E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 31 (1)
Volume: 31  Issue: 1 - 2024
1.Front Matter

Pages I - V

2.Impact of thoracic outlet diameter on surgical outcomes in laparoscopic cholecystectomy
Deniz Tihan, Oğuzhan Fatih Ay, Ilker Mustafa Kafa, Emrah Bayam, Fatma Ezgi Can
doi: 10.14744/less.2024.05658  Pages 1 - 7
INTRODUCTION: This study assesses the influence of inferior thoracic aperture dimensions on the outcomes of laparoscopic cholecystectomy for cholelithiasis. It aims to determine if the size of the thoracic outlet, akin to pelvic measurements in obstetrics, can predict surgical complexity and complications.
METHODS: In this prospective anatomical and clinical study, 32 patients who underwent laparoscopic cholecystectomy between April 2014 and December 2015 at Bursa Yuksek Ihtisas Research and Training Hospital were evaluated. Anteroposterior (AP) and laterolateral (LL) diameters of the inferior thoracic aperture were measured using CT or MRI. The study focused on dissection time and intraoperative blood loss, quantitatively.

RESULTS: Twenty-three of 32 patients (71.9%) were female, and 9 (28.1%) were male. The mean age of the patients was 57.97±16.11 years (min: 29; max: 85). The mean overall dissection time was 1,172.43±427.58 seconds (min: 550; max: 2,157), and the median amount of intraoperative hemorrhage was 6.5 cc (min: 1; max: 23). The mean LL diameter of the patients was 26.02±2.29 cm (min: 21.50; max: 31.50), and the median value of the AP diameter was found to be 11.35 cm (min: 9.40; max: 19.40). A positive relationship was found between the LL and AP diameters (r=0.574; p=0.001). There was a negative relationship between operational time and both LL and AP diameters (r=-0.418; p=0.017 and r=-0.405; p=0.022).
DISCUSSION AND CONCLUSION: Findings suggest that narrower thoracic apertures can prolong the standard 4-port-access laparoscopic cholecystectomy procedure. This study underscores the importance of measuring thoracic outlet diameters for anticipating surgical difficulty in general surgery, analogous to pelvic measurements in obstetrics. Such measurements could be pivotal in preoperative planning and in improving surgical outcomes.

3.Peptic ulcer complications, surgical treatment, comparison of open and laparoscopic approach, minimally invasive approach recommendations
Bahtiyar Muhammedoğlu, Sezgin Topuz
doi: 10.14744/less.2024.82687  Pages 8 - 13
INTRODUCTION: The treatment of peptic ulcer disease (PUD) has undergone significant changes over time. Elective surgical treatment of PUD has been replaced by medical treatment. Surgical treatment of PUD is limited to ulcer complications and disease resistant to medical treatment. The main issue to be decided during surgery is whether to add a definitive anti-ulcer surgery in addition to treating the immediate ulcer complication. Our aim in this study is to share the results of gastric ulcer complications treated with open and laparoscopic methods in our clinic and the postoperative endoscopy results of these patients.
METHODS: Patients who underwent open or closed ulcer surgery due to ulcer complications in our General Surgery clinic between 2014 and 2023 were retrospectively scanned from the hospital information system. In addition to demographic data such as patients’ age and gender, the surgical method applied, duration of hospital stays, and endoscopy findings in patients who underwent endoscopy during the postoperative period were recorded. The results were examined.
RESULTS: A total of 194 patients were included in the study. Of the patients, 178 (91.8%) were male and 16 (8.2%) were female. The patients were between the ages of 18 and 93, with a mean age of 45.4±20.4 years. Endoscopy was performed on 44 patients after surgery. The mean duration between surgery and endoscopy was 504±586 days. Of the surgeries, 145 (74.7%) were open and 49 (25.3%) were laparoscopic. Gastritis and erosion were the most frequently observed findings in postoperative endoscopies, with bleeding in 2 patients, stenosis in 4 patients, and recurrent ulcers in 16 patients.
DISCUSSION AND CONCLUSION: Surgical treatment of PUD can be performed using open and laparoscopic methods. Despite the advances in medical treatments, ulcer complications are still observed after surgery. The dilemma of whether to add anti-ulcer treatment to emergency surgeries continues, and more comprehensive studies are needed in this regard.

