Tahsin Colak

Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease.

The purpose of the study was to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary sacrococcygeal pilonidal disease (SPD).

Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region

Background:  Because controversy still continuous to surround use of total thyroidectomy for the management of benign multinodular goiter, the present study aims to prospectively compare the safety and efficacy of total thyroidectomy with subtotal thyroidectomy.

A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3-port laparoscopic procedures in the treatment of acute appendicitis.

Background: This prospective randomized study aimed to evaluate the surgical outcomes of single-incision laparoscopic appendectomy (SILA) comparing with open appendectomy (OA) and standard 3-port laparoscopic appendectomy (SLA) in the treatment of acute appendicitis (AA). Methods: Adult patients older than 18 years presenting with AA were randomized into 3 groups to undergo OA, SLA, and SILA from September 2010 to May 2011. The groups were compared with regard of patient’s characteristics, perioperative findings/complications, operative time, pain severity, analgesic requirement, time to oral tolerance and flatus, length of hospital stay, and cosmetic results. Results: A total of 75 consecutive patients enrolled in the study. Each group included 25 patients. The groups showed no significant differences in patient’s characteristics. The mean operative time was significantly longer in SILA than OA with a mean difference of 7 minutes (P<0.05). Postoperative pain after OA were significantly higher than SLA and SILA (P<0.05). The average time to oral tolerance and flatus was significantly higher in OA than the laparoscopic groups with a mean difference of 1 and 2.5 hours (P=0.04 and 0.023, respectively). The length of hospital stay in SLA and SILA was significantly lower than OA with a mean difference of 0.8 days (P<0.05). There was no difference in overall complications between the groups. There was no difference between SLA and SILA in terms of surgical outcomes. Conclusions: Either SLA or SILA offer patients faster recovery period with acceptable complications than OA. Hence, laparoscopic approach might be considered as first option in the treatment of AA. However, all 3 techniques provide equivalent clinical outcomes despite the significant findings. Therefore, technique selection is based on surgeon’s decision, experience, and availability of laparoscopic instruments.

Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

ObjectiveThis prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders.MethodsA total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed.ResultsThe mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group.ConclusionThese findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.

Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment

BACKGROUND The aim of the study was to investigate the effects of topical nonsteroidal antiinflammatory drugs (NSAIDs) on mastalgia. STUDY DESIGN A prospective, randomized, blinded, placebo-controlled study was performed to evaluate the effects of topical NSAIDs on cyclic and noncyclic mastalgia. A total of 108 patients, 60 with cyclic (group I) and 48 with noncyclic (group II) breast pain were enrolled. Patients within each group were randomly assigned to receive either topical NSAIDs or placebo three times daily for at least 6 months. Severity of pain was measured before and after 6 months of treatment. RESULTS The pain score decreased significantly when the mean initial breast pain score was compared with the sixth-month breast pain score of the treatment or the placebo group of cyclic (p = 0.0001 and p = 0.0001, respectively) or noncyclic mastalgia (p = 0.0001 and p = 0.0001, respectively). Significant differences were found when the mean within-person change in pain values in each treatment group were compared with the change in the respective placebo group for either cyclic or noncyclic mastalgia (p = 0.0001 and p = 0.0001, respectively). Changes in pain within treatment groups or placebo groups for cyclic versus noncyclic mastalgia were not found to be statistically different (p = 0.53 and p = 0.96, respectively). No side effect was seen in any group. CONCLUSIONS Topical application of NSAIDs was effective in both cyclic and noncyclic mastalgia with minimal side effects.

Randomized clinical trial comparing laparoscopic totally extraperitoneal approach with open mesh repair in inguinal hernia.

