Turkish Journal of Surgery最新文献

Objective: The study aim was to determine our results of minimally invasive technique without aortic cross clamping for mitral valve surgery after previous cardiac surgery.

Material and methods: We performed 24 consecutive mitral valve surgeries between January 2015 and December 2018 in patients with a history of previous cardiac surgery. The procedure was performed using video-assisted right minithoracotomy, femoro-femoral bypass, a temperature of 26 °C, and cardiopulmonary bypass without aortic cross-clamping.

Results: Mitral valve replacement was performed in 12 (50%) of these patients, and mitral valve repair was performed in the same number (50%). The mean ejection fraction was 46.08±6.52% and the mean age was 61.52±11.48 years. Eighteen patients (75%) had previous coronary artery bypass graft surgery, and six patients (25%) had previous mitral valve surgery. In terms of postoperative complication frequencies that patients have experienced, one of the patients (4.1%) had postoperative low cardiac output syndrome. Two patients (8.3%) had renal failure; 2 patients (8.3%) had pneumonia, and stroke was seen in one patient (4.1%) postoperatively, whereas 2 patients (8.3%) had reoperation for bleeding. The mean postoperative packed red blood cell transfusion requirement at 48 hours was 1.00±1.10 units. The mean length of hospital stay was 10.54±4.37 days.

Conclusion: Minimally invasive port access procedure via right thoracotomy may be a safe and effective option in selected patients who need mitral surgery and have a history of prior sternotomy.

Objective: The objective is to assess the clinical efficacy of erector spinae plane block (ESPB) for post-operative analgesia in patients undergoing laparoscopic cholecystectomies.

Material and methods: This prospective, interventional, quasi-randomized single-blind study was approved by institutional ethical committee. Total 82 patients undergoing laparoscopic cholecystectomy were allocated into two groups, ESPB and control group. Postoperatively, the total tramadol consumption in 24 hours, the visual analogue scale (VAS) at various time intervals and time to rescue analgesia in both groups were monitored.

Results: The requirement of tramadol in first 24 hours was significantly more in controls as compared to cases (p=0.005). The mean VAS at rest, coughing and at movement was significantly lower in the immediate period, at 2^nd hour and 4^th hour after being shifted to post-operative area, in case group as compared to control. The time to rescue analgesia was statistically significantly more in ESPB group (p=0.002).

Conclusion: ESPB for laparoscopic cholecystectomy is a safe and effective technique of multimodal analgesia which provides better pain relief, reduced opioid requirement, lower post-operative pain scores, reduced total post-operative analgesic consumption along with prolonged time to rescue analgesia.

Objective: The etiology of primary pilonidal sinus disease (PSD) remains unclear. Prior investigations suggest that sharp fragments from the occiput contribute to the formation of PSD. In 2009 a correlation between PSD and a deeper natal cleft was reported. We investigated the association between intergluteal fold (IGF) depth and PSD risk using a standardized five-step measuring protocol.

Material and methods: Our clinical prospective study included 95 PSD patients and 105 non-PSD individuals, and measurements were taken from the glabella sacralis to the anus in a northern German population.

Results: The mean (± standard deviation) intergluteal depth progressively increased from the intergluteal opening from the sacral glabella at 9.1 (±3.4) mm to a maximum of 62.6 (±10.4) mm. Notably, the deepest point was consistently observed at the anus, where PSD occurrence is rare. No significant difference in IGF depth between PSD and non-PSD patients was found. Additionally, PSD predominantly developed in the proximal (cranial) third of the IGF, despite the maximum depth being in the distal region.

Conclusion: These findings suggest that IGF depth is not a risk factor for PSD.

Objective: Biliary leakage from the cystic duct stump following cholecystectomy is a significant postoperative complication. Endoscopic retrograde cholangiopancreatography (ERCP) with stenting has become the preferred treatment due to its minimally invasive nature and high success rates.

Material and methods: This study retrospectively evaluates the efficacy of ERCP for managing cystic duct stump leakage. A total of 29 patients treated between February 2017 and April 2024 were analyzed. Inclusion criteria included patients with confirmed cystic duct leakage. Primary and secondary success rates were defined as bile leakage cessation and absence of biliary fistula after stent removal, respectively.

Results: The group consisted of 20 females and 9 males, with an average age of 64.14 years and median body mass index of 27.7 kg/m². Cholelithiasis without acute cholecystitis was the primary surgical indication in 48% of cases. ERCP was the first-choice treatment for 89.7% of patients, using stents based on common bile duct width. Initial success was achieved in 89.7% of cases, with a mean drain removal time of 14.3 days. Secondary success was seen in 96.4% of patients. Complications, such as pancreatitis and stent migration, occurred in 13.8% of cases.

Conclusion: The study highlights the effectiveness of ERCP in managing cystic duct leaks, with high success and acceptable complication rates, confirming it should be the treatment of choice for this condition.

Objective: Mastalgia often raises malignancy concerns. This study explores its link to benign breast conditions, and cancer.

Material and methods: This retrospective study included 840 patients presenting to the surgical clinic with breast disease between January 2016 and January 2023.

Results: This study included 840 patients (800 female, 40 male) presenting with mastalgia, either as an isolated symptom or in combination with other complaints. In 350 cases (41.6%), pain alone was reported; in 410 cases (48.8%), pain with a lump; and in 18 cases (2.1%), pain with nipple discharge. Non-cyclic pain (51.5%) was more common than cyclic pain (42.5%), with pain most frequently localized to the right breast (53.5%), followed by bilateral (23.8%) and left breast (17.8%) pain (p<0.001). A significant association was observed between mastalgia and neck/shoulder pain (10.7%, p<0.001). A family history of breast cancer was present in 16.6% of patients. Histologic analysis revealed fibrocystic changes (42.2%), fibroadenoma (21.1%), and ductal ectasia (11%) as the most common diagnoses. Malignancy was detected in 6 cases (1.3%, including 1 male patient), with a significantly higher prevalence in the pain + lump group (p<0.001). Other findings included mastitis (9 cases), abscess (53 cases), and fat necrosis (4 cases). Patients with suspected malignancy underwent biopsy based on radiologic suspicion (BIRADS 2-4a) and physical examination.

Conclusion: Mastalgia is predominantly a benign condition, but non-cyclic pain, particularly when associated with a lump, warrants thorough evaluation to exclude malignancy. The link between mastalgia and fibrocystic changes shows that research is needed into the causes and consequences. It is not a malignancy indicator, accurate diagnosis requires histological and radiological assessments.

Objective: In recent years, the paradigm of surgical approaches for total hip arthroplasty (THA) has evolved, with portal-assisted techniques emerging as a promising avenue for increasing precision and minimizing invasiveness. The purpose of this study was to compare early experience with the Microport anterior percutaneously (MAP) assisted THA system, with the established AMIS direct anterior approach (DAA).

Material and methods: A retrospective chart analysis was performed on 200 consecutive patients who underwent DAA or MAP at our institution in 2022. The research was conducted in accordance with the Declaration of Helsinki (as revised in 2013), and was approved by the institutional review board of the University Duisburg-Essen (23-11274-BO).

Results: Two hundred patients were enrolled (100 DAA and 100 MAP; time to follow-up 1.7 years ±88 days). The mean operative time was 81 minutes (MAP) and 67 minutes (DAA, p>0.05). The mean cup tilt angle was 39° (MAP) and 40° (DAA; p>0.05). The mean cup anteversion angle was 13° (MAP) and 16° (DAA; p>0.05). The mean postoperative hemoglobin (Hb) decrease was 2.6 mg/dL ±0.9 mg/dL (MAP) and 2.5 mg/dL ±0.9 mg/dL (DAA; p>0.05). No major complications were documented in any of the 200 cases during the observation period. Additional screw fixation was performed in 7 cases and hybrid stem cementation was performed in 3 cases due to lack of rotational stability. All 10 cases were in patients with DAA. In only one of the 200 cases, two units of RBC were transfused postoperatively in a DAA case after a postoperative decrease of 5.7 mg/dL Hb.

Conclusion: Anterior Path^® has been demonstrated to provide reliable results, despite the presence of a steep learning curve. The employment of a working cannula has been shown to enhance the surgeon's perspective during the preparation of the acetabulum. In relation to skin incision, the bikini line incision, which is regarded as advantageous due to its alignment with the cleavage lines, has been identified as a notable benefit that is acknowledged by the patient.

Natural orifice specimen extraction surgery (NOSE) is an extension of minimally invasive colorectal surgery. NOSE was introduced into the unit in January 2024 in selected group of patients. The aim of this study was to evaluate the initial experience of NOSE surgery in minimally invasive surgery colorectal surgery in terms of feasibility and safety outcomes. Prospective data was collated for all cases of NOSE in colorectal surgery from Jan 2024 to Dec 2024. Data collected included patient demographics, comorbidities, underlying pathology, pre-, intra- and post-operative outcomes. There were 17 cases considered for NOSE surgery. Eight cases had successful transvaginal NOSE and six cases had successful transanal NOSE. The median age was 68.5 years (range 36-87 years). The median ASA was 3 (range 1-4). All the transvaginal NOSE were performed with laparoscopic right hemicolectomy for neoplasia. Of the six transanal NOSE, four were performed for benign and two for malignant indications. There were no intraoperative complications with no conversion to open surgery. There were no post-operative complications especially anastomotic leak, ileus, wound infection, and extraction-site related complications in transvaginal NOSE cases. There was one anastomotic leak in transanal NOSE that required laparoscopic washout and defunctioning ileostomy. All the neoplasia cases achieved satisfactory oncological outcomes (R0 resection & adequate lymph node yield). The median follow-up was 6 months (range 2-11). The early experience of NOSE in colorectal surgery is safe and feasible in well selected group of patients. It avoids abdominal wall trauma from extraction with reduction of wound infection, pain and long-term risk of incisional hernia.