E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 30 (1)
Volume: 30  Issue: 1 - 2023
1.Front Matter 2023-1

Pages I - IV

2.Clinical and endoscopic characteristics of doxycycline induced esophageal ulcers: Retrospective observational study
Metin Şenol, Emrah Akın
doi: 10.14744/less.2023.46548  Pages 1 - 6
GİRİŞ ve AMAÇ: İlaç kullanımına bağlı özefageal ülserler arasında doksisiklin kullanımı önemli yer tutar. Çalışmanın amacı doksisikline bağlı görülen özefagus ülserlerinin kinik ve endoskopik özelliklerini araştırmaktır.
YÖNTEM ve GEREÇLER: Çalışmaya 2015-2020 tarihleri arasında farklı nedenlerle doksisiklin tedavisi alan ve klinik şikayetleri gelişmesi üzerine değerlendirildiğinde özefageal ülser tespit edilen hastalar dahil edildi. Hastalar demografik özellikleri, klinik başvuru şikayetleri, biyopsi oranları, doksisiklin kullanım endikasyonları, endoskopi bulguları ve ülser tipi açısından retrospektif olarak değerlendirildi.
BULGULAR: Çalışmaya otuz hasta dahil edildi. Hastaların %70’i kadındı. Hastaların %13,3’üne biyopsi yapıldı. En sık doksisiklin kullanım endikasyonu akne vulgaristi (%53,3). Başvuru esnasında en sık klinik presentasyon %43,3 ile disfaji idi. Özefageal ülserler en sık %73,3 ile orta özefagustaydı. Endoskopide en sık görülen ülser tipi %60 tek, %56 sınırlandırılmış tipte ülserlerdi.
TARTIŞMA ve SONUÇ: Doksisiklin kullanımı sırasında disfaji, odinofaji, göğüs ağrısı gibi şikayetleri olan hastalarda özefageal ülser tanısı akılda tutulmalıdır.
INTRODUCTION: Doxycycline usage takes an essential place in drug-induced esophageal ulcers. The study aims to investigate the clinical and endoscopic features of doxycycline-induced esophageal ulcers.
METHODS: Patients who were treated with doxycycline for several reasons between 2014 and 2021 and who were diagnosed with esophageal ulcer after evaluation of their clinical complaints were included in the study. Patients were evaluated retrospectively in terms of demographic characteristics, clinical complaints, biopsy rate, indications for doxycycline use, endoscopy findings, and ulcer type.
RESULTS: The study includes thirty patients. About 70% of the patients were female. Biopsy was performed in 13.3% of the patients. The most common indication for the use of doxycycline was acne vulgaris (53.3%). The most common clinical complaint was dysphagia (43.3%). Esophageal ulcers were most common in the middle esophagus, with 73.3%. In the endoscopic evaluation, the most common ulcer shape was circumscribed form (56%), and most ulcers were single (60%).
DISCUSSION AND CONCLUSION: Esophageal ulcer diagnosis should be considered in patients with complaints such as dysphagia, odynophagia, and chest pain during doxycycline usage.

3.Experience of percutaneous endoscopic gastrostomy in cardiac patients
Sinan Ömeroğlu, Selçuk Gülmez, Emir Çapkınoğlu, Hakan Mustafa Köksal, Mustafa Fevzi Celayir, Helin El Kılıç, Aziz Serkan Senger, Orhan Uzun, Erdal Polat, Mustafa Duman
doi: 10.14744/less.2023.34445  Pages 7 - 11
INTRODUCTION: In this study, we aimed to present our experience and findings in high-risk cardiac patients who were inserted percutaneous endoscopic gastrostomy (PEG) tube due to inability to take oral food, pro-longed intravenous/nasogastric nutrition, or require long-term enteral feeding.
METHODS: A total of 64 patients were examined retrospectively who had PEG tube insertion between 2012 and 2020 in the intensive care unit or clinic by the gastrointestinal surgeon. All patients underwent cardiac surgery before feeding tube insertion. The necessity and short-term results for PEG were evaluated in this patient group.
RESULTS: A total of 64 patients underwent upper gastrointestinal endoscopy for insertion of a PEG tube. The procedure was successful in all patients and no complications were observed in the follow-up. Twenty-five (39.1%) of 64 patients were women. The mean age of the patients was 67.04 (±11.44) years. The number of patients for diabetes mellitus, hypertension, atrial fibrillation, cerebrovascular disease, chronic kidney disease, and chronic obstructive/restrictive pulmonary disease was 36 (56.3%), 53 (82.8%), 21 (32.8%), 19 (29.7%), 21 (32.8%), and 15 (23.4%), respectively. The mean hospital stay of the patients after cardiac surgery was 37.81 (±12.81) days, and the mean feeding from PEG tubes was 13.34 (±4.93) days.
DISCUSSION AND CONCLUSION: Patients with high-risk factors who have undergone cardiac surgery are more likely to need a PEG tube. This patient group should be evaluated well in the pre-operative period. Upper gastrointestinal endoscopy should be performed in patients with gastrointestinal symptoms. Furthermore, information should be given about the PEG tube that may be required in the post-operative period.

4.Retrospective analysis of anesthesia management in endoscopic transsphenoidal pituitary surgery
Gökçe Gişi
doi: 10.14744/less.2023.33230  Pages 12 - 16
INTRODUCTION: Endoscopic transsphenoidal resection of pituitary masses has been preferred by surgeons with increasing frequency in recent years. Anesthesia management for this surgery has unique challenges, requiring special pre-anesthesia preparation and perioperative management.
METHODS: After the approval of the ethics committee, anesthesia follow-up forms and electronic records of 34 patients were retrospectively reviewed. Demographic characteristics of the patients, comorbidities, American Society of Anesthesiologist score, presence of acromegaly, cushing, prolactinoma, presence of intubation difficulty, duration of anesthesia, hypertension, hypotension, bleeding, and similar complications were recorded.
RESULTS: Of the patients included in the study, 20 (58.8%) were female and 14 (41.2%) were male. The mean age was 46.7±16.38. The average duration of anesthesia was 200.7±37.80 minutes. Of the patients 16 (47.1%) had secretory adenoma, eight patients had acromegaly, four patients had cushings, and four patients had prolactinoma. Difficult airway was observed in a total of six patients.
DISCUSSION AND CONCLUSION: Hypo or hypersecretion of pituitary hormones can cause problems affecting anesthesia. Before the operation, patients should be evaluated in detail by a multidisciplinary team working in harmony with anesthesiologist, endocrinologist and neurosurgeon, and appropriate treatments should be initiated. Appropriate anesthesia method and strict perioperative observation are essential for successful endoscopic surgery, providing early recovery and a soft awakening.

5.Gastrointestinal system foreign bodies
Örgün Güneş, Arif Atay, Furkan Karahan, Hakan Camyar, Osman Nuri Dilek
doi: 10.14744/less.2023.45403  Pages 17 - 22
INTRODUCTION: While foreign bodies in the gastrointestinal tract are observed more frequently and accidentally in the childhood age group, they may occur to attract attention, sexual satisfaction, self-harming behavior, abuse, secondary gain, or during self-treatment in young people and adults. In the United States, 1500 people die yearly from ingested foreign bodies. The leading cause of mortality is obstruction and perforation due to impaction in the gastrointestinal system. In this study, we evaluated the clinical findings, risk factors, and clinical output data of foreign bodies in the gastrointestinal tract and presented the most accurate approach considering the literature.
METHODS: This is a retrospective and descriptive study analyzing data from a prospective data-base. Adult patients admitted to the emergency department of our 3rd level university hospital between January 2015 and January 2022 due to foreign bodies in the gastrointestinal tract were included in the study.
RESULTS: Transanal rectal body removal in the operating room was performed using the Crede maneuver in seven patients. Laparotomy or thoracotomy was performed in nine patients, and thirty-six patients were treated with endoscopic methods. Endoscopy and laparotomy were performed simultaneously in one patient. It was determined that the foreign body of 29 patients was removed by conservative methods.
DISCUSSION AND CONCLUSION: For treating of foreign bodies, a multidisciplinary approach, including advanced endoscopic and surgery, is required according to the localization and content of the foreign body, underlying cause and patient population.

