Endometriosis of the rectosigmoid colon mimicking gastrointestinal stromal tumor.

Endometriosis is defined as the growth of functional endometriotic gland and stroma outside the uterine cavity. Although it is common in women of reproductive age, extragenital endometriosis is considerably rare. Due to its frequent localization at the rectosigmoid junction in the gastrointestinal system, endometriosis may manifest with abdominal pain, constipation, and rectal bleeding. Gastrointestinal stromal tumor is the most common mesenchymal tumor of the gastrointestinal system and develops from the muscularis propria. Its extraluminal component is prominent. This study aimed to report a rare case of a 37-year-old patient who was operated with laparoscopic colon resection for a malignant-appearing submucosal mass with indistinct borders at the rectosigmoid junction that received the final diagnosis in histopathological examination. Endometriosis should be considered in the differential diagnosis of non-specific gastrointestinal symptoms in female subjects of reproductive age as the one reported here.

The Effect of Stress Incontinence Operations on Sexual Functions: Laparoscopic Burch versus Transvaginal Tape-O.

AIM: Stress urinary incontinence (SUI) has some negative emotional and physical effects on sexual functions. In this study, we aimed to question the effects of surgical treatment of stress incontinence on sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) form. MATERIALS AND METHODS: A total of 77 sexually active women who were surgically treated for SUI between 2014 and 2015 at a university hospital. Tension-free transvaginal tape (TVT-O) operation and the laparoscopic Burch procedure were performed on 42 and 35 patients, respectively. Patients with isolated stress incontinence were included in this study. All patients enrolled were invited to fill out the PISQ-12 questionnaire before surgery and 6 months after surgery. RESULTS: The mean total postoperative PISQ-12 score in both TVT-O and Burch groups was significantly increased compared to the preoperative period (P < 0.001 and P < 0.001, respectively). When the PISQ-12 scores were evaluated according to the subgroups, physical and partner-dependent scores significantly increased in the postoperative period compared to the preoperative period in the TVT-O group (P < 0.001 and P = 0.004, respectively). CONCLUSIONS: Rate of the surgery success for SUI is positively correlated with the improvement of sexual functions. Minimally invasive methods in SUI surgery has been progressively increasing day-by-day. The lesser invasive approaches seem to replace the more invasive approaches in the near future.

Dynamic MRI Evaluation of the Gastric Fundus and Splenic Circulation to Assess the Gastric Breves Dissection during Laparoscopic Nissen Fundoplication.

AIM: We aimed to evaluate the possible effects of dissecting gastric breves (GB) during the Laparoscopic Nissen Fundoplication (LNF) on the gastric fundus and splenic circulation using dynamic Magnetic Resonance Imaging (MRI). METHODS: In total 14 patients with gastroesophageal reflux disease (GERD) that was diagnosed with esophagogastroduodenoscopy and 24 - hour PH monitorization and undergoing LNF surgery were included. All patients underwent LNF surgery between October 2006 and March 2010. All patients were evaluated regarding gastric fundus and splenic circulation one week before and 15 days after the surgery with dynamic MRI. Alteration of the signal intensity before and after surgery was used to assess gastric fundus and splenic circulation. RESULTS: We detected a significant decrease in DeMeester score before and after surgery (p < 0.001). There were no statistical differences between preoperative and postoperative dynamic MRI measurements of the spleen, anterior wall measurements, posterior wall measurements in different MRI phases (Bonferroni corrected p < 0.01). Postoperative measurements of anterior and posterior gastric wall measurements were comparable (Bonferroni corrected p < 0.0033). CONCLUSIONS: We did not detect any significant differences in the abovementioned tissues regarding perfusion.

Combined procedure of cesarean delivery and preperitoneal mesh repair for inguinal hernia: An initial experience.

BACKGROUND: Combined surgery for cesarean delivery and preperitoneal mesh repair for inguinal hernia has not been previously reported. OBJECTIVES: Our aim was to describe the method and to present the results of this simultaneous surgery through a single incision. METHODS: From 2012 to 2014, 15 patients underwent cesarean delivery combined with preperitoneal mesh repair for inguinal hernia. All patient characteristics and perioperative findings were recorded. RESULTS: Among 15 patients, 13 had unilateral inguinal hernias and two had bilateral hernias. The mean times spent for unilateral and bilateral hernias were 35.8 minutes (range, 30-45 minutes) and 67.5 minutes (range, 65-70 minutes), respectively. Direct and indirect hernias were present in one and 15 patients, respectively. One patient had mixed hernia. No significant complication was observed perioperatively. Hospital stay ranged from 1 day to 3 days (mean, 1.87 days), and all patients were discharged without any problem. No recurrence was found during the follow-up periods. CONCLUSION: Single anesthesia, single incisional scar, and single hospitalization are the major advantages of this simultaneous approach of cesarean delivery and preperitoneal mesh repair for inguinal hernia. Our analysis suggests that this combined procedure can be performed safely in selected cases.

The effects of adding ischemic preconditioning during desflurane inhalation anesthesia or propofol total intravenous anesthesia on pneumoperitoneum-induced oxidative stress.

BACKGROUND: The aim of the study was to explore the differences in oxidative stress during anesthesia with desflurane/N2O or propofol/remifentanil in patients undergoing laparoscopic cholecystectomy and additionally to evaluate the differential effects of desflurane and propofol on ischemic preconditioning (IP). MATERIALS AND METHODS: One hundred patients were randomly allocated to four groups. For anesthesia maintenance, the inhalation group (Group I) and the inhalation plus IP group (Group IIP) received desflurane at an end-tidal concentration of 4-6 vol% in oxygen/N2O, and the TIVA group (Group T) and TIVA plus IP group (Group TIP) received infusions of propofol and remifentanil. In Groups IIP and TIP, IP was carried out by 10 min of pneumoperitoneum followed by 10 min of deflation. Preoperative and postoperative plasma total antioxidant status (TAS), total oxidant status (TOS), paraoxonase, stimulated paraoxonase, arylesterase, ceruloplasmin, and myeloperoxidase levels were analyzed; oxidative stress index (OSI) was calculated. RESULTS: When oxidative stress parameters were compared between groups, myeloperoxidase values in Group I were statistically significantly lower compared to Group TIP (p = .004 with Bonferroni's correction). There were no differences between preoperative and postoperative TAS, paraoxonase, stimulated paraoxonase, arylesterase, or ceruloplasmin levels (p > .05). In intragroup evaluations, postoperative paraoxonase and stimulated paraoxonase levels were found to be lower than preoperative values in Group TIP (p = .021 and .012, respectively). CONCLUSION: In laparoscopic cholecystectomy lasting less than 60 min, there were no differences in the measured oxidative stress parameters between maintenance of anesthesia by desflurane/N2O and propofol/remifentanil/N2O. The addition of 10 min IP administration during both anesthesia techniques did not result in additional changes in the analyzed oxidative stress.

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results.

PURPOSE: In this study we report early-term results of laparoscopic Nissen fundoplication with mesh hiatoplasty that we perform to treat gastroesophageal reflux disease. METHODS: We retrospectively reviewed the medical records of 68 patients who underwent laparoscopic Nissen fundoplication with mesh hiatoplasty at our clinic. Thirty-six (53%) patients were male and 32 (47%) were female. The mean age of the study population was 46.1 (25-72) years. All patients underwent endoscopy, esophagus pH metry and manometry before the operation. All operations were performed under general anesthesia using five ports. In addition to Nissen fundoplication, all patients also underwent polypropylene mesh placement. RESULTS: Preoperatively, all patients reported a burning sensation in the chest and regurgitation of the stomach contents up into the mouth. The mean time from symptom onset to operation was 28 (6-84) months. All patients were diagnosed with  esophagitis in the preoperative endoscopic examination. The mean operative time was 80 (40-125) minutes, the median duration of hospital stay was 1.2 (1-4) days and the median follow-up time was 12 (2-30) months. Functional outcome was excellent in 65% of patients, good in 24.5%, moderately good in 7% and poor in 3.5%. CONCLUSION: Fundoplication with mesh hiatoplasty is a surgical procedure performed for the traetment of gastroesophageal reflux disease and hiatal hernia. Surgery can be safely carried out with low morbidity and mortality rates and constitutes an alternative to long-term drug therapy. We believe that this operation is beneficial since it reduces the rate of recurrences to a significant degree.

Use of fibrin glue in preventing pseudorecurrence after laparoscopic total extraperitoneal repair of large indirect inguinal hernia.

PURPOSE: Seroma is among the most common complications of laparoscopic total extraperitoneal (TEP) for especially large indirect inguinal hernia, and may be regarded as a recurrence by some patients. A potential area localized behind the mesh and extending from the inguinal cord into the scrotum may be one of the major etiological factors of this complication. Our aim is to describe a novel technique in preventing pseudorecurrence by using fibrin sealant to close that potential dead space. METHODS: Forty male patients who underwent laparoscopic TEP for indirect inguinal hernia with at least 100-mL volume were included in this prospective clinical study. While fibrin sealant was used to close the potential dead space in the study group, nothing was used in the control group. The volume of postoperative fluid collection on ultrasound was compared between the groups. RESULTS: Patient characteristics and the volumes of hernia sac were similar between the 2 groups. The mean volume of postoperative fluid collection was found as 120.2 mL in the control group and 53.7 mL in the study group, indicating a statistical significance (P < 0.001). CONCLUSION: Minimizing the potential dead space with a fibrin sealant can reduce the amount of postoperative fluid collection, namely the incidence of pseudorecurrence.

Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: early results from a series of 15 patients.

OBJECTIVE: We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. MATERIAL AND METHODS: From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS: The mean age was 45,80 ± 9,91 years (range: 38-70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23-35.38 kg/m(2)). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30-50 minutes) and 30.67 ± 11.00 cc (range: 10-50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. CONCLUSION: Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.

Laparoscopic type 7 total hysterectomy and adnexectomy with or without Burch colposuspension: operative technique with the LigaSure device and results.

INTRODUCTION: The purpose of the present study was to investigate the use of an operative technique incorporating the LigaSure vessel sealing system in patients undergoing type 7 total laparoscopic hysterectomy (TLH) and adnexectomy with or without Burch colposuspension. METHODS: Data were collected for 68 patients who underwent type 7 TLH with adnexectomy. Analyzed variables included patient characteristics (age, body mass index (BMI), parity, medical and surgical history, indications for hysterectomy, weight of the removed uterus), operative data (operative time, procedures performed in addition to TLH, intraoperative blood loss), complications, difference between preoperative and postoperative hemoglobin levels, and length of hospital stay. RESULTS: Mean age was 53.7 ± 6.9 years (range 46-74) and mean body mass index was 27.9 ± 6.1 kg/m(2) (range 19.4-45.7). Overall mean operative time was 100.4 ± 31.7 min (range 60-180), mean intraoperative blood loss was 98.1 ± 96.9 ml (range 0-700), and the mean difference between preoperative and postoperative hemoglobin levels was 1.39 ± 0.6 g/dl (range 0-3.4). Mean weight of the removed uteruses was 229.4 ± 174.8 g (range 60-750). Mean hospital stay was 1.12 ± 0.7 days (range 1-7). Additional operative procedures included Burch colposuspension (15; 22.1%), adhesiolysis (9; 13.2%), cholecystectomy (2; 2.9%), transabdominal preperitoneal hernia repair (1; 1.5%) and repair of intraoperative bladder injury (1; 1.5%). Major intraoperative complications were encountered in two patients. In one, the left ureter was injured and in the other the bladder was injured. Conversion to open surgery was not needed in any of the patients. CONCLUSION: The procedure we describe here for type 7 TLH with adnexectomy, performed alone or with additional Burch colposuspension, appears to be safe and effective.

Laparoscopic supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy and Burch colposuspension performed during the same operative session via a single port.

Laparoscopic methods that combine multiple surgical procedures are becoming more widely used, but few combined procedures performed through a single incision have been reported. A major difficulty with the single-incision approach is that all the instruments are necessarily oriented along the same axis. Here, we describe a patient in whom supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy and Burch colposuspension were performed during the same operative session via a single umbilical port.

Single-incision Laparoscopic surgery for total extraperitoneal repair of inguinal hernias in 23 patients.

BACKGROUND: Laparoscopic surgery has long been the treatment of choice for recurrent or bilateral hernias, and for unilateral hernias when the patient does not want to undergo open surgery. Each laparoscopic incision or trocar presents risks for hemorrhage, organ injury, incisional hernia, and poor cosmetic outcome. For this reason, single-incision laparoscopic surgery (SILS) is being increasingly used to treat a variety of conditions. The aim of this study was to evaluate the use of SILS for total extraperitoneal (TEP) repair of hernias in the largest series performed to date. PATIENTS AND METHODS: During the period from June to September 2009, 23 consecutive patients underwent SILS for TEP repair of inguinal hernias. SILS was performed under general anesthesia, with the use of a single access port device and articulating as well as standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS: In the 23 patients (mean age 48.4 y; 18 males and 5 females), a total of 27 hernias were repaired. Unilateral hernias were present in 19 patients and bilateral hernias in four. Of the unilateral hernias, 11 were on the right and 8 on the left. Indirect hernias occurred in 15 patients, direct hernias in 7 patients, and a direct+indirect hernia was seen in 1 patient. All hernias were repaired successfully with SILS except in 1 patient. In this patient, due to the large size of the hernia and the presence of adhesions, the procedure was converted to a standard laparoscopic TEP repair. Mean operative times for unilateral and bilateral hernias were 48.4 minutes (range: 32-62 min) and 96.7 minutes (range: 85-120 min), respectively. None of the patients experienced intraoperative or postoperative complications. Mean hospital stay was 1.17 days. CONCLUSIONS: The use of SILS for TEP repair of hernias provides excellent cosmetic results, and articulating instruments seem to be useful for this procedure.

Clipless and sutureless laparoscopic adrenalectomy carried out with the LigaSure device in 32 patients.

BACKGROUND: Laparoscopic adrenalectomy has become the standard procedure for treating patents with adrenal masses. The purpose of this study was to evaluate the use of the LigaSure vessel closure system during laparoscopic adrenalectomy. METHODS: The LigaSure device was used in 32 patients undergoing laparoscopic adrenalectomy for adrenal masses. Adrenalectomy was carried out without the use of clips or sutures for vessel closure. In 1 patient the adrenal tumor had invaded the ipsilateral kidney, so laparoscopic nephrectomy was also carried out during the same operation. In another patient, a renal cell carcinoma in the left kidney had metastasized to the right adrenal gland. Both the kidney and the contralateral adrenal gland were removed laparoscopically during the same operation. RESULTS: Adrenal masses had a mean greatest diameter of 3.48 cm (range 2 to 11 cm). Mean operative time was 83.2 minutes (range 30 to 190 min). Mean blood loss was 36.2 mL (range 10 to 140 mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. Adrenal tumor types included adrenocortical adenoma (16 patients), pheochromocytoma (13 patients), malignant pheochromocytoma (1 patient), chromophobic carcinoma (1 patient), and metastasis from a renal cell carcinoma (1 patient). CONCLUSIONS: For vessel closure during laparoscopic adrenalectomy, the LigaSure device seems to be safe and effective. For patients with conditions such as renal cell carcinoma combined with metastasis to the contralateral adrenal gland, nephrectomy, and contralateral adrenalectomy can be carried out during the same laparoscopic operation.

A simple and effective technique for esophageal retraction and fundal translocation during laparoscopic fundoplication.

Laparoscopic fundoplication is a widely used method for treating gastroesophageal reflux, but the standard methods of the procedure remain difficult and pose some risk of trauma to tissues. We therefore developed a technique in which the Goldfinger device is used for both the retraction of the esophagus and for the translocation of the fundus.

Effects of the histamine H2 receptor antagonist famotidine on the healing of colonic anastomosis in rats.

BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.

Effects of the histamine H2 receptor antagonist famotidine on the healing of colonic anastomosis in rats

BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.