Sefik Hasukic

The Role of Fibrin Glue Polypropylene Mesh Fixation in Open Inguinal Hernia Repair

ABSTRACT The aim: of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. Material and Methods: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients – Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery–the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient’s ability to return to regular activities were followed for 3 months. Results and discussion: Statistically significant difference in the duration of surgery, pain intensity and complications (p<0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh–fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. Conclusions: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.

Efficiency of Local Antiseptic Alkosol (Ethanol, Isopropanol-30g and Ortophenilphenol) and Povidone Iodide on the Incidence Of Surgical Site Infection After Inguinal Hernioplasty.

Background: The risk of wound infection after elective inguinal hernia repair depends on several factors. One of the most important factors is the preoperative skin preparation. The use of antisepsis is performed to reduce the risk of surgical site infections (SSIs) and to remove causing organisms. This work compares two different agent forms for preoperative skin preparation to prevent SSIs. Objectives: The objective of the study is comparing the effects of two different agents used for preoperative skin preparation and prevention of SSIs. Material and methods: 100 adult patients were divided and randomized into two groups, each containing 50 patients. Both groups included patients that are scheduled for elective Lichtenstein inguinal hernia repair. The first group includes patients whose skin preparations were done with povidone iodine (PI) only. The second group included patients that are treated with two antiseptics; Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide. Alkosol is applied before the induction of anesthesia. The povidone iodide is applied after Alkosol has evaporated. The presence of bacterial growth in the wound was determined 24 and 48 hours after operation. Swabs were used to take samples, which were then cultivated to check for bacterial growth. The presence of infection was also determined by the following criteria: pain or tenderness, induration, erythema, local warmth of the wound etc. Results: The surgeon or clinician declared that after 24 hours the wound was infected in 20 patients in the control group and in 22 patients after 48 hours. In the Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide group infection was declared in only 3 patients after 24 hours. Discussion: Compared to the use of providone only, the use of Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide has many advantages and was associated with lower rates of SSIs following clean surgery. A larger trial is warranted in order to add definitive and more conclusive data to the current evidence base.

Upper Urinary Tract Urothelial Cancer in Croatian and Bosnian Endemic Nephropathy Regions.

Objectives Endemic nephropathy (EN) is a chronic tubulointerstitial renal disease associated with increased incidence of upper urinary tract urothelial cancer (UTUC) occurring predominantly in geographically limited areas in villages along big Danube river. Based on results obtained by the research it is confirmed that aristolochic acid is causative agent of endemic nephropathy (EN). Aim The aim of this study was to determine characteristics of UTUC in two endemic areas and analyze trends in 5-year period. Methods This study included all patients with UTUC with or without synchronous/metachronous urothelial cancer in urinary bladder, from Croatian and Bosnian EN and non-EN regions. We analyzed archival data bases from all patients with UTUC who were admitted and operated in Department for surgery and urology, General Hospital Josip Bencevic Slavonski Brod in the time period between 2005 and 2010. Analyzed groups of patients were divided and compared as EN group (that includes patients from Croatian and Bosnian EN region) and non-EN group (that includes patients from Croatian and Bosnian non-EN region). All surgical specimens were processed according to standardized pathological procedures. Results Comparing patients basic characteristics from Croatian and Bosnian EN region there was no significant difference in gender (females were more frequently affected in both EN regions, p=0.99) or age (p=0.43) of patients. We found higher blood levels of urea and creatinine in group of patients from Croatian EN region when compared with group of patients from Bosnian EN region but the difference was not statistically significant (p=0.79 and p=0.44, respectively). In patients from Croatian EN group Hemoglobin levels were significantly lower than levels from Bosnian EN region patients, p=0.0049. In group of patients from Bosnian EN region ureteral tumors were more frequently observed than in Croatian group of patients, when compared with renal pelvis tumors but the difference was not statistically significant (p=0.258). Conclusion Our data showed some differences in tumor localization between to investigated, relatively nearly situated, EN regions in Croatia and Bosnia. Statistically significant difference in hemoglobin levels between Croatian and Bosnian EN regions that should be further analyzed to give some reasonable explanation.

Impact of Preoperative Anxiety in Patients on Hemodynamic Changes and a Dose of Anesthetic During Induction of Anesthesia

Objectives: Each surgical patient is preoperatively, intraoperatively and postoperatively exposed to stress. The aim of this study was to determine the existence of preoperative anxiety, and to determine its impact on hemodynamic parameters (blood pressure, heart rate) in patients and dose of anesthetics during induction of anesthesia. Methods: A prospective clinical study conducted at the Department of Anesthesiology and Reanimation and Surgery Clinic of University Clinical Center Tuzla (UCC) in the period May 2012. to January 2015. The 80 patients were analyzed which were planned for and done an elective cholecystectomy surgery or herniectomy surgical intervention. Preoperative anxiety was measured with the help of Spielberg test and evaluation of depth of anesthesia was performed with BIS monitoring. Results: The results showed that all patients had some degree of preoperative manifest anxiety. Average values of mean arterial pressure, preoperatively and after the induction of general anesthesia, differed for 15,4 mm/Hg, but were not observed significant association between Spielberg score and differences in blood pressure. Preoperative anxiety is a significant predictor of administered dose of anesthetic. Each additional score on Spielberg scale reduces the dose of anesthetic for 0,304 mg/kgTT. Conclusion: Adequate assessment of preoperative anxiety and undertaking of certain steps to reduce it can assist in accurately determining the required dosage of anesthetic for the introduction of general anesthesia.

