Comparison of endocrinological and cytokine response to trauma in laparoscopic and conventional appendectomy in patients with acute appendicitis.

PURPOSE: In this study, we compared the endocrine and cytokine reaction of the patients which laparoscopic and conventional appendectomy was done for acute appendicitis. MATERIALS AND METHOD: 50 patients who were operated for acute appendicitis in Ankara Atatürk Research and Training Hospital between the dates December 2013 and February 2014 were enrolled and grouped as either laparoscopic or conventional. Serum ACTH, IL-6 and CRP levels were obtained at induction of anesthesia and postoperative 6th hour. RESULTS: There was no significant difference between the groups in terms of gender, co-morbidities, and perforation rate. Preoperative ACTH levels were similar for both groups while it is significantly lower in postoperative period for laparoscopy group. Moreover, IL-6 levels were also higher in postoperative period for conventional period compared to laparoscopy group. Despite preoperative CRP value of the laparoscopic group was significantly higher than the conventional group, postop values showed no statistical difference. The mean operation time of the laparoscopic appendectomy group was significantly higher than the conventional group. CONCLUSION: Laparoscopic appendectomy causes less metabolic and cytokine response than conventional surgery. ACTH and IL-6 levels could be assessed to evaluate metabolic outcome of surgical intervention. KEY WORDS: ACTH, Appendectomy, Conventional appendectomy, IL-6, CRP, Laparoscopic appendectomy, Perforation.

Rectal eversion and double-stapled ileal pouch anal anastomosis in familial adenomatous polyposis syndrome.

INTRODUCTION: Surgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique. PRESENTATION OF CASE: A 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal. DISCUSSION: There is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients. CONCLUSION: J-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients.

A general consideration of the importance of nutrition for critically ill patients.

BACKGROUND/AIM: Malnutrition is a common medical condition among intensive care unit patients. It should be monitored carefully, since early management of malnutrition can dramatically improve the medical condition of the patients. A general consideration of enteral feeding shows that it is much more useful than parenteral administration, because it is more physiological and poses a lower risk of hyperalimentation. MATERIALS AND METHODS: In this retrospective study, we scanned all files and personal information of patients hospitalized in intensive care units between 2009 and 2012 due to various medical conditions. We evaluated the nutritional status of patients with biochemical parameters that were retrieved from the files. RESULTS: In total, 198 patients were identified from hospital records. Almost every patient was given nutritional support either through enteral or parenteral feeding. The albumin levels of 56 patients did not increase, even when they were fed with calculated nutritional support (36.6%). The prealbumin levels of the patients had a tendency to increase after the provision of nutritional additives. CONCLUSION: In appropriately selected critically ill patients, the role of nutritional support in the management of nutritional deficiencies is important. In order to calculate proper feeding goals, a full nutritional assessment is necessary.