Ender Onur

Intestinal obstruction due to spontaneous intramural hematoma of the small intestine during warfarin use: a report of two cases.

Warfarin-dependent spontaneous intramural hematoma of the small intestine is a rare complication. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. In some cases, concomitant gastrointestinal bleeding might be seen. Ultrasonography and computed tomography are the most useful radiographic methods for the diagnosis of an intramural hematoma of the intestines. Although it is usually treated conservatively, surgical intervention is required in cases involving active bleeding, intestinal obstruction, or acute abdominal symptoms. Here we present two patients who were treated surgically. Both patients had intestinal obstruction and ischemia, and one had concomitant gastrointestinal bleeding and intussusception due to an intramural hematoma.

The value of preoperative diagnostic tests in acute appendicitis, retrospective analysis of 196 patients.

BackgroundIn this study our aim was to evaluate the diagnostic value of preoperative laboratory and radiological studies for appendicitis.MethodsThe clinical data of 196 patients who have undergone conventional appendectomy between March 2007 and April 2008 were collected retrospectively. Patients were examined for age, sex, white blood cell count, ultrasonography results, histopathological diagnosis and hospital stay.ResultsNegative appendectomy rate was 17.3% (27% for female, 11.5% for male). White blood cell counts were found to be high in 83% for acute appendicitis group and %61 for negative appendectomy group. There were 66 (34%) patients who had negative USG findings for acute appendicitis. Of these patients, histopathological examination revealed acute appendicitis in 46 patients whereas 20 patients had normal appendix. Hospital stays were 2.79 +/- 1.9 and 2.66 +/- 1.7 days for negative and positive appendicectomies respectively.ConclusionsBesides the improvement of diagnostic tests for acute appendicitis, we could not sufficiently reduce the negative appendectomy rate.

Direct trocar insertion technique for initial access in morbid obesity surgery: technique and results.

Purpose Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese patients. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. This study assesses the safety and feasibility of the direct trocar insertion technique without pre-existing pneumoperitoneum in patients undergoing laparoscopic bariatric surgery. Methods From February 2006 to July 2009, 155 morbidly obese patients underwent laparoscopic adjustable gastric band surgery. There were 128 women (82.6%) and 27 men (17.4%). The mean age was 41 and ranged between 18 and 59 years. Results All patients met the National Institutes of Health criteria for bariatric surgery. The mean body mass index was 45 kg/m2 (range 35 to 61). There was no evidence of intestinal or vascular injury during trocar placement. Immediate minor complications were extraperitoneal insufflations in 5 patients, gastric serosal laceration in 1 patient, and left liver lobe laceration in 1 patient. No major complications were associated with this technique. Conclusions All complications related to the direct trocar insertion technique were minor and these complications did not affect the success of surgery. We concluded that the direct trocar technique for initial access in laparoscopic bariatric surgery provides safe and quick entry into the peritoneal cavity.

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.

Ethyl Pyruvate Improves Healing of Colonic Anastomosis in a Rat Model of Peritonitis

Background. This study was designed to evaluate the effects of ethyl pyruvate (EP) on wound healing in primary colonic anastomoses in intraperitoneal sepsis. Methods. Standard left colon resection and end-to-end anastomosis were performed on 30 rats. They were grouped as control (C)—no further treatment; sepsis (S)—received 2 mL Escherichia coli (ATCC 25922) intraperitoneally (IP), and after 5 hours, standard resection and anastomosis were performed; or sepsis-group treated with EP (S-EP)—received 2 mL E coli IP, after 5 hours, standard resection and anastomosis were performed and treated with EP 50 mg/kg IP for 7 days. On the postoperative day 7, the animals were sacrificed. Results. The anastomosis bursting pressure in group S was significantly lower than in the other groups. There were no differences between groups C and S-EP. Tissue hydroxyproline concentrations in group C were significantly higher than in group S. Conclusions. EP administration prevented intraperitoneal sepsis-induced impaired anastomotic healing of colon.

Therapy of solitary cecal diverticulitis in a young patient with laparoscopic right hemicolectomy.

Cecal diverticulum of colon is a relatively rare and benign condition in the western world. The reported frequency is approximately 1 in 300 appendectomies. They are usually asymptomatic but it may cause inflammatory, hemorrhagic, or perforatory complications. It is often clinically indistinguishable from acute appendicitis. The diagnosis is almost made intraoperatively. We present a 21-year-old female patient who admitted to our emergency unit with right lower quadrant abdominal pain. Diagnostic laparoscopy was performed due to suspicious acute appendicitis. During exploration, an inflammatory mass originated from cecum was noticed. Laparoscopic right hemicolectomy was performed due to suspicious malignant mass. The postoperative course was uneventful. Although radiologic techniques are improved; the diagnosis of solitary cecal diverticulum is difficult. The choice of surgical therapy is controversial. The therapy is ranged from a simple diverticulectomy to right hemicolectomy. Diagnostic laparoscopy can help the surgeon in the diagnosis of right lower quadrant pain and therapy of solitary cecal diverticulitis.

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.

Endoscopic stenting for laparoscopic sleeve gastrectomy leaks

OBJECTIVE Laparoscopic sleeve gastrectomy is a widely accepted and effective bariatric surgery method. The rate of leakage at the staple-line has been reported to be between 1.5 and 5%. Aside from the use of percutaneous drainage, re-laparoscopy, or abdominal sepsis control by laparotomy, endoscopic esophagogastric stent placement is increasingly preferred as a treatment method. Because laparoscopic sleeve gastrectomy is a widely used modality in our hospital, we aimed to evaluate the rate of leaks and the results of stent placements in our patients. MATERIAL AND METHODS Between January 1st 2010 and August 31st 2014, laparoscopic sleeve gastrectomy was performed on 236 patients by three surgeons. The demographic information and postoperative discharge summaries were collected and analyzed with the permission of the hospital ethics committee. Information about leak treatment management was also collected. RESULTS Leaks after laparoscopic sleeve gastrectomy in four patients were stented in the first postoperative month. Short (12 cm) Hanora® (M.I.Tech, Gyeonggi-do, Korea) self-expandable coated stents were placed in two patients, and long (24 cm) Hanora® self-expandable coated stents were placed in the other two. The stents were removed after one month in two patients, two and a half months later in one, and five months later in another patient. The leaks were demonstrated to be healed in all patients after stent removal. Endoscopic stent revision was performed in one patient due to migration of the stent and in another for stent breakage. CONCLUSION The success rate of treatment of leaks after laparoscopic sleeve gastrectomy by stent placement has been variable in the literature. The success in early stent placement has been shown to be related to physician expertise. According to the results of our patients, we suggest that endoscopic stent placement in the early stage after controlling sepsis is an effective method in the management of leaks.

Single-incision laparoscopic cholecystectomy: a new retraction technique.

Abstract Background : Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot’s triangle. Surgical technique : Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS® port was placed through an open approach. We inserted a 10-mm 30o camera through the SILS® port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose® needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose® needle. This device provided retraction of the gallbladder in every direction. Conclusions : Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.