E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 26 (2)
Volume: 26  Issue: 2 - 2019
1.Evaluation of the results of colonoscopy in patients with a positive fecal occult blood test for colorectal cancer
Bülent Koca
doi: 10.14744/less.2019.97659  Pages 37 - 40
INTRODUCTION: The objective of this study was to present the pathological findings of fecal occult blood tests and results of colonoscopy procedures to discuss the clinical implications in the context of the current literature.
METHODS: The results of a total of 205 patients (122 male, 83 female) aged 50 to 75 years who underwent a fecal occult blood test for stitching without a clinical complaint and who underwent colonoscopy due to positive results were retrospectively reviewed. Fecal occult blood screening was performed using the fecal immunochemical test method in all patients.
RESULTS: The mean age of the patients was 63 years (range: 50–75 years). Of these patients, 13 (63%) were found to have a colon tumor, 59 (28.7%) had colon polyps, 1 (53%) had colon diverticulum, 8 (3.9%) had inflammatory bowel cast, 6 (2.8%) had hemorrhoids, and anal fissure was determined in 3 (1.4%). Nine (69%) of those with colorectal cancer were in the early stages (stage I–II), 2 patients (15%) were in the advanced stage and 2 patients (15%) were in the advanced stage. Non-neoplastic polyps were found in 18 of the 59 patients with colon polyps. Nonneoplastic polyps were detected in 41 patients.
DISCUSSION AND CONCLUSION: The use of a fecal occult blood test in colorectal cancer screening followed by a colonoscopy when there are positive test results is an effective and essential method of assessment.

2.Role of laparoscopy procedure in the diagnosis and treatment of traumatic acute abdomen: Original article
Murat Kanlıöz, Uğur Ekici
doi: 10.14744/less.2019.16362  Pages 41 - 44
INTRODUCTION: The objective of this study was to analyze the role of laparoscopy in the diagnosis and treatment of traumatic acute abdomen.
METHODS: Cases of patients with traumatic acute abdomen from between 2009 and 2017 diagnosed with laparoscopy but not examination, laboratory tests, or radiological methods were reviewed. These were patients with unstable vital signs for whom time was critical. The patient demographic data, causes of acute abdomen, procedures applied, and duration of hospitalization were analyzed.
RESULTS: Of the total of 138 patients, the cause of admission was a traffic accident in 46 cases (33.33%), sharp object injury in 27 (19.56%), gunshot injury in 19 (13.76%), falling from a height in 16 (11.59%), work accident in 14 (10.14%), physical violence in 9 (6.92%), sports injury in 4 (2.89%), and an animal kick in 3 (2.17%). In all, 56 (40.58%) were female and 82 (59.42%) were male. The mean age was 27.45±9.81 years. Of the patients, 64 (46.38%) had only abdominal trauma, while 74 (53.62%) had multiple trauma. The procedures performed included 83 (60.14%) diagnostic laparoscopies, 30 (21.74%) laparoscopies with additional laparoscopic procedures, and 25 (18.11%) instances of post-laparoscopy open surgery. In the group, 113 (81.88%) were discharged after healing; morbidity and mortality were observed in 21 (15.22%) and 4 (2.89%), respectively. The mean hospital stay was 2.82±1.64 days in patients with only abdominal trauma and 4.34±2.08 days in those with multiple trauma.
DISCUSSION AND CONCLUSION: Laparoscopy contributes significantly to the diagnosis and treatment of selected patients.

3.Indications for reoperation after sleeve gastrectomy
Fadli Doğan, Mürşit Dinçer
doi: 10.14744/less.2019.89421  Pages 45 - 48
INTRODUCTION: Morbid obesity is a serious health condition. Surgical interventions play an essential role in treatment, and sleeve gastrectomy is one of the most widely performed bariatric surgical procedures. After bariatric surgery, some patients may require reoperation for several reasons, such as complications, cholelithiasis, and gastroesophageal reflux. This study is an examination of the indications for reoperation and the results observed in patients who underwent reoperation following sleeve gastrectomy.
METHODS: Patients who were reoperated on after sleeve gastrectomy for various reasons were analyzed retrospectively. The demographic characteristics, reoperation indications, surgical procedures, and results were analyzed.
RESULTS: Of a total of 1268 patients who underwent sleeve gastrectomy due to obesity, 15 who had a reoperation after laparoscopic sleeve gastrectomy were included in the study. The overall reoperation rate after sleeve gastrectomy was 1.18%. Cholelithiasis leak, hemorrhage, stenosis, intra-abdominal hematoma, and incisional hernia were identified as indications for reoperation.
DISCUSSION AND CONCLUSION: Reoperation for the patients who undergo bariatric surgery may be required for a number of reasons. The results of this study indicate that a second procedure after sleeve gastrectomy can be performed safely and with minimal risk.

4.Short-term outcomes of a single center: Laparoscopic resection of colorectal disease
Osman Civil, Murat Burç Yazıcıoğlu, Abdullah Güneş
doi: 10.14744/less.2019.45822  Pages 49 - 54
INTRODUCTION: Laparoscopic colorectal surgery can be performed safely with a low complication rate, short hospital stay, and adequate surgical resection and lymph node dissection. However, it is not accepted as the gold standard in colorectal surgery yet. The objective of this study was to discuss the short-term results of laparoscopic surgical resections for colorectal cancer in the context of the literature.
METHODS: Forty-two patients who underwent laparoscopic colorectal surgery for a malignant etiology between January 2014 and January 2018 were included in the study. The pPatients were evaluated in terms of demographic features, histopathological characteristics of the tumor, type of surgery, and early postoperative complications.
RESULTS: The mean age of the patients was 58.9 years; 36.6% had a T3 status, while 53.7% had a diagnosis of N0 stage. There was a median of 14 dissected lymph nodes. Negative surgical margins were obtained in all patients. The mean postoperative hospital stay was 6 days (range: 3–28) days). Postoperative early complications were observed in only 9 (21.4%) patients and 2 (4.8%) patients died in the early postoperative period.
DISCUSSION AND CONCLUSION: Laparoscopic colorectal surgery can be performed safely with a low complication rate, short hospital stay, sufficient surgical resection, and appropriate lymph node dissection.

5.Effect of preoperative chemoradiotherapy on perioperative outcomes in patients undergoing laparoscopic rectal cancer surgery
Ulaş Aday, Abdullah Böyük
doi: 10.14744/less.2019.54376  Pages 55 - 60
INTRODUCTION: The aim of this study was to investigate the effect of neoadjuvant chemoradiotherapy (nCRT) on perioperative outcomes in patients who underwent laparoscopic rectal cancer surgery.
METHODS: This retrospective study included patients who underwent laparoscopic surgery due to rectal adenocarcinoma between January 2017 and March 2019. Patients who underwent open surgery, transanal excision, or additional resection due to metastasis were excluded from the study. Demographic, clinical, and pathological characteristics of the patients were recorded. Perioperative complications were categorized according to the extended Clavien-Dindo classification.
RESULTS: The 61 patients enrolled in the study comprised 35 (57.4%) patients who received nCRT (nCRT group) and 26 (42.6%) patients who did not receive nCRT (non-nCRT group). The mean age was 54.6±12.9 years in the nCRT group and 62±14.8 years in the non-nCRT group, which represented a significant difference between the 2 groups (p=0.048). The groups were similar with regard to comorbidities, body mass index, American Society of Anesthesiologists score, pathological staging, and length of hospital stay. The mean operative time was 298±36.8 minutes in the nCRT group and 243±50.2 minutes in the non-nCRT group, which amounted to a significant difference (p<0.001). The classification of complications indicated Grade I, II, III, and IV complications in 16 (45.7%), 15 (42.8%), 3 (8.6%), and 1 (2.9%) patients, respectively, in the nCRT group as opposed to 16 (61.6%), 8 (30.8%), 1 (3.8%), and 1 (3.8%), respectively, in the non-nCRT group, and no significant difference was found between the 2 groups (p=0.606).

