Biological and physical properties of calcium hydroxide-based pulp-capping materials and their modifications.

PURPOSE: To evaluate the biological and physical properties of calcium hydroxide-containing pulp-capping materials and their modifications with different solutions and antioxidant Resveratrol (RES) addition. METHODS: Calcium hydroxide+distilled-water:C, calcium hydroxide+saline:S, calcium hydroxide+synthetic tissue fluid:STF, Dycal:D, calcium hydroxide+distilled-water+RES:C+RES, calcium hydroxide+saline+RES:S+RES, calcium hydroxide+synthetic tissue fluid+RES:STF+RES, Dycal+RES:D+RES were tested. Cytotoxicity was determined by WST-1. Antibacterial-activity was evaluated by agar-diffusion. The water-absorption and solubility were examined for ISO-6876 and ISO-3107. The color-change was evaluated by spectrophotometer. Radiopacity was evaluated for ISO-6876 and ISO-9917. The normal distribution and homogeneity were determined and comparisons were made with appropriate analysis and post hoc tests (P < 0.05). RESULTS: The highest cell-viability was determined in the C+RES and the lowest was in D and D+RES after 24 h (P < 0.0001). RES-addition increased cell-viability and the highest rate was detected in C+RES, S+RES and STF+RES after 48 h (P < 0.0001). A limited inhibition-zone against Streptococcus mutans was detected in D and D+RES. RES-addition did not change the water-absorption in S and STF or the solubility in S group. CONCLUSION: RES-addition may be used to increase the biocompatibility of calcium hydroxide without any adverse effect on physical properties. Saline may be the first choice as a mixing solution.

Squamous Cell Carcinoma Arising from Perianal Buschke-Lowenstein Tumor (Giant Condyloma Acuminatum): Comprehensive Literature Review.

PURPOSE: This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum. METHODS: We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020. RESULTS: A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2). CONCLUSION: Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.

Risk factors for postoperative ileus following loop ileostomy closure.

OBJECTIVES: The most common intra-abdominal complication following loop ileostomy closure (LIC) is postoperative ileus (POI). The aim of the study was to determine the risk factors of POI development following LIC and make recommendations for its prevention. MATERIAL AND METHODS: In this study, patients having undergone LIC with peristomal incision following distal colorectal surgery were included. Clavien-Dindo classification was used to evaluate postoperative complications. POI and postoperative leakage were defined based on clinical and radiological criteria. The Centers for Disease Control and Prevention 2017 criteria were used to diagnose surgical site infection (SSI). Postoperative bleeding was diagnosed one day after surgery if there was a >2 g/dL or ≥15% decrease in the hemoglobin level. RESULTS: Seventy-nine patients were included into the study. In nine of the patients POI developed, six had SSI, five had postoperative bleeding, and two had anastomosis leakage. In the univariate analysis; age <60 years (p= 0.02), presence of comorbidity (p= 0.007), using an open technique in the first surgery (p= 0.02), performing total colectomy in the first surgery (p= 0.048), performing hand-sewn anastomosis of LIC (p= 0.01), and postoperative blood transfusion (p= 0.04) were found to be risk factors for POI. Performing hand-sewn anastomosis of LIC (p= 0.03) and using an open technique in the first surgery (p= 0.03) were found to be independent variables for POI risk. CONCLUSION: Using an open technique in the first surgery and performing a hand-sewn anastomosis of LIC may increase POI.

In-vitro evaluation of the effects of insertion and sterilization procedures on the mechanical and surface characteristics of mini screws.

PURPOSE: The aim of the present study was to investigate the effects of insertion and sterilization on primary stability and to examine the mechanical and surface characteristics of mini screws. MATERIALS AND METHODS: 140 miniscrews (70 Dual-Top; 70 Ortho-Easy) were divided into 3 groups. Group 1: control group, 10 miniscrews of each brand, evaluated without any primary procedure. Group 2: 30 miniscrews of each brand, each inserted into the sawbone once, then sterilized and tested. Group 3: 30 miniscrews of each brand, each inserted into the sawbone twice, sterilized after each insertion and then tested. The miniscrews were evaluated for changes in primary stability, mechanical and surface characteristics with scanning electron microscopy (SEM) analysis, torsion tests, maximum insertion-removal torques and vertical-horizontal pull out strength tests. RESULTS: The maximum insertion torque values of the unused miniscrews (Group 1) were found to be significantly higher than those of the reused (Groups 2, 3) mini screws (p<0.05). Removal torque, vertical-horizontal pull-out strength and torsional strength value changes were found to be statistically insignificant. In SEM analysis, wear and atrophy were seen on the threads of used miniscrews especially in the apical region and the oxide layer was seen to have disappeared from some regions of the coated miniscrews. CONCLUSION: Although wear and atrophy were detected in SEM analysis of used miniscrews, the overall primary stability and fracture torque resistance tests did not show any significant changes after the first and second insertion and sterilization procedures.

