The value of preoperative diagnostic tests in acute appendicitis, retrospective analysis of 196 patients

<p>Abstract</p> <p>Background</p> <p>In this study our aim was to evaluate the diagnostic value of preoperative laboratory and radiological studies for appendicitis.</p> <p>Methods</p> <p>The clinical data of 196 patients who have undergone conventional appendectomy between March 2007 and April 2008 were collected retrospectively. Patients were examined for age, sex, white blood cell count, ultrasonography results, histopathological diagnosis and hospital stay.</p> <p>Results</p> <p>Negative appendectomy rate was 17.3% (27% for female, 11.5% for male). White blood cell counts were found to be high in 83% for acute appendicitis group and %61 for negative appendectomy group. There were 66 (34%) patients who had negative USG findings for acute appendicitis. Of these patients, histopathological examination revealed acute appendicitis in 46 patients whereas 20 patients had normal appendix. Hospital stays were 2.79 +/- 1.9 and 2.66 +/- 1.7 days for negative and positive appendicectomies respectively.</p> <p>Conclusions</p> <p>Besides the improvement of diagnostic tests for acute appendicitis, we could not sufficiently reduce the negative appendectomy rate.</p

Subkostal Kesi Fıtığı Onarımında Yama Sabitlemede Sütür Kullanımı: Olgu Sunumu

Kesi fıtıklarında laparoskopi sıklıkla kullanılmaktadır. Zımba atıcılar sayesinde yama sabitleme oldukça kolaylaşmıştır fakat bu aletlerin subkostal bölgede etkinliği azalmaktadır. Transfasyal dikişler, zımba atıcılar için açısı zor ve riskli bölgelerde alternatif olarak kullanılabilirler

Postoperatif paralitik ileus tedavisinde parasempatomimetik sakız kullanımı etkindir

GİRİŞ-AMAÇ: Postoperatif paralitik ileus hastanede yatış süresini uzatır, enteral beslenmeyi geciktirir ve hastane maliyetlerini arttırır. Pratikte pek çok yalancı beslenme yöntemi tedavide kullanılmaktadır. Nikotin güçlü bir parasempatomimetik olup, paralitik ileus tedavisinde denenmemiştir. Çalışmamızın amacı nikotin sakızı da dahil olmak üzere değişik yalancı beslenme metodlarının rektum kanseri cerrahisi sonrası gelişen paralitik ileusa etkilerini ortaya koymaktı. GEREÇ-YÖNTEM: Etik kurul onamını takiben aşağı anterior rezeksiyon ve saptırıcı ileostomi ameliyatı planlanan 68 rektum kanseri hastası çalışmaya dahil edildi. Hastalar 4 gruba randomize edildi; kontrol (n:16), dondurma (n:18), sakız (n:17) ve nikotin sakızı (n:17). Kontrol grubu hastalarına ileostomi deşarjı olana kadar sadece intravenöz tedavi verilirken, dondurma grubunda hastalara ameliyat sonrası 6. saatten itibaren her 8 saatte bir 100 ml sade dondurma (Atatürk Orman Çiftliği, Sade Dondurma, 100ml, Ankara, Türkiye) verildi. Sakız grubu hastalarının yine ameliyat sonrası 6. saatte başlanarak her 8 saatte bir 30 dakika süreyle şekersiz sakız (Falım Sakız, Falım Sakız Sanayi ve Ticaret, İstanbul, Türkiye) çiğnemelerine izin verilirken, nikotin sakız grubunda aynı süre ve aralıkta, hastalara 2 mg nikotin içeren sakız (Nicotinell Sakız, 2 mg; Novartis Consumer Health S.A. Nyon, İsviçre) çiğnettirildi. Hastaların demografik özellikleri, sigara içme alışkanlıkları, kabızlık skorları (Wexner Konstipasyon Skoru), peroperatif kanama ve sıvı infüzyon miktarları, dren kullanımı, hissedilen ilk bağırsak hareket zamanı, ileostomi çalışma zamanı ve acıkma hissi zamanları kaydedildi ve karşılaştırıldı. İstatistiki analizde NCSS (Number Cruncher Statistical System) 2007&amp;PASS (Power Analysis and Sample Size) 2008 Statistical Software (Utah, USA) programı kullanıldı. BULGULAR: Hastaların demografik özellikleri, konstipasyon skorları, neoadjuvan tedavi dağılımları, geçirilmiş batın cerrahisi durumları, cerrahi tipleri, ameliyat süreleri, peroperatif kanama ve verilen intavenöz sıvı miktarları, dren kullanım durumları benzerdi (p&gt;0,05). En yüksek konstipasyon skoru nikotin grubunda hesaplandı (p=0,069). İlk bağırsak hareketi hissi nikotin grubunda kontrol ve sakız grubuna göre kısaydı (p=0,004 ve p=0,046). İleostomi çalışma ve açlık hissi zamanı en kısa nikotin grubunda bulundu. İkili karşılaştırmalarda ileostomi çalışma zamanı nikotin grubunda kontrol grubuna göre anlamlı kısaydı (p=0,011). Sakız grubuyla kıyaslandığında yine nikotin grubunda açlık hissi zamanı daha kısa bulundu (p=0,036). SONUÇ: Rektum kanser cerrahisi sonrası postoperatif ileus tedavisinde nikotinli sakız çiğneme etkili bir yöntemdir

