Comparison of the Effectiveness of Ultrasound Imaging and Perioperative Measurement in the Diagnosis and Characterization of Incisional Hernia.

Background: Incisional hernia (IH) is a common complication after abdominal surgery, and there is no gold standard imaging modality for its diagnosis. Although computed tomography is frequently used in clinical practice, it has limitations such as radiation exposure and relatively high cost. The aim of this study is to establish standardization and hernia typing by comparing preoperative ultrasound (US) measurements and perioperative measurements in IH cases. Methods: The patients who were operated for IH in our institution between January 2020 and March 2021 were reviewed, retrospectively. In result, 120 patients were included in the study, and the cases had preoperative US images and perioperative hernia measurements. IH was divided into three subtypes as omentum (Type I), intestinal (Type II), and mixed (Type III) according to the defect content. Results: Type I IH was detected in 91 cases, Type II IH in 14 cases, and Type III IH in 15 cases. When the diameters of IH types were compared for preoperative US and perioperative measurements, respectively, there was no statistical significance (P = 0.185 and P = 0.262). According to Spearman correlation, there was a positive very strong correlation between preoperative US measurements and perioperative measurements (ρ = 0.861 and P < 0.001). Conclusion: As stated by our results, US imaging can be performed easily and quickly, providing a reliable way to accurately detect and characterize an IH. It can also facilitate the planning of surgical intervention in IH by providing anatomical information.

Measurement of hiatal surface area and other hiatus oesophageal diameters at computed tomography imaging in patients with gastroesophageal reflux disease and its relationship with hiatal hernia.

BACKGROUND: The oesophageal hiatus is a long and oblique opening in the diaphragm where the thoracic section of the oesophagus passes into the abdomen. Enlarged hiatal surface and insufficiency are considered to be associated with gastroesophageal reflux disease (GERD) and hiatal hernia (HH). In this study, we aimed to retrospectively evaluate the relationship and the presence of GERD with HH by performing hiatal surface area (HSA) and other hiatal measurements at the thorax and abdominal computed tomography (CT) images in cases without any intra-abdominal or oesophageal surgery history. PATIENTS AND METHODS: A total of 192 patients of GERD+ and 173 cases with GERD- as a control group were included in the study. In CT examinations of 365 patients included in the study, measurements and comments were made by an experienced radiologist in abdominal radiology. In CT scans, the following were evaluated for each case; HSA, hiatus anterior-posterior (A-P) diameter, hiatus transverse diameter, and HH types. The HSA measurement was made with the freehand region of interest in the picture archiving and communication system. RESULTS: A total of 365 cases were included in this study; there was a significant difference between the median HSA, A-P diameter, and transverse diameter measurements between GERD- and GERD+ groups (P < 0.001). A statistically significant difference was found between the presence of GERD and HH types (P < 0.001). CONCLUSIONS: CT imaging helps investigate the presence of HH at GERD+ patients. In addition, pre-operative valuable data can be obtained from the detection of HH types and HSA measurements in cases with HH.

The sensitivity of ultrasound in the clinical diagnosis of inguinal hernias in adults: a comparative study.

OBJECTIVE: Ultrasonography (US) is a non-invasive, non-ionizing radiation modality highly successful at diagnosing inguinal hernia. The aim of this study is to demonstrate the accuracy of ultrasound in evaluating defects of fascia in inguinal hernias and compare with surgical findings. MATERIAL AND METHODS: A total of 33 patients with a sonographic diagnosis of an inguinal hernia are included to study. After US, all patients underwent a blinded surgery and the surgical findings are compared with the US results. RESULTS: The sensitivity of US was found to be 100% and 80% for indirect and direct types, respectively. The mean size of the defect was found to be 22 mm (max: 70 mm, min: 6 mm) with US; and 27 mm (max: 50 mm, min: 4 mm) at surgery. The size of defects at US and in surgery were correlated with each other (p = 0.001).

Effects of Carvedilol on liver ischemia-reperfusion injury in rats.

BACKGROUND: The aim of this study was to analyze the potential protective effect of Carvedilol against liver ischemia-reperfusion (I/R) injury in rats. METHODS: A total of 40 Wistar albino rats were randomly divided into four groups (n=10 each). Group I (Sham/Control group) underwent only laparotomy, Group II (Carvedilol group) was administered carvedilol and then underwent laparotomy, Group III (I/R group) underwent laparotomy and hepatic ischemia/reperfusion, and Group IV (I/R + Carvedilol group) was administered carvedilol and then underwent laparotomy and hepatic ischemia/reperfusion. Blood samples were collected for malondialdehyde, glutathione (GSH), and myeloperoxidase (MPO) analysis. Liver sections were obtained for histopathological analysis and stained with hematoxy-lin-eosin. Tumor necrosis factor-α (TNF-α) and Caspase-3 primary antibodies were used for the immunohistochemical analysis. RESULTS: Serum GSH levels increased in the I/R + Carvedilol group. MPO activity was increased significantly in the IR group. In I/R + Carvedilol group, serum MPO levels were similar to the control group. Histopathological findings showed reduced dilatation and congestion in vena centralis, regenerative changes in hepatocyte cells with the protected nucleus structure in the I/R + Carvedilol group. Hepatocyte nuclei with increased pycnosis and apoptosis and the dilated vena centralis were observed in I/R group. In the control group, TNF-α showed a positive reaction in macrophage cells around vena centralis. An increase in TNF-α expression was observed in hepatocyte cells of I/R group. Positive expression of caspase-3 in hepatocyte cells and a small number of endothelial and Kupffer cells were seen in I/R group. However, negative caspase-3 expression was seen in hepatocyte, endothelial, and Kupffer cells in I/R + Carvedilol group. CONCLUSION: Carvedilol may prevent initiation of oxidative stress process, inflammation induction and apoptotic progression.

Perforated colorectal cancers: clinical outcomes of 18 patients who underwent emergency surgery.

INTRODUCTION: Although colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment. AIM: In this study, the clinical results of patients who were operated in emergency conditions due to colorectal cancer perforation were evaluated. MATERIAL AND METHODS: The data of 18 patients treated for colorectal cancer perforation in our clinic between February 2014 and February 2017 were retrospectively reviewed. The following data were evaluated: demographic features of the patients, location of the tumour, metastasis, stage of the tumour, number of lymph nodes dissected, survival, type, and prognosis of the surgery. RESULTS: Eight (44%) of 18 patients with perforated colon cancers were female and 10 (56%) were male. The mean age was 65.2 (31-104) years. Four of the patients had liver metastasis only, and 5 had multiple metastases. All cases had sudden abdominal pain and acute abdominal clinical findings. Fourteen of the patients underwent full resection, and 4 of them underwent partial resection and trephine stoma (colostomy). Perioperative mortality was not observed. The long-term mortality rate in our study was 77.7% (n = 14), and the operative mortality rate was 44% (n = 8). Additional organ injuries occurred during resection in 2 patients. CONCLUSIONS: Colorectal cancer perforation seen in advanced ages is one of the causes of acute abdominal syndrome, which can be fatal. The general condition of the patient and the size and localization of the perforation should be taken into consideration in the choice of treatment. Curative surgery can also be performed in perforated colorectal cancers. However, partial resection and trephine colostomy should be performed in patients with multiple metastases and poor general condition.

Comparison of negative-pressure incision management system in wound dehiscence: A prospective, randomized, observational study.

Wound dehiscence is a significant problem faced by surgeons after major abdominal surgery. In this study, it was aimed to select the best incision management system to keep the incision edges together and prevent wound opening, and infection by protecting the incision. In this study, 60 patients who underwent abdominal surgery were evaluated regarding their risk of wound dehiscence. In our clinic, high-risk cases of abdominal surgery are performed, the risk factors being ischemia along the incision line, dirty and contaminated wound, obesity, tension on the suture line, traumatization of the wound site, age at onset (> 65), body mass index (BMI) > 30, diabetes mellitus, chronic obstructive pulmonary disease (COPD), immunosuppressive drug users. A prospective study protocol was planned after ASA (American Society of Anesthesiologists) physical status class assignment. Patients were divided into three groups: patients who underwent a postoperative negative-pressure therapy dressing, patients who underwent subcutaneous aspiration drainage, and patients who received standard dressing. The aim of this study was to evaluate the decompensation, surgical site infection, seroma, hospital stay and costs and to evaluate the results in the postoperative period. Sixty patients were randomized (n = 20, for each group). Thirty-one (51%) of the patients were male, and the mean age was 64.3 ± 8.9 (46-85). The mean BMI was 30.45 ± 7.2. There was no statistically significant difference (p≥0.05) between groups in terms of sex, age, and BMI. The ASA score and surgical interventions were similar between the groups. Wound dehiscence rate was 25% (n = 8), 20% (n = 6) and 3% (n = 1) for the Standard Dressing (SD), Aspiration Drainage (AD) and Negative-Pressure (NP) groups, respectively (p <0.017). Duration of hospitalization was 16.45 ± 6.6, 14.3 ± 7.4 and 8.95 ± 2.8 days (p <0.001) for SD, AD and NP groups, respectively. No statistically significant difference was found between the groups regarding other variables (p≥0.05 for all variables). Negative-pressure wound treatment is an easy, fast and practical technique which reduces lateral tension and swelling. It provides perfusion support and helps to protect the surgical field against external sources of infection.

Laparoscopic transabdominal preperitoneal repair of strangulated femoral hernia: Superiority of an unusual emergency surgical approach due to a case.

INTRODUCTION: Inguinal hernia repair is one of the most common operations of general surgery. In order to avoid complicated and urgent cases, performing such operations electively is generally accepted. Otherwise, unforeseen emergency surgical situations accompanied by incarceration and strangulation may occur. CASE PRESENTATION: In this article, we present a 45-year-old female patient with strangulated femoral hernia repair that we performed using the laparoscopic transabdominal preperitoneal method, unlike other conventional methods. DISCUSSION: Early diagnosis and elective surgical treatment have an important role in hernia surgery, especially due to increased morbidity and mortality. Laparoscopic inguinal hernia repair has developed in the recent years as a prominent method and nowadays it is performed much easier than the open method even in urgent and challenging cases. CONCLUSION: The transabdominal preperitoneal method has superiority over the conventional method in terms of ensuring that intestinal loop is visible during the strangulated femoral hernia repair and that the feeding of the intestine is intact.

Atraumatic splenic rupture secondary to abscess in a hemodialysis patient: a rare and fatal cause of acute abdomen diagnosed late.

Splenic abscess is a very rare condition in the general population. It is more likely to develop in association with underlying comorbidities and trauma. More attention should be paid in patients with immunosuppression, diabetes mellitus, and congenital or acquired immunocompromise. Splenic rupture secondary to nontraumatic abscess causing acute abdomen is a rarer condition. Herein, we report a 55-year-old hemodialysis patient who presented with signs and symptoms of late generalized peritonitis. The patient was operated under emergency conditions and diagnosed with splenic abscess rupture, for which splenectomy with drainage procedure was performed. In such patients, the morbidity and mortality rates vary depending on the intraoperative and postoperative risks.

Intraparenchymal Leiomyoma of the Breast: A Rare Location for an Infrequent Tumor.

Intraparenchymal leiomyoma of the breast are among benign non-epithelial tumors with the lowest incidence. Although it displays a benign histology, it may be confused with malignant lesions and create diagnostic confusion. In this paper, we report a 44-year-old woman with a painless mass with a diameter of 1.5 cm in the upper medial quadrant of her right breast. The lesion was removed surgically. The lesion's histologic examination and immunohistochemical analysis revealed a smooth muscle tumor of the breast. The patient was initially diagnosed with fibroadenoma and was followed in terms of the epicenter for six months before she underwent surgery. Her mammography and histopathology results are discussed in this report.