Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair.

PURPOSE: Corona mortis (CMOR) is the arterial and/or venous vascular communication(s) between the obturator and external iliac vessels. Totally extraperitoneal (TEP) inguinal hernioplasty can be associated with vascular complications especially during the fixation of the mesh. Theoretically, CMOR is an important nominee. But, the data in literature are insufficient about CMOR injury. Additionally, most of the studies about CMOR have been usually performed on cadavers. We aimed to reveal the preperitoneal vascular anatomy of inguinal area and provide in vivo knowledge about CMOR. The risk of arterial injury was also evaluated. MATERIALS: The data of preperitoneal vascular anatomy of 321 patients who underwent TEP procedure between January 2005 and July 2014 were retrospectively evaluated. RESULTS: Mean age was 46 ± 8.9 years, 53 females vs 268 males. 391 hemipelvises were evaluated. Two types of arterial structure were identified; (1) an aberrant obturator artery forming an anastomosis with branches of ordinary obturator artery; (2) a pubic branch of inferior epigastric artery. The incidence of arterial CMOR was 28.4 % and of any arterial structure was 45.0 %. An arterial CMOR was considered as thick (≥2 mm) or thin (<2 mm). Injury of arterial CMOR during tack stapling on Cooper's ligament was seen in six cases (1.5 %). All of them were thin (<2 mm) in structure. Venous CMOR was visible only under low pressure in work space. CONCLUSION: During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper's ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (<2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.

Erratum:Preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as new prognostic factors for patients with colorectal cancer.

In this article published in Volume 21, issue 5, the authors' names appeared in the Pubmed abstract as: "Mahsuni Sevinc M, Riza Gunduz U, Kinaci E, Armagan Aydin A, Bayrak S, Umar Gursu R, Gunduz S". The correct authors' names are: "Sevinc MM, Gunduz UR, Kinaci E, Aydin AA, Bayrak S, Gursu RU, Gunduz S" This error appeared only in the PubMed database and not in the print form of the Journal.

Pulmonary Complications After 1,150 Living Donor Hepatectomies.

AIM: Donor safety is the major concern in living-donor liver transplantation. Studies in literature related to donor hepatectomy (DH) have generally considered intra-abdominal complications. The aim of this study is to specifically evaluate pulmonary complications (PCs) after DH. MATERIALS AND METHODS: We evaluated retrospectively 1150 living donors who underwent to DH between January 2007 and July 2014. Patients with PCs, such as pneumonia, pleural effusion, pneumothorax, and respiratory insufficiency, were considered. A complication was considered only when it was clinically apparent and/or requiring interventions. Any special diagnostic tool was used to expose the clinically silent pathologies. RESULTS: A total of 986 right hepatectomies (RH) and 164 left hepatectomies (LH) (left lobectomy or left lateral segmentectomy) were performed in the study interval. There were 18 (1.6%) donors with PCs (15 males and 3 females). Mean age was 33.8 ± 9.3 years (18-51). Mean hospital stay was 23.8 ± 13.5 days (5-62). Presented PCs were pleural effusion (n = 5, 0.4%), pneumonia (n = 4, 0.3%), combinations (n = 2, 0.2%), pneumothorax (n = 2, 0.2%), and acute respiratory insufficiency (n = 5, 0.4%). Sixteen cases (1.7%) were seen after RH, whereas 2 cases (1.2%) were seen after LH (P = 1.000). CONCLUSION: The most common PCs after living donor hepatectomy were pleural effusion and acute respiratory insufficiency. There was no significant difference between RH and LH. It is possible to overcome those PCs with careful monitoring and timely and appropriate treatment.

Multiple intestinal intussusceptions in Peutz-Jeghers' syndrome: a case report.

Peutz-Jeghers' syndrome (PJS) is an autosomal dominant inherited disease, which is characterized by mucocutaneus pigmentation and hamartomatous gastro-intestinal polyps. Intussusceptions can easily occur in patients with PJS. Repeated laparotomy with resections and eventual short bowel syndrome is a major problem in these patients. We present a 20-year-old woman with multiple intestinal intussusceptions. Multiple enterotomies and intestinal resections were performed to achieve a longer symptom-free period.

Duodenal ulcer perforation and pneumothorax: a case report.

Pneumothorax and pneumomediastinum are rarely observed as a complication of perforated peptic ulcer, which is a common cause of acute abdomen. We report a case of a 30-year-old male patient with abdominal pain and respiratory distress. Resulting from physical examination and laboratory data of the patient, acute abdomen and pneumothorax were diagnosed simultaneously. Laparotomy revealed duodenal ulcer perforation and a simple patch closure was performed. No complications were observed during the postoperative course of the patient.

Efficacy of local adrenalin injection during sacrococcygeal pilonidal sinus excision.

BACKGROUND: The most commonly preferred treatment method for sacrococcygeal pilonidal sinus disease is surgery. Peroperative and postoperative hemorrhages may develop frequently because of the increased vascularity of the region. The aim of this study was to evaluate the effects of adrenalin, a potent vasoconstrictor agent, on pilonidal sinus operations in comparison to a control group. METHODS: A prospective, randomized, double-blind, clinical study was designed and 51 patients with symptomatic, uncomplicated pilonidal disease were included (44 males and 7 females; mean age 24.5, range 16-44 years). Adrenalin 0.1 mg with 10 ml 0.9% NaCl (1/100,000 dilution) was injected through the incision tracts to all layers and the base of the incision area in group 1 (n = 21). The same process was applied to group 2 (n = 21) with 10 ml physiological serum solution. Then, after removal of the sinus and its tracks, a suction-type drain was placed in the pouch in all cases and the incision was primarily closed. Peroperative and postoperative hemorrhage, and operation time were accepted as the evaluation criteria. Cases were followed for 6 months postoperatively. RESULTS: The amount of peroperative hemorrhage was 6.5 +/- 3.5 ml in group 1 and 17.5 +/- 9.5 ml in group 2 (p < 0.001). The postoperative hemorrhage was 11 +/- 7.5 ml in group 1 and 13.5 +/- 6 ml in group 2 (p > 0.05). The operation time was 14 +/- 5 min in group 1 and 22 +/- 8.5 min in group 2 (p < 0.05). No reactionary hemorrhage, hematoma or recurrence was seen during the follow-up period. CONCLUSIONS: Adrenalin injection is quite effective to decrease peroperative bleeding and operation time, but it does not decrease postoperative bleeding and the need for a drain.