Endoscopic diagnosis and treatment of biliary obstruction due to acute cholangitis and acute pancreatitis secondary to Fasciola hepatica infection

In the differential diagnosis of biliary obstruction with unknown etiology, biliary fascioliasis should be considered in endemic and non-endemic regions. After diagnostic evaluation, endoscopic retrograde cholangiopancreatography (ERCP) was performed for etiological evaluation and/or treatment of biliary obstruction in five patients with a mean age of 55.8 years. Endoscopic sphincterotomy and cholangiogram revealed linear filling defects in the biliary system. Fasciola hepatica parasites were extracted using balloon and basket catheters in two and three patients, respectively. No morbidity or mortality was observed. F. hepatica infection should be considered as a differential diagnosis of biliary obstruction with unknown etiology in endemic and non-endemic regions. ERCP can be the standard diagnostic and/or therapeutic procedure in cases of biliary obstruction due to fascioliasis. Due to slippery and gel-like characteristics of the parasite, use of a basket catheter in semi-opened position may be required in case of unsuccessful extraction using a balloon catheter

A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technique

WOS: 000362968800009PubMed ID: 26622118Background and Objectives: Laparoscopic reconstruction of ventral hernia is a popular technique today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technique that combines laparoscopic and open approach in giant incisional hernias. Materials and Methods: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas group 2 (n = 16) labels laparoscopic technique combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. Results: There are 12 patients in group 1 and 16 patients in group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in six patients for group 1 and in only 1 patient for group 2. Group 1 had 1 patient who suffered from recurrence where group 2 had no recurrence. Discussion: Laparoscopic technique combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias

A reliable pancreaticojejunal anastomosis with V-Loc 180 wound closure device for soft pancreatic stump

WOS: 000335085400046PubMed ID: 24901167Background/Aims: Although mortality rates decreased in recent years, pancreaticoduodenectomy is still associated with high morbidity rates. Pancreatic fistula is the leading cause of morbidity after pancreaticojejunal anastomosis and commonly occurs in soft pancreas. The objective of this study is to compare outcomes of conventional modified invaginated end to side pancreaticojejunostomy with a new practical method using V-Loc (TM) 180 wound closure device in soft pancreas. Methodology: Between December 2011 and August 2013, a total of 90 pancreaticoduodenectomy procedures were performed in our hospital. 28 of them were defined as soft pancreas according to attending surgeon and included in this study. Patients were divided into two groups consecutively and analysed for postoperative pancreatic fistula (POPF) rate, length of stay, operation time, cost and particular duration of anastomosis. Pancreatic fistulas were classified according to International Study Group on Pancreatic Fistula (ISGPF) definition. Results: 1 grade A and 2 grade B fistulas appeared in V-Loc group (Group 1), whereas 1 grade A, 2 grade B and 1 grade C fistulas appeared in conventional anastomosis group (Group 2). Conclusions: Pancreaticojejunostomy with V-Loc suture is a convenient method in soft pancreas and can be performed safely

A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technic

BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technic today. Patients with large defects have various diffi culties of laparoscopic approach. In this study, we aimed to present a new reconstruction technic that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm were included in this study and separated into two groups. Group 1 (n = 12) identifi es patients operated with standard laparoscopic approach, whereas Group 2 (n = 16) labels laparoscopic technic combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There were 12 patients in Group 1 and 16 patients in Group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in 6 patients for Group 1 and in only 1 patient for Group 2. Group 1 had 1 patient who suffered from recurrence where as Group 2 had no recurrence. DISCUSSION: Laparoscopic technic combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias

Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer

WOS: 000345121000092PubMed ID: 25356183Background: The red blood cell distribution (RDW) is a test measure of erythrocyte variation and the volume level which shows the heterogeneity and it is a proven test in literature for the determination of survival on cardiovascular diseases. The main purpose of this research is to investigate the relationship between the RDW level and postoperative morbidity as well as its stages in diagnosed pancreatic cancer patients. Methods: In this study we covered 104 diagnosed pancreatic cancer patients who have been operated in 2011-2014. The RDW levels were separated into two groups. Group 1 contains higher level RDW patients (> 14) whereas group 2 contains only lower level RDW patients. We compared both groups in terms of the patients' demographic data, duration of hospitalization, ratio of pancreatic fistula, disease period, and the mortality rates. Results: In group 1 contains 39 patients whereas group 2 contains only 65 patients. We determined the positive correlation between stages of disease with RDW levels as well as the correlation between low level of blood albumin and Ca 19.9 levels (p = 0001). However we did not observe statistically important difference in postoperative morbidity. Conclusions: Based on this study we report that RDW levels can be use as a marker to show the stages of pancreatic cancer in diagnosed patients

