M. Tahir Özer

A simple novel technique for enteroatmospheric fistulae: silicone fistula plug

Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an open abdomen, present serious problems for the surgeon. There are no fixed algorithms for treatment of EAF, and treatment options are determined based on the experience of the surgeon and status of the patient. We developed a ‘suspended silicone fistula plug’ for treating a patient who developed an EAF after undergoing multiple operations in a short period of time. Used in conjunction with negative pressure wound therapy, application of this novel therapy resulted in EAF closure and patient discharge.

A novel laparoscopic suction device for applying precise aspiration during laparoscopic surgery: sponge-tip suction tube.

Aspiration of the intra-abdominal fluid and debris is usually needed during different stages of the operation. This is necessary to protect the intra-abdominal space from contamination and/or to remove blood or tissue fluids occurring during the operation. It is also essential for obtaining a clean surgical area. Aspiration of the intra-abdominal fluid is relatively more difficult in laparoscopic surgery because of the suctioning of the omentum and intestine with the aspirator. In this paper, we report on a new suction device (sponge tip suction tube; STST), which allows the surgeon easier suctioning of intra-abdominal fluid. STST has an additional sponge tip and air channel, which prevents the device from suctioning intra-abdominal organs, such as the intestine and omentum. We tested the efficacy of STST in a simulated intra-abdominal space, such as a large transparent plastic bag with fresh sheep intestine-omentum and with 2000 cc of physiologic saline solution and 14 mm Hg of air pressure. Whereas the suctioning of all the fluid was difficult and time consuming when the conventional suction unit was used, all of the saline solution was easily and quickly suctioned when STST was used. In conclusion, STST provides a safe, fast, and complete fluid extraction.

Use of self‐expanding covered stent and negative pressure wound therapy to manage late rectal perforation after injury from an improvised explosive device: a case report

Blast injuries, caused by explosions accompanied by high‐pressure waves, produce tissue damage in the acute period, followed in the later period by circulatory disorders due to vascular endothelial damage and related tissue necrosis. Blunt rectal perforation is rare and difficult to diagnose. In the acute period following blast pelvic injuries, the main objectives are to stop bleeding, minimise contamination and preserve the patients life. The patient in this report had major vascular injuries, severe pelvic injury and, in the later period, rectal perforation because of vascular endothelial damage caused by the blast effect. Our aim was to treat the patient conservatively because of his poor general condition. We placed a self‐expanding covered stent (SECS) into the rectum and then applied negative pressure wound therapy (NPWT; V.A.C.® Therapy, KCI) to the pelvic region and perirectal area. At the end of the treatment, the rectal perforation was closed, and the patient was discharged with healing. In this article, we discuss the novel use of an SECS with NPWT and review related literature.

A new method for hepatic resection and hemostasis: absorbable plaque and suture.

OBJECTIVE Blunt and penetrating hepatic injuries are conditions that are frequently encountered in emergency surgeries, and they involve high mortality morbidity. In the handling of such injuries, methods ranging from the application of simple cauterization and suturing for hemostasis to hepatic lobectomies, which might involve the removal of the greater part of the organ, have been defined. Due to the organs fragility and susceptibility to bleeding, elective hepatic resections necessitate both surgical experience and technological equipment. Therefore, the demand still exists for an affordable and easy-to-use-method that could be applied by all centers. MATERIALS AND METHODS To meet this demand, we have developed a method of hemorrhage control via sutures supported by absorbable plaques that provide effective compression and prevent the suture from cutting the tissue during the application of the sutures in the treatment of such fragile organs as the liver. In our method, we have achieved hemostasis by bilaterally compressing the tissue through strong ties after placing, on the part of the tissue on which the sutures are applied, absorbable and flexible plaques that prevent the suture from cutting the tissue during the application of a polyglactin suture to the solid organ. To prevent dislocation of the plaques, we have fastened the sutures by reeving them through the holes made in the plaques. RESULTS We have demonstrated the success and the practicality of our method by applying it on four pigs; we experimentally inflicted hepatic injuries on two pigs, and we performed resection on the other two pigs. The hepatic hemorrhages we developed in both of the animals were successfully restrained by the use of our method. On the other hand, two resections were performed on the right and left lobes of the other two animals. There were no hemorrhages during the surgery, and the procedure took 45 minutes in total. No postoperative complications occurred. While the liver function test values were high on the seventh day, due to the operation, they were observed to be normal on the thirtieth day. After the laparotomies, performed six months later, we observed that the plaques as well as the sutures were absorbed and that the injured tissues were completely healed. Additionally, it was observed during the pathological examination that the tissues beneath the area of application were healed through fibrosis and that the liver had no other pathologies. CONCLUSIONS In conclusion, we believe that the method can be safely used in hepatic resections or traumatic hemorrhages in the proper locations.

