Hedef Özgün

Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy.

OBJECTIVE To compare local, spinal, and general anaesthesia for inguinal hemiorraphy in otherwise healthy patients with respect to duration of operation, time in operating room, postoperative pain, complications, rehabilitation, and satisfaction. DESIGN Prospective randomised controlled trial. SETTING University hospital, Turkey. SUBJECTS Seventy-five men with unilateral primary inguinal hernias, Nyhus type II and III, and ASA I and II. INTERVENTIONS Lichtenstein repairs with standard local, spinal, or general anaesthesia. MAIN OUTCOME MEASURES Duration of operation and anaesthesia, postoperative pain scores, analgesic requirements, complications, length of hospital stay, postoperative rehabilitation, and satisfaction. RESULTS With local anaesthesia, we recorded shorter time spent in the operating room, lower incidence of nausea and urinary retention, and more satisfaction. In the local and spinal anaesthetic groups, postoperative analgesic requirements and length of hospital stay were less than in the general anaesthesia group. CONCLUSIONS Local anaesthesia is suitable for day-case hernia repair with fewer postoperative problems and less analgesia requirement. Patients also reported greater satisfaction. Local anaesthesia may be preferred to other methods.

Nitric oxide regulates bacterial translocation in experimental acute edematous pancreatitis

Background/Aims: The role of nitric oxide (NO) in bacterial translocation (BT) associated with acute pancreatitis is controversial. We investigated the effects of the NO synthase substrate, L-arginine, and the NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME), on BT in caerulein-induced acute pancreatitis in rats. Methods: Acute pancreatitis was induced by subcutaneous injections of caerulein (12 µg/kg) at 6-hour intervals for 2 days. Subcutaneous injections of L-arginine (100 mg/kg) or L-NAME (10 mg/kg) were administeredonce daily for 2 days. At 48 h, pancreatic injury and BT to the mesenteric lymph nodes (MLN), liver, and peritoneum were assessed. Results: Compared with controls, rats that received caerulein injections alone had increased BT to the MLN and pancreatic inflammatory changes. L-Arginine significantly reduced the inflammation and BT caused by caerulein. L-NAME did not significantly alter pancreatic inflammation. Although caerulein + L-NAME-treated rats had increased BT to the peritoneum, MLN, and liver compared with controls, rates of BT did not significantly differ between caerulein alone- and caerulein + L-NAME-treated rats. Conclusion: In acute edematous pancreatitis, BT is increased and is regulated by NO. NO substrates limit BT and pancreatic inflammation associated with acute pancreatitis, probably by their bactericidal actions and ability to improve pancreatic blood flow.

C-reactive protein may be a marker of bacterial translocation in experimental intestinal obstruction.

Background:  C‐reactive protein (CRP) is used as a marker of intestinal ischaemia. This study evaluated whether CRP levels can be used to detect ischaemia‐induced (strangulated) intestinal obstruction and subsequent bacterial translocation.

Effect of granulocyte-macrophage colony stimulating factor on bacterial translocation after experimental obstructive jaundice

OBJECTIVE To investigate the effects of granulocyte-macrophage colony stimulating factor (GM-CSF) on bacterial translocation promoted by obstructive jaundice. DESIGN Controlled animal study. SETTING University hospital, Turkey. ANIMALS 30 male Wistar albino rats. INTERVENTIONS The first group (n = 10) was the sham operation (control) group, and the second and the third (n = 10 each) had common bile duct (CBD) ligation and division under sterile conditions. The third group were also treated with GM-CSF 200 ng subcutaneously daily between the fifth and ninth postoperative days. All animals were killed on the tenth day, and evaluated biochemically and histopathologically. Mesenteric lymph nodes were cultured under aerobic conditions. MAIN OUTCOME MEASURES Biochemical analysis, histopathological evaluation, and aerobic cultures. RESULTS There was no bacterial translocation in either the control or GM-CSF groups, whereas Escherichia coli and Salmonella typhimurium were found in 4 and 2 animals, respectively in the ligation group. Although no aerobic bacteria was found in controls and the GM-CSF groups, bacterial translocation was 6/10 in the ligation alone group (p <0.01). CONCLUSION Activation of inflammatory response with GM-CSF is highly effective in prevention of bacterial translocation in obstructive jaundice.

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.

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.

Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer

OBJECTIVE Lymphedema is a chronic major complication that is seen frequently post-operatively and has negative effects on quality of life. In our study, determining the early-stage postoperative lymphedema frequency and specifying the risk factors in its development has been aimed. MATERIALS AND METHODS One hundred one cases that were operated on for breast cancer were evaluated regarding the 12-month control of their clinical specifications, histopathological specifications, and specifications related with the surgical intervention retrospectively. The data related to the parameters envisioned as risk factors were evaluated. RESULTS Lymphedema development was found in 7 (6.9%) out of 101 cases constituting the study group. No significant difference (p>0.05) in terms of lymphedema development was determined among age, body mass index (BMI), chemotherapy (CT), postoperative seroma or infection, mastectomy with the dominant arm, and breast-conserving surgery (BCS), which were evaluated as risk factors. There was a significance (p<0.05) between the other risk factors, which were axillary dissection (AD), number of positive lymph nodes (LN), radiotherapy (RT), the tumor size (T), and lymphedema existence. In every case in which lymphedema was determined, it was seen that there was axillary LN involvement and 15≤LN were ablated in the dissection (p<0.05). CONCLUSION It is seen that AD, RT applied to the breast cancer patients, and T are important risk factors in early-stage lymphedema development. No early-stage lymphedema development was determined in any of the patients to whom sentinel lymph node dissection (SLND) was applied.

Strangulated ventral hernia model in rats.

This study was performed to describe a new model of strangulation obstruction mimicking the situations relevant to abdominal hernias. The strangulation obstruction was induced either by intra-abdominal ligation of an ileal segment 2 cm in length ( n = 20) or by a pursestring suture around a fascial defect with a strangulated intestinal loop placed subcutaneously ( n = 20). Ten animals served as sham operated controls ( n = 10). All animals were euthanized at 12 h postoperatively; strangulated ileum segments were collected for histopathological examination. Microscopic injury scores were similar in both strangulation groups, which were significantly different from the control group ( p < .001). The model described here seems to be appropriate for use in further experimental studies concerning strangulation obstruction injury and its consequences, with the added advantage of visualization of the strangulated intestinal loop beneath the skin.

Comparing reduction mammaplasty specimens between superior and central pedicle techniques: a retrospective study.

The aim of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens in two retrospective series of patients operated using superior and central pedicle mammaplasties. Between November 2000 and December 2011, 60 consecutive patients (120 breasts) underwent breast reduction using the superior pedicle technique with a vertical scar (Lejour’s technique). These patients were compared with another series of 80 patients (150 breasts) who underwent breast reduction using a vertical scar mammaplasty with a central pedicle (Copcu’s technique). The characteristics of the patients were statistically similar between the two groups. Therefore, 140 patients who had undergone reduction mammaplasty were analyzed with respect to their histologic diagnoses, age, and specimen’s weight. In the superior pedicle technique, we found that 30% of these women had pathologic alterations in at least one of their breasts, whereas the pathologic changes in patients who underwent Copcu’s technique were 35%. In terms of tumor diagnosis, the upper quadrant excision technique (e.g. Copcu’s method) may be safer. If there is no other special condition, it is better to use the pedicle technique in which the upper lateral and upper medial pole is removed. Level of Evidence: Level I, therapeutic study.