Comparison of peritoneal closure techniques in laparoscopic transabdominal preperitoneal inguinal hernia repair: a prospective randomized study.

PURPOSE: We aimed to compare tacker and suture techniques for peritoneal closure with respect to patient outcomes. METHODS: A total of 64 patients were included in the study, 32 being in the tacker group and 32 in the suture group. All patients underwent laparoscopic TAPP inguinal hernia repair. Both groups were compared with respect to age, sex, duration of peritoneal closure and the operation, hernia type, the number of tackers used for mesh fixation, postoperative complication rate, visual analogue scale (VAS) scores on 1st, 7th, and 30th days, duration of follow-up, and recurrence rates. RESULTS: Duration of peritoneal closure and the operation was significantly shorter in the tacker group compared to the suture group (p < 0.001, p = 0.008, respectively). Statistical analysis with the two-way analysis of variance method revealed that mesh fixation with one or two tackers did not influence postoperative pain. VAS 1 was significantly lower in patients with peritoneal closure with suture compared to the patients undergoing peritoneal closure with tacker (p = 0.027). VAS 7 and VAS 30 were lower for peritoneal closure with suture versus tacker, although the difference did not reach statistical significance (p = 0.064, p = 0.294, respectively). We observed no recurrence at an average of 21-month follow-up. CONCLUSIONS: Tacker and suture appeared to have a comparable safety for peritoneal closure in laparoscopic TAPP inguinal hernia operation. It can be suggested that peritoneal closure with tacker increased short-term pain, independent of the number of tackers used for mesh fixation. Long-term pain was similar in both groups.

Results of modified Dufourmentel rhomboid flap in patients with extensive Sacrococcygeal pilonidal disease.

PURPOSE: The aim of our study was to assess our modified Dufourmentel flap outcomes in a standardized patient group (a symptom duration of equal to or greater than 60 months, presence of equal to or more than 3 sinus ostia or presence of sinus ostia fistulized equal to or greater than 2 cm laterally, and a normal body mass index) with extensive pilonidal sinus. METHODS: Patients who were diagnosed with chronic pilonidal sinus disease and gave consent to surgical repair with modified Dufourmentel flap were enrolled. Patients were assessed with respect to age, sex, body mass index, presenting symptom, symptom duration, number of previous operations, number of sinus ostia, length of flap rims, depth of intergluteal sulcus, distance of sinus from anus, duration of operation, time of drain removal, length of hospital stay, early postoperative complications, postoperative pain, loss of labor, length of follow-up, and recurrences. RESULTS: A total of 42 patients were enrolled. Average duration of presenting symptoms was 64.4 +/- 4.7 months and average length of follow-up was 29.4 +/- 3.6 months. Average length of hospital stay was 4.2 +/- 0.8 days, and time to return to work was 16.3 +/- 2.1 days. Two patients (4.7%) developed postoperative wound infection, one patient (2.4%) developed seroma, and three patients (7.1%) had wound dehiscence. There was no recurrence. CONCLUSION: Modified Dufourmentel flap application can be safely used in the treatment of extensive pilonidal sinus disease.

Results of surgical treatment of anterior abdominal wall desmoid tumours : 13 cases reviewed with literature.

BACKGROUND: We retrospectively evaluated the results of surgical treatment for anterior abdominal wall -desmoid tumours. METHODS: Records for 13 patients operated on for desmoid tumours from 1997-2013 were searched for age, gender, abdominal/pelvic surgical history, pregnancy, Gardner's syndrome, pre-operative radiological examinations, tumour size, multifocality, surgical procedure, tumour presence at surgical margins, recurrence, morbidity, and mortality. Local recurrence-free survival probabilities were estimated by the Kaplan-Meier method and stratified by various clinicopathological variables. RESULTS: There were 11 female (84,6%) and 2 male (15,4%) patients with a median age of 36 years. Seven (53,8%) -patients had previous abdominal/pelvic surgery, five (38,5%) had a history of pregnancy, and one (7,6%) had Gardner's Syndrome. Two (15,3%) patients had multifocality on their pre-operative radiological examinations. Mean tumour -diameter was 4,6 cm (SD 3,2 cm ; range 2-12 cm). After the excision of the masses in five (38,5%) patients, synthetic materials were used to close the abdominal wall defects. Two (15,3%) patients with positive surgical margins after -surgery were re-operated. Three (23%) patients required a second surgical intervention after the mass excisions were performed. Mean follow-up time was 56,7 months. Recurrence was observed in three patients during follow-up. Increased tumour size, history of previous abdominal/pelvic surgery, and the presence of multifocality had a negative effect on local recurrence-free survival. There was no mortality during follow-up. CONCLUSIONS: Desmoid tumours are characterized by high recurrence, even after proper surgical excisions. Preoperative differential diagnoses of these tumours should be done and a post-operative follow-up protocol should be followed.

Indirect hernial sac containing the uterus, ovary, and fallopian tube in association with a giant intraabdominal lipoma: report of a case.

Presence of the ovary, fallopian tube, and uterus within an inguinal hernia is a rare condition. In this report, we describe the case of a 47-year-old female, multiparous patient with a giant omental lipoma (18 × 8 × 7 cm, 422 g) and left inguinal hernia. The uterus, left ovary, and fallopian tube were in the hernial sac. The presence of the uterus within the hernial sac accompanies mullerian anomalies, although, in this case, there was no such anomaly. To our knowledge, there have been no cases in the literature of a giant intraabdominal lipoma and a hernial sac containing the uterus, ovary, and fallopian tube, but a few cases of inguinal hernia involving the ovary, fallopian tube, and uterus have been reported. The aim of this case report was to call attention to the observation that the inguinal hernia seen in female patients may involve the ovary, fallopian tube, and uterus.

[Nine years of trauma cases]. / Dokuz yillik travma olgularimiz.

Trauma is one of the major cause of death in the young population. The patients treated due to trauma were evaluated retrospectively during the last nine years. 212 cases with trauma were hospitalised in our clinic, between 1.7.1990-11.4.1999. 190 (89.6%) of them were operated and 22 (10.4%) of them were observed selectively. 36 (17%) of the cases were female and 176 (83%) of them were male. The mean age was 32.4 (16-81). 93 (43%) of them were hospitalized following traffic accidents; 56 (26.4%) of them stab wounds, 33 (15.6%) of them gunshots and 30 (14.1%) of them blunt trauma. The diagnosis was done through the diagnostic peritoneal lavage 95.1% of the traffic accident cases. The diagnosis was performed through diagnostic peritoneal lavage 76.9% of the after blunt trauma cases. After gunshots the diagnosis was done by 59.4% of the cases with physical examination. Local lesion exploration helped us to establish the diagnosis 51.4% of the stab wound cases. The most frequent organ injury following traffic accidents is splenic injury and injury of small intestine following penetrating trauma. The amount of our negative laparotomy was more than in literature and 47 (24.7%) cases were accepted as negative exploration. Negative laparotomy was seen mostly by stab wounds (49%). 17 (77.3%) of the 22 cases observed selectively were the cases of the last two years. In the recent two years the amount our negative laparotomy was six and our negative laparotomy ratio is 14%. Our mortality and the morbidity rates were at the acceptable level.

A rare cause of acute abdomen: splenic infarction.

Splenic infarction is a rare disorder. We have treated 4 patients during the last year. Abdominal pain in the left upper quadrant was the common complaint. Other complaints were fever, nausea and vomiting. Computed tomography showed infarcted areas in the spleen in all of the patients. Splenectomy was applied to three of the patients with recurring symptoms. The other patient had the first episode treated medically. Pulmonary embolism in one and surgical wound infection occurred in another patient during postoperative follow-up for nine (range: 4-14) months.