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There are certain problems experienced while retightening the seton material during the patient follow-ups, such as pain and anaesthesia requirements in perianal fistula. The aim of the present study was to compare a sailor's knot with other seton tightening methods for the surgical treatment of perianal fistulas.The records of 105 patients who underwent surgeries for perianal fistulas using the seton method between 2016 and 2019 were analysed retrospectively. The demographic characteristics, complaints, fistula localizations, surgery types, hospital stay lengths, postoperative complications and imaging modalities of the patients included in the study were recorded. The patients were divided into two groups according to the surgical treatment method. Those patients who underwent seton procedures with a sailor's knot were included in Group 1. Group 2 included those patients who underwent other seton procedures, including silk and penrose drain procedures. Groups were compared with regard to success rates and postoperative recurrence.There was no statistically significant difference between the groups in terms of the age, gender, fistula type and follow-up duration. Success rate in all patient was 88.6%, 91.2% in group 1 and 87.1% in group 2 (p=0.36). The number of patients with a kind of incontinence was 7 (7.1%), 3 (5.8%) in Group 1 and 4 (7.4%) in Group 2 (p = 0.297).There were no statistically significant differences with regard to complications and recurrences between the sailor's knot and the other seton tightening methods used for the treatment of anal fistulas. The sailor's knot is recommended with regard to its easy application and seton retightening with satisfactory outcomes.Perianal fistula, Sailor's knot, Seton.Si sono riscontrati alcuni problemi al momento di incrementare la stretta del setone nel corso del follow-up del paziente con fistola perianale, in rapporto al dolore e l’anestesia. Lo scopo del presente studio è quello di confrontare il nodo marinaro con altri metodi di serraggio del setone per il trattamento chirurgico di queste fistole. Sono stati analizzati retrospettivamente i documenti clinici di 105 pazienti sottoposti a interventi chirurgici per fistole perianali utilizzando il metodo del setone tra il 2016 e il 2019. Sono state registrate le caratteristiche demografiche, le lamentele, le localizzazioni delle fistole, i tipi di interventi chirurgici, la durata delle degenze in ospedale, le complicanze postoperatorie e le modalità di imaging dei pazienti inclusi nello studio. I pazienti sono stati divisi in due gruppi secondo il metodo del trattamento chirurgico adottato. I pazienti sottoposti a procedure del setone con nodo marinaro sono stati inclusi nel I gruppo. Il II gruppo comprendeva i pazienti sottoposti ad altre procedure del setone, tra cui il drenaggio con seta o con penrose. I due gruppi sono stati posti a confronto per quanto riguarda il tasso di successo e le recidive postoperatorie. RISULTATI: Non sono state rilevate differenze statisticamente significative tra i gruppi in termini di età, sesso, tipo di fistola e durata del follow-up. La percentuale di successo in tutti i pazienti è stata dell’88,6%, del 91,2% nel gruppo 1 e dell’87,1% nel gruppo 2 (p = 0,36). Il numero di pazienti con una sorta di incontinenza era 7 (7,1%), 3 (5,8%) nel gruppo 1 e 4 (7,4%) nel gruppo 2 (p = 0,297). CONCLUSIONI: Non ci sono state differenze statisticamente significative per quanto riguarda le complicanze e le recidive tra il nodo marinaro e gli altri metodi di serraggio del setone usati per il trattamento delle fistole anali. Il nodo del marinaio è raccomandato per quanto riguarda la sua facile applicazione e il suo riserraggio con esiti soddisfacenti.

Laparoscopic appendectomy is increasingly being performed because of its quick recovery time, low instance of wound infection, and early return of patients to home and work. Operating time should be short yet safe. Therefore, in this study, we compared the effects of various sealing systems on the length of surgery and examined whether these systems could be used to separate the appendix from its stump successfully. This prospective and randomized ex vivo study was conducted on 20 consecutive patients diagnosed with acute appendicitis. All patients underwent classical open appendectomy. The patients were classified into two groups according to the type of sealing system used. The LigaSure® system was used for coagulation in Group L and the Harmonic® system in Group H. After coagulation, a pressure system was used to evaluate the closure of the appendix. Results showed that the use of ultrasonic instruments alone to close the appendiceal stump caused an incomplete closure.Appendicular stump, Laparoscopic appendectomy.

