ÖZET N.ilioinguinalis'e uygun şekilde anestezi yapılması ve sinirin anatomik lokalizasyonunun bil... more ÖZET N.ilioinguinalis'e uygun şekilde anestezi yapılması ve sinirin anatomik lokalizasyonunun bilinmesi herni tamirlerinde ve diğer cerrahi girişimlerde önemlidir. Çalışmanın amacı, n.ilioinguinalis'in anatomik varyasyonlarını ortaya çıkarmak ve seyrini ortaya koymaktır. Çalışmada, 17 adet formalinle fikse kadavra disseke edildi. N.ilioinguinalis bir olguda yoktu ve bir olguda hem sağda, hem solda çift olarak bulundu. Sinirin ligamentum inguinale, canalis inguinalis'in duvarları ve içeriği ile olan ilişkisi analiz edildi. N.ilioinguinalis'in proksimal ucu spina iliaca anterior superior'un ortalama 3.5 cm altında ve 2.96 cm mediyalinde abdominal duvara giriyordu. N.ilioinguinalis, m.obliquus internus abdominis'in yüzeyelinde seyrediyor ve ligamentum inguinale'nin 0.95 cm üzerinden geçiyordu. Sonra sinir linea alba'nın 2.4 cm lateralinde, symphysis pubica'nın 1.5 cm üstünde lineer bir seyirle sonlanıyordu. Spina iliaca anterior superior'un alt seviyesi abdominal duvar cerrahi girişimlerinin yapıldığı bölgedir, dolayısıyla bu bölge n.ilioinguinalis yaralanması için potansiyel alandır.
Mesenteric cystic lymphangiomas (MCLs) are rare benign tumours of abdomen and it is usually diagn... more Mesenteric cystic lymphangiomas (MCLs) are rare benign tumours of abdomen and it is usually diagnosed in pediatric patients. It is very rare that an adult presents with cystic mesenteric lymphangioma. A 29-year-old man presented with ongoing abdominal pain, nausea and vomitting. On physical examination, there was distension on whole abdomen, but no palpable mass was detected. Computed tomography showed that there was a huge cystic mass, with the size of 22x20 cm, originating from ileal mesentery and the cystic mass was extanding till pelvis. Cystic mass was resected with the adjacent, approximately 25 cm, ileal segment. Histopathologic examination revealed the cystic lymphangioma of the mesentery. The clinical presentation is diverse, ranging from an incidentally discovered, asymptomatic abdominal cyst to life-threatening abdominal catastrophes. Preoperatif diagnosis is often impossible, since it has not a characterictic clinic presentation and radiologic imaging. Prognosis is perfe...
Wegener granülomatozisi üst ve alt solunum sisteminde nekrotizan granülomatöz lezyonlara ve glome... more Wegener granülomatozisi üst ve alt solunum sisteminde nekrotizan granülomatöz lezyonlara ve glomerülonefrite neden olan bir vaskülit çeşididir. Gastrointestinal sistem de dâhil olmak üzere diğer pek çok doku ve organ sisteminde de vaskülit gözlenebilmektedir. Ancak, Wegener Granülomatozisi'nde gastrointestinal tutulum oldukça nadirdir. Bu vaka sunumunda birden fazla intestinal perforasyon tanısı alan Wegener granülomatozisli bir olgu sunulmuştur.
To compare 2 laparoscopic appendectomy techniques. We describe a modified technique, the handmade... more To compare 2 laparoscopic appendectomy techniques. We describe a modified technique, the handmade endoloop technique, for closing the base of the appendix. This prospective study was carried out at Harran University Medical Faculty, Sanliurfa, and Gulhane Military Medical Academy, Ankara, Turkey from September 2006 to February 2008. We evaluated the safety and efficacy of the procedure in 98 acute appendicitis cases: 57 patients handmade endoloop patients, and 41 endoloop technique patients. Operative time, postoperative complications, need for analgesics, and procedure cost were measured for both groups. The endoloops and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by appropriate test. The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups. This procedure is simple, safe, and cheap.
Anastomotic healing can deteriorate because of different local and systemic effects in cases of c... more Anastomotic healing can deteriorate because of different local and systemic effects in cases of concomitant left colon and liver injuries. We evaluated the effects of portal triad occlusion (PTO) on bowel anastomosis after concomitant segmental left colonic resections achieved in rats. There were three separate groups of animals; each consisted of 20 Sprague-Dawley male rats weighing 250 +/- 20 g. In group I, left colonic segmental resection 1 cm in diameter and anastomosis were performed as controls. In group II, the same surgical procedure was done after 15 minutes of PTO followed by 30 minutes of reperfusion. In group III, PTO time was held at 30 minutes. The rats were killed at days 4 and 7 to evaluate anastomotic healing, histological changes, bursting pressures, and serum levels of malondialdehyde (MDA) and hydroxyproline. In group II, the bursting pressures of anastomosis on days 4 and 7 were similar to group I; these pressures were significantly lower in group III (P < 0....
Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complica... more Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complication of hydatid disease. Optimal management of cases is crucially important in establishing rapid recovery and avoiding additional complications. The use of an algorithmic guide is essential because of an ongoing dilemma that involves a large variety of therapeutic options. We present four patients with bronchobiliary fistulas caused by liver hydatid disease to discuss the management of therapeutic options through a case-based approach and an extent review to finally generate an algorithm. In this series, two patients were treated surgically, and the remaining were treated with conservative methods. To date, they have developed neither recurrence nor need for additional intervention. Although treatment of bronchobiliary fistulas is traditionally thought to be surgical, most of the less severe cases can be treated nonoperatively. Making an accurate selection among less invasive methods an...
Introduction: We compare the postoperative early and late complications of patients who had under... more Introduction: We compare the postoperative early and late complications of patients who had undergone ileal conduit (IC) urinary diversion and transureteroureterostomy (TUU) with ureterocutaneostomy (UC) urinary diversion during the same interval and by the same surgeons. Materials and Methods: Between 1992 and 2004, we performed TUU with UC urinary diversion in 27 men and 7 women (group I) and ileal conduit urinary diversion in 57 men and 10 women (group II). The mean age of the TUU with UC diversion and the ileal conduit patients was 57 ± 11.2 (range 51–76) and 64 ± 12.6 (range 54–76) years, and the mean follow-up was 37 (range 14–52) and 56 (range 14–72) months, respectively. The 6F or 8F stents were used routinely. Results: Of 34 TUU with UC cases 8 (23.52%) had early postoperative complications and 2 (5.88%) had early reoperation rates, whereas 11 (16.42%) of 67 ileal conduit cases had early postoperative complications and 4 (5.97%) had early reoperation. The mean hospital stay...
Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an ope... more Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an open abdomen, present serious problems for the surgeon. There are no fixed algorithms for treatment of EAF, and treatment options are determined based on the experience of the surgeon and status of the patient. We developed a ‘suspended silicone fistula plug’ for treating a patient who developed an EAF after undergoing multiple operations in a short period of time. Used in conjunction with negative pressure wound therapy, application of this novel therapy resulted in EAF closure and patient discharge.
ABSTRACT Summary BACKGROUND: Neuroma of the extrahepatic biliary tract is an uncommon benign tumo... more ABSTRACT Summary BACKGROUND: Neuroma of the extrahepatic biliary tract is an uncommon benign tumour that most frequently arises from the cystic duct stump after cholecystectomy and is a rare cause of postcholecystectomy symptoms. METHODS: We present two cases of extrahepatic bile duct neuroma 6 and 25 years after cholecystectomy and discuss diagnosis and management of this rare clinical condition. RESULTS: A 63-year-old and a 67-year-old woman were admitted to the hospital with history of gradual onset of right upper quadrant pain radiating to right scapula and epigastric area, 6 and 25 years after cholecystectomy, respectively. Routine laboratory and diagnostic studies were all normal in one patient, while a 1 by 1 cm mass on choledocal wall was diagnosed in the other. Diagnostic laparotomy was performed and a firm nodular mass, localized on cystic duct stump, was detected in both patients. Histopathologic examination confirmed amputation neuroma of the cystic duct remnant. CONCLUSIONS: Amputation neuroma is an unusual cause of benign stricture of the biliary tract that may produce a diagnostic challenge.
