Exploring the Gender-Specific Impact of Intraperitoneal Bupivacaine on Early Postoperative Pain in Sleeve Gastrectomy.

Background: Early postoperative pain is a significant problem in bariatric and metabolic surgery. Our study aimed to investigate the potential role of intraperitoneal bupivacaine hydrochloride in pain management in the early postoperative period after bariatric and metabolic surgery. Methods: This double-blind, prospective, randomized, controlled study included 68 individuals who underwent bariatric and metabolic surgery at the Department of Surgery, Istanbul Aydin University Hospital. The study group received 20 mL of 0.5% bupivacaine hydrochloride intraperitoneally at the operative site, and the control group received 20 mL of normal saline. Visual analog scale (VAS) scores of each patient were recorded at 2nd, 4th, and 6th hours postoperatively. Results: Our study found significant differences in VAS scores of patients between study group and control group at 2nd, 4th, and 6th hours postoperatively. Significant differences were found between male and female patients in the control group at 2nd, 4th, and 6th hours postoperatively. Interestingly, no significant difference was found between female patients in the study group and control group at 2nd, 4th, and 6th hours postoperatively. Conclusions: Our study suggests that intraperitoneal administration of bupivacaine hydrochloride is effective in reducing early postoperative pain in male patients. However, no significant difference was found between the study group and the control group in female patients. Our results indicate that there may be a gender-related difference in the response to bupivacaine administration. Further research is needed to confirm these findings and determine the optimal dosing and administration of local anesthetics for postoperative pain management.

Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis.

OBJECTIVE: Endoscopic balloon dilatation (EBD) is currently accepted as an effective, safe, and first-line treatment of postoperative benign gastrointestinal anastomosis stenosis (BGAS); however, a limited number of publications on the subject exist in the literature. The aim of the study was to retrospectively evaluate the efficiency of endoscopic dilatation in patients with postoperative intestinal anastomotic stenoses at a single surgical center. METHODS: Patients with postoperative BGAS treated by EBD at our institution from February 2008 to 2012 were included. The dilatations were all performed using through-the-scope balloons. The balloon was introduced into the stricture using a guidewire under radiologic guidance. Each dilatation session consisted of 2 to 3 two-minute multistep inflations of the balloon until adequate dilatation was achieved. RESULTS: Of the 48 patients included in the study, 44 patients (91.7%) fully recovered and 4 (8.3%) did not respond to treatment. The mean follow-up period was 24 months (range, 3 to 57 mo). Four patients who did not respond to the procedure were treated surgically. Two patients (4.1%) with intestinal perforation during EBD were treated conservatively with a stent. CONCLUSIONS: EBD has a low rate of complications and a high success rate, is well tolerated, and avoids further surgical procedures for BGAS. Therefore, EBD should be the first choice of treatment for postoperative anastomotic stenoses.

Two different methods for appendiceal stump closure: metal clip and Hem-o-lok clip.

INTRODUCTION: Closure of the appendiceal stump (CAS) is the most crucial part of appendectomy procedures because most of the complications occur by a leak of the stump. The aim of this retrospective clinical study is to emphasize two different methods (metal clip and Hem-o-lok(®) [Teleflex Medical, Research Triangle Park, NC] clip) for CAS. MATERIALS AND METHODS: The cases were divided into two subgroups according to the type of CAS. Subgroups were compared with each other according to age, intraabdominal abscess formation, operation duration, and complication rate. RESULTS: No intraoperative complications were seen in either subgroup. There were 22 postoperative complications in the metal clip subgroup (13 intraabdominal abscesses, 9 wound infections) and 8 postoperative complications in the Hem-o-lok clip subgroup (five intraabdominal abscesses, three wound infections). The cost of the closure was $7 for the metal clip group and $50 for the Hem-o-lok clip group. CONCLUSIONS: The use of Hem-o-lok clips and metal clip for CAS in laparoscopic appendectomy is a feasible, safe, and cost-effective procedure in patients with a mild to moderately inflamed appendix base of less than 10 mm in diameter.

Minimal invasive endoscopic management of synchronous granular cell tumours in the colon and posterior mediastinum.

Granular cell tumour (GCT), which is a rare benign soft tissue neoplasm, is mostly found in the skin and soft tissue but may develop anywhere in the body. There are less than 10 reported cases of mediastinal GCTs in the current literature. Furthermore, colonic GCTs have recently gained attention due to the increased public awareness on the importance of colonoscopy screening. We report a case of a 52-year-old woman diagnosed incidentally with synchronous GCTs of the mediastinum and the hepatic flexure on her routine screening for post-operative follow-up for status-post right modified radical mastectomy due to a T2N1M0, Stage 2B breast cancer.

The early results of our initial experience with robotic adrenalectomy.

OBJECTIVE: Robotic adrenalectomy is one of the minimally invasive surgical methods gaining wide acceptance due to the three-dimensional imaging system and ergonomics of the equipment. We aimed to present the early data on patients who underwent robotic adrenalectomy due to adrenal masses in our hospital. MATERIAL AND METHODS: The records of eight cases, in which a unilateral robotic trans-peritoneal adrenalectomy was conducted due to an adrenal mass between 2011 and 2013, have been evaluated. Demographic characteristics of cases, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative diagnosis, diameter and localization of the adrenal mass, operative time, blood loss, conversion rate to open surgery, morbidity and mortality rates, length of hospital stay, total hospital charges and postoperative pathologic results were considered. RESULTS: The female to male ratio was 6:2, the median age was 49.5 (26-71) and the median BMI was 29.7 (21.7-38.5). An adrenalectomy was performed in six cases for a right adrenal mass and in two cases for a left adrenal mass. The mean tumor diameter was 53.6 mm (20-90). The average surgical time (including docking) was 98 min. (55-175 min.) and the average blood loss was 50 mL. The only complication was a diaphragm injury which was repaired robotically. There were no conversions to traditional laparoscopic or open surgery and there have not been any mortality in the series. The median length of hospital stay was 4.1 days (range 2-11) and the average cost was 3617.12 TL ($1808.56). CONCLUSION: Robotic adrenalectomy is an effective and safe surgical alternative to laparoscopic adrenalectomy. However its high cost has emerged as its main disadvantage.

The importance of defecography in the assessment of the etiology of chronic constipation: An analysis of 630 patients.

OBJECTIVE: Chronic constipation is an entity with a high prevalence in the community. In our study, we analyzed the importance of defecography in the assessment of the etiology of chronic constipation. MATERIAL AND METHODS: Patients who were admitted to our hospital outpatient general surgery clinic with complaints of constipation between July 2010 and January 2014, and who had their demographic data and defecography results recorded were included in the study. The demographic data of patients who underwent defecography and their results were recorded along with patient gender and age. RESULTS: The defecography was abnormal in 573 patients (90.9%) while it was normal in 57 patients (9.1%). CONCLUSION: Defecography is the current standard method of examination in etiological investigations for constipation, and it should be performed in each patient with a diagnosis of chronic constipation.