Turkish Journal of Surgery - 2004; 20(4)

EFFICACY OF 'ALUMINIUM SULPHATE' IN PREVENTION OF HEPATIC PARENCHYMAL BLEEDING

2004-11-01

Hepatic parenchymal hemorrhage is a serious problem in major hepatic surgery and after hepatic trauma. The main purpose of emergent intervention in hepatic trauma is to stop hemorrhage. In major hepatic surgery, the mortality rate is 3-14%, and mostly because of bleeding. Although lots of material and technique have been used to stop the bleeding from hepatic parenchyma, the absolute solution of this problem is controversial. In our study, we used "Aluminium Sulphate" (AS) that is never tried before in literature, because of its argumentative effect to stop bleeding by endothelial penetration. We studied on thirty Wistar albino female rats (172±15 g in weight, 5 months of age, outbred). Bleeding model was performed on left lobe of the liver. A gauge washed with %0.9 NaCI in control group and with AS in work group is compressed to the model for three minute. Peri-operative bleeding amount is measured as milliliter. Post-operative bleeding amount is measured by comparing hematocrit values pre and post-operatively. Per-operative bleeding amounts of control and work group are 2.03+0.83 and 2.13±0.90, respectively (p>0.05). Pre and post-operative hematocrit value difference of groups are 11.20±3.91 and 9.93±4.97, respectively. In his-topathological examination, there was small necrotic areas with sharp range in control group, while large necrotic areas with unsignificiant range are seen in AS group. While, there is less difference between preoperative and posoperative hematocrit value in AS group, the amount of peroperative bleeding is less in control group, but these values are not significant statistically. So, AS is not seemed to be efficient for prevention of hepatic parenchymal bleeding.

IMPORTANCE OF DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY IN UPPER GASTROINTESTINAL BLEEDING

2004-11-01

The aim of this study was to determine the role of urgent therapeutic endoscopy (TE) in the treatment of upper gastrointestinal bleeding (UGB). Data of 351 consecutive patients was evaluated retrospectively. The patients were separated into two groups: first group included patients between 1995 and 1998 where endoscopy was primarily used for diagnostic purposes and the second group included patients whom endoscopy was employed for therapeutic purposes between 1999 and 2002. These groups were compared to each other according to the purpose of endoscopy (diagnostic vs. therapeutic), need for surgery, number of blood product transfusions, mortality rates, and duration of hospitalization. Group 1 included a total of 153 (mean age 49 years) acute UGB patients. Endoscopy was performed in 1 70 (70%) of these patients within an average time of 23 hours period after admission, and TE was performed in only 5 (3%) patients. 198 patients formed group 2 and endoscopy was employed in 190 (98%) patients within an average time of 4 hours after admission. Endoscopic injection therapy (sol. 1:10000 adrenaline) was performed in 58 (29%) patients and endoscopic band ligation was performed in 28 (14%) patients. When group 2 patients were compared to group 1 patients, significant reduction in the need for surgery (from 35% down to 7.5%; p<0.0005), the mean transfusion number (from 4.7 units down to 3.8 units; p<0.05) and mortality rates (from 25.5% down to 8%; p<0.0005) were detected. There was no significant difference in surgical mortality (41% vs. 33%) between groups (p>0.05). There was no significant difference in the mean age and duration of hospitalization between groups (p>0.05). We concluded that urgent TE significantly reduces the need for surgery, number of blood transfusions and mortality rates in patients with acute UGB.

PLANNED RELAPAROTOMIES AND OPEN ABDOMEN IN SEVERE SECONDARY PERITONITIS

2004-11-01

Severe secondary peritonitis remains a highly lethal disease in surgical practice. Planned relaparotomies and open management of the abdomen have been introduced for intra-abdominal sepsis and variable results are reported. Between 1992 and 2004 the medical records of non-trauma patients who underwent planned relaparotomies and open abdomen for secondary peritonitis at our hospital were investigated. Patients are seperated in the groups depending on the source of intra-abdominal infection from upper or lower gastrointestinal system (CIS). Sixty-four laparotomies have been performed in 30 patients. Open management of the abdomen with wet laparotomy pads were the most common used technique. The most encountered complication was intestinal fistula. In-hospital mortality was 43,3%. The mortality rate was higher in patients who were operated for indications emerging from upper CIS conditions (p=0.05). Despite such aggressive therapies, mortality and morbidity in severe secondary peritonitis is still high. Further, prospective trials with large series of homogeneous patient groups are needed to define optimal techniques for open management of abdomen.

LAPAROSCOPIC INTRAPERITONEAL PROSTHETIC MESH PLACEMENT IN VENTRAL-INCISIONAL HERNIAS

Dr. Faz�l SA�LAM, Dr. G�yasettin KESK�N, Dr. Vahit �ZMEN, Dr. Kaz�m SARI — 2004-11-01

After the first repair of ventral-incisional hernias with conventional technique, recurrence rate has changed between 25 % and 49 %. The aim of this study is to review the results of patients with laparoscopically repaired ventral-incisional hernias and compare these results with the literature findings of conventional technique. Between September 1997 and July 2001, we reviewed the results of our cases with ventral-incisional hernias treated with laparoscopically intraperitonal prosthetic mesh placement. We performed laparoscopic intraperitoneal graft placement in 33 patients with ventral-incisional hernias. Of these patients, four were male and 29 were female. We converted laparoscopic surgery to open method in 1 patient (3,1 %). The median defect size was 1 9 cm² (range from 4 to 1 00 cm² ). The median operation time and hospitalization period were 125 minutes (range 45-160) and 1.5 days (range, 0-3 days) respectively. As complications, 3 patients had seromas lasted over four weeks, 2 patients had long lasting incisional pain, 1 had port site serous discharge, 1 had posoperative ileus, 1 had urinary retention and 1 had acute respiratory dystress. In the median 30,5 months (range, 5-34 months) of follow-up, late mesh reaction occured in 1 patient and mesh was removed. Recurrent hernia was seen in 3 patients (9,4%). Laparoscopic treatment of ventral-incisional hernias has advantages such as short hospitalization, less postoperative pain and low complication rate. This method should be considered as an alternative to the conventional technique.

CLINICAL AND SURGICAL DIVERSITY OF PHEOCHROMOCYTOMA

2004-11-01

We investigated the clinical, preoperative and surgical diversity of eleven patients operated for pheochromocyto-ma, which rises from adrenal medulla or other chromaffin cells and causes significant problems, primarily hypertension. This rare disease confronts us with intriguing problems in the diagnosis and surgical intervention because of its clinical diversity. We retrospectively reviewed eleven patients with pheochromocytoma who were operated at Kocaeli School of Medicine, Department of General Surgery between 1997-2004. The ages of seven female and three male patients were between 15 and 55. Headache, tachycardia and sweating were the most prominent presenting symptoms. Nine patients had high blood pressure. There was unilateral and single lesion in nine patients. One patient had a lesion at perihilar region of the left kidney along with the left adrenal mass. Another patient has bilateral and multiple lesions. We performed unilateral adrenalectomy in nine patients, unilateral adrenalectomy and excision of hilar lesion in one patient and bilateral adrenalectomy in one patient. Postoperative periods were uneventful. High blood pressures returned to normal in all patients except one. Pheochromocytoma requires a detailed investigation because of its symptomatic and clinical diversity, meticulous exploration during surgery and a high level of collaboration between anesthetist and surgeon.