E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 30 (4)
Volume: 30  Issue: 4 - 2023
1.Front Matter

Pages I - V

2.Short-term results of laparoscopic surgeries in rectal cancer: Single center experience
Ali Ihsan Sağlam, Murat Yıldırım, Bülent Koca, Namık Özkan
doi: 10.14744/less.2023.66743  Pages 163 - 168
INTRODUCTION: The laparoscopy technique is widely recognized for its numerous benefits in rectal surgery. This study assesses the short-term outcomes of 81 patients who underwent laparoscopic rectal resection.
METHODS: The study included 81 patients who underwent laparoscopic rectal surgery at the General Surgery Clinic of Tokat Gaziosmanpaşa University Faculty of Medicine Hospital from January 2019 to January 2022. The evaluation focused on demographic data, surgical details, tumor TNM staging, and early postoperative complications.
RESULTS: A total of 81 patients with malignant lesions underwent laparoscopic rectal surgery. The median age was 64.4 years (range: 35-86), with 54 patients (66.6%) being male and 27 (33.3%) female. The average BMI was 27.8±3.1 kg/m2. Surgical procedures included abdominoperineal resection (APR) in 16 cases, anterior resection in 13, low anterior resection in 45, and intersphincteric resection in 7 cases. The average surgery duration was 264 minutes (range: 189-435). Stage T3 tumors were present in 47 patients (58%). Neoadjuvant chemoradiotherapy was administered to 68 patients (83.9%). The median number of lymph nodes retrieved was 12 (range: 4-43), with all patients achieving negative surgical margins. The postoperative hospital stay averaged 8.5 days (range: 4-48). Early postoperative complications occurred in 15 patients (18.5%), including wound infection in 9, anastomotic fistula in 3, anastomotic site bleeding in 1, parastomal hernia in 1, and perianal abscess in 1. Intraoperative complications occurred in 3 patients, involving ureter injury, iliac artery injury, and diaphragm injury in one patient each. There were no mortalities in this series of patients.
DISCUSSION AND CONCLUSION: This study demonstrates that laparoscopic rectal surgery is a safe procedure, characterized by a low complication rate, short hospital stays, and effective surgical resection and lymph node dissection.

3.Comparison of short-term results: Laparoscopic sleeve gastrectomy (LSG) vs laparoscopic roux-en-y gastric bypass (LRYGB)
Muhammed Taha Demirpolat
doi: 10.14744/less.2023.72335  Pages 169 - 175
INTRODUCTION: In this study, it was aimed to compare the short-term results of the effects of LSG and LRYGB procedures on weight loss, laboratory parameters and comorbidities.
METHODS: This retrospective study (February 2021-August 2022) includes the prospectively collected data of the 1-year postoperative follow-up of patients who underwent LSG and LRYGB for morbid obesity. EWL%, the percentage of patients who were successful, laboratory parameters of patients and effects on comorbidities were compared between the groups.
RESULTS: When the two surgical techniques were compared in terms of the changes in fasting glucose, liver function tests, kidney function tests, lipid profile (HDL, LDL, cholesterol, triglyceride) and EWL% in both 6th months and 12th months after surgery, no significant difference was found. In the 1-year results, we detected a significant decrease weight, fasting glucose, creatinine, cholesterol, trigliseride values as well as a significant increase in HDL value in LRYGB group (p=0.001, p=0.004, p=0.023, p=0.039, p=0.004, p=0.002 respectively). No significant decrease in the need for medication in DM, HT and HL. In the 1-year results, we detected significant weight loss, decreased fasting glucose, AST, ALT, Trigliseride, TSH, as well as an increase in HDL in LSG group (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.006, and p<0.001 respectively). It is found that LSG significantly reduced the need for medication in DM, HT and HL.
DISCUSSION AND CONCLUSION: Both LSG and LRYGB have effective results on weight loss at the sixth month and first year follow-up. Without superiority between them, both procedures revealed improvements in liver enzymes, lipid profile and thyroid function tests.

4.Factors affecting the healing of arthroscopic microfracture and the role of MRI in follow-up: Talus osteochondral lesions
Murat Gök, Tuna Koçoğlu, Ayşe Berhoğlu Barut, Cemil Kayalı, Ahmet Kurtulmuş
doi: 10.14744/less.2023.45477  Pages 176 - 180
INTRODUCTION: The aim of this study is to compare preoperative and postoperative clinical and radiological findings of patients with talus osteochondral lesion who underwent arthroscopic microfracture surgery.
METHODS: Thirty-two patients who underwent arthroscopic treatment for talus osteochondral lesion between 2014-2017 at the Department of Orthopedics and Traumatology of a tertiary hospital were evaluated retrospectively. Preoperative and postoperative AOFAS and VAS scores were recorded, and the results were compared with demographic data. Twenty-four patients with magnetic resonance imaging were evaluated with the MOCART system. Results were compared with AOFAS, VAS scores, and demographic data.
RESULTS: Of the 32 patients included in the study, 13 (40.6%) were male, and 19 (59.4%) were female. The mean body mass index (BMI) of the patients was 26.1 kg/m². In 14 (43.8%) patients, there was a history of trauma. The number of smokers was 12 (37.5%). Twelve (37.5%) patients had a BMI≤25 kg/m², and 20 (62.5%) patients had a BMI>25 kg/m². The mean age of the patients was 42.62 years. The mean follow-up period was 20.9 months. The mean MOCART value of the patients with MRI after surgery was 56.11.
DISCUSSION AND CONCLUSION: It was found that there was no correlation between cartilage healing detected with MRI and clinical improvement, function, and patient satisfaction. The body mass indexes of the patients and smoking did not have a significant effect on the results.

5.Colonoscopic perforation treatment results: Experience of 16.385 patients in a single center
Murat Yıldırım, Asım Kocabay, Bülent Koca, Ali Ihsan Sağlam, Salih Yılmaz, Namık Özkan
doi: 10.14744/less.2023.53189  Pages 181 - 186
INTRODUCTION: Colonoscopy is the most frequently used procedure in the early diagnosis and treatment of many colon diseases, especially colon malignancies. With the increase in the use of colonoscopy, an increase in the number of colonoscopy-related perforations has been observed. This study aimed to determine the frequency of perforation and the management of colonoscopic perforation.
METHODS: Patients who underwent colonoscopy between January 2012 and December 2022 and were determined to have iatrogenic colon perforation were included in the study. The dermographic characteristics of the patients, length of hospital stay, comorbidity status (defined using the guidelines of the American Society of Anesthesiologists), colonoscopy indications, diagnostic tool of perforation, treatment and follow-up methods were examined and collected.
RESULTS: 16,385 patients were examined in the study cohort. Perforation was detected in a total of 12 (0.07%) patients, 8 women and 4 men. The average age of perforated patients was 62 (23-87) years. Eleven patients were treated with surgical intervention and 1 patient was treated with the endoscopic clip method. One patient died on the 20th day after surgery.
DISCUSSION AND CONCLUSION: Although colonoscopic examination is important for the diagnosis and treatment of colon and rectal diseases, the possibility of procedure-related perforation should not be ignored. Early diagnosis enables minimal surgical procedures such as laparoscopic repair and endoscopic clip application. Immediate surgical management, preferably primary repair and sometimes resection, appears to be a good strategy for most patients.

6.Evaluation of colonoscopy indications and the association with malignancy in patients aged 75 and over
Cem Batuhan Ofluoğlu, Fırat Mülküt
doi: 10.14744/less.2023.82788  Pages 187 - 191
INTRODUCTION: Colonoscopy is the gold standard for early diagnosis of colorectal cancer. Screening programs are recommended for individuals between the ages of 45-75. In this study, we aimed to evaluate the relationship between indications for colonoscopy and malignancy in patients aged 75 and above.
METHODS: Between 2021 and 2023, 12,416 colonoscopic procedures performed in our endoscopy unit were retrospectively analyzed. Of these, 946 were patients aged 75 and over. After excluding those with inaccessible data, incomplete colonoscopies, or a history of colorectal cancer/polyps, 398 were included in the study. Symptoms were categorized as follows: macroscopic bleeding, anemia, changes in bowel habits, suspicion of malignancy, weight loss, and non-specific symptoms. Rates of malignancy were subsequently determined.
RESULTS: The median age of all patients was 77 years (minimum: 75, maximum: 97), with 51.3% being male. Macroscopic bleeding was the most common symptom at 29.9%, followed by changes in bowel habits (28.6%), anemia (25.1%), non-specific symptoms (7.8%), suspicion of malignancy (6.5%), and weight loss (3.3%). Malignancy was detected in 10.8% of patients, with 55.8% of those diagnosed being female. The most prevalent symptom among these patients was macroscopic bleeding (44.2%), then anemia (25.6%), bowel habit changes (2%), suspicion of malignancy (14%), non-specific symptoms (4.7%), and weight loss (2.3%). Macroscopic bleeding (p=0.030) and suspicion of malignancy (p=0.037) were statistically significant in predicting malignancy, whereas the other symptoms were not.
DISCUSSION AND CONCLUSION: Colonoscopy can be safely performed in patients aged 75 and over. It is particularly critical for patients presenting with macroscopic bleeding and suspicion of malignancy. However, the utility of colonoscopy for other symptoms warrants further evaluation.

7.Results of upper gastrointestinal endoscopy conducted at a state hospital
Mehmet Torun, Ismail Ege Subaşı
doi: 10.14744/less.2023.48665  Pages 192 - 195
INTRODUCTION: This study aimed to analyze upper gastrointestinal system endoscopic examination findings from September 2021 to July 2022 at a state hospital.
METHODS: Sedated endoscopic examinations were conducted in the general surgical endoscopy unit, with retrospective evaluation of findings.
RESULTS: Among the patients, 272 (61.1%) were male and 173 (38.9%) were female. Common diagnoses included Duodenal ulcer (16.9%), Esophagitis (16.2%), Pangastritis (12.6%), Alkaline reflux (11.5%), Hiatal hernia (11.0%), Gastric polyp (7.6%), Gastric cancer (7.4%), Antral gastritis (6.5%), Gastric ulcer (6.1%), and Pyloric stenosis (2.5%).
DISCUSSION AND CONCLUSION: Esophagogastroduodenoscopy, a well-tolerated diagnostic procedure under sedation with minimal complications, is increasingly important in smaller, resource-limited hospitals. Its widespread use by healthcare professionals in such settings is crucial for diagnosing and treating patients.

8.Evaluation of the incidence and risk factors of early symptomatic cholelithiasis following obesity surgery in Turkish patients
Mehmet Volkan Yiğit, Zeynep Şener Bahçe
doi: 10.14744/less.2023.82584  Pages 196 - 200
INTRODUCTION: Obesity is a serious public health issue. According to 2016 data from the Turkish Statistical Institute, 15.2% of males and 23.9% of females aged 15 years or older were detected to be obese in Türkiye. The reason obesity alone is a health problem is that it is accompanied by comorbidities such as diabetes, hypertension, and chronic obstructive pulmonary disease.
METHODS: Data of 294 patients admitted to our hospital with a body mass index (BMI)>40 kg/m^2 who underwent laparoscopic sleeve gastrectomy between January 2015 and December 2020 were retrospectively examined. Demographic data, chronic disease histories, biochemical work-up data, hospitalization period, post-operative complications, and histopathological examination results were recorded.
RESULTS: 235 (80%) of our patients were female and 59 (20%) were male. The mean pre-operative BMI value of the females was found to be 42.3±3.58 kg/m2 [41-56 kg/m2]. The mean pre-operative BMI value of the males was found to be 47.6±7.74 kg/m2 [41-62 kg/m2]. After bariatric surgery, within the first 6 post-operative months, cholelithiasis was accompanied in a total of 35 patients (11.9%). Following bariatric surgery, 19 patients were operated on for gallstones. Thirteen of these patients were asymptomatic.
DISCUSSION AND CONCLUSION: We detected that the incidence of post-bariatric surgery cholelithiasis is low. Factors such as sex, age, and comorbidities were not associated with cholelithiasis development in our patients. Therefore, we believe that prophylactic cholecystectomy should be avoided.

9.A case of pneumoperitoneum due to tube dislocation after peg insertion
Ali Ihsan Sağlam, Murat Yıldırım, Bülent Koca
doi: 10.14744/less.2023.33340  Pages 201 - 204
Percutaneous endoscopic gastrostomy (PEG) serves as a preferred method for providing nutrition and nutritional support to patients who require long-term enteral feeding and have a functioning gastrointestinal tract. PEG offers better access to the gastrointestinal tract than surgical alternatives and has well-documented benefits over parenteral nutrition. Given that PEG tube insertion is among the most common endoscopic procedures globally, a thorough understanding of its indications and contraindications is vital in modern medicine.
While PEG is generally seen as a safe intervention, it carries risks for both minor and major complications, which can arise from endoscopic technical challenges, issues during the PEG procedure, or from prolonged PEG tube usage and wound care.
Our case report details an unusual complication of PEG, where the catheter tube penetrated the omentum majus, leading to pneumoperitoneum due to blockage in the catheter’s tract development, followed by the patient’s subsequent treatment. Awareness of such potential complications and knowledge of proper catheter maintenance can enhance the standard of care for patients with PEG tubes.

10.Laparoscopic cholecystectomy for acute cholecystitis caused by a giant gallstone
Burak Dinçer, Ilker Özgür
doi: 10.14744/less.2023.54533  Pages 205 - 206
Gallstone-related acute cholecystitis is the most common reason for cholecystectomy, with laparoscopic cholecystectomy being the current gold standard approach. Gallstones larger than five centimeters, known as ‘giant gallstones,’ are quite rare. Data on the safety of laparoscopic cholecystectomy in cases with giant gallstones are limited. In this case presentation, we discuss the emergency laparoscopic cholecystectomy performed for acute cholecystitis due to a giant gallstone.

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