Anti-adhesive effects of Budesonide combined with spraygel in a cecal abrasion model: an experimental study

Many methods have been described for preventing or reducing postoperative adhesions. In this work, we evaluated the effectiveness of Budesonide in combination with SprayGel in a reducing postoperative adhesion in rats as the model. Cecal abrasion was achieved in 60 male Sprague-Dawley rats, by brushing and by applying 70% alcohol. The rats were separated into six groups and treated with six solutions (Group I – saline; II – Budesonide 50 μg; III – Budesonide 250 μg; IV – SprayGel; V and VI – SprayGel + Budesonide 50 and 250 μg). Serum Budesonide, glucose, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and blood urea nitrogen levels were measured at postoperative day (POD) 2 and 14. The rats were killed on POD 14, and intra-abdominal adhesion formation was scored. Histopathological samples were obtained from the cecum and terminal ileum to evaluate microscopic adhesion formation. Our results showed that Group VI had both the minimum macroscopic adhesion score and the minimum microscopic score. All other groups had significantly lower microscopic adhesion scores than Group I. However, there was no statistical significance among any other groups. Serum AST levels of Group III were significantly higher than in Groups I, II, IV, and V (p < 0.046). Serum AST levels of Group III on POD 14 were also significantly higher than that of all other groups (p < 0.02). On POD 14, there was no Budesonide in the sera of Groups II and V. However, Groups III and VI had trace amounts of Budesonide (0.009 and 0.007 μg, respectively). In conclusion, we have showed that the effect of Budesonide is dosedependent. Both anti-adhesive and hepatotoxic side effects of Budesonide increased as the dose increased. Combining Budesonide with SprayGel synergistically increased the anti-adhesive benefits and prevented hepatotoxicity from the slower release of Budesonide.

Admission of Evacuated Mass Casualties—Experience of the Gulhane Military Medical Academy

Toplu yaralanmalarda olgulara verilecek sa¤l›k hizmetinin kalitesi, genel organizasyonun baflar›s› ile iliflkilidir. H›zl› ve etkin müdahale sistemin tüm basamaklar› için önemlidir. Kitlesel travma olaylar›nda hafif yaral›lar›n tedavileri sahada ve erken dönem tahliye edildikleri istasyonlarda tamamlanabilir. Ancak daha a¤›r yaral›lar için buralarda resüsitatif ifllemler ve hasar kontrol cerrahisi uygulanmal›d›r. ‹leri tedavi gerektiren olgular gerekli donan›ma sahip üçüncü basamak hastanelere sevk edilmelidir. Büyük hastanelerin günlük faaliyetleri devam ederken beklenmedik zamanlarda ortaya ç›kabilecek bu tür durumlar için önceden haz›rlanm›fl planlamalar›n›n olmas› gerekir. Ayn› anda çok say›da yaral›y› kabul etmek terminal hastaneler için bile zordur. Oluflabilecek karmaflada durumu zaten a¤›r olan yaral›lar zarar görebilir. Bu yaz›da Irak’ta meydana gelen bombal› bir eylem sonras›nda ambulans uçaklarla Türkiye’ye tahliye edilen hastalar›n Gülhane Askeri T›p Akademisi’ne nakli, karfl›lanmas› ve triyaj› esas al›narak toplu yaralanmada hastane organizasyonu tart›fl›ld›.

Superior Mezenter Arter (Wilkie’s) Sendromu: Olgu Sunumu

Superior mezenter arter (SMA) sendromu duodenumun ucuncu kitasinin aorta ve SMA proksimal kismi arasinda basiya ugramasi sonucu ortaya cikan ve nadir gorulen bir klinik tablodur. Belirgin kilo kaybi ile birlikte giden bulanti, kusma, anoreksiya, epigastrik agri ve siskinlik baslica yakinmalardir. Skolyozu olan hastalarda, yaniklarda, hareketsiz hastalarda ve idyopatik kilo kaybi olanlarda goruldugu bildirilmistir. Sik karsilasilan nedenlerle aciklanamayan hizli kilo kaybi, atipik ve tekrarlayan obstruktif bulgulari olan hastalarda SMA sendromu dusunulmelidir. Bu hastaligin tedavisinde yan yana duodenojejunostomi etkin, komplikasyonlari az ve kolay uygulanabilir bir cerrahi yontemdir. Bu yazida tani guclugu nedeniyle hastalarin yasam kalitesini uzun sure bozan superior mezenter arter sendromlu bir olgu sunulmus tani ve cerrahi tedavi yontemleri tartisilmistir