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.

Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study.

OBJECTIVE: Although the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey. MATERIAL AND METHODS: The relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically. RESULTS: The study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Baskent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%). CONCLUSION: The findings of the study indicate a steady increase in surgical admissions to emergency units. Non-traumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.

Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation.

A pancreaticoduodenectomy is a surgical procedure with a high morbidity and mortality rate. The injury of the hepatic artery may occasionally lead to intraoperative bleeding. Repair of the injured hepatic artery is of great importance in terms of maintaining the vascular supply of the liver. We report a case with an injury of the hepatic artery that was successfully reconstructed with the gastroduodenal artery and then developed a biliary leak due to bile duct ischemia at an early stage. A 33-year-old women complaining of right upper quadrant pain was found to have a solid pseudopapillary tumor of the pancreas. She underwent an immediate pancreaticoduodenectomy, and her hepatic artery was injured during the operation. The arterial ends were sutured with primary anastomosis, because they could be aligned without any tension. The biliary leak occurred on postoperative day 2. We detected bile duct ischemia and reanastomosed the artery. The patient was discharged on postoperative day 8. Surgeons should be prepared for anomalies of the peripancreatic vascular structures during pancreaticoduodenectomy. Computed tomography angiography should be considered to reveal these anomalies before the surgery. Insufficiency of the biliodigestive anastomosis due to bile duct ischemia in the postoperative period should be kept in mind, even in cases of successful repair.

Does endoscopic retrograde cholangiopancreatography have a negative effect on laparoscopic cholecystectomy?

OBJECTIVE: We have observed that patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) had some difficulties with laparoscopic cholecystectomy procedures. Through a retrospective study, we planned to compare the surgical procedures between patients who had undergone ERCP and those who had not in order to clarify this. MATERIAL AND METHODS: The results of 122 patients who had undergone ERCP because of choledocholithiasis before undergoing laparoscopic cholecystectomy procedures between 2008 and 2011 were compared to the values of 2140 patients operated because of cholelithiasis only within the same period. RESULTS: Among the patients who underwent surgical procedures following ERCP, 80 (65%) were female and 42 (35%) were male. The average age of the patients was 51.9 years (range: 20-83 years). The operation period after the procedure was 30.14 days (range: 1-93 days). Although the hospitalization period was 4.67 days (range: 1-22 days), the postoperative hospitalization period was 2.68 days (range: 1-15 days). Regarding the difficulty of operation, adhesion in 58 (47.5%) patients, bleeding in two (1.6%) patients, and conversion to open procedure in 12 (9.8) patients were observed. In two (1.6%) patients, bleeding and biliary fistula were the reasons for re-operation. CONCLUSION: Laparoscopic cholecystectomy is more complicated in patients who underwent ERCP.

Comparison of mammography sensitivity after reduction mammoplasty targeting the glandular and fat tissue.

OBJECTIVE: Mammography may have some limitations in the diagnosis and screening of breast cancer for women who have previously undergone breast reduction surgery. This study aimed to investigate how the structural defects in the breast tissue formed by postoperative changes are reflected on mammography. MATERIAL AND METHODS: The records of patients who had previously undergone breast reduction surgery and who were requested to undergo mammography for breast cancer screening by the general surgery clinic were retrospectively studied. The patients' ages, surgical procedures, postoperative follow-up periods, amount of removed material, and histopathological and mammographic results were studied. The patients were classified into 3 groups: those older than 40 years who underwent reduction mammoplasty targeting predominantly the glandular tissue (group 1), those younger than 40 years who underwent reduction mammoplasty targeting predominantly the fat tissue (group 2), and those older than 40 years who were diagnosed with breast hypertrophy and were not operated (group 3). RESULTS: The mean follow-up period of the patients was 6 (2-10) years. The mean value of resected tissue was 1120 g (680-2070) in group 1 and 1220 g (720-1980) in group 2. The mean age at the time of surgery was 45 (40-70) years for group 1 and 35 (24-40) years for group 2. All patients in group 1 were classified in Breast Imaging-Reporting and Data System (BI-RADS) category 1-2; 28 patients in group 2 were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 8 were classified in BI-RADS 0. In group 3, 35 patients were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 1 was classified in BI-RADS 0. CONCLUSION: We believe that breast reduction surgery targeting predominantly the glandular tissue in patients older than 40 years increases mammographic sensitivity.

Effect of sex steroids on soleus muscle response in hypocalcemic medium (in vitro).

PURPOSE: Postoperative hypocalcemia is a frequently encountered complication of thyroid surgery. Since hypocalcemic symptoms are closely associated with sex, the aim of this study is to investigate the effects of sex steroids on muscle tissue under hypocalcemic conditions. METHODS: Six groups consisting of control male (M), control female (F), gonadectomized male (M-), gonadectomized female (F-), estradiol-applied gonadectomized male (MX), and testosterone-applied gonadectomized female (FX) rats were used. Contraction recordings were obtained from soleus muscle flaps. Maximal tension (PT), frequency required for 50% of PT (F50), contraction velocity at F50 (V50), and changes in contraction values (d[PT], d[F50], d[V50]) between normocalcemic and hypocalcemic conditions were calculated. RESULTS: d[PT], d[F50], and d[V50] were significantly higher in M- and MX groups compared with control M group. Whereas d[PT], d[F50], and d[V50] parameters of the F- group were significantly higher than control F group, d[F50] and d[PT] of the FX group showed no significant change and d[V50] for the FX group was significantly lower. A comparison of control groups showed that d[PT], d[F50], and d[V50] of the F group were significantly higher than those of the M group. CONCLUSION: Whereas absence of both testosterone and estradiol caused an increase in hypocalcemia-induced changes in contraction parameters of rat skeletal muscle, presence or application of testosterone clearly stabilized contraction parameters.

Can Echinococcus Granulosus Infestation Prevent Pancreatic Cancer? An invivo Experimental Study.

Hydatid cyst is a zoonotic infestation caused by Echinococcus granulosus, and it is known that some parasites found in humans cause cancer in humans or some may have a protective effect against cancer. Cancer is one of the most serious health problems of today and it has been shown in some studies that parasites such as Echinococcus granulosus can have an inhibitory effect. The aim of this study was determined as whether Echinococcus granulosus has an inhibitory effect on exocrine pancreatic cancer with the help of the azaserine-rat model used in different cancer studies.  Material and Methods: During experimental process a total of 45 male Wistar rats used, 14-day-old male Wistar rats were divided into groups according to the experimental protocol, administered azaserine injection protocol or kept as a control group without azaserine injection. Animals are grouped as Group 1, Control Group (group not treated with Azaserine and not injected with protoscolex.) (E-A-) (n=7); Group 2, Group injected with (IP) Azaserine only (30mg/kg) (E-A+)  (n=8);Group 3, Group injected (IP) with protoscolex suspension of 1 cc only (E+A-) (n=15);Group 4, Group injected both Azaserine (IP) and protoscolex suspension (IP) (E+A+) (n=15). Atypical Acinar Cell Foci (AACF) load in the exocrine pancreas of each rat was measured quantitatively with the help of a video image analyzer and the AACF load was calculated with the help of a mathematical model. Results: Findings showed that the Atypical Acinar Cell Foci (AACF) burden was statistically significantly lower in the Azaserine+ protoscolex (Azaserine-injected-protoscolex-implanted) rat group compared to the other groups, suggesting that Echinococcosis in the azaserine-rat model could inhibit the development of precursor foci of neoplastic changes in the exocrine pancreas. Conclusion: The most significant aspect of our study is that it contributes new insights into the controversy that Echinococcosis suppresses pancreatic cancer.

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

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[Early laparoscopic cholecystectomy for acute cholecystitis]. / Akut kolesistit için erken laparoskopik kolesistektomi.

BACKGROUND: The aim of this study was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS: Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS: The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION: LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.

The Use of Radiofrequency Thermal Ablation Method in The Treatment of Hepatic Hydatid Cysts: Ex vivo Sheep Study

Objective: Hydatid disease is a disease caused by parasites belonging to the echinococcus family. This disease is often caused by Echinococcus granulosus and rarely by echinococcus alveolaris.The parasite may cause illness anywhere in the human body, mainly in liver. In this study, we aimed to destroy the hydatid cyst viability by Radiofrequency Thermal Ablation (RFTA) method which has been used in many areas in medicine. Methods: We used fresh sheep liver with hydatid cysts. Average diameter of cysts was 3.3 cm. The study was performed in 3 groups, each of which involved 20 cysts. After more than half of the cyst fluid was drained, ablation was performed. When the core temperature of the cyst exceeded 95°C, ablation procedure was continued for 3 minute in 1st group and for 4 minutes in 2nd group. Third group was the control group. And then, cyst fluid and germinative membrane were collected for microbiologic and pathologic assessment. Results: In 1st group, the cysts could not be destroyed at the desired level. In 2nd group, it was observed that 100% of the protoscolex died and 100% of the germinative membranes was degenerated. In control group, %13 of protoscolex died and %10 of germinative membranes wasdegenerated. Conclusion: We destroyed all the protoscolex and germinative membranes by using RFTA in 2nd group.

Use of chorioamniotic membrane instead of bogota bag in open abdomen: how i do it?

It is one of the most important problems for general surgeons to decide which operation should be undertaken on patients with intra-abdominal infection, especially those with concomitant abdominal hypertension. Recently, closure techniques using prosthetic meshes in order to retain abdominal tension and to control sepsis have become very popular for patients with abdominal sepsis and hypertension. We used chorioamniotic membrane instead of plastic material to cover the open abdomen. We conclude that human chorioamniotic membrane prepared under sterile conditions may be an alternative to conventional plastic bags in daily practice, for preventing serosal erosion and fistulas in patients undergoing open abdominal surgery.

Effects of caffeic acid phenethyl ester (CAPE) on sepsis in rats.

Sepsis is still a major cause of the high mortality rate in the intensive care unit. Many studies have been published about the severity of sepsis, but the cause of mortality in sepsis and multiorgan failure is still obscure. This study investigated the effects of caffeic acid phenethyl ester (CAPE) particularly on the inflammatory and related histopathological changes in the lung, liver and kidney in an experimental sepsis model. Forty Sprague Dawley rats were used in this study, and were divided into four groups of ten rats each, as follows: Group I was given intraperitoneal saline infusion treatment. Group II was given intraperitoneal CAPE infusion treatment. Sepsis was induced in the animals in Group III (sepsis with saline infusion), while Group IV rats underwent induced sepsis plus CAPE infusion treatment (sepsis with CAPE infusion). Sampling was performed 48 h after treatment. The induction of sepsis resulted in a significant increase in serum glucose, leukocytes, urea, creatinine, LDH levels in BAL, plasma MDA, AST and ALT levels in the sepsis + saline group. The use of CAPE significantly decreased these parameters. Histopathological examination revealed less congestion, portal inflammation, and focal necrosis of the liver, and less congestion, edema, and emphysematous and inflammatory changes in the lung in the sepsis + CAPE group than in the other groups. These results support that CAPE may be used for the treatment of organ failure during sepsis.

Internal herniation as a major cause of intestinal obstruction.

OBJECTIVES: To evaluate internal herniation as a rare cause of intestinal obstruction. MATERIALS AND METHODS: Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients (88.8%) were male (mean age: 58.2 years; range: 42-67) and 2 were female (mean age: 56.5 years; range: 52-61).Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. RESULTS: All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. CONCLUSION: In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary.

Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery.

OBJECTIVES: Although laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases, conversion to open surgery is required in a substantial proportion of patients. In this study, we attempted to clarify whether male sex carries an increased risk for conversion to open surgery during laparoscopic cholecystectomy. METHODS: This study comprised 80 patients (41 females, 39 males) with symptomatic gallbladder stones. Average age was 39.2 years, and all female patients were of reproductive age. Patients were excluded from the study if they had acute cholecystitis, previous abdominal surgery, systemic or connective tissue diseases, or were using tobacco, alcohol, or medications that affect wound healing or inflammation. Tissue samples were obtained from the same sites in each gallbladder wall and pericholecystic tissue for the measurement of tissue hydroxyproline (HP) and collagen. Samples were examined under light microscopy for histopathology. Findings in male and female patients were compared by using the Student t test. RESULTS: All patients except 3 males received laparoscopic cholecystectomy. Conversion to open cholecystectomy was necessary in those 3 because of intense pericholecystic fibrosis. In male patient samples, macrophages were twice as numerous as in female samples, whereas mast cells in the men were 4 times more numerous, and eosinophils were 6 times more numerous (P<0.01). In men, HP levels in the gallbladder wall and pericholecystic tissue were 23.4+/-14.9 microg/mg dry tissue and 25.2+/-13.1 microg/mg dry tissue, respectively. The corresponding values in women were 13.1+/-9.4 microg/mg dry tissue and 14.5+/-8.1 microg/mg dry tissue. This higher level of tissue HP in men was statistically significant (P<0.015). Tissue collagen levels both in the submucosal area of the gallbladder wall and in pericholecystic tissue were significantly higher in men than in women (P<0.05). CONCLUSION: Our data suggest that in the context of symptomatic gallbladder stones, inflammation and fibrosis are more extensive in men than in women. These findings may help explain why the rate of conversion to open surgery is higher in men than in women.

Management of Extra-Hepatopulmonary Hydatid Cysts (157 cases).

OBJECTIVE: Hydatid cyst disease (HCD) is a zoonotic infestation of Echinococcus granulosus, which is frequently seen in some regions of the world. Unusual localization of Echinococcus granulosus is very rare. Hence, we would like to present our experience of identifying an extra-hepatopulmonary location of hydatid cysts. METHODS: A total of 157 patients with an unusual location of hydatid cysts treated between 2000 and 2012 were retrospectively evaluated according to their age, sex, symptoms, diagnosis, stage, location of the cyst, and treatment modality. RESULTS: Out of 157 patients, 68 were male and 89 were female. The mean age was 43.65 (4-85) years. The most involved organ was the spleen. The cysts were classified in 96, 57, and 4 patients as type I-II, III, and IV-V, respectively. CONCLUSION: The Puncture, Aspiration, Injection, and Reaspiration regimen should be the primary treatment option for hydatid cysts with unusual locations. As much as possible, organ-preserving surgery should be a treatment of choice in extra-hepatopulmonary hydatid cysts.

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience.

PURPOSE: We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts. METHODS: Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates. RESULTS: Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374). CONCLUSION: This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.

Ileosigmoidal knotting, an unusual form of acute intestinal obstruction.

Aim: Ileosigmoidal knotting is an unusual form of acute intestinal obstruction characterized by closed-loop obstruction of both ileum and sigmoid colon. We present 36 cases of ileosigmoidal knotting. Methods: A retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the 36 patients with ileosigmoidal knotting who were surgically treated in Necmettin Erbakan University's Meram Medical Faculty (Konya, Turkey) throughout a 26-year period. Results: The mean age was 55 (range, 47-61) years. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was acute obstructed bowel in all patients. After resuscitation, all patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was type IA, in which the active ileum encircled the passive sigmoid in a clockwise manner. There was gangrene in both ileum and sigmoid colon in all patients. All ischemic bowels including ileum and sigmoid colon were resected and the continuity was carried out using primary anastomosis or Hartmann's procedure. Conclusions: Ileosigmoidal knotting is a rare disease but its preoperative diagnosis is difficult. In cases of knotting there is no form of conservative treatment. Resective surgery is absolutely necessary.

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.

Enzymatic debridement in necrotizing pancreatitis.

Multiple organ failure and pancreatic necrosis are the factors that determine prognosis in acute pancreatitis attacks. We investigated the effects of collagenase on the debridement of experimental pancreatic necrosis. The study covered 4 groups; each group had 10 rats. Group I was the necrotizing pancreatitis group. Group II was the collagenase group with pancreatic loge by isotonic irrigation following necrotizing pancreatitis. Group III was the collagenase group with pancreatic loge following necrotizing pancreatitis. Group IV was the intraperitoneal collagenase group following necrotizing pancreatitis. The progress of the groups was compared hematologically and histopathologically. There was no difference among the groups regarding the levels of leukocyte, hemogram, and urea. The differences in AST levels between Group I and II; and differences in glucose, calcium, LDH, AST, and amylase between Group II and III; between Group II and IV; between Group I and III; and between Group I and IV were statistically significant (P < 0.05). There were statistically significant differences between Group II and III, and Group II and IV regarding edema, acinar necrosis, inflammatory cell infiltration, hemorrhage, and fat necrosis (P < 0.05). In conclusion, the collagenase preparation used in this experimental pancreatitis model was found to be effective in the debridement of pancreatic necrosis.

The increase of intra-abdominal pressure can affect intraocular pressure.

OBJECTIVE: This study aims to explore the usage of intraocular pressure measurements as the early indicator of the increase in intra-abdominal pressure. METHODS: In this prospective study, 40 patients undergoing elective surgery were included. Patients were divided into four groups of 10 patients. The control group (Group C) was not subjected to laparoscopic intervention. Laparoscopic surgery was, respectively, performed with an intra-abdominal pressure of 9, 12, and 15 mmHg in Groups L (low), M (medium), and H (high pressure). Intraocular pressure was measured binocularly in each patient at three different times (before, during, and end of surgery) using a contact tonometer. RESULTS: Patients' gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, and operative times were not different among the groups. No complications occurred with either the surgery or measurement of intraocular pressure. Intubation was associated with a severe rise in IOP (P < 0.05). An increase in intraocular pressure was seen in groups M and H (P < 0.05). CONCLUSION: Intraocular pressure was increased in the groups with an intra-abdominal pressure of 12 mmHg or more. Measuring the intraocular pressure might be a useful method to estimate the intra-abdominal pressure. This trial is registered with NCT02319213.