The results of this study indicated that HS is more effective than PK and as safe and effective as SC for cystic duct closure.
HS sealer could be an alternative method for cystic duct closure, especially for avoiding the clip displacement and migration of the clip. Results of this study indicated that HS sealer was as reliable as single SC and it could be accepted as a standard closure technic.
Dear Editor,Although adenocarcinoma of the stomach is one of the most common tumors, primary squamous cell carcinoma (SCC) of the stomach is extremely rare. SCC occurs mostly in men and the peak incidence is in older age. 1 A 68-year-old man was admitted to our outpatient clinic with darkened, oily and bad odor stool and 4-5 kg weight loss in 3 months. He was also fatigued with an increased severity. Past medical history was unremarkable. On physical examination, sensitivity and blunt pain on the epigastric area were felt by the patient. The abdomen was distended. Other systems were normal. Melena was observed on rectal examination. The laboratory tests revealed anemia and leukocytosis. Hemoglobin level was 8.9 g/dL, and white blood cell count was 12.700/mm 3 with 84% neutrophils. Occult blood test for stool was positive. Biochemical parameters including liver and renal tests were normal. Upper gastrointestinal endoscopy revealed a protruding and cauliflower-shaped mass on the lesser curvature of the stomach, beginning 5 cm distal from the gastroesophageal junction and was approximately 10 cm in diameter. The mass was white-gray in color and fragile, with active bleeding foci. Other parts of the stomach and the duodenum were normal. Multiple endoscopic biopsies were taken. Endoscopic biopsy revealed the diagnosis of SCC. Thoracoabdominal computerized tomography (CT) showed a thickened stomach wall and a protruding mass into the stomach lumen. The lungs, liver and other abdominal organs were normal (Fig. 1). The tumor marker levels were: carcinoembryonic antigen, 0.74 ng/mL (normal 0-2.5); CA 19-9, 9.45 U/ m-Ll (normal 0-30.9); and a-fetoprotein, 1.1 ng/mL (normal 0-8). The patient underwent laparotomy and total gastric resection with Roux-Y gastrojejunostomy operation was performed (Fig. 2). Pathological examination of the specimen demonstrated SCC of the stomach (Fig. 3). The surgical margins were negative. Nodal metastasis was not observed. Esophagogastric junction was negative for tumor. Chemotherapy and radiotherapy were not given to the patient. At the time of writing, the patient is in the 10th month after the operation and still alive without any evidence of metastasis or recurrence.Pure SCC of the stomach is an extremely rare malignancy with a worldwide incidence of 0.04-0.07%. 2 The peak incidence is in the sixth decade. 1,3 This is a somewhat earlier age than adenocarcinoma of the stomach. Because the tumor is very uncommon and most of the published data are of solitary cases, the pathogenesis has not been well elucidated. Several theories regarding the origin of SCC in the stomach were proposed including nests of ectopic squamous cells in gastric mucosa, squamous metaplasia of the gastric mucosa before malignant transformation, squamous differentiation in a pre-existing adenocarcinoma, multipotential stem cells in the gastric mucosa and gastric vascular endothelial cells. In addition, some authors proposed that the tumor could arise from squamous metaplasia secondary to chronic mucosal damage 2 whereas...
Although the Veress needle (VN) is widely used for insufflation of the peritoneum, direct trocar (DT) insertion is going to be more popular. A lot of complications have been reported because of the use of VN. We designed a prospective, nonrandomized study for the comparison of VN and DT insertion techniques. A pneumoperitoneum was created using the VN in 135 patients and using DT insertion technique in 148 patients during a 3-year period. Although no major complication was seen in the DT group, three major complications were seen in the VN group, but there was no statistically significant difference between both groups. More frequent minor complications were seen in the VN group, but it was statistically insignificant. Surgical skill and experience of the surgeon with the entry technique who is using it is an important factor for the selection of the abdominal insufflation technique.
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