Impact of preoperative carbohydrate loading on postoperative course and morbidity in debulking surgery for epithelial ovarian cancer.

Despite the theoretical benefits, the favorable effect of preoperative carbohydrate loading on postoperative morbidity remains controversial. Most of the outcomes reported in the literature are derived from non-gynecologic surgery data, with only one study involving a limited number of patients specifically in gynecological oncology. The present study aimed to investigate the impact of carbohydrate loading, as a single element of enhanced recovery after surgery protocols, on postoperative course and morbidity in patients undergoing debulking surgery for epithelial ovarian cancer (EOC). The present study was a non-randomized, prospective cohort trial enrolling patients with EOC who underwent surgery between June 2018 and December 2021. An oral carbohydrate supplement with a dose of 50 g was given to patients 2-3 h before anesthesia. Data on postoperative course and morbidity were collected and compared with data of a historical cohort including consecutive patients who underwent surgery without a carbohydrate loading between January 2015 and June 2018. Analyses were performed on a total of 162 patients, including 72 patients in the carbohydrate loading group and 90 patients in the control group. Median length of hospital stay (11 days vs. 11 days; P=0.555), postoperative days 1-7 serum c-reactive protein levels (P=0.213), 30-day readmission (11.6% vs. 11.5%, P=0.985), 30-day relaparotomy (2.8% vs. 3.4%, P=0.809) and 30-day morbidity (48.6% vs. 46.7%; P=0.805) were comparable between the cohorts. No significant differences in grades of morbidities were identified between the cohorts (P=0.511). Multivariate analysis revealed that the sole independent risk factor for any postoperative morbidity was operative time. In conclusion, based on the results of the present study, postoperative course and morbidity seemed to be unaffected by carbohydrate loading in patients undergoing debulking surgery for EOC.

The effects of breast reduction with superomedial and inferior pedicle techniques on radiological breast imaging.

BACKGROUND: Several breast reduction techniques have been introduced, and the reliability of these techniques has been demonstrated in clinical practice. However, it is still controversial how patients should be evaluated radiologically both preoperative and postoperative. This study aims to compare the radiological findings seen following reduction mammoplasty with two different techniques (inferior pedicle and superomedial pedicle), in connection with the surgical steps. METHODS: Medical records of 141 patients and a total of 278 breasts who underwent breast reduction with the diagnosis of macromastia were retrospectively analyzed. Demographic and operative data such as age, type of pedicle, preoperative and postoperative nipple-areola complex (NAC) position, and NAC transfer distance were recorded. Radiological evaluation was performed by two radiologists experienced in breast imaging by reinterpreting preoperative and postoperative mammography images. RESULTS: The rate of postoperative structural distortion (p < 0.001), thickened areola (p = 0.011), and retroareolar fibrotic band (p < 0.001) were observed to be significantly higher in the superomedial group. The risk of fat necrosis increases as the NAC transfer distance increases and a value of >9.5 cm in the NAC transfer distance can be considered as the cutoff value in terms of fat necrosis development, especially in those using superomedial pedicle technique. CONCLUSION: Surgical technique-specific benign radiological changes occur following reduction mammoplasty. However, these changes do not significantly affect the Breast imaging, reporting, and data system category. The localization of fat necrosis differs depending on the surgical technique, and the risk of fat necrosis increases as the NAC transfer distance increases, especially in those who have undergone superomedial pedicle breast reduction surgery.

Diagnostic Accuracy of Imaging Modalities on Occult Groin Hernias According to Hernia type and a Surgeon-centered Individualized Groin Hernia Management Algorithm.

BACKGROUND: The purpose of this study is to evaluate the diagnostic performance of imaging techniques for the identification of groin hernias based on the type of hernia and to demonstrate the efficacy of an algorithm based on the surgeon and surgical technique. MATERIALS AND METHODS: Medical records of 561 patients who were operated on for groin hernia were retrospectively analyzed. A total of 102 patients who had both pelvic computed tomography (CT) and ultrasonography (USG) recordings preoperatively and underwent transabdominal preperitoneal repair were included in the study. RESULTS: A contralateral asymptomatic occult groin hernia was detected in 25.5% of all patients. The overall sensitivity of USG and CT on contralateral asymptomatic occult hernia was 42.3% and 65.4%, respectively. The sensitivity of USG according to the contralateral occult hernia type was 66.7%, 35.7%, 33.3%, and 50% for direct, indirect, femoral, and pantaloon hernias, respectively. The sensitivity of CT according to the contralateral occult hernia type was 0%, 57.1%, 100%, and 100% for direct, indirect, femoral, and pantaloon hernias, respectively. CONCLUSIONS: The handicap created by the variability in the diagnostic sensitivity of imaging modalities can be overcome with the choice of transabdominal preperitoneal repair in the surgical technique.

A rare cause of acute anal pain: strangulated hemorrhoids in a perianal fistula.

BACKGROUND: Hemorrhoidal disease is characterized by painless rectal bleeding and palpable swelling in the anus and very common in the society. In the presence of pain, it is called a complicated hemorrhoidal disease including conditions, such as thrombosed hemorrhoids, strangulation of the internal hemorrhoid, or accompanying anal fissure. Edema that develops as a result of impaired venous return is accepted as the main source of pathology in the development of strangulated internal hemorrhoidal disease, which is one of these complicated conditions. CASE PRESENTATION: This case report shows that strangulated hemorrhoidal disease can also develop due to a mechanical cause as a result of incarceration of the hemorrhoid into the accompanying perianal fistula tract. KEY WORDS: Anorectal pain, Hemorrhoidal disease, Strangulated internal hemorrhoidal, Perianal fistula.

Hepatic artery reconstruction with gonodal vein interposition: First case in patients receiving liver from the living donor.

BACKGROUND: Technical problems such as graft and vascular size are more common in living donor liver transplantation (LDLT) than in deceased donor liver transplantation. It is usually possible to get enough length of vessels on the graft, but the opposite situation is devastating. Finding the suitable vessel graft is life-saving in those situations. In this paper we present a case of gonodal vein interpositioning for hepatic artery reconstruction in an LDLT recipient. To the best of our knowledge, this is the first such case to be reported in the literature. CASE REPORT: A 36-year-old man with cirrhosis secondary to hepatitis B underwent LDLT. Within minutes after completing the anastomosis, the artery was thrombosed. Disrupting the anastomosis showed subintimal dissection of the recipient right hepatic artery extending to the gastro-duodenal junction. A 4 cm segment of gonodal vein, which matched the diameter of the recipient hepatic artery, was used as a bridge. The patient's postoperative recovery was excellent and Doppler ultrasonography demonstrated sufficient hepatic arterial blood flow. At long-term follow-up (18(th) months), the patient's graft is still functioning. CONCLUSIONS: Gonodal vein interposition for hepatic artery reconstruction in living donor liver transplantation has not been previously reported. In light of the urgency of this situation, we believe it can be a life-saving reconstruction.

Effect of positive lcm-igm on graft survival in living donor renal transplantation.

OBJECTIVE: Renal transplantation is an outstanding therapy for end-stage renal failure and has been shown to increase life expectancy and quality of life, while reducing medical expenditure. The presence of IgM antibodies in recipient serum is not a contraindication for renal transplantation. However, the presence of this antibody may have significant clinical implications. IgM autoantibodies have been blamed for a group of accelerated or hyperacute cases of graft rejection. In this study, graft and patient survival outcomes after renal transplantation in LCM IgM-positive recipients have been assessed. MATERIALS AND METHODS: Data from 32 LCM IgM-positive kidney recipients who underwent renal transplantation at the Akdeniz University Transplantation Center between January 2006 and August 2008 were assessed. RESULTS: The mean age was 34 ± 13.5 (9-66). Twenty patients were male, and twelve were female. The mean length of therapy with dialysis was 22.94 ± 30.06 months (0-120). The duration of cold ischemia was 28.63 ± 5.85 minutes (21-42). CONCLUSION: Throughout the follow up period, the mean creatinine level was 1.3 mg/dL (0.69-4.5). Graft loss occurred in only one patient and was due to hemophagocytic syndrome and acute rejection. During follow up, creatinine elevation was seen in 12 patients (4%) in the early postoperative period. These patients were thought to have transplant rejection, and therapy for rejection was given. The therapy was successful. Graft survival was calculated to be 96 ± 3.5%, and none of the patients were lost.