The evaluation of the effect of vaginal delivery and aging on anal sphincter anatomy and function.

OBJECTIVE: This study was conducted to evaluate the effect of vaginal delivery and aging on anal sphincter anatomy and function. METHOD: Asymptomatic thirty women were included in this prospective study. Group 1 included 10 women (age range: 18-50) who had never been pregnant. Group 2 included 10 women (age range: 18-50) who had vaginal delivery. Group 3 included 10 women over 50 who had vaginal delivery. RESULTS: There was no statistically significant difference between the three groups in terms of resting and squeeze pressures. It was found that sphincter thickness showed statistically significant difference between the group 1 and group 3, and also group 2 and group 3. There was not statistically significant difference between the group 1 and group 2 in terms of sphincter thickness. There was a positive correlation between the age and sphincter thickness in all groups. In terms of sphincter thickness and pressure findings there was a positive correlation between the squeeze pressure and external anal sphincter thickness only in group 3. CONCLUSION: The vaginal delivery did not have a negative influence on the structure and function of the anal sphincter in asymptomatic women. However, it was found that anal sphincter thickness changed strongly in a positive manner with aging.

A surgical technique for secondary repair of obstetric anal sphincter injuries; sphinctero-vagino-perineoplasty.

OBJECTIVE: This study was conducted to present the preliminary results of seven patients treated with sphinctero-vagino-perineoplasty for secondary repair of obstetric anal sphincter injuries. MATERIALS AND METHODS: This retrospective study was conducted on the records of seven patients who underwent secondary repair of obstetric anal sphincter injuries at the colorectal surgery unit of a tertiary care center between February 2015 and December 2017. RESULTS: All patients with solid stool incontinence were fully recovered at postoperative month 3. The Wexner incontinence score was significantly improved (decreased from 14.12 [range: 8-20] to 2.28 [range: 1-4]). The complication rate was 85.7% (wound infection, abscess, hematoma, detachment). CONCLUSION: Combined repair of anal sphinchters, perineal body, superficial transverse perineal muscles, and bulbospongious muscles, which contribute to anal continence, may improve surgical outcomes in patients with obstetric anal sphincter injuries.

Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach.

Reconstruction of anomalous portal vein branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. The goal of this article is to describe our surgical technique, named the Malatya Approach, in case of APVB during right lobe LDLT. The technique unifies the APVB and obtains a funnel-shaped common extension with a circumferential fence by a saphenous vein conduit. In total, 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into 2 groups according to the adopted surgical techniques: the Malatya Approach group (n = 91) and the previously defined other techniques group (n = 35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90-day mortality and survival. PVT developed in 3 patients (3.3%) in the Malatya Approach group and developed in 10 (28.6%) patients for the other group (P < 0.001). There were 8 (8.8%) 90-day mortalities in the Malatya Approach group (1 PVT related) and 15 patients (9 PVT related) died in the other techniques group (P < 0.001). Mean follow-up time for both groups was similar (999.1 days for the Malatya Approach group versus 1024.7 days for the other group; P = 0.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; P < 0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (P < 0.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751-761 2017 AASLD.

Antimicrobial activity of different disinfectants against cariogenic microorganisms.

The aim of this study was to assess the in vitro antimicrobial effects of chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHBM), and octenidine dihydrochloride (OCT) on cariogenic microorganisms by using their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). CHX, PHBM, and OCT were diluted in distilled water to the final test concentrations. Using the in-tube dilution method, Streptococcus mutans, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Actinomyces viscosus were cultivated on blood agar and Mueller-Hinton broth (MHB) at 37°C for 48 h. They were read using a spectrophotometer to detect MIC. To determine MBC, samples in the range of the turbidity threshold after 24 h were transferred onto blood agar and evaluated for growth after 24 h. Different MICs and MBCs were observed in all disinfectants against each microorganism. The lowest MIC and MBC against S. mutans (60 mg/L) were obtained from PHBM. The lowest values against L. rhamnosus (15 mg/L, 30 mg/L), A. viscosus (30 mg/L), and L. acidophilus (15 mg/L, 30 mg/L) were determined by OCT. PHBM and OCT have the potential to be replaced with CHX because they were effective against cariogenic microorganisms.

Low Pressure is Necessary to View and to Protect Corona Mortis During Totally Extraperitoneal Hernia Repair.

BACKGROUND: The identification of retropubic vasculature is not easy under the pressure of insufflated gas during totally extraperitoneal (TEP) inguinal hernioplasty. We aimed to present the usefulness of a maneuver that allows the clear identification of retropubic vasculature. METHODS: Vascular anatomy on the retropubic surface in 364 patients who underwent the TEP procedure from January 2005 to September 2015 was evaluated. In patients after July 2014, the pressure in the workspace was decreased from 14 to 8 mmHg before fixation of the mesh to clearly identify the veins. The results before and after July 2014 were compared. RESULTS: Demographic features were not significantly different between two periods. The number of hemipelvises in the first and second periods was 398 and 77, respectively. The rate of identification of venous corona mortis was 31% in the second period, whereas it was 1.0% in the first period (P = .000). The identification of thick (5.5% versus 10.3%; P = .123) and thin (22.8% versus 36.3%; P = .014) arterial structures and their sum were increased in the second period (28.4% versus 46.7%; P = .002). The rate of retropubic bleeding was zero in the second period, while it was 1.5% in the first period. CONCLUSIONS: During TEP hernioplasty, the pressure of insufflated gas more than 10 mmHg in the preperitoneal space hinders the correct identification of vessels on the retropubic surface. The proposed maneuver, to decrease the pressure in the workspace to 8 mmHg, can provide clear identification of all vessels, which decreases the potential risk of vascular injury.

Direct usage of miniscrew anchorage to intrude overerupted maxillary posterior teeth before prosthodontic preparation: a case report.

Overeruption of maxillary molars due loss of opposing teeth creates occlusal and functional interferences. Before reconstruction can be initiated, intrusion of overerupted molars becomes essential. This report illustrates treatment of overerupted maxillary premolar and molar via direct use of miniscrew anchorage. A 24-year old female had lost first and second left mandibular molars due to pulpal necrotizing agents, resulting with a large alveolar bone defect and overerupted maxillary premolar and molar. She had a history of unsuccessful alveolar distraction of mandibular left premolars to increase the alveolar bone height prior to implant placement. Patient was satisfied with her smile and refused comprehensive orthodontic treatment. Maxillary premolar and molar were intruded segmentally for 4mm in 8 months, using a combination of a mini-implant and partialfixed edgewise appliances. Biological responses of teeth and surrounding bony structures to intrusion appeared normal and acceptable in radiographic and clinical examination.

Rapid-maxillary-expansion induced rhinological effects: a retrospective multicenter study.

Conventional dental-borne rapid maxillary expansion (RME) leads to a widening of the airways, followed by improved nasal breathing. Although combined skeletal-dental appliances are nowadays being inserted increasingly often and provide a force at the center of resistance in the nasomaxillary complex, no study exists so far that shows whether this treatment may improve the expansionary effect on the airways. In this study, low-dose computed tomography (CT) images from 31 patients (average age 14.63 ± 0.38 years) were examined retrospectively. Both records (T0 = before expansion and T1 = immediately after maximum expansion) were taken in a time interval of 25 days to avoid growth influence. Five patients were treated with Hyrax RME, 6 patients with Hybrid RME, and 20 patients with acrylic cap RME. The total airway volume increased highly significantly (mean +7272.6 mm(3); P < 0.001, power = 0.998), representing an average airway expansion of +11.54 % (2.35 %/mm activation). While the nasopharynx and oropharynx showed highly significant expansion (P < 0.000, power = 0.999), the airway at the laryngopharynx did not change significantly (P > 0.779, power = 0.05). Although the patients were significantly older in the Hybrid RME group (P = 0.006), the positive rhinological effects were comparable within all groups of different appliances (P > 0.316). Hybrid RME may, therefore, be an advisable procedure in patients with nasomaxillary impairment and pronounced patient's age.

