Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections : a prospective multicentre study (WISS Study)

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p <0.0001). The multivariate logistic regression model was highly significant (p <0.0001, R-2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.Peer reviewe

LONG TERM OUTCOME OF LAPAROSCOPIC NISSEN ROSSETTI FUNDOPLICATION FOR THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

Amaç: Bu tezin amacı gastroözofagiyal reflü nedeniyle yapılan laparoskopik Nissen-Rossetti fundoplikasyonun uzun dönem sonuçlarının semptomların kaybolması, yasam kalitesi gibi subjektif ve patolojik asit reflünün ortadan kalkmasının objektif olarak gösterilerek degerlendirilmesidir. Gereç ve Yöntem: Ocak 2003 &#8211; Haziran 2006 tarihleri arasında gastroözofagiyal reflü nedeniyle laparoskopik Nissen Rossetti fundoplikasyon yapılan 32 hasta çalısmaya dahil edildi. Preoperatif ve postoperatif dönemde hastalara subjektif olarak semptomlar, yasam kalitesi (Gastroesophageal reflux-Health related quality of life index) ve 24 saat pH monitorizasyonu yapılarak sonuçlar degerlendirildi. Bulgular: Hastaların median postoperatif izlem süresi 28 ± 7.92 (16&#8211;52) aydı. Postoperatif dönemde preoperatif döneme göre yasam kalitesinin anlamlı olarak arttıgı (p = 0.001) ve DeMeester skorlarının anlamlı olarak azaldıgı (p = 0.001) görüldü. Hastaların çogunda görülen postoperatif disfajinin yasam kalitesine belirgin olarak etkilemedigi görüldü. Sonuç: Gastroözofagiyal reflü cerrahi tedavisinde laparoskopik Nissen Rossetti fundoplikasyonun uzun dönemde patolojik reflüyü önledigi, semptomları kontrol altına aldıgı ve yasam kalitesindeki iyilesme sagladıgı görülmüstür. Bu sonuçlarla laparoskopik Nissen Rossetti fundoplikasyonun basarılı ve etkili bir yöntem oldugu söylenebilir.Aim: The aim of this thesis is to evaluate the long term outcome of the laparoscopic Nissen Rossetti fundoplication for the treatment of gastroesophageal reflux disease in terms of the relief of symptoms, quality of life and prevention of pathologic acid reflux. Material and Method: Thirty two patients who underwent laparoscopic Nissen Rossetti fundoplication for the treatment of gastroesophageal reflux disease between the dates of January 2003 and June 2006 were included in this thesis. The long term outcome was assessed by subjectively comparing the preoperative and postoperative symptoms and Gastroesophageal reflux-Health related quality of life index. As an objective assessment of the pathological reflux, patients underwent 24 hour pH monitorization in the preoperative and postoperative period. Results: The median postoperative follow-up period for the patients was 28 ± 7.92 (16-52) months. A significant increase was observed in the quality of life scores in the postoperative period when compared to the preoperative period (p = 0.001) and the DeMeester scores decreased significantly (p = 0.001). The postoperative dysphasia was observed even in the long term in most of the patients, without having an important effect on the quality of life. Conclusions: In the treatment of gastroesophageal reflux disease, laparoscopic Nissen Rossetti fundoplication is an effective and successful method in achieving the desired outcome such as preventing pathological reflux, relieving the symptoms and improving the quality of life in the long term

Secondary Vascular Access Procedures for Hemodialysis After Primary Snuff-Box Arteriovenous Fistula

Aim: To investigate the secondary arteriovenous fistulas constructed after a snuff-box fistula. Material and Method: We reviewed data on 95 arteriovenous fistulas that were created as a secondary vascular access between January 2007 and December 2015. Of those 95 fistulas, 37 (39%) were ipsilateral elbow brachial-cephalic arteriovenous fistulas and 58 (61%) were ipsilateral wrist radial-cephalic arteriovenous fistulas; all were created after a primary snuff-box fistula. Results: All arteriovenous fistulas had matured. The primary patency rates for elbow brachial-cephalic arteriovenous fistulas and radial-cephalic arteriovenous fistulas were as follows: 1-year rate, 88% to 87% and 4-year rate, 70% to 61%. The secondary patency rates for were as follows: 1-year rate, 91% to 93%; 4-year rate, 72% to 63%. No early failure occurred. There were 15 late failures. The most common causes of failure were stenosis within the vein (n=8 patients), aneurysm (n=5 patients), and central vein stenosis (n=2 patients). Discussion: These data suggest that before a radial-cephalic or brachial-cephalic arteriovenous fistula is created, the construction of a snuff-box fistula enable the vascular structures to dilate, and may so fascilitate the success rate of seconder AVFs. For this reason a radial-cephalic arteriovenous fistula or an elbow brachial-cephalic arteriovenous fistula should be the second choice

Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors

Background: Transanal endoscopic microsurgery is a minimally invasive technique that allows full-thickness resection and suture closure of the defect for large rectal adenomas, selected low-risk rectal cancers, or small cancers in patients who have a high risk for major surgery. Our aim, in the given prospective study was to report our initial clinical experience with TAMIS, and to evaluate its effects on postoperative anorectal functions. Materials and Methods: In 10 patients treated with TAMIS for benign and malignant rectal tumors, preoperative and postoperative anorectal function was evaluated with anorectal manometry and Cleveland Clinic Incontinence Score. Results: The mean distance of the tumors from the anal verge was 5.6 cm, and mean tumor diameter was 2.6 cm. All resection margins were tumor free. There was no difference in preoperative and 3-week postoperative anorectalmanometry findings; only mean minimum rectal sensory volume was lower at 3 weeks after surgery. The Cleveland Clinic Incontinence Score was normal in all patients except one which resolved by 6 weeks after surgery.The mean postoperative follow-up was 28 weeks without any recurrences. Conclusion: Transanal minimally invasive surgery is a safe and effective procedure for treatment of rectal tumors and can be performed without impairing anorectal functions

Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors

Background: Transanal endoscopic microsurgery is a minimally invasive technique that allows full-thickness resection and suture closure of the defect for large rectal adenomas, selected low-risk rectal cancers, or small cancers in patients who have a high risk for major surgery. Our aim, in the given prospective study was to report our initial clinical experience with TAMIS, and to evaluate its effects on postoperative anorectal functions. Materials and Methods: In 10 patients treated with TAMIS for benign and malignant rectal tumors, preoperative and postoperative anorectal function was evaluated with anorectal manometry and Cleveland Clinic Incontinence Score. Results: The mean distance of the tumors from the anal verge was 5.6 cm, and mean tumor diameter was 2.6 cm. All resection margins were tumor free. There was no difference in preoperative and 3-week postoperative anorectalmanometry findings; only mean minimum rectal sensory volume was lower at 3 weeks after surgery. The Cleveland Clinic Incontinence Score was normal in all patients except one which resolved by 6 weeks after surgery.The mean postoperative follow-up was 28 weeks without any recurrences. Conclusion: Transanal minimally invasive surgery is a safe and effective procedure for treatment of rectal tumors and can be performed without impairing anorectal functions

Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal stem cell disorder of hematopoietic cells. Gastrointestinal complications of PNH are rare and mostly related with intravascular thrombosis or intramural hematoma. PRESENTATION OF CASE: We describe a case of a man with PNH complicated by intramural duodenal hematoma initially treated with supportive care. Three months after his first admission; he was admitted to the emergency department with abdominal pain, nausea and vomiting. He had undergone to surgery because of duodenal obstruction was treated with duodenojejunal by-pass surgery. DISCUSSION: Patients were healed from gastrointestinal complications could suffer from gastrointestinal strictures, which cause wide spread symptoms ranging from chronic abdominal pain and anorexia to intestinal obstruction. CONCLUSION: We report a rare intestinal obstruction case caused by stricture at the level of ligamentum Treitz with PNH. The possibility simply has to be borne in mind that strictures can be occurring at hematoma, ischemia or inflammation site of gastrointestinal tract

EFFECTS OF LOWER GASTROINTESTINAL TRACT SURGERY ON SURVIVAL IN ELDERLY AND OCTOGENARIAN PATIENTS

Introduction: Life expectancy has significantly increased in the last decade. The decision to perform surgery has always been challenging in elderly patients. We aimed to evaluate outcomes in patients who underwent surgery for lower gastrointestinal tract diseases and investigate factors influencing morbidity and mortality, particularly in octogenarian patients, and the effects of age on prognosis and survival in the postoperative period. Materials and Method: This study included patients aged >= 70 years who underwent lower gastrointestinal tract surgery; patients were divided into three groups as 70-75 years, 75-79 years, and >= 80 years. Age, gender, type of surgery, ASA score, length of hospital stay, morbidity, 30-day mortality, and overall survival were evaluated. Results: The surgery was performed to 598 patients due to lower gastrointestinal tract diseases. There was a significant increase in the ASA score with increasing age (Chi-square=35.472; p<0.001). The survival rate was significantly higher in patients with malignancies than in those with benign diseases, and in patients who underwent elective surgery than in those who underwent emergency surgery (p<0.001). When patients were examined according to age groups, the overall survival was similar across groups (p=0.217). Conclusion: There was no significant difference between octogenarian and younger patients for complications and survival. Thus, planned surgical interventions in elderly patients will not negatively affect survival and surgical interventions and can be safely performed in these patients

Arterial complication of irreversible electroporation procedure for locally advanced pancreatic cancer

Irreversible electroporation (IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically unresectable. We present the first case of acute superior mesenteric artery (SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature. A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal adenocarcinoma. IRE procedure was applied to the patient during laparotomy under general anesthesia. After finishing the procedure, an acute intestinal ischemia was detected. A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was maintained. It is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor