Sinan Ersin

Gastric remnant cancer: an old problem with novel concerns

Background and aimsThe patients with cancers in the remnant stomachs after previous partial resections for benign diseases constitute a peculiar subset of the patients with gastric cancer. They are generally at advanced stages on admissions due to disregarding the symptoms related to cancer.Patients and methodsTwenty six patients with cancer arising from the remnant stomach were analyzed. Clinicopathologic features such as age, gender, time interval between the initial operation and diagnosis of gastric remnant cancer, preoperative symptoms, surgical management, and tumor characteristics like size, location, histopathology, depth of invasion, lymph node involvement, presence of distant metastasis, and stages were documented.ResultsNone of the cancers were diagnosed by routine surveillance and all the patients were symptomatic at the time of diagnosis. Twenty five patients were qualified for surgery. The resectability rate was 61% (n = 16). The ability to perform a curative resection and tumor location at the anastomotic site were determined as the factors significantly influencing survival (p < 0.05).ConclusionCurative resection has to be the goal of surgical management in patients with gastric remnant cancer. Concerning clinician should be sceptical about a newly developing cancer in order to detect it in an early stage and enhance resectability.

Is testicular perfusion influenced during laparoscopic inguınal hernia surgery

BackgroundThe influence of laparoscopic inguinal hernia surgery is still unclear. The aim of this study was to compare the possible early effects of laparoscopic and open inguinal hernia repair on testicular perfusion.MethodsIn this prospective trial, 44 patients underwent mesh repair of a primary inguinal hernia assigned to one of two procedures: open anterior mesh repair (n = 29) or a laparoscopic totally extraperitoneal approach (n = 15). Doppler ultrasound was used to determine the hemodynamic characteristics of the testicular blood flow.ResultsNo statistically significant differences were found between the two groups in terms of Doppler flow parameters for the preoperative, very early (day 1), and early postoperative (day 7) periods. When Doppler flow parameters of the testicular artery were compared in the conventional group, statistically significant differences were found between preoperative and very early postoperative values (p < 0.05). Meanwhile, comparison among flow parameters of the testicular, capsular, and intratesticular arteries of the laparoscopic group showed statistically significant differences between preoperative and very early postoperative and between preoperative and early postoperative values (p < 0.05). There were no statistically differences in postoperative complications between the two groups.ConclusionTesticular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.

Is D-dimer a predictor of strangulated intestinal hernia?

BackgroundThe goal of this study was to assess the relevance of serum D-dimer measurement as a possible reliable marker for the diagnosis of strangulated intestinal hernia.MethodsConsecutive patients admitted with nontraumatic acute abdominal gastrointestinal disorders were recruited prospectively in a tertiary referral hospital. The study was conducted in 159 patients between August 2002 and April 2004. D-dimer, lactate dehydrogenase, serum amylase, and international normalized ratio (INR) levels were tested in the emergency room prior to surgical intervention. For each patient, 15 variables, including D-dimer, were available for analysis.ResultsThirty-three (20.7%) of the 159 patients had intestinal ischemia, and 28 (85%) of these 33 patients had D-dimer level > 300 ng/ml. Plasma levels of D-dimer in patients with intestinal ischemia were significantly higher than in patients without ischemia (P < 0.05). There were 29 (18.2%) patients in the hernia group with incarceration (n = 22) or strangulation requiring resection (n = 7). D-dimer levels in patients requiring intestinal resection were insignificantly higher than in patients without resection (P > 0.05). Six (85%) of the 7 hernia patients requiring resection had D-dimer levels > 360 ng/ml. The D-dimer variable correlated best with the leukocyte count in patients with hernia requiring resection. Levels of lactate dehydrogenase, serum amylase, and INR did not show any correlation with D-dimer levels.ConclusionsTo help predict ischemic events, the increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with intestinal emergencies. An elevated D-dimer level on admission had a high sensitivity for identifying patients with intestinal ischemia, although it had a low specificity. Whether it is predictive or preventive for resection in strangulated intestinal hernia patients still remains a question.

Fiber enriched diets and radiation induced injury of the gut

The aim of this study was to evaluate the effect of fiber-enriched defined formula diets (DFDs) on radiation-induced enteropathy. Forty-five male Sprague-Dawley rats were assigned randomly after abdominal irradiation to one of three groups (15 in each group): a fiber-free DFD group, a non-soluble fiber-enriched DFD group, and a soluble fiber-enriched DFD group. They kept their diets respectively for seven days. On day eight, the mesenteric lymph nodes were harvested for bacterial translocation, and segments of jejenum and colon were sampled for microscopic examination. The rats in the fiber-enriched DFD groups lost significantly less body weight than the rats in the fiber-free DFD group. The intestinal structure was the worst in the fiber-free DFD group, intermediate in the soluble fiber-enriched DFD group, and the best in the non-soluble fiber-enriched DFD group with significantly higher measures of villous height and jejunal mucosal thickness. These findings suggest that fiber-enriched DFD may effectively protect intestinal structure against radiation-induced damage by improving mucosal integrity.

