İnsizyonel Herni Onarımının Nadir Komplikasyonu: Gastroenterostomi Hattına Mesh Migrasyonuna Bağlı Gastrik Obstruksiyon

Hernia repair is one of the most common elective procedures in general surgery. Agreement has been achieved that tension-free hernia repair using prostheses reducesrecurrence rates significantly. Approximately 60% of prosthetic repairs of the inguinal flor are believed to use a flat mesh of some type, and 90% of incisional and ventral herniarepairs incorporate the use of a synthetic prosthesis. However, the use of prosthetic mesh for hernia repair can cause serious complicationssuch as infection, seroma formation, fistulae formation, adhesion, biomaterial-related intestinal obstructions, and other miscellaneous complications. Mesh migration is dangerous and rare complication after hernia repair. Hereby, reporting a rare case of intra-peritoneal migration of polypropylene mesh and its adhesion to stomach wall following onlay mesh repair of incisional hernia.Fıtık tamiri genel cerrahide en fazla yapılan ameliyatlardan birisidir. Protez kullanılarak yapılacak gerginliği azaltıcı tamirlerin etkinliği konusunda bir fikir birliği oluştu. Bugün, inguinal fıtıkların %60’ında flat mesh, insizyonel fıtıkların %90’ında prosthetic mesh kullanıldığı sanılmaktadır. Bununla birlikte, mesh kullanımı enfeksiyon, seroma, fistül, barsak fistülü, yapışıklık, barsak tıkanmaları ve diğer nadir görülen komplikasyonlara yol açabilir. Mesh migrasyonu tehlikeli ve nadir bir komplikasyondur. Burada, insizyonel herni nedeniyle onlay olarak uygulanan polipropilen meshin intraperitoneal olarak migrasyonu ve mide duvarına yapıştığı nadir bir vaka sunulmuştur

Roux-en-Y rekonstrüksiyonlu pankreatikoduodenektomi sonrası izole pankreatikojejunostomi pankreas fistülünü azaltabilir mi?

Amaç: Pankreatikoduodenektomi ampulla Vateri, pankreas başı, distal koledok tümörleri ve bazı kronik pankreatit olgularında yaygın kabul gören cerrahi prosedürdür. Rekonstrüksiyon sonrası pankreatik fistül halen ciddi bir problemdir. Rekonstrüksiyon yöntemleri hususunda üzerinde fikir birliği sağlanmış bir yöntem henüz yoktur.Gereç ve Yöntemler: Pankreas tümörü nedeniyle pankreatikoduodenektomi uygulanan hastalarda yapılan rekonstrüksiyon yöntemleri ve sonuçları retrospektif olarak araştırılmıştır. Tüm hastalardaki anastomoz Roux-en-Y şeklinde yapılmış olup birbirinden farkları ise şöyledir; Tip 1: Y bacağı ile sadece pankreatik anastomoz, Tip 2: Y bacağı ile pankreas ve hepatik kanal anastomozu birlikte yapılmıştır.Bulgular: Çalışmaya 31 hasta dahil edilmiştir. Hastaların 21'i erkek, 10'u kadındı. Çalışmamızda pankreatik fistül, kanama, abse, yara yeri enfeksiyonu ve akciğer enfeksiyonu postoperatif dönemde gözlenen komplikasyonlardı. Her ne kadar grup 2'de komplikasyonların sayısı grup 1'e kıyasla daha fazla gözlense de istatistiksel olarak anlamlı fark tespit edilmedi. Mortalite her iki grupta da birer hastada gelişti.Sonuç: Kaçağın sebeplerinden birinin aynı ans üzerine yapılan pankreas ve safra kanalı anastomozlarının birlikte debiyi yükseltmesi ve anastomoz basıncını arttırarak fistül oluşumuna neden olması olduğunu düşünüyoruz. Çalışmamızın dezavantajı ise hasta sayısının az olmasıdır. Pankreatik sıvı ile safranın ayrı anastomozlarla rekonstüksiyonu kronik pankreatik fistülleri azaltabilir.Objective: Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method. Material and Methods: The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb.Results: 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group.Conclusion: In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (

İnsülinoma Tanı Ve Tedavisinde Endoskopik Ve İntraoperatif Ultrasonografinin Birlikte Kullanımının Önemi

