Türkiye’de stoma açılan hastaların kesitsel değerlendirilmesi

Aim: Despite recent technological developments, a stoma formation is needed for the treatment of many diseases, especially in colorectal surgery. Due to the radical principles of cancer treatment, the number of patients living with stoma is increasing. However, there is no study that quantitatively evaluates the stoma patients nationally. In this study, it was aimed to retrospectively evaluate the demographic data, indications, preferred types of stoma and the outcomes of patients who had a stoma formation in our country in the last three years. Method: In our country, there are 3 companies that operate in the field, provide materials for 95% of stoma patients. The data of patients who had a stoma between 2017 and 2019 were collected from these companies retrospectively by protecting personal privacy of patients. The distribution of indications and type of stoma acording to indications were determined. Average age, stoma closure rates and mortality rates were calculated. All data are presented as numbers and percentages and categorical variables are shown as median (minimum-maximum), continuous variables are shown as ± standard deviation. Results: The most common indication for stoma creation was colorectal malignancy (58.4%) and followed by mechanical bowel obstructions (29.6%). Other malignancies (4.16%), inflammatory causes (4.58%), traumatic causes (1.88%) and congenital anomalies (1.17%) constituted a total of 11% stoma indications. It was observed that. ostomies opened due to colorectal malignancy,were closed in 40% of patients with loop ileostomy, 30.1% of patients with loop colostomy, and only 13% of patients with end colostomy. Conclusion: We aimed to obtain a national perspective by evaluating the patients who had a stoma in the last 3 years and to show up the distribution of stoma formation indications in our country. We have determined the demographic data of patients with stoma and calculated the stoma closure and mortality rates according to stoma types. Although this study is a cross-sectional evaluation of patients in the whole country, weak point of our study is there are deficiencies in our evaluation due to the lack of retrospective data. We think that prospective studies should be planned by detailing subgroups.Amaç: Ülkemizde stomalı bireyleri niceliksel olarak inceleyen çalışma henüz bulunmamaktadır. Bu çalışmada ülkemizde son üç yıl içinde stoma açılmış olan hastaların demografik verilerinin, endikasyonlarının, tercih edilen stoma tiplerinin ve hastaların akıbetlerinin retrospektif olarak değerlendirilmesi amaçlanmıştır. Yöntem: Ülkemizde stoma alanında faaliyet göstermekte olan ve stoma hastalarının stoma malzemelerini sağlayan 3 firmanın 2017-2019 yılları arasında, malzeme temin ettiği stoma hastalarının bilgileri, kişisel verilerin gizliliği kurallarına dikkat edilerek retrospektif olarak derlenmiştir. Endikasyona göre hastalara hangi tip stoma açıldığı, bu hastaların cinsiyete göre dağılımı (minimum-maksimum), yaş ortalamaları, stoma kapatılma oranları, ölüm oranları hesaplanmıştır. Bulgular: En sık stoma oluşturma endikasyonunun kolorektal malignite olduğu ve tüm stomaların %58,4’ünü oluşturduğu görüldü. Bunu mekanik barsak tıkanıklıkları (%29,6) takip etmekte idi. Diğer maligniteler (%4,16), enflamatuvar sebepler (%4,58), travmatik sebepler (%1,88) ve doğumsalanomaliler (%1,17) toplamda yaklaşık %11 oranında stoma açılmasına endikasyon oluşturmaktaydı. Kolorektal malignite nedeni ile açılan stomalar değerlendirildiğinde loop ileostomi uygulanan hastların %40’ının, loop kolostomi uygulanan hastaların %30,1’inin stoması kapatılabilmişken, uç kolostomi uygulanan hastaların sadece %13’ünün stomasının kapatıldığı görülmüştür. Sonuç: Ülkemizde son 3 yıl içinde stoma açılmış olan hastaları değerlendirerek ulusal anlamda geniş bir perspektif elde etmeyi amaçladık. Stoma ile yaşamak durumunda olan hastaların demografik verilerini, kaçının stomasının kapatılabildiğini ve stoma tiplerine göre stoma kapatılma ve ölüm oranlarını tespit ettik. Stomalı bireylerin analizini gerçekleştirdiğimiz bu çalışma, ulusal anlamda gerçekleştirilen ilk çalışma olmasına rağmen, retrospektif verilerdeki eksiklikler nedeni ile değerlendirmemizde yetersizlikler mevcuttur. Alt grupların detaylandırılarak, prospektif özellikte çalışmaların planlanması gerektiğini düşünüyoruz

Effects of abdominal and vaginal hysterectomy on anorectal functions along with quality of life of the patient

Objectives and background: Hysterectomy is the most commonly performed major gynecological operation for both benign and malign gynecologic conditions. After hysterectomy, although some investigators have declared an increased incidence of urinary and anorectal dysfunction, some others could not show any connection. Methods: The voluntary patients were divided in two groups: abdominal hysterectomy (Group 1) and vaginal hysterectomy (Group 2). Anal manometry and all the other examinations of the patients were performed at the Department of General Surgery Endoscopy Unit of Ankara University, Faculty of Medicine. Results: When the quality of life of the patients was assessed before the operation and on the 12th post-operative month via the SF-36 form; it can be seen that body pain parameters of the patients in Group 1 had significantly improved and there is no statistical difference in other parameters. When the effect of hysterectomy on the quality of life of the patients was evaluated by the \u201cCleveland Clinic Global Quality of Life\u201d form, the statistically significant improvement in the quality of life of the patients in Group 2 was observed. Conclusion: If the type of operation (vaginal or abdominal) is performed due to benign causes, it does not affect the urinary and anorectal functions of the patients. Depending on the decrease of complaints of the patients, it has a positive effect on the quality of life

Türk kolon ve rektum cerrahisi derneği (TKRCD) terminoloji komisyonu çalışma raporu

This study aimed to explain the working order of the Terminology Commission, which was established at the workshop of the Turkish Society of Colon and Rectal Surgery (TKRCD) on February 22, 2020, the criteria and results in the preparation of the terminology report. The commission prepared a work plan to complete in three main steps. The working process continued in a way that the members expressed their opinions with equal rights and the decisions were taken by consensus or by majority vote. The main purpose of the commission study was determined as “determining the terms that need to be explained and agreed in colorectal surgery, and to define them in a way that is compatible with the literature and contributes to daily practice”. The first meeting of the commission was held on February 22, 2020, and the report was accepted by the TKRCD Board of Directors on May 25, 2021. A total of 20 meetings were held during this period. In the first step, five headings were determined for writing the terms: Anatomy, symptoms and diagnostic tools, diseases, treatments and complications. There was a consensus that the terms met the following three conditions: 1) the need for explanation and consensus in colorectal surgery, 2) literature support, and 3) use in daily practice. The terms were written in the following format: Terms and synonyms, English equivalents, definition, explanation and bibliography. In the second step, each commissioner wrote an average of 10.8±4.3 terms. The distribution of 89 terms in the final report was as follows: Anatomy (n=26, 29.2%), symptoms and diagnostic tools (n=8, 8.9%), diseases (n=20, 22.4%), treatments (n=28, 31.4%), and complications (n=7, 7.8%). Figures (n=7), all from the archives of the commission members, and figures drawn by a new commission member (n=53) were also added to the report. In the third step, the report was submitted to the TKRCD Management with the approval of the TKRCD President. The preparation process of the Terminology Commission report of TKRCD was presented. The final report is open to changes and expansions with future studies.Bu çalışma Türk Kolon ve Rektum Cerrahisi Derneği’nin (TKRCD) 22 Şubat 2020 tarihinde yaptığı çalıştayda kurulan Terminoloji Komisyonu’nun çalışma düzenini, terminoloji raporunun hazırlanmasındaki kriterleri ve sonuçlarını açıklamayı amaçlamaktadır. Komisyon üç ana basamakta tamamlayacak iş planı hazırlamıştır. Çalışma süreci üyelerin eşit haklarla görüş belirttiği ve kararların uzlaşı veya oy çokluğuyla alındığı bir şekilde sürdürülmüştür. Komisyon çalışmasının temel amacı “kolorektal cerrahide açıklanması ve uzlaşı sağlanması gerekli terimlerin belirlenmesi, literatüre uygun ve günlük pratiğe katkı sağlayacak bir şekilde tanımlanması” olarak saptanmıştır. Komisyon ilk toplantısı 22 Şubat 2020’de yapılmış, rapor ise TKRCD Yönetim Kurulu’nda 25 Mayıs 2021’de kabul edilmiştir. Bu dönemde toplam 20 toplantı yapılmıştır. İlk basamakta terimlerin yazılması için beş adet üst başlık belirlenmiştir: anatomi, semptomlar ve tanı gereçleri, hastalıklar, tedaviler ve komplikasyonlar. Terimlerin şu üç şartı sağlaması konusunda karar birliği oluşmuştur: 1) kolorektal cerrahide açıklanması ve uzlaşı sağlanması gerekliliği, 2) literatür desteği ve 3) günlük pratikte kullanılması. Terimler şu formatta yazılmıştır: terim ve eş anlamlıları, İngilizce karşılıkları, tanım, açıklama ve kaynakça. İkinci basamakta her bir komisyon üyesi ortalama 10,8±4,3 terim yazmıştır. Sonuç raporunda yer alan 89 terimin üst başlıklara dağılımı şu şekildedir: anatomi (n=26, %29,2), semptomlar ve tanı gereçleri (n=8, %8,9), hastalıklar (n=20, %22,4), tedaviler (n=28, %31,4) ve komplikasyonlar (n=7, %7,8). Tamamı komisyon üyelerinin arşivlerinden gelen resimler (n=7) ve yeni bir komisyon üyesi tarafından çizilen şekiller de (n=53) rapora eklenmiştir. Üçüncü basamakta rapor TKRCD Başkanının onayıyla TKRCD Yönetimi’ne sunulmuştur. TKRCD’nin Terminoloji Komisyonu raporunun hazırlık süreci sunulmuştur. Sonuç raporu ileride yapılacak çalışmalarla değişiklik ve genişletmelere açıktır

