The effect of chronic constipation on the development of inguinal herniation.

OBJECTIVE: To investigate the effect of constipation on the development of inguinal herniation and type of herniation using the Constipation severity scale. METHODS: A total of 100 patients who underwent surgical inguinal hernia repair (study group) and 100 healthy volunteers without inguinal herniation (control group) were included in this study. The constipation severity scale was administered to all patients. The type of the herniation was classified using Nyhus scale during surgery and the side of the herniation was recorded on completed questionnaires. The obstructive defecation sub-scale score, colonic inertia sub-scale score, pain sub-scale score, and the total score were recorded for each patient and the association between constipation and the development of inguinal herniation was investigated. RESULTS: The mean age of patients in Group 1 and 2 was 40.92 ± 17.80 and 33.71 ± 9.13, respectively. There was a significant difference between the two groups in terms of obstructive defecation and colonic inertia sub-scale scores (p < 0.01). In addition, except for the pain sub-scale score, there were significant differences between Nyhus hernia types with regard to sub-scale scores of the constipation severity scale in patients in Group 1 (p < 0.01). CONCLUSION: Significantly higher obstructive defecation subscale, colonic inertia subscale, pain subscale, and total scores in the study group as compared to controls shows that constipation may represent an important etiological factor for the development of inguinal herniation.

A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technique.

BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technique today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technique that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas group 2 (n = 16) labels laparoscopic technique combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There are 12 patients in group 1 and 16 patients in group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in six patients for group 1 and in only 1 patient for group 2. Group 1 had 1 patient who suffered from recurrence where group 2 had no recurrence. DISCUSSION: Laparoscopic technique combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias.

Impact of allyl disulfide on oxidative damage and liver regeneration in an experimental hepatectomy model.

BACKGROUND: We investigated the effects of allyl disulfide (agarlic extract) on tissue damage, regeneration, proliferation and oxidative damage in an experimental liver resection model. MATERIALS AND METHODS: In the study, 24 female Wistar albinorats weighing approximately 200-250 g were used. Group 1:The rats in the experimental group all received a 70%hepatectomy and were fed an Allyl disulfide (30 λg kg day,Allyl disulfide, Sigma-Aldrich, formula: C6H10S2, CASNumber: 2179-57-9, formula weight: 146.27 g mol) in supplement to a regular diet for 1 week both preoperatively and postoperatively. Group 2: The rats in the control group also underwent a 70% hepatectomy and were given regular food and water for 1 week both preop and postop. Group 3: In the sham group, all rats were sacrificed 7 days after surgery. Forbiochemical evaluation, SGOT, SGPT, bilirubin, CRP and MDA were studied. In a histopathological examination, the fattening of the liver tissue, existence of (macro-micro vesicular),fibrosis, pleomorphism at hepatocyte nuclei, portal inflammation, existence of intralobular inflammatory cells,dilation at sinusoids, congestion, congestion at the central vein, regeneration, existence of Kupffer cells in the sinu soidallumen and ki-67 proliferation index at hepatocytes were examined. RESULTS: A significant difference between group 1 and group2 was observed regarding the existence of regeneration,(p:0.06), the occurrence of nuclear pleomorphisms (p:0,001)and the fibroblast activity status (p:0.001). Significant differences were found between the experimental groups in regard to Kupffer cell increase and dilation and the hyperemiastatus in the sinusoid lumens (p:0.013 and p:0.001,respectively). In the Allyl disulfide group, the proliferation index was significantly higher than that of the other groups(p:0,001), while the average plasma MDA value was lower than that of the other groups (p: 0,042). No significant differences were found among the groups with respect to tissue MDA values (p:0,720). No significant difference was found for SGPT (ALT) and SGOT (AST) levels between Group 1 and the other groups (p:0.247 and p:0.539, respectively).The average total bilirubin (T. Bili) values were 0,12,0,08 and 0,04 in the allyl disulfide group, control group andSham group, respectively. This difference among the groups is statistically significant (p:0.001). The average direct bilirubin (D. Bili) values were 0,06, 0,02 and 0,02 in the allyl disulfide group, control group and Sham group, respectively.This variation among the groups is also statistically significant (0.001). CONCLUSION: We observed that the use of Allyl disulfide supplementation after major hepatectomy has a positive impact on liver regeneration, proliferation and oxidative damage. ABBREVIATIONS: Postop: post-operative, Preop: pre-operative,SGOT(AST): serum glutamic oxaloacetic transaminase,SGPT(ALT): serum glutamate-pyruvate transaminase, CRP:C- Reactive protein, MDA: Malondialdehyde, DAS: Garlicextract diallyl sulfide, AGE: aged garlic extract.

Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer.

