E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 29 (1)
Volume: 29  Issue: 1 - 2022
1. Front Matter

Pages I - IV

RESEARCH ARTICLE
2. Are ABO blood groups associated with premalignant gastric lesions and helicobacter pylori?
Kadir Gisi, Murat Ispiroğlu
doi: 10.14744/less.2022.27870  Pages 1 - 5
INTRODUCTION: ABO blood group, a genetically determined trait for Helicobacter pylori, has been considered as a potential risk factor. Blood groups have also been investigated as a risk factor for H. pylori-related stomach cancer. This study aimed to investigate the relationship between the ABO blood types and H. pylori positivity, H. pylori-related premalignant gastric lesions, age, and gender in people in the present region.
METHODS: Patients who went through endoscopy for various complaints, from whom biopsy was taken during the process, and who knew their blood type were included in the study. The demographic characteristics of the patients, their blood groups, and their place of residence were recorded. H. pylori positivity and premalignant gastric lesion conditions were determined by evaluating the pathology results.
RESULTS: A total of 160 patients, 81 (51%) of whom were female and 79 (49%) of whom were male, were included in the study. H. pylori positivity was found to be 59.2% in women and 37.9% in men, and the difference was statistically significant (P < 0.05). The blood group of 69 of the patients (43%) were A, 53 of the patients (33%) were 0, 29 of the patients (18%) were B, and nine of the patients (6%) were AB. There was no statistically significant difference between H. pylori positivity and ABO blood groups. The relationship between premalignant gastric lesions and blood groups was not statistically significant.
DISCUSSION AND CONCLUSION: This study showed that there was no significant relationship between ABO blood groups and H. pylori positivity and premalignant gastric lesions, while age and gender were important in H. pylori positivity.

3. Challenges of home percutaneous endoscopic gastrostomy feeding of children for mothers with chronic illnesses and their coping mechanisms: A qualitative study
Hatice Donmez, Rukiye Burucu, Aylin Yucel
doi: 10.14744/less.2022.09125  Pages 6 - 13
INTRODUCTION: This paper investigated what challenges mothers with chronic illnesses experienced when feeding their children through PEG tubes and what coping strategies they implemented when those challenges presented themselves.
METHODS: This was a qualitative study that adopted phenomenology as a research design. The sample consisted of nine mothers. Data were collected through focus group interviews and were analyzed using Colaizzi’s content analysis. Intercoder reliability was calculated using the formula proposed by Miles and Huberman.
RESULTS: Participants had a mean age of 31.2±4 years. The data were grouped under three categories, five main themes, and 14 subthemes. Participants expressed concern about the uncertainty of their situation and were afraid of losing their children. They also stated fear that there would be no one there for their children if something happened to them. PEG-related complications were infection, catheter dislodgement/blockage, and hypergranulation.
DISCUSSION AND CONCLUSION: Participants used to go to the hospital when faced with problems in the early days, but then they came up with solutions. At first, they did not know anything about how to insert and use the PEG tube. They learned everything from their friends or the internet. We can state that women are more concerned about their children because of their own chronic diseases.

