Urfettin Huseyinoglu

Alpha-lipoic acid reduces peridural fibrosis after laminectomy of lumbar vertebrae in rabbits

BackgroundPeridural fibrosis is an inevitable healing process causing failed back surgery syndrome after lumbar spinal operations. In this study, alpha-lipoic acid (ALA), reported to reduce fibrosis in liver, oral mucosa, and peritoneum, investigated as a potential candidate for prevention of peridural fibrosis.MethodTwelve adult New Zealand white male rabbits were divided into control (n = 5) and ALA groups (n = 7). Laminectomy of lumbar spine was performed and ALA was applied on the exposed dura mater topically in ALA group.ResultsAccording to histological peridural grading, the ALA group (median grade 1) showed significantly less peridural fibrosis than the control group (median grade 3, p = 0.005).ConclusionsALA is a promising substance in the prevention of peridural fibrosis, especially in early preoperative and postoperative period.

Comparison of Tubal Sterilization Procedures Performed by Keyless Abdominal Rope-Lifting Surgery and Conventional CO2 Laparoscopy: A Case Controlled Clinical Study

Objective. To evaluate the safety and efficacy of Keyless Abdominal Rope-Lifting Surgery (KARS), for tubal sterilization procedures in comparison with the conventional CO2 laparoscopy. Material and Methods. During a one-year period, 71 women underwent tubal ligation surgery. Conventional laparoscopy (N = 38) and KARS (N = 33) were used for tubal sterilization. In KARS, an abdominal access pathway through a single intra-abdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intraumbilical entry without the use of trocars. In CO2 laparoscopy, following the creation of the CO2 pneumoperitoneum a 10 mm trocar and two 5 mm trocars were introduced into the abdominal cavity. Tubal sterilizations were performed following the creation of the abdominal access pathways in both groups. The groups were compared with each other. Results. All operations could be performed by KARS without conversion to CO2 laparoscopy or laparotomy. The mean operative time of the two groups was not significantly different (P > 0.05). Intra- and postoperative findings including complications, bleeding, and hospital stay time did not differ between groups (P > 0.05). Conclusion. KARS for tubal sterilization seems safe and effective in terms of cosmesis, postoperative pain, and early hospital discharge.

Endometriosis presenting with right side hydroureteronephrosis only: a case report

IntroductionEndometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites of endometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis.Case presentationA 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosis of the right ureter with endometrial glandular cells and stromal tissue.ConclusionsClinicians should suspect ureteral endometriosis in premenopausal women with unilateral or bilateral distal ureteral obstruction of uncertain cause. The main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.

Early postoperative pain after keyless abdominal rope-lifting surgery.

Background and Objectives: Keyless abdominal rope-lifting surgery is a novel, gasless, single-incision laparoscopic surgical technique. In this study we aimed to compare the postoperative pain from keyless abdominal rope-lifting surgery with carbon dioxide laparoscopy performed for benign ovarian cysts. Methods: During a 20-month period, 77 women underwent surgery for a benign ovarian cyst. Keyless abdominal rope-lifting surgery and conventional carbon dioxide laparoscopy techniques were used for the operations in 32 women and 45 women, respectively. The 2 operative techniques were compared with regard to demographic characteristics; preoperative, intraoperative, and postoperative data including early postoperative pain scores; and frequency of shoulder pain and analgesic requirements. Results: Data regarding demographic characteristics, preoperative findings, cyst diameters and rupture rates, intra-abdominal adhesions, intraoperative blood loss, and postoperative hospital stay did not differ between groups (P > .05). However, the mean operative and abdominal access times were significantly longer in the keyless abdominal rope-lifting surgery group (P < .05). Visual analog scale pain scores at initially and at the second, fourth, and 24th hours of the postoperative period were significantly lower in the keyless abdominal rope-lifting surgery group (P < .05). Similarly, keyless abdominal rope-lifting surgery caused significantly less shoulder pain and additional analgesic use (P < .05). Conclusion: Keyless abdominal rope-lifting surgery seems to cause less pain in the management of benign ovarian cysts in comparison with conventional carbon dioxide laparoscopy.

Combination of Cholecystectomy and Salpingooophorectomy in Keyless Abdominal Rope-lifting Surgical Technique

Introduction: During keyless abdominal rope-lifting surgery (KARS) the intra-abdominal operations are performed through the single intra-umbilical incision following the lifting of the abdominal wall by sutures loaded in the Veress cannula without using CO2 and trocars. However, it is unclear whether KARS is suitable for the combination of two different surgical procedures performed in the lower and upper abdominal viscera. In this paper we aimed to present the first case of the combination of cholecystectomy and salpingooophorectomy performed by using the KARS technique. Case Report: A sixty-seven year old, gravidity 7, parity 7, postmenopausal woman was referred to our center with the symptoms of nausea, vomiting and right upper abdominal pain. Physical examination was not remarkable other than a mild right upper abdominal tenderness and a positive Murphy sign. Ultrasound examination revealed a hydropic gall bladder with micro calculi and the bile duct was dilated with a width of 11–12 mm and there was an image compiled with bile sludge located distal to the dilatation area. In addition, there was a septated cyst with 95x65x46 mm diameters in the left adnexal region. Cholecystectomy and salpingoophorectomy were performed through the same single incision of KARS. The woman was discharged at the 2 postoperative day. Conclusion: To our knowledge, this is the first case report presenting the operative management of a gall-bladder disease and adnexal cyst by using a single incision and gasless minimal invasive surgical technique. KARS seems feasible for the combination of cholecystectomy and salpingoophorectomy.

Gaseous distension of the urinary bag during CO2 laparoscopy in the usual operative settings: Does the CO2 diffuse into the urinary bladder or is it a sign of urinary tract injury?

Abstract Objective To compare the amounts of any clinically detectable gas passage into the urinary bag in laparoscopic and open surgeries. Methods Seventy-nine women were allocated into two surgical groups; Group 1: carbon dioxide (CO 2 ) laparoscopy ( n =37) and Group 2: gasless laparoscopy or laparotomy ( n =42). All patients had urinary catheter during the surgeries. After checking the tightness of the connection of the urinary catheter and bag operations were performed. At the end of each surgery the urine volumes were recorded. The bags were immersed into a water containing container with a volume scale. The volume rise of the container was recorded. The valve of the outlet of the bag was turned on under the water and any leakage of air bubbles was observed. The final volume of the container was recorded once again while the bag was still in the water. The two groups were compared by using the Students t or Mann Whitney U tests. Results We did not observe and hence measure any gas accumulation in the urine bags of both groups. The womens ages, total intraoperative urine volume, urine production rate and total operative times of the groups were not significantly different. The mean operative time was (82.98±62.14) min in open surgeries and (73.46±52.74) minutes in CO 2 laparoscopic surgeries. The difference between the groups was not significant ( P =0.468). Conclusions Any gas accumulation in the urine bag during CO 2 laparoscopic surgery should raise the suspicion of urinary tract injury. Urinary catheterization helps to diagnose the unnoticed bladder injuries.