Background: Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. this study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks.Methods: this study retrospectively analyzed consecutive total gastrectomies performed from january 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. all surgeries were performed for gastric or junctional cancers (n = 198). all reconstructions (roux-en y esophagojejunostomy) were performed using a stapler. the methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. no test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures.Results: the intraoperative leakage rate was 7.4% in group 1. the postoperative clinical leakage rate was 8.6%. the postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). there were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. the median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). one death occurred in each group. no test-related complications were observed.Conclusion: the methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.
Objective:To assess whether the abdominal scar characteristics and closure of the peritoneum were associated with pelvic adhesions.Materials and Methods:Patients who had undergone cesarean section between December 2015 and February 2016 were assessed prospectively in terms of age, gravida, body mass index, number of living children, number of cesarean sections, time passed since the last cesarean section, closure status of the peritoneum in the last cesarean section, presence of other diseases, smoking status, location of incision in the abdomen (medial, pfannenstiel) scar dimensions (length, width), scar status with respect to skin (hypertrophic, flat, depressive), scar color [color change/no color change (hyperpigmented/hypopigmented)], adhesion of bowel-omentum-uterus, omentum-anterior abdominal wall, uterus-anterior abdominal wall, uterus-bladder, bladder-anterior abdominal wall, fixed uterus, and uterus-omentum-anterior abdominal wall in abdominal exploration.Results:One hundred five pregnant women who had undergone previous ceserean section surgery by the same physician, were at least in their 30th gestational week, had surgery notes about their previous operation, and had no chronic diseases were included in the study. Age, gravida, body mass index, number of children, number of cesarean sections, time passed since the previous cesarean section, closure/non-closure of peritoneum in the previous cesarean section, and smoking status had no effect on pelvic adhesions. Intraabdominal adhesion was not found to be associated with scar length [odds ratio (OR): 1.54, 95% confidence interval (CI): 1.1-2.2; p=0.02], depressive scar (OR: 9.3, 95% CI: 3.2-27.2; p<0.001), or hypopigmented scar [OR: 0.01, 95% CI: 0.003-0.11; p<0.001].Conclusion:Adhesions following surgical operations are of great importance due to complications for the patient, complications in relaparotomy, and high costs. Depressive and hypopigmented abdominal scars may be associated with pelvic adhesions. We believe that closure or non-closure of the parietal peritoneum is not associated with pelvic adhesions.
Background: Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy. Methods: The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 μg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses. Results: In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D ( P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation. Conclusion: Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.
Torsion of a wandering spleen is a rare disease. The symptoms and signs of this condition are only present when the splenic pedicle torts. The etiological factors are the congenital absence of the ligaments that hold the spleen in its normal anatomic position, or the relaxation of these ligaments resulting from conditions like trauma and abdominal surgery. We aimed to present a rare case with torsion of wandering spleen that consequently developed thrombosis of portal vein and its branches, taking into consideration the relevant literature.
Inflammatory myofibroblastic tumor (IMT) is a distinct pseudosarcomatous lesion arising in the soft tissues and interior organs of children and young adults. It is rarely seen in adults. It was first described in lungs. IMT can occur in any location in the body. However, it is seen most commonly in lungs, intestinal mesentery and liver. Non-mesenteric alimentary tract IMT’s are quite rare. The presented case is an ileal IMT that caused small bowel invagination. A 38 year-old male patient presented to the emergency department with the complaint of diffuse abdominal pain, distension and no passage of gas or stools for two days. An abdominal examination revealed distension and tenderness in the abdomen with no guarding or rebound tenderness. Computerized tomography (CT) of the abdomen was ordered. CT revealed an image compatible with invagination of the right lower quadrant of the abdomen and a mass inside the lumen measuring 4x3x3cm. The mass causing invagination was detected during the surgical operation. A segmentary small bowel resection and ileoileal anastomosis was performed. The patient was discharged uneventfully on the postoperative sixth day. The diagnosis of IMT was confirmed histologically and immunochemically.
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