Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recent... more Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. Method: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. Results: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). Conclusions: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.
Journal of Turgut Ozal Medical Center, Feb 1, 2008
Kasık fıtığı içinde apendiksin bulunması Amyand fıtığı olarak bilinir. Kasık fıtığı olan olguları... more Kasık fıtığı içinde apendiksin bulunması Amyand fıtığı olarak bilinir. Kasık fıtığı olan olguların yaklaşık %1' inde görülür. 1735 yılında inguinal kanalda perfore apendisit varlığını ilk tanımlayan ve herniyotomiden başarılı apendektomi uygulayan Claudius Amyand'dı. Amyand fıtığının preoperatif tanısı oldukça zordur. Peroperatif tanı konulduğu zaman herniyotomiden apendektomi tercih edilen yöntemdir. Sıkışmış kasık fıtığı tanısı ile ameliyat edilen ve kese içinde akut apendisit saptanan iki Amyand fıtığı olan olguyu sunuyoruz.
Acute appendicitis and blunt abdominal trauma are common surgical emergencies. The etiology and p... more Acute appendicitis and blunt abdominal trauma are common surgical emergencies. The etiology and pathophysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We describe a child who presented with abdominal pain from blunt abdominal trauma caused by his fall from a height. A perforated appendicitis was detected during surgery and removed. We suggest that the diagnosis of appendicitis should be considered in some patients with blunt abdominal trauma.
Turkish journal of trauma & emergency surgery, 2011
Bu çalışmanın amacı, hayvan modelinde karın duvarı defektlerinin polipropilen yama ile tamirinden... more Bu çalışmanın amacı, hayvan modelinde karın duvarı defektlerinin polipropilen yama ile tamirinden sonra oluşan adezyon formasyonu, fibrozis ve enflamasyon üzerine okside rejenere selüloz, polietilen glikol ve hylan G-F 20'nin etkilerini araştırmaktır. Kırk sıçan dört gruba ayrıldı ve karın duvarı defekti oluşturuldu. Defektler sırası ile grup I, II, III ve IV olacak şekilde; sadece polipropilen yama (kontrol grubu), polipropilen yama ve adezyon bariyeri olarak hylan G-F 20, polipropilen yama ve adezyon bariyeri olarak okside rejenere selüloz, polipropilen yama ve adezyon bariyeri olarak polietilen glikol kullanılarak onarıldı. Sıçanlar 14. günde öldürüldü. Makroskopik adezyon açısından karşılaştırıldıklarında kontrol gurubu ile adezyon bariyeri kullanan gruplar arasında istatistiksel olarak anlamlı fark bulundu. Kontrol grubunda ileri derecede fibroblast proliferasyonu ve polietilen glikol grubunda hafif fibroblast proliferasyonu görüldü. Polietilen glikol etkili bir adezyon bariyeridir. Son dönemde laparoskopik cerrrahi birçok alanda standart metot haline gelmiştir. Polietilen glikol laparoskopik düzeneği sayesinde hasarlı yüzey üzerine uygulama kolaylılığı sağlamaktadır.
Surgical laparoscopy, endoscopy & percutaneous techniques, Jun 1, 2002
The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of ... more The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.
Objective. Perianal fistulas of the perianal soft tissues are an important cause of morbidity and... more Objective. Perianal fistulas of the perianal soft tissues are an important cause of morbidity and a significant portion of colorectal surgery. To our knowledge, there is no study evaluating YouTube videos pertaining perianal fistulas. In this study, we aimed to evaluate YouTube video contents on this topic. Methods. Whether the videos contained real images, animations or presentations, video duration, number of views, comments and likes, uploading date, and daily view were recorded. Reliability of the videos was assessed using the Quality Criteria for Consumer Health Information (DISCERN) scale and quality of the videos using the Global Quality Score (GQS). Results. A total of 100 YouTube videos regarding perianal fistulas were included in the study. Sixty-four (64%) videos were uploaded by healthcare professionals and 36 (36%) videos by nonprofessionals. The mean video length was calculated as 6:70 ± 8:00 minutes for all videos. The mean DISCERN score of all videos was found as 3:92 ± 0:81 and the mean GQS score as 3:97 ± 0:83. According to the DISCERN score, most videos included (94%) were of good quality. There was an excellent agreement between the two surgeons in terms of the DISCERN and GQS scores. Conclusion. Most of the videos included in the study were uploaded by health-care professionals. On the other hand, the majority of the videos contained surgical management of perianal fistulas as it is the definitive treatment. Healthcare related content should be audited and filtered by YouTube with new and effective policies.
Background Malnutrition is known to affect wound healing but it is not known with certainty wheth... more Background Malnutrition is known to affect wound healing but it is not known with certainty whether or not postoperative hyperalimentation can reverse this defect. The present study was designed to examine the effects of recombinant human growth hormone (hGH) on left colonic anastomoses in malnourished rats. Methods Experimental animals were allocated randomly into four groups. In groups 1 and 2 animals were fed with normal diet for 10 days before surgery. In groups 3 and 4 animals were fed with a low-protein diet. Left colonic anastomoses were performed in all animals. Following surgery, rats in groups 1 and 3 received hGH whereas rats in groups 2 and 4 were injected with saline as control. Bursting pressure and hydroxyproline levels on day 4 after operation were used to determine anastomotic healing. Results Bursting pressure was lower in the malnourished rats than those fed with normal diet (P Ͻ 0•05). Bursting pressure was higher in normally fed rats which were given hGH. No significant differences could be noted between malnourished control rats and those receiving hGH. Conclusion These results suggest that hGH strengthened the left colonic anastomoses in rats fed a normal diet, but could not reverse the negative effects of malnutrition on colonic anastomoses.
Polyethylene glycol is an effective adhesion prevention barrier. Laparoscopic surgery has become ... more Polyethylene glycol is an effective adhesion prevention barrier. Laparoscopic surgery has become the standard method in most of the surgical field. With its laparoscopic apparatus, polyethylene glycol allows easy application on the damaged surface.
Surgical laparoscopy, endoscopy & percutaneous techniques, Dec 1, 2002
The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of ... more The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.
Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recent... more Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. Method: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. Results: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). Conclusions: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.
Journal of Turgut Ozal Medical Center, Feb 1, 2008
Kasık fıtığı içinde apendiksin bulunması Amyand fıtığı olarak bilinir. Kasık fıtığı olan olguları... more Kasık fıtığı içinde apendiksin bulunması Amyand fıtığı olarak bilinir. Kasık fıtığı olan olguların yaklaşık %1' inde görülür. 1735 yılında inguinal kanalda perfore apendisit varlığını ilk tanımlayan ve herniyotomiden başarılı apendektomi uygulayan Claudius Amyand'dı. Amyand fıtığının preoperatif tanısı oldukça zordur. Peroperatif tanı konulduğu zaman herniyotomiden apendektomi tercih edilen yöntemdir. Sıkışmış kasık fıtığı tanısı ile ameliyat edilen ve kese içinde akut apendisit saptanan iki Amyand fıtığı olan olguyu sunuyoruz.
Acute appendicitis and blunt abdominal trauma are common surgical emergencies. The etiology and p... more Acute appendicitis and blunt abdominal trauma are common surgical emergencies. The etiology and pathophysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We describe a child who presented with abdominal pain from blunt abdominal trauma caused by his fall from a height. A perforated appendicitis was detected during surgery and removed. We suggest that the diagnosis of appendicitis should be considered in some patients with blunt abdominal trauma.
