Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection. As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously. Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach

Difficulties of Bariatric Surgery after Abdominoplasty

During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting fibrotic tissue and choosing new landmarks. We conclude that after abdominoplasty bariatric surgery can be performed safely either using conventional laparoscopic technique or robotically

Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a non-randomized controlled trial

BACKGROUND: Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure. METHODS: Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months. RESULTS: Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p < 0.05) and from 101 ± 23 mmHg to 83 ± 24 mmHg in the botulinum toxin group (p < 0.05). The mean maximal squeeze pressures were reduced from 70 ± 27 mmHg to 61 ± 32 mmHg (p > 0.05) in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p < 0.01) in the botulinum toxin group. The fissures were healed in 70 percent of patients in the botulinum group and 82 percent in the surgery group (p > 0.05). There were no relapses during the 14 months of follow up. CONCLUSION: Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure

Amyand Herniye Eşlik Eden Komplike Akut Apandisit Vakası

Amyand's hernia is a very rare form of hernia in the inguinal hernia sac. Presently described is a case of Amyand's hernia complicated by acute appendicitis. A 62-year-old male patient presented at the emergency department with complaints of pain in the right inguinal region. He had acute appendicitis in the right inguinal hernia. An appendectomy was performed. Due to the high risk of infection, a mesh application was avoided. The patient was discharged on the rst postoperative day. The incidence of Amyand's hernia accompanied by acute appendicitis is quite low. The current literature generally does not recommended an Amyand's hernia mesh repair with a la- paroscopic appendectomy in the presence of acute appendicitis. In this case, the appendectomy was completed laparoscopically and the hernia sac was repaired intraperitoneally with primary suturing

Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection.As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously.Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach

Pancreatitis due to the total displacement of intragastric balloon to duodenum

Intragastric balloon (IGB) application in obesity treatment is an easily applied non-surgical method which has an effective weight loss potential. However, with increasing use in recent years, life-threatening complications have been reported in the literature. In addition to gastric perforation and intestinal obstruction due to serious complications, it has recently started to take its place in the literature. Thirteen cases of pancreatatitis due to IGB administration have been reported so far.In this study, a patient with morbid obese patient, acute abdominal pain and vomiting, who had intragastric balloon application five months ago, was evaluated.Biochemical and radiological work-up revealed total migration of the balloon to duodenum and acute pancreatitis due to compression effect

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

Intraperitoneal Ventralex Patch Applications in Ventral Hernia Repairs

Ventral hernias are among the common conditions in surgical practice and umbilical hernias are the most frequently encountered ones of them. The development of recurrence at the rates varying from 10% to 54% after the repair of ventral hernias with primary suture techniques (herniorrhaphy) have made patch repairs (hernioplasty) popular. In our clinic, a total of 71 patients were operated by using the Ventralex patch, one side of which was ePTFE and the other side was polypropylene and which could be administered intraperitoneally, between January 2015 and June 2017. Hernias larger than 3 cm were not included in the study. Small ventral hernias were repaired with open surgical method by intraperitoneal tension-free method. Of the patients, 40 were male and 31 were female, and the mean age was 47.5 (range 28-74) years. According to the ventral hernia typing, there were 46 cases with umbilical hernia (65%), 18 cases with paraumbilical hernia (26%), and 7 cases with trocar site hernia. All cases were operated under general anesthesia. Duration of operation, analgesic requirement, duration of hospitalization, postoperative complications, and recurrences were recorded. The mean duration of surgery was detected to be 35 min (range 22-60). All patients were applied analgesia on the first day after surgery and discharged one day after the operation. They were asked to come for the first control examination after 1 week and for the second control examination after 4 weeks. Minimal wound site infection was observed in two cases (2.8%). No recurrence developed in any case. In our study, we concluded that the Ventralex patch used in small ventral hernia cases that were operated with open technique is a prosthetic material that can safely be used owing to its advantages including low complication rate, ease of application and shorter hospitalization