A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience

PURPOSEWe aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts.METHODSPercutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates.RESULTSOut of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374).CONCLUSIONThis novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations

Comparison of Results of Dual Mesh Hernioplasty and Omental Interposition Polypropylene Mesh Hernioplasty in Incisional Hernias

Recently, with the improvement of dual meshes, that has no harm when in touch with the intraabdominal organs, intraperitoneal mesh hernioplasty techniques became more popular. Intraperitoneal repair can also be done by polypropylene mesh with interpositioning of the omentum. This study aims to compare the results of omental interposition mesh hernioplasty and intraperitoneal mesh hernioplasty. The study was conducted as a prospective observational study. In between January 2008 and January 2012, patients with incisional hernia were divided into two groups according to the suitability of the greater omentum as omental interposition mesh hernioplasty and intraperitoneal dual mesh hernioplasty. The median follow-up periods of all 49 patients were 17 (4–48) months. Operation time was significantly longer in the omental interposition mesh hernioplasty group (p < 0.05). Length of hospital stay, drain take off time, and the complication rates were similar in between the groups. The recurrence rates were also similar; however, in omental interposition mesh hernioplasty group, the cost was significantly lower (p < 0.05). Although omental interposition mesh hernioplasty technique takes more time, in cases that great omentum is suitable; this technique can be used safely with lower cost

Our experiences in RF - Assisted resections in liver tumors and hydatid cysts Karaciḡer tümörleri ve kist hidatiklerinde rezektif amaçli radyofrekans enerji uygulamalarimiz

Purpose: In this preliminary study, we applied Radiofrequency(RF) energy in six patients with liver diseases for parenchymal transection to minimize bleeding or to do bloodless hepatectomy. Materials and Methods: Of six patients, four had liver tumors (3 heamangyomas, one hepatocellular carcinoma) and two hepatic hydatic cysts. Surgical procedures were RF assisted hepatectomy, enucleation, cystectomy and pericystectomy. Results: There was no need for blood transfusion except one case. Liver enzymes was normal after one week postoperatively except in two cases. Conclusion: We think that RF will be technique of choice for bloodless hepatectomy in coming years

Memenin inflamatuvar psödotümörü: Nadir bir olgu

Memenin inflamatuar psödotümörü (MIP) çok nadir bir durumdur. Lite- ratürde sınırlı sayıda olgu bildirilmiştir. Patogenezi tartışmalı bir konudur. Memenin inflamatuvar psödotümörü ön tanısıyla rezeksiyon yapılan 65 yaşında bir kadın hasta irdelendi. Sağ memesinde ağrısız kitle yakınması ile kliniğimize başvurdu. Görüntüleme eşliğinde tru-cut biyopsi yapıldı. Tru- cut biyopsi sonrası patolojik bulgular inflamatuvar psödotümörle uyumluy- du. Lokal eksizyon işelemi uygulandı. Yirmi dört aylık takiplerinde nüks saptanmadı.Inflammatory pseudotumor of the breast (IPB) is a very rare condition. Literature reports a limited number of cases. Its pathogenesis is also a con- troversial issue. Within the scope of our study, a 65-year-old female patient, who had resection because of inflammatory pseudotumor of the breast, was evaluated. The patient presented to our clinic with complaints of a painless mass in her right breast. Imaging guided tru-cut biopsy was performed. The pathological findings following the tru-cut biopsy were consistent with inflammatory pseudotumor. Local excision was performed. There was no recurrence during the 24-month follow-ups

Radyofrekans Termal Ablasyon Yönteminin Karaciğer Hidatik Kistlerinin Tedavisinde Kullanımı: Ex vivo Koyun Çalışması

Objective: Hydatid disease is a disease caused by parasites belonging to the echinococcus family. This disease is often caused byEchinococcus granulosus and rarely by echinococcus alveolaris.The parasite may cause illness anywhere in the human body, mainlyin liver. In this study, we aimed to destroy the hydatid cyst viability by Radiofrequency Thermal Ablation (RFTA) method whichhas been used in many areas in medicine.Methods: We used fresh sheep liver with hydatid cysts. Average diameter of cysts was 3.3 cm. The study was performed in 3groups, each of which involved 20 cysts. After more than half of the cyst fluid was drained, ablation was performed. When thecore temperature of the cyst exceeded 95C, ablation procedure was continued for 3 minute in 1st group and for 4 minutes in 2ndgroup. Third group was the control group. And then, cyst fluid and germinative membrane were collected for microbiologic andpathologic assessment.Results: In 1st group, the cysts could not be destroyed at the desired level. In 2nd group, it was observed that 100% of theprotoscolex died and 100% of the germinative membranes was degenerated. In control group, %13 of protoscolex died and %10of germinative membranes wasdegenerated.Conclusion: We destroyed all the protoscolex and germinative membranes by using RFTA in 2nd group.Amaç: Hidatik kist hastalığı, echinococcus ailesine mensup parazitlerin etken olduğu bir hastalıktır. Ülkemizde hastalığın etkenisıklıkla Echinococcus granulosus, nadiren de echinococcus alveolaris’tir. İnsanda başlıca karaciğer olmak üzere birçok yerde hastalıkoluşturabilir. Bu çalışmada, birçok alanda kullanılan Radyofrekans Termal Ablasyon (RFTA) yöntemiyle hidatik kistin canlılığınıyok etmeyi amaçladık.Yöntemler: Çalışmada yeni kesilmiş hidatik kistli taze koyun karaciğerleri kullanıldı. Kistlerin ortalama çapı 3,3 cm idi. Herbirinde 20 kist olan 3 grupta çalışma yapıldı. Kist içeriğinin yarısından fazlası boşaltılarak radyofrekans ablasyon iğnesi yerleştirilipişlemler uygulandı. Kist içi sıcaklığı 95ºC’nin üzerine çıktıktan sonra 1. gruba 3 dakika, 2. gruba 4 dakika daha ablasyon işlemiuygulandı. Üçüncü grup kontrol grubuydu. Kist sıvısı mikrobiyoloji, germinatif membran da patoloji değerlendirmesine gönderildi.Bulgular: Birinci grupta kist canlılığını yok etmek için amaçlanan etki sağlanamadı. İkinci grupta %100 protoskoleks ölümüve %100 germinatif membran dejenerasyonu tespit edildi. Kontrol grubunda % 13 ölü protoskoleks oranı ve %10 germinatifmembran hasarı izlendi.Sonuç: Grup 2’de uyguladığımız RFTA yöntemi ile prtoskoleksler tamamen öldürülmüş ve tam bir germinatif membrandejenerasyonu sağlanmıştır

Use of chorioamniotic membrane instead of bogota bag in open abdomen: How I Do It?

It is one of the most important problems for general surgeons to decide which operation should be undertaken on patients with intra-abdominal infection, especially those with concomitant abdominal hypertension. Recentlly, closure techniques using prosthetic meshes in order to retain abdominal tension and to control sepsis have become very popular for patients with abdominal sepsis and hypertension. We used chorioamniotic membrane instead of plastic material to cover the open abdomen. We conclude that human chorioamniotic membrane prepared under sterile conditions may be an alternative to conventional plastic bags in daily practice, for preventing serosal erosion and fistulas in patients undergoing open abdominal surgery