Mehmet Ozdogan

Effect of Polylactic Acid Film Barrier on Intra-Abdominal Adhesion Formation

PURPOSE The aim of the present study was to evaluate the efficacy of an absorbable polylactic acid film barrier in preventing postoperative intra-abdominal adhesions, inflammation, and fibrosis in an animal model. METHODS Thirty Wistar albino rats were divided into treatment and control groups. All rats underwent laparotomy with subsequent cecal wall abrasion and abdominal wall injury. The treatment group had a polylactic acid film barrier placed between the cecal and abdominal injured surfaces while control group received nothing. The animals were sacrificed on postoperative day 21. Three observers graded the intra-abdominal adhesions and resected specimens for histological examination of fibrosis and inflammation. Fibrosis, inflammation, and adhesions were graded using a quantitative scoring system. RESULTS The treatment group showed significantly less adhesions and inflammation (P < 0.05), while there was no significant difference in the amount of fibrosis. Statistical correlations between adhesion-inflammation, adhesion-fibrosis, and inflammation-fibrosis were also significant (P < 0.05). CONCLUSIONS Placement of polylactic acid film barriers between injured surfaces is associated with a significantly reduced rate of postoperative adhesions and inflammation. This may be a promising result for reducing the morbidity and costs related to postoperative adhesions.

Thrombolysis via an operatively placed mesenteric catheter for portal and superior mesenteric vein thrombosis: report of a case.

Mesenteric venous thrombosis (MVT) is a catastrophic form of mesenteric vascular occlusion. In the absence of peritoneal signs, anticoagulation therapy should be started immediately. For selected patients, thrombolysis through the superior mesenteric artery (SMA), jugular vein, or portal vein via a transhepatic route might be successful; however, exploratory laparotomy is mandatory when peritoneal signs develop. We report a case of acute MVT associated with protein C and S deficiency, treated successfully by limited bowel resection and simultaneous thrombolytic infusion, given via an operatively placed mesenteric vein catheter.

Should the thyroid bed be drained after thyroidectomy

BackgroundAlthough routine drainage of the thyroidectomy bed is not an evidenced-based practice, most surgeons still employ routine drainage with an effort to monitor postoperative bleeding. The aim of this study is present our experience on draining and not draining the thyroidectomy bed.Materials and methodsRecords of 1,066 patients who underwent thyroid surgery were evaluated retrospectively.ResultsThe rates of the re-operations due to life-threatening postoperative hemorrhage and wound infections were higher in the drained group. The average postoperative hospital stay of the drained group was significantly longer than that of the non-drained group.ConclusionRoutine drainage of the thyroidectomy bed is not effective in decreasing the rate of postoperative complications after thyroid surgery, and it causes a prolonged hospital stay and surgical site infection.

Amebic Perforation of the Colon: Rare and Frequently Fatal Complication

Amebic colitis perforation is a rare clinical form of amebiasis characteristically associated with high morbidity and mortality. We here present our series of eight patients with amebic colitis perforation. These patients represent 5% of 150 patients hospitalized during the same period for chronic amebic colitis. Only 50% of our patients had a correct preoperative diagnosis, and signs of generalized peritonitis such as rebound tenderness or muscular rigidity were not as common as might have been expected. Our mortality rate was 50% despite aggressive surgical treatment. Every effort should be made to have an early diagnosis, which would lead to early treatment with antiamebic agents, earlier and more limited surgery, and improved survival of these patients.

Antegrade Jejunojejunal Intussusception After Roux-en-Y Esophagojejunostomy as an Unusual Cause of Postoperative Intestinal Obstruction: Report of a Case

Abstract Postoperative intestinal obstruction in adults is rarely caused by intussusception. A case of antegrade jejunojejunal intussusception that occurred after Roux-en-Y esophagojejunostomy is described, followed by a discussion of the literature on this unusual entity.

Plasma total anti-oxidant capacity correlates inversely with the extent of acute appendicitis: a case control study

BackgroundThe role of free oxygen radicals in inflammatory conditions is well known. Free radicals cause lipid peroxidation of cellular membranes resulting in cell death. The purpose of this study was to investigate the levels of total anti-oxidant status (TAS), as a marker of anti-oxidant defense system and malondialdehyde (MDA), as a marker of oxidative stress, in the plasma of patients with acute appendicitis.MethodsFifty-one adult patients with a median age of 31 years who underwent operations with a preoperative diagnosis of acute appendicitis were included in this prospective study. Blood samples for C-reactive protein (CRP), MDA and TAS were collected preoperatively. Groups were compared by using the Mann-Whitney U test.ResultsThere were 27 patients with acute phlagmenous appendicitis and 19 patients with advanced appendicitis (10 gangrenous and 9 perforated appendicitis), while 5 negative explorations were documented. No significant differences in WBC counts and MDA levels between groups were encountered. Plasma CRP was significantly higher in patients with perforated appendicitis, but not in the other groups. In advanced appendicitis group, TAS level was significantly lower than the other groups. On the other hand, plasma TAS level in acute phlagmenous appendicitis group was significantly higher.ConclusionA decrease in plasma total anti-oxidant capacity might be a predictor of the progression of inflammation to the perforation in acute appendicitis.

The management of penetrating abdominal trauma by diagnostic laparoscopy: A Prospective non-randomized study

BACKGROUND Penetrating abdominal trauma (PAT) has been traditionally treated by exploratory laparotomy (EL). The aim of our study was to examine the use of diagnostic laparoscopy (DL) in the management of hemodynamically stable patients with PAT. METHODS A prospective study was performed to compare the outcomes of hemodynamically stable patients with suspected intra-abdominal injuries due to abdominal stab wounds who underwent either EL or DL. Data extracted for analysis included demographic information, operative findings, rates of non-therapeutic laparotomy, operation time, length of hospital stay, mortality, and postoperative complications. RESULTS Fifty-two hemodynamically stable patients were admitted to the trauma service. There were 45 male (86.5%) and 7 female (13.5%) patients. The average age was 34.5 years-old (18-60). 26 (50%) patients underwent EL, and 26 (50%) patients underwent DL. Re-exploration by laparotomy was required in 9 of the 26 cases (34.6%). Patients who underwent DL had significantly shorter hospital stays (1.82±0.63 days vs. 5.4±2.1 days, p<0.05) and shorter operation time (17.9±6.38 vs. 68.4±33.2 min, p<0.05) than patients who underwent EL. CONCLUSION Selective use of DL in the hemodinamically stable penetrating trauma patients effectively decreased the rate of negative laparotomies, minimized morbidity, and decreased hospital stay.

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.

Mild Hypothermia Improves Survival During Hemorrhagic Shock Without Affecting Bacterial Translocation

Background: Accidental hypothermia in patients with hemorrhagic shock (HS) is associated with increased mortality. However, experimental mild and moderate hypothermia has beneficial effects. The mechanisms for beneficial effects of hypothermia have not been completely understood. Therefore, the aim of this study was to investigate the effect of hypothermia on survival, bacterial translocation (BT), and remote pulmonary injury in a controlled HS model in rats. Methods: HS was achieved by blood withdrawal through femoral vein. Rats in the normothermia group (group I) were maintained at 37°C. Mild hypothermia group (group II) was observed at 32°C that was spontaneously induced by exposure to ambient temperature. Moderate hypothermia of 28°C was actively induced by external cooling in group III for 90 min. Survival and neurological deficit scores (NDS) were recorded at 24th hr. Mesenteric lymph nodes, liver and spleen samples were collected. Myeloperoxidase (MPO) and malondialdehyde (MDA) levels were measured in lung tissue. Results: Blood pressure significantly increased in hypothermia groups. Mild hypothermia significantly increased survival. No difference was found in BT rates in groups. Hypothermia was found to significantly decrease the NDS points in group III, compared to group I. There was no difference in lung tissue MPO levels among groups. Lung tissue MDA levels increased significantly in groups II and III. Conclusions: Mild hypothermia improved blood pressure, survival, and neurological outcome with a possible detrimental effect on pulmonary ROS production during HS in rats. These effects of hypothermia are not associated with BT.

Metastasis from prostatic carcinoma causing acute appendicitis: Report of a case

INTRODUCTION Metastasis induced acute appendicitis is extremely rare. PRESENTATION OF CASE We present a 72-year-old man who presented with typical signs of acute appendicitis. He underwent appendectomy and was successfully discharged without any complication. Histopathological examination diagnosed the metastasis to appendix from prostatic cancer. DISCUSSION Cancers of the appendix are rare and usually diagnosed incidentally in approximately 1% of all appendectomies. The rate of perforation was found to be higher in metastasis induced acute appendicitis in comparison with simple acute appendicitis in the literature. Tumors other than primary appendix tumors when present in the appendix are easily recognized as metastatic, requiring immunohistochemical studies. CONCLUSION Metastasis induced acute appendicitis should be considered as part of the differential diagnosis when a oncologic patient presents with signs of acute appendicitis.