Zafer Malazgirt | Samsun Ondokuz Mayis University (original) (raw)
Papers by Zafer Malazgirt
Turkiye Klinikleri Journal of Case Reports, 1993
The European Journal of Surgery
The effect of appendicectomy on the subsequent development of right inguinal hernia was investiga... more The effect of appendicectomy on the subsequent development of right inguinal hernia was investigated in 583 patients with hernias, 42 of whom had previously had appendicectomies. The incidence of right sided hernias was no greater among these patients than among those who had not had their appendixes removed. Neither sex was more prone to develop an inguinal hernia after appendicectomy, and no type of hernia (direct or indirect) predominated. The cause of right sided inguinal herniation after appendicectomy has been thought to be damage to the nerve supply of the inguinal muscles during the appendicectomy incision. All our 42 cases except two had had their appendicectomies through classic McBurney incisions, which were some distance away from the most common areas of nerve damage. We conclude that development of a right inguinal hernia is an unlikely complication of appendicectomy if a classic McBurney incision was used.
Pathology International
Angiomyxomas are a group of relatively rare mesenchymal myxoid tumors. Three types of angiomyxoma... more Angiomyxomas are a group of relatively rare mesenchymal myxoid tumors. Three types of angiomyxomas have been identified: superficial angiomyxoma, aggressive angiomyxoma and angiomyofibroblastoma. These tumors have a predilection for occurring in the perineum of middle-aged females and are often clinically diagnosed as Bartholin's cyst. A case of a 42-year-old female with a perineal angiomyofibroblastoma mimicking a Bartholin's cyst is presented. The pathological and clinical characteristics of this tumor are discussed.
Journal of trace elements and electrolytes in health and disease
The serum and cyst fluid levels of selenium, zinc and copper were investigated both in patients a... more The serum and cyst fluid levels of selenium, zinc and copper were investigated both in patients and sheep with hydatid cysts. Results were compared with those of healthy subjects in both species. The serum values of Se, Zn and Cu in healthy subjects were 60.24 +/- 1.96 micrograms/L, 0.59 +/- 0.07 mg/L, and 1.01 +/- 0.08 mg/L, respectively. The corresponding serum values of the three trace elements in patients with hydatidosis were 41.30 +/- 1.94 micrograms/L, 1.27 +/- 0.08 mg/L, and 0.89 +/- 0.09 mg/L. These results show a decrease in Se and Zn, and a rise in Cu in sera of patients with hydatid disease. Similar results were obtained in infested sheep as related to the healthy control animals. Our results on the three trace elements were found to correlate well with the incidence of cirrhosis, malignant and infectious diseases and arthritis. Se was not detectable in cyst fluid, while Cu and Zn levels were found significantly lower than serum levels. Cu and Zn levels in cyst fluid sho...
Turkish Journal of Surgery, 2015
The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment... more The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature. Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence. Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.
European Journal of Plastic Surgery, 2000
A case of unilateral anomalous arterial supply of the lower limb and the anterior abdominal wall ... more A case of unilateral anomalous arterial supply of the lower limb and the anterior abdominal wall is presented. In this case, inferior epigastric artery arose from a common trunk with the medial circumflex femoral artery. The common trunk arose from the femoral artery. The inferior epigastric artery reached the anterior abdominal wall by passing deep to the inguinal ligament. The medial circumflex artery ran between the femoral artery and vein within the femoral triangle. A possible ontogenetic explanation is provided for this situation. Awareness of the variations in anatomy of the inferior epigastric and femoral arteries is important for angiographers and the surgeon who operates in this region.
Acta chirurgica Belgica, 2002
Morgagni hernia, which is both infrequent and generally asymptomatic, is often diagnosed when com... more Morgagni hernia, which is both infrequent and generally asymptomatic, is often diagnosed when complications occur. Herein we present two elderly patients with Morgagni hernia, which were complicated with bowel perforation and upper gastro-intestinal bleeding. The recognition and management of these cases are discussed.
Hernia, 2006
Most of the papers published on spigelian hernia are either case reports or small retrospective s... more Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective multicenter study, we aimed to outline the specific features of spigelian hernias and patients' characteristics more clearly. Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34 patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications and is very well tolerated by the patient.
Ulusal travma dergisi = Turkish journal of trauma & emergency surgery: TJTES
Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition f... more Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition for both mother and fetus. In this article, we reported two cases suffered from acute pancreatitis and hyperlipidemia; 24-year old pregnant women and 40 year old non-pregnant women. The risks of the pregnancy in this situation were also discussed.
Hernia, 2000
Summary The feasibility of tension-free repairs in bilateral inguinal hernias has not been well d... more Summary The feasibility of tension-free repairs in bilateral inguinal hernias has not been well documented. In this prospective randomized study patients' characteristics, intra- and postoperative parameters including pain, return to daily activity and work, were assessed in patients undergoing bilateral hernia repair by means of either the Stoppa or the Lichtenstein techniques. A total of 45 patients having bilateral inguinal
Indian Journal of Surgery, 2010
After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to... more After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to mesh had not been clarified. We examined adhesion formation specific to the fixation material in rats. We designed an experimental laparoscopy setup, and placed four intraperitoneal fixation materials on the peritoneum of rats without a mesh graft. Another group of researchers documented the incidence and intensity of postoperative adhesion formation. The adhesion scores for the nickeltitanium anchor were significantly greater than those for polylactic acid (p=0.004), a titanium tacker (p<0.0001), and fibrin glue (p<0.0001). No adhesions occurred in the fibrin glue group. Fibrin glue is the preferred fixation material because it produced no postoperative adhesions. The nickel-titanium anchor produced heavy adhesions but may be applicable for recurrent hernia cases and in patients with thin abdominal walls.
Hernia, 2009
An inguinal hernia containing an ovary, fallopian tube, and uterus is an extremely rare occurrenc... more An inguinal hernia containing an ovary, fallopian tube, and uterus is an extremely rare occurrence in a woman of reproductive age. We herein report a case of a uterine horn from a bicornuate uterus, left ovarian ligament, and partially left fallopian tube within the left inguinal sac and canal diagnosed through laparoscopy in a 23-year-old female who is infertile.
Journal of Experimental and Clinical Medicine, 2012
Journal of Orthopaedic Science, 2001
Various pelvic and visceral complications have been reported resulting from total hip arthroplast... more Various pelvic and visceral complications have been reported resulting from total hip arthroplasty. Most of these complications are known to be related to the intrapelvic migration of the acetabular cup or the cement, or to the heat generated by polymerization of the methylmethacrylate. Complications involving almost every pelvic structure have been described. We report a case of progressive limb shortening and severe pelvic pain beginning 6 months after total hip arthroplasty. To close the acetabular defect after removal of the displaced acetabular component, we used a modified extraperitoneal approach adapted from Stoppa's technique, which is commonly used for inguinal, femoral, and obturator hernias. In this article, we aim to describe this modified extraperitoneal approach and to offer advice for the diagnosis and treatment of this serious complication.
Hernia, 2003
We report on a new method for the repair of spigelian hernia, in which we combined the step-by-st... more We report on a new method for the repair of spigelian hernia, in which we combined the step-by-step local anesthesia and open preperitoneal mesh repair techniques. After initial infiltration of local anesthetics, we incised the attenuated fascia and slightly enlarged the fascial defect to facilitate easy return of hernial content into the abdominal cavity. We injected preperitoneally, in a radial fashion around the peritoneal sac, more saline solution, consisting of 1:200,000 epinephrine (g:g) and 1 3 bupivacain (v:v). We dissected the peritoneum away from the anterior abdominal wall to create a preperitoneal pocket of sufficient size. We spread open a 9·9-cm polypropylene mesh in the area, as if we were doing a GPRVS of Stoppa. We followed up our four patients for an average of 32 months. All four cases had an uneventful recovery and were discharged in an average of 3.5 days. They returned to normal daily activity on the 9 th day after surgery. We suggest that the preperitoneal mesh repair of a spigelian hernia under local anesthesia is a simple and feasible technique with favorable early and late postoperative results and deserves further investigation in larger series.
