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Introduction: Anal malignant melanomas are relatively rare tumors. Because of their polypoid structure, they can be confused with benign anorectal diseases. Wide excision and lymph node dissection is recommended especially in melanomas including lymph node metastasis because it reduces local recurrence. Case report: We performed abdominoperineal resection + bilateral inguinal + bilateral iliac + paraaortic lymph node dissection in our 77-year-old female patient with the diagnosis of anal malignant melanoma as a result of colonoscopic biopsy performed on the polypoid mass in the anal canal. Since 2 lymph nodes located outside the pararectal fascia persisted in postoperative MRI, we performed lymph node excision with a posterior approach. And the pathology result of the excision performed in this second session was found to be compatible with metastasis. Conclusion: Lymph node dissections are beneficial in terms of local recurrence and survival, especially in patients with anal malignant melanoma with lymph node metastases.

Squamous cell carcinoma (SCC) is the second most common skin cancer and it often occurs in sun-exposed areas such as head and neck skin. Invasive SCC located on breast skin is a rare entity and may clinically mimic breast cancer. We report a case of a 39 years old female with a non-eroded, vegetative, growing lesion on the right breast skin, initially mimicking breast cancer both clinically and histopathologically. After surgery with clear margins, adjuvant radiotherapy was administered, by considering the pathological risk factors for recurrence. At 14 months, the patient is disease-free and under regular follow-up. Invasive SCC of the breast skin is a rare entity and may have different etiology/behavior or directly develop de novo when compared to SCCs located on sun-exposed skin. Medical history and physical examination in conjunction with histopathological examination of the biopsy specimen are critical for the accuracy of the diagnosis and the correct treatment decision in patients presenting with a mass invading breast skin., Skuamöz hücreli karsinomu (SHK), 2. en sık cilt kanseridir ve sıklıkla baş- boyun gibi güneş gören bölgelerde ortaya çıkar. Meme cildinden kaynaklanan invazif SHK nadir bir tablodur ve klinik olarak meme kanserini taklit edebilir. 39 yaşındaki hastada; sağ memede non-erode, vejetatif, büyüyen lezyondan biyopsi alınmıştır ve klinik ve histopatolojik olarak meme kanserini taklit eden bu vaka sunulmuştur. Cerrahi sınırları temiz bir şekilde opere edilen hasta, rekürrens için risk faktörleri değerlendirilerek, adjuvant radyoterapi ile tedavi edilmiştir. 14 ay sonrasında, hastada halen nüks saptanmamış ve düzenli takiplerdedir. İnvazif meme cilt SHK’u nadir bir tablodur ve güneşe maruz kalan bölgede gelişen SHK’a göre farklı etiyoloji/ davranışa sahip olabilir. Meme cildinde kitle ile başvuran hastanın doğru tanı ve tedavisi için tıbbi hikaye ve fizik muayene ile birlikte histopatolojik değerlendirme kritiktir.

Sürekli Tıp Eğitimi (STE), güvenli ve etkin bir sağlık hizmeti sunabilmek için gerekli olan bilgi, beceri ve yaklaşımların artırılması, sürdürülmesi ve geliştirilmesini sağlayan etkinlikler olarak tanımlanabilir. Bu çalışmada 2015-2020 yılları arasında Muğla ili içersindeki genel cerrahi uzmanlarını kapsayan, sürekli tıp eğitimi çatısı altında düzenlenen Muğla cerrahi toplantıları sunulmuştur. Continuing medical education can be defined as activities that increase, maintain and develop the knowledge, skills and approaches required to provide safe and effective healthcare services. In this study, Muğla surgery meetings, which are organized under the roof of continuing medical education, which include general surgery specialists in Muğla province between 2015-2020are presented.

Anastomotic leakage is the partial or complete separation of the anastomosis performed in gastrointestinal system surgery for various reasons, which can be determined by clinical and/or radiological methods in the postoperative period. When this situation occurs, besides the increase in the surgical mortality rate of the patient, the incidence of many complications in the early or late period also increases. At the beginning of these complications are reoperation, stoma and stoma problems that impair quality of life, longer hospital stay of the patient, occurrence of locoregional recurrences, reduced five-year survival and economic results.

In this study, mineral nutrition status of some aromatic plants such as Foeniculum vulgare, Cichorium intybus, Brassica oleracea var. capitata, Liquidambar orientalis that are naturally spread in Muğla province and its locality and consumed by the local people, and the soil characteristics of the species were investigated. According to the results, it was determined that the species of plants spread between pH-mild acid and neutral in a loamy, salt-free and low-lime environment. In addition to this, while it was determined that plants were at high levels in terms of N, Ca and Fe contents, Zn value was found to be at a low level. In the second phase of the study, it was aimed to obtain detailed information for above mentioned local plants by using qualitative research method. It was found that there were differences in the nutrition habits of the societies due to different cultures. Local differences mostly stemmed from the yields grown in that region. One another aim is to investigate the food preparations in Muğla cuisine preferred by the local people regarding “arapsaçı, hindiba, cibez and günlük” (TR), which are among the medicinal aromatic plants found in Muğla, and the consumption preferences of these plants. The main purpose of this research was to determine the aromatic plant consumption habits of the people living in Muğla province and evaluate these consumptions in terms of health. As a result of the interviews, the recipes of these dishes, information on their preferability and their effects on health were obtained.

