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1. | Front Matter 2022-4 Pages I - IV |
RESEARCH ARTICLE | |
2. | The effect of weight loss and reflux on quality of life after sleeve gastrectomy Gülten Çiçek Okuyan, Emre Berat Akçay, Sencan Sertçelik doi: 10.14744/less.2022.02223 Pages 179 - 186 INTRODUCTION: Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery in recent years. The primary outcomes expected from bariatric and metabolic surgeries include weight loss, improvement in comorbidities, and increased quality of life (QoL). In this context, the objective of this study is to evaluate the effect of weight loss rates and symptomatic reflux on QoL. METHODS: The study sample comprised 86 patients who underwent laparoscopic SG (LSG) be-tween January 2017 and January 2018. Patients’ demographic characteristics were obtained from hospital records. The effects of excess weight loss rates and symptomatic reflux development on patients’ QoL were evaluated with the 36-Item Short Form Health Survey (SF-36) in the 4th year of follow-up. RESULTS: The median excess weight loss (EWL) was 88.5%, and post-operative weight gain (min. 4.0–max. 18.0 kg) was detected in 26 (30.2%) patients. Reflux was detected in 22 (25.6%) patients. There was a significant correlation between patients’ EWL values and their age and pre-operative body mass index values in the negative direction. In addition, there were significant correlations between EWL values and SF-36’s role limitations due to physical health problems (r=0.425, p<0.001) and general health perceptions (r=0.280, p=0.009) subscale scores in the positive direction. SF-36’s role limitations due to physical health problems, general health perceptions, and perceived change in health subscale scores were significantly lower in patients with reflux than those without reflux. DISCUSSION AND CONCLUSION: The study findings indicated that low EWL and symptomatic reflux after LSG adversely affect the QoL. |
3. | The effect of intraoperative bleeding and staple number on anastomotic leakage in laparoscopic rectal surgery Ertuğrul Gazi Alkurt, Mehmet Berksun Tutan doi: 10.14744/less.2022.27037 Pages 187 - 192 INTRODUCTION: Anastomotic leakage (AL) after colorectal resection remains one of the most important com-plications with associated morbidity and mortality. The aim of this study is to investigate the number of staples used during laparoscopic rectal transection and the effect of intraoperative bleeding on AL. METHODS: The data of 70 patients who underwent low anterior resection (LAR) for colorectal cancer between 2020 and 2022 were retrospectively analyzed. Demographic characteristics of the patients, the number of staples used, intraoperative bleeding status, and the presence of AL were examined. RESULTS: In the group without AL, the median value was found to be two staples, with at least one stapler and at most two staples used. In the operation of patients with AL, the median value was three staples, at least three staples were used, and at most four staples were needed. A statistically significant difference was ob-served between the two groups (p<0.001). While the rate of AL was 5.56% in the group without hemorrhage, this rate was observed as 31.25% in patients with intraoperative hemorrhage. There was a statistically significant difference between the two groups (p=0.013). DISCUSSION AND CONCLUSION: Intraoperative hemorrhage and the use of more than two staples in rectal transection in LAR have been shown to be high-risk for AL. Coloproctologists should try to reduce the number of linear staples and transect the rectum with no more than two staples. |
4. | An effective method for pain control after inguinal hernia repair with TAPP technique: Transversus abdominis plane block a case–control study Mustafa Sami Bostan doi: 10.14744/less.2022.76993 Pages 193 - 199 INTRODUCTION: We aimed to investigate the effects of transversus abdominis plane (TAP block) block on pain control and postoperative analgesic use in patients who underwent laparoscopic transabdominal preperitoneal (TAPP) repair. METHODS: A single-center retrospective study was conducted to investigate the efficacy of TAP block in patients who were operated on with the laparoscopic TAPP technique for inguinal hernia. The data of 92 patients who were operated with the TAPP technique between 2019 and 2020 were analyzed. The patients were divided into two groups as TAP block applied and not applied. Those who underwent TAP block were also divided into two subgroups as preincisional and postincisional. RESULTS: The TAP block group (n=34) was statistically the same as the control group (n=58) in terms of age, gender, and body mass index. Visual analog scale scores in the TAP block group were statistically lower in the first 24 h (p<0.001) and on the 10th day (p<0.001) compared to the control group. The level of nonsteroidal anti-inflammatory administered intravenously in the first 24 h and orally in the first 10 days after discharge was significantly lower in the TAP block group (p<0.001 and p<0.001, respectively). There was no statistical difference in the preincisional or postincisional application of TAP block. DISCUSSION AND CONCLUSION: TAP block reduces pain and analgesic use in the early period after the TAPP procedure. |
