Serdar Yol

Endoscopic clipping versus band ligation in the management of bleeding esophageal varices.

Background: The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation. Methods: Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child–Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared. Results: Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05). Conclusions: With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.

Does large-bowel enema reduce septic complications in acute pancreatitis?

BACKGROUND The source of septic complications in acute pancreatitis was unknown until recent years. The pathogenesis of bacterial translocation from the gut has been accepted as the main source of pancreatic or peripancreatic infection. This study was designed to investigate the role of large bowel enema during acute pancreatitis in preventing bacterial translocation. MATERIALS AND METHODS Twenty-four Spraque-Dawley rats were used in this study. The rats were divided into two groups. Group I animals received biliopancreatic duct ligation plus colon cleansing by rectal enemas; group II animals received only biliopancreatic duct ligation. Rectal enemas were applied to the first group of animals three times, at 6, 24, and 48 hours after the operation using 10 cc sodium hydrogen phosphate solutions. All animals were sacrificed 72 hours later, and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures via a midline laparatomy. Blood and cecum cultures were also prepared. RESULTS Positive mesenteric lymph node cultures were found in all 12 animals in group II but in only 3 of 11 animals of group I (P <0.05). Distant organ cultures were positive in 9 of group II, but the only infected distant organ culture found in group I was the positive liver culture (P <0.05). CONCLUSION As a result of this study, we believe that large bowel enema can reduce the frequency of septic complications in acute pancreatitis by reducing bacterial translocation.

Retroperitoneal and scrotal giant liposarcoma: Report of a case

The case of a 63 year-old man with a giant scrotal and retroperitoneal tumor is herein reported. The initial symptoms began in the scrotum and subsequent abdominal distention resulted in discomfort 2 years later. The intraabdominal organs were under pressure because of the bulky mass, and the patient had dyspnea. Ultrasonograpy, computed tomography, and fine needle aspiration biopsy investigations all revealed a retroperitoneal tumor suspected to be liposarcoma. At operation, a tumor weighing 42 kg was excised. Respiratory support was provided in the early postoperative period. The histopathological diagnosis was myxoid liposarcoma. The patient was discharged from the hospital 14 days after the operation and was scheduled to undergo radiotherapy.

Long-term results utilizing the unroofing technique in treating hydatid cysts of the liver

PurposeThe aim of this study was to present the long-term follow-up results of liver hydatid cysts treated with unroofing, together with a review of the related literature data.MethodsOf 700 liver hydatid cyst patients examined and treated at Selcuk University Meram Medical Faculty, General Surgery Department, between 1985 and 2007, 650 had accessible data and the unroofing method had been applied in 189 of them. The clinical and laboratory findings, stages, operations, and complications of patients treated with unroofing were reviewed. In particular, the resolution of residual cyst cavities over time after the application of this method was evaluated using computed tomography.ResultsFour hundred and thirty-six (67.07%) of the cases were female [mean age: 35 (range: 10–73) years] and 214 (32.9%) were male [mean age: 46 (range: 12–76) years]. Of the 189 cases treated with unroofing and followed by tomography, the data of 144 were documented. Cavities were classified into five groups (A-E) according to their postoperative appearance.ConclusionsUnroofing is an easy approach and it does not require extensive experience. This technique is recommended for peripherally localized cysts but may also be applied to those more deeply situated. Unroofing should be applied as deeply as possible and the residual cavity should also be as shallow as possible.

Effect of pedunculated seromuscular flap on bursting strength of intestinal anastomosis after corticosteroid treatment

PURPOSE: This study was designed to investigate the protective effect of a pedunculated seromuscular flap on intestinal anastomosis after corticosteroid treatment. METHODS: Forty male Sprague-Dawley rats were divided into four groups, and all animals underwent intestinal anastomosis. Two groups, with or without seromuscular flap wrapping, received 5 mg cortisone acetate, and two groups received placebo (saline) preoperatively for 16 days. Anastomotic strength was defined as bursting pressure (in millimeters of mercury). The pedunculated seromuscular flap was prepared from a segment of intestine next to the anastomosis. Intestinal bursting strength at the anastomotic site was measured at Postoperative Day 8. RESULTS: The anastomotic bursting strength was significantly lower in the steroid groups at Postoperative Day 8 (P<0.01). The pedunculated seromuscular flap increased the strength of the anastomosis both in the steroid and control groups (P<0.05). CONCLUSION: The adverse effect of corticosteroids on intestinal anastomoses may be prevented by a pedunculated seromuscular flap.

Effect of Octreotide (Sandostatin 201-995) on Bile Flow and Bile Components

Octreotide (Sandostatin 201-995) has aninhibitory effect on gastric, intestinal, and pancreaticsecretions and hepatic and splachnic blood flow. Weexamined the effects of octreotide on bile flow and bile components in 10 patients with T-tubecholedochostomy. A Fogarty balloon catheter was inserteddistal to the T-tube of these patients for measurementof bile flow and bile components. Bile samples were obtained to analyze bile acid, phospholipid,lipoprotein, and cholesterol, and bile flow measurementswere performed every 15 min for a period of 90 minbefore study and after normal saline and octreotide administrations. While octreotide had aninhibitory effect on bile flow, the concentrations ofbile acid, phospholipid, and lipoprotein in bile wereincreased with octreotide.

Internal Herniation as a Major Cause of Intestinal Obstruction

Objectives: To evaluate internal herniation as a rare cause of intestinal obstruction.Materials and Methods: Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients (88.8%) were male (mean age: 58.2 years; range: 42–67) and 2 were female (mean age: 56.5 years; range: 52–61).Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. Results: All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. Conclusion: In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary.

A comparison of the hemodynamic and metabolic effects of extraperitoneal carbon dioxide and nitrous oxide insufflation

BACKGROUND The aim of the present study was to compare the hemodynamic and metabolic effects of extraperitoneal carbon dioxide (CO(2)) and nitrous oxide (N(2)O) insufflation. MATERIAL AND METHODS Fourteen dogs were used in the experiment. All the animals were intubated under general anesthesia. A catheter was placed into the right jugular vein for central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and heart rate (HR) monitorization. End-tidal CO(2) pressure was measured by a capnometer connected to the endotracheal tube. Another catheter was inserted into the left femoral artery for arterial blood gas analysis and blood pressure monitorization. The preperitoneal dissection was made from a 1.5 cm subumbilical incision by using a preperitoneal dissection balloon. A laparoscope was placed in the preperitoneal space and the gas insufflation was kept at a constant pressure of 12 mm Hg throughout the experiment. All the study parameters were measured at the beginning of the insufflation and at every 15 minutes for 1 hour. RESULTS Mean artery pressure increased with time in both groups, but the increase was only significant in the CO(2) group. PWP, CVP, PAP, and HR increased slightly in both groups, but there was no significant difference between the groups. The end-tidal CO(2) increased in the CO(2) group but decreased from the baseline in the N(2)O group. A significant acidosis was observed in only the CO(2) group. PaCO(2) significantly increased in the CO(2) group; hence, PaCO(2) slightly decreased in N(2)O group. The difference between the groups was significant. CONCLUSIONS N(2)O insufflation of the extraperitoneal space in dogs avoided the unwanted metabolic and hemodynamic side effects of CO(2) insufflation. Thus, N(2)O insufflation in the extraperitoneal space is a safer alternative to CO(2) insufflation experimentally, and can be preferred especially in patients with cardiac and pulmonary diseases.

Effect of Laparoscopic Cholecystectomy on Platelet Aggregation

Abstract. The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on platelet function. We operated on 40 women with symptomatic gallbladder stone, 20 of whom (study group) underwent laparoscopic cholecystectomy and 20 of whom (control group) open cholecystectomy. Patients with a history of bleeding, abnormal platelet count, or systemic disorders and those who were on salicylates, heparin, or oral anticoagulants were excluded. Blood parameters were checked at the beginning and the end of the operation, including platelet aggregation using adenosine 5′-diphosphate (ADP), collagen, and ristocetin in a whole-blood aggregometer. Platelet aggregation was evaluated by percent aggregation. Platelet aggregation due to collagen and ristocetin increased significantly at the end of the operation in the study group (p < 0.001). Aggregation due to ADP did not differ significantly from the start to the end of the operation. Control group results did not show any differences. Although the clinical findings of aggregated platelet are not frequently observed in practice, we suggest that laparoscopy increases platelet aggregation.

The management of hepatic hydatid cyst cavity by overlapping.

The obliteration of the cyst cavity after evacuation is a controversial procedure in hepatic hydatid disease. There is no ideal surgical technique which can be used in all hydatid cyst cavities. Since 1989 we have been using a new technique, which we call overlapping, in the treatment of suitable cases of hepatic hydatid cyst cavities. The technique depends on the obliteration of the cavity without drainage. After evacuating the hydatid material from the cavity, instillation of the cystic cavity is performed with scolecidal agent (silver nitrate solution, 0.5%). The cavity is opened along its long axis. The pericyst is prepared, and the upper edge is sutured to the bottom of the cavity with absorbable stitch (modified external collapse). Before doing this, if there is no possibility of operative ultrasonography, the cavity is punctured with a fine needle to evaluate any dangerous areas. Then the other edge of the pericyst is laid down beside the collapsed one and sutured to the former with the same technique. The term “overlapping” stems from this second procedure. During the operation, we decide which pericyst will collapse and which one will overlap. Before overlapping, openings between the cavity and biliary tree should be found and if there are any, they should be secured. In cases of large and multiple openings, T-tube choledochostomy is necessary. We applied overlapping to 31 of 43 hepatic hydatid cysts (ranging from 5 to 17 cm in diameter, with a mean of 12 cm) in 19 patients. Twenty-four of 31 cysts had partial pericystectomy before overlapping. Three cystic cavities were connected to the biliary tree. Because of a large connection, T-tube choledochostomy was added in one case. We have not seen any complications, either infection or biliary fistula. The results of the obliteration of cavities were excellent in 15 cysts. There were no residual cavities