Ertugrul Kargi

Antiadhesive and anti-inflammatory effects of pirfenidone in postoperative intra-abdominal adhesion in an experimental rat model

BACKGROUND Pirfenidone (PF) is a potent antifibrotic and anti-inflammatory agent. We investigated the protective effect of PF against postoperative intra-abdominal adhesions. MATERIAL AND METHODS Thirty male Sprague-Dawley rats were divided into three groups (n = 10 in each group). In group 1 (control), adhesion induction was performed by cecal abrasion, and no treatment was administered. In group 2 (vehicle), for 2 wk after adhesion induction, 0.4%-carboxymethylcellulose was administered by gavage. In group 3 (PF treatment), for 2 wk after adhesion induction, 500-mg/kg/d PF was administered by gavage. On the 15th postoperative day, the animals were killed, and cecal and peritoneal tissues were excised. The adhesions were graded macroscopically. The protein concentrations and mRNA expression levels of the following genes were measured in the tissues: matrix metallopeptidase-9 (MMP-9); tissue inhibitor of metalloproteinase-1 (TIMP-1); tumor necrosis factor-alpha (TNF-α); and transforming growth factor-beta 1 (TGF-β1). The tissue samples were also evaluated histopathologically. RESULTS Macroscopic and histopathologic evaluation showed that PF-reduced adhesion and inflammation (P < 0.001, P = 0.004, respectively). Pretreatment with PF-reduced TIMP-1, TNF-α, and TGF-β1 protein concentrations (P < 0.001, P < 0.001, and P < 0.001, respectively) and mRNA expression levels (P = 0.030, P = 0.005, and P = 0.016, respectively) and increased MMP-9 protein concentrations (P < 0.001) and mRNA expression (P = 0.021). CONCLUSIONS The findings of this study suggest that PF can be used as a protective agent to prevent the development of peritoneal adhesions and inflammation during the postoperative period.

Ambulatory laparoscopic cholecystectomy: A single center experience

Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC) in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction) was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92%) patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7%) cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7%) cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively). Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018). Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

Patients Recovering From Abdominal Surgery Who Walked With Volunteers Exhibited Improved Postoperative Recovery Profiles During Hospitalization

Background Early walking as part of a perioperative care program benefits patients who have had surgery. However, the impact of early walking by itself on the mental and physical recovery of postoperative patients has not been examined.

Impact of diabetic foot on selected psychological or social characteristics.

With great interest, we read the recent paper [1] “Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus?”. The authors aimed to compare selected psychological and social characteristics between diabetic patients with and without the diabetic foot (DF). They have concluded that patients with DF had a predominantly worse standard of living and patients with DF appeared to have good stress tolerability and mental health and did not reveal severe forms of depression or any associated consequences.

Laparoscopic Nissen Fundoplication: Analysis of 162 Patients

METHODS One hundred and sixty-two patients with GERD were treated surgically with LNF from October 2006 to March 2010. Diagnoses were made by using upper gastrointestinal system (GIS) endoscopy and 24-hour pH monitoring, and all the patients underwent routine LNF surgery. The patients were questioned regarding complaints and proton pump inhibitor (PPI) usage during the postoperative period, and forty patients who had postoperative GIS symptoms were included. Upper GIS endoscopy with antral biopsy for Helicobacter pylori (HP) identification and multichannel intraluminal impedance pH(MII-pH) monitoring were applied Results:The median postoperative follow-up time was 1.84 ± 0.850 (0.29-3.48) years. PPI treatment frequency was 37.5% (15 patients) in the 40 symptomatic 40 patients, or 9.26% in all 162 patients who were operated on. The reason for PPI usage in three patients (7.5%) was regarded as recurrence. HP positivity was 67.5% in the symptomatic patients and 73.3% in the PPI treated group; 40% (six patients) recovery was achieved in the HP (+) patients by using an HP eradication treatment protocol. The operated patients displayed statistically significant results in increased quality of life (p = 0.001) and lowered DeMeester scores (p = 0.000) during the postoperative period when compared to preoperative period. CONCLUSION PPI treatment alone during the postoperative period does not indicate recurrence. One of the most important reasons for recurrence is antral gastritis secondary to HP infection; PPI usage diminishes remarkably with an HP eradication protocol. MII-pH monitoring is an effective method of determining recurrences due to reflux and their types in postoperative symptomatic patients.