Gallbladder tumours rank fifth in the world among gastrointestinal system tumours. Coincidental gallbladder tumours are diagnosed during cholecystectomies, or by examining the cholecystectomy material.In this study, we aimed to evaluate the incidence of gallbladder cancer among patients undergoing cholecystectomies due to gallbladder disease.Retrospective study METHODS: The files of 341 patients who had undergone routine cholecystectomy operations between January 2013 and March 2016 were reviewed, and their pathology results were recorded. Those patients with gallbladder carcinomas were evaluated in terms of age, gender, preoperative findings, existing symptoms, radiological findings, surgical findings and follow-up. The cancer invasion depth was classified according to the American Joint Commission on Cancer (AJCC) atlas, and this study was approved by the ethical committee of our university.Among the 341 patients who participated in this study, 253 (74.41%) were female, 88 (25.80%) were male, and their average age was 49.61 years old (17-86). Seven of the patients (2.05%) had gallbladder tumours; six of which were female, one was male and their average age was 67.71 years old (62-76). One tumour was diagnosed as a frozen specimen during the operation, while the others were diagnosed during the postoperation phase. Three of the patients had T1b and four had T2 tumours.Gallbladder tumours detected incidentally could extend survival rates with proper surgical intervention and chemotherapy. The possibility of a tumour should not be dismissed in those patients with advanced age, females or patients with gallbladder stones. Frozen specimens should be created during a cholecystectomy, and if there is any doubt about the diagnosis, a postoperative histopathological examination of the gallbladder should be conducted.Cholecystectomy, Gall bladder stone, Incidental gallbladder carcinoma.I tumori della colecisti occupano il Quinto posto nel mondo tra i tumori del sistema gastroenterico. Accidentalmente essi vengono diagnosticati durante una colecistectomia oppure all’esame anatomopatologico del pezzo anatomico. Lo scopo di questo studio retrospettivo è stato quello di valutare l’incidenza del cancro della colecisti nei pazienti sottoposti a colecistectomia per patologia della colecisti. Sono state sottoposte a revisione le cartelle cliniche di 341 pazienti sottoposti a colecistectomia tra il gennaio 2013 e il Marzo 2016, registrando i referti anatomo-patologici. Dei pazienti con carcinoma della colecisti sono state considerate l’età, il genere, gli esami preoperatori, la sintomatologia esistente, i referti radiologici, i reperti chirurgici ed il follow up. La profondità di invasione carcinomatosa è stata classificata secondo la American Joint Commission on Cancer (AJCC) e lo studio è stato approvato dal comitato etico della nostra università. Risultati: tra i 341 pazienti partecipanti allo studio 253 (74,41%) erano donne, 88 (25,80%) uomini, e l’età media era di 49,61 anni (range 17-86). Sette di questi pazienti (2,05%) avevano tumori della colecisti; sei di essi erano donne ed uno un uomo, dell’età media dii 67,71 anni (range 62-76). Un tumore è stato diagnosticato all’esame estemporaneo al congelatore durante l’intervento, mentre gli altri sono stati diagnosticati nella fase postoperatoria. Tre dei pazienti avevano tumori T1b e quattro T2. In conclusion I tunori della colecisti diagnosticati accidentalmente possono aumentare l’incidenza della sopravvivenza con trattamento chirurgico opportuno e chemioterapia. La possibilità di un tumore non dovrebbe essere trascurata in pazienti in età avanzata, di sesso femminile o in pazienti con calcolosi della colecisti. Durante l’intervento chirurgico dovrebbe essere effettuato l’esame estemporaneo al congelatore, e se c’è un dubbio circa la diagnosi dovrebbe essere effettuato l’esame istologico postoperatorio.

Acute appendicitis is the most common surgical abdominal emergency. In the early diagnosis of acute appendicitis, the fact that there is no a sign which could be a reliable indicator in most of the patients increases the complications. In this study we aimed to search the relation between Ultrasonography(US) findings in patients with diagnosis of acute appendicitis and postoperative histopathologic investigation on remoced appendix..The files of 174 patients who came in our emergency department with lower right abdominal pain were studied retrospectively from January 2013 to May 2014. Of them, 26 patients were excluded, because these patients were not studied with US. US findings and histopathology reports of 148 patients with suspected acute appendicitis and studies preoperatively with abdominal US were enrolled. Greater than 6-mm diameter of the appendix under compression was accepted as positive sign of appandicitis in US. The demographic characteristics of the patients, US findings (acut appendicitis or not) and the pathology results were recorded on the standard proform.Of these 148 patients, 100 were acute appendicitis in preoperative US, and of these 100 patients, 93 histopathologic reports were acute appendicitis, 7 were normal appendices. The sensitivity of US was 75.6 % and specificity was 72 %. Positive predictive value (PPV) was 93 %, negative predictive value (NPV) was 14.6 % and the accuracy of US value was 81.7%. As a result, although US in diagnosis of acute appendicitis is a reliable technique, negative result doesn't mean no acute appendicitis. In order to determine an accurate diagnosis of acute appendicitis clinical and laboratoary findings should be assessed together.Abdominal pain, Acute appendicitis, Ultrasonography.L’appendicite acuta rappresenta la più comune causa di urgenza chirurgica. Il fatto che per la diagnosi precoce non c’è un segno indicativo caratteristico accresce le complicazioni. Con questo studio si è cercato di riconoscere un rapporto tra i casi di appendicite acuta posta con gli US ed i riscontri istopatologici sull’appendice asportata. Sono state esaminate retrospettivamente le cartelle cliniche di 174 pazienti del dipartimento di emergenza che via vevano fatto ricorso per dolori in fossa iliaca destra da gennaio 2013 a maggio 2014. 26 di questi paziente sono stati esclusi perchè non studiati preoperatoriamente con l’ecografia, includendo nello studio i referti istopatogici di 148 pazienti che erano stati sospettati di appendicite acuta. Era stata accettata la diagnosi ecografica di appendicite acuta nel caso di un diametro appendicolare superiore ai 6 mm sotto compressione. Sono state registrate in un modulo standard le caratteristiche demografiche dei pazienti ed i reperti ecografici, positivi o meno per appendicite acuta. In 100 di questi 148 pazienti la diagnosi ecografica preoperatoria era stata di appebdicite acuta, ed il referto istopatologico aveva confermato la diagnosi in 93 casi, mentre in 7 casi si trattave di appendici normali. La sensibilità degli US è risultata del 75,6% e la specificità del 72%. Il valore predittivo positivo (PPV) è stato del 93% e quello negativo (NPV) 14,6% con accuratezza del valore ecografico 81,7% Risulta che l’ecografia è una tecnica affidabile per la diagnosi di appendicite acuta, ma la negatività non significa negazione della diagnosi. Per una diagnosi più accurata i dati ecografici devono essere associati ai rilievi clinici ed ai dati di laboratorio.

The aim of this study is to evaluate the thyroid function tests in order to examine whether 10 % of Povidone-Iodine(PI), the medication we applied in 1/5 ratio diluted with 0.9 %NaCl, joins the systemic circulation during clean contaminated, contaminated and dirty operations for solid organ hydatid cysts in abdominal area to avoid abscess formation and spreading. 7 men and 6 women were included to the present study, prospectively. The mean age was 33.69(± 13.49). TSH, free T3 (fT3) and free T4 (fT4) hormone levels were measured before the operation and at the third day of postoperative period. Amount of used povidone-iodine for patients was recorded. As a result of statistical analysis applied, the preoperative and post operative values were not significantly different regarding with the measured hormone levels (preTSH vs postTSH: p= 0.984; prefT3 vs postfT3: p= 0.101; prefT4 vs postfT4: p=0.146). Thus, it has been shown that the dose we used is effective, and it does not enters at all or at quite low levels into the systemic circulation. Patients whom this application performed, abscess and intestinal adhesions have not been observed in our clinical experience. We recommend the use of suggested doses of Povidone-Iodine in the presence of intraabdominal perforation and abscess or in cases such as carrying a risk of cyst spreading to intraabdominal area in hydatid cysts.Povidone-iodine, Surgical adhesions, Surgical wound infections, Thyroid function tests.Scopo di questo studio è quello di valutare i test di funzione tiroidea per indagare se una soluzione di Povidone- Iodine (PI) al 10%, che usiamo nella diluizione 1/5 con 0,9% NaCl in area addominale durante interventi puliti- contaminati, contaminati e sporchi in caso di idatidosi in organi parenchimatosi, al fine di evitare la formazione di ascessi e la disseminazione, raggiunge la circolazione sistemica. In questo studio sono stati inclusi 7 uomini e 6 donne in maniera prospettica. L’età media era di 33,69 (± 13.49). Preoperatoriamente ed al terzo giorno postoperatorio sono stati dosati i livelli ormonali di TSH, T3 libero (FT3) e T4 libero (FT4). È stata presa nota della quantità di PI usata per ogni paziente. Dall’analisi statistica non sono risultati valori significativamente differenti tra il preoperatorio ed il postoperatorio relativamente al livello degli ormoni tiroidei (preTSH vs postTSH: p= 0.984; preFT3 vs postFT3: p= 0.101; preFT4 vs postFT4: p=0.146). Così si è dimostrato che la dose di PI usata è efficace e non entra, o quanto meno a livello piuttosto basso, nella circolazione sistemica. I pazienti in cui tale procedura è stata usata non sono andati incontro in questa nostra esperienza ad ascessi addominali o aderenze intestinali. Raccomnadiamo dunque l’uso di queste dosi suggerite di PI in caso di perforazioni intestinali o ascessi, o in caso di possibile rischio di disseminazione in area intraaddominale di cisti idatidee.

We aimed to retrospectively analyze patients who underwent surgical treatment in our clinic for hydatid cysts in terms of the surgical methods implemented and their results.Archival records of the patients who underwent surgery for the treatment of hydatid cysts between 2007 and 2014 were analyzed retrospectively.The records of 425 patients who underwent surgery with varying ages of 16 to 88 years (mean: 44.5) were obtained. Among the patients, 33.9% (n=144) were male and 66.1% (n=281) were female. The most frequent symptoms were abdominal pain (46.4%) and dyspepsia (30.9%). About 79.5% of the patients had hydatid cysts in their livers, and 66.8% of these cysts were on the right lobe of the liver. Surgical intervention was performed on 513 cysts. The average diameter of these cysts was 8.3 cm. About 85.5% (n= 438) of the interventions implemented were partial cystectomy. Laparotomy was performed through the right subcostal incision on 81% (n=345) of the patients who underwent conventional surgery. The most frequently encountered complication was biliary fistula. The mortality rate was 0%.The results showed that most of the cases were uncomplicated isolated hepatic hydatid cysts frequently found on the right lobe of the liver. The most frequently implemented surgical procedure was partial cystectomy. This procedure was simple, fast and applicable for uncomplicated hepatic hydatid cysts.Hepatic hydatid cyst, Mortality, Partial cystectomy.