The advantages and intraoperative management of the laparoscopic approach in perforated appendicitis.

INTRODUCTION: Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and post-operative complications of laparoscopic interventions in the treatment of perforated appendicitis. PATIENTS AND METHODS: One hundred and ten patients (50 men and 60 women) diagnosed with perforated appendicitis based on history, physical examinations, laboratory and computed tomography findings between January 2016 and May 2022 were analysed retrospectively. Preoperative laboratory and radiological findings, surgical methods and post-operative complications were evaluated. RESULTS: Abdominal pain defence and rebound were present in all patients. In terms of radiological findings, intra-abdominal free fluid was present in all patients and abscess in 42. Post-operative abdominal surgical site infection developed in six patients. No intra-abdominal abscess or incisional hernia was observed during follow-ups. CONCLUSION: As a diagnostic tool, permitting better visualisation of the abdominal cavity, entailing fewer post-operative complications and obviating the need for large incisions, laparoscopy can represent the approach of choice in the treatment of perforated appendicitis.

Treatment Options and the Management of Complications in Hydatid Cysts of the Liver in Endemic Regions.

BACKGROUND: Hydatid cyst of the liver induced by Echinococcus granulosus is a pervasive zoonotic disease in our region. Its incidence varies across age groups, contingent on community lifespans and hygiene standards. Therapeutic modalities include Puncture, Aspiration, Injection, Re-aspiration (PAIR), and surgery. Due the limited feasability of PAIR, we suggest that surgery represents the optimal treatment in all stages, especially in endemic regions, depending on patient-specific variables. METHOD: Patients with hydatid cyst of the liver treated with PAIR and surgery in our center between January 2016 and January 2022 were analyzed retrospectively. PAIR or cystectomy were applied in treatment. These were then compared in terms of efficacy, feasibility, and complications. RESULTS: A single hydatid cyst of the liver was detected in 184 of the 225 cases, two cysts in 33, and three or more cysts in eight. The largest cyst diameter was 233 × 124 mm in the surgery group and 100 × 90 mm in the PAIR group. One hundred thirty-three of the 225 patients underwent open surgery, and no recurrence was encountered in these. However, recurrence was observed 19 patients treated with PAIR. Allergic reaction developed in one case during surgery, postoperative abscess in two cases, biliary fistula in five, and pneumonia in one. CONCLUSION: Surgical treatment should represent the standard procedure since it is safe and effective, ensures complete elimination of the parasite, involves no intraoperative shedding, preserves healthy tissues, and minimizes the risk of long-term recurrence and cavity-related complications.

Acute abdomen due to torsion of the wandering spleen: A rare clinical presentation.

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.

Evaluation of tube drainage method in the treatment of hydatid cyst of liver.

BACKGROUND/AIMS: It has been reported that surgical methods such as marsupialization and tube drainage were unfavorable due to their possible complications in surgical treatment of hydatid cyst in liver. We aimed to compare tube drainage technique with other surgical modalities. METHODOLOGY: Seventy-two patients who underwent surgical treatment due to hydatid cyst of liver in Haseki Education and Research Hospital between 2000 and 2003 constituted our study group. The mean age of patients was 42 +/- 17 years, 31 being male and 41 being female. Tube drainage was applied to 32 patients, whereas the remaining 40 patients were treated by other surgical methods such as omentoplasty, total cystectomy, intraflexion, capitonnage. These two groups of patients were compared with each other according to their postoperative hospitalization time and resulting complications. RESULTS: The complication rate was 28.1% in patients who underwent tube drainage. Their mean postoperative hospitalization time was 7.3 +/- 3.19 days. The complication rate was 17.5% in patients who underwent any kind of surgery other than tube drainage. Their mean postoperative hospitalization time was 7.4 +/- 4.5 days. No statistical significant difference was found in the comparison of these two groups concerning both the postoperative hospitalization time and the rate of complications (p > 0.05). CONCLUSIONS: The method of tube drainage is a safe surgical modality in the treatment of hydatid cyst disease of liver if applied properly on appropriate patient according to the data we obtained.

An evaluation of low molecular weight heparin and hyperbaric oxygen treatment in the prevention of intra-abdominal adhesions and wound healing.

BACKGROUND: Abdominal surgery can lead to intra-abdominal adhesions with significant morbidity and mortality. To prevent adhesions, an experimental study was planned to designate the effects of low molecular weight (LMW) heparins and hyperbaric oxygen (HBO) therapy both on the formation of adhesions and wound healing. METHODS: Thirty-eight Wistar albino rats underwent laparotomy to cause intra-abdominal adhesions by mechanical abrasion of the cecum and ethanol application. The rats were divided into 4 groups. In the control group (group 1) no further management was undertaken. Group 2 was treated by Enoxaparine Na, group 3 received HBO therapy, and group 4 was given both enoxaparine Na and HBO treatment. RESULTS: There was a statistically significant difference between the control and enoxaparine Na groups regarding adhesions. Statistically significant differences were observed between groups 1 and 4 and between groups 1 and 3 regarding the hydroxyproline content of the abdominal wounds. In the pathologic analysis of the abdominal wounds, there was no statistically significant difference between any of the groups, including the control group, regarding inflammation. Statistically significant differences were observed regarding angiogenesis between the control group and groups 3 and 4. There was also a statistically significant difference regarding fibrosis between groups 1 and 4. CONCLUSIONS: Enoxaparine Na decreased intra-abdominal adhesions, and HBO therapy had no beneficial effect on adhesions. Enoxaparine Na had no harmful effects on wound healing, and HBO therapy increased the process of wound healing.

[Retrospective analysis of the patients with penetrating cardiac trauma]. / Penetran kardiyak travmali hastalarin retrospektif analizi.

BACKGROUND: Penetrating cardiac stab wounds are among rarely seen traumas, associated with high mortality. We aimed to present and investigate our experience in such cases. METHODS: Eighteen cases with penetrating cardiac stab wounds, between 1993-2001, were investigated retrospectively. Gender, age, conditions at application, injured areas, extent of cardiac damage, accompanying organ damages and outcomes of these patients were studied. RESULTS: All patients were male with a mean age of 25.38 years (between 16-42 years). Heart was the only affected organ in nine 9 patients, whereas there were additional organ injuries in the remaining patients. The injuries were at left ventricle in 11, right ventricle in 4 and right atrium in three patients. Only two patients survived among 14 patients who developed cardiac arrest. There was additional organ damage in three of the six survivors. CONCLUSION: The overall mortality was 66%. Suspect of cardiac injury should be considered in patients who are injured close around cardiac area and one should intervene quickly both in diagnosis and treatment.