An alternative anterior tension free preperitoneal patch technique by help of the endoscope for femoral hernia repair

AbstractBackgroundFemoral hernias are relatively uncommon and have a higher risk for strangulation and incarceration. We introduce an alternative anterior tension free inlay patch technique by help of the endoscope for femoral hernia repair.MethodCharacteristics of patients undergoing femoral hernia repair between March 2006–April 2011 and description of the surgical technique is presented.ResultsWe analyzed our experience with this technique in 26 consecutive patients with femoral hernias (1 bilateral, 15 right, 10 left femoral hernia) in 5 year period. Seven of these 26 femoral hernias were recurrent and 2 of them were concomitant with inguinal hernia. Mean operation time was 30.0 ± 12.1 min. Seroma was seen in 2 patients at postoperative 1st week. There were no; hematoma, wound infection and separation of wound edges and early recurrence at postoperative 1st week and 1st month. The mean follow up period was 41.8 ± 18.2 months. All of 22 patients who were contacted were satisfied with the operation. There was no recurrence, chronic pain and foreign body feeling in any patient at the end of the follow-up period.ConclusionThis feasible and safe alternative anterior inlay patch repair might be used in all femoral hernias with the exception of the ones requiring intestinal resection

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report

AbstractINTRODUCTIONTo present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS.PRESENTATION OF CASETwenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up.DISCUSSIONManagement of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period.CONCLUSIONCombination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula

Duodenumda Tubulovillöz Adenom: Olgu Sunumu

İnce barsak tümörleri, gastrointestinal sistemin diğer tümörlerine göre oldukça nadirdir.İnce barsağın malign ve bening tümörleri sıklıkla duodenum yerleşimlidir. İnce barsağın en sık görülen malignitesi adenokarsinomlardır. Benign ince barsak tümorleri de nadir olup, adenomları genellikle duodenum 2. kıta yerleşimlidir. Villöz adenomlarda malign transformasyon olası- lığı daha yuksektir. Burada dispepsi ve kilo kaybı etyolojisinin araştırılması sıra sında saptanmış olan ve endoskopik yöntemle tedavi edilen, periampuller yerleşlimli tübülovillöz adenom olgusu sunulmaktadır

Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation

Introduction: We show the management of a delayed jejunal perforation, after irreducible femoral hernia operation with the help of negative pressure therapy (NPT) and delayed abdominal closure (DAC) with skin flap approximation in an elderly woman for the first time in the literature. Presentation of case: A 76 year-old woman was admitted to the emergency department with irreducible femoral hernia and ileus. After examining the femoral hernia sac and noting the presence of viable intestine within the hernia sac, a femoral hernia repair with mesh was performed. At postoperative day 1 she started to defecate and oral intake was started. The patient was discharged on postoperative day 3. On postoperative day 8, she was re-admitted to the emergency department with septic shock. The patient underwent reoperation. Septic abdomen and delayed perforation from strangulated part of the jejunum were seen. A jejunostomy was opened and patient was treated with open abdomen management and delayed abdominal closure with skin flap. The ostomy was closed 4 months later. Discussion: The exact mechanism of delayed presentation of small bowel perforation remains controversial. Delayed intestinal perforation has rarely been reported after blunt abdominal trauma (BAT), conductive burn injuries of the bowel with cautery, or necrosis of strangulated bowel in a hernia sac. Open abdomen (OA) management is a life-saving and challenging strategy in severe generalized peritonitis. Conclusion: Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient

The Effect of Lagenaria Siceraria Molina on Acute Lung Injury Induced by Oleic Acid in Rats

Oleic acid has been used to induce acute lung injury in experimental studies. Lagenaria siceraria (Molina) has been reported to have cardiotonic, hepatoprotective, immunomodulatory,antihyperglycemic, antihyperlipidemic, analgesic and anti-inflammatory properties. In this study, we investigated the effects of Lagenaria siceraria (LS) fruit juice on acute lung injury induced by oleic acid in rats. Thirty five adult female Sprague Dawley rats divided into 5 groups, 7 in each. Group I and group II received normal saline for 30 days, group III, IV and group V received LS at a dose of 200 mg/kg, 200 mg/kg and 400 mg/kg for 30 days by gavage respectively. 100mg/kg oleic acid was administered i.v in group II, group IV and group V. Histopathological examination of the lung was performed with light and electron microscopy. Levels of protein carbonyl, malondialdehyde, superoxide dismutase, catalase and glutathione peroxidase levels were measured in tissue samples. Levels of TNF alpha, IL10, IL6 and total tissue oxidant status and total tissue antioxidant status were measured in serum samples.&nbsp; Light microscopy showed that LS at both doses decreased the total lung injury score compared to group II. In electron microscopy, LS at both doses decreased the thickness of the fused basal lamina when compared to group II. TNF&alpha;, IL6 in serum and MDA in tissue were higher in group II when compared to group me and attenuated in group V&nbsp; ignificantly.&nbsp;Lagenaria siceraria attenuated the extent of acute lung injury induced by oleic acid in rats.</p

Management of Recurrent Rectourethral Fistula by York Mason Posterior Transrectal Transsphincteric Approach

Rectourethral fistula (RUF) may develop after ureterovesical and rectal intervention or radiation therapy (RT) rarely, but it is associated with significant morbidity and mortality. The patient will typically present with pneumaturia, faecaluria, and urinary drainage from the rectum. Diagnosis can be easily done with digital rectal examination, cystography, and urethrocystoscopy. Conservative supportive management of RUF does not appear to be successful in most patients, and management with surgical intervention remains the best treatment option. Several surgical techniques have been described including transabdominal, transanal, transperineal, combined abdominoperineal, anterior and posterior transsphincteric, transsacral, laparoscopic, robotic, and endoscopic minimally invasive approaches. There have been very few data about treatment of recurrent RUF. We would like to report the management of recurrent RUF following transurethral resection of prostate and RT for prostate carcinoma in an immunosuppressed, 75-year-old patient by York Mason posterior transrectal transsphincteric approach

Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely

Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely