An analysis of percutaneous endoscopic gastrostomy complications

Objective: To determine the indications of early and late complications in 224 patients who underwent Percutaneous Endoscopic Gastrostomy (PEG) procedure. Study Design: Observational study. Place and Duration of Study: Department of General Surgery, Karatay University and Medipol University, Turkey, from January 2014 to December 2020. Methodology: Patients' age, gender, primary diseases, PEG indications, morbidity, mortality, and complications were recorded by performing the PEG procedure. Hospitalisation, follow-up periods of the patients, and the re-insertion of PEG were evaluated. Results: The most common indication for PEG tube insertion was nutritional disorder associated with cerebrovascular diseases in 81 (37%) patients. No mortality was perceived due to the PEG tube insertion. However, mortality was observed in 84 (38.4%) patients in the first six months, in 6 (2.7%) patients between the sixth and twelfth month, and in 8 (3.7%) patients after the twelfth month. All these mortalities were attributed to the primary disease. In the early and late periods, complications were observed in the total of 45 (20.4%) patients. Among them, 17 (7.7%) patients experienced early period complications, whereas 28 (12.7%) patients experienced late period complications. Conclusion: Enteral nutrition should be preferred in order to avoid complications of parenteral nutrition in the patients who need long-term nutrition. In enteral nutrition, PEG should be preferred to surgical gastrostomy because it has less morbidity and mortality, can be done at the bedside and outpatiently when necessary, does not require general anesthesia, and is cheaper and practical

The importance of inflammatory parameters in the management of adhesive small bowel obstructions

Aim: In the present study, we aimed to examine the role of the Neutrophil-lymphocyte ratio (NLR) and Platelet-Lymphocyte ratio (PLR), which are cheap and easy-to-calculate markers, in surgical treatment decisions for patients with ASBO. Material and Methods: A total of 103 patients with ileus or similar diagnosis in system records and who underwent bridectomy due to brid ileus, as stated in the surgery notes, were included. The age of patients at the time of application, gender, previous abdominal surgeries, whether they had previous surgery due to ileus, and duration of hospitalization were recorded. NLR and PLR ratios were obtained using a simple calculation model. Results: According to the data obtained, the sensitivity and specificity values of WBC at 11.10 cut-off value were found to be 72.34% and 85.71%, while the sensitivity and specificity values of CRP at 2.13 were found to be 59.57% and 85.71%. The same values were found to be 82.98% and 85.71%, and 61.70% and 100% for NLR and PLR, respectively. The Youden Index was used to compare the accuracy rates, and NLR with a value of 0.68 was found to be the best parameter. Discussion: In conclusion, various studies examining the estimation of the need for surgical treatment in patients with ASBO and emphasizing mostly radiological results have been published. Although the present study was not designed to evaluate all radiological, biochemical, and clinical parameters regarding the decision of surgical treatment for the patients, it provides evidence that NLR can be a critical indicator in this matter

Comparison of short-term results of open and laparoscopic surgery in gastric cancer at a new regional hospital: A single surgeon experience

Aim: To compare the short-term results of open and laparoscopic gastrectomy in gastric cancer surgery. Material and Method: From 15 May 2018 to 28 June 2021, patients who underwent open and laparoscopic gastrectomy for gastric cancer by a single surgeon between were retrospectively analyzed from a prospectively maintained database. Patients were compared in terms of early intraoperative and postoperative outcomes. Both surgical methods were compared in terms of early intraoperative and postoperative outcomes. Results: A total of 34 patients (open n=23, laparoscopic n=11) were included in the study. While the mean number of lymph nodes was similar between the groups, more metastatic lymph nodes and more advanced disease were detected in the open group (p=0.007, p=0.002, respectively). According to tumor location, patients who underwent laparoscopic gastrectomy were more distally located (p=0.01). The mean operative time was shorter in the open group (171.5 min and 206 min, p=0.006, respectively), while the estimated blood loss was less in the laparoscopic group (158.2 mL vs 186.7 mL, p=0.003). Four patients (17.4%) in the open group and two patients (18%) in the laparoscopic group had at least Clavien-Dindo grade III complications (p=0.96). Earlier gas output was seen in the laparoscopic group (p=0.002), while other postoperative outcomes were similar between the groups. Mean follow-up time was longer in the open group (13.4 months and 7.6 months, respectively, p=0.004). Conclusion: Until sufficient experience is reached in laparoscopic gastrectomy, choosing earlier stage and distally located tumors is a safe method with postoperative results similar to open gastrectomy

Physio-pathological risk factors from gallbladder affecting the conversion from laparoscopic cholecystectomy to open cholecystectomy

Aim: Laparoscopic cholecystectomy is the first-line treatment method in the surgical treatment of gallbladder pathologies. Predicting conversion from laparoscopic to open cholecystectomy is still an important problem in the world. In our study, we aimed to investigate the gallbladder-derived physiopathological risk factors that affect the conversion from laparoscopic to open cholecystectomy. Materials and Methods: 370 patients who underwent cholecystectomy with the indications of symptomatic gallstone, acute cholecystitis, asymptomatic gallstones and gallbladder polyps were included in the study. Patients' demographic data such as age and sex, and pathological diagnoses, gallbladder wall thickness, and gallbladder volumes were obtained from pathology results. The effects of physiological parameters on conversion to open cholecystectomy were compared. Results: The most common indication for surgery is symptomatic gallstones (227 patients, 74.9%). The first preferred surgical technique is laparoscopic cholecystectomy with 86.5%. The conversion rate was 10.5% (n=39). The rate of conversion to open cholecystectomy was found to be high and a statistically significant difference was observed in patients with high gallbladder wall thickness and large sac volume (p<0.001 for wall thickness, p=0.008 for gallbladder volume) Conclusions: We determined that the wall thickness and volume of the gallbladder had a significant effect on the conversion rate of laparoscopic cholecystectomy to open cholecystectomy. We believe that, patients who can be detected ultrasonographically prior to surgery with increased gallbladder wall thickness, and gallbladder volumes are more likely to conversion to open surgery and that patients should be informed in detail

Factors affecting cecal intubation tinae in colonoscopy: Impact of obesity

Objective This study aims to determine the factors that prolong cecal intubation time (CIT) and determine the effect of obesity on CIT measured using multiple indexes. Methods Patients who underwent elective colonoscopy between July 10, 2020, and January 20, 2021, were evaluated in this prospective observational study. Age, gender, constipation, bowel preparation, presence of diverticulosis, previous surgery history, auxiliary maneuver and additional analgesic requirement, cecum intubation length (CL) and obesity indices [body mass index (BMI), waist circumference (WC), waist-toheight ratio (WHIR)] were analyzed. Factors affecting CIT were assessed by both univariate and multivariate logistic regression (LR) analyses. Results A total of 512 patients were analyzed. Mean CIT was 5.6 +/- 1.6 min, and median CIT was 5.17 min. The CIT median was 5.17 min in 248 (48.5%). In the univariate LR results, young age, constipation, poor bowel preparation, increased CL, additional analgesic requirement, low WHtR, and low BMI (0.5 and BMI >30 kg/m2 were found to be independent factors that decrease CIT [OR: 0.01 (0.01 0.03) p 0.5) and BMI (>30 kg/m2) were the best predictors of decreased CIT

The learning curve of laparoscopic inguinal hernia repair: A comparison of three inexperienced surgeons

