Search

BACKGROUND As a chronic condition, pilonidal disease affects a young population and the surgical procedures performed to treat this condition require a recovery time with time off work. Therefore, the search for ideal treatment is still ongoing. OBJECTIVE The aim of this study is to compare early and late results of two minimally invasive treatment options used to treat pilonidal disease. DESIGN This study is designed as a two parallel group randomized clinical trial. SETTINGS The study consists of two groups: curettage+platelet rich plasma and curettage+phenol. PATIENTS Patients with pilonidal disease were evaluated for the study, and enrolled if they met inclusion criteria and gave informed consent. INTERVENTIONS Patients in the platelet rich plasma group were treated using curettage+platelet rich plasma gel. In Phenol group patients were treated using curettage+crystallized phenol. MAIN OUTCOME MEASURES The primary study end point was the time to achieve healing; the secondary outcome was recurrence rate. RESULTS In the platelet rich plasma group, 96% of cases achieved healing after one application. In the phenol group, only 53% cases achieved healing after one application. The median healing time was shorter in the platelet rich plasma group; 6 (4-14) vs 10 (5-42) days (p more...

Objective: Coordination function of primary care (PC) enables continuous, efficient, and cost-effective health care provided to patients with chronic disease and multimorbidity (MM). The aim of this study was to identify the most common chronic diseases and to determine the prevalence of MM in PC registries. Methods: Our study is a cross-sectional study. All the individuals aged 40 and over who were registered to the primary care units (PCUs) of the Uskudar district of Istanbul have formed the population of the study. A systematic cluster sampling was used. The patient list of each family physician in Uskudar district was accepted as a cluster and an equal number of patients from each cluster were enrolled. Only the information on the patients’ MM data was requested from the primary care physicians. Results: The 108 physicians of the Uskudar district (response rate: 73.4%) gave consent to participate in the study. The 1187 (40.3%) of registered patients of all PCUs were 40 years old and over. The multimorbid patients were found as 330 (27.8%). Conclusion: Approximately, one of four patients have multimorbidity. So, the policy of primary care services should be redesigned for the management of MM patients including the ‘goal-oriented care’ approach. more...

The improvement of endoscopy aims to decrease the probability of skip lesions and increase the accuracy of diagnosis. The improvement of technology and widespread use of endoscopy caused it to be used for follow-up and therapeutic purposes. Although, the terms prophylactic endoscopy or endoscopic prophylaxis are not used in literature; endoscopic procedures include prophylactic procedures. Removal of a suspicious or premalignant polyp by endoscopic polypectomy is cancer prophylaxis. more...

PubMed ID: 28614171 Background: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for treatment of biliary disorders. There are several studies to increase the success rate and decrease the complication rate of ERCP. In this study we aimed to evaluate the affect of safety steps in success and complication rate of ERCP. Materials and Methods: In this cohort study patients were evaluated under 2 groups divided as before the introduction of safety steps and after. Successful cannulation rate, difficult cannulations, and complications of the procedure were recorded. Result: Failed ampullary cannulation rates were 8.2% in group 1 and 4% in group 2. In terms of postprocedural complications; in group 2 complication rates significantly decreased from 10.7% to 4.3%. Moreover, post-ERCP pancreatitis rate decreased from 9.1% in group 1 to 4% in group 2. Conclusions: Introduction of safety steps, significantly increase the cannulation rate and decrease both overall complication rate and pancreatitis risk. © 2017 Wolters Kluwer Health, Inc. All rights reserved. more...

Background: Although, there are several treatment options for treatment of pilonidal disease, nowadays minimally invasive modalities are becoming more common. The aim of this study is to evaluate the results of platelet rich plasma application for pilonidal disease. Methods: For this prospective cohort study, cases with pilonidal disease were evaluated. All cases that are eligible and accepted to be involved were included in the study. Platelet rich plasma was applied into the pilonidal sinus under local infiltration anesthesia. Healing of the disease and recurrence rates were recorded. Results: The success rate of the application was 97.1% at the first month. With a median follow up of 60.2 months the recurrence rate was 8.2%. Conclusion: Platelet rich plasma can be safely used for treatment of pilonidal disease with high success and low recurrence rate. © 2019 Elsevier Masson SAS more...

Objective Surgery and percutaneous aspiration-injection-re-aspiration (PAIR) are widely accepted treatment modalities for hepatic hydatid cysts. Endoscopic retrograde cholangiopancreaticography (ERCP) acts as a minimally invasive rescue method for the biliary complications of both the hydatid cysts and treatment modalities. The aim of this study was to identify the role of different treatment modalities in the obliteration of hydatid cysts. Methods Patients treated for hydatid cysts between January 2009 and December 2013 were evaluated in the study. Data were collected from hospital records. All cyst cavities were evaluated by ultrasonography or computed tomography. Results Ninety-five (40.4%) males and 140 (59.5%) females were included in the study. Before the procedures, the mean cyst diameter was 89.7±33.5 mm. At follow-up, the mean cyst diameter decreased to 53.2±30.1 mm. In the ERCP group, the mean diameter of the residual hydatid cyst cavity was significantly lower than that of the other groups (p=0.003). Conclusion ERCP provides faster cyst shrinkage and even disappearance of the residual cavity in 50% of cases. Moreover, in hydatid cysts with biliary communication, ERCP+ES can be safely used for primary treatment. more...

