Sıçanlarda Deneysel ERCP Modelinde; Kontrast Madde Uygulama Hızının ve Kanal İçi Basınç Artışının Etkileri

Amaç: Bu çalışmanın amacı ERCP işlemi sonrası akut pankreatit gelişiminde biliopankreatik kanaldaki basınç artışının ve opak madde verilme hızının etkilerini belirlemektir.Gereç ve Yöntem: Çalışmamızda 24 adet rat 4 gruba ayrıldı. Grup 1 de sadece biliopankreatik kanal kanülasyonu yapıldı. Diğer gruplara biliopankreatik kanal içerisine farklı hızlarda opak madde infüzyonu uygulandı ve kanal içinde oluşan basınç ölçüldü. Bulgular: Deney sonrası sıçanlar takibe alındı. 24 saat sonra akut pankreatit gelişimi ve şiddetinin değerlendirilmesi amacıyla sıçanlar sakrifiye edilerek kan ve doku örnekleri alındı. Alınan kan örneğinden lökosit sayısı, amilaz, lipaz, üre, kreatinin, glukoz, AST, ALT, ALP, LDH, kalsiyum, CRP, albümin, total protein, MDA, TAS, TOS değerleri çalışıldı. Pankreas dokuları akut pankreatit gelişimi açısından histopatolojik olarak değerlendirildi.Sonuç: Kanal içi hidrostatik basınç artışın akut pankreatit gelişmesine neden olmaktadır ve biliopankreatikkanal içerisindeki hidrostatik basınç arttıkça, pankreatitin şiddetinin de arttığı gözlenmişti

Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair

Background: Laparoscopic surgery has been a frequently performed method for inguinal hernia repair. Studies have demonstrated that the laparoscopic transabdominal preperitoneal (TAPP) approach is an appropriate choice for inguinal hernia repair. Single-incision laparoscopic surgery (SILS) was developed to improve the cosmetic effects of conventional laparoscopy. The aim of this study was to evaluate the safety and feasibility of SILS-TAPP compared with TAPP technique. Materials and Methods: A total of 148 patients who underwent TAPP or SILS-TAPP in our surgery clinic between December 2012 and January 2015 were enrolled. Data including patient demographics, hernia characteristics, operative time, intraoperative and postoperative complications, length of hospital stay and recurrence rate were retrospectively collected. Results: In total, 60 SILS-TAPP and 88 TAPP procedures were performed in the study period. The two groups were similar in terms of gender, type of hernia, and American Society of Anesthesiologists (ASA) classification score. The patients in the SILS-TAPP group were younger when compared the TAPP group. Port site hernia (PSH) rate was significantly high in the SILS-TAPP group, and all PSHs were recorded in patients with severe comorbidities. The mean operative time has no significant difference in two groups. All SILS procedures were completed successfully without conversion to conventional laparoscopy or open repair. No intraoperative complication was recorded. There was no recurrence during the mean follow-up period of 15.2 ± 3.8 months. Conclusion: SILS TAPP for inguinal hernia repair seems to be a feasible, safe method, and is comparable with TAPP technique. However, randomized trials are required to evaluate long-term clinical outcomes

A New Approach to the Complicated Liver Hydatid Cyst – Laparoscopic Roux-en-Y Cystojejunostomy

Surgery is still the gold standard in the treatment of hepatic hydatid disease. One of the major problems associated with hydatid cyst surgery is biliary fistula. In this report, we aimed to describe a laparoscopic internal drainage method for the treatment of complicated hepatic hydatid cyst in order to prevent long-term biliary fistulas. A 44-year-old female was referred to our clinic with the complaints of flank pain. On computerized tomography of the abdomen, an 8-cm hydatid cyst was detected on the right lob of the liver. Laparoscopic exploration demonstrated a cysto-biliary communication, and laparoscopic cystojejunostomy was performed to prevent long-term bile leakage. The patient was discharged on postoperative day 5 without any problems. In 45th days, nearly complete obliteration of the cavity was observed. Laparoscopic cystojejunostomy can be an effective and safe surgical approach for the treatment of complicated hepatic hydatid cysts

Minimally invasive management of anastomotic leak after bariatric Roux-en-Y gastric bypass

The aim of this retrospective study was to examine the anastomotic erosion due to drain and success of fibrin sealant in its management. Between 2013 and 2014, 102 patients underwent LRYGB and gastrojejunal anastomotic leak occurred due to drain erosion in 2 of them. The diagnosis was established with saliva drainage and was confirmed by upper gastrointestinal series. The absence of hemodynamic instability was directed us to conservative treatment. During the endoscopy, dehiscence was assessed and fibrin sealant was applied. The leaks healed progressively in a few days, and the drains removed within 6 days. Seven and 9 days later, the patients were discharged without any problem. Anastomotic leaks after bariatric surgery can cause severe morbidity, cost, and effects quality of life. Hemodynamically stable and drained patients are candidates for conservative methods. Endoscopic injection of fibrin sealant has been successful in closing gastric leaks

A Novel First-Line Treatment Alternative for Noncomplicated Idiopathic Granulomatous Mastitis: Combined Intralesional Steroid Injection with Topical Steroid Administration

Background: Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. Methods: Between June 2015 and April 2018, the patients' data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, n = 46) and the peroral systemic steroid treatment group (group 2, n = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. Results: Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (p = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; p = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; p = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. Conclusion: Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM