Oge Tascilar

Superiority of Asymmetric Modified Limberg Flap for Surgical Treatment of Pilonidal Disease

PurposeCases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period.MethodsIn this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6–44) months after wide excision plus classic Limberg flap (Group 1, n = 35) and after asymmetric modified Limberg flap closure (Group 2, n = 33).ResultsThere were significantly more macerations in Group 1 (P < 0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P = 0.028). We noted that as a result of these complications, time to suture removal (P = 0.001), discharge from hospital (P = 0.001), and time off from work (P = 0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P = 0.493).ConclusionsThe deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.

Evaluation of a New Hemostatic Agent Ankaferd Blood Stopper in Experimental Liver Laceration

Introduction: Hemorrhage is a leading cause of death after trauma. It is also the major cause of operating room deaths among patients who undergo liver surgery. Various techniques and materials have been attempted to manage bleeding, but a standard method has not been defined yet. We studied the hemostatic effects of Ankaferd Blood Stopper on liver injury in comparison with regenerated oxidized cellulose. Materials and Methods: Thirty Wistar albino rats underwent partial hepatic laceration by scissors. The animals were randomized to the treatment of resected surface with either Ankaferd Blood Stopper® (ABS, n = 11) or regenerated oxidized cellulose (Surgicel®, n = 9), or were left untreated (controls, n = 10). All the animals were resuscitated with lactated Ringers solution at 3.3 ml/min/kg to a mean arterial pressure (MAP) of 100 mmHg. Survival time, total blood loss, resuscitation volume, and MAP were recorded for 30 min or until death. The rats that were alive at the end of 30 min were sacrificed with blood withdrawal from catheters. Results: Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (p =.0001). There were no significant differences between the ABS and the Surgicel groups in survival (p =.91). Application of ABS and Surgicel was associated with a significant reduction in blood loss compared to controls (p =.008), with no significant differences between active treatment groups (p =.74). The resuscitation volume was not different. Conclusions: ABS is as effective as Surgicel in achieving hemostasis following partial liver excision in an experimental rat model.

Complications of total thyroidectomy performed by surgical residents versus specialist surgeons

PurposeSurgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups.MethodsBetween April 2001 and May 2007, 144 patients underwent TT at our hospital. For 75 operations, the primary surgeon was a resident under the direct supervision of the attending surgeon, and for 69 operations, the primary surgeon was the experienced attending surgeon. Pre-and postoperative vocal cord examinations and serum calcium level evaluations were carried out in all patients.ResultsThe rates of temporary (unilateral) recurrent laryngeal nerve (RLN) palsy were 2.66% vs 2.17% after TT performed by the residents vs the attending surgeon, respectively. There were no significant differences in the incidences of temporary hypoparathyroidism (20% vs 20.28%), permanent (unilateral) RLN palsy, hematoma, infection, seroma, and incidental parathyroidectomy between the two groups.ConclusionThe complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance.

The effect of sildenafil on an animal model for ischemic colitis.

Introduction Sildenafil both enhances vasodilatation by relaxing the smooth muscle in the vessels and inhibits platelet aggregation. We have therefore examined the potential benefits of sildenafil on an animal model for ischemic colitis (IC). Methods Twenty-eight female Wistar albino rats weighing 250–300xa0g were randomized into three experimental groups as follows: in Group 1, animals were sham operated (nxa0=xa08) and received tap water; in Groups 2 and 3, the rats underwent a standardized surgical procedure to induce IC (nxa0=xa010 in each group). Group 2 animals served as the controls, receiving only tap water, while Group 3 animals received 10xa0mg/kg sildenafil per day as a single dose for a 3-day period. All animals were sacrificed 72xa0h after devascularization. To determine the severity of the ischemia, we scored the macroscopically visible damage, measured the ischemic area and scored the histopathology. Tissue malondialdehyde levels were also evaluated. Results The mean area of ischemic changes were 116.80xa0±xa0189.93 and 0.55xa0±xa01.01xa0mm2 in Group 2 and 3 animals, respectively (pxa0=xa00.0001), while the macroscopically mean visible damage score decreased to 0.66xa0±xa00.70 (pxa0=xa00.0001) for Group 3 animals. The Chiu scores were 0.00, 3.80xa0±xa00.91 and 2.66xa0±xa01.00 in Group 1, 2 and 3 animals, respectively. There was a statistically significant difference between Group 2 and 3 animals (pxa0=xa00.017). Conclusions Our findings support the view that sildenafil leads to a improvement in IC due to its well-known effects on the vascular smooth muscle and on the microcirculatory hemodynamics.

Simvastatin Improves Wound Strength after Intestinal Anastomosis in the Rat

BackgroundSimvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor commonly known as a cholesterol-lowering drug with additional pleiotropic effects. Also, it is demonstrated that it prevents postoperative peritoneal adhesions in rat. This study was designed to assess its effects on the healing process of colonic anastomosis.MethodsThirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with simvastatin and the control group received only tap water instead. The rats were killed 3 and 7xa0days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline content, histopathology, and biochemical analysis.ResultsCompared to the control group, simvastatin-treated rats displayed a higher bursting pressure (pu2009<u20090.001) and anastomotic hydroxyproline content (pu2009<u20090.05). Simvastatin treatment leads to a significant decrease in malondealdehyde levels (pu2009<u20090.05) and increase in paraoxonase activity (pu2009<u20090.001) at both time points. Histopathological analysis revealed that simvastatin administration leads to a better anastomotic healing in terms of reepithelialization, decreased granuloma formation, reduced ischemic necrosis, and inflammatory infiltration to muscle layer.ConclusionClinically relevant doses of simvastatin do not have a negative impact on colonic anastomosis but improve intestinal wound healing in rats.

