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    Combined resections with colorectal surgeries and their combined natural orifice specimen extractions (NOSE): a clinical practice review
    (Ame Publishing Company, 2023) Aydin, Mehmet Can; Saglam, Kutay
    Compared to conventional ones, minimally invasive surgical techniques have come to the fore in many fields, especially in colorectal surgery (CRS), due to their benefits. These benefits are better postoperative outcomes, particularly due to less abdominal trauma and smaller incisions. However, postoperative pain, incisional hernia or infection, and poor cosmesis, due to abdominal incisions made for specimen extraction, reduce the positive results that can be achieved. The basic starting point of natural orifice specimen extraction (NOSE) surgery is to eliminate these incisions and their negative effects. NOSE has been performed more frequently, especially in CRS, with the increase in experience. In some of the patients, in addition to CRS, combined resections may be required for metastases, secondary primary malignancies, or benign diseases. However, in the literature, NOSE in combined resections with CRS is limited to case reports and it is controversial. We aimed to review the literature in terms of NOSE for combined resections with CRS, including preoperative details, technical feasibility, perioperative findings and postoperative results. When a total of 42 cases in the literature were examined; it was observed that organs such as liver, stomach, pancreas, gallbladder, endometrium and ovaries were removed synchronously in CRS combined with NOSE. No major complication due to NOSE was observed perioperatively. According to these available data, NOSE in combined organ resections with CRS may be a safe and effective alternative surgical technique. It is obvious that there is a need for studies on this subject in order to obtain more reliable results.
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    Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Minor Hepatectomy
    (Springer India, 2022) Aydin, Mehmet Can; Bag, Yusuf Murat; Gunes, Orgun; Sumer, Fatih; Kayaalp, Cuneyt
    Natural orifice specimen extraction (NOSE) is an emerging technique usually preferred for colorectal resections or cholecystectomy. NOSE following laparoscopic liver resections is limited to case reports, and there is no previous study comparing the outcomes of NOSE and transabdominal (TA) specimen extraction. Our aim was to compare NOSE and TA specimen extraction methods following laparoscopic minor hepatectomy. Thirty-one patients undergoing laparoscopic minor hepatectomy between 2014 and 2020 were evaluated. The patients were divided into two groups as NOSE (n: 12) and TA (n: 19). The patients' demographics, preoperative and postoperative findings, pain, and cosmetic scores were compared. Female ratio was higher in the NOSE group (83.3% vs 31.6%, p=0.005); other demographics were similar. The median length of incision was 6 cm in the TA group but only trocar incisions in the NOSE group. There was no difference between intraoperative and postoperative findings except pain and cosmetic scores. Pain scores on postoperative days 1, 2, and 3 and in total were lower in the NOSE group (4.1 +/- 0.6 vs. 5.6 +/- 1.1, p=0.001; 2.2 +/- 04 vs. 4.1 +/- 0.9, p<0.001; 1.7 +/- 0.6 vs. 2.4 +/- 0.8, p=0.025; 8.1 +/- 1.4 vs. 12.2 +/- 2.5, p<0.001). In addition, patients in NOSE group had better cosmetic scores (9.2 +/- 0.6 versus 7.0 +/- 0.6, p<0.01). Laparoscopic minor hepatectomy combined with NOSE is a safe and effective procedure in selected patients with the advantages of less postoperative pain and better cosmesis. NOSE is ideal for female patients with high cosmetic expectancy.
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    Conversion in laparoscopic gastric cancer surgery a highlight on the abdominal access
    (2021) Zengin, Akile; Bag, Yusuf Murat; Aydin, Mehmet Can; Kayaalp, Cuneyt
    Aim: The aim of this study was to compare the data of patients who underwent gastric cancer surgery as laparoscopically completed and converted to open surgery and draw attention to complications arising from trocar entry. Materials and Methods: This study included 211 patients who underwent laparoscopic gastric cancer surgery. Patients were divided in to two groups as laparoscopically completed and converted to open surgery. Demographics parameters and perioperative data were retrospectively analyzed. Results: The median age of the study group was 62 (19-91) years and 68.2% were males. Conversion occured in 16 patients (7.5%). The reasons for conversion were locally advanced tumor (n=6), complications due to trocar insertion (n=4), technical difficulty in performing esophagojejunostomy anastomosis (n=4), leakage in esophagojejunostomy anastomosis (n=1), and persistent bradycardia (n=1). Intraoperative blood loss was higher and time to oral intake was longer in the conversion group. No significant difference was found in terms of demographic parameters, operative time, length of hospital stays, the rate of postoperative complications, reoperation, 30-day mortality. Conclusion: Complications due to trocar entry is an unpredictable and preventable conversion reason in laparoscopic gastric cancer surgery. Thin patients are riskier for complications during abdominal access. Abdominal access should be performed with an open technique in thin patients
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    Is Prognostic Nutritional Index an Indicator for Postoperative 90-Day Mortality in Laparoscopic Gastric Cancer Surgery?