&NA; The aim of this study was to compare laparoscopic totally extraperitoneal approach (TEP) repair with tension‐free open mesh repair in inguinal hernia. One hundred thirty‐four patients were allocated randomly to undergo TEP repair (n = 67) or open mesh repair (n = 67). Operative and postoperative outcomes were determined. The mean of operating time (49.67 ± 14.11 vs. 56.64 ± 12.32; P = 0.001), visual analog scale score (2.73 ± 1.69 vs. 4.61 ± 1.77; P = 0.001), hospital stay (1.8 ± 0.7 vs. 2.7 ± 1.6; P = 0.001), and duration of recovery (10.8 ± 7.4 vs. 15.2 ± 8.5; P = 0.001) was significantly less for TEP repair when compared with open mesh repair. The incidence of complications (13.4% vs. 16.4%; P = 0.631) and recurrence (2.9% vs. 5.9%; P = 0.407) was approximately equal in each group. Our results showed that laparoscopic TEP repair is superior to open mesh repair.

Influence of age on prognosis and management of patients with colorectal carcinoma.

OBJECTIVE To see if the prognosis and management differed in patients with carcinoma of colon and rectum above and below 65 years of age. DESIGN Retrospective study. SETTING University hospital, Turkey. SUBJECTS 822 consecutive patients with colorectal carcinoma operated on between 1984 and 1994, 565 of whom were less than 65, and 257 of whom were 65 or more. MAIN OUTCOME MEASURES Factors that affected prognosis and management. RESULTS There were no significant differences between the two groups in mode of presentation, site and type of tumour, histological grade, incidence of curative and palliative operations, and postoperative morbidity and mortality. Obstruction and perforation were more common in the elderly group (p<0.0001). The postoperative (30 day) mortality was 3% in the younger group (20/565) and 7% in the older group (17/257). It was higher in those who were operated on as emergencies but was not significantly related to age. The actuarial five- year survival rates for older and younger patients were 33% and 45%, respectively (p<0.05). CONCLUSION Age alone has no characteristic effect on the treatment of colorectal carcinoma.

Phenol procedure for pilonidal sinus disease and risk factors for treatment failure

BACKGROUND The present study was designed to evaluate the results of phenolization for pilonidal sinus disease and the risk factors for treatment failure. METHODS Between June 2005 and July 2009, 76 consecutive patients with nonrecurrent sacrococcygeal pilonidal sinus were treated with a phenol treatment and included in the study. The clinical (age, sex, story of treatment for abscess formation, and comorbidity), operative (localization and number of sinus openings and volume of cavity), and follow-up data (healing time, time off work, postoperative complications, morbidity, and number of phenolization sessions) of the patients was recorded. Gender, age, history of abscess drainage, number of sinus openings, localization of sinus openings, volume of cavity, and the number of phenolization sessions were analyzed as risk factors for treatment failure. RESULTS The overall success rate was 67% (51 of 76 patients). The mean time to complete healing was 16 days (range, 10-45). The time off work was 0 days. Age and gender were not found to be risk factors for treatment failure (P > .05 and P > .05, respectively). Patients with a history of abscess drainage and more than 3 sinus openings had a significantly higher risk of treatment failure (P = .001 and P = .046, respectively). There was no difference between the localization of sinus openings and treatment failure (P > .05). There were statistically significant differences between treatment failure and both the cavity volume and number of phenolization sessions (P = .016 and P = .001, respectively). Patients were followed up for a mean period of 25 months (range, 13-48). One patient (2%) showed recurrence. CONCLUSION With an early return to work and low rates of complications and recurrence, phenolization is a simple outpatient procedure for the treatment of pilonidal sinus disease in selected patients.

An Unusual Cause of Intestinal Obstruction: Abdominal Cocoon

OBJECTIVE abdominal cocoon is characterized by total or partial encasement of the small bowel by a thick fibrotic membrane, leading to mechanical obstruction. Here, we report two cases of abdominal cocoon; both patients presented with symptoms of intestinal obstruction. CONCLUSION We describe the CT and sonographic features of this disease, emphasizing the role of MDCT, and discuss the preoperative diagnostic clues.

Effects of trapidil on the healing of colonic anastomoses in an experimental rat model.

Background:  Trapidil has various properties including vasodilatation, inhibition of lipid peroxidation and platelet aggregation as well as, and reduction of, the inflammatory response to injury. The aim of the present study was to investigate the effects of trapidil on dexamethasone‐impaired colonic anastomotic healing in an experimental rat model.