Comparison of crystallized phenol and Karidakis flap treatment in pilonidal sinus disease.

PURPOSE: In this study, we aimed to compare the results of Karidakis flap reconstruction with crystallized phenol in pilonidal sinus treatment. METHODS: 216 patients treated for pilonidal sinus disease with the researched methods between June 2016 and July 2019 were included in the study. RESULTS: 142 (65.7%) of the patients were treated with the KFR technique and 74 (34.3%) with the crystallized phenol method. Of the patients included in the study, 157 (72.7%) were male, and 59 (27.3%) were female. The mean age was calculated as 24.89 (± 8.4). The mean hospital stay in the KFR group was 1.21 (± 0.4) days. The mean time to return to work was 2.79 (± 1.03) days in the phenol group and 15.35 (± 3.39) days in the KFR group. In 4 (5.4%) patients, the improvement could not be achieved despite multiple sessions of phenol administration, and the procedure was considered unsuccessful. Recurrence occurred in 6 patients (4.22%) in the KFR group. The mean follow-up period was 13.44 (11-16) months in the KFR group and 13.67 (11-16) months in the phenol group. CONCLUSION: It is thought that phenol administration can be applied in selected single-pit cases with high success, low complications, hospitalization, and early return to work. While the KFR method's lower recurrence rates are advantageous, it was noteworthy that the complication rates were higher. KEY WORDS: Crystallized phenol, Karydakis flap reconstruction, Pilonidal sinus disease.

A retrospective comparative study of hemorrhoidal artery ligation versus ligasure hemorrhoidectomy for the third degree hemorrhoidal disease.

BACKGROUND: Hemorrhoidal disease (HD) is the most common disease of the anorectal region. Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure, which is basically an electrosurgical device, is one of the treatment methods Ligasure hemorrhoidectomy (LH). In another method applied for the first time by Morinaga, the vascular plexus is provided by Doppler-guided ligation of the hemorrhoidal arteries (ADHL). In our study, we aimed to compare and evaluate the results of these two minimally invasive treatment methods. MATERIALS AND METHODS: Patients treated with ADHL and LH for HD in our Surgery Clinic were included in the study. Demographic data, complaints, number of hemorrhoidal structures, location, complications, operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results were evaluated from the patient files. RESULTS: The number of patients included in the study was 91. While 54 patients were treated with ADHL (group 1), 37 patients (group 2) were treated with LH. Although the gender distribution between the groups was similar, there was male predominance in both groups. The mean operative time was shorter in group 1. The number of packages was 2.7 in group 1 and 2.4 in group 2. The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group. In the postoperative period, bleeding was not observed after an average of 1.4 days in group 1, while this period was 4.9 days in group 2. While recurrence occurred in 4 patients in the ADHL group, recurrence developed in 3 patients who underwent LH. CONCLUSION: ADHL and LH techniques have advantages and disadvantages over each other. Although the ADHL technique seems to be superior to LH in terms of post-defecation pain and shorter hospital stay, prospective randomized controlled studies are needed to determine which method should be chosen in which patient.

Do we need mesh fixation at the laparoscopic hernia repair?

OBJECTIVE: With the development of laparoscopic treatment, widespread use of laparoscopy has become inevitable for the treatment of inguinal hernias, which is one of the most common ailments in surgical practice. Fixing or not fixing the mesh during laparoscopic repair remains a debate. In our study, we aimed to compare patients with and without mesh fixation in terms of postoperative pain, recurrence, complications, hospitalization and return to social life. METHOD: The surgical technique to be performed was randomly determined, 81 patients whose data were kept prospectively and evaluated retrospectively were included in the study. Total extraperitoneal repair (TEP) was performed in all patients. While the mesh was not fixed in 50 patients, it was fixed with 2 tackers in 31 patients. RESULTS: When the two groups of patients were compared, the group without mesh fixation was found to be superior in terms of postoperative pain, length of hospital stay and return to social life. There was no difference between the 2 groups in terms of complications and recurrence. CONCLUSIONS: In the light of these findings, it is seen that TEP hernia repair can be performed safely without mesh fixation, although prospective randomized studies are needed.

Evaluation of the predictive effects of trauma scoring systems in colorectal injuries.

INTRODUCTION: Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury. METHODS: The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated. RESULTS: The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant. CONCLUSION: A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.

Incidental gallbladder cancer: a retrospective clinical study of 40 cases.

Purpose: Cholecystectomy is one of the most common surgeries today due to gallbladder diseases. The most prevalent malignancy of the biliary tract is gallbladder cancer. We aimed to discuss the results of our patients who underwent cholecystectomy for benign reasons in our clinic and who had gallbladder cancer due to pathology. Methods: The results of cholecystectomy performed in General Surgery Clinic of Seyhan Government Hospital were evaluated. Cases diagnosed as gallbladder as a result of histopathological examination were included. Preoperative ultrasonography, laboratory findings, and postoperative pathology results of the patients were reviewed retrospectively. The pathologist repeated histopathological evaluations. Results: Between 2010 and 2019, incidental gallbladder cancer (IGBC) was detected in 40 patients (0.3%) in 11,680 cholecystectomy operations. Of the patients diagnosed with IGBC, 14 (35.0%) were T1a, 11 (27.5%) were T1b, 11 (27.5%) were T2, and 4 (10.0%) were T3. T4 tumor was not seen in any patient. Three patients who were T1b at initial evaluation were identified as T2 at evaluation for the study. The pathology results of 37 patients (92.5%) were adenocarcinoma, 2 (5.0%) were adenosquamous type, and 1 (0.5%) was squamous cell carcinoma. Conclusion: There has been a remarkable increase in the number of IGBCs over the past 20 years. Appropriate staging and histopathological evaluation are essential in guiding the surgeon's operation. It is crucial to accurately determine the T stage, the most influential parameter on patient survival and residual recurrences. The distinction between pathologic (p) T1a and pT1b should be made carefully. Surgery is the only potentially curative method.

The effect of progesterone in the prevention of the chemically induced experimental colitis in rats / Efeito da progesterona na prevenção de colite experimental induzida quimicamente em ratos

PURPOSE: To study the effects of progesterone on an experimental colitis model. METHODS: Wistar albino rats were treated subcutaneously with 2mg/kg once a day during seven days Colitis was induced by intrarectal administration of 5mg trinitrobenzene sulfonic acid (TNBS). Disease activities, macroscopic and microscopic scores were evaluated. To determine the response provoked by progesterone we measured Colonic malondialdehyde (MDA), TNF alfa, IL-6 and Nitric oxide (NO) levels in addition to the MPO (Myeloperoxidase) and caspase-3 activities. RESULTS: Progesterone ameliorated significantly the macroscopic and microscopic scores. TNBS-induced colitis significantly increased the colonic MDA levels and caspase-3 activities in group 2 in comparison to the control group. The results of the study revealed a decline in MDA, NO, IL6 and TNF-α levels in the colon tissue and in blood due to progesterone therapy in group 3 when compared to the group 2, a significant improvement. Progesterone treatment was associated with decreased MDA, MPO, TNF alfa and caspase-3 activity. CONCLUSION: Progesterone therapy decreased oxidative damage in the colonic mucosa.

OBJETIVO: Investigar os efeitos da progesterona em um modelo de colite experimental. MÉTODOS: Ratos albinos Wistar foram tratados subcutaneamente com 2mg/kg por dia durante sete dias. A colite foi induzida por administração intrarretal de 5mg ácido sulfônico trinitrobenzeno (TNBS). Foram avaliadas as atividades da doença, escores macroscópicos e microscópicos Para determinar a resposta provocada pela progesterona foi medida no cólon os níveis de malondialdeído (MDA), TNF alfa, IL-6 e óxido nítrico (NO), além da atividade da MPO (Myeloperoxidase) e caspase-3. RESULTADOS: A progesterone melhorou significantemente os escores macroscópicos e microscópicos. A colite induzida pelo TNBS significantemente aumentou os níveis colônicos de MDA e a atividade da caspase-3 no grupo 2 em comparação com o grupo controle. Os resultados do estudo revelaram um declínio nos níveis de MDA, NO, IL6 e TNF-α no tecido colônico e no sangue devido à terapia com a progesterona no grupo 3 quando comparado ao grupo 2. O tratamento com a progesterona foi associado com decréscimo do MDA, MPO, TNF alfa e atividade da caspase-3. CONCLUSÃO: A terapia com progesterona decresce o dano oxidativo na mucosa do cólon.

The effect of progesterone in the prevention of the chemically induced experimental colitis in rats.

PURPOSE: To study the effects of progesterone on an experimental colitis model. METHODS: Wistar albino rats were treated subcutaneously with 2mg/kg once a day during seven days Colitis was induced by intrarectal administration of 5mg trinitrobenzene sulfonic acid (TNBS). Disease activities, macroscopic and microscopic scores were evaluated. To determine the response provoked by progesterone we measured Colonic malondialdehyde (MDA), TNF alfa, IL-6 and Nitric oxide (NO) levels in addition to the MPO (Myeloperoxidase) and caspase-3 activities. RESULTS: Progesterone ameliorated significantly the macroscopic and microscopic scores. TNBS-induced colitis significantly increased the colonic MDA levels and caspase-3 activities in group 2 in comparison to the control group. The results of the study revealed a decline in MDA, NO, IL6 and TNF-α levels in the colon tissue and in blood due to progesterone therapy in group 3 when compared to the group 2, a significant improvement. Progesterone treatment was associated with decreased MDA, MPO, TNF alfa and caspase-3 activity. CONCLUSION: Progesterone therapy decreased oxidative damage in the colonic mucosa.

Effects of glutamine and curcumin on bacterial translocation in jaundiced rats.

AIM: To investigate the effect of curcumin on bacterial translocation and oxidative damage in an obstructive jaundice model and compare the results to glutamine, an agent known to be effective and clinically used. METHODS: Twenty-four female Wistar-Albino rats, weighing 200-250 g, were randomly divided into three groups (8 in each group). After ligation of the common bile duct in all animals, Group I received oral normal saline, Group II received oral glutamine and Group III received oral curcumin for seven days. Blood samples via cardiac puncture, tissue samples (terminal ileum, liver and mesenteric lymph node) and peritoneal fluid were obtained from the animals at the time of death to investigate bacterial translocation and oxidative damage. RESULTS: We observed that both glutamine and curcumin reduced bacterial translocation in blood, hepatocellular damage, plasma cytokine levels, oxidative tissue damage and apoptosis significantly compared to the control group. Additionally, glutamine showed protective effects on ileal epithelium and reduced villus atrophy. CONCLUSION: On the basis of these findings, both curcumin and glutamine are thought to be effective in preventing or reducing bacterial translocation and oxidative damage in obstructive jaundice.

Meckel's diverticulum manifested by a subcutaneous abscess.

This case report describes an extremely rare complication of a Meckel's diverticulum: enterocutaneous fistula of the diverticulum. The presence of Meckel's diverticulum is a well known entity, but subcutaneous perforation of the diverticulum is very rare. Here we report the case of a patient with the complaint of a right lower quadrant abscess, preoperatively diagnosed as enterocutaneous fistula, which was determined intraoperatively to be a fistula resulting from Meckel's diverticulum.

The effect of hyaluronic acid carboxymethyl cellulose on the healing of colonic anastomosis in rats.

BACKGROUND: This study demonstrates the effect of hyaluronic acid-carboxymethylcellulose on the healing of colonic anastomosis. METHOD: 30 female Wistar-Albino rats were divided into three groups; control group 1 (n=10), treated with hyaluronic acid-carboxymethylcellulose, group 2 (n=8) treated with HBO and group 3 with hyaluronic acid-carboxymethylcellulose and HBO. RESULT: Bursting pressure and rupture strength were significantly higher in the group 3 compared to other two groups (p<0.05). The severity of necrosis, granulation, neovascularisation and epithelization among groups did not show any significant difference (p>0.05). But the evaluation of inflammation showed a statistical significance (p<0.001) such as as granulation (p<0.05). CONCLUSION: This study did not detect the negative affect of seprafilm on wound healing. Combined treatment with seprafilm and HBO has a favorable therapeutic effect on the healing of ischemic colonic anastomosis (Tab. 4, Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Diagnostic problems with parasitic and non-parasitic splenic cysts.

BACKGROUND: The splenic cysts constitute a very rare clinical entity. They may occur secondary to trauma or even being more seldom due to parasitic infestations, mainly caused by ecchinocccus granulosus. Literature lacks a defined concencus including the treatment plans and follow up strategies, nor long term results of the patients. In the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and non-parasitic splenic cysts together with their long term follow up progresses. METHODS: Twenty-four patients with splenic cysts have undergone surgery in our department over the last 9 years. Data from eighteen of the twenty-four patients were collected prospectively, while data from six were retrospectively collected. All patients were assessed in terms of age, gender, hospital stay, preoperative diagnosis, additional disease, serology, ultrasonography, computed tomography (CT), cyst recurrences and treatment. RESULTS: In this study, the majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. All patients were operated on electively. The patients included 14 female and 10 male patients, with a mean age of 44.77 years (range 20-62). Splenic hydatid cysts were present in 16 patients, one of whom also had liver hydatid cysts (6.25%). Four other patients were operated on for a simple cyst (16%) two patients for an epithelial cyst, and the last two for splenic lymphangioma. Of the 16 patients diagnosed as having splenic hydatit cysts, 11 (68.7%) were correctly diagnosed. Only two of these patients were administered benzimidazole therapy pre-operatively because of the risk of multicystic disease The mean follow-up period was 64 months (6-108). There were no recurrences of splenic cysts. CONCLUSION: Surgeons should keep in mind the possibility of a parasitic cyst when no definitive alternative diagnosis can be made. In the treatment of splenic hydatidosis, benzimidazole therapy is not necessary, although it is crucial to perform splenectomy without rupturing and spilling the cysts.

Esophageal stent migration can lead to intestinal obstruction.

BACKGROUND: Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of the esophagus. Stent migration is a well-known complication of this procedure. AIMS: We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used. METHODS: A 65-year-old woman, who had a medical history of gastric cancer operations and esophageal stent applications, was admitted to our emergency department with a 48-hour history of abdominal pain, nausea and vomiting. An emergency laparotomy was performed and the migrated stent causing intestinal obstruction was removed. RESULTS: The patient recovered without incident and was discharged on postoperative day 3. CONCLUSION: This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

Gaucher's disease diagnosed by splenectomy.

CONTEXT: Splenectomy continues to find common therapeutic indications for hematologic disorders. In addition, recently it is also performed in surgical clinics to assist diagnose of some illnesses. Gaucher's disease, especially Type I, is the most frequently encountered lysosomal storage disorder in man. Manifestations of it are highly variable. The most frequently found symptoms include splenomegaly with anaemia and thrombocytopenia, mostly due to hypersplenism, hepatomegaly and bone disease. CASES: Four patients were reported in the present study. Three of them were easily diagnosed with Gaucher's disease via bone marrow cytology, and one with Gaucher's disease was detected by pathological examination following the splenectomy. CONCLUSIONS: For the pouse of diagnosis of the Gaucher's disease, performing surgery is generally not necessary. However, for the cases of difficult to diagnose by classical methods, the corect diagnosis of Gaucher's disease can only be made by a special operation.

The comparison of preperitoneal and Lichtenstein repair for incarcerated groin hernias: a randomised controlled trial.

BACKGROUND: Lichtenstein hernioplasty can be performed successfully as an emergency operation for incarcerated inguinal hernia. The aim of the study was to compare the short-term and long-term outcomes of the preperitoneal mesh with the Lichtenstein mesh technique in strangula groin hernia. METHODS: Forty consecutive patients with strangulated inguinal hernia were randomized (according to a random table) to undergo either a preperitoneal or a Lichtenstein repair under general anesthesia. Early outcome measures were age, gender, duration of surgery, operating time (min), side of hernia, other pathology, contents of hernia sac, the ratio of the bowel resection, required laparatomy, complete release of the intestinal loop and postoperative complications, time to return to work, driving and full activity. Long-term outcome measures were recurrence. A Student's t-test and Chi-square analysis were used for statistical analysis. RESULTS: They were randomly allocated to undergo either a preperitoneal mesh repair (n=19) or a tension-free mesh repair Lichtenstein (n=21). There were no persistent complications. Mean duration of surgery in the preperitoneal group was 54 min (SD - 11) versus 50 min in the Lichtenstein group (SD - 8). There was no significant difference with regards to age, race, gender, or comorbidities between the 2 groups. Four of the 21 patients (10.5%) who required an additional incision developed some type of complication. This circumstance was found to have significant influence on morbidity (P=0.003) but not on mortality. The median follow-up for the study was 24 months. Patients were seen 1 to 2 weeks after surgery. CONCLUSIONS: In conclusion we recommend preperitoneal repair in strangulated hernia instead of Lichtenstein repair. The use of preperitoneal hernia repair for strangulated inguinal hernia is safe, and any need for laparatomy if bowel resection is necessary.

Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases.

Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.