İsmayil Yilmaz

Late Complications of Incisional Hernias Following Prosthetic Mesh Repair

Abstract Background: Incisional hernias still continue to be a serious problem for surgeons. In this study, we aimed to investigate the effects of polypropylene mesh and mersilene mesh, which are frequently employed in incisional hernias, as well as the effects of their application techniques on late complications. Methods: Two-hundred-sixty-four open abdominal hernia repairs were performed between 1986–2000, using prosthetic materials: polypropylene mesh and mersilene mesh were used in hernia repair. Mesh was placed as onlay, underlay and sandwich techniques. Follow-up data were obtained from medical records. Results: Comparisons were made with respect to surgical techniques and to late complications such as recurrence, ente-rocutaneous fistula, intestinal obstruction, and infections. Enterocutaneous fistulas developed in two patients. Recurrence occurred in 6.4 per cent. Chronic infection and wound sinus formation occurred in 5 per cent. The causes of recurrence included smoking, cellulitis, chronic infection/sinus tract, upper abdominal localization, and obstruction. Fistula formation occurred in patients with no peritoneal prevention, which was statistically significant (p=0.012). Chronic infection/sinus tract was high in patients for whom mersilene mesh was used, and enterocutaneous fistula occurred in 2 patients. Conclusion: To prevent late complications, it is necessary to avoid the contact of mesh with bowel.

Dehydroepiandrosterone prevents oxidative injury in obstructive jaundice in rats.

We investigated the effect of dehydroepiandrosterone (DHEA) on oxidative injury in obstructive jaundice using three groups of rats: sham-operated group; common bile duct (CBD) group — the CBD was ligated; and DHEA group — DHEA administration followed CBD ligation. Liver function tests were performed using blood samples, and malondialdehyde concentration (MDA), superoxide dismutase activities (SOD), glutathione peroxidase (GPx), and total glutathione (tGSH) concentrations were measured in liver tissue. Serum alkaline phosphatase, γ-glutamyltransferase and alanine aminotransferase activity were significantly elevated in the CBD group compared with the other groups. Serum aspartate aminotransferase and total bilirubin were highest in the CBD group; the MDA concentration was higher in the CBD group than the sham group. There were no significant differences in GPx activity among the groups. SOD activity and tGSH concentration were significantly lower in the CBD group than the other groups. DHEA may protect hepatic tissue against oxidative injury in obstructive jaundice by decreasing MDA concentration and increasing SOD activity and tGSH concentration.

Periampullary Diverticula Causing Pancreaticobiliary Disease

Our purpose was to determine if the presence of duodenal diverticula predisposes to the development of pancreaticobiliary disease. Between May 1999 and February 2001, 381 patients were examined by endoscopic retrograde cholangiopancreaticography. Of these patients, 51 had periampullary diverticula. In 27 patients the papilla was located inside the diverticulum (Group I), in 19 patients it was located at the edge of the diverticulum (Group II), and 5 patients it was located at a distance closer than 3 cm to the diverticulum (Group III). Seventeen patients in group I and 11 patients in group II had had a previous cholecystectomy. The overall incidence of biliary system stone disease was 22.2% in group I, 36.8% in group II, and 100% in group III. All patients were treated with endoscopic sphincterotomy and three (two in group I and one in group II) developed biliary system disease (cholangitis or pancreatitis). We think that sphincterotomy should be applied regardless of the presence of stone if the papilla is located inside or at the edge of the diverticulum. If the papilla is located 3 cm or more far for diverticulum, it should be considered within the frame of general sphincterotomy indications in the absence of stone disease.

Correlation of Bowel Wall Thickening Seen Using Computerized Tomography With Colonoscopies: A Preliminary Study

Purpose: Bowel wall thickening (BWT) is a common finding in abdominal computerized tomography imaging (CTi). The purpose of the present study was a prospective assessment and management of patients who have BWT in abdominal CTi. Materials and Methods: This study was conducted between January 2012 and July 2014 at Erzincan University Hospital, Turkey, with 64 patients who were admitted to the emergency and general surgery department. All of the patients had received colonoscopies due to BWT seen in abdominal CTi. Results: Twenty-three (36%) female and 41 (64%) male patients were included in the study. The mean age was 56.2 years (range, 14 to 84 y). The positive predictive value of CTi for BWT was 87.5%. The positive predictive value of a CTi diagnosis of the disease according to a radiologist’s report was 78.1%. Common pathologies detected by colonoscopy included neoplasia and inflammatory bowel disease. Conclusions: Diagnosis of BWT by abdominal CTi reveals pathologies in many cases. Colonoscopies will be helpful in the differential diagnosis.

Mekanik intestinal obstrüksiyona neden olan kolorektal anostomoz darlığnın endoskopik balon dilatasyonla tedavisi

1 Ibni Sina Hospital, Kayseri, Turkey 2 Erzincan University Department of General Surgery, Erzincan, Turkey Yazışma Adresi /Correspondence: Kemal Peker, Mengücek Gazi Eğitim ve Araştırma Hastanesi Genel Cerrahi Anabilim Dalı, Erzincan, Türkiye Email: k.peker@yahoo.com.tr Geliş Tarihi / Received: 16.01.2013, Kabul Tarihi / Accepted: 09.02.2013 Copyright

Use of radiopaque capsules in diagnosis and decision for surgical management in bowel obstruction

Abstract Early surgical intervention in small intestine obstructions is very important in preventing mortality and morbidity. In this study, attempts were made to determine whether it is possible to predict timing and necessity for surgical intervention in intestinal obstructions using radiopaque capsules.Need for surgical intervention was evaluated depending on the location of the capsule as observed in the plain abdominal radiograph at the 2nd, 5th and 8th hours of the study. If the capsule was fixed in the epigastric region (Group I) all such patients required surgical intervention; if it was located in the small intestine (Group II), 84.6% of the patients, and if it moved along the small intestine (Group III), 2.1% needed surgical intervention. If the capsule had passed into the colon (Group IV), no operation was needed.

Importance of Psychiatric Intervention in Intolerances in Endoscopic Procedures

Despite the fact that pre-medication, in a number of different drug combinations, has been used for a long time in endoscopy units, and has been subject to extended clinical studies, it is still not possible to claim that it has attained an ideal state with regard to patient tolerance to endoscopy procedures. In this clinical study, we have investigated the effects of psychological intervention in addition to medication, which we used on patients with intolerance to endoscopy. Intolerance was very high in all endoscopic procedures (15.8% total). It was observed that average midazolam doses were significantly higher in intolerant than in tolerant patients. It was found that in patients who had received psychiatric intervention, the decrease in midazolam dose was statistically significant in a subsequent endoscopy procedure.