Easy-to-use electrocautery smoke evacuation device for open surgery under the risk of the COVID-19 pandemic.

OBJECTIVE: This study was performed to introduce an easy method of surgical smoke evacuation for patients with confirmed or suspected COVID-19 undergoing emergency surgery. METHODS: An easy, inexpensive, protective, and practical surgical smoke evacuation device/system was developed and is herein described. RESULTS: The use of this surgical smoke evacuation device/system in open surgery is convenient and effective. It allows for easy, economic, useful, and protective surgical smoke evacuation. CONCLUSIONS: COVID-19 infection causes direct mortality and morbidity, and its incidence has recently increased. Protection from electrosurgery-related smoke is recommended particularly during the current pandemic. This surgical smoke evacuation device/system is easy to use and provides a convenient and effective method of smoke evacuation during both open surgery and all cauterization interventions.

Should Surgeons Evaluate the Anatomy of Drummond Marginal Artery and Riolan's Arch Preoperatively?

INTRODUCTION: The Drummond marginal artery and the Riolan's arch are important links between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA), which provide collateral flow in case of arterial occlusion or significant stenosis. The Riolan's arch is important in colorectal surgery since it allows for vascularization of the descending colon by the SMA after ligation of the IMA at its origin, especially in cancer patients. In this study, we aimed to evaluate the presence of the Drummond marginal artery and the Riolan's arch. In addition, we assessed anatomic variants of the middle colic artery (MCA) and classified the anatomic relationships between SMA and SMV. MATERIALS AND METHODS: Following screening, 115 abdominal CT scans were included in the study. For all cases, the presence of the Drummond marginal artery and the Riolan's arch, the first diameter of these arterial structures at their origins, the first emerging diameter and anatomic variants of the MCA, and the anatomic relationships between SMA and SMV were evaluated. RESULTS: Drummond marginal artery was present in all participants (100%). The Riolan's arch was observed in 27.8% of all cases and was higher than in other studies. This can be related to the focus of this arch. In addition, we did not find any similar study in the literature that evaluated MCA origin types, SMA-SMV variants with the presence of the Drummond artery and the Riolan's arch, and the first emerging diameters of vascular structures, such as the Drummond marginal artery, the Riolan's arch, and MCA. CONCLUSION: Evaluating and stating whether the Drummond marginal artery and the Riolan's arch are seen in thin section abdominal computed tomography (CT) and CT angiographies preoperatively may help in planning appropriate resections and can reduce unwanted postoperative morbidity.

Superior mesenteric artery syndrome: A rare but life threatening disease.

Superior mesenteric artery syndrome was observed in an adolescent patient. He had a 1-day history of nausea, vomiting, and abdominal pain, without chronic or recurrent symptoms. Diagnosis was established by abdominal plain x-ray, contrast enhanced abdominal computed tomography, and endoscopic examination. The patient was hospitalized, monitorized, and decompressed by nasogastric tube without oral feeding. The symptoms of the patient were gradually relieved by conservative treatment and he was discharged after one week. Clinicians should be careful when facing upper gastrointestinal symptoms that are resistant and non-responsive to treatment, and this syndrome should be kept in mind. This case is presented to draw attention to this disease because of its rare incidence.

Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign.

PURPOSE: The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). MATERIALS AND METHODS: Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. RESULTS: Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. CONCLUSION: In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.

Dynamic power Doppler ultrasonography of anterior abdominal wall hernias: confirmation of incarceration.

PURPOSE: Power Doppler ultrasonography (PD-US) is a motion-sensitive modality that can display flow characteristics regardless of the direction. This increased motion sensitivity can be used as a parameter to show the tissue motion on artificially generated fremitus images. This study aimed to confirm any signs of incarceration in abdominal wall hernias proven by herniorrhaphy by examination with dynamic PD-US (during manual compression-decompression maneuvers). METHODS: Twenty-seven patients with anterior abdominal wall hernia with a narrow neck (<1 cm in diameter) were examined firstly with gray-scale ultrasonography (GS-US), and then with dynamic PD-US. Two independent radiologists, who were blinded to the real-time images showing the orientation and motion of the hernia neck, completed the examinations. These images were evaluated for any signs of incarceration, as well as the orientation of the hernia neck. RESULTS: Orientations of the hernia neck were not described on GS-US images in 13 lesions and on dynamic PD-US images in 3 lesions. While the GS-US examination revealed incarcerated hernia in four of the patients, the dynamic PD-US examination revealed an additional seven patients with symptoms associated with incarceration. CONCLUSION: Dynamic PD-US may show the orientation of the hernia neck and any sign of incarceration more accurately and clearly than conventional GS-US. Being informed about these features preoperatively is of utmost importance. Thus, anterior abdominal wall hernias should be examined by dynamic PD-US.

The value of ultrasound elastography-guided fine-needle aspiration biopsy of thyroid nodules in reducing nondiagnostic results.

Fine-needle aspiration biopsy (FNAB) is an important tool for diagnosing thyroid nodules; however, nondiagnostic results are a problem with FNAB. We evaluated the optimal targeting area of thyroid nodules for FNAB by using ultrasound elastography (USE) to reduce nondiagnostic results. Between December 2008 and November 2010, 96 consecutive prospective subjects scheduled to undergo FNAB were included in the study. Initially, the dominant nodule was evaluated with ultrasound, after which USE was performed. FNABs were performed from both the red (hard foci) and the green (soft foci) color-coded areas using the same technique according to the USE maps. The cellularity of all the specimens was evaluated cytopathologically. Nondiagnostic results from the red and green color-coded areas were compared by Chi-square test. In the red color-coded regions on USE images, the diagnostic rate was 76.0 % and the nondiagnostic rate was 24.0 %. In the green color-coded regions on USE images, the diagnostic rate was 53.1 % and the nondiagnostic rate was 46.9 %. Seven nodules were malignant and 89 were benign. Nondiagnostic results were significantly fewer in red color-coded regions (P = 0.0001). USE can help to enhance the cellularity of biopsy of thyroid nodules to reduce the nondiagnostic results if the red color-coded (less elastic or hard) areas are preferred.

From the pseudolipoma to lipoma: staging of the typical radiological appearances. Pictorial essay.

Lipomas are benign mesenchymal tumors, which accounts for 50% of soft tissue tumors. Although the etiopathogenesis has not yet been fully understood, it is known that lipomas developed at a rate of 1% in the related localizations after traumas. Trauma initiates inflammatory reactions in fatty tissue and these can be the trigger mechanism for the development of lipomas. In this pictorial essay the objective was to present the imaging findings associated with the process of lipomas development. "The phases of lipomas formation" was schematized based on these data.

Ethyl pyruvate improves healing of colonic anastomosis in a rat model of peritonitis.

BACKGROUND: This study was designed to evaluate the effects of ethyl pyruvate (EP) on wound healing in primary colonic anastomoses in intraperitoneal sepsis. METHODS: Standard left colon resection and end-to-end anastomosis were performed on 30 rats. They were grouped as control (C)--no further treatment; sepsis (S)--received 2 mL Escherichia coli (ATCC 25922) intraperitoneally (IP), and after 5 hours, standard resection and anastomosis were performed; or sepsis-group treated with EP (S-EP)--received 2 mL E coli IP, after 5 hours, standard resection and anastomosis were performed and treated with EP 50 mg/kg IP for 7 days. On the postoperative day 7, the animals were sacrificed. RESULTS: The anastomosis bursting pressure in group S was significantly lower than in the other groups. There were no differences between groups C and S-EP. Tissue hydroxyproline concentrations in group C were significantly higher than in group S. CONCLUSIONS: EP administration prevented intraperitoneal sepsis-induced impaired anastomotic healing of colon.

Appendectomy with single-port laparoscopic transumbilical surgery.

PURPOSE: Acute appendicitis is among the most common emergency conditions in surgical practice and appendectomy is the most common treatment. Single-port (SP) laparoscopic transumbilical surgery has emerged in clinical practice. The aim of this study is to describe SP laparoscopic transumbilical surgery procedure performed in three patients undergoing appendectomy. METHODS: Three patients diagnosed with acute appendicitis were operated with SP laparoscopic transumbilical surgery technique. Patient's gender, age, BMI, operation time and length of hospital stay were recorded. RESULTS: Three patients (2 female, 1 male) with a mean age of 38 (range 28-48) years underwent appendectomy. The mean postoperative length of stay was 1 day. The mean operative time was 35 minutes (range 30-45 minutes). No scar formation was observed and incisions were nearly invisible in the umbilicus in all patients. CONCLUSION: SP laparoscopic transumbilical appendectomy is a safe, effective and reliable technique leading potentially scarless abdominal surgery. Even though SP laparoscopic transumbilical surgery cannot substitute laparoscopic appendectomy for the moment, it is assumed that this procedure will become widespread by putting novel instruments into practice.

