Turkish Journal of Surgery - 2008; 24(3)

Pelvic septic complications after rectal cancer surgery

2008-09-01

Purpose: The aim of this study was to evaluate the parameters related to septic complications after curative surgery for rectal cancer. Patients and Methods: Eighty-two patients treated in our clinic with the diagnosis of stage II and III rectal carcinoma have been evaluated retrospectively. The parameters evaluated were age, gender, tumor localisation (lower, mid, upper rectum), the type of surgery (low anterior resection, abdominoperineal resection), the presence of radical abdominopelvic lymph node dissection, emergency or elective surgery, hand sewn or stapled anastomosis, diverting ileostomi or colostomy, peroperative blood transfusion, stage, preoperative albumin and hemoglobin measurements. Results: The type of surgery was low anterior resection for 42 patients and abdominoperineal resection for 40 patients. Septic complications were seen in 26 (31%) patients. Twelve (14%) of them were anastomotic leak and 14 were pelvic abscess. In univariate analysis, low anterior resection, emergency surgery, preoperative low albumin and hemoglobin levels (≤3gr /dL and ≤11 gr/dL, respectively) were found to increase pelvic septic complications. In multivariate analysis, low anterior resection and low albumin levels were found to be related to pelvic septic complications. Conclusion: Low rectal anastomosis is a significant risk factor for complications. Preoperative treatment of hypoalbuminemia and anemia and preference of elective surgery are important for this group of patients.

The comparison of adhesion formation effects of H�-TEX�PARP NT and Proceed Mesh

Ercan YAL�IN, O�uz HASDEM�R, Oktay B�Y�KA�IK, Kahraman D�NLER, Cavit ��L — 2008-09-01

Purpose: Aim of this experimental study is to compare the adhesion formation effects of two different prosthetic materials (HI-TEX �Parp NT mesh and Proceed mesh) in hernia repair. Material and Methods: Twenty Wistar-Albino rats were used for the study. Defects of 2x1 cm size were created at the right and left of each rat's anterior abdominal wall. Proceed mesh is implanted on the right side and HI-TEX mesh on the left side at half of them (Group A), and Proceed mesh is implanted on the left side and HI-TEX mesh on the right side at the other half (Group B) to repair the defect. Two rats of each group is sacrificed at the 7^th , 14^th , 21^st , 28^th and 35^th days postoperatively and extension and severity of the adhesion and tissue reaction to the implants are evaluated. Results: At the end of the study, no difference was found between two groups concerning extension and severity of the adhesion. Adhesion were more frequent in the rats sacrificed on the 7^th and 14^th days. Proceed mesh adhesion extension (U=376, p<0.05) and severity (U=352, p<0.05)) were significantly less than HI-TEX mesh. Tissue reactions to implants were more with HI-TEX mesh, however, no difference was found statistically significant (x2=0.41, p>0.05). Conclusion: We have the opinion that Proceed mesh is superior to HI-TEX mesh in hernia repair as it has less adhesion formation effect. As a result, Proceed mesh is thought to be a more suitable hernia repairment material compared to HI-TEX mesh.

The effect of glutathione preconditioning on heme oxygenase-1 system established by whey protein feeding on hepatocellular injury in a rat hepatic normothermic i/r injury model

2008-09-01

Purpose: Oxygen radicals which are produced during reperfusion phase play a central role for hepatocellular damage during ischemia/reperfusion (I/R) injury. Antioxidant strategies appear a promising approach to prevent I/R injury. In the present study, the effect of glutathione (GSH) preconditioning established by whey protein feeding on hepatocellular injury markers was assessed in a rat hepatic normothermic I/R injury model. The interaction between intracellular GSH content and heme oxygenase-1 (HO-1) enzyme expression was also determined in order to understand the level of upgrading of HO-1 system in a high GSH content environment after preconditioning. Material and Methods: Livers of female Sprague-Dawley rats were subjected to 45/45 minutes of normothermic I/R injury. A group of rats were fed by standard chow for a three week duration before I/R procedure (CONTROL I/R; n=16), whereas another group was fed by “whey” protein for preconditioning (WHPR I/R; n=16) during the same period. Two SHAM groups were constituted accordingly but rats were not subjected to I/R injury (STD SHAM and WHEY SHAM; n=6 in each). Following 45 minutes of reperfusion, serum transaminase levels as well as GSH, malondialdehyde (MDA) levels, apoptotic index (AI) and HO-1 gene expression in liver tissue were determined. Half of the animals in both injury groups were surveilled for a week without sampling. Results: Intracellular GSH levels in WHEY SHAM group were significantly higher than those of STD SHAM group which indicated a successful preconditioning. Preconditioning by “whey” protein feeding prior to I/R injury (WHPR I/R) significantly ameliorated the increased levels of serum transaminase as well as liver MDA levels and A� in CONTROL I/R group. Survival of the rats in both injury groups were not different. “Whey” preconditioning also significantly increased GSH levels, whereas HO-1 expression was lower when compared to rats subjected to I/R injury without preconditioning. Conclusion: Feeding with “whey” protein successfully resulted high GSH content in rat liver. Whey preconditioning ameliorated hepatic I/R injury. HO-1 enzyme seems to have a less important role in antioxidant defense system when GSH production was induced prior to I/R injury.

Results of 230 patients that underwent groin hernia repair in a rural hospital

2008-09-01

Purpose: Groin hernia repair is one of the most common operations in surgical practice. The best choice of anaesthesia and repair technique is still under debate. The aim of the study is to evaluate the results of groin hernia repair in a local hospital in Anatolia. Materials and Methods: Data of the 230 adult patients, that underwent a hernia repair at a rural state hospital, were evaluated retrospectively. Results: Regional anaesthesia and local anaesthesia were the mostly preferred types of anaesthesia. Lichtenstein procedure is the mostly used surgical method for groin hernia repair. Mean postoperative time spent in hospital was shorter in local anaesthesia group and was shorter for elective operations compared to emergency conditions. Another factor affecting postoperative hospitalization time is comorbid diseases. Postoperative morbidity was about the same between different anaesthesia groups. Conclusion: Local anaesthesia has the shortest postoperative hospitalisation time for groin hernia. It would be used more common in groin hernia repair.

Results of general surgeons' preferences in the general surgery educational institutions. Preliminary report

2008-09-01

Purpose: To reveal Turkish surgeon generals opinions on surgical routins and debatable subjects. Material and Methods: Thirtytwo questions asked directly to 302 Turkish General Surgeons who were working in Istanbul, Ankara, Izmir and Bursa cities, between 2001 August – November 2001 in their clinics. Any communication ways such as fax, e-mail, letter and the others were not used to reach them. All participants were working on the university or educational and research hospitals in four biggest cities (Istanbul: 119, Ankara:109, Izmir: 53, Bursa:21) of Turkey. Results: Operation techniques and technical details have large variations, debating subjects on general medical literature are also debatable between the Turkish surgeons, to insertion and to use of the innovations in daily rotine is problematic, surgical education is not standardized in Turkey yet and surgeons are under pressure of serious economic problems. Conclusion: Results constitute the large database because of they got from 24 university and educational hospital clinics in 4 biggest Turkish cities. These results reveal the current situation of the Turkish surgery and also reveal the problems to need solve.

The internet usage of general surgery patients and the patients' relatives in seeking information

2008-09-01

Purpose: The study evaluated the frequency of internet utilization among the patients and their relatives who were treated in a clinic. Materials and Method: 700 patients and 700 of their relatives were asked to complete a questionnaire regarding their internet utilization and sociodemographic features. Results: There were 673 (%48) males and 727 (%52) females, aged between 16-75 years (median, 52). There were 657 (%46.9) literate patients and their relatives, who had minimum high school degrees and 743 ( %53.1) who had lower education degrees. There were 504 (%36) patients and relatives with internet access at home and 418 (%29) of them used internet in their daily lives. It was found out that 385 (27.5) of them who have high education degrees and 33 (%2.3) of them who have lower education degrees used internet in their daily lives. When the frequency of internet usage about their illnesses was assessed, it was found that 234 (%16.7) of them searched knowledge on internet,but only 109 (%7.7) of them could find adequate Turkish resources.65 (%4.6) of them knew specific health sites on the web. Conclusion: Patients and their relatives attending to the study had a significantly low internet utilization. It is essential that health facilities should familiarize themselves with these resources and should attempt to provide relevant, clear and up-to-date information that patients could readily identify and access.

Diagnosis of intra-abdominal sepsis

R�fat Yal�n — 2008-09-01

General surgery resident training programme and ultrasonography training

Orhan Veli �zkan — 2008-09-01

Since it is non-invasive, radiation-free, easy to perform, and easy to transport to emergency rooms or intensive care units; USG is an effective and commonly performed method that contributes both diagnosis and tratment. Therefore, it is required for general surgeons to learn how to perform USG. This letter is written to open a discussion forum about ultrasonography teaching in general surgery resident training in Journal of National Surgery owned by Turkish Surgery Society, one of the most populated societies.