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Introduction: Sleeve gastrectomy is probably the most preferred morbid obesity surgery. It is important to provide patient comfort and early return to daily life after sleeve gastrectomy. Our aim w...

Background Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci Xi® robotic system versus straight laparoscopy for gastric adenocarcinoma. Methods Between December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes. Results Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p = 0.02, p = 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p = 0.052). Operating time in the robotic group was longer (p = 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p = 0.047). Conclusion Totally robotic technique with the da Vinci Xi® robotic system provides similar short-term results compared to laparoscopic surgery in radical gastrectomy.

INTRODUCCION La extraccion de muestras de orificio natural (NOSE) para resecciones colorrectales, que mejoran aun mas las ventajas de la cirugia minimamente invasiva, se utilizan cada vez con mayor frecuencia. En este estudio, nuestro objetivo fue comparar los metodos de extraccion de muestras de nariz y transabdominales en casos de resecciones de colon derecho totalmente laparoscopicas. METODOS Se incluyeron datos de 52 pacientes que se sometieron a cirugia laparoscopica de colon derecho entre 2013 y 2019. La extraccion de muestras transabdominales se realizo en 35 pacientes, mientras que 17 pacientes fueron sometidos a NOSE. Se compararon datos demograficos, hallazgos operativos, resultados patologicos y datos de seguimiento. RESULTADOS Las mujeres (94% frente a 28%, p = 0,0001), comorbidas (76% frente a 40%, p = 0,01) y antecedentes de cirugia abdominal previa (75% frente a 23%, p = 0,001) fueron mas altas en el grupo NOSE . Todas las otras caracteristicas preoperatorias de los grupos fueron comparables. La perdida de sangre intraoperatoria, el tiempo de operacion y las tasas de complicaciones fueron similares en ambos grupos. La escala VAS postoperatoria (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) y los puntajes cosmeticos fueron mejores en el grupo NOSE (10 vs. 7, p = 0.0001). Los resultados oncologicos fueron similares despues de un seguimiento medio de 27.4 ± 20.5 (1-77) meses. CONCLUSION El metodo NOSE despues de la reseccion laparoscopica del colon derecho fue un metodo mas ventajoso en terminos de cosmeticos y dolor postoperatorio que la extraccion de muestras transabdominales. INTRODUCTION Natural orifice specimen extraction (NOSE) for colorectal resections, which further enhance the advantages of minimally invasive surgery, are being used increasingly more often. In this study, we aimed to compare NOSE and transabdominal specimen extraction methods in cases of totally laparoscopic right colon resections. METHODs Data of 52 patients who underwent laparoscopic right colon surgery between 2013 and 2019 were included in the study. Transabdominal specimen removal was done in 35 patients, while 17 patients underwent NOSE. Demographic data, operative findings, pathological results, and follow-up data were compared. RESULTS Female (94% vs. 28%, p = 0.0001), co-morbid (76% vs. 40%, p = 0.01), and previous abdominal surgery history (75% vs. 23%, p = 0.001) were higher in the NOSE group. All the other pre-operative features of the groups were comparable. Intraoperative blood loss, operation time, and complication rates were similar in both groups. Post-operative visual analog scale (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) and cosmetic scores were better in the NOSE group (10 vs. 7, p = 0.0001). Oncologic results were similar after a mean follow-up of 27.4 ± 20.5 (1-77) months. CONCLUSION The NOSE method following laparoscopic right colon resection was a more advantageous method in terms of cosmetics and post-operative pain than transabdominal specimen extraction.

