Bridged one-anastomosis gastric bypass: technique and preliminary results.

PURPOSE: One-anastomosis gastric bypass (OAGB) is an established bariatric procedure performed worldwide. We developed a modification of OAGB leaving a bridge at the cranial 2 cm of the fundus as a gastro-gastric fistula to allow for endoscopic access to the bypassed stomach. We present the preliminary results of 44 patients who underwent this technique in our hospital. METHODS: We analyzed, retrospectively, data collected prospectively on 44 patients who underwent our bridged one-anastomosis gastric bypass (BOAGB) procedure between September, 2018 and November, 2020. RESULTS: The mean age of the patients was 45.2 ± 9.3 years (range 20-66 years). The mean preoperative body mass index (BMI), weight, and HbA1c values were 41.5 ± 6.4 kg/m2 (range 35-59), 116 ± 22.7 kg, and 8.2 ± 2.1%, respectively. After a median follow-up period of 18 months (11-26 months), the mean postoperative BMI was 28.4 ± 3.2 kg/m2 (range 21-38), the mean total weight loss was 35.8 ± 13.5 kg (range 20-80 kg), and the mean percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were 79.8 ± 16.1% (range 47-109) and 30.6 ± 6.9% (range 19-48), respectively. The mean postoperative HbA1c level was 6.3 ± 0.9%. There were two early complications (stenosis and bleeding) and one late complication (marginal ulcer). CONCLUSION: Patients who underwent BOAGB lost weight similarly to those who underwent OABG as reported in the literature, without an apparent increase in complications related to the technique. Randomized studies with longer term follow-up are needed.

Comparison of Clinical Outcomes of Single-Incision Versus Conventional Multiport Laparoscopic Distal Pancreatectomy: A Single Institution Experience.

OBJECTIVES: Single-incision laparoscopic procedures have been gaining popularity in recent years due to their minimal incisional morbidity and improved cosmetic outcomes. Herein, we will compare the feasibility and outcomes of single-incision and conventional multiport laparoscopic distal pancreatectomy. METHODS: This study involves consecutive patients who underwent either single-incision or conventional multiport laparoscopic distal pancreatectomy from March 2007 to February 2014. The patients were divided into two groups, based on the surgical approach: single-incision laparoscopic surgery (Group 1) and conventional multiport laparoscopic surgery (Group 2). The parameters evaluated included estimated blood loss, operative time, postoperative pain, duration of hospital stay, complications, conversion, and final pathology. RESULTS: There were a total of 20 patients, 10 in each study group. Baseline characteristics were similar, and there was no mortality in either of the groups. The low-flow pancreatic fistula was the most commonly seen morbidity, but it was ceased spontaneously in each group by a ratio of 30%. The operative time was significantly shorter in Group 2, with a mean of 116 minutes versus a mean of 180 minutes for Group 1 (p<0.001). One of the procedures in Group 2 was converted to open surgery due to peroperative bleeding. The median follow-up periods of the patients were 22 months and 56 months. The spleen was preserved in only 1 patient from Group 1, whereas in Group 2, the spleen preservation was achieved in 5 patients. CONCLUSION: The single-incision laparoscopic technique is a safe and effective alternative to standard laparoscopic distal pancreatectomy.

Minimally invasive distal pancreatectomy A retrospective review of 30 cases.

OBJECTIVES: Pancreatic surgery has been greatly influenced by the advent of laparoscopic surgery and increasing experience in its performance and by advances in techniques and surgical devices. This study aimed to represent two centers' initial experiences in laparoscopic distal pancreatic surgery. METHODS: This study was a bi-centric study including 30 patients undergoing distal pancreatectomy for pancreatic disorders. All the patients were operated on from November 2006 to November 2013 in Turkey and Spain. RESULTS: Laparoscopic spleen-preserving distal pancreatectomy was performed in 9 patients, laparoscopic distal pancreatectomy was performed in 14 patients, laparoscopic enucleation was performed in 4 patients, and single-incision laparoscopic distal pancreatosplenectomy with splenectomy was performed in 3 patients. CONCLUSIONS: Laparoscopic distal pancreatectomies for pancreatic disorders are feasible and safe procedures if performed by experienced laparoscopic surgeons. KEY WORDS: Laparoscopy, Pancreas, Multi-port, Tumor, SILS.

Safety and feasibility of laparoscopic adrenalectomy: What is the role of tumour size? A single institution experience.

BACKGROUND: Although, there are studies in the literature having shown the feasibility and safety of laparoscopic adrenalectomy, there are still debates for tumour size and the requirement of the minimal invasive approach. Our hypothesis was that the use of laparoscopy facilitates minimally invasive resection of large adrenal tumours regardless of tumour size. MATERIALS AND METHODS: Within 7 years, 149 patients underwent laparoscopic adrenalectomy at one institution. The patients were divided into two study groups according to tumour size. Group 1 included patients with adrenal tumours smaller than 5 cm and group 2 included larger than 5 cm. Patient demographics and clinical parameters, operative time, complications, hospital stay and final pathology were analysed. Statistical analyses of clinical and perioperative parameters were performed using Student's t-test and Chi-square tests. RESULTS: There were 88 patients in group 1 and 70 in group 2. There were no significant differences between study groups regarding patient demographics, operative time, hospital stay, and complications. Estimated blood loss was significantly higher in group 2 (P = 0.002). The conversion to open rate was similar between study groups with 5.6% versus 4.2%, respectively. Pathology was similar between groups. CONCLUSION: Our study shows that the use laparoscopy for adrenal tumours larger than 5 cm is a safe and feasible technique. Laparoscopic adrenalectomy is our preferred minimally invasive surgical approach for removing large adrenal tumours.

Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura: Clinical comparative study.

AIM: Single-port laparoscopic surgery (SILS) has become increasingly popular during the last decades. This prospective study was undertaken to evaluate the feasibility of single-port laparoscopic splenectomy compared with conventional multiport laparoscopic splenectomy. MATERIALS AND METHODS: Between February 2, 2009 and August 29, 2011, a total of 40 patients with the diagnosis of immune thrombocytopenic purpura were included to study. Patients were alienated into two groups according to the procedure type including SILS and conventional multiport splenectomy. RESULTS: There were 19 patients in group 1, and 21 in group 2. Operative time was significantly shorter in group 1 versus group 2 (112.4 ± 13.56 vs 71.2 ±18.1 minutes, respectively, P < 0.05). One patient in group 1 had converted to laparatomy due to preoperative bleeding. Postoperative pain analyses (VAS Score) revealed superiority of SILS in the early post-operative days (P < 0.05). CONCLUSIONS: SILS splenectomy is a safe and effective alternative to standard laparoscopic splenectomy.

Increased interleukin 1 and tumor necrosis factor alpha levels after thyroid surgery.

OBJECTIVE: The aim of this study was to consider levels of the proinflammatory cytokines IL-1 and TNFα after thyroid surgery. MATERIAL AND METHODS: A total of 200 patients who underwent total thyroidectomy enrolled in this study. Drain fluid samples were taken. IL-1 and TNFα results and their relationship with other factors were analyzed. RESULTS: There was a positive correlation between IL-1 and hyperthyroidism (rs=0.614, p<0.001), operative time (rs=0.770, p<0.001), and excised thyroid volume (rs=0.829, p<0.001). Moreover, there was a positive correlation between TNFα and hyperthyroidism (rs=0.430, p<0.001), operative time (rs=0.392, p<0.001), and excised thyroid volume (rs=0.398, p<0.001). CONCLUSION: The results of this study showed us that the parameters related to increased proinflammatory cytokine levels after thyroid surgery were hyperthyroidism, operative time, and excised thyroid volume, but this increase did not show us any clinical outcomes related to these parameters.

The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study.

PURPOSE: Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. METHODS: In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. RESULTS: Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). CONCLUSION: SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.).

Laparoscopic surgery of the splenic artery and vein aneurysm with spontaneous arteriovenous fistula.

Visceral artery aneurysms are rare and important vascular entities due to the quarter of all cases presented as surgical emergency. Nevertheless, splenic artery aneurysm (SAA) is the most common visceral and third most common intra-abdominal artery aneurysm after aorta and iliac artery. SAA accompany splenic vein aneurysm because arteriovenous fistula communication between them is a very rare entity. Location and size of the SAA determine the likelihood of rupture. Women of child-bearing age who have SAAs are at particularly high risk of death as a result of aneurysm rupture and should be treated with elective repair. Herein, we report a case of a splenic artery and vein aneurysm with arteriovenous fistula in a 25-year-old young female patient who presented with left upper quadrant pain. Diagnosis was established by computerized tomography angiogram. The patient underwent laparoscopic resection of splenic artery and vein, as well as with splenectomy. Laparoscopic therapy for SAA should be considered for the patient with a low periprocedural morbidity at experienced surgical clinics.

Laparoscopic transperitoneal partial nephrectomy for renal hydatid cyst: a case report.

A 29-year-old female patient with an isolated hydatid cyst in the lower pole of the left kidney presented with a history of weight loss and cloudy, foul-smelling urine. Laparoscopic partial nephrectomy was performed, at which the cyst was removed en bloc. On the fifth postoperative day, she was discharged without any complication. Nine months postoperatively, a computed tomography scan revealed no recurrence of hydatidosis.

Laparoscopic posterior retroperitoneal adrenalectomy.

Almost more than a decade ago laparoscopic retroperitoneal adrenalectomy was introduced as an alternative to lateral approach. Today both of the techniques have become standard in removal of adrenal tumors and many surgeons showed favorable results in malignant tumors. This review outlines the technical details of the procedure and provides a summary of the literature.

Pure SILS Floppy Nissen Fundoplication with Hiatal Repair: A Case Report.

Background. Single-incision laparoscopic surgery has recently became popular on behalf of inventing less invasive procedures. In this paper, we present a case of Pure SILS Nissen Fundoplication. Patient and Methods. In February 2010 a 29-year old male patient with a 4 cm sliding hiatus hernia presenting with reflux symptoms had undergone a standard floppy Nissen Fundoplication with a hiatus repair via single 2 cm incision in umbilicus. Results. The procedure had obeyed the standard natural orifice surgery rules, and no needlescopic assistance for any stage of the operation was used so to be a pure single-incision procedure. The operation lasted for 120 minutes without any need of conversion, and the patient was discharged the following day of operation. Conclusion. In the recent time, hybrid single incision laparoscopy techniques have been defined with the use of extra-abdominal supplements for retraction of liver or stomach for Nissen procedure. In addition the main issue in single-incision upper GI and/or hiatus surgery is still the retraction of liver. We succeeded to retract the left lobe of liver through the incision and completed the operation without any need for supplemental access besides the umbilical incision till the end. SILS Hiatus Surgery can be safely and effectively done but the issue needs further clinical studies to state the efficacy when compared to standard laparoscopy.

SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases.

Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.

A New Era in Minimally Invasive Liver Resection (MILR) Single-Incision Laparoscopic Liver Resection (SIL-LR): The First Two Cases.

Laparoscopy has gained a place in everyday surgical routine as an alternative surgical approach that decreases morbidity and postoperative hospitalization. Single port laparoscopic surgery has been introduced as a further development of laparoscopy. The feasibility and safety of single port laparoscopy is under extensive evaluation in specialized laparoscopic centers. Nevertheless, wide acceptance of the technique requires adequate documentation of the advantages of the approach over conventional laparoscopy and further refinement of surgical instrumentation to overcome intraoperative ergonomic problems.

Our early experiences with single-incision laparoscopic surgery: the first 32 patients.

BACKGROUND: Most of the laparoscopic surgeons have been attempting to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. Single-incision laparoscopic surgery (SILS) is a new laparoscopic procedure. Herein we would like to present our experiences. PATIENTS AND METHODS: Between January 2009 and October 2009, data of the 32 patients who were operated through SILS are evaluated prospectively. There were 22 females and 10 males with a mean age of 45.1±14.8 years. Ten splenectomies for idiopathic thrombocytopenic purpura, 16 cholecystectomies for acute cholecystitis or asymptomatic gallstones, 3 appendectomies for acute appendicitis, one distal pancreatosplenectomy for Renal Cell Cancer metastases, 1 adrenalectomy for Conn Syndrome and 1 case of liver resection for hepatic adenoma were carried out. The most common splenectomy indication was idiopathic thrombocytopenic purpura, cholecystectomy indication was acute cholecystitis (n=8), and asymptomatic cholelithiasis (n=8), appendectomy indication was acute appendicitis, distal pancreatosplenectomy indication was renal cell cancer metastases, adrenalectomy indication was Conn syndrome and liver resection indication was left hepatic mass in between segments 1 and 2. SILS was carried out successfully in 31 patients. Only in 1 patient conversion was required owing to bleeding. RESULTS: All procedures were carried out through a 2-cm umbilical incision. There was no mortality and morbidity recorded. CONCLUSIONS: In experienced hands of minimally invasive surgeons, SILS incision laparoscopic surgery could be carried out successfully in a wide range of surgical operations. However, to be able to show the differences between Standard laparoscopic surgery and single SILS, prospective randomized comparative studies are required.

N-butyl cyanoacrylate versus conventional suturing for fixation of meshes in an incisional hernia model.

BACKGROUND: Chronic pain and related complications reported after the use of perforating fixation devices in hernia surgery have led to the use of tissue sealants. Fibrin sealant is a feasible option for mesh fixation; however data on cyanoacrylate glues are limited. METHODS: 32 Sprague-Dawley rats were divided into two groups and a 1.5 cm abdominal wall defect was created on each animal. The lesions were then repaired with 2 × 2 cm polypropylene meshes, fixed with n-butyl-cyanoacrylate in the first group and with polypropylene sutures in the second group. The rats were sacrificed on the 21st and 42nd days. The presence of infection, recurrence, and abdominal adhesions were evaluated, followed by biomechanical testing and histological examination. RESULTS: No mesh infection or hernia recurrences were recorded. There was no statistically significant difference between neither the adhesion scores nor the mean broken pressure of the two groups. Cyanoacrylate sealing was found equivalent to suturing in terms of tissue ingrowth, fibrosis, inflammatory infiltration, abscess formation, and necrosis. Furthermore, cyanoacrylate resulted in less foreign body reaction. CONCLUSIONS: Mesh fixation by cyanoacrylate may be considered as an alternative to suture fixation.

Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma.

BACKGROUND: Transumbilical single incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. Herein, we report the first transumbilical single incision laparoscopic pancreatectomy case in a patient who had renal cell cancer metastasis on her pancreatic corpus and tail. METHODS: A 59-year-old female who had metastatic lesions on her pancreas underwent laparoscopic subtotal pancreatectomy through a 2-cm umbilical incision. RESULTS: Single incision pancreatectomy was performed with a special port (SILS port) and articulated equipment. The procedure lasted 330 minutes. Estimated blood loss was 100mL. No perioperative complications occurred. The patient was discharged on the seventh postoperative day with a low-volume (20mL/day) pancreatic fistula that ceased spontaneously. Pathology result of the specimen was renal cell cancer metastases. CONCLUSION: This is the first reported SILS pancreatectomy case, demonstrating that even advanced surgical procedures can be performed using the SILS technique in well-experienced centers. Transumbilical single incision laparoscopic pancreatectomy is feasible and can be performed safely in experienced centers. SILS may improve cosmetic results and allow accelerated recovery for patients even with malignancy requiring advanced laparoscopic interventions.

Laparoscopic treatment of a wandering spleen causing partial colonic obstruction: report of a case.

Wandering spleens are rarely encountered ectopic localizations of the spleen. They are either congenital or acquired owing to the lack of or weakening of the major splenic ligaments. Herein, we present a female patient who was admitted to our hospital with the complaint of abdominal distension and chronic constipation. We performed laparoscopic splenectomy in this case for the diagnosis of a wandering spleen located in the right upper quadrant. The accepted treatment of this pathology is splenopexy unless there is no necrosis of the organ. Minimal invasive procedures should be the primary choice in the treatment of this entity.

Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies.

BACKGROUND: Preoperative determination of the accessory spleen still is a major factor in the failure of both laparoscopic and conventional techniques. This study aimed to evaluate the practicability and efficacy of a handheld gamma probe in identifying accessory spleens at the initial intervention. METHODS: This study evaluated 17 patients undergoing laparoscopic splenectomy attributable to benign hematologic disorders. All the patients had preoperative ultrasonography, computed tomography (CT) scan, and nuclear scintigraphic examination of the abdominal cavity to assess the size of the spleen, and to determine the existence of the accessory spleen or spleens. For all the patients, a handheld gamma probe count was used intraoperatively as an adjuvant method to define the presence and location of the accessory splenic tissue. Control nuclear scintigraphic examinations of all the patients were performed 1 month after the surgical procedure. RESULTS: In two cases, intraoperatively accessory splenic tissue was detected by gamma probe, confirming the preoperative CT findings for the patients. One of these patients had three accessory spleens, although preoperative CT scan showed only two of them. However, by the help of the gamma probe, a third spleen located retroperitoneally was defined. For two patients, laparoscopic exploration and handheld gamma probe count did not identify any accessory splenic tissue, although preoperative CT scan indicated accessory spleens. For detecting accessory splenic tissue, the sensitivities of the studied techniques were 0% for ultrasonography, 75% for CT scan, 0% for preoperative nuclear scintigraphy, 75% for laparoscopic exploration, and 100% for perioperative gamma probe examination. CONCLUSION: Preoperative imaging methods for accessory spleen determination still have limited benefits because of their limited sensitivity. Thus, the handheld gamma probe technique may be an adjuvant method for laparoscopic exploration ensuring that no accessory splenic tissue is missed during the initial surgical treatment of benign hematologic disorders.

Endometriotic umbilical port site metastasis after laparoscopy.

We present the case of a 40-year-old woman who had been previously operated for endometrioma 2 years ago by laparoscopy, with the complaint of an umbilical mass with cyclical pain pattern. The dark-colored mass was excised and pathology report revealed it to be an endometriotic implant.

Is laparoscopic enucleation the gold standard in selected cases with insulinoma?

We present the case of a 49-year-old male with the diagnosis of pancreatic insulinoma who underwent laparoscopic enucleation. The surgical procedure was completed successfully. The patient suffered from postoperative low-volume pancreatic fistula, which was self-limited. This was the first laparoscopic enucleation of an insulinoma in Turkey. The laparoscopic enucleation procedure is an appropriate method for superficially located pancreatic corpus and tail insulinomas.