Rupture of liver hydatid cysts into the peritoneal cavity. A challenge in endemic regions.

OBJECTIVE: To evaluate the clinical presentation and early and long-term outcomes of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. METHODS: The medical records of 21 patients with rupture of hydatid cysts were evaluated retrospectively between January 2000 and April 2009 at Izmir Ataturk Training and Research Hospital, Izmir, Turkey, as were the records of 368 patients with hydatid cysts. Age, gender, symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality, and recurrence were evaluated. RESULTS: Sixteen of these patients (76.2%) were women. The mean age was 43.8 years. Cysts were single in 16 cases (76.2%). In 14 cases (66.7%) cysts were localized only in the right lobe. There was also a cyst in the spleen in 4 patients (19%). Simple falls or direct abdominal minor trauma was responsible in 8 patients (38.1%), and pedestrian mishaps in 4 (19%). Nine (42.8%) patients experienced spontaneous rupture. External drainage was performed in 12 (57.1%) patients and omentoplasty in 9 patients (42.8%) to manage the cyst cavity. A total of 11 morbidities developed in 9 patients (42.8%). There was no postoperative mortality. The mean hospital stay was 11.37.4 days, and mean follow-up was 63.131.3 months. The recurrence rate was 23.8%. CONCLUSION: The morbidity and recurrence rates of surgical interventions for ruptured hydatid cysts are high. This pathology, although rare, should be included in the differential diagnosis of an acute abdomen in endemic areas.

Prosthetic repair of incarcerated inguinal hernias: is it a reliable method?

BACKGROUND AND AIM: It is generally accepted that most inguinal hernias should be operated on electively using synthetic grafts. However, limited information is available on the usage of these materials in patient with incarcerated and strangulated hernias. The objective of this study is to compare the outcomes of incarcerated inguinal hernia repair with or without graft. MATERIALS AND METHODS: One hundred-thirteen patients with incarcerated inguinal hernia that underwent surgery were included in this study. Patients who underwent Lichtenstein repair were assigned to group I; those who underwent primary repair were assigned to group II. Demographics and characteristics of patients in each group were compared. Chi-square and Student's t-tests were used. RESULTS: No statistical difference was found between patients who did and did not receive anastomosis in both groups in terms of surgery duration, length of hospital stay, postoperative morbidity, and mortality. Recurrence was found in 4.0% and 20.8% patients in group I and group II, respectively (P = 0.036). CONCLUSIONS: Mesh repair can be preferred in incarcerated inguinal hernia patients because recurrence rate was significantly lower in patients who underwent Lichtenstein repair in this study.

Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables.

BACKGROUND: We sought to review the clinical presentation and outcomes of surgical management of gastrointestinal stromal tumours (GISTs). METHODS: We reviewed clinical and pathological records of 41 patients (23 men and 18 women) with GISTs. We performed survival analyses using the Kaplan- Meier method and evaluated long-term survival and the independent prognostic factors that affect survival using univariate analyses. We used the Cox proportional hazards regression model to estimate the simultaneous effect on overall survival. RESULTS: The stomach was the most common tissue of origin (n = 20, 48.8%). The mean tumour diameter was 8.3 cm. We detected advanced-stage tumours in 22 (53.7%) patients. We performed complete resection in 31 (75.6%) patients. Mitotic count was greater than 5/50 high-power field [HPF] in 22 (53.6%) patients. Immunohistochemical staining for CD117 was positive in 40 (97.6%) patients. Five patients (12.2%) died in the early postoperative period. The mean follow-up period was 38.7 months. The median length of survival was 53 months and the 5-year survival rate was 49.4%. Univariate analyses revealed significantly enhanced survival for the following variables: patient age less than 60 years (p = 0.011), male sex (p = 0.048), tumour diameter less than 5 cm (p = 0.029), low-risk tumour according to Fletcher classification (p = 0.022), complete resection (p < 0.001), and lack of local recurrence (p < 0.001) and/or metastasis (p < 0.001). Our Cox proportional hazards model revealed that complete tumour resection was the only factor to increase survival. CONCLUSION: Overall survival is significantly affected by positive margins. A complete surgical resection with negative margins is the best method for definitive treatment of GISTs.

Axillary lymph node metastasis from serous ovarian cancer: a case report and review of the literature.

INTRODUCTION: The symptoms and findings of ovarian cancer are parallel with the degree of intra-abdominal expansion of the tumor. Metastases in the early stage occur by peritoneal fluid's tracking via the circulatory system. Renal and cerebral metastases of ovarian cancer have been previously reported, but axillary lymph node metastasis is quite rare. Axillary lymph node metastasis usually occurs in the advanced stage. MATERIALS AND METHODS: We present a 47-year-old female who had applied adjuvant chemotherapy following cyto-reductive surgery because of stage 3C ovarian cancer. Axillary lymph node metastasis was detected in the postoperative 32 months. CONCLUSION: As tumors in axillary lymph nodes are found in patients with an ovarian carcinoma, the treatment is also so important too. Metastasis to the breast be differentiated accurately from primary breast cancer, because prognosis and treatment differ significantly. Accurate diagnosis of these metastases may allow more appropriate therapy, such as chemotherapy, and prevent the patient from an unnecessary major breast surgery.

Lower recurrence rate for Limberg vs. V-Y flap for pilonidal sinus.

PURPOSE: Pilonidal sinus is a disease that does not have a standardized surgical treatment method. This study was designed to compare the outcomes of Limberg fasciocutaneous transposition and V-Y fasciocutaneous advancement flaps in the treatment of patients with pilonidal sinus. METHODS: A total of 111 patients (98 males; 88.3 percent; mean age, 27.1 years) who received reconstruction after pilonidal sinus excision in our clinics with Limberg flap (Group 1, n = 66, 59.5 percent) or V-Y flaps (Group 2, n = 45, 40.5 percent) between 1997 and 2004 were investigated retrospectively. RESULTS: No significant difference was detected between Groups 1 and 2 in terms of gender, history of infection or abscess, mean duration of operation, requirement for analgesics, wound-related complications, such as necrosis, seroma, and infection, and average time off work. Mean follow-up periods were 45.4 vs. 48.8 months in Group 1 and Group 2, respectively (P = 0.337). On the other hand, rate of recurrence was significantly lower in Group 1 (n = 1, 1.5 percent) compared with Group 2 (n = 5, 11.1 percent; P = 0.039). CONCLUSIONS: We conclude that, if the defect is to be reconstructed with a flap in pilonidal sinus cases, reconstruction with Limberg flap should be preferred over reconstruction with V-Y flap because of its lower rate of recurrence.