Jülide Sağıroğlu

Strategies to treat idiopathic granulomatous mastitis: Retrospective analysis of 40 patients

BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease which often mimics breast carcinoma both clinically and radiologically. Confirmation of diagnosis is only made by histopathological analysis. This study aims to define clinical and demographic features of IGM patients and discuss the results of treatment modalities. METHODS Forty patients with IGM who were assigned in Istanbul Medeniyet University General Surgery Clinic between March 2008 and October 2013 were retrospectively analyzed. RESULTS Mean age was 39.07 ± 11.5. The most common complaint was breast mass (55%). Nipple retraction was present in 6 patients (15%) and 9 patients (22.5%) had fistulizing abscess. Two patients had erythema nodosum on the lower extremity. Breast ultrasonography (USG) (n:40), mammography (MG) (n:20), and magnetic resonance imaging (MRI) (n:20) were used for imaging. Selected treatment methods were antibiotics and anti-inflammatory agents (27.5%), steroids (15%), abscess drainage (40%), and surgical excision (17.5%). Fifteen patients had recurrence after their first line treatment protocol. Mean follow-up period was 24.85 ± 19.7 months. CONCLUSION Surgical excision still seems to be the best treatment method for IGM patients. Administration of steroids for large lesions prior to surgery may help minimize the lesion size and obtain better cosmesis.

Robot‐assisted laparoscopic (RAL) procedures in general surgery

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot‐assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures.

Factors Effecting Mastalgia

Background: Breast pain is one of the leading complaints that ends up with referral to breast surgery clinics. The purpose of the present study was to investigate the factors that cause mastalgia, and its relation with benign or malignant breast disease. Methods: The study was performed in 700 patients. Data obtained from surveys, and imaging findings were prospectively recorded, and analyzed. Results: The mean age was 45.20 ± 10.78 years. The mastalgia group included 500 cases; the asymptomatic group comprised 200 individuals. Stressful lifestyle, caffeine consumption, and smoking were associated with mastalgia (p < 0.05). Rates of women who had breast fed 3 times or more were higher in the mastalgia group (p < 0.05). Increased breast density, and breast imaging-reporting and data system (BI-RADS) 2 mammography findings were related with mastalgia (p < 0.05). Cysts and fibroadenomas were more common in the mastalgia group (p < 0.05). The incidence of a past history of malignant breast disease was significantly higher in the mastalgia group (p < 0.05). Conclusions: Stress, caffeine, smoking, lactation frequency, and benign disorders were factors detected to be related with mastalgia. Although a significant relation between mastalgia and malignant breast disease was detected in our study, more controlled studies are still required to investigate this issue further.

A retrospective analysis of early and late term complications in patients who underwent application of retention sutures for gastrointestinal tract malignancies.

OBJECTIVE Complications associated with wound healing after abdominal tumor operations continue to be a significant problem. This study aimed to determine the significance of retention sutures in preventing these complications. For this purpose, early and late term results of patients who underwent application of polydioxanone (PDS) and additional retention sutures for abdominal closure were retrospectively evaluated. MATERIAL AND METHODS Clinical files of 172 patients who were operated due to gastrointestinal tract malignancies in our clinic between January 2007 and January 2011 were retrospectively analyzed. Patients in whom the fascia was repaired only with PDS (Group 1) were compared to patients in whom the fascia was repaired with PDS and retention sutures (Group 2) in terms of age, gender, postoperative evisceration-wound infection (<1 month), incisional hernia (>1 month), incision type, co-morbid factors, and operative time. RESULTS There was no significant difference between the two groups in terms of age or gender (p=0.680 and p=0.763). No significant difference was detected in terms of postoperative incisional hernia (p=0.064). Evisceration and post-operative wound infection were significantly lower in Group 2 as compared to Group 1 (p=0.008 and p=0.002). Operative time was significantly longer in Group 1 than in Group 2 (p<0.0001). Co-morbid features were significantly higher in Group 2 than in Group 1 (p<0.0001). There were no significant differences between the groups in terms of incision type (p=0.743). CONCLUSION In the presence of co-morbid factors that disrupt wound healing in surgical patients with gastrointestinal malignancy, retention suture can be safely used as a supplement for optimal wound care.

Robotik Gastrointestinal Cerrahide Güncel Uygulama

Cerrahi tedavi gerektiren hastaliklar icin, uzun zamandir konvansiyonel (acik) veya laparoskopik ameliyatlar uygulanabilmektedir. Gunumuzde teknolojideki hizli ilerlemeler, bu konudaki arastirmalarda konvansiyonel laparoskopiden farkli yontemlere de odaklanilmasina neden olmustur. Bunlar arasinda tek kesiden laparoskopik cerrahi (single incision laparoscopic surgery—SILS), dogal menfezden transluminal endoskopik cerrahi (natural orifice transluminal endoscopic surgery—NOTES) ve robotik cerrahi, minimal invaziv cerrahi icin yeni seceneklerdir. Bircok calismada cesitli genel cerrahi ameliyatlarinin robot yardimli laparoskopik (ROYAL) cerrahi ile guvenli ve etkin bir sekilde uygulanabildigi gosterilmistir. Bu derlemede, genel cerrahi alaninda en sik uygulanan gastrointestinal operasyonlara yonelik robotik cerrahideki guncel gelismeler ve uygulamalar irdelenecektir

Rural surgery in Guinea Bissau: an experience of Doctors Worldwide Turkey

OBJECTIVE: In Africa, there is critical shortage of surgeons. Majority of the surgeons work in urban centers, and almost none of them is working in the rural areas. This study documents surgical interventions performed in Guinea-Bissau by Doctors Worldwide Turkey. METHODS: A group of surgeons from the Doctors Worldwide Turkey performed various surgical interventions in the Simao Mendes, Gabu and Bafata community hospitals. Demographics, surgical methods, anesthesia techniques and complications were recorded. RESULTS: Sixty- four procedures were undertaken between 5–16 February 2010 and 6–11 May 2011. The patient population consisted of 47 male (82.5%) and 10 female (17.5%) patients with a mean age of 44.5 (range: 6–81) years. Five emergency cases were observed. Hartmann’s procedure for rectal carcinoma; modified radical mastectomy for breast carcinoma; 2 right total thyroidectomies, 1 bilateral subtotal thyroidectomy; 2 incisional hernia repairs with mesh, 1 breast lumpectomy, 3 mass excisions, 2 keloidectomies, and various techniques of hernia repair for 35 inguinal hernias (4 bilateral, 3 strangulated and 2 coexisting with hydrocele), Winkelmann’s procedure for 5 hydroceles (1 bilateral), and unilateral orchiectomy for 1 bilateral hydrocele were recorded. Sixteen patients received general (23.5%), 23 spinal (33.8%), 7 epidural (10.3%), 15 local (22.1%), and 7 ketamine (10.3%) anesthesia. There was no mortality. CONCLUSION: Surgical diseases, majority of which are hernias threaten public health in underdeveloped regions of Africa. Blitz surgery may be an efficient temporary solution.

Comparison of clinicopathological findings among patients whose mammography results were classified as category 4 subgroups of the BI-RADS

OBJECTIVE: Our aim is to compare mammographic, demographic and clinicopathological characteristics of patients whose mammographies were classified as subgroups of BI-RADS 4 category (Breast Imaging – Reporting and Data System). METHODS: In total, 103 patients with mammography (Senographe 600t Senix HF; General Electric, Moulineaux, France) results classified as BI-RADS 4 were included in the study. Demographic data (age, menopause, and family history) were recorded. All data were compared among BI-RADS 4 subgroups. RESULTS: In all, 68.9% (71/103), 7.8% (8/103) and 23.3% (24/103) the patients were in groups BI-RADS 4A, 4B and 4C, respectively. The incidence of malignancy was higher in Groups 4B and 4C than in Group 4A (p<0.05), but similar in Groups 4B and 4C (p>0.05). Mean age was lower in Group 4B than in Groups 4A and 4C (p<0.05). A positive family history was more common in Group 4A than in Group 4B (p=0.025). The frequency of menopausal patients was greater in Groups 4A and 4C than in Group 4B (p=0.021, and 0.003, respectively). METHODS: The rate of malignancy was higher in Groups 4B, and 4C than in Group 4A. A positive family history was more common in Group 4A than in Group 4C. Groups 4A, and 4C patients tended to be older and were more likely to be menopausal than Group 4B patients.