    (Routledge Journals, Taylor & Francis Ltd, 2022) Zengin, Akile; Bag, Yusuf Murat; Aydin, Mehmet Can; Kocaaslan, Huseyin; Kaplan, Kuntay; Sumer, Fatih; Kayaalp, Cuneyt
    Gastic cancer is a life-threatening malignancy in the world. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a guiding marker for gastric cancer patients with laparoscopic gastrectomy. We retrospectively examined the medical records of 138 gastric cancer patients who had adenocarcinoma pathological diagnosis and operated laparoscopically. Patients were divided into two groups (survived and death) and these groups were compared with clinical and laboratory parameters results. The PNI was calculated as 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm(3)). Logistic regression analyses were performed to identify the risk factors of 90-day mortality. The median age of the study cohort was 62.5 (19-91) years, 98 (71%) were males, and 9 (6.5%) patients died during the 90-day after laparoscopic gastrectomy. The PNI levels were significantly lower in death group compared with survived group 37.5 (25-47.1) to 46.9 (22.8-64.9). The PNI (Odds Ratio = 0.81, 95% Confidence Interval 0.70-0.92, p = 0.003) was found as an independent factor for 90-day mortality in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 45.15 is the best-cutoff value for 90-day mortality after laparoscopic gastrectomy. 90-day mortality rate of PNI > 45.15 was 2.2% and PNI <= 45.15 was 13.6% found. Lower PNI is associated with increased 90-day mortality in laparoscopic gastrectomy for gastric cancer. The PNI may be a useful marker for predicting the 90-day mortality of gastric cancer patients after laparoscopic gastrectomy.
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    Isolated Roux loop versus conventional pancreaticojejunostomy following pancreaticoduodenectomy
    (Edizioni Luigi Pozzi, 2022) Ozdemir, Egemen; Gokler, Cihan; Gunes, Orgun; Kaplan, Kuntay; Aydin, Mehmet Can; Sumer, Fatih; Kayaalp, Cuneyt
    AIM: This study aimed to examine the effects of isolated Roux loop (IP) versus conventional pancreaticojejunostomy (CP) techniques on the rate of postoperative pancreatic fistula and its severity. MATERIAL AND METHODS: This study included retrospectively collected data from 132 patients who underwent pancreaticoduodenectomy in a single institute. Collected data were compared between IP and CP groups. Postoperative pancreatic fistula and its grades were defined according to International Study Group on Pancreatic Fistula (ISGPF) definition. RESULTS: A total of 58 patients had IP and 74 patients had CP. Biochemical leak (IP 20.6% versus CP 14.9%, p=0.38) and grade B/C pancreatic fistula (IP 20.6% versus CP 32.4%, p=0.13) rates of both groups were similar. Durations of hospital stay and intensive care unit stay and 30-day mortality rates of the two groups were similar. CONCLUSION: Isolated Roux loop reconstruction following pancreaticoduodenectomy is not associated with a lower rate of pancreatic fistula but may contribute to reducing the severity of pancreatic fistula.
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    Mini-laparoscopic adrenalectomy with transgastric specimen extraction
    (Springer-Verlag Italia Srl, 2021) Sumer, Fatih; Bag, Yusuf Murat; Aydin, Mehmet Can; Evren, Bahri; Aydin, Emine Sener; Sahin, Ibrahim; Kayaalp, Cuneyt
    We aimed to describe the initial experience of mini-laparoscopic adrenalectomy combined with transgastric specimen extraction and to assess its safety and feasibility. We used only 5-mm trocars, three ports for left adrenalectomy and four for right. Intraoperative gastroscopy was performed for specimen extraction through the mouth via an endoscopic snare. The gastrotomy was closed intracorporeally. Demographic, perioperative and pathological data were analyzed. There were 16 patients (12 females) with the mean age of 46.5 +/- 11.3 years and half of them had previous abdominal surgeries. The median operative time was 150 (45-432) min with a median blood loss of 88 (0-350) ml. The median oral intake time was 2 (1-4) days and the median length of hospital stay was 2 (2-5) days. There was no mortality and extraction-related complication. Histopathological median tumor length, width and depth were 3 cm, 2.15 cm, and 1.9 cm, respectively. The median specimen length, width and depth were 6.25 cm, 4 cm, and 2.2 cm, respectively. Mini-laparoscopic adrenalectomy combined with transgastric specimen extraction is a safe and feasible surgical technique. It provides a less invasive surgery and may also have some benefits on wound-related complications and cosmesis.
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    Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?
    (Mary Ann Liebert, Inc, 2021) Aktas, Aydin; Kayaalp, Cuneyt; Gunes, Orgun; Kirkil, Cuneyt; Tardu, Ali; Aydin, Mehmet Can; Bag, Yusuf Murat
    Background: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infection (SSI) on the one hand and irrational use of antibiotics on the other. The aim of this study was to determine the need/rationale for antibiotic prophylaxis in patients undergoing laparoscopic bariatric surgery, especially low-risk patients. Methods: This retrospective analysis involved 313 morbidly obese patients (body Mass Index [BMI] >= 40) who underwent laparoscopic BS at three medical centers between September 2018 and June 2019. During the trial, no inducement was given to use antibiotics, and the centers had chosen whether to use prophylaxis. The U.S. Centers for Disease Control and Prevention (CDC)-2016 criteria were used for the diagnosis of SSI. Results: Antibiotic prophylaxis was given to 181 patients, and the SSI rate in the entire series was 4.5% (14/313). There was no significant difference in SSI between the group who received antibiotics and that who did not (2.8% versus 6.8%, respectively; p = 0.09). Post-operative intra-abdominal complications were the main independent determinant for SSIs (p < 0.001). Antibiotic prophylaxis did not have any significant effect on the rate of SSI caused by these complications (2.2% versus 3.8%, respectively; p = 0.50). The second independent factor was the rate of SSI in patients with super-obesity (BMI >= 60), particularly incisional SSIs (p < 0.001). Antibiotic prophylaxis did not produce any significant decrease in the rate of SSI in patients with a BMI < 60 (2.8% versus 5.5%, respectively; p = 0.24). When these two independent factors were excluded, there were no patients with SSI in the no-antibiotics group, and only one in the antibiotic prophylaxis group (0.5%) (p = 1.00). Conclusions: Routine antibiotic prophylaxis should be questioned in laparoscopic BS. Prophylaxis may reduce incisional SSI in patients with a BMI of >= 60. In other cases, antibiotic prophylaxis does not provide a decrease in SSI