Fade or fate. Seroma in laparoscopic inguinal hernia repair.

BackgroundPostoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery.MethodsThirty patients with unilateral inguinal hernia who had a hernia sac of >4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month.ResultsUSG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups.ConclusionsSuperficial USG is a beneficial tool in differentiating early recurrence or seroma in patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma.

Does sildenafil reverse the adverse effects of ischemia on ischemic colon anastomosis: yes, 'no'.

INTRODUCTIONnSildenafil may lead an improvement in anastomotic healing of ischemic left colon anastomosis.nnnMETHODSnThirty-six male Wistar albino rats were randomized into four experimental groups (n=9 in each group). In group 1, a well-perfused left colonic segment was transected, and free ends were anatomosed. In groups 2, 3 and 4 animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. Group 2 animals received only tap water. In groups 3 and 4 animals received 10mg/kg/body-weight and 20mg/kg/body-weight sildenafil, single dose a day during 4 days, respectively. Rats were sacrificed on day 4 following operation. Anastomotic integrity, intra-peritoneal adhesion scores, anastomotic bursting pressures and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed.nnnRESULTSnThere was no statistically significant difference among groups with respect to anastomotic integrity (p=0.142) but ischemia decreased the anastomotic bursting pressure. The mean bursting pressure values were 78.8+/-24.1, 43.3+/-26, 55.1+/-32.4, and 43.3+/-20.4 in groups 1, 2, 3, and 4, respectively. Group 1 had the highest values whereas; there was no statistically significant difference between groups 1 and 3. There was no statistically significant difference among groups 2, 3, and 4 with respect to tissue hydroxyproline levels, adhesion scores and the Chiu scores. The highest inflammatory cell presence in the granulation tissue was detected in group 2, whereas the lowest was detected in group 4 (p=0.0001). The highest fibroblast infiltration in the granulation tissue was detected in group 1 (p=0.045).nnnDISCUSSIONnOur results showed that 10mg/kg sildenafil decreased the adverse effects of ischemia on the healing of ischemic left colon anastomosis. Additional investigations are needed to confirm the effects of phosphodiesterase-5 inhibitors in ischemic colon anastomosis models.

Diagnostic adequacy of surgeon‐performed ultrasound‐guided fine needle aspiration biopsy of thyroid nodules

Surgeon‐performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention.

N-acetyl-cysteine improves anastomotic wound healing after radiotherapy in rats.

ABSTRACT Aim: This study was designed to determine the effects of intraperitoneally or orally administered N-acetylcysteine (NAC) on anastomotic healing of irradiated rats. Methods: Thirty-two male Wistar albino rats were randomized into four groups containing 8 rats each: I; standard resection plus anastomosis, II; radiation plus standard resection plus anastomosis, III; radiation plus standard resection plus anastomosis plus oral NAC, IV; radiation plus standard resection plus anastomosis plus intraperitoneal NAC. Four types of assessment were performed: bursting pressure, hydroxiproline (OHP) content, histopathology, and biochemical evaluation, including serum malondialdehyde (MDA), advanced oxidation protein products (AOPP), reduced glutathione (GSH) and superoxide dismutase (SOD) activities. Results: Group comparisons demonstrated that bursting pressure was significantly higher in NAC treated rats. The mean tissue OHP concentration in the anastomotic tissue was significantly lower in irradiated rats (group II) than in the other groups. NAC treatment caused increased activity of SOD and GSH. In contrast, MDA levels were found to be decreased in groups III and IV. Histopathological analysis revealed that NAC administration, either orally or intraperitoneally, leads to a better anastomotic healing in terms of reepithelialization, perianastomotic fibrosis, ischemic necrosis, and muscle layer destruction. Conclusion: The present study supports the hypothesis that NAC administration alleviates the negative effects of radiotherapy on anastomotic healing. Nevertheless, the underlying mechanisms responsible for this protective effect is unknown today.

The Effects of Resveratrol on the Healing of Left Colonic Anastomosis

Introduction: Resveratrol (RSV) is a natural polyphenolic compound found in grape skins and the red wine which improves histological reorganization of the regenerating tissue in dermal wound healing. Since anastomotic healing possesses paramount importance to prevent complications in colorectal surgery, the present study is aimed to evaluate the effect of RSV on the healing of experimental left colonic anastomoses. Methods: Thirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with RSV and the control group received tap water instead. The rats were sacrificed 3 and 7 days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline (OHP) content, histopathology, and biochemical analysis. Results: Compared to the control group, the RSV-treated rats displayed a higher bursting pressure (p <. 001) and anastomotic OHP content (p <. 05)]. RSV treatment leads to significant increase in PON activity at both time points and decrease in malondialdehyde levels on postoperative day 3 (p <. 001). Histopathological analysis revealed that RSV administration leads to a better anastomotic healing in terms of mucosal ischemia, neovascularization, reepithelialization, fibroblast, and lymphocyte infiltration. Conclusion: The study results suggest that exogenous RSV administration exerts a positive effect on experimental colonic wound healing in the rat. Although the precise cellular mechanisms by which RSV enhances anastomotic wound healing is not clear, stimulation of neovascularization, generation of collagen synthesis, inhibition of overinflammation, and restriction of oxidative injury seems to be of paramount importance.