Surgical treatment of inguinal hernia: Our experience

Aim: In present retrospective analysis, we aimed to evaluate the treatment results of subjects with inguinal hernia whom underwent surgical repair. Methods: Surgical treatment of inguinal hernia for last 7 years have been retrospectively analyzed. Surgical procedures include anterior mesh, posterior mesh, Mc Vay, non-mesh repair, plug mesh. Results: A total of 2320 patients underwent hernia surgery were included to the study. While, 2224 of the cases were elective procedures while 96 were operated in emergency conditions. Incarceration 78 of emergent cases were incarcerated and 18 were strangulated. Patients requiring emergency surgery were significantly older than the patients underwent elective hernia repair. Duration of hospital stay was significantly longer in emergent cases compared to elective cases. Need for intestinal resection was more common in emergent cases compared to elective surgery cases. Mc Vay and plug mesh procedures were more commonly used in emergent cases compared to elective surgery cases. Intestinal laceration and development of recurrences were more common in emergent surgery cases compared to elective surgery. Conclusion: Inguinal hernia patients should be scheduled for elective surgery without delay since need for emergent surgery may increase by time and emergent cases are associated with more complications and surgical morbidity

Clinical Study Laparoscopic Treatment of Adrenal Tumors: A Single-Center Experience with 58 Patients

Background. The aim of this study is to discuss the laparoscopic approach and assess the immunohistochemical expression profiles of synaptophysin, Ki-67, and inhibin and patient outcomes in adrenal masses through a series of cases treated at our institution. Method. The study was conducted on 58 patients who were diagnosed with adrenal masses. All cases were operated on laparoscopically for adrenal masses. Results. Both inhibin and synaptophysin were found positive in 45 patients (77,6%). Ki-67 was negative in 11 patients, whereas it was found positive in 42 with a rate of 1%. The size of the masses ranged from 1 up to 9 cm (mean 4,3 ± 1,5). Urine hormone excretion was measured within normal ranges in 47 out of 58 patients (81%). Most of the diagnosed patients were harboring Cortical Adenoma ( : 38; 65,5%). All of the masses were successfully resected without complication except 3 patients. Because of complications of bleeding, the operation was converted to open surgery for 2 patients. Conclusion. Morbidity, mortality, and healing were comparable, regardless of tumor size, yet involvement in both laparoscopic and adrenal surgery was required. Our results suggested that laparoscopic adrenalectomy should replace open surgery as the standard treatment for most adrenal masses

Preoperative MELD-Na Score Predicts 30-day Post-operative Complications After Colorectal Resection for Malignancy

Introduction:Predicting possible complications in colon surgery is important in terms of reducing postoperative mortality and morbidity rates. Various scoring methods have been used to predict these complications. The MELD score was developed to predict mortality following Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement in cirrhotic patients. This model was revised by adding Na data and used to predict complications in non-cirrhotic patients. We investigated the value of the MELD-Na score in predicting postoperative 30-day complications in patients undergoing colorectal resection for malignancy.Methods:Patients who underwent colorectal resection for malignant diseases were included in the study. Demographics and clinical outcomes were recorded. The MELD-Na scores of the patients were calculated within 48 h before the surgery. Patients were divided into 2 groups according to the status of development of any complication.Results:Age, gender, operative time, and length of stay was not statistically significant for developing complications. The MELD-Na score was significantly higher in patients with any complications. Also, MELD-NA score, stoma creation, and postoperative erythrocyte suspension replacement were found to be independent risk factors for developing complications in patients undergoing surgery for colon cancer.Conclusion:The MELD-Na score may predict the complications that may develop in the first 30 days postoperatively in patients undergoing colorectal resection for malignant diseases

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Prevalance of Male Breast Cancer and our Clinical Experiences

Aim: Male breast carcinomas are very rare tumors. In this study, we aimed to evaluate the male patients who were diagnosed with breast carcinoma and admitted to our outpatient clinic. Methods: Among 268 patients diagnosed with breast carcinoma in the General Surgery Department at Haseki Training and Research Hospital between January 2009 and December 2012, a total of six male patients, who were operated on for breast cancer, were retrospectively reviewed. Results: The mean age of the subjects was 61 years (range: 50- 73). The most clinical presentation was a palpable breast mass. The mean diameter of the lesions was 2.58 cm (range: 2.0-3.5 cm). All patients underwent modified radical mastectomy. The postoperative histopathology confirmed the diagnosis of invasive ductal carcinoma consistent with the results of preoperative core biopsies. Preoperative imaging studies and postoperative pathological analyses indicated axillary lymph node positivity. Postoperative adjuvant therapies were performed. Conclusion: The prognosis of breast cancer is similar in male and female patients when detected in similar stages. Although breast cancer is very rare in men, it is detected in advanced stage because of late diagnosis. (The Medical Bulletin of Haseki 2013; 51: 99-101

Laparoscopic resection for gastric neuroendocrine and stromal tumors: a single-center prospective study

In stomach, the majority of the endocrine system neoplasm is situated in the corpus or the fundus, constituting a collection of non-functioning, enterochromaffin similar cell, and proper differentiated carcinoid. The golden standard in gastric GIST and NET is always operational removal whenever possible. In this study, we aimed to exhibit our outcomes by experience on laparoscopic resection of GIST and NETs, each one in the stomach. The current study was prospectively designed in our hospital to assess the likelihood and the safeness of the laparoscopy for individuals with GISTs and NETs, between January 2012 and 2014. Partial gastric resection was applied to eleven individuals (6 males /5 females) who were clinically determined as stomach-located GIST and NETs. The mean value of the tumor diameter was 4.2±1,36 cm (range: 2.5-6.8, median:4.3 cm). Tumor locations were around the fundus (n:2;%18.1), the antrum (n:3;%27.3), and the corpus (n:6; %54.5). The mitotic counts of the tumors were found to be 10/50 HPF in 2 patients. All 7 GISTs were c-KIT (CD117), DOG1 or CD34 positive (n:7). All 4 NETs were both Synaptophysin and Chromogranin positive. The main presenting symptom was abdominal pain (n:6, %54). In this article, the results supported that the laparoscopic way on the treatment of gastric GISTs and NETs is a secure and profitable selection for individuals if treated properly. [Med-Science 2017; 6(1.000): 104-8

Preperitoneal Mesh Placement with Anterior Approach in Incarcerated Femoral Hernia (Our Experiences with 23 Cases)

Aim: To investigate the effectiveness of preperitoneal mesh placement with anterior approach in incarcerated femoral hernia and to reveal morbidity and recurrence rates. Methods: Twenty-three patients with incarcerated inguinal hernia, who were admitted to our emergency surgery clinic between the years 2009 and 2012 and found to have incarcerated femoral hernia during exploration, were included in the study. All patients underwent inguinal transverse incision suitable for anterior approach. By cutting transversalis fascia, polypropylene mesh was placed preperitoneally between Cooper‘s ligament and the conjoint tendon. Results: The mean age was 54.2 (39-85) years; 16 (69%) subjects were men, 7 (31%) were women. Five patients had no complaints related to hernia before being admitted to the hospital. Six (26%) patients underwent bowel resection and anastomosis. Small intestines or omentum incarcerated in the hernia sac were reduced into the abdomen in 17 (74%) patients. There was no complication during surgical interventions. Average length of hospital stay in patients with resection and anastomosis were 5.3 days, and 2.1 days in patients with no resection. In follow-up, 3 (13%) patients had hematoma-seroma and 2 (8%) patients had wound infection. In 2-4 years follow-up, no recurrence was detected. Chronic pain related to nerve damage was not observed. Conclusion: Preperitoneal mesh placement with anterior approach in incarcerated femoral hernia as an emergency is safe in terms of complications and recurrence either with or without intestinal resection. (The Medical Bulletin of Haseki 2015; 53: 196-8

Evaluation of pleural effusions developed after abdominal operations

Respiratory problems may develop after abdominal operations. It is more common especially in upper abdominal surgeries than in lower abdominal surgeries. In this study, patients with pleural effusion developed after abdominal operations were evaluated retrospectively in terms of etiology and drainage indications. A total of 56 patients who underwent abdominal surgery between March 2012 and November 2018 with pleural effusion were included in the study. Age, sex, smoking history, concomitant diseases, operative diagnoses, and operations performed and treatment results of the patients were recorded. 19 (33.9%) of the cases were female, 37 (66.1%) were male, and the mean age was 52.5±12.16 (24-82). In the postoperative period; pleural effusion developed in 12 (21.4%) bilaterally, in 15 (26.8%) on the right side, and in 29 (51.8%) on the left side. 18 (32.1%) of the cases underwent liver cyst and tumor surgery; 15 (26.8%), splenic surgery; 17 (30.3%), gastric tumor surgery; 2 (3.6%), calculous pouch-cholecystitis surgery; and 4 (7.1%), colon-rectum surgery. Fluid transfer to the intrathoracic area may occur due to the high intra-abdominal pressure as a result of the disruption in the integrity of the diaphragmatic peritoneal face after abdominal surgery. Additionally, hypoalbuminemia in the postoperative period has a role in the development of pleural effusion. Pleural fluid drainage may be required to prevent possible morbidities and mortalities in such cases. [Med-Science 2022; 11(2.000): 537-9