E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 28 (2)
Volume: 28  Issue: 2 - 2021
RESEARCH ARTICLE
1.Laparoscopic gastrectomy vs open gastrectomy with D2 lymph node dissection in gastric cancer: Early postoperative outcomes and feasibility of laparoscopic procedures
Azmi Lale, Erhan Aygen
doi: 10.14744/less.2021.35556  Pages 83 - 92
GİRİŞ ve AMAÇ: Minimal invaziv gastrektomi prosedürleri geleneksel açık gastrektomi (AG) prosedürlerine kıyasla ameliyat sonrası daha az komplikasyon oranlarına sahiptir ve daha erken iyileşme imkanı sunar. Ayrıca onkolojik sonuçları AG prosedürleri kadar başarılıdır. Bu çalışmada, merkezimizde yaptığımız laparoskopik gastrektomi (LG) ile AG sonrası kısa dönem postoperatif klinik sonuçları ve histopatolojik sonuçlarını karşılaştırmak amaçlanmıştır.
YÖNTEM ve GEREÇLER: Çalışmaya toplam 50 hasta dahil edildi. Tüm hastalar LDG (n = 18) ve AG (n = 32) olarak iki ana gruba ayrıldı. Demografik parametreler, intraoperatif bulgular, erken postoperatif sonuçlar ve histopatolojik bulgular gruplar arasında karşılaştırıldı.
BULGULAR: Gruplardaki yaş, cinsiyet, VKİ, komorbid hastalıklar, ASA skorları, neoadjuvan tedavi öyküsü benzerdi. Ortalama ilk gaz çıkarma zamanı (LG: 2.01'e karşı AG: 2.62 gün, p = 0.002) ve hastanede kalış süresi (LG: 10.2'ye karşı AG: 14.4 gün, p = 0.004) daha kısaydı. İntraoperatif tahmini kan kaybı LG'de daha azdı (LG: 147.5'e karşı AG: 194,5 ml, p = 0,041). Operasyon süresi LG hastalarında anlamlı olarak daha yüksek (285,7'ye karşı 239,7 dk, p <0,001) bulundu. Postoperatif 30 günlük minör ve majör komplikasyonlar ve mortalite oranları LG hastalarında daha düşüktü ancak farklar anlamlı değildi. Çıkarılan toplam lenf düğümü ortalama sayısı total gastrektomi hastalarında (LTG: 39,2'ye karşı ATG: 38,7, p = 0,982) ve distal gastrektomi hastalarında (LDG: 32,4'e karşı ADG: 37,1, p = 0,649) açık prosedürlerle benzerdi.
TARTIŞMA ve SONUÇ: Laparoskopik gastrektomi prosedürleri hem distal hem de total gastrektomi hastalarında avantajlı postoperatif klinik sonuçlar ve benzer onkolojik sonuçlarla AG'den üstündür. Erken evre veya lokal ileri mide karsinomlarında güvenle uygulanabilir.
INTRODUCTION: Minimal invasive gastrectomy procedures offer better postoperative recovery and lower complication rates. Furthermore, oncological outcomes are not inferior to conventional open gastrectomy (OG) procedures. The aim of this study was to evaluate the short-term postoperative clinical outcomes and histopathological results after laparoscopic gastrectomy (LG) versus OG in our clinic.
METHODS: A total of 50 eligible patients were included in the study. All the patients were divided into two main groups as LG (n=18) and OG (n=32). Demographic parameters, intraoperative findings, early postoperative outcomes, and histopathological findings were compared between the groups.
RESULTS: Age, gender, BMI, comorbid diseases, ASA scores, neoadjuvant treatment history were similar in both LG and OG groups. The mean first flatus time (LG: 2.01 vs. OG: 2.62 days, p=0.002) and hospital stay (LG: 10.2 vs. OG: 14.4 days, p=0.004) were shorter and estimated blood loss was lesser (LG: 147.5 vs. OG: 194.5ml, p= 0.041) in LG patients. The duration of operation significantly higher in LG patients (285.7 vs. 239.7 min, p<0.001). Postoperative 30-day minor and major complications and mortality rates were lesser in LG patients but the differences were not significant. The mean number of retrieved total lymph nodes in total gastrectomy patients (LTG: 39.2 vs. OTG: 38.7, p=0.982) and in distal gastrectomy patients (LDG: 32.4 vs. ODG: 37.1, p=0.649) were similar to open procedures.
DISCUSSION AND CONCLUSION: LG procedures are superior to OG with advantageous postoperative clinical outcomes and similar oncologic results in both distal or total gastrectomy patients and can be safely performed for early or locally advanced gastric carcinomas.

2.Post-ERCP complications, risk factors and management of complications
Ufuk Arslan, Hacı Murat Cayci, Gözde Doğan, Umut Eren Erdogdu, Ali Tardu, Direnç Yiğit, Yurdakul Deniz Firat, Müfit Şansal
doi: 10.14744/less.2021.58966  Pages 93 - 98
GİRİŞ ve AMAÇ: Endoskopik retrograd kolanjio pankreatografi (ERCP), hepatopankreatikobiliyer sistem hastalıklarının tanı ve tedavisinde kullanılan girişimsel bir yöntemdir. Bu çalışmanın amacı hastanemiz endoskopi ünitesinde uygulanan ERCP işlemleri sonrası görülen komplikasyonlar, risk faktörleri ve komplikasyon yönetiminin değerlendirilmesidir.
YÖNTEM ve GEREÇLER: Nisan 2019- Şubat 2021 tarihleri arasında tek merkezde hepatopankreatikobiliyer sistem hastalıklarında tanı ve tedavi amacıyla aynı endoskopist tarafından uygulanan 765 hastanın ERCP verileri retrospektif incelendi. İşlemler; ERCP endikasyonları, işleme bağlı komplikasyonlar, komplikasyonlar için risk faktörleri ve komplikasyonların yönetimi açısından değerlendirildi.
BULGULAR: Yapılan işlem sayısı 765 idi. Başarılı kanulasyon oranı % 91.9 olarak bulundu. ERCP işlemi için en sık endikasyonlar koledok taşı (%43.6), yükselmiş kolestaz enzimleri/ intra-ekstrahepatik safra yolu dilatasyonu (%19) ve stent çıkarılması (%12.5) idi. Post-Ercp pankreatit için en sık izlenen risk faktörleri kadın cinsiyet (%60.9) ve yaş (%42.3), kanama için pre-cut (%10.9) ve antikoagulan kullanımı (%7.5), perforasyon için anormal papilla (%22.4), kolanjit için yaş (%42.8) idi. En sık izlenen komplikasyonlar hiperamilazemi ve pankreatit (% 17.2), kanama (%2), kolanjit (% 1.83) ve perforasyon (% 0.65) olarak izlendi. Post ERCP kolanjitine bağlı % 0.26 hastada mortalite izlendi.
TARTIŞMA ve SONUÇ: ERCP sonrası komplikasyon yönetiminde risk faktörlerinin iyi anlaşılması, komplikasyonların erken tanı ve tedavisi ile morbidite ve mortalitenin azalabileceğini düşünmekteyiz.
INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure used for the diagnosis and treatment of hepatopancreaticobiliary system diseases. The aim of this study is to evaluate post-ERCP complications, risk factors, and management of complications of ERCP procedures performed in the endoscopy unit of our hospital.
METHODS: The study retrospectively reviewed 765 patients’ data of ERCP performed by the same endoscopist for the diagnosis and treatment of hepatopancreaticobiliary diseases at a single center between April 2019 and February 2021. Interventional procedures were reviewed in terms of ERCP indications, procedure-related complications, risk factors for complications, and management of the complications.
RESULTS: A total of 765 procedures were carried out. The successful cannulation rate was 91.9%. The most common indicators for the ERCP procedure were choledocholithiasis (43.6%), high levels of cholestasis biomarkers/ intra-extrahepatic bile duct dilatation (19%) ve removal of bile duct stents (12.5%). The most common risk factors were; female gender (60.9%) and younger age (42.3%) for post-ERCP pancreatitis, pre-cut (10.9%) and anticoagulant therapy (7.5%) for bleeding, papillary abnormalities (22.4%) for perforation, and older age (42.8%) for cholangitis. The most common complications were hyperamylasemia and pancreatitis (17.2%), bleeding (2%), cholangitis (1.83), and perforation (0.65%). Mortality occurred in 0.26% of patients due to post-ERCP cholangitis.
DISCUSSION AND CONCLUSION: Understanding the risk factors and early diagnosis and treatment of complications are the ways to reduce morbidity and mortality in the management of post-ERCP complications.

3.COVID-19 pandemic and our endoscopy experiences
Celil Ugurlu, Murat Yildirim, Bülent Koca, Mustafa Sami Bostan, Salih Yilmaz, Namik Ozkan
doi: 10.14744/less.2021.99075  Pages 99 - 104
INTRODUCTION: It is known that endoscopic procedures are reduced all over the world in the coronavirus disease 2019 (COVID-19) pandemic. The results of clinics operating without interrupting elective endoscopic procedures during the pandemic process are unknown. We aimed to explain the endoscopy procedures, precautions, experiences, and how safe endoscopy service is provided by our clinic, which continues its endoscopy service during the pandemic without patient selection and number restrictions.
METHODS: This is a retrospective, cross-sectional and descriptive study. Between March 2020 and March 2021, the patients who underwent endoscopic procedures have included in the study. Medical files of 5986 patients were accessed from the hospital database and evaluated. COVID-19 transmission status of healthcare professionals working in endoscopy was analyzed.
RESULTS: About 3722 of patients were men (62.2%), 2264 of patients were women (37.8%). The mean age of the patients was 53±12 (17–85). Gastroscopy was performed in 3824 (63.8%) patients, and colonoscopy was performed in 1606 (30%) patients. Rectoscopy and sigmoidoscopy 205 (2.68%), colonoscopic polypectomy 190 (3.17%), gastroscopic polypectomy 77 (1.28%), foreign body removal by emergency gastroscopy 31 (0.51%), endoscopic percutaneous gastrostomy 29 (0.48%), emergency gastroscopy for upper gastrointestinal bleeding 19 (0.31%) and 5 (0.08%) emergency colonoscopy for volvulus detorsion was performed. Only 2 (8.3%) of healthcare workers had Covid 19 transmission during the pandemic process.
DISCUSSION AND CONCLUSION: Endoscopic procedures can be performed safely under pandemic conditions, with arrangements in the endoscopy unit, complete procurement of Personal protective equipment, training of healthcare professionals, and pre-procedure polymerase chain reaction.

4.Hysteroscopy findings in cases diagnosed histopathologically with chronic endometritis
Murat Bakacak, Zeyneb Bakacak
doi: 10.14744/less.2021.29567  Pages 105 - 108
INTRODUCTION: Chronic endometritis (CE) is a persistent inflammation of the endometrium, which can lead to various clinical conditions. Although CE can be diagnosed histopathologically, edema, focal or diffuse hyperemia, and endometrial micropolyps seen during hysteroscopy have been associated with CE. In this study, we planned to retrospectively analyze the hysteroscopic findings of our patients who were diagnosed with histopathologically CE in our clinic.
METHODS: The study included cases reported as CE as a result of endometrial biopsy performed at the end of a hysteroscopy surgical procedure applied for any reason in our clinic. The hysteroscopy findings of the cases were retrospectively investigated and analyzed.
RESULTS: In the 29 cases evaluated in the study, the most frequent hysteroscopy indication was repeated failure of implantation at the rate of 37.9%, followed by a history of repeated pregnancy loss at 34.4%. The most frequently seen hysteroscopy finding was endometrial hyperemia (27.5%) and in 9 cases, the hysteroscopy appearance was normal.
DISCUSSION AND CONCLUSION: The visualization during hysteroscopy of the presence of lesions with central white points accompanying stromal edema, endometrial hyperemia, micropolyps, and diffuse hyperemia should suggest a diagnosis of chronic endometritis.

5.Easier laparoscopic surgery in giant hydronephrosis: Intermittent drainage by percutaneous nephrostomy tube with simultaneous laparoscopic nephrectomy
Yunus Emre Göger, Mehmet Serkan Özkent, Muzaffer Tansel Kılınç, Hakan Hakkı Taşkapu
doi: 10.14744/less.2021.01069  Pages 109 - 115
INTRODUCTION: The aim of the study is to describe intermittent drainage via percutaneous nephrostomy tube with simultaneous laparoscopic nephrectomy (LN) as a more feasible technique in giant hydronephrosis (GH).
METHODS: All of the patients with GH who underwent LN between March 2016 and December
2019 in our tertiary center were retrospectively evaluated. Patient demographics, perioperative data, surgical
technique, complications, and results were described. Ultrasound-guided percutaneous nephrostomy
catheter was inserted on the operating table in order to provide collector system decompression. 20–30% of the measured volume was evacuated, and nephrostomy was clamped. As the renal sac was partially emptied, it contributed to the renal sac and other abdominal organs preservation during trocar insertion. 0–15% more urinary drainage was performed through nephrostomy in cases where the colon could not be assessed clearly with direct vision. During dissection, since the renal sac was partially filled, orientation was maintained and the renal pedicle was reached. In addition, it could be detected more easily in aberrant vessels. The remaining steps were similar to conventional transperitoneal LN.
RESULTS: The total number of the participants was 11, four female, and seven male, with a mean age of 25.6 ± 6.9 years. The mean surgical intervention time was 72.7±16.9 min. The mean urine volume discharged from the kidney was 2331.8±760 ml. Hospitalization time was, on average, 3.5±0.6 days. Clavien 1 complication occurred only in one patient. There was no observed any complication-related nephrostomy.
DISCUSSION AND CONCLUSION: This procedure is an easier way of dealing with a complicated surgical challenge. Intermittent drainage by percutaneous nephrostomy tube with simultaneous LN for GH is technically feasible and safe for selected patients.

6.Unplanned laparoscopic peritoneal biopsy for gastric cancer
Akile Zengin, Yusuf Murat Bag, Mehmet Can Aydın, Fatih Sumer, Cuneyt Kayaalp
doi: 10.14744/less.2021.90008  Pages 116 - 120
INTRODUCTION: It is thought that the sensitivity of computed tomography (CT) in detecting peritoneal metastases (PM) is low. In this study, we aimed to present our experience on gastric cancer (GC) patients with intraoperatively detected PM whose preoperative CT was normal in terms of distant metastasis.
METHODS: We retrospectively analyzed the demographics and perioperative data of ten patients with gastric adenocarcinoma whose preoperative CT was normal in terms of PM, but intraoperatively PM was detected.
RESULTS: The mean age of the patients was 68.30±9.44 years. Six patients (60%) were male. Tumors were mostly localized in the distal 1/3 of the stomach (n=5, 50%). The median carcinoembryonic antigen and carbohydrate antigen 19.9 levels were 2.00 ng/ml (0.60–37.50) and 30.76 IU/ml (3.28–449.30), respectively. There were PM on the visceral peritoneum (small bowel mesentery) in two patients (20%) and on the parietal peritoneum in eight patients (80%). The operations were terminated in five patients (50%) when the PM detected as they did not have any complications due to cancer. Laparoscopic feeding jejunostomy (n=2, 20%), laparoscopic tube gastrostomy (n=1, 10%), and laparoscopic gastroenterostomy (n=2, 20%) were performed on the patients with oral intake deficiency due to GC.
DISCUSSION AND CONCLUSION: Preoperative staging with CT before GC surgery is still valid. Multidetector CT scan should be preferred. However, it is still not enough for detecting all PM before surgery. Staging laparoscopy should be in mind, especially for patients with a high risk of PM.

CASE REPORT
7.A case with annular pancreas and accompanying ectopic pancreas
Deniz Esin Tekcan Sanli, Ayse Neval Erozan, Şafak Kızıltaş, Metin Ertem
doi: 10.14744/less.2021.24471  Pages 121 - 124
Congenital anomalies of the pancreas are quite common. The cases may present with different symptoms at different ages. While severe forms cause more noisy pictures in infancy and early childhood, mild forms may give symptoms in adulthood or they may be completely asymptomatic. Being aware of these anomalies guides clinicians in terms of diagnosis in clinical approach and helps prevent undesirable complications, especially during biliary, liver, and pancreatic operations. This case report aimed to present a case with annular pancreas and accompanying ectopic pancreas presenting in adult age with complaints consistent with severe upper gastrointestinal system obstruction with clinical, radiological, and endoscopic findings.

8.Laparoscopic treatment of a rare cause of acute abdomen; primary omental torsion
Muhammer Ergenç, Tevfik Kıvılcım Uprak
doi: 10.14744/less.2021.82653  Pages 125 - 127
Primary omentum torsion is one of the diseases of the omentum that can lead to an acute abdomen. In this case report, primary omentum torsion was detected in a patient admitted to the emergency department with abdominal pain and was operated on due to acute abdomen findings, and its laparoscopic treatment will be explained. The purpose of the case presentation is to emphasize the necessity that primary omental torsion should be considered in acute abdomen patients whose history and physical examination do not comply with specific pathologies. Laparoscopic surgery can help with both the diagnosis and treatment of this unusual condition.

9.Laparoscopic partial splenectomy: Our series of 3 patients
Fatih Sumer, Necip Tolga Baran, Orgun Gunes, Kuntay Kaplan, Ersin Gündoğan, Cuneyt Kayaalp
doi: 10.14744/less.2021.24571  Pages 128 - 130
Total splenectomy can cause many perioperative and postoperative complications. Partial splenectomy has been preferred in recent years in order to minimize the immunological complications associated with splenectomy. With this case series, we aim to present our own experiences with 3 patients.

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