Turkish Journal of Surgery - 2009; 25(1)

T�rk Cerrahi Derne�i ve Gelecek

M. Cem TERZ� — 2009-01-01

Editorial

�skender Sayek, Feza Remzi, Ertu�rul G�ksoy, Sad�k K�l��turgay — 2009-01-01

Efficacy of clinoptilolite on hepatic parenchymal bleeding

Erhan Ay�an, Hasan Bekta�, Arslan Kaygusuz, G�lben Erdem Huq — 2009-01-01

Purpose: Hepatic bleeding following abdominal trauma and hepatic surgery is a serious problem. Aim of this research is to evaluate of clinoptilolite on hepatic parenchymal bleeding. Materials and Methods: Hepatic resection model was performed on 20 Wistar albino female rats. The efficacy of hemostasis with clinoptilolite has been evaluated through the comparison of perioperative bleeding amount and preoperative and postoperative hematocrit levels. Results: Peroperative bleeding amounts were 0.3ml (0.18-0.4) in the control group, 0.2ml (0.1-0.3) in the clinoptilolite group (p>0.05). Preoperative and postoperative hematocrit differences were 9 (4- 12.3) in control group and 8 (4.75-10.5) in clinoptilolite group (p>0.05). Conclusions: Clinoptilolite decreases peroperative and postoperative hepatic parenchymal bleeding, but is not statistically significant. Clinoptilolite is not effective on hepatic parenchymal bleeding.

Results of laparoscopic adjustable gastric band surgery for morbid obesity: First 100 cases

2009-01-01

Purpose: Our aim in this study was to present the results of our first 100 cases that have undergone laparoscopic adjustable gastric band surgery. Materials and Methods: One hundred patients underwent adjustable laparoscopic gastric band surgery between February 2006 and April 2008 and the data of patients including age, gender, operation time, complication rate, excess weight loss at 6, 12, 18 months analyzed retrospectively. Results: Eighty-three (83%) of 100 patients were female, 17 (17%) were male and mean age was 36. Ninety-eight patients were operated by laparoscopic technique and 2 patients converted to open surgery. Mean body mass index was 44 kg/m2 (37-61). Mean operation time was 46 minutes and mean hospital stay was 1.8 days. Early postoperative complications developed in 4 patients. Band slippage occurred in 5 patients and port problems occurred in 7 patients as late postoperative complications. One postoperative death occurred due to pulmonary embolism. Calculated excess weight loses were 25.8 %, 46.3 % and 66 % at 6, 12, 18 months, respectively. Conclusion: When literature and our study were evaluated, laparoscopic adjustable gastric banding can be safely performed because of its features like short operation time, low complication rate, good tolerability, short learning period and satisfactory weight loss ratio.

The effects of hyaluronic acid/carboxymethylcellulose membrane on adhesions and anastomotic healing after Hartmann colostomy closure

Ahmet Ender Demirk�ran, Hakan Erpek, Cumhur �ak�r, Didem Kozac�, Pars Tun�y�rek — 2009-01-01

The effects of hyaluronic acid/carboxymethylcellulose membrane on adhesions and anastomotic healing after Hartmann colostomy closure Background: Adhesion formation is one of the leading causes of morbidity after abdominal surgery. In this study, it is aimed to investigate effects of anti-adhesive hyaluronic acid/carboxymethylcellulose membrane on adhesions and anastomotic healing after Hartmann colostomy closure in a rat model. Materials and Methods: Thirty male Wistar-Albino rats are randomised into 3 groups: Standard colostomy (Grup A), standart colostomy + hyaluronic acid/carboxymethylcellulose (Grup B), and control group (Grup C). Adhesions were evaluated by means of a scoring system. Bursting pressure values, and hydroxyproline levels were detected. Results: Adhesion score of group A (1.7�0.6) was statistically higher compared to group B (1.1�0.3), and to control group C (1.2�0.4) (p<0.05). There was no statistical difference between bursting pressure values, and hydroxyproline levels. Conclusions: Although hyaluronic acid/carboxymethylcellulose membrane decreased adhesion formation, there was no obvious effect on anastomotic strength and healing. On the other hand, further clinical studies are needed to draw major conclusions.

Hydatid disease of the spleen: Evaluation of 5 cases

2009-01-01

Purpose: The aim of this study was to analyse the clinical and radiological findings of five patients treated with the diagnosis of hydatid disease of the spleen and discuss their treatment in the view of current literature. The most commonly affected organs are the liver (70%) and the lung (15-20%). But almost every organ of the body can be affected. Among these splenic involvement varies between 0.9 and 8% and isolated splenic involvement is very uncommon. Patients and Methods: Five patients (four female and one male) with hydatid disease of spleen have been enrolled to this study. Results: The average age of the patients was 48.8 (39-60). The most frequent complaint was the pain or mild discomfort in the left upper quadrant. Splenomegaly was found at physical examination of two patients. Three patients were presented with isolated splenic involvement. One of these patients presented with the past medical history of surgery for liver involvement. The cysts of three patients were localised at the splenic hilum and the other two cysts were within paranchima. All patients were operated with splenectomy and intraoperative blood transfusion was needed for one patient. The treatment is indicated due to the risk of infection and rupture. Average operating time was 140 (65-200) minutes and average hospital stay was 11.8 (10-13) days. Conclusion: The preservation of the splenic tissue is especially important for children and should be tried if possible.

