INTRODUCTİON: Currently, the management of cholelithiasis in combination with choledocholithiasis involves endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy. However, recently, early surgical approaches are becoming more common, even in the treatment of acute cholecystitis. METODS: Patients diagnosed as having cholelithiasis and choledocholithiasis between October 2017 and May 2019 were prospectively enrolled in the study in a randomized manner. Patients undergoing ERCP + LC (laparoscopic cholecystectomy) in the same session were assigned to group A (n = 39), those undergoing ERCP + LC in the same hospitalization period were assigned to group B (n = 43), and patients who underwent delayed cholecystectomy after ERCP were included in group C (n = 37). RESULT: A total of 119 patients (47 females and 72 males) were included in the study and divided into three groups. Statistical comparisons of the study groups showed a significant difference between the three groups in terms of the length of hospital stay (days) and total cost (p < 0.001). The total cost was significantly higher for patients in group C in comparison with those in groups A and B (p < 0.001). Compared with patients in groups A and B, there was statistically significant difference in the length of hospital stay for patients in group C (p < 0.001). CONCLUSİONS: Single-stage ERCP plus LC is a safe and feasible strategy for the management of cholelithiasis and choledocholithiasis, offering advantages of cost, shorter hospital stay, and total anesthesia time. The major advantage of ERCP and LC performed in the same session and during the same hospitalization is the absence of the risk of recurrent episodes of acute cholecystitis, which occur with delayed cholecystectomy.

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. İn 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.

Ectopic opening of the common bile duct (EO-CBD) is a rare pathology, and its management is important. To date, only a few studies have been conducted for EO-CBD due to its low incidence. A retrospective review was conducted on 54 patients with available prospective data. Among them, 30 patients (group 1) underwent choledochoduodenostomy for reasons other than anomalous opening, and 24 patients (group 2) had an EO-CBD. Endoscopic retrograde cholangiopancreatography (ERCP) was performed for 24 patients with duodenal deformity and apical stenosis. EO-CBD was detected in 2.72% of all patients who underwent ERCP (24/880 ERCPs). The occurrence of hyperbilirubinemia (total bilirubin >1.2 mg/dL) was not significantly different between groups: 3.83±4.57 mg/dL for group 1 and 2.26±2.17 mg/dL for group 2. Failed ERCP, giant stones, and recurrent episodes (>2) of cholangitis requiring ERCP constitute indications for surgical treatment in cases of EO-CBD into the duodenum.

Cerrahi’nin Tarihçesi Adem ASLAN Cerrahi Hastalarda Sıvı ve Elektrolit Yönetimi Tuba MERT Şok Burak UÇANER Cerrahi Enfeksiyon Oğuz HANÇERLİOĞULLARI Travma Cerrahisi Çağdaş KARAMAN Cerrahi Yara İyileşmesi Mehmet Sabri ÇİFTÇİ Cerrahi Kanama ve Transfüzyon Serdar ACAR Baş Boyun Cerrahisinde Yenilikler Seda SEZEN GÖKTAŞ Tiroid Hastalıklarına Yaklaşım Zeynep ANADOLULU Paratiroid Hastalıklarına Yaklaşım Murat ÖZKARA Benign Meme Hastalıklarına Yaklaşım Nimet SÜSLÜ Malign Meme Hastalıkları Cerrahisi Murat KARTAL Meme Kanserinde Sentinel Lenf Nodu Biyopsisi Furkan SAVAŞ Onkoplastik Meme Cerrahisi Hasan Turgut AYDIN Diyafragma Cerrahisi İsa KARACA Özofagus Kanseri Cerrahisi Mevlüt YORDANAGİL Akalazya: Tanı ve Tedavi Sacit Altuğ KESİKLİ Güncel Mide Cerrahisi Ali DURAN Midenin Selim Hastalıklarına Yaklaşım Mehmet ARSLAN Güncel Bariatrik Cerrahi Yunus YAPALAK Obezitenin Cerrahi Dışı Tedavi Yöntemleri Elnur HÜSEYNOV Safra Kesesi Cerrahisi Özkan SUBAŞI Safra Yolları Girişimleri Mirkhalig JAVADOV Emrah KARATAY Pankreas Hastalıkları ve Tedavisi Gökhan GARİP Açık ve Laparoskopik Splenektomi Erhan ERÖZ Sürrenal Hastalıkları ve Cerrahisi Baran MOLLAVELİOĞLU Güncel Apandisit Cerrahisi Sibel ÖZKARA Kasık Fıtığının Açık ve Laparoskopik Cerrahisi Murat DEMİR Ventral Herni Cerrahisi Abdullah AS Malign ve Benign Hastalıklarda Karaciğer Cerrahisi Seda BAŞTÜRK Karaciğer Kistlerinin Tedavisi Mevlüt Harun AĞCA Karaciğer Kistlerinde PAIR Uygulaması Mehmet Emin UNUTMAZ Endoskopik Retrograd Kolanjiyopankreatografi ERCP Mikail UYAN HIPEC, Sıcak Kemoterapi Gözde ERTUNÇ AÇIKGÖZ Transanal Endoskopik Mikrocerrahi (TEM) Serdar ACAR İnce Bağırsak Cerrahisi Serkan YILMAZ Gastrointestinal Sistem Kanamaları Mesud FAKİRULLAHOĞLU Hasar Kontrol Cerrahisi Sümeyra GÜLER Laparoskopik Diagnostik Girişimler Bilal TURAN Endsokopik Submukozal Diseksiyon Mehmet BİÇER Laparoskopik İnce Barsak Cerrahisi Mesut YUR Güncel Kolorektal Cerrahi Barış CANDAN Benign Kolorektal Hastalıklara Yaklaşım Osman AKDOĞAN Mehmet KARAHAN Rektal Prolapsus Cerrahisi Yasin Orhan ERKUŞ Karın Duvarı Tümörlerine Yaklaşım Göktürk GÜRSOY Proktolojide Güncel Tedavi Yöntemleri Muhammet Fikri KÜNDEŞ Transplantasyon Emil HÜSEYİNOĞLU Bahtiyar MUHAMMEDOĞLU Genel Cerrahide Lazer Teknolojisinin Kullanımı Şükran ÇAVDAR Murat Bulut ÖZKAN Cerrahi Komplikasyon Yönetimi Gizem FIRTINA Perkütan Abdominal Apse, Sıvı Drenajı Tuğberk BAŞTÜRK Cerrahide Stapler Teknolojisi ve Enerji Aletleri Oğuzhan ÇÖĞÜRLÜ Jinekolojide Minimal İnvaziv Cerrahi Burcu AYDIN BOYAMA İleri Endoskopik Girişimler Girayhan ÇELİK Anormal Uterin Kanama ve Cerrahisi Cansu ÖNAL KANBAŞ Endoscopik Ultrasonografi Mahmut Baran YERLİKAYA Batın Kapama Yöntemlerinde Yenilikler İbrahim KILINÇ Pelvik Taban Kusurlarında Cerrahi Uygulamalar Tamer TOPALOĞLU Omurga Cerrahisi Furkan SOY Halil GÖK Pediatrik Yaş Grubunda Pilonidal Sinüs Tedavisine Güncel Yaklaşımlar Gonca GERÇEL Ali İhsan ANADOLULU Pediatrik Minimal İnvaziv Uygulamalar Ali İhsan ANADOLULU Gonca GERÇEL Jinekolojik Onkolojik Aciller Nur Cansu YILMAZ BALDAN Cerrahide Anestezi Yönetimi Fatma OKUCU Robotik Cerrahi Teknolojisinin Gelişimi Berke MANOĞLU

BACKGROUND Currently, perioperative complications of classic Whipple surgery occur at a rate of approximately 40%. Common complications include delayed gastric emptying, pancreatic fistula, and bile leakage, whereas gastrojejunostomy (GJ) leakage is rare. CASE SUMMARY This case report will assess the management of a GJ leak in a 71-year-old male patient following the Whipple procedure. After surgery, the patient was transferred to the clinic after four days of intensive care, where vacuum therapy was used to handle a developing subcutaneous collection. The patient, who had bile in the drains and incision during follow-up, underwent endoscopic examination on the 21st day after the operation. An opening of approximately 4 mm was observed in the GJ anastomosis during endoscopy. Five titanium clips were used to close the openings. The drainage of bile decreased to less than 50 mL on the first day after the procedure, and the patient's oral intake was opened. CONCLUSION Current literature reports a GJ leakage rate of 0. 54% following Whipple surgery, with clinical findings lasting on average between 4-34 days. Surgery was the main form of therapy for this case, with a success rate of 84%, and percutaneous drainage was also utilized as a treatment option. This case report is the first to document endoscopic treatment of GJ leaks following the classic Whipple procedure.

Amaç: Safra kesesi taşı başta olmak üzere benign safra kesesi hastalıklarında altın standart cerrahi yöntem laparoskopik kolesistektomidir ve standart laparoskopik kolesistektomi 4 port kullanarak uygulanır. Laparoskopik cerrahide artan deneyimle birlikte, ağrının, kesi sayısının azaltılması bunlara bağlı yatış süresi ve maliyetinin düşürülmesi kaygıları gündeme gelmiş bu amaca yönelik 3 porttan, tek porttan veya doğal açıklıklardan kolesistektomi uygulanmaya başlanmıştır. Bu çalışmada amacımız hastanemizde 3 port veya 4 porttan uygulanan laparoskopik kolesistektomi olgularımızı karşılaştırmaktır. Gereç ve Yöntemler: Kahramanmaraş Necip Fazıl şehir hastanesinde 2017-2022 yılları arasında Laparoskopik kolesistektomi uygulanan hastalar, hastanelerin dijital verileri ve ameliyat defterleri yardımıyla tarandı. Hastaların yaş, cinsiyet, ek hastalıkları gibi demografik verileri kaydedildi. Hastalar 3 port ve 4 portla kolesistektomi uygulananlar olmak üzere iki gruba ayrıldı. Gruplar ameliyat süresi, intraoperatif komplikasyonlar (kanama, safra yolu yaralanması, komşu organ yaralanması), postoperatif komplikasyonlar (kanama, safra fistülü), ameliyat süreleri, yatış süreleri postoperatif hemoglobin ve karaciğer fonksiyon testleri açısından karşılaştırıldı. Bulgular: Çalışmaya 843 hasta dahil edilmiş olup 262’si erkek (%31.1) ve 581’i (%68.8) kadındı. Yaş ortalaması 50.52 ±16.4 olup yaşları 18 ile 92 yaşları arasında değişmekteydi. 509 (%60.4) hastaya 4 portla ve 334‘üne (%39.6) 3 portla laparoskopik kolesistektomi uygulanmıştı. 3 port ve dört port karşılaştırıldığında istatistiksel olarak yatış süresi (p<0.05), 4 port grubunda yüksekti. Ameliyat süreleri arasında istatistiksel açıdan bir fark saptanmadı. Port sayılarına göre intraoperatif kanama, safra kaçağı, açık cerrahiye geçiş ve ilave port kullanımı açısından fark saptanmamıştır. Sonuç: Laparoskopik kolesistektomide 3-4 port arasında ameliyat süreleri, postoperatif safra kaçağı ve kanama komplikasyonu açısından fark saptanmamıştır. Komplikasyonlar göz önüne alındığında 3 port uygulamalar en az 4 port kolesistektomi kadar güvenlidir. Prospektif randomize çalışmalar konuyu daha net ortaya koyacaktır.