Ambulatory laparoscopic cholecystectomy: A single center experience.

AIM: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC) in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. MATERIALS AND METHODS: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction) was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. RESULTS: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92%) patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7%) cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7%) cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively). Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018). CONCLUSION: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

Utility of the omentum in sacral reconstruction following total sacrectomy due to recurrent and irradiated giant cell tumour of the spine.

Reconstruction of the lumbosacral region after surgical excision of irradiated and recurrent spinal giant cell tumours remains a challenging problem. In this case report, we describe the use of the pedicled omentum flap in reconstruction of an irradiated and infected wide sacral defect of a 19-year-old male patient. The patient had radiotherapy and subsequent wide surgical resection after recurrence of the tumour. A myocutaneous flap from the gluteal area had failed previously. Local flap options could not be used because of the recent radiotherapy to the gluteal area. Since the patient had a laparotomy for tumour resection and a colostomy, abdominal muscles were not considered reliable for reconstructive procedures. A pedicled omentum flap was chosen as a reconstructive option because of its rich blood supply, large surface area, and angiogenic capacity. This report aims to describe the use of the pedicled omentum flap for reconstruction of the lumbosacral area following surgical resection of a spinal tumour, when gluteal and abdominal flap options for reconstruction are jeopardised.

Lower gastrointestinal bleeding, hematuria and splenic hemangiomas in Klippel-Trenaunay syndrome: a case report and literature review.

Klippel-Trenaunay syndrome is a congenital vascular anomaly characterized by a triad of varicose veins, cutaneous capillary malformation, and hypertrophy of bone and soft tissue. Gastrointestinal and genitourinary vascular malformations in Klippel- Trenaunay syndrome may present with lower gastrointestinal bleeding and hematuria. The majority of patients with splenic hemangiomatosis are asymptomatic. We herein report a case admitted to the Gastroenterology Clinic with life-threatening hematochezia and symptomatic iron deficiency anemia. The patient's history was remarkable for subtotal cystectomy and enterocystoplasty in December 2002 for vascular malformation, located in the bladder, which presented with hematuria. Although the patient was also diagnosed with colonic varices and splenic hemangiomas at that time, due to the asymptomatic mild intermittent hematochezia and splenic hemangiomas, the patient did not seek any help for rectal bleeding until her admittance to our department for evaluation of massive lower gastrointestinal bleeding. Endoscopy revealed vascular malformations starting from the transitional zone in the rectum extending up to the descending colon. Due to this extensive involvement of the rectum and sigmoid colon, no interventional endoscopic procedure was attempted and she was referred to surgery. A very low anterior resection with double stapling technique was done. Postoperative follow-up has been uneventful for six months since the operation. To the best of our knowledge, this is the first Klippel-Trenaunay syndrome case presenting with lower gastrointestinal bleeding, hematuria and splenic hemangiomas. The literature on the evaluation and management of lower gastrointestinal and genitourinary bleeding in Klippel-Trenaunay syndrome is reviewed.

Is minisite cholecystectomy less traumatic? Prospective randomized study comparing minisite and conventional laparoscopic cholecystectomies.

The main objectives of minisite cholecystectomy (MC) are to have smaller incisions, better cosmetic results, less trauma, and a lower morbidity rate. This prospective randomized study compares MC with conventional laparoscopic cholecystectomy (CLC) in terms of surgical trauma and cosmetic results in 44 patients. Conversion from MC to CLC was required in five patients. No conversion to open surgery was needed in the CLC group. The average operating time was slightly longer in the MC group, but the difference was not statistically significant (81 minutes versus 72 minutes, p = 0.22). The population characteristics, postoperative respiratory function measurements, pain scores, and analgesic requirements were similar in the two groups. The average score for scar tissue was significantly lower in the MC group (0.73 versus 1.93, p = 0.0045). Only the cosmetic results of MC were superior to CLC. This technique could be a feasible alternative procedure in patients seeking better cosmetic results. However, further studies with larger sample sizes are needed to evaluate the postoperative morbidity of MC.

Mitomycin-C prevents reformation of intra-abdominal adhesions after adhesiolysis.

BACKGROUND: Prevention of adhesions is central to surgical practice, because they cause significant morbidity. Inhibition of fibroblast proliferation is a way to prevent adhesions. Mitomycin-C (MMC) (Kyowa-Hakko-Kogyo Co, Ltd, Tokyo, Japan) is an alkylating agent that also inhibits fibroblast proliferation for up to a few weeks. We investigated the effect of MMC on the prevention of adhesion reformation. METHODS: Adhesions were generated by brushing the cecum and parietal peritoneum in 60 female Wistar albino rats. Ten days later, during a second laparotomy, adhesions were graded. After adhesiolysis, rats were divided into 3 groups. Group 1 was intraperitoneally administered 5 mL of saline solution, whereas groups 2 and 3 were intraperitoneally administered 0.5 mg/kg MMC in 5 mL of saline solution. MMC solution in the abdomen was completely rinsed and aspirated after 5 minutes in group 2 and after 10 minutes in group 3. Then, all the rats were administered 5 mL of saline solution intraperitoneally. After 10 days, adhesions were graded again during a third laparotomy. RESULTS: Both MMC groups had significantly lower adhesion scores compared with the control group (P <.001). No side effects from MMC were observed during the experiment. CONCLUSIONS: MMC was found to be very effective in preventing adhesion reformation.