Objective: This study aimed to evaluate outcomes, complications, and follow-up results of ultrasound-guided vacuum-assisted breast biopsy (UG-VABB) in BI-RADS 4 A and B lesions. Material and Methods: Between Agust 2014 to January 2018, fifty BI-RADS 4A and BI-RADS 4B lesions of 41 patients biopsied with 10G vacuum needle by a single radiologist were retrospectively evaluated. Results: All patients were females and mean age of the 41 patients was 50.12 ± 8.63. Of all lesions, 84% was benign, 6% was ADH, 4% was in-situ cancer, and 6% was diagnosed as malign. Follow-up duration after VABB was 0-51 months and mean was 20.92 months. Complications were as vasovagal-induced seizure in 3 patients (7.3%) and intramammary hematoma in 16 patients (39%). Hematoma was diagnosed in 3 patients (7.3%) at the 6th month follow-up and it was resolved in all patients at the 12th month follow-up. Higher breast density resulted in higher hematoma rates. There was no relationship between lesion BI-RADS subgroups, lesion size or sample number and hematoma development. During the follow-up, residue lesion in 1 (2.4%) patient and scar tissue in 2 (4.9%) patients was detected. Conclusion: US-guided VABB, with low complication rates and low scar development, is also a therapeutic excision method without remaining residue, which should be primarily preferred in smaller than 2 cm BI-RADS 4A and 4B lesions whose malignancy rates are relatively low. Hematoma, which is the most frequent complication, resorbed entirely in the 12th month in all patients. © Copyright 2020 by Turkish Surgical Society Available online at

0000-0001-8252-3339; 0000-0002-3979-4413 WOS: 000440304500007 PubMed ID: 30023973 Objective: The spleen is the most vulnerable organ in blunt abdominal trauma. Spleen-preserving treatments are non-operative management with or without splenic angioembolization, partial splenectomy, and splenorrhaphy. The aim of the present study was to determine the rate of SPTs and to evaluate the usefulness of Injury Severity Score after traumatic splenic injury. Material and Methods: We searched our institution's database between May 2012 and December 2015. Patients' clinicopathological features, surgeon's title, type of treatment, admission and discharge dates, duration of surgery, intensive care unit requirement, and Glasgow Coma Scale were recorded. Results: The mean age of patients was 33.36 +/- 11.58 years. Of the 33 patients, 26 (78.8%) were males, and 7 (21.2%) were females. Thirty (90.9%) had total splenectomy (TS), and 3 (9.1%) had spleen preserving treatment (2 Nonoperative management and 1 partial splenectomy). No fatal hemorrhage developed after nonoperative management. Exitus rates were 5/30 (15.1%) and 0/3 in the total splenectomy and spleen preserving treatment groups, respectively. Of the 18 hemodynamically stable patients, only 2 (11.1%) had spleen preserving treatment. Of the 19 patients with grade I-III splenic injury, only 3 (15.8%) had spleen preserving treatment. For academic and non-academic surgeons, spleen preserving treatment rates were 3/11 (27.3%) and 0/22 (0%), respectively (p

Microbial accumulation in materials used in sectors such as medical, textile and food can lead to serious diseases, infections and uncontrollable problems. Many of the materials used in the above-mentioned industries have highly sensitive surfaces for microorganisms and cause colonization and biofilm formation. Colonization and biofilm formation threaten human health and they cause many diseases that result in death every year. Antimicrobial materials have an important role in combating pathogens. This article is about a new material with antibiofilm and antimicrobial properties combining polyurethane and Hypericum perforatum extract (PHPE) together. Antimicrobial effect of H. perforatum extract was determined against three clinical pathogens; C. albicans, E. coli and S. aureus. The highest antimicrobial activity of H. perforatum extract was found against S. aureus strain. Antibiofilm analysis results revealed that H. perforatum was also inhibited by the biofilm formation of S. aureus by 56.85%. The combination of polyurethane material and H. perforatum extract (PHPE) resulted in 92.85% decrease in S. aureus biofilm compared to control group. The reduction of S. aureus after H. perforatum incorporation was revealed by Scanning Electron Microscopy (SEM) study. The results show that the polyurethane material combined with H. perforatum extract inhibits the formation of S. aureus biofilm.

0000-0001-8252-3339; 0000-0002-3979-4413 WOS: 000439418700010 PubMed ID: 30028492 BACKGROUND: The occurrence of a serious infection called overwhelming post-splenectomy infection (OPSI) increases more than 50 times in patients who have hyposplenia. The aim of this study was to investigate the adherence to vaccination recommendations after traumatic splenic injury. METHODS: We identified patients who underwent total splenectomy due to abdominal trauma between May 2012 and March 2016. We recorded the clinical, laboratory, and pathological features of the patients. We calculated the vaccination proportions before discharge, after discharge, and final. RESULTS: Twenty-seven patients underwent total splenectomy. For the vaccination status before discharge, after discharge, and final, the number of patients who received all the three vaccinations were 0 (0%), 0 (0%), and 8 (18.5%) and those who received none were 13 (48.2%), 11 (40.8%), and 9 (33.4%), respectively. The data of 17 patients were available for developing OPSI. The median follow-up time was 17.8 (4.4-41.2) months, and no OPSI cases were observed. CONCLUSION: Adherence to vaccination recommendations remains still low. Establishing a vaccination tracking system and following vaccination recommendations will be helpful to prevent serious infections, such as OPSI, after traumatic splenectomy.

Seroid granulomu; lipid ve lipoproteinlerin kismi oksidasyonu sonucu, kanama ve nekroz alanlarinda ortaya ci- kan, makrofajlar icinde depolanan, en sik kadin genital sisteminde ve genelde tesadufen rastlanan bir pigmenttir. Bizim hastamizin sag memesinden malignite suphesiyle eksize edilen kitlenin histopatolojisinde histiositlerde depolanan, Sudan Black B ile lipid oldugu saptanan ve granulom yapisi olusturan seroid saptandi ve olgu Seroid Granulomu tanisi aldi. Meme parankiminde ve duktuslarinda atipik bulgu saptanmadigindan malignite ekarte edildi. Hastamizda seroid granulomunun daha once Fibrokistik degisiklik nedeniyle ayni bolgeden gecirmis oldugu cerrahi isleme sekonder olarak olustugu dusu- nuldu. Maligniteyle klinik ve radyolojik olarak karisabilen, memede cok nadir gorulen Seroid granulomu klinisyenler ve patologlar tarafindan ayirici tanida akilda tutulmalidir. Anahtar kelimeler: Meme, seroid, granulom

WOS: 000394508600015 PubMed ID: 28074454 Obturator hernia is a rare disease usually occurring in debilitated elderly women. Pain radiating down the medial thigh and knee (Howship-Romberg sign) is a specific sign of the disease. Presently described is a case of obturator hernia in a 73-year-old female patient who presented with severe left hip pain radiating down the medial thigh and knee, nausea, and loss of appetite. Initially, vertebral disc herniation was thought to be cause, but abdomino-pelvic computed tomography scan revealed left strangulated obturator hernia. Diagnosis of obturator hernia can be challenging. Physicians should consider obturator hernia in the differential diagnosis of knee and hip pain, and investigate for Howship-Romberg sign. Early diagnosis of the disease not only decreases morbidity and mortality, but also presents opportunity to treat with minimally invasive methods.

Background: The purpose of this study is to evaluate perioperative morbidity, mortality and the prognostic factors that influence survival of the patients with transmural advanced gastric carcinoma after curative surgical therapy. Methods: Fifty patients with transmural advanced gastric adenocarcinoma underwent curative resection in our clinic. The records of the patients were reviewed and the prognostic factors such as age, gender, location and size of the tumor, type of surgery, blood transfusion, depth of tumor invasion, lymph node metastases, stage of the disease, grading, vascular invasion, lymph vessel invasion, characteristics of the tumor according to Lauren’s classification, and lymph node ratio were evaluated by using statistical methods. Results: In a total of 12 patients (24%) major morbidities developed, and five patients (10%) died. The overall survival rate was 48% at 1 year, 31% at 3 years, and 19% at 5 years. Lymph node metastases (P = 0.03), lymph vessel invasion (P = 0.001), blood transfusion (P = 0.021), and lymph node ratio (P = 0.006) were the prognostic features identified by univariate analysis. Among the multiple significant prognostic factors in the univariate analysis only one factor, lymph node ratio, proved to be independently significant in the multivariate analysis (RR: 4.47). Conclusions: Our data showed that we can expect a good survival for patients with a lymph node ratio less than 0.2.

Objective The aim of this study was to evaluate the effectiveness of en bloc multivisceral resection of organs involved by locally advanced rectal carcinoma. Method A total of 312 patients with primary rectal cancer underwent surgery between January 1994 and April 2005. Of these, 57 patients (18.3%) had macroscopically direct invasion of an adjacent organ or structure, and underwent multivisceral resection with curative intent. Survival analyses were made by the Kaplan–Meier and the Cox proportional hazards regression model. Results The postoperative mortality was 3.5%. The overall survival rate at 1, 3 and 5 years was 96.4%, 81.6% and 49.0%. Age (≥65 years), depth of tumour invasion (pT3 stage), lymph node status (pN0), tumour stage (III A–B), grading (G1), vascular and neural invasion (not extensive), type of adhesion (inflammatory) and type of resection (R0) were significant factors favouring survival in the univariate analysis. Only two factors, lymph node status pN0 (P = 0.007) and R0 resection (P = 0.005) were independently significant factors in the multivariate analysis. Conclusion R0 resection and pN0 status influence overall survival for locally advanced rectal carcinoma.