Objective: Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods: Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results: Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion: We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage. Giriş ve Amaç: Koledok kistleri malignite potansiyeli nedeniyle cerrahi tedavinin ön planda olduğu konjenital bir hastalıktır. Son yıllarda teknolo-jik gelişmeler ve laparoskopik tecrübede artış erişkin koledok kist cerrahisinde laparoskopinin kullanımını yaygınlaştırmaktadır. Bu çalışmada amacımız laparoskopik koledok eksizyonu yapılan sekiz erişkin hastanın sonuçlarını sunmaktır. Gereç ve Yöntem: Kliniğimizde 2013-2018 yılları arasında laparoskopik koledok kist eksizyonu ve hepatiko-jejunostomi uygulanan hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, peroperatif ve postoperatif bulguları, patolojik sonuçları ve son durumları irdelendi. Bulgular: Çalışmaya dahil edilen sekiz hastanın üçü erkek, beşi kadın idi. Yaşların median değeri 41.5 (22-49) idi. Hastaların bir tanesinde tip IVa, diğerlerinde ise tip 1 koledok kisti saptandı. Hastaların tamamına laparoskopik koledok eksizyonu, kolesistektomi ve heptiko-jejunostomi yapıldı. Bir hastada açık cerrahiye geçildi. Üç hastada postoperatif safra kaçağı oldu. Operasyon süreleri median 330 (240-480) dakika ve kan kaybı 50 (10- 100) mL olarak saptandı. Hastaların yatış süreleri median 6 (4-23) gün ve takip süreleri median 20 (2-65) ay olduğu tespit edildi. Geç dönemde; bir hastada medikal tedavi ile düzelen kolanjit atağı gözlendi, mortalite ise görülmedi. Sonuç: Kendini sınırlayan safra kaçakları dışında erken dönemde önemli sorun yaşamamamız ve geç dönemdeki tatminkar sonuçlar nedeniyle laparoskopik koledok kist eksizyonunun erişkinlerde açık cerrahiye bir alternatif olabileceğini söyleyebiliriz.

Introduction Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric surgery in recent years, and some modifications have emerged to improve its efficacy. Melissas has described SG plus jejuno-ileal bypass (JIB), which has reported good results in a few studies. We performed this procedure in 21 cases and in one case, we observed acute liver failure (ALF) that has not been reported before. Case presentation A 38-year-old female (BMI: 56.1 kg/m2) underwent laparoscopic SG plus JIB. There was no sign of diarrhea, malnutrition or liver failure for eight months and her BMI was 43.0 kg/m2. At the 9th month, she was hospitalized for abdominal pain, jaundice and ALF. The patient was treated by plasmapheresis and molecular absorptive recirculation system. She was planned to undergo liver transplantation but died of multiorgan failure on the 40th day of hospitalization. Conclusion ALF can be observed following SG plus JIB. JIB reversal before compromising liver functions should be taken into consideration.

There is currently no evidence to support the routine use of an abdominal drain following laparoscopic Roux-en-Y gastric bypass (RYGB). Our aim was to investigate drain use in laparoscopic RYGB and its effects on postoperative pain. Sixty-six patients were randomly divided into two groups as no-drain (n = 36) and with-drain (n = 30). Intraoperative (time, blood loss, complications) and postoperative outcomes (morbidities, pain scores, hospital stay) were compared. Demographics of both groups were comparable. Three patients in the no-drain group required a drain (8.3%). Median visual analog scale scores for days 1–3 for with-drain and no-drain groups were 4.5 (2–9) vs. 3 (0–8) (p = 0.02), 3 (0–7) vs. 2 (0–7) (p = 0.10), and 2 (0–7) vs. 0 (0–4) (p = 0.0004), respectively. There was no difference between the groups in terms of complications and length of hospital stay. Drain use increased the postoperative pain following laparoscopic RYGB. Drain placement following laparoscopic RYGB should be selective instead of a routine application.

Laparoscopic surgery for remnant gastric cancer has been reported in a limited number of cases, and data on post-operative complications are lacking. A 58-year-old male was admitted with remnant gastric cancer. He had undergone open subtotal gastrectomy 9 years ago for gastric cancer. Laparoscopic total gastrectomy was performed, and he was discharged on the 10th day uneventfully. The patient had complained of nausea and vomiting in the 2nd post-operative month. He clinically and radiologically diagnosed as ileus and required open emergency surgery. There was a transverse colon stenosis near the splenic flexure. Hartmann's procedure was done, and he was discharged on day 17. We have limited knowledge about colonic complications after laparoscopic gastric surgery. The development of stenosis in the transverse colon is one of these complications that should be kept in mind. As far as we know, such a complication has never been reported before.

Introduction Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Materials and methods Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants; and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols. Results A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for ≥150 minutes, surgical duration of ≥600 minutes, intraoperative hemorrhage of ≥1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61. Discussion Organ/space SSIs were the essential part of SSIs following right lobe living donor liver transplantations. Donor-recipient age gap, prolonged cold ischemia time, complicated surgery, and postoperative biliary complications were the main causes of SSIs. Although they did not increase the perioperative mortality, they promote increased rate of reoperations, remote infections, prolonged intensive care unit, and hospital stays.

Background Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. Objectives The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. Setting University hospital. Methods A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. Results A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. Conclusions In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.