E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 29 (2)
Volume: 29  Issue: 2 - 2022
1.LESS 2022-2 Front Matter

Pages I - IV

2.Elective laparoscopic splenectomy: A single-center experience and results
Serdar Öter, Metin Yalçın
doi: 10.14744/less.2022.37640  Pages 57 - 60
INTRODUCTION: Studies have shown that laparoscopic splenectomy (LS) is effective, safe, and also more advantages to open surgery with relatively fewer complications and improved patient outcomes. In this retrospective study, we evaluated the pre-operative, peroperative, and post operative patient data, pre-operative diagnoses, and patient demographics of our center experience.
METHODS: Between January 2017 and December 2020, 106 patients underwent total or partial splenectomy for traumatic or non-traumatic reasons. Elective LS was performed on 25 patients in our clinic between these dates. Twenty-three of these patients finished with laparoscopically were evaluated in this study.
RESULTS: Of the 23 patients who underwent LS, 7 (30.4%) were male, 16 (69.6%) were female, and the mean age was 33.7±12.24. Splenectomy indications are shown in Table 1. The most common indication for surgery in our series was idiopathic thrombocytopenic purpura and the second most was hereditary spherocytosis. The mean operative time was 145±40 min. An abdominal drain was placed in all patients. The drains were removed in an average of 1.4 (1–2) days postoperatively. The blood loss during the operation was 60±15 ml. The mean post-operative hospital stay was 3.17±0.71 days. Post-operative wound infection was observed in the incision in which the piece was removed in four patients. All wound infections resolved with drainage, wound dressing, and antibiotics.
DISCUSSION AND CONCLUSION: LS is a method that can be safely performed by experienced surgeons. Laparoscopy should be the first choice if possible in elective benign conditions of the spleen, especially if the spleen size is not too large.

3.Incidence of lymphoid aggregates and associated factors in a large gastric biopsy series
Mehmet Reşit Sönmez, Selçuk Gülmez
doi: 10.14744/less.2022.90197  Pages 61 - 64
INTRODUCTION: Lymphoid aggregates (LA) in gastric biopsies have traditionally been linked to Helicobacter pylori (HP) gastritis and other inflammatory and neoplastic conditions. In the literature review on this subject, it is seen that the studies are limited and the number of patients in the studies is low. The aim of this study was to evaluate the relationship between the incidence of LA and patient’s age, gender, HP, and other gastric mucosal pathologies in pathological examinations of gastric mucosal biopsies in a large series.
METHODS: Endoscopic gastric mucosal biopsies taken from 1427 adult patients due to dyspeptic complaints were evaluated in terms of the relationship of LA with age, gender, HP, inflammation, gastric activity, and intestinal metaplasia (IM).
RESULTS: LA was associated with HP positivity, age, inflammation, activity, and IM. No relationship was found with gender.
DISCUSSION AND CONCLUSION: In our study, relatively young age, HP, and presence of inflammation were independent risk factors for lymphoid aggregates.

4.Epigastric port site complications and affecting factors used for gallbladder specimen extraction in laparoscopic cholecystectomy
Elbrus Zarbaliyev, Murat Sevmiş, Abdulselam Özdemir, Sebahattin Çelik, Mehmet Çağlikülekçi
doi: 10.14744/less.2022.78942  Pages 65 - 74
INTRODUCTION: Complications occur at the port site where the specimen is excised after laparoscopic cholecystectomy (LC). In this study, it was aimed to investigate port-site complications.
METHODS: The results of patients who underwent LC surgery in our center between January 01, 2018, and December 31, 2020, were retrospectively analyzed. Patients who were decided to have open surgery and reside abroad were excluded from the study. Pre operative, intraoperative, and post-operative factors of all patients, which were considered to impact the development of complications, were noted down.
RESULTS: A total of 357 patients were included in the study. A total of 24 (6.7%) patients had epigastric trocar site infection (EPSI). It was found out that trocar site hematoma was a risk factor causing a 39.37-fold increase in the development of EPSI (<0.001) (95% confidence interval =10.69–144.97), while dilatation at the trocar site was a risk factor causing a 3.1-fold increase (p=0.027) (95% confidence interval =1.14–8.48). Ten patients had epigastric trocar insertion site hernia (EPSH). As a result of the multivariant analysis, it was determined that the development of EPSI caused the development of EPSH 27.59 times more (95% confidence interval =5.92–128.7) (p<0.001), while the accompanying additional laparoscopic procedure caused the development of EPSH 6.2 times more (95% confidence interval =6.2–1.17) (p=0.032).
DISCUSSION AND CONCLUSION: Preventing the occurrence of hematoma in the epigastric trocar insertion site, where the specimen is excised after LC surgery, reduces the risk of EPSI, and indirectly reduces the incidence of EPSH. Moreover, we recommend careful follow-up for EPSH in patients who underwent additional laparoscopic surgery during LC.

5.Reliability of port entry techniques applied in laparoscopic surgery and their effects on post-operative outcomes
Serkan Tayar, Murat Kartal, Tolga Kalaycı
doi: 10.14744/less.2022.29963  Pages 75 - 82
INTRODUCTION: The aim of this study is to show the reliability of three different access techniques (Hasson Technique [HT], Veress Needle Technique [VNT], and Direct Trocar Technique [DTT]) commonly used in laparoscopic surgery and to investigate their effects on the early and late outcomes.
METHODS: This single-center cohort study was designed as a retrospective study (between May 2019 and July 2020) at a tertiary health center with 290 patients. Pre-operative, operative, and post-operative parameters were gathered from hospital archive system. Post-operative outcomes were divided into two categories: Early outcomes and late outcomes. Early outcomes were defined as complications detected within the first 30 days after surgery, while late outcomes were defined as complications occurring between 30 days and 1 year. The differences of the investigated parameters in the three insertion techniques were evaluated statistically.
RESULTS: HT was used in 113 (39%) patients, VNT in 104 (35.9%), and DTT in 73 (25.2%) patients. DTT was a preferred method at younger ages (P<0.001). Twelve (4.1%) patients had complications during the first trocar insertion. While both operative complications and visceral injury were higher in the DTT group, the rate of vascular injury was the same between all groups. The early outcomes were seen in 34 (11.7%) patients.. The rates of both subcutaneous emphysema and ecchymosis were significantly lower in the HT group, P=0.011 and P=0.008, respectively. On the other hand, late outcomes were seen in 9 (3.1%) patients. The rates of late outcomes were similar between all groups.
DISCUSSION AND CONCLUSION: HT is a reliable method for the first trocar insertion due to the low rates of operative complications, and low incidence of early complications.

6.Endoscopic treatment and outcomes of sigmoid volvulus: A single-center experience
Metin Yalçın, Serdar Öter
doi: 10.14744/less.2022.35403  Pages 83 - 86
INTRODUCTION: There are many different approaches in the treatment of sigmoid volvulus (SV) in the literature, the first choice in patients without peritonitis findings is endoscopic treatment, while the standard treatment in complicated cases is surgery. The aim of this study is to evaluate the demographic characteristics, diagnostic methods, and post-treatment results of patients who underwent endoscopic detorsion with the diagnosis of SV in our clinic.
METHODS: Between January 2016 and December 2020, 39 patients with the diagnosis of SV were treated endoscopically or surgically in our clinic. Eighteen SV patients had successful detorsion and decompression procedures were included in the study.
RESULTS: The mean age of 18 patients was 66.55±20.26 years and 14 (77.8%) patients were male. The median time between the onset of symptoms and admission to the hospital was 3.52±2.23 days. Elective surgery was performed in a total of 6 (33.3%) patients whose performance status was appropriate. Hartmann end colostomy was performed in only one patient, while anastomosis was preferred in five patients. Remaining 12 patients whom outpatient follow-up was recommended due to performance status were followed at our outpatients clinic. Eight (66.67%) of these 12 patients were hospitalized for recurrent SV. Six of these patients can be successfully treated with endoscopic redetorsion and two patients were operated urgently.
DISCUSSION AND CONCLUSION: SV is a surgical emergency with high morbidity and mortality rates if effective treatment is not applied. Endoscopic detorsion can be preferred and safely applied as first-line treatment in non-complicated cases without peritoneal irritation findings.

