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Increased nutritional risk in major trauma: correlation with complications and prolonged length of stay.

BACKGROUNDnAcute Physiology and Chronic Health Evaluation II (APACHE II) and the Trauma Injury Severity Score (TRISS) are physiological and anatomical severity scores to predict trauma outcome. Nutritional Risk Screening (NRS-2002) is used for the screening of nutritional risk, which can affect outcome adversely. The objective of this study was to determine the reliability of these scales to predict disease severity, complications and mortality, and to compare the reliability of the NRS-2002 in predicting outcome with different scoring systems in trauma-intensive care unit (ICU) patients.nnnMETHODSnThe study enrolled 100 consecutive patients who were admitted to the ICU in a training hospital due to trauma in the six-month study period (1 July 2008 and 1 January 2009). Discrimination characteristics of the scoring systems were evaluated using receiver operating characteristic (ROC) curves.nnnRESULTSnOverall mortality was 14%, and the complication rate was 22%. Nutritional risk at admission was found to be increased in 58% of the patients. The NRS-2002 score was increased in patients with complication. ISS, TRISS and APACHE II at admission had a reliable power of discrimination (AUC>0.8) for mortality and complication prediction. The NRS-2002 score had moderate discrimination power for complication prediction (AUC=0.708) but showed high correlation with increased length of stay (LOS).nnnCONCLUSIONnA significant percent of trauma patients are at nutritional risk. The NRS-2002 score can be useful in predicting complication and prolonged LOS in trauma patients.

An extremely rare appendiceal anomaly: horseshoe appendicitis.

Appendiceal anomalies are extremely rare malformations that are usually found in adult populations as an incidental finding. Agenesis and duplication of the appendix have been well documented, but we know of only three reported cases of a horseshoe appendix. A 64-year-old woman admitted to the emergency department. A provisional diagnosis of acute appendicitis was made, and the patient was taken to the operating room. While appendectomy was being performed with a standard approach, the distal tip was seen to communicate with the cecum by another stump, or horseshoe appendix. The aim of this report is to share our experience with this extraordinary finding.

Effect of Preserving the Hepatic Vagal Nerve During Laparoscopic Nissen Fundoplication on Postoperative Biliary Functions

BackgroundCutting the hepatic branch of the anterior vagus nerve (HB-AVn) technically facilitates the laparoscopic Nissen fundoplication. The aim of this study was to investigate the effects of preserving or sacrificing this branch on postoperative gallbladder functions.MethodsThe patients (nxa0=xa040) were prospectively randomized into two groups. The HB-AVn was preserved during the dissection of the lesser omentum in the first group. The nerve was cut in the second group. Postoperative fasting gallbladder volumes were calculated by ultrasonography. Postoperative gallbladder ejection fraction (GEF) and gallbladder emptying time (GET) were determined by calculating intestinal transit time scintigraphically.ResultsFasting gallbladder volumes and GEF values were not different between the groups. On the other hand, in patients with HB-AVn preserved, GET measurements were found to be significantly shorter than those with HB-AVn sacrificed.ConclusionsSacrificing the hepatic branch causes prolongation in the GET. This change in the motor functions of the gallbladder does not cause any symptomatic effect during the early postoperative period. However, the delay in the GET may increase the risk of gallbladder stone formation in the long term.

Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy

BACKGROUNDnSeveral appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy.nnnMETHODSnThis study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared.nnnRESULTSnA total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups.nnnCONCLUSIONnIn the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscopy.

Ateşli Silah Yaralanmasında Gözden Kaçan İncebarsak Yaralanması: Olgu Sunumu

Yuksek kinetik enerjili atesli silahlarla meydana gelen abdominal yaralanmalarda ilk laparatomide gozden kacan yaralanmalar ozellikle savas bolgelerinde sik karsilasilan bir durumdur. En onemli sebebi yetersiz cerrahi eksplorasyon ve cerrahin deneyimsiz olmasidir. Cok erken tespit edilerek tedavi edilenler disinda mortalite orani yuksektir. Onlenmesi icin yaralilarin degerlendirilmesi ve eksplorasyonu sistematik bir sekilde yapilmalidir. Hemodinamik olarak instabil olan yaralilarda hasar kontrol cerrahisi prensipleri uygulanmalidir. Bu yazida yuksek kinetik enerjili atesli silahla abdominal bolgeden yaralanma sonrasi laparotomi yapilan, ancak peritonit gelismesi uzerine hastanemize gonderilen ve relaparatomide incebarsakta gozden kacan yaralanma tespit edilen 21 yasindaki erkek hastayi sunduk. Anahtar kelimeler: Gozden kacan yaralanma, Atesli silah yaralanmasi, Hasar kontrol cerrahisi