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Öğe 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, CüneytIntroduction: 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.Öğe Laparoscopic resection of choledochal cysts in adults: a series from Turkey(2019) Gündoğan, Ersin; Sümer, Fatih; Çolakoğlu, Muhammed Kadri; Çiçek, Egemen; Gökler, Cihan; Aydın, Mehmet Can; Kayaalp, CüneytAbstract: 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.Öğe Laparoscopic sleeve gastrectomy technique: How we do it(2018) Şansal, Müfit; Sağlam, Kutay; Gökler, Cihan; Sümer, Fatih; Kayaalp, CüneytA total of 1002 bariatric procedures were performed at our clinic between March 2006 and December 2016.The laparoscopic Roux-en-Y gastric bypass (LRYGB) technique was performed on 833 patients. Three ofthe LRYGB procedures were revisions of a previous laparoscopic sleeve gastrectomy (LSG). In 169 patients,the sleeve gastrectomy technique was used. One procedure was performed via laparotomy, but the otherswere performed laparoscopically. Six patients’ sleeve gastrectomy lines were transected and sutured usinga laparoscopic needle holder, while the others were closed with a stapling device. Ileojejunal bypass wasadded in 21 of the LSG procedures. This clinic’s experience with morbid obesity surgery began with opengastric bypass surgery and later evolved into use of the LRYGB method. Sleeve gastrectomy, which is popular in this country and around the world, has been performed since July 2014 (handmade as of May). Thisarticle describes some of the nuances and subtleties of the LSG technique.Öğe Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass(Elsevıer scıence bv, po box 211, 1000 ae amsterdam, netherlands, 2018) Gündoğan, Ersin; Kayaalp, Cüneyt; Aktaş, Aydın; Sağlam, Kutay; Sansal, Müfit; Uylas, Ufuk; Gökler, Cihan; Çiçek, Egemen; Sümer, FatihBackground: 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.