5. | Early term results of the left colic artery preservation in colorectal cancer surgery Kuntay Kaplan, Cihan Gökler, Yusuf Murat Bağ, Emrah Cengiz, Fatih Sümer, Cemalettin Aydın, Cüneyt Kayaalp doi: 10.14744/less.2022.37790 Pages 200 - 204 INTRODUCTION: Colorectal cancer is a common type of cancer that causes significant morbidity and mortality. Post-resection anastomosis safety is important. The most important factor affecting anastomosis safety is blood accumulation in the anastomosis. In this study, we aimed to examine the early-term results of the preservation of the left colic artery (LCA) during laparoscopic anterior and low anterior resection (LAR) for the treatment of rectum and sigmoid colon cancers based on our clinical experience. METHODS: A total of 192 archive files that were operated for rectum and sigmoid colon cancer in our center between April 2019 and October 2022 were reviewed retrospectively. The patients were diagnosed using colonoscopy and biopsy during the pre-operative period. The patients and their results were discussed in the oncology council, and the patients’ treatment plans were formed based on the council’s decision. RESULTS: The patients’ mean age was 65.4±9.33 years and nearly half of them were males (n=8, 53.3%). Of the patients, 12 (80%) of them underwent LAR, while three patients (20%) underwent AR. The mean duration of surgery was 322.66±101.8 min, while the median bleeding amount was 50 (20–150) cc. One patient (6.7%) required reoperation due to an anastomotic leak, and abscess drainage was performed using the transanal method. No mortality was observed in patients at 30 days. DISCUSSION AND CONCLUSION: In our study, the low ligation (LL) and LCA were preserved during laparoscopic AR and LARs for rectum and sigmoid colon cancers, preserving blood accumulation in the anastomosis. However, multicenter prospective randomized controlled studies are required to demonstrate whether LL significantly reduces anastomotic leaks. |
6. | Risk factors and clinical outcomes of laparoscopic cholecystectomy in elderly patients Arif Atay, Feyyaz Güngör, Mehmet Sercan Candan, Örgün Güneş, Özlem Gür, Osman Nuri Dilek doi: 10.14744/less.2022.35762 Pages 205 - 210 INTRODUCTION: Significant advances in medicine have led to a prolongation of life expectancy and an increase in the rate of operations performed on the elderly. However, despite all these developments, advanced age continues to be one of the factors affecting perioperative and post-operative morbidity and mortality. Considering the increase in elderly population, it is estimated that an increasing number of elderly patients will apply for cholecystectomy in the next decade. METHODS: In this retrospective single-center study, the files of patients over 65 years of age who underwent laparoscopic cholecystectomy (LC) between January 2018 and February 2020 were evaluated. We divided the patients into two groups. Patients aged 65–74 as Group A, and patients aged 75 and over as Group B. Besides the clinical data of the patients, we compared inflammatory markers. RESULTS: Of the 92 patients included in the study, 35 (38.05%) were male, 57 (61.95%) were female, and the mean age was 71.72±5.06. The operation was completed laparoscopically in 85 of the patients who under-went cholecystectomy. The morbidity rate was statistically significantly higher in Group B. Furthermore, Group B stayed in hospitals more than Group A, which was statistically significant. DISCUSSION AND CONCLUSION: LC is a safe surgical method for elderly patients. However, comorbidity, length of hospital stay, and morbidity seem to be higher with advanced age. This age group should be evaluated with a multidisciplinary approach before and after surgery. |
7. | The role of preoperative MRCP in interval laparoscopic cholecystectomy after biliary pancreatitis and acute cholecystitis Sinan Ömeroğlu, Mehmet Ali Uzun, Mert Tanal, Selçuk Gülmez doi: 10.14744/less.2022.03779 Pages 211 - 214 INTRODUCTION: Early or at the same hospitalization laparoscopic cholecystectomy (LC) is recommended for acute calculous cholecystitis and biliary pancreatitis. Interval cholecystectomy is planned for patients who cannot undergo early or in same hospitalization cholecystectomy. We examined the role of pre-operative magnetic resonance cholangiopancreatography (MRCP) in interval LC. METHODS: Twenty-three patients aged between 45 and 70, who underwent interval LC after biliary pancreatitis or acute cholecystitis, had no history of endoscopic retrograde cholangiopancreatography, had no abnormality in laboratory tests and underwent pre-operative MRCP in our hospital between April–June 2022, were retrospectively analyzed. Patients who did not have recurrent biliary pancreatitis/acute cholecystitis/cholangitis attacks during the waiting period but who admitted to the hospital with mild complaints such as biliary colic-nausea or asymptomatic patients were included. RESULTS: Fourteen patients were female and nine patients were male, mean age was 62.5 years. Thirteen patients had a history of acute cholecystitis and ten patients had a history of biliary pancreatitis. During the waiting period, five patients after acute cholecystitis and four patients after biliary pancreatitis received symptomatic treatment. All patients underwent pre-operative MRCP. Choledocholithiasis was detected in pre-operative MRCP in two patients with a history of acute cholecystitis and in three patients with a history of biliary pancreatitis. It was found that three out of five patients with choledocholithiasis received symptomatic treatment in the emergency department with mild complaints. Cystic duct anatomical variation was detected in six different patients. DISCUSSION AND CONCLUSION: MRCP can reduce the incidence of LC complications and conversion rates. Pre-operative use of MRCP is controversial and criteria are needed for its indication. Interval cholecystectomy and biliary colic may be among them. |
8. | Cancer incidence rate in 3217 gastrointestinal system endoscopic procedures: Single surgeon experience Mehmet Reşit Sönmez doi: 10.14744/less.2022.98360 Pages 215 - 218 INTRODUCTION: Gastrointestinal system cancers are the most common malignant neoplasms in the world. Endoscopic diagnostic methods have an active role in the early diagnosis of gastrointestinal system cancers and in improving treatment outcomes. In this study, a single surgeon’s gastrointestinal system endoscopic procedures were evaluated to determine the cancer incidence rate. METHODS: The data obtained from 3217 endoscopic procedures were evaluated retrospectively. RESULTS: Of the cases examined, 1818 (56.52%) were female and 1399 (43.48%) were male. The mean age was 44.3 for women and 46.5 for men. Of the procedures, 2245 were esophagogastroduodenoscopy (EGD) and 972 were colonoscopy. Of the EGD cases, 1443 (64.27%) were female and 802 (35.72%) were male. Of the colonoscopic procedures, 375 (38.58%) were female and 597 (61.41%) were male. While the malignancy rate was 0.44% in esophagogastroduodenoscopies, this rate was found as 2.46% in colonoscopic examinations. DISCUSSION AND CONCLUSION: Endoscopic examination is the most important diagnostic method in diagnosing cancers in the gastrointestinal tract early. |
9. | Is laparoscopic colorectal cancer surgery safe in patients with previous major abdominal surgery? Örgün Güneş, Yusuf Murat Bağ doi: 10.14744/less.2022.57070 Pages 219 - 223 INTRODUCTION: Minimally invasive surgery (MIS) has been performed safely for the past three decades. How-ever, sometimes performing MIS is challenging such as in patients with the previous abdominal surgery (PAS). Therefore, in this study, we aimed to investigate the feasibility and safety of laparoscopic colorectal surgery (LCS) in patients with only major PAS. METHODS: Data from 59 patients who underwent LCS performed by a single surgeon between 2019 and 2022 were retrospectively reviewed. Patients were divided into two groups; those with major PAS (PAS group, n=19, 32.2%) and those were not (NPS group, n=40, 67.8%). Demographics, previous medical and surgical history, and perioperative data were evaluated and compared between groups. RESULTS: The median operation time was 180 (120–240) min and it was significantly longer in the PAS group (p<0.001). The post-operative serious complication and mortality rates were not significantly different be-tween the groups. DISCUSSION AND CONCLUSION: We found that LCS, which is a complex surgery, can be performed safely even after major PAS, despite the prolongation of hospital stay and operation time and the increase in the number of ports used. |
CASE REPORT | |
10. | Subcutaneous emphysema after endoscopic retrograde cholangiopancreatography in a liver transplant recipient: A case report Fatih Özdemir doi: 10.14744/less.2022.32744 Pages 224 - 226 Endoscopic retrograde cholangiopancreatography (ERCP) is a widespread performed diagnostic and therapeutic tool for biliary and pancreatic disorders. Risk of perforation after ERCP is approximately 1%. ERCP-re-lated perforation may be a severe lethal complication, and sometimes, it needs surgical intervention for the treatment. Surgical treatment options are based on the type, size, and location of the perforation. Here, we report a liver transplant recipient with subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum after ERCP who was treated conservatively. |
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11. | Reviewer List 2022 Page 227 Abstract | |