Guldeniz Karadeniz Cakmak

Superiority of Asymmetric Modified Limberg Flap for Surgical Treatment of Pilonidal Disease

PurposeCases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period.MethodsIn this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6–44) months after wide excision plus classic Limberg flap (Group 1, n = 35) and after asymmetric modified Limberg flap closure (Group 2, n = 33).ResultsThere were significantly more macerations in Group 1 (P < 0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P = 0.028). We noted that as a result of these complications, time to suture removal (P = 0.001), discharge from hospital (P = 0.001), and time off from work (P = 0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P = 0.493).ConclusionsThe deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.

A Randomized Prospective Study of Complications Between General Surgery Residents and Attending Surgeons in Near-Total Thyroidectomies

PurposeRecurrent laryngeal nerve palsy and hypoparathyroidism are the most common and serious complications after thyroid operations. Surgeon experience has been defined as a significant factor in the number of complications occurring in thyroid surgery. There has so far been no prospective randomized study that compares the complication rates between residents and the attending surgeon in statistically similar patient groups in which all of the patients undergo the same type of thyroid surgery by the same surgical team. In this prospective study the performances of residents and attending surgeons were evaluated and compared according to the complication rates in near-total thyroidectomies.MethodsOne hundred and fifty-two patients underwent near-total thyroidectomies between April 2001 and May 2003. The number of randomly selected patients operated on by residents at the level of postgraduate year two, under the direct supervision of an attending surgeon, and the number of patients operated on by attending surgeons were 78 and 74, respectively. All patients had preoperative and postoperative videolaryngostroboscopic examinations of the vocal cords and serum calcium level evaluation.ResultsThe rates of temporary vocal cord paralysis with respect to the nerves at risk for residents and attending surgeons were 3.7% and 2.7%, respectively. The temporary hypoparathyroidism rate was 8.1% for attending surgeons, whereas it was found to be 6.4% for residents. Neither any cases of permanent vocal cord paralysis nor permanent hypoparathyroidism were detected.ConclusionOur results indicate that the complication rates in near-total thyroidectomies performed by residents and attending surgeons are similar. Thyroid surgery can therefore be safely and effectively performed by residents under close supervision.

Evaluation of a New Hemostatic Agent Ankaferd Blood Stopper in Experimental Liver Laceration

Introduction: Hemorrhage is a leading cause of death after trauma. It is also the major cause of operating room deaths among patients who undergo liver surgery. Various techniques and materials have been attempted to manage bleeding, but a standard method has not been defined yet. We studied the hemostatic effects of Ankaferd Blood Stopper on liver injury in comparison with regenerated oxidized cellulose. Materials and Methods: Thirty Wistar albino rats underwent partial hepatic laceration by scissors. The animals were randomized to the treatment of resected surface with either Ankaferd Blood Stopper® (ABS, n = 11) or regenerated oxidized cellulose (Surgicel®, n = 9), or were left untreated (controls, n = 10). All the animals were resuscitated with lactated Ringers solution at 3.3 ml/min/kg to a mean arterial pressure (MAP) of 100 mmHg. Survival time, total blood loss, resuscitation volume, and MAP were recorded for 30 min or until death. The rats that were alive at the end of 30 min were sacrificed with blood withdrawal from catheters. Results: Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (p =.0001). There were no significant differences between the ABS and the Surgicel groups in survival (p =.91). Application of ABS and Surgicel was associated with a significant reduction in blood loss compared to controls (p =.008), with no significant differences between active treatment groups (p =.74). The resuscitation volume was not different. Conclusions: ABS is as effective as Surgicel in achieving hemostasis following partial liver excision in an experimental rat model.

Complications of total thyroidectomy performed by surgical residents versus specialist surgeons

PurposeSurgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups.MethodsBetween April 2001 and May 2007, 144 patients underwent TT at our hospital. For 75 operations, the primary surgeon was a resident under the direct supervision of the attending surgeon, and for 69 operations, the primary surgeon was the experienced attending surgeon. Pre-and postoperative vocal cord examinations and serum calcium level evaluations were carried out in all patients.ResultsThe rates of temporary (unilateral) recurrent laryngeal nerve (RLN) palsy were 2.66% vs 2.17% after TT performed by the residents vs the attending surgeon, respectively. There were no significant differences in the incidences of temporary hypoparathyroidism (20% vs 20.28%), permanent (unilateral) RLN palsy, hematoma, infection, seroma, and incidental parathyroidectomy between the two groups.ConclusionThe complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance.

Fade or fate. Seroma in laparoscopic inguinal hernia repair.

BackgroundPostoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery.MethodsThirty patients with unilateral inguinal hernia who had a hernia sac of >4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month.ResultsUSG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups.ConclusionsSuperficial USG is a beneficial tool in differentiating early recurrence or seroma in patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma.

Does sildenafil reverse the adverse effects of ischemia on ischemic colon anastomosis: yes, 'no'.

INTRODUCTION Sildenafil may lead an improvement in anastomotic healing of ischemic left colon anastomosis. METHODS Thirty-six male Wistar albino rats were randomized into four experimental groups (n=9 in each group). In group 1, a well-perfused left colonic segment was transected, and free ends were anatomosed. In groups 2, 3 and 4 animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. Group 2 animals received only tap water. In groups 3 and 4 animals received 10mg/kg/body-weight and 20mg/kg/body-weight sildenafil, single dose a day during 4 days, respectively. Rats were sacrificed on day 4 following operation. Anastomotic integrity, intra-peritoneal adhesion scores, anastomotic bursting pressures and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. RESULTS There was no statistically significant difference among groups with respect to anastomotic integrity (p=0.142) but ischemia decreased the anastomotic bursting pressure. The mean bursting pressure values were 78.8+/-24.1, 43.3+/-26, 55.1+/-32.4, and 43.3+/-20.4 in groups 1, 2, 3, and 4, respectively. Group 1 had the highest values whereas; there was no statistically significant difference between groups 1 and 3. There was no statistically significant difference among groups 2, 3, and 4 with respect to tissue hydroxyproline levels, adhesion scores and the Chiu scores. The highest inflammatory cell presence in the granulation tissue was detected in group 2, whereas the lowest was detected in group 4 (p=0.0001). The highest fibroblast infiltration in the granulation tissue was detected in group 1 (p=0.045). DISCUSSION Our results showed that 10mg/kg sildenafil decreased the adverse effects of ischemia on the healing of ischemic left colon anastomosis. Additional investigations are needed to confirm the effects of phosphodiesterase-5 inhibitors in ischemic colon anastomosis models.

Comparison Between Powdered Gloves, Powder-free Gloves and Hyaluronate/Carboxymethylcellulose Membrane on Adhesion Formation in a Rat Caecal Serosal Abrasion Model

OBJECTIVE Intraabdominal adhesion formation and prevention is one of the major conflicts of modern surgery. We aimed to determine the effects of powdered gloves versus powder-free gloves and hyaluronate/carboxymethylcellulose membrane (H/CMCm) in a rat caecal serosal abrasion model. METHODS Sixty wistar albino rats were subjected to a standardized lesion by caecal abrasion model. In group 1, the procedure was performed with sterile powdered gloves. In group 2, the procedure was performed with powder-free sterile gloves. The H/CMCm was applied directly to the abraded caecum in group 3. Formation of adhesions were determined on one half of the animals from each group on the 7th postoperative day, and on the other half on the 15th postoperative day. RESULTS There was a statistically significant difference between the adhesion scores on day 7 and 15 in groups 1 and 2 (p = 0.005, p = 0.007). There was no significant difference in adhesion scores on day 7 and 15 in group 3 (p = 0.145). The mean adhesion score was significantly higher in group 1 (powdered glove group) than group 2 (powder-free glove group) and group 3 (powder-free glove plus H/CMCm) on postoperative day 7 (p = 0.001). However, no significant difference was found between groups regarding adhesion scores on postoperative day 15 (p = 0.607). The comparisons of group 2 versus group 3, both on postoperative day 7 (p = 0.051) was not statistically significant, whereas a significant difference was detected between group 1 versus group 2 and group 3 on postoperative day 7 (p = 0.013, p = 0.001). CONCLUSION Our experiment shows that the use of powder-free gloves may be as beneficial as Seprafilm in preventing postoperative adhesion formation.

Diagnostic adequacy of surgeon‐performed ultrasound‐guided fine needle aspiration biopsy of thyroid nodules

Surgeon‐performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention.

N-acetyl-cysteine improves anastomotic wound healing after radiotherapy in rats.

ABSTRACT Aim: This study was designed to determine the effects of intraperitoneally or orally administered N-acetylcysteine (NAC) on anastomotic healing of irradiated rats. Methods: Thirty-two male Wistar albino rats were randomized into four groups containing 8 rats each: I; standard resection plus anastomosis, II; radiation plus standard resection plus anastomosis, III; radiation plus standard resection plus anastomosis plus oral NAC, IV; radiation plus standard resection plus anastomosis plus intraperitoneal NAC. Four types of assessment were performed: bursting pressure, hydroxiproline (OHP) content, histopathology, and biochemical evaluation, including serum malondialdehyde (MDA), advanced oxidation protein products (AOPP), reduced glutathione (GSH) and superoxide dismutase (SOD) activities. Results: Group comparisons demonstrated that bursting pressure was significantly higher in NAC treated rats. The mean tissue OHP concentration in the anastomotic tissue was significantly lower in irradiated rats (group II) than in the other groups. NAC treatment caused increased activity of SOD and GSH. In contrast, MDA levels were found to be decreased in groups III and IV. Histopathological analysis revealed that NAC administration, either orally or intraperitoneally, leads to a better anastomotic healing in terms of reepithelialization, perianastomotic fibrosis, ischemic necrosis, and muscle layer destruction. Conclusion: The present study supports the hypothesis that NAC administration alleviates the negative effects of radiotherapy on anastomotic healing. Nevertheless, the underlying mechanisms responsible for this protective effect is unknown today.

Effect of erythropoietin on liver regeneration in an experimental model of partial hepatectomy

BACKGROUND AND AIM The liver shows remarkable regeneration ability after damage or resection. The main stimulant for hepatic regeneration is resection. Erythropoietin (EPO), which was initially used for anemia therapy, is today known as a general tissue protector owing to its anti-inflammatory, anti-oxidant, anti-apoptotic, and angiogenic properties. This study aims to investigate the effect of systemically administered EPO on liver regeneration after partial hepatectomy. METHODS Forty-eight male Wistar albino rats were randomly split in two groups A and B consisting of 24 rats each. Standard 70% hepatectomy was performed on the rats in group A. The same surgical procedure was performed on the rats in group B, and they were additionally administered 3000 U/kg/subcutaneous EPO. The rats were sacrificed 24, 48, and 72 h after resection. The groups were compared in terms of biochemical, morphological, and histopathological parameters. RESULTS The biochemical results showed that the administration of EPO decreased aspartate aminotransferase levels significantly (p < 0.05) at 24 h after hepatectomy. A comparison of the groups in terms of relative liver weight showed that EPO-treated groups exhibited a statistically significant increase (p < 0.05) for all three time periods. Histopathology results showed that in the EPO-treated groups, the mitosis index at 48 and 72 h, double nuclei cell number at 72 h, and proliferating cell nuclear antigen ratio at 48 h showed a significant increase (p < 0.05). CONCLUSION Our study showed that systemically administering high-dose EPO increases regeneration by affecting the biochemical, morphological, and histopathological parameters after liver resection.