Introduction: Totally extra-peritoneal (TEP) inguinal hernia repair is a minimally invasive procedure that is safe and efficacious as open hernia repair. Despite advancements in technology, the presence of mesh inside the abdomen poses a risk for the development of complications during the post-operative period such as mesh migration, mesh infection, and abscess development. Rarely, this abscess can create a fistula tract between different structures such as the urinary bladder and the skin. Case presentation: A 86-year-old male patient with a 10-year history of laparoscopic bilateral totally extra-peritoneal (TEP) hernia repair with mesh graft presented with symptoms of watery yellow discharge from the left inguinal region. A mesh-related complication was considered. The patient’s swelling in the inguinal region was diagnosed as an abscess collection and drainage was performed. The computerized tomography of the abdomen revealed a fistula tract formation between the bladder and the skin. Discussion: The TEP hernia repair allows the surgical space to be limited to above the peritoneum and avoids entrance inside the abdomen. Although this approach was a breakthrough in the field of hernia surgery, it could lead to a few complications such as seroma development and mesh migration. Conclusion: Patients with complicated mesh infection may result in an abscess development, which can rarely create a fistula tract between different structures such as the urinary bladder and the skin. Any patient presenting with urinary tract infection symptoms with a history of a synthetic mesh should prompt clinicians to consider mesh-related complications in the differential diagnosis.

Lipomas are benign soft tissue tumours that can occur anywhere on the body and are rarely encountered on the chest. The pathophysiology between soft tissue trauma and lipoma development is not fully understood, and various theories have been presented. We present the case of a violinist with a 40-year occupational history who presented with swelling of the left upper chest wall. The microscopic sample of the resected lipoma showed inflammatory cells with fat necrosis, which are features thought to be involved in the development of a lipoma following soft tissue trauma.

Liposarcoma is a common soft tissue neoplasm but its presence within the gastrointestinal system, especially the esophagus, is quite rare. It usually presents as an intraluminal or an intramural mass, with symptoms such as dysphagia and throat discomfort. Liposarcoma must be differentiated from benign tumors of the esophagus and managed appropriately. In this report, we present the case of a 26-year-old woman who complained of dysphagia to liquids and solids and vague abdominal discomfort. The radiological modalities and endoscopic examination revealed a near-obstructing esophageal polypoid mass of 15 × 7.5 cm in size in the thoracal esophagus. A diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma was made with morphological and immunohistochemical findings. Esophageal liposarcomas originate from primitive mesenchymal cells and are divided into several subtypes, with well-differentiated liposarcoma being the most common subtype. Various diagnostic tests are available, such as barium swallow, computerized tomography, magnetic resonance imaging, and esophagogastroduodenoscopy. Depending on the size and location of the tumor, minimally invasive endoscopic resection or more radical surgery such as esophagectomy can be performed. Modern radiological imaging modalities have allowed better understanding and early diagnosis of lipomatous tumors of the esophagus. Optimal management varies, but minimally invasive techniques allow easy removal of the tumor stalk. However, more radical surgery such as esophagectomy is still performed. Due to its rarity, little is known about the prognosis of esophageal liposarcoma. Patients should be followed-up closely in the long term regarding recurrence.

INTRODUCTION: Surgical management of pancreatic cysts differ according to the specific location of the cyst on the pancreas. Cysts located on the pancreatic head require a radical procedure such as pancreaticoduodenectomy (Whipple procedure). Cysts of the pancreatic body or tail, however, require distal pancreatectomy as the standard surgical approach. An alternative surgical approach for cysts located in the mid-pancreas is central pancreatectomy with distal pancreaticogastrostomy. PRESENTATION OF CASE: In this report, we present a case of a 22-year-old woman with a cyst located on the mid-pancreas consistent with a solid pseudopapillary neoplasia. Central pancreatectomy with distal pancreaticogastrostomy was the surgical technique of choice performed in this case. DISCUSSION: Central pancreatectomy has emerged as an alternative surgical approach to mid-pancreatic cysts which includes only the removal of a segment of the pancreas, thereby sparing the distal parenchyma. Compared with the traditional approach, this technique of partial resection of the pancreatic tissue is desirable due to its organ-sparing function. CONCLUSION: Central pancreatectomy with distal pancreaticogastrostomy can be an alternative to distal pancreatectomy for cysts located in the mid-pancreatic region. This rare procedure prevents any unnecessary healthy pancreatic tissue loss, reduces the risk of developing complications, and is an alternative treatment of choice to distal pancreatectomy. (C) 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Amaç: Kolon anastomozu (CA) sonrası gelişen anastomoz kaçağı morbidite ve mortaliteyi artırır.Kalsiyum dobesilate (CaD) anjiyoprotektif, antioksidan, lenfatik kan akımını artırıcı ve nöroprotektif etkilere sahiptir.Bu kapiller ve hücresel sahadaki etkilerine rağmen CaD'nin

Ozet Medikal tedavinin etkinli¤i sayesinde peptik ulser sebebiyle ameliyat edilen hastalar›n say›s› azalsa da ameliyat olmufl hasta- larda geliflen nuks ulserin cerrahi tedavisi halen onemli bir cerrahi problemdir.Peptik ulser nedeniyle ameliyat edilen hastalar›n uzun donem sonuclar›n›n tatmin edici olmamas›n›n bafll›ca nedenleri alkalen reflu gastrit ve nuks peptik ulserdir. Nuks ulser gelifliminden ilk cerrahi giriflimin yetersiz veya uygunsuz olmas› sorumlu tutulur. Bu cal›flmada 1989 – 2003 y›llar› aras›nda ‹s- tanbul Universitesi Cerrahpafla T›p Fakultesi Genel Cerrahi Anabilim dal›nda peptik ulser icin ceflitli cerrahi giriflimler sonras› nuks peptik ulser geliflen ve bu nedenle tekrar ameliyat edilen 46 hastan›n verileri retrospektif olarak incelendi. Yeni bir cerrahi giriflim icin aday olan hastalar, yo¤un medikal tedaviyle iyileflmeyenler, medikal tedaviye ba¤l› ciddi yan etki gosterenler, konservatif tedavi s›ras›nda ulserleri nuksedenler ve komplikasyonlu nuks ulserlerdi. Nuks ulser icin uygulanacak cerrahi yontem primer ameliyat›n niteli¤ine gore belirlendi. Eksik vagotominin tamamlanmas›, yetersiz rezeksiyonun geniflletilmesi gibi tamamlay›c› ifllemler kullan›ld›. Serimizde cerrahi mortalite gorulmedi. . Anahtar Kelimeler: Nuks peptik ulser, cerrahi tedavi Cerrahpafla T›p Derg 2007; 38: 51 - 55 Results of surgical treatment in patients with recurrent peptic ulcer after original operation Abstract As a result of the efficacity of the medical therapy of peptic ulcer the quantity of the patients those receive surgical treatment are getting lower but it is still a problem as a recurring disease for the patient who had surgery because of peptic ulcer. Alkaline reflux gastritis and recurrent peptic ulcer are the main reasons of the long term unsatisfactory results. The insufficient or improper first surgical operation is usually responsible for the recurrent peptic ulcer. In this study, we evaluated, the retrospective data of 46 patients who underwent repeat surgery because of recurrent peptic ulcer after various surgical treatments between 1989- 2003 in Department of General Surgery at Cerrahpasa Medical Faculty. The patients whose symptoms did not regress with medi- cal therapy or developed side effects due to medical therapy, developed recurrent peptic ulcer during conservative treatment or the ulcers with complication were the candidate of the repeat surgical therapy. The surgical technique was determined accor- ding to primary surgery. Some complementary operations were performed such as the accomplishment of insufficient vagotomy and the enlargement of few resections. There were no surgical mortality in our series. KeyWords: Recurrent peptic ulcer, surgical treatment, ulcer Cerrahpasa J Med 2007; 38: 51 - 55

Received / Geliş Tarihi: 14.01.2014 Accepted / Kabul Tarihi: 03.03.2014 © Telif Hakkı 2014 AVES Yayıncılık Ltd. Şti. Makale metnine www.jarem.org web sayfasından ulaşılabilir. © Copyright 2014 by AVES Yayıncılık Ltd. Available online at www.jarem.org DOI: 10.5152/jarem.2014.458 ABSTRACT Obturator hernia is a very rare abdominal hernia that is located in the anterior pelvis. Patients apply to a hospital with a clinical intestinal obstruction table in this type of hernia. Prognosis in obturator hernia remains quite poor because of delayed diagnosis and surgical management. Nowadays, radiological techniques, especially computed tomography, are very advanced. Nevertheless, obturator hernia is a serious problem with its increased mortality, because it is detected quite hardly. We tried to offer an 82-year-old woman with acute abdomen that was considered on mechanic intestinal obstruction table for us in this article. Computed tomography is useful on these patients, just as it is useful in this article. For this reason, we scanned computed tomography and recognized a strangulated obturator hernia on the left. Afterwards, we planned a surgical operation and repaired the obturator hernia laparoscopically. The patient was transferred to the intensive care unit because of respiratory failure after the operation was finished. The patient, who was followed in the intensive care unit, died five days later because of acute respiratory failure. Obturator hernia is a rare cause of acute intestinal obstruction. Therefore, increased mortality rates should be remembered in elderly patients because of delayed diagnosis and accompanying chronic diseases. (JAREM 2014; 1: 31-4)

BACKGROUND:Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.METHODS:This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).RESULTS:All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.CONCLUSION:Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD) is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient.

Laparoscopic cholecystectomy has become the standard approach since its introduction in 1987 by Mouret. Situs inversus totalis is a rare anomaly in which transposition of the organs to the opposite side of the body occurs. Laparoscopic cholecystectomy due to gallbladder diseases in such few cases has been reported in the literature. We aimed to present a new case with symptomatic cholelithiasis, situs inversus totalis, and with a past-medical history of multiple abdominal operations. Special attention has also been paid to the modification of the laparoscopic cholecystectomy procedure.

Laparoscopic cholecystectomy has become the standard approach since its introduction in 1987 by Mouret. Situs inversus totalis is a rare anomaly in which transposition of the organs to the opposite side of the body occurs. Laparoscopic cholecystectomy due to gallbladder diseases in such few cases has been reported in the literature. We aimed to present a new case with symptomatic cholelithiasis, situs inversus totalis, and with a past2medical history of multiple abdominal operations. Special attention has also been paid to the modification of the laparoscopic cholecystectomy procedure.

BACKGROUNDSpontaneous intramural hematoma of the small intestine is a rare clinical condition that may result in potentially serious complications. The purpose of this study was to present our experience with the diagnosis and management of spontaneous intramural hematoma of the small intestine.METHODSThe medical records of the patients with spontaneous intramural hematoma of the small intestine were retrospectively reviewed. Six patients were included in this study.RESULTSAnticoagulation therapy and factor VIII deficiency were found to be responsible for the intramural hemorrhage in five patients (83%) and one patient, respectively. Acute abdominal pain followed by nausea and vomiting were the most common presenting symptoms. Abdominal computed tomography scan was diagnostic in five of the six patients. Four patients were followed up with conservative therapy. Surgical intervention was required in two patients due to acute abdomen. All patients were discharged from the hospital uneventfully.CONCLUSIONThe patient's medical history, physical examination and radiological evaluation proved adequate for the diagnosis. Conservative therapy provides regression of the hematoma in most patients. Surgery should be reserved only for the complicated cases.

PURPOSE:Many different remedial operations for alkaline reflux gastritis have been described. Analysis of their efficacy is difficult, because while many of the procedures have good early results, there are long-term failures due to their own complications. The aim of this study is to evaluate our experience with patients undergoing remedial operations for alkaline reflux gastritis syndrome.MATERIAL AND METHODS:The clinical features and results of remedial operations of 65 patients with alkaline reflux gastritis syndrome were reviewed retrospectively. Data on the hospital course were collected by interviewing patients directly or by telephone contact. An assessment of each patient's response to remedial operation was then made and a Visick score assigned.RESULTS:All patients had been tried on a medical treatment and dietary restriction or both prior to remedial operation. Long-term follow up was possible in 46 patients. Seventy-six percent of patients who at the final state had a truncal vagotomy, distal gestrectomy and Roux-en-Y gastrojejunostomy have been found to show satisfactory results (Visick-I/Visick II). Three patients who had previously undergone a Roux-en-Y conversion later required re-operation for Roux-stasis syndrome and a near-total gastrectomy was performed on these patients. Other operations performed for alkaline reflux gastritis were converted to "uncut" Roux-en-Y in five patients and dismantling of gastrojejunostomy in two patients.CONCLUSIONS:For patients unresponsive to medical treatment, we reccommend the following strategy: a) for patients with truncal vagotomy plus gastrojejunostomy, dismantling of gastrojejunostomy should be the first choice b) for patients with prior Billroth-II gastrectomy, Roux-en-Y conversion is the most effective corrective operation, although it has its proper including Roux statis syndrome.

Background: Various techniques have been used for the division of mesoappendix, such as endoloops, endoscopic linear cutting staplers, an electrothermal vessel-sealing system (LigaSure), the Harmonic Scalpel, clips, and bipolar coagulation. In the present study, LigaSure and an endoclip were compared in laparoscopic appendectomy (LA). Materials and Methods: This study included patients who underwent LA for acute appendicitis at Istanbul University, Cerrahpasa Medical Faculty, Emergency Unit (Istanbul, Turkey) between May 2003 and April 2007. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and endoclip groups. The main outcome measures (e.g., operating time, conversion rate, hospital stay, postoperative complications, etc.) were then compared. Results: LA was performed in 280 patients with acute appendicitis. LigaSure and endoclips were used in 127 and 153 patients, respectively. The mean operative times were 41 and 54 minutes in the LigaSure and endoclip groups, respectively. Conversions to open rates were found to be 9.4% (12 patients) in the LigaSure and 11.1% (17 patients) in endoclip groups. No statistically significant differences regarding hospital stay or complications were found, whereas significant differences were observed in surgical time and conversion rate. Conclusion: The use of LigaSure facilitates the dissection of mesoappendix and shortens the operation time in LA. We believe that LigaSure is a safe, useful tool for mesoappendix dissection.

Introduction Tuberculosis can present in many varied clinical situations in immunosuppressed patients. It has been reported that the sigmoid colon is the most common site for colonic perforation in renal transplant recipients and diverticulitis is its most common cause. Cecal perforation because of tuberculosis is extremely rare in a renal transplant recipient. We present the case of a renal transplant patient with cecal perforation due to tuberculosis, 10 years after renal transplantation. Case presentation A 39-year-old Caucasian man, who was a renal transplant recipient, was admitted to our emergency surgery unit with an acute abdomen. A cecal perforation was found at exploratory laparotomy, and a right hemicolectomy with an end ileostomy and transverse colonic mucous fistula were performed. Necrotizing granulomatous colitis due to tuberculosis was reported in the histopathologic examination. Conclusion Colonic perforations in immunosuppressed patients may have unusual presentations and unusual causes. Tuberculosis infection should be considered in the differential diagnosis during the histopathologic evaluation in immunocompromised patients such as renal transplant recipients.

