Comparison of transhiatal esophagectomy using a mediastinoscope with transhiatal esophagectomy by the classic method.

BACKGROUND: This study aimed to evaluate the results of transhiatal esophagectomy using a mediastinoscope in comparison with conventional transhiatal esophagectomy. METHODS: Sixty-two esophageal cancer patients who were referred to our thoracic surgery clinic between April 2015 and March 2017, and met the inclusion criteria, were randomly divided into two groups of 31 each. In the first group, patients were operated on by conventional transhiatal esophagectomy. In the second group, only release of the thoracic esophagus through a neck incision (mediastinal esophagolysis) was performed using a mediastinoscope. The other surgical procedures were similar to those in the first group. RESULTS: The mean age of the patients was almost the same in both groups (57.7 years in the first group versus 56.7 years in the second group). There was no significant difference in sex ratio. The mean volume of blood loss during the operation, mean operative time, and intensive care unit stay as well as cardiopulmonary complications and early postoperative complications were lower in the group that had esophagectomy using a mediastinoscope, and the number of resected mediastinal lymph nodes was greater. CONCLUSION: Based on the results of this study, it can be expected that use of a video mediastinoscope for esophagolysis of the thoracic esophagus in a transhiatal esophagectomy procedure is safe and it will reduce the morbidity and mortality in these patients.

Iatrogenic Seeding of Tumor Cells in Thigh Soft Tissue Upon Surgical Removal of Intracranial Meningioma.

INTRODUCTION: Meningioma is a benign and slowly-growing tumor that is responsible for 20% of brain neoplasms. It can be accompanied by some genetic disorders such as neurofibromatosis type 2 and is more common among women. As a space occupying lesion, it produces a wide range of signs and symptoms by compressing the adjacent and underlying tissues in the brain. Trauma and viruses are possible etiologies for meningioma. The ideal treatment of benign meningioma is surgical resection. CASE PRESENTATION: In this case report, we present a middle-aged man with a seeding metastasis of the cranial meningioma (after its removal) in the left thigh. During the removal operation, fascia lata had been used to repair the dura mater and the skin defect was repaired primarily. CONCLUSION: We believe that the occurrence of meningioma at the site of incision in the thigh is related to using the same surgical instruments for the removal of the brain tumor.

Temporary abdominal closure in the critically ill patients with an open abdomen.

The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag). The study population comprised of 11 (57.9%) male and 8 (42.1%) female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 (57.9%) patients, subjective judgment that the fascia closure is too tight in 6 (31.6%) patient's damage control surgery in one patient (5.3%) and development of abdominal compartment surgery in one patient (5.3%). Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 (47.4%) patients, post operative intestinal fistula in 4 (21.1%) patients, post traumatic intra abdominal bleeding in 3 (15.8%) patients and intestinal obstructions in 3 (15.8%) patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 (%21.1) early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 (26.3%) late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 (range 2-54) months. Currently 10 patients (52.6%) are alive at a follow up of 45 (range 1-94) months. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogotá bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage.