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Endoscopic hernia repair integrates the advantages of tension-free preperitoneal mesh support of the groin with the advantages of minimally invasive surgery procedures. To compare outcomes between slit mesh (SM) and nonslit mesh (NSM) placement in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. This is a retrospective study of 353 patients who underwent TEP inguinal hernia repair between January 2010 and December 2011. One hundred forty-nine and 154 hernias were operated on in the SM and NSM groups, respectively. Postoperative complications, recurrence, early postoperative pain, and chronic pain levels were evaluated. In a total of 303 patients, hernia repair was performed as 395 direct and indirect hernias. Nonslit mesh was converted from TEP to transabdominal preperitoneal patch plasty (TAPP) in 4 patients in the group and 6 patients in the slit mesh group. The average operation time of the SM group was significantly higher than that of the NSM group (p < 0.001). In the evaluation of early postoperative pain, VAS levels of the NSM group were statistically significantly lower than those of the SR group in all evaluations (p = 0.001). The pain rate of the SM group after 3 months of chronic pain was significantly higher than that of the NSM group (p = 0.004). There was no difference in recurrence rate, 6 month chronic pain, wound infection or wound hematoma. The use of SM and NSM in TEP operations is not different in terms of recurrence and complications. However, the use of NSM gives better results in terms of early postoperative pain and chronic pain.

Background/Objectives: Chronic anal fissure, an anorectal condition, is characterized by internal anal sphincter fibers at the base of the fissure. The lifetime prevalence is 7–8%. Medical management and lifestyle modifications are the first-line treatments, whereas chemical or surgical internal anal sphincterectomy is an option for refractory cases. The aim of this study was to evaluate the impact of surgical anal canal length and sphincter pressure on postoperative symptom relief and continence outcomes. Methods: A total of 26 patients diagnosed with chronic anal fissures were selected for surgical treatment. Five patients voluntarily withdrew, leaving 21 cases for analysis. In patients undergoing open lateral internal sphincterotomy, anal canal length and sphincter pressure were assessed preoperatively and three months postoperatively using endoanal ultrasonography and high-resolution anal manometry. Results: Postoperatively, all patients experienced complete resolution of pain and bleeding. The expected decrease in resting pressure was not significantly associated with sex. A significant weight gain was observed postoperatively (p = 0.001). Although a significant decrease was observed in preoperative sphincter resting pressure and VAS scores, Wexner scores remained unchanged. Preoperatively and postoperatively, mean sphincter pressure was significantly lower in the spontaneous vaginal delivery group than that in the non-spontaneous vaginal delivery group (p < 0.05). Patients with short anal canal lengths had greater pressures reductions, though not statistically significant. Conclusions: Lateral internal sphincterotomy is an effective and safe treatment for chronic anal fistula when performed by experienced surgeons. Anal canal length may influence postoperative complications and surgical decisions. Larger studies are needed to confirm these findings.

Adrenal angiosarcoma is an uncommon neoplasm that derives from the vascular endothelium; due to its biological behavior, it should be distinguished from other adrenal tumors. We herein report a case of a 57-year-old woman with diagnosis of an adrenal tumor that was suspected to be malignant. The specimen was histopathologically proved to be an angiosarcoma. The patient was suffering from right upper quadrant pain; after laboratory and radiological workup, a non-functioning right adrenal mass, 14 cm in size, was recognized. A right subcostal incision was made, and adrenalectomy was performed successfully with tumor-free surgical margins. Two months after the operation, a positron emission tomography-computed tomography scan was ordered for follow-up. No tumor tissue or any other metastatic foci remained. The patient had been referred to our medical oncology department and underwent retroperitoneal radiotherapy. However, unfortunately, the patient died due to cardiac insufficiency during the follow-up period.

A case of acute mesenteric ischemia due to thrombosis of superior mesenteric artery and vein in a 44-year-old woman following chemotherapy for invasive laryngeal carcinoma was diagnosed on a multi-detector CT scan. Although the link between malignancy and thromboembolism is widely recognized in patients with cancer, chemotherapy further elevates the risk of thrombosis. Acute mesenteric ischemia associated or not associated with chemotherapy rarely occurs in patients with cancer. Moreover, co-occurrence of superior mesenteric artery and superior mesenteric vein thrombosis is reported for the first time.

