E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 28 (3)
Volume: 28  Issue: 3 - 2021
RESEARCH ARTICLE
1.Can red cell distribution width and mean platelet volume be a marker in patients with asymptomatic gallstones?
Muhammed Rasid Aykota, Mustafa Atabey, Sevda Yılmaz
doi: 10.14744/less.2021.70456  Pages 131 - 135
INTRODUCTION: Gallstone disease (cholelithiasis) is one of the most common diseases of the digestive system. In the present study, we aimed to analyze the relationship of coincidentally encountered asymptomatic gallstones with red cell distribution width (RDW) and mean platelet volume (MPV) values investigated as the prognostic indicators for their use in the diagnosis and monitorization of the patients that developed gallstone-associated complications.
METHODS: In the present study, RDW, PLT, and MPV values of 255 asymptomatic patients with coincidentally detected gallstones in their gallbladders were compared with those of 109 healthy patients (control group) that applied to the check-up clinic between the years 2018 and 2020.
RESULTS: Mean RDW values of the patients with asymptomatic gallstones (mean RDW: 15.09, SD: 2.04) were found statistically significantly higher than those of the control group (mean RDW: 14.21, SD: 0.90) (p<0.001). In the same manner, also mean MPV values of the patients with asymptomatic gallstones (mean RDW: 7.87, SD: 1.40) were found statistically significantly higher than those of the control group (mean RDW: 7.38, SD: 1.06) (p<0.001).
DISCUSSION AND CONCLUSION: Our results demonstrated as a consequence that RDW and MPV values can be used in prediction of the patients with asymptomatic gallstones.

2.Baseline laboratory parameters as predictors of admission to intensive care unit after laparoscopic cholecystectomy
Aziz Ahmet Surel
doi: 10.14744/less.2021.26928  Pages 136 - 140
INTRODUCTION: The role of laboratory biomarkers for predicting adverse clinical outcomes after laparoscopic cholecystectomy is unclear. This study aimed to investigate the potential biomarkers for predicting admission to intensive care unit (ICU) in patients who underwent laparoscopic cholecystectomy.
METHODS: All patients over 18 years old that underwent successful laparoscopic cholecystectomy between February 20, 2019, and June 15, 2021, at Ankara City Hospital Department of General Surgery were included in the study. The main outcome of the study was unplanned admission to ICU after laparoscopic cholecystectomy. Stata statistical package program (version 15.1/IC; StataCorp) was used to perform all data analyses.
RESULTS: Of 877 patients that were included in the current study, 76 (8.6%) were admitted to ICU. Multivariable logistic regression analysis revealed that lower levels of potassium (odds ratio [OR]: 0.206; 95% confidence interval [CI]: 0.109–0.388; p<0.001) and higher levels of monocyte (OR: 3.145; 95% CI: 1.472–6.715; p=0.003), total bilirubin (OR: 1.002; 95% CI: 1.001–1.003; p<0.001) and neutrophil (OR: 1.171; 95% CI: 1.102–1.244; p<0.001) were independently associated with an increased risk of admission to ICU. The accuracy of predicting ICU admission was assessed by the area under the receiver operating characteristic curve which was = 0.83. A nomogram was developed with significant predictors (neutrophil, total bilirubin, monocyte, and potassium) for the admission ICU.
DISCUSSION AND CONCLUSION: This is the first study investigating the role of laboratory parameters for predicting the need for ICU admission after laparoscopic cholecystectomy. If validated, this simple approach can contribute to the development of new personalized treatment strategies.

3.Effect of pressure-controlled recruitment maneuver on hemodynamics and respiratory mechanics during pneumoperitoneum
Kadir Arslan, Yasemin Özşahin, Hülya Yılmaz Ak, Ziya Salihoğlu
doi: 10.14744/less.2021.02212  Pages 141 - 147
INTRODUCTION: Laparoscopic surgery has become an increasingly preferred method due to the small size of the abdominal incision line, causing less tissue trauma, reduced post-operative analgesic requirement, providing early mobilization, decreased post-operative ileus, and shortened hospital stay. However, pneumoperitoneum may cause upward displacement of the diaphragm by increasing intra abdominal pressure, decrease functional residual capacity and lung compliance, and develop atelectasis. The aim of this study is to investigate the effect of recruitment maneuver and positive end expiratory pressure (PEEP) applications performed together with graduated pressure levels and low O2 concentration on respiratory mechanics, oxygenation, and hemodynamic parameters in patients who underwent laparoscopic cholecystectomy.
METHODS: Sixty patients with laparoscopic surgery and ASA I and II were divided into three groups (n=20 in each group). Recruitment maneuvers were performed in the patients in Group R with a stepwise method twice, 5 min after insufflation and desufflation. While the patients were at 8 cmH2O PEEP value, they were ventilated 10 times with 5 cmH2O < PEEP increments while the Ppeak<50 cmH2O up to 20 cmH2O PEEP value. The gradually increased PEEP value was reduced again gradually and terminated at the initial PEEP value of 8 cmH2O. In the patients in Group P, only 8 cmH2O PEEP was initiated after intubation and recruitment maneuver was not performed. On the other hand, PEEP was not initiated and recruitment maneuver was not performed in the patients in Group C after intubation. In all patients, 5 min after insufflation and desufflation, intraoperative arterial blood gas analysis was performed twice, and simultaneous static and dynamic compliance values and hemodynamic values (systolic, diastolic, mean arterial pressure, and heart rate) were recorded.
RESULTS: PaO2 values 5 min after insufflation and desufflation in Group C (insufflation: 156.65±43.21 and desufflation: 165.45±35.83) were detected significantly lower than Group R (insufflation: 199.50±29.32 and desufflation: 253.33±37.93) and Group P (insufflation: 200.93±58.16 and desufflation: 202.84±47.13) (p<0.05). PaO2 measurements 5 min after desufflation in the cases in the R group were found to be significantly higher than the cases in Group P (p<0.05). In the cases in Group R, the increase in the PaO2 value 5 min after desufflation was significantly higher to the PaO2 value 5 min after insufflation (p<0.05). The change in PaO2 values in the cases in Group P and Group K was not statistically significant (p>0.05). Compliance measurements of the cases in Group R 5 min after desuflation were found to be significantly higher than the cases in Groups P and C.
DISCUSSION AND CONCLUSION: It is thought that recruitment maneuver and PEEP application with gradually increasing pressure in patients undergoing laparoscopic surgery have positive effects on oxygenation, increases lung compliance and can be used safely.

4.How long does it take to be an ERCP expert?
Ozan Andaç Erbil
doi: 10.14744/less.2021.68553  Pages 148 - 157
INTRODUCTION: Although many researches have been done on the success and complications of the endoscopic retrograde cholangiopancreatography (ERCP) procedure, the effects of the endoscopist’s experience are still a controversial issue.
METHODS: Between January 2016 and January 2020, 320 ERCP procedures with natural papilla performed sequentially by a single endoscopist were divided into 4 groups only in chronological order. Medical records from the hospital automation system and ERCP forms were reviewed retrospectively. The effects of experience on the ERCP procedure were investigated by comparing the success rate and complications between the groups.
RESULTS: In the procedures carried out on 320 native papilla, success rate was 88.43%; the success rates of selective biliary cannulation in four groups were, respectively, 83.75, 93.75, 88.75, and 87.50%. It was determined that success rate did not increase by increasing experience (p=0.696). Cannulation period and attempts are reduced by group 1 to 4 (p<0.01), but the decrease in ERCP specific complications which are associated with cannulation time and the number of attempts was not statistically significant. On the contrary, hemorrhage complication in the syphinchteretomy line was increased from group 1 to group 4. (p=0.014).
DISCUSSION AND CONCLUSION: 240 cases refer to the critical value in terms of complications. Therefore, in difficult procedures and for patient selection, this value (240 cases) should be considered. Since being an expert is a highly individual situation at ERCP, the standard number of case or definitions of experience are likely to be discussed for a longer time.

CASE REPORT
5.Ectopic liver tissue on gallbladder (choristoma): Two case reports
Erdem Sarı, Alpaslan Fedayi Calta, Gülden Taşova Yılmaz, Çiğdem Saraçoğlu
doi: 10.14744/less.2021.34654  Pages 158 - 161
Ectopic liver tissue is a rare developmental anomaly and is most commonly seen on the gallbladder. A 45-year-old male and 41-year-old female patient underwent laparoscopic cholecystectomy due to gallstones, and ectopic liver tissue was found on the patients’ gallbladder. During the operation, ectopic liver tissue removed with the surgical specimen material. Pathology report is compatible with the usual liver parenchyma. Discussion: Although there is no strong information about the long-term follow-up results of the ectopic liver, surgical resection is recommended due to the high probability of carcinogenesis (hepatocellular carcinoma). However, this possibility is lower in localizations on the gallbladder. Therefore, if there is a pathology in the gallbladder, its excision with the gallbladder is recommended

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