The Comparison of Four-Port, Two-Port Without Suspension Suture and Single Port Laparoscopic Cholecystectomy Results.

BACKGROUND: Single-port surgery has recently become popular, however, many surgeons have to use additional ports during the surgery due to difficulties. OBJECTIVES: We performed two-port MCAP (with an additional port using a multi-channel device through the umbilicus) without a suspension suture in a group of patients. We compared the results of this technique to the LC and SILC techniques. MATERIAL AND METHODS: A total of 90 patients with gallbladder disease were included in the study. LC (n = 30) and SILC (n = 30) were performed in two groups. The other group underwent cholecystectomy (MCAP) by using an additional 5 mm port through the subxiphoid region with a multi-channel port through the transumblical. A transabdominal suspension suture was not used for the patients in this group. The surgery duration, estimated blood loss, length of hospitalization, visual analogue scale (VAS) score in the postoperative 1st and 7th day, need for analgesia in the postoperative period and complications, and the conversion rate were compared between the three methods. RESULTS: A total of 62 females (68.9%) and 28 males (31.1%) participated in the study. MCAP duration was significantly shorter than LC and SILC (38.1 ± 16.6, 49.4 ± 15.8, 77.8 ± 26.7 min respectively) (p < 0.05). The conversion rate was similar in all three groups. Hernia developed in the port area in two patients after SILC (6.7%). No significant difference was found between the groups for the other data we compared. CONCLUSIONS: MCAP seems to be an easier technique with a shorter operation time compared to the other two techniques. However, there is a need for other studies to evaluate the cosmetic results.

Single Port vs. Four Port Cholecystectomy--Randomized Trial on Quality of Life.

BACKGROUND: Classical laparoscopic cholecystectomy involves four ports while most novel 'single port' technique only requires one incision on the abdominal wall. This technique is thought to decrease surgical trauma and improve cosmesis although there are reports pointing out that classical laparoscopic cholecystectomy is also feasible in terms of cosmesis. OBJECTIVES: In this study we tried to determine if there are certain advantages in quality of life after single port surgery which would justify its utilization instead of classical laparoscopic cholecystectomy. MATERIAL AND METHODS: This is a prospective randomized study which enrolled 30 patients randomized either into classical laparoscopic cholecystectomy or single port surgery. The primary endpoint was patient satisfaction after surgery. This was assessed with short form 36 and gastrointestinal quality of life index (first preoperatively and then 3 months postoperatively) and a visual analogue scale on the first and seventh days. RESULTS: There was not a statistically significant difference between groups in the emotional role, social functions, mental health, vitality and general health subscales of short form 36. At the end of 12 weeks, both groups demonstrated increases in the gastrointestinal and social subscales of the gastrointestinal quality of life index. There was not a statistically significant difference between groups when the visual analogue scale scores on first and seventh days were compared. CONCLUSIONS: The equal length of hospitalization, patient quality of life and pain perception and the longer operative times, high likelihood of incisional hernia and surgical site infection call into question the utilization of single port surgery, as it does not seem to confer an advantage over classical laparoscopic cholecystectomy.

Effects of alpha lipoic acid on intra-abdominal adhesion: an experimental study in a rat model.

BACKGROUND: This study was performed to determine the effect of alpha lipoic acid, a powerful antioxidant, on intra-abdominal adhesion formation. METHODS: Twenty-four female Wistar Albino rats weighing 250-300 g were used in this study conducted on three groups consisting of the alpha lipoic acid group (Group I, n=8), control group (Group II, n=8), and sham group (Group III, n=8). After performing laparotomy with a midline incision under general anesthesia, the adhesion model was created on the antimesenteric side of the caecum in Group I and Group II. 50 mg/kg alpha-lipoic acid was administered intraperitoneally (IP) in Group I while the surgical procedure was performed but no drugs administered in Group II. Only laparotomy was performed in Group III. Rats were sacrificed at the end of the tenth day. RESULTS: Macroscopic scoring was performed, tissue samples were obtained and subjected to biochemical and histopathological evaluation. The degree of adhesion and malondialdehyde level decreased (p<0.01), and glutathione levels had increased (p<0.01) in Group I compared to Group II in macroscopic scoring. CONCLUSION: Alpha lipoic acid was found to significantly decrease (p<0.01) intra-abdominal adhesion when administered IP compared to the control group.

A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture.

OBJECTIVE: Many surgeons face difficulties during single-incision laparoscopic cholecystectomy (SILC) surgery and are forced to use an additional port. We compared the results of a technique that we developed with SILC. MATERIAL AND METHODS: Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multi-channel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. RESULTS: The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analog scale scores, need for analgesia in the postoperative period, and rate of changing to another technique due to inadequacy of the surgical technique. CONCLUSION: MCAP is as safe as SILC for cholecystectomy and is easier for the surgeon to perform.

The healing effect of shark cartilage in rabbits after colonic anastomosis.

AIM: Shark cartilage has anti-inflammatory, analgesic, anti-angiogenic, anti-tumoral, and immunomodulatory properties. We studied the effect of shark cartilage on the healing of colonic anastomoses, which are among the gastrointestinal system anastomoses that most commonly cause leakage. MATERIAL OF STUDY: Rabbits were divided into two groups of seven as the study and control groups. A normal diet was given to both groups before and after right colonic anastomosis. Shark cartilage tablets were given orally to the study group for five days before and after the anastomosis. Bursting pressures, hydroxyproline levels and translocation of the intestinal flora in anastomosis region were evaluated on the 6th day by operating on both groups. RESULTS: Bursting pressure and hydroxproline levels were higher in the experimental group compared to the control group (p<0.05). An increase in connective tissue and vascularization without growth of microorganisms was observed in the experimental group on microbiological examination. CONCLUSIONS: Shark cartilage given orally to rabbits increased anastomotic healing and did not cause serious consequences such as bacterial translocation.

The minimally invasive approach is associated with reduced perioperative thromboembolic and bleeding complications for patients receiving preoperative chronic oral anticoagulant therapy who undergo colorectal surgery.

BACKGROUND: The data on the perioperative risk of both thromboembolism and hemorrhage for patients receiving chronic oral anticoagulation who undergo colorectal surgery are sparse. In addition, it is uncertain whether the use of the laparoscopic instead of open technique entails additional risk for these patients. This study aimed to evaluate surgical outcomes, with a particular focus on perioperative thromboembolic and bleeding complications for patients receiving chronic oral anticoagulation therapy who undergo open or laparoscopic colorectal resection. METHODS: Patients undergoing colorectal resection between 1994 and 2011 on preoperative chronic oral anticoagulant therapy were included in the study. Patient demographics, characteristics, and perioperative outcomes, with particular emphasis on thromboembolism and bleeding risks, were evaluated comparing laparoscopic and open colectomy. RESULTS: The study enrolled 261 patients receiving chronic anticoagulation therapy (102 laparoscopic colectomy vs 159 open colectomy patients). The patients had a mean age of 57.9 years and a mean body mass index (BMI) of 29.3 kg/m(2). The conversion rate was 8.8 % (n = 9) for laparoscopic operations. Laparoscopic and open cases had comparable BMIs and levels of preoperative hemoglobin. Anastomotic leak, postoperative hospital stay, and surgical-site infection rates were similar for the two groups. Although the laparoscopic group had a significantly greater mean age (p < 0.001) and American Society of Anesthesiology (ASA) score (p = 0.005), the rates for postoperative venous thromboembolism (24.5 vs 2.9 %; p < 0.001), urinary complications (6.9 vs 0 %; p = 0.008), and overall morbidity (44.7 vs 17.7 %; p < 0.001) were lower after laparoscopic surgery. Although the rates for intra- and postoperative blood transfusion were similar, the postoperative hemoglobin levels were significantly higher after laparoscopic surgery. One patient in the laparoscopic group died of sepsis on postoperative day 3. CONCLUSION: For the patients receiving preoperative chronic anticoagulant therapy who underwent colorectal resection, the laparoscopic approach was associated with lower thromboembolic and hemorrhagic complications than open surgery.

