Are the single-step resection and primary anastomosis suitable for obstructıve colorectal patients in older cases?

Aim To investigate the efficacy and safety of the single-step surgery in elderly patients with obstructive colorectal cancer. Methods All patients who underwent single-step surgery and primary anastomosis for obstructive colorectal cancer in the period between January 2012 December 2017 were evaluated in this study. The patients were divided into two groups: younger than 65 (Group Young) and older than 65 (Group Old). Demographic data, American Society of Anesthesiologists scores (ASA) scores, comorbidities, preoperative albumin levels, type of surgery, postoperative morbidity and mortality, pathological stages, and overall survival rates were investigated. Results A total of 89 patients were included: 49 (54%) were older than 65 (Group Old). In Group Old, the mean age was 75 (65-97), of which 28 (58.3%) were males. There were 41 patients younger than 65 (Group Young) with the mean age of 52.6 (41-64 years of age), of which 21 (51.2%) were males. There was no difference between groups according to albumin level. There was no statistical difference between two groups according to tumour localization, pathological stage and type of surgery, as well as according to surgical complications. The median overall survival rate was 11 months in both groups (0-66) (p=0.320). Conclusion Meticulous preparation of older patients (correction of anaemia, electrolyte levels and pH ) paves the road for successful surgeries, including single-step resection and primary anastomosis

An interesting journey of an ingested needle: a case report and review of the literature on extra-abdominal migration of ingested Foreign bodies

Swallowed foreign bodies encounter a major problem especially in children, but fortunately they mostly do not cause any related complication and are easily passed with the stool. In this paper, an interesting journey of a needle is presented. A 20-year old female admitted to our emergency service after she had swallowed a sewing machine needle, which is initially observed in the stomach in the plain abdominal radiography. During the follow-up period, the needle traveled through bowels, and surprisingly was observed in the left lung on 10th day of the follow-up. It was removed with a thoracotomy and pneumotomy under the fluoroscopic guidance. The postoperative period was uneventful and the patient was discharged from the hospital on the day 5. We also review the literature on interesting extra-abdominal migrations of swallowing foreign bodies

Bilateral kasık fıtıklarında transabdominal preperitoneal onarım: Tek merkez deneyimi

Aim: To evaluate outcomes of transabdominal preperitoneal repair in patients with bilateral inguinal hernias. Methods: Sociodemographic data, and data about disease and operation with postoperative data of all patients with bilateral inguinal hernias, who were treated by transabdominal preperitoneal repair were prospectively collected. Patients were followed-up for recurrence and chronic pain in the long-term. Results: A total of 70 (67 [95.7%] males, mean age was 53.4±13.6 years) cases were included. Total 138 hernias (mostly Nyhus type 3 [n=116; 84.1%]) were repaired in 70 cases. Unilateral inguinal hernia was diagnosed in two cases during the operation. Mean operation time was 80.6±26.5 minutes. Inferior epigastric vein was injured in 2 (1.4%) cases. Parenteral analgesics were required in only 10 (14.3%) patients. Patients were discharged 1.21±0.67 days after the operation, and only 9 (12.8%) cases were hospitalized more than one day. Patients returned work or normal activity 10.5±4.7 days after the surgery. The mean follow-up period was 25.9±19.4 months. Symptomatic recurrence was observed in 2 (1.4%) patients. Six (8.7%) cases had chronic pain. Conclusion: Transabdominal preperitoneal repair may be an alternative approach in treatment of bilateral inguinal hernias.Amaç: Bilateral kasık fıtığı olan hastalarda transabdominal preperitoneal tamir sonuçlarını irdelemek. Yöntemler: Transabdominal preperitoneal yöntemle bilateral kasık fıtığı tamiri uygulanan tüm hastalarda prospektif olarak sosyodemografik veriler, hastalık ve operasyona ait veriler ile postoperative veriler değerlendirildi. Uzun dönemde hastalar kronik ağrı ve nüks açısından takip edildi. Bulgular: Toplam 70 hasta (67 [95.7%] erkek, ortalama yaş 53.4±13.6) çalışmaya dahil edildi. İki hastada ameliyat esnasında tek taraflı fıtık saptandığından toplam 138 fıtık (Nyhus tip 3 [n=116; %84.1]) tamiri yapıldı. Ortalama operasyon süresi 80.6±26.5 dakikaydı. İki hastada inferior epigastrik ven yaralanması görüldü. Sadece 10 (%14.3) hastada parenteral analjezik ihtiyacı gelişti. Ortalama hastanede kalış süresi 1.21±0.67 gün olup sadece 9 (%12.8) hastada bir günden fazla yatış gerekti. İş veya normal aktivitelere dönüş süresi 10.5±4.7 gündü. Hastalar ortalama 25.9±19.4 ay takip edildi. Semptomatik nüks 2 (%1.4) hastada gelişti. Kronik ağrı ise 6 (%8.7) hastada saptandı. Sonuç: Bilateral kasık fıtıklarında transabdominal preperitoneal tamir bir alternatif olarak düşünülebili

Intra-abdominal use of taurolidine or heparin as alternative products to an antiadhesive barrier (Seprafilm (R)) in adhesion prevention: An experimental study on mice

PURPOSE: Seprafilm (R) (Genzyme Biosurgery, Cambridge, MA) remains a widely used product in postoperative adhesion prevention. This study was designed to compare the antiadhesive effects of taurolidine, heparin, and Seprafilm (R) in a murine cecal abrasion model. METHODS: Sixty male Balb/c mice underwent a cecal abrasion procedure and were randomized into four groups (n=15 in each). Groups T, H, and S animals intraperitoneally received taurolidine, heparin, and Seprafilm (R), respectively, and Group C animals were reserved as control. Animals were killed on Day 21, and the severity of adhesions was evaluated with a scoring system ranging between 0 to 5. In addition, the localizations of the adhesions were questioned. RESULTS: Five (1 in Group S and 4 in Group H) animals died before they were killed. The deaths were related to intra-abdominal bleeding, and mortality rate was significantly higher in Group H than those in other groups (P < 0.05 for each comparison). The severity of adhesions was significantly less in the study groups than Group C, and in Group H than Groups T and S (P < 0.05 for each comparison). In addition, adhesions located cecum over itself were significantly less in the study groups than the control group, and those between small bowel and cecum were significantly lower in Groups T and S than the control group (P < 0.05 for each comparison). CONCLUSIONS: All products are effective in adhesion prevention. Heparin use provides the best results but may be associated with a higher mortality rate related to intra-abdominal bleeding. Taurolidine may be an alternative product to Seprafilm (R), but further studies are required

The feasibility of hepatic resections using a bipolar radiofrequency device (Habib®)

WOS: 000367103500006PubMed ID: 26702234The bipolar radiofrequency device (HabibA (R)) has been recently introduced in order to reduce intraoperative bleeding for a safe hepatic resection as an alternative to the conventional tools. However, indications, perioperative findings, and outcome of the device for hepatic resections remain and deserve to be analyzed. The current study aims to analyze the feasibility of the bipolar radiofrequency device (HabibA (R)) for hepatic resections. Information of the patients that underwent hepatic resection using with the HabibA (R) device between 2007 and 2011 was abstracted. Patient, disease, and operation-related findings and perioperative data were investigated. A total of 71 cases (38 [53.5 %] males, mean age was 56.8 A +/- 11.9) were analyzed. Metastatic disease (n = 55; 77.5 %) was the leading indication followed by primary liver and biliary malignancies (n = 7; 9.9 %), hemangioma (n = 5; 7 %), hydatid disease (n = 3; 2.8 %), and hepatic gunshot trauma (n = 1; 1.4 %). Metastasectomy was the most commonly performed procedure (n = 31; 56.3 %), but in 24 (77.4 %) cases, it was performed in addition to extended resections. Other procedures in the study patients include segmentectomy in 17, bisegmentectomy in 19, trisegmentectomy in 17, right or left hepatectomy in 8, and extended right/left hepatectomy in 3. The mean (+/- SD) operation time was 241.7 +/- 78.2 min. The median amount of bleeding was 300 cc (range 25-2500), and 23 (32.4 %) cases required perioperative transfusion. The median hospitalization period was 5 days (range 1-47). Lengthened drainage (n = 9, 12.7 %) and intraabdominal abscess (n = 8, 11.23 %) were the most common problems. Hepatic resections using the HabibA (R) device seem to be feasible in cases with primary and metastatic hepatic lesions and benign liver masses and even those with hepatic trauma. It may lessen the amount of intraoperative hemorrhage, although lengthened drainage and intraabdominal abscess were the major postoperative problems in these cases

A descriptive survey study to evaluate the relationship between socio-demographic factors and quality of life in patients with a permanent colostomy

WOS: 000344515000006PubMed ID: 25299814The impact of having a stoma on quality of life is increasingly recognized and studied. A descriptive survey study was conducted between January 2006 and December 2011 among 44 patients (18 women, 26 men) with a permanent stoma receiving care at the Kartal Training and Research Hospital, Istanbul, Turkey, to evaluate socio-demographic factors that may affect the quality of life in Turkish Muslim patients with an enteral stoma. A socio-demographic questionnaire, a 10-item Religious Orientation Scale (Modified Allport-Ross ROS), and the Medical Outcomes Study Short Form 36 Quality of Life survey were administered by a stoma therapy nurse at least 6 months after completion of all surgical and oncological treatments. The mean follow-up period was 15.3 +/- 9.7 (range 6-44) months since completion of all treatments. Data were collected using paper/pencil instruments and entered for data analysis using Student's t-tests or one-way ANOVA univariate and multivariate analyses. No significant differences were observed for income, education level, surgical history, or religion score. Gender, geographic region, and household status were found independently related to quality of life in stoma patients. Female patients had significantly lower scores than males in general health perception (P=0.049), role emotion (P=0.02), mental health perception (P=0.026), and mental component (P=0.007). Patients living in a village (four) had significantly lower scores than patients living in a big city (33) in all scales (P<0.05 for all comparisons). Village-dwelling patents also had significantly lower scores than patients living in a town (seven) in physical function (P =0.001), vitality (P=0.012), social function (P=0.003), and mental component scores (P=0.021). Patients living alone (seven) had significantly lower scores than patients living with a partner (11) in three of eight scales (physical functioning [P<0.001], role-physical [P=0.047], and bodily pain [P=0.015]) and physical component scores (P<0.001); they also had significantly lower scores than patients living with their families (26) in four of eight scales (physical functioning [P <0.001], role-physical [P=0.032], bodily pain [P=0.02], and general health perception [P=0.036]) and physical component scores (P<0.001). Although these findings provide evidence for the relationship between some socio-demographic factors on quality of life of patients with a stoma, the results of the study should be interpreted with caution; multicenter, prospective, controlled studies are needed to substantiate and clarify the relationships among these variables