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Aim:Postoperative complications after colorectal cancer surgery result in increased treatment costs, prolonged hospital stays and poor prognosis and reduce quality of life of the patients. Here, we aim to contribute to the literature in terms of being a reliable marker of postoperative C-reactive protein (CRP) to albumin ratio (CAR) after colorectal cancer surgery.Method:A total of 213 patients undergoing colorectal cancer surgery between 2013 and 2018 were analyzed in this study. Risk factors for the development of postoperative complications were analyzed using univariate and multiple logistic regression models. A receiver operating characteristic (ROC) curve analysis was used to analyze the association with the CRP and CAR variables, with the aim being to differentiate postoperative complications.Results:Postoperative complications occurred in 87 (40.8%) patients. Based on the Clavien-Dindo classification, 25 (18.7%) patients developed major complications. Perioperative blood transfusion [odds ratio (OR)=1.3; 95% confidence interval (CI)=1.08-1.55] and postoperative CAR (OR=1.2; 95% CI=1.05-1.35) were independent risk factors for postoperative complications (p=0.005 for each). The cut-off value for CAR was 4.3 (sensitivity: 51.72; specificity: 71.43; and area under the curve: 0.642), meaning that CAR was found to be statistically significantly effective in differentiating postoperative complications (p4.3) group (p=0.001), while the laparoscopic surgery rate was statistically significantly lower in the high CAR group (p=0.039).Conclusion:CAR is a novel, reliable and independent marker. Moreover the ratio is useful for clinicians and provides the determination of early postoperative complications after colorectal cancer surgery.

Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival. Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival. There were 91 patients in the CME group (58 males, mean age 64 ± 16 years) and 192 patients in the CC group (96 males, mean age 66 ± 14 years). The mean number of harvested lymph nodes (CME: 42 ± 15 vs CC: 34 ± 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 ± 2.2 vs CC: 2.4 ± 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I–III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients. LNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery.

INTRODUCTION: In line with the developments in technology, the number of minimally invasive procedures in pancreatic surgery is increasing gradually in order to reduce the morbidity rates. We aimed to present the results of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumors in our clinic.METHODS: Data of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumor between April 2014 and August 2020 were retrospectively analyzed. Demographic and clinical characteristics, surgical outcomes, postoperative results and pathological data of the patients were presented.RESULTS: Of the 30 patients, 12 (40%) were female, 18 (60%) were male, and the mean age was 64±14. Laparoscopy was converted open technique in 5 (13.3%) patients. The mean operative time was 378±72 minutes and the mean length of hospital stay was 10±4 days. In postoperative period, 7 (23.3%) patients had minor complications and 4 (13.3%) patients had major complications. Major complications were grade B pancreatic fistula in 3 patients and intraabdominal abscess in 1 patient. Pathological diagnosis of patients were adenocarcinoma in 20 (66.7%) patients, intrapapillary mucinous neoplasm in 6 (20%) patients, solid pseudopapillary neoplasm in 2 (6.6%) patients, neuroendocrine tumor in 1 (3.3%) patient and gastrointestinal stromal tumor in 1 (3.3%) patient. The mean number of harvested lymph nodes was 16.5±8.2.DISCUSSION AND CONCLUSION: Laparoscopic assisted pancreaticoduodenectomy is a feasible method due to the advantages of minimally invasive procedures such as reducing local complications, morbidity, and length of hospital stay. However, we believe that laparoscopic assisted pancreaticoduodenectomy should be performed by teams experienced in laparoscopy in selected patients., GİRİŞ ve AMAÇ: Teknolojideki gelişmeler doğrultusunda, morbidite oranlarını azaltmak amacıyla pankreas cerrahisinde de minimal invaziv girişimlerin sayısı giderek artmaktadır. Bu çalışmada, kliniğimizde periampuller bölge tümörlerinde laparoskopi yardımlı pankreatikoduodenektomi uyguladığımız hastaların sonuçlarını paylaşmayı amaçladık.YÖNTEM ve GEREÇLER: Nisan 2014 ile Ağustos 2020 yılları arasında periampuller bölge tümörü nedeniyle laparoskopi yardımlı pankreatikoduodenektomi uygulanan hastaların demografik ve klinik özellikleri, ameliyat verileri, postoperatif sonuçları ve patolojik verileri retrospektif olarak incelendi.BULGULAR: Çalışmaya dahil edilen 30 hastanın 12’si (%40) kadın, 18’i (%60) erkek, ortalama yaşları 64 ± 14 idi. Beş (%13,3) hastada açık yönteme geçildi. Ortalama ameliyat süresi 378 ± 72 dakika ve ortalama hastanede kalış süresi ise 10 ± 4 gündü. Postoperatif dönemde, 7 (%23,3) hastada minor komplikasyon, 4 (%13,3) hastada ise major komplikasyon saptandı. Major komplikasyonlar; 3 hastada grade B pankreatik fistül ve 1 hastada ise karın içi apse idi. Hastaların patolojik tanıları; 20’sinde (%66,7) adenokarsinom, 6’sında (%20) intrapapiller müsinöz neoplazm, 2’sinde (%6,6) solid psödopapiller neoplazm, 1’inde (%3,3) nöroendokrin tümör ve 1’inde (%3,3) ise gastrointestinal stromal tümör idi. Ortalama çıkarılan lenf nodu sayısı 16,5 ± 8,2 idi.TARTIŞMA ve SONUÇ: Laparoskopi yardımlı pankreatikoduodenektomi, lokal komplikasyonları ve morbiditeyi azaltması, hastanede kalış süresini kısaltması gibi minimal invaziv girişimlerin sağladığı avantajlar nedeniyle uygulanabilir bir yöntemdir. Ancak laparoskopi yardımlı pankreatikoduodenektomi için, uygun hasta seçimi ile birlikte bu işlemin laparoskopi konusunda tecrübeli ekipler tarafından uygulanması gerektiği kanaatindeyiz.

