Anil Çubukçu

Is minisite cholecystectomy less traumatic? Prospective randomized study comparing minisite and conventional laparoscopic cholecystectomies.

The main objectives of minisite cholecystectomy (MC) are to have smaller incisions, better cosmetic results, less trauma, and a lower morbidity rate. This prospective randomized study compares MC with conventional laparoscopic cholecystectomy (CLC) in terms of surgical trauma and cosmetic results in 44 patients. Conversion from MC to CLC was required in five patients. No conversion to open surgery was needed in the CLC group. The average operating time was slightly longer in the MC group, but the difference was not statistically significant (81 minutes versus 72 minutes, p=0.22). The population characteristics, postoperative respiratory function measurements, pain scores, and analgesic requirements were similar in the two groups. The average score for scar tissue was significantly lower in the MC group (0.73 versus 1.93, p=0.0045). Only the cosmetic results of MC were superior to CLC. This technique could be a feasible alternative procedure in patients seeking better cosmetic results. However, further studies with larger sample sizes are needed to evaluate the postoperative morbidity of MC.RésuméLes objectifs principaux de la cholécystectomie laparoscopique minime (CM) (par mini-trocars) sont de réaliser de plus petites incisions, d’obtenir un meilleur résultat esthétique, de provoquer moins de trauma et d’avoir un taux plus bas de morbidité que la cholécystectomie par laparoscopic classique. Cette étude prospective randomisée a comparé la CM à la cholécystectomie par laparoscopic (CL) traditionnelle en termes de traumatisme chirurgical et de résultat esthétique chez 44 patients. On a du convertir la CM en CL chez cinq patients. Aucune conversion vers la chirurgie ouverte n’a été nécessaire dans le groupe de CL traditionnelle. Le temps moyen d’intervention a été plus long dans le groupe CM mais cette différence n’était pas statistiquement significative (81 min vs. 72 min, p=0.22). Les caractéristiques de la population, les fonctions respiratoires, les scores de la douleur et les besoins en analgésiques étaient similaires dans les deux groupes. Les scores moyens d’évaluation de la cicatrice ont été significativement plus bas dans le groupe CM (0.73 vs. 1.93, p=0.0045). Seuls les résultats esthétiques de la CM étaient supérieurs à la CL. Cette technique pourrait être une alternative valable chez les patients cherchant une amélioration des résultats esthétiques. Cependant, d’autres études avec des échantillons plus larges sont nécessaires pour évaluer la morbidité postopératoire de la CM.ResumenEl propósito principal de la colecistectomía de invasión mínima (CIM) es lograr una cicatriz pequeña, mejor apariencia estética, menos trauma y morbilidad reducida. El présente estudio prospective y aleatorizado compara la CIM con la colecistectomía laparoscópica convencional (CLC) en cuanto a trauma operatorio y resultado estético en 44 pacientes. Se requirió conversión de CIM a CLC en cinco pacientes, pero ninguna CLC tuvo que ser convertida a cirugía abierta. El promedio del tiempo operatorio fue ligeramente más prolongado en la CIM, pero la diferencia no es estadísticamente significativa (81 min versus 72 min, p=0.22). Las características demográficas de los dos grupos eran similares y las determinaciones postoperatorias de función respiratoria, grado de dolor y requerimiento analgésico fueron sensiblemente iguales. El grado de tejido cicatricial fue significatamente menor en el grupo de la CIM (0.73 versus 1.93, p=0.0045). Sólo el resultado estético de la CIM fue superior al de la CLC. Esta técnica podría ser una alternativa factible en pacientes que busquen un mejor resultado estético. Sin embargo, se requieren estudios adicionales y grupos de pacientes más numerosos para evaluar la morbilidad postoperatoria de la CIM.

Lack of evidence that Obesity is a cause of pilonidal sinus disease

OBJECTIVE To find out whether pilonidal sinus is more common among obese people. DESIGN Retrospective study from hospital records. SETTING Two university hospitals, Turkey. SUBJECTS 419 patients who were operated on for pilonidal sinus disease; and 213 age and sex matched patients with benign diseases other than pilonidal sinus disease and who were not morbidly obese acted as controls. MAIN OUTCOME MEASURES Comparison of body mass index (BMI) in the two groups. RESULTS Patients with BMI of 25-30 were classified as overweight (61/419, 15% compared with 28/213, 13%), and those with BMI of 30 or more as obese (7/419 compared with 4/213, 2% in each group). Mean (SD) BMI of patients with pilonidal sinus disease was 26.0 (3.9) compared with 25.6 (3.9) in the control group (p = 0.4). CONCLUSION Obesity alone is not an important factor in the aetiology of pilonidal sinus disease.

Carboxymethylcellulose coated on visceral face of polypropylene mesh prevents adhesion without impairing wound healing in incisional hernia model in rats.

Adhesions between viscera and mesh may result in intestinal obstruction and fistulae formation. Fewer adhesions with sodium carboxymethylcellulose (SCMC)-coated polypropylene mesh (PM) has been reported, but impaired wound healing was the major concern. We investigated the adhesion-prevention effect of SCMC in different concentrations, as coating only on visceral face of PM and its effects on wound healing. A full-thickness abdominal wall defect was created in 28 rats, which were then divided into three groups. In Group I (control), the defect was repaired with PM only; in Group II and Group III, the defects were repaired with 1% and 1.6% SCMC-coated-PM, respectively. All animals were sacrificed at day 30, and histological evaluation and adhesion scoring were done. Animals in the group in which 1.6% SCMC-coated PM was used developed significantly fewer adhesions compared with other animals (P=0.04). Histological evaluation using a semiquantitative scoring system showed no difference between the groups in fibrosis and inflammation scores (P=0.9 and P=0.3, respectively), and thickness of fibrosis on mesh was also similar (P=0.5). SCMC in 1.6% concentration as coating only on the visceral face of PM reduced the incidence and severity of adhesions without impairing wound healing.

Imprint cytology in the diagnosis of Helicobacter pylori : Does imprinting damage the biopsy specimen?

OBJECTIVE To investigate the efficacy of imprint cytology in the diagnosis of Helicobacter pylori infection and whether it damages the biopsy specimen for subsequent histologic examination. STUDY DESIGN Two antral biopsies were taken from 76 patients with dyspeptic symptoms undergoing upper gastrointestinal endoscopy. Imprint cytology was made from the first specimen. This specimen was fixed in 10% formalin and sent for histopathologic examination. The second specimen was directly fixed in 10% formalin for routine histopathologic examination without being used for an imprint. The imprint smears were examined by cytopathologists. The biopsy specimens were examined by pathologists who did not know which specimens were used for the imprints. RESULTS H pylori was seen in smears from 55 (72%) patients and in both biopsy specimens from the same patients. The pathologists could not recognize the biopsy specimens from which the imprints were made. Concordance between imprint cytology and histopathology was 100%. CONCLUSION Imprint cytology is a suitable test for H pylori diagnosis, and imprints do not adversely affect the quality of the biopsy specimen.

Open tension‐free Cooper ligament repair for femoral hernia

Many techniques have been described for the repair of femoral hernia. The technique applying the principles of the tension‐free method of McVays Cooper ligament repair by covering all potential hernia sites in the myopectineal orifice with a mesh has also been described, but no report has yet been published with large number of cases and long follow‐up period. We used this technique in 28 patients (19 females and 9 males) with femoral hernia. The average operating time was 40 min (range 25–75) and average follow‐up period was 40 months (range 6–75). No postoperative infection or seroma was recorded. There was no recurrence at the time of writing. This technique seems to be a good alternative for the repair of femoral hernia and also for concurrent femoral hernia with inguinal hernia.

A comparison of two omental lengthening techniques by the pedicled omentum to close a knee disarticulation defect: a case report

Pedicled omental flaps have been used successfully for soft tissue reconstruction of complicated wounds. Distal reach and the lengthening technique of the pedicled omentum are less highlighted. Unestimated size availability of coverage by the lengthening technique has restricted common practice in clinical use. We have used the cadaveric scale of Das preoperatively to assess the distal reach and coverage on the lengthened pedicled omentum, this can correlate well intraoperatively.

Commentary on “A comparison of two omental lengthening techniques by the pedicled omentum to close a knee disarticulation defect: a case report” by A. Sarlak et al.

We highly appreciate the comments made by Prof. Costa. As he points out and we have mentioned in our paper, to cover a knee disarticulation defect pedicled omentum with a skin graft is not the first option. A free myocutaneous or a sensate cutaneous–myocutaneous flap is definitely a better choice in a weight-bearing area. Although seen in a small percentage of cases, knowledge of the anatomical variations are imperative in selective divisions and lengthening for more distant pedicle application. We think that intraoperative templating is mandatory, especially for distal defects. With the more frequent use of endoscopic surgery, omental lengthening might be a good alternative in patients having laparotomy with the defects to be covered in the same session. Eur J Plast Surg (2008) 30:247 DOI 10.1007/s00238-007-0175-1