Kolesistektomi esnasında laparoskopik cerrahiden açık cerrahiye geçişi etkileyen risk faktörleri

Objective: Laparoscopic cholecystectomy has obvious advantages over open surgery, such as shorter hospital stay, lower morbidity, better cosmetic results and faster return to daily activities. However, in some cases, conversion to open technique may be inevitable for patient safety or for the management of complications having occurred. Although various risk factors have been identified in many studies, variables such as technical facilities, surgical technique and experience affect risk factors. Our study aims to identify these risk factors. Method: In this study, 2,483 cholecystectomy cases performed in the general surgery clinic of our hospital between December 2013 and 2016 were retrospectively analyzed. 110 cholecystectomy cases initiated with open surgery and performed during another operation were excluded from the study, and 88 patients who were started laparoscopic surgery and converted to open surgery were selected for the study. Information on the demographic and clinical characteristics of the patients was obtained from hospital records. The data of an equal number of consecutively selected patients from the patients who were completed laparoscopically were obtained and compared, and whether these factors had a significant effect on conversion to open surgery was evaluated. Results: The rate of conversion from laparoscopic cholecystectomy to open surgery was 3.7%. The most common reason for conversion to open surgery was adhesion due to inflammation (n=65, 73.9%). While male gender, advanced age, diabetes, median incision above the umbilicus, multiple millimetric calculus and increased wall thickness in ultrasonography had a significant effect on the conversion to open surgery (p<0.001), there was no significant correlation with body mass index, pancreatitis, cholangitis, endoscopic retrograde cholangiopancreatography or abdominal surgery, anesthesia evaluation score and laboratory values (p>0.05). The durations of hospitalization and operation were found to be significantly longer in the open group (p<0.001). Conclusion: Male gender, advanced age, presence of diabetes, presence of supra-umbilical median incision, multiple millimetric calculus and increased wall thickness in ultrasonography are associated with increased rates of conversion from laparoscopic cholecystectomy to open surgery. If the coexistence of parameters that we find significant is detected in the preoperative period, it may be possible to take precautions such as involving the experienced surgical team in the operation, planning the operating room, and providing more detailed information to the patient.Amaç: Laparoskopik kolesistektominin, ameliyat sonrası daha kısa hastanede kalış süresi, daha düşük morbidite, daha iyi kozmetik sonuçlar ve günlük aktivitelere daha hızlı dönebilme sağlaması gibi avantajları ile açık cerrahiye göre üstünlüğü aşikardır. Ancak bazı durumlarda açık tekniğe geçmek hasta güvenliği veya meydana gelmiş olan komplikasyonu yönetmek için kaçınılmaz olabilmektedir. Birçok çalışmada çeşitli risk faktörleri tanımlanmış olsa da teknik imkanlar, cerrahi teknik ve tecrübe gibi değişkenler risk faktörlerini etkilemektedir. Çalışmamız bu risk faktörlerinin tespit edilmesini amaçlamaktadır. Yöntem: Çalışmada Aralık 2013-2016 tarihleri arasında hastanemiz genel cerrahi kliniğinde gerçekleştirilmiş 2,483 kolesistektomi olgusu retrospektif olarak incelenmiştir. Açık cerrahiyle başlanan ve başka bir operasyon sırasında uygulanan 110 kolesistektomi olgusu çalışma dışı bırakılarak, laparoskopik başlayıp açık cerrahiye geçilen 88 hasta araştırma için seçilmiştir. Hastaların demografik ve klinik özelliklerine ait bilgiler hastane kayıtlarından elde edilmiştir. Laparoskopik tamamlanan hastalardan ardışık seçilen eşit sayıda hastanın verileri elde edilerek karşılaştırılmış, bu faktörlerin açığa geçişe anlamlı etkisi olup olmadığı değerlendirilmiştir. Bulgular: Laparoskopik kolesistektomiden açığa geçiş oranı %3,7, en sık açığa geçiş nedeni ise enflamasyona bağlı adezyon (n=65, %73,9) olarak bulunmuştur. Açığa geçiş üzerine erkek cinsiyet, ileri yaş, diyabet, göbek üstü medyan kesi, ultrasonografide multipl milimetrik kalkül ve duvar kalınlık artışı olmasının anlamlı etkisi olduğu tespit edilirken (p<0,001), vücut kitle indeksi, pankreatit, kolanjit, endoskopik retrograd kolanjiopankreatikografi ya da batın operasyonu geçirmiş olma öyküsü, anestezi değerlendirme skoru ve laboratuvar değerleri ile anlamlı ilişki tespit edilmemiştir (p>0,05). Yatış ve operasyon süreleri açığa geçilen grupta anlamlı olarak daha uzun bulunmuştur (p<0,001). Sonuç: Erkek cinsiyet, ileri yaş, diyabet varlığı, göbek üstü medyan kesi varlığı, ultrasonografide multipl milimetrik kalkül ve duvar kalınlık artışı olması artmış açığa geçiş oranları ile birliktedir. Anlamlı bulduğumuz parametrelerin birlikteliğinin preoperatif dönemde tespit edilmesi halinde zor kolesistektomi olabileceği ve açığa geçiş riskinin artabileceği düşünülerek eğitim olgusu olarak seçilmeyerek tecrübeli cerrahi ekibin ameliyata dahil edilmesi, ameliyathanenin planlanması, hastaya daha ayrıntılı bilgi verilmesi gibi önlemleri almamız mümkün olabilmektedir

