The effect of suture materials with different absorption times on isthmocele: a retrospective study

Objectives: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches. Material and methods: This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl® in 49 patients and Vicryl® in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate. Results: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002). Conclusions: The formation of niches and associated PMS rates were less with suture materials that were absorbed faster

Acute appendicitis during pregnancy: case series of 20 pregnant women

BACKGROUND: Acute appendicitis (AA) is the most common cause of acute abdomen during pregnancy. Most of the signs of appendicitis are also found during normal pregnancy period, however, and diagnosis of appendicitis during pregnancy remains challenging. The aim of the current study was to report our clinical experience of AA during pregnancy and investigate optimal management of this difficult situation. METHODS: Records of 20 pregnant women with diagnosis of AA who underwent appendectomy between 2005 and 2015 were included in this study. Data were collected retrospectively. Patients were evaluated according to age, signs and symptoms, gestational age, physical findings, serum white blood cell count, ultrasound (US) findings, pathology reports, surgical technique, operation time, and complications. RESULTS: Of 20 patients, 16 (80%) underwent open appendectomy and 4 (20%) underwent laparoscopic appendectomy. Mean age of patients was 29.6 +/- 5.6 years. Most common symptom was abdominal pain (95%). Six (30%) patients were in first trimester, 9 (45%) patients were in second trimester and 5 (25%) patients in were in third trimester. US findings consistent with AA were found in 12 (60%) patients. Negative appendectomy rate was 30%. Maternal complication was seen in only 1 (5%) patient. No fetal complication was observed. CONCLUSION: Accurate diagnosis and prompt surgical treatment of AA in pregnant women should be performed due to high rates of maternal and fetal complications

Turkish coffee effect on postcaesarean section bowel motility

To investigate the effect of coffee consumption on bowel motility on postcaesarean patients. This study is designed as a prospective randomized trial. Patients who are operated between dates June 2017-July 2017 are assessed for eligibility. We included patients who are operated under elective conditions. Leading exclusion criterias were; emergency caesarean section , patients diagnosed with inflammatory bowel disease, chronic constipation, irritable bowel syndrome and who had previous bowel or endometriosis surgery. Simple randomization scheme is used. Patients allocated to intervention group drank 65 cc Turkish coffee at postoperative 4 th and 12 th hour; control group patients drank warm water starting from postoperative 4th hour. Time to first flatus, presence of stool passage and nausea, vomiting are questioned and recorded. Sixty five patients' data was available for final analysis. General characteristics of control and intervention group patients were similar regarding mean age, body mass index (BMI), operation time, type of anesthesia , postoperative analgesic requirement . Mean time to first flatus was 17.7±6.1 and 13.0±5.7 hours respectively for control and intervention group (p:0.004). Number of patients whose stool passage assured before discharge were 7 (22.6%) in control and 3 (8.8%) in intervention group (p:0.174). There was not any patient who had nausea and vomiting in both groups. Postoperative coffee consumption is a cheap, attainable and safe practice that can be utilized to expedite gastrointestinal motillity during postcaesarean period. [Med-Science 2022; 11(2.000): 651-5

Does high pneumoperitoneal pressure level has an impact on postoperative pain ? A prospective randomized trial

To investigate the postoperative pain intensity after laparoscopic gynecologic surgeries conducted with different pneumoperitoneal pressures. This study was designed as a single-blinded prospective randomized trial in a tertiary referral center. Patients who were scheduled to undergo laparoscopic surgery for benign gynecologic pathologies between dates August 2018 and December 2019 were included. Exclusion criterias were ; malign gynecologic diseases , lack of consent and conversion to laparotomy. Primary outcome measure was postoperative pain scores at 6th and 24th hour time point ; secondary outcome measures were shoulder tip pain and need for opioid type analgesic. The initial and intraoperative pressure for group 1 was 15 mm Hg, the initial pressure was 15 mm-Hg and intraoperative pressure was 12 mm Hg for group 2, and the initial and intraoperative pressure was 12 mm Hg for group 3. Visual analog score (VAS) surveys were performed in postoperative follow-ups for the 6th and 24th hours. The presence of shoulder tip pain and the postoperative opioid analgesic requirement was additionally evaluated. One hundred and seventy-one patients were investigated for per-protocol analysis. The mean 6th and 24th-hour VAS scores of the three study groups were 4.9;3.5; 5.0;4.1, and 5.3;4.3 respectively, for groups 1, 2, and 3 (p=0.506). The difference in shoulder tip pain rates was not statistically significant at each time point between the patient groups (p=0.829 and p=0.334, respectively). Opioid analgesic requirement was significantly higher in patients undergoing laparoscopic hysterectomy with 15 mm Hg intraabdominal pressure (p=0.004). Surgeons should take into account that high intraperitoneal pressures may cause more opioid analgesic requirement. Although pain scores and shoulder tip pain were comparable, opioid analgesic requirement is an important health issue. [Med-Science 2022; 11(2.000): 471-7