Tayfun Yücel

Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: A prospective, randomized study

AIM The results of controlled-intermittent anal dilatation (CIAD) or lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissures are presented. MATERIAL AND METHODS Forty patients who were randomized to two groups underwent CIAD or a LIS. The pre- and post-operative mean anal canal resting pressures (MACRPs) and symptoms were recorded and the results were compared. RESULTS Two months post-operatively, 18 patients in the CIAD group and 17 patients in the LIS group had healed completely, and had no anal incontinence or other complications. The post-operative improvement in pain, bleeding, and constipation did not differ significantly between the two groups. In the CIAD and LIS groups, the pre-operative MACRPs were 89.7+/-16.5 and 87.6+/-12.3 mmHg, respectively; 2 months post-operatively, the MACRPs had significantly decreased to 76.9+/-13.7 and 78.1+/-11.3 mmHg in the CIAD and LIS groups, respectively. No statistical difference existed in the pre- or post-treatment MACRPs between the groups. CONCLUSION CIAD applied with a standardized technique reduced anal canal resting pressure and provided symptomatic healing that was equivalent to a LIS. Since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that CIAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety. In addition, the CIAD method may be an alternative procedure in older and multiparous women who has a higher risk of incontinence.

Laparoscopic Management of Left Thoracoabdominal Stab Wounds: A Prospective Study

Background Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW. Methods This study included 36 cases of LTSWs with no hemodynamic instability or abdominal tenderness seen between June 2002 and June 2007. After systemic examination and resuscitation of the patients, chest x-ray and focused assessment with sonography for trauma were carried out and then laparoscopic exploration was performed in all cases. Results Of the 36 cases, 36.1% (n=13) had injuries to the diaphragm and 53.8% (7/13) had associated intraabdominal injuries. Nine (69.2%) of the patients with diaphragmatic injuries, but no hollow organ injuries, were repaired through laparoscopy. The hemopneumothorax was found in 33.3% (n=12) of the patients. No relationship was seen between diaphragmatic injuries and the location of the LTSW and existence of hemopneumothorax. Conclusions Laparotomy was required in only 11.1% (4/36) of the cases with LTSWs and 30.8% (4/13) of the cases with diaphragmatic injury. Diagnostic and therapeutic laparoscopy was a sufficient and necessary surgical procedure in cases with a hemodynamically stable LTSW, when emergency surgery (laparotomy or thoracotomy) was not necessary.

Treatment of Penetrating Hepatic Injuries: A Retrospective Analysis of 50 Patients

Aim: The aim of this study was to determine the possibility of non-operative treatment via retrospective analysis of our patients. Methods: Fifty patients with penetrating hepatic injuries were examined retrospectively with respect to trauma scores, associated injuries, complications, and mortality parameters. Results: Thirteen injuries were caused by firearms, whereas 37 injuries were caused by stab wounds. Forty-three patients (86%) underwent laparotomy and 7 patients (14%) were monitored by CT and clinical findings (nonoperative group, NO group). The laparotomies were evaluated as non-therapeutic in 11 patients (22%) (NTL group) and therapeutic in 32 patients (64%) (TL group). The morbidity and mortality rates were 40 and 10%, respectively. RTS and ISS scores of the nonsurviving and the surviving patients were significantly different. The rates of major venous, grade IV–V hepatic injuries, and gunshot wounds were significantly higher in the nonsurviving patients when compared to the surviving patients. Conclusion: Major venous and grade IV–V hepatic injuries were the primary factors determining mortality and these injuries generally occurred as a result of firearm injuries. NTL occurring at a rate of 22% would decrease to 2% if ‘RTS <7’ criteria was added to the hemodynamic instability and/or peritoneal irritation findings determining surgical candidacy.

The effects on diet, anastomotic type, and loxiglumide on gastric emptying following gastrojejunostomy

PURPOSE The effects on gastric emptying of feeding with a normal diet (ND), an early high-calorie and hyperosmolar diet (HCHOD) or normal diet plus intraperitoneal loxiglumide (LOX) were investigated in rats with antecolic (ACGJ) or retrocolic (RCGJ) gastrojejunostomy. METHODS Sixty rats were separated into six groups of ten animals each (ACGJ+ND, RCGJ+ND, ACGJ+HCHOD, RCGJ+HCHOD, ACGJ+ND+LOX, and RCGJ+ND+LOX). On the seventh day, scintigraphic measurements of solid gastric emptying were made at 1, 30 and 60 min. RESULTS According to the 60-min results, the RCGJ+ND group exhibited delayed emptying compared to the ACGJ+ND group (p=0.023). Gastric emptying of ACGJ+HCHOD rats was delayed compared with the other ACGJ groups (compared to ACGJ+ND: p=0.000, and ACGJ+ND+LOX: p=0.015). Gastric emptying was more effective in the RCGJ+ND+LOX group than the other RCGJ groups (compared to RCGJ+ND: p=0.003, and RCGJ+HCHOD: p=0.001). CONCLUSION Antecolic gastrojejunostomy provided better gastric emptying. An early high-calorie and hyperosmolar enteral diet delayed gastric emptying in both types of anastomosis.

Lokalizasyonlarına göre rektum yaralanmalarının cerrahi tedavisi

Bulgular: 17 hastadaki yaralanmalar, %41 atesli silah, %29 kesici-delici alet, %18kunt, %6 iatrojenik ve %6 yabanci cisim nedeniyle gerceklesmistir. Sekiz (%47) hastada ek organ yaralanmasinin oldugu seride, rektum yaralanmalarinin lokalizasyonlari, %71 ekstraperitoneal, %23 intraperitoneal ve %6 ekstra ve intraperitoneal seklindedir. Ekstraperitoneal yaralanmalar primer tamir ve/veya loop kolostomi; intraperitoneal yaralanmalar ise primer tamir ile tedavi edilmistir. Lokalizasyondan bagimsiz olarak, atesli silaha bagli genis doku kaybi olanlarda rezeksiyon ve Hartmann islemi uygulanmistir. Gec (>12 saat) basvuran ekstraperitoneal yaralanmalarda presakral drenaj eklenmistir. Uc hastada (%17.8) morbidite gelisirken, mortalite gozlenmemistir.

Impact of ligating gonadal or adrenal collateral veins with the left renal vein on renal function and histology in right-nephrectomized rats.

BACKGROUND In cases of trauma to the left renal vein (LRV), its ligation near the inferior vena cava (IVC) is considered, but the consequences are not always good. We investigated the role of collateral venous drainage after ligation of the LRV by studying the renal function and histology after ligation of the LRV near the IVC alone or with ligation of the gonadal or adrenal collaterals, in right-nephrectomized (RN) rats. MATERIAL AND METHODS Ligation of the LRV near the IVC alone (group 1) or with ligation of the adrenal (group 2) or gonadal (group 3) collaterals was studied in RN Wistar rats (n=18 per group). The renal histopathology (ischemic cortical necrosis) and functional status (urea, creatinine, sodium, and potassium) were compared. RESULTS In RN rats, the results were better when ligating the LRV near the IVC alone or with the adrenal collaterals [mortality 4/18 (22.2%) and 3/18 (16.7%), respectively] than when ligating the LRV near the IVC plus the gonadal collaterals [mortality 15/18 (83.3%)] (p<0.0001). All early deaths occurred within three days and resulted from serious histopathological (ischemic cortical necrosis) and functional (increased urea, creatinine, and potassium; decreased sodium) renal damage. CONCLUSION In right-nephrectomized rats, the LRV near the IVC and the adrenal collateral can be ligated, while the gonadal collateral should be preserved.