Gökhan Selçuk Özbalcı

The Whitehead operation procedure: Is it a useful technique?

OBJECTIVE Hemorrhoidal disease is a very common entity in the general population; however, the therapeutic approaches to hemorrhoids remain controversial. The choice of treatment method depends on the grade of the hemorrhoid as well as the experience of the surgeon. The Whitehead hemorrhoidectomy procedure is often applied for grade IV hemorrhoids. MATERIAL AND METHODS We studied 49 patients who underwent surgery between December 1982 and January 2013. The indications for the Whitehead procedure in all patients were grade IV hemorrhoidal disease. The data on these patients were evaluated retrospectively with respect to age, gender, preoperative diagnosis, and postoperative complications. RESULTS Of the patients included in this study, 34 were male and 15 were female. The mean age of the patients was 41.93±12.42, and the age range was 24-70 years. Complications of the Whitehead procedure included bleeding (6.12%, three cases), stricture (2.04%, one case), urinary retention (16.33%, eight cases), and temporary anal incontinence (2.04%, one case). No patients developed Whitehead deformities, entropion, or infectious complications. All patients were discharged from hospital between the fifth and eighth days post-surgery (6.45±1.00 days). The follow-up period was 1-234 months (70.02±54.89). CONCLUSION The Whitehead procedure is successful in patients with prevalent peripheral prolapse and/or thrombosed hemorrhoids. With the right indications, and if the surgeon has adequate experience, the morbidity rate of the Whitehead procedure is similar to that of other treatment methods.

EuroSurg: Cerrahide, öğrenci odaklı Avrupa çapında yürütülen alışılmışın dışında yeni bir çalışma grubu

Dear Editor, In 2013, a student-oriented working group called STARSurg (The Student Audit and Research in Surgery) directed to medical students and surgical residents was founded in the UK. STARSurg is a group offering students the opportunity to participate in high-quality studies and encouraging them to be clinicians engaged in active research in the future (1). The first study of STARSurg was joined by more than 250 students from 109 hospitals. This study was related to the post-operative impacts of nonsteroidal anti-inflammatory drugs in patients undergoing major gastrointestinal tract surgery, and was performed prospectively on 1500 patients. All participants were co-authors in the publication on completion of the study (2). STARSurg have been established in all schools in England and Ireland, and now includes more than 180 hospitals. All manuscripts of STARSurg projects can be accessed through PubMed and can be used as references. Everyone involved in studies is included in these publications. In some countries, students do not have the opportunity to participate in surgical research. It is expected that students would benefit from such type of working groups by actively participating in projects in collaboration with students from various countries, and that their research related abilities would improve. Students were invited to the ESCP (European Society of Coloproctology) Congress in Dublin in September 2015, to hold a meeting aiming to develop an international research network. The student-oriented research model developed by STARSurg was discussed, and it was decided to conduct a cohort study focused on international students at the beginning of 2016. The students, guided by experienced surgeons in this debate, chose to investigate the relationship between obesity and complications following major gastrointestinal surgery. This study was based on the Determining Surgical Complications in the Overweight (DISCOVER) study that was successfully held in the UK and Ireland by STARSurg (3). During this session in Dublin, students decided to work in partnership and to establish a working group they called EuroSurg. This group has active members in Ireland, Italy, Spain, Turkey, Netherlands and United Kingdom, and these countries also have a national management committee of their own. Students from each participating country focused on publishing their results in the ESCP Congress in 2016, while developing the international cohort study protocol. This initiative is supported by STARsurg, ESCP, Societa Italiana di Chirurgie Colo-Rettal and many experienced surgeons. The letters sent by EuroSurg working group was published online in the Colorectal Disease (4). This article stated that EuroSurg is conducted by students and residents, that it is supported by ESCP, as well as listing the countries participating in EuroSurg. In Turkey, most medical students and surgical residents are not involved in formal research education and their participation to studies is limited. An official network supporting, controlling, and improving residents and students’ research skills should be established. More than 120 students from 20 Medical Faculty from Turkey has been included in this study. STARSurg decided to benefit from social media to be in constant contact with participants (5). EuroSurg was able to recruit many participants from more than 60 universities in Europe by using this method since December 2015. We invite all interested students, residents and surgeons to register to our website to take part in the unique opportunity of the Eurosurg working group (www.eurosurg.org) (6).

Laparoscopic Extraction of a Gastric Phytobezoar: A Different Approach

To the Editor, There are many therapeutic modalities for managing gastric bezoars. These include nasogastric lavage or suction, enzymatic therapy, the use of prokinetic agents and gastroscopic fragmentation and extraction (1–3). If these non-operative treatments fail, a surgical approach is needed and removal of the bezoar has classically been performed by gastrotomy. To our knowledge there are few articles about the laparoscopic treatment of gastric bezoars (1–5). A 54-year-old-female was admitted with severe abdominal pain, loss of appetite and with having had feelings of ‘a moving object’ in the stomach for a year. Gastroscopy demonstrated a hard phytobezoar of approximately 7 × 5 cm in size with-in the stomach that could not be fragmented using endoscopic techniques. Therefore laparoscopic removal was considered. First, the gastrocolic ligament was cut approximately 6–7 cm along the stomach (Figure 1). Then the bezoar was removed via a gastrotomy from the greater curvature using the three-trocar technique (Figure 1). It was successfully retrieved from the abdominal cavity after having been fragmented within an endobag (Figure 2). After the extraction, the gastric incision site was closed using two staplers (Tri-Staple 60, Covidien). Finally, the gastrocolic ligament was closed using continuous sutures, and a drainage tube was inserted near the gastrotomy site. The pathologic diagnosis was gastric phytobezoar. All the patient’s complaints were gone and the wound healed 2 weeks after the operation. FIG. 1. Gastrotomy line in the greater curvature (straight stripe), opened gastrocolic ligament (big arrow), posterior wall of the stomach (small arrow) FIG. 2. Extraction of phtyobezoar from the stomach Herein we presented a laparoscopic treatment of a gastric phytobezoar. Our approach was unique because we made a gastric incision in the greater curvature, which we think this is much more anatomically effective than previously reported techniques, such as anterior wall incisions. This approach affects the natural shape of the stomach minimally and a minimal amount of gastric tissue is extracted (Figure 3). FIG. 3. The remains of the phtyobezoar and removed minimal gastric tissue after the surgery

Laparoscopic resection of retroperitoneal bronchogenic cyst clinically presenting as adrenal cyst

Bronchogenic cyst localized in the retroperitoneum is a rare clinical entity. It is a congenital malformation generally occurring in the posterior mediastinum due to the abnormal development of the foregut. We report the case of a retroperitoneal cyst presenting as left adrenal cyst. A 38-year-old female presented with left upper abdominal pain. Endocrinological evaluation was done, and no adrenal hormonal secretion was detected. The cyst was removed laparoscopically. Pathologic examination confirmed it as a bronchogenic cyst. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cysts. Laparoscopic resection of retroperitoneal cysts results in favorable outcome.

A rare cause of acute abdomen in the ED: Chemotherapy-induced pneumatosis intestinalis

Pneumatosis intestinalis (PI) and portomesenteric venous gas (PVG) refers to the presence of air within the intestinal wall and portomesenteric vessels. Most of the time, it is associated with mesenteric ischemia that requires immediate surgical intervention as it has high mortality rate. It may also be seen secondary to various conditions, including infections, surgeries, and some chemotherapeutic drugs. A 61-year old-male was admitted to our emergency department complaining of abdominal pain after chemotherapy. Radiological evaluation of the patient demonstrated massive PVG and PI. Patient underwent urgent surgery due to the possibility of intestinal ischemia and infarction, but no necrosis was identified Chemotherapeutic drug-induced PI and PVG was the final diagnosis. Although PI and PVG are signs of mesenteric ischemia and intestinal necrosis most the of time, chemotherapeutic drugs may also cause PI and PVG rarely. Recent history of chemotheraphy and absence of any mesenteric vascular occlusion may be the diagnostic clue.

A Pancreatic Fistula after the Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is a popular surgical weight-loss procedure in the treatment of morbid obesity. There are some complications regarding this procedure in the literature. This report presents a pancreatic fistula (PF) case, which has not been previously seen.

First-line therapy in Helicobacter pylori eradication therapy: experience of a surgical clinic.

OBJECTIVE Helicobacter pylori (HP) is the worlds most common infectious agent. Despite conventional therapy consisting of proton pump inhibitor (PPI), amoxicillin (AMO) and clarithromycin (CLA), approximately half of the patients remain infected. We compared the PPI-based triple therapy with quadruple treatment (BPMT) including bismuth citrate (BS), PPI, metronidazole (MET) and tetracycline (TET). MATERIAL AND METHODS Forty-three patients who used triple therapy (LAC) consisting of lansoprazole (L), AMO and CLA and 42 patients who used quadruple therapy (BPMT) for 14 days between May 2008 and November 2013 were included in the study. The LAC group included patients who received 30 mg L 2×1, 1000 mg AMO 2×1, and 500 mg CLA 2×1 for 14 days, whereas the BPMT group was designed from patients who received 600 mg BS 2×1, 40 mg omeprazole (O) 2×1 or 30 mg L 2×1, 500 mg MET 3×1 and 500 mg TET 4×1. RESULTS Demographic characteristics and endoscopic findings were similar in both groups. The eradication rate was 53.4% in the LAC group and 78.5% in the BPMT group (p<0.05). Compliance problems and side effects were significantly higher in the BPMT group as compared to the LAC group (p<0.05). CONCLUSION Due to high antibiotic resistance in Turkey, the efficacy of LAC treatment has reduced. The BPMT protocol should be kept in mind in the first line of treatment, since it provides a higher eradication rate.

Recurrent Bilateral Breast Abscesses after Sternotomy

Median sternotomy is the most commonly used incision in cardiothoracic procedures. Development of breast abscess after sternotomy is a very rare situation. We present a case of sternal wound infection with recurrent bilateral breast abscess after sternotomy. Our case is the first and only case in the literature due to the presence of sternal wound infection with recurrent bilateral breast abscess after sternotomy.