INTRODUCTION: Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours of the gastrointesti-nal tract. Laparoscopic wedge resection is the first and most appropriate option. It is becoming increasingly common to use intraoperative endoscopy to ensure adequate surgical margins. In this study, we tried to make a suggestion by examining the clinical and operative features of gastric GIST patients in whom we performed endoscopy-assisted laparoscopic wedge resection.
METHODS: Patients underwent laparoscopic wedge resection for tumors located in various locations of the stomach with another surgeon providing endoscopic support. Age, gender, endoscopic and radiological localization of the tumor, tumor size, type of operation, duration of operation, amount of bleeding during operation were recorded from file data; and tumor cell type, size, surgical margin distance, number of mitosis, and GIST risk scores were recorded from pathology reports. We especially examined completeness of resection in pathology reports.
RESULTS: During the four-year study period, 22 patients underwent resection for gastric GIST. No complica-tions occurred during the surgery. The mean tumor size was 4.5 cm (2-7). We achieved complete resection in 100% of cases.
DISCUSSION AND CONCLUSION: Preserving the gastric tissue as much as possible and maintaining proper functions are achieved with wedge resections rather than formal gastrectomy. In this study, we tried to show that endoscopy is use-ful in wedge resections for these tumours regardless of localisation, not only at the junction or in difficult locations. We believe that endoscopic control before and after wedge resection for any localised tumour will reduce the number of complications and provide a safer operation, as well as having a positive effect on the surgical margin. We can say that endoscopic support is advantageous in confirming complete resection and absence of stenosis, deformation and leakage at the stapler line, and we recommend routine endoscopy support in these operations.

INTRODUCTION: In laparoscopic surgery, pneumoperitoneum is created using carbon dioxide, helium, or ambi-ent air. We aimed to investigate the effects of these gases on the organs.
METHODS: The experiment involved 25 male Sprague-Dawley rats aged 5-6 months, were divided into four groups. Group 1 (n=4) was the control group. Pneumoperitoneum was induced in Groups 2 (n=7), 3 (n=7), and 4 (n=7) using carbon dioxide, helium, and room air, respectively. After 2 hours, the gas was evacuated, and blood samples were collected. Blood was drawn 24 h later. The rats were euthanized, and tissue samples from the liver, pancreas, kidney, intestine, and lungs were collected for examination.
RESULTS: There were no significant differences in the severity of inflammation or intestinal effects between the groups. Adverse effects on the lungs, liver, and pancreas were greater in the carbon dioxide group. All groups showed negative effects on the kidneys, regardless of the gas type. Although laparoscopic surgery has many advantages over open surgery, the type of gas used and the increased intra-abdominal pressure can cause adverse effects. However, we believe that these effects are likely transient and should be verified through clinical experience.
DISCUSSION AND CONCLUSION: In laparoscopic surgery, the choice of insufflation gas and elevated intra-abdominal pressure may induce transient adverse effects in various organs, highlighting the need for further clinical studies to substantiate these findings.

INTRODUCTION: The necessity of routine intraoperative biopsy during emergency surgery for peptic ulcer perforation (PUP) remains controversial when malignancy is not suspected. This study evaluated the diagnostic yield of intraoperative biopsy and identified prognostic factors for mortality and intensive care unit (ICU) admission.
METHODS: This retrospective single-center cohort included 77 adults undergoing emergency laparotomy for PUP, excluding tumor perforations and cases with radiological suspicion of malignancy. Clinical, laboratory, and perioperative variables, including Boey and PULP scores, were analyzed. Outcomes were compared between patients with and without intraoperative biopsy, and according to mortality and ICU admission. Postoperative endoscopy at one month was used for secondary malignancy screening
RESULTS: Intraoperative biopsy was performed in 58.4% of patients, detecting malignancy in only one case (1.3%). No malignancy was found on postoperative endoscopy in patients without intraoperative suspicion. Overall mortality was 11.7% and was significantly associated with advanced age, delayed presentation, larger perforation size, comorbidity, higher Boey and PULP scores, elevated creatinine, and hypoalbuminemia. ICU admission (84.4%) showed similar associations. Intraoperative biopsy had no significant impact on mortality or ICU requirement.
DISCUSSION AND CONCLUSION: Routine intraoperative biopsy provides minimal diagnostic benefit in the absence of macroscopic suspicion of malignancy. A selective approach, guided by intraoperative findings and supported by early postoperative endoscopy, appears safe and sufficient. Prognosis is mainly determined by patient-related and physiological factors, perforation severity, and established risk scores.

INTRODUCTION: Obesity is now a critical public health challenge globally. Laparoscopic Sleeve Gastrectomy (LSG) is a widely performed obesity surgery known for its effectiveness in promoting weight loss and improving obesity-related conditions. The aim of study was to assess the presence of gastroesophageal reflux symptoms (GERD) symptoms after LSG.
METHODS: This retrospective observational study included patients who underwent LSG for morbid obesity between October 2022 and March 2024. Demographic characteristics, body mass index (BMI), percentage of excess weight loss (%EWL), and comorbidities were assessed preoperatively and at 6, 12, and 18 months postoperatively. Esophagogastroduodenoscopy (EGD) was performed before surgery and at the 18-month follow-up.
RESULTS: Eighty-six patients met the inclusion criteria (52 females, 60.4%), with a mean age of 39±8 years. Mean preoperative BMI was 43.8±14 kg/m², which decreased to 28.6±6 kg/m² at 18 months, corresponding to a mean %EWL of 61±8.4%. Preoperative GERD symptoms were present in 19 patients (22.1%), increasing to 25 (29.1%) postoperatively (p>0.05). EE was identified in 14 patients (16.2%) before surgery and in 25 patients (29.1%) after surgery (p<0.001). De novo EE developed in 22 patients (25.5%), mostly Grade A (72.7%). HH prevalence increased from 20.9% to 30.2% (p<0.001).
DISCUSSION AND CONCLUSION: In summary, our 18-month follow-up demonstrated an increase in gastroesophageal reflux and endoscopic evidence of esophagitis after sleeve gastrectomy.

INTRODUCTION: Optimal management of patients presenting with acute cholecystitis and suspected choled-ocholithiasis remains debated, with both one-stage (laparoscopic cholecystectomy with intraoperative cholangiography ± CBD exploration) and two-stage (preoperative ERCP followed by delayed laparoscopic cholecystectomy) strategies widely employed. The objective is to compare clinical outcomes, postoperative morbidity, and length of stay between one-stage and two-stage approaches in patients with acute cholecystitis and radiologic or biochemical suspicion of CBD stones
METHODS: This retrospective cohort study included 247 consecutive patients treated at a tertiary HPB referral center between 2020–2025. Primary outcomes were total length of hospital stay and 30-day morbidity. Secondary outcomes included residual stones, reintervention, readmission, and predictors of postoperative complications. Multivariable logistic regression, Kaplan–Meier analyses, and ROC modeling were performed.
RESULTS: Of 247 patients, 118 (47.8%) underwent a one-stage strategy and 129 (52.2%) received the two-stage approach. Length of stay was significantly shorter in the one-stage group (8.6±4.4 vs 11.2±4.4 days, p<0.001). Overall, 30-day morbidity was comparable between strategies (19.5% vs. 19.4%, p=1.000). Logistic regression revealed no independent predictors of morbidity. ROC analysis demonstrated poor diagnostic performance for bilirubin and CBD diameter in predicting CBD stones (AUC=0.53).
DISCUSSION AND CONCLUSION: In appropriately selected patients with acute cholecystitis and suspected choledocholithiasis, the one-stage strategy is safe and provides significantly shorter hospitalization while maintaining similar morbidity rates compared with the conventional two-stage approach.

INTRODUCTION: YouTube is widely used as a supplementary educational resource by surgical trainees, yet the reliability and educational quality of its content vary considerably. Laparoscopic colorectal cancer surgery demands advanced technical skills, making high-quality visual material essential for safe and effective training. However, despite the growing use of online platforms, systematic evaluations of YouTube content in this field remain limited. The aim is to evaluate the reliability, educational quality, and technical completeness of laparoscopic colorectal cancer surgery videos on YouTube using validated assessment tools.
METHODS: This cross-sectional study evaluated YouTube videos of laparoscopic colorectal cancer surgery identified through predefined search terms. Uploader type, video characteristics, engagement metrics, language, and image quality were recorded. Reliability was assessed using JAMA criteria, educational quality with the GQS, and technical completeness with a 10-item surgical checklist. Pearson correlation and independent samples t-test were used for analysis.
RESULTS: A total of 20 videos met the study criteria, with laparoscopic low anterior resection and right hemi-colectomy being the most common procedures (each 35%). The mean video duration was 32.2±30.1 minutes. The mean JAMA, GQS, and technical scores were 3.2±1.1, 10.3±4.5, and 7.7±2.1, respectively. No significant correlations were found between view count and JAMA, GQS, or technical scores. In contrast, GQS showed a strong positive correlation with technical score (r=0.77, p<0.001). Videos with verbal narration had significantly higher JAMA, GQS, and technical scores than those without narration (all p<0.05).
DISCUSSION AND CONCLUSION: Verbal narration significantly enhances the reliability and educational value of laparoscopic colorectal cancer surgery videos on YouTube, underscoring the need for higher-quality and professionally curated online surgical content.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a common therapeutic procedure for biliary and pancreatic diseases. However, severe complications such as duodenal perforation and nec-rotizing pancreatitis may require urgent surgical intervention. This study aimed to present our institution-al approach to the management of ERCP-related complications, including both surgical and conservative strategies.
METHODS: In our clinic, seventeen patients who were hospitalized and followed due to ER-CP-related complications between January 2022 and December 2024 were evaluated retrospectively. Data on patient demographics, type of complication, management approach, hospital stay, and outcomes were analyzed descriptively.
RESULTS: Seven patients underwent surgical intervention due to major complications such as duodenal per-foration and necrotizing pancreatitis, while ten patients were managed conservatively due to pancreatitis, cholangitis, or bleeding. Early surgical intervention in appropriately selected patients was effective in con-trolling contamination and preventing sepsis. Conservatively managed patients responded well to support-ive care, with no mortality. One patient who had undergone surgery died due to complications.
DISCUSSION AND CONCLUSION: Management of ERCP-related complications should be individualized based on the type and severity of the complication. Early surgery is lifesaving in selected cases, while conservative treatment is sufficient for stable patients. A multidisciplinary approach is essential for optimizing outcomes.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic gallbladder disease. However, conversion to open cholecystectomy (OC) is sometimes necessary and is associated with increased morbidity and healthcare costs. Identifying preoperative predictors of conversion is crucial for surgical planning and patient counseling. This study aimed to describe the preoperative radiological features in a series of patients who required conversion from LC to OC.
METHODS: We conducted a retrospective, single-center descriptive study at a tertiary training and research hospital. All patients (n=104) who underwent conversion from LC to OC between January 2020 and May 2025 were included. Preoperative ultrasonography (USG) findings, along with demographic, clinical, and intraoperative data, were systematically analyzed.
RESULTS: The most prevalent preoperative radiological findings were a hydropic gallbladder, identified in 59 patients (56.7%), gallbladder wall thickening (>4 mm) observed in 68 patients (65.4%), and pericholecystic fluid, observed in 55 patients (52.9%). The primary intraoperative reason for conversion was dense adhesions, reported in 62 patients (59.6%).
DISCUSSION AND CONCLUSION: Preoperative USG findings of a hydropic gallbladder and pericholecystic fluid are common in patients requiring conversion to OC and serve as important “warning signs” for a difficult procedure. These features, indicative of severe inflammation leading to adhesions, should prompt careful preoperative planning, patient counseling, and consideration of safe bailout strategies to maximize patient safety.

INTRODUCTION: Malignant gastric outlet obstruction (MGOO) is a debilitating complication of advanced upper gastrointestinal and pancreatobiliary cancers. While endoscopic stenting offers rapid symptom relief, its long-term durability is limited. Surgical bypass, particularly laparoscopic gastrojejunostomy (Lap-GJ), has gained popularity due to its minimally invasive nature, yet comparative real-world data remain scarce. This study evaluates perioperative outcomes, complications, and short-term mortality of Lap-GJ compared with open gastrojejunostomy (Open-GJ) and endoscopic stent placement in a large tertiary-center cohort.
METHODS: A retrospective cohort study was conducted at Erzurum City Hospital, including 156 patients treated for MGOO between 2015 and 2024. Patients were categorized into Lap-GJ (n=62), Open-GJ (n=54), and endoscopic stent (n=40) groups. Primary outcomes were time to oral intake (liquid, soft, and full diet) and length of hospital stay. Secondary outcomes included early postoperative complications, reintervention rates, stent-related adverse events, and 30- and 90-day mortality. Statistical analyses utilized Python-based libraries, employing appropriate parametric and non-parametric tests.
RESULTS: Lap-GJ resulted in significantly faster dietary progression compared with Open-GJ (median liquid diet: 2 vs. 4 days; soft diet: 4 vs. 7 days). Patients undergoing stenting advanced even more rapidly (1 and 2 days, respectively). Length of stay was shortest after stenting (median 3 days), intermediate after Lap-GJ (6 days), and longest after Open-GJ (10 days). Open-GJ demonstrated the highest complication burden, including wound infections (18.5 percent), pulmonary complications (20.4 percent), and anastomotic leak (5.6 percent). Lap-GJ showed a markedly lower morbidity profile, whereas stent patients frequently required reintervention (30 percent), primarily due to migration or recurrent obstruction. Mortality increased stepwise across modalities, with 30-day mortality of 9.7 percent (Lap-GJ), 18.5 percent (Open-GJ), and 30 percent (stent). Ninety-day mortality remained lowest in the Lap-GJ group.
DISCUSSION AND CONCLUSION: Laparoscopic gastrojejunostomy provides substantial advantages over open surgery in terms of postoperative recovery and complication rates while offering more durable palliation compared with endoscopic stenting. These real-world findings support the preferential use of Lap-GJ in appropriately selected patients with MGOO, particularly those with adequate functional reserve and expected survival beyond the short term. Endoscopic stenting remains valuable for rapid palliation in patients with limited prognosis.

INTRODUCTION: Laparoscopic colorectal surgery over the years has become the approach of choice for various pathologies. Despite having a lower complications rate compared to open, studies have shown significant complications rate among laparoscopic patients as well. Our study is to assess the intestinal function recovery (Time to pass flatus) among laparoscopic patients provided with Resource Ice Popsicle and standard clear fluid post operatively.
METHODS: A randomized controlled trial was conducted from August 2022 till November 2023 at 2 centres, namely Hospital Kuala Lumpur and Hospital Canselor Tuanku Muhriz. The time to pass flatus among elective laparoscopic colorectal surgery patients for each group (Popsicle and Clear fluid) as well as time to pass motion, post-operative length of stay and complications of surgery for the two groups were documented.
RESULTS: Total of 62 samples were recruited. It was found that the time to pass flatus, and post-operative length of stay were significantly shorter in the popsicle as compared to clear fluid group. Time to pass motion and complication rates between both groups showed no significant difference.
DISCUSSION AND CONCLUSION: Our study showed no difference in occurrence of anastomotic leak or Resource related mortality. Easy availability and simple preparation with improved outcome, makes this a promising alternative among patients. This can be further extrapolated to other surgical units. A well- designed, large-scale, multi-centered RCT in the future is recommended.

INTRODUCTION: Laparoscopic gynecologic surgery in the steep Trendelenburg position alters pulmonary mechanics and oxygenation. The optimal ventilation mode remains uncertain.
METHODS: In this prospective, randomized controlled trial, 60 patients (20 per group) undergoing elective laparoscopic gynecologic surgery in the steep Trendelenburg position were randomly assigned to Volume-Controlled Ventilation (VCV), Pressure-Controlled Ventilation (PCV), or Pressure-Controlled Volume-Guaranteed Ventilation (PCV-VG®). The primary outcome was peak airway pressure (Ppeak). Secondary outcomes included other respiratory variables, oxygenation parameters, and hemodynamic variables.
RESULTS: Ppeak and Pplateau values were significantly higher in the VCV group compared to the PCV and PCV-VG® groups at T2, T3, and T4 (p<0.01). After Bonferroni correction, these differences remained significant between VCV and the other groups, while no difference was found between PCV and PCV-VG®. PaCO2 levels were significantly lower in the PCV-VG® group compared to VCV and PCV at T3 (p=0.008). No significant differences were observed in PaO2, SaO2, Pmean, exhaled tidal volume, or hemodynamic parameters.
DISCUSSION AND CONCLUSION: Both PCV and PCV-VG® provided lower airway pressures and better lung compliance than VCV, while PCV-VG® additionally improved CO2 elimination. PCV-VG® may be a favorable ventilation strategy in laparoscopic gynecologic surgery performed in the steep Trendelenburg position.