Turkish Journal of Surgery - 2011; 27(4) - Current Issue

Problems related to informed consent in surgery and recommendations

Ali R�za T�mer, Emre Karacao�lu, Ramazan Ak�an — 2011-10-01

Informed consent is a term based on the doctrine that “every individual has the right to know and to determine any medical intervention which is performed on her/his own body”. Although many national and international regulations have been composed until today, misapplications are still encountered in medical practice because of lack of knowledge regarding legislations or inappropriate medical and legal approach to the issue. In this article, the problems related to informed consent –through surgical interventions in particular- are noted and suggestions are presented in detail.

Colorectal cancer: are genetic and molecular biology researches reflected enough in the patient management?

Emel Canbay, Dursun Bu�ra — 2011-10-01

Nowadays, the results of clinical translational researches reflecting in the management of colorectal cancer patients are limited with usa of antibody therapy and detection of KRAS mutation determining the response to antibody treatment. However, in the near future, the new molecular markers are expected to enter into clinical usa with the results of these studies. In this review, the genetic and epigenetic risk factors which play a role in the development of colorectal cancer, molecular diagnostic and prognostic markers, molecular- targeted treatments and promising molecules that are critical in determining the response to the therapy will be examined.

Adaptation of the ostomy adjustment inventory into Turkish Language

Ayi�e Karada�, Zehra Baykara G��men, Hatice Korkut, B�lent �elik — 2011-10-01

Purpose: In the present study, the reliability and validity of the Ostomy Adjustment Inventory, which is a scale designed to assess psychosocial adjustment in patients with ostomy is examined in a Turkish sample. Patients and Method: Authors were asked for consent for the adaptation studies of Ostomy Adjustment Inventory. The adaptation of the scale was carried out in two stages. In the first stage, the language adaptation was made. Language adaptation was made by five language experts as from English to Turkish and retranslated. In the second stage, the data was gathered in order to test the validity and reliability of the scale. A questionnaire form and the Ostomy Adjustment Inventory, developed by Simmons, Smith and Maekawa in 2009 were used to collect the data. The inventory contained 23 items and 4 sub-factors. One hundred patients followed in the Stomatheraphy unit of Gazi University, Centre for Health Researches and Applications were included in the study and the inventory was applied through a face-to-face interview method twice, within three weeks intervals. Results: Average age of patients was 55.7 � 12.2 with 53% male, and 44% had a permanent colostomy, 21% with nonpermanent ileostomy and 14% had urostomy. Confirmatory Factor Analysis was applied to the new model that was obtained through the changes. All the coefficients were significant (p<0.01). The overall scale coefficient was 0.874. The overall correlation coefficient obtained through test-restest method in the scale was 0.766. Conclusion: The results of the research show that Ostomy Adjustment Inventory was found a valid and reliable instrument for Turkish society.

luation of 213 thyroidectomy cases: Hakkari experience

Hakan Yabano�lu, Cem Aydo�an, Emre Sahillio�lu — 2011-10-01

Background: Herein we tried to discuss the position of the new specialists who are accepted inexperienced on surgical treatment of thyroid diseases. The evaluations are made by taking into account the geographical region's social and cultural conditions to create a different perspective. Material and Methods: Two hundred and thirteen patients who underwent thyroidectomy surgery because of various indications at Hakkari State Hospital between January 2010 and June 2011 are evaluated retrospectively. Patients were evaluated in terms of age, gender, preoperative diagnosis, surgical technique, complications and pathology results. Results: Twelve (5.6 %) of the 213 patients were male in respect to 201 (94.4 %) female patients. The proportion of the female patients to male patients was 16.7/1. Seven patients (3.3 %) underwent bilateral subtotal thyroidectomy, 5 patients (2.3 %) underwent completion thyroidectomy and 201 (94.4 %) patients underwent total thyroidectomy surgery. There were 4 patients (1.8 %) with postoperative hematoma, 23 patients (10.7 %) with temporary hypocalcaemia, 3 patients (1.4 %) with permanent hypocalcaemia, 1 patient (0.4 %) with wound infection, 17 patients (7.9 %) with seroma, 2 patients (0.9 %) with suture reaction, 3 patients (1.4 %) with temporary recurrent nerve paralysis. Conclusion: We believe that the disadvantage of inexperienced surgeons who are new in their practice that are making health care particularly in major surgical procedures such as thyroidectomy can be eliminated by acquiring new experiences everyday in operations and a higher level of social collaboration between the patient and the physician.

Risk factors in non-variceal and non-malignancy upper gastrointestinal system bleedings in the patients undergoing surgery

2011-10-01

Purpose: Despite the advances in treatment methods, upper gastrointestinal system bleeding still appears as a serious problem. In this study, we aimed to investigate the effective risk factors on mortality in the patients that underwent surgery due to non-variceal and non-malignant bleeding from upper gastrointestinal tract, which was not responding to endoscopic management. Materials and Methods: Between 1997 – 2010, 74 patients who underwent surgery due to upper gastrointestinal system bleeding were analyzed retrospectively. The bleeding due to the malignancy and varices were excluded. Results: There were 81 (82.4%) male and 13 (17.6%) female patients, with a mean age of 51.8 years. The common complaint at the admission was melena (50%). Cardiovascular diseases were the most common comorbidity which were seen in 19 (27.4%) cases. Shock symptoms were seen in 48 (64.9%) patients. Forrest 1a was the most common bleeding form, which was detected endoscopically in 34 (51.5%) patients. Duodenal ulcer was detected in 56 (75.7%) patients. Commonly performed surgical procedure was bilateral truncal vagotomy and pyloroplasty with the ligation of gastroduodenal artery. Morbidiy rate was 24.3% and common one was pulmonary complication. Mortality occured in 15 (24.3%) patients. There was no mortality in the patients with Rockall score <5, while the mortality rate was 25.4% in the others. Elder age, male gender, comorbid disease, shock, low hemoglobin value, blood transfusions and high Rockall score were effective risk factors on mortalilty. Conclusion: Early surgery and close cooperation between gastroenterologists and surgeons may be benefical at the treatment of high risk upper gastrointestinal bleeding, except variceal and malignancy bleedings.

Mesh repair in hiatal hernia surgery: Surgical technique and early results in hiatal hernia repair

Metin Ertem, Emel �zveri, Hakan G�k — 2011-10-01

Purpose: The recurrence rates after laparoscopic hiatal hernia repair are very high. In the recent years, hiatal hernia repair using mesh has gained popularity because of the recurrences. In this study, the application technique, prosthetic indications and early results are discussed in accordance with the current literature. Methods: Forty five patients, ages between 29-71, underwent laparoscopic hiatal hernia repair between June 2008-July 2011. In fourteen (9 male, 5 female) patients cruroplasty was supported by mesh. Five of these patients underwent redo surgery. Results: We performed mesh repair in 14 patients with weak crus structure, recurrence hernia and wide hiatal defect. In redo surgery of 5 patients, we identified stenosis in one case due to previously applied polypropilen mesh, in three cases detachment of cruroplasty sutures and in one case sliding hernia. Cruroplasty, Nissen fundoplication and mesh repair were applied to all of these patients. No complications were detected in peroperative and postoperative periods. Four patients had temporary dysphagia symptoms in the early follow-up period for 2 to 6 months. Conclusion: The prosthetic repair of hiatal hernia has advantages as well as some problems. The patients did not have any problems due to repair with mesh in the follow-up period. We wait for the long term results currently. In our opinion, due to the high risk ratio of recurrence, using mesh in the selected patients would be advantageous to reduce the risk of recurrence in hiatal hernia.

A rare soft tissue tumour: Eccrine spiradenoma

2011-10-01

Aim: Eccrine spiradenoma is a rare soft tissue tumor that originates from the eccrine sweat glands. We aimed to evaluate the outcomes of our patients who underwent surgery for eccrine spiradenoma. Material-Methods: Nine patients who underwent surgery for eccrine spiradenoma between January 2006 and July 2011 were reviewed in detail to obtain information regarding clinical and histopathological features retrospectively. All patients' age, gender, symptomts and duration, mass localization, surgical findings, pathology reports, postoperative complications and follow-up data were recorded. Results: There were 3 (33.3%) male/ 6 (66.7%) female patients with a median age 37,7 � 14,8 (24-75) years in the study group. The pathology report of 8 patients was benign, while one was malignant. The patient with malign eccrine spiradenoma was a 75 year-old female. All patients presented with a palpable mass (100%) and 5 of them (55%) had also pain and tenderness. The average duration of complaints was 8.6 years (3-15 years). The masses were localized in back in the thoracic spine in 3 patients, on the scapula in 2, on an arm in 2 and on the right lateral neck in 1 case. The malign mass was located in the haired skin of the patient. All masses were excised with a clean surgical margin. No recurrence was detected at a median follow-up period of 31.8 months. Conclusion: Eccrine spiradenoma should be taken into consideration in the differential diagnosis of the soft tissue masses of the skin. Radical surgical excision should be planned due to the risk of malignancy and recurrence.

Urinary bladder rupture in the differential diagnosis of acute abdomen: two case reports

B�lent Koca, Bekir Kuru — 2011-10-01

The rupture of the urinary bladder may cause acute abdomen. However, this has not been emphasized in the classical surgical textbooks (such as Sabiston, Schwarts). In the present manuscript we report two cases of bladder rupture with iatrogenic and spontaneous origin and suggested that bladder rupture has to be considered in the differential diagnosis of acute abdomen. We evaluated the importance of the physical examination, laboratory findings and imaging modalities in the diagnosis of bladder rupture. The authors think that presentation of these cases were interesting, because we have found only 4 cases published in the literature which report the presence of urinary bladder rupture as a cause of pneumoperitoneum were found. We discussed the importance of pneumoperitoneum in the differential diagnosis in rupture of urinary bladder.

