Turgut Ipek

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.

Ectopic Thyroid in the Abdomen: Report of a Case

Ectopic thyroid tissue can be seen anywhere along the path of the descending glands, but it is rarely seen in the abdominal cavity. An ectopic thyroid was encountered incidentally in the pancreas of a 50-year-old woman who underwent a bilateral truncal vagotomy and pyloroplasty for a duodenal ulcer. There were no signs or symptoms of a thyroid tumor.

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.

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.

The Effects of Cefephim, G-CSF, and Sucralfate on Bacterial Translocation in Experimentally Induced Acute Pancreatitis

Abstract The preventive effects of granulocyte colony-stimulating factor, cefephim, and sucralfate on bacterial translocation in experimentally induced acute pancreatitis were investigated. Forty male Wistar albino rats were used in this study. For each rat, the pancreatobiliary ductus was ligated and hence acute pancreatitis was induced. In the control group, no further procedure was performed. Meanwhile, cefephim as an antibiotic, filgrastim, which is a colony-stimulating factor, and sucralfate were given to the other groups at the specified doses. To inhibit bacterial translocation by preserving the bowel barrier, sucralfate, which is known to have a cytoprotective effect on the gastrointestinal system, was used in high doses. Cefephim 30 mg/kg per day (intramuscularly) in group II, filgrastim 10 mg/kg per day (subcutaneously) in group III, and sucralfate 50 mg/kg per day by 8-F feeding tube gavage into the stomach in group IV were given. The number of bacteria translocated into the mesenteric lymph nodes, pancreas, liver, and spleen in the control group significantly increased in comparison with the other groups (P < 0.05). The average number of leukocytes (per mm3) in the control group was significantly higher than that of other groups (P < 0.0001). Regarding the average serum amylase levels, the values of all groups clearly decreased in comparison with the control group (P < 0.0001). Although in the cefephim, filgrastim, and sucralfate groups, (+) pancreatitis was generally seen, in the control group (+++) pancreatitis was detected. Bacterial translocation to the mesenteric lymph nodes and pancreas was partially prevented by filgrastim and sucralfate, and was completely prevented by cefephim. We conclude that in the management of acute pancreatitis, the use of the prophylactic antibiotics, sucralfate and filgrastim, may be advantageous.

Partial Splenic Infarction as a Complication of Laparoscopic Floppy Nissen Fundoplication

BACKGROUND The division of the short gastric vessels (SGVs) is a common practice during laparoscopic floppy Nissen fundoplication (NF) to achieve an adequate mobilization of the gastric fundus. However, the terminal branches of splenic vessels can also be ligated during SGV division, resulting in splenic infarction (SI). The aim of this study was to evaluate our results with SI as a complication of laparoscopic floppy NF. MATERIALS AND METHODS All patients with direct laparoscopic evidence of SI during laparoscopic floppy NF, between August 1993 and August 2009 and under the care of two surgeons, were included in this retrospective study. RESULTS Over the past 16-year period, 2100 patients underwent laparoscopic floppy NF, and splenic infarction was demonstrated in 20 cases (0.95%). There were 11 women (55%) and 9 men (45%), with a mean age of 35.2 years (range, 25-68). The classic pattern, in all cases, was a small area of infarction, less than 10-15% of the total splenic volume, localized mainly in the upper pole. There were no conversions. The mean length of hospital stay was 1.2 days (range, 1-2). During the follow-up period of 3 months, only 2 patients (10%) had persistent abdominal pain, in which computed tomography demonstrated the infarcted areas involving less than 15% of the splenic parenchyma. All cases were managed succesfully with observation alone. CONCLUSIONS Based on the results, partial SI is a recognizable condition during laparoscopic floppy NF. Conservative therapy and close follow-up, without any unnecessary intervention, is an appropriate management that provides a favorable outcome.

Single-Port Laparoscopic Floppy Nissen Fundoplication: A Novel Technique with the Aid of the Cerrahpasa Retractor

With the advent of single-port laparoscopy, the spectrum of abdominal surgeries performed is widening. The retraction of the left lobe of the liver in the upper gastrointestinal procedures is a critical maneuver with its added possible complications. In our study, we used the Cerrahpasa retractor (trademark pending by E. Eyuboglu and T. Ipek) for the retraction of the left liver in 22 patients with a different concept other than using the suturing or silk lace techniques described in previous studies. In our technique, the potential of tearing the liver or other anatomical structures is minimal. We believe that, with the aid of our Cerrahpasa retractor, the problem of liver retraction is being solved by a simple and safe technique.

Buschke-Löwenstein Tumor of the Anal Region

Giant invasive condyloma acuminatum, also known as Buschke-Lowenstein tumor, is a human papilloma virus (HPV) type 6 or 10-associated lesion which is rarely seen in the anorectum. These lesions despit