Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.6285
Ali Vedat Durgun, Sefa Ergün, Başar Can Turgut, Osman Şimşek, Mehmet Velidedeoglu, Kaya Sarıbeyoğlu, Salih Pekmezci
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.
目的:胆管囊肿是胆管扩张的一种,其中 20% 的囊肿在成年后才被确诊。腹痛、黄疸和可触及的腹部肿块被定义为典型的三联征。然而,恶心、呕吐、发烧、瘙痒和体重减轻也是常见症状。根据囊肿的类型,有多种治疗方案可供选择。本研究旨在分享我们在胆道囊肿方面的经验,并为这方面的文献做出贡献:回顾性研究了 1981 年 1 月至 2018 年 12 月在本诊所接受胆道囊肿治疗的 30 名患者。根据年龄、性别、囊肿类型、诊断和治疗方法、术后随访和并发症对患者进行分析:结果:27例患者为女性,3例为男性。患者年龄在 16 至 76 岁之间,中位年龄为 41.9 岁。所有患者均有腹痛症状,其中 9 名患者伴有胆管炎,4 名患者伴有恶心和呕吐,3 名患者伴有消化不良,1 名患者可触及肿块。根据托达尼(Todani)分类法,23 名患者的胆道囊肿符合 I 型,3 名患者符合 V 型,2 名患者符合 IV 型,1 名患者符合 II 型,1 名患者符合 III 型:结论:胆道囊肿的诊断和治疗因解剖学上的邻近性和变异而复杂。结论:由于胆道囊肿的解剖位置接近且存在变异,诊断和治疗都很复杂,因此将其转诊到转诊中心是有益的。应根据囊肿的类型选择治疗方法。
{"title":"Biliary cysts in adults: Cerrahpaşa experience.","authors":"Ali Vedat Durgun, Sefa Ergün, Başar Can Turgut, Osman Şimşek, Mehmet Velidedeoglu, Kaya Sarıbeyoğlu, Salih Pekmezci","doi":"10.47717/turkjsurg.2023.6285","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6285","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.4768
Mehmet Köstek, Özgür Bostancı, Muharrem Battal, Hüseyin Alkım
Hydatid disease is a zoonotic parasitic disease which rarely involves pancreas primarily. Diagnosis of pancreatic hydatid cyst is a challenge and operative skills are important to avoid spillage of cyst's content. A 19-year-old male patient was admitted to hospital with recurrent abdominal pain which was on epigastrium and left upper quadrant of abdomen. Pain was not associated with nausea, vomiting or fever. An abdominal computed tomography (CT) scan was ordered. As a result of abdominal CT scan, there was a cystic area in tail of pancreas with a diameter of 5.6 cm which includes septa and there was calcification on borders of the cyst. Possible diagnosis were either pancreatic hydatid disease, pancreatic cyst adenoma or cystadenocarcinoma or pseudocyst of autoimmune pancreatitis. Whole body positron emission tomography (PET-CT) scan showed no other cyst or lesion other than pancreatic cyst. Hydatid disease indirect hemagglutination test has been studied and it was positive. Imaging studies and laboratory results were suggested hydatid disease and laparoscopic distal pancreatectomy has been applied. Primary pancreatic hydatid disease should be in differential diagnosis when newly appearing pancreatic cyst has been diagnosed, especially in endemic areas. Appropriate surgical technique has to be applied to avoid dissemination of cyst's content.
{"title":"Primary pancreatic hydatid disease: A rare presentation of echinococcosis.","authors":"Mehmet Köstek, Özgür Bostancı, Muharrem Battal, Hüseyin Alkım","doi":"10.47717/turkjsurg.2023.4768","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.4768","url":null,"abstract":"<p><p>Hydatid disease is a zoonotic parasitic disease which rarely involves pancreas primarily. Diagnosis of pancreatic hydatid cyst is a challenge and operative skills are important to avoid spillage of cyst's content. A 19-year-old male patient was admitted to hospital with recurrent abdominal pain which was on epigastrium and left upper quadrant of abdomen. Pain was not associated with nausea, vomiting or fever. An abdominal computed tomography (CT) scan was ordered. As a result of abdominal CT scan, there was a cystic area in tail of pancreas with a diameter of 5.6 cm which includes septa and there was calcification on borders of the cyst. Possible diagnosis were either pancreatic hydatid disease, pancreatic cyst adenoma or cystadenocarcinoma or pseudocyst of autoimmune pancreatitis. Whole body positron emission tomography (PET-CT) scan showed no other cyst or lesion other than pancreatic cyst. Hydatid disease indirect hemagglutination test has been studied and it was positive. Imaging studies and laboratory results were suggested hydatid disease and laparoscopic distal pancreatectomy has been applied. Primary pancreatic hydatid disease should be in differential diagnosis when newly appearing pancreatic cyst has been diagnosed, especially in endemic areas. Appropriate surgical technique has to be applied to avoid dissemination of cyst's content.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.6181
Daniela Tendeiro, Teresa Mestre, Helga Martins, André Carmo
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.
{"title":"Prophylactic negative pressure wound therapy in patients with closed surgical wound: An integrative review.","authors":"Daniela Tendeiro, Teresa Mestre, Helga Martins, André Carmo","doi":"10.47717/turkjsurg.2023.6181","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6181","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.230402
Kaya Sarıbeyoğlu
{"title":"FROM THE EDITOR'S DESK.","authors":"Kaya Sarıbeyoğlu","doi":"10.47717/turkjsurg.2023.230402","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.230402","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.4552
Loo Guo Hou, Baharudin Nadia Nafasha, Hameed Sultan Mohamed Arif, Rajan Reynu, Ritza Kosai Nik, Rasul Hamidi Lizawati
Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare entity first described by Cruveilhier in 1835. There are only approximately 200 cases reported in the English literature to date. Histologically, it may be mistaken for spindle cell neoplasms such as gastrointestinal stromal tumour (GIST). Patients with AIHPS usually present with early satiety, abdominal fullness, postprandial vomiting, epigastric pain, and eructations. Adult intussusception is rare and only accounts for 5% of all intussusceptions. Gastroduodenal intussusception is one of the rare types of adult intussusception. This is more likely to occur when a benign or malignant stomach lesion acts as a lead point. We report a case of AIHPS in a 70-year-old lady presenting with gastroduodenal intussusception. An oesophagogastroduodenoscopy (OGDS) was performed, and it revealed a diffusely thickened and narrowed pyloric antrum. A contrasted computed tomography (CECT) of the thorax and abdomen showed a distended stomach with circumferential thickening of the pylorus. The pre-pyloric antrum was intussuscepting into the pylorus, and the apex is seen within the first part of duodenum. She underwent distal gastrectomy with a Roux-en-y reconstruction via laparoscopic approach and was discharged well. AIHPS is a rare condition and should be a differential in adults presenting with gastric outlet obstruction. We believe in cases of AIHPS presenting with gastroduodenal intussusception, a distal gastrectomy with reconstruction is a reasonable approach. A multidisciplinary approach is essential to obtain the best outcome.
{"title":"Adult idiopathic hypertrophic pyloric stenosis presenting with gastroduodenal intussusception: A rare case report.","authors":"Loo Guo Hou, Baharudin Nadia Nafasha, Hameed Sultan Mohamed Arif, Rajan Reynu, Ritza Kosai Nik, Rasul Hamidi Lizawati","doi":"10.47717/turkjsurg.2023.4552","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.4552","url":null,"abstract":"<p><p>Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare entity first described by Cruveilhier in 1835. There are only approximately 200 cases reported in the English literature to date. Histologically, it may be mistaken for spindle cell neoplasms such as gastrointestinal stromal tumour (GIST). Patients with AIHPS usually present with early satiety, abdominal fullness, postprandial vomiting, epigastric pain, and eructations. Adult intussusception is rare and only accounts for 5% of all intussusceptions. Gastroduodenal intussusception is one of the rare types of adult intussusception. This is more likely to occur when a benign or malignant stomach lesion acts as a lead point. We report a case of AIHPS in a 70-year-old lady presenting with gastroduodenal intussusception. An oesophagogastroduodenoscopy (OGDS) was performed, and it revealed a diffusely thickened and narrowed pyloric antrum. A contrasted computed tomography (CECT) of the thorax and abdomen showed a distended stomach with circumferential thickening of the pylorus. The pre-pyloric antrum was intussuscepting into the pylorus, and the apex is seen within the first part of duodenum. She underwent distal gastrectomy with a Roux-en-y reconstruction via laparoscopic approach and was discharged well. AIHPS is a rare condition and should be a differential in adults presenting with gastric outlet obstruction. We believe in cases of AIHPS presenting with gastroduodenal intussusception, a distal gastrectomy with reconstruction is a reasonable approach. A multidisciplinary approach is essential to obtain the best outcome.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.6165
Joseph Do Woong Choi, Matthew John Fong, Aswin Shanmugalingam, Anoosha Aslam, Syed Aqeel Abbas Kazmi, Rukmini Kulkarni, Richard James Curran
Objectives: There is growing evidence for reduced post-operative complications, and lower hospital costs associated with early cholecystectomy for acute calculus cholecystitis (AC) compared to delayed surgery. Limited high-quality evidence exists for how early, if at all, should surgeons be operating emergently for AC based on symptom onset.
Material and methods: Seven hundred seventy-four patients who had cholecystectomy performed by a single surgeon between January 2015-October 2022 were retrospectively reviewed. Five hundred fourty-one patients were analysed. Patients were divided into three groups based on symptom onset: Group 1: 0-72 hours (n= 305), Group 2: 72 hrs-1 week (n= 154) and Group 3: >1 week (n= 82).
Results: Median operative time was most prolonged in Group 2 (96.5 minutes), and had the greatest proportion of reconstituting 95% cholecystectomies (n= 22/154, 14.29%) compared to Group 1 (p> 0.05). The conversion to open was between 0.65-1.64% in all groups. The greatest proportion of bile leak occurred in Group 1 (n= 7/305, 2.3%) followed by Group 3 (n= 1/82, 1.22%) (p> 0.05). All were successfully managed with ERCP and biliary stent. Median hospital stay was significantly prolonged in Group 2 (2.3 days) compared to Group 1 (2 days) (p= 0.03). The proportion of 95% cholecystectomies in Group 2 and 3 were not significant compared to Group 1.
Conclusion: Early cholecystectomy for calculus cholecystitis, irrespective of the timing of symptoms appears to have safe postoperative outcomes. Surgeons do not necessarily need to limit early cholecystectomy for within 72 hours of symptom onset.
{"title":"Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset.","authors":"Joseph Do Woong Choi, Matthew John Fong, Aswin Shanmugalingam, Anoosha Aslam, Syed Aqeel Abbas Kazmi, Rukmini Kulkarni, Richard James Curran","doi":"10.47717/turkjsurg.2023.6165","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6165","url":null,"abstract":"<p><strong>Objectives: </strong>There is growing evidence for reduced post-operative complications, and lower hospital costs associated with early cholecystectomy for acute calculus cholecystitis (AC) compared to delayed surgery. Limited high-quality evidence exists for how early, if at all, should surgeons be operating emergently for AC based on symptom onset.</p><p><strong>Material and methods: </strong>Seven hundred seventy-four patients who had cholecystectomy performed by a single surgeon between January 2015-October 2022 were retrospectively reviewed. Five hundred fourty-one patients were analysed. Patients were divided into three groups based on symptom onset: Group 1: 0-72 hours (n= 305), Group 2: 72 hrs-1 week (n= 154) and Group 3: >1 week (n= 82).</p><p><strong>Results: </strong>Median operative time was most prolonged in Group 2 (96.5 minutes), and had the greatest proportion of reconstituting 95% cholecystectomies (n= 22/154, 14.29%) compared to Group 1 (p> 0.05). The conversion to open was between 0.65-1.64% in all groups. The greatest proportion of bile leak occurred in Group 1 (n= 7/305, 2.3%) followed by Group 3 (n= 1/82, 1.22%) (p> 0.05). All were successfully managed with ERCP and biliary stent. Median hospital stay was significantly prolonged in Group 2 (2.3 days) compared to Group 1 (2 days) (p= 0.03). The proportion of 95% cholecystectomies in Group 2 and 3 were not significant compared to Group 1.</p><p><strong>Conclusion: </strong>Early cholecystectomy for calculus cholecystitis, irrespective of the timing of symptoms appears to have safe postoperative outcomes. Surgeons do not necessarily need to limit early cholecystectomy for within 72 hours of symptom onset.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.6271
Vitor F Kruger, Thiago A R Calderan, Elcio S Hirano, Gustavo P Fraga
Objectives: In hospital attendance, 75% of diaphragmatic hernias occur on left as opposed to 25% on the right side. Right side hernias are associated with abdominal injuries, mainly the liver. However, right-side injuries are frequently underdiagnosed due to the complexity of associated injuries and high mortality rates. The aim of this study was to perform a retrospective analysis of records from our clinical experience to investigate demographics, TM, diagnosis, morbidity, and mortality associated with right sided TDH. These findings may provide insights into improving the clinical management of patients with this serious injury, potentially reducing morbidity and mortality rates.
Material and methods: Retrospective analysis of the medical records of patients from the trauma database of the Division of Trauma Surgery at University of Campinas in 32-year period was performed. Only records of patients with right sided TDH were included in the analysis.
Results: Blunt trauma was the most common mechanism. Diagnoses were made by laparotomy in eight cases, all these cases were hemodynamically unstable. TDH grade III injury occurred in most cases followed by grade IV. Liver injuries were present in almost all cases, most of them high grade, followed by colon and small bowel. Extra-abdominal associated injuries with a predominance of femur fractures, pelvic fractures and hemothorax. Post-operative complications were associated with length of stay in intensive care unit. Pneumonia was the most frequent complication. The overall mortality rate was 16%.
Conclusion: Most diagnoses were performed through laparotomy and not by radiologic exams, due to hemodynamic instability on admission. There is underdiagnosis of right-side TDH due to the high-energy trauma mechanism with high grade associated injuries and mortality on pre-hospital.
目的:在医院就诊的患者中,75% 的膈疝发生在左侧,而 25% 发生在右侧。右侧疝气与腹部损伤有关,主要是肝脏损伤。然而,由于相关损伤的复杂性和高死亡率,右侧损伤往往诊断不足。本研究旨在对我们的临床经验记录进行回顾性分析,调查与右侧 TDH 相关的人口统计学、TM、诊断、发病率和死亡率。这些研究结果可能有助于改善对这种严重损伤患者的临床管理,从而降低发病率和死亡率:对坎皮纳斯大学(University of Campinas)创伤外科分部创伤数据库中 32 年来的患者病历进行了回顾性分析。分析只包括右侧 TDH 患者的病历:结果:钝性外伤是最常见的发病机制。8例患者通过开腹手术确诊,所有这些患者的血流动力学均不稳定。大多数病例为 TDH III 级损伤,其次为 IV 级。几乎所有病例都有肝脏损伤,其中大部分为高级别损伤,其次是结肠和小肠损伤。腹外相关损伤以股骨骨折、骨盆骨折和血气胸为主。术后并发症与重症监护室的住院时间有关。肺炎是最常见的并发症。总死亡率为16%:结论:由于入院时血流动力学不稳定,大多数诊断是通过开腹手术而非放射检查进行的。结论:由于入院时血流动力学不稳定,大多数诊断都是通过开腹手术而非放射检查进行的。右侧 TDH 的高能量创伤机制导致入院前相关损伤和死亡率较高,因此诊断不足。
{"title":"The silent threat: A retrospective study of right-sided traumatic diaphragmatic hernias in a university hospital.","authors":"Vitor F Kruger, Thiago A R Calderan, Elcio S Hirano, Gustavo P Fraga","doi":"10.47717/turkjsurg.2023.6271","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6271","url":null,"abstract":"<p><strong>Objectives: </strong>In hospital attendance, 75% of diaphragmatic hernias occur on left as opposed to 25% on the right side. Right side hernias are associated with abdominal injuries, mainly the liver. However, right-side injuries are frequently underdiagnosed due to the complexity of associated injuries and high mortality rates. The aim of this study was to perform a retrospective analysis of records from our clinical experience to investigate demographics, TM, diagnosis, morbidity, and mortality associated with right sided TDH. These findings may provide insights into improving the clinical management of patients with this serious injury, potentially reducing morbidity and mortality rates.</p><p><strong>Material and methods: </strong>Retrospective analysis of the medical records of patients from the trauma database of the Division of Trauma Surgery at University of Campinas in 32-year period was performed. Only records of patients with right sided TDH were included in the analysis.</p><p><strong>Results: </strong>Blunt trauma was the most common mechanism. Diagnoses were made by laparotomy in eight cases, all these cases were hemodynamically unstable. TDH grade III injury occurred in most cases followed by grade IV. Liver injuries were present in almost all cases, most of them high grade, followed by colon and small bowel. Extra-abdominal associated injuries with a predominance of femur fractures, pelvic fractures and hemothorax. Post-operative complications were associated with length of stay in intensive care unit. Pneumonia was the most frequent complication. The overall mortality rate was 16%.</p><p><strong>Conclusion: </strong>Most diagnoses were performed through laparotomy and not by radiologic exams, due to hemodynamic instability on admission. There is underdiagnosis of right-side TDH due to the high-energy trauma mechanism with high grade associated injuries and mortality on pre-hospital.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We developed a prototype VR platform, VECTORS L&M (VLM), aiming to enhance the understanding of digestive surgery for students, interns, and young surgeons by limiting costs. Its efficacy was assessed via questionnaires before implementation in surgical education. The VLM provides nine-minute VR views of surgeries, from both 180- and 360-degree angles. It was created with L.A.B. Co., Ltd. and incorporates surgery videos from biliary malignancy patients. Following VLM development, a survey was conducted among surgeons who had experienced it. Twenty-eight participants (32% of observers) responded to the survey. A majority (81%) reported positive experiences with the VR content and showed interest in VR video production, though some reported sickness. Most respondents were experienced surgeons, and nearly all believed VR was important for medical education with a mean score of 4.14 on a scale of up to 5. VR was preferred over 3D printed models due to its application versatility. Participants expressed the desire for future VR improvements, such as increased mobility, cloud connectivity, cost reduction, and better resolution. The VLM platform, coupled with this innovative teaching approach, offers experiential learning in intraabdominal surgery, effectively enriching the knowledge of students and surgeons ahead of surgical education and training.
{"title":"Questionnaire survey of virtual reality experiences of digestive surgery at a rural academic institute: A pilot study for pre-surgical education.","authors":"Atsushi Nanashima, Kengo Kai, Takeomi Hamada, Shun Munakata, Naoya İmamura, Masahide Hiyoshi, Kiyoaki Hamada, Ikko Shimizu, Yuki Tsuchimochi, Isao Tsuneyoshi","doi":"10.47717/turkjsurg.2023.6202","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6202","url":null,"abstract":"<p><p>We developed a prototype VR platform, VECTORS L&M (VLM), aiming to enhance the understanding of digestive surgery for students, interns, and young surgeons by limiting costs. Its efficacy was assessed via questionnaires before implementation in surgical education. The VLM provides nine-minute VR views of surgeries, from both 180- and 360-degree angles. It was created with L.A.B. Co., Ltd. and incorporates surgery videos from biliary malignancy patients. Following VLM development, a survey was conducted among surgeons who had experienced it. Twenty-eight participants (32% of observers) responded to the survey. A majority (81%) reported positive experiences with the VR content and showed interest in VR video production, though some reported sickness. Most respondents were experienced surgeons, and nearly all believed VR was important for medical education with a mean score of 4.14 on a scale of up to 5. VR was preferred over 3D printed models due to its application versatility. Participants expressed the desire for future VR improvements, such as increased mobility, cloud connectivity, cost reduction, and better resolution. The VLM platform, coupled with this innovative teaching approach, offers experiential learning in intraabdominal surgery, effectively enriching the knowledge of students and surgeons ahead of surgical education and training.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Hemorrhoidal disease, which affects nearly 40% of people, is characterized by pathological alterations and distal displacement of hemorrhoidal tissue. The short health scale (SHSHD) and the hemorrhoidal disease symptom score (HDSS) are two tools that can be utilized to assess the quality of life of hemorrhoidal patients. The present study aims to translate, modify, and validate the HDSS and SHSHD questionnaires in Indonesian.
Material and methods: This cross-sectional study assessed the validity and reliability of the HDSS and SHSHD Indonesian adaptation instrument in hemorrhoidal patients from April 15, 2022, and April 1, 2023.
Results: There were 91 study subjects, 55 males and 36 females. The study showed that the subscale interpretations of the R-values and the full scale scored above 0.25, indicating weak to very strong correlations. These results mean that the HDSS and SHSHD questionnaires are valid for use. Based on the study's results, the R-value of each item, domain, and total score ≥0.8 (p <0.05) indicates that the HDSS and SHSHD instruments are reliable.
Conclusion: The Indonesian adaptation of the HDSS and SHSHD demonstrates validity and reliability as an assessment tool for measuring the healthrelated quality of life in Indonesian patients diagnosed with hemorrhoidal disease.
{"title":"Translation and validation of Indonesian hemorrhoidal disease symptom score (HDSS) and short health scale hemorrhoidal disease (SHSHD).","authors":"Fadli Robby Amsriza, Rizka Fakhriani, Asmaya Aji Pangki","doi":"10.47717/turkjsurg.2023.6148","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6148","url":null,"abstract":"<p><strong>Objectives: </strong>Hemorrhoidal disease, which affects nearly 40% of people, is characterized by pathological alterations and distal displacement of hemorrhoidal tissue. The short health scale (SHSHD) and the hemorrhoidal disease symptom score (HDSS) are two tools that can be utilized to assess the quality of life of hemorrhoidal patients. The present study aims to translate, modify, and validate the HDSS and SHSHD questionnaires in Indonesian.</p><p><strong>Material and methods: </strong>This cross-sectional study assessed the validity and reliability of the HDSS and SHSHD Indonesian adaptation instrument in hemorrhoidal patients from April 15, 2022, and April 1, 2023.</p><p><strong>Results: </strong>There were 91 study subjects, 55 males and 36 females. The study showed that the subscale interpretations of the R-values and the full scale scored above 0.25, indicating weak to very strong correlations. These results mean that the HDSS and SHSHD questionnaires are valid for use. Based on the study's results, the R-value of each item, domain, and total score ≥0.8 (p <0.05) indicates that the HDSS and SHSHD instruments are reliable.</p><p><strong>Conclusion: </strong>The Indonesian adaptation of the HDSS and SHSHD demonstrates validity and reliability as an assessment tool for measuring the healthrelated quality of life in Indonesian patients diagnosed with hemorrhoidal disease.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29eCollection Date: 2023-12-01DOI: 10.47717/turkjsurg.2023.6258
Binura Buwaneka Wijesinghe Lekamalage, Anh Ngoc Vu, Lucinda Jane Duncan-Were, Asiri Arachchi, Andrew Bui
Complete splenic flexure mobilization is a critical step in left-sided colorectal resections. Surgeons use three approaches-anterior, medial, and lateral-to divide peritoneal ligaments connecting the left colon. The decision to perform mobilization varies, with minimal impact on post-operative outcomes but longer surgery times and rare complications. Pancreatic injury risk is low, though other structures, like arteries and the duodenum, may be at risk. Our video outlines the medial trans-mesocolic approach, with the patient positioned in lithotomy. We expose the duodenal-jejunal flexure, ligate the inferior mesenteric vein, and perform medial to lateral dissection, completing splenic flexure mobilization. This video vignette outlines how to perform this technique for left sided colorectal resections.
{"title":"How to do it: Splenic flexure mobilisation via medial trans-mesocolic approach.","authors":"Binura Buwaneka Wijesinghe Lekamalage, Anh Ngoc Vu, Lucinda Jane Duncan-Were, Asiri Arachchi, Andrew Bui","doi":"10.47717/turkjsurg.2023.6258","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6258","url":null,"abstract":"<p><p>Complete splenic flexure mobilization is a critical step in left-sided colorectal resections. Surgeons use three approaches-anterior, medial, and lateral-to divide peritoneal ligaments connecting the left colon. The decision to perform mobilization varies, with minimal impact on post-operative outcomes but longer surgery times and rare complications. Pancreatic injury risk is low, though other structures, like arteries and the duodenum, may be at risk. Our video outlines the medial trans-mesocolic approach, with the patient positioned in lithotomy. We expose the duodenal-jejunal flexure, ligate the inferior mesenteric vein, and perform medial to lateral dissection, completing splenic flexure mobilization. This video vignette outlines how to perform this technique for left sided colorectal resections.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}