Mirizzi Syndrome Type 2: A Case Report

Mirizzi syndrome is an unusual complication of gallstone disease and occurs in approximately 1% of these pa-tients. Some cases can not be identified preoperatively; despite modern imaging techniques. Today; treatment of Mirizzi syndrome is surgical. If Mirizzi syndrome is pre-sent; the risk of bile duct injury increases; particularly during laparoscopic surgery. Therefore; preoperative or intraoperative diagnosis is important. Here; we pre-sented a 29 year-old woman with obstructive jaundice who diagnosed as cholelithiasis and choledocholithiasis. Preoperative endoscopic retrograde cholangiography re-lieved the common bile duct stone but cound not diag-nosed the Mirizzi syndrome preoperatively. During lapa-roscopy; the diagnosis of Mirizzi syndrome was sus-pected early and the procedure was converted to open cholecystectomy and T-tube to common bile duct. There was no bile duct injury and postoperative course was uneventful

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report

AbstractINTRODUCTIONTo present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS.PRESENTATION OF CASETwenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up.DISCUSSIONManagement of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period.CONCLUSIONCombination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula

Erişkinlerde laparoskopik koledok kist rezeksiyonu: Türkiye’den bir seri

Objective: Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods: Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results: Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion: We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.Giriş ve Amaç: Koledok kistleri malignite potansiyeli nedeniyle cerrahi tedavinin ön planda olduğu konjenital bir hastalıktır. Son yıllarda teknolo-jik gelişmeler ve laparoskopik tecrübede artış erişkin koledok kist cerrahisinde laparoskopinin kullanımını yaygınlaştırmaktadır. Bu çalışmada amacımız laparoskopik koledok eksizyonu yapılan sekiz erişkin hastanın sonuçlarını sunmaktır. Gereç ve Yöntem: Kliniğimizde 2013-2018 yılları arasında laparoskopik koledok kist eksizyonu ve hepatiko-jejunostomi uygulanan hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, peroperatif ve postoperatif bulguları, patolojik sonuçları ve son durumları irdelendi. Bulgular: Çalışmaya dahil edilen sekiz hastanın üçü erkek, beşi kadın idi. Yaşların median değeri 41.5 (22-49) idi. Hastaların bir tanesinde tip IVa, diğerlerinde ise tip 1 koledok kisti saptandı. Hastaların tamamına laparoskopik koledok eksizyonu, kolesistektomi ve heptiko-jejunostomi yapıldı. Bir hastada açık cerrahiye geçildi. Üç hastada postoperatif safra kaçağı oldu. Operasyon süreleri median 330 (240-480) dakika ve kan kaybı 50 (10- 100) mL olarak saptandı. Hastaların yatış süreleri median 6 (4-23) gün ve takip süreleri median 20 (2-65) ay olduğu tespit edildi. Geç dönemde; bir hastada medikal tedavi ile düzelen kolanjit atağı gözlendi, mortalite ise görülmedi. Sonuç: Kendini sınırlayan safra kaçakları dışında erken dönemde önemli sorun yaşamamamız ve geç dönemdeki tatminkar sonuçlar nedeniyle laparoskopik koledok kist eksizyonunun erişkinlerde açık cerrahiye bir alternatif olabileceğini söyleyebiliriz

Towards a classification for sacrococcygeal pilonidal disease – Berlin 2017

Introduction: Sacrococcygeal Pilonidal Disease (SPD) presents in a variety of patterns. Multiple classifications have been proposed but none are in everyday use. In order to compare treatment outcomes, a method of categorizing is required. Methods: Discussion over e-mail between several surgeons was performed over a period of 10 months. Results: Surgeons recognize that SPD presents in a variety of patterns but there is a lack of scientific evidence on which to base a categorization system or treatment. Conclusion: A simple classification system suitable for everyday use can be defined