Safety and efficacy of laparoscopic colectomy in low volume centre following effective laparoscopic training. Retrospective cohort study.

The use of minimally invasive surgery in colon cancers is becoming widespread and developing day by day Laparoscopic right hemicolectomy (LRHC) with complete mesocolic excision is gradually becoming the standard oncological surgical principle for right hemicolectomy. The aim of our study was to evaluate the safety and efficacy of laparoscopic right hemicolectomy in a small-volume center. METHODS: Clinical outcomes were analyzed in a study comparing laparoscopic right hemicolectomy with conventional right hemicolectomy. By standardizing laparoscopic right hemicolectomy in our center, data on patient characteristics, surgical details, tumor, lymph node, and metastasis stage (TNM), postoperative recovery, and survival were retrieved and analyzed from retrospective databases. RESULTS: Patients underwent open (n. 63) and laparoscopic (n. 51) right hemicolectomies in our units. In the laparoscopic group, the rate of conversion to open was 5.8%, and there was no mortality for 30 days. In the open group, the first-month mortality was 6.3%, and the rate of complications was 15.9%. The mean age of the patients in the laparoscopic group (65.7±13.46) was statistically significantly higher than that of the open group 60.49±12.67) (p=0.042). Operation time was 147.53±57 minutes in the laparoscopic group and 132.84±34 minutes in the open batch, and there was no statistically significant difference between them. Significant correlations were found between stage and cancer subgroup information (p=0.001). Adenocarcinoma (42%) and mucinous (43.8%) type cancers were found more frequently in patients with stage III, while signet ring cancers were more common (100%) in stage IV patients. CONCLUSIONS: LRHC and laparoscopic conventional right hemicolectomy offered similar oncologic outcomes for right colon cancers in small volume centers. LRHC can be performed safely, and sufficient laparoscopic experience is essential for it to be considered the gold standard procedure. With an improved standard technique and systematic learning method, patient safety and surgical results can be achieved as successfully as in the open surgical approach. KEY WORDS: Colorectal cancer, Intracorporeal anastomosis, Right laparoscopic hemicolectomy, Side-to-side anastomosis.

Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study.

INTRODUCTION: Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures. MATERIALS AND METHODS: Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed. RESULTS: Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography. CONCLUSIONS: ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. In some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.

A Rare Cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception.

Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology. HOW TO CITE THIS ARTICLE: Sertkaya M, Emre A, Pircanoglu EM, Yazar FM, Tepe M, Cengiz E, Isler A, Vicdan H. A Rare cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(2):179-182.

Giant Appendicular Mucocele Due to Mucinous Cystadenoma.

Mucocele of the appendix is a rare clinicopathological entity simulating acute appendicitis. The most common form of the mucocele is cystadenoma, which is characterized by luminal dilatation producing large amounts of mucin. We present a new case of a giant mucocele of appendix with mucinous cystadenoma. A 61-year-old female was admitted with complaints of severe lower right quadrant pain. Ultrasonography and computed tomography (CT) suggested that it was a mucocele, but due to severity of pain, she underwent an emergency operation. Fortunately, without a perforation, it was a giant mucocele and the operation was terminated with an uneventful appendectomy with segmental cecal resection. The histopathological evaluation of the specimen reported to be a mucocele with mucinous cystadenoma with negative surgical margins. The patient was discharged postoperative 6th day, and a control colonoscopy and abdominal CT was planned for 6 months following surgery. Appendicular mucocele is rare and difficult to diagnose preoperatively, and sometimes it may be of large size which increases the risk of perforation. Pseudomyxoma peritonei (PP) is the most feared complication of mucocele perforation. Appendectomy with negative margins is a requirement for adequate treatment for most cases. Utmost care should be taken during surgery to avoid perforation of mucocele. HOW TO CITE THIS ARTICLE: Sertkaya M, Emre A, Pircanoglu EM, Peker O, Cengiz E, Karaagaç M. Giant Appendicular Mucocele Due to Mucinous Cystadenoma. Euroasian J Hepato-Gastroenterol 2016;6(2):186-189.

A rare cause of dyspnea in a patient presenting to the emergency department: a case report and review of the literature of laparoscopic cholecystectomy complication.

UNLABELLED: In recent years, there has been an emerging preference by patients for emergency services due to the efficiency of transactions and the increased quality of service. As a result, emergency departments have experienced an extreme density of patients. Nevertheless, patients require the same standard of care and should be evaluated carefully. The emergency physician should evaluate the patient as a whole in light of the findings and not merely according to the recommendations of the consultant. We describe in this case report a rare complication occurring after laparoscopic cholecystectomy, shortness of breath, which could easily be disregarded. KEYWORDS: Laparoscopic cholecystectomy complication; Dyspnea; Intrahepatic subcapsular hematoma.