Laparoscopic Surgery for Gastric Cancer

In patients with gastric cancer, surgical resection is the only treatment that can offer cure or increase long-term survival. With the accumulation of experience in laparoscopic radical gastrectomy and the progress in surgical instruments, laparoscopic surgery for gastric cancer has gained popularity despite initial concerns regarding safety and oncological adequacy. As a result, laparoscopic technique has been widely applied in gastric cancer. Different meta-analyses showed that laparoscopic procedures are associated with less blood loss but longer operation time. Many studies have reported outcomes of laparoscopic surgery for early gastric cancer, but several authors also have shown that a laparoscopic approach can also be used in cases of advanced gastric cancer. We therefore conducted this study to expand our experience and to evaluate laparoscopic gastrectomy step by step in the light of recent reports while defining key points and surgical technique

Role of digital infrared thermal imaging in surgical management of fistula-in-ano

Anal fistulas represent an inflammatory condition with a connection formed between the anal canal and the perianal skin. Surgery aims to eradicate the fistula while preserving sphincter function. However, inadequate removal of fistula tracts often results in recurrence, and excessive division of the anal sphincter complex can result in fecal incontinence. Therefore, comprehensive preoperative evaluation of the fistula tract is crucial and contributes considerably to outcomes. MRI has emerged as a key method in patients with perianal fistula, but is expensive, uses intravenous contrast agent, and experience is needed to interpret images. Endoanal ultrasound (EUS) is cheaper and more practical than MRI, but is highly operator dependent and its role in suprasphincteric and complex fistulas is controversial. This study aimed to assess the usefulness of digital infrared thermal imaging (DITI) for evaluating of fistula-in-ano. DITI monitors infrared radiation emanated by a surface, in this case the perianal skin. The scientific rationale is based on the inflammatory state caused by perianal fistulization. Because one of the pathological findings of inflammation is increased local temperature due to altered blood flow, we hypothesized that by using a contrast agent colder than the human body, the perianal fistula tract could be visualized by DITI cameras. A protocol and simple diagnostic algorithm for evaluation of perianal fistulas are presented

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. Case report

<div><p>ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. CASE REPORT: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.</p></div