Hakan Erpek

Hyaluronic acid/carboxymethylcellulose membrane barrier versus taurolidine for the prevention of adhesions to polypropylene mesh.

Background: A hyaluronic acid/carboxymethylcellulose (HA/CMC) membrane is an effective measure to prevent polypropylene mesh induced adhesions. We hypothesized that taurolidine 2% solution might be a cost-effective alternative to decrease adhesion formation. Materials and Methods: Twenty-four rats were randomized into three groups: mesh alone (group 1), mesh + taurolidine 2% (group 2), and mesh + HA/CMC (group 3). Polypropylene mesh (4 cm2) was used to repair surgically induced anterior abdominal wall defects. Taurolidine 2%or a HA/CMC membrane was used as an antiadhesive measure. The animals were sacrificed 6 weeks after the operation, and adhesions to the prosthetic material were evaluated with digital image analysis. Results: Group 1 (mesh alone) had the highest adhesion ratio (58.5 ± 4.8%) compared with groups 2 and 3 (p < 0.05). The differences between groups 2 (mesh + taurolidine 2%; adhesion ratio 42.9 ± 1.6%) and 3 (mesh + HA/CMC; adhesion ratio 40.3 ± 3.0%) were not significant (p > 0.05). Conclusions: The animals of both treatment groups (2 and 3) had lower adhesion ratios compared with the controls (group 1). In particular, the HA/CMC membrane did not present with a superior antiadhesive effect compared with taurolidine. Therefore, taurolidine is a cost-effective alternative to HA/CMC membranes when a polypropylene mesh is used in direct contact with the abdominal viscera.

The Right Method for Midline Laparotomy : What is the Best Choice for Wound Healing ?

Abstract Background: The techniques used for midline laparotomy affect healing in surgical wounds, but the relationship between cold scalpel and haemostatic methods (harmonic scalpel, diathermy) regarding wound healing remains unclear. There are also limited studies concerning the effects of harmonic scalpel on abdominal fascia. This study was aimed at comparing myofascial wound healing following laparotomy incision on fascia by cold scalpel (CS), harmonic scalpel (HS), and diathermy in terms of hydroxyproline content, inflammatory changes and tensile strength. Materials and methods: Twenty-seven male Wistar albino rats underwent midline laparotomy either with cold scalpel (CS), harmonic scalpel (HS) or diathermy. Fascia incisions were closed with continuous 4/0 polypropylene and skin incisions were closed with interrupted 4/0 polypropylene stitches. On the 7th postoperative day, the abdominal walls of the rats were tested for tensile strength. In addition, each abdominal fascia was evaluated for inflammation scores and hydroxyproline levels. Results: HS caused less inflammation and necrosis in abdominal fascia compared to the diathermy group (p < 0.01 and p < 0.05, respectively), whereas the CS group showed no difference in inflammation scores, but had significantly lower necrosis scores than the HS and diathermy groups (p < 0.05 and p < 0.001, respectively). Hydroxyproline content of the fascia did not differ among groups, while the tensile strength of the wound was obviously higher in the CS group (p < 0.001). Conclusion: HS causes less inflammatory reaction and necrosis than diathermy, but more necrosis than CS. Fascia incisions with CS gains tensile strength faster than in other groups. HS appears to cause less tissue injury than diathermy and also has comparable results for wound healing. Further clinical studies on the impact of HS in fascia incisions are needed.

Thrombotic thrombocytopenic purpura as the first manifestation of metastatic adenocarcinoma in a young woman

Thrombotic microangiopathy occurs in 5-10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patients refusal. Although chemotherapy including cis-platinum, infusional 5-fluorouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.

Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing

Background:  Elevated intra‐abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model.

Is synchronous bowel anastomosis safe

Abstract In this study, we investigated the effects of synchronous anastomosis on intestinal healing in experimental colonic resection. Sprague-Dawley rats were randomized into 3 groups; control (group I), single anastomosis (group II) and synchronous (double) anastomosis (group III). Single and proximal anastomoses were located 3 cm distal to caecum, and distal anastomoses were done 3 cm distal to them. On the 7th postoperative day, bursting pressure, hydroxy-proline level and histology of the anastomotic site were assessed. Bursting pressures and hydroxyproline levels indicated that impaired healing of proximal anastomoses in group III was evident. Proximal anastomoses in group III had the lowest hydroxyproline value and bursting pressure level. Significant fibrosis was observed in the histological examination of distal anastomoses in group III. Double colonic anastomoses is not as safe as single anastomoses and involves additional risk. The healing of proximal anastomosis is significantly altered after experimental synchronous resection.