Aim:Although there are clinical differences in colon cancer according to the location of the tumor, the differences between right and left colon cancers (CC) in terms of survival are not clear. Our aim was to analyze the clinicopathological differences between right and left CC and to investigate the effect of primary tumor location on recurrence and survival.Method:The data of 330 patients who underwent curative surgery for right (n=155) or left (n=175) colon cancer between 2011 and 2018 were retrospectively analyzed. Demographic characteristics, surgical data, pathological data, recurrence and survival rates of the patients were examined and the two groups were compared in terms of these parameters.Results:Male to female ratio was significantly higher and operative time was significantly longer in the left CC than in the right CC. The mean number of harvested lymph nodes was significantly higher in the right CC than the left CC (32±3 and 27±9, respectively, p=0.001). Compared to patients with left CC, those with right CC had higher tumor diameter and tumor volume, had more poorly differentiation and tended to have more mucinous and medullary type cancer. As a result of a median follow-up of 54 months, it was determined that the 5-year overall survival in stage I-III patients was worse in the right CC than in the left CC. Especially in stage III patients, both overall and disease-free survival rates were found to be statistically significantly lower in the right CC compared to the left CC (In stage III disease, overall survival was 66.9% in right CC and 81.8% in left CC, p=0.03; disease-free survival was 54.2% in right CC and 70.6% in left CC, p=0.04).Conclusion:There may be clinicopathological and prognostic differences in CC depending on the location of the tumor. As a result of the long followup period in our case series, the prognosis in the right CC was worse, especially in stage III patients.

Background This study primarily aimed to assess the impact of prolonged neoadjuvant treatment-surgery interval (PNSI) on histopathologic and postoperative outcomes. Impacts of the mode of neoadjuvant treatment (NT) and surgery on the outcomes were also evaluated in the same patient population. Patients and methods Between February 2011 and December 2017, patients who underwent NT and total mesorectal excision for locally advanced rectal cancer were included. PNSI was defined as >4 and >8 weeks after short-course and long-course NT modalities, respectively. Results A total of 44 (27%) patients received short-course NT (standard interval: n=28; PNSI: n=16) and 122 (73%) patients received long-course NT (standard interval: n=39; PNSI: n=83). Postoperative morbidity was similar between the standard interval and PNSI in patients undergoing short-course [n=3 (11%) vs. n=3 (19%), P=0.455] and long-course [n=6 (15%) vs. n=16 (19%), P=0.602] NT. PNSI was associated with increased complete pathologic response in patients receiving short-course NT [0 vs. n=5 (31%), P=0.002]. Compared with short-course NT, long-course NT was superior in terms of tumor response based on the Mandard [Mandard 1 to 2: n=6 (21%) vs. 6 (38%), P=0.012] and the College of American Pathologists (CAP) [CAP 0 to 1: n=13 (46%) vs. n=8 (50%), P=0.009] scores. Postoperative morbidity was similar after open, laparoscopic, and robotic total mesorectal excision [n=1 (14.2%) vs. n=21 (21%) vs. n=6 (12.5%), P=0.455] irrespective of the interval time to surgery and the type of NT. Conclusions PNSI can be considered in patients undergoing short-course NT due to its potential oncological benefits. The mode of surgery performed at tertiary centers has no impact on postoperative morbidity after both NT modalities.

In minimally invasive surgery, complete mesocolic excision (CME) for transverse colon cancer is challenging; thus, non-CME resections are commonly preferred when laparoscopy is used. Robotic technology has been developed to reduce the limitations of laparoscopy. The aim of our study was to evaluate whether robotic CME for transverse colon cancer can be performed with short-term outcomes similar to those of laparoscopic conventional colectomy (CC). A retrospective review of 118 consecutive patients having robotic CME or laparoscopic CC for transverse colon cancer in two specialized centers between May 2011 and September 2018 was performed. Perioperative 30-day outcomes of the two procedures were compared. There were 38 and 80 patients in the robotic CME group and laparoscopic CC group, respectively. The groups were comparable regarding preoperative characteristics. Intraoperative results were similar, including blood loss (median 50 vs 25 ml), complications (5.3% vs 3.8%), and conversions (none vs 7.5%). The rate of intracorporeal anastomosis was significantly higher (86.8% vs 20.0%), mean operative time was longer (325.0 ± 123.2 vs 159.3 ± 56.1 min (p

Diverting stoma has many complications and requires another operation. Ghost ileostomy is an option for occasional cases. We aimed to present the clinical data and early postoperative outcomes of our patients who had undergone ghost ileostomy. Ghost ileostomy was performed in 58 patients, depending on the level of the anastomosis, together with the experience and intraoperative decision of the surgeon. The patients were evaluated in terms of comorbidities, type of colorectal disease, and postoperative complications. Thirty-eight patients were male, the mean age was 59 ± 9 years, and the mean body mass index was 27 ± 5 kg/m2. Forty-six patients in whom a ghost ileostomy procedure was performed had sigmoid colon or proximal/middle rectal cancer, whereas eight patients had sigmoid diverticulitis, and four patients had ulcerative colitis. Anastomotic leakage was identified in 3 (5.1%) patients. In one patient, laparoscopic peritoneal lavage was performed, and ghost ileostomy was converted to diverting stoma, whereas in the other two patients, ghost ileostomy was converted to diverting stoma under local anesthesia. Ghost ileostomy can easily be converted to diverting stoma in some patients with no need for general anesthesia to reduce the morbidity of anastomotic leakage. With this method in selected patients, it is possible to avoid diverting stoma and unwanted complications of ileostomy.

Medullary carcinoma (MC) is a rare tumor with a solid growth pattern without glandular differentiation and constitutes less than 1% of colorectal cancers. Lymph node positivity and distant organ metastasis were reported to be lower than in other poorly differentiated adenocarcinomas. Therefore, the diagnosis of MC is pathologically important in terms of follow-up and treatment. We aimed to investigate the characteristics of medullary cancer in our case series. 427 patients with colorectal cancer (CRC) who underwent surgery between January 2011 and December 2017 were evaluated retrospectively in 2 groups as MC (n = 13) and non-MC (n = 414) in terms of demographic characteristics, pathological data, and oncological outcomes. 76.9% (n = 10) of the MC group were female while 36% (n = 149) of the non-MC group were female (p = 0.003). The tumors were located in the right colon in 84.6% (n = 11) of the MC patients and in 26.6% (n = 110) of the non-MC patients (p

Objective: In this study, it was aimed to compare short-term outcomes of minimally invasive and open surgery for gastric cancer in the Turkish population carrying both European and Asian characteristics. Material and Methods: Short-term (30-day) outcomes of the patients undergoing minimally invasive and open gastrectomy with D2 lymphadenec- tomy for gastric adenocarcinoma between January 2013 and December 2017 were compared. Patient demographics, history of previous abdominal surgery, comorbidities, short-term perioperative outcomes and histopathological results were evaluated between the study groups. Results: There were a total of 179 patients. Fifty (28%) patients underwent minimally invasive [laparoscopic (n= 19) and robotic (n= 31)] and 129 (72%) patients underwent open surgery. There were no differences between the two groups in terms of age, sex, body mass index and ASA scores. While operative time was significantly longer in the minimally invasive surgery group (p< 0.0001), length of hospital stay and operative morbidity were com- parable between the groups. Conclusion: While both laparoscopic and robotic surgery is safe and feasible in terms of short-term outcomes in selected patients, long operating time and increased cost are the major drawbacks of the robotic technique preventing its widespread use.

The location of colonic tumors has been linked to different clinical and oncologic outcomes. Transverse colon cancers are generally included as right colon cancers. Furthermore, hepatic and splenic flexure tumors are usually included as components of the transverse colon.This study was aimed at comparing the clinicopathologic characteristics and long-term outcomes between mid-transverse and right and left colon cancers and determining the prognostic impact of the primary tumor location in the mid-transverse colon.This was a retrospective study.Two specialized colorectal centers were included.Patients who underwent curative surgery for colon cancer were analyzed. Tumors located in the transverse colon, excluding the flexures, were defined as mid-transverse colon cancers.Demographic characteristics, operative outcomes, pathologic results, and long-term outcomes were the primary outcome measures.Of the 487 patients, 41 (8.4%) had mid-transverse, 191 (39.2%) had right, and 255 (52.4%) had left colon cancers. For mid-transverse colon cancers, the mean length of hospital stay, mean length of the resected specimen, and the mean number of harvested lymph nodes were significantly higher. For patients with stage I to III cancer, the 5-year overall and disease-free survival rates were significantly worse in the mid-transverse colon cancers than in the right and left colon cancers (overall survival: 55.5% vs 82.8% vs 85.9%, p = 0.004, and disease-free survival; 47.7% vs 72.4% vs 79.5%, p = 0.003). After adjustment for other clinicopathologic factors, mid-transverse colon cancers were significantly associated with a poor prognosis (HR = 2.19 [95% CI, 1.25-3.83]; p = 0.006).Molecular and genetic information were unavailable in this retrospective study.In our case series, colon cancers located in the mid-transverse colon showed poorer prognosis than cancers in other locations. The impact of tumor location in the mid-transverse colon on prognosis, including molecular and genetic markers, should be investigated further in prospective studies. See Video Abstract at http://links.lww.com/DCR/B631.ANTECEDENTES:La ubicación de los tumores de colon se ha relacionado con diferentes resultados clínicos y oncológicos. Los cánceres de colon transverso se incluyen generalmente como cánceres de colon derecho. Además, los tumores del ángulo hepático y esplénico suelen incluirse como un componente del colon transverso.OBJETIVO:Este estudio tuvo como objetivo comparar las características clínico-patológicas y los resultados a largo plazo entre los cánceres de colon transverso medio y derecho e izquierdo y determinar el impacto pronóstico de la ubicación del tumor primario en el colon transverso medio.DISEÑO:Este fue un estudio retrospectivo.AJUSTE ENTORNO CLINICO:Se incluyeron dos centros colorrectales especializados.PACIENTES:Se analizaron los pacientes que fueron sometidos a cirugía curativa por cáncer de colon. Los tumores ubicados en el colon transverso, excluidos los ángulos, se definieron como "cánceres de colon transverso medio".PRINCIPALES MEDIDAS DE RESULTADO VOLARACION:Las características demográficas, los resultados quirúrgicos, los resultados patológicos y los resultados a largo plazo fueron las principales medidas de resultado valoracion.RESULTADOS:De los 487 pacientes, 41 (8,4%) tenían cáncer de colon transverso medio, 191 (39,2%) derecho y 255 (52,4%) cáncer de colon izquierdo. Para los cánceres de colon transverso medio, la duración media de la estancia hospitalaria, la duración de la muestra resecada y el número medio de ganglios linfáticos extraídos fueron significativamente mayores. Para los pacientes en estadio I-III, las tasas de supervivencia general y sin enfermedad a 5 años fueron significativamente peores en los cánceres de colon transverso medio que en los cánceres de colon derecho e izquierdo (supervivencia general: 55,5% frente versus a 82,8% frente versus a 85,9%, p = 0,004 y supervivencia libre de enfermedad; 47,7% frente a 72,4% frente a 79,5%, p = 0,003, respectivamente). Después del ajuste por otros factores clínico-patológicos, los cánceres de colon transverso medio se asociaron significativamente con un pronóstico desfavorable (Razón de riesgo: 2,19; intervalo de confianza del 95%: 1,25-3,83; p = 0,006).LIMITACIONES:La información molecular y genética no estuvo disponible en este estudio retrospectivo.CONCLUSIONES:En nuestra serie de casos, los cánceres de colon localizados en el colon transverso medio mostraron un peor pronóstico que los cánceres en otras localizaciones. El impacto de la ubicación del tumor en el colon transverso medio sobre el pronóstico, incluidos los marcadores moleculares y genéticos, debe investigarse más a fondo en estudios prospectivos. Consulte Video Resumen en http://links.lww.com/DCR/B631. (Traducción-Dr Adrián Ortega).

Differentiation of the histopathologic subtypes can be clinically important as it can affect the course of treatment and the prognosis. The aim of this study was to investigate both the clinicopathological features and prognosis of histologic subtypes in right-sided colon cancer.This study included 138 patients who underwent surgery for right-sided colon cancer. The patients were divided into three groups according to histopathological subtypes as follows: medullary carcinoma (MC, n=11), mucinous adenocarcinoma (MAC, n=29), and classic adenocarcinoma (AC, n=98). The groups were compared in terms of demographic characteristics, type of surgery, pathological outcomes and survival.The rate of laparoscopic surgery was significantly lower in the MC group compared with MAC and AC groups (45.4% vs 54.5% vs 35.7%, respectively, p=0.001). In MC group, T4 stage was significantly higher than in other groups (90.0% vs 34.5% vs 35.7%, respectively, p=0.001). While patients with MAC had no distant metastasis, 18.2% and 15.3% of patients with MC and AC respectively, had distant metastasis (p=0.07). MAC vs MC, p=0.01, MAC vs AC, p=0.03). Tumor size, tumor volume, and the rate of microsatellite instability were found significantly higher in the MC group (p0.05). The 5-year overall (OS) and disease-free survival (DFS) were better in the MAC group compared with MC and AC groups, but these differences did not reach statistical significance (OS: 92.8% vs 72.7% and 68.7%, p=0.16 and DFS 87.3% vs 58.2% and 64%, p=0.10, respectively).MC is associated with more advanced tumor size and T stages, and therefore entails reduced rate of minimally invasive procedures. In our series, the absence of distant metastasis in the patients of MAC also had a positive effect on survival.

Amaç: Teknolojideki gelişmeler sayesinde, pankreas cerrahisinde de minimal invaziv girişim tercih etme oranları giderek artmaktadır. Bu çalışmadaki amacımız, pankreasın benign veya malign lezyonları için laparoskopik distal pankreatektomi (LDP) uyguladığımız hastalar ile açık distal pankreatektomi (ADP) uyguladığımız hastaları klinik, patolojik ve postoperatif sonuçlar açısından karşılaştırmaktır.Gereç ve yöntemler: Mart 2014 ile Eylül 2020 tarihleri arasında, pankreasın gövde veya kuyruk yerleşimli hastalıkları nedeniyle kliniğimizde distal pankreatektomi uygulanan hastaların verileri retrospektif olarak incelendi. Olgular, ameliyat yöntemlerine göre laparoskopik veya açık olacak şekilde iki gruba ayırıldı. Demografik özellikler, ameliyat verileri, postoperatif sonuçlar ve patolojik veriler açısından iki grup arasında karşılaştırmalar yapıldı.Bulgular: LDP grubunda 40, ADP grubunda ise 43 olgu vardı. İki grup arasında yaş, cinsiyet, vücut kitle indeksi ve ASA skorları açısından istatistiksel farklar saptanmadı. Ortalama ameliyat süresi LDP’de 259 ± 71 ve ADP’de 260 ± 68 dakikaydı (p=0.86). LDP grubunda 18 (%45) hastada pankreas güdüğü stapler ile kapatılmışken ADP grubunda 6 (%14) hastada stapler ile güdük kapatıldı (p = 0.03). Hastanede kalış süresi LDP grubunda ADP grubuna göre istatistiksel olarak anlamlı derecede kısa idi (LDP; 7.8 ± 1.9 vs ADP; 10.9 ± 4.2, p = 0.01). Klinik ile ilgili Grade B postoperatif pankreatik fistül, LDP grubunda 5 (%12.5) hastada ADP grubunda ise 7 (%16.2) hastada tespit edildi (p>0.05). Gruplar arasında tümör boyutu, ortalama çıkarılan lenf nodu ve patolojik lenf nodu sayısı açısından istatistiksel anlamlı farklar saptanmadı. Sonuç: Pankreasın benign veya malign lezyonları için distal pankreatektomi uygulanacak olgularda laparoskopik yöntemin güvenle tercih edilebilebileceği düşüncesindeyiz.

The aim of this study was to compare ghost ileostomy (GI) and defunctioning ileostomy (DI) in patients who underwent low anterior resection (LAR) for rectal cancer in terms of postoperative morbidity, rehospitalization rates, and total costs. Patients with an anastomosis level between 5 and 10 cm from the anal verge after LAR were analyzed retrospectively. Clinical characteristics, operative outcomes, postoperative morbidity, rehospitalization rates, and total costs were compared. A total of 123 patients were enrolled as follows: 42 patients in the GI group and 81 patients in the DI group. Anastomotic leakage (AL) was identified in three patients who underwent GI, and in all of them, GI was easily converted to DI. There were 96.3% of the patients with DI rehospitalized at least one time because of surgery-related and/or stoma-related complications or stoma closure. When we did not take into account the patients who were rehospitalized for stoma closure, the rates of rehospitalization were 4.7% and 22.2% in the GI and DI groups, respectively (P= 0.01). The mean total costs calculated by removing additional surgical procedures and adding all of the rehospitalization costs were 25,767 USD and 41,875 USD in the GI and DI groups, respectively (P= 0.0001). GI may be a safe and cost-effective method in patients who underwent LAR with low or medium risk factors for AL. It is possible to avoid unnecessary ileostomy and reduce unwanted outcomes due to it, such as postoperative complications, rehospitalizations, and increased total costs by performing GI.

We describe the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating, and report our preliminary results of using this technique to treat patients with the hemorrhoidal disease (HD). The subjects of this retrospective analysis were patients with symptomatic grades 2 or 3 HD. We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL. A total of 75 patients were included in the study (male/female ratio 1.88; mean age 48 ± 19 years; mean BMI 24 ± 3 kg/m2). Thirty-nine patients (52%) did not require hospitalization and were discharged from the day clinic approximately 4 h postoperatively. Four patients (5.3%) suffered tenesmus for about 1 week postoperatively and two (2.7%) suffered temporary rectal bleeding. The mean VAS scores 1 day postoperatively, then at 1 week, 1 month and 1 year were 2.9, 1.5, 0.4, and 0, respectively. At the 1-month follow-up, there was no sign of recurrence and the satisfaction rate was 78.6% (n = 59). At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65). Based on our preliminary findings, ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity. We anticipate that the incidence of tenesmus, which is encountered frequently after other dearterialization methods, will be lower after the ADL technique, which avoids both mass ligation of hemorrhoidal arteries deeper than 12 mm and running a long mucopexy suture line.

Background: The rate of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is high and insertion of preoperative bile duct catheterization (PBDC) predispose a high risk of SSI with multidrug resistant (MDR) microorganisms. Aim: To describe the effects of PBDC and the prophylaxis in development of SSI. Methods: We conducted a retrospective study between January 01, 2010 and December 2018 including the patients with PD and total pancreatectomy. Findings: In total 214 consecutive patients were included. The PBDC was inserted to 63 (29%) patients. The rate of intraoperative bile fluid culture positivity was higher among the patients with PBDC (84% vs. 17% respectively, p < 0.001). The SSI was detected in 52 patients (24%). In multivariate analysis, the rate of SSI was found to be higher among the patients with PBDC (OR: 2.33, 95% Cl: 1.14–4.76, p = 0.02). As the etiologic agents of SSI, Pseudomonas spp. and MDR pathogens were mainly detected in PBDC group. The resistance to ampicillin-sulbactam was significantly higher in the PBDC group (87.5% vs. 25%, p = 0.012). The similar bacterial species both in bile fluid and the surgical site were detected in 11 (21%) patients with SSI. Among 8 patients (15%), antimicrobial susceptibility was the same. Only in five out of 52 (10%) patients, the SSI pathogens was susceptible to the agent that was used for surgical prophylaxis. Conclusion: Unnecessary catheterizations should be avoided. By considering the increasing prevalence of resistant bacteria as the cause of SSI, the clinicians should closely follow-up their patients for choosing the proper antimicrobials., NA

In this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index >= 30 kg/m(2)), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P

Situs inversus totalis (SIT) is a rare condition. In this case, a patient who underwent laparoscopic anterior resection for repeated sigmoid colon diverticulitis with SIT was presented. Laparoscopy surgery in patients with this condition has some important technical differences than standard laparoscopic procedures. Therefore, it may be more appropriate to request surgical experience to perform safe laparoscopic surgery in patients with SIT., NA

The aim of this study was to evaluate the feasibility of robotic total/subtotal colectomy procedures with the Xi robot and to compare its short-term outcomes with those of conventional laparoscopy. Between October 2010 and September 2018, consecutive patients with colonic neoplasia, inflammatory bowel disease, familial adenomatous polyposis or colonic inertia who underwent elective robotic or laparoscopic total/subtotal abdominal colectomy at two specialized centers in Turkey were included. Data on perioperative characteristics and 30-day outcomes were compared between the two approaches. There were a total of 82 patients: 26 and 56 patients in the robotic and laparoscopic group, respectively (54 men and 28 women, mean age 54.7 ± 17.4 years). The groups were comparable regarding preoperative characteristics. All the robotic procedures were completed with a single positioning of the robot. Estimated blood loss (median, 150 vs 200 ml), conversions (0% vs 14.3%), and complications (0% vs 7.1%) were similar but operative time was significantly longer in the robotic group (median, 350 vs 230 min, p

Heald and Ryall introduced surgical techniques consisting of the complete removal of the mesorectum, which was named total mesorectal excision (TME) in the 1980s. The main outcome that could be achieved in the surgical treatment of rectal cancer is obtaining a good quality mesorectal excision besides enough harvested lymph nodes. TME reduces the risk of local recurrence and improves survival in patients with mid and low rectal disease. Many studies have indicated that minimally invasive surgery provides a faster postoperative recovery and a lower complication rate compared to conventional surgery. Ever since laparoscopic colectomy was done in 1991, its volume has increased over the last 30 years. In 2002 the first robotic-assisted colectomy article was published and in 2006 the first robotic-assisted TME article was published. After a learning curve for robotic surgery, it could be possible complete TME for oncological outcomes. Many studies have shown that there were no differences in terms of surgical and oncological outcomes between robotic and laparoscopic methods in rectal surgery. The aim of this video presentation study is to report the technical details of laparoscopic and robotic approaches for rectal cancer surgery and to state the similarities and differences between these two methods., NA

Appendiceal intussusception (AI) is a difficult disease to diagnose. Various features of the disease were analyzed in a 35-year-old female patient admitted with abdominal pain and diagnosed with AI. The diagnosis was made with colonoscopy and abdominal computed tomography. Laparoscopic partial cecum resection was performed. Pathology examination revealed foci of endometriosis externa, which infiltrated the muscular layer of the appendix. AI should be kept in mind in the differential diagnosis of recurrent abdominal pain. Colonoscopy is an indispensable examination for differential diagnosis. Laparoscopic partial cecum resection, preserving the ileocecal valve, is an appropriate treatment approach in irreducible cases that are not suspected to be malignant., NA

Appendix intussusception (AI) is a difficult disease to diagnose. Various features of the disease have been analyzed in a 35-year-old female patient who was admitted with abdominal pain and diagnosed with AI. The diagnosis was made with colonoscopy and abdominal computed tomography. Laparoscopic partial cecum resection was performed. The pathology examination revealed foci of endometriosis externa, which infiltrated the muscular layer of the appendix. AI should be kept in mind in the differential diagnosis of recurrent abdominal pain. Colonoscopy is an indispensable examination for the differential diagnosis. Laparoscopic partial cecum resection, preserving ileocecal valve, is an appropriate treatment approach in irreducible cases that are not suspected to be malignant.