Contrubition of Laparoscopic Level Determination on Hirschsprung Disease Diagnosis and Management

Aim:Laparoscopic-assisted transanal pull-through (LATP) is a procedure that has gained increasing popularity in the management of Hirschsprung’s disease. The purpose of this study was to compare outcomes of patients treated with LATP and transanal pull-through (TPT).Methods:Records of 45 patients with Hirschsprung’s disease who underwent surgery between 2006 and 2017 were retrospectively evaluated.Results:LATP was performed in 16 patients [13 male (81%), three female (19%)]. The median age of the patients was four months (7 days-84 months). Twenty nine patients [21 male (72.4%), eight female (27.6%)] underwent TPT. The median age of the patients was 11 months (10 days-90 months). The mean time to start feeding in LATP and TPT groups was two days (one-three days) and 2.6 days, respectively (p=0.074). The mean operative time was 2.6 hours in the LATP group (two-four hours) and 2.7 hours in the TPT group (p=0.971). The mean length of hospital stay in for LATP and TPT groups was 4.8 days (two-nine days) and six days (3-14 days), respectively (p=0.305).Conclusion:The advantages of LATP include multiple sample collection from several segments of the colonn at the same time as well as shorter time to frozen section diagnosis. In addition, the possibility of intraabdominal dissection allows transanal surgery to be faster and more effective

Surgical Approach to the Management of Cardiovascular Echinococcosis

Objective: Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important. Methods: We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years. Results: The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence. Conclusions: Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk.OBJECTIVE:Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important.METHODS:We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years.RESULTS:The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence.CONCLUSIONS:Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk

Surgical approach to the management of Brucella endocarditis

Objective: Brucella endocarditis is a rare complication of Brucella infection; however, it is the major cause of deaths in those infected with this disease. In this study, we aim to discuss the results of seven cases who underwent surgery for Brucella endocarditis in our clinic using the knowledge gathered through the literature. Methods: We reviewed seven patients with Brucella endocarditis, who underwent surgery in our department between October 1990 and April 2007. Brucella endocarditis was diagnosed by physical examination, laboratory findings, serological tests, blood culture, transthoracic and trans-oesophageal echocardiography. All cases underwent surgery after 4-6 weeks of medical therapy. Antimicrobial treatment was maintained for an average of 6 months after surgery. The mean follow-up was 27.4 months. Results: The mean age was 30 years (range, 5-47 years). Four of the patients were male. Of the cases, aortic valve replacement (AVR) was performed in three, mitral valve replacement (MVR) was performed in three and combined aortic and mitral valve replacement (AVR + MVR) was performed in one patient. Pericardial tube drainage was done in one patient because of pericardial effusion and cardiac tamponade that developed 13 days after surgery. One (14.3%) of our patients died 15 days after surgery. The others were discharged. Conclusions: We concluded that medical and surgical treatment had to be performed simultaneously for the successful management of Brucella endocarditis, a fatal complication of Brucella infection. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved