E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 31 (3)
Volume: 31  Issue: 3 - 2024
1.Front Matter

Pages I - V

RESEARCH ARTICLE
2.The influence of laparoscopic and conventional surgical approaches on the development of surgical site infections in colon cancer
Isa Caner Aydin, Mehmet Torun, Serkan Ademoğlu, Ahmet Orhan Sunar, Ömer Özduman, Aziz Serkan Senger, Erdal Polat
doi: 10.14744/less.2024.15493  Pages 73 - 81
INTRODUCTION: Minimal invasive surgery techniques are getting more popular by surgeons relying their advantages such as pain control, feasibility and increased affinity. Both techniques have similar prognostic influence regarding survival in colon cancer but increased versatility of laparoscopy in years shows more tendency of laparoscopy among surgeons. This study aims to evaluate of surgical site infection (SSI) rates between conventional and laparoscopic colon cancer procedures.
METHODS: Patients operated due to colon adenocarcinoma between 2018 and 2023 evaluated. Emergency, palliative or incomplete resections excluded. Demographic, pathologic, peroperative and postoperative records of patients evaluated. Patients seperated into groups by SSI occurance and surgical method choice.
RESULTS: SSI development was found higher in conventional surgery group (30.0% vs 11.6%; p=0.013). In comparison of patients by SSI development; only intraoperative Red Blood Concentrate (RBC) replacement founded to be higher in SSI (+) group (0±1 vs 0±1; p=0.002). All variables associated with SSI development were subjected to univariate regression analysis. It’s shown that only conventional surgery choice was a indipendant risk factor for SSI development (OR: 3.489 (1.289 – 9.415); p=0.017).
DISCUSSION AND CONCLUSION: Laparoscopic colon surgery has better SSI rates than conventional colon surgery procedures. Our findings are similar with the general view on SSI ratio’s between two surgical practices.

3.Is macroscopic evaluation sufficient in sleeve gastrectomy specimens?
Serhat Doğan, Bahadır Öndeş, Cengiz Ceylan
doi: 10.14744/less.2024.23356  Pages 82 - 86
INTRODUCTION: The incidence of bariatric procedures is on the rise, primarily driven by the escalating prevalence of obesity. Among these procedures, laparoscopic sleeve gastrectomy (LSG) has gained significant popularity. However, ongoing debates persist regarding the necessity of microscopic examination of post-operative pathology specimens for certain benign conditions, including those related to bariatric surgery, due to financial concerns. In our retrospective study, we aimed to investigate the adequacy of macroscopic evaluation of pathology specimens obtained from patients who underwent bariatric surgery and to identify any unforeseen pathologies that may be detected through microscopic evaluation.
METHODS: Demographic and pathological data of patients who underwent surgical intervention for morbid obesity at our clinic from May 2017 to December 2021 were retrieved from the patient data-base. Following the macroscopic assessment of LSG specimens, the surgeon identified suspicious lesions, prompting further microscopic evaluation by pathologists. A p-value of less than 0.05 was considered statistically significant.
RESULTS: A total of 225 patients and corresponding specimens were included in the study. The majority of patients were female (82.2%). The median age of the patients was 36 (range: 19–61) years, and the mean preoperative body mass index (BMI) was 42.6±4.21 kg/m². Macroscopic examinations revealed pathological suspicions in 21 cases (9.3%), and subsequent microscopic evaluations confirmed pathology in 20 of these cases (p<0.001). Notably, microscopic evaluation of all specimens identified pathology in 175 patients (77.8%).
DISCUSSION AND CONCLUSION: Based on our findings, we conclude that relying solely on macroscopic examination of LSG specimens is inadequate for detecting lesions. Therefore, we strongly advocate for the inclusion of microscopic evaluation, particularly due to its importance in detecting premalignant lesions. We recommend that microscopic assessment be routinely performed to ensure comprehensive pathological evaluation in LSG specimens.