Background. The aim of this paper is to assess the effects of halofuginone, a specific inhibitor of synthesis of collagen Type 1, on fibrogenetic process in an experimental model of early pancreatic fibrosis.Methods. Thirty rats were divided into three equal groups: group 1, sham laparotomy; group 2, severe hyperstimulation and obstruction pancreatitis (SHOP) with no treatment; group 3, SHOP with halofuginone treatment group. SHOP model was induced by complete pancreatic duct obstruction and daily cerulein hyperstimulation (50 mu g/kg, intraperitoneally). Halofuginone was administered daily from the operative day (5 mg/kg, intraperitoneally). All of the animals were sacrificed, and blood and pancreatic tissue samples were obtained for biochemical and histopathological. examination on the 5th postoperative day.Results. No mortality was observed in any group. Serum amylase, lipase, hyaluronic acid, and nitric oxide levels were significantly higher in groups 2 and 3 compared with group 1 (P < 0.05), but were significantly lower in group 3 compared with group 2 (P < 0.05). No significant differences were observed regarding serum malondialdehyde and glutathione levels between groups 1 and 3. Tissue hydroxyproline levels were found to be significantly higher in groups 2 and 3 compared with group 1 (P < 0.001), but were significantly lower in group 3 compared with group 2 (P < 0.001). Although tissue hydroxyproline levels were significantly higher in the halofuginone treatment group compared with the control group, histopathological evaluation did not reveal a significant difference between these groups regarding collagen deposition. When group 3 was compared with group 2, halofuginone significantly reduced inflammation and acinar atrophy in the pancreas as well (P < 0.05).Conclusion. Halofuginone was found to be effective in reducing SHOP-related inflammation, acinar atrophy, and fibrosis in the pancreas. (C) 2008 Elsevier Inc. All rights reserved.

Pneumothorax is rare but can be a severe complication of laparoscopic surgery. Diagnosis of pneumothorax in laparoscopy includes the sudden increase in end-tidal carbon dioxide (EtCO2) with a decrease in compliance and an abnormal increase in airway pressure. By these case reports, we recommend the simultaneous monitoring of airway pressures, dynamic compliance, and particularly, EtCO2 for an immediate diagnosis and prompt treatment of pneumothorax.

Objective: We aimed to investigate, in a retrospective manner, technical characteristics and clinical outcome of our experience in laparoscopic repair of peptic ulcer perforation.Material and Methods: Patients who underwent laparoscopic repair of peptic ulcer perforation between June 1997 and May 2007 were included into the study. Those who underwent open repair or were subjected to conversion from laparoscopy to laparotomy were excluded. Poor general status, severe sepsis, septic shock and hemodynamic instability were considered as contraindications for laparoscopy. Demographic features, technical details and clinical outcome were retrospectively evaluated. Laparoscopic repair was performed via four trocars with primary suturing and intracorporeal knotting.Results: Ninety-six patients underwent laparoscopic surgery due to peptic ulcer perforation. Sixty-six patients (69%) underwent laparoscopic repair alone or laparoscopic repair with omentoplasty. In the remaining thirty patients (31%) the procedure was converted to laparotomy. Amongst sixty-six patients who were included into the study, fifty-one patients (77%) were male and fifteen (23%) were female; the mean age was 39.6 (15-80). In thirteen patients (20%; 13/66) preoperative diagnosis was unclear and the patients were taken to the operating theater because of acute abdomen. In all patients, but one, duodenal defect was repaired by primary suturing; in one patient, simply intraabdominal lavage and drainage were performed. Omentoplasty was performed in 35 (53%) patients. One and two abdominal drains were used in 46 (70%) and 20 (30%) respectively. The mean hospital stay was 6.3 (3-20) days. Morbidity was 8% (n=5). Early morbidity included bile leakage in three patients and postoperative intraabdominal bleeding in one. One patient had trocar site hernia as a late complication. There was no mortality.Conclusion: Laparoscopic primary repair is a safe and efficient method in peptic ulcer perforation