GÝRÝÞ ve AMAÇ: Bu çalýþmada, hematolojik problemler nedeniyle elektif laparoskopik splenektomi yapýlan ardýþýk 36 hastada dalak hilus ligasyonunda vasküler endostapler kullanýmýnýn sonuçlarýný ve etkinliðini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2012-Mayýs 2015 tarihleri arasýnda hematolojik hastalýklarý nedeniyle LS yapýlan ardýþýk 36 olgu çalýþmaya dahil edildi. LS standart 4 trokar tekniði ile yapýldý. Tüm hilus rezeksiyonlarý sadece vasküler kartuþlu endostapler kullanýlarak yapýldý. Hastalarýn demografik verileri, hematolojik tanýlarý, dalak boyutlarý, operasyon süreleri, hastanede kalýþ süreleri, post operatif komplikasyonlarý, post operatif analjezik gereksinimleri, patolojik sonuçlarý incelendi. Tüm hastalarýn verileri retrospektif taranarak toplandý.
BULGULAR: Tek merkezde ve 2 cerrah tarafýndan yapýlan toplamda 36 ardýþýk vakada konversiyon veya ikinci bir operasyon gerektirecek komplikasyon görülmedi. Bir hastada post op dönemde akut portal ven trombozu görüldü ve medikal olarak tedavi edildi. Bir baþka hastada da ameliyat esnasýnda diafragma yaralanmasýna baðlý olarak pnömotoraks geliþti ve laparoskopik onarým ile tedavi edildi. Ortalama ameliyat süresi 97 dakika, ortalama post-op drenaj miktarý 75cc, hastanede ortalama kalýþ süresi ort. 2.3 gün ve ortalama dalak boyutu 14.5 cm olarak tespit edildi. 5 hastada aksesuar dalak tespit edildi.
TARTIÞMA ve SONUÇ: Elektif þartlarda yapýlan laparoskopik splenektomi de hiler diseksiyonda vasküler endostapler kullanýmýnýn maliyet dezavantajý yanýnda oldukça güvenilir bir yöntem olduðu kanaatindeyiz.

INTRODUCTION: This study aimed to assess the results and effectiveness of using endoscopic vascular staplers for splenic hilar control in 36 consecutive cases who underwent elective laparoscopic splenectomy due to hematologic problems.
METHODS: Thirty-six consecutive patients who underwent laparoscopic splenectomy (LS) due to hematologic diseases over a 3-year period between January 2012–May 2015 were included in this study. LS was carried out with the standard 4-port method. All hilar vessels were divided by using an endoscopic stapler loaded with vascular cartridges. Patient demographic data, hematologic diagnosis, size of the spleen, duration of operation, length of hospital stay, post-operative complications, postoperative analgesic requirement were retrospectively extracted from patient files.
RESULTS: A total of 36 consecutive patients were treated in a single center and were operated by two surgeons. There was no conversion to laparotomy or reoperation in the series. One patient developed acute portal vein thrombosis that was medically treated in the early post-operative period. Another patient experienced pneumothorax due to a diaphragmatic injury that was repaired during surgery. The average spleen size was identified as 14.5 cm. An accessory spleen was detected in 5 patients. The mean operative time was 97 minutes, and the mean length of hospital stay was 2.3 days.
DISCUSSION AND CONCLUSION: We believe that using an endoscopic vascular stapler for ligation of hilar vascular structures during elective laparoscopic splenectomy by experienced surgeons is efficient despite the cost disadvantage.

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GÝRÝÞ ve AMAÇ: Morbid obezite, kiþinin hayatýný tehdit eden ve yaþamýný kýsaltan þiddette obeziteyi tanýmlar.Günümüzde cerrahi, morbid obeziteyi tedavi ettiði kanýtlanmýþ tek tedavi yöntemidir. Önceden tanýmlanmamýþ mide patolojileri ile iliþkili komplikasyonlar nedeniyle endoskopik gastrik muayene preoperatif yapýlmamaktadýr. Sleeve gastrektomi örneklerinde histopatolojik bulgularýn belirlenmesi amacýyla az sayýda çalýþma bulunmaktadýr.
YÖNTEM ve GEREÇLER: Patoloji laboratuvarýnda incelenen 816 sleeve gastrektomi spesimeninin preparatlarý tekrar deðerlendirildi ve histopatolojik olarak deðerlendirildi.
BULGULAR: 816 hastanýn (n = 465) %57'sinde anlamlý bir anomali görülmedi. %14'ünde (n = 114), Helicobacter ile iliþkili olmayan gastrit görüldü. Olgularýn% 26'sýnda (n = 212) Helicobacter pylori ile iliþkili gastrit tespit edildi ve% 0.36 (n = 3) olguda spesifik gastrit (lenfositik gastrit) saptandý. Olgularýn% 2.64 (n=22) 'sinde intestinal metaplazi gözlendi. H.pylori olgularýn% 72'sinde (n = 588) negatif,% 28'inde (n = 228) pozitif bulundu.
TARTIÞMA ve SONUÇ: H.pylori enfeksiyonlarýnýn postoperatif komplikasyon riski taþýmadýðý sonucuna vardýk. Ancak, intestinal metaplazisi gibi premalign lezyonlardan þüpheleniliyorsa, midenin preoperatif endoskopik muayenesinin yapýlmasý gerektiðine inanýyoruz.

INTRODUCTION: Morbid obesity is severe obesity that threatens and shortens a person’s life. Today, surgery is almost the only treatment method that has been proven to treat morbid obesity. Endoscopic gastric examination is not performed preoperatively due to the complications that are associated with gastric pathologies that have not been defined. There are few studies for the purpose of determining histopathological findings in cases of sleeve gastrectomy specimens. It is thought that some postoperative complications may be related to existing histopathologic findings.
METHODS: Preparations of 816 sleeve gastrectomy specimens examined in the pathology laboratory were reevaluated and evaluated histopathologically.
RESULTS: Fifty-seven percent of 816 patients (n=465) showed no significant anomaly. Fourteen percent (n=114) showed non-Helicobacter-related gastritis. In 26% (n=212) of cases, Helicobacter pylori-associated gastritis was detected, and in 0.36% (n=3) of cases,specific gastritis (lymphocytic gastritis) was found. In 2.64% (22) of cases, intestinal metaplasia was observed. H.pylori was negative in 72% (n=588) and positive in 28% (n=228) of cases.
DISCUSSION AND CONCLUSION: We concluded that H.pylori infections do not have a risk of postoperative complications. However, if premalignant lesions, such as intestinal metaplasia, are suspected, we believe that preoperative endoscopic examination of the stomach should be performed.

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GÝRÝÞ ve AMAÇ: Kist hidatik hastalýðý halen bölgemiz ve ülkemiz için yaygýn bir saðlýk sorunu olarak önemini korumaktadýr. Bu çalýþmada Laparoskopik olarak tedavi edilen karaciðer kist hidatik olgularý retrospektif olarak incelendi.
YÖNTEM ve GEREÇLER: Haziran 2016 ve Haziran 2017 tarihleri arasýnda kliniðimizde karaciðer kist hidatiði nedeniyle laparoskopik olarak tedavi edilen toplam 25 hastanýn (16 kadýn, 9 erkek; ort.yaþ 41±3.42; daðýlým 20-78) týbbi kayýtlarý geriye dönük olarak incelendi. Hastalar yaþ, cinsiyet, kistin yerleþim yeri, uygulanan cerrahi yöntem, hastanede kalýþ süresi, meydana gelen komplikasyonlar ve komplikasyonlara yönelik uygulanan tedavi yöntemleri açýsýndan irdelendi.
BULGULAR: Ýntraperitoneal rüptür nedeniyle bir hasta (%4) acil olarak ameliyat edildi. Olgularýn 5’ünde (%20) ameliyat esnasýnda kist poþuna safra kaçaðý gözlendi ve perioperatif laparoskopik sütüre edildi. Bu hastalarýn üçünde (%12) kaçak herhangi bir müdahaleye gerek kalmadan kapandý, ikisinde (%8) ise bir haftadan fazla kaçak sürdü ve günlük debi 150 cc’nin üzerinde idi. Bu olgulara endoskopik sfinkterotomi uygulandý.
TARTIÞMA ve SONUÇ: Günümüzde deneyimli merkezlerde seçilmiþ hastalarda, laparoskopik cerrahi giriþimler karaciðer kist hidatik hastalýðýnýn tedavisinde etkin ve güvenli bir yöntem olarak tedavi algoritmasýnda yerini almaktadýr. Komplike olmayan kist hidatiklerin cerrahisinde özelleþmiþ laparoskopik aletlere gerek olmadýðýný düþünmekteyiz.

INTRODUCTION: Cyst hydatid disease is still our territory and remains a common health problem for our country. In this clinical retrospective study, cases of liver hydatid cysts treated as laparoscopic were analysed.
METHODS: Medical records of 25 patients (16 female, 9 male; mean age 41±3.42; range 20–78) who were treated for hepatic hydatid disease in our clinic between June 2016 and June 2017 were retrospectively reviewed. Patients were evaluated in terms of age, sex, location of cyst, surgical method applied, duration of hospital stay, postoperative complications and treatment methods for complications.
RESULTS: One patient (4%) due to intraperitoneal rupture was operated urgently. In 5 (20%) of the cases, bile leakage were seen in the cyst sponge during the operation and perioperative laparoscopic suture was performed. In three of these patients (12%), the leakage was closed without any intervention, two (8%) lasted more than a week and the daily flow was over 150 cc. Endoscopic sphincterotomy was applied to these cases.
DISCUSSION AND CONCLUSION: Nowadays at experienced centers, laparoscopic surgical interventions in selected patients take place in the treatment algorithm as an effective and safe method for the treatment of liver cyst hydatid disease. We think that uncomplicated hydatid cysts do not need specialized laparoscopic instruments in the surgery.

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GÝRÝÞ ve AMAÇ: Akut apandisit, genel cerrahi kliniklerinde en sýk rastlanan ve acil cerrahi giriþim gerektiren hastalýklardan biridir. Apandisit tanýsýnda iyi bir anamnez ve fizik muayene halen ilk öncelikli yapýlmasý gereken basamaklardýr.
Bu çalýþmamýzda Erzurum Oltu devlet hastanesinde akut apandisit ön tanýlý olgularýn klinik ve cerrahi sonuçlarýný deðerlendirmeyi amaçladýk.

YÖNTEM ve GEREÇLER: Hastanemizde 2015-2017 yýllarý arasýnda akut apandisit ön tanýsý ile ameliyat edilen 123 hastanýn dosyalarý retrospektif olarak yaþ, cinsiyet, alvarado skoru, laboratuvar, radyoloji bulgularý açýsýndan, cerrahi yöntemler ise ameliyat süresi, yatýþ süresi ve komplikasyonlar açýsýndan incelendi.
BULGULAR: Hastanemizde 2015-2017 yýllarý arasýnda appendektomi uygulanan toplam 123 hasta çalýþmaya dahil edildi. Bu hastalarýn 49 (39,8%)’u kadýn,74 (60,2%)’ü erkekdir. Olgularýn 32(26%)’sine ultrasonografi(US), 91(74%)’ine bilgisayarlý tomografi (BT), 12(9,7%)’sine ise hem US hemde BT yapýldý. Hastalarýn 66 (53,6%)’sýna laparoskopik apendektomi(LA), 57 (46,4%)’sine açýk apendektomi(AA) yapýldý. Hastalarýn 71 (57,8%)’i süpüratif apandisit, 38 (30,9%)’i kataral apandisit, 8 (6,5%)’i perfore apandisit, 3 (2,4%)’ü gangrenöz apandisit, geri kalan 3 (2,4%) hastanýn intraoperatif ve histopatolojik tanýsý normaldi. AA yapýlan hastalarýn 3 (2,4%)’ünde ileus, 1 (0,8%)’inde yara yeri enfeksiyonu geliþti. LA ‘de 1 (0,8%) hastada ileus geliþti.
TARTIÞMA ve SONUÇ: Akut apandisitte anamnez ve iyi bir fizik muayene yapýlmasý, laboratuvar, skorlama ve yardýmcý görüntüleme yöntemlerinin etkin olarak kullanýlmasý negatif apendektomi ve postoperatif komplikasyon oranlarý azaltýlabilir. Laparoskopik cerrahi yöntem, postoperatif yaþam kalitesi üzerine ve postoperatif aðrý üzerine olumlu etkiye sahiptir. LA akut apandisit tedavisinde, tecrübe ve laparoskopik donaným yeterli ise tercih edilecek ilk cerrahi yöntem olmalýdýr.

INTRODUCTION: Acute appendicitis is a disease requiring urgent surgical intervention. It is frequently encountered in general surgical clinics. Maintaining a good medical record and physical examination are the first priorities in diagnosing appendicitis. This study aimed to evaluate the clinical and surgical results of patients prediagnosed with acute appendicitis in a Erzurum Oltu State Hospital.
METHODS: The records of the 123 patients [49 (39.8%) female and 74 (60.2%) male], who were diagnosed with acute appendicitis in the hospital between 2015 and 2017, were retrospectively analyzed in terms of age, gender, Alvarado score, and laboratory and radiology findings. Furthermore, surgical methods were examined with regard to the duration of surgery, hospitalization, and complications.
RESULTS: A total of 32 (26%) patients were scanned with ultrasonography (US), 91 (74%) with computed tomography (CT), and 12 (9.7%) with both US and CT. Laparoscopic appendectomy (LA) was performed in 66 (53.6%) patients, and open appendectomy (OA) in 57 patients (46.4%). Further, 71 (57.8%) of the 120 patients with intraoperatively diagnosed appendicitis had suppurative, 38 (30.9%) had catarrhal, 8 (6.5%) had perforated, 3 (2.4%) had gangrenous appendicitis. The histopathological and intraoperatively diagnosis of the remaining 3 (2.4%) patients was normal. Three (2.4%) of the patients who underwent OA developed ileus, and one (0.8%) patient had wound infections. One (0.8%) patient who underwent LA developed ileus.
DISCUSSION AND CONCLUSION: The effective use of laboratory, scoring, and assisted imaging methods can reduce the rates of negative appendectomy and postoperative complications. Laparoscopic surgery has a positive effect on postoperative pain and quality of life. If laparoscopic equipment and experience with the method are sufficient, the first choice should be laparoscopic surgery for acute appendicitis.

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Eriþkinlerde nadiren görülen Morgagni hernisi, abdominal organlarýn retrosternal diyafragmatik defekten göðüs boþluðuna konjenital herniasyonudur. Burada barsak obstruksiyonu semptomlarý ve nefes darlýðý ile kliniðimize kabul edilen inkarsere Morgagni hernili 40 yaþýnda erkek hasta sunuldu. Taný preoperatif direk radyografi, thorax bilgisayarlý tomografi ile konuldu. Herniye omentumun ve kolon segmentinin batýn içerisinealýndýktan sonra diyafragmatik defekt önce prolen stur ile sonra dual mesh ile kapatýldý. Kabýzlýk veya dispeptik þikayetler ile baþvuran hastalarda ayýrýcý tanýda Morgagni hernisi akýlda tutulmalý ve rutin olarak akciðer grafisi çekilmelidir.

Morgagni hernia is herniation of the abdominal contents through a congenital retrosternal defect to the thoracic cavity. In the present study we report a case of 40 years old male patient who was admitted to our department with signs of intestinal obstruction and dyspnea and was diagnosed as incarcerated Morgagni hernia. The diagnosis was established with direct chest radiograms and thorax computerized tomography. Following the reduction of the omentum and the colon segment in the hernia, the defect was sutured primarily and the repair was reinforced by a dual mesh. In patients with constipation and obstipation possibility of presence of Morgagni hernia should be kept in mind and proper investigative measures should be obtained.

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Castleman’s disease is a rare proliferative disorder of benign nature characterized by hyperplasia of the lymphoid follicles. The abdomen is rarely affected by this pathology. The difficult preoperative diagnosis has recently led laparoscopic surgery to become an option for diagnosis and treatment of the unicentric form of the disease. Herein we present a literature review reporting our experience representing, according to our knowledge, one of the first cases of totally laparoscopic resection of single abdominal localization of Castelman’s disease.

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Portomezenterik venöz tromboz (PVT) laparoskopik bariatrik cerrahi sonrasý nadir görülen, hayatý tehdit eden bir komplikasyondur. Laparoskopik sleeve gastrektomi (LSG) günümüzde bariatrik cerrahi prosedürler arasýnda en popüler yöntemlerinden biridir. Bu yazýda laparoskopik sleeve gastrektomi sonrasýnda geliþen portal ven, süperior mezenterik ven (SMV) ve splenik ven trombozu ile baþvuran 27 yaþýnda erkek hastayý sunmayý amaçladýk. Postoperatif 41. günde, epigastrik bölgede belirgin yaygýn karýn aðrýsý, iþtahsýzlýk ve kabýzlýk semptomlarý ile baþvuran olgunun renkli Doppler ultrasonografi(USG) ve bilgisayarlý tomografi(BT)’de portal ven ve dallarý ile splenik ven, portal konflüens düzeyi ve süperior mezenterik ven’de tromboz saptandý. Antitrombolitik tedavi uygulanan hasta semptomsuz olarak taburcu edildi. Laparoskopik bariatrik operasyonlarýn sayýsý arttýkça portal ven trombozu sýklýðý giderek artmaktadýr. Spesifik olmayan semptomlarý nedeniyle yüksek klinik þüphe gerektirir, bariatrik cerrahi sonrasý atipik karýn aðrýsý olan olgularda PVT akýlda bulundurulmalýdýr.

Portomesenteric venous thrombosis (PVT) is a rare and life-threatening complication after laparoscopic bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is one of the most popular methods of bariatric surgical procedures. We aimed to present a 27-year-old male patient who presented with thrombosis in the portal vein, superior mesenteric vein, and splenic vein following LSG. Patient presented with widespread abdominal pain in the epigastric region, loss of appetite, and constipation at the postoperative 41st day; in color Doppler ultrasonography and computerized tomography, thrombosis was detected in portal vein and branches, splenic vein, portal confluence level, and superior mesenteric vein. The patient was given antithrombotic therapy and discharged without symptoms. The incidence of portal vein thrombosis has steadily increased with the increased number of laparoscopic bariatric operations. It requires a high degree of clinical suspicion as it presents with nonspecific symptoms. PVT should be considered in cases with atypical abdominal pain after bariatric surgery.

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Sayra yolu yaralanmalarý halen en sýk laparaskopik kolesistektomi ameliyatý sýrasýnda oluþmaktadýr. Eþlik eden damar yaralanmasý, durumu daha komplike hale getirir ve yaralanmalarýnýn cerrahi onarýmýnda, otolog ya da allojenik greftler kullanýlmasý gibi karmaþýk iþlemler gerektirir. Laparaskopik kolesistektomi ameliyatý sýrasýnda oluþan, sað hepatik arter kesisinin otolog inferior mezenterik ven interpozisyon grefti ile, sað portal ven yaralanmasýnýn otolog pariyetal periton yama grefti ile ve koledok kesisinin Roux-en-Y hepatikojejunostomi le onarýldýðý otuz-iki yaþýnda kadýn hasta sunulmaktadýr.

Biliary tract injuries are still the most hazardous complications of laparoscopic cholecystectomy. Concomitant vascular injuries make them further more complicated and complex surgical interventions including autologous grafting can be required. We presented a 32-year-old female referred us with combined bile duct, portal vein and hepatic artery injuries occurred during laparascopic surgery. The repairs of hepatic artery and portal vein were achieved by autologous inferior mesenteric vein and peritoneum grafts, respectively. Bile duct reconstruction was done by Roux-en-Y hepaticojejunostomy. Postoperative course was uneventful and she was asymptomatic following 16 months follow-up. Autologous vein and peritoneal grafts can be used for repair of vascular injuries of laparascopic cholecystectomy.

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