22 research outputs found
Zapomniany zabieg hernioskopii – możliwe najwłaściwsze postępowanie w zadzierzgniętej przepuklinie pachwinowej w dobie pandemii COVID-19
No full textWstęp: Podczas gdy zabiegi elektywne są przekładane na całym świecie z powodu pandemii COVID-19, operacji nagłych nie można opóźniać i są one wykonywane.
Cel: W praktyce chirurgii ogólnej przepukliny pachwinowe uwięźnięte/zadzierzgnięte zajmują wiodące miejsce wśród operacji nagłych. U 1% pacjentów dochodzi do samoistnego odprowadzenia zawartości przepukliny do jamy brzusznej, o ile wrota pozostają otwarte. Konieczna jest ocena tych odcinków jelita w kierunku cech martwicy.
Metody: Do badania włączono pacjentów, którzy od marca 2020 r. do października 2020 r. byli poddawani hernioskopii i operacji w trybie nagłym w Klinice Chirurgii Ogólnej Szpitala Klinicznego w Sakarya z powodu uwięźnięcia lub zadzierzgnięcia przepukliny pachwinowej. Zabieg hernioskopii wykonano metodą jednoportową lub poprzez rękawicę chirurgiczną. U każdego pacjenta zebrano dane dotyczące: wieku, czasu od początku objawów, chorób współistniejących, sposobu plastyki przepukliny, czasu trwania operacji, uwięźniętego narządu, poprawy ukrwienia jelit po odprowadzeniu, konieczności resekcji jelit oraz powikłań pooperacyjnych.
Wyniki: Hernioskopię wykonano u dziesięciu pacjentów z powodu zadzierzgniętej przepukliny pachwinowej w okresie ośmiu miesięcy. Przepuklinę udową stwierdzono u 2 pacjentów, u pozostałych ośmiu przepuklinę pachwinową. U 1 chorego wykonano resekcję jelita i zespolenie z dostępu przezbrzusznego z powodu stwierdzenia martwicy jelita cienkiego w czasie zabiegu hernioskopii.
Wnioski: Hernioskopia, która jest wykonywana w znieczuleniu podpajęczynówkowym, pozwala odstąpić od niepotrzebnej laparotomii i powinna być częściej wykonywana w czasie pandemii COVID-19 u pacjentów pilnie operowanych z powodu zadzierzgniętej przepukliny pachwinowej
The neglected surgery – Hernioscopy – Maybe the best choice for strangulated groin hernias in the COVID-19 pandemic
No full textIntroduction: While elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed just like before the pandemic outbreak [1].
Aim: Although elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed. In general surgery practice, incarcerated / strangulated inguinal hernias take a prominent place among emergency surgeries. In 1% of these patients, the hernia contents retreat spontaneously into the abdomen until the hernia sac is opened. It is strongly recommended that these bowel segments be evaluated for possible intestinal necrosis.
Results: Patients who underwent emergency surgery and hernioscopy in the Sakarya Training and Research Hospital General Surgery Service due to incarcerated or strangulated inguinal hernia between March 2020 and October 2020 were included in the study. Hernioscopy procedure was performed using the single-port and glove-port methods. For each patient, the following variables were recorded: age, duration of complaints, comorbidities, hernia repair method, operation time, incarcerated organ, postoperative complications and whether ischemia improved after reduction or resection was required.
Conclusion: Hernioscopy is a procedure performed under spinal anesthesia which prevents unnecessary laparotomies and should be considered as first-line treatment during the COVID-19 pandemic in patients who undergo emergency surgery for strangulated inguinal hernia
Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups
No full textBackground. Many scoring systems have been developed for acute appendicitis, which is the most common emergent disorder in surgical practice. Considering the physiological changes and chronic diseases occurring with advancing age, an applied scoring system may not produce the same score in similar patients in all age groups. Objectives. We aimed to compare the predictive values of scoring systems in different age groups. Methods. In this prospective study, the patients operated on in our clinic with a prediagnosis of acute appendicitis between March 2020 and March 2021 were included. We divided them into three age groups as 18–45 years (group 1), 46–65 years (group 2), and >65 years (group 3). We compared the scores of the nine acute appendicitis scoring systems most commonly used in the literature for these age groups. Results. A total of 203 patients were included in our study. The Alvarado scoring system yielded the most accurate results for group 1, whereas the Fenyo–Linberg scoring system was the most accurate system for group 2 and the Eskelinen scoring system for group 3. Conclusion. Age should be considered as a major parameter during the selection of the scoring system to be applied for patients with prediagnosis of acute appendicitis. Our study revealed the Alvarado and the Fenyo–Lindberg scoring systems as the most accurate systems for the differential diagnosis of appendicitis in the 18–45 and 46–65 years age groups, respectively. Although we found the Eskelinen scoring system as the most accurate one in the >65 years age group, the confidence intervals indicated that it may not be appropriate for use alone in this group
Leczenie zapalenia samotnego uchyłka jelita ślepego – doświadczenie z jednego ośrodka
No full textWstęp: Zapalenie uchyłka jelita ślepego może być faktycznym czynnikiem etiologicznym odpowiedzialnym za ok. 1/300 zabiegów appendektomii. Diagnostyka różnicowa ostrego zapalenia wyrostka robaczkowego i zapalenia uchyłka jelita ślepego ma kluczowe znaczenie z uwagi na różnice w leczeniu obu tych schorzeń. Cel: Celem niniejszej pracy jest ujawnienie znaczenia rozróżnienia między ostrym zapaleniem wyrostka robaczkowego a zapaleniem uchyłka jelita ślepego. Materiał i metody: Wykonano retrospektywną analizę danych pochodzących od pacjentów poddawanych w latach 2015–2019 hospitalizacji w związku z następczym ostatecznym rozpoznaniem choroby uchyłkowej jelita grubego, zapalenia uchyłków jelita grubego lub ostrego zapalenia wyrostka robaczkowego. Wyniki: W trakcie zabiegu chirurgicznego wykonywanego w związku z ostrym zapaleniem wyrostka robaczkowego lub też w trakcie oceny klinicznej i radiologicznej wykryto łącznie 19 przypadków zapalenia uchyłka jelita ślepego. Dokonano oceny 1247 zabiegów appendektomii. W tej liczbie ostateczne rozpoznanie zapalenia uchyłka jelita ślepego postawiono u 5 pacjentów (0,4%). Ocenie poddano również 119 osób z rozpoznaniem zapalenia uchyłków jelita grubego w momencie rozpoznania; 105 pacjentów (88,2%) w tej grupie cierpiało na lewostronne zapalenie uchyłków, zaś 14 (11,7) na zapalenie samotnego uchyłka jelita ślepego. Wszystkich chorych z zapaleniem samotnego uchyłka jelita ślepego poddano leczeniu zachowawczemu, z wyjątkiem jednego, u którego stwierdzono zapalenie uchyłka stopnia 3 w skali Hincheya. Wniosek: Różnicowe rozpoznawanie zapalenia uchyłka jelita ślepego i ostrego zapalenia wyrostka robaczkowego ma znaczenie, ponieważ pierwsze z wymienionych schorzeń można w większości przypadków leczyć zachowawczo. Znaczenie tego rozpoznania dla zapobieżenia zbędnym interwencjom chirurgicznym rośnie szczególnie w okresie pandemii COVID-19
Analiza rezultata dijagnostičke ekscizijske biopsije limfnih čvorova: 12-godišnje iskustvo jednog centra
No full textLymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy
due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration
biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma
is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional
biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may
also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical
departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional
lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having
undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and
Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were
evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph
nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph
node dissections performed for any known malignancy were excluded from the study. Statistical data
analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male
patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal
lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph
node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node
biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy
was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found
to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23
(31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed
with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy
was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis
(20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes
was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was
no statistically significant difference between benign and malignant patients according to gender, age,
lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic
lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily.
If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it
is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for
diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and
treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity
in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is
an invasive procedure, excisional biopsy should be performed in a selected patient group.Biopsija limfnih čvorova indicirana je u bolesnika sa sumnjom na zloćudnu bolest ili s limfadenopatijom nejasnog uzroka.
Biopsija limfnih čvorova može se izvesti kao tankoiglena aspiracijska biopsija, širokoiglena biopsija ili ekscizijska biopsija
limfnih čvorova. Dijagnoza zloćudnog limfoma smatra se naročito nedostatnom za onkološko liječenje ako nije provedena
klasifikacija u podskupine. Širokoiglena biopsija i ekscizijska biopsija mogu se provesti kako bi se dijagnosticirao limfom i
klasificirao u podskupine. Širokoiglena biopsija može se također u nekim slučajevima pokazati ograničenom u dijagnosticiranju
limfoma. Zato se bolesnici upućuju u kirurške odjele na ekscizijsku biopsiju limfnih čvorova. Cilj ovoga istraživanja bio
je analizirati rezultate ekscizijskih biopsija limfnih čvorova izvedenih u dijagnostičke svrhe na našem odjelu. Retrospektivno
su analizirani podaci za 73 bolesnika podvrgnutih dijagnostičkoj ekscizijskoj biopsiji limfnih čvorova u Sveučilišnoj bolnici
Sakarya između siječnja 2008. i siječnja 2020. godine. Analizirani su sljedeći podaci: dob, spol, mjesto gdje je izvedena biopsija,
patološka dijagnoza, broj i promjer ekscidiranih limfnih čvorova. Iz istraživanja su bili isključeni bolesnici mlađi od 18
godina, oni s biopsijom sentinel limfnih čvorova te oni s disekcijom limfnih čvorova zbog bilo kakve poznate zloćudne bolesti.
Statistička analiza podataka provedena je pomoću statističkog programa SPSS. Bilo je 37 (50,7%) ženskih i 36 (49,3%)
muških bolesnika srednje dobi od 52,07 (18-90) godina. Biopsija aksilarnih limfnih čvorova izvedena je u 32, ingvinalnih
limfnih čvorova u 29, cervikalnih limfnih čvorova u 3, intra-abdominalnih limfnih čvorova u 6 bolesnika, mediastinalnih limfnih
čvorova u 1 bolesnika i supraklavikularnih limfnih čvorova u 2 bolesnika. Sve biopsije limfnih čvorova izvedene su kao
ekscizijske biopsije. Malignitet je otkriven u 36 (49,3%) bolesnika, dok su u 37 (50,3%) bolesnika uzroci limfadenopatije bile
dobroćudne patologije. Ispitivanje uzroka zloćudne bolesti pokazalo je da je limfom bio dijagnosticiran u 23 (31,5%) bolesnika.
Hodgkinov limfom otkriven je u 5 bolesnika u kojih je dijagnosticiran limfom, dok je ne-Hodgkinov limfom utvrđen u 18
bolesnika. Metastatska limfadenopatija zabilježena je u 13 (17,8%) bolesnika. Među uzrocima dobroćudne limfadenopatije
nađeni su reaktivna limfoidna hiperplazija (26%) i limfadenitis (20,5%). Broj izvađenih limfnih čvorova bio je od 1 do 4, a
njihov promjer bio je od 9 do 75 (srednja vrijednost 29,53±15,56) mm. Nije bilo statistički značajne razlike između bolesnika
s dobroćudnom i zloćudnom limfadenopatijom u dobi, spolu, promjeru limfnih čvorova, broju izvađenih limfnih čvorova i
mjesta izvođenja ekscizijske biopsije limfnih čvorova. Za dijagnostičku biopsiju limfnih čvorova treba najprije napraviti tankoiglenu
aspiracijsku biopsiju i širokoiglenu biopsiju. Ako se dijagnostički posumnja na limfom tada tankoiglena aspiracijska
biopsija nije potrebna. U tom slučaju smatra se da je primjerenije najprije napraviti širokoiglenu biopsiju. Ako se širokoiglena
biopsija pokaže nedostanom za postavljanje dijagnoze tada je primjerenije napraviti kiruršku biopsiju kako ne bi došlo do
kašnjenja u dijagnozi i liječenju. Ekscizijska biopsija je metoda koja se može sigurno izvoditi i ne uzrokuje teži pobol kod
palpabilnih perifernih limfadenopatija. Iako ne uzrokuje teži pobol s obzirom na to da je invazivni postupak, ekscizijsku
biopsiju treba izvoditi u odabranoj skupini bolesnika
Management of solitary cecum diverticulitis – Single-Center Experience
No full textObjective: Cecal diverticulitis may be encountered as a real etiological factor in 1/300 appendectomies. Differential diagnosis of acute appendicitis and cecal diverticulitis is crucial because of the different treatment methods. Our aim is to reveal the importance of distinguishing acute appendicitis from cecal diverticulitis. Methods: The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively. Results: A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis. Conclusion: Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period
Appendix Neuroendocrine Tumor: Retrospective Analysis of 4026 Appendectomy Patients in a Single Center
No full textBackground/Aim. Appendix tumors are mostly incidentally identified in patients who were operated with the diagnosis of acute appendicitis. They are detected in approximately 1% of appendectomy specimens. Neuroendocrine tumors (NETs) account for over 50% of appendix neoplasms. NETs appearing in the appendix can cause carcinoid syndrome. In our study, we aimed to retrospectively examine the clinical features of patients who underwent appendectomy with the diagnosis of acute appendicitis and diagnosed with appendix NET in the postoperative period. Materials/Methods. The records of 4026 patients who were operated with the diagnosis of acute appendicitis between January 2008 and January 2020 at the Department of General Surgery at the Sakarya University Faculty of Medicine, were evaluated retrospectively. Clinical findings, demographic data, surgical findings, and results of the patients with appendix NET, as a result of histopathology, were examined in detail. Results. 16 of 4026 patients were reported as NET. Nine of the patients were male, and seven were female. The average age was 33 (19–49). Any of the patients had no signs and symptoms of carcinoid syndrome. All tumors were located at the tip of the appendix, and the mean tumor diameter was 0.85 cm (0.3–2.5 cm). As a result of pathology, one patient had mesoappendix and one patient had serosa invasion. Right hemicolectomy was applied to both patients. In other patients, meso, serosa, and lymphatic invasion were not detected. Tumor size was 2.5 cm in one of the patients, 1.5 cm in one, and 1.4 cm in the other, and the others were below 1 cm. In the postoperative follow-up, all the patients were discharged on average 2.71 (2–6 days) days without any complications. Conclusion. Appendix NETs are mostly asymptomatic and localized in a distal third of the appendix. Symptoms are mostly related to tumor size and distant metastases. Clinical behavior and prognosis can best be predicted by tumor size. Complementary hemicolectomy is recommended for tumors larger than 2 cm and tumors smaller than 1 to 2 cm, such as mesoappendix invasion, positive or uncertain surgical margin, high proliferative rate, and angioinvasion. For tumors whose diameter is less than 1 cm, simple appendectomy alone is sufficient
Analysis of Diagnostic Excisional Lymph Node Biopsy Results: 12-Year Experience of a Single Center
No full textLymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy
due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration
biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma
is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional
biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may
also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical
departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional
lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having
undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and
Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were
evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph
nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph
node dissections performed for any known malignancy were excluded from the study. Statistical data
analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male
patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal
lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph
node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node
biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy
was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found
to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23
(31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed
with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy
was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis
(20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes
was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was
no statistically significant difference between benign and malignant patients according to gender, age,
lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic
lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily.
If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it
is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for
diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and
treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity
in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is
an invasive procedure, excisional biopsy should be performed in a selected patient group
Evaluation of the Effect of Platelet‐Rich Plasma Injection After Recurrent Nerve Injury in Rats
No full textABSTRACT Introduction Injuries to the recurrent laryngeal nerve (RLN) that may occur during thyroidectomy cause hoarseness, dysphagia, and dyspnea. Even if the injured nerve can be repaired surgically, it heals slowly and not completely. Platelet‐rich plasma (PRP) is obtained by centrifuging blood taken from the human body. PRP accelerates the healing of the injured nerve due to the many growth factors it contains. The aim of this study is to investigate the therapeutic effectiveness of PRP and assess surgical repair after RLN injury. Materials and Methods Twenty‐eight male Wistar albino rats were used in this study. We divided the rats into four groups, with seven animals in each group. Group 1: RLN was cut and primary repair was performed. Group 2: RLN was cut but not repaired. Group 3: RLN was cut, primary repair was performed, and PRP was injected. Group 4: RLN was cut, and PRP was injected without repair. Laryngoscopy and electromyography (EMG) were conducted before and after the procedure. For histopathological evaluation, parameters such as Schwann cell count, axon damage, and immunohistochemical staining intensity of Ki‐67 cell proliferation marker were examined. Results The highest amplitudes in EMG were seen in Group 3 rats at the third‐ and sixth‐week postoperatively (p < 0.05). Regarding histopathological evaluation, Schwann cell count, and Ki‐67 immunohistochemical staining were primarily observed in Group 3 rats (p < 0.05). Axonal damage and cytoplasmic vacuolization were minimally detected in Group 3 rats (p < 0.05). Conclusion In our experimental rodent model, PRP injection increased the Schwann cell count and cell proliferation rate in the injured RLN area by promoting the healing of nerve axons
Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members (World Journal of Emergency Surgery, (2022), 17, 1, (34), 10.1186/s13017-022-00424-0)
No full textFollowing the publication of the original article [1], the author name “Dragos Serban” under The WSES COVID-19 emergency surgery survey collaboration group was incorrectly written as “Dragos Seban” instead of “Dragos Serban”. The original article has been corrected
