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The objectives of the study were to investigate and compare the susceptibility profiles of preoperative and postoperative intestinal Bacteroides fragilis and Bacteroides thetaiotaomicron strains against antimicrobials to evaluate their resistance development patterns due to prophylactic antibiotic administration. Preoperative and postoperative stool samples were obtained from patients undergoing elective abdominal surgery with a "clean-contaminated" wound categorization. All patients received cefoxitin 2 g as prophylaxis. Isolates of Bacteroides species were identified. Susceptibility tests against ampicillin, piperacillin, cefoxitin, clindamycin, chloramphenicol, metronidazole, imipenem, and amoxicillin-clavulanate were performed. Stool samples were collected from 40 patients at two settings: before and after the operation. Most of the patients (53%) were operated on because of colorectal carcinoma and underwent surgery that included colectomy or anterior resection. Bacteroides fragilis and Bacteroides thetaiotaomicron were isolated in both samples obtained from 22 and 34 patients, respectively. In the present study 95% to 100%, 50% to 74%, 46% to 64%, and 18% to 35% of preoperatively isolated Bacteroides species were resistant to ampicillin, cefoxitin, clindamycin, and piperacillin, respectively. Although there were no statistically significant difference, postoperative strains were more resistant than preoperative isolates, and the resistance rates were found to be 95% to 100%, 55% to 82%, 46% to 86%, and 37% to 41%, respectively. Both Bacteroides species isolated from all specimens before and after the surgery were uniformly susceptible to amoxicillin-clavulanate, imipenem, metronidazole, and chloramphenicol.Our data revealed that Bacteroides strains revealed high resistance to ampicillin, cefoxitin, piperacillin, and clindamycin. Metronidazole, imipenem, and amoxicillin-clavulanate seem highly effective against both Bacteroides species. Cefoxitin prophylaxis did not significantly increase the resistance patterns against antimicrobial agents.

Objective Laparoscopic hernioplasty was performed by either transabdominal preperitoneal or totally extraperitoneal approaches, The purpose of this study was to demonstrate that laparoscopic hernioplasty is a way to treat military personnel in the army with less pain and for the patients to return to an active lifestyle in a short time. Methods A total of 217 laparoscopic hernioplasty were performed in 192 patients. Eighty-eight hernias were operated by transabdominal preperitoneal and the 146 hernias were operated by totally extraperitoneal approach hernioplasty. Results The mean +/- SD operation times were 69.4 +/- 23.94 and 58.3 +/- 24.13 minutes for the transabdominal preperitoneal and the totally extraperitoneal approach, respectively (p = 0.42). Postoperative pain was monitored by the visual analog scale. Hospitalization time for patients without complications was significantly shorter (p = 0.02). Conclusion Laparoscopic hernioplasty could be performed on military personnel who need to return to work quickly with a short hospitalization time, less pain, and lower recurrence rate.

The aim of the study was to evaluate the results of treatment for ano-rectal gunshot injuries in civilian population, caused by low-velocity bullets.Nine patients with ano-rectal gunshot injuries were admitted to the emergency department. All the patients were males, with a mean age of 23 years (range 20 to 37 years) and presented within the first two hours following injury. Complete physical and abdominal examinations were performed and injury severity scores (ISS) were calculated. Injuries were evaluated by rectosigmoidoscopy in the operating room. Seven patients had associated tissue or organ injuries including bladder disruption, pelvic bone fractures, and wide muscular defects. Surgical procedures included a diverting ostomy, irrigation of distal rectum, presacral drainage (6 patients), and retrorectal drainage through the abdomen (3 patients). Antibiotic prophylaxis was routinely administered. Control examinations were made at the end of the second month.Seven patients had rectal blood discharge on admission. The mean ISS score was 7.3+/-3.7, with only one patient having an ISS of 15. Early postoperative complications were urinary infection in three patients, wound dehiscence in five patients, and osteomyelitis in one patient. Anal continence was not adversely influenced after surgery.Our results suggest that a diverting ostomy, distal rectal irrigation, and presacral drainage yields favorable outcome in patients with ano-rectal gunshot injuries.

Purpose. Total rectal prolapse is a devastating disorder causing constipation and anal incontinence. We compared open and laparoscopic surgical approaches in a limited series. Methods. The subjects of this study were 23 patients who underwent laparoscopic procedures (LP group) and 17 patients who underwent open procedures (OP group) for rectal prolapse. We assessed the preoperative colonic transit time, postoperative pain scoring, pre- and postoperative anal functions, and changes in constipation and related symptoms. Results. The median operation time was 140.8 min for the LP group and 113.1 min for the OP group (P 0.037). The median postoperative hospital stay was 4.8 days after the LPs and 9.6 days after the OPs (P 0.001). Less analgesia was needed in the early postoperative period after the LPs (P 0.007). While more than 70% improvement in continence was seen in the patients who underwent OPs, it was about 85% in those who underwent LPs. Improvement in constipation and related symptoms were similar in both groups. More than 30% of patients still suffered from hard stools and other symptoms of constipation. The colonic transit times were reduced in about 50% of patients who had suffered constipation in both groups. There was no incidence of recurrence in the median follow-up period. Conclusion. Although transabdominal rectopexy has been performed conventionally for rectal prolapse for many years, laparoscopic rectopexy and laparoscopic resection rectopexy are associated with lower morbidity and less postoperative pain. We eliminated the total prolapse and cured incontinence in almost all patients, with a short hospital stay.