7.Laryngopharyngeal lesion awareness of physicians performing upper gastrointestinal endoscopy: Survey study
Gözde Orhan Kubat, Mehmet Kubat, Mahmut Demirtaş, Ozan Bağış Özgürsoy
doi: 10.14744/less.2022.05914  Pages 87 - 97
INTRODUCTION: Early diagnosis of cancers in the laryngeal and pharyngeal (LF) region is important for minimally invasive treatment and prolongation of survival. In the practice of otolaryngology diseases, hypopharyngeal cancers are mostly diagnosed in the late period. The aim of this study is to evaluate the approaches of gastroenterology and general surgery specialists to LF region lesions during upper gastrointestinal (UGI) endoscopic procedures.
METHODS: Endoscopist physicians who agreed to participate in our study and performed UGI endoscopy were asked to fill out the online questionnaire and the results were evaluated. Survey results; It is based on demographic information, professional experience and characteristics of the procedure, endoscopy evaluation criteria, whether anatomical regions are evaluated and laryngeal and hypopharyngeal region lesions can be defined.
RESULTS: It was observed that 88% of the 100 participants who participated in the survey evaluated the LF region, and 71% encountered lesions in the hypopharynx, 62% with lesions obstructing the esophagus entrance, and 52% with laryngeal lesions. It was determined that 23.7% of the physicians who encountered hypopharyngeal lesions and 11.5% of the physicians who encountered laryngeal lesions took biopsies from the lesions in these regions. As the endoscopic experience increased, the identifiability of the lesions increased statistically significantly (p<0.05). The identifiability of the lesions was found to be statistically significantly lower in the group who thought that the education received during their residency was insufficient (p<0.05).
DISCUSSION AND CONCLUSION: With the routine evaluation of LF structures during endoscopy of the UGI, it is possible to diagnose lesions in this region at an early stage. In this age, where minimally invasive and organ-preserving endoscopic treatments are at the forefront, routine evaluation of LF regions should be included in the UGI endoscopy training required to increase the accuracy of diagnostic approaches. To increase the early diagnosis rate, endoscopists should be informed about the examination of anatomical regions in detail, and they should be encouraged to take biopsies in suspicious cases. In this period, the percentage of biopsy should be increased by performing simultaneous otolaryngology consultation.

8.High red cell distribution width value is a good predictive factor for detecting the complexity and difficulty of the laparoscopic cholecystectomy
Volkan Oter, Kerem Karaman, Ali Bal, Mehmet Aziret, Metin Ercan, Erdal Birol Bostancı
doi: 10.14744/less.2022.49368  Pages 98 - 102
INTRODUCTION: Several studies demonstrated that high red cell distribution width (RDW) values are associated with the severity of inflammatory processes. A recent study found that high RDW values significantly decrease after laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Therefore, we aimed to investigate, whether pre-operative RDW can predict the complexity of surgery and the risk of conversion from LC to open cholecystectomy (OC).
METHODS: Patients were divided into two groups according to the severity of inflammation with dense adhesions surrounding the gallbladder as Group I (n=140 patients); films adhesions around the gallbladder that allow easy dissection, Group II (n=100 patients); severe adhesions encasing the gallbladder, including fibrosis, which makes dissection difficult.
RESULTS: The mean age was 46.54±12.21 years. Eighty-five patients were female and 155 patients were male. The mean percentage of pre operative RDW was significantly higher in Group II patients when compared with Group I (15.26±2.0 vs. 12.53±0.84, p<0.001). Conversion cholecystectomy was performed significantly higher in Group II patients (n=18, %18) than in Group I patients (n=3, 2.1%), (p<0.001).
DISCUSSION AND CONCLUSION: Results of the present study indicate that high RDW values are associated with inflammation and dense adhesions both in the gallbladder and surrounding tissue which make operation difficult and increase rate of conversion to open surgery. Future studies consisting of large populations are needed to reach a definite conclusion.

