Fehmi Çelebi

Late Complications of Incisional Hernias Following Prosthetic Mesh Repair

Abstract Background: Incisional hernias still continue to be a serious problem for surgeons. In this study, we aimed to investigate the effects of polypropylene mesh and mersilene mesh, which are frequently employed in incisional hernias, as well as the effects of their application techniques on late complications. Methods: Two-hundred-sixty-four open abdominal hernia repairs were performed between 1986–2000, using prosthetic materials: polypropylene mesh and mersilene mesh were used in hernia repair. Mesh was placed as onlay, underlay and sandwich techniques. Follow-up data were obtained from medical records. Results: Comparisons were made with respect to surgical techniques and to late complications such as recurrence, ente-rocutaneous fistula, intestinal obstruction, and infections. Enterocutaneous fistulas developed in two patients. Recurrence occurred in 6.4 per cent. Chronic infection and wound sinus formation occurred in 5 per cent. The causes of recurrence included smoking, cellulitis, chronic infection/sinus tract, upper abdominal localization, and obstruction. Fistula formation occurred in patients with no peritoneal prevention, which was statistically significant (p=0.012). Chronic infection/sinus tract was high in patients for whom mersilene mesh was used, and enterocutaneous fistula occurred in 2 patients. Conclusion: To prevent late complications, it is necessary to avoid the contact of mesh with bowel.

Intra-Abdominal Extrahepatic Echinococcosis

Abstract Twenty-seven patients who were treated surgically because of extrahepatic abdominal hydatid disease between 1981 and 1999 were retrospectively reviewed. Nineteen patients had coexistent hepatic cysts while 8 patients had only peritoneal cysts. The cysts were located in the spleen, pancreas, adrenal gland, mesentery of the intestines, ovaries, retroperitoneum, omentum, abdominal wall, rectovesical region, and the psoas muscle. Due to organ destruction because of large cysts in 8 patients, the involved organ had to be sacrificed. The other 19 patients were treated by a pericystectomy. No postoperative mortality or severe morbidity was seen. In conclusion, symptomatic or large cysts should be surgically treated. In cases suspected of having peritoneal spillage, antihelminthic drugs should be administered. In addition, small asymptomatic cysts may also be effectively treated with antihelminthics.

Ileosigmoidal Knotting: Outcome in 63 Patients

PURPOSE:This study was designed to review the outcomes of 63 patients with ileosigmoidal knotting.METHODS:Sixty-three, surgically treated patients (47 males; 74.6 percent) were reviewed retrospectively. The mean age was 45.6 (range, 7–75) years. The most common symptoms were abdominal pain and obstipation, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was obstructive emergencies in 49 patients (77.8 percent) and nonobstructive emergencies in 14 (22.2 percent).RESULTS:All patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was Type 1A in 30 patients (47.6 percent), in which the active ileum encircled the passive sigmoid colon in a clockwise direction. Fifty patients (79.4 percent) developed gangrenous bowel. Resection of gangrenous segments and enteroenteric or enterocolic anastomosis combined with the Hartmann procedure was the most preferred operation, used in 34 patients (54 percent). The mortality rate was 15.9 percent (10 patients), and toxic shock was the most frequent cause of death.CONCLUSIONS:Ileosigmoidal knotting is a rare but serious form of intestinal obstruction. Its preoperative diagnosis is difficult and may present as an obstructive or nonobstructive emergency. Early and effective resuscitation, prompt surgical intervention selected on the basis of clinical and operative findings, and effective postoperative intensive care are the basis of treatment.

Dehydroepiandrosterone prevents oxidative injury in obstructive jaundice in rats.

We investigated the effect of dehydroepiandrosterone (DHEA) on oxidative injury in obstructive jaundice using three groups of rats: sham-operated group; common bile duct (CBD) group — the CBD was ligated; and DHEA group — DHEA administration followed CBD ligation. Liver function tests were performed using blood samples, and malondialdehyde concentration (MDA), superoxide dismutase activities (SOD), glutathione peroxidase (GPx), and total glutathione (tGSH) concentrations were measured in liver tissue. Serum alkaline phosphatase, γ-glutamyltransferase and alanine aminotransferase activity were significantly elevated in the CBD group compared with the other groups. Serum aspartate aminotransferase and total bilirubin were highest in the CBD group; the MDA concentration was higher in the CBD group than the sham group. There were no significant differences in GPx activity among the groups. SOD activity and tGSH concentration were significantly lower in the CBD group than the other groups. DHEA may protect hepatic tissue against oxidative injury in obstructive jaundice by decreasing MDA concentration and increasing SOD activity and tGSH concentration.

Intrabiliary rupture in liver hydatid cysts: results of 20 years' experience.

Abstract To assess the diagnostic tools and results of treatment of biliary rupture observed in liver cyst hydatids, clinical findings of 562 patients with hepatic hydatid disease were reviewed. Imaging techniques were not very effective to determine intrabiliary ruptures. Rates of rupture sizes determined in the patients were as follows; 22 (%24.7) large, 38 (%42.7) small, and 29 (%32.6) occult. Most frequently utilized procedures for patients with intrabiliary rupture were Roux-en-y cystojejunostomy, tube drainage + omentoplasty, sutured fistula + omentoplasty, and sutured fistula + tube drainage. Of the total 25 external biliary fistulas, 21 closed spontaneously. Of the four fistulas that did not close, one was managed by internal drainage and three by endoscopic sphincterotomy. Preoperative diagnosis of biliary rupture in liver hydatid cyst allows early planning of operation and helps the surgeon design the operative strategy. In the treatment of cases with large rupture, internal drainage may be proposed.

Comparison of iodine contents in gastric cancer and surrounding normal tissues

Abstract It has been suggested that iodine plays an important role in gastric cancer. Gastric cancer ranks first among the cancers in the north-eastern Anatolia region, Turkey, where iodine deficiency is common. In this study, iodine levels were determined in gastric cancer and surrounding normal tissues in 19 patients with gastric cancer. Tissue iodine levels were determined by the Foss method based on the Sandell-Kolt-hoff reaction. Tissue iodine levels were lower in gastric cancer tissue (17.8±3.4ngI/mg protein, mean±SEM) compared with surrounding normal tissue (41.7±8.0ngI/mg protein) (p<0.001). There was positive correlation between the iodine levels in gastric cancer tissue and surrounding normal tissue (r=0.845, p<0.001). There was no significant difference in iodine levels in cancer and surrounding normal tissue between male and female subjects. The iodine deficiency in our region may be one of the factors for increased gastric cancer prevalence. Our results support the hypothesis that iodine plays an important role in gastric cancer development.

Hydatid disease in childhood.

Abstract.To review the results of different modalities of treatment of hydatid disease of the liver (HDL) in pediatric patients, 31 children treated surgically between 1990 and 2000 at the departments of general surgery and pediatric surgery, Atatürk University School of Medicine, were reviewed retrospectively; 19 were male and 12 were female. The mean age was 8.4 years (range 4–12 years). The most common complaints were an abdominal mass and right-upper-quadrant pain, which were present in 35.5% and 77.4% of cases, respectively. Twenty-five cysts were in the right lobe, 2 in the left lobe, and 4 in both lobes; 8 patients had multiple hepatic cysts and 5 had coexisting cysts in other organs. Surgical procedures were: unroofing plus tube drainage (UTD); capitonnage; omentoplasty; and pericystectomy. Of the patients treated by UTD, 2 developed cholangitis and 1 developed a biliary fistula. Of the patients with capitonnage, 1 developed cholangitis. Surgery is still one of treatment modalities for management of HDL. Omentoplasty and capitonnage are the most effective modalities for the management of the cyst cavity.

Hydatid disease of the liver in children: Evaluation of surgical treatment

The medical records of 55 paediatric patients with hepatic hydatidosis, who were treated between 1990 and 2001 at Atatürk University, Turkey, were reviewed retrospectively. The most common symptoms at presentation were abdominal mass (32.7% of cases) and pain (81.8% of cases) in the right upper quadrant of the abdomen. Cysts were found in the right lobe in 41 patients, in the left lobe in four patients and in both lobes in 10 patients. Multiple hepatic cysts were present in 12 cases and eight patients also had cysts in other organs. Surgical procedures were evacuation of the cyst and management of the cavity with tube drainage, capitonnage, omentoplasty, cystectomy or segmentectomy. Long-lasting biliary fistula (two patients) and cholangitis (two patients) developed following evacuation and tube drainage, and one patient developed cholangitis after capitonnage. This review suggests that omentoplasty and capitonnage are more effective than tube drainage in the management of the cyst cavity.

Posttraumatic gallbladder torsion in a child

Torsion of the gallbladder in an 8-year-old boy, which was precipitated by blunt abdominal trauma from a ball-strike during a soccer game, is reported. Of the 13 reported childhood cases of gallbladder torsion, this is the first to be precipitated by blunt abdominal trauma in the presence of congenital anatomic predilection.

Gastric perforation caused by Strongyloides stercoralis: a case report

Strongyloidiasis is a parasitosis caused by the female nematode of the Strongyloides stercoralis. S. stercoralis causes a chronic infection that is asymptomatic in 50% of chronically infected patients, and it can also affect the stomach. Gastric involvement causes symptoms mostly mimicking gastritis. We report herein a case of gastric perforation in a 37-year-old woman, which was thought to be caused by S. stercoralis.