During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration. We used the needle grasper in SILC to hang and manipulate the gallbladder. Sixty-five patients (43 female, 22 male) who underwent SILC between December 2013 and December 2014 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. To place the SILC port (Covidien, Inc.), the needle grasper was inserted at the right upper abdominal quadrant without an incision to hang and manipulate the gall-bladder. The mean age was 47.9 ±13.068 years; the mean body mass index (BMI) was 26.94 ±3.913 kg/m . ASA scores were 1, 2, and 3. Two patients with high BMI with additional trocar use were excluded. The operations were completed without any additional trocar in 59 patients. The mean operation time was 89 ±22.41 min. Eighteen patients required a drain; all were discharged after drain removal. One patient needed re-hospitalization and percutaneous drainage and was discharged on the 9 day. Fifty-three patients were discharged on the 1 post-operative day. Eleven patients with drains were discharged on the 2 day, and 1 was discharged on the 7 day. The mean hospital stay period was 1.26 ±0.815 days. The main difficulty of SILC is to manipulate hand tools because the triangulation principle of laparoscopy use is not possible in SILC. Inserting a needle grasper into the abdominal cavity at the right subcostal area to manipulate the gallbladder helps and does not leave a visible scar.

BACKGROUND: This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated. METHODS: Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65[+ or -]I0.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was assessed using the Paris bleeding severity score. Femoral artery access was utilized for embolization in all patients, and superior rectal artery branches were embolized exclusively with coils. All patients were treated electively except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was conducted via clinical examination and rectoscopy at I, 3, and 6 months. RESULTS: All patients underwent successful treatment with 100% technical success. No procedure-related ischemic complications or femoral artery puncture-related complications were observed in any patient. All patients were classified as grade 4 according to the Goligher classification prior to treatment. The mean Paris bleeding severity score was 6.6[+ or -]1.1 before treatment, 3.4[+ or -]1.5 at the first month, 3.8[+ or -]1.61 at the third month, and 3.6[+ or -]1.29 at the sixth month. Recurrence occurred in one patient at the first month and in another at the third month. Clinical success was 95% at the first month and 85% at the third and sixth months. Re- embolization was not performed in patients with recurrence. CONCLUSION: In conclusion, this study demonstrates that coil embolization of the superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade 4 hemorrhoidal disease and the elective treatment of patients unsuitable for surgical intervention. Keywords: Emborrhoid technique; emergency treatment of active rectal bleeding; hemorrhoidal disease; superior rectal artery embolization. AMAC: Bu calismanin amaci cerrahinin kontrendike oldugu Goligher grade 4 hemoroide bagli rektal kanamanin acil ve elektif tedavisinde superior rektal arterin koil embolizasyonunun guvenilirligini ve etkinligini degerlendirmektir. GEREC VE YONTEM: 2019-2024 yillari arasinda yas ortalamalari 65[+ or -]10.3 olan 18 hasta (11 erkek, 7 kadin) calismaya alindi. Hemoroid derecelendirmesi Goligher siniflamasina gore, rektal kanama derecelendirmesi ise Paris kanama siddeti skoruna gore yapilmistir. Tum hastalarda embolizasyon icin femoral arter girisi yapilmistir ve superior rektal arter dallari yalnizca koiller ile embolize edilmistir. Yogun bakim unitesinde takip sirasinda masif rektal kanama nedeniyle hemodinamik instabilite gelisen bir hasta disinda tum hastalar elektif olarak tedavi edildi. Takipler 1., 3., ve 6. ayda klinik muayene ve rektoskopi ile yapilmistir. BULGULAR: Hastalarin tamami %100 teknik basari ile tedavi edildi. Isleme bagli herhangi bir iskemik komplikasyon izlenmedi ve hicbir hastada femoral arter ponksiyonuyla ilgili komplikasyon gozlenmedi. Tedavi oncesinde Goligher siniflamasina gore tum hastalar grade-4 olarak tespit edilmistir. Paris kanama siddeti skoru tedavi oncesi ortalama 6.6[+ or -]1.1 olup 1. ayda bu skor 3.4[+ or -]1.5, 3. ayda 3.6[+ or -]1.29 ve 6. ayda 3.6[+ or -]1.29 olarak bulunmustur.1 hastada 1. ayda ve 1 hastada 3. ayda nuks goruldu. 1. ayda klinik basari %95, 3. ay ve 6. ay kontrolleri sonrasi %85 olarak bulunmustur. Nuks gorulen hastalara re-embolizasyon yapilmadi. SONUC: Sonuc olarak, bu calisma grade-4 hemoroidal hastaliga bagli kanamanin hem acil tedavisinde ve hem de cerrahi tedaviye uygun olmayan hastalarin elektif tedavisinde superior rektal arter dallarinin koil embolizasyonunun guvenli ve etkili minimal invaziv bir prosedur oldugunu gostermistir. Anahtar sozcukler: Aktif rektal kanamanin acil tedavisi; emboroid teknigi; hemoroidal hastalik; superior rektal arter embolizasyonu.

