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Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic tool in patients with hepato-pancreatobiliary diseases. In the present study, we sought to determine predictors of post-ERCP complications at our institution.A retrospective analysis of patients who underwent ERCP in between January 2010 and November 2011 was done. Demographics, indications, ERCP findings, success rate, complications and the need of repeat procedure were evaluated with special emphasis on the difficulty in cannulation procedure, the primary etiology of the disease (benign/malign) and age. Chi-square analysis was applied for statistical analysis. The differences were considered statistically significant, if the p value was less than 0.05.A total of 112 ERCP was performed in 81 patients. Thirty-eight were male (46.9 %) and 43 were female (53.1%). Mean age was 61.3 (range 17-88), and 31 patients was seventy years and older (38.3 %). Complications were detected in 28 patients (34.6 %). Nine cases with difficult or unsuccessful cannulation (69.2 %) had complications (p=0.001). Patients with benign diseases showed less complications (21/70), in comparison with those with malignancies (7/11) (30 % vs. 63.6 %, respectively; p0.05). Complication rate in patients 70 years and older was 32.2 % (n=10) compared to 35.3 % in patients younger than 70 (n= 18) (p0.05).Risk factors such as difficult or incomplete cannulation and malignancy are considered as possible predisposing factors for complications. Age is an independent factor.Endoscopic cholangiopancreatography, Risk factors.La colangiopancreatografia retrograde (ERCP) è una importante procedura sia diagnostica che terapeutica in pazienti affetti da patologie epato-bilio-pancreatiche. Con questo studio abbiamo inteso determinare nella nostra istituzione le cause predisponenti alle possibili complicazioni. Si tratta di una analisi retrospettiva sui pazienti sottoposti ad ERCP tra Gennaio 2010 e Novembre 2011, prendendo in considerazione i dati demografici, le indicazioni alla procedura, i relativi referti, l’entità dei successi, le complicanze e la necessità di ripetere la procedura con particolare attenzione alle difficoltà di incannulazione, la natura benigna o maligna della patologia e l’età dei pazienti. Per l’analisi statistica è stato usato il Chi-quadro, considerando significative le differenze per il valore di p0.05. La casistica riguarda un totale di 112 ERCP in 81 pazienti: 38 uomini (46.9%) e 43 donne (53,1%). L’età media dei pazienti è di 63,3 anni (da 17 a 88) e 31 pazienti sono di età superiore ai 70 anni (38,3%). Le complicazioni si sono registrate in 28 pazienti (34,6%). In 9 casi (69,2%) con difficoltà o impossibilità di incannulamento si sono avute complicazioni (p=0.001). I pazienti con patologia benigna hanno avuto minori complicazioni (21/70) in paragone con l’incidenza di complicazioni in quelli con patologia maligna (7/11): rispettivamente 30% vs 63,6%, con p0,05. L’incidenza di complicanze negli ultrasettantenni è stata del 32,2% (n=10) in paragone con il 35,3% di quelli di età inferiore ai 70 anni (n=18) con p0.05). In conclusione la difficoltà o impossibilità di incannulamento e la natura maligna della patologia rappresentano potenziali fattori predisponenti alle complicanze, mentre l’età rappresenta un fattore indipendente.

AMAÇ Travma sonrası gözden kaçan diyafram yaralanmaları karın içi organların toraksa fıtıklaşması ile sonuçlanabilir. Bu çalışmada, travma sonrası gecikmiş diyafram yaralanması nedeniyle tedavi edilen hastalar değerlendirildi. GEREÇ VE YÖNTEM 2001-2009 yılları arasında travma sonrası geç bulgu veren diyafram hernisi tanısı alan hastaların dosyaları geriye dönük olarak incelendi. BULGULAR Çalışmaya alınan 10 hastanın yaş ortalaması 44,3 yıl idi. Hastaların altısı kadındı. Etyolojide künt travma daha sık (n=7) olarak saptandı. Travma ile travma sonrası diyafram hernisi tanısıyla hastaneye başvuru arasında geçen süre ortalama 5,9 yıl (4 ay-19 yıl) idi. Dokuz hastada diyafram hernisi soldaydı. Tüm hastaların arka-ön akciğer grafisi çekildi ve çoğunda sadece grafi ile tanı kondu (n=8). Yedi hastada ilave olarak bilgisayarlı tomografi ve manyetik rezonans görüntüleme kullanıldı. Herni tamiri için yedi hastada laparotomi iki hastada torakotomi yapılırken, bir hastada sol torakoabdominal insizyon kullanıldı. Onarım için yedi hastada yama kullanıldı. Ameliyat sonrası ortalama hastanede kalış süresi 10,6 gündü. Bir hastada ampiyem ve atelektazi saptandı. Ameliyat sonrası mortalite saptanmadı. SONUÇ Travma sonrası geç bulgu veren diyafram hernisi travma cerrahları için ciddi bir problemdir. Tanı ve tedavinin doğru ve hızlı uygulanması fıtıklaşmış organların perforasyon veya gangreni sonrası gelişebilecek morbidite ve mortaliteyi engeller. BACKGROUND Missed diaphragmatic injuries after trauma may present with herniation of intraabdominal organs into the thoracic cavity. We aimed to review our patients who presented with delayed posttraumatic diaphragmatic hernia. METHODS A retrospective review of the medical records of patients with delayed diagnosis of posttraumatic diaphragmatic hernia between 2001 and 2009 was performed. RESULTS Ten patients with a mean age of 44.3 years were included. Six patients were female. Blunt injuries (n: 7) were more common. Mean duration between trauma and presentation to the hospital was 5.9 years (4 months - 19 years). Nine patients had left-sided diaphragmatic hernia. All patients had chest X-ray and most were diagnostic (n: 8). Additional diagnostic imaging with computerized tomography (CT) and magnetic resonance (MR) was used in seven patients. For the repair, laparotomy incision was chosen for seven patients and thoracotomy incision for two patients. One patient underwent left thoracoabdominal approach. Mesh repair was used in seven patients. Postoperative mean hospitalization was 10.6 days. Empyema and atelectasis were the morbidities in one patient. No postoperative mortality was detected. CONCLUSION Delayed presentation of posttraumatic diaphragmatic hernia is a serious challenge for trauma surgeons. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and/or perforation of the herniated organ.