It is generally accepted that most inguinal hernias should be operated on electively using synthetic grafts. However, limited information is available on the usage of these materials in patient with incarcerated and strangulated hernias. The objective of this study is to compare the outcomes of incarcerated inguinal hernia repair with or without graft. One hundred-thirteen patients with incarcerated inguinal hernia that underwent surgery were included in this study. Patients who underwent Lichtenstein repair were assigned to group I; those who underwent primary repair were assigned to group II. Demographics and characteristics of patients in each group were compared. Chi-square and Student's t-tests were used. No statistical difference was found between patients who did and did not receive anastomosis in both groups in terms of surgery duration, length of hospital stay, postoperative morbidity, and mortality. Recurrence was found in 4.0% and 20.8% patients in group I and group II, respectively (P = 0.036). Mesh repair can be preferred in incarcerated inguinal hernia patients because recurrence rate was significantly lower in patients who underwent Lichtenstein repair in this study.

Background Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention. Methods Seventeen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 18 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively. Results Five cases (29.4%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases. Intraperitoneal multiple cysts with heterogeneous cavity or cystic structures in the liver were shown in 14 cases. Computed tomography and magnetic resonance imaging showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Four patients (23.5%) died in the early postoperative period. A total of nine morbidities developed in six patients (35.3%). Median hospital stay was 18 days and median follow-up was 78 months. Intra-abdominal recurrence occurred in one case (7.7%). Conclusions Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. Computed tomography scan, in addition to clinical presentation, is essential for diagnosis. Emergency surgery is the main treatment for acute ruptured hydatid cysts. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.

Retroperitoneal soft-tissue sarcomas are rare malignant tumors and make up 1% of all adult malignancies. We aimed to evaluate the morbidity, the mortality, and the prognostic factors that affect su

Gallbladder perforation is a serious complication of acute cholecystitis. Spontaneous healing is very rare, and only three cases have been reported in the English literature. In this study, we present a 73-year-old female patient who underwent a laparoscopic cholecystectomy years after a gallbladder perforation and spontaneous healing.

Perforation of the gall bladder is a frequent complication during laparoscopic cholecystectomy. Grasping the perforated part of the gall bladder, clip application, or endoscopic loop application are possible solutions to prevent spillage. We propose laparoscopic rubber band application to close the perforated part of the gall bladder as an easy and safe method. We performed rubber band application after iatrogenic perforation of the gall bladder during laparoscopic cholecystectomy in 5 patients. Two-millimeter-wide multiple rubber rings, cut from a 14-Fr Foley catheter, are loaded on a grasper. When a perforation occurred during the dissection of the gall bladder, the hole is grasped with this instrument and 1 of the rings is placed on the gall bladder by the aid of a dissector. Thus, the grasper remained available for traction of the Hartmann's pouch during further dissection of the gall bladder. The rubber bands were placed successfully in all cases. Two perforations occurred in 1 case, and 2 bands were placed with ease. Bile leakage or gall stone spillage did not occur. Operation time was not prolonged. Rubber band ligation of perforation of the gall bladder is a simple, safe, inexpensive, and effective method to prevent spillage of the bile or gallstones in laparoscopic surgery.

Background: The synchronous occurrence of gastric adenocarcinoma and gastrointestinal stromal tumors is extremely rare. We report a case of synchronous gastric adenocarcinoma and three stromal tumo

Background: Soft-tissue sarcomas may develop in the retroperitoneal space, in the peritoneal cavity and in the lower extremities. They are rare tumors, and make up 1% of all adult malignancies. Complete resection of the tumor is of crucial importance to achieve a long-term survival. Multivisceral resections are required in the majority of cases. Mucinous cystadenoma of the appendix is an uncommon condition, too. Most of the patients with mucinous cystadenoma present with clinical symptoms of acute appendicitis. The diagnosis is usually made postoperatively by histopathological examination. Case Report: We here present a rare co-existence of a retroperitoneal liposarcoma and an appendiceal mucinous cystadenoma. Conclusion: En bloc resection of retroperitoneal soft-tissue sarcomas also provides removal of invaded adjacent organs with any co-existing disease.

The association between the infusion of continuous epidural anesthesia and the anastomotic strength of colonic anastomosis was examined in an animal model.Fourteen white male New Zealand rabbits were included in the study and randomly assigned to two groups. Group 1 (n=7) had continuous epidural 0.9% NaCl infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion) and Group 2 (n=7) had continuous epidural 1% lidocaine infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion). Infusions started at the beginning of the operation and were continued for six hours postoperatively. All experimental animals underwent right colon resection and colo-colonic anastomosis under general anesthesia. On the fourth postoperative day, relaparotomy was applied and the bursting pressures of the anastomosis (BPA) were measured in situ. Segments 1-cm long consisting of the complete suture lines were excised, and the levels of hydroxyproline and collagen were measured.BPAs were statistically higher in the epidural lidocaine group (median: 248 mmHg; min 117 - max 300) than in the saline group (median: 109 mmHg; min 47 - max 176) (p=0.006). There was no difference between the groups in terms of hydroxyproline and collagen levels in the sample tissues (p0.05).We concluded that the strength of colonic anastomosis may be increased by epidural lidocaine infusion.

Derici, Hayrullah (Balikesir Author), Amaç: Bu çalışmada safra kesesi perforasyonu gelişen olguların klinik özellikleri, perforasyon tipleri arasındaki farklılıkları ve perforasyona etki eden risk faktörleri incelemek amaçlanmıştır. Yöntem: Kliniklerimizde Ocak 1997-Kasım 2008 tarihleri arasın- da akut kolesistit nedeniyle acil cerrahi girişim uygulanan 478 olgu retrospektif olarak incelendi. Olguların demografik özellikle- ri, semptom süresi, yandaş hastalıklar, ASA skorlaması, labaratuvar değerleri, tanısal yöntemler, intraoperatif bulgular, cerrahi işlemler, postoperatif komplikasyonlar ve hastanede kalış süresi incelendi. Bulgular: Olguların 46'sı (%9.6) safra kesesi perforas- yonu tanısı aldı. Morbidite ve mortalite sırasıyla 15 (%32.6) ve 7 (%15.2) olguda görüldü. İleri yaş, erkek cinsiyet, 38°C üstündeki ateş, lökositoz ve kardiovasküler sistem yandaş hastalığı risk faktörleri olarak bulundu. Sonuç: Risk faktörlerine sahip olguların daha dikkatli değerlendirilmesi gerektiğini, erken tanı ve tedavi ile morbidite ve mortalitenin azalacağına inanıyoruz., Background/aims: We aimed to investigate the clinical features and the relation between patient characteristics and the different types of gallbladder perforation and to determine the predisposing factors. Material and Methods: The medical records of 478 patients who received urgent surgical treatment with the diagnosis of acute cholecystitis and underwent urgent surgery in our clin- ics between January 1997 and November 2008 were reviewed retrospectively. The demographic data of patients, time elapsed from the onset of the symptoms to the time of surgery, comorbidity status, American Society of Anesthesiologists classification, laborato- ry data, imaging results, surgical procedures, postoperative complications, and postoperative length of stay of the patients were ana- lyzed. Results: There were 46 (9.6%) patients with the diagnosis of gallbladder perforation. Morbidity and mortality occurred in 15 (32.6%) and 7 (15.2%) patients, respectively. Advanced age, male gender, fever >38°C, high white blood cell count, and presence of cardiovascular comorbidity were found to be significant risk factors for gallbladder perforation. Conclusions: While early diagno- sis and early surgical intervention are the keys to managing gallbladder perforation, we suggest that patients having the above-men- tioned clinical features should be carefully investigated.

Background The effect of vasopressors on the healing of gastrointestinal anastomoses is still controversial. The purpose of our study was to research the relationship between dose of dopamine, which is used generally as a vasopressor in shock status, and anastomotic leak in colonic surgery. Methods Forty-two male New Zealand rabbits were included in the study. Under general anesthesia, the right colon was identified, incised, and divided 5cm distal to the ileocecal valve. Colonic integrity was then established with end-to-end anastomosis in all animals. The animals were randomized into 6 groups. While group 1 was not given any vasopressors, groups 2, 3, 4, 5, and 6 were administered 5, 10, 15, 20, and 25μgkg −1 h −1 dopamine infusions, respectively, for 2h. On the 4th postoperative day, relaparotomy was performed under general anesthesia. The bursting pressures of anastomoses (BPA) were measured in situ, and then the lines of anastomoses were excised. The levels of hydroxyproline and collagen were measured in this tissue. Results When compared with the control group (140±39mmHg), BPA were found to be statistically increased only in group 5 (238±91mmHg) ( p =0.03) and group 6 (277±64mmHg) ( p =0.002). There were no differences between groups in terms of the hydroxyproline and collagen levels in the tissue ( p >0.05). Conclusions Although vasopressors appeared to increase the risk of anastomotic leakage as a result of splanchnic vasoconstriction, deterioration of microcirculation, and local hypoxia, we found that BPA were increased with high doses of vasopressor. We speculated that the use of vasopressors without shock might increase blood supply to the anastomotic line by increasing cardiac output.

An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent the difficulties during application of the purse-string suture, and we used the videoanoscope in 18 stapled haemorrhoidopexy procedures. The videoanoscope is made up of three pieces. The front part is in the form of an open half-cylinder. The second piece is a sliding lid that covers the front piece. The rear part of the anoscope includes a hollow handle in which a scope can be inserted, and the whole procedure can be transmitted to a monitor via this scope. The opening on the anoscope can be adjusted by sliding the lid. A purse-string suture is placed on the rectal mucosa protruding through this adjustable opening. The anoscope is rotated to apply the subsequent suture bites and when the starting point is reached again the purse-string is completed. Then the stapled haemorrhoidopexy procedure is continued in the usual fashion. Videoanoscope-assisted stapled haemorrhoidopexy was easily performed in 18 patients (12 men, 6 women; mean age 48.9 years). The mean operative time was 32.8 minutes. The excised rectal mucosal rings were complete in all of the patients. Optimal purse-string depth was reflected in the presence of only mucosa and submucosa in all specimens, without incorporation of muscle cells. Postoperative complications were urinary retention in one patient and bleeding in five patients, one of whom requiring sutures for haemostasis. Further studies are required to assess the potential advantages of this technique.

Nonsteroidal antiinflammatory drugs are widely used for acute and chronic pain, but they may have serious side effects such as impairment of renal function, asthma, erosions of the mucosa in the gastrointestinal tract, colonic and intestinal strictures, and gastrointestinal tract bleeding. Although the upper gastrointestinal tract disturbances caused by nonsteroidal antiinflammatory drugs are well known, their side effects in the lower gastrointestinal tract are not clearly defined. There are a limited number of articles and case reports about the latter in the literature. We report two cases of colonic perforation due to short-term use of nonsteroidal antiinflammatory drugs in this study. Colonic perforation should be considered as one of the possible diagnoses in patients with acute abdominal pain and nonsteroidal antiinflammatory drug use should be considered as a possible cause of colonic perforation if other possibilities are excluded.

We aimed to determine the factors that affect morbidity and mortality in patients that underwent surgery for hepatic injury.Records of 109 blunt or penetrating hepatic trauma patients that underwent surgery in the Third Surgical Clinic of Izmir Atattürk Training and Research Hospital between 1994 and 2004 were reviewed retrospectively. Evaluated parameters were: age, gender, cause of injury, diagnostic procedures, preoperative blood pressure (BP), hemoglobin (Hb) level, amount of intraabdominal blood, associated injuries, the number of involved hepatic segments and anatomic distribution, severity of injury, abdominal trauma index (ATI), amount of blood transfusions, type of surgery, hospital stay, and rates of morbidity and mortality.Median age of the patients was 29 years. The injury was penetrating in 53.2% of the patients and blunt in 46.8%. Abdominal blood was 500cc or less in 70 (64.2%) patients. Isolated hepatic injury was encountered in 29 (26.6%) cases. 22.9% of the patients had major injuries. Hemostasis was achieved by electrocautery, sponge-gel, primary suturing, hepatic resection or perihepatic packing. Morbidity and mortality rates were 40.4% and 14.6% respectively.Age, type of the injury, BP and Hb levels, amount of intraabdominal blood, degree of injury, ATI, and accompanying organ injuries significantly affect morbidity and/or mortality.

Pilonidal sinus is a disease that does not have a standardized surgical treatment method. This study was designed to compare the outcomes of Limberg fasciocutaneous transposition and V-Y fasciocutaneous advancement flaps in the treatment of patients with pilonidal sinus. A total of 111 patients (98 males; 88.3 percent; mean age, 27.1 years) who received reconstruction after pilonidal sinus excision in our clinics with Limberg flap (Group 1, n = 66, 59.5 percent) or V-Y flaps (Group 2, n = 45, 40.5 percent) between 1997 and 2004 were investigated retrospectively. No significant difference was detected between Groups 1 and 2 in terms of gender, history of infection or abscess, mean duration of operation, requirement for analgesics, wound-related complications, such as necrosis, seroma, and infection, and average time off work. Mean follow-up periods were 45.4 vs. 48.8 months in Group 1 and Group 2, respectively (P = 0.337). On the other hand, rate of recurrence was significantly lower in Group 1 (n = 1, 1.5 percent) compared with Group 2 (n = 5, 11.1 percent; P = 0.039). We conclude that, if the defect is to be reconstructed with a flap in pilonidal sinus cases, reconstruction with Limberg flap should be preferred over reconstruction with V-Y flap because of its lower rate of recurrence.

This study was performed to evaluate major morbidity, early mortality and to analyze survival in our patients that underwent surgical treatment for gastric cancer.Records of 121 patients with gastric adenocarcinoma that underwent surgery between 1997 and 2004 were reviewed retrospectively. Age, gender, tumor site, presence of local invasion, depth of tumor invasion, lymph node metastases, stage of the disease, distant metastases, histological differentiation, type of surgery, and blood transfusions were evaluated in relation to survival. Survival curves were estimated using the Kaplan-Meier method and the differences in survival were compared by the log-rank test.Forty-two cases (34.7%) underwent total gastrectomy, 34 (28.1%) had subtotal gastrectomy, and 45 (37.2%) received palliative surgery. The majority of the patients (61.2%) had stage IV gastric cancer. Total morbidity and mortality were 26.4% and 17.3%, respectively. The factors that influence survival were type of surgery, adjacent organ invasion, existence of metastases, lymph node status, blood transfusions, and stage of the disease in this study. Among the significant prognostic factors in the univariate analysis, only one factor, R0 resection proved to be independently significant in the multivariate analysis.R0 resection was found to have a significant favorable effect on survival in our study.

The factors that effect resectability, major morbidity, early mortality, and survival in advanced stage gastric adenocarcinoma patients are evaluated.Records of 74 patients that underwent surgery for stage IV gastric adenocarcinoma in the Third Surgical Clinic of Izmir Atatürk Training Hospital between January 1997 and January 2004 were reviewed retrospectively. Two groups (the patients with resectable disease and those with unresectable disease) were compared with regard to age, gender, primary complaint, symptoms, site of the tumor, involvement of adjacent organs, lymph node involvement, distant metastases, differentiation of tumor, surgical procedure, perioperative blood transfusions, and postoperative hospital stay.Mean age of the 74 patients was 58.4 years. Forty-five cases (60.8%) were considered as unresectable and 29 (39.2%) patients underwent a palliative resection. There was a significant relation between resectability and site of the tumor, and severity of invasion. As the number of perioperative blood transfusions increased, morbidity and mortality increased significantly. Although early mortality was high in the palliative resection group, survival (mean 10.4 months, longest 25 months) was better compared to that of the unresectable gastric cancer group (mean 3.5 months, longest eight months).A palliative gastric surgery may be applied to improve prognosis of advanced gastric cancer patients, even at the presence of peritoneal dissemination, hepatic metastases, N3 lymph node involvement, adjacent organ invasion, or poor differentiation of the tumor.

Internal hemorrhoids and loose rectal mucosa may block exposure during the purse-string suturing in stapled hemorrhoidopexy, and this may lead to complications. To retract the prolapsing rectal mucosa, we modified the purse-string anoscope of the PPH01 kit (Ethicon-Endosurgery, Cincinnati, OH, USA) and produced a special anoscope. The open part of the purse-string suture anoscope is covered by transparent acrylic (Orthoacryl®, Dentaurum, Pforzheim, Germany). The covering had completely cylindrical outer and inner surfaces and was thin enough to let the anoscope easily rotate in the anal dilator and to let the 26 mm curved, round-bodied needle of the 2/0 polypropylene suture move in the anoscope. A window, 3 cm long and 3–4 mm wide, was opened at the angled part of the anoscope 2 cm to the tip. This special anoscope was used for the purse-string suture during the stapled hemorrhoidopexy procedure in five patients. No postoperative complications, early or late, were encountered, and we propose that stapled hemorrhoidopexy procedure can be applied more easily by using this special anoscope.

AIM: To present our clinical experience with gallbladder perforation cases. METHODS: Records of 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated. RESULTS: Seven patients had typeⅠgallbladder perforation, 7 type Ⅱ gallbladder perforation, and 2 type Ⅲ gallbladder perforation according to Niemeier’ s classification. The patients underwent surgery after administration of intravenous electrolyte solutions, and were treated with analgesics and antibiotics within the first 36 h (mean 9 h) after admission. Two patients died of sepsis and multiple organ failure in the early postoperative period. Subhepatic abscess, pelvic abscess, pneumonia, pancreatitis, and acute renal failure were found in 6 patients. CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

Incarcerated abdominal wall hernia cases may necessitate emergency interventions, but under such circumstances morbidity and mortality rates may increase. The aim of this study was to investigate the factors that affect morbidity and mortality in patients with incarcerated abdominal wall hernias who underwent emergency surgery.Urgent surgical interventions due to incarcerated abdominal wall hernias were performed in 182 patients in our clinics between January 1998 and January 2006. Factors that affect morbidity and mortality in incarcerated abdominal wall hernias were investigated retrospectively by browsing the archives. Logistic regression analysis was used to evaluate parameters that affect morbidity and mortality.Morbidity and mortality occurred in 43 (23.6%) and 9 (4.9%) patients, respectively. A symptomatic period of longer than 8 h, presence of accompanying disease, high American Society of Anesthesiology (ASA) score, general anesthesia, presence of strangulation, and necrosis were found to affect morbidity significantly by univariate analysis. Necrosis was the sole factor affecting morbidity significantly by multivariate analysis. Advanced age, presence of accompanying disease, high ASA score, presence of strangulation, necrosis, and hernia repair with graft were found to affect mortality significantly by univariate analysis; however, necrosis was the sole factor affecting mortality significantly by multivariate analysis.Intestinal necrosis, which was followed by bowel resection, was the sole factor affecting morbidity and mortality using multivariate logistic regression analysis. Emergency surgery is required for incarcerated abdominal wall hernias before intestinal necrosis develops.

Tumors of the ileocecal valve are rarely mentioned, and are mostly defined radiologically. In this manuscript, we report a case of ileocecal valve adenocarcinoma diagnosed endoscopically. The case is a male patient, 78-years-old, with abdominal pain and weight loss in whom a mass was palpated in the lower right quadrant. Abdominal ultrasound examination followed by colonoscopy and pathological diagnosis revealed adenocarcinoma of the ileocecal valve confirmed by surgical diagnosis. We report this case because of its rarity and because there is no endoscopic image in the medical literature.

Gastric cancer is one of the most common organ cancers all around the world and surgical resection is essential for treatment. Total gastrectomy is the procedure of choice for treatment of proximal gastric cancer. Mortality and morbidity risks of this procedure are high, especially among the elderly.Thirty-eight gastric cancer patients underwent total gastrectomy in the Third Surgical Clinic of Izmir Ataturk Training and Research Hospital between 1996 and 2001. Age, gender, location of the tumor, histopathological findings, TNM stage, type of anastomosis, operation time, blood transfusions, oral food intake, postoperative hospital stay, morbidity, mortality both early and late, and survival rate were evaluated.Mean age of the patients was 59.5 years (22-85 years). Sites of the tumors were: cardia 28.9%, cardia and corpus 15.8%, corpus 34.3%, corpus and antrum 18.4%, linitis plastica 2.6%. Histological types were adenocarcinoma (97.4%), and squamous cell carcinoma (2.6%). TNM stages were: stage la 2.6%, stage II 7.9%, stage IIIa 39.5%, stage IIIb 42.1%, and stage IV 7.9%. Esophagojejunostomies were performed manually (34.3%) or by circular staplers (65.7%). Operation time ranged between 3 and 6.5 hours. Gastric tubes were removed on the fourth postoperative day. Average postoperative hospital stay was 12.9 days. Postoperative morbidity was 21%. Wound infection occurred in three patients (7.9%), pulmonary infection occurred in two patients (5.2%) and anastomotic stricture developed in three patients (7.9%). Hospital mortality was 20%. Anastomotic leak occurred in five cases (13.2%) and all died on days 8, 13, 14, 26, and 30. Three patients (7.9%) died of cardiac complications on days 1, 5, and 29. Twelve patients survived for less than one year and eight patients survived for one to two years. Average survival was 10.5 months for 20 out of 30 patients (median 8 months). Ten patients are still alive after 14.3 months. Four patients have been living for less than one year, another four patients for one to two years, and two patients for more than two years.Total gastrectomy, either performed with a curative or palliative aim, is a safe procedure with acceptable mortality rates. 89.5% of our cases were stage III or IV resulting in a low survival rate. Longer survival rates can be achieved in patients with comparatively earlier stages.

The neoplasms of the small intestine are rare and the preoperative diagnosis is difficult. The aim of this study is to review difficulties in diagnosis, treatment options and important prognostic factors.Fifteen patients who underwent surgical resection for intestinal tumors from 1990 to 2000 in the Third Surgical Clinic of Izmir Atatürk Training and Research Hospital were reviewed retrospectively. Age, symptoms, diagnostic methods, operative procedures, and their effects on prognosis were evaluated.Seven patients were male and eight were female. The mean age was 52.3 years (27-77). Eight patients underwent urgent intervention and seven had elective surgery. Three cases were diagnosed as small bowel tumor preoperatively. The radical resection of the small bowel neoplasm was possible in 12 patients (80%), eight of whom being malignant and four of whom being leiomyoma. Three patients with leiomyoma are still alive for 3.5, 6 and 9 years but one patient died perioperatively because of respiratory distress syndrome. Two cases with lymphoma survived for 16 and 37 months while another two have been still alive for 7 and 8 years. The patients who had malignant epithelial tumor, leiomyosarcoma, and malignant mesenchymal tumor survived for 17, 54, and 20 months, respectively. The patient with malignant tumor of endocrine origin has still been living for 3 years.As a result we concluded that better evaluation of signs and symptoms may facilitate the diagnosis; and the most important prognostic factors are early diagnosis and radical surgery.

Context: Fournier's gangrene (FG) is a rapidly progressing acute gangrenous infection of the anorectal and urogenital area. Aims: The objectives of this study were to investigate patients with FG and to determine risk factors that affect mortality. Settings and Design: Retrospective clinical study. Materials and Methods: Clinical presentations and outcomes of surgical treatments were evaluated in 68 patients with FG. Statistical Analysis Used: Chi-square, Student's t -test, and logistic regression test. Results: Mean age of patients was 54 and female-to-male ratio was 9:59. Among the predisposing factors, diabetes mellitus (DM) was the most common ( n =24, 35.3%), and sepsis on admission was detected in 31 (45.6%) and 15 (22.1%) patients, respectively. Seven (10.3%) patients died. Using logistic regression test, Fournier's Gangrene Severity Index (FGSI) >9, DM and sepsis on admission were found as prognostic factors. Conclusions: FG has a high mortality rate, especially in patients with DM and sepsis. An FGSI value >9 indicates high mortality rate.