Sigmoid volvulus: long-term clinical outcome and review of the literature

Objective. Little has been published regarding long-term surgical outcome after the initial management of acute sigmoid colon volvulus. Methods. Patients undergoing primary resection and anastomosis (PRA) or Hartmann's procedure (HP) for sigmoid volvulus between September 1992 and August 2000 were reviewed. Eligible patients who had had the initial procedure at least 5 years previously were contacted and completed a questionnaire regarding recurrence, current symptoms and bowel habits. Results. Data on 42 PRA patients and 36 HP patients were analysed. Follow-up (mean 7.2 years, range 5 - 11 years) was completed for 63 patients (37 PRA, 26 HP). Restoration of bowel continuity was successfully performed in 25 of 26 HP patients. No patient had megacolon. Constipation was reported by 83% of PRA and 65% of HP patients. Of these patients, 51% regularly used laxatives. No patient complained of incontinence, and no recurrences of sigmoid volvulus were recorded during the follow-up period. Conclusion. Sigmoidectomy with primary anastomosis is a good option for the definitive management of sigmoid volvulus. Despite the high constipation rate, no recurrence occurred during long-term follow-up

Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, 'report of a case'

Pilonidal sinus (PS) is an acquired disease at the sacrococcygeal region that can be treated by different surgical techniques. Crystallised phenol application seems to be an alternative therapy to surgery with higher success rates, lower costs, faster recovery and earlier return to work. We aimed to state the success of phenol application for PS in adolescence. A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised. All patients underwent phenol application in an outpatient setting. The patients were followed thereafter. The 14-year-old boy and 18-year-old girl did not face any problems and all sinuses healed completely. The 15-year-old girl was followed for 2 weeks because of intergluteal maceration and ongoing drainage. She underwent another phenol application and the course after intervention was uneventful with complete healing of the sinus. Crystallised phenol application seems to be a promising non-operative therapy for PS in adolescents. Copyright 2013 BMJ Publishing Group. All rights reserved

Enteral glutamine pretreatment does not decrease plasma endotoxin level induced by ischemia-reperfusion injury in rats

AIM: To investigate whether oral glutamine pretreatment prevents impairment of intestinal mucosal integrity during ischemia-reperfusion (I/R) in rats

The effectiveness of two different treatment approaches in individuals with chronic non-specific neck pain: a randomized control trial

Abstract The aim of this study is to examine the effectiveness of conventional treatment and mobilization exercises in individuals with chronic nonspecific neck pain (CNNP). A total of 28 patients enrolled in the study. The Mobilization group (MG) completed a 4-week combined conservative physiotherapy and cervical mobilization program, whereas the control group (CG) received only the 4 weeks of conservative physiotherapy. Pain severity according to the Visual Analogue Scale (VAS) was used as primary outcome. Secondary outcomes were included the Bourdon Attention Test (BAT), Beck Anxsiety Scale (BAS), range of motion (ROM), muscle strength. All outcomes were assessed both prior to and following the treatment. In 2-way mixed-design repeated-measures ANOVA analysis, when the change in time was analyzed between the groups (Group*Time [interaction]), a statistical difference was found for the VAS (p = .000, ηp2 = .007), BAT score ( p = .001, ηp2 = .082), BAS ( p= .000, ηp2 = .001), ROM flexion (p= .000, ηp2 = .104), ROM extansion (p= .000, ηp2 = .076), ROM right rotation (p= .006, ηp2 = .033), ROM left rotation (p= .05, ηp2 = .006), ROM right lateral flexion (p= .000, ηp2 = .060), ROM left lateral flexion (p= .002, ηp2 = .019), muscle strength flexion (p= .000, ηp2 = .008), muscle strength extansion (p= .000, ηp2 = .019), muscle strength right rotation (p= .000, ηp2 = .012), muscle strength left rotation (p= .000, ηp2 = .001), muscle strength right lateral flexion (p= .000, ηp2 = .001) and muscle strength left lateral flexion (p= .000, ηp2 = .011) parameters in favour of MG. Cervical mobilization produced a significant benefit to recovery of pain, ROM, muscle strength, attention and anxiety outcomes of patients with CNNP when added to a conventional CNNP physical therapy program. Keywords: Chronic non-specific neck pain, cervical mobilization, pain The study was registered on the Clinical Trials Registry (registration number: NCT05377645