Comparison of the results of using a self-adhesive mesh and a polypropylene mesh in open inguinal hernia repair: a prospective randomized controlled study.

<b> Introduction:</b> Inguinal hernia repair is the most common operation worldwide. The essential factors in hernia repair have been the postoperative quality of life, early return to work, low recurrence rate, and chronic pain prevention. </br></br> <b>Aim:</b> The aim of this study was to compare the short- and long-term results of the self-adhesive mesh and the conventional polypropylene mesh in Lichtenstein repair. </br></br> <b> Material and methods:</b> A total of 100 male patients were randomized and operated on, 50 with the self-adhesive mesh (S group), 50 with the conventional polypropylene mesh (P group). Prospectively, the patients were followed for an average of 36 months. The two groups were compared for the duration of surgery, duration of hospital stay, duration of daily activity/resumption of work, postoperative pain, chronic pain, recurrence, wound infection, hematoma/seroma formation, and postoperative analgesic consumption. </br></br> <b>Results:</b> The study involved 39 patients in the P group and 37 patients in the S group who underwent inguinal hernia surgery. The P group had a longer mean operation time than the S group, and the difference between the two groups was statistically significant (45.1 ± 6.6 min vs. 28.8 ± 3.0 min, P = 0.0001). In recurrence, postoperative discomfort, chronic pain, length of hospital stay, daily activity/return to work, wound infection, hematoma/seroma, and postoperative analgesic use, there was no statistically significant difference between the two groups. </br></br> <b>Conclusion:</b> It was found that the self-adhesive mesh did not produce statistically significant advantages over the conventional polypropylene mesh, except for operative time, in the Lichtenstein repair.

Routine Histopathological Examination of the Specimen After Laparoscopic Cholecystectomy: Can We Be Brave Enough to Give Up?

BACKGROUND: Selective versus routine histopathological examination after cholecystectomy is still in debate. This study aims to investigate the effect of histopathology results on treatment modality and surgery strategy. The validity of the selective histopathology approach was questioned. METHODS: The data of patients undergoing laparoscopic cholecystectomy between January 2009 and December 2019 were retrospectively analyzed. The demographics and histopathology results, whether the operation was emergent or elective, and the reasons for conversion to open surgery were recorded. Malignant and precursor histopathology diagnoses were examined, and their relationship with the surgical strategy was questioned. RESULTS: A total of 2723 patients were included in the study. Of these patients, 2600 (95.5%) were operated under elective, while 123 (4.5%) were operated under emergency conditions. While the surgery was completed laparoscopically in 2685 (98.6%) patients, it was converted to open surgery in 38 (1.4%) patients. Age, gender, the presence of primary gallbladder cancer, acute cholecystitis, and xanthogranulomatous cholecystitis in histopathological examination were found to be independent predictive factors for conversion to open surgery (P < .05). The rate of primary invasive carcinoma in the series was 0.1%. CONCLUSION: Routine histopathological examination of the gallbladder is important for demonstrating a wide spectrum of pathological changes in this organ. Invasive cancer or precursor lesions can be detected even in patients without any macroscopic abnormality. Histopathological examination also plays a role in determining follow-up, further examination, and treatment modality in addition to the diagnosis in these patients.

A new criterion to predict recurrence after laparoscopic ventral hernia repair: mesh/defect area ratio.

<b>Introduction:</b>Minimizing recurrence in hernia surgery is one of the major aims. Defining surgeon-dependent risk factors for recurrence is therefore of great importance in laparoscopic ventral hernia repair (LVHR). This study aims to analyze the predictive value of the mesh area/defect area ratio (M/D ratio) in terms of recurrence as a new criterion in LVHR.</br> </br> <b>Methods:</b> A total of 124 patients were enrolled in the study. Age, gender, hernia type, body mass index, defect size, size of the mesh, mesh overlapping, area of the defect, area of the mesh, M/D ratio, postoperative complications, follow-up time, recurrences and timing of recurrence were also recorded. The potential variables that may affect recurrence were examined by univariate and multivariate analysis.</br> </br> <b>Results:</b> There were 12 (9.7%) recurrences in our series. A statistically significant difference was found if either the mesh/defect ratio was ≤6 or >6 (p = 0.012). Multivariate analysis confirmed that M/D ratio was the only independent parameter for recurrence. </br></br><b>Conclusion:</b> Understanding M/D ratio concept and using it in surgical clinical practice may help reduce recurrence rates after LVHR.</br>.

Acute Appendicitis in Pregnancy: How to Manage?

OBJECTIVES: Acute appendicitis during pregnancy may be associated with severe maternal and fetal complications. The clinical, laboratory and radiological parameters used in diagnosis and the effects of the surgical method and timing on the results are controversial. The present study aims to reveal the relationship between clinical approach, surgical treatment methods and complications in pregnant women with suspected acute appendicitis. METHODS: Between December 2007 and August 2019, 21 pregnant women who underwent appendectomy were included in this study. Age, gestational age, complaints at admission, leukocyte count, radiological examination results, type of surgery (conventional or laparoscopic), histopathology results, time from admission to operation, maternal and fetal complications were retrospectively evaluated. RESULTS: The number of patients who developed complications was six (28.6%). Three (14.3%) of these patients had preterm birth and three (14.3%) had an abortion. There was no statistically significant relationship between trimester and complication (p=0.747). Fourteen patients (66.7%) underwent laparoscopic surgery and seven patients (33.3%) underwent conventional surgery. Although the complication rate was higher in the laparoscopic group, there was no statistically significant difference (p=0.306). The fetal loss rate in the series was 14.3% and all were in the laparoscopic group. However, there was no statistically significant difference between the groups (p=0.158). CONCLUSION: Pregnancy-related limiting factors may complicate the diagnosis of acute appendicitis. These patients definitely need a more skeptical assessment and additional diagnostic tools beyond the standard clinical approach. Although laparoscopic appendectomy appears to be a safe option in treatment, its relationship with a higher risk of fetal loss should be kept in mind.

Comparison of laparoscopic primary and open primary repair of ventral hernias.

Prosthetic materials have gained popularity for ventral hernia repair. There are situations when the use of a mesh is either unnecessary or contraindicated. This study compares 51 patients with ventral hernia who underwent laparoscopic or open primary suture repair. Results were determined by a median follow-up of 33 months. Recurrence rates and operative time were the major parameters of outcome. Mean operative time was insignificantly shorter in the laparoscopic group (14.8 ± 4.3 vs. 15.6 ± 3.7 min). There were no short-term complications in groups. One patient in each group had recurrence. Conclusively, laparoscopic primary repair of small ventral hernias is simple and can be performed as an initial approach for small defects. Compared with open repair, it has the advantages of better exposure, reduced pain, and less morbidity. It can also be performed as a component of a combined laparoscopic operation. However, this technique is not recommended for repair of large ventral hernias.

Phyllodes tumor of the breast; a case series.

BACKGROUND: Phyllodes tumor (PT) is a rare neoplasm comprising less than 1% of all breast tumors. Its clinical spectrum ranges from a benign and locally recurrent form of behavior to malignant and metastatic forms. The aim of the study was to evaluate the clinical characteristics, treatment regimens, survival and late complications in patients with PT. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 10 women who were treated for PT in our center between 1998 and 2002. All cases were histologically examined by an experienced breast pathologist, and tumors were classified as benign, borderline malignant or malignant according to standard histological criteria. RESULTS: The median age at diagnosis was 45.5 years (range: 21-69 years). Seven (70%) of 10 tumors were benign and 3 (30%) were malignant. The median tumor size was 29 mm (range: 12-80 mm). The least safe margin was 1 cm. Three of 10 patients had malignant PT and underwent simple mastectomy. Local recurrence was determined in no patients. Only one patient had lung metastasis. Median follow-up period was 62 months (range, 12-96 months). The patient with lung metastasis was treated with doxorubicine but died one year after the operation. CONCLUSION: PT is a rare neoplasm of the breast. It resembles fibroadenoma. Local excision with appropriate surgical margins seems adequate in all patients (Tab. 1, Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Laparoscopic primary repair of ventral hernias: early results of a new technique.

Epigastric, umbilical, incisional, parastomal, and trocar site hernias are all classified as "ventral" hernias, which constitute a great portion of the surgery in a general surgical practice, and debate still continues regarding the optimal surgical strategy to correct these anatomical defects. Although repairing these hernias using a synthetic material, whether placed open or laparoscopically, has gained wide popularity, there are some situations where the use of a mesh is either unnecessary or contraindicated. This article presents the cases of 10 patients with some kind of ventral hernia which were all repaired laparoscopically with a primary suturing technique.

The protective role of anandamide in mesenteric ischemia reperfusion injury in guinea pig.

BACKGROUND: Acute mesenteric ischemia is an entity characterized by rapid developing of circulatory failure. Reperfusion following ischemia causes further mucosal injury. METHODS: In our study, an experimental model of 15 minutes of reperfusion following 45 minutes of superior mesenteric artery occlusion was established. The segments which underwent I/R injury were histopathologically examined, and blood samples obtained from the heart were analyzed for alkaline phosphatase and creatine kinase levels. RESULTS: The results of the study demonstrated that mucosal injury in anandamide injected group was less expressed than in other groups suggesting that anandamide might have a protective effect on the mucosa. After L-NAME and indomethacin injection, the protective effect of anandamide seems to disappear due to inhibition of NO and prostaglandins. The results of histopathological examination of specimens from CB1 receptor and anandamide injected group indicate that I/R injury has regressed. CONCLUSION: The protective effect of endogenous anandamide on I/R injury may take place through CB2 receptors in the small intestine; NO and prostaglandin, which are activated through the stimulation of CB2 receptors may be responsible for this protective effect (Fig. 8, Ref. 29). Full Text (Free, PDF) www.bmj.sk.

Comparison of intraperitoneal honey and sodium hyaluronate-carboxymethylcellulose (Seprafilm) for the prevention of postoperative intra-abdominal adhesions.

BACKGROUND: Abdominal surgery can lead to postoperative intra-abdominal adhesions (PIAAs) with significant morbidity and mortality. This study compares the use of honey with a standard bioresorbable membrane (SEPRAFILM) to prevent the formation of PIAAs in rats. METHODS: Thirty rats underwent laparotomy, and PIAAs were induced by scraping the cecum. The animals were divided into three groups, each containing ten rats. Group 1 (control) represented the cecal abrasion group, with no intraperitoneal administration of any substance. Group 2 (honey group) underwent cecal abrasion and intraperitoneal administration of honey. Group 3 (Seprafilm group) underwent cecal abrasion and intraperitoneal Seprafilm application. RESULTS: Group 1 exhibited higher adhesion scores for adhesions between the abdominal wall and the organs. Groups 2 and 3 had decreased adhesive attachments to the intra-abdominal structures. Compared to group 1, the incidence of adhesion formation was lower in both group 2 (p=0.001) and group 3 (p=0.001). The incidence of fibrosis was also lower in group 2 (p=0.016) and group 3 (p=0.063) compared to group 1. There was no significant difference between the histopathological fibrosis scores for the rats in group 2 and those in group 3 (p= 0.688). CONCLUSION: This study suggests that both honey and Seprafilm decrease the incidence of PIAAs in the rat cecal abrasion model. Although the mechanism of action is not clear, intraperitoneal administration of honey reduced PIAAs. The outcome of this study demonstrates that honey is as effective as Seprafilm in preventing PIAAs.

The value of breast ductoscopy in radiologically negative spontaneous/persistent nipple discharge.

Breast ductoscope is a fiberoptic endoscope used for examining the distal breast ducts under direct vision in order to identify the source of pathologic nipple discharge. The purpose of this study was to investigate the reliability of intra-operative breast ductoscopy in patients with pathologic nipple discharge, which could not be identified by radiologic tests. Between April 2002 and March 2007, breast ductoscopy was performed in 34 patients who had pathologic nipple discharge with no radiologic evidence about the source. The procedures were carried out under general anesthesia and ductoscopic findings were as well as the histopathology of the specimens were recorded and documented. In 88%, (30 of 34) of the patients, endoscope was successfully introduced into the external orifice of the ducts at the nipple and proximal breast ducts were successfully visualized. Ductoscopy revealed intraductal lesions (i.e., ductal obstruction, intraductal papilloma, red patches, and erythematoid platter) in 20 patients (66%). Among the 20 patients with visible endoluminal pathology, nine had a papilloma and eight had signs of either acute inflammation (bleeding, erythema) or previous inflammation with healing (adhesions and blocked ducts). In two cases, invasive breast carcinoma was identified, one of which was ductal carcinoma in situ (DCIS) with minimal invasion. In both cases, there had been blocked ducts. In one case DCIS was identified. Breast ductoscopy is a reliable and easy-to-use method to demonstrate the source of pathologic nipple discharge in cases with bleeding and other intraductal lesions.

Analysis of surgical complications of thyroid diseases: results of a single institution.

BACKGROUND: The purpose of this study is to compare the complications of different types of thyroidectomy for benign and malignant thyroidal diseases. METHODS: Between January 2001 and March 2006, 982 patients underwent thyroidectomy in single institute. A retrospective analysis was performed on demographic characteristics and pathology reports of patients, complications of surgery as well as the follow-up of patients. Sixty patients could not be fully followed up and were excluded. RESULTS: The types of the surgical procedures were as follows; 451 (48.9%) total, 137 (14.9%) subtotal, 60 (6.5%) near-total thyroidectomy and 274 (29.8%) lobectomy with isthmectomy. In the benign group, temporary recurrent laryngeal nerve injury (RLNI) was the most common complication in patients with toxic diffuse goiter (TDG 2%) while this complication occurred in patients with differentiated thyroid cancer (DTC 1.5%) in the malign group. Permanent RLNI in benign thyroidal diseases was seen more commonly in patients with toxic multinodular goiter (1.3%). In benign thyroidal diseases, temporary hypoparathyroidism (THPT) was mostly found in patients with TDG (8%), whereas in malignant thyroidal diseases this was found more in patients with DTC (2%). Permanent HPT (PHPT) in benign thyroidal diseases was observed more commonly in patients with multinodular goiter (0.9%). In malignant thyroidal diseases, it was more frequently observed in patients with DTC (0.5%). Infective complications after thyroid surgery are rarely observed and have a low incidence (0.4%). CONCLUSION: RLNI and HPT are the most common complications of after thyroid surgery but they may be avoided with an accurate technique (Tab. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Comparison of intraperitoneal honey and sodium hyaluronate-carboxymethylcellulose (SeprafilmTM) for the prevention of postoperative intra-abdominal adhesions

BACKGROUND: Abdominal surgery can lead to postoperative intra-abdominal adhesions (PIAAs) with significant morbidity and mortality. This study compares the use of honey with a standard bioresorbable membrane (Seprafilm tm) to prevent the formation of PIAAs in rats. METHODS: Thirty rats underwent laparotomy, and PIAAs were induced by scraping the cecum. The animals were divided into three groups, each containing ten rats. Group 1 (control) represented the cecal abrasion group, with no intraperitoneal administration of any substance. Group 2 (honey group) underwent cecal abrasion and intraperitoneal administration of honey. Group 3 (Seprafilm tm group) underwent cecal abrasion and intraperitoneal Seprafilm tm application. RESULTS: Group 1 exhibited higher adhesion scores for adhesions between the abdominal wall and the organs. Groups 2 and 3 had decreased adhesive attachments to the intra-abdominal structures. Compared to group 1, the incidence of adhesion formation was lower in both group 2 (p=0.001) and group 3 (p=0.001). The incidence of fibrosis was also lower in group 2 (p=0.016) and group 3 (p=0.063) compared to group 1. There was no significant difference between the histopathological fibrosis scores for the rats in group 2 and those in group 3 (p= 0.688). CONCLUSION: This study suggests that both honey and Seprafilm tm decrease the incidence of PIAAs in the rat cecal abrasion model. Although the mechanism of action is not clear, intraperitoneal administration of honey reduced PIAAs. The outcome of this study demonstrates that honey is as effective as Seprafilm tm in preventing PIAAs.

Acute hemiscrotum due to inguinoscrotal Littre hernia: a case report.

Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract that is generally asymptomatic and only manifests in a specific way when complications exist. An unusual complication of MD is known as Littre hernia. It comprises less than 1% of all MD. Littre hernia is the protrusion of an MD through a potential abdominal opening. Usual sites of Littre hernia are right inguinal (50% of cases), umbilical hernia (20%), and femoral hernia (20%). We report a case of Littre hernia in a boy who presented with acute scrotal pain and swelling.

Vogt-Koyanagi-Harada syndrome and mesenteric ischemia: a case report.

Vogt-Koyanagi-Harada (VKH) disease is a rare inflammatory ocular disorder that is characterized by bilateral granulomatous panuveitis, neuropathy, and aseptic meningitis, along with various extraocular manifestations. VKH disease has been reported to be associated with various immune disorders. In this report, a case of VKH disease is presented that is associated with mesenteric vascular disease and intestinal necrosis, with an emphasis on the fact that this is the first case documented in the literature of both diseases occurring simultaneously.