Influence of Prognostic Factors for Recurrence of Adenocarcinoma of the Stomach

Introduction: Gastric cancer is the second most important neoplasm in the world. Surgical resection is the treatment of choice for gastric cancer, and recognized by the International Union against Cancer (International Union Against Cancer – UICC) TNM classification of the parameters of the tumor and lymph node. Prognostic factors related to characteristics of the tumor by histopathologic findings have an impact on the planning of the operation. According to the results of most studies it is possible to predict survival and recurrence based on histological type and TNM classification of tumors on the one hand and the surgical procedure on the other. Aim: The aim of the research was to analyze prognostic factors that influenced the frequency of recurrence in gastric surgery patients. Patients and methods: The five year study covered a population of 100 treated patients of adenocarcinoma of the stomach at the Department of Surgery, University Clinical Center Tuzla. The first group were characteristics of tumors in patients with gastric adenocarcinoma. Lymphadenectomy and splenectomy, types of surgery were the second group of prognostic factors. Results: Histological type and TNM stage of tumor as prognostic factors had a significant impact on local tumor recurrence. The type of surgery had no statistically significant value for tumor recurrence (p = 0.7520). Conclusion: Statistical analysis of prognostic factors related to histopathologic characteristics of tumors and the type of surgery gave the results that had an impact on recurrence in gastric surgery patients. The most important prognostic factors were TNM stage of tumor and histological type of tumor that influenced the incidence of recurrence.

Laparoscopic Wedge Resection of Gastric Stromal Tumor (GIST)

Introduction: Laparoscopic treatment in general, in recent age has proven that it is well associated with low morbidity, mortality, fast recovery, less pain and sound oncologic outcomes. Recent reports from the National Comprehensive Cancer Network (NCCN) GIST Task Force and the GIST Consensus Conference under the auspices of The European Society for Medical Oncology (ESMO) show that laparoscopic resection may be used for small gastric GISTs (< 2 cm in size). Case report: We report, all the benefits of laparoscopic approach which include short hospitalization, less pain, better cosmetic effect and good oncological outcome, in this case report of 60 year old female patient with gastric GIST larger than 2 cm.

Use of a circular stapler for Billroth I anastomosis after distal gastrectomy.

Staplers are widely used in gastrointestinal surgery. We used a circular stapler to establish gastroduodenal anastomosis after distal gastrectomy in a recent case. After separating the stomach from the duodenum, we anastomosed the posterior wall of the stomach to the duodenum by introducing the circular stapler through the part of the stomach that was to be resected. Then we separated the distal part of the stomach with a linear stapler, and so completed the distal gastric resection. The advantages of this technique are that it is simple and safe.

THE IMMUNE RESPONSE OF THE ORGANISM DURING LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY

Introduction: Laparoscopic cholecystectomy (LC) is a method of choice for chronic gallbladder calculus. Surgeon’s experience and sophistication of the work method itself have brought a number of advantages in comparison to open cholecystectomy (OC). Particularly, the advantage corresponds to decreased immune response of the organism on surgical stress. The aim of this study was to define the level of surgical stress through immune response of the organism on stress. Patients and Methods: One hundred patients were involved in the study, 50 of whom were treated by LC method and the other 50 by open method. The patients were of middle age group, between 47 and 57 years of age, mostly female. C-reactive protein was studied as one of the parameters of the organism’s immune response during LC and OC, and also a number of leucocytes, erythrocytes, haemoglobin and hematocrit after LC and OC procedures. C-reactive protein is a biochemical marker, as an organism’s response to stress and the aim of this study is to confirm the CRP values during surgical treatment of chronic calculus of the gallbladder through different surgical methods: conventional or open surgery and laparoscopic surgery which is considered less invasive. Number and frequency of intra-operative and post-operative complications during laparoscopic and open cholecystectomy were also compared. The erythrocytes, haemoglobin and hematocrit and leucocytes, were also determined in both groups of patients with the aim to confirm the hypothesis that the laparoscopic cholecystectomy is a less invasive method compared to the classic or open method. Results and Discussion: The results have confirmed the hypothesis that the laparoscopic cholecystectomy surgical method is less invasive and showed that the value of CRP is much less in post-operative period after LC than OC. In this way, decreased immunological response of the organism on the surgical laparoscopic procedure were confirmed in this study. Decreased value of leucocytes was determined in laparoscopic technique in the post-operative period in comparison to open technique. The number of erythrocytes, hematocrots and haemoglobin were not significantly different in the post-operative period during LC and OC. Complications such as bleeding, bile leakage, subphrenic abscess, post-operative pancreatitis, post-operative wound infection, hernias of post-operative sections and keloid were present more in OC than in LC. Conclusion: Inflammation of early protective homeostatic immune response on post-operative wound characterises the production of C-reactive protein as one of the activities of cellular and humoral mechanisms. This comparative study between laparoscopic and open cholecystectomy in light of immune response of the organism to stress, number and type of intra-operative and post-operative complications, confirmed advantages of laporascopic technique in comparison to open method.