Familial adenomatous polyposis associated desmoid tumors: Presentation of two cases with literature evaluation

Sebahattin �elik, Muhittin Ahmet �zen�, Erhan Hamalo�lu, Derya Karako� — 2011-10-01

Familial adenomatous polyposis (FAP) coli is an autosomal dominant disease where hundreds to thousands of polyposis occur in the colon and rectum. The mutations in APC gene causes the disease. Colectomy or proctocolectomy was used as a routine surgery in a prophylactic manner to prevent colorectal cancer in FAP patients. In FAP patients some extraintestinal problems are observed: osteoma, brain tumors, hepatoblastoma, papillary carcinoma and desmoid tumor. In FAP patients desmoid tumors are mostly seen in the abdomen or abdominal wall (80-90%) but rarely may be seen in the extremities as well. After a prophylactic colectomy, desmoids become a serious problem with high mortality and morbidity. There are surgical and medical treatment modalities for desmoids. Tamoxifen-NSAIDs-cytotoxic agents are medical options for the first line treatment in abdominal desmoids whereas surgical excision is recommended in complicated cases. In abdominal wall desmoids, surgical excision is the best way. In this study we discuss our two FAP patients in whom desmoid tumor in the abdomen and abdominal wall developed. In the light of the literature and as we have observed in our patients, in a FAP patient proctocolectomy ileal J pouch anal anastomosis should be preferred as a surgical option. In cases of intraabdominal desmoids, tamoxifen-NSAIDs is the first line treatment. Partial and sometimes complete response to medical treatment may be seen.

Primary malignant melanoma of the anorectum: a case report

Hakan Bulus, Ahmet Koyuncu, Tongu� Sug�ne�, Ali Co�kun — 2011-10-01

Anorectal malignant melanoma is a very aggressive and rare tumor. This devastating malignancy is often mistaken for benign conditions as either hemorrhoids or rectal polyps. Unfamiliarity with this bleeding anorectal lesion can lead to a delay in diagnosis and therapy. The patient, a 72 year-old female, complaining for six months was treated for hemorrhoids. An abdomino-perineal resection was performed. Pathologic examination revealed an anorectal melanoma with numerous lymph node metastases but there was no liver or peritoneal metastases or ascites.

Recto-sigmoid perforation mimicking peptic ulcer perforation: a case report

Alper Yavuz, Duray �eker, Hakan Bulu�, Altan Ayd�n — 2011-10-01

Spontaneos perforation of the colon is a rare condition. It is often seen in elderly patients and especially associated with chronic constipation. This disease has a high mortality rate. In contrast with the literature, in this article we report a spontaneous colonic perforation case in a young man without chronic constipation. Colonic perforation is usually misdiagnosed by the clinicians since it occurs rarely. It must be taken into consideration by the clinicians in the pre-diagnostic period, especially in elderly patients with constipation and it should also be kept in mind that it can be also observed in young patients.

Amputation of the glans penis and hypospadias after circumcision: a case report

Muazzez �evik, �zg�r S��t, Mehmet Emin Boleken, Kaya Halil, Servet �cal — 2011-10-01

Circumcision is one of the most frequent surgical procedures performed worldwide. Like all surgical interventions, complications might arise during the circumcision as well. While fewer complications are observed in circumcisions performed by professionals in developed countries, the rate of complications might be higher in circumcisions performed by circumcisers in developing countries and under poor health and hygienic conditions. In addition to severe early complications ranging from bleeding and infection to penile amputation, complications like skin bridge and urethrocutaneous fistula may also emerge. The most severe complication of circumcision is penile or glans amputation. In this case report, circumcision and its complications are discussed A 4-year-old male child due to amputated glans penis during the circumcision by the circumciser is presented.

Rectovaginal septum type-III injury during parturition: A case report

Fatih Alt�ntoprak, Enis Dikicier, Bet�l Kuru, G�khan Akbulut — 2011-10-01

Isolated rectal injury during parturition is a rare clinical entity and it is very important to determine this complication immediately. A 29 year-old pregnant woman was admitted to our hospital to give birth. The dilatation period lasted 9 hours. In the pelvic examination performed after parturition, there was a rectal injury 3 cm in length including the posterior vaginal wall with intact perineum. This case has been reported because of its rare incidance and to discuss the management of these types of rare rectal injuries.

Akut biliyer pankreatitte laparoskopik kolesistektomi

Yaman Tekant — 2011-10-01

Yazarlar�n Yorumu: Akut biliyer pankreatitte laparoskopik kolesistektomi

2011-10-01

Yazarlar�n Yorumu: Akut biliyer pankreatitli olgularda erken ve ge� laparoskopik kolesistektominin yeri

2011-10-01