Giant colon lipoma.

Colon lipomas are rare, non-epithelial tumors. They are generally smaller than two centimeters and asymptomatic, they are incidentally diagnosed and do not require treatment. Large and symptomatic colon lipomas are rather rare. Its differential diagnosis is generally made by histopathological examination of the resected specimen. A fifty-year-old female patient presented with the symptoms of abdominal pain, swelling in the abdomen and loss of weight. During colonoscopy, there was a submucosal mass of 8×6 cm, which almost completely obstructed the lumen in the hepatic flexure and was covered by a mucosa that was sporadically ulcerated and necrotic in nature. In magnetic resonance imaging, an ovoid mass with a diameter of 8.5 cm at its widest dimension was detected, which had signal intensity similar to that of adipose tissue. Since the patient was symptomatic and differential diagnosis could not be made, she underwent laparoscopic right hemicolectomy. A submucosal lipoma was detected on histopathological examination of the specimen. The patient was discharged without any problems on post-operative day 7. Definite diagnosis of lipomas before surgery is challenging; they may be mistaken for malignancy, especially if the lesion is large and ulcerated. For large and symptomatic colon lipomas, surgery is required to both prevent complications and rule out malignancy.

Symptomatic duodenal lipoma with endoscopic snare polypectomy.

Duodenal lipomas are extremely rare benign tumors. 90% arise from the submucosa and is usually localized in the second portion. They are usually asymptomatic and are detected incidentally during endoscopy or surgery. Appearance of symptoms are related to lesion size, those greater than four centimeters frequently may cause intussusception, obstruction or bleeding. A 59- year-old woman presented with complaints of abdominal fullness in the upper quadrants after meals, and heartburn symptoms. She had been under treatment for iron deficiency anemia during the last five months. The upper gastrointestinal endoscopy revealed a mobile, 4×2 cm polypoid mass extending from the second portion of the duodenum to the third portion, with a regular mucosa and wide pedicle. Saline and epinephrine was injected to polyp base and "snare" polypectomy was performed. Patient's complaint of fullness in the upper part of the abdomen declined after polypectomy and the treatment of anemia was discontinued after a month, with normal blood count values in the fourth month.

Effects of resveratrol on incisional wound healing in rats.

PURPOSE: The objective of this study was to investigate the effect of resveratrol on the healing process after midline laparotomy in rats. METHODS: The study was performed on adult female Wistar-Albino rats. The study group was orally administered 0.5 mg/kg resveratrol once a day for 7 days before the operation until 12 h before surgery and then the treatment was maintained throughout the study. Each rat was anesthetized, and a 4-cm midline laparotomy was performed. Ten animals in each group were sacrificed on postoperative days 7, and 14. A tensile strength analysis was performed, hydroxyproline levels were measured, and the abdominal incision wounds were examined histologically. RESULTS: Resveratrol administration significantly increased the tensile strength of the abdominal fascia, and increased the hydroxyproline levels on postoperative day 14. The acute inflammation scores, collagen deposition scores and the neovascularization scores on postoperative days 7 and 14 were found to be significantly higher in the resveratrol treatment group compared to the control group. The amount of granulation tissue and the fibroblast maturation scores were found to be significantly higher only on postoperative day 14 in the treatment group compared to the control group. CONCLUSION: Our findings show that resveratrol may have a beneficial effect on incisional wound healing.

Simvastatin improves incisional wound healing in a rat model: an experimental study.

UNLABELLED:  This study investigated the effect of simvastatin on the heal- ing process of abdominal wall wounds in rats. METHODS: The study was performed with adult female Wistar-Albino rats. Control group (n = 20) rats were fed standard laboratory diet until 12 hours before sur- gery. Study group (n = 20) rats received oral simvastatin therapy with an orogastric tube (10 mg/kg once a day) for 7 days until 12 hours before surgery. Each rat was anesthetized, and a 4 cm-long midline laparotomy was performed. Ten animals from each group were killed at postoperative days (PODs) 7 and 14. Breaking strength analysis was measured, and the abdominal incision wounds were examined histolog- ically. RESULTS: Hydroxyproline levels and tensile strength of abdominal fascia were significantly higher in the study group on PODs 7 and 14 compared to the control group. The granulation tissue fibroblast matu- ration scores on POD 7, and both collagen deposition scores and neo- vascularization scores on PODs 7 and 14, were found to be statistically significantly higher in the simvastatin treatment group compared to the control group, based on the results of the histologic tissue examina- tions. CONCLUSION: Simvastatin can be used as a supporting therapy in wound healing. .

Effect of sildenafil on wound healing: an experimental study.

PURPOSE: We aimed to investigate the effect of sildenafil on the healing process of abdominal wall wound in rats. MATERIALS AND METHODS: The study was performed with adult female Wistar-Albino rats. Control group (n = 50) were fed on standard laboratory diet until 12 h before surgery. Study group (n = 50) were applied orally with orogastric tube 10 mg/kg once a day for 10 days of sildenafil therapy. Each rat was anesthetized, and a 4-cm-long midline laparotomy was performed. Ten animals from each group were killed at postoperative days (PODs) 4, 7, 14, 21, and 35. Breaking strength analysis was measured, and the abdominal incision wounds were examined histologically. RESULTS: Breaking strength for the midline incision, acute inflammation score on POD 14, and neovascularization on PODs 7, 14, 21, and 35 were significantly higher in the study group. CONCLUSIONS: Sildenafil can be used as a supporting factor in wound healing.

Prosthetic repair of incarcerated inguinal hernias: is it a reliable method?

BACKGROUND AND AIM: It is generally accepted that most inguinal hernias should be operated on electively using synthetic grafts. However, limited information is available on the usage of these materials in patient with incarcerated and strangulated hernias. The objective of this study is to compare the outcomes of incarcerated inguinal hernia repair with or without graft. MATERIALS AND METHODS: One hundred-thirteen patients with incarcerated inguinal hernia that underwent surgery were included in this study. Patients who underwent Lichtenstein repair were assigned to group I; those who underwent primary repair were assigned to group II. Demographics and characteristics of patients in each group were compared. Chi-square and Student's t-tests were used. RESULTS: No statistical difference was found between patients who did and did not receive anastomosis in both groups in terms of surgery duration, length of hospital stay, postoperative morbidity, and mortality. Recurrence was found in 4.0% and 20.8% patients in group I and group II, respectively (P = 0.036). CONCLUSIONS: Mesh repair can be preferred in incarcerated inguinal hernia patients because recurrence rate was significantly lower in patients who underwent Lichtenstein repair in this study.

Flapless conventional thyroidectomy: a prospective, randomized study.

PURPOSE: Conventional thyroid surgery is one of the most common operations performed worldwide. The conventional technique involves placement of small or large cutaneous flaps. However, the published data regarding flap use for thyroidectomy are contradictory. This study presents the results using a flapless conventional thyroidectomy and the efficacy of this approach in a thyroidectomy. In addition, the study determined whether there are any advantages associated with the use of this approach in comparison to conventional thyroid surgery. METHODS: One hundred and forty-two patients underwent a thyroidectomy. The patients were randomly assigned to surgical procedures. Patients in Group 1 (n = 70) underwent a conventional thyroidectomy, and patients in Group 2 (n = 70) underwent a conventional thyroidectomy without a cutaneous flap. RESULTS: There was no significant difference between the two groups in terms of age, sex, body mass index, length of incision, gland volume, and length of hospital stay. Postoperative pain was significantly less in Group 2 than in Group 1 (P = 0.006). Patients in Group 2 showed significantly lower requirement for postoperative intravenous analgesic (P = 0.001), and postoperative peroral analgesic (P = 0.023) in comparison to those in Group 1. Incidences of transient vocal cord paralysis and hypocalcemia were 1.4% and 1.4%, respectively. Of 140 patients, 5 (3.6%) developed postoperative wound complications. CONCLUSIONS: These results indicate that a flapless thyroidectomy is safe and technically feasible, and therefore could be an alternative to a conventional thyroidectomy.

Effect of ascorbic Acid on incisional wound healing in streptozotocin-induced diabetic rats.

UNLABELLED: Abstract: Background. Abdominal wall repair after celiotomy is important because insufficient incisional wound strength results in wound failures such as fascial dehiscence and herniation. Ascorbic acid has been shown to play an important role in wound healing. The purpose of this study was to investigate whether ascorbic acid improves incisional wound healing in a diabetic rat. METHODS: Male Wistar-Albino streptozosin-induced diabetic rats (n = 20) were divided into two groups: control group (CG; n = 10), and daily 200 mg/kg ascorbic acid (study group, [SG], n = 10) given orally. Ten animals from each group were euthanized on postoperative day (POD) 14 after wounding; breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. RESULTS: The hydroxyproline tissue content of the abdominal fascia in the ascorbic acid treatment group was superior to the control group, and the difference was statistically significant (P < 0.05). The tensiometric analyses revealed that tensile strength for the midline incision was significantly higher in the study group compared to the control group (P < 0.05). Significant differences were found in the results of histologic examination of tissue specimens between the two groups regarding acute inflammation, chronic inflammation, granulation tissue fibroblast maturation, collagen deposition, and neovascularization on POD 14 (P < 0.05). CONCLUSION: The present study demonstrates that administration of ascorbic acid prior to laparotomy expedites wound healing in a rat. On the contrary, we suggest that it could confer benefits to tissue healing by significantly enhancing tissue hydroxyproline levels, neovascularization, fibroblast maturation, and collagen deposition.

Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables.

BACKGROUND: We sought to review the clinical presentation and outcomes of surgical management of gastrointestinal stromal tumours (GISTs). METHODS: We reviewed clinical and pathological records of 41 patients (23 men and 18 women) with GISTs. We performed survival analyses using the Kaplan- Meier method and evaluated long-term survival and the independent prognostic factors that affect survival using univariate analyses. We used the Cox proportional hazards regression model to estimate the simultaneous effect on overall survival. RESULTS: The stomach was the most common tissue of origin (n = 20, 48.8%). The mean tumour diameter was 8.3 cm. We detected advanced-stage tumours in 22 (53.7%) patients. We performed complete resection in 31 (75.6%) patients. Mitotic count was greater than 5/50 high-power field [HPF] in 22 (53.6%) patients. Immunohistochemical staining for CD117 was positive in 40 (97.6%) patients. Five patients (12.2%) died in the early postoperative period. The mean follow-up period was 38.7 months. The median length of survival was 53 months and the 5-year survival rate was 49.4%. Univariate analyses revealed significantly enhanced survival for the following variables: patient age less than 60 years (p = 0.011), male sex (p = 0.048), tumour diameter less than 5 cm (p = 0.029), low-risk tumour according to Fletcher classification (p = 0.022), complete resection (p < 0.001), and lack of local recurrence (p < 0.001) and/or metastasis (p < 0.001). Our Cox proportional hazards model revealed that complete tumour resection was the only factor to increase survival. CONCLUSION: Overall survival is significantly affected by positive margins. A complete surgical resection with negative margins is the best method for definitive treatment of GISTs.

Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test: a prospective study.

AIM: To evaluate the use of the trypsinogen-2 dipstick (Actim Pancreatitis) test for early diagnosis and prediction of severity in acute pancreatitis (AP). METHODS: Ninety-two patients with AP were included in this study. The control group was 25 patients who had acute abdominal pain from non-pancreatic causes. Urine trypsinogen-2 dipstick test (UTDT) and conventional diagnostic tests were performed in all patients. Patients were divided by the Atlanta classification into two groups as having mild or severe pancreatitis. RESULTS: UTDT was positive in 87 (94.6%) of the AP patients and in two (8%) controls (P < 0.05). Positive UTDT was found in 61 (92.4%) of 66 (71.7%) patients with mild pancreatitis and in all (100%) of the 26 (28.3%) with severe pancreatitis (P > 0.05). UTDT positivity lasted longer in severe pancreatitis compared with that in mild pancreatitis (6.2 +/- 2.5 d vs 2.0 +/- 1.43 d, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of UTDT were 91%, 72%, 96.6%, 70.4%, 3.4 and 0.1, respectively. CONCLUSION: UTDT is a simple, rapid and reliable method for use on admission. It has high specificity and low NLR for early diagnosis and prediction of severity in AP. However, its relatively low NPV does not allow trypsinogen-2 dipstick test to be a stand-alone tool for diagnosis of acute pancreatitis; the use of other conventional diagnostic tools remains a requirement.

Survival analysis after surgical treatment of gastric cancer: review of 121 cases.

BACKGROUND/AIMS: This study was performed to evaluate major morbidity, early mortality and to analyze survival in our patients that underwent surgical treatment for gastric cancer. METHODOLOGY: Records of 121 patients with gastric adenocarcinoma that underwent surgery between 1997 and 2004 were reviewed retrospectively. Age, gender, tumor site, presence of local invasion, depth of tumor invasion, lymph node metastases, stage of the disease, distant metastases, histological differentiation, type of surgery, and blood transfusions were evaluated in relation to survival. Survival curves were estimated using the Kaplan-Meier method and the differences in survival were compared by the log-rank test. RESULTS: Forty-two cases (34.7%) underwent total gastrectomy, 34 (28.1%) had subtotal gastrectomy, and 45 (37.2%) received palliative surgery. The majority of the patients (61.2%) had stage IV gastric cancer. Total morbidity and mortality were 26.4% and 17.3%, respectively. The factors that influence survival were type of surgery, adjacent organ invasion, existence of metastases, lymph node status, blood transfusions, and stage of the disease in this study. Among the significant prognostic factors in the univariate analysis, only one factor, R0 resection proved to be independently significant in the multivariate analysis. CONCLUSIONS: R0 resection was found to have a significant favorable effect on survival in our study.

Band ligation of the perforated gall bladder during laparoscopic cholecystectomy.

Perforation of the gall bladder is a frequent complication during laparoscopic cholecystectomy. Grasping the perforated part of the gall bladder, clip application, or endoscopic loop application are possible solutions to prevent spillage. We propose laparoscopic rubber band application to close the perforated part of the gall bladder as an easy and safe method. We performed rubber band application after iatrogenic perforation of the gall bladder during laparoscopic cholecystectomy in 5 patients. Two-millimeter-wide multiple rubber rings, cut from a 14-Fr Foley catheter, are loaded on a grasper. When a perforation occurred during the dissection of the gall bladder, the hole is grasped with this instrument and 1 of the rings is placed on the gall bladder by the aid of a dissector. Thus, the grasper remained available for traction of the Hartmann's pouch during further dissection of the gall bladder. The rubber bands were placed successfully in all cases. Two perforations occurred in 1 case, and 2 bands were placed with ease. Bile leakage or gall stone spillage did not occur. Operation time was not prolonged. Rubber band ligation of perforation of the gall bladder is a simple, safe, inexpensive, and effective method to prevent spillage of the bile or gallstones in laparoscopic surgery.

A new approach in bowel preparation before colonoscopy in patients with constipation: A prospective, randomized, investigator-blinded trial.

OBJECTIVE: Enema administration in the morning of routine colonoscopy is known to be useless. However, the potential bowel cleansing effects of distal colon emptying with enema prior to purgatives are not known. The aim of this study is to investigate the effects of enema use before purgatives in preparation for colonoscopy. MATERIAL AND METHODS: Two hundred twenty-seven patients were randomly assigned into three groups; enema before purgative use, enema after purgative use, and no enema. Patients were compared in terms of age, sex, BMI, Rome III constipation criteria, history of abdominal surgery, tolerance to the preparation procedure, complications during preparation such as nausea, vomiting, headache and dizziness, cecal insertion time, total duration of colonoscopy, polyp determination rate and colonic cleansing based on the Boston Bowel Preparation Scale. RESULTS: One hundred two (44.9%) patients were male and 125 (55.1%) female. The mean age and BMI was 55.4±11.8 years and 28.8±4.7, respectively. No difference was observed between the groups in terms of sex, age, or BMI. The number of fulfilled Rome criteria and of previous abdominal surgeries were significantly higher in females than in men. Right colon Boston Bowel Preparation Scale score was higher in the group using enemas before purgatives than the scores of other groups. This improvement was statistically significant in the female patient group with higher constipation rate. CONCLUSIONS: Use of enemas before purgatives in patients with constipation significantly improves adequacy of right colon cleansing.

Diagnosis and treatment of gallbladder perforation.

AIM: To present our clinical experience with gallbladder perforation cases. METHODS: Records of 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated. RESULTS: Seven patients had type I gallbladder perforation, 7 type II gallbladder perforation, and 2 type III gallbladder perforation according to Niemeier's classification. The patients underwent surgery after administration of intravenous electrolyte solutions, and were treated with analgesics and antibiotics within the first 36 h (mean 9 h) after admission. Two patients died of sepsis and multiple organ failure in the early postoperative period. Subhepatic abscess, pelvic abscess, pneumonia, pancreatitis, and acute renal failure were found in 6 patients. CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

[Our experience in the cases with penetrating colonic injuries]. / Penetran kolon yaralanmali olgulardaki deneyimlerimiz.

BACKGROUND: In this study, the factors that effect the morbidity and mortality in patients with penetrating colonic injuries were evaluated. METHODS: Fourty-two patients (37 males, 5 females; mean age 30,1; range 14 to 63 years) with penetrating colonic trauma were evaluated according to age, gender, type of penetrating trauma, location and severity of the colonic injury, associated injury, interval between the trauma and the definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality. RESULTS: Type of the penetrating trauma was stab injury in twenty-eight (67%) patients, and gunshot injury in fourteen (33%) patients. The mean Colon Injury Severity Score was 2,1. The mean Abdominal Trauma Index (ATI) was 17,2 and it was over than 25 in eight (19%) patients. The symptoms of shock were present in eleven (26%) patients at admission. Blood transfusions were applied in sixteen (38%) patients. In twenty-one patients intraabdominal bleeding was observed and it was more than 500 mL in eleven (26%) patients. Primary repair was performed in 36 (86%) of the 42 patients and colostomy was performed in six (14%) patients. Morbidity and mortality rates were 41% and 10% respectively. CONCLUSION: It was found that morbidity rates were increased in patients with ATI score higher than 25, and mortality rates were increased in patients presenting shock at admission, with the amount of intraabdominal blood more than 500 mL, and who needed three or more units of blood transfusion. The primary repair of the penetrating colon trauma can be performed confidently in the hemodynamically stable patients with ATI score less than 25.

Gallbladder perforation: clinical presentation, predisposing factors, and surgical outcomes of 46 patients.

BACKGROUND/AIMS: We aimed to investigate the clinical features and the relation between patient characteristics and the different types of gallbladder perforation and to determine the predisposing factors. MATERIAL AND METHODS: The medical records of 478 patients who received urgent surgical treatment with the diagnosis of acute cholecystitis and underwent urgent surgery in our clinics between January 1997 and November 2008 were reviewed retrospectively. The demographic data of patients, time elapsed from the onset of the symptoms to the time of surgery, comorbidity status, American Society of Anesthesiologists classification, laboratory data, imaging results, surgical procedures, postoperative complications, and postoperative length of stay of the patients were analyzed. RESULTS: There were 46 (9.6%) patients with the diagnosis of gallbladder perforation. Morbidity and mortality occurred in 15 (32.6%) and 7 (15.2%) patients, respectively. Advanced age, male gender, fever >38°C, high white blood cell count, and presence of cardiovascular comorbidity were found to be significant risk factors for gallbladder perforation. CONCLUSIONS: While early diagnosis and early surgical intervention are the keys to managing gallbladder perforation, we suggest that patients having the above-mentioned clinical features should be carefully investigated.

Spontaneous healing of gallbladder perforation: report of a case.

Gallbladder perforation is a serious complication of acute cholecystitis. Spontaneous healing is very rare, and only three cases have been reported in the English literature. In this study, we present a 73-year-old female patient who underwent a laparoscopic cholecystectomy years after a gallbladder perforation and spontaneous healing.

Comparison of a modified anoscope and the purse-string anoscope in stapled haemorrhoidopexy.

AIM: To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS: The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients (Group 1), and the modified anoscope was used on 22 patients (Group 2). Demographic characteristics of the patients, operation time, surgeon's performance, analgesic requirement, and complications were compared. RESULTS: Operation time was significantly longer in Group 1 (42.0 +/- 8.4 min vs 27.7 +/- 8.0 min, P = 0.039). The surgeons reported their operative performance as significantly better in Group 2 (the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P < 0.001). The need for haemostatic sutures was significantly higher in Group 1 (six cases) and was needed in two cases in Group 2 (P = 0.034). CONCLUSION: Operation time decreased and the surgeon's satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.

Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia?

Total thyroidectomy (TT) has emerged as a surgical option in the surgical treatment of patients with multinodular goiter. TT carries potential risk to all parathyroid glands and both recurrent laryngeal nerve. The aims of this study are to evaluate the difference between serum calcium levels before and after total and near total thyroidectomy and to compare the rate of postoperative hypocalcemia according to surgical procedures. This prospective study included 143 consecutive patients undergoing surgical therapy for non-toxic multinodular goiter. Patients were randomly assigned to surgical procedures. Patients in group 1 (n=75) performed TT, and patients in group 2 (n=68) performed near total thyroidectomy (NTT). The difference between serum calcium levels and percentage decrease in serum calcium levels before and after thyroidectomy were calculated. TT had a 33-fold (OR: 33.1; 95% CI: 7.5-145.02) increased risk for hypocalcemia. Moreover, TT had a 8-fold (OR: 8.09; 95% CI: 3-21.4) and a 27-fold (OR: 27.9; 95% CI: 3.5-219.6) higher risk than NTT for moderate and severe percentage decreases in serum calcium level, respectively. NTT can offer an advantage over TT in terms of postoperative hypocalcemia in the patients with benign multinodular goiter.