A novel sutureless colonic anastomosis with self-gripping mesh: an experimental model

Introduction: Anastomotic leakage is one of the most feared complications of colorectal surgery. High morbidity and mortality rates are related to this complication and several studies had been performed to test new techniques which are suggested to reduce leakage rates. The aim of our study was to evaluate the safety and effectiveness of a novel technique sutureless anastomosis with self-gripping mesh in an animal model by examining wound healing process in anastomosis. Methods: In this study sixteen Norwegian Wistar Albino female rats were used. The rats' weights ranged from 250 to 300 g. The rats were divided into control and study groups. The control group underwent a colocolic anastomosis using the conventional method of hand-sewing with single-layer interrupted nonabsorbable sutures. The study group underwent a colocolic anastomosis using self-gripping mesh without sutures. These rats were sacrificed on the 10th postoperative day. The sample pieces obtained from the groups were subjected to anastomotic bursting pressure tests, to a test for hydroxyproline levels in the tissue and to histopathological examinations. The tissue was evaluated in terms of quantity of inflammatory cells, fibroblasts, neovascularization level and collagen content and classified according to the Ehrlich-Hunt model. Statistical analysis was done by using Mann-Whitney U test. Results: The burst pressure mean +/- range of control and study groups were 162 +/- 78 and 123 +/- 35, respectively (P = 0.049). The mean peritoneal adhesion grades were 3.2 +/- 0.7 in the study group and 2.3 +/- 0.7 in the control group (P = 0.036). The operative time was significantly shorter in the study group. The difference between the groups by mean of hydroxyproline levels was found to be significant (P = 0.001). According to histopathological examinations by means of the Ehrlich-Hunt model, the fibroblast activation and collagen fiber ratio were higher in the study group and the difference between these measurements was statistically significant (P = 0.006; P = 0.028). Conclusion: This study showed that use of self-gripping meshes for colocolic anastomosis in rats is a safe and feasible method. It is suggested that the most important advantage of this technique is the shorter operative time

The role of miRNAs as a predictor of multicentricity in breast cancer

Expression profiles of miRNAs are shown to be different in various cancers to regulate expression of mRNA or to have a role in inhibition of translation, thus it shows the possible effect in progression, invasion and metastasis of breast cancer cells. The effect of breast conserving treatment in local recurrence and survival rates for the patients who have multicentric breast cancer is still controversial. In our study, we intended to evaluate the foresight of 84 miRNAs which are identified in breast cancer for having differentiated expressions. Thirty-one patients with unifocal and 26 patients with multicentric breast cancer were included in this study. These tissue samples of both malignant and normal breast tissues were kept in RNA later solution at -80 degrees C. Eighty-four miRNAs were studied with miScript miRNA PCR Array Human Breast Cancer kit. Fold change, cut off value was accepted as four. In unifocal group, there were 13 upregulated and five downregulated miRNAs and in multicentric group, there were three upregulated and seven downregulated miRNAs. To reach better results for breast cancer diagnosis and treatment, it is important to enlighten tumor biology, and pay attention to target and individual therapy. Thus, miRNAs have potential role in identifying tumor characteristics in supporting diagnosis and resulting with better evaluated disease for better treatment results with individual strategies

The use of 18f-fluorodeoxyglucose positron emission tomography to assess clinical outcomes of patients wıth borderline resectable pancreatic cancer

The aim of this study is to evaluate the effect of 18FDG PET on preoperative staging and clinical management of pancreatic cancer. Between December 2011 and February 2015, 28 consecutive patients with borderline resectable pancreatic cancer were evaluated with both 18FDG PET scans and conventional preoperative imaging studies. Medical records of all patients were noted prospectively. 18FDG PET findings were compared with conventional imaging studies and over-staging or down-staging rates with changes in clinical management were evaluated. The correlation of 18FDG PET with conventional imaging studies was evaluated with a kappa agreement coefficient. A number of 22 (78.5%) patients had pancreatic head cancer and 6 (21.4%) patients had pancreatic body and tail cancers. Based on 18FDG PET, additional lesions were found in 4 (14.28%) of the patients which were lung and peritoneal lesions as metastasis. No hepatic metastasis or supraclavicular lymph node involvement was confirmed in patients. Routine use of 18FDG PET for preoperative staging has not an effect on cancer management in 96.8% of our patients. In conclusion, 18FDG PET has additional value over conventional radiologic techniques for monitoring the treatment response in locally advanced pancreatic cancer patients. It is feasible to predict early metastasis and patient outcome early (after one course of IC) during therapy