Bahadır Ege

Extent of Lateral Internal Sphincterotomy: Up to the Dentate Line or Up to the Fissure Apex?

PURPOSEThe aim of this randomized, prospective study was to compare the results of lateral internal sphincterotomy up to the dentate line or up to the fissure apex in the treatment of chronic anal fissure.METHODSAdult patients with chronic anal fissure were randomly assigned to undergo lateral internal sphincterotomy to the level of the dentate line or to the level of the fissure apex. The patients were reexamined on postoperative Days 1, 7, 14, 28, and then at 2 and 12 months.RESULTSThe time required for relief of pain postoperatively was 2.08 ± 1.44 days in the dentate line group, which was significantly shorter than that for the fissure apex group (4.72 ± 4.86 days; P = 0.002). Objective healing was achieved in 23.7 percent and 17.6 percent at 14 days, 97.4 percent and 88.2 percent at 28 days, and 100 percent and 97.7 percent at 2 months in the dentate line and fissure apex groups, respectively (P > 0.05 for all comparisons). Only sphincterotomy up to the dentate line caused a significant change in anal incontinence (P = 0.016). Both groups had significantly lower anal resting pressures at 4 months postoperatively, compared with their corresponding preoperative levels (P = 0.005 and P = 0.007). The postoperative resting pressures did not differ significantly between the two groups (P = 0.273). By 12 months postoperatively, no treatment failures or recurrences were noted in the dentate line group (100 percent healing rate). In the fissure apex group, there was one nonhealing case and four recurrences, resulting in a 13.2 percent rate of treatment failure (P = 0.058).CONCLUSIONSSphincterotomy up to the dentate line provided a faster and definitive healing within the time limits of this study, but it was associated with a significant alteration in anal continence. In turn, sphincterotomy up to the fissure apex was free of significant disturbance of continence, but its healing effect was slower and it was prone to an insignificantly higher rate of treatment failure.

A prospective comparison of local and spinal anesthesia for inguinal hernia repair

Aim Today, in inguinal hernia repair, postoperative pain and costs are regarded as equally important issues as technique and recurrence rates. Postoperative pain is thought to vary according to the applied anesthesia method. As local anesthesia is reported to inflict less pain, its effects on early period post-operative complications should also be evaluated.

Laparoscopic Gastric Banding for Morbid Obesity in a Patient with Situs Inversus Totalis

We discuss the operative challenges posed by the advanced laparoscopic approach for a patient with situs inversus totalis. The patient was a morbidly obese woman with multiple co-morbidities related to her weight. The modifications in the surgical technique include the insertion of trocars according to the mirror image anatomy of the intra-abdominal organs under laparoscopic visualization. We suggest preoperative abdominal ultrasound in order to diagnose both gallbladder stones and also the reverse location of intra-abdominal organs that is rarely seen. A laparoscopic gastric banding, not a contradiction for situs inversus totalis, was performed successfully.

Primary leiomyosarcoma of the thyroid.

A 56-year-old male with primary leiomyosarcoma of the thyroid is presented. The paucity of diagnostic maneuvers, including tumor markers, fine needle aspiration, and frozen section biopsy, are stressed, in addition to the fulminate course of the disease.

Robotic Sleeve Gastrectomy For Morbid Obesity

OBJECTIVE To determine the weight loss, and complications as well as to exemplify the use of vessel sealer and the triple stapler establish the safety and efficacy of vessel sealer for robotic surgery and triple stapler in robotic sleeve gastrectomy. STUDY DESIGN Observational case series. PLACE AND DURATION OF STUDY Private Koru Hospital, Ankara, Turkey, from December 2015 till January 2016. METHODOLOGY Twenty robotic sleeve gastrectomy was performed. Demographics, body mass index, comorbidities, docking time, surgical time, leaks, bleeding, stapler number, strictures, mortality, conversion, weight loss, and hospital length of stay were included for data collection. RESULTS The mean age and body mass index were 40.73 ±11.2 years and 44.75 ±8.38 Kg/m2, respectively. Postoperative trocar site (assistance port) bleeding occurred in one patient. There were no conversions, stricture, leakage or mortality. The mean number of staplers used was 6.27 ±0.46 and excess body weight loss (EWL%) at three months was 24.91 ±2.84 kg. CONCLUSION Robotic surgery for obesity surgery was safe during our initial experience and use of vessel sealer and triple stapler was effective, safe and facilitates procedure in obese patients.

Anal Canal Duplication in Adults: Report of Five Cases

Anal canal duplications are very rare noncommunicating second anal orifices located posterior to the true anus. In this study, 5 adult cases of anal canal duplication are reported as extremely rare entities in the literature. The medical records of anal canal duplication patients treated from 2011 to 2014 were reviewed retrospectively. Five adult patients with symptoms of mucous discharge, anal pain, and or perianal fistula/abscess were admitted. Findings of physical examination and radiologic imaging (pelvic magnetic resonance, endoanal ultrasound, and or colonoscopy) suggested anal canal duplication. The mean age of patients was 40.4 ± 8.7 (range, 33–55), and the mean follow-up period was 18.4 ± 11.2 (range, 6–36) months. Histologic features of the removed samples confirmed anal canal duplication. All patients underwent complete surgical excision of the rudimentary anal canal. Anal canal duplication is a very rare congenital anomaly, and 5 additional adult cases are reported. Although this is a referral...

Surgical Treatment of Anal Stenosis with Diamond Flap Anoplasty Performed in a Calibrated Fashion.

BACKGROUND: Regarding anoplasty for anal stenosis, it is not clear to what extent the final anal caliber should be targeted. OBJECTIVE: The aim of this study was to investigate the results of diamond-flap anoplasty performed in a calibrated manner for the treatment of severe anal stenosis due to a previous hemorrhoidectomy. DESIGN AND SETTING: Prospectively prepared standard forms were evaluated retrospectively. PATIENTS AND INTERVENTIONS: Anoplasty with unilateral or bilateral diamond flaps was performed for moderate or severe anal stenosis, targeting a final anal caliber of 25 to 26 mm. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis staging (Milsom and Mazier), anal calibers (millimeter), the Cleveland Clinic Incontinence Score, and the modified obstructed defecation syndrome Longo score were recorded on pre-prepared standard forms, as well as postoperative complications and the time of return to work. RESULTS: From January 2011 to July 2013, 18 patients (12 males, 67%) with a median age of 39 years (range, 27–70) were treated. All of the patients had a history of previous hemorrhoidectomy. The number of previous corrective interventions was 2.1 ± 1.8 (range, 0–4), and 2 patients had a history of failed anoplasty. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5–15), 25 ± 0.75 mm (range, 24–26), and 25 ± 1 mm (range, 23–27) (p < 0.0001, for immediate postoperative and 12-month postoperative anal calibers compared with the intraoperative). Preoperative and 12-month postoperative Cleveland Clinic Incontinence Scores were 0.83 ± 1.15 (range, 0–4) and 0.39 ± 0.70 (range, 0–2) (p = 1.0). The clinical success rate was 88.9%. No severe postoperative complications were observed. LIMITATIONS: This study was limited because it was a single-armed, retrospective analysis of prospectively designed data. CONCLUSION: Diamond-flap anoplasty performed in a standardized and calibrated manner is a highly successful method for the treatment of anal stenosis caused by previous hemorrhoidectomy.