4. Peri-And Post-Operative Comparison Of 24 Hour Ph Monitoring Results In Patients Who With Laparoscopic Ant-Reflux Surgery
Mümtaz Erakın, Murat Akıcı, Sezgin Yılmaz, Yüksel Arıkan
doi: 10.14744/less.2022.83435  Pages 14 - 17
INTRODUCTION: Gastroesophageal reflux disease(GERD) is a common medical problem affecting the quality of life and causing morbidity.24 hour pH monitoring is the most sensitive and specific test in diagnosing GERD. The aim of this study is to compare pre-and postoperative 24 hour pH monitoring results, life quality, and demographic features of patients with GERD diagnosis who underwent laparoscopic ant-reflux surgery.
METHODS: İn this study 40 patients who were referred to Afyon Kocatepe university hospital general surgery clinic between January 2016 to August 2017, diagnosed with GERD and underwent laparoscopic ant-reflux surgery were enrolled. The results of pre- and at least 3 months post-operative 24-hour pH monitoring were compared.
RESULTS: Of those 40 patients who were enrolled to the study 16(%40) were male and 24 (%60) were female. The overage age of the male patients was 47.65± 15.3 and the average age of the females was 42.55±13.5. It was observed that the quality of life scores of the patients, evaluated with GERD-HRQL in the preoperative period, decreased statistically significantly in the postoperative period. (p = 0.001) The preoperative DeMeester Score (DMS) of all patients was above the normal value, and when the postoperative analysis results were examined, it was observed that the reflux parameter results decreased.
DISCUSSION AND CONCLUSION: It has been shown that the postoperative 24-hour pH monitoring results in patients who underwent laparoscopic anti-reflux surgery decreased significantly compared to the preoperative results. It was observed that the symptoms were brought under control and the quality of life was improved in the patients. Based on these results, Nissen fundoplication is a successful and effective procedure. 24 hour pH monitoring should be done post anti-reflux surgery to assess the effectiveness of the procedure and symptom post-surgery.

5. The effects of using metal clips to support the stapler line lengthwise on bleeding and leakage in laparoscopic sleeve gastrectomy
Mehmet Volkan Yiğit, Zeynep Şener Bahçe
doi: 10.14744/less.2022.67689  Pages 18 - 22
INTRODUCTION: The aim of our study is to evaluate the results of our patients who underwent laparoscopic sleeve gastrectomy (LSG) procedure due to morbid obesity and to whom we applied hemoclips to reinforce the resection line and provide hemostasis. Morbid obesity is one of the most common health problems today. Satisfactory results are obtained after LSG surgery performed for therapeutic purposes. However, it causes serious complications such as leakage and bleeding from the stapler line.
METHODS: The files of 403 patients who were intervened with LSG for morbid obesity in our clinic and who had hemoclips inserted along the entire resection line for reinforcement and hemostasis were reviewed. The patients’ demographic parameters, body mass index (BMI), and changes in hemoglobin (Hb) were evaluated.
RESULTS: About 329 (81%) of the patients were female, whereas 74 (19%) were male. Preoperatively, the mean BMI in women was 42.4±3.56 kg/m2 and the mean BMI in male was 47.5±7.72 kg/m2. The mean operation time was calculated to be 58.3 min. Pre-operative mean Hb values were calculated to be 13.8±0.77 g/dL, and mean Hb values on the 3rd day of surgery were calculated to be 13.2±0.82 g/dL. Only one of our patients had gastric fundus leakage. Six of our patients experienced bleeding during the first 6 h after surgery.
DISCUSSION AND CONCLUSION: Following resection with new generation stapler in our clinic, we reinforced the stapler line lengthwise using hemoclips in all patients. In our cases, we found that using hemoclips to support the stapler line is safe in terms of bleeding and leaking.

6. Examination of polyp lesions detected in colonoscopy over a 10-year period
Murat Ispiroğlu, Kadir Gişi
doi: 10.14744/less.2021.70845  Pages 23 - 28
INTRODUCTION: To contribute to the literatüre, the demographic features, frequency, histological features, size and location of polyps examined during 10 years were evaluated.
METHODS: Reports of 5561 colonoscopy procedures performed between 2008 and 2018 were reviewed retrospectively. Statistical analysis was made.
RESULTS: Polyps were found in 1835 (32.9%) of the 5561 whom colonoscopy performed. Of the patients with polyps, 16.1% were <40-years-old, 43.9% were between 40 and 60-years-old and 39.8% were over 60-yearsold. The mean age of patients with polyps was 57 ± 78 years, and those without polyps were 51 ± 35 years. 37.6% of those with polyps were female and 62.4% were male. In histopathological examination, 37.38% of the polyps were found hyperplastic polyps, 55.9% adenomatous, and 6.7% adenocarcinoma. Of the adenomatous polyp (1026) cases, 48.8% were tubular, 44.5% were tubulovillous, and 6.6% were villous. The number of those with a polyps >1 cm was 1491 (81.3%), the average age was 54.47, while those larger than 1 cm were 344 (18.7%) and the average age was 58 ± 12. The percentage of polyp detection in men (62.4% vs. 37.6%) and the frequency of detecting >1 cm polyp (22.09% vs. 13.18%) were higher than in women. The most common location of polyps was the rectosigmoid region (1053 patients [57.38%]). Malignancy risk and size increased with age.
DISCUSSION AND CONCLUSION: In our study, the frequency of polyps increased with age in both genders. The prevalence of polyps detected was higher than the literature. This shows the importance of widespread and timely colonoscopic examination.

7. Management of migrated plastic biliary stents in patients with benign biliary diseases
Ali Erkan Duman, Sadettin Hülagü
doi: 10.14744/less.2022.95777  Pages 29 - 35
INTRODUCTION: Biliary stenting using plastic stents is widely used in the treatment of benign and malignant disorders of pancreaticobiliary system. Despite widespread use of plastic biliary stents, migration occurs in 5–10 patients undergoing biliary stenting. Migration may lead to complications and endoscopic retrieval of migrated plastic stents may be challenging for the endoscopists. The aim of the study was to determine migration rates of biliary stents, complications related to migration and endoscopic retrieval techniques, and success rates in patients with benign biliary disorders.
METHODS: Medical records of 1653 ERCP procedures performed between December 2016 and May 2021 were retrospectively examined. Indications for stenting, presentation of migration, length and diameter of the stents, endoscopic retrieval techniques, and success rate were analyzed.
RESULTS: There were 295 plastic stents inserted for benign biliary disorders in 211 patients. Migration occurred in 11.4% of cases; 5.7% distal migration and 5.7% proximal migration. While cases with proximal migration mostly presented with cholangitis, most cases were asymptomatic with distal migration. Endoscopic retrieval success rate was 100% in proximally migrated plastic biliary stents. In one case, cholangioscopy-assisted retrieval was used as a rescue therapy. As most of the distally migrated stents passed through the intestine spontaneously, endoscopic retrieval was not required.
DISCUSSION AND CONCLUSION: Migration of stents is an undesirable condition but endoscopic retrieval may be achieved with a high success rate in experienced centers using the available equipment properly. Cholangioscopy-assisted stent retrieval may be used as a rescue therapy if conventional methods are unsuccessful.

8. An analysis of weight loss failure and weight regain in patients undergoing laparoscopic sleeve gastrectomy
Cihan Gökler, Sabri Özdaş
doi: 10.14744/less.2022.80488  Pages 36 - 41
INTRODUCTION: The present study evaluates the weight regain and weight loss failure at the end of four years in patients undergoing LSG.
METHODS: The data of patients who underwent a laparoscopic sleeve gastrectomy in a single center for the treatment of morbid obesity was reviewed and analyzed retrospectively. Body mass index (BMI) was measured before surgery in all patients. The patients underwent a control examination and BMI measurement at 1, 2 3 and 4 years. The data was analyzed using SPSS.
RESULTS: A total of 179 patients were included in the study. The proportion of male patients was significantly higher in the group of patients who re-gained weight than in those who did not re-gain weight at the end of four years. The rate of smokers was lower in the group of patients who re-gained weight than those who did not re-gain weight at the end of four years (p < 0.05).
DISCUSSION AND CONCLUSION: The short- and long-term results of the present study suggest that LSG is an effective bariatric surgery procedure. Weight regain was at the lowest levels in the first three years after LSG, but showed a progressive increase at the end of four years.

9. Can the degree of fibrosis in the gallbladder wall be predicted by pre-operative routine examinations in chronic cholecystitis? A retrospective analysis
Ali Kemal Kayapinar, Samir Abdullazade
doi: 10.14744/less.2022.48108  Pages 42 - 48
INTRODUCTION: Fibrosis caused by chronic inflammation in the gallbladder increases the risk of biliary tract injury. Our aim was to investigate a possible correlation between pre-operative routine examinations and the degree of chronic inflammation.
METHODS: Samples from 74 patients with chronic cholecystitis (CC) were reevaluated to determine the degree of chronic inflammation. The relationship of gallbladder wall thickness and gallbladder stone size in pre-operative abdominal ultrasonography (USG), pre-operative laboratory values, and endoscopic retrograde cholangiopancreatography (ERCP) history with the degree of histopathological chronic inflammation in the gallbladder wall was evaluated. In addition, adhesion of the surrounding tissues to the gallbladder, operation time, hospitalization period, biliary tract injury, and post-operative complications were examined in the context of degree of chronic inflammation.
RESULTS: Grade I CC was detected in 53 (69.8%) and Grade II in 21 (27.6%) patients. While the gallbladder wall was thick (>3 mm) on pre operative USG in 7 (33.3%) patients with Grade II CC, it was normal in all patients with Grade I (p<0.001). A history of pre-operative ERCP was found in 2 (3.8%) patients in Grade I CC and in 7 (33.7%) patients in Grade II (p=0.002). In univariate and multivariate analysis, gallbladder wall thickness and history of ERCP were found to be significant in predicting the degree of chronic inflammation [(p<0.001 and p=0.002), (p=0.003 and p=0.014), respectively]. In multivariate analysis, an increase in AST value of 1 U/L increases the probability of CC grade II by 1.1 times compared to CC grade I (p=0.019).
DISCUSSION AND CONCLUSION: Increased gallbladder wall thickness, history of ERCP, and elevated AST value in CC increase the possibility of a high degree of chronic inflammation (fibrosis rate).

CASE REPORT
10. A serious danger in laparoscopic cholecystectomy: Middle hepatic vein (Careful for serious bleeding)
Bülent Kaya
doi: 10.14744/less.2022.22043  Pages 49 - 51
The incidence of vascular injuries during cholecystectomy is reported as 0–2% in different series. The liver bed is a potential area that some serious bleeding can occur. It is well-known that middle hepatic vein is very close to gallbladder. It can be injured specially in patients with acute or chronic cholecystitis. We presented two patients, in which middle hepatic vein was detected very near to gallbladder during laparoscopic cholecystectomy. Two operations were done without any bleeding complication.

11. Ileal perforation secondary to fish bone ingestion mimicking acute appendicitis
Mehmet Akif Aydın, Nusabe Kaya, Farid Aghazada, Khoshbo Noor
doi: 10.14744/less.2021.49389  Pages 52 - 55
Foreign body (FB) ingestion is commonly encountered in a clinical setting. However, the presence of perforation resulting from the ingested FB is an occurrence that is rarely seen. The most common cause of FB perforation is known to be fish bone. It’s important to emphasize that the complications resulting from fish bone ingestion may lead to findings such as acute abdomen signs that can also be interpreted as other medical conditions, including acute appendicitis, acute diverticulitis, or peptic ulcer perforation. Thus, the differential diagnosis should be made, and the patient should be managed accordingly. In cases where the patient presents with acute abdomen signs but there are no clinical findings that may explain the initial diagnosis of the patient, a complete surgical exploration should be performed. We present a 50-year-old male patient who presented to the emergency room with complaints of abdominal pain. Following a thorough clinical examination and blood investigations, it was revealed that he had acute abdomen signs and a high level of C-reactive protein (CRP) and because of these findings, exploratory laparoscopy was decided to be performed. Intraoperatively, the FB was removed, and the site of perforation was repaired with primary closure.

LookUs & Online Makale