The median arcuate ligament syndrome is a rare clinical condition with no standardized method of laparoscopic treatment. Exposure of the aorto-celiac axis might be considered as the most challenging part of the surgical procedure. It is important to secure total release while enabling adequate vision as the compressing musculofibrous ligament is located in the deepest part of the aorto-celiac hiatus. A 29-year-old male patient presenting with recurrent abdominal pain and diagnosed with the median arcuate ligament syndrome underwent laparoscopic surgery. The patient was discharged without problems on the fourth day after the surgery. In this case report we present a maneuver that enables easy and safe exposure of the celiac trunk.
Objective: Endoscopic examinations have great potential in early diagnosis of colorectal adenomas and carcinomas with reducing to colorectal cancer incidence and mortality. We aimed to evaluate for diagnostic purposeful lower gastrointestinal endoscopic procedures in the second step state hospital retrospectively Methods: Between June 2010 and June 2013, we evaluated 278 patients with rectal bleeding, constipation and abdominal pain detected by lower gastrointestinal endoscopic procedures retrospectively. Results:The mean age of the patients was 54.8 ± 16.8 (15-90) year, respectively. 172 (61.9%) of the patients were male and 106 (38.1%) of the patients were female. 116 (41.7%) of the patients was performed rectosigmoidoscopy and 162 (58.3%) of the patients was performed colonoscopy. 51(18.3%) of our patients were normal. 10 (3.6%) of patients had colorectal cancer, 11(3.9%) of patients had inflammatory bowel disease, 8 (2.9%) of patients had parasitosis, 31(11.1%) of patients had colorectal polyps, 12 (4.3% ), in patients had diverticular disease, 2 (0.7%) patients had rectal ulcer, 25 (9%) patients had anal fissure and 159 (57.2%) of the patients had hemorrhoidal disease. Conclusion:Lower gastrointestinal endoscopy is a method been the gold standard with a low complication rate and that can be easily applied in the evaluation to pathology of colorectal and anal canal. GİRİŞEndoskopik incelemeler, kolorektal adenom ve karsinomlarının erken tanısı, eksizyonu ile kolorektal kanser insidansını ve mortalitesini azaltmada bü-yük potansiyele sahiptirler. Hastaların bir çoğuna alt gastrointestinal sistem endoskopi istemi anemi etiyolojisini araştırmak, karın ağrısı, rektal kanama ve kabızlık nedeniyle yapılmaktadır, bu şikayetler iyi huylu anorektal hastalıklara bağlı olabileceği gibi kolorektal malignitelerde de görülmektedir [1,2]. Kolorektal kanserler tüm dünyada 3. en sık izlenen kanser olup, ortalama her yıl 1 milyon yeni olgu ve 500.000 ölüm bildirilmektedir. Kolon kanseri için risk
IntroductionWhether complete splenic flexure mobilization (SFM) is required remains a controversial issue and there are numerous approaches regarding the performance of this procedure.AimTo investigate the effect of SFM performed with a medial-to-lateral and superior-to-inferior approach on early clinical outcomes in laparoscopic resection of rectal cancer.Material and methodsThe SFM procedure was initiated by the ligation of the inferior mesenteric vein followed by dissection extending from the upper border of the pancreas to the splenic hilum through the gastrocolic space. The mesocolon was dissected in a superior-to-inferior and medial-to-lateral fashion and the presacral space was entered by dividing the inferior mesenteric artery. The procedure was completed by dividing all the splenocolic, phrenicocolic, gastrocolic, and pancreaticomesocolic ligaments.ResultsA total of 43 patients were included in the study, comprising 26 (60.5%) men and 17 (39.5%) women with a mean age of 58.2 ±13.9 (range: 30–87) years. Of the 43 patients, 21 (48.8%) underwent neoadjuvant chemotherapy and a diversion stoma was performed in 37 (86%) patients. No adjacent organ injury occurred intraoperatively. Mean operative time was 271 ±50 min and mean blood loss was 144 ±83 ml. One (2.3%) patient might have developed anastomotic leakage secondary to bevacizumab therapy postoperatively and developed no anastomotic stenosis in the follow-up period. Mean length of hospital stay was 9.3 ±4.3 days and no mortality occurred in any patient.ConclusionsSplenic flexure mobilization performed via the superior-to-inferior and medial-to-lateral approach appears to be a safe and feasible procedure.
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