The growing role of laparoscopic repair in patients with early diagnosed peptic ulcer perforation.

OBJECTIVE: Laparoscopy is gaining more importance in emergency abdominal surgery. Peptic ulcer perforation (PUP) constitutes a significant portion of surgical emergencies. The aim of this study was to evaluate the methods and results of patients who underwent surgery due to PUP in our department. MATERIAL AND METHODS: Patients who were admitted to the hospital in the early period and received Graham-patch (GP) repair due to PUP from January 2009 to January 2013 were divided into two groups as laparoscopic (group L) or open (group O) surgery. Demographic data of the patients, duration of the operation, conversion to open surgery, length of hospital stay, secondary interventions, re-admissions, morbidity and mortality rates were retrospectively evaluated. Patients with conversion to open surgery were included in Group O. RESULTS: Two hundred and nineteen patients were included in the study, 148 of which were in Group O (including the 47 patients with conversion), and 71 in group L. In patients with early admission, the rate of laparoscopically completed GP was 19.6% in the first year of the study, whereas this rate was 61.8% in the fourth year (p<0.001). The rate of conversion to open surgery was 50% in 2009, and 24.4% in 2012 (p=0.028). Length of hospital stay was shorter in group L (p=0.35). The complication rate was 4.2% in patients who had laparoscopic procedures, and was 6.1% in patients who underwent open surgery (p=0.57). Seventy-three percent (n=11) of re-hospitalized patients in the perioperative period (n=15) were treated conservatively. When costs related to secondary interventions and re-hospitalization were included, there was no significant difference between laparoscopic and open surgery groups in terms of cost (p=0.06). CONCLUSION: Laparoscopic surgery for PUP is a reliable method and has been used increasingly over the years in our department. The operative time is longer, the length of hospital stay is shorter, the complication rates are less than open surgery, and the conversion rate is significantly reduced. Laparoscopic GP is feasible in early-admitted patients with PUP, due to the above-mentioned advantages. We believe the rate of conversion to open surgery decreases with increasing experience in laparoscopy.

The role of selective venous sampling in patients with non-localized primary hyperparathyroidism.

OBJECTIVES: The aim of this observational clinical study was to evaluate the success of angiographic selective venous sampling (ASVS) in locating parathyroid adenoma in patients with primary hyperparathyroidism (PHPT), in whom the other imaging modalities have failed, and and to evaluate its possible contribution to the applicability of minimal invasive surgery. MATERIAL AND METHODS: Fifty-five patients who were admitted to our hospital's General Surgery department between January 2012 and January 2015 for PHPT in whom ultrasound and sestamibi scintigraphy have failed to localize the diseased gland were included to the study. Patients were divided into two groups: those who underwent ASVS and those who did not. The outcomes of patients were reviewed retrospectively. RESULTS: Among 55 patients, 20 underwent ASVS. ASVS successfully lateralized the diseased gland in 17 (85%) patients, and minimally invasive parathyroidectomy could be performed in 14 (70%) patients. The cut-off value of parathormon gradient was considered 10% for lateralization and the accuracy of ASVS in lateralization was 94.1%. In 11 (59%) patients, the superior-inferior discrimination could be achieved in addition to lateralization. CONCLUSION: ASVS has a high sensitivity in locating the diseased gland in patients with PHPT in whom ultrasound and sestamibi scan have failed, and thereby, rendering the performance of minimally invasive surgery possible. Further studies may reveal the role of ASVS in providing useful information about not only lateralization but also the superior-inferior discrimination.

Colonoscopic Perforations, What is Our Experience in a Training Hospital?

The aim of this study was to describe our experience in patients treated with the diagnosis of colonoscopic perforation. A retrospective institutional computer-based search of the patients treated with the diagnosis of colonoscopic perforation between July 2009 and May 2014 was undertaken. Our study included 16 patients. In 9 (56%) patients, perforations occurred during the diagnostic colonoscopy. Snare polypectomy was the causative factor in 5 patients associated with therapeutic colonoscopy. The perforation was significantly higher in patients who underwent therapeutic colonoscopy than those had diagnostic colonoscopy (P<0.007). The sigmoid colon was the most common perforation site (62.5%). Twelve patients (75%) were treated by surgically, 3 (19%) patients by conservatively, and 1 (6%) by endoscopic clipping. Early recognition of the perforation is critical. Therefore, a high index of suspicion is essential for the prompt and accurate diagnosis.

Intramural hematomas of the gastrointestinal system: a 5-year single center experience.

PURPOSE: Although spontaneous intramural hematomas of the gastrointestinal tract are very rare, they may be observed with the use of oral anticoagulant, though less frequently in cases of hematological malignancy and other bleeding disorders. Cases diagnosed as spontaneous intramural hematoma have been assessed in our clinic. METHODS: The cases, which were diagnosed as spontaneous intramural hematoma in the gastrointestinal tract (SIHGT) following anamnesis, physical examination, biochemical, radiological and endoscopic findings from July 2008 to July 2012, have been assessed retrospectively. RESULTS: Seven out of 13 cases were women and the mean age was 65.1 years (34 to 82 years). The most frequent complaint on admission was abdominal pain. The most frequent location of SIHGT was the ileum (n = 8). Oral anticoagulant use was the most common cause of etiology (n = 12). In 10 cases, International normalized ratio values were higher than treatment range (2 to 3, where mechanical valve replacement was 2.5 to 3.5) and mean value was 7.6 (1.70 to 23.13). While 12 cases were discharged without problems with medical treatment, one case with acute myeloid leukemia died in the intensive care unit following cerebrovascular attack. CONCLUSION: Spontaneus bleeding and hematomas that may arise in connection with bleeding diathesis may be fatal in cases with long-term oral anticoagulant treatment and insufficient follow-up. In management of these cases, it may be necessary to arrange conservative follow up and/or initialize low molecular weight heparin, and administer vitamin K as well as replace blood products and coagulation factors when indicated.