4.Assessment of helicobacter pylori colonization in patients with duodenogastric reflux: A retrospective study
Fırat Mülküt, Cem Batuhan Ofluoğlu, Zeki Salih Tuncer, Mehmet Saydam, İbrahim Aydın
doi: 10.14744/less.2024.60134  Pages 14 - 17
INTRODUCTION: This study investigates the relationship between duodenogastric reflux (DGR), Helicobacter pylori (HP) colonization, and their impact on gastric health. Given the established risks of both DGR and HP for gastric mucosal damage and the development of pre-cancerous lesions, we aimed to explore their interrelation and the effect of bile reflux on HP colonization in an acidic environment.
METHODS: A retrospective analysis was conducted on patients who underwent gastroscopy at our hospital between December 2022 and December 2023. DGR diagnosis was based on the endoscopic observation of bile-stained fluid or reflux, while HP presence was confirmed via giemsa staining of biopsy samples. Statistical analysis utilized SPSS software, with significance set at p<.05.
RESULTS: Out of 4.316 gastroscopies performed, 743 patients were identified with DGR, and HP positivity was found in 34.9% of the cohort. Comparison of HP infection rates between patients with and without DGR revealed no significant difference, indicating the independent nature of these conditions regarding gastric colonization.
DISCUSSION AND CONCLUSION: HP and DGR synergistically inflict damage on the gastric mucosa. However, consistent with the existing literature, our study also demonstrates that, although both DGR and HP infection are significant risk factors for gastric mucosal injury independently, there is no observed association between HP colonization and DGR. Given the complexity of the gastric mucosal structure and its acidic environment, we believe further research is needed to understand the underlying mechanisms of these relationships.

5.Liver hydatid cyst rupture in biliary tree resulting in cholangitis and pancreatitis: A case report
Burak Dinçer, Ali Fuat Kaan Gök
doi: 10.14744/less.2024.14890  Pages 18 - 20
Hydatid disease is commonly observed in the Mediterranean region and North Africa and is caused by Echinococcus species. The liver is the most commonly affected organ, and biliary complications are the most frequent complications of hepatic hydatid disease. Despite this, pancreatitis due to hepatic hydatid disease is rare. In this case report, we describe a patient with cholangitis and pancreatitis resulting from the rupture of a hepatic hydatid cyst into the biliary system.

6.Laparoscopic management of subhepatic appendicitis
Burak Mahmut Kılcı, Nurullah Bilen, Fatih Süslü
doi: 10.14744/less.2024.58235  Pages 21 - 23
Acute appendicitis is one of the most common causes of acute abdomen that requires an emergency surgical approach. Acute appendicitis usually presents with diffuse pain that starts from the periumbilical area and localizes to the right lower quadrant. However, the clinical features might differ if the locations of the appendix change in the abdomen.
A 25-year-old male patient presented to the emergency department with a complaint of right upper quadrant pain for two days and clinical signs similar to acute cholecystitis. On his first physical examination, there was tenderness in the right upper quadrant. White blood cell count levels and neutrophil levels were elevated on blood test results. He was considered for acute cholecystitis after the first evaluation, and hepatobiliary ultrasonography was performed. The liver parenchyma and the biliary tract structures were shown to be non-pathological on ultrasonography (USG). Thus, computed tomography (CT) of the whole abdomen was planned and performed. It demonstrated the upper location of the cecum and subhepatic appendix. Inflammatory signs were detected on the appendix wall and surrounding tissues on the CT scan. Thereupon, emergency surgery was planned, and a laparoscopic appendectomy was performed.
The subhepatic location of the appendix is reported as extremely rare, with a rate of approximately 0.08% of all appendicitis cases. This clinical presentation was first reported in 1955 by King. This rare anatomic variation may cause delayed diagnosis and treatment difficulties. Subhepatic appendicitis can mimic hepatobiliary, gastric, or renal disorders like acute cholecystitis, hepatic abscess, perforated duodenal ulcer, and right nephrolithiasis.

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