9.Evaluation of post-surgical respiratory functions of patients who underwent sleeve gastrectomy
Hasan Elkan, Funda Cansun, Kuntay Kaplan
doi: 10.14744/less.2022.02997  Pages 103 - 106
INTRODUCTION: This study aimed to investigate the changes in respiratory functions of patients who underwent sleeve gastrectomy (SG) compared to the pre-operative period.
METHODS: In our study, the pre- and post-operative data of 132 patients who underwent SG for obesity between March 2018 and March 2021 were retrospectively scanned. Post-operative pulmonary function tests and body mass indexes (BMI) at the 3rd, 6th, and 12th month were evaluated.
RESULTS: Of the patients, 99 (75%) were female, 33 were male (25%), and the mean age was 35.6±10.7 (18–63). Pre-operative mean forced expiratory volume in the 1 second of forced was 2.5±0.8. The mean air volume exhaled in the 1 second of forced expiration measured at post-operative 3, 6, and 12 months were 2.5± 0.6, 2.5±0.7, and 2.9±0.7, respectively. The mean air volume exhaled in the first second of forced expiration measured at post-operative 3, 6, and 12 months/forced vital capacity (VC) values was 89.6±7.5; 89.8±8.3, and 89.8±8.8, respectively. While the air volume/forced VC values in the 1 second of the forced expiration measured at the post-operative 3rd, 6th, and 12th month were not statistically significant when compared with the pre-operative values, the improvement in the air volume values in the 1 second of the mean forced expiration at the post-operative 12th month was statistically significant when compared with the pre-operative values (p=0.03). When the mean BMI values at the post-operative 3rd, 6th, and 12th month were compared with the pre-operative values, it was observed that all three values were significantly lower (p<0.001).
DISCUSSION AND CONCLUSION: In our study, to evaluate airflow limitation, the pre-operative mean air volume exhaled in the 1 second of forced expiration was calculated as 2.5±0.8. The values were re-evaluated at 3rd, 6th, and 12th month postoperatively. While there was no significant difference in the values of the air volume exhaled in the 1 second of the forced expiration compared to the pre-operative period in the post-operative 3rd and 6th month, a significant improvement was found in the values of the air volume exhaled in the 1 second of the forced expiration in the post-operative 12th month of the cases compared to the pre-operative period.

10.Incidental gallbladder carcinoma diagnosed after laparoscopic cholecystectomy
Muhammer Ergenç, Tevfik Kıvılcım Uprak
doi: 10.14744/less.2022.98704  Pages 107 - 110
INTRODUCTION: Laparoscopic cholecystectomy (LC) is one of the most performed general surgeries. Incidental gallbladder carcinoma (IGBC) is diagnosed in 0.3–2.9% of all cholecystectomies and accounts for most detected gallbladder cancers (GBCs). This study aims to evaluate the incidence, clinical, and prognostic features of IGBC diagnosed after LC for benign gallbladder disease.
METHODS: We performed a retrospective analysis of patients who underwent cholecystectomy between January 2016 and October 2021 at the Istanbul Sultanbeyli State Hospital General Surgery Clinic. Data regarding the demographics, pathological features of the tumors, and survival times of patients were examined.
RESULTS: A total of 745 patients were analyzed. The patients’ median age was 43 (18–78), and the male-tofemale ratio was 137: 608. Four patients were diagnosed with gallbladder carcinoma after LC; however, one patient had pre-operative suspicious GBC. Three patients were diagnosed with IGBC. The cancer stages and survival times of the IGBC patients were pT2, pT2, and pT1a and 8, 34, and 40 months, respectively.
DISCUSSION AND CONCLUSION: Most GBCs are detected incidentally. The most significant factor determining the prognosis is an early stage detection. To detect IGBC, cholecystectomy specimens must be carefully examined histopathologically.

11.Effective elements for the standardization of sleeve gastrectomy
Mehmet Volkan Yigit, Zeynep Şener Bahçe
doi: 10.14744/less.2022.87360  Pages 111 - 116
INTRODUCTION: Morbid obesity is one of the most common health-care issues in our present day. Various surgical methods were developed to combat obesity. Laparoscopic sleeve gastrectomy (LSG) is the most common surgical treatment in the world and our country. In the present study, the purpose was to share the 6-year results of bariatric surgeries performed in our center.
METHODS: The retrospective records of the patients who underwent bariatric surgery between 2015 and 2021 were examined, and demographic data, indications for surgery, preparation for surgery, surgical technique, post-operative follow-up steps, post-operative complications, recovery rates of comorbid diseases, and the changes in post-operative biochemical parameters were evaluated.
RESULTS: A total of 457 patients underwent LSG over 6 years. The median age of the patients was 34.3 years (13–68) and the median body mass index was 43.74 (35.60–66.72) kg/m2. Among the patients, 261 (57.1%) were female and 196 (42.9%) were male. The mean surgery time was 58 (32–88) min. Improvements were detected in 91.6% of patients with pre-operative hypertension, in 87.3% of patients with diabetes, 91.6% of patients with sleep apnea, and 84.3% of patients with hyperlipidemia. Iron deficiency anemia was detected in 11 (2.4%) of the patients as a biochemical abnormality in the post-operative follow-ups, the folic acid deficiency was detected in 3 (0.7%) patients, Vitamin D deficiency in 6 patients (1.31%), and Vitamin B12 deficiency in 5 patients (1.1%).
DISCUSSION AND CONCLUSION: LSG is a safe method in the treatment of obesity facilitating weight loss and regressing comorbidities accompanying obesity. Although the decrease in biochemical parameters in the long-term followup is a disadvantage, it can be treated with replacement therapy.

12.Epiduroscopy in the treatment of chronic low back pain: A retrospective study
Emrullah Cem Kesilmez, Kasım Zafer Yüksel, Ayşe Azak Bozan
doi: 10.14744/less.2022.32032  Pages 117 - 122
INTRODUCTION: Chronic low back pain is a condition that impairs people’s quality of life, has an indirect impact on society, and results in economic labor losses. The results of epiduroscopy performed in our clinic for chronic low back pain were evaluated in this study.
METHODS: Patients who were admitted to our clinic between January 1, 2018, and January 1, 2022, and underwent epiduroscopy due to chronic low back pain were included in this study. Medical records of these patients were reviewed retrospectively, and their pain was assessed using the visual analog scale (VAS) scores in the files, as well as their functional status according to the Oswestry disability index (ODI), and their satisfaction using the Odom criteria. The VAS and ODI values of patients who had epiduroscopy were assessed before, after, and the 2nd, 1st, and the 3rd month after the procedure. The patients were divided into three groups according to the pathology (Group spinal stenosis-SS, Group lumbar disk hernia-LDH, and Group LDH+SS-SLD).
RESULTS: Of the 192 patients, 114 (59.4%) were female and 78 (40.6%) were male. There were 78 patients (40.6%) in Group SS, 62 patients (32.3%) in Group LDH, and 52 patients (27.1%) in Group SLD. There was no statistical difference seen between the groups in pre operative and post-operative VAS values (p>0.05). The 3rd month post-operative data demonstrated no statistical differences in patient satisfaction due to epiduroscopy between groups (p>0.05). There was a statistically significant improvement in pre-operative and post-operative VAS and ODI scores (p<0.05).
DISCUSSION AND CONCLUSION: Epiduroscopy techniques produce excellent results in managing low back pain in eligible patients.

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