Risk Factors Effecting Conversion from Laparoscopic Cholecystectomy to Open Surgery

Objective:Laparoscopic cholecystectomy has obvious advantages over open surgery, such as shorter hospital stay, lower morbidity, better cosmetic results and faster return to daily activities. However, in some cases, conversion to open technique may be inevitable for patient safety or for the management of complications having occurred. Although various risk factors have been identified in many studies, variables such as technical facilities, surgical technique and experience affect risk factors. Our study aims to identify these risk factors.Method:In this study, 2,483 cholecystectomy cases performed in the general surgery clinic of our hospital between December 2013 and 2016 were retrospectively analyzed. 110 cholecystectomy cases initiated with open surgery and performed during another operation were excluded from the study, and 88 patients who were started laparoscopic surgery and converted to open surgery were selected for the study. Information on the demographic and clinical characteristics of the patients was obtained from hospital records. The data of an equal number of consecutively selected patients from the patients who were completed laparoscopically were obtained and compared, and whether these factors had a significant effect on conversion to open surgery was evaluated.Results:The rate of conversion from laparoscopic cholecystectomy to open surgery was 3.7%. The most common reason for conversion to open surgery was adhesion due to inflammation (n=65, 73.9%). While male gender, advanced age, diabetes, median incision above the umbilicus, multiple millimetric calculus and increased wall thickness in ultrasonography had a significant effect on the conversion to open surgery (p0.05). The durations of hospitalization and operation were found to be significantly longer in the open group (p<0.001).Conclusion:Male gender, advanced age, presence of diabetes, presence of supra-umbilical median incision, multiple millimetric calculus and increased wall thickness in ultrasonography are associated with increased rates of conversion from laparoscopic cholecystectomy to open surgery. If the coexistence of parameters that we find significant is detected in the preoperative period, it may be possible to take precautions such as involving the experienced surgical team in the operation, planning the operating room, and providing more detailed information to the patient

Evaluation of the effect of vacuum assisted closure in the surgical management of Fournier's gangrene: A single center experience

Fournier's gangrene is a surgical emergency arising in the perineum and genital area and is characterized as necrotizing fasciitis of the perineum and genital area. It quickly spreads between the fascial planes and causes soft tissue necrosis. Diabetes mellitus is the most prevalent predisposing factor. Early diagnosis and management are critical in the progression of the disease. Surgical debridement and wide-spectrum antibiotic therapy are the first steps in treatment. Despite advancements in diagnosis and treatment procedures and changes in critical care techniques, the disease has a death rate of 16-40%. This research compares patients operated on for Fournier's gangrene between January 2016 and January 2022, including those treated with vacuum-assisted closure technique, vs those who were not. We acquired and analyzed the data on the patients' demographic and clinical features from hospital records. The study involved 16 patients, six (38%) in Group 1 and 10 (62%) in Group 2, 11 men (68 %) and five women (32%). Swelling in the wound region was the most prevalent complaint. The most common gangrene site was the perianal region, and diabetes was the most common predisposing condition. Group 2 had a significantly shorter hospital stay (p=0.02). There was no statistically significant difference in mortality or other parameters between the groups. The main advantages of VAC therapy are that it requires fewer dressings, causes less pain, and reduces the risk of contamination. The advantages of the traditional wet dressing include its ease of use and low cost and the fact that VAC therapy promotes faster wound healing and shorter hospital stays

Giant retroperitoneal malignant peripheral nerve sheath tumor treated with multiorgan resection: A case teport and review of the literature

Malignant peripheral nerve sheath tumors (MPNST) are rare. Although they originate from Schwann cells or pluripotent neural crest cells, they constitute less than 10% of all soft tissue sarcomas and more than 60% develop on the basis of neurofibromatosis. It is difficult to diagnose MPNST. Although it mostly occurs in the head and neck region or upper extremities, only 1% of cases are located in the retroperitoneal region. The main treatment is surgery, but survival results are not satisfactory even after surgery with R0 resection. They are not sensitive to chemotherapy and radiotherapy and tend to recur locally. The mass detected by imaging in a 57-year-old male patient who admitted to hospital with the complaint of abdominal pain was excised with clear surgical margins. The tumor was located in the left upper quadrant of the abdomen and seemed to invade the pancreas and left kidney in the computed tomography images. The patient had no history of neurofibromatosis or radiation. In this study, it was aimed to present our case diagnosed with retroperitoneal MPNST and treated with multiorgan resection, which is a rare entity, and to increase the awareness of clinicians about the diagnosis, treatment and prognosis of this rare tumor

De Garengeot hernia associated with perforated appendicitis: A rare case report

De Garengeot hernia is defined as the presence of the appendix vermiformis in the femoral hernia sac by a French surgeon, Rene Jacques Croissant de Garengeot, in 1731 . In literature, there are less than 100 cases. This clinical entity is usually diagnosed peroperatively and it is rarely noticed preoperatively on tomography scan. In this paper, it was aimed to present a patient admitting the emergency service with abdominal pain, diagnosed as De Garengeot hernia  with perforated appendicitis preoperatively and undergone laparoscopic appendectomy. Depending on the presence or absence of acute infection of the appendix vermiformis, presence of perforation / abcess, type of surgical approach and whether appendectomy and hernia repair are performed sımultaneously or not, there are different treatment modalities. In our case, laparoscopic appendectomy with abscess drainage was performed and hernia repair is planned as a delayed secondary intervention

Comparison of staging systems in gastric carcinoma

Aim: Gastric carcinoma is one of the most frequent cancers and leading causes of cancer-related death worldwide. Treatment strategies are planned according to the Tumour-Node-Metastasis (TNM) stage of the disease. However, the prognosis varies substantially even within the same stage. Prognostic nomograms were designed to overcome this diversity. In this study, staging systems and prognostic tools are compared in the context of their ability to predict patients’ prognosis. Methods: Records of 391 patients operated for gastric cancer from January 2006 to September 2013 were analysed retrospectively. TNM staging system, Metastatic lymph node ratio (LNR), Kattan Prognostic Tool and Prognostic Tool of Italian Research Group on Gastric Cancer (GIRCG) were compared with the patients’ survival times by their concordance indices and correlation coefficients. Results: A total of 343 patients were included in the study. Concordance indices of the compared staging systems were 0.678 for TNM, 0.601 for GIRCG scale, 0.646 for LNR stage and 0.680 for Kattan scale. Pearson correlation coefficients were 0.404 for TNM staging, 0.314 for GIRCG scale, 0.304 for LNR stage and −0.406 for Kattan scale. Spearman correlation coefficients were 0.383, 0.311, 0.310 and −0.400 respectively. Conclusion: Based on these results, Kattan prognostic scale was found to be the most accurate system for predicting mortality. This was followed by TNM staging system. © 2021 John Wiley & Sons Lt

Comparison of endoloop and Hem-o-lok clip for stump closure in laparoscopic appendectomy: which one is more cost-effective. A retrospective study

We aimed to show the effect of closure of the appendix stump with different methods during laparoscopic appendectomy (LA), on postoperative complications, healing process and costs. Patients who underwent LA due to acute appendicitis in the last 5 years in Rize were retrospectively analyzed. Our study includes comparative analysis on two patient groups in which we carried LA. We used endoloop (EL) in Group 1 and hem-o-lok polymeric clip (HC) in Group 2 to close the appendix stump. Patients were compared in terms of demographic characteristics, American Society of Anesthesiologists (ASA) score, preoperative white blood cell and C-reactive protein (CRP) elevation, whether a drain was used, appendix diameter, pathological diagnosis, postoperative complications, duration of surgery and length of stay, and cost. Of 209 patients, 111 (51.2%) were male and 98 (48.8%) were female. The frequency of drain placement was higher in Group 2 (P = 0.005). No stump leakage was observed in either group, but the incidence of other postoperative complications was significantly higher in the EL group (P=0.041). The use of HC is cheaper than the use of EL. There was no significant difference in other parameters. Both EL and HC are used safely in LA. Although both methods do not have obvious advantages over each other, HC stands out one step further due to its more affordable cost and less possibility of postoperative complications

A rare form of persistent Mullerian duct syndrome: Transverse testicular ectopia with germ cell testis cancer and hernia uteri inguinalis

Persistent Mullerian duct syndrome is a rare form disorder of sexual differentiation characterised by the persistence of Mullerian derivatives (fallopian tubes, uterus and the proximal vagina) in males with an XY karyotype and normal virilisation. We report a case of a 29-year-old man with right transverse testicular ectopia, mix germ cell cancer at ectopic right testis and left-sided obstructed inguinal hernia containing a uterus and fallopian tube. We performed orchiectomy and hysterectomy on the patient