DOES NEUTROPHIL TO LYMPHOCYTE RATIO PREDICT HOSPITAL STAY IN APPENDECTOMY PATIENTS

BACKGROUND We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and postoperative length of hospital stay. In addition, the impact of radiological and histopathological findings on hospital stay was also evaluated. METHOD This is a retrospective study. One hundred three patients with appendicitis were in-cluded. The diagnosis was confirmed by computed tomography (CT), ultrasonography and histopathological examination. Correlations between the length of hospital stay and age, gender, NLR, c-reactive peptide levels (CRP), the appendix diameter on CT or ultrasonogra-phy, appendix localisation and pathology reports were evaluated. RESULTS The length of hospital stay was not related to age or gender. The length of hospital stay after appendectomy was correlated with appendix diameter on CT and phlegmonous appendicitis, but it was not associated with NLR, CRP levels or the appendix diameter on ultrasonography. CONCLUSION To our knowledge, this is the first comprehensive study to evaluate the associa-tion between NLR levels and the length of hospital stay in patients with acute appendicitis. The NLR was not found to be associated with the length of hospital stay. The appendix di-ameter on CT and appendix pathology reports were correlated with the length of postopera-tive hospital stay in appendectomy patients.

Vitamin B12 and vitamin B12 supplementation effects on cognitive functions after bariatric surgery.

1. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014;207: 1–6. 2. Sørensen LT, Hemmingsen UB, Kirkeby LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg 2005;140:119–23. 3. Sørensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 2003;238:1–5. 4. Owens M, Barry M, Janjua AZ, et al. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011;9:218–24. 5. Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS 2010;14:490–7. 6. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2011;15:113–21.

Is Same-Day Inguinal Hernia Surgery Possible?

1-INTRODUCTION: The Lichtenstein hernia repair is associated with low recurrence rates and short operation times, and can be performed under local anaesthesia. Thus, this is among the most-preferred methods used in recent years. Our objective was to explore the same-day discharge rates, and the causes of delayed discharge and re-admission to hospital, of patients treated using the Lichtenstein repair method, to evaluate the feasibility of performing same-day hernia surgery in clinical practice. 2. MATERIALS AND METHODS . One hundredof a total of 236 patients diagnosed with unilateral inguinal or femoral hernias, who required surgical treatment, and who agreed with the conditions of the study, were prospectively included. All patients were treated using the Lichtenstein mesh repair method, under local anaesthesia between June 2006 and January 2008. We investigated the types and locations of hernias, duration of surgery, seniority of the surgeon, the feasibility of same-day surgery in subgroups stratified by ASA risk scores, and postoperative complication rates, in patients who underwent inguinal surgery under local anaesthesia 3. RESULTS , DISCUSSION AND CONCLUSIONS:. The rates of pain and post-operative complications were very low in hernia patients who underwent same-day surgery under local anaesthesia. The operation reduces the length of hospital stay and helps patients mobilise earlier. Both the literature, and our data, indicate that inguinal hernia repair under local anaesthesia is safe and effective, reducing anaesthesia-related complications and the length of hospital stay; is cost-effective; and is applicable in all patients.

Pankreatikoduodenektomi Operasyonu Sonuçları: 71 Olguluk Tek Merkez Deneyimi

Aim: To retrospectively evaluate the results our pancreaticoduodenectomy surgeries in terms of morbidity and mortality rates as well as safety. Materials and methods: Medical records of 71 patients, who underwent pancreaticoduodenectomy surgery between January 2007 and September 2012 at Department of General Surgery, Kocaeli University School of Medicine, were examined retrospectively. Age, sex, the type and localization of the lesion, surgical properties and postoperative complications were studied. Results: A total of 71 patients (48 male, 23 female) with a mean age of 59.9 years who underwent pancreaticoduodenectomy were included in the study. Forty two patients (59%) had pancreatic head malignancies, 19 patients (27%) had ampulla malignancies, 4 patients (5.5%) had duodenum malignancies and 4 patients (5.5%) had common bile duct malignancies. Two of our cases (3%) underwent surgery for pancreatitis. Surgery related mortality rate was 2.8% (2 cases). The most frequently encountered complications were delay in gastric emptying (19%), pancreatic fistula (14%) and wound infection (10%). Postoperative morbidity rate was detected to be 28%. Conclusion: Pancreatic and other periampullary tumors are serious clinical problems that cause morbidity. Traditionally, these patients have a dark prognosis but correct staging and appropriate patient selection allow better results. Surgical resection, the one reason for long-term survival, should be preferred whenever possible. In conclusion, we have found out that pancreaticoduodenectomy surgery is an effective and safe surgical method in the treatment of pancreas and common bile duct problems. This surgical procedure can be performed with low morbidity and mortality rates in experienced but low-density centers. Key Words: Pancreaticoduodenectomy; Pancreas tumors; Periampullar region tumors; Mortality; Morbidity.

Diyabetes mellitüs ve periferik organ tutulumu: Güncel tedavi seçenekleri

Diabetes mellitus is a chronic and multi-systemic disease with various treatment options and has long-term effect on lifestyle of individuals and society. Not only disesase itself but also damage to peripherical organs as a result of disease in long term is an important cause of morbidity and mortality. In this review study it has been aimed to assess complications caused by peripherical organ involvment and treatment options rather than those caused by diabetes mellitus itself. J Clin Exp Invest 2014; 5 (2): 329-335