Turkish Journal of Surgery - 2007; 23(1)

The effect of taurolidine on healing of colonic anastomosis in rats with obstructive jaundice

2007-03-01

Summary: The effect of taurolidine on healing of colonic anastomosis in rats with obstructive jaundice Purpose: The aim of the study is to investigate the effect of Taurolidine on intestinal anastomosis and wound healing in rats with obstructive jaundice. Material and Methods: In this study 40 male Wistar-Albino rats were used. Rats were not given any food for 12 hours before the procedure and a blood sample was taken for TNF-α. Rats were divided into two groups, each containing 20 rats. The first group was sham group and the second group was obstructive jaundice group that is performed by ligation and division of choleduct. Four days later from the first surgical procedure we performed full thickness incision and anastomosis to the descending colon. Group 1 and 2 were also subdivided within themselves. We administered 200 mg/kg/day isotonic sodium (IS) via intraperitoneal route for the first half and Taurolidine to the second. Rats were sacrificed 7 days after the anostomosis. Anastomotic segments were resected and explosion pressure was measured. Samples were take from these segments for hydroxiproline and histological investigation. Blood samples were also taken for TNF-α and bilirubin. Results: Mean anastomosis explosion pressure in obstructive jaundice-IS group, was statistically significantly lower than the obstructive jaundice-Taurolidine (OJ-T) group and the IS only group (p<0.01). However there was not a significant difference between OJ-T and non obstructive jaundice group in mean explosion pressure (p>0.05). Mean tissue hydroxyproline concentration at the anastomosis of OJ-IS group was significantly lower than OJ-T and only IS groups (p<0.001). Mean TNF-α concentration at the anastomosis healing of OJ-IS was significantly higher than OJ-T and non-obstructive only IS group (p<0.001). When TNF-α concentrations were compared, there was no statistically significant difference between the Taurolidine-Obstructive jaundice and Tauroludine-non-obstructive groups. There was also no significant difference between non-obstructive Taurolidine and IS given groups. At the histopatological investigation, it was discovered that there was less edema and infiltration of inflammatory cells in every layer in OJ-T group when compared to OJ-IS group. However, new collagen synthesis accompanying fibroblastic activity and neoangiogenesis was more prominent in OJ-T group. Conclusion: Intraperitoneally administered Taurolidine decreases high TNF-α levels and colonic anostomosis explosion pressure and positively affects hydroxyproline concentrations.

Laparoscopic cardiomyotomy and Dor's fundoplication for the treatment of achalasia: at least two-year follow-up

Tayfun Karahasano�lu, �smail Hamzao�lu, Bilgi Baca, Ahmet Dobrucal� — 2007-03-01

Purpose: The aim of this study was to assess our results of laparoscopic Heller myotomy and Dor's fundoplication in patients with achalasia. Materials and Methods: Twelve consecutive patients who underwent laparoscopic Heller myotomy and Dor's fundoplication for achalasia by the same surgical team were retrospectively evaluated on a prospective database. Minimum follow-up was two years. Patients were assessed with symptom scoring scale and manometry and/or pH monitorization if clinically indicated. Results: Myotomy with fundoplication was completed laparoscopically in all patients whereas a mucosal esophagus perforation occurred in one patient and it was repaired laparoscopically. There was no mortality and none of the patients required reoperation. Mean follow-up was 44 (24-77) months. Permanent healing of the disease was observed in all patients, except in one whose disphagia complaint was not sufficiently resolved in the early postoperative period. Postoperatively, gastroesophageal reflux was observed in two patients (16%) whose symptoms were taken under the control with medical treatment. Patient satisfaction rate was 91%. Conclusion: Laparoscopic Heller myotomy and Dor's fundoplication is reliable and effective procedure for the treatment of achalasia. Symptom-free survival was permanent in the patients who were symptomatically healed in the early postoperative period.

Bilateral inguinal hernias may be repaired simultaneously

Haluk Recai �nalp, Erdin� Kamer, Hayrullah Derici, Okay Nazl�, Mehmet Ali �nal — 2007-03-01

Purpose: Simultaneous repair of bilateral inguinal hernias remains controversial for some surgeons because of the increased risk of postoperative pain, wound complications, or recurrences. The current study reports a retrospective study comparing unilateral hernia repair versus simultaneous bilateral inguinal hernia repair. Materials and Methods: Demographic features, additional diseases, type of anesthesia, operating time, hospital stay, developed complications, required analgesics, returning time to basic activity in postoperative period and recurrence rates of the patients with unilateral (Group-1; n=495, 84.3%) and simultaneous inguinal hernia repairs (Group-2; n=92, 15.7%) were evaluated retrospectively. Results: Mean operating time was longer in Group-2 (p=0.001). There was no difference in mean hospital stay (p=0.606), complication rates (p=0.715), postoperative analgesia requirements (p=1.000) and recurrence rates (p=0.302) between the groups but returning time to basic activity was significantly shorter in Group-1 (p=0.001). The mean follow-up time was 40.1 in Group-1 and 35.1 months in Group-2 (p=0.051). Conclusions: We believe that a tension-free technique allows bilateral inguinal hernias to be repaired in one operation, and result in similar outcomes as a unilateral tension-free repair.

