E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 28 (4)
Volume: 28  Issue: 4 - 2021
1.Ten years single center bariatric surgery experience
Emre Turgut, Kuntay Kaplan, Gökalp Okut, Emrah Cengiz, Huseyin Kocaaslan, Necip Tolga Baran, Mehmet Karahan, Fatih Sumer, Cemalettin Aydın, Cuneyt Kayaalp
doi: 10.14744/less.2021.73383  Pages 163 - 168
INTRODUCTION: Various surgical modalities have been developed to reduce the amount and absorption of nutrients in the fight against obesity. We aimed to share how the single-center experience was affected by the developments in the world and its change over time with the literature.
METHODS: The records of patients who underwent laparoscopic bariatric surgery between May 2010 and December 2020 were reviewed retrospectively. Demographic characteristics of the patients, indications for surgery, preparation for surgery, surgical technique, and post operative follow-up stages were examined in detail.
RESULTS: A total of 1422 patients underwent bariatric surgery over a 10-year period. Laparoscopic Roux-n-Y Gastric Bypass (LRYGB) was performed in 946 patients and Laparoscopic Sleeve Gastrectomy (LSG) was performed in 476 patients. The operation time (p<0.001) and the intraoperative blood loss (p<0.001) in LRYGB were significantly higher than LSG. The difference was not significant in terms of length of hospital stay (p=0.149) and drain usage (p=0.782). While intraoperative complications occurred in 49 (5.1%) patients in LRYGB, this number was 5 (1%) in LSG (p<0.001). There was no significant difference in Clavien Dindo class 3 and higher complication rates between the groups (p=0.782). Mortality was seen in only 7 (0.5%) patients.
DISCUSSION AND CONCLUSION: Today, standard techniques are applied in both procedures and the choice is left to the patient. Regardless of the technique applied, laparoscopic bariatric surgery can be applied as an effective and safe method in the treatment of morbid obesity until an alternative treatment is found.

2.Predictive value of pre-operative blood markers in patients undergoing open and laparoscopic curative resection for colorectal cancer
Aziz Serkan Senger, Selçuk Gülmez, Orhan Uzun, Bülent Şen, Ismail Ege Subaşı, Deniz Avan, Erdal Polat, Mustafa Duman
doi: 10.14744/less.2021.10337  Pages 169 - 175
INTRODUCTION: Individual risk prediction tools for post-operative morbidity assessments are increasingly becoming prominent. Blood markers obtained from peripheral blood are an essential part of the systemic inflammatory response and are good indicators of complications. The study aimed to cross-compare the ratio-based pre-operative laboratory parameters to predict post-operative complications (POCs) in patients with curative surgery for colorectal cancer.
METHODS: This retrospective cohort and single-center study evaluated the data of 323 colorectal cancer patients who underwent curative surgery between January 2007 and November 2019 in a tertiary hospital in Istanbul, Turkey. A receiver operating characteristic (ROC) curve was generated to evaluate the ability of laboratory values to predict clinically relevant POCs. The area under the curve was computed to compare the predictive power of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRP-albumin ratio (CAR). Then, the cutoff points were selected as the stratifying values for all four indexes.
RESULTS: Complications developed in 109 (33.7%) of the patients postoperatively. Patients with POC had higher Charlson comorbidity index (CCI) scores and higher intra-operative bleeding. Length of hospital stay was also increased in the POC group. ROC curve analysis revealed that NLR was significantly effective in predicting POC, while LMR, PLR, and CAR were ineffective. According to multivariate analysis, CCI score ≥3, higher IOP-Bleeding, length of stay, and NLR ≥3.00 were independent risk factors influencing the POC.
DISCUSSION AND CONCLUSION: Pre-operative NLR was predictive for POI. LMR, PLR, and CAR did not have any prediction for POC. In addition, CCI score, IOP Bleeding, length of post-operative stay, and pre-operative NLR≥ 3.00 were found to be independent risk factors that influence the occurrence of POC.

3.Evaluation of the effectiveness of using two different probiotics in helicobacter eradication treatment
Bülent Koca, Erol Kılıç, Saim Savaş Yürüker, Murat Yıldırım, Mustafa Sami Bostan, Celil Uğurlu, Namık Özkan
doi: 10.14744/less.2021.03764  Pages 176 - 181
INTRODUCTION: We aimed to evaluate the effects of the addition of probiotics containing Lactobacillus acidophilus + Bifidobacterium animalis Subsp lactis to the classic triple treatment protocol (lansoprozole + amoxycillin + clarithromycin) on the success of Helicobacter pylori eradication and antibiotic side effects.
METHODS: Standard therapy (lansoprozole + amoxycillin + clarithromycin), and probiotics containing in addition to standard therapy were determined. Patients in both groups were treated for 14 days. The prebiotic, containing two different strains, was in capsule form and used twice a day. We demonstrated the helicobacter eradication status by looking at the helicobacter antigen from the stool. Statistical analyzes between the two groups were made using the pearson Chi-square test. P<0.05 was accepted as the significance level.
RESULTS: The rate of discontinuing treatment due to side effects was 15.3% in group 1, this rate was 4.5% in group 2. When double probiotics were added to the treatment, it was observed that there was a decrease of 11.2% in serious side effects (p<0.001). After the completion of the treatments. It was observed that helicobacter eradication was achieved in 152 out of 222 patients (68%) in group 1 and in 214 (89%) of 240 patients in group 2. When double probiotics were added to the treatment, it was observed that the success of eradication increased by 21% (p<0.001).
DISCUSSION AND CONCLUSION: Combined use of probiotic increases helicobacter eradication in addition to reducing the side effects of antibiotics due to H. pylori.

4.Evaluation of factors relating with early period complications that develop following application of percutaneous endoscopic gastrostomy
Erdoğan Mütevelli Sözüer, Mahmut Onur Kültüroğlu, Fatih Dal, Muhammet Akyüz, Uğur Topal, Tutkun Talih, Hızır Yakup Akyıldız
doi: 10.14744/less.2021.75046  Pages 182 - 186
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is the method which is preferred for nutrition in patients who need long-term enteral nutrition. In this procedure which seems to be simple technically, complications which can form following the process can give rise to serious results. In this study, it has been aimed to examine the factors relating with complications observed in early period following PEG process.
METHODS: Patients who underwent PEG process in our clinic between years of 2014 and 2020 are included in the study. Patients are divided into two groups within the first period of 30 days depending on whether complication has developed or not. Factors that could be related with complications in groups and long-term results in patients relating with whom complications developed are analyzed retrospectively.
RESULTS: One hundred and six patients were included in our study. In the group with early complications, long-term complications (30.8% vs. 6.3% p=0.001), catheter dysfunction (19.2% vs. 3.8% p=0.009), and withdrawal of the PEG tube (11.5% vs. 0% p=0.002) were found to be more frequent at a significant level statistically.
DISCUSSION AND CONCLUSION: None of the parameters evaluated in our study alone were associated with PEG complications. In patients with early PEG complications, the rate of complications, catheter dysfunction, and withdrawal of the PEG catheter increased in the long term. Prevention of early complications in patients with PEG can increase the quality of life of patients by preventing complications that may occur in the long term, while also reducing hospital costs.

5.Factor to consider in gastroesophageal reflux disease refractory to proton pump inhibitor therapy: Bile reflux
Mustafa Sami Bostan, Celil Uğurlu
doi: 10.14744/less.2021.04875  Pages 187 - 191
INTRODUCTION: We aimed to investigate the effect of bile reflux (BR) in patients whose symptoms did not improve despite proton pump inhibitor (PPI) treatment.
METHODS: In our retrospective study, patients who were refractory to PPI treatment were divided into two groups as BR and non-BR patients based on the upper gastrointestinal endoscopy and endoscopic biopsy data. Age, sex, and endoscopic biopsy data of the patients were analyzed statistically.
RESULTS: A total of 154 patients were included in the study. BR was detected in 107 of the patients, while BR was not observed in 47. While, 53% (n=81) of the patients were male and 47% (n=73) were female. There was no statistically significant difference between the two groups in terms of age, sex, and endoscopic biopsy data. When BR and the presence of Helicobacter pylori were compared, it was found that BR was higher in patients who were refractory to PPI therapy.
DISCUSSION AND CONCLUSION: We believe that BR is a more effective factor than H. pylori in PPI-refractory gastroesophageal reflux patients.

6.Comparison of early and late period outcomes of transabdominal pre-peritoneal technique and Lichtenstein technique in repair of bilateral inguinal hernia
Tolga Kalaycı, Mustafa Yeni
doi: 10.14744/less.2021.46034  Pages 192 - 198
INTRODUCTION: The aim of this study is to compare the early and late period outcomes of transabdominal preperitoneal (TAPP) technique and Lichtenstein technique (LT), which are two different methods used in the surgical treatment of bilateral inguinal hernia.
METHODS: Patients who were operated for bilateral inguinal hernia at Erzurum Regional Education and Research Hospital between January 2015 and January 2021 were selected for the study retrospectively. The patients were divided into two groups according to the surgery performed: TAPP technique group and LT group. Complications occurred in the first 30 days of the post-operative period were defined as early period outcomes, and complications occurred after the first 30 days postoperatively were defined as late period outcomes. The outcomes differences between TAPP technique and LT were evaluated with appropriate statistical tests, and p=0.05 was considered statistically significant.
RESULTS: During the study period, 110 patients underwent bilateral inguinal hernia surgery. One hundred and nine patients (99.1%) were men. The mean age of all patients was 56.6±14.27 years (20-84). TAPP technique group had 28 (25.5%) patients. Overall morbidity rate and length of hospital stay were higher in LT group, p=0.029 and p<0.001, respectively. There was no difference between the groups in terms of recurrence (p=0.255).
DISCUSSION AND CONCLUSION: Comorbid diseases and age of the patients are important factors in the selection of surgical method. TAPP technique, which reduces the overall morbidity and shortens the duration of hospital stay and does not have a significant increase in terms of recurrence, can be performed safely in bilateral inguinal hernia cases.

7.A comparison of educational quality, reliability and accuracy of videos in laparoscopic nissen fundoplication surgery: YouTube® vs WebSurg®
Banu Yigit, Rumeysa Kevser Liman, Bulent Citgez
doi: 10.14744/less.2021.15428  Pages 199 - 209
INTRODUCTION: The objectives of this study were to assess the quality of data, reliability, scientific accuracy, and educational power of the videos published on YouTube® (YTb) and to compare two online video platforms, WebSurg® (WS) and YTb using novel scoring systems and laparoscopic Nissen fundoplication scoring system (LNFSS), which we modified from the recent literature considering pre-operative, perioperative, and post-operative evaluation of the laparoscopic Nissen fundoplication surgery.
METHODS: The first 100 videos were reviewed on YTb, an open-access video platform, using “laparoscopic Nissen fundoplication” as the search term. The quality of data, reliability, scientific accuracy, and educational power of the videos were assessed through novel scoring systems such as video power index (VPI), DISCERN questionnaire (DISCERNqs), Journal of American Medical Association Benchmark Criteria (JAMABC), global quality score (GQSc), and LNFSS. The first 20 videos in WS were compared to the 20 YTb videos with the highest LNFSS scores.
RESULTS: The first 100 YTb videos had an average VPI, DISCERNqs, JAMABC, GQSc, and LNFSS scores of 1034.9, 39.73, 2.06, 2.44, and 7.81, respectively. There was no significant difference between the first 20 WS videos and the 20 YTb videos in terms of video sources, time since upload, and number of views. WS videos had significantly more likes, fewer dislikes, and longer running times (p=0.007, p=0.002, and p=0.043, respectively). Significantly higher JAMABC scores were observed especially in WS videos (p<0.001). The VPI, DISCERNqs, GQSc, and LNFSS scores were evaluated between the two online video platforms, and no significant difference was found.
DISCUSSION AND CONCLUSION: Laparoscopic Nissen fundoplication videos on YTb are below the expected quality. When videos with the highest LNFSS scores were selected from YTb’s video database, no significant difference was found between WS and YTb in terms of educational quality. Thus, it is recommended to use LNFSS points to improve educational quality.

8.Percutaneous endoscopic gastrostomy: A secondary care hospital experience
Muhammer Ergenç, Serhat Tolga Derici, Tevfik Kıvılcım Uprak
doi: 10.14744/less.2021.39205  Pages 210 - 214
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is the most common enteral feeding method in patients with swallowing disorders. PEG is a minimally invasive procedure, but acute and chronic complications may develop after the procedure. Therefore, in this article, we evaluated PEG interventions that were performed in a secondary care hospital.
METHODS: We performed a retrospective observational study of patients who underwent PEG intervention from January 2019 to June 2021 at the Istanbul Sultanbeyli State Hospital Endoscopy Unit. This study was approved by the local Ethics Committee and registered with ClinicalTrials.gov (NCT05012527). A total of 45 patients’ comorbidities, indications, complications, and 30-day mortality rates were analyzed.
RESULTS: The majority of our population was elderly patients, and the mean age of the patients was 74. Most patients had multiple comorbidities such as hypertension, Alzheimer’s disease, stroke, and diabetes mellitus. The minor complication rate was 24.4%, and the major complication rate was 4.4%. Thirty-day mortality was observed in 18% of this cohort.
DISCUSSION AND CONCLUSION: Before the PEG procedure, the patient’s general condition, the expected time of insufficient food intake, life expectancy, and comorbidities should be carefully examined. Our study has shown that PEG is a viable and safe procedure.

9.Neuroendoscopic management of a pineal glioblastoma: A case report with a systematic literature review
Halil Olgun Peker
doi: 10.14744/less.2021.92603  Pages 215 - 222
Pineal region glioma histologies are fibrillary astrocytoma, pilocytic astrocytoma, anaplastic astrocytoma, glioblastoma, oligodendroglioma, ependymoma, and choroid plexus papilloma. Malignant tumors of the pineal region are difficult to manage. Glioblastomas are rare aggressive tumors that can cause acute hydrocephalus and life-threatening complications in this area. We present a case of pineal region glioblastoma, who diagnosed and treated with neuroendoscopy as well as radiotherapy and chemotherapy. We also provided a literature review specifically focused on neuroendoscopic treatment of the disease with a comparison between those with and without surgical resection.

10.“Posterior first” dissection approach may contribute safe laparoscopic cholecystectomy
Tufan Egeli, Cihan Agalar, Mucahit Unal, Tarkan Unek
doi: 10.14744/less.2021.09825  Pages 223 - 224
Abstract | Full Text PDF

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