4.What to expect in the first 3 months following a sleeve gastrectomy?
Müjgan Kaya Tuna, Ismail Ertuğrul, Özlem Çakır Madenci, Dilek Yavuzer
doi: 10.14744/less.2024.94809  Pages 87 - 92
INTRODUCTION: The purpose of this descriptive study was to analyze the clinical, laboratory, anthropometric, and histological results of patients who underwent laparoscopic sleeve gastrectomy (LSG) before and three months after the operation.
METHODS: A total of 110 patients who were followed and underwent LSG between January 2021 and December 2021 were included in this study. Body mass index (BMI), waist and hip circumference, soft lean mass (SLM), percent body fat (PBF), and common laboratory parameters were evaluated before and three months after the LSG. Endoscopic biopsies and LSG specimens were examined by the pathology department.
RESULTS: The mean age of the patients was 40.8±11.3 years, and 78.4% were female. There was no significant difference in age in terms of gender (p=0.789). The mean age was significantly lower in patients without comorbid diseases and chronic drug use (p<0.001). There was a significant decrease in BMI, PBF, SLM, glucose, HOMA-IR, HbA1c, total cholesterol, and triglyceride values in the third month (all p’s <0.001). A significant correlation was observed between PBF% change and SLM% change values at post-op 3rd month (r=0.332, p=0.001). BMI% and PBF% change showed a stronger correlation than BMI% and SLM% change with (r=0.447, p<0.001) and (r=0.253, p=0.016), respectively. Histopathologic findings of LSG revealed gastrointestinal stromal tumor in 2 cases, neuroendocrine hyperplasia in 2 cases, and intestinal metaplasia in 13 cases, which were detected incidentally.
DISCUSSION AND CONCLUSION: LSG is an effective treatment for obesity and associated comorbidities, with significant improvements observed in metabolic parameters, hypertension, and laboratory values. Careful monitoring and follow-up are essential to detect and treat potential histopathologic findings.

5.Laparoscopic versus open right hemicolectomy for colon cancer: Long-term outcomes from a Tertiary Care Teaching Hospital
Murat Yıldırım, Bülent Koca
doi: 10.14744/less.2024.22308  Pages 93 - 99
INTRODUCTION: The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery and open surgery in right colon cancer.
METHODS: Demographic, clinicopathological, postoperative complications, mortality and long-term oncological outcomes of 162 patients who underwent laparoscopic (n=61) or open (n=101) surgery for colon cancer between January 2014 and December 2019 were compared in two groups.
RESULTS: The operation time was significantly longer in the laparoscopic group (p<0.001). Length of hospital stay, tumor stage, T stage, N stage, tumor diameter and number of excised lymph nodes were significantly higher in the OS group. Postoperative morbidity and mortality rates were similar in both groups. The surgery was converted to open surgery in five patients (8.1%) in the LS group. There was no significant difference between the groups in terms of overall survival (p=0.086) and disease-free survival (p=0.089).
DISCUSSION AND CONCLUSION: Laparoscopic and open right hemicolectomy operations had similar results in terms of short-term complications, mortality and long-term oncological findings.

6.Comparison of postoperative outcomes between laparoscopic and mini-incision open appendectomy for acute appendicitis
Mehmet Torun
doi: 10.14744/less.2024.34966  Pages 100 - 105
INTRODUCTION: Acute appendicitis is one of the most common causes of emergency abdominal surgery. La-paroscopic and open (mini-incision) appendectomy are the two primary surgical techniques used for treat-ment, each offering unique advantages.
This study aims to compare postoperative outcomes, including wound infection rates and pain levels, be-tween laparoscopic and mini-incision open appendectomy.
METHODS: A prospective study was conducted from July 2021 to July 2022 in Van, Türkiye, with 239 patients. After excluding 13 patients, 226 were analyzed. Surgeries were performed by a single surgeon. Data on age, gender, wound infection rates, postoperative pain (measured by the Visual Analog Scale), and length of hospital stay were collected. Statistical analysis was conducted using Mann-Whitney U and Chi-square tests.
RESULTS: No significant differences were found between the laparoscopic and mini-incision open groups in terms of age, gender, wound infection rates, or postoperative pain at 12 and 24 hours (p>0.05). The wound infection rate was slightly lower in the laparoscopic group, but the difference was not statistically significant.
DISCUSSION AND CONCLUSION: Both laparoscopic and mini-incision open appendectomy are safe and effective methods for treating acute appendicitis. No significant differences were observed in terms of wound infection rates, postoperative pain, or patient demographics. Larger studies with longer follow-up periods are recommended to further evaluate long-term outcomes.

7.Evaluation of the clinical impact of preoperative gastroscopy in patients undergoing cholecystectomy: A retrospective study
Burak Dinçer, Burak Dinçer, İnan Güden, Leman Damla Ercan, Ali Fuatkaan Gök
doi: 10.14744/less.2024.43827  Pages 106 - 109
INTRODUCTION: The role of esophagogastroduodenoscopy (EGD) in the preoperative period for patients scheduled for cholecystectomy due to cholelithiasis is controversial. Some studies recommend routine application, while others suggest selective application. Our study aimed to evaluate EGD findings in patients who underwent EGD before cholecystectomy.
METHODS: In our single-center retrospective study, patients who underwent cholecystectomy between 2020 and 2023 and had an EGD in the preoperative period were included. Patients who did not have a preoperative EGD, those who underwent cholecystectomy as part of another surgical procedure, and those with missing data were excluded from the study. Patients were evaluated based on demographic, clinical, endoscopic, and pathological findings.
RESULTS: A total of 336 patients were analyzed. The median age was 53 years (range 24–87), and 216 (64.3%) of the patients were women. Endoscopic pathology was detected in 180 (53.6%) of the patients. Histopathological abnormalities were detected in 199 (87.3%) of 228 patients. Helicobacter pylori (HP) positivity was detected in 90 patients (39.5%), atrophic gastritis in 45 patients (19.7%), and intestinal metaplasia in 41 patients (18%). Statistically, significantly more active and severe gastritis findings were observed in mucosal areas that appeared endoscopically pathological (p<0.001 and p<0.001, respectively).
DISCUSSION AND CONCLUSION: It can be concluded that the routine application of EGD before cholecystectomy may impact the clinical approach.