Introduction: Steroid cell tumors (SCTs) constitute less than 0.1% of all ovarian tumors. They are divided into 3 categories according to cell of origin: Stromal Luteoma arising from stromal cells of the ovary, Leydig cell tumor arising from Leydig cells, and SCT not otherwise specified (NOS) when the origin of the tumor is not defined. Case Presentation: Herein is presented a case of SCT diagnosed one month after a caesarian section delivery of a female fetus with ambiguous genitalia. The patient was admitted to the emergency department with the findings of acute abdomen, and surgery was performed under emergency conditions. The patient had virilization and hoarsening of the voice before surgery. Intraoperatively, a 21-cm ovarian mass was detected and resected with unilateral salpingo-oophorectomy. Conclusion: A histopathological examination of the tumor showed a tumor with cystic degeneration, necrosis, hemorrhage, and tumoral embolism. The pathological examination revealed ovarian SCT. Virilization was resolved immediately after the surgery. In women with virilization who give birth to a fetus with ambiguous genitalia, SCTs should be kept in mind. more...

Although it is a rare condition, traumatic colonic perforation has a significant morbidity and mortality rate. Especially in cases with sexual abuse, the patient may not give detailed information and this may cause delays in diagnosis and treatment. Here, we present a patient with acute abdominal findings who was diagnosed with traumatic colonic perforation intraoperatively. In cases with gastrointestinal perforation, traumatic colonic perforation should be kept in mind and patients must be asked about trauma. more...

Aim: Acute appendicitis (AA) is the most common surgical emergency in the world, and its diagnosis is mainly dependent on clinical findings. Recently, secretion of CA125 from peritoneal cells due to inflammatory stimulus has been shown. The aim of this study was to evaluate the relation between CA25 levels and AA. Materials and Methods: In this prospective trial, CA125 levels were measured. Group 1 consisted histopathologically approved AA cases. Group 2 consisted healthy individuals. Results: Seventy-four cases (37 AA and 37 healthy individuals) were included in the study. In the AA group, the mean CA125 level was 9.8±9.3 U/mL, and in the control group, it was 4.6±1.5 U/mL. In Pearson correlation analysis, the CA125 level had a positive correlation with AA (r0.371, p0.001). Conclusion: Recent studies demonstrate that CA125 can help distinguish patients with or without AA. CA125 levels can be used as a marker of AA in cases with clinical doubt more...

Objective: The aim of this study was to compare minimally invasive preperitoneal (MIP) single layer mesh repair with total extraperitoneal (TEP) inguinal hernia repair in terms of complications, recurrence, and chronic pain. Material and Methods: A total of 240 patients who underwent elective, primary, unilateral inguinal hernia operation between April 2011 and September 2012 were divided into two randomized groups. The first group underwent MIP repair and the second group underwent TEP repair. Visual Analogue Scale (VAS) and Sheffield Scale (SS) were used to evaluate chronic pain. Results: In all, 225 (95%) of the patients completed follow-up and were included in analyses. A significant difference was not detected between groups in terms of demographics, operative time, or intraoperative, early, or late complications. Length of time before return to work was significantly shorter in the TEP group (p< 0.001). Recurrence was seen in 1 (0.88%) patient in the MIP group and 1 (0.89%) patient in the TEP group (p= 0.993). Evaluation of chronic pain revealed no significant difference between groups in VAS and SS values at postoperative 6 th , 12 th , and 24 th months. Conclusion: In conclusion, it was observed that MIP repair for inguinal hernia has all of the advantages of preperitoneal repair and eliminates disadvantages of TEP repair. MIP technique is as safe as TEP repair and has similar qualities in terms of chronic pain, even though it is an open intervention. Copyright © 2019 by Turkish Surgical Society. more...

Background/aim Inguinal hernia repair is one of the most common surgical procedures worldwide. There is still controversy over which method has the best postoperative results. The aim of this study was to compare early and late postoperative results of laparoscopic totally extraperitoneal herniorrhaphy (TEP) and open Lichtenstein herniorrhaphy (OLR). Materials and methods The study was conducted in a randomized prospective manner and it was concluded with 302 patients (147 cases in TEP group and 155 cases in OLR group). All procedures were performed by two experienced surgeons in both open and laparoscopic inguinal hernia repair. Results The groups were similar in terms of age, sex, and types of inguinal hernia according to Nyhuss classification. The mean operation time was shorter in TEP group with 49.2 ± 15.5 min vs 54.3 ± 14.6 min in OLR group (P = 0.004). The mean length of hospital stay was significantly shorter in TEP group (P = 0.001). The mean postoperative visual analogue scale score was significantly lower in TEP group. With a mean follow-up of 40.95 months, the recurrence rates were similar in both groups with a rate of 4.3%. In terms of chronic pain, TEP group has better results than OLR with 3.4% vs 25.2%, respectively (P = 0.001). Conclusion In experienced hands, TEP procedure has better early and late postoperative results than OLR, whereas recurrence rates are similar. more...

Adrenal hemorrhage is a rare but life-threatening condition. Spontaneous hemorrhage occurs without any trauma. A focal bleeding may cause even a subclinical condition or cardiovascular collapse with massive bleeding. Non-proper diagnosis may cause even death. In literature most of the cases are treated conservatively. Conservative treatment necessitates close follow up and if fails, surgery becomes challenging. Here, we present a case with spontaneous adrenal hemorrhage that was first taken to conservative treatment and undergone emergency surgery. more...

Background: The diagnosis of acute appendicitis (AA) is mainly dependent on clinical evaluation. There are several scoring systems developed for an accurate and early diagnosis of AA. Modified Alvarado score is one of the most common systems. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was developed in 2010. The aim of this study is to evaluate and compare the accuracy of modified Alvarado and RIPASA scoring systems for the diagnosis of AA. Methods: A total of 100 cases with the clinical diagnosis of AA were included in the study. All the cases were treated surgically. For all cases, modified Alvarado and RIPASA scores were calculated and recorded. According to the calculated cut-off values, sensitivity, specificity, negative and positive predictive values and total accuracy were calculated for each scoring systems. Results: According to the receiver operating characteristic curve. the optimal score of modified Alvarado score for AA was found to be 5.5 with a sensitivity of 88% and specificity of 69%. According to the receiver operating characteristic curve, the optimal score of RIPASA score for AA was found to be 8.75 with a sensitivity of 94% and specificity of 88%. With the cut-off value of 8.75, total accuracy of RIPASA scoring was found to be 85.2%. Although there is no significant difference in negative appendicectomy rate, both sensitivity and the specificity of the RIPASA were found to be significantly higher than the modified Alvarado. Conclusion: According to the current study, RIPASA scoring system was found to be superior to modified Alvarado in the prediction of cases with AA. © 2019 Royal Australasian College of Surgeons more...

Primary hyperparathyroidism (PHPT) has been considered a cause of insulin resistance (IR) and impaired glucose metabolism. However, there are conflicting results related with the recovery of insulin resistance in patients with PHPT following curative parathyroidectomy. Our aim is to evaluate the effects of curative parathyroidectomy on IR in patients with PHPT. This is a prospective interventional study. Twenty-one consecutive patients with symptomatic PHPT were included into the study. All patients underwent parathyroidectomy. Fasting serum glucose, calcium, phosphorous, parathormone, plasma insulin, and vitamin D levels were measured both at baseline and 2 months after parathyroidectomy. Insulin resistance was calculated by homeostasis of model assessment-insulin resistance (HOMA-IR). Two months after curative parathyroidectomy, serum levels of calcium (p = 0.001), PTH (p more...

Objective Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an ideal treatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques. Material and Methods In this randomized prospective trial, 100 patients were divided into two groups: onlay and sublay groups. Recurrences were evaluated by performing a physical examination. Results The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time was significantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantly better results. The recurrence rates were found to be similar in both groups (6% in the onlay group and 2% in the sublay group). Conclusion In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms of postoperative pain and wound complications. Both techniques have similar recurrence rates. more...

Radioactive iodine (RAI) treatment is recommended as the first choice for toxic thyroid nodules by American Thyroid Association (ATA). Here, we present our second case of papillary thyroid carcinoma after RAI therapy. A fifty fiveyear-old woman received RAI therapy for toxic thyroid nodule in the right lobe in 2005. Pre-treatment fine needle aspiration biopsy (FNAB) revealed benign cytology. She was euthyroid after the therapy. However, 8 years after the treatment she had 15 mm thyroid nodule in the same location. This time, FNAB result was suspected for papillary thyroid carcinoma. The patient underwent bilateral total thyroidectomy and the histopathological evaluation revealed papillary thyroid carcinoma in the nodule. This is the second case with papillary carcinoma after RAI therapy. Papillary carcinoma developed after the RAI therapy. In conclusion, all cases should be closely followed up after RAI therapy for carcinoma development., Amerikan Tiroit Derneği (ATA) toksik tiroit nodüllerinde ince iğne aspirasyon biyopsisi (İİAB) yapılmaksızın radyoaktif iyot (RAI) tedavisi önermektedir. Elli beş yaşında kadın hasta 2005 yılında tespit edilen tiroit sağ lobunda yerleşimli toksik nodül nedeniyle RAI tedavisi almış. Hastanın RAI öncesi yapılan İİAB sonucu benign tiroit nodülü olarak rapor edilmiş. Hastanın 8 yıl sonra yapılan kontrol ultrasonografisinde tiroit sağ lobda yerleşimli 15 mm çaplı solid nodül saptandı. Hastaya yapılan İİAB sonucu papiller karsinom açısından şüpheli olarak rapor edildi. Hastaya bilateral total tiroidektomi yapıldı. Histopatolojik incelemede nodülde papiller tiroit karsinomu tespit edildi. Bu vaka RAI sonrası karşılaştığımız ikinci papiller karsinom vakasıdır. Bu yazıda sunduğumuz olgu, RAI öncesi hastanın karsinomunun olmadığı ve kanser gelişiminin RAI tedavisi sonrası olduğu İİAB ile gösterilmiştir. Sonuç olarak, RAI tedavisi alan hastalar uzun dönemde karsinom gelişimi açısından yakın takip edilmelidir. more...

Objective: Non-operative management of abdominal injuries has recently become more common. Especially nonoperative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of nonoperative treatment in abdominal trauma (blunt penetrating) is discussed. Material and Methods: All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated. Results: The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively. Conclusion: Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring. more...

Aim: We aimed at evaluating the Histopathological examination results of biopsies obtained from the anastomosis line of patients with previous gastrectomy in terms of malignancy. Material and Method: The endoscopic findings and the biopsy records obtained from the anastomosis line of 23 patients with gastrectomy history for whom upper gastrointestinal system (GIS) endoscopy was performed at the General Surgery Clinic, Endoscopy Unit of Training & Research Hospital in Konya between Jan. 2009 and Dec. 2011 were retrospectively examined for the existence of Helicobacter pylori, intestinal metaplasia (IM), dysplasia and cancer. Results: The average age of patients was 63 (range 30-82), with 17 males (74%) and 6 females (26%). 15 (65%) of these patients had undergone a gastrectomy for a malignity, and 8 (35%) for a benign reason. The time elapsed after the surgical operation was 46 (range 12-144) months in average. 17 (74%) of these surgical operations were Billroth II, 3 (13%) gastroenterostomy without resection, 2 (9%) total gastrectomy, and 1 (4%) Billroth I. Upper GIS endoscopy revealed alkaline reflux gastritis at 14 (61%) patients, anastomosis ulcer at 6 (26%) patients, polyp at 2 (9%) patients, and cancer at 1 (4%) patient. Histopathological examination of the biopsy results displayed 5 (22%) reactive hyperplasic changes, 5 (22%) chronic active gastritis, 5 (22%) dysplasia, 3 (13%) IM, and 2 (9%) cancer. Discussion: Patients with gastrectomy history develop IM in the anastomosis line in parallel with the time elapsed after surgical operation, and subsequently develop dysplasia. Monitoring with endoscopy will make diagnosis and appropriate treatment possible in the stage of dysplasia. more...

Background Acute appendicitis (AA) is the most common reason for abdominal surgery in the world. The aim of this study was to evaluate the effect of medical treatment on histological findings in rabbits with AA. Methods Twenty-one male New Zealand rabbits were divided into 3 groups: appendix ligation and medical treatment, appendix ligation and no treatment, and control group, which underwent only laparotomy. Results In appendix ligation without treatment group, AA findings were much more severe. Conclusion Medical treatment reduced inflammation of AA. more...

BACKGROUND We aimed to compare the effects of topical zinc oxide and topical silver sulfadiazine in the treatment of partial-thickness burn wounds. METHODS The study was conducted with 20 New Zealand rabbits, and burn wounds were created by a brass probe. The animals were randomly divided into two groups. The burns were treated with zinc oxide (Group O) or silver sulfadiazine (Group S) with daily application. The wound healing process was followed both clinically and histopathologically. We determined the days at which 50% and 80% re-epithelization was observed. RESULTS The mean time for 50% and 80% re-epithelization was 21.4 and 25.4 days in Group O and 25.8 and 30.2 days in Group S, respectively (p more...

Purpose: In this study, we aimed at comparing the sensitivity and selectivity rates of Ultrasonography (USG), Mamography (MG) and Magnetic Resonance (MR), based on the biopsy results of breast mass lesions. Materials and methods: Between January 2009 and December 2010 in Konya Training and Research Hospital the biopsy results and reports of imaging tecniques such as USG, MG and MR, were obtained from the hospital automation. The sensitivity and selectivity of the USG, MG and MR were calculated. Results: The avarage age of the 112 patients included in this study is 49 ± 10 (23 - 71). 27 (24%) of the patients were found to have breast cancer after the histopathologic examination. USG was used with the 95 (94%) of the patients and 17 (18%) of the patients were diagnosed to have cancer. MG was used with the 75 (67%) of the patients and 15 (20%) of the patients were diagnosed to have cancer, and MR was used with the 112 (100%) of the patients and 25 (22%) of the patients were diagnosed to have cancer. In the pathologic diagnosis of cancer, the sensitivity of USG was found 85%, the sensitivity of MG was found 89%, and the sensitivity of MR was found 92%. The selectivity of these tecniques were 58%, 87% and 57% respectively. Conclusion: MR and MG have similar sensitivity rates in the diagnosis of breast cancer. Breast MR is an appropriate imaging tecnique that can be used in suitable indications in addition to USG and MG. more...

Purpose: The aim of this study was to compare magnetic resonance cholangiopancreatography (MRCP) with endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing bile duct pathologies. Materials and Methods: We documented the data of 171 patients with both ERCP and MRCP between January 2009 and December 2010 at the Konya Education and Research Hospital. Results: Of the 171 patients, 100 (58.5%) were female and 71 (41.5%) were male. The median age was 63 (55 to 89). ERCP was used to diagnose bile duct stones in 102 (59%) patients, bile duct tumour in 14 (8%) patients, hydatic cysts opening up to the bile duct in 4 (2%) patients and bile duct stenosis in 3 (1.8%) patients. For the detection of bile duct stones, MRCP had a sensitivity of 92%, a specificity of 74% and a diagnostic accuracy of 83%. For bile duct tumours, MRCP had a sensitivity of 85%, a specificity of 98% and a diagnostic accuracy rate of 92%. Conclusion: In our centre, the results of MRCP and ERCP were similar for the last two years. However, MRCP was superior with respect to diagnosis as it was cheaper and non-invasive. Thus, ERCP should be preferred for therapeutic processes. more...

Spindle cell lipoma is a rare lipoma, originates from subcutaneous tissue and mostly seen at back region. In this case report we represent a case with inguinal mass misdiagnosed as inguinal hernia and then diagnosed as spindle cell lipoma. There are two cases in literature with spindle cell lipoma originating from spermatic cord. This case is unique as having both pheochromacytoma and inguinal spindle cell lipoma mistaken as inguinal hernia., İğsi hücreli lipom subkutan dokulardan kaynaklanan genellikle sırt ve ensede görülen nadir bir lipom çeşididir. Bu olgu sunumunda sol kasığında fıtıkla karışan kitlesi mevcut olan ve daha sonra bu kitlenin iğsi hücreli lipom olduğu saptanan hastayı sunduk. Literatürde daha önce 2 defa spermatik kord kaynaklı iğsi hücreli lipom bildirilmiştir. Bu olgu sunumu feokromasitomayla birlikte olan ve kasık fıtığıyla karışan literatürdeki ilk iğsi hücreli hücreli lipom olma özelliğine sahiptir more...

Colonoscopy is the gold standard in diagnosis of colorectal diseases. It is generally a safe procedure with low complication rate. Splenic rupture is a very rare complication of colonoscopy. The case presented here, is a 57 years old male patient with complaint of hematochesia. He had colonoscopy and diagnosed as sigmoid colon tumor. After colonoscopy he had the findings of acute abdomen. At the operation splenic rupture was detected and he had undergone splenectomy with subtotal colectomy for the sigmoidal tumor. Splenic rupture is very rare but fatal complication of colonoscopy. In the management of patients with post-colonoscopy abdominal pain splenic injury should be kept in mind., Kolonoskopi, Kolorektal hastalıkların tanısında, düşük kmlikasyon oranına sahip ve güvenli olmasıyla altın standart yöntem olarak kabul edilmektedir. Dalak rüptürü kolonoskopinin nadir bir komplikasyonu olarak bildirilmektedir. Burada sunulan hasta, 57 yaşında hematokezya şikayeti olan bir erkek hastadır. Hastaya yapılan kolonoskopide sigmoid kolonda tümöral lezyon tespit edildi. Kolonoskopi sonrası akut batın bulguları gözlenen hasta ameliyata alındı. Ameliyatta, dalak rüptürü tespit edilerek, hastaya subtotal kolektomi ve splenektomi yapıldı. Dalak rüptürü kolonoskopiye bağlı nadir görülen ancak ölümcül bir komplikasyondur. Kolonoskopi sonrası karın ağrısı olan hastalarda dalak rüptürü olabileceği akılda tutulmalıdır more...

Background Pilonidal sinus is a chronic inflammatory disorder of the intergluteal sulcus. The disorder often negatively affects patients’ quality of life, and there are numerous possible methods of operative treatment for pilonidal sinus. The aim of our study was to compare the results of 3 different operative procedures (tension-free primary closure, Limberg flap, and Karydakis technique) used in the treatment of pilonidal disease. Methods The study was conducted via a prospective randomized design. The patients were randomized into 3 groups via a closed envelope method. Patients were included in the study after admission to our clinic with pilonidal sinus disease and operative treatment already were planned. The 2 main outcomes of the study were early complications from the methods used and later recurrences of the disease. Results A total of 150 patients were included in the study, and the groups were similar in terms of age, sex, and American Society of Anesthesiologists scores. The median follow-up time of the study was 24.2 months (range, 18.5–34.27) postsurgery. The recurrence rates were 6% for both the Limberg and Karydakis groups and 4% for the tension-free primary closure group. Therefore, there was no substantial difference in the recurrence rates. Conclusion The search for an ideal treatment modality for pilonidal sinus disease is still ongoing. The main conclusion of our study is that a tension-free healing side is much more important than a midline suture line. Also, tension-free primary closure is as effective as a flap procedure, and it is also easier to perform. more...

PURPOSE While LigaSure is commonly used for blood vessel closure, our aim was to research the effectiveness of using the latter tool for the purpose of closing intestines in rats. METHODS Twenty Wistar albino rats were divided into two groups per 10 each. In Group 1, the sigmoid colon was cut from its middle and its distal was closed with 4/0 silk. In Group 2, on the other hand, the sigmoid colon was divided from the middle with LigaSure LS1200 probe and its distal was closed with LigaSure. In both groups, the proximal sigmoid colon was entered by means of colostomy with 4/0 silk to the left part of the abdomen. Operation durations, adhesion levels and explosion pressures were recorded. Tissue samples were taken for tissue hydroxyproline level. RESULTS While the average duration of the operation was 25.7 minutes in Group 1, it was 18.8 minutes in Group 2 and the difference between them was significant in favour of LigaSure. (p more...

Aim: The aim of the study is to evaluate the impact of endoscopy training during residency on endoscopic diagnosis. Material and Method: the patients files who had undergone endoscopy between 2009 and 2011 in surgical endoscopy unit, retrospectively evaluated. Endoscopists were divided into 2 groups as endoscopy training during residency (group 1) or than after (group 2). Histopathological evaluation was accepted as the method to confirm the diagnosis. Endoscopic and pathological diagnoses were compared and the consistencies of the Endoscopists were calculated. Results: There were 9055 endoscopic evaluation and 1285 biopsies were taken in 3 years period. The mean age of the patients were 54 (15-94). There were 15 surgeons, 8 in group 1, 7 in group 2. In upper gastrointestinal system endoscopy the consistency rates were 79% in group 1 and 72% in group 2 (p=0,035). In lower gastrointestinal system endoscopy, the consistency rates were 79% in group 1 and 80% in group 2 (p=0,709). Discussion: Endoscopy training during residency has positive impact on identification of upper gastrointestinal system lesions. more...

Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in both the diagnosis and the treatment of biliary and pancreatic disorders. The aim of this study is to evaluate the effects of OB usage during ERCP on duodenal motility, the tolerability of the procedure (by patients) and the difficulty of the procedure (by the endoscopist). The study was conducted in Konya Training and Research Hospital General Surgery Endoscopy Unit in randomized prospective pattern. The patients were divided into the two groups as spasmolytic and control groups. The procedure was performed under topical anesthesia and sedation. There were 100 cases included into the study (50 cases in each group). The mean duodenal motility score was found to be 1.9 ± 0.5 in the study group and 3 ± 0.6 in the control group. In the study group, the tolerability of the procedure score by the endoscopist was moderate in 16 % and well/very well in 78 % of the cases. On the other hand, in the control group, the scores were poor in 21 %, moderate in 71 %, and well/very well in 24 % of the cases. In terms of patient satisfaction, in study group 42 % of the cases reported the procedure as moderate and 58 % reported as well/very well. However, in the control group 16 % of the cases reported the procedure as poor, 58 % moderate, and 26 % as well/very well. Otilonium bromide is a safe agent with low side effects. It can be used before the ERCP procedure to decrease the duodenal motility. It eases the procedure, moreover, it increases the patients’ satisfaction. more...

To clarify the role of medical treatment in the management of acute appendicitis and the value of C-reactive protein (CRP) for predicting its failure. Patients with clinically diagnosed acute appendicitis, confirmed by imaging studies, were enrolled in this study. We measured leukocyte counts and CRP levels and recorded success and recurrence rates and the efficiency of medical treatment during follow-up. The efficiency of CRP values to predict failure of medical treatment was evaluated using receiver operating characteristics (ROC) curve analysis. The subjects comprised 193 patients (mean age 30.9 years) who received medical treatment for acute appendicitis. The mean follow-up period was 12.3 (6–24) months and the early success rate of medical treatment was 86.5 % (160/185). Fifteen (9.3 %) patients suffered recurrence during follow-up. The leukocyte and CRP levels in these two groups of patients were not significantly different at the beginning of the treatment, but the increase in the CRP value differed significantly between the two groups during the follow-up period (p more...

Background Experimental research into the viability and functionality of splenic tissue placed in the liver and the omentum. Methods There were 4 groups in this study. First group: sham laparotomy, 2nd group: splenectomy, 3rd group: splenectomy and splenic autotransplantation into the greater omentum and 4th group: splenectomy and splenic autotransplantation into the liver. Blood levels of haemoglobin, leukocytes, thrombocytes, immunoglobulin G (IgG), immunoglobulin M (IgM) and complement protein 3 (C3) were studied 1 day before and 6 weeks after the procedure. At the end of 6 weeks, scintigraphy was performed. Splenic tissue in the liver and the omentum were subjected to macroscopic and histopathologically. Results Pre- and postoperatively, no significant differences were found in terms of haematological and immunological measurements of groups I, III and IV. An increase in the numbers of thrombocytes and leukocytes and a decrease in the levels of IgG, IgM and C3 were observed in the postoperatively in group II.When the postoperative hematological and immunological values of the second group are compared to those of groups III and IV, the difference was significant in terms of levels of thrombocyte, leukocyte and IgM; insignificant in terms of levels of IgG and C3. In the microscopic and scintigraphic analyses the spleen tissue was found to be viable in all of the six rabbits in groups III and IV. Conclusions The liver is a suitable organ for splenic autotransplantation (Tab. 6, Fig. 2, Ref. 17). more...

Aim: Although there are several auxiliary laboratory tests, diagnosis of acute appendicitis (AA) mainly depends on clinical findings. The aim of this study was to evaluate the role of ischemia-modified albumin (IMA) in the diagnosis of AA. Methods: IMA levels of histopathologically confirmed AA cases and healthy volunteers were evaluated. Results: Mean IMA levels were 9.6 ± 12.5 absorbance units (ABSU) in the AA group and 3.04 ± 0.47 ABSU in the control group. Moreover, IMA levels positively correlated with the diagnosis of AA (r = 0.309, P = 0.013). The preoperative mean IMA level was 9.6 ± 12.5 ABSU, while the postoperative mean IMA level was 6.9 ± 11.7 ABSU (P = 0.001). There was a significant decrease in IMA levels after appendectomy. Conclusion: This study shows elevated IMA levels in patients with AA and a significant decrease of IMA levels after appendectomy. Oxidative stress plays a role in the pathogenesis of AA, and IMA levels can be used as an accessory parameter in diagnosis. more...