Radioguided occult lesion localization (ROLL) of the nonpalpable breast lesions

2009-01-01

Radioguided occult lesion localization (ROLL) of the nonpalpable breast lesions Purpose: The incidence of non-palpable breast lesions has been significantly increased because of widespread use of breast screening techniques and the fact that women are becoming more conscious about breast cancer. Standard method for localization of nonpalpable lesions is the wire localization.The aim of this study is to present the results of ROLL (Radioguided occult lesion localization) which is a new technique in our clinic for localization of non-palpable lesions. Patients and Methods: ROLL was performed for 260 patients (from December 2004 to August 2008) who had radiologically suspicious lesion. In the time period 24 hours before surgery all patients had an injection of 1-2 mci Tc-99m labelled Human Serum Albumin in 0.2- 0.5 cc saline directly into the lesion under ultrasound or stereotacticly. The excision was made in the operating room with the help of gama probe. All excision materials were evaluated with heamatoxylene & eosine staining and parafine cross sections. Results: In 255 patients out of 260 (98%) the non-palpable lesion was correctly localized with ROLL and excized. In 3 patients the injected contrast material was seen to disperse in the duct and in 1 patient it did not cover the lesion.There was residual microcalcification postoperatively in 1 patient. In pathologic evaluation the lesion was found to be benign in 175 patients (68.7%) and malignant in 80 patients (31.3%). Conclusion: ROLL is a safe and easily performed method for localization of non-palbable breast lesions. Because of the fact that the localization with ROLL can be performed one day before surgery, it is a better alternative than wire localization.

Needloscopy-assisted transvaginal cholecystectomy: First national N.O.T.E.S. (natural orifice transluminal endoscopic surgery) experience

R�dvan Seven, Umut Barbaros — 2009-01-01

Aim: Natural orifices of the human body are becoming popular as the new routes through which surgical procedures can be performed. Herein we would like to present the first national transvaginal cholecystectomy cases. Materials and Methods: Two symptomatic female cholelithiasis cases underwent successful transvaginal cholecystectomies. Results: Two cases have undergone successfull transvaginal cholecystectomies. No morbidity occurred. Less postoperative pain was considerable. Conclusion: Amazingly fast developing medical technologies are leading and searching for less invasive surgical procedures. Even though as academicians we are looking for an evidence based data to practice routinely new surgical interventions, we should also be pioneers to catch-up the newest modalities as tertiary experienced centers.

Surgical management of paraesophageal (Type II hiatal) hernias: Report of four cases

Zafer Teke, Fuat Atalay, Ali Eba Demirba�, G�rel Ne��ar, Orhan Hayri Elbir — 2009-01-01

Purpose: We aimed to evaluate our surgical management and outcomes of the patients with paraesophageal hernias in this study. Materials and Methods: Four patients were operated on for paraesophageal hernia in our hospital. Preoperative clinical findings, diagnostic methods, operative records, postoperative followup and results were evaluated. Results: All four patients diagnosed with paraesophageal hernia had symptoms associated with gastroesophageal reflux disease such as heartburn. Diagnostic methods included chest X-ray, barium esophagogastroduodenography, upper gastrointestinal endoscopy, computed tomography, esophageal manometry and pH monitorization. The patients were operated on by the transabdominal open procedure under the elective conditions. Diaphragmatic closure was accomplished primarily in 2 patients with a hiatal defect of 5 cm or smaller. A patch of expanded polytetrafluoroethylene (ePTFE) was used to reinforce the closure of the hiatus in 2 patients with a hiatal defect of 8 cm or larger. Mean follow-up period was 26 months (range, 8-48 months). There were no recurrences or no additional complications were noted in any patients during the followup period. Conclusion: In this study, satisfactory results for repair of paraesophageal hernia by using both primary cruroplasty alone and mesh reinforcement were achieved in the medium-term follow-up. Meticulous work-up and surgical technique are required for optimal results. The size of hiatal defect is obviously important for the selection of operative management.

Organ transplantation surgery in Turkey and in the world: The management of transplantation logistics

Ruhet Gen� — 2009-01-01

Objectives: Disorganization or incoordination among transplant centres or other health care centres may have negative effects on the transplantation activities. Especially, the effective management on the allocation and transportation of the organs to the target hospital (transplantation logistics) are extremely important. Study plan: This review paper aims to shed light on to the managerial difficulties and common problems in the transplantation logistics. Initially, the organizational issues in international and national coordination centres are reviewed and then the common problems of transplant phycisians and health care managers are focused. Difficulties encountered specifically in the allocation and transportation of organs are also discussed.