Comparison of the outcomes of overlapping and direct apposition sphincteroplasty techniques in anal sphincter repair.

Objectives: Sphincteroplasty is of great importance in the repair of anal sphincter damage. In the present study, we compared the results of overlapping sphincteroplasty and direct apposition techniques used in anal sphincter repair. Material and Methods: Between 2011 and 2021, 36 patients underwent sphincteroplasty for anal sphincter injury and were analysed retrospectively. Sex, age, etiologic factors, repair technique, degree of laceration, postoperative complications, length of hospital stay, time between injury and repair, follow-up time and postoperative Cleveland Clinic Incontinence Score (CCIS) were recorded for analysis, and the two techniques were compared statistically using SPSS statistics, Version 17.0. Results: Of the sample, 31 were females and five were males, with a mean age of 31.50 ± 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal interventions in seven patients and other traumas in four patients. The overlapping technique was applied to 14 patients and the direct apposition technique was applied to 22 patients. Mean postoperative CCIS of all cases was 5.53 ± 2.59, and was significantly lower in those who underwent overlapping sphincteroplasty technique than those who underwent apposition repair (p= 0.006). It was observed that postoperative CCIS decreased as the time between sphincter injury and repair decreased (p <0.001; r= 0.625). Conclusion: It is vital to repair anal sphincter damage as early as possible. The overlapping sphincteroplasty and direct apposition methods can both be considered safe for anal sphincter repair although in terms of faecal incontinence, the outcomes of overlapping sphincteroplasty are better than those of the direct apposition technique.

The risk factors of intraoperative hyperlactatemia in patients undergoing laparoscopic colorectal surgery.

AIM: The aim of this study is to determine the incidence of intraoperative hyperlactatemia and its risk factors in patients undergoing laparoscopic colorectal surgery. MATERIAL AND METHODS: We retrospectively enrolled 75 patients who underwent laparoscopic resection for colorectal cancer. Initial lactate levels were determined from blood gas analysis before the incision. The end lactate values were recorded after the termination of the pneumoperitoneum. Hyperlactatemia defined as lactate levels between 2 mmol/L and 5 mmol/L without evidence of acidosis. The patients were divided into two groups as normolactatemia and hyperlactatemia according to lactate values at the end of the surgery. RESULTS: Of the 75 patients, 45 (60.0%) had higher lactate levels than normal at the end of the surgery. The median age of the study population was 62 (24-84) years. Forty (53.3%) of the patients were male. Most of the patients in the study had colon cancer origin [56 cases (74.7%)]. Univariate logistic regression analysis for a possible independent risk factor in terms of hyperlactatemia showed that Charlson comorbidity index (CCI) ≥ 3, body mass index (BMI) ≥ 30 kg/m2, the operative time, and the tumor size were significant (p < 0.05). Multivariate analysis found that only BMI ≥ 30 kg/m2 and the operative time were significant (p = 0.004, and p < 0.001, respectively). CONCLUSION: According to our work, obesity (BMI ≥ 30 kg/m2) and the operative time in laparoscopic colorectal surgery were independent risk factors for intraoperative hyperlactatemia at the end of the operation. Therefore, clinicians should be vigilant about the inevitable consequences of surgery by making appropriate preparation. KEY WORDS: Colorectal cancer, Lactate, Hyperlactatemia, Laparoscopy.

Relationship between Sarcopenia and Surgical Site Infection in Patients Undergoing Colorectal Cancer Surgical Procedures.

Background: Sarcopenia is a syndrome that can be associated with unfavorable outcomes after colorectal cancer surgical procedures. The present study evaluates the relationship between sarcopenia and surgical site infections (SSIs) that can occur after colorectal cancer operations and that are a significant cause of morbidity. Methods: The research was designed as a retrospective study in which data were collected on patients who underwent colorectal cancer surgical procedures between January 2013 and July 2019. A diagnosis of sarcopenia was established based on the skeletal muscle index (SMI), calculated from pre-operative computed tomography scans. The SSI scores of patients with sarcopenia (sarcopenic group, SG) and those without sarcopenia (non-sarcopenic group, NSG) were compared, and a logistic regression analysis was performed to determine the risk factors for SSI. Results: A total of 209 patients with a mean age of 61.2 years were included in the study. Post-operative complications (Clavien-Dindo ≥1) developed in 97 (46.4%) patients, SSIs developed in 46 (22%) patients, and sarcopenia developed in 97 (46.4%) patients. The mean age was 64.8 years in the SG group and 58.1 years in the NSG group (p = 0.016). No significant relationship was found between the development of SSI and sarcopenia (20 (20.6%) patients in the SG vs. 26 (23.2%) patients in the NSG, p = 0.65). Those in whom superficial SSIs developed in the early period formed the largest group (20 patients). The most commonly detected micro-organism was Escherichia coli with a rate of 55%. In a multi-variable logistic regression analysis, only the non-laparoscopic approach was identified as a risk factor (odds ratio 3.83; 95% confidence interval 1.26-11.58; p = 0.017). Conclusions: The present study reports no relationship between sarcopenia and SSI after colorectal cancer operations. The authors consider that studies that endeavor to reduce the incidence of SSI, as a significant cause of morbidity after colorectal surgical procedures, should be supported.

A rare case of Castleman disease mimicking a pancreatic tumor.

Castleman's disease or angiofollicular lymph node hyperplasia is a rare clinical entity, and may involve any parts of the body. Unicentric presentation of the disease is the most common presentation. Castleman's disease of the pancreas that mimics a pancreatic neoplasm is more uncommon. We present a 38-year-old female patient with a one-month past history of abdominal pain. Imaging studies revealed hypervascular, 4 x 2 cm in size nodular mass localised in the pancreatic body. In FDG PET/CT, the pancreatic mass was FDG-avid. Laparoscopic enucleation of the lesion was performed. Histopathological study revealed unicentric form of Castleman's disease, a hyaline vascular variant. Since these lesions are rare and resembling malignant tumors on computed tomography and angiography, we discuss the problems of diagnosing Castleman's disease, together with the literature. KEY WORDS: Castleman's disease, Lymphoid Follicular hyperplasia, Lymphoproliferative disorder, Peripancreatic tumor.

A rare case of jejunal gastrointestinal stromal tumor.

Gastrointestinal stromal tumors(GISTs) are rare neoplasms of the gastrointestinal(GI) system originating from the mesenchyme. GISTs mostly develop in the stomach and small intestine. We present here a case of jejunal GIST which is the rarest subtype. A 54-year-old man presented with lower right side abdominal pain. On workup, images showed a 7cm solid-cycstic lesion adjacent to ascending colon. On surgical exploration, a large jejunal tumor en bloc resected and jejuno-jejunal primary anastomosis was performed. Pathologic results showed a 9cm jejunal GIST with 5% proliferation index. Immunohistochemistry results demonstrated high expressions of CD117, whereas CD34 negative. The patient was discharged uneventfully. GISTs should be considered in patients with abdominal pain. The mainstay treatment of the jejunal GIST is complete surgical resection. The definitive diagnosis of GISTs is by immunohistochemical stains. KEY WORDS: GIST, Stromal tumor, Jejunum.

The diagnostic value of irisin in patients with acute abdominal pain: A preliminary study.

BACKGROUND: The aim of this study was to investigate the prognostic value of irisin by examining the serum level of this smooth muscle protein in patients presenting at the emergency department (ED) with acute abdominal pain. METHODS: This research was performed as a single-center, prospective, cross-sectional study. In all, 213 adult patients presenting at the ED with acute abdominal pain and 140 healthy controls were enrolled. The serum irisin level was correlated with the leukocyte, C-reactive protein, amylase, and creatine kinase values. The irisin level was compared between groups of those who were admitted or discharged, and those who received surgical or medical treatment. RESULTS: The mean irisin level of the 213 patients and the 140 controls was 6.81±3.17 mcg/mL vs. 5.69±2.08 mcg/mL. The mean irisin value of the hospitalized patients (7.98±3.11 mcg/mL) was significantly higher than that of the discharged patient group (6.38±3.09 mcg/mL) and the controls (control vs. discharged: p=0.202; control vs. hospitalized: p<0.001; discharged vs. hospitalized: p=0.001). When compared with that of the control group, the irisin level was significantly higher in patients with gall bladder diseases, urolithiasis, and acute appendicitis (p=0.001, p=0.007, p=0.007). CONCLUSION: The serum irisin level in patients with abdominal pain may serve as a guide in diagnostic decision-making and determining the prognosis for cases of acute abdominal pain involving luminal obstruction in tubular intra abdominal organs.