Turkish Journal of Surgery - 2003; 19(1)

ELECTRON BEAM RADIOTHERAPY IN BREAST CONSERVING SURGERY, ELIOT: A RANDOMIZED "EUROPEAN INSTITUTE OF ONCOLOGY" STUDY

2003-01-01

Patients with breast conserving surgery are being randomized to take conventional radiotheraphy or "Electron Beam Intraoperative Radiotheraphy" in a study (ELIOT) which is being carried out in European Institute of Oncology in Italy. Present study informs in detail on ELIOT study.

EVALUATION OF GENERAL SURGICAL LITIGATIONS DISCUSSED IN HEALTH COUNCIL BETWEEN 1995-2000

Dr. Ali R�za T�MER — 2003-01-01

The aim of this retrospective study was to differentiate complication and malpractice in surgical cases and to help forensic medicine specialists who work as consultative authority in malpractice litigations. Data based on 540 reviews of malpractice claims between the years of 1995-2000 was obtained from Health Council Registrations. Current data shows that a considerable amount of malpractice actions against surgeons result from their practicing in other specialies. Informed consent was lacking in majority of cases. The rate of autopsy in cases resulted with death was %57.8. %50 of surgery malpractice litigations appeared groundless and the incessant exposure to critism and complaints might make surgeons less willing to take risks.b

LOW MOLECULER WEIGHT HEPARIN EFFECT ON COLONIC ANASTOMOSIS HEALING IN RATS

2003-01-01

The aim was to evaluate the effects of low molecular weight heparin (LMVVH) on healing of colonic anastomosis in rats. In the experimental animal model, thirty male Wistar-albino rats were randomized into three groups consisting often rats each. All were anesthesized with ketamin and xylasine, celiotomy and left colonic anastomosis were performed on each animal. In the first group, no medication was given pre or postoperatively. In the second group, single dose of LMVVH was given preoperatively. In the third group, LMVVH was administered subcutaneously on the operation and for 6 postoperative days. In the sixth day, all rats were sacrificed and bursting pressure and the tissue hydroxyproline content of the anastomoses were assessed and compared. The results were compared statistically by using one way ANOVA test. There was no significant difference between the groups in anastomotic bursting pressure and tissue hydroxyproline levels (P>0.05). In conclusion, both single or six day administrations of LMWH are not effective on healing of colonic anastomosis and can be safely used as medication in patients who have undergone colonic anastomosis.

THE IMPACT OF HIGH BILIRUBIN LEVELS ON FASCIA HEALING

Dr. Tolga M�FT�O�LU, Dr. Erhan BAKIRCIO�LU, Dr. Abdullah SA�LAM — 2003-01-01

The aim of this experimental study is to check anastomotic disruption force, after common bile duct ligation and to asses impact of high bilirubin level on fascia healing process. It has been shown that high bilirubin level has negative effect on fascial healing. Hydroxyproline level in the tissue is known as an indicator of tissue healing. High bilirubin level reduces prolyl hydrolylase enzyme activity and prevents incorparation of proline into collagen. Sixty Wistar Albino type female rats were randomized into four groups. Group I was control group. Common bile ducts were ligated for 7, 14 and 21 days in group II, III and IV, respectively. Rats were sacrificed at the end of the study and total bilirubin level in blood, hydroxyproline level in fascia and fascial disruption force were determined. ANOVA test was used for statistical analysis. Total bilirubin level (p<0.001), hydroxyproline level in fascia (p<0.001) and fascial disruption force (p<0.001) were found statistically different in four groups. We concluded that higher bilirubin levels had negative impact on fascial healing process.

QUALITY OF LIFE AFTER RESTORATIVE PROCTOCOLECTOMY IN PATIENTS WITH ULCERATIVE COLITIS

2003-01-01

The aim of this study is to evaluate the issue of long-term quality of life after restorative proctocolectomy in patients| with ulcerative colitis. A questionnaire was sent to the patients who had restorative proctocolectomy between 1990 and 2001 for ulcerative colitis. The questions covered stool frequency, incontinence, usage of hygenic pads, stool characteristics, symptoms, eating, social, working and sexual life, sport and travelling activities. Twenty nine of the 44 patients (66%) replied. Mean follow-up was 42 months (ranging from 4 to 104 months). Stool frequency and abdominal symptoms decreased after the operation (p<0.001). Perfect and good day-time continence were 75.9% and 17.2%, respectively. Seventy-two percent of the patients did not require any medication. Eating, daily working activities, social and sexual life of the patients improved after the operation. Difficulty in travelling a very common complaint (96%) was relieved in most patients (21.5%, p<0.001). Sporting activities improved significantly in the postoperative period (25.9% vs 65.5%, p=0.01). Restorative proctocolectomy in patients with surgical indication for ulcerative colitis restored the quality of life by decreasing stool frequency and symptoms alongside increased eating, working, sexual, social, travelling and sporting activities.

PALLIATION IN PANCREAS CANCERS

2003-01-01

To evaluate and compare operative and non-operative treatment modalities in the palliative care of pancreas carcinoma with local invasion and/or hepatic metastasis defined by pre-operative evaluation. Palliative treatment modalities for pancreas carcinoma with early local invasion and/or hepatic metastases can be operative or non-operative. Especially, the contribution of the chosen method of treatment to survival, cost, mortality and morbidity rates has suggested different results. The data of 72 patients with pancreas carsinoma (55 males, 19 females; aged 38-82 years, mean 52±3.14) treated between 1993 and 2001 were evaluated retrospectively. The surgical and non-surgical palliative methods were compared for cost-effeciency, mortality and morbidity rates and survival. Kaplan-Meier and Mann-Whitney U tests were used for the relevant comparisons. 27 patients (37.5%) underwent curative surgery, 16 (22.2%) palliative surgery and 29 (40.3%) non-surgical palliative methods. Considering patients who were treated palliatively, it was noted that percutaneous biliary stents were placed in 25 patients (55.5%), surgical palliation was accomplished in 16 (35.5%) and non-surgical pain palliation in 4 (9%). While patients with biliary stents experienced no early complications, the complication rate was 37.5% in the surgical palliation group. Late-term complication rate was 24% in the stent group and 25% in the surgical palliation group. The survival rates of the two groups were comparable. Because of the high complication rate and long hospitalization period, the cost of surgical palliation reached to that of stent placement. The results, suggest that it is better to plan the method of palliation to the pancreas carcinoma patients with late local invasion and/or hepatic metastases on the basis of operation risk and life expectancy factors.

PREDISPOSING FACTORS IN CHRONIC PILONIDAL SINUS DEVELOPMENT

Dr. Ramazan ERYILMAZ, Dr. Mustafa �AH�N, Dr. Orhan AL�MO�LU, Dr. M. Kamil YILDIZ — 2003-01-01

We have investigated predisposing factors in development of chronic pilonidal sinus. Pilonidal sinus is a common, chronic, intermittent disease of the sacrococcygeal region that effects young adults after puberty. It is now widely accepted to be an acquired disorder. Deep natal cleft, hairiness, dark skin, obesity, local trauma and irritation, poor personal hygiene, hyperhidrosis, familial disposition, sedentary occupation were claimed as predisposing factors in development of pilonidal disease. In this prospective study that was conducted between July 1998 and July 2002; age and sex distribution, body-mass index, hairiness, skin color, deep natal cleft, personal hygiene, hyperhidrosis, local trauma and irritation, relation of disease with occupation were recorded in 181 patients with diagnosis of chronic pilonidal sinus. Eighty-nine percent of patients were male, mean age was 25.7 (range, 17-46), 12.2% were obese, 49% were overweight, 60.7% had abundant hair, 83.4% had dark skin, %45.9 had poor personal hygiene, 23.2% had hyperhidrosis complaint, 10.5% had familial disposition, 54.6% had sedentary occupation and there was no patient with history of sacrococcygeal trauma and irritation. In conclusion; the etiology of pilonidal sinus is multifactorial. In this prospective study; male sex, youth, hairiness, dark skin, deep natal cleft, being overweight, poor personal hygiene were detected as predisposing factors.

THE COMPARISON OF MAYO HERNIORRAPHY AND MESH REPAIR FOR INCISIONAL HERNIAS

2003-01-01

There have been reports on high recurrence rates for repairing methods of incisional hernias with synthetic materials recently. We compared the results of mayo herniorraphy, a doublelayer musculofacial repair and prosthetic mesh repair for incisional hernias. 125 patients were operated for incisional hernia at F�rat University General Surgery Department between 1994-2001. 80 of them were followed and the results were compared median follow up for mayo herniorraphy and mesh repair group were 24 (range between 7 and 91 months) and 27 (range between 3 and 84 months) months respectively. Nine of the patients were male (11%), and 71 were female (88%). Mayo herniorraphy was performed on 39 patients and mesh repair was performed on 41 patients. Mean defect area in mayo herniorraphy and mesh repair were 25±4.0 cm² and 81 ±12.6 cm² (mean±standart deviation) respectively. Five complications occured in mayo herniorraphy group. Eight complications occured in mesh repair group. Mesh had to be removed in one patient for infection. Three recurrences occured in both groups. Recurence rates were 7.6% in mayo herniorraphy group and 7.3% in mesh repair group. Mayo herniorraphy can be safely applied for incisional hernia repairs if the defect diameter is small and patient has no predisposing factor.