Fallopian tube herniation from trocar-site after laparoscopic appendectomy

Trocar site hernias are a type of incisional hernias and may occur within a variable time shift after surgery. A mean incidence of 1.85% was reported, and the first trocar site hernia was narrated by Maio et al. in 1991 describing small bowel obstruction due to trocar site herniation after laparoscopic cholecystectomy. The 10-mm-trocar port is more frequently problematic, and a trocar site hernia in 5 mm port is very rare. This report unveils a 5mm trocar site herniation of right fallopian tube following laparoscopic appendectomy. In this case study, a 19-year-old female patient applied to the emergency department because of a discharge in the right lower quadrant was reported. She explained that she had undergone laparoscopic appendectomy two days before and discharged the next day uneventfully. The surgical report described a suction drain in the right lower quadrant where the patient was suffering from the discharge. The physical examination revealed no tenderness, but an abdominal CT disclosed an edematous tubular structure herniating from the 5 mm trocar site where the drain was put. She was re-operated laparoscopically due to early trocar site hernia, and the right fallopian tube was observed herniating through the defect. After the reduction into the abdomen, the fallopian tube was observed fine, and the defect was closed using 2/0 polypropylene suture. Trocar site hernias are rare but may cause serious complications after laparoscopic surgery. They may occur early after the surgery, but the time shift is variable. Although mechanical bowel obstructions are more frequent endpoint, it should be remembered that any organ within the abdominal cavity may herniate

Comparison of sexual, sensory, urinary function and life quality between laparoscopic total extraperitoneal repair and Lichtenstein procedure in inguinal hernia

Introduction: The advantage of laparoscopic inguinal hernia surgery over open surgery is evidenced by the return to early work, less pain and good cosmetic results in many high patient studies. The aim of this study is to reveal the differences between the two methods in terms of sexual, sensory, quality of life and urinary results. Methods: Between July 2017 and January 2018, sexually active 42 male patients were randomized by laparoscopic total preperitoneal method (TEP) and Lichtenstein method (LCH) to perform inguinal hernia repair. Patients were evaluated preoperatively, at 1 month and 6 months postoperatively by the International Index of Sexual Function (IIEF), International Prostate Symptom Score, SF-36 Quality of Life, Visual Analogue Scale, Beck Depression Scale, Inguinal Region Two Point Discrimination Test (DT), DN4 Neuropathic Pain Questionnaire and FSH, LH and Total Testosterone levels. Results: The mean age was 49.86 ± 11 and the body mass index was 25.51 ± 2.84. Patients were randomized into two groups as LCH 20(47.6%) and TEP 22 (52.4%). There were no statistically significant differences between the two groups in terms of FEVS, IPSS and VAS. When BECK depression scale was evaluated, there was no statistically significant difference between preoperative and postoperative 1 month (p = 0.049; p \0.05). However, BECK levels in the LCH group were statistically significantly higher when compared with TEP group. In the first month and 6th month DT, the measurements in the LCH group were statistically significantly higher than the TEP group (p: 0.028, p \0.05, p: 0.017, p \0.05, respectively). The DN4 values of the LCH group were significantly higher than the TEP group (p: 0.000, p\ 0.05, p: 0.000, p \0.05, respectively). There was no difference between the groups in the uroflowmetry analysis but the decrease in void volume in the TEP group was statistically significant (p: 0.01) Conclusion: In terms of sexual function, urinary function and pain, TEP was not superior to LCH. The LCH method has been found to be disadvantageous in neuropathic pain and discriminant analysis. In terms of quality of life, the results of the TEP method are more pleasant

Trocar-Site Hernia After Diagnostic Laparoscopy

Trocar-site hernias occur due to various reasons and may cause life-threatening complications. Early diagnosis and treatment reduces morbidity and mortality rates. In this paper, we present a 43-year-old patient who presented to our emergency department with the complaints of nausea, vomiting, distention and inability to defecate occurred after a diagnostic laparoscopy for an abdominal stab wound. A computed tomography revealed a trocar-site hernia involving a small bowel segment. Trocar site was evaluated under general anesthesia and, after reduction of the bowel, the defect was closed primarily. On the first postoperative day, he was discharged uneventfully. Immediate mechanical bowel obstruction after laparoscopic surgery should be kept in mind to deal with these complications