A selective conservative treatment for penetrating anterior abdominal stab injuries is an increasingly recognized approach. We analyzed patients who followed-up and treated for penetrating anterior abdominal stab injuries. The anterior region was defined as the area between the arcus costa at the top and the mid-axillary lines at the laterals and the inguinal ligaments and symphysis pubis at the bottom. An emergency laparotomy was performed on patients who were hemodynamically unstable or had symptoms of peritonitis or organ evisceration; the remaining patients were followed-up selectively and conservatively. A total of 175 patients with purely anterior abdominal injuries were included in the study. One hundred and sixty-five of the patients (94.29%) were males and 10 (5.71%) were females; the mean age of the cohort was 30.85 years (range: 14-69 years). While 16 patients (9%) were made an emergency laparotomy due to hemodynamic instability, peritonitis or evisceration, the remaining patients were hospitalized for observation. During the selective conservative follow-up, an early laparotomy was performed in 20 patients (12%), and a late laparotomy was performed in 13 patients (7%); the remaining 126 patients (72%) were discharged after non-operative follow-up. A laparotomy was performed on 49 patients (28%); the laparotomy was therapeutic for 42 patients (86%), non-therapeutic for 4 patients (8%), and negative for 3 patients (6%). A selective conservative approach based on physical examination and clinical follow-up in penetrating anterior abdominal stab injuries is an effective treatment approach.

[Cukurova Med J 2016; 41(0.100): 128-129]

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures.Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery.Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality.Wide variety of procedures of general surgery can be managed safely and effectively by RALS. Copyright © 2015 John WileySons, Ltd.

Aim: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses. Materials and methods: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student’s t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients. Results: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001). Conclusion: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development.

Background/Aims The aim of this study is to investigate the reflux patterns in patients with galbladder stone and the change of reflux patterns after cholecystectomy in such patients. Methods Fourteen patients with cholecystolithiasis and a control group including 10 healthy control subjects were enrolled in this prospective study. Demographical findings, reflux symptom score scale and 24-hour impedance pH values of the 14 cholecystolithiasis cases and the control group were evaluated. The impedance pH study was repeated 3 months after cholecystectomy. Results Age, gender, and BMI were not different between the two groups. Total and supine weakly alkaline reflux time (%) (1.0 vs 22.5, P = 0.028; 201.85 vs 9.65, P = 0.012), the longest episodes of total, upright and supine weakly alkaline reflux mediums (11 vs 2, P = 0.025; 8.5 vs 1.0, P = 0.035; 3 vs 0, P = 0.027), total and supine weakly alkaline reflux time in minutes (287.35 vs 75.10, P = 0.022; 62.5 vs 1.4, P = 0.017), the number of alkaline reflux episodes (162.5 vs 72.5, P = 0.022) were decreased with statistical significance. No statistically significant difference was found in the comparison of symptoms between the subjects in the control group and the patients with cholecystolithiasis, in preoperative, postoperative and postcholecystectomy status. Conclusions Significant reflux symptoms did not occur after cholecystectomy. Post cholecystectomy weakly alkaline reflux was decreased, but it was determined that acid reflux increased after cholecystectomy by impedance pH-metry in the study group.

Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP) case. This study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP.Between 2000 and 2008, 744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy unit. The demographic features, and clinical and laboratory findings were collected from a prospectively held database. Bile duct calculi were extracted by basket and/or balloon catheter following ERCP and sphincterotomy. Patients with retained stones were regarded as difficult cases. These patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement.Two hundred and forty-five patients (41%) were male and 347 (59%) were female with a mean age of 58 years (range 19-95 years). Stones were impacted in 27 patients (5%). Stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures, and lithotripsy was performed in 70 ERCP procedures. Forty-four patients underwent stent insertion, and 20 underwent stent replacement. Morbidity occurred in 39 patients (5%), with no mortality associated with the procedure. Hemorrhage occurred in 9 patients and basket impaction in 4. Mild pancreatitis and cholangitis developed in 12 and 11 patients, respectively.Difficult cases of bile duct stones can be treated successfully with lithotripsy, and a stent should be applied when the common bile duct cannot be cleared completely.