Urgent Abdominal Re-Explorations

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality. METHODS: Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s) performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. RESULTS: Early UAR was performed in 81 out of 4410 cases (1.8%). Average patient age was 50.46 (13–81) years with a male-to-female ratio of 60/21. Fifty one (62.96%) patients had infection, 41 (50.61%) of them had an accompanying serious disease, 24 (29.62%) of them had various tumors and 57 (70.37%) patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%); hemorrhage (n:15; 18.51%); intestinal perforation (n:8; 9.87%); intraabdominal infection or abscess (n:8; 9.87%); progressive intestinal necrosis (n:7; 8.64%); stomal complications (n:5; 6.17%); and postoperative ileus (n:4; 4.93%). Two or more UARs were performed in 18 (22.22%) cases, and overall mortality was 34.97% (n:30). Interval between the first laparotomy and UAR averaged as 6.95 (1–20) days, and average hospitalization period was 27.1 (3–78) days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5%) cause of mortality was sepsis/multiple organ failure (MOF). The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were significantly higher in patients who received GIS surgery than in those who received other types of surgeries (p:0.000 and 0.010, respectively). CONCLUSION: UARs that are performed following complicated abdominal surgeries have high mortality rates. In particular, UARs have higher mortality rates following GIS surgeries or when infectious complications occur. The possibility of efficiently lowering these high rates depends on the success of the first operations that the patient had received

Extra-Gastrointestinal Stromal Tumor of Prostate

Background: Extra-gastrointestinal stromal tumor is defined as a mesenchymal neoplasm arising from soft tissues outside the gastrointestinal tract. Prostatic extra-gastrointestinal stromal tumor has rarely been noted. Case Report: A 56 year-old man presented with pain in the anal region. A digital rectal examination revealed that the prostate was markedly enlarged with a smooth, bulging surface. Computerized tomography images showed a 6 cm heterogeneous, infiltrative tumor within the prostate gland extending to the trigon of the bladder, left seminal vesicle and rectum. The tru-cut biopsy of the prostate was reported as leiomyoma. It was decided to perform surgery and the masses were easily and completely removed from the adjacent structures. The case was reported as extra-gastrointestinal stromal tumor within the intermediate- risk category with free surgical margins. Four years after the surgery, a locoregional failure was observed and treated with imatinib. Conclusion: Stromal tumor, although rare, should be considered in the differential diagnosis in patients with an enlarged prostat

Coincidence of right adrenal vein and retroaortic left renal vein variations in a patient undergoing laparoscopic adrenalectomy

In this case, we report an interesting right adrenal vein variation with renovascular variations discovered during the laparoscopic right adrenalectomy. A Sixth eightyear-old woman was referred for treatment of a right adrenal mass. Computed tomography sections revealed 3x4.5x3.5 cm well defined right adrenal mass and retroaortic left renal vein. Conventional laparoscopic transabdominal approach was scheduled. During the laparoscopic exploration It was noted that there was no vein drainage from adrenal gland to the inferior vena cava. As this dissection completed, right adrenal vein was exposed arisen from accessory right hepatic vein. In some reports ıt has been reported that adrenal vein variations can be associated with retroaortic left renal vein, but the right adrenal vein joined with an accessory right hepatic vein and retroaortic left renal vein combination is extremely uncommon condition

Sigmoid Colon Fistula due to Mesh Infection in a Patient Operated for Incarcerated Groin Hernia with Transabdominal Pre-Peritoneal (TAPP) Technique

Although laparoscopic surgery is an accepted procedure in elective inguinal hernia repair, it is controversial for incarcerated hernias. Persistent infections due to inflammation of mesh; visceral tissue erosion and migration of mesh are rare but possible complications. In this manuscript, we report a case of laparoscopic hernia repair with transabdominal preperitoneal technique complicated with both these complications and discuss with literature. [Cukurova Med J 2015; 40(Suppl 1): 122-126

Our Surgical Experience in Desmoid Tumors

BackgroundDesmoid tumour (DT) is a locally aggressive soft tissue tumour which is histologically characterized by fibroblastic proliferation in collagen matrix. They may originate from almost any location, mainly from limbs, abdominal wall and abdominal cavity, and occur more frequently in women of childbearing age.AimsRadical resection is generally considered as the most appropriate treatment for patients with desmoid tumours. Alternative methods of treatment are available for patients with unresectable. Methods Nine patients who had DT pathology between January 2008 and January 2013 in İzmir Katip Çelebi University Atatürk Training and Research Hospital, General Surgery Clinic were included in the study.Results The mean age of the nine patients (three males and six females) was 40.1. Two patients (one male and one female) had been diagnosed with familial adenomatous polyposis (FAP), accompanied by Gardner’s syndrome (GS). Among the desmoid tumours, five (55.6 per cent) were intra-abdominally located, two (22.2 per cent) were located in the anterior abdominal wall, one (11.1 per cent) in limbs, and one (11.1 per cent) in breast.ConclusionSurgical resection in which a sufficient amount of surrounding healthy tissue is removed together with the tumour provides an effective treatment. We believe that, for those tumours which cannot be resected or incompletely resected, addition of Tamoxifen to the therapy will provide favourable results for regression

Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection

Objectives: Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival