Manuk Manukyan

The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study

Purpose Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. Methods In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. Results Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). Conclusion SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.)

Giant tubular adenoma of the breast: a rare entity.

infiltrate like small nests and strands of tumor cells, which are usually of the signet ring type. This morphology may mimic other primary tumors, i.e., gastric carcinoma. The lack of dysplasia or atypia in adjacent colonic epithelium suggests a metastatic growth. Immunohistochemistry may also be useful in reaching the correct diagnosis. The GCDFP-15 and ER and PgR receptors are usually positive in MBC. Unlike the original tumor, this was also confirmed in our case. Although GI tract metastases are an underdiagnosed complication of BC, we suggest that an alert physician should always suspect this possibility whenever a patient with such a medical history experiences GI symptoms.

Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer

Purpose Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. Methods A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. Results According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS. Conclusion This study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.

Bilateral Nipple Leiomyoma

Cutaneous leiomyomas are benign smooth muscle neoplasms of the skin. They arise from vascular, arrector pili, genital, and areolar smooth muscles. The most common localizations of cutaneous leiomyomas are the extensor surfaces of the extremities and the trunk. To our knowledge, only few cases of one-sided nipple leiomyomas have been reported, but two-sided nipple leiomyomas have not been presented. For the first time, here, we report a bilateral nipple leiomyoma.

Evaluation of Factors Affecting the Type of Gallstone

The aim of this study is to determine the factors affecting the formation of the gallstone types of cholesterol and pigment stones. This descriptive and retrospective study comprised 164 patients who underwent cholecystectomy. Research data were obtained using a data collection form with 34 questions developed by the researchers based on the relevant literature. Statistical analysis of the data was made on SPSS 15.0 software using the percentage assessment method and chi-square test. Advanced statistical analysis of the data was performed using multivariate logistic regression. Cholesterol stone was found to form in individuals with anemia, those going through the menopause, and those consuming liquid oil and not undertaking exercise. The risk of pigment stone formation was found to be higher in the obese and those with liver disease and who do not consume milk. From the results of the study, it was determined that the dietary habits, chronic diseases, and lifestyle behaviors of individuals could be effective factors in the formation of cholesterol and/or pigment stone.

Solid pseudopapillary neoplasm of the pancreas: report of a rare case and review of the literature.

Abstract Solid pseudopapillary neoplasm, a rare primary neoplasm of the pancreas that typically affects young women, is a relatively indolent entity with favorable prognosis. We here report a 20-year-old young girl with solid pseudopapillary neoplasm who presented with mild dull abdominal discomfort without any significant laboratory findings. On MRI, a heterogenous mass was found at the distal pancreas. The patient underwent en-block distal pancreatectomy with splenectomy with the presumptive diagnosis of cystic neoplasm of the pancreas. The tumor was well-circumscribed, encapsulated, 5.5 cm in the greatest dimension and showed typical papillary and pseudopapillary structures. Capsular invasion was seen on focal areas. The patient was not given any adjuvant therapy and shows no sign of disease after six months follow-up. It is important to differentiate this tumor from other pancreatic neoplasms because this neoplasm is amenable to cure after complete surgical resection even in cases with capsular invasion, unlike malignant tumors of the pancreas. Öz Solid psödopapiller neoplazm, genç kadınlarda görülen ve iyi prognoza sahip, pankreasın nadir görülen bir tümörüdür. Bu sunumda, hafif karın ağrısı dışında tüm klinik ve laboratuvar bulguları normal olan, solid psödopapiller neoplazm tespit ettiğimiz 20 yaşındaki genç kadın hastayı sunmayı amaçladık. MR görüntülemesinde, distal pankreas yerleşimli 5,5 cm çapta kitle nedeniyle, pankreatik kistik neoplazi ön tanısıyla distal pankreatektomi ve splenektomi yapılan hastanın tümörünün mikrokopisinde tipik papiller ve psödopapiller yapılar vardı. Kapsül invazyonu fokal alanlarda bulunmakta idi. Hastaya ek tedavi verilmedi ve 6. ay klinik izleminde metastaz ya da rekürrens bulgusu saptanmadı. Olgudaki gibi histopatolojik olarak kapsül invazyonu bulgusu izlense bile (solid psödopapiller) komplet cerrahi rezeksiyon yeterli olduğu ve klinik olarak benign davranış gösterdiğinden, pankreasın malign tümörlerinden ayırt etmek önemlidir.

Non-spesifik karın ağrısı bulunan hastalarda kolonoskopik incelemenin yeri

Hastaların NSKA grubunda olup olmadığına karar vermek ciddi bir problemdir. Öncelikli olarak akut karın dışlanmalıdır. Bunu yapabilmek için fizik muayene sonrası pek çok laboratuar tetkiki ve radyolojik inceleme gereklidir. Karın ağrısının altında yatan patolojiyi ortaya koymak bazen uzun süreli takip gerektirir ve yine de altta yatan bir hastalığın atlanma olasılığı mevcuttur. De Dombal (3), 50 yaş üzeri NSKA ile başvuran hastalarda %10 sindirim sistemi malignitesi geliştiğini bildirmiştir.