Introduction: Studies with inexperienced surgeons in terms of the learning curve for laparoscopic totally extraperitoneal (TEP) inguinal hernia repair are limited. Aim: To compare three inexperienced surgeons in terms of the learning curve without supervision. Material and methods: Patients' data, which were from consecutive laparoscopic TEP hernioplasties between December 2017 and February 2020, were analysed retrospectively. The primary outcome was to compare the learning curve of three surgeons (Surgeon A, B, and C) in terms of complications, conversion, and duration of surgery. Secondary outcomes were recurrence rates. Results: A total of 299 patients were included in the study. Conversion and intraoperative complication rates decreased after the first 60 cases (from 10% to 2.5%, p = 0.013 and from 9% to 2.5%, p = 0.027, respectively). The mean operative time reached a plateau of less than 40 min after 51-81 cases (Surgeon A 51, B 71, and C 81 cases). Ageing was a risk factor for intraoperative complications and recurrence (p < 0.001, p = 0.008, respectively), and higher body mass index (BMI) was a risk factor for conversion (p = 0.004). Age = 60 years compared to age < 60 years increased intraoperative complications five-fold and recurrence six-fold (p = 0.001). On the other hand, BMI = 30 kg/m(2) increased the possibility of conversion to open surgery nine-fold (p < 0.001). In addition, a positive correlation was found between the operative time and the BMI and VAS score (p = 0.004, p = 0.015, respectively). Conclusions: In order to reach the plateau in the operative time during the TEP learning curve period, more than 50 cases should be experienced, whereas more than 60 cases are needed for conversion, intraoperative complications, and recurrence

Learning curve of laparoscopic surgery for colorectal cancer at a new regional state hospital: A single-surgeon experience of 106 consecutive cases without supervision

Background: Laparoscopic surgery for colorectal cancer is mostly performed in university hospitals or experienced centers. This study aimed at determining the learning curve of laparoscopic surgery for col-orectal cancer at a new regional state hospital. Patients and Methods: Clinico-pathological data of 106 consecutive patients who underwent laparoscopic surgery for colorectal cancer at a new regional state hospital between August 2018 and September 2021 were prospectively recorded and analyzed. All surgeries were performed by a single inexperienced surgeon without supervision. The primary outcome of the study was the operative time, which was used for a Cumulative Sum (CUSUM) analysis of the learning curve. The secondary outcomes included a comparison of preoperative, intraoperative, and postoperative outcomes during the learning curve period. Results: According to the CUSUM analysis, the learning curve consisted of three unique phases: phase 1 [the initial learning period (cases 1-53)], phase 2 [the consolidation period (cases 54-68)], and phase 3 [the experienced period (cases 69-106)]. Of the intraoperative outcomes, operative time and estimated blood loss were significantly reduced from phase 1 to phase 3 (p<0.001). Of the postoperative outcomes, time to pass stool (p<0.05), time to oral feeding (p=0.001), drain removal time (p<0.001), and length of hospital stay (p=0.042) were shorter in phase 3 compared to phases 1 and 2. Of the histopathological results, the specimen length and the number of harvested lymph nodes increased with experience (p=0.001). Conclusions: The present results suggest that a surgeon at a new regional state hospital must experience 53-68 cases to achieve competence in laparoscopic colorectal cancer surgery

Laparoscopic inguinal hernia repair-TAPP versus TEP: Results of 301 consecutive patients

Introduction: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are the two most commonly used techniques in laparoscopic inguinal hernia repair, and the results of comparative studies are conflicting. The objective of this study is to compare the two methods in unilateral inguinal hernia repair. Materials and methods: The data of consecutive patients who underwent TEP and TAPP due to unilateral inguinal hernia between December 7, 2017, and March 15, 2020, were analyzed retrospectively. The primary outcome was to compare the clinical outcomes of the two techniques in terms of complications, conversion, pain, and operative time. The secondary outcome was recurrence rates. Results: A total of 301 (TEP n=234, TAPP n=67) patients were included in the study. The mean age was 43 years, and the follow-up period was two years. The groups were similar in terms of demographic characteristics and hernia type. The mean operative time was longer in the TAPP group than in the TEP group (67 min and 58 min, p=0.007). The recurrence rate was 4.3% in the TEP group and 5.9% in the TAPP group (p>0.05). The conversion rate was 6% in both groups. In total, 19 (6.3%) patients had intraoperative complications (TEP n=16, TAPP n=3), and 23 (7.6%) patients had postoperative complications (TEP n=16, TAPP n=7). Both intraoperative and postoperative complication rates were similar between the groups (p=0.31 and p=0.051, respectively). The early postoperative pain was less in the TEP group (p=0.004). Conclusion: Less early postoperative pain and shorter operative time were detected in patients who underwent TEP