Kenan Erzurumlu

Giant adrenal myelolipoma: Case report and review of the literature

Myelolipoma is a tumor‐like growth composed of mature fat tissue and bone marrow elements. It occurs in the adrenal gland or as an isolated soft tissue mass. It may be associated with endocrine disorders such as hermaphroditism, Cushing’s disease, Addison’s disease and obesity of unknown cause. These lesions rarely measure more than 5 cm in diameter, although giant tumors have been reported in the literature. The fifth largest surgically resected adrenal myelolipoma in the literature is reported and its clinical associations and, macroscopic and microscopic features are discussed.

Results of alcohol and albendazole injections in hepatic hydatidosis: Experimental study

Background:  Percutaneous drainage with alcohol injection for hydatid cysts has been commonly used in the last two decades. Albendazole is the drug of choice in the medical treatment of hydatidosis, and has also been used as an intraoperative scolicidal solution. The side‐effects of its local application are not well known and have not been investigated. The purpose of the present study was to investigate the effects of the intracystic injections of alcohol and albendazole solutions on the hydatid cysts and hepatobiliary system of rabbits.

Effect of Gentamicin-absorbed Collagen in Wound Healing in Pilonidal Sinus Surgery: A Prospective Randomized Study

Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.

Dual treatment of albendazole in hepatic hydatidosis: New therapeutic modality in 52 cases

Background:  Hepatic hydatidosis still remains as a serious problem in general surgery. Recurrence and/or secondary hydatidosis rates are up to 25% in the cases treated with surgery alone. Albendazole is the most commonly used drug in the medical treatment of echinococcosis. The aim of the present study was to evaluate the effect of albendazole using the intraoperative and perioperative periods as dual therapy.

Effect of Local Gentamicin Application on Healing and Wound Infection in Patients with Modified Radical Mastectomy: a Prospective Randomized Study

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Postoperative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved postoperative outcomes in patients undergoing modified radical mastectomy.

Is oval flap reconstruction a good modification for treating pilonidal sinuses

BACKGROUND Flap techniques are acceptable for the surgical treatment of pilonidal sinuses. This study assessed a new modification of the rhomboid flap technique. METHODS The study included 133 patients with pilonidal disease who were treated between April 2004 and April 2009. The pilonidal sinus was removed with an oval excision, and an oval head rhomboid flap was prepared to reduce flap necrosis. RESULTS The mean age of the patients was 27.4 ± 4.6 years (range, 13-80). The rate of minor postoperative complications was 11.3%. The mean hospital stay was 2.3 ± .8 days (range, 1-6). The rate of recurrence was 1.5%. Regarding cosmetic results, 116 (87%) patients were very pleased, 15 (11.2%) were pleased, and 5 (3%) were displeased. The mean follow-up period was 22.5 ± 12.4 months (range, 5-57). CONCLUSIONS The oval flap reconstruction method is a recommended procedure that produces fewer ischemic flaps with a low rate of recurrence and acceptable cosmesis.

The Predictivity of Serum Biochemical Markers in Acute Biliary Pancreatitis

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis.

Long-term outcomes of intraoperative and perioperative albendazole treatment in hepatic hydatidosis: single center experience

Purpose The aim of this study was to evaluate long-term outcome of the intraoperative and perioperative albendazole (ALB) treatment on the recurrence and/or secondary hydatidosis. Methods One hundred and one patients with hepatic hydatidosis were treated intraoperatively and perioperatively with ALB, in addition to surgery. Perioperative ALB treatment was given in a dose of 12-15 mg/kg/day. The ALB treatment was started 13.27 ± 14.34 days before the surgery, and it was continued for 4.39 ± 3.11 months postoperatively. A total of 1.7 µg/mL of ALB solution was used as a protoscolidal agent. The follow-up period was 134.55 ± 51.56 months. Results Four patients died, with only one death was secondary to hydatid disease (cerebral eccinococcus). There was only one recurrence (1%) of hepatic hydatidosis. Early and late morbidity rates were 8.91% and 7.92%, respectively. Conclusion Our results suggest that intraoperative and perioperative ALB is effective for the prevention of hepatic hydatidosis recurrence and/or secondary hydatidosis.

The Whitehead operation procedure: Is it a useful technique?

OBJECTIVE Hemorrhoidal disease is a very common entity in the general population; however, the therapeutic approaches to hemorrhoids remain controversial. The choice of treatment method depends on the grade of the hemorrhoid as well as the experience of the surgeon. The Whitehead hemorrhoidectomy procedure is often applied for grade IV hemorrhoids. MATERIAL AND METHODS We studied 49 patients who underwent surgery between December 1982 and January 2013. The indications for the Whitehead procedure in all patients were grade IV hemorrhoidal disease. The data on these patients were evaluated retrospectively with respect to age, gender, preoperative diagnosis, and postoperative complications. RESULTS Of the patients included in this study, 34 were male and 15 were female. The mean age of the patients was 41.93±12.42, and the age range was 24-70 years. Complications of the Whitehead procedure included bleeding (6.12%, three cases), stricture (2.04%, one case), urinary retention (16.33%, eight cases), and temporary anal incontinence (2.04%, one case). No patients developed Whitehead deformities, entropion, or infectious complications. All patients were discharged from hospital between the fifth and eighth days post-surgery (6.45±1.00 days). The follow-up period was 1-234 months (70.02±54.89). CONCLUSION The Whitehead procedure is successful in patients with prevalent peripheral prolapse and/or thrombosed hemorrhoids. With the right indications, and if the surgeon has adequate experience, the morbidity rate of the Whitehead procedure is similar to that of other treatment methods.

Laparoscopic Extraction of a Gastric Phytobezoar: A Different Approach

To the Editor, There are many therapeutic modalities for managing gastric bezoars. These include nasogastric lavage or suction, enzymatic therapy, the use of prokinetic agents and gastroscopic fragmentation and extraction (1–3). If these non-operative treatments fail, a surgical approach is needed and removal of the bezoar has classically been performed by gastrotomy. To our knowledge there are few articles about the laparoscopic treatment of gastric bezoars (1–5). A 54-year-old-female was admitted with severe abdominal pain, loss of appetite and with having had feelings of ‘a moving object’ in the stomach for a year. Gastroscopy demonstrated a hard phytobezoar of approximately 7 × 5 cm in size with-in the stomach that could not be fragmented using endoscopic techniques. Therefore laparoscopic removal was considered. First, the gastrocolic ligament was cut approximately 6–7 cm along the stomach (Figure 1). Then the bezoar was removed via a gastrotomy from the greater curvature using the three-trocar technique (Figure 1). It was successfully retrieved from the abdominal cavity after having been fragmented within an endobag (Figure 2). After the extraction, the gastric incision site was closed using two staplers (Tri-Staple 60, Covidien). Finally, the gastrocolic ligament was closed using continuous sutures, and a drainage tube was inserted near the gastrotomy site. The pathologic diagnosis was gastric phytobezoar. All the patient’s complaints were gone and the wound healed 2 weeks after the operation. FIG. 1. Gastrotomy line in the greater curvature (straight stripe), opened gastrocolic ligament (big arrow), posterior wall of the stomach (small arrow) FIG. 2. Extraction of phtyobezoar from the stomach Herein we presented a laparoscopic treatment of a gastric phytobezoar. Our approach was unique because we made a gastric incision in the greater curvature, which we think this is much more anatomically effective than previously reported techniques, such as anterior wall incisions. This approach affects the natural shape of the stomach minimally and a minimal amount of gastric tissue is extracted (Figure 3). FIG. 3. The remains of the phtyobezoar and removed minimal gastric tissue after the surgery