8.Comparison of VATS and open thoracotomy in anatomical lung resections according to multifaceted parameters
Selime Kahraman, Serdar Evman, Mesut Buz, Talha Dogruyol, Attila Özdemir, Berk Çimenoglu, Recep Demirhan
doi: 10.14744/less.2024.82608  Pages 110 - 117
INTRODUCTION: In our research, the data of lung cancer patients operated via VATS and thoracotomy methods were investigated. In the evaluation performed by using versatile parameters, both methods were compared on the basis of objective criteria. Our study was carried out in order to assess the outcomes of both methods.
METHODS: 232 patients who underwent surgery with a diagnosis of lung cancer of various stages between the dates of January 2016 and June 2021 were involved in the research, and the patients’ data were retrospectively scanned. To ensure balance between both groups, cases that were operated on for benign causes, performed pneumonectomy, received neoadjuvant, underwent chest wall resection, and cases converted to open from VATS were excluded from the research. The patients’ hospitalization, amount of drainage, count of dissected lymph nodes, stages, complications and early mortality were reviewed.
RESULTS: There were 81 patients underwent VATS lobectomy and 151 patients underwent thoracotomy, in our study. The mean age was 63.5 in the thoracotomy group, and, 61.8 in VATS group. In the thoracotomy group, there were 31 female and 120 male patients; and in VATS group, 28 female and 53 male patients. The hospitalization times were shorter in VATS group; however, it was not statistically significant. In thoracotomy group, drainage amount and the count of lymph node dissections were significantly higher. The stage was determined significantly earlier in VATS group. Despite the rate of complication was lower in VATS group, there was no statistical difference between the both groups. Early mortality rates were comparable.
DISCUSSION AND CONCLUSION: Even though our research has limitations, we believe that we will gain better outcomes as our learning curve enhances in VATS.

9.The effect of laparoscopic sleeve gastrectomy on serum levels of vitamin A, D and B12 and iron profile in patients with morbid obesity: Short term outcomes
Nail Omarov, Elnur Huseynov
doi: 10.14744/less.2024.57984  Pages 118 - 122
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has emerged as a prominent surgical intervention for morbid obesity. In the present study, we aimed to evaluate the effect of LSG on serum levels of vitamins A, D, B12, and the iron profile in patients with morbid obesity.
METHODS: This single-center, retrospective cohort study was conducted at Department of General Surgery between February 2021 and March 2023. Inclusion criteria were established in accordance with the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. Exclusion criteria were as follows: pregnant or lactating women; those receiving medications known to affect vitamin or iron levels (e.g., anticonvulsants, long-term proton pump inhibitors); having prior gastrointestinal surgeries affecting nutrient absorption. A total of 116 patients who met the inclusion criteria were enrolled.
RESULTS: The mean age of the participants was 38.7±7.5 years, and 80 of them (68.9%) were females and 36 of them (31.03%) were males. The mean preoperative BMI was 42.1±4.1 kg/m2 A comparison of parameters before and after surgery showed that serum changes in vitamins A, B12, ferritin, and TIBC were not significantly different from before surgery, indicating that long-term LSG did not alter serum levels of these micronutrients. However, serum vitamin D showed a significant difference before and after surgery (p<0.001).
DISCUSSION AND CONCLUSION: Nutritional deficiencies are a significant concern both before and after bariatric surgery. The results of the present study showed that laparoscopic sleeve gastrectomy is one of the most effective surgical methods that does not cause a lack of nutrients and vitamins in the long term.

10.Contributions and outcomes of terminal ileum intubation in a surgical endoscopy unit: Retrospective cohort study
Burak Dinçer, Sinan Ömeroğlu
doi: 10.14744/less.2024.57442  Pages 123 - 126
INTRODUCTION: The necessity of routine terminal ileum intubation during colonoscopy is controversial, with literature suggesting it has a low impact on clinical outcomes. Our study aimed to evaluate the effect of terminal ileum intubation on the clinical approach in a surgical endoscopy unit.
METHODS: This retrospective study included 137 patients over the age of 18 who underwent colonoscopy with successful terminal ileum intubation in 2023. The patients were evaluated based on their demographic, clinical, endoscopic, and pathological data.
RESULTS: The median age was 55 years (range 18–86), and 77 (56.2%) of the 137 patients included in the study were female. A total of 5 (3.5%) patients had a pathological appearance in the terminal ileum mucosa, necessitating an ileal biopsy. Of these 5 patients, 3 (2.2%) were referred for colonoscopy due to diarrhea, 1 (0.7%) due to abdominal pain, and 1 (0.7%) due to radiological findings. All biopsies resulted in a diagnosis of non-specific ileitis.
DISCUSSION AND CONCLUSION: In surgical endoscopy units, terminal ileum intubation has minimal impact on the clinical approach and can be applied selectively based on the indication.

11.Midterm outcomes of one anastomosis gastric bypass versus Roux-en-y gastric bypass: Single center experience
Servet Karagul, Serdar Şenol, Oktay Karaköse, Hüseyin Eken
doi: 10.14744/less.2024.26818  Pages 127 - 132
INTRODUCTION: One anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are successful surgical treatment options for morbid obesity. In this study, we aimed to share our results by comparing these two bypass techniques in a retrospective analysis.
METHODS: A retrospective study was conducted at a single center at Samsun Training and Research Hospital. The outcomes of two groups, laparoscopic OAGB and laparoscopic RYGB, were compared. Patients with a BMI over 40 kg/m² and patients with a BMI over 35 kg/m² with obesity-related comorbidities were included. Patient demographics, obesity-related comorbidities, medications, postoperative outcomes, percentage excess weight loss (%EWL), percentage total weight loss (%TWL), and postoperative BMI were recorded retrospectively.
RESULTS: A total of 64 patients were retrospectively analyzed. Fifty-one of the patients were female, and thirteen were male. There were 21 patients in the OAGB group and 43 patients in the RYGB group. The mean follow-up period was 42.86±3.54 months in the OAGB group and 52.21±11.58 months in the RYGB group (p<0.05).
The mean %TWL was 35.43±5.26 in the OAGB group and 34.70±11.31 in the RYGB group (p>0.05). The mean %EWL was 83.02±18.95 and 76.08±22.84, respectively (p>0.05). The mean BMI was 29.62±5.42 kg/m² in the OAGB group and 30.14±5.05 kg/m² in the RYGB group (p>0.05).
There was no significant difference in the improvement of obesity-related comorbidities. However, de novo reflux was significantly higher in OAGB patients.
DISCUSSION AND CONCLUSION: OAGB and RYGB are both effective procedures for treating morbid obesity. Both procedures provide similar improvements in obesity-related diseases, although de novo reflux appears to be more common in OAGB patients.

12.Comparison of the effects of endoscopic intragastric balloons: A single-center study
Burak Yalçın Kara, Yahya Özel, Süleyman Çağlar Ertekin, Samet Yardımcı
doi: 10.14744/less.2024.82609  Pages 133 - 141
INTRODUCTION: Obesity is a major health care problem and one of the sustained solutions of obesity is bariatric surgery and bariatric endoscopic procedures. An endoscopic intragastric balloon (IGB) is a procedure for achieving weight loss in obese patients. This study evaluated the effects of two types of endoscopic IGBs and compared their outcomes at our center.
METHODS: This retrospective analysis included patients who had endoscopic IGBs between 2021–2024 and recorded their demographic data: age, gender, weight, height, and body mass index (BMI). The patients were divided into two groups according to balloon type—adjustable IGB and non-adjustable IGB—to compare their weight loss, excess weight loss percentage (EWL%), and total weight loss percentage (TWL%). We also analyzed initial balloon volume, increase in balloon volume, balloon intolerance, and balloon complications.
RESULTS: Among the 93 patients included, 50 had non-adjustable IGBs, and 43 had adjustable IGBs. Their mean age was 34.9±8.8 years, 82.8% were women, and the mean BMI was 32.7±4.2 kg/m2. Eight patients (8.6%) removed the balloon due to intolerance. The mean weight loss was 9.1±7.6 kg, the mean TWL% was 9.9±7.9, and the mean EWL% was 42.6±66%. IGBs achieved sufficient weight loss (p<0.00), with no significant difference in weight loss, EWL%, or TWL% changes found between the adjustable IGB and the non-adjustable IGB groups. Furthermore, no relationship was observed between balloon type or initial balloon volume in patients with early removal. No major complication was observed.
DISCUSSION AND CONCLUSION: Endoscopic IGBs achieved significant weight loss in patients with obesity, with low complication rates and no significant difference in weight loss between adjustable or non-adjustable IGBs of different volumes.

LETTER TO THE EDITOR
13.A rare case in the literature; isolated cystic duct cyst
Serhat Doğan
doi: 10.14744/less.2024.00087  Pages 142 - 144
Abstract |Full Text PDF

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