Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing ...excision of RTs at our institution.
A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated.
Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma.
RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.
Faecaloma is a mass of inspissated faeces, typically found in the rectosigmoid colon. Furthermore, faecalomas may cause intestinal obstruction,
stercoral ulcer development and colon perforation, ...which may be due to the pressure effect of large faecal mass. We herein present a case of massive
megacolon due to giant faecaloma in a 72-year-old man with symptoms of mechanical ileus. During surgery, there was a giant faecaloma, 10 cm in
diameter, within the sigmoid colon, and a Hartmann left colon resection was performed. The purpose of this article is to provide a brief overview of
this condition and discuss treatment options.
Purpose: A significant number of the protective stomas temporarily applied in order to reduce the effects of anastomosis complications after rectal cancer surgery cannot be closed and become ...permanent. In this study, the causes that can lead to a permanent stoma were investigated.Materials and Methods: Patients who underwent elective surgery with low anterior resection and protective ileostomy due to rectal cancer were included in the study. Patients whose stoma could not be closed within one year were evaluated as permanent stoma.Results: 66 patients were included in the study. The mean closing time for the stomas were found as 5, 6 +2,5 (1-12)months. The stomas of twelve (18.2%) of the patients could not be closed and became permanent. The presence of metastatic disease at the time of diagnosis, the proximity of the anastomosis to the anal entry, coloanal anastomosis, and the final pathology showing stage IIIC were found to be risk factors for permanent stoma.Conclusion: Some of the stomas applied temporarily due to surgical treatment of rectal cancer became permanent. Before the index operation, the patient and their relatives should be informed that in the presence of certain risk factors, these stomas may not be closed and become permanent.
Amaç: Rektum kanseri cerrahisi sonrası anastomoz komplikasyonlarının etkilerini azaltmak amacı ile geçici amaçla uygulanan koruyucu stomaların önemli bir kısmı kapatılamayarak kalıcı hale gelmektedir. Bu çalışmada kalıcı stomaya neden olabilecek nedenler araştırılmıştır.Gereç ve Yöntem: 2015-2018 tarihleri arasında elektif şartlarda rektum kanseri nedeni ile aşağıanterior rezeksiyon ve koruyucu ileostomi uygulanan hastalar çalışmaya alındı. Bir yıl içerisinde stoması kapatılamayan hastalar kalıcı stoma olarak değerlendirildi.Bulgular: Çalışmaya 66 hasta dahil oldu. Stomaların ortalama kapatılma süresi 5,6 +2,5 (1-12) ay olarak bulundu. On iki hastanın (%18,2) stoması kapatılamayarak kalıcı hale geldi. Tanı anında metastatik hastalık varlığı, anastomozun anal girime yakınlığı, koloanalanastomoz yapılması, cerrahi sonrası patoloji sonucunun evre IIIC olmasıstoma kapatılamaması açısından risk faktörü olarak bulundu.Sonuç: Rektum kanseri cerrahi tedavisinde geçici amaçla uygulanan stomaların bir kısmı kalıcı hale gelmektedir. İndeks operasyondan önce hasta ve yakınlarına, bazı risk faktörü ya da faktörleri varlığında bu stomaların kapatılamayarak kalıcı hale gelebileceği bilgisi verilmelidir.
Objective: Paragangliomas are rare tumors arising from extra-adrenal chromaffin tissue, which are widely distributed near or within the autonomic nervous system in the retroperitoneal sites and in ...the sympathetic ganglia of various viscera. We present a review of our 18-year institutional experience with resected abdominal paragangliomas. Methods: The data collected from 12 patients who underwent surgery due to abdominal paraganglioma in our clinic between 2002 and 2020 were analyzed retrospectively. Results: There were 12 patients in our study. The median age was 44 years (range: 21-81 years). The patients had one or more of the symptoms of headache (n=2, 16,6%), palpitations, abdominal pain (n=5, 41.6%), sweating (n=2, 16.6%) and hypertension (n=5, 41.6%), which are the classic clinical symptoms. One of the cases (1/12; 8,3%) was detected incidentally. The mass location was in the retroperitoneal region in 10 cases (83.3%) and in the pelvic region in 2 cases (16.6%). Five of the patients applied to our clinic with episodes of paroxysmal hypertension, and vanillylmandelic acid and metanephrine levels were found to be high in the blood and 24-h urinary tests. After a median follow-up period of 60 months, only 1 patient (8.3%) had metastasis and required reoperation 2 years after the first operation. One patient (8.3%) died on postoperative 36th month due to cardiac problems. Conclusion: Abdominal paragangliomas are rare tumors whose optimal management requires the surgeon to be highly attentive to the disease course, from diagnosis of functioning or nonfunctioning lesions, through operative treatment that may require adjacent organ resection, to lifelong follow-up for recurrences.
Objective: Formation of gallbladder stone is frequently observed after resection for gastric cancer. Extended lymph dissection is shown to be among risk factors. Materials and Methods: We compared ...patients with limited lymphatic dissection (D1) and extended lymphatic dissection (D2) in terms of gallstone formation and complications. Results: We observed gallbladder stone formation in 13 (12.8%) patients. Gallbladder stone formation was observed in 11.1% of patients in the D1 group and in 14.3% of patients in the D2 group, but no statistically significant difference was found between lymphatic dissections. Of 13 patients, 5 (38.4%) were symptomatic and 3 (23.1%) developed choledocholithiasis. Five patients who were symptomatic were operated without any problems. The groups did not show a statistically significant difference in terms of cumulative survival times. While patients who underwent D2 dissection had more formed gallbladder stone, there were no significant differences between the groups. Conclusion: The complications related to gallbladder stone developed after gastrectomy can be safely managed. Keywords: Gallstone, total gastrectomy
The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emer-gency surgical interventions. Here, we examined patients with acute appendicitis who ...presented to emergency departments and com-pared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis.
A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diag-nosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1-April 30, 2019) and after (pandemic period: January 1-April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pan-demic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up.
Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this infor-mation non-operative management can be employed for patients diagnosed with appendicitis.
Amaç: Bu çalışmada bir üniversite kliniğinde gerçekleştirilen laparoskopik gastrektomilerin erken dönem sonuçlarının paylaşılması amaçlanmıştır.Gereç ve Yöntem: Eylül 2015- Eylül 2018 tarihleri ...arasında yapılan laparoskopik gastrektomiler total ve distal olmak üzere iki gruba ayrılmış, teknik, patolojik sonuç ve erken postoperatif komplikasyonlar açısından incelenmiştir.Bulgular: Çalışmaya 11’i erkek, 7’si kadın olmak üzere 18 hasta dahil edilmiştir. Yaş ortalaması 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmuş sadece beş hastaya neoadjuvan tedavi protokolü uygulanmıştır. Total gastrektomi 14 hastada, distal gastrektomi 4 hastada tercih edilen ameliyat yöntemidir. Tüm hastalara tümör yerleşimine göre standart D2 lenf disseksiyonu uygulandı ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral başlama süresi ve Total gastrektomi grubunda 6,4 gün distal gastrektomi grubunda 2,5 gün idi. Duodenal güdük kaçağı 4 hastada, özefagojejunostomi kaçağı 2 hastada tespit edilirken 1 hastada da dren yerinde kanama görüldü.Sonuç: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliliğini gösteren birçok çalışma bulunmaktadır. Ancak öğrenim süreci uzun, teknik zorlukları fazla olan bu ameliyatlarda deneyim ve tecrübe arttıkça ameliyat sürenin kısalacağını ve komplikasyon oranının azalacağını düşünmekteyiz.
Purpose: The aim of this study was to evaluate the early results of laparoscopic gastrectomy performed in a university clinic.Materials and Methods: Laparoscopic gastrectomy performed between September 2015 and September 2018 were divided into two groups as total and distal, and evaluated in terms of the technical, pathological and early postoperative complications.Results: Eighteen patients (11 male and 7 female) were included in the study. The mean age was 57.4 and the mean BMI was 26.3. Surgical treatment was prioritised in 13 patients and only five patients underwent neoadjuvant treatment protocols. Total gastrectomy was the preferred surgical method in 14 patients and distal gastrectomy in 4 patients. All patients underwent standard D2 lymph dissection according to tumor localization and 33.2 was the mean number of lymph nodes dissected in the total gastrectomy group; while a mean of 32 lymph nodes were dissected in the distal gastrectomy group. The mean oral start time was 6.4 days in the total gastrectomy group and 2.5 days in the distal gastrectomy group. Duodenal stump leak was detected in 4 patients, esophagojejunostomy leak was detected in 2 patients, while 1 patient had bleeding in the drain location.Conclusion: There are many studies demonstrating the adequacy of laparoscopic gastrectomy and lymphatic dissection. However, we believe that as the experience increases in these surgeries with many technical difficulties and a long learning duration; the operation time will be shortened and the complication rate will decrease.
Aim: Recently, the preoperative systemic inflammatory response has been reported to be a prognostic factor in patients with colorectal cancer (CRC).
In this context, the preoperative ...neutrophil/lymphocyte ratio (NLR) has been proposed as a useful predictor of prognosis. In this study, we aimed
to determine the clinical value and prognostic significance of neutrophil/lymphocyte ratio in predicting postoperative complications in patients
undergoing surgical treatment for colorectal cancer.
Method: Patients who underwent surgical treatment for colorectal cancer between 2015-2019 were included in the study. group 1 (Low NLR)
and group 2 (High NLR) were formed. Demographic and clinical characteristics, intraoperative and postoperative results, and mean survival were
compared. The value of NLR in predicting postoperative complications at the determined cut-off value was examined.
Results: Patients were divided into two groups according to the cut-off value of 2.08. Group 1 consisted of 56 patients, and group 2 consisted of
223 patients. Male sex was dominant in both groups (60% vs 64%, p=0.349), while patients in group 2 received more neoadjuvant treatment (29.1%
vs 12.5%, p=0.007). Intraoperative complication rates were similar (1.8% vs 4%, p=0.369), pathological grade (p=0.031), and stage (p=0.113) were
similar. Postoperative complications were more common in group 2 (24.7% vs 10.7%, p=0.015). Total survival was shorter in group 2 (46 months
vs. 52 months, p=0.025). At the determined cutoff value, NLR predicted postoperative complications with 22.94% specificity and 90.6% sensitivity.
Conclusion: High NLR was associated with postoperative complications and survival. Although it has a prognostic value, its value in predicting
postoperative complications is limited and cannot be used alone.
Purpose: The aim of this study was to compare the results of conventional and laparoscopic adrenalectomy in adrenal mass cases operated on during a 9-year period.Materials and Methods: A total of 81 ...patients who underwent adrenalectomy were included in the study. Patients were divided into two groups as; Group 1 - conventional surgery and Group 2 - laparoscopic surgery. Two groups were compared retrospectively on characteristics such as; age, sex, body mass index (BMI), American Society of Anesthesiologists' score (ASA), mass localization, mass size and hormonal activity of the mass, duration of operation, amount of bleeding in operation, duration of hospitalization, duration until food intake, perioperative mortality, early complications and readmission to hospital within 90 days. Results: There were 22 patients in Group 1 and 59 patients in Group 2. No statistically significant difference was found between the groups in terms of age, sex, BMI, ASA score, tumor localization, indications for operation, postoperative complication, perioperative mortality and re-admittance within 90 days. The hormonal activity of the mass was higher and the mass was smaller in size in Group 2. The duration of operation (min), the amount of bleeding in the operation (ml), the duration until oral intake (days) and the length of hospital stay (days) were found to be statistically significantly higher in Group 1.Conclusion: Laparoscopic adrenalectomy should be the preferred surgical method because of its short duration of operation, low blood loss, early onset of oral food intake and shorter hospital stay, as well as its safety.
Amaç: Bu çalışmada, 9 yıl içerisinde adrenal kitle nedeni ile ameliyat edilen olgularda konvansiyonel ve laparoskopik adrenalektominin sonuçlarının karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Adrenalektomi uygulanan 81 hasta çalışmaya dahil edildi. Grup 1 konvansiyonel, Grup 2 Laparaskopik cerrahi olarak hastalar iki grupa ayrıldı. İki grup, yaş, cinsiyet, vücut kitle indeksi (VKİ), Amerikan anestezistler derneği skoru (ASA), kitle lokalizasyonu, kitle büyüklüğü ve kitlenin hormonal aktivitesi, operasyon süresi, operasyonda kanama miktarı, yatış süresi, gıdaya başlama süresi, perioperatif mortalite, erken dönem komplikasyonlar ve 90 gün içinde hastaneye tekrar başvuru gibi özellikleri esas alınarak retrospektif olarak karşılaştırıldı. Bulgular: Grup 1’de 22, Grup 2’de 59 hasta mevcut idi. Gruplar arasında yaş, cinsiyet, VKİ, ASA skoru, tümör lokalizasyonu, operasyon endikasyonları, postoperatif komplikasyon, perioperatif mortalite ve 90 gün içinde tekrar başvuru açısından istatistiksel olarak anlamlı fark saptanmadı. Kitlenin hormonal aktivitesi Grup 2’de daha yüksek, boyutu ise daha küçük saptandı. Operasyon süresi (dak), ameliyatta kanama miktarı (ml), oral alım süresi (gün) ve hastanede yatış süresi (gün) Grup 1’de daha fazla ve istatiksel olarak anlamlı bulundu. Sonuç: Laparoskopik adrenalektomi uygun hastalarda, kısa operasyon süresi, az kan kaybı, oral gıdaya erken başlama süresi ve daha kısa hastanede kalış süresi gibi avantajları, ayrıca güvenli olması nedeni ile tercih edilmesi gereken cerrahi yöntem olmalıdır.
Aim: Various factors including free oxygen radicals were have been described in the pathogenesis of inflammatory bowel disease. The aim of this study
was to investigate the effects of antioxidant ...N-acetylcysteine (NAC) and combined glutamine (Gln) on experimental colitis.
Method: In order to achieve this, rats were randomized and administered intraperitoneal NAC or oral Gln + intraperitoneal NAC one day after
experimental colitis model induced with trinitrobenzen sulphonic acid. After the treatment, the rats were sacrificed and colon damage was evaluated
macroscopically and microscopically. Malonyldialdehyde level and superoxide dismutase activity were analyzed biochemically.
Results: NAC and Gln + NAC groups showed macroscopically better results than the colitis group. Histopathologically, all treated groups provided
significantly lower scores than the colitis group. Similarly, all treated groups provided better biochemical results than the colitis group.
Conclusion: According to the results of the experiment, it was concluded that NAC had positive effects on experimental colitis model.
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