıt vardır. Bu çalışmada mide kanseri nedeniyle gastrektomi + D2 lenf nodu diseksiyonu yapılan olgularda laparoskopinin operasyon sonrası komplikasyonlara ve eksize edilen toplam ve metastatik lenf nodu sayısına etkisi amaçlanmıştır.
YÖNTEM ve GEREÇLER: Mart 2019- Mart 2020 tarihleri arasında kliniğimizde gastrektomi ve rutin D2 lenf nodu diseksiyonu yapılan ardışık 40 hasta çalışmaya dahil edildi. Hastalar uygulanan tekniğe göre iki gruba ayrıldı; açık cerrahi uygulananlar (Grup 1), laparoskopik cerrahi uygulananlar ise (Grup 2). Gruplar arasında, demografik özellikler, cerrahi süre ve kan transfüzyon ihtiyacı, postoperatif komplikasyonlar ve histopatolojik özellikler karşılaştırılmıştır.
BULGULAR: Gruplar incelendiğinde Grup 1’de daha uzun hastanede yatış süresi olduğu görüldü (p=0,03). Bunun haricindeki klinik özellikler, intraoperatif ve postoperatif komplikasyon oranları benzerdi. Gruplar arasında patolojik inceleme sonucunda eksize edilen lenf nodu sayısı, metastatik lenf nodu sayısı ve metastatik lenf nodlarının çıkarılan lenf nodlarına oranında istatistiksel fark olmadığı saptanmıştır.
TARTIŞMA ve SONUÇ: Laparoskopik cerrahi güvenli bir şekilde yapılabilir ve açık cerrahiye olası bir alternatif olarak önerilebilir. Vurgulanan ana fayda, daha hızlı postoperatif iyileşmedir.
INTRODUCTION: Laparoscopy-assisted distal gastrectomy (LADG) has rapidly been gaining popularity. However, there is only limited evidence regarding its oncological safety. The aim of this study is to identify the effects of laparoscopy on post-operative complications and on the total number of excised and metastatic lymph nodes in cases with + D2 lymph node dissection due to gastric cancer.
METHODS: 40 consecutive patients, who underwent gastrectomy and routine D2 lymph node dissection in our clinic between March 2019 and March 2020, were included in the study. The patients were divided into two groups as per the technique applied; open surgery (Group 1) and laparoscopic surgery (Group 2). Demographic characteristics, intra-operative time, need for blood transfusion, post-operative complications, and histopathological features were compared between the groups.
RESULTS: The results of the study revealed that Group 1 had longer hospital stay periods (p=0.03) but other clinical features like intra-operative and post-operative complication rates were similar in both groups. Pathology results of the groups also showed no statistically significant difference in terms of the number of excised lymph nodes, the number of metastatic lymph nodes, and the ratio of metastatic lymph nodes to excisedlymph nodes.
DISCUSSION AND CONCLUSION: Laparoscopic surgery can be performed safely and may be recommended as a possible alternative to open surgery. The study emphasized a faster post-operative recovery as the main benefit of laparoscopic gastrectomy.

4.Emergency laparoscopic common bile duct exploration and analysis of risk factors for post-procedure leak: A seven years’ experience
Yousif Aawsaj, James Brown, Liam Horgan, Duncan Light
doi: 10.14744/less.2020.80388  Pages 137 - 142
INTRODUCTION: Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis in the emergency setting is challenging and technically demanding. This study aims to assess the safety and efficacy of emergency LCBDE and to analyze risk factors for post-operative bile leak.
METHODS: A retrospective data collection was done over medical notes and electronic records of the patient for the period between January 2011 to October 2017. Merelythe emergency LCBDEs were involved in this series. All of the emergency LCBDEs performed were on the index admission. Univariate and multivariate analysis were caried out for the risk factors of bile leak post-procedure.
RESULTS: 78 patients were undergone emergency LCBDE in the given period. 76 patients had a laparoscopic cholecystectomy as well as emergency LCBDE; two patients had previously undergone laparoscopic cholecystectomy. While choledochotomy was performed in 62 patients, 16 patients had a transcystic approach. All emergency LCBDEs were initiated laparoscopically, three (4%) patients had to be converted to open procedure due to adhesions (one) and impacted stones (two). In 72 patients (%89), the CBD was cleared in 72 patients (89 %) and 9 patients were considered to be in need of post-operative ERCP (6 for retained stone, 2 showing clear ducts, and 1 for continuous bile leak). Normal CRP and bilirubin values were significantly associated with post-operative bile leak.
DISCUSSION AND CONCLUSION: Emergency laparoscopic common bile duct exploration is safe, feasible, and efficient in the emergency management of common bile duct stones.

5.Comparative review of outcomes of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) Rives-Stoppa in robotic ventral hernia repair
Omar Yusef Kudsi, Naseem Bou-Ayash, Fahri Gokcal
doi: 10.14744/less.2020.49140  Pages 143 - 150
INTRODUCTION: Extraperitoneal approaches to ventral hernia repair (VHR) utilize the inner layers of the abdominal wall as a barrier. The robotic approach is promising in that it provides repair quality similar to its open and laparoscopic counterparts, with a decreased perioperative morbidity. Our aim is to compare the short-term outcomes between robotic totally extraperitoneal Rives-Stoppa (rTEP-RS) and transabdominal
preperitoneal (rTAPP) VHR.
METHODS: A comparative analysis was performed in terms of perioperative and early outcomes. Univariate tests were used to compare two groups. A subset analysis of all variables was conducted in patients with and without complications. A logistic regression analysis was used to determine factors affecting the presence of postoperative complications.
RESULTS: From 598 patients, 63 patients underwent rTEP-RS and 143 patients underwent rTAPP VHR. There were no differences between the groups in terms of patient demographics. The average defect size, mesh size and overlap were higher in the rTEP-RS group. Operative times were longer in the rTEP group. There were no differences between the two groups in terms of post-operative outcomes including complication rates and surgical site events. Female sex and console time were associated with postoperative complications.
DISCUSSION AND CONCLUSION: This is the largest study to date comparing the rTEP-RS and rTAPP approaches to VHR. The short-term results for rTEP-RS repair were similar rTAPP repair. The rTEP-RS approach allowed for large hernias defects to be repaired with large-sized mesh.

6.Laparoscopy in non–traumatic emergency general surgery operations
Serdar Kırmızı
doi: 10.14744/less.2020.04657  Pages 151 - 155
GİRİŞ ve AMAÇ: Laparoskopik cerrahi günümüzde birçok elektif cerrahi vakalarının standart bir tedavi yöntemidir. Acil genel cerrahi ameliyatlarında da laparoskopik cerrahi tercihi giderek artmaktadır. Bu çalışmanın amacı ikinci basamak bir hizmet hastanesinde acil laparokopik cerrahinin yerini araştırmaktır.
YÖNTEM ve GEREÇLER: Çalışma Ocak 2018-Mart 2020 tarihleri arasında Yozgat Şehir Hastanesi Genel Cerrahi Servisinde retrospektif olarak gerçekleştirildi. Non-travmatik acil cerrahi girişim uygulanan hastalar çalışmaya alındı. Laparoskopik cerrahi uygulanan vakalar belirlendi.
BULGULAR: Acil ameliyat edilen 768 hastanın 732’ini non travmatik vakalar oluşturmaktaydı. Appendektomi vakalarının % 62.8’inde, kolesistektomilerin % 75 ‘inde, saptırıcı stoma ameliyatlarının % 66.6’sında, brid ileus vakalarının % 8.3’ünde, inkarsere/strangule hernilerin % 2.92’unda ve peptik ülser perforasyonlarının % 11.1’inde laparoskopik cerrahinin uygulandığı saptandı.
TARTIŞMA ve SONUÇ: Appendektomi, kolesistektomi ve saptırıcı stoma ameliyatlarında laparoskopik cerrahi daha fazla tercih edilmektedir. Diğer hasta gruplarının minimal invazif cerrahinin avantajlarından faydalanması için uzmanlık eğitimi süresince cerrahların acil laparoskopik cerrahi tecrübesi artırılmalıdır.
INTRODUCTION: Laparoscopic surgery is currently a standard treatment procedure for many elective surgery cases. Laparoscopic surgery has been increasingly preferred in emergency general surgery operations. This study aims to investigate the importance of emergency laparoscopic surgery in a secondary hospital.
METHODS: The study was conducted retrospectively at Yozgat City Hospital General Surgery Service between January 2018 and March 2020. Patients who underwent non-traumatic emergency surgery were included in the study. The cases who underwent laparoscopic surgery were determined.
RESULTS: Of the 768 patients who underwent emergency surgery, 732 were non-traumatic cases. It was found that laparoscopic surgery was performed in 62.8% of appendectomy cases, 75% of cholecystectomies, 66.6% of diverting stoma operations, 8.3% of brid ileus cases, 11.1% of incarcerated/strangulated hernias and 11.1% of peptic ulcer perforations.
DISCUSSION AND CONCLUSION: Laparoscopic surgery is more preferred in appendectomy, cholecystectomy, and diverting stoma operations. In order for other patient groups to benefit from the advantages of minimally invasive surgery, in the emergency laparoscopic surgical experience of surgeons should be increased during their residency.

7.Can intraoperative hyperlactatemia have an impact on early postoperative infections in patients undergoing laparoscopic colorectal cancer surgery
Selçuk Gülmez, Orhan Uzun, Aziz Serkan Senger, Zehra Zeynep Keklikkıran, Sinan Ömeroğlu, Hilmi Bozkurt, Deniz Avan, Uğur Duman, Erdal Polat, Mustafa Duman
doi: 10.14744/less.2020.36539  Pages 156 - 161
GİRİŞ ve AMAÇ: Major cerrahinin doku hipoksisi üzerindeki etkisi, ameliyat sonunda laktat ile dolaylı olarak değerlendirilebilir. Bu çalışmada ameliyat sonunda hiperlaktateminin ameliyat sonrası erken dönem enfeksiyöz komplikasyonlar üzerine etkisi araştırıldı.
YÖNTEM ve GEREÇLER: Retrospektif olarak kolorektal kanser (CRC) nedeniyle laparoskopik rezeksiyon uygulanan 75 hastayı inceledik. Ameliyat sonunda 2 mm/L'yi aşan laktat seviyeleri hiperlaktatemi olarak tanımlandı. Ameliyat sonrası ilk 30 gün içinde enfeksiyöz komplikasyonlar çalışmaya dahil edildi. Hastalar postoperatif enfeksiyonu (POI) olan ve olmayanlar olmak üzere iki gruba ayrıldı.
BULGULAR: On dokuz hastada (% 25.3) erken POI komplikasyonları vardı. Enfektif gruptaki hastaların Charlson comorbidity indeks CCİ ≥ 3 (p = 0.021) ve tip 2 diabetes mellitus (DM) (p = 0.003) ile anlamlı bir ilişkisi vardı.. Hiperlaktateminin POI'u anlamlı olarak etkilediği gösterilmiştir (p = 0.013). On dokuz POI hastasının 16'sında (% 84.2) laktat seviyeleri yükselmiştir. POI olmayanlar ortanca değer olarak 7 gün hastanede kalırken, POI olanlar 11 gün kaldı (p = 0.002). Genel cerrahi alan enfeksiyon (SSI) ile diabetes mellitus (p = 0.006) ile hastanede kalış süresi (p = 0.001) arasında anlamlı bir ilişki vardı.
TARTIŞMA ve SONUÇ: Laparoskopik kolorektal kanser cerrahisi hastalarında CCİ ≥ 3, tip 2 DM ve operasyon sonundaki hiperlaktatemi, bu çalışmada POI için bağımsız risk faktörleri idi. POI ve SSI hastanede kalış süresinin uzamasını öngörebilir. Bu sonuçları doğrulamak için, prospektif tasarımda yüksek hasta volümlü çalışmalar yapılması gerekmektedir.
INTRODUCTION: The impact of major surgery on tissue hypoxia can be evaluated indirectly with lactate at the end of the operation. This study aimed to investigate the impact of hyperlactatemia on early postoperative infectious complications at the end of surgery.
METHODS: We retrospectively examined 75 patients who underwent laparoscopic resection for colorectal cancer (CRC). Lactate levels above 2 mm/L was defined as hyperlactatemia at the end of the surgery. Postoperative infectious complications occurred within the first 30 days were included in the study. The patients were divided into two groups as those with and without postoperative infection (POI).
RESULTS: Nineteen patients (25.3%) had early POI complications. Patients in the POI group had a significant association with the Charlson Comorbidity Index (CCI) ≥3 (p=0.021) and type 2 diabetes mellitus (DM) (p=0.003). Hyperlactatemia was found to significsantly affect POI (p=0.013). Lactate levels increased in 16 (84.2%) of 19 POI patients. While the median value for the hospital stay was 7 days for those without POI, it was 11 days for those with POI (p=0.002). There was a significant relationship between general surgery site infection l (SSI) and diabetes mellitus (p=0.006), and length of hospital stay (p=0.001).
DISCUSSION AND CONCLUSION: In this study, CCI ≥3, type 2 DM, and hyperlactatemia at the end of the operation were independent risk factors for POI in laparoscopic colorectal cancer surgery patients. SSI and POI may predict the prolonged hospital stay. To validate these findings, studies with a higher patient volume in a prospective design are required.

8.Comparison of outcomes between totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy for gastric cancer: A retrospective cohort study
Nguyen Van Huong, Dinh Van Chien, Dang Dinh Khoa, Nguyen Van Thuy, Pham Van Anh, Pham Van Duyet, Pham Van Thuong
doi: 10.14744/less.2020.74508  Pages 162 - 168
INTRODUCTION: To compare the efficacy and safety between totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG) with D2 lymph node dissection.
METHODS: This was a retrospective cohort study comparing patients who underwent TLTG
(group 1) and LATG with D2 lymph node dissection (group 2) between 01/2012 to 03/2020.
RESULTS: 59 patients in the TLTG group and 36 patients in the LATG group with D2 lymph node dissection were included in the analysis. All cases in both groups showed no microscopic tumor cells on the proximal and distal resection margins (R0). Postoperative complications were lower in the TLTG group than in the LATG group (p<0.05). There was no death during or after the surgery. The number of harvested lymph nodes in the TLTG group was higher than in the LATG group (p<0.05). The operation time, gastric tube removal time, first flatus time, drain removal time, diet time, and hospital stay time in the TLTG group were shorter than the LATG group (p<0.05). The mean postoperative survival times of the patients in both groups were insignificantly different (p>0.05).
DISCUSSION AND CONCLUSION: TLTG and LATG with D2 lymph node dissection were safe and effective inr the treatment of gastric cancer. However, the TLTG had more benefits over LATG, as patients had less pain, and shorter intensive care, recovery, operative, hospital stay time. The surgical site by TLTH was also smaller than LATG.

9.Is jejunoduodenostomy anastomosis better than jejunogastrostomy anastomosis in laparoscopic gastrectomy and jejunal interposition?
Akile Zengin, Yusuf Murat Bag, Mehmet Can Aydın, Cüneyt Kayaalp
doi: 10.14744/less.2020.68095  Pages 169 - 173
GİRİŞ ve AMAÇ: Gastrektomi sonrası rekonstrüksiyon için jejunal interpozisyon hem bir rezervuar vazifesi görmesi hem de duodenumla olan bağlantıyı devam ettirmesi sebebiyle tercih edilebilir. Bu prosedürde jejunal segment proksimal mide ile duodenum ya da distal mide arasında anastomoz edilir. Bu çalışmada laparoskopik gastrektomi sonrası jejunal interpozisyonda jejunoduodenostomi ve jejunogastrostomideki erken dönem tecrübemizi ve bu iki anastomozun sonuçları arasındaki farkları sunmayı amaçladık.
YÖNTEM ve GEREÇLER: Ocak-Ağustos 2020 tarihleri arasında yapılan altı laparoskopik gastrektomi ve jejunal interpozisyon hastası incelendi. Demografik data ve perioperatif parametreler retrospektif olarak analiz edildi. Sindirim semptomları telefon görüşmesi yoluyla değerlendirildi.

BULGULAR: Toplam altı vakanın beşi (%83.3) erkekti, ortanca yaş 70 (19-78) yıldı, ortanca beden kitle indeksi (BMI) 25.8 (23-31) kg/m2 idi. En sık cerrahi endikasyon mide adenokarsinomuydu (n=4). Ortanca ameliyat süresi 280 (200-360) dk, kanama miktarı 95 (50-100) ml idi. Ortanca oral alım başlama süresi 3.5 (2-13) gündü. Ortanca hastanede yatış süresi 7.5 (4-16) gündü. Jejunogastrostomi 3 (%50) hastada yapıldı. Postoperatif komplikasyon dört (%66.6) hastada görüldü ve bunlardan üçünde jejunogastrostomi mevcuttu. En sık gözlenen komplikasyon anastomoz kaçağı idi (n=2).
TARTIŞMA ve SONUÇ: Laparoskopik gastrektomi ve jejunal interpozisyon sonrası jejunoduodenostomi jejunogastrostomiden daha güvenlidir.

INTRODUCTION: The jejunal interposition can be preferred for reconstruction after laparoscopic gastrectomy because it functions as a reservoir and maintains the connection with the duodenal passage. In this procedure, the jejunal segment can be anastomosed between the proximal stomach and the duodenum or distal stomach. We aimed to present our initial experience with the jejunoduodenostomy and jejunogastrostomy inin jejunal interposition after laparoscopic gastrectomy and the differences between the results of these two anastomoses.
METHODS: Six patients who underwent laparoscopic gastrectomy with jejunal interposition between January and August 2020 were investigated. Demographic data and perioperative parameters were analyzed retrospectively. Digestive symptoms following the surgery were assessed by phone call.
RESULTS: Five (83.3%) of the total six patients were male. The median age was 70 (range 19–78) years, with a median body mass index (BMI) of 25.8 (range 23–31) kg/m2. The most common surgical indication was gastric adenocarcinoma (n=4). The median operative time was 280 (200–360) minutes, and the median blood loss was 95 (50–100) ml. The median time to oral intake was 3.5 (2–13) days. The median hospital stay was 7.5 (4–16) days. Jejunogastrostomy was performed in three (50%) patients. Postoperative complications occurred in four (66.6%) patients, three of whom were with jejunogastrostomy. The most common postoperative complication was anastomotic leak (n=2).
DISCUSSION AND CONCLUSION: Jejunoduodenostomy is safer than jejunogastrostomy after laparoscopic gastrectomy and jejunal interposition.

10.Percutaneous endoscopic gastrostomy placement without sedation in high-risk patients: A safe and well-tolerated technique
Güngör Gül, Mehmet Akif Aydın
doi: 10.14744/less.2020.97752  Pages 174 - 179
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is regarded as the standard enteral feeding procedure for patients requiring long-term enteral nutrition. Although it is considered as a safe procedure, PEG may be associated with severe cardiorespiratory complications, especially in patients with sedation-induced respiratory compromise. This article is a retrospective analysis of 49 patients at high-risk of complications, who undergone unsedated peroral PEG tube placement.
METHODS: PEG was placed in 49 patients through the peroral endoscopic way without sedation. The patients were given pharyngeal anesthesia and the PEG tubes were inserted using the ‘pull ‘ technique. The comorbidities, PEG indications, pharyngeal anesthesia indications, arterial oxygen saturations throughout the procedure, the comfort and the tolerability score and complications were recorded.
RESULTS: Of all patients 27 (55.1%) were female and 22 (44.9%) were male. The mean age of the patients was 81 (range: 33–99) years. PEG procedure was performed due to the loss of swallowing reflex and dysphagia in 24 (48.9%), replacement of the previously inserted PEG tube in 11 (22.5%), malnutrition in 9 (18.3%) and nasogastric tube intolerance in 5 (10.2%) patients. Unsedated procedure was performed due to aspiration pneumonia in 21 (42.8%), chronic pulmonary disease in 10 (20.4%), request from patient relatives in 15 (30.6%), and on patient’s own request in 3 (6.1%). Modified Gloucester Comfort Scale was used to evaluate the comfort and the tolerability of the patients. According to the scale, 24.4% of the patients showed no signs of discomfort, 42.8% showed mild signs of discomfort yet well tolerated the procedure. Only 8.1% showed significant discomfort. As complications, tube dislodgement was observed in 3 patients and wound infections were recorded in 4 patients.
DISCUSSION AND CONCLUSION: PEG placement using a peroral route without sedation is a safe and well-tolerated method in patients with high sedation risk.

11.Robotic thoracic esophagectomy with radical lymphadenectomy: A preliminary study
Afag Aghayeva, Ismail Ahmet Bilgin, Ebru Kırbıyık, Ahmet Demirkaya, Erman Aytaç, Ismail Hamzaoğlu, Tayfun Karahasanoğlu, Bilgi Baca
doi: 10.14744/less.2020.50251  Pages 180 - 186
INTRODUCTION: Esophagectomy with the maximal number of harvested lymph nodes remains the mainstay for esophagus cancer (EC) treatment. The present study aims to evaluate the short and long-term outcomes of patients with EC who underwent robotic esophagectomy (RE) with thoracic radical lymphadenectomy.
METHODS: Between April 2015 and April 2018, consecutive patients who underwent RE were retrieved from a prospectively maintained registry. Patient demographics, operative variables and postoperative outcomes were assessed.
RESULTS: In this study, there were 22 (10 females) patients (mean age was 60.3±8.9 years). The mean operative time and estimated blood loss was 456±71.85 minutes and 213±157 mL, respectively. The mean number of harvested lymph nodes was 24.5±9.96. The overall 30-day complication rate was 36% (n=8). OS was calculated as 87% during 25.6 (range, 12-51) months of mean follow-up time.
DISCUSSION AND CONCLUSION: According to our limited number of patients, robotic technology was safe and feasible in esophageal cancer surgery. Comparative studies with the robotic approach are needed.

CASE REPORT
12.Laparoscopic segmental resection for complete obstructive jejunal adenocarcinoma
Ulaş Aday, Faik Veysel Akpulat, Kendal Yalçın
doi: 10.14744/less.2020.92259  Pages 187 - 189
Small bowel adenocarcinoma (SBA) is a rare entity and surgical resection is the mainstay treatment of early-stage SBA. Laparoscopic surgery has become a well-established and popular treatment method worldwide and is known to provide numerous advantages. In this report, we present an SBA patient who developed complete obstruction of the small bowel and underwent laparoscopic segmental resection.

LETTER TO THE EDITOR
13.A novel laparoscopic surgical device design in order to achive easy encircling and hanging manuevers in laparoscopic surgery
Tufan Egeli
doi: 10.14744/less.2020.93653  Pages 190 - 191
Abstract | Full Text PDF

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