BACKGROUND: The red blood cell distribution (RDW) is a test measure of erythrocyte variation and the volume level which shows the heterogeneity and it is a proven test in literature for the determination of survival on cardiovascular diseases. The main purpose of this research is to investigate the relationship between the RDW level and postoperative morbidity as well as its stages in diagnosed pancreatic cancer patients. METHODS: In this study we covered 104 diagnosed pancreatic cancer patients who have been operated in 2011-2014. The RDW levels were separated into two groups. Group 1 contains higher level RDW patients (> 14) whereas group 2 contains only lower level RDW patients. We compared both groups in terms of the patients' demographic data, duration of hospitalization, ratio of pancreatic fistula, disease period, and the mortality rates. RESULTS: In group 1 contains 39 patients whereas group 2 contains only 65 patients. We determined the positive correlation between stages of disease with RDW levels as well as the correlation between low level of blood albumin and Ca 19.9 levels (p = 0001). However we did not observe statistically important difference in postoperative morbidity. CONCLUSIONS: Based on this study we report that RDW levels can be use as a marker to show the stages of pancreatic cancer in diagnosed patients.

Incidental parathyroidectomy as a cause of postoperative hypocalcemia after thyroid surgery: reality or illusion?

AIM: We aimed to investigate the incidence and clinical relevance of incidental parathyroidectomy (IPT) following thyroid surgery. METHODS: A retrospective review of thyroid operations was performed between January 2013 and January 2014. Pathology and operative reports were analyzed to identify the specimens which included parathyroid tissue. Information related to diagnosis, operative details and postoperative complications were collected. Calcium levels of ≤8 mg/dL was defined as biochemical hypocalcemia and those presenting with classic findings of acute hypocalcemia, were classified as clinical hypocalcemia. RESULTS: Two hundred and forty-five thyroid procedures were performed during study period. IPT was found in 34 (13.8%) cases: 25 were benign and 9 were malignant. Parathyroid tissue was found intrathyroidal in 6 patients (17.6%); lobar locations were right lobe in 19 (55.8%) and left lobe in 13 (38.2%) and isthmus in 2 cases (5.8%). The frequency of biochemical and clinical hypocalcemia were 50% (N.=17) and 8.8% (N.=3), respectively. Neither surgical type (lobectomy or thyroidectomy) nor malignancy (benign or malign) was not found associated with biochemical hypocalcemia. In those with biochemical hypocalcemia, left location of both dominant nodule and extracted parathyroid gland were significantly higher (P=0.01 and 0.04, respectively). CONCLUSION: Incidental parathyroidectomy which is not uncommon (13.8%) after thyroidectomy is not associated with postoperative biochemical hypocalcemia. Neither the type of surgical procedure (lobectomy or thyroidectomy) nor the pathology but adjacent dominant nodule location may increase the risk of IPT.

Conservative treatment of arterial pseudoaneurism in patients with behcet disease.

Behcet's Disease (BD) is a rare disease, of unknown origin that generally causes an inflammation in the subcutaneous tissue, eyes and brain vessels, and related with the immune system, predominantly seen in male patients and the mean age at onset is mainly in the third decade. The aim of the study was to present our experiences with the cases of arterial pseudoaneurysms that we treated conservatively without surgical or radiological intervention. Eleven patients with Behcet's disease who developed arterial pseudoaneuryms and responsed to the medical treatment are included in the study. The operation requirement, the complication rates, and factors that influence morbidity and mortality are evaluated. The mean age of the patients was 29,5 (18-35) years. Nine of the patients were male and 2 were female. The mean period of hospitalization was 18 (11-34) days. Six patients redeveloped aneurysm during their follow-up. Three of these patients were treated with surgery. Five patients had no complication during an average of 20 months of follow-up period. Arterial pseudoaneurysm is a rare complication of Behcet's disease. Despite the good response to conservative treatment at the beginning period, the patients should be closely followed up and redevelopment of the aneurysm should be kept in mind.

The role of cervical thymectomy in surgical treatment of secondary hyperparathyroidism.

OBJECTIVE: Parathyroid glands are frequently found in the thymus. We aimed to investigate the frequency of inferior parathyroid glands, and supernumerary glands located in the thymus in our series of renal hyperparathyroidism. METHODS: From January 2004 to September 2008, subtotal parathyroidectomy and cervical thymectomy was performed in 25 consecutive patients. Of these 25 patients, reoperation was carried out for one patient with persistent hyperparathyroidism and one patient with recurrent hyperparathyroidism. Operative details and pathology results were prospectively collected and reviewed. RESULTS: In 13 of 25 (52%) patients, at least one parathyroid gland was found in the thymus. In 7 (28 %) patients, at least one inferior gland was located in the thymus. In 7 patients (28%), supernumerary glands were found in the thymic tongue. One patient had both inferior and supernumerary glands in the thymus. In 8 patients (32%), 10 supernumerary glands were detected. The frequency of rudimentary and proper supernumerary glands were 5 (50%) and 5 (50%), respectively. Seven (3 proper and 4 rudimentary) of 10 supernumerary glands (70%) glands were located in the thymus. CONCLUSIONS: Thymectomy contributed to the treatment of 52% of patients. We conclude that to minimize the risk for missing parathyroid glands, thymectomy should be considered as a routine part of total parathyroidectomy with autotransplantation and subtotal parathyroidectomy in addition to careful cervical exploration for secondary hyperparathyroidism (Tab. 1, Ref. 27).

Late results of a simple closure technique and Helicobacter pylori eradication in duodenal ulcer perforation.

BACKGROUND AND AIM: The aim of this study is to determine the incidence of Helicobacter pylori (H. pylori) in patients operated on for duodenal ulcer perforation and to evaluate the late results of a simple closure technique in patients positive and negative for H. pylori. METHODS: The data of 84 patients who underwent simple closure for duodenal ulcer between 2003-2007 were retrospectively studied. Antral biopsy material taken from all patients during laparotomy was studied with the rapid urease test and the patients were then separated into 2 groups. Group 1 (H. Pylori positive) received postoperative H. pylori eradication treatment, and Group 2 (H. pylori negative) received only lansaprasol treatment after surgery. All patients were evaluated with upper gastrointestinal endoscopy on the 6th and 14th postoperative weeks. Primary treatment failure was considered in patients who had non-healing ulcers after 14 weeks. Patients with healed ulcers were scheduled for annual examinations. The results were compared between the groups. RESULTS: The rate of H. pylori infection in duodenal ulcer perforation was found to be 80.9%. Ulcer healing rates on the postoperative 6th and 14th weeks were 88.2% and 97.5% in the first group, and 68.8% and 81.2% in the second group, respectively. Mean postoperative follow-up was 41.28 +/- 17.63 (range 17-73) months. Ulcer recurrence rate was found to be 4.54% in Group 1 and 30.76% in group 2 (p = 0.012). CONCLUSIONS: All patients with a perforated peptic ulcer should be treated with simple closure of the perforation followed by medical therapy aimed at healing the ulcer. We believe that H. pylori negative patients have more risk of recurrence and such patients require close postoperative follow-up.

Delayed small bowel perforation due to blunt abdominal trauma and periappendicitis in a patient with situs inversus totalis: a report of a case.

BACKGROUND: Delayed intestinal perforation after blunt trauma is very rare. Peri-appendicitis is the serosal inflammation of the appendix, which is generally caused by extra-appendicular sepsis. Our purpose is to present this case with delayed ileum perforation after blunt trauma and peri-appendicitis. CASE REPORT: A 29-year-old male patient presented with abdominal pain starting from the left lower region, diffusing to all regions. He had a history of a blunt trauma to the left lower quadrant of the abdomen, caused by a wooden block springing from a press machine seven days before. There were no pathological signs in his first evaluation but at the radiological scanning after 16 hours, free air was detected under the left diaphragm. In the abdomen, CT dextrocardia, situs inversus totalis and minimal free liquid near the caecum was found. At laparotomy, a 0.5 cm perforation was observed, localised at the distal ileum and the appendix was oedematous and hyperaemic, consistent with acute inflammation. Resection of the injured bowel and appendectomy were performed. At the pathological examination, the perforation area was non-specific and peri-appendicitis was found. CONCLUSION: Delayed postraumatic perforation of the intestine occurs as a result of ischaemia. There is no reported case of a patient with situs inversus totalis. If acute abdomen is the case even with a history of minimal abdominal trauma, delayed intestinal trauma should be considered in the diagnosis. Peri-appendicitis secondary to intestinal perforation, which is a rare condition, should come to mind at the diagnosis.

Inflammatory pseudo-tumour of the appendix and acute appendicitis: a case report.

Inflammatory myofibroblastic tumour (IMT) is a rare benign lesion of unknown aetiology. It mimics, clinically and radiologically, malignant tumours (especially sarcoma). It was initially described in the lung, but it was subsequently recognised that virtually any anatomic location can be involved. IMTs of the gastro-intestinal tract are rare and there have been only nine confirmed cases involving the appendix to date. We presented a 20-year-old male patient with a diagnosis of IMT that caused acute appendicitis. An appendectomy is the most efficient treatment in cases where the lesion is limited to the appendix. Being aware of such an entity and being careful in the differential diagnosis of the appendiceal masses, especially the large masses, may prevent overtreatment.

Incarceration of umbilical hernia during pregnancy due to a sessile fibroid.

The incidence of both umbilical hernias and fibroids during pregnancy is reported to be rare. Another rare entity is the incarceration of fibroids in pregnancy. We report here the case of a 30-year-old woman in her 32nd gestational week with an incarcerated umbilical hernia. She was operated on an emergency basis, the sessile fibroid was mobilized and the hernia defect was repaired with the Mayo technique. No complications were observed during the post-operative period. She gave birth to a baby girl during the 38th gestational week by means of a cesarean section. The possibility of a fibroid entrapped in the hernial sac should always be taken into consideration at the evaluation of incarcerated hernias during pregnancy. If the contents of the hernial sac cannot be pushed into the abdominal cavity easily, an emergency operation should be considered as a means to prevent further complications related to pregnancy.