Utilization and outcomes of Hartmann's procedure in emergency left colon surgery: evaluating postoperative complications and stoma reversal rates.

OBJECTIVE: The aim of the study was to investigate the utilization and outcomes of Hartmann's procedure in the emergency left colon surgery with respect to other stoma interventions. PATIENTS AND METHODS: A total of 70 consecutive patients (mean±SD age: 71.1±15.5 years, 51.4% were males) who underwent emergency surgery for the left colon were included in this retrospective cohort study. Data on patient demographics, primary diagnosis, emergency surgery indication, operative risk, stoma type (Hartmann's procedure, primary anastomosis with diverting loop ileostomy, double-barreled ostomy), surgeon sub-specialty, postoperative complications, and stoma reversal time and rates were recorded. RESULTS: Hartmann's procedure (72.9%) was the most commonly utilized stoma type, followed by primary anastomosis with diverting loop ileostomy (14.3%) and double-barreled ostomy (10.0%), while primary anastomosis was performed only in 2.8% of patients. The stoma reversal rate was 25.0%, and the median time to stoma reversal was 10 months (range, 3 to 48 months). Hartmann's procedure was less commonly performed by colorectal surgeons than by general surgeons (35.3% vs. 68.4%, p=0.013) and was associated with a lower chance of stoma reversal compared to other stoma types, including primary anastomosis with diverting loop ileostomy and double-barreled ostomy (15.7% vs. 52.9%, p=0.006). CONCLUSIONS: In conclusion, our findings revealed that Hartmann's procedure, although performed less commonly by colorectal surgeons than by general surgeons, was still the most prevalent procedure applied for the surgical management of left colon emergencies, particularly in the setting of tumor-induced obstruction or perforation, despite the potential risk of severe postoperative complications and lower stoma reversal rates with this procedure.

The relationship between serum tumor-associated trypsin inhibitor levels and clinicopathological parameters in patients with gastric cancer.

BACKGROUND: Tumor-associated trypsin inhibitor (TATI) is expressed with trypsinogen in tumors. We studied the clinical-pathologic association and significance of preoperative serum levels of TATI in gastric cancer patients. PATIENTS AND METHODS: Pre-treatment serum levels of TATI in patients with gastric cancer and healthy controls were analyzed by a specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Statistically significant differences were found in serum TATI levels between patients with gastric cancer and healthy controls (p < 0.0001). There was a significant relationship between the serum levels of TATI and clinicopathological parameters. However, serum levels of TATI were significantly higher in patients with an advanced T stage (T3) (p < 0.001), lymph node metastasis (p < 0.001) and an advanced TNM stage (stage III or IV; p < 0.001). CONCLUSIONS: Our study suggests that TATI may be used to identify potentially high-risk groups of upper gastric carcinoma. Elevated level of TATI was associated with progressive disease or advanced stage.

Evaluation of the effects of hyperbaric oxygen treatment and enoxaparin on left colon anastomosis. An experimental study.

BACKGROUND: Surgical interventions on left colon lead to high morbidity. The problems in wound healing are the main cause of this morbidity. Hypoxia retards wound healing and hyperbaric oxygen treatment (HBOT) has an anti-hypoxic effect. MATERIALS AND METHODS: In this experimental study we divided eighty Wistar albino rats into eight groups and numbered between 1 and 8. Normal (non-ischemic) and ischemic left colon anastomosis were performed in the first and second four groups respectively. HBOT and subcutaneous enoxaparin were applied to the groups separately and in combination for four days, except the control groups. (Group-1 and Group-5). We measured anastomotic bursting pressures and performed pathological examinations besides electron microscopic study in one sample from each group after sacrificing the rats on the fourth day. RESULTS: There were no statistically significant differences in bursting pressures when we compared Group-1 with other non-ischemic groups, and Group-5 with Group-6, but there were statistically significant differences when we compared Group-5 with Group-7 and 8. In pathological examination, there were no statistically significant differences between the groups concerning necrosis, epithelization, granulation tissue formation and collagen deposition. Statistically significant differences were found in the scores of neovascularization when we compared Group-1 with Group-3 and 4, and Group-5 with Group-8. Electron microscopic evaluation revealed a prominent increase both in neovascularization and collagen fibers in the samples taken from the groups received enoxaparine and hyperbaric oxygen treatment in combination. CONCLUSIONS: These findings suggest that HBOT increases neovascularization and bursting pressures in ischemic colon anastomosis in contrast with enoxaparin.

Comparison of the right and left laparoscopic live donor nephrectomies: a clinical case load.

BACKGROUND: The aim of the present study was to retrospectively compare the results of right- and left-laparoscopic donor nephrectomy (LDN) performed in our Center. PATIENTS AND METHODS: Two hundred and eight patients who were operated on between October 2010 and October 2011 were included. Of the patients, 65 underwent right-LDN and 143 underwent left-LDN. The groups were compared in terms of duration of surgery, warm ischemia time, postoperative complications, length of hospital stay, and donor outcomes. RESULTS: The mean duration of surgery was 144±19.7 min and 147.8±20.2 min in the right- and left-LDN groups, respectively. The mean warm ischemia times were 139.1±54.1 s and 141.5±37.9 in the right- and left-LDN groups, respectively. The mean length of hospital stay was 2.4±1.0 days for both groups. No major complications were observed in the groups. There was no significant difference between the groups in terms of donor outcomes. CONCLUSIONS: The right-LDN is approached cautiously because of short length of vein and the risk for thrombosis. The results of the present study demonstrated that the right-LDN is as safe and effective as the left-LDN.

Liver Transplantation in Patients With Complete Portal Vein Thrombosis: Renoportal or Varicoportal Anastomosis Using Cryopreserved Vein Grafts.

BACKGROUND: Despite technical developments in transplantation surgery, complete portal vein thrombosis still remains a challenge for restoration of adequate portal vein inflow. Renoportal or varicoportal anastomosis provides an effective alternative solution for patients with complete portal vein thrombosis. This study describes our experience with renoportal and varicoportal anastomosis during liver transplantation. PATIENTS AND METHODS: Between January 2014 and May 2016, 5 patients with complete portal vein thrombosis underwent extra-anatomic portal anastomosis. In 3 cases, varicoportal anastomosis was performed and for the others, end-to-end renoportal anastomosis. We used iliac cryopreserved vein grafts to restore portal anastomosis in 3 cases. Epidemiology, risk factors, surgical techniques, complications, and outcomes of these procedures were evaluated over short- and long-term follow-ups. RESULTS: The follow-up time is 3 years for our first renoportal case, which was performed in a cadaveric liver transplantation; it was also first nationwide case. The other renoportal anastomosis was practiced in a living donor liver transplantation and the follow-up time is 8 months. The patient and graft survival rates were 100% at the last follow-up. The follow-up times are 10.9 and 4 months for the patients with varicoportal anastomosis. One of these patients died due to recurrence of hepatocellular carcinoma. The other two patients are alive with good graft functions. CONCLUSION: Our experience suggests that reno-varicoportal anastomosis is a useful technique for patients with complete portal vein thrombosis and cryopreserved grafts may be safely used.

Laparascopic Donor Nephrectomy Is Safe for Extremely Old Donors and Provides a Good Outcome for Their Recipients.

PURPOSE: This study sought to evaluate the outcomes of laparoscopic donor nephrectomy in donors age 70 years and older, who may be considered extremely old. PATIENTS AND METHODS: We compared the outcomes of grafts from donors age 70 years and older (group ≥ 70; n = 28) with donors younger than 55 years (group < 55; n = 28) after matching these 2 groups in terms of sex, date of surgery, body mass index, and immunological features, retrospectively. RESULTS: There was no statistical difference between the 2 groups in terms of operation duration, estimated blood loss, and cold ischemia time. However, warm ischemia time was found to be slightly longer in the younger group. The mean hospital stay length was similar for both groups, and no postoperative complications occurred in any donor. Early and intermediate-term serum creatinine levels of donors and their recipients were not statistically different in both groups. CONCLUSIONS: Laparoscopic donor nephrectomy can be performed safely in selected extremely old donors without concern for early and intermediate-term graft function, with the aim of extending donor pool.

Oncostatin-M as a novel biomarker in colon cancer patients and its association with clinicopathologic variables.

OBJECTIVE: The aim of this study was to evaluate preoperative serum oncostatin M (OSM) concentration as a diagnostic marker in colon cancer patients and its association with clinicopathologic variables. PATIENTS AND METHODS: Preoperative serum OSM concentrations were measured in 100 colon cancer patients and 70 healthy volunteers by enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum OSM concentrations were significantly higher in colon cancer patients than in controls (p < 0.001). Serum OSM concentrations increased significantly with higher T stage (p < 0.001) and were significantly higher in patients with increased tumor burden, lymphovascular involvement, and lymph node and distant metastasis (p < 0.001 for each). CONCLUSIONS: To our knowledge, this is the first report showing that elevated OSM concentration was associated with colon cancer and its clinicopathologic variables, including invasion and metastasis. These findings indicate that serum OSM may serve as a novel biomarker in the diagnosis of colon cancer.

The role of preoperative serum levels for Dickkopf-related protein 1 as a potential marker of tumor invasion in patients with stage II and III colon cancer.

OBJECTIVES: To determine and correlate preoperative serum levels of CEA and Dickkopf-related protein 1 (DKK-1) in stage II and III colon cancer and so identify the patients at high risk for early relapse. PATIENTS AND METHODS: A total of 100 patients with stage II (n = 50; median age: 53 years, 31 males) and III (n = 50; median age: 57 years, 32 males) colon cancer and 50 controls (median age: 53.9 years, 25 males) were included. Serum levels for CEA and DKK-1 were recorded in each subject. RESULTS: Mean (SD) levels for serum CEA and DKK-1 were significantly higher in stage III patients than in stage II patients and controls (p < 0.001 for each). There was a significant correlation between serum levels of CEA and DKK-1 in stage II (r = 0.71, p < 0.001) stage III (r = 0.62, p < 0.001) patients. CONCLUSIONS: Preoperative serum levels for DKK-1 seem to be a potential marker in prediction of tumor invasion and relapse in stage II-III colon cancer.