Turkish journal of trauma & emergency surgery, 2011
Bu çalışmanın amacı, hayvan modelinde karın duvarı defektlerinin polipropilen yama ile tamirinden... more Bu çalışmanın amacı, hayvan modelinde karın duvarı defektlerinin polipropilen yama ile tamirinden sonra oluşan adezyon formasyonu, fibrozis ve enflamasyon üzerine okside rejenere selüloz, polietilen glikol ve hylan G-F 20'nin etkilerini araştırmaktır. Kırk sıçan dört gruba ayrıldı ve karın duvarı defekti oluşturuldu. Defektler sırası ile grup I, II, III ve IV olacak şekilde; sadece polipropilen yama (kontrol grubu), polipropilen yama ve adezyon bariyeri olarak hylan G-F 20, polipropilen yama ve adezyon bariyeri olarak okside rejenere selüloz, polipropilen yama ve adezyon bariyeri olarak polietilen glikol kullanılarak onarıldı. Sıçanlar 14. günde öldürüldü. Makroskopik adezyon açısından karşılaştırıldıklarında kontrol gurubu ile adezyon bariyeri kullanan gruplar arasında istatistiksel olarak anlamlı fark bulundu. Kontrol grubunda ileri derecede fibroblast proliferasyonu ve polietilen glikol grubunda hafif fibroblast proliferasyonu görüldü. Polietilen glikol etkili bir adezyon bariyeridir. Son dönemde laparoskopik cerrrahi birçok alanda standart metot haline gelmiştir. Polietilen glikol laparoskopik düzeneği sayesinde hasarlı yüzey üzerine uygulama kolaylılığı sağlamaktadır.
Surgical laparoscopy, endoscopy & percutaneous techniques, Jun 1, 2002
The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of ... more The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.
Objective. Perianal fistulas of the perianal soft tissues are an important cause of morbidity and... more Objective. Perianal fistulas of the perianal soft tissues are an important cause of morbidity and a significant portion of colorectal surgery. To our knowledge, there is no study evaluating YouTube videos pertaining perianal fistulas. In this study, we aimed to evaluate YouTube video contents on this topic. Methods. Whether the videos contained real images, animations or presentations, video duration, number of views, comments and likes, uploading date, and daily view were recorded. Reliability of the videos was assessed using the Quality Criteria for Consumer Health Information (DISCERN) scale and quality of the videos using the Global Quality Score (GQS). Results. A total of 100 YouTube videos regarding perianal fistulas were included in the study. Sixty-four (64%) videos were uploaded by healthcare professionals and 36 (36%) videos by nonprofessionals. The mean video length was calculated as 6:70 ± 8:00 minutes for all videos. The mean DISCERN score of all videos was found as 3:92 ± 0:81 and the mean GQS score as 3:97 ± 0:83. According to the DISCERN score, most videos included (94%) were of good quality. There was an excellent agreement between the two surgeons in terms of the DISCERN and GQS scores. Conclusion. Most of the videos included in the study were uploaded by health-care professionals. On the other hand, the majority of the videos contained surgical management of perianal fistulas as it is the definitive treatment. Healthcare related content should be audited and filtered by YouTube with new and effective policies.
Background Malnutrition is known to affect wound healing but it is not known with certainty wheth... more Background Malnutrition is known to affect wound healing but it is not known with certainty whether or not postoperative hyperalimentation can reverse this defect. The present study was designed to examine the effects of recombinant human growth hormone (hGH) on left colonic anastomoses in malnourished rats. Methods Experimental animals were allocated randomly into four groups. In groups 1 and 2 animals were fed with normal diet for 10 days before surgery. In groups 3 and 4 animals were fed with a low-protein diet. Left colonic anastomoses were performed in all animals. Following surgery, rats in groups 1 and 3 received hGH whereas rats in groups 2 and 4 were injected with saline as control. Bursting pressure and hydroxyproline levels on day 4 after operation were used to determine anastomotic healing. Results Bursting pressure was lower in the malnourished rats than those fed with normal diet (P Ͻ 0•05). Bursting pressure was higher in normally fed rats which were given hGH. No significant differences could be noted between malnourished control rats and those receiving hGH. Conclusion These results suggest that hGH strengthened the left colonic anastomoses in rats fed a normal diet, but could not reverse the negative effects of malnutrition on colonic anastomoses.
Polyethylene glycol is an effective adhesion prevention barrier. Laparoscopic surgery has become ... more Polyethylene glycol is an effective adhesion prevention barrier. Laparoscopic surgery has become the standard method in most of the surgical field. With its laparoscopic apparatus, polyethylene glycol allows easy application on the damaged surface.
Surgical laparoscopy, endoscopy & percutaneous techniques, Dec 1, 2002
The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of ... more The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.
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