Turkish Journal of Surgery最新文献

Stoma prolapse is one of the most common late complications following stoma construction. Although prolapses can be managed conservatively, they often require surgical revision. This study aimed to describe a revision method called peristomal cerclage applied with local anesthesia to treat stoma prolapse. A 66-year-old male patient with advanced rectal cancer underwent sigmoid loop colostomy one year ago due to a distal occlusive tumor. A revision of the colostomy prolapse that developed postoperatively was planned. After the reduction of the 12 cm prolapse into the abdomen under local anesthesia, a repair was performed in the form of peristomal wrapping of a vessel tape; except for short-term abdominal distension, no complications developed in the patient. He is currently in the postoperative 26^th month and terminal period, and his colostomy is working normally. The present report aimed to describe the peristomal cerclage method, a minimally invasive revision procedure applied to patients with stoma prolapse, and to deliver its long-term results. It is important to report the results obtained with the more widespread use of this method.

Objectives: Safe removal of extensive liver tumor burdens depends on regeneration of the remnant liver, which requires a large amount of zinc over a short period of time. We studied how zinc influences regeneration.

Material and methods: We measured perioperative serum zinc concentrations after liver cancer diagnosis in 77 patients undergoing hepatectomy to determine how serum zinc affected short-term outcomes and remnant liver regeneration.

Results: Serum zinc concentration at diagnosis showed no correlation with inflammatory or nutritional parameters except for a weak correlation with the lymphocyte-to-monocyte ratio. When patients were divided into a high pre-hepatectomy zinc group (≥75 µg/dL, n= 39, H group) and a low zinc group (<75 µg/dL, n= 38, L group), short-term results such as mortality (p> 0.999), morbidity (p= 0.490), and hospital stay (p= 0.591) did not differ between groups. However, hypertrophy in the future liver remnant after hepatectomy in the H group (127.7 ± 24.7% of original volume) was greater than in the L group (115.9 ± 16.7%, p= 0.024). In a subgroup of patients with extended hepatectomy, hypertrophy was 130.9 ± 26.8% in the H group vs. 116.4 ± 16.5% in the L group (p= 0.037).

Conclusion: Greater serum zinc at diagnosis was associated with greater hypertrophy in the future liver remnant.

Objectives: Laparoscopic gastrectomy (LG) was challenging to most surgeons due to the two-dimensional view, difficult manipulations of the instruments, ergonomic discomfort, and the associated muscular spasm and effort. Technological advances with improved surgical experience, have made LG a more feasible and favorable approach for gastric cancer (GC) patients.

Material and methods: LG was performed in 44 patients with GC between July 2015 to June 2022, in the Department of Surgical Oncology, Oncology Center, Mansoura University, Egypt, and we assessed the surgical outcomes of this approach as an initial experience of a single cancer center.

Results: Twenty-seven patients underwent laparoscopic distal gastrectomy, and seventeen underwent laparoscopic total gastrectomy. Two cases had combined resection. Operative time was 339.2 ± 76.73 min, while blood loss was 153.86 ± 57.51 mL. The patients were ambulant on postoperative day 0, oral intake was started within three days (range 1-5 days) and the hospital stay was six days (range 3-9 days).

Conclusion: LG for GC is a feasible approach for both early and advanced GC patients as it allows for adequate diagnosis of the peritoneal disease, meticulous dissection, and identification of the lymph nodes with minimal blood loss and decrease surgery-related problems and encourage the early patients' discharge from hospital and return to daily life activities.

Objectives: The involvement of axillary lymph nodes plays a key role in breast cancer staging. Positron emission tomography is a promising modality for detecting axillary lymph node metastasis. In addition, nomograms are used to predict the status of axillary lymph nodes. In this study, the role of positron emission tomography in determining axillary metastasis and its correlation with the nomogram was evaluated.

Material and methods: The axillary maximum standard uptake value (SUVmax) values of the patients in the preoperative period, the features in the perioperative and postoperative specimen and Memorial Sloan Kettering Cancer Center nomogram data were evaluated.

Results: As axillary SUVmax detected by Positron emission tomography in the preoperative period increased, so did the likelihood of lymph node involvement. Axillary SUVmax value were compared with Memorial Sloan Kettering Cancer Center nomogram data but no correlation was found. Age, lymph node number, histopathology results, mass diameter, presence or absence of lymphovascular invasion and/or perineural invasion, tumor type, estrogen receptor status, Ki67 and Cerb-B2 statuses were not correlated. However, axillary SUVmax was inversely correlated with grade and progesterone receptor status.

Conclusion: Results from positron emission tomography of axillary lymph nodes in breasts cancer patients showed that SUVmax was only inversely related to cancer grade and progesterone receptor status while not correlating with other accepted parameters for tumor assessment. Thus there is insufficient reliability for the use of axillary SUVmax alone for accurate assessment of tumor characteristics at present.

Objectives: Secondary peritonitis is caused by infection of the peritoneal cavity due to perforation of the alimentary tract. Mannheim's peritonitis ındex (MPI) is a prognostic scoring system that predicts outcomes in peritonitis. Increasing MPI scores correlate with poor outcomes and mortality. The objective of this study is to evaluate the effectiveness of MPI-based prognosis and its impact on Indian patients with secondary peritonitis.

Material and methods: For understanding the effectiveness of the MPI scoring system, a cross-sectional data analysis of published studies on secondary peritonitis from 10 geographical locations in India was performed. The 10-site study results were compared with unpublished in-house study data for individual MPI parameters to analyze any variations of MPI score-based predictions across a diverse Indian population. Patients were divided into risk groups on the basis of MPI scores: <21 mild, MPI= 21-29 moderate, MPI> 29 severe risk.

Results: We observed a significant correlation between mortality with age and gender as reported worldwide. Site of perforations were prevalent in the upper alimentary tract with the majority being gastro-duodenal for the Indian population as opposed to distal parts in the western population. Higher lethality in India is often associated with evolution time, organ failure, and sepsis due to delayed presentation and poor management.

Conclusion: MPI scoring is effective in predicting risk across geographically diverse Indian populations. The sensitivity and specificity of MPI scores are more reliable and a score >29 specifically recommends aggressive resuscitation & monitoring of patients, initiation of broad-spectrum antibiotics, and intensive care support to reduce mortality and morbidity.

Objectives: The aim of this study was to compare the results of the evaluation of HPB-specific pathologists and general pathologists on the specimens of patients who underwent pancreaticoduodenectomy by the same surgical team.

Material and methods: The pathological results of 159 patients who underwent pancreaticoduodenectomy (PD) in the periampullary region was retrospectively examined. Histopathological evaluation results of HPB-specific pathologist (S group) and other pathologists (NS group) were compared. Tumor size (mm), total lymph nodes, metastatic lymph nodes, surgical margin positive/negative (RO/R1/R2 resection) and data of patients who underwent vascular resection were evaluated.

Results: The specimens of 91 patients were examined by a HPB-specific pathologist (S group), and the specimens of 68 patients were examined by non-specific pathologists (NS group). When compared in terms of the average total number of lymph nodes and metastatic lymph nodes dissected, a statistically significant result was observed (p= 0.04, p <0.01 respectively). Additionally, surgical margin positivity (R1) was found to be statistically higher in the S group (p= 0.02).

Conclusion: In order for the success of HPB surgery to be reflected in the clinic, it is of great importance that the specimens are examined by HPBspecific pathologists.

Objectives: Biliary cysts are biliary duct dilatations, with 20% of the cysts being diagnosed in adulthood. Abdominal pain, jaundice and palpable abdominal mass are defined as the classical triad. However, nausea, vomiting, fever, itching and weight loss are frequent complaints. There are several treatment options depending on the type of the cyst. This study aimed to share our experience with biliary cysts and contribute to the literature on this subject.

Material and methods: Thirty patients, who received treatment for biliary cyst from January 1981 to December 2018 at our clinic, were studied retrospectively. The patients were analyzed based on age, sex, type of the cyst, diagnosis and treatment methods, post-op follow up and complications.

Results: Twenty-seven of the patients were females, and three were males. The patients were aged between 16 and 76 years, and the median age was 41.9 years. All patients presented with abdominal pain, which was accompanied by cholangitis in nine patients, nausea and vomiting in four patients, dyspepsia in three patients and palpable mass in one patient. According to the Todani classification, biliary cyst findings were consistent with Type I in 23 patients, Type V in three patients, Type IV in two patients, Type II in one patient and Type III in one patient.

Conclusion: Diagnosis and treatment are complex in biliary cysts due to anatomical proximity and variations. Therefore, it would be beneficial to refer them to referral centers. Choice of treatment should be based on the type of the cyst.

Surgical site infection is the leading healthcare-associated infection and a major contributor to rising healthcare costs. Implementation of measures to reduce this problem, particularly the prophylactic use of negative pressure wound therapy, may be an effective and promising method to reduce the risk of surgical site infection in patients with closed surgical wounds. The aim of the study was to identify the effectiveness of negative pressure wound therapy as a prophylactic measure in reducing the risk of surgical site infection in patients with a closed surgical wound. Whittemore and Knafl's five-step integrative review framework was carried out using three electronic databases. MEDLINE with Full-text, CINAHL with Full-text and Academic Search Complete were searched through the EBSCOhost Web platform. Articles search publication date was between 2018 and 2022. Nine studies were identified that addressed the effectiveness of prophylactic negative pressure wound therapy in reducing the risk of surgical site infection in the patient with a closed surgical wound. There was also evidence of effectiveness in reducing surgical wound dehiscence, drainage output and drainage time, as well as reducing the incidence of hospital readmissions and the need for wound debridement. Prophylactic negative pressure wound therapy can be an effective treatment option, among others, in reducing the risk of surgical site infection in patients with a closed surgical wound. This evidence promotes improved clinical practice regarding the management of the closed surgical wound, promoting health gains for patients.