Transdiaphragmatic blockage of the lymphatic may reduce bacterial translocation.

PURPOSE: Bacterial translocation is a spread of living and non-living bacteria and bacterial end-products, passing over the mucosal barrier distending mesenteric lymph nodes, blood and viscera. DuraSeal(polyglycolic acid glue) has adhesive power and it usually used in brain or spinal surgery. We aimed to show the barrier system effect using experiments, in which intraabdominal infection induced and translocation from diaphragm to thorax is researched. METHODS: We used 90 Wistar Albino male rats weighing 200-250 grams in our experiment. Laparotomy was performed to all groups. After laparotomy, intraperitoneal 1 cc physiological saline was given in Group I (control). 1 x 109 cfu/m/kg (colony forming unit/mililiter/kilograms) E. Coli was injected intraperitoneally in Group II. In Group III, DuraSeal (Confluent Surgical, Inc., Waltham, MA) was sprayed on the diaphragm. After waiting for approximately 2 minutes to see the barrier effect, 1 x 109 cfu/ml/kg E Coli was injected intraperitoneally. RESULTS: For the samples taken intraperitoneally, 100% breeding was determined in all groups except Group 1. While no positive staining was observed in the thoraxes of the rats in Group I and Group III at the first hour, the positive staining ratio in the Group II was 70%. The positivity ratio of Group II was 80% and the ratio was 50% in Group III at the third and sixth hours. Regarding hemoculture E Coli positivity, there was no proliferation in the hemoculture samples of Group I at all time periods, whereas it was positive in the other groups excluding the first hour. CONCLUSIONS: The synthetic hydrogel Duraseal, which was designed to prevent postoperative fibrosis and air leakage, was able to partially block the translocation of the bacteria to the thorax via lymphatic or directly.

The effects of laparoscopic mesh fixation device on bone, costo-chondral junction and tendon site.

Osteitis pubis is one of the important complications of inguinal hernia repair surgery occurring with the placement of sutures through the periosteum. The aim of this study is to evaluate scintigraphic and histopathological alterations associated with the use of mesh fixation device on pelvic bone, cartilage and tendons in an experimental animal model. Twenty New-Zealand young male rabbits were used. A mesh fixation device was inserted at each animal's costa-chondral junction, superior anterior iliac crest, and achiles tendon. One week prior to the surgery and 16 weeks after the operation, scintigraphic evaluation was performed. Histopathological evaluation was performed at the end of study. No nuclear activity or pathological change was found at bone site (p > 0.05). Foreign body reaction was evident at the tendon and costa-chondral site (p = 0.001). In conclusion; the mesh fixation device leads to foreign body reaction in costa-chondral junction and tendon. It does not cause any nuclear activity increase.

Open 3-step local anesthesia technique is a more applicable method as compared with spinal anesthesia in inguinofemoral hernia repair.

OBJECTIVE: To compare the effects of spinal anesthesia with those of the open 3-step local anesthesia (TSLA) technique under visual control. METHODS: Between January 2005 and August 2006, the data of 55 patients undergoing groin hernia repair with either the TSLA technique or spinal anesthesia (SA) were collected via retrospective case note review at the General Surgical Unit of the Ardahan Military Hospital, Ardahan, Turkey. Patient characteristics, preoperative and postoperative measurements prior to discharge, average pain, and nausea during the postoperative hospital stay were recorded. RESULTS: While there was no preoperative preparation time for the induction of anesthesia in the TSLA method, it was found that a preparation time of 24.56±8.85 minutes was required for the SA preoperatively. The evaluation of the visual analogue scores of both groups yielded no significant differences between the eighth and twenty-fourth hours. When the postoperative complications in both groups were considered, 3 patients had headache whereas 2 had nausea, and 5 had complications of urinary retention in the SA group. CONCLUSION: Except for the negative factors such as patient refusal, allergic reaction history, previous vaso-vagal episode, or fainting during local anesthesia, incooperability caused by psychiatric disorder or language barriers, the results of the present study indicate that the TSLA is a safe, effective, and appropriate anesthetic technique in the adult age group.

The effect of omega-3 fatty acid and ascorbic acid on healing of ischemic colon anastomoses.

PURPOSE: Many systemic and local factors contribute to gastrointestinal tract anastomoses dehiscence, which is a serious and potentially fatal postoperative complication. The aim of this study was to evaluate the effects of omega-3 fatty acid and ascorbic acid on the healing of ischemic colon anastomosis. PATIENTS AND METHODS: 40 Wistar Albino rats weighing between 180 and 220 g were divided into four groups. Groups were assigned as follows; Group 1 (control): anastomosis and no treatment, Group 2: anastomosis plus ascorbic acid, Group 3: anastomosis plus omega-3 fatty acid, and Group 4: anastomosis plus ascorbic acid and omega-3 fatty acid. Colon anastomoses was were performed in all rats. All animals were sacrificed on the 5th postoperative day. Healing of the anastomoses was assessed by measuring the burst pressures (BP) and hydroxyproline levels. RESULTS: No mortality was observed and perianastomotic abscesses were not noted in any rats. The BP was significantly higher in the ascorbic acid plus omega-3 fatty acid combination group than the other groups (p < 0.05). The hydroxyproline levels were significantly high in ascorbic acid plus omega-3 fatty acid combination group than the other groups (p < 0.05). CONCLUSION: Dietary supplementation with omega-3 fatty acid and ascorbic acid improved colonic anastomoses healing. Ascorbic acid and omega-3 fatty acid enhance the colonic wound healing process by additive action.

[The protoskolicidal effect of 1% polyvinylpyrrolidone-iodine (PVP-1) and 2% taurolidine on abdominal hydatidosis]. / %1'lik Polivinilprolidon - Iyot (Pvp-1) ve %2'lik taurolidinin abdominal hidatidosis üzerine protoskolisidal ajan olarak etkileri.

The aim of this study is to determine the efficacy of 1% polyvinylprolidone-iodine (Betadine, PVP-I) and 2% Taurolidine as scolicidal agents for the prevention of abdominal hydatidosis defined as the rupture of the echinococcal cyst spontaneously or traumatically. The study was carried out in fifty mice randomly assigned into 5 treatment groups as following: group with no expose to any scolicidal agent, groups with 1% PVP-I for 2 and 5 minutes; groups with 2 % Taurolidine for 2 minutes, and 5 minutes. PVP-I has found to be effective according to results of staining with the eosin dye in vitro and abdominal hydatidosis in vivo, while Taurolidine was ineffective as a scolicidal agent.

Apocrine fibroadenoma of the perianal region associated with perianal fistula.

UNLABELLED: A case of a 45 year-old woman who presented with a perianal fistula was reported. Histologically, the excised lesion showed features of apocrine fibroadenoma. In addition, the lesion had both glandular and stromal growth patterns and active chronic inflammation in the background. Malignant or benign counterparts of these types of lesions are widely described in literature. However fistula does not usually accompany and is very rare. Therefore, it is crucial for the pathologists and clinicians to be aware of such lesions. The relationship between apocrine fibroadenoma and perianal region was also discussed. KEYWORDS: Apocrin fibroadenoma; Perianal region; Fistula.

A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report.

BACKGROUND: Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. CASE REPORT: We present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery. CONCLUSION: It is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.

A new flap technique to treat pilonidal sinus.

BACKGROUND: Failures of flap rotation, flap necrosis, recurrence of the disease, maceration at the incisional line and insufficient or late healing of flap corners which can be associated with ischemia appear to be the main problems associated with the closing techniques during the surgical treatment of this disease. We describe a simple, effective and incision protective repair method for excision of the pilonidal cyst. METHODS: Data from 17 (12 males and 5 females) consecutive patients who had elective surgery for chronic pilonidal sinus disease with wide excision of all the sinuses and a new flap technique closure with adipo-fascio-cutaneous flaps which was used in our series for the treatment of pilonidal sinus disease were retrospectively analyzed. RESULTS: Satisfactory results were achieved with this flap rotation technique in 17 patients. There were no flap rotation failures, flap necrosis, disease recurrence, incisional line maceration, or delayed wound healing. CONCLUSION: As a result, presented technique provides avoidance of flap necrosis, maceration on the incision and insufficient or late healing of the flap. We describe a technique which has a minimal amount of scar across the midline natal cleft and fewer flap corners resulting in a lower chance of margin necrosis.