6.Effect of spleen size on complications of laparoscopic sleeve gastrectomy
Sinan Arıcı, Oğuzhan Fatih Ay
doi: 10.14744/less.2023.42103  Pages 23 - 28
INTRODUCTION: In bariatric surgery, examining the spleen dimensions via USG in a routine manner prior to surgery, could help the physician to predict probable complications on bariatric surgery as enlarged spleen size restricts the surgeon’s working area and leaks often occur in the upper part of the stomach adjacent to the spleen. The aim of this research was to elucidate the benefits of spleen USG in pre-operative period to determine the risk of complications in advance.
METHODS: A total of 316 patients who had undergone sleeve gastrectomy have been retrospectively analyzed. The spleen dimensions of the patients were obtained from the routine USG reports and CT scans. In this research we took the spleen size as 12 cm from the previous radiological studies in the literature and stated the ones above this reference point.
RESULTS: The number of staples and duration of surgery were higher in individuals with abnormal spleen size compared to individuals with normal spleen dimensions. Presence of CAD – arrhythmia and asthma – COPD were effective in the development of complications (p<0.05) according to logistic regression analysis. Considering the factors affecting the development of complications, CAD-Arrhythmia caused a 5-fold increase, and asthma-COPD 4.9-fold increased the development of complications.
DISCUSSION AND CONCLUSION: In patients scheduled for bariatric surgery, examining spleen dimensions via USG imaging in a routine manner prior to surgery, could help the physician to predict probable complications on bariatric surgery due to spleen size.

7.Laparoscopic cholecystectomy for a heart transplant candidate: A case report
Mustafa Şimşek, Mustafa Emre Gürcü, Mürşit Dinçer, Ayla Güney Bağrıyanık, Kaan Kirali
doi: 10.14744/less.2023.65390  Pages 29 - 31
Laparoscopic cholecystectomy remains the standard treatment for cholelithiasis. An increasing number of patients with numerous medical diseases are being treated with this technique. However, there is a surgical concern about its safety in patients with cardiac comorbidities. Cardiac arrest developed at 15 min pre-operative during laparoscopic cholecystectomy in a patient with a diagnosis of advanced heart failure (EF: 15–20%), who was a heart transplant candidate, and CPR was started. Peripheral VA-ECMO was inserted in the patient who did not respond to conventional CPR and was transferred to the surgical intensive care unit with inotropic medication and VA-ECMO support. Laparoscopic cholecystectomy was decided before the transplant because the patient’s complaints increased and there were immunosuppressives, anticoagulant drugs used after the heart transplant, and health problems with increased risk after the transplant.

8.Retroperitoneoscopic resection of a jejunal gastrointestinal stromal tumor masquerading asan adrenal incidentaloma; a unique reminder of the importance of clinical decision-making
Mina Guirgis, Mathew Ollapallil Jacob, Ming Khoon Yew
doi: 10.14744/less.2023.76892  Pages 32 - 35
Although gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors, they are rare, especially those arising from the small bowel. Adrenal incidentalomas (AI) are much more common, the majority of which are non-functional. Radiological features largely guide the diagnosis and management of both types of tumors and due to investigative limitations, gastric and small bowel GISTs can be misdiagnosed on imaging as AI, especially if present in the left upper quadrant. A 58-year-old male was referred for the management of a left adrenal incidentaloma following investigations for weight loss. An adrenal protocol computed tomography demonstrated a 32-mm left adrenal mass without atypical features. Investigations including gastroscopy and adrenal biochemistry were normal. Positron emission tomography revealed a highly avid adrenal mass suggesting a non-functioning adrenal carcinoma. A prone retroperitoneoscopic left adrenalectomy was per-formed, but no abnormal adrenal lesion was found. An intraoperative re-review of imaging, further retroperitoneoscopic exploration of the retroperitoneum and the peritoneum identified a pedunculated tumor attached to the proximal jejunum. The tumor was successfully resected retroperitoneoscopically. Histopathology revealed a GIST. No previous reports of a retroperitoneoscopic GIST resection have been published nor has a misdiagnosis of a small bowel GIST as an adrenal tumor been published. This highlights the importance of intraoperative correlation of imaging and intraoperative findings and exploring alternative diagnoses when encountering discordance. Attention to detail is required when tumors are solely radiologically diagnosed without additional confirmatory investigations, especially so in potentially anatomically unclear regions.

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