Ediz Altinli

Comparison of prosthetic materials in incisional hernia repair

PurposeIncisional hernias are not uncommon after abdominal surgery, but their repair is associated with a high risk of complications, including adhesions and recurrence. Many different types of meshes and adhesion barriers have been developed in an attempt to overcome these problems, some of which we have assessed in a rat model.MethodsWe made a full-thickness 1.5 × 2.5-cm abdominal wall defect in 30 Sprague-Dawley rats, which were divided into three groups according to the materials used for repair: 2 × 3-cm polypropylene mesh (group 1); expanded polytetrafluoroethylene (PTFE) with double-layer polypropylene mesh (group 2); or polypropylene mesh with oxidized cellulose adhesion barriers (group 3). We assessed adhesion formation, tensile strength, and histopathologic findings.ResultsThe mean adhesion scores were 3.3, 1.3, and 0.7, in groups 1, 2, and 3, respectively (P < 0.001). The area involved by adhesions was significantly greater in group 1 than in groups 2 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 2 and 3 (P < 0.05). The tensile strength in group 2 was less than that in groups 1 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 1 and 3 (P > 0.05).ConclusionAlthough there was less adhesion formation with PTFE and oxidized cellulose, PTFE not only impaired the tensile strength, but also induced fibrosis and inflammation. An oxidized cellulose adhesion barrier can be safely used in incisional hernia repair to prevent intra-abdominal adhesions.

Laparoscopic repair of a Morgagni-Larrey hernia: report of three cases.

Abstract.Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into the right hemithorax; however, one was symptomatic and had herniation of the omentum and large bowel. Tension-free closure of the defects was done using Prolene mesh with a hernia stapler, helical fastener, and Endostitch. There were no early complications and the patients were discharged on the fourth postoperative day. The mean follow-up period was 41 months, and there has been no late morbidity or mortality related to this procedure. Using a laparoscopic approach to repair a Morgagni-Larrey hernia provides an excellent view of the surgical field and allows easy manipulation with minimal surgical trauma, followed by rapid recovery of the patient.

Laparoscopy-assisted Resection of Complicated Meckel's Diverticulum in Adults

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckels diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckels diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckels diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckels diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckels diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.

Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstructions.

The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6–39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.

Anthropometric Measurements in Male Breast Cancer

Background: 1% of breast cancers occur in men.The etiology is obscure. An elevated BMI has been postulated to be a cause. Methods: All male breast cancer patients operated from January 1990 to May 2001 were retrospectively reviewed. Relation between BMI and male breast cancer was examined. Results: 43 males underwent breast surgery for breast cancer during this period. 3 patients were excluded from the study because of other risk factors for breast cancer.The average BMI of 40 patients was 26.54 kg/m2, which is mildly above the level for normal weight. Conclusions: Excessive adipose tissue may increase risk of male breast cancer.

Fournier's gangrene current approaches †

Fourniers gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fourniers gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi‐Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fourniers gangrene is a safe dressing method. It promotes granulation formation. Flexi‐Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi‐Seal and NPWT) is an effective and comfortable method in the management of Fourniers gangrene in appropriate patients.

Impact of herniorraphy technique on testicular perfusion: results of a prospective study.

Background Inguinal hernia repair is one of the most frequently performed operations. The Lichtenstein hernia repair is the most popular hernia repair technique in general surgical practice. However, totally extraperitoneal-preperitoneal hernia repair technique has been frequently used technique recently. The aim of this prospective, randomized, clinical study was to evaluate testicular perfusion after these 2 procedures. Methods In our prospective randomized study, 32 male patients, aged 33 to 72 years who fulfilled the inclusion criteria underwent elective herniorraphy for groin hernia. The patients were randomly assigned into either Lichtenstein hernia repair (n=16) or totally extraperitoneal-preperitoneal hernia repair (n=16) group according to their admittance. Color Doppler ultrasonography of the testes was performed on all patients 1 day before the operation, 3 days and 6 months after the operation. Results The results of the resistive index of the both groups; Lichtenstein hernia repair and totally extraperitoneal-preperitoneal hernia repair are statistically insignificant in all preoperative, early and late postoperative periods (P>0.05). Conclusions Either Lichtenstein hernia repair or totally extraperitoneal-preperitoneal hernia repair does not effect the testicular perfusion.

The shrinking rates of different meshes placed intraperitoneally: a long-term comparison of the TiMesh, VYPRO II, Sepramesh, and DynaMesh.

Aim The aim of our study was to determine and compare the shrinking rates of different prosthetic materials used in ventral hernia repair and to establish a possible correlation with macroscopic adhesions, histopathologic inflammation, and fibrosis. Methods Thirty-six Wistar albino rats were divided into 4 groups (T, V, S, and D). A midline laparotomy was performed under general anesthesia. A 30×40 mm-sized mesh was placed intraperitoneally and fixed with an interrupted 4/0 polypropylene suture to the anterior abdominal wall. In group T, TiMesh; group V, Vypro II; group S, Sepramesh; and group D, DynaMesh-IPOM were used. All rats were killed at the 90th day postoperatively and the mesh area and the shrinking rate were calculated. Each group was evaluated in correlation with shrinking, adhesion, histopathologic inflammation, and fibrosis, and compared with each other. Results The mean area was 1013.33 mm2 in the T group, 930.44 mm2 in the V group, 1024.44 mm2 in the S group, and 1073.8 mm2 in the D group. The shrinking areas were found as 186.67 mm2, 269.55 mm2, 177.55 mm2, and 126.2 mm2, respectively. The shrinking rates were statistically significant in each group. The lowest shrinking rate was found in group D and highest in group V, but the results were statistically insignificant. In terms of macroscopic adhesion, histopathologic inflammation, and fibrosis no statistically significant differences were found among all the groups in comparison with each other. Conclusions Although the shrinking rate of DynaMesh is lowest among all the groups, the results are statistically insignificant. The results of our experimental study revealed no superiority in the means of mesh shrinkage among TiMesh, Vypro II, Sepramesh, and DynaMesh in the rats.

Unusual locations of hydatid disease: diagnostic and surgical management of a case series.

BACKGROUND Hydatid disease is endemic in many areas of the world, where it is an important public health problem. The aim of this study was to describe a series of patients with atypically located primary hydatid disease, accompanied by a literature review. METHODS Six male and four female patients with atypically located hydatid cysts who presented to the Kars State Hospital between September 2004 and March 2008 were evaluated. The mean age was 42.5 years (range 17-72 years). Hydatid cysts were identified by using a combination of serology tests, ultrasonography, and computed tomography (CT). RESULTS Six of the patients underwent surgical treatment. Three patients (two with pericardial hydatid involvement and one with pancreatic involvement) were sent to a tertiary medical center for surgery, and one patient died from cardiac and renal failure two days after diagnosis. CONCLUSIONS Although this disease is seen most often in the liver and lungs, it can be found in any part of the body. Hydatid disease must be considered in the differential diagnosis of cystic lesions, especially in patients who have spent time in endemic areas.

Isolated duodenal rupture due to blunt abdominal trauma

Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.