E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 31 (2)
Volume: 31  Issue: 2 - 2024
1.Front Matter

Pages I - V

RESEARCH ARTICLE
2.The relationship between age and the development of major complications in patients who underwent laparascopic surgery due to colon cancers
Isa Caner Aydın, Ahmet Orhan Sunar, Serkan Ademoğlu, Aziz Serkan Senger, Mürşit Dincer, Erdal Polat, Mustafa Duman
doi: 10.14744/less.2024.04764  Pages 25 - 32
INTRODUCTION: The laparoscopic approach is preferred in colorectal cancer cases, yet concerns arise regarding the development of complications among the elderly patient population. This study aims to investigate the difference in the development of major complications between patients aged 65 and older undergoing laparoscopic procedures for colorectal cancer diagnoses and the younger patients.
METHODS: Between 2013 and 2023, records of patients who underwent laparoscopic surgery due to colorectal cancers at our center were extracted. Demographic characteristics, pathology data, complications developed during hospitalization, and lengths of stay were gathered from hospital records.
RESULTS: A total of 72 patients were included in the study, with 18 patients aged 65 and older and 54 patients aged younger than 65. When patients were evaluated based on the development of major and minor complications, all demographic and pathological characteristics were found to be similar. Only in the group of patients aged 65 and older, the length of hospital stay was found to be longer (p<0.001). In the multivariate analysis conducted, age was not found to be significant for the development of major complications (OR: 0.895 [0.246-3.264], p=0.897).
DISCUSSION AND CONCLUSION: This study has shown that being aged 65 or older or younger is not associated with the development of major complications in patients undergoing surgery for colorectal cancer. It has also demonstrated that laparoscopic surgical procedures can be safely used in patients aged 65 and older. Further studies with larger patient cohorts could provide more clarity on this topic.

3.Effect of closed drainage system on prevention of seroma after laparoscopic total extraperitoneal repair in primary M3 and L3 inguinal hernia
Birol Ağca, Yalin Işcan, Yasin Güneş, Nuriye Esen Bulut, Ali Cihan Bilgili, Berk Topaloğlu, Mehmet Mahir Fersahoğlu, Ayşe Tuba Fersahoğlu, Anıl Ergin, Iksan Taşdelen, Mehmet Timuçin Aydin, Kemal Memisoğlu
doi: 10.14744/less.2024.68889  Pages 33 - 37
INTRODUCTION: Seroma that can be seen after endoscopic completely extraperitoneal inguinal hernioplasty (TEP) is a major problem in patients who are concerned about recurrence. In this study, a prospective study design was prepared in our clinic in order to see the incidence of seroma after TEP and the effect of closed system negative pressure drainage, which is one of the methods thought to reduce it.
METHODS: Primary M3 and L3 unilateral inguinal hernias were randomly divided into two groups. Group I was the group in which a drain was placed after TEP, and Group II was the group in which no drain was placed after TEP. In Group I patients, a hemovac drain was placed behind the mesh and the perforated end of the drain was placed in the preperitoneal space. Anatomical 3D mesh (3DMax™ Mesh, BD, USA) was applied to all cases.
RESULTS: There were 41 patients in Group I and 39 patients in Group II. 73 of the patients were men and 7 were women. According to the EHS classification, 47 of the hernias were L3 type and 33 were M3 type. Seroma was detected in 5 patients in Group I and 13 patients in Group II on the 7th postoperative day (p<0.024). There was no difference between the groups in the seromas seen in the 3rd month after surgery.
DISCUSSION AND CONCLUSION: Seroma is common after TEP, especially in M3 and L3 hernias. This situation is confused with hernia recurrence in the patient. This may cause fear and panic in the patient. The drainage system installed in large hernias in the early postoperative period reduces the development of seroma and these concerns are eliminated. In addition, having patients come to the team performing the surgery for check-ups at regular intervals is effective in relieving patients’ concerns.

4.Is endoscopic balloon dilatation and oral iron preparation treatment adequate in the treatment of Plummer-Vinson syndrome?
Ebubekir Gündeş, Özcem Ofkeli, Orhan Uzun, Selçuk Gülmez, Aziz Serkan Senger, Murşit Dinçer, Erdal Polat, Mustafa Duman
doi: 10.14744/less.2024.78095  Pages 38 - 44
INTRODUCTION: The main objective of this study is to present 10 Plummer-Vinson Syndrome cases treated and followed up at our clinic alongside cases in current literature.
METHODS: The cases of 10 patients with prospective records of Plummer-Vinson Syndrome treated and followed up in the Gastroenterological Surgery Clinic of the hospital were evaluated.
RESULTS: Seven (70%) of the patients were female, and three (30%) were male, with a mean age of 45±18. All the patients had a mean hemoglobin value of 8.4±0.94 g/dL and a mean erythrocyte volume level of 63±5.01 fL, and their ferritin levels were 6.5±5.42 ng/dL, which accounted for iron deficiency in the patients. With barium swallow studies before endoscopy, all patients were shown to have esophageal webs. All patients underwent endoscopic balloon dilatation under sedoanalgesia. Three cases of recurrence were observed, and those patients underwent the balloon dilatation process again. Squamous cell carcinoma in the distal esophagus was detected in one case in the 72nd month of follow-up.
DISCUSSION AND CONCLUSION: Endoscopic balloon dilatation together with oral iron replacement is a safe, simple, and efficient mode of treatment. As Plummer-Vinson Syndrome is regarded as a precancerous condition, endoscopic follow-up is required for subsequent treatment.

5.Laparoscopic versus open repair for perforated peptic ulcer: A single-center analysis
Şakir Karpuz, Gülşah Filiz Karpuz, Mümin Coşkun, Süleyman Çaglar Ertekin, Muhammer Ergenç
doi: 10.14744/less.2024.08216  Pages 45 - 49
INTRODUCTION: The aim of this study was to evaluate and compare the early postoperative outcomes of patients who underwent laparoscopic and open repair for perforated peptic ulcer disease in our clinic.
METHODS: An observational single-center study was conducted at the Marmara University Pendik Training and Research Hospital between June 2018 and June 2023. Demographic characteristics, comorbidities, preoperative laboratory tests, surgical technique, duration of operation, ulcer location (duodenal, gastric, prepyloric), postoperative length of hospital stay, readmission, and complications were analyzed. Patients were divided into two groups, open and laparoscopic operations, and compared.
RESULTS: We compared 99 patients who underwent open surgery (OS) with 23 who underwent laparoscopic surgery (LS). The median age of the entire cohort was 42.5 years (IQR 30.3–62). There was no difference between the two groups in terms of ulcer location. The operative time was longer in the laparoscopic group (45 min OS vs. 60 min LS, p<0.001). Although the median length of hospital stay was three days between the two groups, there was a significant difference in favor of the laparoscopic group. There were no significant differences in postoperative complications or 30-day mortality between the two groups (0.754 and 0.684, respectively).
DISCUSSION AND CONCLUSION: Compared with the open method, the laparoscopic method can be safely applied in the surgical treatment of peptic ulcer perforation without increasing complications. In suitable patients, advantages such as shorter hospital stays can be utilized.

6.Comparison of three-dimensional mesh (3D mesh) without fixation versus polypropylene mesh with fixation in patients of inguinal hernia undergoing totally extraperitoneal repair
Nail Omarov, Elnur Huseynov, Ayşegül Bahar Özocak
doi: 10.14744/less.2024.79095  Pages 50 - 56
INTRODUCTION: We aimed to compare the results of patients who underwent inguinal hernia repair with non-fixation pre-shaped three-dimensional (3D) mesh and fixation with polypropylene meshes (PPM) using the totally extraperitoneal (TEP) method.
METHODS: A total of 96 patients who underwent laparoscopic hernia repair with the diagnosis of inguinal hernia between April 2019 and September 2023 were retrospectively analyzed. The patients were divided into two groups according to the mesh type used: staple fixation (SF) group (n=52), in which light-weight PPM was used, and non-staple fixation (NSF) group (n=44), in which pre-shaped 3D mesh was used. Patients’ age, sex, body mass index (BMI), ASA score, comorbidities, hernia type, Visual Analog Scale (VAS) score at rest (VAS-rest) and while in motion (VAS-act), and chronic groin pain (CGP) were recorded. Postoperative follow-ups were performed at one, four weeks and three, and 12 months.
RESULTS: The surgical time was found to be shorter in NSF group patients than in the SF group (p=0.011). In the SF group, four patients developed seroma, one patient developed urinary retention, and two patients developed hematoma. In the NSF group, seroma developed in three patients, urinary retention developed in two patients, and one hematoma was observed. Recurrence was observed in two patients in the SF group at 10 and 14 months, and in one patient in the NSF group at eight months. In the NSF group, groin pain was found less frequently on Day 1 and at Week 1 than in the SF group, indicating a statistically significant difference (p<0.001 and p<0.001, respectively).
DISCUSSION AND CONCLUSION: Applying pre-shaped 3D mesh without any fixation is a safe and applicable method in inguinal hernia surgery. We recommend this method, as CGP is less than the polypropylene mesh fixation method and does not increase recurrence. This method can be performed by experienced surgeons with low complication rates.

