E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 24 (1)
Volume: 24  Issue: 1 - 2017
1.Comparison of adrenal vein control methods in laparoscopic adrenalectomy
Murat Arslan, Altuğ Tuncel, Tansu Değirmenci, Zafer Kozacıoğlu, Ersin Köseoğlu, Yılmaz Aslan, Cenk Gürbüz, Ali Atan
doi: 10.14744/less.2017.10820  Pages 1 - 4
INTRODUCTION: The aim of the present study was to compare different methods of adrenal vein control in patients undergoing laparoscopic adrenalectomy.
METHODS: Total of 87 patients who underwent laparoscopic adrenalectomy (transperitoneal, n=61; retroperitoneal, n=26) due to adrenal mass were included in this study. Mean age was 50.9 years. In 57 patients (65.5%), adrenal vein was controlled using Hem-o-lok (Teleflex, Inc., Wayne, PA, USA) ligation clip, and in remainder (n=30; 34.5%), adrenal vein was controlled using LigaSure (Medtronic, Inc., Minneapolis, MN, USA) vessel sealing system (Group 2).
RESULTS: Mean age of the patients in Group 1 and Group 2 was 52.7±4.5 years and 54.4±4.0 years, respectively (p=0.264). Mean diameter of lesion was 42.7±2.2 mm (range: 21-87 mm) and 37.5±3.6 mm (range: 15-72 mm) in Group 1 and 2, respectively (p<0.001). Mean operating time was 97.5±5.8 minutes (range: 60-126 minutes) and 90.2±4.6 minutes (range: 50-150 minutes) in Group 1 and 2, respectively (p=0.001). Mean estimated blood loss was 100 mL (range: 20-350 mL) and 5 mL (range: 0-10 mL) in Group 1 and 2, respectively (p<0.001). Mean length of postoperative hospitalization was 4.9±4.2 days (range: 1-13 days) and 2.9±1.8 days (range: 1-9 days) in Group 1 and 2, respectively (p=0.029). Intraoperative complication occurred in 3 patients (5.2%) (adrenal vein avulsion) and 1 patient (3.3%) (spleen laceration) in Group 1 and 2, respectively.
DISCUSSION AND CONCLUSION: LigaSure vessel sealing system had lower complication rate compared with Hem-o-lok ligation clip during laparoscopic adrenalectomy.

2.Comparison of Endoloop and polymer locking clip in ligating appendiceal stump during laparoscopic appendectomy
Osman Şimşek, Ismail Ahmet Bilgin, Sezgin Uludağ, Fatih Dal, Mehmet Velidedeoğlu, Kaya Sarıbeyoğlu, Salih Pekmezci
doi: 10.14744/less.2017.65375  Pages 5 - 8
INTRODUCTION: The aim of this study was to compare use of Endoloop (Ethicon, Inc., Somerville, NJ, USA) and Hem-o-lok (Teleflex, Inc., Wayne, PA, USA) polymer locking clip for closure of the appendix base during laparoscopic appendectomy.
METHODS: In this prospective clinical study, 2 groups (Group 1: Endoloop; Group 2: Hem-o-lok) were formed and demographics, operating time, stump closure time, length of postoperative hospital stay, cost, and complications were compared.
RESULTS: No perioperative or major postoperative complications were encountered. There was no mortality. Mean operating time was 50±10.6 minutes for Group 1 and 40±12.6 minutes for Group 2. Mean appendiceal base closure time was determined to be 187±102 seconds and 69±30 seconds in Group 1 and 2, respectively. Mean hospital stay was 53±33.4 hours and 47.5±34 hours for Group 1 and 2, respectively. Comparison of operating time revealed statistically significant difference (t=3.22; p=0.002), and base closure time in Group 1 was significantly longer (z=6.388; p<0.001). Remaining statistical comparisons did not reveal any statistically significant results.
DISCUSSION AND CONCLUSION: Polymeric clip application of the appendiceal base had statistically significantly better results in terms of technical comfort and operating time in comparison with application of Endoloop. Further clinical studies are required to reach a final conclusion.