Introduction: Insulinoma is a usually benign tumor of pancreas. It is seen rarely and incidence of insulinoma is 1 in 250,000 patient-years. We present a rare case with insulinoma which well diagnosed and treated with aid of endoscopic and intraoperative ultrasonography. Case Report: A patient involving a 39-year-old woman with complaints of cold sweats, weakness, syncope attacks, palpitations was evaluated in polyclinic. She was hospitalized with the diagnosis of pancreatic insulinoma after abdominal computer tomography(CT), magnetic resonance imaging(MRI) endoscopic ultrasonography(EUS), and biochemical parameters. The patient was well treated with enucleation and after imaging aid of endoscopic and intraoperative ultrasound(IOUS). Discussion: In patients with insulinoma, preoperative localization of tumor is most important for diagnosis and treatment. Therefore; CT scanning, MRI, EUS and SPECT / CT are used for diagnosis of insulinoma. Together use of endoscopic and intraoperatively ultrasonography are increasing recently. Enucleation is a curative treatment approach in insulinoma. Conclusion: Together using of preoperative endoscopic and intraoperative ultrasound is quite helpful in the diagnosis and treatment of insulinoma.Giriş: İnsülinoma pankreasın genellikle benign tümörüdür. Yıllık insidansı 250.000’de 1’dir ve nadir görülmektedir. Tanı ve lokalizasyon amaçlı olarak endoskopik ve intraoperatif ultrasonografinin kullanıldığı ve başarılı bir şekilde tedavi edilen insülinomalı hasta sunuldu. Olgu Sunumu: 39 yaşında bayan hasta uzun süre aç kalması sonucu artan, soğuk terleme, halsizlik, bayılma ve çarpıntı şikâyetleriyle poliklinikte değerlendirildi. Batın bilgisayarlı tomografi(BT), manyetik rezonans görüntüleme(MRG), endoskopik ultrasonografi(EUS) ve biyokimyasal parametrelerden sonra hasta insülinoma tanısıyla yatırıldı. Hastaya EUS ve intraoperatifUSG(IOUS) yardımıyla enüklüasyon yapıldı. Tartışma: İnsülinomalı hastalarda ameliyat öncesi kitlenin lokalizasyonu çok önemlidir. Bu yüzden BT tarama, MRG, EUS ve SPECT/BT tanı amaçlı olarak kullanılmaktadır. Son zamanlarda EUS ve IOUS’un birlikte kullanımı artmaktadır. Insülinomada küratif tedavi yöntemi enükleasyondur. Sonuç: İnsülinoma’nın tanı ve tedavisinde, endoskopik ve intraoperatif ultrasonografinin birlikte kullanımı oldukça yararlıdır

Basal Cell Carcinoma Appearing As a Suture Reaction Along The Incision Line

The most frequently occurring malignant neoplasm of the skin is basal cell carcinoma (BCC). It is seen most often around the head and neck area. Predisposing factors include exposure to ultraviolet radiation (UV) and inorganic arsenic, trauma, chronic wounds, immune dysfunction and plaques, such as sebaceous nevus.While squamous cell carcinoma is frequently encountered as a result of chronic wounds, silk fistulas and scar formation, cases of BCC are very rare. In incidences of BCC developing along the incision line, the treatment involves making a large surgical excision. Problems related to the incision site are most often observed in operations conducted at surgical clinics, with the most common cause being suture reactions. In cases of chronic ulceration and discharge, a diagnosis of BCC should be considered and a biopsy should be conducted

Importance of Together Use of Endoscopic and Intraoperative Ultrasonography In The Diagnosis and Treatment of Insulinoma

Introduction:Insulinoma is a usually benign tumor of pancreas. It is seen rarely and incidence of insulinoma is 1 in 250,000 patient-years. We present a rare case with insulinoma which well diagnosed and treated with aid of endoscopic and intraoperative ultrasonography.Case Report:A patient involving a 39-year-old woman with complaints of cold sweats, weakness, syncope attacks, palpitations was evaluated in polyclinic. She was hospitalized with the diagnosis of pancreatic insulinoma after abdominal computer tomography(CT), magnetic resonance imaging(MRI) endoscopic ultrasonography(EUS), and biochemical parameters. The patient was well treated with enucleation and after imaging aid of endoscopic and intraoperative ultrasound(IOUS).Discussion:In patients with insulinoma, preoperative localization of tumor is most important for diagnosis and treatment. Therefore; CT scanning, MRI, EUS and SPECT / CT are used for diagnosis of insulinoma. Together use of endoscopic and intraoperatively ultrasonography are increasing recently. Enucleation is a curative treatment approach in insulinoma.Conclusion:Together using of preoperative endoscopic and intraoperative ultrasound is quite helpful in the diagnosis and treatment of insulinoma

Agreement Between Pathologic Diagnosis and Endoscopic Findings on Esophagogastroduodenoscopy Performed by General Surgeons

Aim: The aim of this study is to evaluate cognitive competence of surgeon-endoscopists in esophagogastroduodenoscopy (EGD) by comparison between endoscopic and pathologic diagnosis. Methods: This study is a retrospective chart review of 257 EGDs performed between September 2008 and March 2010 by two attending surgeons (OI, FAG) at the Zonguldak Karaelmas University, Medical Faculty, Department of General Surgery. Cognitive competence was examined by comparison between endoscopic and histopathological diagnosis. Endoscopic and pathologic reports were collected from the hospital database. Results: 217 of 257 EGDs were evaluated. Demographic data of the patients showed that 36% were male and 64% were female. The mean age was 51 years with a range of 24 to 78 years. Endoscopic diagnosis was gastritis in 78% of patients (n=168) and suspicion of malignancy in 11% (n=25). After histopathologic examination, 142 out of 168 patients with endoscopically suspected gastritis were diagnosed as having chronic gastritis or chronic-active gastritis. Surgeons were able to identify an abnormality with a detection rate of 86%. Surgeon-endoscopists had 80% positive predictive and 100% negative predictive value for malignancy according to EGD findings. H. pylori-positive gastric mucosal pattern was accurately identified by surgeons, and the infection was found in 67% (n=112) of patients with chronic gastritis or chronic-active gastritis. Conclusion: Taking into consideration the good agreement observed between endoscopic and pathologic findings in our study, we may conclude that surgeon-endoscopists with high cognitive competence in EGD may establish accurate diagnosis. (The Medical Bulletin of Haseki 2011; 49: 26-9