DISCUSSION AND CONCLUSION: The results indicated that nCRT had no effect on perioperative complications and resulted in longer operative times in laparoscopic rectal cancer surgery.

6.Laparoscopic pancreaticoduodenectomy: Single-surgeon experience
Bahtiyar Muhammedoğlu, Sezgin Topuz, Süleyman Kökdaş, Eyüp Mehmet Pircanoğlu, Onur Peker
doi: 10.14744/less.2019.06025  Pages 61 - 67
INTRODUCTION: Pancreaticoduodenectomy is a technically demanding surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. Pancreatic surgery and associated complications pose challenges for clinicians. Adenocarcinoma of the pancreas is one of the most aggressive malignant neoplasms. Patients who undergo an R0 resection have significantly better survival than those with R1/R2 resection. This article describes the use of laparoscopic pancreaticoduodenectomy in 9 cases.
METHODS: Nine patients underwent a laparoscopic pancreaticoduodenectomy in the department of gastroenterology of a city hospital between April 2018 and August 2018. The demographic characteristics, perioperative details, and pathological results of 5 female and 4 male patients were retrospectively reviewed.
RESULTS: The mean age of the patients was 64.5±14 years. The average operative time was 593 minutes (range: 480–797minutes) and the intraoperative blood loss was 207 mL (range: 110–500 mL). None of the patients required a blood transfusion, but 1 patient required conversion to an open pancreaticoduodenectomy procedure due to uncontrolled bleeding. Prophylactic abdominal drainage was performed for all patients.

DISCUSSION AND CONCLUSION: Based on the results of this initial study, laparoscopic pancreaticoduodenectomy appears to be safe and feasible, producing satisfactory results when performed by experienced surgeons in carefully selected patients. However, long-term outcome data and a learning curve analysis should be fully demonstrated. Further studies from multiple centers are needed to support our conclusions.

7.An evaluation of the reliability of the neutrophil-to-lymphocyte ratio in patients with acute cholecystitis undergoing laparoscopic surgery
Yaşar Özdenkaya, Refik Bademci
doi: 10.14744/less.2019.93275  Pages 68 - 72
INTRODUCTION: Acute cholecystitis is observed quite commonly in emergency surgery clinics and parameters are needed for diagnosis and treatment. The aim of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) is of benefit in the diagnosis of acute cholecystitis.
METHODS: A retrospective evaluation of patients who were hospitalized between January 2014 and February 2018 for the treatment of acute cholecystitis was conducted. The blood tests and radiological tests of the patients were evaluated. The NLR was calculated and compared with the clinical and laboratory values of the patients.
RESULTS: A total of 185 patients were identified, comprising 102 (55.1%) females and 83 (44.9%) males with a mean age of 51.5±15.9 years. The mean leukocyte count was 11.6±3.6 109/L and the mean C-reactive protein (CRP) value was 37±76.4 mg/L. Overall, 90 (48.6%) patients had normal leukocyte values and 59 (31.8%) patients had normal CRP values. In 20 (10.8%) patients with an NLR of approximately 1, only 1 (5%) was aged >60 years and all of the remaining patients were <45 years of age. In 53 (28.6%) patients, the NLR was determined to be approximately 2, and the NLR value was ≥3 in 112 (60.5%) patients.
DISCUSSION AND CONCLUSION: Awareness of an increased NLR may be beneficial in the diagnosis of patients with acute cholecystitis.

8.Robotic repair of complicated vesico (-utero)/cervico-vaginal fistula after caesarean section
Pengfei Wang, Michael Mesbah, George Lazarou, Matthew Wells, Farr Nezhat
doi: 10.14744/less.2019.90377  Pages 73 - 77
In developed countries, urogenital fistula primarily occurs after gynecological surgeries, but rarely, it may be seen as a result of obstetric complications. The primary treatment of a urogenital fistula is either transvaginal or transabdominal surgical repair. Presently described is the case of a 36-year-old woman (G3P3003) who developed a complicated large vesico-(utero)/cervico-vaginal fistula after an emergent repeat caesarean section. Robotic repair was performed 2 months after the injury using a modified O’Connor method. Blood loss was minimal and the patient was only in the hospital for 1 day postoperatively. Follow-up showed complete healing of the fistula with no urine leakage, frequency or dyspareunia, and a normal menstrual period up to one year. This case demonstrates that robotic surgery can be effective in the management of complicated urogenital fistula repair.

9.Endoscopic removal of gossypiboma with gastric penetration
Mustafa Şentürk, Celalettin Vatansev, Mehmet Metin Belviranli, Ömer Kişi
doi: 10.14744/less.2019.47560  Pages 78 - 80
Retained surgical material is a potentially dangerous medico-legal problem. Gossypiboma may cause abscess-like complications in the early postoperative period, as well as a long-term asymptomatic pseudotumor. The preoperative diagnosis may be difficult. Presently described is a case that mimicked an intra-abdominal malignancy that had created a fistula in the stomach. A 54-year-old man presented with a history of laparoscopic cholecystectomy performed 1 year prior. Subsequent continued pain and swelling in the epigastric region led the patient to seek care at several health institutions. The patient brought abdominal tomography results from one of these presentations revealing a heterogeneous, high-density mass 5x4x5 cm in size located between the liver and the stomach. Gastroscopy revealed a foreign body near the pylorus at the level of the gastric antrum. The tomography image revealed that the mass was a gossypiboma and had penetrated the pylorus. The foreign body was removed endoscopically in 5 parts with the help of endoscopic forceps and a snare. The postoperative recovery was uneventful. Gossypiboma should be included in the differential diagnosis of tumoral masses detected in patients with a surgical history. Gossypiboma with gastric fistulization can be removed endoscopically.

10.Posterior sector biliary duct injury during laparoscopic cholecystectomy: Case report
Serdar Karakaş, Sertaç Usta, Fatih Özdemir
doi: 10.14744/less.2019.00922  Pages 81 - 83
Biliary injuries are common after a cholecystectomy. One of the most important reasons for biliary injury during laparoscopic cholecystectomy (LC) is variant anatomy of the extrahepatic bile duct. Described in this report is a rare complication of a LC that included a posterior right sectoral duct injury. A 45- year-old woman was referred with peritonitis, including a large quantity of fluid in the abdomen. She had undergone an LC at a state hospital 14 days before the referral. Pouchography revealed a connection between the site of fluid collection and the posterior sector of the right main bile duct. An exploratory laparotomy revealed a dissected right posterior sector channel. A Roux-en-Y hepaticojejunostomy was constructed with no complication. Surgical experience, training, and maintaining a critical view toward safety are the most important factors to prevent bile duct injuries after LC. Care taken with anatomical variance of the extrahepatic biliary tree is also a key factor in the prevention of iatrogenic biliary injuries. Posterior sector injuries should be kept in mind; however, hepaticojejunostomy is a feasible method to overcome this potential complication after the elimination of any intra-abdominal infection.

11.Gastrocolocutaneous fistula: An unusual complication of percutaneous endoscopic gastrostomy
Nihan Acar, Yunus Sür, Turan Acar, Osman Nuri Dilek
doi: 10.14744/less.2019.87004  Pages 84 - 86
Gastrocolocutaneous fistula is a rare potential complication of percutaneous endoscopic gastrostomy (PEG). This case report is a description of the approach used to manage a gastrocolocutaneous fistula that developed after a PEG procedure. A 35-year-old male with amyotrophic lateral sclerosis had a PEG tube inserted in the endoscopy unit due to recurrent episodes of aspiration pneumonia. During the postoperative period, the PEG tube was withdrawn as a result of bilious discharge from the rim of the tube and maceration of the skin around the tube The patient was referred to us due to the leakage of feces from the PEG site. Given the high rate of flow observed during follow-up and the unlikelihood of spontaneous closure, surgical repair was planned. The operation included repair of a fistula between the stomach and the colon, partial gastric resection, and primary sutures to effect a repair of the colon. Proper management of complications of a PEG procedure can lead to a quick and effective recovery.

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