Süphan Ertürk

Laparoscopic repair of a Morgagni-Larrey hernia: report of three cases.

Abstract.Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into the right hemithorax; however, one was symptomatic and had herniation of the omentum and large bowel. Tension-free closure of the defects was done using Prolene mesh with a hernia stapler, helical fastener, and Endostitch. There were no early complications and the patients were discharged on the fourth postoperative day. The mean follow-up period was 41 months, and there has been no late morbidity or mortality related to this procedure. Using a laparoscopic approach to repair a Morgagni-Larrey hernia provides an excellent view of the surgical field and allows easy manipulation with minimal surgical trauma, followed by rapid recovery of the patient.

Effects of Hyaluronic Acid–Carboxymethylcellulose Antiadhesion Barrier on Ischemic Colonic Anastomosis

AbstractPURPOSE: Intraperitoneal adhesions may help the healing of marginally viable bowel ends. If adhesion formation is prevented by various methods, the integrity of ischemic bowel anastomosis may be compromised. Thus, we decided to study the effects of hyaluronic acid–carboxymethylcellulose, an antiadhesion barrier, on ischemic bowel anastomosis. METHODS: Thirty Wistar-Albino rats were divided into three groups. In Group A (control), a well-perfused distal colonic segment was transected, and free ends were anastomosed. In Group B, an ischemic colonic segment was prepared, then divided and anastomosed. In Group C, after completion of ischemic colonic anastomosis, hyaluronic acid–carboxymethylcellulose film was wrapped around the anastomosis. In all groups, rats were killed on the seventh day. Intraperitoneal adhesions were graded by adhesion score, and healing of the anastomosis was assessed by measurement of bursting pressure and hydroxyproline levels in the anastomotic tissue. RESULTS: A statistically significant difference was found between hydroxyproline levels of the control group and the ischemic group (P = 0.02). HP level was also significantly higher in the hyaluronic acid–carboxymethylcellulose group than in the ischemic group (P = 0.01). There was no difference in hydroxyproline levels between the control and hyaluronic acid–carboxymethylcellulose groups. Compared with the control group, bursting pressure was lower in the ischemic group (P = 0.02). Hyaluronic acid–carboxymethylcellulose wrapping increased the bursting pressure significantly (P < 0.001). However, there was no difference in bursting pressure between the control group and the hyaluronic acid–carboxymethylcellulose group (P = 0.13). A marked increase in the adhesion score was observed in the ischemic group (P = 0.01). The difference between adhesion scores of the hyaluronic acid–carboxymethylcellulose and ischemic groups was not found to be significant, although the adhesion score in the hyaluronic acid–carboxymethylcellulose group was lower (P = 0.16). There was no difference in adhesion score between the control and hyaluronic acid–carboxymethylcellulose groups. CONCLUSIONS: Application of hyaluronic acid–carboxymethylcellulose in ischemic colonic anastomosis did not compromise anastomotic integrity. The adverse effect of ischemia on healing of colonic anastomosis was counteracted by hyaluronic acid–carboxymethylcellulose.

The role of oxygen free radicals in acute renal failure complicating obstructive jaundice: an experimental study.

Oxydant injury is considered to be an important mechanism in the pathophysiology of acute renal failure. It has been thought that decrease in extracellular and intracellular fluid and endotoxemia seen in obstructive jaundice may cause an increase in production of oxygen free radicals and impairment in antioxydant defense mechanism. This study is designed to investigate the possible role of oxydant injury in renal failure seen in jaundiced patients. In this study, 28 rats were divided into four groups: Control(C) (N=7); Renal ischemia (RI) (N=7); Obstructive jaundice+renal ischemia (OJ+RI) (N=7); Obstructive jaundice (OJ) (N=7). All groups were compared with each other according to renal failure findings and enzyme activities, such as Xanthine oxidase (XOD), Superoxide Dismutase (SOD) and Catalase in renal cortex and Glutathione Peroxidase (GSH-Px), in blood at 3rd day after ischemia and reperfusion. Renal failure findings monitored by blood urea and creatinine levels, seemed more evident in OJ+RI than RI group (p <0.05). When compared with RI, in OJ+RI group, increase in XOD activity at 3rd day was statistically significant [0.259 ±0.01 U/g (tissue) and 0.362±0.03 U/g (tissue) respectively] (p <0.05). SOD and GSH-Px activities of each ischemic group at 3rd day were decreased compared to non-ischemic groups. This fall was significant (p <0.05). But there was no statistical difference between jaundiced and non-jaundiced groups. Alterations in catalase activities also had no statistical significance. These findings may suggest that the injury induced by oxygen free radicals at re-oxygenation of tissue after ischemia may also play a role in the pathogenesis of acute renal failure developed in obstructive jaundice.

