RESEARCH ARTICLE | |
1. | Risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis: Evidence from 810 cases Bahtiyar Muhammedoğlu doi: 10.14744/less.2020.16046 Pages 1 - 8 INTRODUCTION: The risk and causes of post ERCP pancreatitis and associated risk factors are summarized, and potential prophylactic measures with strong evidence for effective prevention of post ERCP pancreatitis are discussed. METHODS: Prospectively collected patient data were reviewed retrospectively for a total of 810 ERCPs undertaken in our hospital between June 2015 and September 2018. All ERCP procedures were performed by a single surgeon. Risk factors for post-ERCP pancreatitis were investigated, which included endoscopist experience, ERCP team and ERCP room equipment. We focused on factors related to endoscopist experience, ERCP team and ERCP room equipment. RESULTS: A total of 810 patients, including 439 females and 371 males, were enrolled in this study. Amylase levels and pancreatitis were evaluated 24 hours after ERCP. Post ERCP pancreatitis developed in a total of 46 (5.5%) patients out of 810 patients undergoing ERCP. Also, the incidence of post ERCP pancreatitis was 2-fold higher in the first 400 patients versus in the last 400 patients. This higher post ERCP pancreatitis incidence found among the first 400 patients of our series can be explained by the relative lack of experience and expertise of the endoscopist and the ERCP team. DISCUSSION AND CONCLUSION: The risk of post-ERCP pancreatitis is multifactorial and the effects of some of the risk factors may be minimized or completely eliminated. The findings suggest that endoscopist and his/her experience have a major role in avoiding or minimizing the negative effects of these factors. |
2. | Evaluating the laparoscopic approach to proximally located benign gastric tumors Engin Hatipoğlu, Mehmet Sabri Ergüney, Metin Ertem doi: 10.14744/less.2020.01488 Pages 9 - 15 INTRODUCTION: The aim of this study was to evaluate the surgical and histopathological outcomes of proximally located benign gastric tumors. METHODS: This retrospective study included 14 patients with a proximally localized gastric tumor classified as Siewert III that was diagnosed between January 1, 2010 and December 31, 2019 in the general surgery clinics of Cerrahpasa Medicine Faculty Hospital or Acıbadem Kozyatağı Hospital. Patients who underwent laparoscopic and open surgery were included. Details of the patient characteristics, the clinical and pathological features of the tumors, and the patients’ perioperative and postoperative results were recorded and analyzed. RESULTS: The most common cause of hospital admission was gastric bleeding (28.6%). Localization of the tumor was the lesser curvature in 42.9%, the posterior wall in 28.6%, the anterior wall in 21.4%, and the fundus in 7.1%. Seven of the 10 laparoscopic operations were a hybrid-type procedure (endoscopic and laparoscopic). While 1 patient required admission to the intensive care unit, there was no mortality in the postoperative period. The pathological diagnosis was 64.3% (n=9) gastrointestinal stromal tumor, 14.2% (n=2) schwannoma, 7.1% (n=1) leiomyoma, 7.1% (n=1) well–differentiated neuroendocrine tumor, and 7.1% (n=1) enteric cyst. The surgical margin was clear in 92.9% (n=13) of the patients. DISCUSSION AND CONCLUSION: Resection of benign proximal gastric tumors was successful with laparoscopic endoscopic and open surgery. In this study, no major morbidity or mortality developed in the postoperative period. Although the superiority to open surgery has not yet been proven with long-term results, the laparoscopic endoscopic method should be the first choice due to known advantages, including ease of exploration. |
3. | Comparison of laparoscopic cystectomy and purse-string suture technique in the surgical treatment of ovarian dermoid cysts Remzi Atilgan, Şehmus Pala doi: 10.14744/less.2020.09326 Pages 16 - 20 INTRODUCTION: This study is a comparison of the outcomes of 2 cystectomy modalities in the surgical treatment of ovarian dermoid cysts. METHODS: The intraoperative and postoperative results of 44 ovarian dermoid cyst patients who underwent surgical treatment between 2012 and 2019 using 2 different methods were compared. The study population was divided into 2 groups: Group 1 (n=21) underwent cystectomy using the purse-string suture method via mini-laparotomy and Group 2 (n=23) underwent laparoscopic cystectomy. RESULTS: The mean ovarian cyst diameter was 11 cm in Group 1 and 6 cm in Group 2. The diameter of the cyst was significantly larger in Group 1 than in Group 2. The duration of the operation was significantly shorter in Group 1 than Group 2 (45 min. vs. 70 min.). The intraoperative rupture rate was significantly lower in Group 1 compared with Group 2 (4.7% vs. 30%). Chemical peritonitis did not develop in either group. The duration of hospitalization was similar between the groups. The recurrence rate was significantly lower in Group 1 than Group 2 (0% vs. 21%). DISCUSSION AND CONCLUSION: For clinicians who do not have the optimal conditions or surgical experience for a laparoscopic operation, and particularly for large ovarian dermoid cysts, the cystectomy technique performed using a purse-string suture via a mini-Pfannenstiel incision can be an effective treatment method. |
4. | The short-term effects of laparoscopic sleeve gastrectomy on hematological parameters Fatih Can Karaca doi: 10.14744/less.2020.48379 Pages 21 - 24 INTRODUCTION: Sleeve gastrectomy (SG) surgery is an effective method for weight loss in obese individuals. The data on the effect of this surgical intervention on iron metabolism and hematological factors are limited. This study aimed to investigate the effects of SG surgery on iron and red blood cell-related parameters. METHODS: The six-month follow-up data of 33 patients who underwent SG for obesity treatment were evaluated retrospectively in this study. Whole blood levels of hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW-CV), and serum iron concentrations were evaluated. RESULTS: Mean hemoglobin, MCHC, and RDCV levels did not show a significant difference compared to the baseline and between months. Mean MCV levels significantly differed from baseline values at the end of the third month. Serum iron levels were significantly higher on the 6-month follow-up visit. DISCUSSION AND CONCLUSION: The findings suggest that the iron level and other iron-related hematological parameters of the patients who underwent SG improved after the surgery. |
5. | Gall bladder stone formation in the postoperative first year after sleeve gastrectomy Mehmet Buğra Bozan doi: 10.14744/less.2020.37880 Pages 25 - 29 INTRODUCTION: This study aims to evaluate the incidence of cholelithiasis formation in the postoperative first year of patients who underwent laparoscopic sleeve gastrectomy. METHODS: The first 100 consecutive patients operated for morbid obesity between January 2016 and January 2017 by the same surgeon were retrospectively evaluated. One patient who underwent laparoscopic mini-gastric bypass and seven patients who had previously undergone cholecystectomy or underwent concomitant cholecystectomy were excluded from this study, and 92 patients who underwent sleeve gastrectomy were included. Demographic data (age, sex), changes in body mass index (BMI), new cholelithiasis formation in the postoperative period, in preoperative period presence of diabetes mellitus (DM) and helicobacter like organism (HLO) positivity were examined. Student’s t-test or Mann-Whitney U test was used to compare numerical data, and the chi-square test was used to evaluate categorical data. RESULTS: The preoperative mean age of patients was 36.16±9.8 (18–58) years and mean BMI was 45.09±4.96 (37–67.1) kg/m2. Male/Female rate was 15/77.There is no statistically significant difference between postoperative cholelithiasis formation and gender (p>0.05). There is no statistically significance between postoperative cholelithiasis formation and preoperative DM presence (p>0.05). There is statistically significance between postoperative cholelithiasis formation and preoperative HLO positivity (p<0.05). Cholesistectomy was performed for symptomatic eight patients (8.7%). There is no statistically significant between patients with or without postoperative cholelithiasis formation for BMI changes between preoperative values and postoperative follow-up (p>0.05). DISCUSSION AND CONCLUSION: The formation of cholelithiasis is an important complication of bariatric surgery, but quick weight loss does not have an effect on cholelithiasis. Cholesistectomy should not be performed until symptomatic cholelithiasis. Preoperative HLO eradication can diminish the formation of the cholelithiasis. |
6. | The importance of the structure of pylorus in the success of the gastric botulinum toxin injections Murat Kanlıöz, Uğur Ekici, Faik Tatlı, Turgay Karataş doi: 10.14744/less.2020.94557 Pages 30 - 33 INTRODUCTION: In clinical practices, our success rate proved lower in patients with hypotonic pylorus who underwent gastric botulinum toxin A (GBTA) injection. To analyze this methodologically, we researched how considering the pyloric structure contributes to the treatment success in GBTA injection. METHODS: This study included 196 patients who underwent GBTA injection between 2017 and 2018. We measured their body mass indexes (BMI) before treatment (BT) and six months after treatment (AT). Upon no contraindications in the endoscopy, we applied GBTA 200 U to the patients. During the endoscopy, we named the pylori able to strain & relax spontaneously or by a stimulus and close firmly as normotonic pylorus (NP) and patients unable to close firmly and respond to the stimulus as hypotonic pylorus (HP). The patients were analyzed under three groups: G1, G2 and G3, which included patients with NP, HP and NP (+) HP, respectively. In independent group comparisons, we used the Mann-Whitney U test. Further, we made the dependent group comparisons using the Wilcoxon paired sample test. In all tests, a level of 0.05 was considered significant. RESULTS: Of the patients, 63.8% (125) were female and 36.2% (71) were male. Their mean age was 32.27±9.2 years. 148 and 48 of the patients had NP and HP, respectively. The median BMIs of groups were as follows: 35.5 (27.4–48) kg/m2 BT and 32.55 (24–44.1) kg/m2 AT in G3 with -2.95 kg/m2 variation (p=0.048*), 35.7 (27.4–48) kg/m2 BT and 32.35 (24–42.8) kg/m2 AT in G1 with -3.35 kg/m2 variation (p=0.036*), 35.1 (29–46.2) kg/m2 BT and 34.15 (27.9–44.1) kg/m2 AT in G2 with -0.95 kg/m2 variation (p=0.098). DISCUSSION AND CONCLUSION: We recommend administering GBTA injection therapy especially to the patients with NP. |
CASE REPORT | |
7. | Laparoscopic treatment of morgagni hernia: Two case reports Emrah Akın, Fatih Altıntoprak, Muhammet Burak Kamburoğlu, Metin Ertem, Fehmi Çelebi doi: 10.14744/less.2020.32154 Pages 34 - 36 Morgagni hernias account for only 2–3% of all diaphragmatic hernias, and most of them (91%) are right-sided. Most Morgagni hernias are diagnosed in childhood, but rarely diagnosis may be late because they can be asymptomatic or present nonspecific-nonrespiratory symptoms. Thus, Morgagni hernia diagnosis is incidental in the majority of adulthood cases. The defect arises from a fusion failure of the diaphragm with the central arches. Surgery is the main treatment modality of the Morgagni hernia due to defect enlargement and strangulation- incarceration risks. In this paper, we present two Morgagni hernia cases treated with laparoscopic surgery. Minimal invasive techniques can be used in Morgagni hernia with all advantages. |