Hasan Bektas

Abdominal Wall Endometrioma; A 10-Year Experience and Brief Review of the Literature

BACKGROUND Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of Cesarean section or hysterectomy. Certain factors relating to knowledge of the clinical pattern of this disease make correct diagnosis and treatment difficult. The aim was to identify the different forms of presentation of this disease entity through publishing the results from our experience of surgical management of such lesions. METHODS Patients diagnosed with abdominal wall endometrioma over a period of 10 y were identified from the comprehensive surgical database of our institution. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, current operation, and recurrences were surveyed and analyzed. RESULTS There were 40 patients with a mean age of 32.3 ± 5.2 y. All of the patients (100%, n = 40) had an abdominal mass in or adjacent to surgical scars. The main symptom was pain, noncyclic (45%, n =18), or cyclic (40%, n = 16) in nature. The mean duration of symptoms was 18.2 ± 23.4 mo. The preoperative diagnosis was correct in 47.5% (n = 19) of the cases. Surgical treatment failed in 3 cases (3/33, 9.1%), and the operations were performed once again. CONCLUSIONS Abdominal wall endometriosis may be difficult to diagnose as it is comparatively an unfamiliar entity that has not received its due attention among general surgeons, so far. Therefore, in patients with a palpable subcutaneous mass in or around surgical scars with a history of violation of uterus, a thorough history and physical examination is necessary, and usually sufficient to make correct diagnosis of endometrioma.

Extraordinary cause of acute gastric dilatation and hepatic portal venous gas: Chronic use of synthetic cannabinoid

Addiction to synthetic cannabinoids (SCs) is a growing social and health problem worldwide. Chronic use of SCs may cause adverse effects in the gastrointestinal system. We describe a very rare case of acute gastric dilatation (AGD) and hepatic portal venous gas (HPVG), with findings of acute abdomen resulting from chronic use of a SC, Bonzai. AGD and HPVG were detected by computerized tomography examination. Patchy mucosal ischemia was seen in endoscopic examination. Despite the findings of an acute abdomen, a non-surgical approach with nasogastric decompression, antibiotic therapy, and close radiologic and endoscopic follow-up was preferred in the presented case. Clinical and radiologic findings decreased dramatically on the first day, and endoscopic findings gradually disappeared over 7 d. In conclusion, this case shows that chronic use of a SC may cause AGD and accompanying HPVG, which can be managed non-surgically despite the findings of acute abdomen.

Effects of contractubex on the prevention of postoperative peritoneal adhesion.

BACKGROUND There are numerus techniques and agents in use for reducing peritoneal adhesion formation. But in this research we believe this is the first research to reveal that contractubex (allium cepae, sodium heparin, and allantoin mixture) is reducing formed peritoneal adhesions. So it may be used to reduce the number of re-laparotomies/re-laparoscopies caused by peritoneal adhesions related complications. OBJECTIVE To evaluate the effects of contractubex (CT) in a rat model of postoperative peritoneal adhesion (PPA). METHODS Fifty rats were divided into four equal groups. In group 1, 1 g of CT was injected into the peritoneal cavity. In group 2, adhesions were generated. In group 3, adhesions were generated, and 1 g of CT was immediately applied into the peritoneal cavity. In group 4, adhesions were generated, and at postoperative d 7, 1 g of CT was applied into the peritoneal cavity. In group 5, adhesions were generated, and at postoperative d1, 3, 5, and 7, 1 g of CT was applied into the peritoneal cavity. The adhesions were scored both macroscopically and microscopically. RESULTS The mean macroscopic adhesion scores in groups 1-5 were 0 ± 0, 2.9 ± 0.21, 2.3 ± 0.54, 0.8 ± 0.63, and 2.2 ± 0.72, respectively (P < 0.0001); the mean microscopic values were 0 ± 0, 2.8 ± 0.42, 2.8 ± 0.42, 0.6 ± 0.52, and 2.3 ± 0.48, respectively (P < 0.0001). The mean macroscopic adhesion score in group 4 was lower than that in group 2 (P = 0.001). The mean macroscopic adhesion scores in groups 3 and 5 were higher than those in group 4 (P = 0.045 and P = 0.038, respectively) but did not significantly differ from those in group 2 (P = 0.171 and P = 0.124, respectively). COMMENTARY A single dose of contractubex did not prevent PPA formation but did diminish the amount of formed PPAs.

COMPARISON OF SODIUM PHOSPHATE, POLYETHYLENE GLYCOL AND SENNA SOLUTIONS IN BOWEL PREPARATION: A PROSPECTIVE, RANDOMIZED CONTROLLED CLINICAL STUDY

Background:  Low volume oral solutions for colon cleansing before colonoscopy are gaining popularity over large volume oral lavage solutions. Therefore, we aimed to compare three oral solutions for colonoscopy to determine any changes in either patient compliance or cleansing ability.

Duodenal somatostatinoma: a case report and review of the literature

IntroductionAbout 70% of well-differentiated endocrine tumors arise from the gastrointestinal tract. Duodenal well-differentiated endocrine tumors account for only 2.6% of all neuroendocrine tumors. Following the first two case reports of somatostatin-secreting tumors in 1977, fewer than 200 cases of somatostatinoma have been reported. These tumors of the duodenum are usually silent and asymptomatic, but can cause gastrointestinal symptoms. Depending on the localization of the tumor, multiple surgical procedures can be performed, ranging from local resection to pancreaticoduodenectomy.Case presentationHere, we report a case of a submucosal duodenal mass in a 42-year-old Turkish White man presenting with nausea, vomiting, fatigue and abdominal pain. The treatment decision of pancreaticoduodenectomy made preoperatively was later altered to intraoperative removal via local resection with sphincteroplasty.ConclusionTumors of the periampullary region are considered highly malignant, and the Whipple operation is usually the only procedural treatment. In the current case, we decided not to perform pancreaticoduodenectomy but to excise the mass intraoperatively, and consequently avoided unnecessary resection of the pancreas and anastomosis to undilated hepatic and pancreatic ducts. This protective strategy prevented duodenum- and pancreas-related morbidity.

Effects of totally extraperitoneal (TEP) and Lichtenstein hernia repair on testicular blood flow and volume.

BACKGROUND Laparoscopic totally extraperitoneal hernia repair (TEP) has been compared with the open technique in several studies in terms of technical properties and perioperative outcomes. There are few studies that compare the long-term effects of each technique on testicular structure and function on the side of the hernia repair. The objective of this study is to investigate the effects at 6 months of the TEP and the Lichtenstein technique on testicular volume and arterial flow by the use of Doppler ultrasonography. METHODS A total of 148 men with a unilateral hernia were randomized prospectively to undergo TEP or Lichtenstein repair. In both groups, unilateral resistive indices, pulsatile indices of capsular and intratesticular artery flow, and testicular volume (in milliliters) were measured preoperatively and 6 months postoperatively by the use of grayscale and color Doppler ultrasonography (CDUS). The primary outcomes of the study were postoperative findings from history, physical examination, and CDUS measurements at 6 months postoperatively. Demographics, clinical and operative data, CDUS measurements, and recurrence patterns were analyzed. RESULTS Of 148 procedures, 134 cases consisting of 64 TEP and 70 Lichtenstein repairs were evaluated. Pre- and postoperative CDUS findings, rates of complications, and recurrence in both groups did not show any difference. Operative time was greater with a Lichtenstein repair (36 vs 30 minutes; P = .01). CONCLUSION Complications and recurrence rates and effects on testicular perfusion and testicular volume in both laparoscopic and open techniques are similar, whereas the laparoscopic approach has shorter operative time than open hernia repair.

Diagnostic and Therapeutic Value of ERCP in Acute Cholangitis

Cholangitis, with a clinical spectrum between acute ascending cholangitis and acute fulminant cholangitis, the mildest and the most severe forms, respectively, is the infection of bile ducts with a potential of serious mortality and morbidity. Obstruction of the bile ducts followed by infection, with E. coli being the most commonly isolated agent, is common to all forms of cholangitis. Biliary obstruction is caused by choledocholithiasis mostly. “Choledochal pressure” is the most important factor, determining morbidity. If the pressure exceeds 25 cm H2O, which is the critical value, immune dysfunction ensues. Sepsis is common if the infection of biliary ducts is suppurative. Mortality and morbidity are inevitable if left untreated or drained late. The objective of this study is, in the stand point of the current literature, to analyse the diagnostic, therapeutic success and complication rates of ERCP (Endoscopic retrograde cholangiopancreatography) in patients with a diagnosis of acute purulent cholangitis with no response to medical treatment.

New and Simple Approach for Preventing Postoperative Peritoneal Adhesions: Do not Touch the Peritoneum without Viscous Liquid—A Multivariate Analysis

Background. Postoperative peritoneal adhesions (PPAs) are an unsolved and serious problem in abdominal surgery. Method. Viscous liquids of soybean oil, octyl methoxycinnamate, flax oil, aloe vera gel, and glycerol were used in five experiments, using the same methodology for each. Liquids were applied in the peritoneal cavity before and after mechanical peritoneal trauma. Results were evaluated by multivariate analysis. Results. Compared with the control group, macroscopic and microscopic adhesion values before (P < .001) and after (P < .05) application of viscous liquids significantly reduced PPAs. Values were significantly lower when liquids were applied before rather than after peritoneal trauma (P < .0001). Discussion. Viscous liquids injected into the peritoneal cavity before or after mechanical peritoneal trauma decrease PPA. Injection before trauma was more effective than after trauma. In surgical practice, PPA formation may be prevented or decreased by covering the peritoneal cavity with an appropriate viscous liquid before abdominal surgery.

MALT lymphoma of the rectum, presenting with rectal prolapsus: a case report.

Up to now, there have been only a few reported cases of Mucosa-associated lymphoid tissue (MALT) lymphomas arising in the rectum. Its clinical presentation is indistinguishable from that of rectal carcinoma but the treatment is apparently different. Symptoms of primary lymphomas involving the rectum include; anorexia, weight loss, change in bowel habits, obstruction, and bleeding. These symptoms are not disease specific and can be seen in many other gastrointestinal disorders. Patients with polypoid masses may present with obstruction symptoms. In this rare case, a female patient admitted to the emergency service with prolapsus of a rectal mass.The optimal treatment of rectal MALT lymphoma is not well defined yet, given the rarity of the disease. Surgical resection of the localized lesion and following adjuvant chemotherapy has proved to be an effective treatment option. However, a close and long-lasting follow-up is important.

Laparoscopic cholecystectomy on the bikini line for invisible scar.

Background A traditional laparoscopic cholecystectomy uses 4 trocar incisions on the upper abdomen, which may be the source of undesirable cosmetic outcomes. We describe here a modification of the traditional laparoscopic cholecystectomy by which scars remain underwear. Supplemental Digital Content 1, http://links.lww.com/SLE/A27. Methods A 32-year-old woman and 43-year-old man with symptomatic cholelithiasis were chosen for laparoscopic cholecystectomy on the bikini line. Four trocar were used, all of them were positioned at the lower abdomen in the same parallel on the bikini line. All procedure was performed with standart laparoscopic instrumentation. Gallbladder was removed through the median suprapubical trocar site. Results Both procedures were technically successful with no skin incisions outside the bikini line. The total operation times were: 65 and 45 minutes, and the hospital stay were 2 days. There were no complications during or after surgery. We left no scar on the upper abdomen. Conclusions Laparoscopic cholecystectomy on the bikini line is technically feasible, safe, and effective. There is no need for learning curve and extralaparoscopic instrumentation. The major advantage of this method is improved cosmetic outcome with no visible abdominal scars. This new technique carries the potential to be an option for the traditional laparoscopic cholecystectomy.