The effect of carbon monoxide releasing molecule-2 (CORM-2) on healing of ischemic colon anastomosis in rats

Background/aim: Ischemia on the colon wall negatively affects healing of anastomosis. We were aimed to evaluate the effects of carbon monoxide releasing molecule-2 (CORM-2) on the healing of anastomosis in a rat model of the ischemic colon. Materials and methods: In this prospective study a total of 60 rats were randomly divided into three groups as colon transection and end-to-end anastomosis (Group I), colon transection, and end-to-end anastomosis following the induction of ischemia (Group II), and colon transection and end-to-end anastomosis following the induction of ischemia and treated with daily intraperitoneal administration of CORM-2 (Group III). Each group was also divided into two equal subgroups as postoperative 3rd and 7th day. Postoperative healing of anastomoses was evaluated by anastomosis burst pressure (ABP), tissue biomarkers including hydroxyproline (HP), malondialdehyde (MDA), glutathione (GSH), and histopathological findings. Results: In the ischemic group treated with CORM-2, lower MDA and higher HP levels were observed in comparison to the untreated ischemic group on the 3rd day. GSH and HP levels were higher and MDA levels was lower in the ischemic rats treated with CORM-2 than in the ischemic untreated rats on the 7th day. In the ischemic group treated with CORM-2, the mucosal epithelial score decreased and the neoangiogenesis score increased compared to the untreated rats on the 7th day. Conclusion: In ischemic colon anastomosis, reduces cell destruction by suppressing the oxidative reaction, and strengthening the antioxidative mechanisms of the cells. It also increases collagen formation, epithelial development, and neoangiogenesis.

A new prognostic marker in patients undergoing Hartmann's procedure for acute tumoral obstruction of the left colon.

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann's Procedure (HP) and post-operative complications. METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade

Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries.

Objectives: The effective way to reduce the risk of fecal incontinence (FI) in primary repaired obstetric anal sphincter injuries (OASIS) patients is to accurately detect the injury and provide complete anatomical reconstruction. The aim of the study was to evaluate the short-term and long-term results of OASIS cases that were diagnosed by an experienced surgical team and whose perineal body and anal sphincters were reconstructed separately. Material and Methods: Sixteen patients that required consultations due to anal sphincter damage during vaginal delivery and underwent anatomical reconstruction due to Grade 3c and Grade 4 sphincter damage between 2007 and 2019 were included in the study. These cases were divided into three groups [Group 1 (≤12 months), Group 2 (12-60 months), Group 3 (≥60 months)] according to the time elapsed until anal manometry, and incontinence questionnaires were conducted in the postoperative period. Recto-anal inhibitory reflex (RAIR), mean resting (IB) and squeezing (SB) pressures were measured by anal manometry. Anal incontinence (AI) and FI rates were determined by questionnaires. Anal sphincter damage repair techniques (overlapping, end-to-end) were determined. These parameters were compared between the three groups. Results: Mean age of the patients was 27.5 (16-35) years. Six (37.5%) patients had Grade 3c, while 10 (62.5%) had Grade 4 injury. The overall mean RP and SP were 35 (26-56) mmHg and 67 (31-100) mmHg, respectively. Mean RP and SP were 46/67 mmHg, 33.5/75.5 mmHg, and 37.5/70.5 mmHg in Groups 1, 2, and 3 respectively. There was no difference between the three groups in terms of mean RP and SP (p= 0.691, p= 0.673). The rate of AI and FI in all patients were 18.75% and 12.5%, respectively while the rate of severe AI incontinence was 6%. Severe AI was observed in 1 (16.7%) case in Group 1, mild AI was observed in 1 (25%) case in group 2, and in 1 (16.7%) case in Group 3. RAIR was positive in all patients. In Group 1, 5 (83.3%) patients underwent overlapping repair, and in Group 3, 6 (100%) patients underwent end-to-end repair. This difference was statistically significant (p= 0.011). Conclusion: In vaginal births, evaluation of anal sphincter damage, determination of perineal body structures and anal sphincters separately and performing anatomical reconstruction when needed significantly reduce the rate of FI in the short and long term.

