The Use of Rigiflex Pneumatic Balloon Dilator during Laparoscopic Heller's Myotomy in Patients with Achalasia: A Novel Technical Method and Its Surgical Outcomes

Pneumatic balloon dilatation (BD) and laparoscopic Heller's myotomy (LHM) are usually preferred treatment options for relieving dysphagia symptoms in achalasia. The aim of the present study was to describe a new technical method for a safe and effective LHM. Endoscopic BD tube (Rigiflex 30-mm pneumatic balloon) is simultaneously insufflated and desufflated in the esophagus during LHM to assess myotomy in 50 consecutive patients. Dysphagia symptoms were determined using Eckardt's score. Three esophageal mucosal perforations occurred during surgery, which was primary repaired. The preoperative Eckardt score improved significantly from 4.54 +/- 1.85 to 0.54 +/- 0.73 (P < 0.001) at the first postoperative annual follow-up. The use of endoscopic BD tube during LHM is an easy and valuable method that allows to assess whether the dissection of muscular fibers in the myotomy area is appropriate or not

Effects of preoperative endoscopic pneumatic balloon dilatation on postoperative achalasia symptoms after Heller esophageal myotomy plus Dor fundoplication.

Conclusion: HM+DF is an effective procedure in relieving achalasia symptoms as a first-line therapy as well as in individuals unresponsive to repeated endoscopic PBDs

Algılanan Hizmet Kalitesinin Hasta Bağlılığı Üzerine Etkisi: Devlet Hastanesi Üzerine Bir İnceleme

Bu çalışmada devlet hastanelerinde sunulan sağlık hizmetlerinden yararlanan hastaların, hastane hizmetlerine ilişkin algıladıkları hizmet kalitesi boyutları ve bu boyutların hastane bağlılığı üzerine etkisi incelenmektedir. Çalışma, Türkiye’nin Güneydoğu’sunda yer alan bir ilde devlet hastanesinden hizmet alan hastalar ile gerçekleştirilmiştir. Veriler 300 yatan hastanın katılımıyla yüz yüze görüşme tekniği ile yapılandırılmış anket formunun uygulanması ile elde edilmiştir. Araştırmada örnekleme yöntemi olarak, "kolayda örnekleme yöntemi" kullanılmıştır. Araştırma sonuçlarına göre hekim hizmetleri, muayene öncesi hizmetler, kişisel ihtiyaçları karşılama ve hastane ile ilgili değerlendirmelerin hasta bağlılığını anlamlı ve olumlu yönde etkisinin olduğu görülmektedir. Elde edilen sonuçlar, gerek teori gerekse uygulamacılar açısından çıkarımlar sağlamaktadır

Investigation of procalcitonin, IL-6, oxidative stress index (OSI) plasma and tissue levels in experimental mild and severe pancreatitis in rats

AIM: This study was planned to evaluate blood and tissue levels of procalcitonin, IL-6 and Oxidative Stress Index (OSI), which have a role in the pathophysiology of inflammation, in rats with experimental mild and severe pancreatitis. MATERIAL AND METHODS: Thirty male Wistar Albino rats were included in the study and the rats were equally divided into the three groups. After 1, 5 and 24 hours, blood was obtained from the tail of all rats and samples were taken from pancreas tissue after 24 hours. Amylase, lipase, AST, ALT, WBC, LDH, glucose, total bilirubin, direct bilirubin, GGT, ALP and TNF-alpha, Procalcitonin and IL-6 levels were evaluated from blood and tissue specimens. RESULTS: The mild pancreatitis group (group 1) and the severe pancreatitis group (group 3) were compared according to the OSI, Amylase, Lipase, Pct, IL-6, AST, ALT, Glucose, WBC, LDH and Tnf-a levels. In the severe pancreatitis group, a statistically significant increase was detected compared to the mild pancreatitis group (p 0.05). Statistically significant increase was observed in severe pancreatitis group according to OSI, Amylase, Lipase, Pct, IL-6, LDH, WBC and TNF-a levels samples obtained from pancreatic tissues, compared to mild pancreatitis group (p < 0.05). CONCLUSION: In conclusion, our study showed that OSI, TNF-a, IL-6 and procalcitonin levels increases proportionally with the severity of pancreatitis. This also suggests that OSI, TNF-a, IL-6 and procalcitonin are the guiding substances in acute pancreatitis, and that this damage increases as the duration and severity of the pathological process increase. However, this result must be confirmed with more detailed and broadly planned future studies (Fig. 3, Ref. 25). Text in PDF www.elis.sk

The effects of the fine needle aspiration biopsy method to the surgical treatment decision of the thyroid nodules

Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB’ nin histopatolojik inceleme ile korelasyonunu yaparak kendi klinik deneyimimiz eşliğinde bu yöntemin duyarlılığını ortaya koymayı amaçladık. Gereç ve yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi 2. Cerrahi Kliniği’nde Ocak 2006- Aralık 2010 tarihleri arasında total tiroidektomi ameliyatı uygulanan 355 hasta malignite oranı ve ince iğne aspirasyon biyopsinin tiroidektomi öncesi maligniteyi saptamadaki özgüllüğü ve duyarlılığı yönünden geriye dönük olarak incelendi. Hastaların preoperatif dönemde yapılan laboratuar incelemeleri, tiroidin fonksiyonel durumu, ultrasonografi, sintigrafi ve tiroid İİAB gibi tanı yöntemleri ile postoperatif histopatolojik inceleme sonuçları korele edildi. Bulgular: İİAB uygulanan 167 hastanın patolojik inceleme sonucunda, benign sonuç % 58 (n=97), şüpheli sonuç % 29,9 (n=50), yetersiz materyal oranı % 6,6 (n=11) ve malign sonuç % 5,4 (n=9)’unda raporlandı. Çalışmamızdaki İİAB nin duyarlılığı %83, özgüllüğü %100 olarak saptandı. Sonuç: Bu çalışmada sunulan veriler, operasyon gerekliliğinin belirlenmesi ve malignitenin doğrulanmasında İİAB nin kullanımını desteklemektedir. Negatif İİAB sonucu diğer klinik faktörlerle gerekliliği gösterilen operasyonu engellememelidir. Rezeksiyonun büyüklüğüne, oluşmuş risk faktörlerinin ve boyun eksplorasyonundaki bulgularına bakılarak karar verilmelidir.Background: We aimed to investigate the sensitivity of the frequently used preoperative diagnostic test FNAC (fine needle aspiration cytology) in thyroid diseases by analysing the correlation between this test and histopathological examination in the light of our clinical experience. Materal and Methods: The medical records of 355 thyroid patients who underwent bilateral total thyroidectomy operation in the 2nd General Surgery Clinic of Ankara Numune Training and Research Hospital between 2006 January- October 2010 were reviewed. The detection rate of malignancy by fine-needle aspiration biopsy prior to thyroidectomy in terms of specificity and sensitivity were retrospectively analyzed. The diagnostic tests performed in the preoperative period of the patients, including thyroid function tests, US, scintigraphy and thyroid FNAC results were correlated with postoperative histopathological examination results. Findings: The results of FNAC in 167 cases were as follows; benign in 97 (58%), suspicious in 50 (29.9%), insufficient material in 11 (6.6%) and malignant in 9 cases (5.4%). The sensitivity and specificity of FNAC in our study were 83% and 100% respectively. Results: According to the data presented in this study, determination of the need for operation and verification of malignancy supports the use of FNAC. But a negative FNAC result should not impede the indication of thyroidectomy which is planned by the results of other diagnostic tests. The extension of resection should be decided by analyzing of risk factors and by findings of the neck eksploration

The effects of the fine needle aspiration biopsy method to the surgical treatment decision of the thyroid nodules

Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB’ nin histopatolojik inceleme ile korelasyonunu yaparak kendi klinik deneyimimiz eşliğinde bu yöntemin duyarlılığını ortaya koymayı amaçladık. Gereç ve yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi 2. Cerrahi Kliniği’nde Ocak 2006- Aralık 2010 tarihleri arasında total tiroidektomi ameliyatı uygulanan 355 hasta malignite oranı ve ince iğne aspirasyon biyopsinin tiroidektomi öncesi maligniteyi saptamadaki özgüllüğü ve duyarlılığı yönünden geriye dönük olarak incelendi. Hastaların preoperatif dönemde yapılan laboratuar incelemeleri, tiroidin fonksiyonel durumu, ultrasonografi, sintigrafi ve tiroid İİAB gibi tanı yöntemleri ile postoperatif histopatolojik inceleme sonuçları korele edildi. Bulgular: İİAB uygulanan 167 hastanın patolojik inceleme sonucunda, benign sonuç % 58 (n=97), şüpheli sonuç % 29,9 (n=50), yetersiz materyal oranı % 6,6 (n=11) ve malign sonuç % 5,4 (n=9)’unda raporlandı. Çalışmamızdaki İİAB nin duyarlılığı %83, özgüllüğü %100 olarak saptandı. Sonuç: Bu çalışmada sunulan veriler, operasyon gerekliliğinin belirlenmesi ve malignitenin doğrulanmasında İİAB nin kullanımını desteklemektedir. Negatif İİAB sonucu diğer klinik faktörlerle gerekliliği gösterilen operasyonu engellememelidir. Rezeksiyonun büyüklüğüne, oluşmuş risk faktörlerinin ve boyun eksplorasyonundaki bulgularına bakılarak karar verilmelidir.Background: We aimed to investigate the sensitivity of the frequently used preoperative diagnostic test FNAC (fine needle aspiration cytology) in thyroid diseases by analysing the correlation between this test and histopathological examination in the light of our clinical experience. Materal and Methods: The medical records of 355 thyroid patients who underwent bilateral total thyroidectomy operation in the 2nd General Surgery Clinic of Ankara Numune Training and Research Hospital between 2006 January- October 2010 were reviewed. The detection rate of malignancy by fine-needle aspiration biopsy prior to thyroidectomy in terms of specificity and sensitivity were retrospectively analyzed. The diagnostic tests performed in the preoperative period of the patients, including thyroid function tests, US, scintigraphy and thyroid FNAC results were correlated with postoperative histopathological examination results. Findings: The results of FNAC in 167 cases were as follows; benign in 97 (58%), suspicious in 50 (29.9%), insufficient material in 11 (6.6%) and malignant in 9 cases (5.4%). The sensitivity and specificity of FNAC in our study were 83% and 100% respectively. Results: According to the data presented in this study, determination of the need for operation and verification of malignancy supports the use of FNAC. But a negative FNAC result should not impede the indication of thyroidectomy which is planned by the results of other diagnostic tests. The extension of resection should be decided by analyzing of risk factors and by findings of the neck eksploration

Management of difficult gallbladder and comparison of laparoscopic subtotal cholecystectomy with open subtotal cholecystectomy

Aim: Laparoscopic cholecystectomy is the optimal surgical treatment for benign gallbladder diseases. Under curtain conditions it is very hard to distinguish the Calot triangle and it becomes difficult to perform safe cholecystectomy. Subtotal cholecystectomy is a salvage option in such conditions. The aim of this study is to compare the results of open and laparoscopic subtotal cholecystectomy in difficult gallbladder management. Material and Methods: In this retrospective study results of all consecutive patients who were performed subtotal cholecystectomy between July 2014 and August 2017 were collected and laparoscopic and open methods were compared. Results:Forty-five of 396 laparoscopic cholecystectomy cases underwent subtotal cholecystectomy during the study period. Subtotal cholecystectomy was performed laparoscopically in 27 of 45 patients (Group I), and open method in 18 patients (Group II). Convertion rate was %34.1. No significant difference was observed in terms of both preoperative and postoperative laboratory results. There was no difference between two groups in terms of ERCP history. The rate of open operation was statistically higher in acute cases. The duration of surgery was significantly higher in laparoscopic group but length of hospital stay was significantly higher in open group. Total cost was higher in group 2 but this result did not reach statistical significance. Total bile leak rate was 2.2%. Conclusion: Laparoscopic subtotal cholecystectomy is a safe and appropriate method which can be compared with open subtotal cholecystectomy in difficult gallbladder management