Effects of dextran-40 on flap viability after modified radical mastectomy.

BACKGROUND: Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40. OBJECTIVE: To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy. METHODS: Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed. RESULTS: Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement. CONCLUSIONS: Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.

HISTORIQUE: La prise en charge postopératoire des patientes qui ont subi une mastectomie radicale modifiée a évolué depuis quelques décennies. Au début de la période postopératoire, le taux de complication des plaies peut atteindre les 60 %. La nécrose des lambeaux après une mastectomie radicale modifiée est un problème courant pour les chirurgiens. Diverses stratégies thérapeutiques sont proposées dans les publications, mais aucune n'a porté sur l'utilisation de dextran 40. OBJECTIF: Déterminer si l'injection de dextran 40 améliore la viabilité des lambeaux cutanés après une mastectomie radicale modifiée. MÉTHODOLOGIE: Vingt-huit patientes ayant subi une mastectomie radicale modifiée ont été réparties au hasard pour recevoir ou non du dextran 40 pendant l'opération, après la dissection des lambeaux. Elles ont subi un suivi prospectif de cinq ans dans un hôpital général. Les chercheurs ont évalué l'incidence de nécrose des lambeaux cutanés après une mastectomie et le pronostic de zone nécrosée après l'injection de dextran 40. RÉSULTATS: Les chercheurs ont observé une nécrose des lambeaux chez cinq patientes (17,8 %). L'hypertension et le diabète étaient des facteurs de risque (P<0,05). L'épaisseur et la tension des lambeaux y étaient liées. Six des sept patientes présentant des problèmes de perfusion des lambeaux (ecchymose ou nécrose) ont subi un traitement au dextran 40 et ont guéri sans qu'il soit nécessaire de remplacer la greffe. CONCLUSIONS: Le traitement au dextran 40 n'influait pas sur l'apparition d'une nécrose des lambeaux, mais en présence d'une nécrose, l'état de la zone nécrosée des lambeaux cutanés s'améliorait grâce au traitement au dextran 40.

Comparison of meperidine versus hyoscine during colonoscopy in the elderly: a prospective randomized study.

BACKGROUND: Colonoscopy is the gold standard in diagnosis of diseases of the colon. Sedation and antispasmodic agents are recommended during colonoscopy. Age is a limiting factor when the surgeon is deciding whether to use these medications or not. SUBJECTS AND METHODS: One hundred twenty patients older than 65 years of age were randomized into two groups. The first group (n=60) received 2 mg of midazolam and 25 mg of meperidine intravenously. The second group (n=60) received 2 mg of midazolam and 20 mg of hyoscine N-butylbromide intravenously. The data collected were colonoscopy procedure time, time to cecum, visual analog pain scale, systolic blood pressure before and after the procedure, pulse, partial oxygen pressure, comfort of the endoscopist, the modified observer's assessment of alertness/sedation scale, and morbidity. RESULTS: Total colonoscopy and cecal reach times were shorter in Group 2 (19.58±4.82 minutes and 10.57±2.54 minutes, respectively) than in Group 1 (25.05±5.93 minutes and 13.78±3.37 minutes, respectively) (P<.001). The sedation score of Group 2 (4.52±0.50) was better than that of Group 1 (3.45±0.75) (P<.001). Nine patients (15%) in Group 1 experienced diaphoresis, temporary memory loss, or lip smacking. Three patients in Group 1 and 1 patient in Group 2 had hypoxia. Three patients in Group 1 had hypotension; this was seen in 1 patient in Group 2. One patient had perforation in Group 1. The visual analog scale score was 4.37±1.38, and the endoscopist satisfaction was 6.72±0.99 in Group 1, while these values were 3.95±0.81 and 7.75±0.89, respectively, in Group 2 (P>.05). CONCLUSIONS: Use of midazolam and hyoscine N-butylbromide during colonoscopy is safe in the elderly and significantly reduces procedure time while increasing comfort for the endoscopist.

[Using the properties of Amyand's hernia in children in the preoperative diagnosis: our experience and review of the literature]. / Cocuklarda Amyand herninin özellikleri ve bu özelliklerin ameliyat öncesi tanida kullanilmasi: Deneyimlerimiz ve literatürlerin degerlendirilmesi.

BACKGROUND: Amyand's hernia is a rare hernia in which a normal or inflamed appendix is found in the inguinal hernia sac. Differential diagnosis of Amyand's hernia prior to surgery is quite difficult. In this study, in order to develop a preoperative diagnostic approach, cases of pediatric patients at different ages were analyzed and their common properties are discussed herein. METHODS: In the present study, the findings in pediatric patients (ages 0-15) with Amyand's hernia reported in the literature together with findings in four cases operated in our center were retrospectively assessed with respect to their demographic, preoperative, peroperative, and postoperative characteristics. These 19 cases in total were divided into two groups as age 0-1 and over age 1, and their characteristics were compared. RESULTS: The two groups revealed different characteristics. However, in children over age 1, in the presence of appendicitis in the hernia sac, criteria like the frequency and order of symptoms, leukocytosis and bowel sounds showed similarity with abdominal appendicitis (acute appendicitis). CONCLUSION: In children over age 1 with Amyand's hernia who are admitted to the emergency clinic with suspected incarcerated and strangulated hernia, it is possible to diagnose Amyand's hernia after a detailed preoperative examination.

Epidemiological and demographic features of appendicitis and influences of several environmental factors.

BACKGROUND: In this study, we present the demographic features of appendicitis and investigate the influence of several factors (season, temperature, humidity, altitude) on the development of the condition. METHODS: A total of 1871 patients operated between 2004 and 2007 were included and divided into two subgroups as perforated and non-perforated appendicitis. The demographic features and environmental factors were investigated. We compared the effects of environmental conditions with those observed in other countries. RESULTS: Appendicitis was most frequent among males between 10 to 19 years of age. Perforated appendicitis was mostly seen between 0-9 years and after 50 years of age. The frequency of appendicitis was the highest during winter, but the rate of perforation was at its minimum during this season. During the coldest three months of the year, non-perforated appendicitis was mostly seen at temperatures of -8.8 degrees C; however, perforated appendicitis was mostly seen at -11.2 degrees C (p<0.01). CONCLUSION: Our findings show that the frequency of appendicitis and perforation rate are influenced by sex and age. Environmental factors like season, temperature and altitude may also influence the frequency of appendicitis.

Is long-term hunger (Ramadan model) a risk factor for acute appendicitis?

OBJECTIVE: To investigate whether long-term hunger and the changes in nutritional routines during Ramadan constitute risk factors in acute appendicitis on the model of Ramadan fasting in this study. METHODS: This retrospective study was carried out in 2 different hospitals (Istanbul Haydarpasa Numune Training and Research Hospital and Kars State Hospital, Kars, Turkey) between January 2004 and December 2007. The data obtained from the patients were classified according to age, gender, age group, and pathological characteristics of the appendix. The data obtained during the Ramadan fasting period was compared with the periods before and after. RESULTS: Nine hundred and ninety-two of the 4288 patients who received a diagnosis of acute appendicitis during the 4 years received their diagnosis during the 3 periods. Three hundred sixty-eight (37.1%) patients underwent surgery before Ramadan, 318 (32.1%) during, and 306 (30.8%) after. No significant difference was observed in terms of perforated and non-perforated AA frequency, age, age group, and gender (p>0.05). CONCLUSION: There are changes in the nutritional routines during the Ramadan fasting period due to long-term hunger; and limitations were seen in the fluid and food intake. We detected that these changes did not constitute risk factors for acute appendicitis formation as a result of our study.