E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 30 (2)
Volume: 30  Issue: 2 - 2023
1.Front Matter 2023-2

Pages I - IV

2.The safety and efficiency of pericardial window by using uniportal video-assisted thoracoscopic surgery for the treatment of pericardial effusion: A single-center experience
Murat Ersin Çardak, Şeyhmus Külahçıoğlu
doi: 10.14744/less.2023.05935  Pages 37 - 41
INTRODUCTION: Pericardial window (PW) is a surgical procedure in which a part of the pericardium is removed so that the effusion can flow into the chest cavity. Our study aims to analyze a series of patients with chronic recurrent and/or large pericardial effusions who underwent single-port video-assisted thoracoscopic surgery (VATS)-PW opening. The uniportal method seems to be a better option because it is performed with small cosmetic incisions and is less painful.
METHODS: Thirty-six patients were referred to our clinic with recurrent, chronic, and/or large PE between March 2019 and May 2022. All patients were analyzed for gender, age, body mass index (BMI), symptom, operation side, discharge time, complications, and pathologic specimens.
RESULTS: Of the 35 patients, 25 (71.4%) were male, 10 (28.6%) were female, and the mean age was 60.1±15.4 years. The left side was preferred for 28 patients (80%) and the right for 7 (20%). The median BMI was 25.5 kg/m² (24.0–28.1). The median day of stay in our clinic and/or referred clinic where they are followed up due to comorbidities was 1 (1–2). Four patients (11.4%) who were previously diagnosed with malignancy and whose pericardial biopsy was compatible with the primary disease died within the 1st month postoperatively. The mortalities were not attributed to the pericardial procedure.
DISCUSSION AND CONCLUSION: PW opening using uniportal VATS seems to be a safe method for patients with PE without needing one-lung ventilation. In addition, uniportal VATS can be considered the first surgical option in obese patients.

3.Transumbilical single-incision laparoscopic appendectomy in pediatric appendicitis: A single-surgeon experience
Sinan Kılıç
doi: 10.14744/less.2023.90912  Pages 42 - 47
INTRODUCTION: Appendicitis is the most frequent emergency in children. In recent years, transumbilical single-incision laparoscopic appendectomy (TULA), a single-incision procedure exteriorizing the appendix from inside the umbilicus, has shown shorter operation duration and almost invisible scars. In this study, we present our single-surgeon experience on TULA in the treatment of appendicitis in children and guide young surgeons who have started learning laparoscopy.
METHODS: Between January 2017 and December 2022, 79 patients with acute appendicitis who underwent TULA were retrospectively analyzed. The operation was performed as an emergency appendectomy. Data including demographic, laboratory, preoperative, and postoperative data were recorded.
RESULTS: Of the patients, 55 were boys and 24 were girls. The mean age was 10.4±2 (range, 5–17) years. The main symptoms were abdominal pain in 89.8% (n=71), anorexia in 31.6% (n=25), nausea in 36.7% (n=29), vomiting in 52.1% (n=65), and fever 13.9% (n=10). In the laboratory examinations, leukocytosis was identified in 62 (78.4%) patients and C-reactive protein value was elevated in 10 (87.3%) patients. Significant ultrasonographic findings were observed in 58 (73.4%) patients. The diagnosis was made in 21 (26.5%) patients using computed tomography.
DISCUSSION AND CONCLUSION: TULA is a less invasive procedure which can be performed in children and adolescents by a young surgeon easily and safely. It has a short operation time and hospital stay, and the rate of conversion to open surgery is also very low. This technique is a good start to learn laparoscopic surgery.

4.TAP block efficacy in laparoscopic TAPP
Halit Batuhan Demir, Serhat Kırçiçeği, Ebubekir Korucuk, Alev Yağız Atalay, Mustafa Nuri Deniz
doi: 10.14744/less.2023.47690  Pages 48 - 51
INTRODUCTION: The effectiveness of transversus abdominis plane (TAP) block has been shown in recent studies to provide post-operative analgesia in abdominal surgeries. Local anesthetic drugs used in TAP block are generally cheaper and have less side effects than drugs used for post-operative analgesia. We investigated the effectiveness of TAP block in order to reduce the cost and side effects of analgesic drug use in patients after laparoscopic TAPP (transabdominal pre-peritoneal) operations.
METHODS: The data of 52 patients who underwent laparoscopic TAPP for inguinal hernia be-tween January 2020 and July 2021 in the Department of General Surgery were retrospectively analyzed. Patients who had been operated for inguinal hernia with open procedure and patients younger than 18 years of age were selected as the exclusion criteria.
RESULTS: TAP block was applied to 26 of the patients. The mean visual analog scale (VAS) scores of the patients who underwent TAP block were 2.5, 2.12, and 1.12 at the post-operative 0, 6, and 24 h, respectively. The mean VAS scores of the patients who did not experience TAP block were 5.38, 3.04, and 1.5 at the post-operative 0, 6, and 24 h, respectively. The mean VAS score of the patient group in whom TAP block was applied was lower in all measurements, the greatest difference was at the post-operative 0th h, followed by the 6th h. There was no difference between the groups in terms of the mean VAS score at the 24th h.
DISCUSSION AND CONCLUSION: In our study, the need for post-operative analgesics is lower in patients who underwent TAP block, due to less pain at the post-operative 0th and 6th h.

5.Neuroendoscopic approach to ıntracerebral hemorrhages opening to the ventricle
Emrullah Cem Kesilmez, Kasım Zafer Yüksel
doi: 10.14744/less.2023.33603  Pages 52 - 56
INTRODUCTION: Because of the intense contents of the hematoma, the external drainage system is often blocked and cannot function as expected. Subsequently, hydrocephalus develops. In our clinic, the process of hematoma evacuation with the help of neuroendoscopy and placement of external ventricular drainage is carried out in the same session as a treatment for patients with intracerebral hemorrhage opening into the ventricle. This study aimed to show the method we used in our clinic and its results.
METHODS: This study evaluated patients who applied to our hospital’s brain and neurosurgical clinic with a spontaneous intracerebral hemorrhage diagnosis between January 1, 2020, and January 1, 2023. Of these, 13 patients whose hematoma was evacuated with the help of a neuroendoscope and external ventricular drainage system which was placed in the same session were included in the study. Data such as age, gender, the anatomical region of the bleeding, bleeding volume, external ventricular drainage time, operation time after bleeding, Glasgow coma score, development of hydrocephalus, and mortality of these patients were analyzed.
RESULTS: Of the 13 patients who met the criteria of the study, 9 (69.2%) were male and 4 (30.8%) were female. In all patients, the pathology was located in the thalamic (100%). Hydrocephalus was not observed in any patient (0%). Three of the patients became exitus after the procedure (23.1%).
DISCUSSION AND CONCLUSION: We think that endoscopic intraventricular hematoma evacuation is a simple method in the treatment of patients with spontaneous intracerebral hemorrhage opening into the ventricle and has a low risk of complications.

6.Evaluation of surgical margins of laparoscopic gastric cancer surgery: Single-center results
Kutay Sağlam, Cengiz Ceylan, Huseyin Kocaaslan, Mehmet Kulus, Ömer Güngörür, Fatih Karayol, Yavuz Selim Angin, Fatih Akdamar, Cemalettin Aydın
doi: 10.14744/less.2023.60024  Pages 57 - 65
INTRODUCTION: Surgical margin positivity incidence is reported between 5 snd 20% in gastric cancer surgery. Although some studies showed that presence of positive surgical margins affects overall survival negatively, others reported no effect. The aim of this study is to investigate the relationship between surgical margin and the survival of patients who underwent laparoscopic gastrectomy in our clinic.
METHODS: Between 2015 and 2022 years, patients who underwent laparoscopic gastrectomy because of gastric cancer were included in this study. Surgical resection margin (diameter) width, microscopic evaluation of the surgical margin, pathological tumor stage, resected lymph nodes numbers and involvement, and overall survival were analyzed.
RESULTS: After patients with benign disorders and inadequate lymph nodes resection were excluded from the study, 136 patients were included the study. Median surgical margin length width? was 2.3 (0.1–10) cm, and 13 (9.6%) patients had positive surgical margin after pathological evaluation. Median survival was 51.00±18.56 months in patients with positive surgical margins and 46.00±2.99 months in patients with negative surgical margins (p=0.977). The 1, 3, and 5-year survival rates of patients with negative versus positive surgical margins (78.9% vs. 69.2%, p=0.426), (46.3% vs. 46.2%, p=0.990), and (17.1% vs. 30.8%, p=0.225), respectively. Surgical margin was positive in 3 (7.7%) patients with proximal tumors, and in 10 (10.3%) patients with distal located tumors.
DISCUSSION AND CONCLUSION: While most studies emphasized surgical margin positivity in proximal tumors, the rate of distal surgical margin positivity was found to be higher in this study. In conclusion, no correlation was found be-tween surgical margin positivity and overall survival.

7.Effects of botulinum toxin and factors on weight loss in patients with gastric balloon and without gastric balloon
İsmail Ozsan, Halit Batuhan Demir
doi: 10.14744/less.2023.77785  Pages 66 - 71
INTRODUCTION: In this research, it was aimed to evaluate effects of botulinum toxin (BoNT) and factors on weight loss in patients with gastric balloon (GB) and without GB.
METHODS: A total of 629 patient files attempted to our clinic between December 2020 to December 2022 were subjected to the study divided by two groups as patients with (GB, n=512) and without GB (NGB, n=117).
RESULTS: Male rate in GB group was significantly higher (p<0.05). Body mass index (BMI), weight, weight difference and BMI difference means were significantly higher in GB group (p<0.05). Ursactive rate was significantly higher in NGB group (p<0.05). Age, height, last weight, hormone usage, hunger, medicine, illness, and diet history differences were insignificant (p>0.05). Weight difference was significantly correlated with group (r=−0.212; p<0.01), gender (r=0.161; p<0.01), BMI (r=0.305; p<0.01), BMR (r=0.268; p<0.01), height (r=0.151; p<0.01), weight (r=0.333; p<0.01), and medicine usage (r=−0.072; 0.05). BMI difference was significantly correlated with group (r=−0.209; p<0.01), BMI (r=0.308; p<0.01), BMR (r=0.165; p<0.01), and weight (r=0.250; p<0.01). GB (B=2.410; p<0.01), BMI (B=0.344; p<0.01), and BMR (B=0.004; p<0.01) had significant contribution on weight difference.
DISCUSSION AND CONCLUSION: BoNT is more effective in patients with GB than patients without GB.

8.Comparison of open surgery and transoral approach in Zenker’s diverticulum
Batuhan Halit Demir, Tolga Girgin, Bartu Çetin
doi: 10.14744/less.2023.52207  Pages 72 - 76
INTRODUCTION: In the surgical treatment of Zenker’s diverticulum, endoscopic methods applied under general anesthesia have been used frequently in recent years. Endoscopic methods have gained popularity due to the shorter operative time, shorter hospital stay and transition to oral feeding, and low complication rates in selected patients. In this article, in the surgical treatment of Zenker’s diverticulum; the open surgical approach and the transoral endoscopic surgical technique were compared.
METHODS: The patients in the study were divided into two groups those who underwent open surgery and those who underwent stapled diverticulectomy. Demographic data (age and gender), preoperative symptoms (vomiting, dysphagia, and regurgitation), presence of post-operative complications, duration of hospitalization, diverticulum size, and long-term recurrence status of all patients were included in the study.
RESULTS: A total of 12 patients were included in the study. Staple diverticulectomy was performed in six of 12 patients by open surgical technique and in the other six patients by endoscopic technique. The mean ages of the patients who underwent endoscopic and open surgical modalities were 69 (61–84) and 68 (53–81), respectively. Of the patients who underwent open surgery, five were male and one was female. Of the patients who underwent endoscopic stapler diverticulectomy, four were male and two were female. Of the patients in the group who underwent open surgery, one had preoperative vomiting, three had dysphagia, and two had regurgitation.
DISCUSSION AND CONCLUSION: We think that transoral diverticulotomy is an effective surgical option that can be safely per-formed in selected patients and can provide successful results at least in the early period.

9.Nightmare of a surgeon; “stapler missfire during sleeve gastrectomy” due to swallowed orogastric tube intraoperatively: A case report
Mehmet Emin Gönüllü, Erman Yekenkurul, Mehmet Fuat Çetin, Mevlüt Pehlivan
doi: 10.14744/less.2023.28247  Pages 77 - 79
Obesity is at the top of the list of chronic diseases a pandemic disease in the world as the second cause of preventable deaths. Bariatric and methabolic surgery is one of the main interests in general surgery. There-fore, obesity surgery is one of the most made surgeries in the world. There is a trend for sleeve gastrectomy that is as the most applied and accepted technique in bariatric surgery compared to other bariatric surgery techniques. A 25-year-old male patient with BMI: 45.7 operated for sleeve gastrectomy. Intraoperatively, the 4th 60 mm Ethicon Echelon blue cartige with the guidance of 40 F bugie was applied (fired) in standard fashion. The operation, we were doing it in a systematic way that we used in previous operations. However, after stapler discarded, it was observed that there was a foreign body “shinning” in the stapler line. Although the surgery is always done systematically, it can happen when it does not always go well. After this surprising situation during this straigtforward surgery, we began to investigate what was wrong? and how this happened? How to move in developing decide to manage a complications can be the savior of every surgeon. In this article, we aimed to present our case and the management of the catastrophobic event.

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