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    The impact of previous open abdominal surgery on the outcome of laparoscopic colorectal surgery
    (2021) Eray, Ismail Cem; Topal, Ugur; Yalav, Orcun; Dalci, Kubilay; Saritas, Ahmet Gokhan; Rencuzogullari, Ahmet
    Aim: Although the laparoscopic approach is increasingly being used in colorectal surgery, it is anticipated that the technical problems caused by previous abdominal open surgery (PAOS) will adversely affect the outcomes. The aim of this study was to evaluate the outcomes of previous abdominal surgery in patients with colorectal cancer who underwent laparoscopic surgery for treatment. Material and Methods: Among the patients who underwent laparoscopic surgery for colorectal cancer between January 2015 and December 2018, those who had a history of previous abdominal surgery and those who did not were compared. Those with a history of laparoscopic abdominal surgery are not included in the PAOS group and short-term postoperative complications, conversion to open surgery, reoperations, hospital readmissions, and mortality rates were analyzed between the groups. Results: 21 of 140 patients who underwent laparoscopic surgery for colorectal cancer had PAOS. The groups with and without PAOS were similar in terms of age, sex, body mass index, ASA score, and comorbid disease. No difference was observed regarding conversion to open surgery (p = 0.513), postoperative complications (p> 0.05), reoperations (p = 0.162), unplanned hospital readmissions (p = 0.154), and perioperative mortality (p = 0.136) between the two groups. Conclusion: We believe that laparoscopy can be safely performed in patients with colorectal cancer who had previous abdominal open surgery with similar clinical and postoperative complication rates as in patients without a history of PAOS.
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    Management of rectovaginal fistulas secondary to use of stapling device for rectal cancer surgery
    (2019) Topal, Ugur; Rencuzogullari, Ahmet; Eray, Ismail Cem; Alabaz, Omer
    Aim: Scarce data are available for rectovaginal fistula (RVF) as a serious complication of low anterior resection with a double-stapled anastomosis for rectal cancer. In this study, we aimed to evaluate our surgical management of RVFs formed due to stapler use.Material and Methods: Between 2010 and 2018, patients who developed rectovaginal fistula after the use of circular stapler during rectal surgery were included. Clinic characteristics, type of surgical treatment performed and details of surgery in patients were retrospectively evaluated.Results: Ten patients for whom stapler device was used for rectal cancer surgery and diagnosed with RVF were included in our study. The mean age of the patients was 45.7±11.8 and mean BMI value was 27±2.4. For 9 patients who had primary repair for RVFs, 7 patients experienced recurrence after their first operation. For this subgroup, muscle flap was performed in 3, vaginal mucosa advancement flap 2, sartius flap one, and another primary repair plus fibrin glue application one patient. After the second interventions, two patients were managed with muscle flap creation and primary repair plus fibrin glue was required for one patient, for their recurrence. For patient who had primary repair plus fibrin glue application for her second operation, sigmoid colostomy followed by abdominoperineal resection was required for persisting complaints.Conclusion: The management of postoperative (RVF) after low anterior resection for rectal cancer is difficult and the results are often unsatisfactory. Endoanal mucosal flaps and muscle flaps are the treatment modalities we recommend, especially in patients with recurrence.Keywords: Circular stapler; rectovaginal fistula; rectal cancer.