Effects of Glutamine, Arginine and Beta Hydroxymethybutirate on Anastomotic Leakage in Experimental Colon Anastomosis

Amaç: Kolon anastomozu ile ilgili kaçak nedenleri konusunda devam etmekte olan araştırmalar vardır. Bu çalışmada anastomoz dayanıklılığının ameliyat öncesinde beta-hidroksi-metil bütirat (HMB) ile artıp artmayacağı denetlenmiştir. Gereç ve Yöntemler: Kırk rat 4 gruba randomize edildi. Grup A (n=10) ratları standart rat yemi ile birlikte arjinin+glutamin+HMB’den zengin diyetle 7 gün beslendikten Öz Objective: The studies on anastomotic leakage which is one of the leading serious complications of colonic anastomoses keep going as well as other surgical researches. This study was designed to investigate effects of hydroxy-ß-methyl butyrate (HMB) on anastomotic healing. Materials and Methods: Forty rats were randomized into four groups. Group A (n=10) rats received chow food plus arginine+glutamine+HMB rich diet for 7 days before right colonic transection followed by an end-to-end anastomosis. Group B (n=10) rats received chow food plus arginine and glutamine rich diet for 7 days before the same surgical procedure. Group C (n=10) rats underwent the same procedure after a 7-day chow plus glutamin rich diet. Group D (n=10) rats had the surgery after a chow food only diet for seven days. All the subjects were fed accordingly to their groups for 7 days postoperatively. On the 7th day, all rats were sacrificed under anesthesia to measure anastomotic bursting pressure and evaluate hydroxyproline levels as well as histopathological scoring of anastomotic line. Results: This study revealed significantly increased hydoxyproline level at the 7th day in group A (p<0.002) and group B (p<0.001) relative to group D. There were no significant differences among the groups for anastomotic bursting pressures and histopathological scores. Conclusion: Enteral HMB support may result statistically significant increased biochemical anastomotic strength with an insignificant difference in biomechanical force. Although more studies are needed to delineate better efficacy, preoperative enteral HMB support may decrease postoperative morbidity and mortality. Ad dress for Cor res pon den ce/Ya zış ma Ad re si: Hakan Erpek MD, Adnan Menderes University Faculty of Medicine, Department of General Surgery, Aydın, Turkey Phone : +90 548 822 71 04 E-mail : hakanerpek@yahoo.com Received/Geliş Ta rihi : 12.01.2017 Accepted/Ka bul Ta ri hi : 17.05.2017 Anah tar Ke li me ler Beta-hidroksi-beta-metil butirat, anastomoz, nütrisyon

Hepatic Vein Doppler Waveform Changes in Nonalcoholic Fatty Liver Disease with Hepatomegaly

Aim: Doppler Ultrasonography (DUS) has become an important diagnostic technique in the hepatic vasculature evaluation. Fatty infiltration of the liver can also change the Doppler findings -like cirrhosis- of hepatic veins. Diffuse fatty liver (DFL) is the most common finding in liver with the method of ultrasonography. Most literature reports mention the effect of chronic liver

Laparoskopik appendektomi açık girişimin güvenilir bir alternatifidir

Laparoscopic appendectomy has progressed to become a reliable surgical procedure in recent years. However, there are some pros and cons comparable with open appendectomy. Materials and methods: The results of 91 patients with acute appendicitis who were operated either with laparoscopic or open technique were retrospectively evaluated. Results: Laparoscopic appendectomy was performed in 28 (30.7%) patients, whereas 63 (69.3%) cases underwent open procedure. Two (6.6%) laparoscopic procedures were converted to open because of perforation and anatomical problems. The duration of operation, hospital stay, and rate of complications did not differ among groups (p>0.05). One patient in each group developed intraabdominal abscess. Conclusions: Laparoscopic appendectomy does not increase postoperative complications as previously speculated, and therefore is a reliable alternative for open appendectomy.