Hernia, 2001
Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intra... more Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.
Indian Journal of Surgery, 2010
Background The prosthetic mesh grafts used to repair the abdominal wall may become infected, prim... more Background The prosthetic mesh grafts used to repair the abdominal wall may become infected, primarily by S. aureus and E. coli. This study sought to provide a rational basis for the choice of mesh used to repair a hernia when there is a likelihood of infection or contamination.
World Journal of Endocrine Surgery, 2011
Secondary hyperparathyroidism is the hyperplasia and hyperfunctioning of the parathyroid gland in... more Secondary hyperparathyroidism is the hyperplasia and hyperfunctioning of the parathyroid gland in chronic renal failure. The aim of our study was to evaluate the efficiency and complications of surgical methods for secondary hyperparathyroidism in patients requiring dialysis. Forty-one patients operated for secondary hyperparathyroidism before renal transplantation were retrospectively analysed. The efficiency and complications of types of surgery in relation with age, gender, duration of dialysis, symptoms, laboratory test results before and after surgery were evaluated. Mean duration of dialysis was 6.2 ± 3.98 years. Patient's calcium, phosphorus and parathormone levels before surgery were 9.83 ± 1.25 mg/dl, 5.73 ± 2.15 mg/dl, 1847, 0.02 ± 666.602 pg/ml and, after surgery, were 7.85 ± 1.36 mg/dl, 4.5 ± 1.55 mg/dl, 288.05 ± 404.09 pg/ml. The differences betweeen preoperative and postoperative values were statistically significant (p < 0.05) recognizing the efficiency of surgery. The age of patients, the duration of dialysis and the type of surgery were not significantly effective on this difference (p > 0.05). Fifteen patients had subtotal parathyroidectomy, 25 patients had total parathyroidectomy with autotransplantation and one patient had total parathyroidectomy. The incidence of complications did not differ with age, gender, duration of dialysis and type of surgery (p > 0.05). The type of surgery did not possess difference in the improvement in levels of calcium, phosphorus and parathormone and also in the incidence of complications in secondary hyperparathyroidism. Surgeon's experience and individual patient characteristics seem to be more important in determining the type of surgery.
ISRN Gastroenterology, 2011
Journal of Experimental and Clinical Medicine, 2010
Recently, stapler anastomosis is the method of choice in low or ultra low resection for rectal ca... more Recently, stapler anastomosis is the method of choice in low or ultra low resection for rectal carcinoma. In this study, risk of rectal stricture formation after double stapling colorectal anastomosis was evaluated. We here with presented an invitro investigation and a retrospective analysis of 91 cases of rectal carcinoma treated by low or ultra low anterior resection with hand-sewn or double-stapled colorectal anastomosis between the years 2002-2006 regarding the late complication of postoperative stenosis. In in vitro investigation external and internal diameters of staplers were measured. Also diameters of anastomotic lines were investigated on stapled sheep intestine and low anterior resection specimen of human, in vitro. External and internal diameters of 29 and 33 mm staplers were found 19.5-24 mm respectively. Also diameters of anastomosis with 29 mm stapler at sheep intestine and 33 mm stapler at low anterior specimen were found 15 mm, 20 mm respectively.Rectal stricture was not seen in any of the patients with hand-sewn anastomoses. We found postoperative stricture of the rectal anastomosis in 11 (17.2 %) of the patients treated by double-stapled group (p=0.022). The risk factors that we have investigated were age and gender of the patient, location and stage of the tumour, diameter of EEA staplers, and presence of neoadjuvant or adjuvant chemoradiotherapy. Although double-stapling anastomosis in rectal cancers has clear technical advantages over hand-sewn technique, the late complication of stenosis occurred at a significantly higher rate after this technique.
