Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial.

BACKGROUND: Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy. METHODS: Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality. RESULTS: The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001). CONCLUSION: The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.

The Effect of Epidermal Growth Factor on Anastomotic Leaks: An Experimental Study in Rats.

INTRODUCTION: To investigate the effects of local epidermal growth factor (EGF) use on anastomotic healing during primary repair of anastomosis in rats with anastomotic leaks (AL). METHODS: Thirty albino Wistar rats were divided into three groups. Anastomoses were performed in group 1 after colon transection. In groups 2 and 3, ALs were created with an incomplete colon anastomosis model. Relaparotomy was conducted on rats in groups 2 and 3 72 h after the first procedure. ALs of the rats were repaired with a primary suture in group 2 and with a primary suture and the application of submucosal EGF in group 3. All rats were sacrificed through cervical dislocation on the 6th day after the first procedure. Four-centimeter colonic segments containing 2-cm distal and proximal parts of the anastomotic lines of the subjects were resected. The primary outcome was anastomotic burst pressure (ABP). The secondary outcomes included limitation in inflammation, increased neovascularization, increased fibroblast activation and increased collagen synthesis. RESULTS: The ABP value of group 2 was significantly lower than that of group 3 (P < 0.05). No significant difference was detected in the ABP value between group 3 and group 1 (P > 0.05). There was significantly less inflammatory cell infiltration in group 3 than in group 2 (P < 0.05). Collagen synthesis and neovascularization were significantly higher in group 3 than in group 2 (P < 0.05). CONCLUSIONS: A single-dose of submucosal EGF applied to the AL line limited inflammation and stimulated neovascularization. It also had a positive effect on the strength of the anastomosis.

Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study.

BACKGROUND: Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which has previously proven reliability for AMI. METHODS: The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. TDH, IMA, and serum lactate values were measured at h 0, 1, 3, and 6. RESULTS: In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION: TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.

Unroofing Curettage Versus Modified Limberg Flap in Pilonidal Disease: A Retrospective Cohort Study.

BACKGROUND: Sacrococcygeal pilonidal disease (estimated incidence, 25/100,000) is a chronic inflammatory condition that commonly affects young adults. However, the ideal surgical treatment for this disease remains undetermined. OBJECTIVE: This study aimed to compare the results of the unroofing curettage and those of the modified Limberg flap surgical technique. DESIGN: This is a retrospective cohort study. SETTINGS: Procedures were performed by 2 surgeons between January 2013 and January 2017. PATIENTS: The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed. INTERVENTIONS: Unroofing curettage was performed under local or spinal anesthesia, whereas spinal anesthesia was used for the modified Limberg flap procedure. MAIN OUTCOME MEASURES: The primary outcome was recurrence rate. Secondary outcomes included adverse events, limitation of daily activities, and healing time. RESULTS: Between the 2 groups (unroofing curettage, n = 135; modified Limberg flap, n = 143), recurrence was lower in the unroofing curettage group after a 60-month median follow-up period, but the difference was not statistically significant (1.5% vs 4.2%, p = 0.45). The duration of surgery and length of hospital stay were shorter in the unroofing curettage group (11.44 ± 3.56 minutes vs 52.47 ± 7.92 minutes and 0.27 ± 0.45 days vs 1.07 ± 0.26 days, p < 0.001). Postoperative complications were significantly higher in the modified Limberg flap group (9.8% vs 2.2%, p = 0.009). The time required to return to work or school was shorter in the unroofing curettage group (8.6 ± 7.8 days vs 25.01 ± 6.3 days, p < 0.001). The complete healing time was longer in the unroofing curettage group (35.3 ± 9.2 days vs 23.2 ± 5.4 days, p < 0.001). LIMITATIONS: The retrospective study design was a limitation of this study. CONCLUSIONS: Unroofing curettage provided more clinical benefits than the modified Limberg flap approach. Unroofing curettage should be considered as the first choice of surgical treatment for pilonidal disease. See Video Abstract at http://links.lww.com/DCR/B824 . DESTECHAMIENTO Y CURETAJE VERSUS COLGAJO DE LIMBERG MODIFICADO EN LA ENFERMEDAD PILONIDAL UN ESTUDIO DE COHORTE RETROSPECTIVE: ANTECEDENTES:La enfermedad pilonidal sacrococcígea (incidencia estimada, 25 / 100.000) es una enfermedad inflamatoria crónica que comúnmente afecta a adultos jóvenes. Sin embargo, el tratamiento quirúrgico ideal para esta enfermedad permanece indeterminado.OBJETIVO:Comparar los resultados del destechamiento y curetaje y los de la técnica quirúrgica con colgajo de Limberg modificado.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Los procedimientos fueron realizados por dos cirujanos, entre enero del 2013 y enero del 2017.PACIENTES:Se analizaron datos de 278 pacientes intervenidos quirúrgicamente para el tratamiento de la enfermedad pilonidal.INTERVENCIONES:Se realizó destechamiento y curetaje con anestesia local o raquídea, mientras que para el procedimiento de colgajo de Limberg modificado se utilizó anestesia raquídea.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de recurrencia. Los resultados secundarios incluyeron eventos adversos, limitación de las actividades diarias y tiempo de curación.RESULTADOS:Entre los dos grupos (destechamiento y curetaje, n = 135; colgajo de Limberg modificado, n = 143), la recurrencia fue menor en el grupo con destechamiento y curetaje después de un período de seguimiento medio de 60 meses, pero la diferencia no fue estadísticamente significativa (1,5% vs 4,2%, p = 0,45). La duración de la cirugía y la estancia hospitalaria fueron más cortas en el grupo de destechamiento y curetaje (11,44 ± 3,56 min vs a 52,47 ± 7,92 min y 0,27 ± 0,45 días vs 1,07 ± 0,26 días, p < 0,001). Las complicaciones posoperatorias fueron significativamente mayores en el grupo de colgajo de Limberg modificado (9,8% vs 2,2%, p = 0,009). El tiempo necesario para regresar al trabajo o la escuela fue menor en el grupo de destechamiento y curetaje (8,6 ± 7,8 días vs 25,01 ± 6,3 días, p < 0,001). El tiempo de cicatrización completo fue mayor en el grupo de destechamiento y curetaje (35,3 ± 9,2 días vs 23,2 ± 5,4 días, p < 0,001).LIMITACIONES:El diseño del estudio retrospectivo.CONCLUSIONES:El destechamiento y curetaje proporcionó más beneficios clínicos que el abordaje con colgajo de Limberg modificado. El destechamiento y curetaje debe considerarse como la primera opción de tratamiento quirúrgico para la enfermedad pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/B824 . (Traducción- Dr. Francisco M. Abarca-Rendon ).

An innovative procedure: Laparoscopic sterilisation of liver hydatid cyst cavities with Foley catheter method.

Sterilisation of the liver hydatid cyst cavities is a significant step in the surgical treatment of these cysts. We previously performed a study addressing the Foley catheter method in sterilisation of the cyst cavities with open surgery. Recently, we have been laparoscopically using Foley catheters for sterilisation of the cyst cavities. We tried laparoscopically in five cases with six cysts. A Foley catheter can be used in the sterilisation of hydatid cysts cavity both in laparoscopic and open interventions. We think that this procedure can reach cysts at all locations of liver and be applied to multiple liver cysts, too. From laparoscopic point of view, the method we presented is innovative procedure. To date, we have not seen any morbidity including recurrence and mortality in cases we applied this procedure.

The management of xanthogranulomatous cholecystitis.

OBJECTIVES: Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis. This rare pathology is characterized by severe and progressive fibrosis of the gallbladder wall as well as infiltration of fat-laden macrophages. MATERIAL AND METHODS: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients' demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy. RESULTS: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p <0.05). Total complication rate in XGC cases was 3.9%. CONCLUSION: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.

Withdrawn: An innovative procedure: Laparoscopic sterilization of liver cyst cavities with foley catheter method.

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Role of Different Treatment Modalities in Cavity Volume during the Treatment of Cystic Ecchinococcosis.

OBJECTIVE: Surgery and percutaneous aspiration-injection-re-aspiration (PAIR) are widely accepted treatment modalities for hepatic hydatid cysts. Endoscopic retrograde cholangiopancreaticography (ERCP) acts as a minimally invasive rescue method for the biliary complications of both the hydatid cysts and treatment modalities. The aim of this study was to identify the role of different treatment modalities in the obliteration of hydatid cysts. METHODS: Patients treated for hydatid cysts between January 2009 and December 2013 were evaluated in the study. Data were collected from hospital records. All cyst cavities were evaluated by ultrasonography or computed tomography. RESULTS: Ninety-five (40.4%) males and 140 (59.5%) females were included in the study. Before the procedures, the mean cyst diameter was 89.7±33.5 mm. At follow-up, the mean cyst diameter decreased to 53.2±30.1 mm. In the ERCP group, the mean diameter of the residual hydatid cyst cavity was significantly lower than that of the other groups (p=0.003). CONCLUSION: ERCP provides faster cyst shrinkage and even disappearance of the residual cavity in 50% of cases. Moreover, in hydatid cysts with biliary communication, ERCP+ES can be safely used for primary treatment.

Effect of medical treatment on histological findings in rabbits with acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is the most common reason for abdominal surgery in the world. The aim of this study was to evaluate the effect of medical treatment on histological findings in rabbits with AA. METHODS: Twenty-one male New Zealand rabbits were divided into 3 groups: appendix ligation and medical treatment, appendix ligation and no treatment, and control group, which underwent only laparotomy. RESULTS: In appendix ligation without treatment group, AA findings were much more severe. CONCLUSION: Medical treatment reduced inflammation of AA.

Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery.

BACKGROUND: Pilonidal sinus is a chronic inflammatory disorder of the intergluteal sulcus. The disorder often negatively affects patients' quality of life, and there are numerous possible methods of operative treatment for pilonidal sinus. The aim of our study was to compare the results of 3 different operative procedures (tension-free primary closure, Limberg flap, and Karydakis technique) used in the treatment of pilonidal disease. METHODS: The study was conducted via a prospective randomized design. The patients were randomized into 3 groups via a closed envelope method. Patients were included in the study after admission to our clinic with pilonidal sinus disease and operative treatment already were planned. The 2 main outcomes of the study were early complications from the methods used and later recurrences of the disease. RESULTS: A total of 150 patients were included in the study, and the groups were similar in terms of age, sex, and American Society of Anesthesiologists scores. The median follow-up time of the study was 24.2 months (range, 18.5-34.27) postsurgery. The recurrence rates were 6% for both the Limberg and Karydakis groups and 4% for the tension-free primary closure group. Therefore, there was no substantial difference in the recurrence rates. CONCLUSION: The search for an ideal treatment modality for pilonidal sinus disease is still ongoing. The main conclusion of our study is that a tension-free healing side is much more important than a midline suture line. Also, tension-free primary closure is as effective as a flap procedure, and it is also easier to perform.

Early hospital readmission after laparoscopic cholecystectomy.

INTRODUCTION: Laparoscopic cholecystectomy (LC) now has become the golden standard in the treatment of symptomatic gallstone cholecystitis. AIM: This retrospective analysis was conducted to clarify the reasons of early return to the hospital after discharge following a procedure like LC that has been frequently performed in daily surgical practice. MATERIALS AND METHODS: This study covers 586 patients, who were called to follow-ups and thus evaluated, of 676 patients who had had LCs at Meram Medical School's General Surgery Clinic between January 2010 and May 2011. FINDINGS: The rate of representation to the hospital during the early phase following LC was found to be 2.4% in our study. It was observed that 71% of returning patients had presented to the hospital with complaints of abdominal pain. DISCUSSION: We believe that the rate of 2.4% early return to the hospital in our series is a bit high when all the complications are taken into consideration. This retrospective analysis, however, has shown that this rate can further be decreased by taking simple measures.

Bilateral Breast Abscess Caused by E. coli in a Non-lactating Woman: A Rare Case.

Breast abscess usually occurs during lactation and the responsible organism is often S. Aureus. Breast abscess in non-lactating women is extremely rare and limited data is available in the literature regarding this entity. In our study, a 36-year-old non-lactating female patient who developed bilateral breast abscess due to E. coli infection without any predisposing factors has been discussed in light of the literature.

Single incision laparoscopic appendectomy with two port: a case of appendiceal mucocele.

Laparoscopic appendectomy for the neoplasm of the appendix remains a controversial subject in the literature. The main concern regarding laparoscopic treatment for the neoplasm of the appendix is incomplete resection and rupture of the tumor into the peritoneal cavity. There is a slight increase in the rate of invasion of the surgical margins in laparoscopic interventions. However, the prognosis of the neoplasm of the appendix treated with laparoscopic appendectomy is not different from an open surgical technique. A series of cases have been reported in the literature concerning the success rate of single-incision laparoscopic appendectomy used in the treatment of acute appendicitis. In our clinic, two-port laparoscopic appendectomy through a single incision was successfully performed on a 45-year-old male patient diagnosed with an appendiceal mucocele. Despite some concerns in the literature about laparoscopic treatment of neoplasms of the appendix, we suggest that single-incision laparoscopic appendectomy can be successfully performed in patients diagnosed with neoplasms of the appendix.