AIM: To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid d... more AIM: To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid disease of the liver. METHODS: Between January 2000 and December 2010, out of 301 patients with a diagnosis of hydatid cyst of the liver, 282 patients who underwent treatment [either surgery or puncture, aspiration, injection and reaspiration (PAIR) procedure] were analysed. Patients were grouped according to the presence or absence of postoperative biliary fistula (PBF) (PBF vs no-PBF groups, respectively). Preoperative clinical, radiological and laboratory characteristics, operative characteristics including type of surgery, peroperative detection of BF, postoperative drain output, morbidity, mortality and length of hospital stays of patients were compared amongst groups. Multivariate analysis was performed to detect factors predictive of PBF. Receiver operative characteristics (ROC) curve analysis were used to determine ideal cutoff values for those variables found to be significant. A comparison was also made between patients whose fistula closed spontaneously (CS) and those with intervention in order to find predictive factors associated with spontaneous closure. RESULTS: Among 282 patients [median (range) age, 23 (16-78) years; 77.0% male]; 210 (74.5%) were treated with conservative surgery, 33 (11.7%) radical surgery and 39 (13.8%) underwent percutaneous drainage with PAIR procedure A PBF developed in 46 (16.3%) patients, all within 5 d after operation. The maximum cyst diameter and preoperative alkaline phosphatase levels (U/L) were significantly higher in the PBF group than in the no-PBF group [10.5 ± 3.7 U/L vs 8.4 ± 3.5 U/L (P < 0.001) and 40.0 ± 235.1 U/L vs 190.0 ± 167.3 U/L (P = 0.02), respectively]. Hospitalization time was also significantly longer in the PBF group than in the no-PBF group [37.4 ± 18.0 d vs 22.4 ± 17.9 d (P <
ÖZET N.ilioinguinalis'e uygun şekilde anestezi yapılması ve sinirin anatomik lokalizasyonunun bil... more ÖZET N.ilioinguinalis'e uygun şekilde anestezi yapılması ve sinirin anatomik lokalizasyonunun bilinmesi herni tamirlerinde ve diğer cerrahi girişimlerde önemlidir. Çalışmanın amacı, n.ilioinguinalis'in anatomik varyasyonlarını ortaya çıkarmak ve seyrini ortaya koymaktır. Çalışmada, 17 adet formalinle fikse kadavra disseke edildi. N.ilioinguinalis bir olguda yoktu ve bir olguda hem sağda, hem solda çift olarak bulundu. Sinirin ligamentum inguinale, canalis inguinalis'in duvarları ve içeriği ile olan ilişkisi analiz edildi. N.ilioinguinalis'in proksimal ucu spina iliaca anterior superior'un ortalama 3.5 cm altında ve 2.96 cm mediyalinde abdominal duvara giriyordu. N.ilioinguinalis, m.obliquus internus abdominis'in yüzeyelinde seyrediyor ve ligamentum inguinale'nin 0.95 cm üzerinden geçiyordu. Sonra sinir linea alba'nın 2.4 cm lateralinde, symphysis pubica'nın 1.5 cm üstünde lineer bir seyirle sonlanıyordu. Spina iliaca anterior superior'un alt seviyesi abdominal duvar cerrahi girişimlerinin yapıldığı bölgedir, dolayısıyla bu bölge n.ilioinguinalis yaralanması için potansiyel alandır.
Mesenteric cystic lymphangiomas (MCLs) are rare benign tumours of abdomen and it is usually diagn... more Mesenteric cystic lymphangiomas (MCLs) are rare benign tumours of abdomen and it is usually diagnosed in pediatric patients. It is very rare that an adult presents with cystic mesenteric lymphangioma. A 29-year-old man presented with ongoing abdominal pain, nausea and vomitting. On physical examination, there was distension on whole abdomen, but no palpable mass was detected. Computed tomography showed that there was a huge cystic mass, with the size of 22x20 cm, originating from ileal mesentery and the cystic mass was extanding till pelvis. Cystic mass was resected with the adjacent, approximately 25 cm, ileal segment. Histopathologic examination revealed the cystic lymphangioma of the mesentery. The clinical presentation is diverse, ranging from an incidentally discovered, asymptomatic abdominal cyst to life-threatening abdominal catastrophes. Preoperatif diagnosis is often impossible, since it has not a characterictic clinic presentation and radiologic imaging. Prognosis is perfe...
Wegener granülomatozisi üst ve alt solunum sisteminde nekrotizan granülomatöz lezyonlara ve glome... more Wegener granülomatozisi üst ve alt solunum sisteminde nekrotizan granülomatöz lezyonlara ve glomerülonefrite neden olan bir vaskülit çeşididir. Gastrointestinal sistem de dâhil olmak üzere diğer pek çok doku ve organ sisteminde de vaskülit gözlenebilmektedir. Ancak, Wegener Granülomatozisi'nde gastrointestinal tutulum oldukça nadirdir. Bu vaka sunumunda birden fazla intestinal perforasyon tanısı alan Wegener granülomatozisli bir olgu sunulmuştur.
To compare 2 laparoscopic appendectomy techniques. We describe a modified technique, the handmade... more To compare 2 laparoscopic appendectomy techniques. We describe a modified technique, the handmade endoloop technique, for closing the base of the appendix. This prospective study was carried out at Harran University Medical Faculty, Sanliurfa, and Gulhane Military Medical Academy, Ankara, Turkey from September 2006 to February 2008. We evaluated the safety and efficacy of the procedure in 98 acute appendicitis cases: 57 patients handmade endoloop patients, and 41 endoloop technique patients. Operative time, postoperative complications, need for analgesics, and procedure cost were measured for both groups. The endoloops and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by appropriate test. The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups. This procedure is simple, safe, and cheap.
Anastomotic healing can deteriorate because of different local and systemic effects in cases of c... more Anastomotic healing can deteriorate because of different local and systemic effects in cases of concomitant left colon and liver injuries. We evaluated the effects of portal triad occlusion (PTO) on bowel anastomosis after concomitant segmental left colonic resections achieved in rats. There were three separate groups of animals; each consisted of 20 Sprague-Dawley male rats weighing 250 +/- 20 g. In group I, left colonic segmental resection 1 cm in diameter and anastomosis were performed as controls. In group II, the same surgical procedure was done after 15 minutes of PTO followed by 30 minutes of reperfusion. In group III, PTO time was held at 30 minutes. The rats were killed at days 4 and 7 to evaluate anastomotic healing, histological changes, bursting pressures, and serum levels of malondialdehyde (MDA) and hydroxyproline. In group II, the bursting pressures of anastomosis on days 4 and 7 were similar to group I; these pressures were significantly lower in group III (P < 0....
Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complica... more Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complication of hydatid disease. Optimal management of cases is crucially important in establishing rapid recovery and avoiding additional complications. The use of an algorithmic guide is essential because of an ongoing dilemma that involves a large variety of therapeutic options. We present four patients with bronchobiliary fistulas caused by liver hydatid disease to discuss the management of therapeutic options through a case-based approach and an extent review to finally generate an algorithm. In this series, two patients were treated surgically, and the remaining were treated with conservative methods. To date, they have developed neither recurrence nor need for additional intervention. Although treatment of bronchobiliary fistulas is traditionally thought to be surgical, most of the less severe cases can be treated nonoperatively. Making an accurate selection among less invasive methods an...
Introduction: We compare the postoperative early and late complications of patients who had under... more Introduction: We compare the postoperative early and late complications of patients who had undergone ileal conduit (IC) urinary diversion and transureteroureterostomy (TUU) with ureterocutaneostomy (UC) urinary diversion during the same interval and by the same surgeons. Materials and Methods: Between 1992 and 2004, we performed TUU with UC urinary diversion in 27 men and 7 women (group I) and ileal conduit urinary diversion in 57 men and 10 women (group II). The mean age of the TUU with UC diversion and the ileal conduit patients was 57 ± 11.2 (range 51–76) and 64 ± 12.6 (range 54–76) years, and the mean follow-up was 37 (range 14–52) and 56 (range 14–72) months, respectively. The 6F or 8F stents were used routinely. Results: Of 34 TUU with UC cases 8 (23.52%) had early postoperative complications and 2 (5.88%) had early reoperation rates, whereas 11 (16.42%) of 67 ileal conduit cases had early postoperative complications and 4 (5.97%) had early reoperation. The mean hospital stay...
Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an ope... more Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an open abdomen, present serious problems for the surgeon. There are no fixed algorithms for treatment of EAF, and treatment options are determined based on the experience of the surgeon and status of the patient. We developed a ‘suspended silicone fistula plug’ for treating a patient who developed an EAF after undergoing multiple operations in a short period of time. Used in conjunction with negative pressure wound therapy, application of this novel therapy resulted in EAF closure and patient discharge.
ABSTRACT Summary BACKGROUND: Neuroma of the extrahepatic biliary tract is an uncommon benign tumo... more ABSTRACT Summary BACKGROUND: Neuroma of the extrahepatic biliary tract is an uncommon benign tumour that most frequently arises from the cystic duct stump after cholecystectomy and is a rare cause of postcholecystectomy symptoms. METHODS: We present two cases of extrahepatic bile duct neuroma 6 and 25 years after cholecystectomy and discuss diagnosis and management of this rare clinical condition. RESULTS: A 63-year-old and a 67-year-old woman were admitted to the hospital with history of gradual onset of right upper quadrant pain radiating to right scapula and epigastric area, 6 and 25 years after cholecystectomy, respectively. Routine laboratory and diagnostic studies were all normal in one patient, while a 1 by 1 cm mass on choledocal wall was diagnosed in the other. Diagnostic laparotomy was performed and a firm nodular mass, localized on cystic duct stump, was detected in both patients. Histopathologic examination confirmed amputation neuroma of the cystic duct remnant. CONCLUSIONS: Amputation neuroma is an unusual cause of benign stricture of the biliary tract that may produce a diagnostic challenge.
AIM: To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid d... more AIM: To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid disease of the liver. METHODS: Between January 2000 and December 2010, out of 301 patients with a diagnosis of hydatid cyst of the liver, 282 patients who underwent treatment [either surgery or puncture, aspiration, injection and reaspiration (PAIR) procedure] were analysed. Patients were grouped according to the presence or absence of postoperative biliary fistula (PBF) (PBF vs no-PBF groups, respectively). Preoperative clinical, radiological and laboratory characteristics, operative characteristics including type of surgery, peroperative detection of BF, postoperative drain output, morbidity, mortality and length of hospital stays of patients were compared amongst groups. Multivariate analysis was performed to detect factors predictive of PBF. Receiver operative characteristics (ROC) curve analysis were used to determine ideal cutoff values for those variables found to be significant. A comparison was also made between patients whose fistula closed spontaneously (CS) and those with intervention in order to find predictive factors associated with spontaneous closure. RESULTS: Among 282 patients [median (range) age, 23 (16-78) years; 77.0% male]; 210 (74.5%) were treated with conservative surgery, 33 (11.7%) radical surgery and 39 (13.8%) underwent percutaneous drainage with PAIR procedure A PBF developed in 46 (16.3%) patients, all within 5 d after operation. The maximum cyst diameter and preoperative alkaline phosphatase levels (U/L) were significantly higher in the PBF group than in the no-PBF group [10.5 ± 3.7 U/L vs 8.4 ± 3.5 U/L (P < 0.001) and 40.0 ± 235.1 U/L vs 190.0 ± 167.3 U/L (P = 0.02), respectively]. Hospitalization time was also significantly longer in the PBF group than in the no-PBF group [37.4 ± 18.0 d vs 22.4 ± 17.9 d (P <
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