Bulent Hamdi Ucan

Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery

Background: u2003The present study analyses the results of wide excision with primary closure (PC), wide excision with classical Limberg flap reconstruction (LF) and wide excision with modified Limberg flap reconstruction (MLF) in the surgical treatment of sacrococcygeal pilonidal disease.

Superiority of Asymmetric Modified Limberg Flap for Surgical Treatment of Pilonidal Disease

PurposeCases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period.MethodsIn this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6–44) months after wide excision plus classic Limberg flap (Group 1, n = 35) and after asymmetric modified Limberg flap closure (Group 2, n = 33).ResultsThere were significantly more macerations in Group 1 (P < 0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P = 0.028). We noted that as a result of these complications, time to suture removal (P = 0.001), discharge from hospital (P = 0.001), and time off from work (P = 0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P = 0.493).ConclusionsThe deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.

A Randomized Prospective Study of Complications Between General Surgery Residents and Attending Surgeons in Near-Total Thyroidectomies

PurposeRecurrent laryngeal nerve palsy and hypoparathyroidism are the most common and serious complications after thyroid operations. Surgeon experience has been defined as a significant factor in the number of complications occurring in thyroid surgery. There has so far been no prospective randomized study that compares the complication rates between residents and the attending surgeon in statistically similar patient groups in which all of the patients undergo the same type of thyroid surgery by the same surgical team. In this prospective study the performances of residents and attending surgeons were evaluated and compared according to the complication rates in near-total thyroidectomies.MethodsOne hundred and fifty-two patients underwent near-total thyroidectomies between April 2001 and May 2003. The number of randomly selected patients operated on by residents at the level of postgraduate year two, under the direct supervision of an attending surgeon, and the number of patients operated on by attending surgeons were 78 and 74, respectively. All patients had preoperative and postoperative videolaryngostroboscopic examinations of the vocal cords and serum calcium level evaluation.ResultsThe rates of temporary vocal cord paralysis with respect to the nerves at risk for residents and attending surgeons were 3.7% and 2.7%, respectively. The temporary hypoparathyroidism rate was 8.1% for attending surgeons, whereas it was found to be 6.4% for residents. Neither any cases of permanent vocal cord paralysis nor permanent hypoparathyroidism were detected.ConclusionOur results indicate that the complication rates in near-total thyroidectomies performed by residents and attending surgeons are similar. Thyroid surgery can therefore be safely and effectively performed by residents under close supervision.

Complications of total thyroidectomy performed by surgical residents versus specialist surgeons

PurposeSurgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups.MethodsBetween April 2001 and May 2007, 144 patients underwent TT at our hospital. For 75 operations, the primary surgeon was a resident under the direct supervision of the attending surgeon, and for 69 operations, the primary surgeon was the experienced attending surgeon. Pre-and postoperative vocal cord examinations and serum calcium level evaluations were carried out in all patients.ResultsThe rates of temporary (unilateral) recurrent laryngeal nerve (RLN) palsy were 2.66% vs 2.17% after TT performed by the residents vs the attending surgeon, respectively. There were no significant differences in the incidences of temporary hypoparathyroidism (20% vs 20.28%), permanent (unilateral) RLN palsy, hematoma, infection, seroma, and incidental parathyroidectomy between the two groups.ConclusionThe complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance.

CD24 and Galectin-1 Expressions in Gastric Adenocarcinoma and Clinicopathologic Significance

CD24 and galectin-1 expression in gastric adenocarcinoma and their clinicopathologic significance remained largely unknown. We aimed to evaluate expressions and staining intensities of CD24 and galectin-1 in gastric adenocarcinoma and to investigate the interrelation with clinicopathologic parameters including survival. 93 cases with gastric adenocarcinoma were reevaluated histopathologically and immunohistochemistry was performed with antibodies against CD24 and galectin-1. Staining intensities of both markers in tumor cells and staining intensity of galectin-1 in tumor-associated stromal cells were scored semiquantitatively. The relationship between expression and staining intensity of CD24 and galectin-1 and clinicopathologic variables were assessed. CD24 staining intensity was associated with lymphovascular invasion (pu2009=u20090.007), serosal invasion (pu2009=u20090.001), stage (pu2009=u20090.001) and lymph node metastasis (pu2009=u20090.005). Galectin-1 staining intensity in tumor-associated stromal cells was associated with tumor location (pu2009=u20090.031), lymphovascular invasion (pu2009=u20090.001), perineural invasion (pu2009=u20090.001), serosal invasion (pu2009=u20090.001), differentiation (pu2009=u20090.003), stage (pu2009=u20090.001) and lymph node metastasis (pu2009=u20090.001). Staining intensity of CD24 (pu2009=u20090.019) and gal-1 (pu2009=u20090.018) were associated with patient survival. Staining intensity of CD24 in tumor cells and galectin-1 in tumor-associated stromal cells were related with certain clinicopathologic variables. Our findings suggest that these markers are independent prognostic indicators of poor survival and may serve as useful targets for novel therapies.

The effect of sildenafil on an animal model for ischemic colitis.

Introduction Sildenafil both enhances vasodilatation by relaxing the smooth muscle in the vessels and inhibits platelet aggregation. We have therefore examined the potential benefits of sildenafil on an animal model for ischemic colitis (IC). Methods Twenty-eight female Wistar albino rats weighing 250–300xa0g were randomized into three experimental groups as follows: in Group 1, animals were sham operated (nxa0=xa08) and received tap water; in Groups 2 and 3, the rats underwent a standardized surgical procedure to induce IC (nxa0=xa010 in each group). Group 2 animals served as the controls, receiving only tap water, while Group 3 animals received 10xa0mg/kg sildenafil per day as a single dose for a 3-day period. All animals were sacrificed 72xa0h after devascularization. To determine the severity of the ischemia, we scored the macroscopically visible damage, measured the ischemic area and scored the histopathology. Tissue malondialdehyde levels were also evaluated. Results The mean area of ischemic changes were 116.80xa0±xa0189.93 and 0.55xa0±xa01.01xa0mm2 in Group 2 and 3 animals, respectively (pxa0=xa00.0001), while the macroscopically mean visible damage score decreased to 0.66xa0±xa00.70 (pxa0=xa00.0001) for Group 3 animals. The Chiu scores were 0.00, 3.80xa0±xa00.91 and 2.66xa0±xa01.00 in Group 1, 2 and 3 animals, respectively. There was a statistically significant difference between Group 2 and 3 animals (pxa0=xa00.017). Conclusions Our findings support the view that sildenafil leads to a improvement in IC due to its well-known effects on the vascular smooth muscle and on the microcirculatory hemodynamics.

Simvastatin Improves Wound Strength after Intestinal Anastomosis in the Rat

BackgroundSimvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor commonly known as a cholesterol-lowering drug with additional pleiotropic effects. Also, it is demonstrated that it prevents postoperative peritoneal adhesions in rat. This study was designed to assess its effects on the healing process of colonic anastomosis.MethodsThirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with simvastatin and the control group received only tap water instead. The rats were killed 3 and 7xa0days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline content, histopathology, and biochemical analysis.ResultsCompared to the control group, simvastatin-treated rats displayed a higher bursting pressure (pu2009<u20090.001) and anastomotic hydroxyproline content (pu2009<u20090.05). Simvastatin treatment leads to a significant decrease in malondealdehyde levels (pu2009<u20090.05) and increase in paraoxonase activity (pu2009<u20090.001) at both time points. Histopathological analysis revealed that simvastatin administration leads to a better anastomotic healing in terms of reepithelialization, decreased granuloma formation, reduced ischemic necrosis, and inflammatory infiltration to muscle layer.ConclusionClinically relevant doses of simvastatin do not have a negative impact on colonic anastomosis but improve intestinal wound healing in rats.

Fade or fate. Seroma in laparoscopic inguinal hernia repair.

BackgroundPostoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery.MethodsThirty patients with unilateral inguinal hernia who had a hernia sac of >4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month.ResultsUSG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups.ConclusionsSuperficial USG is a beneficial tool in differentiating early recurrence or seroma in patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma.

Does sildenafil reverse the adverse effects of ischemia on ischemic colon anastomosis: yes, 'no'.

INTRODUCTIONnSildenafil may lead an improvement in anastomotic healing of ischemic left colon anastomosis.nnnMETHODSnThirty-six male Wistar albino rats were randomized into four experimental groups (n=9 in each group). In group 1, a well-perfused left colonic segment was transected, and free ends were anatomosed. In groups 2, 3 and 4 animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. Group 2 animals received only tap water. In groups 3 and 4 animals received 10mg/kg/body-weight and 20mg/kg/body-weight sildenafil, single dose a day during 4 days, respectively. Rats were sacrificed on day 4 following operation. Anastomotic integrity, intra-peritoneal adhesion scores, anastomotic bursting pressures and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed.nnnRESULTSnThere was no statistically significant difference among groups with respect to anastomotic integrity (p=0.142) but ischemia decreased the anastomotic bursting pressure. The mean bursting pressure values were 78.8+/-24.1, 43.3+/-26, 55.1+/-32.4, and 43.3+/-20.4 in groups 1, 2, 3, and 4, respectively. Group 1 had the highest values whereas; there was no statistically significant difference between groups 1 and 3. There was no statistically significant difference among groups 2, 3, and 4 with respect to tissue hydroxyproline levels, adhesion scores and the Chiu scores. The highest inflammatory cell presence in the granulation tissue was detected in group 2, whereas the lowest was detected in group 4 (p=0.0001). The highest fibroblast infiltration in the granulation tissue was detected in group 1 (p=0.045).nnnDISCUSSIONnOur results showed that 10mg/kg sildenafil decreased the adverse effects of ischemia on the healing of ischemic left colon anastomosis. Additional investigations are needed to confirm the effects of phosphodiesterase-5 inhibitors in ischemic colon anastomosis models.

Comparison Between Powdered Gloves, Powder-free Gloves and Hyaluronate/Carboxymethylcellulose Membrane on Adhesion Formation in a Rat Caecal Serosal Abrasion Model

OBJECTIVEnIntraabdominal adhesion formation and prevention is one of the major conflicts of modern surgery. We aimed to determine the effects of powdered gloves versus powder-free gloves and hyaluronate/carboxymethylcellulose membrane (H/CMCm) in a rat caecal serosal abrasion model.nnnMETHODSnSixty wistar albino rats were subjected to a standardized lesion by caecal abrasion model. In group 1, the procedure was performed with sterile powdered gloves. In group 2, the procedure was performed with powder-free sterile gloves. The H/CMCm was applied directly to the abraded caecum in group 3. Formation of adhesions were determined on one half of the animals from each group on the 7th postoperative day, and on the other half on the 15th postoperative day.nnnRESULTSnThere was a statistically significant difference between the adhesion scores on day 7 and 15 in groups 1 and 2 (p = 0.005, p = 0.007). There was no significant difference in adhesion scores on day 7 and 15 in group 3 (p = 0.145). The mean adhesion score was significantly higher in group 1 (powdered glove group) than group 2 (powder-free glove group) and group 3 (powder-free glove plus H/CMCm) on postoperative day 7 (p = 0.001). However, no significant difference was found between groups regarding adhesion scores on postoperative day 15 (p = 0.607). The comparisons of group 2 versus group 3, both on postoperative day 7 (p = 0.051) was not statistically significant, whereas a significant difference was detected between group 1 versus group 2 and group 3 on postoperative day 7 (p = 0.013, p = 0.001).nnnCONCLUSIONnOur experiment shows that the use of powder-free gloves may be as beneficial as Seprafilm in preventing postoperative adhesion formation.