Laparoscopic cholecystectomy in patients aged 80 years and older: an analysis of 111 patients.

INTRODUCTION: The incidence of cholelithiasis increases with age. More octogenarian (≥80 y) patients are undergoing laparoscopic cholecystectomy (LC) operation throughout the world. PATIENTS AND METHODS: A retrospective study was conducted on patients older than 80 years (group 1: 111 patients) and those in the 18 to 79 years age group (group 2: 185 patients), who underwent LC between July 2005 and October 2009. The variables analyzed were the presentation, demographics, comorbid illnesses, American Society of Anaesthesiology (ASA) scores, history of previous abdominal surgery, the operative time, postoperative morbidity and mortality, and the length of hospital stay. A comparison was made between the two groups. Data was evaluated by using the χ and the Fisher exact test. P<0.005 was considered significant. RESULTS: The difference in both groups in the mean age and ASA scores were significant. The indication for LC was gallstone disease in 87 (78.4%) patients, acute cholecystitis in 16 (14.4%), and gallstone pancreatitis in 8 (7.2%) of group 1 patients. The conversion rate was not statistically significant. The mean operative time was 77 minutes in group 1 patients, and this was significantly longer than that of group 2 patients. The postoperative oral intake within 24 hours of surgery was significantly earlier in group 2 patients. Other parameters were not significantly different between the 2 groups. CONCLUSIONS: LC in octogenarians is a relatively safe procedure that can be performed with low morbidity and mortality rates. The comorbidities and higher ASA scale are major risk factors for postoperative complications in this age group of patients.

Acute small bowel obstruction due to ileal endometriosis: a case report and review of the most recent literature.

INTRODUCTION: Endometriosis is defined as the presence of benign endometrial glands and stroma outside the normal anatomical location. Endometriosis of the small bowel, especially symptomatic small bowel involvement, is very unusual. CASE REPORT: We presented a 45-year-old woman with acute intestinal obstruction due to ileal endometriosis The patient complained of severe abdominal pain, nausea and vomitting. Immediate laparotomy was carried out. Above the ileocecal valve there was an ulcerated, edematous and fragile segmental lesion that caused intestinal obstruction. Histology of this ileal segment revealed endometriosis and an annular stricture that again showed foci of endometriosis. CONCLUSION: In reproductive-age women with the symptoms of intestinal obstruction, intestinal endometriosis should be kept in mind.

Determinants of postoperative hypocalcemia in vitamin D-deficient Graves' patients after total thyroidectomy.

BACKGROUND: The etiology of postoperative hypocalcemia after total thyroidectomy appears to be multifactorial, that is, postoperative transient hypoparathyroidism, low 25-hydroxy vitamin D (25-OHD) concentrations, aging, and hyperthyroidism with increased bone turnover. Our aim was to evaluate the factors responsible for postoperative hypocalcemia in euthyroid vitamin D-deficient/insufficient Graves patients who underwent total thyroidectomy at our institution. METHODS: Thirty-five consecutive patients with Graves disease treated by total thyroidectomy were included in the present study. All patients were vitamin D deficient/insufficient (ie, 25-OHD concentrations of <20/<30 ng/mL, respectively). Patients were divided into 2 groups according to postoperative serum albumin corrected calcium concentrations: group 1 (n = 13) patients had postoperative serum calcium concentrations of 8 mg/dL or less; group 2 (n = 22) patients had serum calcium concentrations greater than 8 mg/dL. Bone turnover markers (deoxypiridinoline, bone-specific alkaline phosphatase) and 25-OHD were determined the day before surgery. RESULTS: In group 1 patients, disease duration was significantly longer, 25-OHD and postoperative parathyroid hormone concentrations were significantly lower, and bone turnover markers were significantly higher. Logistic regression analysis revealed that a postoperative parathyroid hormone concentration less than 10 pg/mL was the most powerful parameter to predict postoperative hypocalcemia (odds ratio, 23; 95% confidence interval, 3.3-156). CONCLUSIONS: In Graves patients with vitamin D deficiency/insufficiency, postoperative (transient) hypoparathyroidism is the most significant parameter to determine the development of postoperative hypocalcemia.

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.

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.

[Prognostic factors for hospital mortality in patients with acute mesenteric ischemia who undergo intestinal resection due to necrosis]. / Nekroz nedeniyle bagirsak rezeksiyonu uygulanan akut mezenterik iskemili olgularda hastane mortalitesi için prognostik faktörler.

BACKGROUND: The purpose of this study was to review our experience in patients with acute mesenteric ischemia (AMI) and to identify prognostic factors associated with hospital mortality. METHODS: Clinical data of patients with AMI were reviewed and analyzed retrospectively. A total of 67 patients (34 female, overall mean age 66 years) were evaluated in the study. RESULTS: Small bowel necrosis was detected in all patients, while colonic involvement was present in 21 (31.3%). Necrosed small bowels were resected in 59 (88%) in the first intervention. Embolectomy was also performed in 2 (3%) of these cases. Anastomosis was established in 22 (32.8%). Second-look operation was performed in 31 (46.3%) and primary resection and re-resection were performed in 8 (11.9%) and 11 (16.4%) patients, respectively. Hospital mortality rate was 56.7% (n=38). Logistic regression analysis showed prolonged symptom duration (>24h) (p=0.000), sepsis (p=0.022) and colonic necrosis accompanied with small bowel necrosis (p=0.002) as the independent prognostic factors in hospital mortality. CONCLUSION: AMI has a high hospital mortality rate due to late diagnosis and sepsis. Another risk factor is colonic involvement. Early evaluation in high-risk patients and resection for necrosed intestinal segments as soon as possible prior to sepsis may reduce the hospital mortality rate.

Rupture of liver hydatid cysts into the peritoneal cavity. A challenge in endemic regions.

OBJECTIVE: To evaluate the clinical presentation and early and long-term outcomes of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. METHODS: The medical records of 21 patients with rupture of hydatid cysts were evaluated retrospectively between January 2000 and April 2009 at Izmir Ataturk Training and Research Hospital, Izmir, Turkey, as were the records of 368 patients with hydatid cysts. Age, gender, symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality, and recurrence were evaluated. RESULTS: Sixteen of these patients (76.2%) were women. The mean age was 43.8 years. Cysts were single in 16 cases (76.2%). In 14 cases (66.7%) cysts were localized only in the right lobe. There was also a cyst in the spleen in 4 patients (19%). Simple falls or direct abdominal minor trauma was responsible in 8 patients (38.1%), and pedestrian mishaps in 4 (19%). Nine (42.8%) patients experienced spontaneous rupture. External drainage was performed in 12 (57.1%) patients and omentoplasty in 9 patients (42.8%) to manage the cyst cavity. A total of 11 morbidities developed in 9 patients (42.8%). There was no postoperative mortality. The mean hospital stay was 11.37.4 days, and mean follow-up was 63.131.3 months. The recurrence rate was 23.8%. CONCLUSION: The morbidity and recurrence rates of surgical interventions for ruptured hydatid cysts are high. This pathology, although rare, should be included in the differential diagnosis of an acute abdomen in endemic areas.

Preventive effect of pentoxifylline on acute radiation damage via antioxidant and anti-inflammatory pathways.

PURPOSE: The aim of the present study was to investigate whether pentoxifylline (PTX) treatment could protect against induced acute radiation enteritis. METHOD: Rats received 100 mg/kg/day PTX for 7 days before irradiation and continued on treatment for 3 days after irradiation. The intestinal myeloperoxidase (MPO) activities and malondialdehyde (MDA), glutathione (GSH), prostaglandin E2, and thromboxane B2 levels were determined. Terminal ileum tissue was evaluated for morphological changes. Also, nuclear factor kappa (NF-kappa), tumor necrosis factor-alpha (TNF-alpha), and intercellular adhesion molecule 1 (ICAM-1) expressions were analyzed with immunohistochemisty methods. RESULTS: PTX treatment was associated with increased GSH levels and decreased MPO activity and MDA, prostaglandin E2, and thromboxane B2 levels. Histopathologic examination showed that intestinal mucosal structure was preserved in the PTX-treated group while having significant decreases in NF-kappaB, TNF-a, and ICAM-1 expression. CONCLUSIONS: PTX appears to have a protective effect against radiation damage. This protective effect is mediated in part by decreasing both inflammatory reactions and oxidative stress.

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.