Ulusal cerrahi dergisi最新文献

Objective: Burns continue to be a devastating trauma worldwide. Most of the childhood burns are due to preventable injuries. Burns occurring as a result of negligence of the parents'/carers' may cause mortality or life-long morbidities. Identification of the etiologies will direct the precautions that should be undertaken.

Material and methods: One hundred consequent burn patients admitted to our clinics were included to the study. A questionnaire was filled in with the information gathered from the parents/carers.

Results: The mean age of the patients was 3.74±3.07 years, and 52% was male. Most of the injuries occurred in the noon (median 12:45). Seventy-eight percent of the burns occurred at children's own home. Parents/carers were close enough to prevent the child from injury in 66% of the cases. While there was no first intervention in 21% of burns, 14% applied ice and 1% yoghurt. Taxi was the means to reaching the hospital in 45%. Hot liquids were the leading etiology (p<0.003). Sixty-two percent of the patients were dining at the living room and on the floor.

Conclusion: The occurrence of the majority of injuries near parents/carers can be related to inadvertence or lack of awareness. To decrease burns incidence among children in our country, dining at the floor and stove heating should be avoided as much as possible. Not cooling the burn with running tap water at the time of injury leads to deepening of the burn, which consequently makes management more complex. Based on our study, there is an apparent need for determination of preventive measurements and to raise public awareness.

Umbilical hernia is a rather common surgical problem. Elective repair after diagnosis is advised. Suture repairs have high recurrence rates; therefore, mesh reinforcement is recommended. Mesh can be placed through either an open or laparoscopic approach with good clinical results. Standard polypropylene mesh is suitable for the open onlay technique; however, composite meshes are required for laparoscopic repairs. Large seromas and surgical site infection are rather common complications that may result in recurrence. Obesity, ascites, and excessive weight gain following repair are obviously potential risk factors. Moreover, smoking may create a risk for recurrence.

Objective: Surgical site infection (SSI) is a common complication after surgery and is an indicator of quality of care. Risk factors for SSI are studied thoroughly for most types of gastrointestinal surgeries and especially colorectal surgeries, but accumulated data is still lacking for gastric surgeries. We studied the parameters affecting SSI rate after gastric cancer surgery.

Material and methods: Consecutive patients, who underwent elective gastric cancer surgery between June and December 2013, were included. Descriptive parameters, laboratory values and past medical histories were recorded prospectively. All patients were followed for 1 month. Recorded parameters were compared between the SSI (+) and SSI (-) groups.

Results: Fifty-two patients (mean age: 58.87±9.25 [31-80]; 67% male) were included. SSI incidence was 19%. ASA score ≥3 (p<0.001), postoperative weight gain (p<0.001), smoking (p=0.014) and body mass index (BMI) ≥30 (p=0.025) were related with a higher SSI incidence. Also patients in the SSI (+) group had a higher preoperative serum C-reactive protein level (p=0.014).

Conclusion: We assume that decreasing BMI to <30, stopping smoking at least 3 weeks before the operation, and preventing postoperative weight gain by avoiding excessive intravenous hydration will all help decrease SSI rate after gastric surgery.

Objective: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature.

Material and methods: Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed.

Results: The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence.

Conclusion: Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

Objective: Weight gain can be detected during adjuvant chemotherapy in breast cancer patients, leading to administration of lower drug doses than planned and a decrease in long-term survival. In this study, the effect of weight gain on survival in breast cancer patients was investigated.

Material and methods: Breast cancer patients treated with adjuvant chemotherapy between May 2002 and May 2003 were prospectively included in the study. Patients treated with neoadjuvant chemotherapy or with chemotherapy for metastatic disease were excluded from the study. Data regarding patients' demographic, clinical and pathologic characteristics and chemotherapy protocols were recorded. Patients were grouped as those with weight gain less than or more than 3 kg, and those with a body mass index of less than or more than 30. The impact of weight gain on patients' disease-free and overall survival was investigated. Log-rank test and Cox regression analyses were utilized for survival analyses. P<0.05 value was accepted as statistically significant.

Results: Eighty-eight consecutive female patients with a median age of 46 (29-71) were included in the study. Patients received anthracycline based chemotherapy protocols. Weight gain was detected in 79 patients (89.8%), with more than 3 kg weight gain detected in 38 patients (43.2%). In a median follow-up time of 98 months (62-120), distant metastases were detected in 21 patients (23.9%), and 11 patients (12.5%) died. Mean disease-free survival of patients with a weight gain less than and more than 3 kg during chemotherapy was 89.1±3.9 and 84.7±4.2 months (p=0.007), whereas mean overall survival was 95.6±2.2 and 92.5±2.1 months (p=0.01), respectively. Mean disease-free survival of patients with a body mass index less than and more than 30 was 87.3±2.3 and 85.1±3.6 months (p=0.4), whereas mean overall survival was 94.2±2.3 and 92.1±1.1 months (p=0.35), respectively.

Conclusion: Weight gain during adjuvant chemotherapy has a negative effect on both disease-free and overall survival in patients with breast cancer.

Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.

Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.