Surgical Outcomes of Solid Pseudopapillary Neoplasm of the Pancreas: A Single Institution's Experience of 16 Cases

Conclusion: SPT is a rare pancreatic neoplasm with a low malignant potential, and is common in young women. If SPT is diagnosed before surgery, complete surgical resection, generally enucleation is the most effective therapy for SPT

İntraoperatif splenik hilus kanaması ve splenomegali robotik ve laparoskopik splenektomiden açık cerrahiye geçişe etki eden risk faktörleridir

Objective: Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different_x000D_ clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum_x000D_ dissection technique._x000D_ Material and Methods: A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the_x000D_ study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8)._x000D_ Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity._x000D_ Results: No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease,_x000D_ operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet_x000D_ distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular_x000D_ thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p< 0.05) were higher_x000D_ in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-_x000D_ 981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to_x000D_ open surgery._x000D_ Conclusion: Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3_x000D_ ) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.Giriş ve Amaç: Minimal invaziv cerrahi tüm dünyada farklı klinik pratiklerde etkili ve güvenli popüler tedavi yöntemlerinden biridir. Bu çalışmada_x000D_ amacımız, robotik veya laparoskopik splenektomi (RLS)’den açık cerrahiye geçişe etki eden risk faktörlerini ve indirekt hilum diseksiyonu tekniğinin performansını ortaya koymaktır._x000D_ Gereç ve Yöntem: Çalışmaya izole dalak hastalıkları nedeniyle RLS splenektomi yapılan 56 hasta kabul edildi. Hastalar iki gruba ayrıldı; RLS yapılan_x000D_ hastalar (grup 1) (n= 48) ve açık cerrahiye geçilen hastalar (grup 2) (n= 8). Hastalar yaş, cinsiyet, beden kütle indeksi (BKİ), yandaş hastalık, tanı, ASA_x000D_ skoru, dalak çapı, biyokimyasal, mikrobiyolojik parametreler ve morbiditeler açısından retrospektif olarak değerlendirildi._x000D_ Bulgular: Yaş, cinsiyet, BKİ, ASA skoru, yandaş hastalık, operasyon süresi, hastanede kalış süresi, takip süresi, aksesuar dalak, tanı, Uluslararası_x000D_ Normalizasyon Oranı (INR), eritrosit dağılım genişliği (RDW), trombosit dağılım genişliği (PDW), trombosit-lenfosit oranı (PLR), nötrofil-lenfosit_x000D_ oranı (NLR), tekrar başvuru, splenozis, cerrahi alan infeksiyonu, vasküler trombüs ve insizyonel herni açısından gruplar arasında istatistiksel olarak_x000D_ farklılık yoktu (p> 0,05). Diğer taraftan, açık splenektomiye geçilen grupta intraoperatif splenik hilustan kanama ve dalak çapı istatistiksel olarak_x000D_ daha fazlaydı (p< 0,05). Multivaryant analizde açığa geçişe etki eden faktörler; intraoperatif hilustan kanama (B= 4,127) (OR= 61,974) (%95 GA=_x000D_ 3,913-981,454) (p= 0,003) ve artmış dalak çapı (> 400 cm3) (B= 3,114) (OR= 22,509) (%95 GA= 1,818-278,714) (p= 0,015) olarak tespit edilmiştir._x000D_ Sonuç: İntraoperatif splenik hilustan kanama ve artmış dalak çapı (> 400 cm3_x000D_ ) elektif RLS’den açık splenektomiye geçişe etki eden risk faktörleridir._x000D_ İndirekt splenik hilum diseksiyonu intraoperatif kanama ve açık cerrahiye geçişi azaltabilir