Mehmet Aziret

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus.

Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis.

AIM To assess the reliability and practical applicability of the widely used Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems in patients with suspected acute appendicitis. METHODS Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group. Patients were divided into two groups. appendicitis group (Group A) consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis, and non-appendicitis group (Group N-A) consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively. The operative findings for the patients, the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms. RESULTS One hundred and thirteen patients with suspected acute appendicitis were included in the study. Of the 113 patients (62 males, 51 females), the mean age was 30.2 ± 10.1 (range 18-67) years. Of the 113 patients, 94 patients underwent surgery, while the rest were followed non-operatively. Of the 94 patients, 77 patients were histopathologically diagnosed with acute appendicitis. Our study showed a sensitivity level of 81% for the Alvarado system when a cut-off value of 6.5 was used, a sensitivity level of 83.1% for the Ohmann system when a cut-off value of 13.75 was used, a sensitivity level of 80.5% for the Eskelinen system when a cut-off value of 63.72 was used, and a sensitivity level of 83.1% for the RIPASA system when a cut-off value of 10.25 was used. CONCLUSION The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.

Minimizing Shoulder Pain Following Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Trial

UNLABELLED Abstract Background: Postoperative abdominal and shoulder pains after laparoscopic cholecystectomy (LC) are the most frequent complaints and are related to delayed recovery. There is a strong correlation between the residual gas volume and the severity of pain following various laparoscopic procedures. We aimed to investigate the effects of aspiration of residual gas on postoperative outcomes and pain following LC. SUBJECTS AND METHODS Patients were randomly assigned to either the active gas reduction group (Group 1, n=105) or the control group (Group 2, n=95). After completion of the operative procedures, residual gas was aspirated with a flexible cannula in Group 1. In Group 2, gas release from the abdomen was performed using the port site by opening the gas tap only. The demographic data, operation time, insufflated CO2 volume during the operation, hospitalization period, and time to return to daily activities were recorded. Postoperative shoulder and abdominal pain assessment was performed using a numerical pain intensity scale (NPIS) at 1 hour, 24 hours, 3 days, and 7 days postoperatively. RESULTS There was no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. NPIS scores for shoulder pain at 1 hour and 24 hours were significantly lower in Group 1 (P=.001 and P=.021, respectively). However, there were no significant differences in the NPIS scores for shoulder and abdominal pain following 24 hours. No differences were found in the hospitalization duration and time to return to daily activities data (P>.05). CONCLUSIONS Active aspiration of the residual gas just before the removal of the trochars is a simple procedure and leads to a more comfortable hospital stay for patients.

Pancreatic schwannoma: A rare case and a brief literature review

Highlights • Pancreatic schwannoma is an extremely rare tumor.• Pancreatic schwannoma was stained with S-100 and vimentin.• The preoperative diagnosis of pancreatic schwannoma is an important in terms of choose surgery method.• Surgical resection is a curative treatment method for pancreatic schwannoma.

The effect of laparoscopic sleeve gastrectomy on morbid obesity and obesity-related comorbidities: A cohort study

OBJECTIVE Bariatric surgery with multidisciplinary management is a more effective method to treat morbid obesity and obesity-related comorbidities compared with nonsurgical treatments. Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch in the super-obese population. In the past few years, however, LSG has been performed as a definitive procedure because of its promising early and midterm results. The aim of this study is to evaluate the efficacy of our initial LSG series of 73 patients on excess weight loss (EWL) and resolution of obesity-related comorbidities in short-term follow-up. MATERIAL AND METHODS From March 2013 to May 2014, 78 morbid obese patients with an average body mass index (BMI) of 46.3 kg/m(2) underwent LSG. There is a 9-month follow-up period on average. Five patients were excluded from the study, because they could not be contacted. Comorbidities, preintervention BMI, glucose, HbA1c, and lipid profiles were recorded at 1, 6, and 12 months postintervention. RESULTS After the surgery, the percent EWL was 58%. The mean serum glucose level, HbA1c level, LDL-cholesterol level, triglyceride level, insulin, and insulin resistance decreased significantly and the mean HDL-cholesterol level increased. CONCLUSION For the resolution of comorbidities, LSG may be used as an effective bariatric and metabolic surgery.

Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü

Tiroidektomi sonrasi postoperatif hipokalsemi ve rekurren laringeal sinir yaralanmasi, en sik karsilasilan komplikasyonlardir (1,2). Diger onemli komplikasyonlar arasinda superior laringeal sinir hasari, infeksiyon, havayolu zedelenmesi ve kanama sayilabilir. Tiroid cerrahisinde kabul edilebilir kalici hipokalsemi ve vokal kord paralizisi oranlari % 1-2’dir (3). Gecici hipokalsemi literaturde % 6-50 arasinda genis bir insidans araliginda bildirilmektedir (4-6). Literaturde tiroidektomi sonrasi rekurren sinir yaralanmalari % 0,3-14 arasinda degismekle beraber, deneyimli cerrahlar tarafindan yapildigi zaman bu oran % 0.2-0.3 ’lere yaklasmaktadir (7,8). Literaturde gecici sinir yaralanmasi orani, bir anlamda sinir iyilesmesi orani % 50-86 arasinda degismektedir (9-11). Tiroid cerrahisi sonrasi postoperatif komplikasyonlar hastanede kalis suresini ve biyokimyasal tetkik ihtiyacini arttirdigindan tiroidektominin maliyetini yukseltmektedir. Bu calismada tiroidektomi komplikasyonlari ve cerrahin deneyimi ile komplikasyonlar arasindaki baglantiyi arastirmak amaclandi.

Laparoscopic sleeve gastrectomy on a morbidly obese patient with situs inversus totalis: A case study and systematic review of the literature.

INTRODUCTION Situs inversus totalis (SIT) is a condition where the internal organs or organ systems are located contra-laterally to the norm, forming a mirror image. Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure that has become more common over the last two decades. We report on a morbidly obese patient with SIT who underwent a successful LSG. CASE REPORT A 54-year-old female morbidly obese patient (136k; 167cm; body mass index (BMI): 48kg/m2) was admitted for bariatric surgery. She had congenital SIT, a history of open cholecystectomy and, despite implementing the suggestions of the dietitian and endocrinologist, she had failed to lose weight. A standard LSG was performed successfully using the French method. The patients postoperative course was uneventful and she was discharged on the 5th postoperative day. She is now in the 4th month with a weight loss of 30kg. DISCUSSION SIT is a rare congenital condition, occurring in 1/10,000 to 1/50,000 live births. Organ function is generally normal, although it may sometimes be accompanied by respiratory or cardiovascular anomalies. Although undertaking LSG on morbidly obese patients with SIT may seem a daunting proposition at first, experienced laparoscopic surgeons can manage this operation with success. CONCLUSION Although SIT is a rare congenital condition, LSG can be performed safely and effectively.

Which Suture Material is Optimal for Pancreaticojejunostomy Anastomosis? An In Vitro Study

ABSTRACT Background: Which suture material is optimal for pancreaticojejunostomy (PJ) anastomosis is a matter of debate with contradictory results. The aim of the present in vitro study was to determine the effects of pancreatic juice, bile, and their mixture on different suture materials in terms of breaking strength and disintegration. Material and Methods: Four suture materials, silk, polyglactin 910, polydioxanone, and polypropylene, were tested in pancreatic juice, bile, and their mixture. Determination of breaking strength and disintegration under electron microscope for each suture material was done on days 0, 3, 6, and 10. Results: The breaking strength of polyglactin 910 and silk was significantly higher than polypropylene and polydioxanone (p < .05). Polyglactin 910 significantly lost its breaking strength with time in pancreatic juice, bile, and their mixture (p < .001). The breaking strength of each type of suture did not significantly alter in pancreatic juice, bile, and their mixture at the baseline measurement and at the end of the experiment (p > .05). No obvious disintegration has been observed under electron microscope in the architecture and appearance of suture materials after days of exposure to pancreatic juice, bile, and their mixture. Conclusions: None of the suture materials was disintegrated on exposure to pancreatic juice, bile, and their mixture. Polyglactin 910 has the highest breaking strength and significantly loses its strength throughout the experiment but still remains higher than other suture materials. Polypropylene, polydioxanone, and silk showed less variation across the incubation period.

Efficacy of Pentoxifylline and Tadalafil in Rat Model of Ischemic ColITIS

ABSTRACT Objective: The aim of this study is to investigate the efficacy of tadalafil against pentoxifylline in rat model of ischemic colitis (IC). Material-Methods: Thirty-two Wistar albino rats were subjected to laparotomy and left colon devascularization to create an IC model and then randomly placed into four groups. Group-1 (sham group) was administered 0.9% NaCl following laparotomy, group 2 (control group) was administered 0.9% NaCl following induced IC, group 3 was given pentoxifylline (n = 8), and group 4 was given tadalafil. On the third day; macroscopic findings, Gomellas ischemic area and Wallace scoring, histopathological analysis, and Chiu scoring were performed, and malondialdehyde (MDA) measurement in ischemic colon tissue was carried out through chemical analysis. Results: Significant differences were observed in acidic fluid, bowel dilatation, and serosal change (p < .05). The ischemic area measured 63.3 mm2 in the control group, 2.8 mm2 in the pentoxifylline group (p = .0001), and 2.4 mm2 (p = .0001) in the tadalafil group. A significant difference was seen between the sham group and the control and pentoxifylline groups (p < .01), in terms of Wallace score and Chiu classification. Similarly, a significant difference was determined between the control group and pentoxifylline and tadalafil groups (p < .01), but no significant difference was established between the pentoxifylline group and tadalafil group (p = .33). MDA measurement was found on an average to be 63.7 in the control group, 22.7 in group 3 and 22.8 in group 4 (p = 001). Conclusion: Although tadalafil is superior to pentoxifylline, both drugs are considered to have positive effects.

Abolition of anti-adhesiogenic effect of heparin by protamine sulfate

OBJECTIVE Intraabdominal adhesion is a frequently encountered condition after surgery and can end up in important complications. The objective of this study is to test whether the antiadhesiogenic effect of heparin could be antagonized by administration of protamine in a rat model. MATERIAL AND METHODS A laparotomy with caecal abrasion model was used in 40 Wistar rats. Single dose of 1 cc saline was injected subcutaneously (SC) in one group (control); 50 IU/kg heparin was injected SC in Group 2; 50 IU/kg protamine SC given to Group 3; 50 IU/kg heparin and 50 IU/kg protamine was given SC to Group 4 for 3 consecutive days. Each group consisted of 10 rats. All rats were sacrificed one week later for macroscopic and microscopic examination and they were scored for adhesion using Mazuji adhesion scale. RESULTS There was significant difference in the heparin group with respect to Mazuji adhesion score, histopathological score (fibrosis, inflammation and vascular proliferation) and S-100 staining (P < 0.05). Additionally, the inflammation was more severe in the mucosa and submucosa compared to serosa in the heparin group (P < 0.01). With respect to fibrosis and vascular proliferation, apart from submucosal fibrosis, heparin group was statistically superior to the control group by means of each layer (P < 0.01). CONCLUSION It seems that heparin is effective preventing adhesion in this rat model. Abolition of heparins antiadhesiogenic effect by protamine administration is likely exerted via its antithrombine activity. Clinical application of our findings in intraabdominal surgery warrants further investigation.