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    The association between psoas muscle area index and morbidity/mortality in laparoscopic gastric cancer surgery
    (2022) Turgut, Emre; Zengin, Akile; Bağ, Yusuf Murat; Kaplan, Kuntay; Güneş, Orgun; Karatoprak, Sinan; Sümer, Fatih
    As advanced gastric cancer often leads to obstruction or cancer-related cachexia, gastric cancer seems to have a closer association with sarcopenia than other types of cancer. Our study aim was to investigate the relationship between the psoas muscle area (PSMA) and morbidity and mortality in patients undergoing gastric cancer surgery. The data of patients who underwent laparoscopic gastric resection between November 2014 and April 2020 were analyzed retrospectively. The intervertebral disc space was verified at L3-4 in the sagittal plane. The PSMA on the right and left sides were measured separately and then added to obtain the total PSMA. This value was then divided by the patient's height (m2) to calculate the psoas muscle area index (PSMAI) (mm2/m2). The mean PSMAI of men (741.1 mm2/m2) was significantly higher than that of women (502.1 mm2/m2) (p<0.001). While there was a positive correlation between the PSMAI and BMI (r:0.352, p:0.019 in women; r:0.447, p<0.001 in men), the correlation between PSMAI and age was negative (r: -0.369, p:0.014 in women; r:-0.349, p<0.001 in men). PSMAI was statistically lower in patients with attendant morbidity (p:0.035). There was no significant relationship between PSMAI and the first 30-day mortality rate (p:0.096); however, the association between PSMAI and both the 90-day mortality rate (p:0.023) and the total mortality rate (p:0.046) were significant. In our opinion, assessing gastric cancer patients for sarcopenia and supporting them with the necessary nutrition and exercise program prior to surgery can help predict and lower postoperative morbidity and mortality rates.
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    Conversion in laparoscopic gastric cancer surgery ahighlight on the abdominal access
    (2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Kayaalp, Cuneyt
    Aim: The aim of this study was to compare the data of patients who underwent gastric cancer surgery as laparoscopically completedand 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 dividedin to two groups as laparoscopically completed and converted to open surgery. Demographics parameters and perioperative datawere 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 difficultyin performing esophagojejunostomy anastomosis (n=4), leakage in esophagojejunostomy anastomosis (n=1), and persistentbradycardia (n=1). Intraoperative blood loss was higher and time to oral intake was longer in the conversion group. No significantdifference was found in terms of demographic parameters, operative time, length of hospital stays, the rate of postoperativecomplications, reoperation, 30-day mortality.Conclusion: Complications due to trocar entry is an unpredictable and preventable conversion reason in laparoscopic gastric cancersurgery. Thin patients are riskier for complications during abdominal access. Abdominal access should be performed with an opentechnique in thin patients.
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    Does body mass index affect the intraoperative and early postoperative outcomes in patients with laparoscopic distal gastrectomy for gastric cancer?
    (2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Kaplan, Kuntay; Sümer, Fatih; Kayaalp, Cüneyt
    The effect of increased body mass index (BMI) on the short- and long-term outcomes of laparoscopic distal gastrectomy (LDG) is controversial. We aimed to evaluate the influence of BMI on intraoperative and early postoperative outcomes in patients with LDG for gastric cancer (GC). Eighty-six patients who underwent LDG for GC were included in this study retrospectively. The patients were divided into two groups as normal weighted (BMI=18.5-24.9 kg/m2, n=29) and overweighted-obese (BMI?25 kg/m2, n=57). Preoperative and intraoperative data, postoperative outcomes were retrospectively analyzed and compared between the two groups. The preoperative data were similar between the groups. The rate of the history of previous abdominal surgery (19.3% to 3.4%, p=0.05) and the median preoperative carcinoembryonic antigen (CEA) levels (1.7 ng/ml to 1 ng/ml, p=0.06) were higher in the overweighted-obese group but the differences were not significant. There were no significant differences in intraoperative data and early postoperative outcomes between the groups but the rate of postoperative serious complications (12.3% to 6.9%, p=0.71), the reoperation rate (10.5% to 6.9%, p=0.71), and 90-day-mortality rate (5.3% to 0%, p=0.5) were higher in the overweighted-obese group. Although the rates of postoperative serious com- plications, reoperation, and mortality were higher in the overweighted-obese patients, BMI had no significant effect on intraoperative and early postoperative outcomes in patients who underwent LDG for GC. LDG for GC is a feasible and safe approach for overweighted-obese patients.
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    Early term results of the left colic artery preservation in colorectal cancer surgery
    (2022) Kaplan, Kuntay; Gökler, Cihan; Bağ, Yusuf Murat; Cengiz, Emrah; Sümer, Fatih; Aydın, Cemalettin; Kayaalp, Cüneyt
    Introduction: Colorectal cancer is a common type of cancer that causes significant morbidity and mortality. Post-resection anastomosis safety is important. The most important factor affecting anastomosis safety is blood accumulation in the anastomosis. In this study, we aimed to examine the early-term results of the preservation of the left colic artery (LCA) during laparoscopic anterior and low anterior resection (LAR) for the treatment of rectum and sigmoid colon cancers based on our clinical experience. Materials and Methods: A total of 192 archive files that were operated for rectum and sigmoid colon cancer in our center between April 2019 and October 2022 were reviewed retrospectively. The patients were diagnosed using colonoscopy and biopsy during the pre-operative period. The patients and their results were discussed in the oncology council, and the patients’ treatment plans were formed based on the council’s decision. Results: The patients’ mean age was 65.4±9.33 years and nearly half of them were males (n=8, 53.3%). Of the patients, 12 (80%) of them underwent LAR, while three patients (20%) underwent AR. The mean duration of surgery was 322.66±101.8 min, while the median bleeding amount was 50 (20–150) cc. One patient (6.7%) required reoperation due to an anastomotic leak, and abscess drainage was performed using the transanal method. No mortality was observed in patients at 30 days. Conclusion: In our study, the low ligation (LL) and LCA were preserved during laparoscopic AR and LARs for rectum and sigmoid colon cancers, preserving blood accumulation in the anastomosis. However, multi-center prospective randomized controlled studies are required to demonstrate whether LL significantly reduces anastomotic leaks.
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    Management of acute cholecystitis in elderly (?65 years old) patients: A retrospective study comparing early versus delayed cholecystectomy
    (2023) Barut, Bora; Bağ, Yusuf Murat; Patmano, Mehmet; Gündoğan, Ersin; Tuncer, Adem; Dalda, Yasin; Gönültaş, Fatih
    Aim: Acute cholecystitis is the most common causes of acute abdomen in elderly popula tion. This study aimed to present the early postoperative period (? 30 days) outcomes of elderly patients (? 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Materials and Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and chole cystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and chole cystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conver sion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically signifi cant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no signif icant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group (5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient’s clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.
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    Systematic review of 241 laparoscopic isolated liver segment VII resections
    (2021) Sağlam, Kutay; Güneş, Örgün; Bağ, Yusuf Murat; Aydın, Mehmet Can; Sümer, Fatih; Kayaalp, Cuneyt
    Laparoscopic liver resections are performed with increasing frequency; however, they are less preferred for the deep parts of liver because of difficulty in reaching a posterior superior segment and working in a narrow area. The aim of this study is to analyze the outcomes of laparoscopic segment 7 resections with two new patients and previously published 239 patients. PubMed, Scopus, and Google Scholar databases were scanned for the topic with several keywords. Eligible studies were selected for the analysis and reference cross-check was added to the search. Surgical technique details (application of Pringle maneuver, using Cavitron ultrasonic surgical aspirator (CUSA), patient position, Glissonean approach, and intercostal trocar (ICT) placement) were examined for the outcomes (operating time, blood loss, conversion to open surgery, and post-operative complications). Total data of 239 cases were collected from 27 studies and we added two more cases from our clinic. Lateral decubitus patient position was with less post-operative complications when compared to the supine position (8.4% vs. 50.0%, p=0.01). ICT placement seemed to have less conversion rate (1.3% vs. 7.3%, p=0.07) and less post-operative complications (4.5% vs. 19.1%, p=0.05). Glissonean approach increased the operating time but had no effect on blood loss. Using CUSA for parenchymal transection lowered the rates of post-operative complications (4.4% vs. 19.5%, p<0.05) but it was not useful for blood loss or operating time. Application of Pringle maneuver had no effect on these outcomes. Laparoscopic isolated segment 7 liver resection is a feasible surgical procedure for selected patients in centers with experienced surgeons on advanced laparoscopy. Lateral decubitus patient position, ICT placement, and using CUSA for parenchymal transection seem beneficial to decrease conversion to open surgery and complication rates. Pringle maneuver or Glissonean approach were not found as useful for the outcomes.
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    Unplanned laparoscopic peritoneal biopsy for gastric cancer
    (2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Sümer, Fatih; Kayaalp, Cüneyt
    Introduction: It is thought that the sensitivity of computed tomography (CT) in detecting peritoneal metas tases (PM) is low. In this study, we aimed to present our experience on gastric cancer (GC) patients withintraoperatively detected PM whose preoperative CT was normal in terms of distant metastasis. Materials and Methods: We retrospectively analyzed the demographics and perioperative data of ten pa tients with gastric adenocarcinoma whose preoperative CT was normal in terms of PM, but intraoperativelyPM was detected. Results: The mean age of the patients was 68.30±9.44 years. Six patients (60%) were male. Tumors weremostly localized in the distal 1/3 of the stomach (n=5, 50%). The median carcinoembryonic antigen andcarbohydrate antigen 19.9 levels were 2.00 ng/ml (0.60–37.50) and 30.76 IU/ml (3.28–449.30), respectively.There were PM on the visceral peritoneum (small bowel mesentery) in two patients (20%) and on the parietalperitoneum in eight patients (80%). The operations were terminated in five patients (50%) when the PM de tected as they did not have any complications due to cancer. Laparoscopic feeding jejunostomy (n=2, 20%),laparoscopic tube gastrostomy (n=1, 10%), and laparoscopic gastroenterostomy (n=2, 20%) were performedon the patients with oral intake deficiency due to GC. Conclusion: Preoperative staging with CT before GC surgery is still valid. Multidetector CT scan should bepreferred. However, it is still not enough for detecting all PM before surgery. Staging laparoscopy should bein mind, especially for patients with a high risk of PM.
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    Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?
    (2022) Zengin, Akile; Bağ, Yusuf Murat; Öğüt, Mehmet Zeki; Sağlam, Kutay
    Abstract Aim: To investigate the clinical significance of the simple laboratory test values on differentiating complicated acute appendicitis. Materials and Methods: We retrospectively examined the medical records of 216 acute appendicitis patients. Patients were divided into two groups according to pathological results (non-complicated (n=157) and complicated (n=59)). The demographic and clinical data, laboratory findings, length of hospital stay, and pathological results were compared between the two groups. Receiver operating characteristics (ROC) curves were performed to analyze the optimal cutoff value of numerical variables which were significantly differed between the group comparisons. Results: The preoperative data were similar between the groups except for age. The length of hospital stay was longer and total/direct bilirubin levels higher in the complicated group (p=0.002, p=0.002, and p=0.002, respectively. The lymphocyte level and amylase level were lower in the complicated group (p=0.02 and p=0.004, respectively). ROC curve analysis provided a cutoff value of ?0.89 mg/dL for total bilirubin, ?0.43 mg/dL for direct bilirubin, ?1.63% for lymphocyte and ?46.5 U/L for amylase. Conclusion: Preoperative higher total and direct bilirubin levels are able to predict complicated appendicitis. Preoperative higher serum amylase levels should not have a place in the differential diagnosis of complicated appendicitis. This means that if serum amylase is elevated in a patient with suspected acute appendicitis, it does not suggest acute complicated appendicitis.