7.Management of the stump in complicated acute appendicitis: Conversion to open surgery or laparoscopic stapler?
Fırat Mülküt, Cem Batuhan Ofluoğlu
doi: 10.14744/less.2024.58224  Pages 57 - 61
INTRODUCTION: This study aims to compare the efficacy and safety of using laparoscopic staplers versus conversion to open surgery in the management of the appendiceal stump in cases of complicated acute appendicitis (AA).
METHODS: A total of 123 patients who underwent surgery for complicated AA at our clinic between 2020 and 2024 were included in the study. Of these, 98 (79.7%) underwent open appendectomy (OA), and 25 (20.3%) underwent laparoscopic appendectomy (LA) with a stapler. The patients were retrospectively analyzed and compared in terms of demographic characteristics, hospital stay duration, post-operative complications, and surgical site infections.
RESULTS: The mean age of the patients was 37.60±11.23 years, and the mean BMI was 28.77±3.90kg/m². The mean hospital stay was 5.02±1.77 days. Surgical site infections were more frequent in the OA group (27.6%) compared to the LA group (8.0%) (p=0.040). The mean hospital stay was longer in the OA group (5.16±1.79 days) compared to the LA group (4.44±1.58 days) (p=0.049). No significant difference was found in the incidence of post-operative complications between the two groups (p=0.526).
DISCUSSION AND CONCLUSION: The findings suggest that completing the surgery laparoscopically results in better outcomes compared to converting to open surgery in cases of complicated acute appendicitis. The use of a laparoscopic stapler is associated with safer and more effective closure of the appendiceal stump, leading to fewer surgical site infections and shorter hospital stays. Prospective studies with larger patient populations are needed to confirm these findings.

8.Which technique is used in laparoscopic bilateral inguinal hernia surgery ?
Hüseyin Kılavuz, Feyyaz Güngör, Murat Demir, Idris Kurtuluş
doi: 10.14744/less.2024.69926  Pages 62 - 67
INTRODUCTION: The present study aims to bridge this gap by providing an extensive comparative analysis of totally extraperitoneal (TEP) versus transabdominal preperitoneal (TAPP) techniques to correct bilateral inguinal hernias focussing on their efficiency, safety levels, and complications rates.
METHODS: We used a retrospective cohort study design that compared TEP with TAPP results among adult patients who underwent bilateral inguinal hernia repair from January 2021 to December 2023 at our institution. Exclusion criteria were recurrent hernias, emergency procedures, or patients who were not suitable for the minimally invasive approach. Surgical results, including complication rates, recovery outcomes, and operative details, were analysed in a systematic manner.
RESULTS: A total of 144 patients, 51 with TAPP and 93 with TEP, were included in the study. There was no statistical difference between the groups in terms of mean age, body mass index, length of hospital stay. The mean VAS scores in pain assessment the morning after surgery were 3.1 ± 1.5 (TAPP) and 2.9 ± 1.4 (TEP) respectively, and there was no significant difference between the two methods (p=0.346). Complications and readmission rates did not show significant differences between the two approaches.
DISCUSSION AND CONCLUSION: Both TEP and TAPP are effective laparoscopic methods that can be applied in bilateral inguinal hernia surgery. This is because no major complications are observed in either surgical procedure. Patient characteristics and surgical experience are the main determinants of the procedure to be chosen.

LETTER TO THE EDITOR
9.An unexpected complication after bariatric surgery due to combine antidiabetic drugs; euglycemic diabetic ketoacidosis
Serhat Doğan
doi: 10.14744/less.2024.00921  Pages 68 - 69
Abstract |Full Text PDF

10.The use of rigid bronchoscopy in foreign body aspiration
Mesut Buz
doi: 10.14744/less.2024.90001  Pages 70 - 71
Abstract |Full Text PDF

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