32 research outputs found
Factors affecting cecal intubation tinae in colonoscopy: Impact of obesity
No full textObjective 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
Learning curve of laparoscopic surgery for colorectal cancer at a new regional state hospital: A single-surgeon experience of 106 consecutive cases without supervision
No full textBackground: 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
The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy
No full textBACKGROUND: This study was designed to investigate the diagnostic efficacy of computed tomography (CT) for the detection diaphragmatic injury in cases undergoing diagnostic and therapeutic laparoscopy in left thoracoabdominal penetrating injuries.METHODS: Demographic properties, stabbed body region, additional injuries, hemodynamic parameters, time to admission, diagnostic examinations, and type of treatment were retrospectively reviewed in one hundred and eight patients presenting with left thoracoabdominal injury after penetrating sharp object injury between April 2010 and December 2014. Preoperative CT scans of all patients were reviewed blind to the results of surgical evaluation. The relationship between diaphragmatic injury and hemothorax, pneumothorax, abdominal free fluid, and solid organ injuries were analyzed. All patients underwent physical examination, complete blood count monitoring, and hemodynamic assessment prior to surgery.RESULTS: The most common finding on physical examination was anterior left thoracoabdominal injury. The injury was detected surgically in 36% of twenty-five cases with lateral injury. Diaphragmatic injury was present in twenty-five (23.1%) of all cases, all of whom were treated with laparoscopic repair. An analysis of all CT findings in relation to surgical results revealed that CT had a sensitivity of 80%, a specificity of 95%, a PPV of 83%, and a NPV of 94% for the detection of diaphragmatic injuries. Mean duration of hospital stay was 5.4 days (range, 1-16 days) in the entire study population.CONCLUSION: CT is still associated with diagnostic challenges in penetrating diaphragmatic injuries. Nevertheless, CT showed a high specificity and a negative predictive value in our study. Detection of a diaphragmatic defect and fatty tissue herniation makes the definitive diagnosis of diaphragmatic injury in penetrating thoracoabdominal injuries. Prospective studies with a larger sample size are necessary to further clarify the role of CT in detection of diaphragmatic injuries in thoracoabdominal sharp penetrating object injuriesBACKGROUND: This study was designed to investigate the diagnostic efficacy of computed tomography (CT) for the detection diaphragmatic injury in cases undergoing diagnostic and therapeutic laparoscopy in left thoracoabdominal penetrating injuries.METHODS: Demographic properties, stabbed body region, additional injuries, hemodynamic parameters, time to admission, diagnostic examinations, and type of treatment were retrospectively reviewed in one hundred and eight patients presenting with left thoracoabdominal injury after penetrating sharp object injury between April 2010 and December 2014. Preoperative CT scans of all patients were reviewed blind to the results of surgical evaluation. The relationship between diaphragmatic injury and hemothorax, pneumothorax, abdominal free fluid, and solid organ injuries were analyzed. All patients underwent physical examination, complete blood count monitoring, and hemodynamic assessment prior to surgery.RESULTS: The most common finding on physical examination was anterior left thoracoabdominal injury. The injury was detected surgically in 36% of twenty-five cases with lateral injury. Diaphragmatic injury was present in twenty-five (23.1%) of all cases, all of whom were treated with laparoscopic repair. An analysis of all CT findings in relation to surgical results revealed that CT had a sensitivity of 80%, a specificity of 95%, a PPV of 83%, and a NPV of 94% for the detection of diaphragmatic injuries. Mean duration of hospital stay was 5.4 days (range, 1-16 days) in the entire study population.CONCLUSION: CT is still associated with diagnostic challenges in penetrating diaphragmatic injuries. Nevertheless, CT showed a high specificity and a negative predictive value in our study. Detection of a diaphragmatic defect and fatty tissue herniation makes the definitive diagnosis of diaphragmatic injury in penetrating thoracoabdominal injuries. Prospective studies with a larger sample size are necessary to further clarify the role of CT in detection of diaphragmatic injuries in thoracoabdominal sharp penetrating object injurie
The learning curve of laparoscopic inguinal hernia repair: A comparison of three inexperienced surgeons
No full textIntroduction: 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
The mechanisms of recurrent laryngeal nerve injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring on surgical strategy
No full textObjective: To evaluate the mechanisms of recurrent laryngeal nerve (RLN) injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring (C-IONM) on surgical strategy
Laparoscopic inguinal hernia repair-TAPP versus TEP: Results of 301 consecutive patients
No full textIntroduction: 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
Aksesuar Veya Polar Renal Arteri Olan Canlı Vericilerden Renal Transplantasyonda Mikrocerrahi Sonuçları 4 Farklı Vaka Sunumu
No full textGraves Oftalmopatisinde Tiroidektomi Sonrası Orbital Doku Volümleri ve Proptozis Değişikliklerinin Manyetik Rezonans Görüntüleme ile Değerlendirilmesi.
No full textComparison of Clinical Outcomes of Single-Incision Versus Conventional Multiport Laparoscopic Distal Pancreatectomy: A Single Institution Experience
No full textObjectives: Single-incision laparoscopic procedures have been gaining popularity in recent years due to their minimal incisional morbidity and improved cosmetic outcomes. Herein, we will compare the feasibility and outcomes of single-incision and conventional multiport laparoscopic distal pancreatectomy
Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus
No full textIntroduction: New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment (EPSIT) and sinus laser therapy (SiLaT) have promising results and advantages of laparoscopic surgery. Aim: To compare the efficiency and safety of EPSIT with SiLaT. Material and methods: Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively. Data of patients’ demographics, complications and postoperative course were collected and compared between the two groups. Results: We analyzed seventy-three patients who underwent EPSIT or SiLaT, with a mean age of 23.4 ±8.4 (12–46) years and body mass index (BMI) of 25.5 ±4.5 (18–38) kg/m2. Among them, 36 patients (26 males, ten females) underwent EPSIT and 37 patients (27 males, ten females) underwent SiLaT. Mean operative time was similar for both groups (32.3 ±14.8 vs. 31.0 ±14.8; p = 0.757). Early complications (minimal bleeding) were recorded in 2 patients in the SiLaT group. The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group (1.3 ±0.5 (1–3) vs. 1.9 ±1.1 (1–5); p = 0.005). The mean postoperative time of total wound healing was similar for both groups: 23.6 ±14.7 (12–90) vs. 25.2 ±14.5 (14–90) days (p = 0.385). There was no significant difference in the average time of return to total daily activity (3.4 ±0.9 (2–5) vs. 3.6 ±1.2 (2–7) days, p = 0.679). There were no significant differences between the groups regarding late postoperative complications (recurrence: 7). Conclusions: Both methods have similar early and late complications. The duration of need for analgesic usage was shorter in EPSIT patients
