Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection. As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously. Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach

An extra-adrenal paraganglioma treated with radiotherapy

Abdominal paragangliomas (PG) are usually misdiagnosed as retroperitoneal masses originated from pancreas, kidney or adrenal gland. Although the optimum treatment of the disease is surgical excision, resection may not be proper secondary to advanced disease or close relationship with the main vessels.Case:A 72 year old female patient was suffering from right lumbar pain and feeling of fullness for last 1 year. In another medical center a computed abdomen tomography (CT) had been carried out which was showing a pancreatic mass. For further evaluation she was referred to our clinic. Physical examination revealed bilateral grade 2 lower extremity edema and an appendectomy scar. We repeated CT and performed three-dimensional reconstruction revealing of a 35x52x42 mm sized hypervascular mass which was separate from the pancreas. This mass was partially surrounding inferior vena cava and entering the aorta-caval groove. CT-guided trucut biopsy was performed. Pathology resulted as benign, low mitotic activity PG. She was diagnosed as extra-adrenal paraganglioma (EAPG). Being close to the main vessels, instead of surgical excision radiotherapy (RT) was decided. After completion of the treatment, abdominal pain and lower extremity edema disappeared. 6 months after RT on control CT, there was no progression in the size of the mass.PG is a rare tumor. Because of the risk of malignant transformation, decided treatment should be surgery. After confirmation of the diagnosis, for paragangliomas which has close relationship to main vessels RT is an alternative treatment

Learning curve for unilateral endoscopic totally extraperitoneal inguinal hernioplasty in a teaching hospital

INTRODUCTION: The present study is a description of the learning curve experienced and the process implemented to incorporate the increasingly common laparoendoscopic technique of totally extraperitoneal (TEP) inguinal hernia repair at our clinic.METHODS: Patients with a primary unilateral inguinal hernia who underwent laparoscopic TEP repair between May 2013 and May 2018 were included in the study. The patients were separated into 7 groups. The learning curve parameters (duration of operation, rate of conversion to open surgery, intraoperative and postoperative complications) were recorded and statistically compared.RESULTS: Of the 380 patients, 349 were male and 31 were female, and the mean age was 52±14.2 years. The mean duration of the operation was 46±25.9 minutes. There was a statistically significant difference between the groups in terms of surgical time. The duration of the operation plateaued at <1 hour after 60 surgeries. There was no statistically significant difference between the last 2 groups in terms of the duration of the operation. A total of 7 patients were converted to open surgery. There was no difference between groups in terms of the duration of hospitalization. The average follow-up period was 18 months (range: 3–63 months). Seroma and hematoma occurred in 3 patients and hernia recurrence was observed in 4 patients.DISCUSSION AND CONCLUSION: It was concluded that a surgeon who has already performed a certain number of inguinal hernia operations can complete the learning curve for TEP repair after 60 operations when the appropriate technical conditions are provided, and that subsequent surgeries can be performed in an optimal time with low complication and recurrence rates.Keywords:Duration of surgery, laparoendoscopic repair; learning curve; totally extraperitoneal

Intraperitoneal Ventralex™ ST Hernia Patch Application for Ventral Hernia Repair

Objective:Traditional methods commonly used in ventral hernia repair have a high recurrence rate. In patch repair, the recurrence rate is low, but there are many prosthetic materials. Ventralex™ ST hernia patch has small and medium sizes. We aimed to determine the results in ventral hernias.Methods:A single-center retrospective analysis was performed. Ventral hernias <3 cm were repaired using intraperitoneal Ventralex™ ST hernia patch between January 2015 and March 2017. Demographic characteristics, operative time, analgesic requirement, length of hospital stay, postoperative complications, and recurrences were recorded.Results:A total of 65 patients with umbilical, epigastric, and trocar site hernia underwent surgery. Thirty-four patients were female, and 31 were male. According to the localization, 43 patients had an umbilical hernia, 16 had an epigastric hernia, and six had trocar site hernia. Hernia size was <2 cm in 35 patients and 2-3 cm in 30 patients. The mean body mass index was 28 kg/m2. Wound infection was detected in two patients, and one patient had seroma. The mean follow-up was 17 months. No recurrence was observed during follow-up.Conclusion:Ventralex™ ST hernia patch is a safe prosthetic material that can be applied by open surgical technique with low complication and recurrence rates, especially in small and medium-sized umbilical, epigastric and trocar site hernias.Keywords:Ventral hernia, umbilical hernia, Ventralex™ hernia patc

Subkostal Kesi Fıtığı Onarımında Yama Sabitlemede Sütür Kullanımı: Olgu Sunumu

Kesi fıtıklarında laparoskopi sıklıkla kullanılmaktadır. Zımba atıcılar sayesinde yama sabitleme oldukça kolaylaşmıştır fakat bu aletlerin subkostal bölgede etkinliği azalmaktadır. Transfasyal dikişler, zımba atıcılar için açısı zor ve riskli bölgelerde alternatif olarak kullanılabilirler

Amyand Herniye Eşlik Eden Komplike Akut Apandisit Vakası

Amyand's hernia is a very rare form of hernia in the inguinal hernia sac. Presently described is a case of Amyand's hernia complicated by acute appendicitis. A 62-year-old male patient presented at the emergency department with complaints of pain in the right inguinal region. He had acute appendicitis in the right inguinal hernia. An appendectomy was performed. Due to the high risk of infection, a mesh application was avoided. The patient was discharged on the rst postoperative day. The incidence of Amyand's hernia accompanied by acute appendicitis is quite low. The current literature generally does not recommended an Amyand's hernia mesh repair with a la- paroscopic appendectomy in the presence of acute appendicitis. In this case, the appendectomy was completed laparoscopically and the hernia sac was repaired intraperitoneally with primary suturing

Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection.As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously.Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach

Pancreatitis due to the total displacement of intragastric balloon to duodenum

Intragastric balloon (IGB) application in obesity treatment is an easily applied non-surgical method which has an effective weight loss potential. However, with increasing use in recent years, life-threatening complications have been reported in the literature. In addition to gastric perforation and intestinal obstruction due to serious complications, it has recently started to take its place in the literature. Thirteen cases of pancreatatitis due to IGB administration have been reported so far.In this study, a patient with morbid obese patient, acute abdominal pain and vomiting, who had intragastric balloon application five months ago, was evaluated.Biochemical and radiological work-up revealed total migration of the balloon to duodenum and acute pancreatitis due to compression effect