Ali Doğan Bozdağ

Acute Intraperitoneal Rupture of Hydatid Cysts

BackgroundRupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.MethodsSeventeen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 18 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.ResultsFive cases (29.4%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases. Intraperitoneal multiple cysts with heterogeneous cavity or cystic structures in the liver were shown in 14 cases. Computed tomography and magnetic resonance imaging showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Four patients (23.5%) died in the early postoperative period. A total of nine morbidities developed in six patients (35.3%). Median hospital stay was 18 days and median follow-up was 78 months. Intra-abdominal recurrence occurred in one case (7.7%).ConclusionsRupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. Computed tomography scan, in addition to clinical presentation, is essential for diagnosis. Emergency surgery is the main treatment for acute ruptured hydatid cysts. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.

Prosthetic repair of incarcerated inguinal hernias: is it a reliable method?

Background and aimIt is generally accepted that most inguinal hernias should be operated on electively using synthetic grafts. However, limited information is available on the usage of these materials in patient with incarcerated and strangulated hernias. The objective of this study is to compare the outcomes of incarcerated inguinal hernia repair with or without graft.Materials and methodsOne hundred-thirteen patients with incarcerated inguinal hernia that underwent surgery were included in this study. Patients who underwent Lichtenstein repair were assigned to group I; those who underwent primary repair were assigned to group II. Demographics and characteristics of patients in each group were compared. Chi-square and Students t-tests were used.ResultsNo statistical difference was found between patients who did and did not receive anastomosis in both groups in terms of surgery duration, length of hospital stay, postoperative morbidity, and mortality. Recurrence was found in 4.0% and 20.8% patients in group I and group II, respectively (P = 0.036).ConclusionsMesh repair can be preferred in incarcerated inguinal hernia patients because recurrence rate was significantly lower in patients who underwent Lichtenstein repair in this study.

A New Technique for Presentation of Scientific Works: Video in Poster

BackgroundPresentations at scientific congresses and symposiums can be in two different forms: poster or oral presentation. Each method has some advantages and disadvantages. To combine the advantages of oral and poster presentations, a new presentation type was conceived: “video in poster.”MethodsThe top of the portable digital video display (DVD) player is opened 180° to keep the screen and the body of the DVD player in the same plane. The poster is attached to the DVD player and a window is made in the poster to expose the screen of the DVD player so the screen appears as a picture on the poster. Then this video in poster is fixed to the panel. When the DVD player is turned on, the video presentation of the surgical procedure starts.ResultsSeveral posters were presented at different medical congresses in 2007 using the “video in poster” technique, and they received poster awards.ConclusionsThe video in poster combines the advantages of both oral and poster presentations.

ASYMPTOMATIC GOSSYPIBOMA MIMICKING A LIVER MASS

Gossipiboma ozellikle karin ici cerrahi girisimler sonrasinda gorulen hem cerrah hem de hasta icin cok ciddi sonuclara yol acabilecek nadir bir durumdur. Vucut icinde yer alan, pamuk yapidan olusan bir kitleyi tanimlamakta kullanilan bir terimdir. Gossypium (Latince, pamuk) ve boma (Svahilice, unutulan cismin yeri) kelimelerinden koken almaktadir (1). Karin ici cerrahi girisim sonrasi 1/3000-1/5000 arasi degisen oranlarda gorulebilecegi bildirilmekle birlikte yasal, tibbi sorunlar ve bazi hastalarin asemptomatik olabilmeleri nedeniyle bu oranin daha yuksek oldugu dusunulmektedir (2,3). En sik genel cerrahi girisimler sonrasinda gorulmekle birlikte kardiyovaskuler, ortopedik, urolojik islemler sonrasinda da gorulmektedir (4). En sik unutulan yabanci cisim cerrahi tamponlardir (3-5). Erken donemde karin ici abse gibi ciddi komplikasyonlara neden olabilmekle birlikte, yillarca asemptomatik kalip yalanci tumor goruntusu vererek insidental olarakta saptanabilirler (3,6,7).

Contribution of an educational video to surgical education in laparoscopic appendectomy

Objective With recent widespread advances in laparoscopy, providing education on this subject has become a significant challenge. The aim of this study was to determine the degree of contribution made by surgeons to laparoscopic education through an educational video. Material and Methods A total of 40 volunteer general surgery residents and specialists participated in our study. Before watching the approximately six-minute educational video prepared for laparoscopic appendectomy, the participants were asked to fill out participant information forms and information measurement questionnaire forms. After the video, the participants were asked to fill out the information measurement questionnaire forms a second time; additionally, attitude evaluation forms and education evaluation questionnaire forms were presented to the participants for completion, and statistical analysis was performed. Furthermore, the total watching duration and the number of times the video was paused were recorded. Results A total of 40 surgeons participated in the study (75% residents and 25% specialists). When the results of the information determination questionnaire forms filled out by the resident and specialist groups before and after the video were compared, it was observed that the scores of both groups significantly increased after watching the video (p=0.001). A statistical significance was identified between the length of time the video was watched and the education evaluation form scores of the participants (p<0.01). It was observed that the longer the video was watched, the greater the increase in the education evaluation scores. The results of the attitude evaluation forms implied that the video could be produced more professionally. Conclusion Although education is an inevitable requirement of laparoscopic surgery, many teaching methods are available. Awareness-enhancing videos prepared on this topic can be efficient in providing laparoscopic education.

Stapler hemoroidektominin yaşam kalitesine etkisinin SF-36 ölçeği ile değerlendirilmesi

We read the article entitled ‘Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire’ by Erdoğdu and friends published in the last issue of Ulusal Cerrahi Dergisi ( Ulusal Cer Der 2013; 29: 59-62) with great interest (1). We presume that the author thinks “stapled hemorrhoidectomy” process is the same process as “stapled hemorrhoidopexy“. The procedure is named as stapled hemorrhoidectomy in the title, as “stapled hemorrhoidopexy” in the introduction, and as “stapled hemorrhoidectomy “ in material and methods section. In fact, these two definitions describing different surgical procedures also have different meanings according to their terminology (Hemorrhoidectomy; excision of hemorrhoids hemorrhoidopexy ; hanging of hemorrhoids), and we see that they are used as synonyms in the literature. The aim of this letter is to correct this misperception and emphasize that the term that best describes the procedure is “stapled hemorrhoidopexy”.Dear Editor, We read the article entitled ‘Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire’ by Erdoǧdu and friends published in the last issue of Ulusal Cerrahi Dergisi (Ulusal Cer Der 2013; 29: 59–62) with great interest (1). We presume that the author thinks “stapled hemorrhoidectomy” process is the same process as “stapled hemorrhoidopexy“. The procedure is named as stapled hemorrhoidectomy in the title, as “stapled hemorrhoidopexy” in the introduction, and as “stapled hemorrhoidectomy “ in material and methods section. In fact, these two definitions describing different surgical procedures also have different meanings according to their terminology (Hemorrhoidectomy; excision of hemorrhoids - hemorrhoidopexy ; hanging of hemorrhoids), and we see that they are used as synonyms in the literature. The aim of this letter is to correct this misperception and emphasize that the term that best describes the procedure is “stapled hemorrhoidopexy”. Koblandin and Schalkow from Kazakhstan, first described excision of hemorrhoids with circular stapler in 1981 (2). First publication on this subject from Europe was by Allegra in 1990, where he described anal purse-string stitches by finger retraction of the anal region followed by hemorrhoidectomy with circular stapler (3). In both studies, the methods described stapled excision of hemorrhoids, thus stapled hemorrhoidectomy (4). However, in stapled hemorrhoidopexy a hemorrhoidectomy is not performed, instead an annular tissue containing mucosa and submucosa layers from the proximal of internal hemorrhoids is removed. In this way, both hemorrhoidal arterial and venous devascularization and fixation of hemorrhoids to their anatomical location are provided. The purpose of this procedure is to hang the hemorrhoids to their original location and to reduce their blood supply, rather than removing them (4). The literature published in the first five years following implementation of this surgery, various terms like stapled hemorrhoidectomy, stapled anopexy, the Longo procedure has been extensively used in addition to “stapled hemorrhoidopexy”. In order to prevent using different names for the same surgery the consensus study published in 2003 suggested that the method should be defined as “stapled hemorrhoidopexy” (5). Currently this recognition is mostly complied. We believe preferring this terminology in publications originating from Turkey is important to avoid any further confusion and to show that we carry the correct point-of-view.

Synchronous Primary Gastric Adenocarcinoma and Gastrointestinal Stromal Tumor

Background: The synchronous occurrence of gastric adenocarcinoma and gastrointestinal stromal tumors is extremely rare. We report a case of synchronous gastric adenocarcinoma and three stromal tumors, incidentally detected in the stomach and in the esophagus. Case Report: A 67-year-old woman presented with nausea, vomiting, and abdominal pain. Ultrasound and CT scans revealed a thickening of the wall of the stomach and cholelithiasis. Upper gastrointestinal endoscopy demonstrated a mass in the distal stomach. Histological examination of the endoscopic biopsy specimens showed a poorly differentiated adenocarcinoma. The patient underwent total gastrectomy and cholecystectomy. Microscopically, the gastric tumor was a poorly differentiated adenocarcinoma. Microscopic examination also showed one stromal nodule in the stomach and two nodules in the esophagus at the proximal resection margin which were composed of spindle cells with no pleomorphism and mitotic activitiy. Immunohistochemically, all three nodules were focally positive for CD117 and negative for CD34, smooth muscle actin, S-100 protein, desmin, and Ki-67. Conclusion: Synchronous gastric tumors may be detected preoperatively by endoscopic ultrasound. Moreover, the extratumoral wall of the stomach should be meticulously palpated during surgery to rule out any synchronous tumors.

Retroperitoneales Weichgewebssarkom zusammen mit einem muzinözen Zystadenom des Appendix

Background: Soft-tissue sarcomas may develop in the retroperitoneal space, in the peritoneal cavity and in the lower extremities. They are rare tumors, and make up 1% of all adult malignancies. Complete resection of the tumor is of crucial importance to achieve a long-term survival. Multivisceral resections are required in the majority of cases. Mucinous cystadenoma of the appendix is an uncommon condition, too. Most of the patients with mucinous cystadenoma present with clinical symptoms of acute appendicitis. The diagnosis is usually made postoperatively by histopathological examination. Case Report: We here present a rare co-existence of a retroperitoneal liposarcoma and an appendiceal mucinous cystadenoma. Conclusion: En bloc resection of retroperitoneal soft-tissue sarcomas also provides removal of invaded adjacent organs with any co-existing disease.

Prognostic Factors of Retroperitoneal Soft-Tissue Sarcomas

Retroperitoneal soft-tissue sarcomas are rare malignant tumors and make up 1% of all adult malignancies. We aimed to evaluate the morbidity, the mortality, and the prognostic factors that affect survival of the patients with retroperitoneal soft-tissue sarcoma in this study. Patients and Methods: 27 adult patients with retroperitoneal soft-tissue sarcoma underwent surgery between 1992 and 2005 in our clinic. Long-term survival and the independent prognostic factors that affect survival, e.g. age, gender, type of resection (complete resection, partial resection, or only laparotomy and biopsy), site of the tumor, invasion to adjacent organs, tumor size, type of tumor histology, histologic grading, stage of the tumor, and adjuvant radiochemotherapy application, were evaluated. Results: Overall survival rate was 58.1% at 1 year, 58.1% at 3 years, and 32.3% at 5 years. Resection type (p = 0.002), grade (p = 0.011), and stage (p = 0.005) were the prognostic features identified by univariate analysis. Among the significant prognostic factors in the univariate analysis, only two factors, surgical resection (p = 0.011, hazard ratio = 15.570) and tumor grade (p = 0.002, hazard ratio = 12.491), proved to be independently significant in the multivariate analysis. Conclusion: The completeness of resection and tumor grade significantly influence overall survival in this tumor entity.