Turkiye Klinikleri Journal of Case Reports, 1993
The European Journal of Surgery
The effect of appendicectomy on the subsequent development of right inguinal hernia was investiga... more The effect of appendicectomy on the subsequent development of right inguinal hernia was investigated in 583 patients with hernias, 42 of whom had previously had appendicectomies. The incidence of right sided hernias was no greater among these patients than among those who had not had their appendixes removed. Neither sex was more prone to develop an inguinal hernia after appendicectomy, and no type of hernia (direct or indirect) predominated. The cause of right sided inguinal herniation after appendicectomy has been thought to be damage to the nerve supply of the inguinal muscles during the appendicectomy incision. All our 42 cases except two had had their appendicectomies through classic McBurney incisions, which were some distance away from the most common areas of nerve damage. We conclude that development of a right inguinal hernia is an unlikely complication of appendicectomy if a classic McBurney incision was used.
Pathology International
Angiomyxomas are a group of relatively rare mesenchymal myxoid tumors. Three types of angiomyxoma... more Angiomyxomas are a group of relatively rare mesenchymal myxoid tumors. Three types of angiomyxomas have been identified: superficial angiomyxoma, aggressive angiomyxoma and angiomyofibroblastoma. These tumors have a predilection for occurring in the perineum of middle-aged females and are often clinically diagnosed as Bartholin's cyst. A case of a 42-year-old female with a perineal angiomyofibroblastoma mimicking a Bartholin's cyst is presented. The pathological and clinical characteristics of this tumor are discussed.
Journal of trace elements and electrolytes in health and disease
The serum and cyst fluid levels of selenium, zinc and copper were investigated both in patients a... more The serum and cyst fluid levels of selenium, zinc and copper were investigated both in patients and sheep with hydatid cysts. Results were compared with those of healthy subjects in both species. The serum values of Se, Zn and Cu in healthy subjects were 60.24 +/- 1.96 micrograms/L, 0.59 +/- 0.07 mg/L, and 1.01 +/- 0.08 mg/L, respectively. The corresponding serum values of the three trace elements in patients with hydatidosis were 41.30 +/- 1.94 micrograms/L, 1.27 +/- 0.08 mg/L, and 0.89 +/- 0.09 mg/L. These results show a decrease in Se and Zn, and a rise in Cu in sera of patients with hydatid disease. Similar results were obtained in infested sheep as related to the healthy control animals. Our results on the three trace elements were found to correlate well with the incidence of cirrhosis, malignant and infectious diseases and arthritis. Se was not detectable in cyst fluid, while Cu and Zn levels were found significantly lower than serum levels. Cu and Zn levels in cyst fluid sho...
Turkish Journal of Surgery, 2015
The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment... more The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature. Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence. Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.
European Journal of Plastic Surgery, 2000
A case of unilateral anomalous arterial supply of the lower limb and the anterior abdominal wall ... more A case of unilateral anomalous arterial supply of the lower limb and the anterior abdominal wall is presented. In this case, inferior epigastric artery arose from a common trunk with the medial circumflex femoral artery. The common trunk arose from the femoral artery. The inferior epigastric artery reached the anterior abdominal wall by passing deep to the inguinal ligament. The medial circumflex artery ran between the femoral artery and vein within the femoral triangle. A possible ontogenetic explanation is provided for this situation. Awareness of the variations in anatomy of the inferior epigastric and femoral arteries is important for angiographers and the surgeon who operates in this region.
Acta chirurgica Belgica, 2002
Morgagni hernia, which is both infrequent and generally asymptomatic, is often diagnosed when com... more Morgagni hernia, which is both infrequent and generally asymptomatic, is often diagnosed when complications occur. Herein we present two elderly patients with Morgagni hernia, which were complicated with bowel perforation and upper gastro-intestinal bleeding. The recognition and management of these cases are discussed.