Effects of Somatostatin Analogues and Vitamin C on Bacterial Translocation in an Experimental Intestinal Obstruction Model of Rats

The passage of viable endogenous bacteria and their products across the intact intestinal mucosal barrier, disseminating to the mesenteric lymph nodes, peritoneal cavity, spleen, liver, and circulation, is defined as bacterial translocation. Intestinal obstruction induces bacterial translocation due to mucosal disruption, motility dysfunction, and increased intestinal volume, leading to bacterial overgrowth. In a rat model of intestinal obstruction, the effects of both high-dose vitamin C (350 microg/kg), an antioxidant agent known to have a cytoprotective effect in ischemia-reperfusion injury, and somatostatin (20 microg/kg), a gastrointestinal antisecretory agent, in preventing bacterial translocation were studied. Both intestinal and liver samples from the rats was observed, and it was found that the rate of bacterial translocation was 100% in the control group, and only 43% for the rats who were given intraperitoneal vitamin C and somatostatin. The difference was statistically significant. In conclusion, we are convinced that vitamin C and somatostatin analogues may have protective effects against bacterial translocation in mechanical bowel obstruction.

Surgeon's View on the Limitations of Left-Handedness During Endoscopic Surgery

BACKGROUND The influence of endoscopic surgery on left-handedness is unclear. The aim of this study was to investigate the role of left-handedness during endoscopic surgery. MATERIALS AND METHODS A survey distributed during the 15th Congress of the Turkish Society of Surgery, held in 2006, was conducted to 194 participants. The survey was focused on hand preference and endoscopic surgery. Besides demographic data and use of endoscopy, lateral predominance, questions related to surgical performance (open and endoscopic), training support during residency, and operating room experiences during endoscopic surgery were assessed. RESULTS The laterality preference in performing surgery was left in 9.3% (n = 18). Almost 50% of the left-handed surgeons believed that endoscopic surgery needs to be modified for the left-handed endoscopic surgeon, although 66% reported they had no difficulty while using endoscopic instruments and did not need any modification during surgical endoscopy. Over 86% of all surgeons reported that laterality had no importance for them if they were a patient undergoing endoscopic surgery, while 14% of surgeons refused to be operated on by a left-handed surgeon. CONCLUSION Endoscopic surgery has impact on laterality-related comfort, and technical modifications are warranted for left-handed surgeons. Further research is needed to address questions related to hand dominance in surgical endoscopic skill performance that allows more comprehensive conclusions.

Effects of ropivacaine on pain after laparoscopic cholecystectomy: A prospective, randomized study

Postoperative pain after laparoscopic cholecystectomy is an ongoing problem. To relieve this pain, practitioners have used many anesthetic and analgesic drugs. This study was undertaken to assess the effects of incisional and intraperitoneal administration of ropivacaine on postoperative pain and stress response in patients undergoing laparoscopic cholecystectomy. In this prospective, singleblinded, randomized study, 45 patients with ASA (American Society of Anesthesiologists) scores I and II who were about to undergo laparoscopic cholecystectomy were divided into 3 groups. After cholecystectomy, a total of 40 mL of 3.75% ropivacaine was administered preincisionally and intraperitoneally to patients in group 1 (n=14); preincisionally and intraperitoneally to patients in group 2 (n=17); and intraperitoneally and locally at incision sites to patients in group 3 (n=14). Blood levels of epinephrine and norepinephrine were examined preoperatively, 15 min after insufflation, and at the end of the operation. Visual analog pain scale scores and analgesic requirements were used for 24-h postoperative follow-up of pain levels reported by patients. No statistically significant difference was found among the 3 groups with respect to visual analog pain scale scores, total analgesic requirements, and accompanying pain, nausea, and vomiting. The earliest analgesic requirements were seen in group 2 (P < .005), and less shoulder pain was noted in group 3 (P < .005). Norepinephrine and epinephrine levels showed no statistically significant differences between the 3 groups. Administration of ropivacaine preoperatively and postoperatively for laparoscopic cholecystectomy has similar effects on postoperative pain and the stress response of patients.

Abdominal cocoon syndrome as a rare cause of mechanical bowel obstruction: report of two cases.

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.

ω-3 Fatty acids have no impact on serum lactate levels after major gastric cancer surgery.

BACKGROUND Preoperative and intraoperative nutrition support in patients undergoing major surgery results in decreased incidence of morbidity and mortality. Studies investigating the role of ω-3 fatty acids in these patients are increasing. Some are focused on perfusion at the cellular level. This study was undertaken to address the effect of postoperative administration of ω-3 fatty acids on cellular hypoperfusion associated with major gastric surgery. METHODS Twenty-six patients undergoing gastric cancer surgery were randomly assigned to receive parenteral nutrition (PN) supplemented with a combination of ω-6 and ω-3 fatty acids (Omegaven, 0.2 g/kg/d; Lipovenoes 10%, 0.6 g/kg/d) or with ω-6 fatty acid (Lipovenoes 10%, 0.8 g/kg/d) for 5 days. Blood samples were taken preoperatively, postoperative day 1, and on the last day of PN therapy (day 5). RESULTS Patients receiving ω-3 and ω-6 fatty acids showed neither lower serum lactate levels nor lower rates of complications compared with patients receiving ω-6 only. There were no statistically significant differences between the groups in other biochemical parameters, complications, or length of hospital stay or mortality. CONCLUSION PN with ω-3 fatty acid supplementation does not have a significant impact on cellular hypoperfusion and lactate clearance after major gastric surgery.

Pancreatic Castleman's tumour: an unusual case.

Abstract We present an uncommon case of hyaline vascular type Castleman’s disease mimicking a pancreatic tumour. A 56-year-old woman with constitutional symptoms was investigated. Pre-operative interventions failed to produce a definitive diagnosis. Surgical excision was performed and the tumour was diagnosed to be the hyaline vascular type of Castleman’s disease histopathologically. Pancreatic Castleman’s disease should remain a consideration in the differential diagnosis of a pancreatic mass.