Histopathological examination of the impact of sodium hypochlorite on the hepatobiliary system. An experimental study.

BACKGROUND: The liver is the most common organ for settlement of hydatic cyst disease. All acknowledged protoscolicidals that are used for echinococcus degeneration have a risk of caustic secondary sclerosing cholangitis. The sodium hypochlorite is an effective protoscolicidal agent for treatment of hydatid liver cysts in vitro. OBJECTIVE: This study aimed to investigate the safe usability of sodium hypochlorite for the treatment of hydatid cyst in the hepatobiliary system in an experimental rat model. METHODS: This experimental study designed as one side blinded animal study. Study was carried out between October 2017 and August 2018. Rats were randomly allocated to the study (n=7), control (n=7), and sham (n=7) groups. A duodenotomy was performed, and a catheter was inserted through the ampulla. The tip of the catheter was placed to instill 0.15 ml sodium hypochlorite (0,25%) solution, and 0.15 ml isotonic saline solution were into the common bile duct in the study and control groups, respectively. After three months, all rats were sacrificed. Livers, biliary tracts, pancreas, and duodenum were investigated for histopathological changes by blinded two pathologists. RESULTS: No significant difference was found between groups for periductal portal inflammation (p=0.077), parenchymal inflammation, and focal necrosis (p=0.119). There was not any histopathological change in 71.4 % of the subjects in control and experimental groups. CONCLUSION: Sodium hypochlorite (0,25%) did not cause any unfavorable changes in the hepatobiliary system, and this reminds that sodium hypochlorite can be a safe alternative in percutaneous drainage, laparoscopic, and open surgery in the treatment of hydatid cyst. KEY WORDS: Hepatobiliary system, Hydatid disease, Sodium hypochlorite, Treatment.

Intussusception Can Be the First Sign of Post-transplant Lymphoproliferative Disease.

Intussusception is usually seen in the pediatric age group and rarely seen in adults. It results in the progression of the proximal segment of the intestine into the distal intestine. A 50-year-old immunosuppressive male patient presented with the complaints of abdominal pain, nausea, vomiting, and no gas or stool discharge for 2 days. He was hospitalized with the presumptive diagnosis of acute abdomen. He has a history of renal transplantation due to chronic renal insufficiency. An explorative laparotomy was performed. The operative findings were compatible with jejunojejunal intussusception, and a segmental small bowel resection and end-to-end anastomosis were performed. The patient was uncomplicated postoperatively and discharged on the fifth postoperative day. The pathology was reported as Epstein-Barr virus negative with diffuse large-cell B lymphoma. In this case report, we aim to report on a jejunojejunal intussusception that was presented as the first sign of post-transplant lymphoproliferative disease.

Management of Laparoscopic Cholecystectomy-Related Bile Duct Injuries: A Tertiary Center Experience.

BACKGROUND: Laparoscopic cholecystectomy (LC)-related bile duct injuries remains a challenging issue with major implications for patient's outcome. METHODS: Between January 2008 and December 2012, we retrospectively analyzed the management and treatment outcomes of 90 patients with bile duct injury following LC. RESULTS: Forty-seven patients (52.2%) were treated surgically while the remaining 43 patients (47.8%) underwent non-surgical intervention. Injuries of Strasberg Type A and C were significantly more frequent in the non-surgical intervention group (P = 0.016, P = 0.044) whereas Type E2 was more frequent in the definitive surgery group (P < 0.001). The success rate of non-surgical intervention decreased as the waiting time increased whereas the success of definitive surgery was not time-dependent (P = 0.048). Initial jaundice (direct biluribin >1.3 gr/dL) significantly reduced the success rate of non-surgical interventions (P = 0.017). Presence of intraabdominal abscess significantly increased the complication rate after both definitive surgery and non-surgical interventions (P = 0.04, P = 0.023). Treatment success rates were similar in both surgery and non-surgical intervention groups according to the distribution of Strasberg injury types. CONCLUSION: A multimodality approach is recommended in planning for patient-based treatment. Delayed referral reduces the success of nonsurgical interventions while it does not seem to significantly affect the success of surgical interventions when intraabdominal sepsis is under control.