Background: More than 85% of primary hyperparathyroidism (PHPT) cases are due to solitary, benign parathyroid adenomas. Recently, the success rate of Tc99m sestamibi scintigraphy in localization has made minimally invasive parathyroidectomy (MIP) more prominent. MIP is as effective as conventional bilateral neck exploration. Moreover, it offers lower morbidity, cost effectiveness, and better cosmetics effects. Aim: We aimed to evaluate the success of MIP, which happens only under local anesthesia, in this study. Materials and Methods: Total of 63 patients were operated for PHPT, of which 54 had solitary adenoma. Five patients underwent bilateral neck exploration under general anesthesia for thyroid nodules or unlocalizated adenomas. A total of 49 patients underwent MIP under local anesthesia without any sedation. During MIP, gamma probe was used for all patients. The patients were followed for parathyroid functions. Results: The mean age of 49 patients with MIP (5 male, 44 female) was 59 years. The mean follow-up time was 16.4 (±10.1) months (range: 2-36 months). Of the 49 patients, 47 (96%) were totally cured. In 2 patients, the procedure was switched to conventional bilateral neck exploration. Temporary hypocalcaemia was noted in 4 patients. Conclusions: If the adenoma is localizated, MIP under only local anesthesia can be performed with a high success rate. Gamma probe-guided MIP under local anesthesia is an effective and safe method. It has the advantage of being minimally invasive and, therefore, it should be preferred over the conventional method. more...

Background This study was designed in order to compare the effectiveness of subtotal-total colectomy with other surgical methods in the treatment of malignant obstructive lesions of the left colon. Methods Patients admitting with symptoms of colonic obstruction and treated by emergency surgery in Konya Education and Research Hospital between 2004 and 2007 were enrolled. Patients were divided into three groups according to the surgical procedures (Group I: Hartmann procedure; Group II: resection + diverting ileostomy; Group III: total-subtotal colectomy). Related patient data were evaluated retrospectively. Results The mean age of 62 patients was 64 (38-89) years. There were no significant differences between the groups with respect to gender, age, American Society of Anesthesiology scores, and tumor stages. There were no significant differences between the study groups in terms of operative duration, postoperative mortality, and five-year survival; however, the length of hospital stay and hospitalization costs were lower in Group III compared to the other groups. Conclusion We suggest that subtotal-total colectomy performed by experienced surgeons may be a good alternative to the other procedures. more...

Pilonidal disease is an inflammatory disease seen in the intergluteal region. In this study, our aim was to compare the efficacy of the Limberg flap versus a tension-free primary closure.A total of 93 patients were included in this study. The patients were assigned consecutively by the closed-envelope technique to one of two groups: 49 patients in group 1 (excision and Limberg flap) and 44 patients in group 2 (tension-free primary closure). Excision and reconstruction with the Limberg flap was performed in its classic form. For tension-free primary closure after excision of the sinus tract with an elliptical incision, the skin and subcutaneous tissue were released 2-3 cm away from the incision line. The subcutaneous tissue was closed twofold with 2/0 polyglactin sutures. The skin underwent 3/0 polypropylene mattress suturing.The median age was 25 years (17-43 years). The median follow-up period was 29.5 months (8-43 months). There was no significant difference between the groups in terms of age, sex, follow-up time, or anesthesia method. One patient in each group experienced wound infection. During the first 6 months of follow-up there was no recurrence. However, at later visits recurrences were seen in two patients in each group (4.1% in group 1, 4.5% in group 2).The lower rates of wound infection and recurrence associated with the Limberg flap reported elsewhere may be associated with healing of the tension-free procedure. In this study, tension-free primary closure was found to be as effective as the Limberg flap reconstruction. more...

Aim: Pilonidal disease is an inflammatory disorder, mainly affecting young adults. Platelet-rich plasma (PRP) is shown to have a positive impact on the wound healing process. Herein, the study aims to define the application of PRP and report early results. Methods: The study data were collected prospectively. PRP was prepared from the patients' own blood samples, transformed into gel form, and applied to the sinus tract under local anesthesia. Furthermore, the healing rate and recurrence rate of the disease were evaluated. Results: There were 50 cases included in the study, with 48 cases were cured at the end of the 1st month. At this stage, with a median follow-up of 15 months, there have been no documented recurrences. Conclusion: Minimally invasive treatment of pilonidal disease with PRP application has promising results. Treatment of pilonidal disease by PRP can be applied in outpatient clinic and provides total cure in a short time. The method is simple, painless, with no hospital stay required, less wound care, shorter time to return daily activity, and the cost is effective. However, long-term outcomes are unknown, and additional follow-up is required. more...

Aim: The study aims to evaluate the relation between red cell distribution width (RDW) and papillary thyroid carcinoma. RDW is a part of routine complete blood count which shows the heterogeneity of the circulating red cells. Studies showed that RDW increases in inflammatory disorders. Methods: The patients' data from 100 cases with total thyroidectomy were retrospectively evaluated. A total of 50 cases with thyroid papillary carcinoma and 50 cases with benign thyroid nodule were included into the evaluation. Results: The mean RDW value was 14.5 ± 1.7 in papillary carcinoma group and 13.4 ± 0.8 in benign thyroid nodule group. Other hematological parameters of the groups were similar. According to the receiver operating characteristic (ROC) curve, the optimal RDW value for thyroid papillary carcinoma was found to be 12.95% with a sensitivity of 88.00% and specificity of 70.00% (the area under an ROC curve: 0.718, P Conclusion: There is no study in literature evaluating the relation between RDW value and papillary thyroid carcinoma. According to the recent study, an increase in RDW value can be a helping parameter in differentiating papillary carcinoma from benign thyroid nodule. more...

The obliteration of the cyst cavity after evacuation is a controversial procedure in hepatic hydatid disease. There is no ideal surgical technique which can be used in all hydatid cyst cavities. Since 1989 we have been using a new technique, which we call overlapping, in the treatment of suitable cases of hepatic hydatid cyst cavities. The technique depends on the obliteration of the cavity without drainage. After evacuating the hydatid material from the cavity, instillation of the cystic cavity is performed with scolecidal agent (silver nitrate solution, 0.5%). The cavity is opened along its long axis. The pericyst is prepared, and the upper edge is sutured to the bottom of the cavity with absorbable stitch (modified external collapse). Before doing this, if there is no possibility of operative ultrasonography, the cavity is punctured with a fine needle to evaluate any dangerous areas. Then the other edge of the pericyst is laid down beside the collapsed one and sutured to the former with the same technique. The term “overlapping” stems from this second procedure. During the operation, we decide which pericyst will collapse and which one will overlap. Before overlapping, openings between the cavity and biliary tree should be found and if there are any, they should be secured. In cases of large and multiple openings, T-tube choledochostomy is necessary. We applied overlapping to 31 of 43 hepatic hydatid cysts (ranging from 5 to 17 cm in diameter, with a mean of 12 cm) in 19 patients. Twenty-four of 31 cysts had partial pericystectomy before overlapping. Three cystic cavities were connected to the biliary tree. Because of a large connection, T-tube choledochostomy was added in one case. We have not seen any complications, either infection or biliary fistula. The results of the obliteration of cavities were excellent in 15 cysts. There were no residual cavities more...

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures. more...

But: Presenter nos premiers resultats du traitement des tumeurs rectales par electrovaporisation par voie endoscopique transanale. Type d'etude: Etude retrospective. Provenance: Departement de chirurgie, faculte de Medecine, Universite de Selcuk. Sujets: 10 patients, 4 presentant des lesions malignes et 6 presentant des lesions benignes. Intervention: Vaporisation de la tumeur en utilisant une nouveau rouleau a crete, le VaporTrode, et un resectoscope urologique standard 24F. Principaux criteres de jugement: Morbidite et recidive. Resultats: Il n'y eut aucune complication et tous les adenomes furent entierement vaporises. 2 patients presentant une obstruction necessiterent un nouveau traitement 3 et 5 mois plus tard, en raison d'une recidive. La duree mediane des interventions fut de 22.5 minutes (limites 10-38) et la duree mediane du sejour hospitalier fut de 3 jours (limites 1-4). Conclusions: Le VaporTrode est un instrument sur et potentiellement utile pour les excisions transanales des tumeurs rectales. L'efficacite a long terme de cette approche doit encore etre testes sur un collectif plus important de patients. more...

In our recent article [1], the results of tension-free primary closure and of the Limberg flap were similar. These results have caused immediate comment [2, 3]. Azizi et al. [4] reported no recurrence at 1-year follow-up after performing the Limberg flap procedure. In addition, there are studies that reported a 1 % recurrence rate after flap reconstruction for pilonidal sinus [5] in our country. Therefore, flap reconstruction is a highly chosen procedure. However, as Azizi et al. [4] reported, there is no consensus among surgeons about the ideal treatment method. There are successful results for primary closure but the choices of surgeons show variability in the treatment method. In our study we tried to find whether there is a commonality between the different procedures. Our results showed that being tension-free is the key to reduce recurrences. We are glad that our study triggered the search for the ideal procedure. Moreover, we agree with the other researchers that only time will tell the truth [1, 2]. Additional studies will clarify the situation. For this purpose we have begun a randomized prospective study that compares the results of tension-free primary closure, tension-free primary oblique closure, and Limberg flap reconstruction. The study began 4 months ago and when it is finished we will publish the results. more...

PURPOSE This experimental study aimed at comparing the cyanoacrylate abdomen closure to the effectiveness of triclosan coated polidioxanone abdomen closure. METHODS The abdomen layers were closed with 3/0 polidioxanone suture in the first group. In the second group, the layers were closed with triclosan coated polidioxanone suture in a single layer. The abdomen layers of rats in the third group were attached with cyanoacrylates without sutures. The rats were sacrificed on the 14th day and the adhesive level was recorded. The incision resistance strength was measured. The tissue was examined blindly in the terms of inflammatory cell infiltration, capillary proliferation, fibrosis and micro-abscess by the pathologist. RESULTS No significant difference was determined between the 1st and 2nd groups in the terms of inflammatory cell infiltration, capillary proliferation, collagen deposition, fibroblast activity, adhesive and tissue distension strength. The fibrosis and adhesive rate of the 3rd group was significantly higher than the 1st and 2nd groups statistically. The tissue distension strength was lower than in the other groups and the differences between the groups were found to be significant (p < 0.05). No significant difference was determined between the groups in the term of micro-abscess. CONCLUSIONS Antibacterial suture is not superior to the conventional suture. It is concluded that cyanoacrylate is not an appropriate molecule for abdomen closure (Tab. 1, Fig. 3, Ref. 17). more...