Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience.

BACKGROUND: The present study aimed to evaluate the safety and efficacy of transperitoneal laparoscopic adrenalectomy (LA) for large adrenal tumours by comparing the outcomes of tumours larger than 6 cm with those smaller than 6 cm and also to identify the risk factors associated with prolonged operative time in transperitoneal LA. PATIENTS AND METHODS: One hundred and sixty-three patients underwent LA at our clinic from January 2014 to December 2020. Bilateral LA was performed in 20 of these 163 patients. A total of 143 patients were included in this study. Data were analysed retrospectively from the patients' medical records collected. RESULTS: Large tumour (LT) group consists of 33 patients and the small tumour (ST) group consists of 110 patients. There was no statistically significant difference between the groups regarding conversion to open surgery and complications. A multiple regression analysis was conducted to identify the independent predictors of prolonged operation time. The tumour size ≥8 cm (odds ratio [OR], 19.132; 95% confidence interval [CI], 3.881-94.303; P < 0.001) and diagnosis of pheochromocytoma (OR, 2.762; 95% CI, (1.123-6.789, P = 0.026) were the significant predictors of prolonged operation time. CONCLUSION: Our study shows that LA can be considered the treatment of choice for small and large adrenal tumours. The tumour size ≥8 cm and diagnosis of pheochromocytoma are the independent risk factors for the prolonged operative time in transperitoneal LA.

Comparison of single incision and multi incision diagnostic laparoscopy on evaluation of diaphragmatic status after left thoracoabdominal penetrating stab wounds.

AIM: Single incision diagnostic laparoscopy (SIDL) may be an alternative procedure to multi-incision diagnostic laparoscopy (MDL) for penetrating thoracoabdominal stab wounds. The purpose of this study is sharing our experience and comparing two techniques for diaphragmatic status. MATERIALS AND METHODS: Medical records of 102 patients with left thoracoabdominal penetrating stab injuries who admitted to Istanbul School of Medicine, Trauma and Emergency Surgery Clinic between February 2012 and April 2016 were examined. The patients were grouped according to operation technique. Patient records were retrospectively reviewed for data including, age, sex, length of hospital stay, diaphragm injury rate, surgical procedure, operation time and operation time with wound repair, post-operative complications and accompanying injuries. RESULTS: The most common injury location was the left anterior thoracoabdomen. SIDL was performed on 26 patients. Nine (34.6%) of the 26 patients had a diaphragm injury. Seventy-six patients underwent MDL. Diaphragmatic injury was detected in 20 (26.3%) of 76 patients. The average operation time and post-operative complications were similar; there was no statistically significant difference between MDL and SIDL groups. CONCLUSION: SIDL can be used as a safe and feasible procedure in the repair of a diaphragm wounds. SIDL may be an alternative method in the diagnosis and treatment of these patients.

Comparison of the clinical outcomes of self-gripping mesh versus staple fixation mesh in laparoscopic inguinal hernia repair.

AIM: Inguinal hernia repairs are the most common operations performed in general surgery practice worldwide. Different surgical techniques, mesh types and different fixation methods have been developed for hernia repair. The aim of this study was to compare the clinical results of staple fixation and self-gripping meshes used in laparoscopic inguinal hernia repair. MATERIAL AND METHOD: Forty patients who presented with inguinal hernia between January 2013 and December 2016 and underwent laparoscopic hernia repair were analyzed. The patients were divided into two groups according to used staple fixation (SF group, n = 20) and self-gripping (SG group, n = 20) meshes. Operative and follow-up data of both groups were analyzed and compared in terms of operative time, postoperative pain levels, complications, recurrence, and patient satisfaction. RESULTS: The groups were similar in terms of age, sex, BMI, ASA score, and comorbidities. The mean operative time of SG group (52.75 ± 17.58 min) was significantly lower than SF group (64.75 ± 16.66 min) (p = 0.033). The mean postoperative 1st hour and 1st week pain scores was lower in SG group. Long-term follow-up revealed a single case of recurrence in the SF group, and none of the cases in either group had chronic groin pain. CONCLUSION: In conclusion, in our study where we compared two mesh types in laparoscopic hernia surgeries, it was concluded that self-gripping mesh is a fast, effective and safe mesh similar to polypropylene mesh, which can be used without increasing recurrence and postoperative pain rates, when applied by experienced surgeons. KEY WORDS: Chronic groin pain, Inguinal hernia, Self-gripping mesh, Staple fixation.

Is laparoscopic splenectomy safe in patients with immune thrombocytopenic purpura and very low platelet count? A single-institution experience.

PURPOSE: Minimal invasive procedures has become increasingly popular during the last decades. The aim of this retrospective study was to evaluate the safety and feasibility of laparoscopic splenectomy in patients with immune thrombocytopenic purpura who has very low platelet counts. METHODS: Between March 28, 2005 and June 08, 2013, a total of 132 patients with the diagnosis of immune thrombocytopenic purpura were included to study. The patients who underwent laparoscopic splenectomy were alienated into two groups according to their platelet counts lower than 10000 (group 1) and higher than 10000 (group 2) RESULTS: There were 16 patients in group 1 with very low platelet counts, and 116 in group 2. One patient in group 1 had converted to laparotomy due to peroperative bleeding, and there were 5 conversion to open in group 2. There were also 2 patients in group 2 who underwent laparatomy on post operative day 1 due to delayed intra-abdominal bleeding. Moreover, one patient in each group had pancreatic fistula. CONCLUSIONS: Laparoscopic splenectomy is a safe technique in patients with ITP even the patients have very low platelet counts. KEY WORDS: ITP, Laparoscopy, Low platelet count, Splenectomy.