Effect of Simultaneous Splenectomy on the Survival of Patients Undergoing Curative Gastrectomy for Proximal Gastric Carcinoma

Abstract.Purpose: Splenectomy is sometimes performed simultaneously with curative gastrectomy for gastric carcinoma, especially when the tumor originates in the proximal one-third of the stomach or corpus, or when it invades the entire stomach, in an effort to remove metastatic lymph nodes at the splenic hilus and improve survival. However, splenectomy is not an innocent procedure and may cause increased morbidity and even mortality. Moreover, the long-term effect of splenectomy on survival is still controversial. The purpose of this study was to investigate the effect of simultaneous splenectomy on survival in patients with proximal tumors undergoing curative gastrectomy for gastric cancer. Methods: The effect of splenectomy on the 5-year survival of 61 patients with proximal gastric cancer (located in the cardia or the corpus) who underwent curative gastrectomy in our hospital between 1989 and 1993 was investigated retrospectively. Of these 61 patients, 38 (62.3%) underwent splenectomy and 23 (37.7%) did not. The relationship between the clinicohistopathological parameters and 5-year survival was retrospectively analyzed. Results: No significant differences were found in bivariate analysis between the survival of patients who underwent curative gastrectomy with and those who underwent curative gastrectomy without splenectomy (P = 0.984). Multivariate regression analysis indicated that only histological grade (P < 0.003) and lymph node metastasis (P < 0.001) were independent prognostic factors with or without splenectomy. Splenectomy itself was not an independent prognostic factor (P = 0.528). Conclusion: The findings of this retrospective study showed that simultaneous splenectomy had no effect on the survival of patients who underwent curative gastrectomy for gastric carcinoma. Thus, splenectomy may only be appropriate for patients with direct invasion of the spleen.

Role of the antiangiogenetic drug paclitaxel on healing of intestinal anastomosis: an experimental study

BackgroundThe aim of intraperitoneal administration of antineoplastic agents is the prevention of the implantation of tumoral cells after surgical intervention or the treatment of peritoneal carcinomatosis. The efficiency of intraperitoneal administration of paclitaxel, which is also an antiangiogenetic agent, has been investigated recently. The aim of this experimental study was to evaluate, taking into consideration its antiangiogenetic properties, the effects of intraperitoneal paclitaxel on healing of end to end colonic anastomosis.Methods42 rats were allocated to 2 main groups (n = 21 for each group) to be evaluated on postperative day 3 (group A) and postoperative day 7 (group B). Each of the two main groups was divided into 3 subgroups (7 rats each). These subgroups were determined as control and two treatment groups administered paclitaxel in a dose of 2.5 mg/kg and 3.5 mg/kg intraperitoneally. Anastomosed segments of colon were harvested on postoperative day 3 or 7 and evaluated to determine bursting pressure of anastomoses, hydroxyproline levels and neovascularization with CD–31.ResultsIn both groups, there were no significant differences between control and paclitaxel–treated groups with respect to bursting pressure. The level of hydroxyproline showed a significant decrease in all paclitaxel–treated groups compared with control groups (p = 0.001). Neovascularization was found to be decreased significantly on day 3 in the doses of paclitaxel 2.5 mg/kg (6.4 ± 1.63) and 3.5 mg/kg (5.89 ± 1.01) compared with control (8.02 ± 0.88) (p = 0.029 and p = 0.005, respectively). There were no significant differences in neovascularization in either groups on postoperative day 7.ConclusionWe suggest that intraperitoneal administration of paclitaxel during surgical procedure decreases the hydroxyproline content and neovessel formation that are necessary for healing of intestinal anastomosis.

Comparison of classical surgery and sutureless repair with DuraSeal or fibrin glue for duodenal perforation in rats.

BACKGROUND The purpose of the study was to compare classical primary suture repair and sutureless repair with fibrin glue or DuraSeal adhesion barrier for the closure of duodenal perforation in rats. METHODS Forty adult female Wistar Albino rats weighing between 250-300 g were randomly divided into four equal groups. Primary repair, primary repair and omentoplasty, or application of fibrin glue or DuraSeal adhesion barrier was performed in each of the four groups, respectively. The bursting pressure, tissue hydroxyproline levels and histopathology were evaluated. RESULTS Bursting pressure values of the primary repair and primary repair and omentoplasty groups were significantly higher than in the fibrin glue and DuraSeal groups (p < 0.001). There were no significant differences between the experimental groups regarding hydroxyproline levels and histological parameters. CONCLUSION The sutureless methods (Fibrin glue, DuraSeal) have no superior effects when compared with the conventional repair techniques. We observed similar results between the sutureless repair groups; thus, DuraSeal can be considered an alternative to fibrin glue for this purpose. This suggestion must be supported with new studies, however, which would be planned with other wound healing markers and different designs.

Heterotopic ossification of the anterior abdominal wall

Heterotopic ossification is the formation of bone tissues in areas other than the skeletal system. It is more often seen as a complication of orthopedic surgery; however, it is a pathological condition that might be observed during the healing of abdominal incisions in the midline. The aim of this study is to present a case of a 63-year-old male patient with complaints of induration and pain on the region of his previous incision through which he had been operated for achalasia. Heterotopic ossification has also been discussed in the light of the current literature.