Hernia, 2006
Most of the papers published on spigelian hernia are either case reports or small retrospective s... more Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective multicenter study, we aimed to outline the specific features of spigelian hernias and patients' characteristics more clearly. Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34 patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications and is very well tolerated by the patient.
Ulusal travma dergisi = Turkish journal of trauma & emergency surgery: TJTES
Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition f... more Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition for both mother and fetus. In this article, we reported two cases suffered from acute pancreatitis and hyperlipidemia; 24-year old pregnant women and 40 year old non-pregnant women. The risks of the pregnancy in this situation were also discussed.
Hernia, 2000
Summary The feasibility of tension-free repairs in bilateral inguinal hernias has not been well d... more Summary The feasibility of tension-free repairs in bilateral inguinal hernias has not been well documented. In this prospective randomized study patients&amp;amp;amp;amp;amp;amp;#39; characteristics, intra- and postoperative parameters including pain, return to daily activity and work, were assessed in patients undergoing bilateral hernia repair by means of either the Stoppa or the Lichtenstein techniques. A total of 45 patients having bilateral inguinal
Indian Journal of Surgery, 2010
After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to... more After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to mesh had not been clarified. We examined adhesion formation specific to the fixation material in rats. We designed an experimental laparoscopy setup, and placed four intraperitoneal fixation materials on the peritoneum of rats without a mesh graft. Another group of researchers documented the incidence and intensity of postoperative adhesion formation. The adhesion scores for the nickeltitanium anchor were significantly greater than those for polylactic acid (p=0.004), a titanium tacker (p<0.0001), and fibrin glue (p<0.0001). No adhesions occurred in the fibrin glue group. Fibrin glue is the preferred fixation material because it produced no postoperative adhesions. The nickel-titanium anchor produced heavy adhesions but may be applicable for recurrent hernia cases and in patients with thin abdominal walls.
Hernia, 2009
An inguinal hernia containing an ovary, fallopian tube, and uterus is an extremely rare occurrenc... more An inguinal hernia containing an ovary, fallopian tube, and uterus is an extremely rare occurrence in a woman of reproductive age. We herein report a case of a uterine horn from a bicornuate uterus, left ovarian ligament, and partially left fallopian tube within the left inguinal sac and canal diagnosed through laparoscopy in a 23-year-old female who is infertile.
Journal of Experimental and Clinical Medicine, 2012
Journal of Orthopaedic Science, 2001
Various pelvic and visceral complications have been reported resulting from total hip arthroplast... more Various pelvic and visceral complications have been reported resulting from total hip arthroplasty. Most of these complications are known to be related to the intrapelvic migration of the acetabular cup or the cement, or to the heat generated by polymerization of the methylmethacrylate. Complications involving almost every pelvic structure have been described. We report a case of progressive limb shortening and severe pelvic pain beginning 6 months after total hip arthroplasty. To close the acetabular defect after removal of the displaced acetabular component, we used a modified extraperitoneal approach adapted from Stoppa's technique, which is commonly used for inguinal, femoral, and obturator hernias. In this article, we aim to describe this modified extraperitoneal approach and to offer advice for the diagnosis and treatment of this serious complication.
Hernia, 2003
We report on a new method for the repair of spigelian hernia, in which we combined the step-by-st... more We report on a new method for the repair of spigelian hernia, in which we combined the step-by-step local anesthesia and open preperitoneal mesh repair techniques. After initial infiltration of local anesthetics, we incised the attenuated fascia and slightly enlarged the fascial defect to facilitate easy return of hernial content into the abdominal cavity. We injected preperitoneally, in a radial fashion around the peritoneal sac, more saline solution, consisting of 1:200,000 epinephrine (g:g) and 1 3 bupivacain (v:v). We dissected the peritoneum away from the anterior abdominal wall to create a preperitoneal pocket of sufficient size. We spread open a 9·9-cm polypropylene mesh in the area, as if we were doing a GPRVS of Stoppa. We followed up our four patients for an average of 32 months. All four cases had an uneventful recovery and were discharged in an average of 3.5 days. They returned to normal daily activity on the 9 th day after surgery. We suggest that the preperitoneal mesh repair of a spigelian hernia under local anesthesia is a simple and feasible technique with favorable early and late postoperative results and deserves further investigation in larger series.
Hernia, 2001
Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intra... more Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.
Indian Journal of Surgery, 2010
Background The prosthetic mesh grafts used to repair the abdominal wall may become infected, prim... more Background The prosthetic mesh grafts used to repair the abdominal wall may become infected, primarily by S. aureus and E. coli. This study sought to provide a rational basis for the choice of mesh used to repair a hernia when there is a likelihood of infection or contamination.
World Journal of Endocrine Surgery, 2011
Secondary hyperparathyroidism is the hyperplasia and hyperfunctioning of the parathyroid gland in... more Secondary hyperparathyroidism is the hyperplasia and hyperfunctioning of the parathyroid gland in chronic renal failure. The aim of our study was to evaluate the efficiency and complications of surgical methods for secondary hyperparathyroidism in patients requiring dialysis. Forty-one patients operated for secondary hyperparathyroidism before renal transplantation were retrospectively analysed. The efficiency and complications of types of surgery in relation with age, gender, duration of dialysis, symptoms, laboratory test results before and after surgery were evaluated. Mean duration of dialysis was 6.2 ± 3.98 years. Patient's calcium, phosphorus and parathormone levels before surgery were 9.83 ± 1.25 mg/dl, 5.73 ± 2.15 mg/dl, 1847, 0.02 ± 666.602 pg/ml and, after surgery, were 7.85 ± 1.36 mg/dl, 4.5 ± 1.55 mg/dl, 288.05 ± 404.09 pg/ml. The differences betweeen preoperative and postoperative values were statistically significant (p < 0.05) recognizing the efficiency of surgery. The age of patients, the duration of dialysis and the type of surgery were not significantly effective on this difference (p > 0.05). Fifteen patients had subtotal parathyroidectomy, 25 patients had total parathyroidectomy with autotransplantation and one patient had total parathyroidectomy. The incidence of complications did not differ with age, gender, duration of dialysis and type of surgery (p > 0.05). The type of surgery did not possess difference in the improvement in levels of calcium, phosphorus and parathormone and also in the incidence of complications in secondary hyperparathyroidism. Surgeon's experience and individual patient characteristics seem to be more important in determining the type of surgery.
ISRN Gastroenterology, 2011
Journal of Experimental and Clinical Medicine, 2010
Recently, stapler anastomosis is the method of choice in low or ultra low resection for rectal ca... more Recently, stapler anastomosis is the method of choice in low or ultra low resection for rectal carcinoma. In this study, risk of rectal stricture formation after double stapling colorectal anastomosis was evaluated. We here with presented an invitro investigation and a retrospective analysis of 91 cases of rectal carcinoma treated by low or ultra low anterior resection with hand-sewn or double-stapled colorectal anastomosis between the years 2002-2006 regarding the late complication of postoperative stenosis. In in vitro investigation external and internal diameters of staplers were measured. Also diameters of anastomotic lines were investigated on stapled sheep intestine and low anterior resection specimen of human, in vitro. External and internal diameters of 29 and 33 mm staplers were found 19.5-24 mm respectively. Also diameters of anastomosis with 29 mm stapler at sheep intestine and 33 mm stapler at low anterior specimen were found 15 mm, 20 mm respectively.Rectal stricture was not seen in any of the patients with hand-sewn anastomoses. We found postoperative stricture of the rectal anastomosis in 11 (17.2 %) of the patients treated by double-stapled group (p=0.022). The risk factors that we have investigated were age and gender of the patient, location and stage of the tumour, diameter of EEA staplers, and presence of neoadjuvant or adjuvant chemoradiotherapy. Although double-stapling anastomosis in rectal cancers has clear technical advantages over hand-sewn technique, the late complication of stenosis occurred at a significantly higher rate after this technique.