3.Efficacy of acute laparoscopic cholecystectomy for acute calculous cholecystitis regardless the length of symptoms
Marek Soltes, Jozef Radonak
doi: 10.14744/less.2017.21931  Pages 9 - 12
INTRODUCTION: Although early acute laparoscopic cholecystectomy within 72 hours is considered method of choice for acute calculous cholecystitis, controversy persists concerning its indication in case of prolonged symptoms.
METHODS: Prospectively run data of patients operated on for acute calculous cholecystitis over period of 3 years in tertiary referral center were analyzed. Acute surgery was performed, regardless of the duration of symptoms, provided that no prohibitive surgical factors were present. Only patients with histopathologically confirmed acute cholecystitis were included in the study. Analyzed parameters included age, gender, preoperative C-reactive protein (CRP) level, time interval from onset of symptoms until surgery, operating time, intraoperative and postoperative complications, conversion rate, length of hospital stay, readmission, and reoperation rate. Analysis was performed on intention-to-treat basis.
RESULTS: Total of 157 consecutive patients, of whom 90 were female and 67 were male, underwent acute cholecystectomy during study period. In all, 130 laparoscopic procedures were performed (83%) and there were 15 conversions (11.5%). Mean patient age was 59.15±13.33 years (range: 24-83 years), preoperative CRP was 57.04 ±80.84 mg/L (range: 0.6-455 mg/L), onset of symptoms-operation interval was 81.92±81.12 hours (range: 5-336 hours), and operating time was 84.47±35.35 minutes (range: 35-270 minutes). Ten intraoperative complications: 3 cases of bleeding from the liver bed, 5 gallbladder perforations, 1 bile duct injury, and 1 instance of arrhythmia were observed. Four postoperative complications occurred: 1 hemoperitoneum, 1 subhepatic connection, 1 transitory intestinal obstruction, and 1 port site abscess. Mean hospital stay was 6.48±4.00 days (range: 3-26 days). Although 1 reoperation was necessary, there was no readmission.
DISCUSSION AND CONCLUSION: Acute laparoscopic cholecystectomy for acute calculous cholecystitis seems to be effective when performed at experienced center regardless of duration of symptoms.

4.Laparoscopic ventral hernia repair with new generation bilaminar mesh
Başar Aksoy, Erdal Uysal, M. Fatih Yüzbaşıoğlu, Ahmet Orhan Gürer, Hasan Bakır, Mehmet Ali Ikidağ
doi: 10.14744/less.2017.54264  Pages 13 - 16
INTRODUCTION: The aim of this study was to assess laparoscopic ventral hernia repair (LVHR) using new generation bilaminar mesh and to share our experience. Laparoscopic approaches are preferred in the surgical repair of ventral hernia due to low postoperative pain and complication rates, quick recovery, and short time for return to work. They can be performed in primary ventral hernia as well as incisional hernia, which is one of the most frequent complications of surgical procedures. Furthermore, recurrence rate is low, unlike open-conventional hernia repair.
METHODS: Fifteen patients who underwent laparoscopic ventral-incisional hernia repair between 2012 and 2014 were included in the study. A patch, 20x15 cm in size, of Parietex (Covidien-Medtronic, Inc. Minneapolis, MN, USA) polyester mesh, which has absorbable collagen film and preplaced sutures, was used. Mesh was fixed to the abdominal wall with transfascial fixation sutures and tacker. Patients were periodically followed-up for evaluation of hernia recurrence, pain, infection, and other complications.
RESULTS: Fifteen patients (3 male and 12 female) underwent laparoscopic ventral hernia repair. Mean operating time was 118.75 minutes (range: 120-250 minutes). Mean length of hospitalization was 2.8 days. One patient had small intestine laceration during surgery. One patient had hernia recurrence, 1 developed seroma, and 1 experienced prolonged pain.
DISCUSSION AND CONCLUSION: LVHR is an efficient and reliable method of ventral hernia repair. It is easy to perform in midline small and average-sized defects. It is possible to perform successful operation with low complication rate using new generation bilaminar mesh. In order to avoid prolonged postoperative pain, redundant use of tacker should be avoided. Transfascial fixation sutures will reduce recurrence rate.

5.Is the number of trocars important in laparoscopic cholecystectomy?
Münevver Moran, M. Mahir Özmen, Ismail Bilgiç, Hayrettin Dizen, Ali Emre Akgün, Emre Gündoğdu
doi: 10.14744/less.2017.98608  Pages 17 - 22
INTRODUCTION: Laparoscopic cholecystectomy (LC) is the criterion standard for cholelithiasis. There have been some changes in LC technique, one of which was a reduction in the number of trocars used. The aim of the present study was to explore the feasibility of reducing the number of ports in cases of LC without compromising safety, and to evaluate the benefits associated in terms of pain, recovery, and patient satisfaction.
METHODS: Sixty adults with symptomatic cholelithiasis were enrolled in this study, and patients were divided into 4 equal groups of 15. During the operation, 1- (single incision laparoscopic surgery [SILS]), 2-, 3-, or 4-trocar LC was performed. For the assessment, the following parameters were compared: operating time, success rate, visual analogue pain score, requirement for analgesia (diclofenac), complications, patient satisfaction score with respect to operation and scars, and length of postoperative hospital stay.
RESULTS: There were 45 female (75%) and 15 male (25%) patients with median age of 42.8 years (range: 20-62 years). Demographic data (age, sex, body mass index) were similar in all groups. The 3- and 4-trocar groups had significantly shorter mean operating time than the other groups (SILS: 50±14 minutes; 2-trocar: 36±10 minutes; 3-trocar: 27±10 minutes; 4-trocar: 24±7 minutes; p=0.01). There was no instance of bile duct injury or intra-abdominal collection in any group. One patient in SILS group developed cholangitis, and 1 one patient in 3-trocar group developed wound infection postoperatively that improved with conservative treatment. There was no difference in terms of analgesia requirement, mean overall pain score, overall satisfaction score, or length of hospital stay between the 4 groups. Scar satisfaction score was significantly higher in SILS and 2-trocar groups compared with the others.
DISCUSSION AND CONCLUSION: It appears that SILS and 2-port techniques are as reliable as 3-port and 4-port methods, with no obvious increase in bile duct injury, and although use of these techniques did not reduce need for analgesia, it did increase patient satisfaction.

6.Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases
Mariel Gonzalez- Calatayud, Eduardo M. Targarona, Carmen Balague, Carlos Rodriguez- Luppi, Ana B. Martin, Manuel Trias
doi: 10.14744/less.2017.29291  Pages 23 - 30
Epiphrenic diverticula is an uncommon disease, and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach, but a number of surgical controversies remain unresolved. The present study is a description of our experience with minimally invasive treatment of epiphrenic diverticula and a systematic review of the current literature on this subject. All data from the Hospital de Sant Pau were reviewed to identify patients who underwent minimally invasive treatment for epiphrenic diverticulum since 1998. In addition, systematic literature review focused on minimally invasive approach for epiphrenic diverticula was performed. Total of 6 patients have been treated (6 transhiatal and 1 with abdominal and thoracic approach) at the hospital. Predominance of male patients was observed, with median age of 63 years. Diagnosis was made with endoscopy, barium swallow, or manometry. Half of manometry results where pathological. Surgical techniques applied were diverticulectomy, myotomy, and Dor partial fundoplication. Two patients with suture line leakage were treated conservatively. No mortality was reported. Systematic literature review was conducted using the PRISMA scheme, and 21 studies with 189 patients were found. No comparative or prospective randomized trials were located. Overall morbidity rate was 24%, suture line leakage rate was 12%, hospital stay was 5 days, and mortality rate of 1.5% in the literature. After median follow up of 42 months, 81.5% of the patients were asymptomatic. Minimally invasive approach for epiphrenic diverticula is a safe and feasible procedure.

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