Turkish Journal of Surgery - 2002; 18(5)

THE EFFECT OF LOOP COLOSTOMY ON THE HEALING OF COLON ANASTOMOSIS IN RATS

2002-12-01

Diverting colostomy reduces collagen accumulation, and decreases or delays the gain in anastomotic strength due to absence of intraluminal transit. As for loop colostomy, intact mesenteric side maintains the integrity of myoelectric activity, which in turn promotes to collagen synthesis. With these background information, the healing of colon anastomosis following loop colostomy comparing with diverting colostomy was investigated. Thirty rats were divided into three equal groups. Following colon resection Group I had colon anastomosis only, Group II had colon anastomosis and diverting colostomy, and Group III colon anastomosis and loop colostomy. On the seventh postoperative day, anastomotic bursting pressures and tissue hydroxyproline levels in anastomotic segments of all subjects were determined. Bursting pressures of anastomoses in Group I was higher than in Group II and III (p=0.0024, one-way ANOVA), Tissue hydroxyproline levels in Group II were lower than in Group I and III (p<0.0001, one-way ANOVA). Although anastomotic strength decreases in loop colostomy, collagen accumulation similar to the levels of anastomoses without colostomy may be due to a delay in collagen maturation. Loop colostomy may be preferred to prevent anastomoses with minimal effects on healing.

GOS TEST AS A NEW SCREENING TEST FOR COLORECTAL TUMORS

H�LYA KOYUNCU, G�RSEL SOYB�R, KEMAL DOLAY, YUNUS A�RALI, G�KHAN ADA�, E B�LGE — 2002-12-01

The aim of this prospective clinical study was to evaluate the value of Galactose Oxidase Schiff (GOS) test in rectal mucus specimens taken from the patients admitted to surgical clinic or endoscopy unit. The chemical structure of mucus secreted into the lumen is changed in colorectal neoplasms. GOS is a test in detecting the structurally changed mucus and can be used as a screening tool in colorectal cancer. The series was compared of consecutive patients, 66 of them with colorectal polyp and/or cancer and 34 individuals apparently free of colorectal disease served as the control group. The colorectal pathology was determined with the histopathologic evaluation of specimens taken during colonoscopy or operation. Patients were recorded according to their age, sex, history of rectal bleeding, the localization of the lesion in colon and the values of CEA and CA 19-9. The sensitivity and specificity of the test in detecting polyp and cancer was calculated. Correlation of the GOS test with the age, sex, lesion localization, tumor differantion, CEA and CA 19-9 levels was evaluated. We find that GOS test can detect colorectal polyps and cancers with 90% sensitivity, 88% specificity, 93% positive predictive value and 90% accuracy. The positivity of the test has no correlation with age, sex, localization of lesion, rectal bleeding, tumor differentiation, CEA and CA19-9 levels, As a result, GOS test is an effective and simple test in screening of colorectal polyps and cancer. With the confirmation of the safety of this test also by other centers and by conclusion of wide-range researchers, we believe that this test can take place in screening program for determination of high risk patients for colonoscopy.

THE RESULTS OF TYROIDECTOMY IN GOITER PATIENTS WITH SUPPRESSED TSH LEVELS

2002-12-01

The situation of normal T3 and T4 levels and a suppressed TSH level consists of the patients with subclinic hypertiroidism or who have recently begun anti-thyroid therapy that normalized T3 and T4 but not TSH, To evaluate whether or not tyroidectomy is risky for these cases, patients were operated in our hospital, were divided into 2 groups according to their TSH levels (if normal, group 1, n=61; if suppressed, group 2, n=29), There was a homogeneous female dominancy in the groups. Group 1 patients were younger than group 2 (p<0.05). No statistical difference was observed in complications rates and hospitalization periods between the groups (p>0.05). No mortality or severe surgical or endocrinological complications were observed in the study patients. As a conclusion, the tiroidectomy is a safe operation in patients with normal T3 and T4 levels, and suppressed TSH levels.

NEAR TOTAL THYROIDECTOMY FOR THE SURGICAL TREATMENT OF MULTI NODULAR GOITER IN AN ENDEMIC REGION

2002-12-01

The aim of this study is to point out an efficient surgical treatment for multi nodular goiter in endemic regions with minimal morbidity. In the surgical treatment of multi nodular goiters in endemic regions morbidity and recurrent nodular goiter are the major problems. In order to solve these problems various kinds of surgical procedures has been used; total thyroidectomy eliminates the potential risk of reoperation but this procedure has a more morbidity rate and also the patients need thyroxine supplementation during whole life. In this study we evaluate the early results and postoperative morbidity of the 76 patients with multi nodular goiter which are treated surgically. Female/male ratio was 3/1 (56/20) and mean age was43.53 (24-75) years in the series. 35 patients (%46) had hyperthyroidy. We perform a total lobectomy on the dominant nodule side with isthmectomy and a near total conterlateral lobectomy on the other lobe. There were no postoperative deaths, 5 complications occurred during 76 operations (% 6.5). There was no permanent complication (%0). In two patients transient hypoparathyroidism in two patients transient recurrent laryngeal nerve palsy and in one patient hematoma occurred. There were no wound infection and seroma. in the surgical treatment of multinodular goiter in endemic regions near total thyroidectomy is an effective surgical procedure with low morbidity.

ANALYSIS OF MORBIDITY AND MORTALITY OF 50 PANCREATICODUODENECTOMIES

AKIN BOSTANO�LU, C�NEYT KAYAALP, FUAT ATALAY — 2002-12-01

Pancreaticoduodenectomy is preferred increasingly for resection of malign and benign periampullary diseases. As far as we know, there is no collective review about the results of pancreaticoduodenectomies in our country. The aim of the present study was to analyze our pancreaticoduodenectomies and compare them with national and international series. We evaluated 50 consecutive pancreaticoduodenectomies between March 1999 and August 2001. There were 32 males and 18 females, age ranges between 33 and 75 (mean 58) years. The main outcomes were postoperative morbidity and mortality. There were four (8%) mortality and 25 (50%) postoperative morbidity. Pancreaticojejunal anastomotic leakage was the main cause of morbidity (% 16) and two of mortalities (%50). Other two mortalities were not related to surgical techniques. We believe that our pancreaticoduodenectomy results were acceptable and improved experience and patient selection may decrease morbidity and mortality.

MESENTERIC CYSTS IN ADULTS

ORHAN AL�MO�LU, MUSTAFA �AH�N, ADEM AK�AKAYA, ATILLA KARAKELLEO�LU, B�LENT KAYA — 2002-12-01

Mesenteric cysts are uncommon intraabdominal tumors. The incidence of disease is between 1 per 100.000 and 290.000 general hospital admissions. They can occur anywhere along the gastrointestinal tract mesentery, although most commonly found in the small bowel mesentery. There are no pathognomonic signs or symptoms of the cysts. They may present with a partial intestinal obstruction associated with a palpable mass, rupture and hemorragia in the cyst. Between 1995 and 2002, 9 patients who underwent surgery for mesenter cysts were evaluated retrospectively. Sex, age, complaints, diagnostic modalities, location of cysts, surgical procedure and postoperative complications were evaluated. There were 7 females and 2 males and mean age was 52 years (Range 33 to 70). Presenting symptoms of 6 patients were abdominal pain and distention, 1 patient with gastrointestinal bleeding, 1 patient with constipation and 1 patient with acute abdomen, 7 patients had both abdominal ultrasonography and CT tests. 5 cysts were located in the colon mesentery, 4 cysts in the small bowel mesentery. 7 cysts underwent enucleation, 1 excision, 1 small bowel resection. The cysts ranged in size from 5x4x4 cm to 18x18x12 cm, with a mean of 12.4x10.9x9.2cm. There was 1 wound infection with no mortality. Enucleation of mesenteric cysts is effective and sufficient surgical modality.