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 (

Surgical approach in adrenal incidentalomas: Report of thirteen cases and review of the literature

Amaç: Adrenal insidentalomalar rutin görüntüleme tekniklerinde yaklaşık %4-7 oranında tespit edilirler. Çoğunlukla benign olmakla birlikte dikkatli klinik ve laboratuvar incelemeleri sonrasında karsinom veya fonksiyonel adenomlar belirlenebilir.Gereç ve Yöntemler: Ocak 2010-Haziran 2014 tarihleri arasında adrenal kitle tespit edilerek cerrahi tedavi uygulanan 13 hastanın bulguları retrospektif olarak incelendi.Bulgular: Olgulardan 7'si (%54) erkek, 6'sı (%46) kadın, ortalama yaş 38,2 idi. Klinik tanılarda 5 hastada (%38,4) feokromasitoma, 5 hastada (%38,4) nonfonksiyone adenom, 1 hastada (%7,6) metastatik lezyon, 1 hastada (%7,6) Cushing sendromu, 1 hastada (%7,6) sürrenal karsinom tespit edilmiştir. Cerrahi tedavi uygulanan hastaların 8'ine laparotomi ile, 52'sine de laparoskopik adrenalektomi uygulanmıştır.Sonuç: Adrenal insidentaloma saptanan olgular asemptomatik olsa dahi hormonal yönden detaylı olarak incelenmeli, non-fonksiyone kitlelere ise malignite kuşkulu lezyonlar olarak bakılmalıdır. Kitle boyutu 6 cm'den küçük ve komşu organ infiltrasyonu bulunmayan hastalarda laparoskopik adrenalektomi altın standart haline gelmektedir.Objective: The rate of adrenal incidentalomas detected in routine diagnostic imaging techniques is approximately 4-7%. Although the lesions are generally benign, carcinoma and functional adenomas can be diagnosed with careful clinic and laboratory evaluation.Material and Methods: Data of 13 patients who underwent surgery for an adrenal mass between January 2010-June 2014 were analyzed retrospectively.Results: Seven (54%) patients were male, 6 (46%) were female, and the mean age was 38.2. The clinical diagnosis was pheochromacytoma in 5 patients (38.4%), non-functional adenoma in 5 (38.4), and metastatic lesion, Cushing syndrome, and adrenal carcinoma each in one patient (7.6%). Conventional open adrenalectomy was performed in 8 patients, while 5 patients underwent laparoscopic adrenalectomy.Conclusion: Adrenal incidentalomas should be carefully evaluated for hormonal activity even if asymptomatic, and non-functional lesions should be considered as suspicious-for-malignancy. Laparoscopic adrenalectomy has become the gold standard for patients with a mass less than 6 cm, and without infiltration to adjacent organs

Gastric Trichobezoar: Case Report

Bezoar, sindirilemeyen maddelerin gastrointestinal sistem içinde birikmesiyle oluşan kitlelere verilen isimdir. Bu yazıda, bulantı, kusma, karın ağrısı, anemi ve epigastrik kitle nedeni ile opere edilen, 28 yaşındaki bir kadın hasta sunuldu. Laparotomi ile hastanın midesini tamamen dolduran ve mide şeklini almış olan trikobezoar çıkarıldı. Ameliyat sonrası dönemde sorunsuz iyileşen hastada, psikiyatrik değerlendirmede, dürtüsel saç çekme (trikotillomani) ve depresyon olduğu tespit edildi.Bezoar is a mass that cannot be digested and that is collected in the gastrointestinal system. A 28-year-old girl, underwent an operation for abdominal pain, nausea, vomiting, anemia and epigatsric mass, was presented in this study. A mass which took the shape of the stomach was removed out of her stomach by laparatomy. Postoperative period was uneventful. A subsequent psychiatric consultation revealed trichotillomania and depression

Gastric Trichobezoar: Case Report

Bezoar is a mass that cannot be digested and that is collected in the gastrointestinal system. A 28-year-old girl, underwent an operation for abdominal pain, nausea, vomiting, anemia and epigatsric mass, was presented in this study. A mass which took the shape of the stomach was removed out of her stomach by laparatomy. Postoperative period was uneventful. A subsequent psychiatric consultation revealed trichotillomania and depression

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

Gastrointestinal quality of life in patients with asymptomatic cholelithiasis after laparoscopic cholecystectomy

To assess the outcome of laparoscopic cholecystectomy for asymptomatic cholelithiasis before and after laparoscopic cholecystectomy using a specific quality of life instrument for gastrointestinal disorders in adults : The Gastrointestinal Quality of Life Index (GIQLI) was used to study the quality of life in patients before and after laparoscopic cholecystectomy : Seventy one patients completed the GIQLI questionnaire both preoperatively and after a minimum postoperative follow-up of three months. Mean preoperative score was 126.8±14.07 out of a theoretical maximum score of 144.After three months, the score had significantly improved to 136.6±9.31, close to the range for the normal population. Not only items assessing gastrointestinal symptoms but also the domains of physical, social, and emotional function improved significantly. The most marked improvements were achieved in patients with the lowest preoperative scores. Laparoscopic cholecystectomy significantly improves the quality of life in patients with cholelithiasis who are asymptomatic or have nonspecific gastrointestinal symptoms that cannot be explained by another gastrointestinal pathology.Bu çalısmada asemptomatik kolelitiyazis olgularının ameliyat öncesi ve ameliyat sonrası hayat kalitesi degerlendirilmistir. Hastaların ameliyat öncesi ve sonrası hayat kalitelerinin ölçümü gastrointestinal hayat kalitesi indeksi parametreleri kullanılarak belirlenmistir. Çalısmaya alınan 71 hasta ameliyat öncesi ve ameliyattan en az 3 ay sonra gastrointestinal hayat kalitesi indeksine göre sorgulanmıstır. Preoperatif dönemde ortalama skor 126.8±14.07, 3 ay sonra yapılan sorgulamada ise ortalama 136.6±9.31 olup normal populasyona yakın bir oranda saptanmıstır. (toplam skor 144). Gastrointestinal semptomlarının yanı sıra fiziksel, sosyal ve duygusal durumlarında da anlamlı düzelme gözlenmistir.Düsük skorlu hastalarda bu iyilesmedaha belirgindir. Asemptomatik kolelitiyazisli hastalarda baska gastrointestinal patolojilerle açıklanamayan nonspesifik semptomların laparoskopik kolesistektomiyle iyilesme gösterdigi, hastaların hayat kalitelerinde anlamlı bir artıs oldugu görülmektedir

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide