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Öğe 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, FatihAs 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.Öğe Can revision of RYGB to sleeve gastrectomy be a solution to inadequate weight loss treatment?(Mexican Acad Surgery, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Sumer, Fatih; Kayaalp, CuneytWe aimed to discuss the weight loss success of the revision of RYGB to sleeve gastrectomy (SG). Between January 2019 and June 2020, four patients' files were analyzed retrospectively. Post-RYGB mean minimal BMI was 27.4 +/- 9.47 kg/m2, be-fore SG the mean BMI was 43.41 +/- 4.16 kg/m2. Post-operative gastric fistula developed in two patients. The mean follow-up time after revision surgery was 17.25 +/- 6.89 months, mean excess weight loss (EWL) was 74.77 +/- 8.94%, and mean BMI was 32.65 +/- 2.9 kg/m2. Despite high rate of major complications, revision of RYGB to SG is successful in weight loss and resolving certain complications of RYGB.Öğe Coronavirus Precautions: Experience of High Volume Liver Transplant Institute(Aves, 2022) Baskiran, Adil; Akbulut, Sami; Sahin, Tevfik Tolga; Tuncer, Adem; Kaplan, Kuntay; Bayindir, Yasar; Yilmaz, SezaiBackground: To present the struggle of a high volume liver transplant center against coronavirus infectious disease-2019 pandemic. Methods: Between March 2020 and December 2020, the demographic and clinical data of staff and liver transplant candidates diagnosed with coronavirus infectious disease-2019 in our Liver Transplant Institute were prospectively analyzed. Results: First, 32 healthcare staff were diagnosed with coronavirus infectious disease-2019, and 6 of them were surgeons. Six staff were asymptomatic, while 24 staff had mild or moderate and 2 staff had severe coronavirus infectious disease-2019. All the staff recovered from the disease without any permanent sequela and returned to duty after 2 consecutive negative polymerase chain reaction results within 24-hour intervals. Second, during the preoperative investigation, 6 living liver donor candidates and 13 recipients were tested positive for coronavirus infectious disease-2019 (son = 6, unrelated = 3, cousin = 3, daughter = 2, cadaveric = 1). Eleven patients received favipiravir and 8 did not receive any treatment because they were asymptomatic. Only one recipient who had severe coronavirus infectious disease-2019 died due to multiple organ failure syndrome. One recipient died in the early postoperative period. The median duration from the initial diagnosis of the patients till the transplant procedure was 21-days (min-max: 14-105 days). During the time of operation, the polymerase chain reaction tests of the donors and the recipients were negative, and the thorax tomography images showed no signs of viral pneumonia. Conclusion: Meticulous precautions, multidisciplinary approach, team effort, and organization of facilities can increase the quality of care of these patients in the coronavirus infectious disease-2019 era. Healthcare workers have shown tremendous effort and are the true heroes of this era.Öğe 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, CüneytThe 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.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 Helicobacter pylori Increases Gastric Compliance on Resected Stomach After Laparoscopic Sleeve Gastrectomy(Springer, 2021) Kaplan, Kuntay; Turgut, Emre; Okut, Gokalp; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytBackground The relationship between high body mass index (BMI) and Helicobacter pylori (HP) was reported previously. But the mechanism is not clear. We aimed to evaluate the effect of HP on gastric compliance and volumes in obese patients. Materials and Methods One hundred fifty-nine patients who underwent sleeve gastrectomy due to morbid obesity were enrolled in the study and were divided into two groups as HP+ (n = 86) and HP- (n = 73) according to the HP status in resection materials. Demographics, pathological data, specimen sizes, volume, and compliance were retrospectively analyzed. Results The median age of the study group was 34 years (17-64 years) while the median BMI was 43 kg/m(2) (35-64, 3 kg/m(2)). Most of the patients (n = 134, 84.3%) were female. The median diameter of the widest point of the specimen was 22.5 cm (14-32 cm), and the median volume of the specimen was 790 cc (330-1920 cc). Both the diameter of the widest point and the volume of the specimens were significantly increased in the HP+ group compared to the HP- group (p < 0.001 and p = 0.017, respectively). In addition, the median compliance was 52.6 cc/mmHg, and the compliance was significantly higher (p < 0.001) in the HP+ group. There were no significant differences in specimen sizes between the two groups. Conclusion This is the first study showing that HP increases gastric compliance in obese patients who underwent LSG. The etiology and the effects of this increase in compliance have not been fully clarified yet. Further studies are needed to shed light on these effects.Öğe How much more can minimally invasive surgery be minimized? Mini-laparoscopic Nissen fundoplication in adults(2021) Sümer, Fatih; Okut, Gokalp; Kaplan, Kuntay; Baran, Necip Tolga; Kayaalp, CuneytIntroduction: Mini-laparoscopy has become a current issue as a minimally invasive technique in gastroesophageal reflux surgery, which does not require specimen extraction. There are a limited number of cases of Nissen fundoplication performed in the adult age group using the mini-laparoscopic method. In this article, our aim is to draw attention to the fact that mini-laparoscopy is a preferable technique in Nissen fundoplication surgery. Materials and Methods: Seven patients underwent mini-laparoscopic Nissen fundoplication between January 2010 and December 2019. Demographic data and perioperative parameters were analyzed retrospectively. Results: Three of our patients (43%) were female and the average age of our patients was 45.4±11.1. All patients presented with complaints of heartburn and regurgitation. There was Barrett metaplasia in the pathology results and no dysplasia was observed in any patient. Mean operation time was 117±49.9 min, bleeding amount was <10 ml in all surgeries. The median time to oral intake was 8th post-operative h, and no complications developed in any of our patients. In the post-operative period, there was no need for narcotic analgesic, after a single dose of nonsteroidal anti-inflammatory drugs, the treatment was continued with two doses of oral analgesic. Median length of stay hospital was 3 (2–4) days, the median follow-up period was 67 (29–120) months. Conclusion: Anti-reflux surgery can be easily performed, mini-laparoscopically since it is not a resective surgical procedure. It can provide advantages such as better cosmesis, less port site complications, and less analgesic useÖğe Is It Possible to Estimate the Liver Left Lobe Volume Using Preoperative Data Before Bariatric Surgery?(Springer, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytY Purpose Retraction of the left lobe of the liver (LLL) is an important step in bariatric surgical procedures. A good liver retraction will both facilitate the operation and reduce complications. The aim of the study is to identify patients with large LLL with preoperative anthropometric and laboratory data, and to reveal complications due to large LLL. Materials and Methods The data of 245 patients who underwent bariatric surgery in our department between April 2019 and March 2021 were retrospectively analyzed. The patients were divided into two groups according to the visibility of the caudate lobe of the liver, the left diaphragmatic artery-vein, and the fat pad on the esophagus after liver retraction. Results Univariate analyses revealed significant differences in BMI, waist and hip circumferences, TG, DM, and HbA1c values, but only BMI (p = 0.001) and the presence of DM (p = 0.017) were found to be independent predictors of LLL size. BMI >= 42.1 kg/m(2) indicates the size of LLL with 83% sensitivity and 49% specificity. Retractor-related complications were significantly higher in the large LLL group (p = 0.036). There was no difference between the two groups in terms of complications related to trocar insertion (p = 0.014) and postoperative liver enzyme levels (p = 0.714). The operation time (laparoscopic sleeve gastrectomy [LSG]; p = 0.021) (laparoscopic Roux-N-Y gastric bypass [LRYGB]; p = 0.020) and the amount of bleeding (LSG; p < 0.001) (LRYGB; p = 0.011) are higher in patients with large LLL. Conclusion Large LLL can be predicted and complications may be reduced with the help of preoperative data.Öğe Is Previous Abdominal Surgery an Obstacle to Laparoscopic Bariatric Surgery?(Springer India, 2021) Turgut, Emre; Kaplan, Kuntay; Okut, Gokalp; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytIt is generally considered that a previous history of abdominal surgery can negatively impact the patient's perioperative course. But the effects of it on laparoscopic bariatric surgery have not been sufficiently documented. Therefore, our study aims to analyse the impact of previous abdominal surgery on patients undergoing bariatric surgery. Data from patients who underwent surgery between January 2011 and November 2019 was analysed retrospectively. The study population was divided into the following four groups: those with no history of previous abdominal surgery (group A), those who had previously undergone lower abdominal (group B), upper abdominal (group C) and those who had both lower and upper abdominal surgery (group D). Patients' demographic data, type of surgical procedure, operative time, length of hospitalization, perioperative and postoperative complications were recorded for each patient in the database. In the case of 4 (0.3%) patients, conversion to open surgery from a laparoscopic intervention was required. No significant difference was found between the groups with previous abdominal surgery in terms of intraoperative complications (p: 0.551). The rate of postoperative complications was higher in patients who had previously undergone upper abdominal surgery; however, the difference in this rate compared to the other groups was found to be statistically insignificant (p: 0.189). We believe that during the decision-making process, neither patients nor surgeons should see previous abdominal surgery as an obstacle to laparoscopic bariatric surgery, thus permitting more freedom in selecting the most appropriate type of surgery for the patient.Öğe 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, CuneytGastic 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.Öğe Is Sleeve Gastrectomy or Roux-en-Y Gastric Bypass Better in Terms of Quality of Life?(Mary Ann Liebert, Inc, 2021) Turgut, Emre; Okut, Gokalp; Kaplan, Kuntay; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytIntroduction: Obesity has increased in frequency over recent years. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used technique worldwide, followed by the laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aims to compare the effects of these two techniques, LSG and LRYGB, on the patients' quality of life. Material and Methods: All patients who underwent surgery or postoperative checkups at our obesity clinic between December 2018 and December 2019 completed two face-to-face questionnaires: the Short Form 36 Health Survey and the Obesity-related Problems Scale. Information on each patient such as demographic data, American Society of Anesthesiologists scores, any previous surgeries, preoperative and/or postoperative complications, the type of surgery, and time elapsed since surgery was compared, retrospectively. Results: No significant statistical differences were found between the two procedures. A significant improvement in the postoperative quality of life was observed in all patients. Scores for female patients were observed to be lower than for male patients. No significant statistical difference was observed between the two age groups (50 years and older or <50 years) for either the LSG or LRYGB patients. Higher body mass index levels have prolonged hospital stay and score lower on many of the parameters.Öğe 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, CuneytAIM: 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.Öğe Laparoscopic partial splenectomy: Our series of 3 patients(2021) Sümer, Fatih; Baran, Necip Tolga; Güneş, Orgun; Kaplan, Kuntay; Gündoğan, Ersin; Kayaalp, CüneytAbstract: Total splenectomy can cause many perioperative and postoperative complications. Partial splenectomy has been preferred in recent years in order to minimize the immunological complications associated with splenectomy. With this case series, we aim to present our own experiences with 3 patients.Öğe Management of the staple line bleeding in laparoscopic sleeve gastrectomy: monopolar cautery versus oversewing(Mexican Acad Surgery, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Karahan, Mehmet; Bag, Yusuf M.; Sumer, Fatih; Kayaalp, CuneytObjective: Staple line bleeding control (SLBC) after laparoscopic sleeve gastrectomy (LSG) is a serious problem. Cauterization alone is generally not preferred because of concerns about weakening the staple line. The aim of this study was to compare the suturing and monopolar cauterization methods for SLBC in LSG. Methods: 212 patients were divided into two groups as cautery and suture groups. Demographic characteristics, intraoperative, and post-operative results were analyzed. Results: Post-operative complications were seen in seven patients, four of them staple line bleeding (three patients were in the cautery group and one patient was in the suture group), and three of them leakage (all patients were in the suture group) from the staple line. There was no significant difference between the groups in terms of staple line bleeding (p = 0.35), staple line leakage (p = 0.09), blood loss (p = 0.12), intraoperative complications (p = 0.16), post-operative hemoglobin decrease (p = 0.63), and length of hospital stay (p = 0.35), but the operation time was longer in the suture group. Conclusion: This is the first study in literature comparing monopolar cauterization with another technique. Monopolar cauterization can be used for SLBC in LSG. It is a safe and efficient method as well as inexpensive.Öğe Omentopexy versus falciformopexy for peptic ulcer perforation(Turkish Assoc Trauma Emergency Surgery, 2019) Olmez, Aydemir; Cicek, Egemen; Aydin, Cemalettin; Kaplan, Kuntay; Kayaalp, CuneytBACKGROUND: Open or laparoscopic Graham's omentopexy is frequently used in the treatment of peptic ulcer perforation (PUP). The technical difficulty of applying the omental plug, especially in patients with previous omentum resection, has led to the use of falciform ligament for the PUP, and some studies have reported that PUP may even be a more advantageous technique than omentopexy. Here, in this study, we aimed to compare the retrospective results of patients who underwent falciformopexy or omentopexy for PUP. METHODS: Between 1999 and 2018, 303 patients who were followed-up and treated for PUP were included in this study. Patients who had malignancy, gastric resection, definitive ulcer surgery, laparoscopic surgery and nonoperative treatment were excluded from this study. In the remaining patients, either open ometopexy or falciformopexy were applied based on the surgeon's choice. These two techniques were compared for intraoperative and postoperative outcomes. RESULTS: Falciformopexy (n=46) and omentopexy (n=243) groups had similar demographics, but ASA scores were lower in the falciformopexy group. For ulcer size and localization, duration of operation, no difference was found between the groups. There was no significant difference between the groups concerning general postoperative morbidity and mortality. However, atelectasis was more frequently observed in the omentopexy group, whereas the pexia failure was more frequent in the falciformopexy group (2.6% and 8.7%, p=0.04). CONCLUSION: Falciformopexy is an alternative technique that can be used in situations where it is not possible to use the omentum. Falciformopexy is not superior to omentopexy for the repair of the PUP.Öğe Primary Hepatic Actinomycosis Mimicking Neuroendocrine Tumor(Springer, 2023) Kaplan, Kuntay; Sarici, Kemal Baris; Usta, Sertac; ozdemir, Fatih; Isik, Burak; Yilmaz, SezaiIntroduction The Actinomyces species is a fastidious, gram-positive, non-spore-forming bacteria that thrive in microareophilic and anaerobic conditions. Infection in the liver, an organ rarely affected by this pathogen, is presumed to be caused by hematogenous spread through the portal vein from a mucosal injury or other abdominal injury or a focus of infection. Case Description A 60-year-old male patient has a mass lesion of 15 x 10 cm in the left lobe on computed tomography. A tru-cut biopsy was performed with USG, and fragmented tissue pieces were obtained. In histopathological examination, these samples were reported as tumors with neuroendocrine differentiation. The biopsy sample contains a large amount of tumor neighborhood, and tumoral area is quite small. And, therefore, a clear diagnosis could not be found. A mass lesion with mildly increased Ga 68 DOTATATE uptake was observed in the left lobe of the liver (SUVmax value 3.8) and was interpreted in favor of the primary neuroendocrine tumor of the liver. Discussion Actinomyces cases are very rare and their diagnosis is usually delayed due to its slow and insidious course, and lack of specific clinical and radiological findings. It is difficult to make a correct diagnosis even in microbiological examinations and biopsy materials obtained in the presence of imaging methods. It can mimic tumors of abdominopelvic structures. Conclusion Actinomyces should be kept in mind in cases with liver masses accompanied by previous abdominal surgery, abdominal trauma, high fever, and leukocytosis.Öğe Ten years single center bariatric surgery experience(2021) Turgut, Emre; Kaplan, Kuntay; Okut, Gokalp; Cengiz, Emrah; Kocaaslan, Hüseyin; Baran, Necip Tolga; Karahan, Mehmet; Kayaalp, CuneytIntroduction: Various surgical modalities have been developed to reduce the amount and absorption of nutrients in the fight against obesity. We aimed to share how the single-center experience was affected by the developments in the world and its change over time with the literature. Materials and Methods: The records of patients who underwent laparoscopic bariatric surgery between May 2010 and December 2020 were reviewed retrospectively. Demographic characteristics of the patients, indications for surgery, preparation for surgery, surgical technique, and post-operative follow-up stages were examined in detail. Results: A total of 1422 patients underwent bariatric surgery over a 10-year period. Laparoscopic Roux-n-Y Gastric Bypass (LRYGB) was performed in 946 patients and Laparoscopic Sleeve Gastrectomy (LSG) was performed in 476 patients. The operation time (p<0.001) and the intraoperative blood loss (p<0.001) in LRYGB were significantly higher than LSG. The difference was not significant in terms of length of hospital stay (p=0.149) and drain usage (p=0.782). While intraoperative complications occurred in 49 (5.1%) patients in LRYGB, this number was 5 (1%) in LSG (p<0.001). There was no significant difference in Clavien Dindo class 3 and higher complication rates between the groups (p=0.782). Mortality was seen in only 7 (0.5%) patients. Conclusion: Today, standard techniques are applied in both procedures and the choice is left to the patient. Regardless of the technique applied, laparoscopic bariatric surgery can be applied as an effective and safe method in the treatment of morbid obesity until an alternative treatment is found.Öğe Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors(Lippincott Williams & Wilkins, 2022) Sumer, Fatih; Gundogan, Ersin; Kaplan, Kuntay; Okut, Gokalp; Kayaalp, CuneytAim: The aim was to evaluate the feasibility of transvaginal specimen extraction after laparoscopic gastrectomy for tumors. Method: Inclusion criteria were females not planning to deliver a child and an accessible vaginal entry. Exclusion criteria were benign gastric pathologies and emergency cases. Results: There were 24 females with a mean age of 54.5 +/- 12.0. Subtotal, total, central, and vertical gastrectomies were implemented in 17, 4, 2, and 1 patients, respectively. There was no conversion to open or conventional laparoscopic surgery. Specimens were removed from the vagina in all cases successfully. Histopathologies were adenocarcinoma in 20, gastrointestinal stromal in 3, neuroendocrine tumors in 2 and high-grade dysplasia in the rest. Mean blood loss and duration of surgery were 122.5 +/- 163.4 (range: 10 to 800) ml. and 287.7 +/- 95.9 (range: 120 to 440) minutes, respectively. No patient required intraoperative blood transfusions. The median length of hospital stay was 7 days (range: 3 to 22). The mean tumor size was 7.8 +/- 6.5 (range: 0.5 to 24) cm. Fourteen of 24 cases were advanced gastric cancers. Mean dissected lymph node numbers in the patients with radical gastrectomy was 35.3 +/- 12.9 (range: 18 to 62). There were no early or late complications related to the specimen extraction and no wound-related problems were observed. Conclusions: In the selected cases, transvaginal specimen extraction was feasible after laparoscopic gastric resections in patients with stomach tumors. As far as we know, this was the largest study on the transvaginal extraction of gastric tumors.