The efficacy of methylene blue in showing occult cystobiliary communication in hydatic liver disease

2007-03-01

Purpose: Occult cystobiliary fistula is frequently encountered in hydatic liver disease that is usually overt in the postoperative period and leads to certain complications. In the present study it is aimed to evaluate the efficacy of methylene blue injection technique in determining the occult cystobiliary communication in the peroperative period. Materials and Methods: Thirty five patients with the diagnosis of hydatic liver disease in whom conservative surgery has been performed were included in the study. The patients with biliary soiling of the cyst fluid and overt cystobiliary communication have been determined. In the remaining patient regardless of bile stain the common bile duct was isolated and methylene blue injection was performed. Results: Of the eight patients with bile stain of the cyst fluid, a cystobiliary communication was shown in 5 (63%). In the remaining 3 patients (37%) in whom no communication could be demonstrated, methylene blue injection showed the communication. In the remaining 27 patients with no sign of cystobiliary communication methylene blue injection showed a communication in 6 (22%). Conclusion: In hydatic liver disease in which conservative surgery has been performed methylene blue injection technique is a safe and effective procedure in the demonstration of occult cystobiliary communication

Laparoscopic splenectomy versus conventional splenectomy in hematological diseases: A thirteen-years experience

2007-03-01

Purpose: Nowadays, laparoscopic splenectomy (LS) is a well-accepted, less-invasive procedure for hematological disorders. Except for patients with very large spleens, LS can be performed in almost all patients. Our aim was to analyse operative and postoperative results of laparoscopic splenectomy performed for hematological disorders versus conventional splenectomy (CS). Materials and Methods: Between 1993 and 2006, 100 consecutive patients who underwent elective splenectomy at the General Surgery Department of Erciyes University Medical Faculty were enrolled in the study. Results: Fifty-eight patients were operated conventionally while 42 patients were operated laparoscopically. Patient demographics were similar between the two groups. LS was succesfully performed in 39 patients (93%). Altough the operation time was significantly longer in CS group, the postoperative mean visual analogue score and the lenght of hospital stay were significantly lower in LS group. Postoperative complications were comparable in both groups and atelectasis was the most frequent complication. Conclusion: With low complication and conversion rates, LS has nearly become the gold standard for the surgical treatment of hematologic diseases.

A rare cause of intestinal obstruction: obturator hernia (report of a case and review of literature)

Osman Y�ksel, Tolga �ahin, Hasan Bostanc�, Nusret Aky�rek — 2007-03-01

Here we present a case of 70 female emaciated patient with a positive Howship-Romberg sign but who had been treated with the diagnosis of osteoarthritis in various clinics previously. She was admitted to our department with the signs and symptoms of partial intestinal obstruction. She was found to have obturator hernia during the evaluation period. We aimed to discuss the difficulties encountered during the evaluation period, the modalities of diagnosis and the difficulties that come across at the level of treatment in the guidance of the literature.

Primary rectal lymphoma: unusual treatment for a rare case

B�lent �nal, Melih Karabeyo�lu, Bet�l Bozkurt, Ebru �zel, �mer Cengiz — 2007-03-01

Primary gastrointestinal lymphomas account for 5 % of all lymphomas. Lymphomas could be seen through gastrointestinal tract from oral cavity to rectum. Rectum is fairly uncommon site for lymphoma compared to other gastrointestinal sites. Primary rectal lymphomas (PRL) are the most rarely disorder accounting for 0.05 % of all colonic malignancies and 0.1-0.6 % of primary rectal tumors. It is unclear whether surgery or combination or alone chemo/radiotherapy improves the prognosis and survival in such patients. The role of surgery in PRL of the rectum is still controversial. Therefore we want to present a case, provided complete remission treated with combination chemo / radiotherapy without any operation.

Enhanced recovery after surgery

Eren Ersoy, Haldun G�ndo�du — 2007-03-01

Clinical management, complication rates and lengths of stay differ significantly for the same types of operations among different centers, despite the fact that the discharge criteria are almost always the same. This is the result of different perioperative management of the patients. The ‘'Enhanced recovery after surgery'' protocol was started by five northern European universities in 2001 for the clinical management of colonic resections because of the need to develop a consensus on key elements of perioperative care. Their results showed that the recovery period can be shortened after major surgical operations. However, effects on morbidity and mortality remain to be determined. This protocol also showed us that the traditional clinical management elements like preoperative fasting, anesthesia route and bowel preparation are open for discussion because the current approaches are radically different with better outcomes. The protocol is limited to a few countries but the results are promising. Although it is not easy to change the traditional applications in surgery, we have to be aware of the current approaches. This review is about the ‘'Enhanced recovery after surgery'' protocol's details and current results. By this way we can adopt the results for our current and future clinical trials in an evidence based manner for the enhancement of recovery.