Tevfik Küçükkartallar

The Effects of Anti-Adhesion Materials in Preventing Postoperative Adhesion in Abdominal Cavity (Anti-Adhesion Materials for Postoperative Adhesions)

PurposeThe purpose of this study was to compare the effects of anti-adhesion materials in postoperative adhesions.Materials and MethodsRats were assigned to five groups: Group 1: Control. Group 2: chitin layers were used. Group 3: Na-hyaluronate / carboxymethylcellulose layers were used. Group 4: Na-hyaluronate gel was poured into the abdomen. Group 5: methylprednisolone was injected. The adhesion frequency and grade were scored according to Granat. Blood was taken for Hb, AST, BUN and albumin levels determination.FindingsThe adhesion frequencies (right and left) and grades were as follow in Groups; I: 82%, 91%, 2.63 ± 1.22; II: 8.3%, 25%, 0.58 ± 0.66; III: 17%, 33%, 1.08 ± 1.08; IV: 50%, 58%, 1.41 ± 1.44; V: 50%, 42%, 1.41 ± 1.50. The adhesion phase in all study groups was found significantly low compared to control group, p < 0.05. No difference was observed among serologic and hematological parameters in all groups.ConclusionAll the materials used significantly lowered the adhesion frequency and grade.

A New Seton Type for the Treatment of Anal Fistula

In this retrospective study, our aim was to introduce an industrial synthetic material that can be used as a seton and then to present the results of complicated anal fistula cases treated with this different sort of seton. Between 1997 and 2005, 32 patients (aged 27–63 years) with a high anal or rectal internal opening were treated with a cutting seton. In the postoperative period none of the patients had recurrence or solid stool incontinence. However, three of them had just flatus incontinence, and two had flatus and liquid stool incontinence. The new material we used as a new type of seton can be used efficiently; it can be inserted easily, is cheap and effective, and may give better therapeutic results and better patient satisfaction.

Spontaneous Infarction in a Fibroadenoma of the Breast.

Background: Fibroadenomas are common neoplasms in young women but occur in a wide age range from adolescent females to octogenians. Case Report: A 21-year-old female patient presented with a 10-week history of a mass in her breast. Ultrasound examination demonstrated a 3.5 × 3 cm, well-circumscribed, semisolid mass. An excisional biopsy but no fine needle aspiration was performed. The patient had no history of pregnancy or lactation, or trauma or infection to the area of the lesion. The histopathological examination showed a spontaneously infarcted fibroadenoma. Conclusions: Spontaneous infarction is an uncommon complication in fibroadenoma of the breast, and there are very few reported cases in the literature.

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.

Management of patients with retroperitoneal tumors and a review of the literature

BackgroundRetroperitoneal tumors (RTs) develop insidiously and are generally seen as large masses, and 50% of RTs are larger than 20 cm at the time of diagnosis. In this article, we share our experience of 5 years of surgical management of RTs.MethodsWe evaluated 28 RT cases operated on in three education hospitals in Turkey from January 2008 onwards, with regard to patients’ demographic characteristics, complaints, weight loss figures, the location and size of the tumor, blood transfusion, intra-operational time, metastases (in malignant cases), additional organ resection, histological grade, local recurrences, average life expectancy, and post-operative treatment methods.ResultsThe mean age of the patients was 49 years (range, 18 to 78 years). Twenty (71.43%) were female, and 8 (28.57%) were male. The primary complaint was abdominal pain in 18 patients (64.28%). CT scans were performed in 17 (61%) patients, 10 (35.4%) underwent abdominal MR imaging, and 1 (3.6%) underwent both abdominal CT and abdominal MR imaging. A mass was palpated in the pelvis (suprapubic region) in seven (25%) of the patients during physical examination. The largest tumors were detected in the left lumbar area. The mean tumor size was 12.78 cm (range, 2 to 30 cm). The mean intra-operational time was 192 min (range, 70 to 380 min). The mean hospitalization period was 11 days (range, 8 to 23 days). Seven (25%) patients were reported to have benign tumors, while 21 (75%) were reported to have malignant tumors. The most frequently seen malignant pathology was liposarcoma (eight cases; 38.09%) followed by leiomyosarcoma (five cases; 23.8%) and malignant fibrous histiocytoma (four cases; 19.04%). The earliest local recurrence was detected in the 12th month and the latest in the 28th month. A total of 11 (52.3%) of the total of 21 malignant cases experienced local recurrence within 3 years. The 3-year average life expectancy was 85.7% in the 18 malignant cases.ConclusionsDue to the low response rate of all but two types of RT to chemotherapy, the best remaining treatment option is surgery with wide resection margins, whereby all macroscopic traces of tumor are removed.

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.

Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions

INTRODUCTION The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. METHODS The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group. Group 2: Normal saline group. Group 3: Sterile Novuxol group. Group 4: The group where the intraperitoneal and systemic effects of sterile Novuxol were investigated. Adhesion frequency and grades were scored on the post-op 11th day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. RESULTS Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35 ± 1.42 for Group 1, 0.31 ± 1.15 for Group 2, and 0.20 ± 0.41 for Group 3. Adhesion stage of the Sterile Novuxol Group was lower than all the other groups (p < 0.05). Biochemical and hematological parameters were similar in all groups (p > 0.05). Histopathological analysis revealed no hepatotoxicity. CONCLUSIONS According to the results of our study, we believe that Sterile Novuxol can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness.

Mechanical intestinal cleansing and antibiotic prophylaxis for preventing bacterial translocation during the pringle maneuver in rabbits

PurposeWe investigated the effectiveness of mechanical intestinal cleansing and antibiotic prophylaxis in preventing bacterial translocation (BT) during the Pringle maneuver in rabbits.MethodsForty-eight rabbits were allocated to one of the following four groups: a control group (group 1); an antibiotic group, given 100 mg/kg intravenous ceftizoxime (group 2); a mechanical intestinal cleansing group, given a Fleet enema (group 3); and a mechanical intestinal cleansing plus antibiotic group (group 4). After performing laparotomy, we dissected the portal region and turned the portal triad, using tape. Pringle maneuver was applied for 30 min in all groups. Blood samples were collected from the portal vein for blood culture before the Pringle maneuver. All groups underwent relaparotomy 30 min after the Pringle maneuver, to obtain portal blood, mesenteric lymph nodes (MLNs), and splenic tissue for culture.ResultsAll cultures from the portal vein specimens taken before the Pringle maneuver were negative. The rate of bacterial isolation in the portal vein (P < 0.001), MLNs (P < 0.01), and splenic (P < 0.001) cultures was significantly lower in group 4 than in the other groups. It was also lower in group 3 than in groups 1 and 2 (P < 0.05 for all).ConclusionsThe combination of mechanical intestinal cleansing and preoperative broad-spectrum antibiotics was most effective for preventing BT during the Pringle maneuver.

Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation

A pancreaticoduodenectomy is a surgical procedure with a high morbidity and mortality rate. The injury of the hepatic artery may occasionally lead to intraoperative bleeding. Repair of the injured hepatic artery is of great importance in terms of maintaining the vascular supply of the liver. We report a case with an injury of the hepatic artery that was successfully reconstructed with the gastroduodenal artery and then developed a biliary leak due to bile duct ischemia at an early stage. A 33-year-old women complaining of right upper quadrant pain was found to have a solid pseudopapillary tumor of the pancreas. She underwent an immediate pancreaticoduodenectomy, and her hepatic artery was injured during the operation. The arterial ends were sutured with primary anastomosis, because they could be aligned without any tension. The biliary leak occurred on postoperative day 2. We detected bile duct ischemia and reanastomosed the artery. The patient was discharged on postoperative day 8. Surgeons should be prepared for anomalies of the peripancreatic vascular structures during pancreaticoduodenectomy. Computed tomography angiography should be considered to reveal these anomalies before the surgery. Insufficiency of the biliodigestive anastomosis due to bile duct ischemia in the postoperative period should be kept in mind, even in cases of successful repair.

Primary pancreatic hydatid cyst resembling a pseudocyst

Hydatid cyst is a parasitic disease that is commonly seen in certain areas. It may localize in many organs in the body. Pancreas is a rarely involved organ. A 48 years old patient who could not be diagnosed before surgery was then diagnosed with hydatid cyst localized in the uncinate process of the pancreas post-operatively. Albendazole treatment was begun after the operation. No problem was observed in the follow-up ultrasonography. This rare case may be mistaken for cystic malignancies and pseudocysts of pancreas.