Antimicrobial activity of different disinfectants against cariogenic microorganisms

Abstract The aim of this study was to assess the in vitro antimicrobial effects of chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHBM), and octenidine dihydrochloride (OCT) on cariogenic microorganisms by using their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). CHX, PHBM, and OCT were diluted in distilled water to the final test concentrations. Using the in-tube dilution method, Streptococcus mutans, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Actinomyces viscosus were cultivated on blood agar and Mueller-Hinton broth (MHB) at 37°C for 48 h. They were read using a spectrophotometer to detect MIC. To determine MBC, samples in the range of the turbidity threshold after 24 h were transferred onto blood agar and evaluated for growth after 24 h. Different MICs and MBCs were observed in all disinfectants against each microorganism. The lowest MIC and MBC against S. mutans (60 mg/L) were obtained from PHBM. The lowest values against L. rhamnosus (15 mg/L, 30 mg/L), A. viscosus (30 mg/L), and L. acidophilus (15 mg/L, 30 mg/L) were determined by OCT. PHBM and OCT have the potential to be replaced with CHX because they were effective against cariogenic microorganisms.

Effects of different antibacterial agents on enamel in a biofilm caries model.

Using a mature biofilm model, the aim of this study was to evaluate the effectiveness of different antibacterial agents in comparison with silver diamine fluoride (SDF). Forty-eight saliva-coated enamel slabs were inoculated with Streptococcus mutans monospecies biofilm. The biofilms were then exposed to 10% sucrose in tryptone yeast-extract culture medium, 8 times per day for 7 days. After the biofilm growth period, the enamel slabs were treated with one of the following substances: 1) distilled water; 2) SDF; 3) acidulated phosphate fluoride (APF); 4) ammonium hexafluorosilicate (AHF); 5) ammonium hexafluorosilicate + cetylpyridinium chloride (AHF+CPC); or 6) 0.2% chlorhexidine (CHX). After these treatment procedures, the samples were incubated at 37ºC for 2 days, and the numbers of viable microorganisms in the biofilms were counted. The number of viable bacteria was significantly reduced by all of the antibacterial agents (P < 0.05). However, SDF showed the highest antibacterial activity (P < 0.05), and the effectiveness of the other agents was lower (P < 0.05). SDF has a highly effective antibacterial action against cariogenic Streptococcus mutans biofilm; none of the other fluoride agents used in this study, or 0.2 CHX agent, showed an antibacterial effect comparable to that of SDF.

Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction.

AIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn's disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture. RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient (adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimens were 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up (ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the overall experience in the literature was 80% (12/15) in selected cases. CONCLUSION: Transcolonic specimen extraction for right-sided colonic resection is feasible in selected patients. Both natural orifice surgery and intracorporeal anastomosis avoids mini-laparotomy for specimen extraction or anastomosis.

Donor Postoperative Biliary Complications After Living-Donor Liver Transplant.

OBJECTIVES: Although the main factors responsible for donor deaths after living-donor liver transplant are liver failure and sepsis, the most common donor complications are associated with the biliary tract. MATERIALS AND METHODS: Between April 2006 and May 2012, five hundred ninety-three donors underwent living-donor hepatectomy procedures for living-donor liver transplants. The mean age of donors was 31.0 ± 9.9 years and the ratio of men to women was 341:252. Of all donors, 533 (89.9%) underwent a right lobe hepatectomy, 45 (7.6%) underwent a left lateral segmentectomy, and 15 (2.5%) underwent a left hepatectomy. RESULTS: Biliary complications were observed in 51 liver donors (8.6%). Based on the Clavien-Dindo classification, grade I and grade II complications were 3.2% and 0%, while grade IIIa and grade IIIb complications were observed in 3.5% and 1.85% of cases. Right lobe donor biliary complications occurred at the rate of 8.2% in 44 donors. Grade IV and grade V complications were not observed. Grade IIIa complications necessitating radiologic and endoscopic procedures were observed in 21 liver donors (3.5%). Bile leakage unresponsive to medical therapy was detected in 19 donors (3.2%). Nasobiliary catheters were placed in 3 of 19 donors and internal stents were placed in 1. Two sessions of balloon dilatation were performed in the 2 grade IIIb donors (0.33%). Biliary strictures observed in 2 right lobe donors and 1 left lobe donor was treated by hepaticojejunostomy an average of 14 months after surgery. CONCLUSIONS: Avoidance of intraoperative issues and early recognition of bile leakage are fundamental in preventing complications in living-donor liver transplant donors.

Consequences of the use of extended criteria donors in living donor liver transplantation.

BACKGROUND: Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation (LDLT). This retrospective study reports our center's experience in utilizing extended criteria donors for LDLT. MATERIAL AND METHODS: The charts of 342 LDLT donors who underwent right hepatectomy between September 2007 and December 2010 were reviewed. Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors. The surgical complications in the extended criteria donors and non-extended criteria donors were compared. RESULTS: There were 61 extended criteria donors (21 male, 40 female; mean age 41 years) and 281 non-extended criteria donors (189 male, 92 female; mean age 31 Years). Surgical morbidities were observed in 70 (20.4%) of donors. The number of patients with complications according to Clavien's system were: Grade I, 30 (43%); Grade II, 11 (16%); Grade IIIa, 12 (17%); Grade IIIb, 16 (23%); and Grade IV, 1 (1%). Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors (p>0.05). However, only the Grade IIIb complication rate in donors with extended criteria was significantly higher than in non-extended criteria donors (p=0.04). Complications developed in 3 of 7 donors aged >55 years and with BMI >30. There was no donor mortality. CONCLUSIONS: Although there was no statistical difference between the 2 groups' postoperative complication rates, Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor's postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.

A pancreatic pseudopapillary tumor enucleated curatively.

INTRODUCTION: Pseudopapillary tumors (PPT) of the pancreas are very rare, comprising 0.3-2.7% of all pancreatic tumors, and they occur mostly in young women. Generally, they are benign, but in rare cases they can enlarge, invade adjacent organs, and metastasize distantly. Radiological assessments and biochemical markers are important for diagnosing tumor characteristics. The main treatment is tumor resection. PRESENTATION OF CASE: An 18-year-old female was referred to our department suffering from abdominal discomfort and upper quadrant abdominal pain. Abdominal computed tomography (CT) revealed a 6-×5-cm mass between the pancreatic head and right adrenal gland (Fig. 1). The histological assessment was a solid PPT of the pancreas with intact surgical borders. DISCUSSION: PPT are very rare, comprising approximately 5% of cystic pancreatic tumors and ∼1% of exocrine pancreatic neoplasms and present mainly during the second and third decades of life. PPTs are usually indolent tumors. As such, they tend to produce vague nonspecific symptoms or may be detected incidentally on imaging. Complete surgical resection (R0) is the most effective therapy for PPT. CONCLUSION: Although PPT is a very rare, benign tumor, it has the potential to metastasize to adjacent and distant organs. Consequently, they should be detected early, so that they can be treated surgically before malignant conversion.

Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis.

OBJECTIVE: Endoscopic balloon dilatation (EBD) is currently accepted as an effective, safe, and first-line treatment of postoperative benign gastrointestinal anastomosis stenosis (BGAS); however, a limited number of publications on the subject exist in the literature. The aim of the study was to retrospectively evaluate the efficiency of endoscopic dilatation in patients with postoperative intestinal anastomotic stenoses at a single surgical center. METHODS: Patients with postoperative BGAS treated by EBD at our institution from February 2008 to 2012 were included. The dilatations were all performed using through-the-scope balloons. The balloon was introduced into the stricture using a guidewire under radiologic guidance. Each dilatation session consisted of 2 to 3 two-minute multistep inflations of the balloon until adequate dilatation was achieved. RESULTS: Of the 48 patients included in the study, 44 patients (91.7%) fully recovered and 4 (8.3%) did not respond to treatment. The mean follow-up period was 24 months (range, 3 to 57 mo). Four patients who did not respond to the procedure were treated surgically. Two patients (4.1%) with intestinal perforation during EBD were treated conservatively with a stent. CONCLUSIONS: EBD has a low rate of complications and a high success rate, is well tolerated, and avoids further surgical procedures for BGAS. Therefore, EBD should be the first choice of treatment for postoperative anastomotic stenoses.

Transvaginal appendectomy in morbidly obese patient.

Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES). Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m(2), ASA III) patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm trocar was inserted through the umbilicus and a 5 mm telescope was placed. A 12 mm trocar and a 5 mm grasper were inserted separately through the posterior fornix of the vagina under laparoscopic guidance. The appendix was divided with an endoscopic stapler through the transvaginal 12 mm trocar and removed from the same trocar. The operating time was 75 minutes with minimal blood loss (<10 mL). The patient was discharged 16 hours after surgery uneventfully and she did not require any analgesic administration. Conclusion. To the best of our knowledge, this is the first clinical case that focuses on the transvaginal appendectomy at morbid obesity. We can say that morbid obesity does not constitute an obstacle for treatment of acute appendicitis by transvaginal endoscopic surgery.