Aim: Despite surgical and radiological innovations, gallbladder cancer (GC) is usually diagnosed incidentally by the pathological examination of the cholecystectomy specimens, and it is defined as incidental GC (IGC). Methods: Medical files of patients, who underwent cholecystectomy, were analyzed retrospectively. We investigated the relationship between clinicopathological features and survival in patients with IGC. Results: We performed cholecystectomy surgery in 6225 patients in 20 years. Only 21 patients with IGC were included in this study. The distribution of the tumor stages was as follows: in situ cancer (n=1), T1 (n=2), T2 (n=7), and T3 (n=11). Tumor subtypes were identified as adenocarcinoma (n=16), neuroendocrine tumor (n=2), mucinous carcinoma (n=2), and adenosquamous carcinoma (n=1). Advanced ‘‘T stage’’, conversion of laparoscopic cholecystectomy to open cholecystectomy (OCC), positive surgical margins, positive lymphovascular invasion and increased levels of pre-operative alkaline phosphatase (ALP) were found to be associated with poor survival. Conclusion: In case of OCC or high preoperative ALP activity in cholelithiasis, IGC should be kept in mind. Pathology report on IGC should give information on all histopathological prognostic features in order to avoid loss of time associated with re-examination of specimens due to absence of sufficient information in the initial pathology report and enable the surgical team to perform re-operation for T1b tumors or more advanced IGC in a timely fashion.

Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method.

Aim: Anastomotic leakage in colon anastomosis (CA) increases morbidity and mortality. Calcium dobesilate (CaD) has angioprotective, antioxidant, lymphatic flow enhancing-and neuroprotective effects. Despite these capillary and cellular effects, there is no data in the literature regarding the effects of CaD on CA healing. Method: Fifty Wistar-albino rats were randomly divided into five groups. All rats underwent CA after transverse colon transection. CaD was not administered to the control group (Group 1). CaD was administered to the experimental groups (Groups 2, 3, 4 and 5) intraperitoneally or by gavage at doses of 50 or 100 mg/kg/day. CaD was given as a single dose daily during postoperative five days. Bursting pressure values (BPV) and hydroxyproline values (HV) were measured. At the end of histopathological evaluation, polymorphonuclear leukocytes (PNLS), mononuclear leukocytes (MNLS), neovascularization (VS) and collagen fibers (CFS) were scored. Results: CaD increased BPV and HV in experimental groups. We found a decrease in PNLS, MNLS, VS, and an increase in CFS in experimental groups. These increases seemed to be related to the administration doses of CaD. The decreases in PNLS, MNLS and VS were much more evident in Groups 4 and 5 than the other groups. There was no significant difference in terms of VS between experimental groups. Conclusion: We found that CaD not only decreased the pathological parameters of inflammation, but also increased the strength of CA mechanically and biochemically. Although VS reduction seemed to have negative outcomes on CA, we know that CaD inhibits over-expression in angiogenesis. As a result, these effects of CaD appear to be dose-dependent rather than the administration methods.

Some anesthetics including ketamine/xylazine and thiopental have been shown to alter the expression of genes related with inflammatory cytokines and chemokines in previous studies unassociated with wound healing, arising the question of whether commonly used anesthetics in wound healing models could interfere with the transcriptional responses of the genes associated with skin wound healing. The gene expression profile in wound biopsies of rats who received widely used anesthetics doses of intraperitoneal ketamine/xylazine (50 mg/kg and 10 mg/kg) or thiopental (50 mg/kg) in comparison with control rats was analyzed by monitoring the expression of genes effective on various phases of wound healing. The expression levels of 84 genes were determined on 3rd, 7th and 14th days of post-wounding using a qPCR array system. Of the genes either up or downregulated fivefolds or more, three (Egf, Col5a1 and Cxcl3) and two (Tgfa and Il2) genes were found to be the most responsive ones to ketamine/xylazine or thiopental anesthesia respectively in a period of 14 days after correction for multiple testing. However, up to 22 and 24 genes for ketamine/xylazine and thiopental were found to be differentially expressed in the same period without correction for multiple-comparisons testing (p < 0.05). In conclusion, our data suggest that ketamine/xylazine and thiopental may alter the transcriptional responses of some genes associated with wound healing in rats. We strongly suggest to consider the possible alteration effect of these anesthetics on gene expression in animal models of dermal wound healing.