INTRODUCTION: General anesthesia-related side effects are more common in the presence of chronic obstructive pulmonary disease (COPD). Regional anesthesia techniques should be considered in these patients to reduce the risks. In this study, we aimed to retrospectively review our experience of laparoscopic cholecystectomy with thoracic epidural anesthesia, which we carried out in the COPD group.

METHODS: A total of 34 patients who underwent laparoscopic cholecystectomy operation under thoracic epidural anesthesia in our general surgery clinic between 2014 and 2018 were enrolled in this study. All patients had COPD with American Society of Anesthesiologist (ASA) III-IV.

RESULTS: All patients were successfully operated with low CO2 pneumoperitoneum (10 mmHg) under thoracic epidural anesthesia. Of all patients, 21 (61.8%) of them were male, and 13 (38.2%) of them were female with a mean age of 64 years (range: 52–76). Thirty-one (91.2%) of the patients had ASA III and 3 (8.8%) of them had ASA IV status. Analgesic was needed in 13 (38.2%) patients at the 6th hour and three (8.8%) patients at the 12th hour, while no analgesic was needed in any patients at the 24th hour. The most common complaint in the perioperative period was right shoulder pain by 35.2% (n=12). In addition, nausea occurred in 29.4% (n=10) of the patients; abdominal discomfort, or pain was noted in nine (26.5%) patients. In the per-op period, three (8.8%) patients developed hypotension and two patients (5.9%) bradycardia. In the post-op period, any complain was not observed in 14 (41.2%) patients, while 11 (32.5%) patients had nausea/vomiting, shoulder pain in four (11.8%), and abdominal discomfort was seen in four (11.8%). When pre- and post-op respiratory function tests were compared, no adverse effect was seen due to thoracic epidural anesthesia.

DISCUSSION AND CONCLUSION: COPD patients who are at a high risk of general anesthesia can be operated under regional anesthesia without experiencing respiratory system complications and with less post-op pain.

INTRODUCTION: The most difficult step of laparoscopic total gastrectomy for gastric cancer is esophagojejunostomy anastomosis. Although various techniques are recommended for this anastomosis, there is no standard method. This study aims to present the outcomes of our patients who underwent esophagojejunostomy using the hemi-double stapling technique (HDST).
METHODS: Patients who had laparoscopic surgery due to gastric cancer in our hospital between October 2016 and May 2019 were retrospectively analyzed. Patients who underwent laparoscopic total gastrectomy with HDST were included in this study. The patients’ clinical characteristics and histopathological data were evaluated. Age, sex, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) scores were documented. Operative time, intraoperative blood loss, specimen extraction site, day of oral intake, length of stay, postoperative complications, and mortality were evaluated.

RESULTS: A total of 13 patients (eight male, five female) were included in this study. The mean age was 63.3±15.8 years, and mean BMI was 26.4±6.8 kg/m2. ASA score was ASA III in seven patients (54%), ASA II in three patients (23%), and ASA I in the remaining three patients (23%). Mean operative time was 222.7±39.6 minutes, and mean intraoperative blood loss was 97.3±52.4 mL. There were no complications related to esophagojejunostomy. A mean of 23.8±11.1 lymph nodes was removed, of which a mean of 10.8±11.9 were tumor-positive. Mean length of stay was 10.9±9.8 days, and mean follow-up was 10.1±7 months.

DISCUSSION AND CONCLUSION: HDST appears to be a safe method that can be used in the esophagojejunostomy step of laparoscopic total gastrectomy for gastric cancer.

INTRODUCTION: To evaluate the pathology results of patients who had laparoscopic sleeve gastrectomy due to obesity in our hospital and who did not have stomach complaints before the operation.
METHODS: We retrospectively evaluated the pathology results of the patients who underwent laparoscopic sleeve gastrectomy for obesity between March 2018 and December 2018 at the Şanlıurfa Training and Resarch Hospital General Surgery Clinic. A total of 107 patients underwent surgery in our hospital.

RESULTS: The mean age of the patients who underwent sleeve gastrectomy for morbid obesity between March 2018 and December 2018 was 36 (min: 20-max: 60 years). Eighty-one of the patients were female, and 26 were male. The mean BMI of the patients was 45.1 (min: 37.2-max: 63.4). When the pathology results of the patients were examined, the mean length of the specimen was 18.5 cm (min: 14 cm-max: 25 cm), and the mean width was 4.2 cm (min: 3 cm-max: 8 cm). Normal gastric tissue was observed in 25 (23.3%) patients. Chronic gastritis was found in 82 (76.6%) patients. In 32 (29.9%) patients with chronic gastritis, a Helicobacter pylori microorganism was positive. Metaplasia was observed in 4 (3.7%) of the patients with chronic gastritis. A patient with suspected gastrointestinal stromal tumor was diagnosed as spindle cell mesenchymal lesion and chronic gastritis.

DISCUSSION AND CONCLUSION: The number of Helicobacter pylori positive patients is related to the nutritional habits of our region. We believe that H. pylori infections are not a risk of postoperative complications. However, we think that gastroscopy should be carried out in patients with preoperative gastric complaints.

INTRODUCTION: Increase in intra-abdominal pressure during pneumoperitoneum (Pp), and inflation-deflation, which cause splanchnic ischemia-reperfusion (I/R), are the reasons for oxidative stress in LS. However, not only Pp and I/R but also surgical trauma has an effect on oxidative stress. This study aims to discuss the number of trocar entry effects on oxidative stress as a surgical trauma in LS.

METHODS: Patients were divided into two groups; three-port cholecystectomy (group 1, n=20) and four-port cholecystectomy (group 2, n=20). All patients’ venous blood samples were taken three times; preoperatively, postoperative 6th and 24th hours for study Malondialdehyde (MDA) and advanced oxidation protein products (AOPP) to evaluate oxidative stress.

RESULTS: There was no statistically significant difference between the two groups. However, a statically significant difference was observed in MDA levels between preoperative and PO six hours, and duration of operation (p=0.001).

DISCUSSION AND CONCLUSION: In our study, the findings showed that laparoscopic cholecystectomy (LC) can be performed safely with three or four trocars, and a similar oxidative response was observed in both groups. Surgical trauma that arises from trocar entry (3 or 4-trocar) did not change the oxidative stress response in our patients.

INTRODUCTION: This study aimed to evaluate the risk factors associated with conversion from laparoscopic colorectal resection to open surgery and investigate whether the possibility of such a conversion requirement can be predicted in the preoperative period.
METHODS: Between 2014 and 2018, following the diagnosis of colorectal cancer, 467 patients underwent laparoscopic resection in our general surgery clinic, of whom 126 were included in this study based on the availability of the parameters of conversion of laparoscopic rectal resection to open surgery (CLRROS) and the Cleveland Clinic Foundation colorectal laparoscopic conversion (CCF-CLC) scores.
RESULTS: Of the 126 patients included in this study, 97 (76%) underwent laparoscopic resection (classified as Group 1), and 29 (24%) cases were converted to open surgery (classified as Group 2). The mean age±standard deviation (SD) was 58±13 and 62±15 years for Groups 1 and 2, respectively. The CLRROS and CCF-CLC scores were 8±8 and 16.6±9.2, respectively in Group 1, and 17±10 and 17.7±10.5, respectively in Group 2. The receiver operating characteristic analysis results were 0.769 (95% CI: 0.666–0.871, p=0.000) and 0.508 (95% CI: 0.382–0.634, p=0.896) for the CLRROS and CCF-CLC scores, respectively.
DISCUSSION AND CONCLUSION: To predict conversion from laparoscopy to open surgery, it was concluded that the CLRROS and CCF-CLC scores could help in selecting cases suitable for laparoscopy and inform patients about the expected postoperative outcomes, as well as minimizing postoperative disadvantages.

INTRODUCTION: The laparoscopic approach to appendectomy surgery led to various appendiceal ligation methods; however, the ideal technique for appendiceal stump closure has yet to be determined. This study is a comparison of intracorporeal knotting (IK) and Endoloop (Ethicon, Inc., Somerville, NJ, USA) (EL) techniques for appendiceal stump closure during laparoscopic appendectomy (LA) surgery.
METHODS: All of the LAs included in the study were performed by only 2 surgeons between June 2013 and June 2018 and the results were retrieved retrospectively. The patients were divided into an IK group and an EL group. Early postoperative complications (<30 days) were evaluated. All of the LAs were performed using 3 trocars. In the IK group, the appendiceal base was ligated with a manually constructed single intracorporeal knot. In the EL group, the appendiceal base was ligated with a single Endoloop tie (Vicryl ligature; Ethicon, Inc., Somerville, NJ, USA). A LigaSure device (Medtronic, Inc., Minneapolis, MN, USA) was utilized in both techniques for transection of the appendix. The specimen was extracted through the umbilical port within an Endobag (Medtronic, Inc., Minneapolis, MN, USA). A normal diet was administered within 6 hours postoperatively and the patients were discharged the day after the operation.

RESULTS: The IK group consisted of 54 patients and the EL group comprised 75 patients. The groups were similar regarding gender, age, body mass index, and American Society of Anesthesiologists score. Although the operation time tended to be longer in the IK group, the difference was not statistically significant (48.46±23.85 vs. 45.36±22.28 minutes; p=0.459). In the EL group, the drain was retained in 1 patient for 2 weeks due to liver cirrhosis and 1 patient had an intraabdominal abscess. The latter patient was treated with percutaneous drainage and antibiotherapy.
DISCUSSION AND CONCLUSION: The IK technique and the EL technique had similar results. Due to its lower cost and wider availability, IK might be suggested over the EL technique. Eliminating the dependence on commercial products and providing the means for the development of advanced laparoscopic skills are additional benefits of the IK technique.

Percutaneous endoscopic gastrostomy (PEG) has so many complications, such as haemorrhage and gastrocutaneous fistula, and can be treated with several common procedures. When the common procedures are not successful, we must perform new procedures, such as eFe technique. We use this technique for gastrostomy tube removal at the same session to prevent fistula formation in our clinical practice. Sometimes, leakage beside the gastrostomy tube can be seen during feeding from PEG; we also treat this problem with the same eFe technique in our clinic. We used this technique for the treatment of hemorrhage due to PEG for the first time when could not control with routine procedures and became successful.

Recently, non-operative follow-up in non-penetrating abdominal injuries is often preferred. However, emergency laparotomy still remains the most exclusive method of treatment for gunshot wounds of the abdomen and laparoscopic approach is rarely reported in selected cases. In this study, our aim is to share our experience in a case with abdominal gunshot wound who was treated by a laparoscopic surgery. A 52-year-old male patient admitted with a gunshot wound that was penetrating to the abdomen. The gunshot line was from left subcostal to the right mid-axillary. He was hemodynamically stable but had abdominal sensitivity. Computed tomography confirmed the liver injury. Laparoscopic exploration was performed with three ports. A tunnel-shaped injury was detected through the liver segments 4–7 and hemostasis of the bleeding liver parenchyma was achieved by laparoscopy. No other abdominal organ injuries were detected. The patient had an uneventful postoperative course and discharged on the third day and had no complaints during the six months follow-up. In certain circumstances, laparoscopy can be used both for diagnosis and treatment of penetrating gunshot wounds and may reduce the risk of unnecessary laparotomy.

Today, obesity is an epidemic problem, especially in developed countries, and it is the second most common preventable disease after smoking that causes death. Surgical treatment is an appropriate and effective option in the treatment of this endemic disease which causes premature deaths with comorbidities. Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor originating from the wall of the gastrointestinal tract. The annual incidence of GIST is reported to be 6–15 per million. GIST may occur anywhere in the gastrointestinal tract, starting from the esophagus to the anus. It is most frequently settled in the stomach. In our case, we aimed to present a case of mesenchymal tumor incidentally detected during the sleeve gastrectomy.

Gastric phytobezoars are usually treated with conservative (i.e. medical, endoscopic) methods. However, when conservative treatment methods are failed, surgical treatment is inevitable. In this study, we report the results of two gastric phytobezoar cases which were not treated with conservative methods and laparoscopic anterior gastrotomy with four ports was performed. Bezoar was extracted within endobag through the port site after partially enlarging of the incision. Both patients were discharged on the postoperative fifth day. The findings suggest that laparoscopic surgery is a safe and feasible method for the treatment of gastric phytobezoar.