Reports on the outcomes of emergency and elective femoral hernia surgery are scarce. Most studies do not distinguish femoral hernia from other types of groin hernia; studies of femoral hernia alone are few in number. The main objective of the present study was to identify factors affecting morbidity of femoral hernia patients. We retrospectively analyzed data on 80 patients who underwent femoral hernia surgery between June 2009 and June 2013. Patients who did and did not experience morbidity were compared in terms of age, sex, hernia location, the presence of any comorbid disease, the type of anesthesia employed, the operative technique used, the type of surgical intervention, and performance of small bowel resection. Forty-three patients (53.8%) underwent emergency surgery because of incarceration. Of these, 18 (41.9%) experienced strangulation and underwent resection. Postoperative complications developed in 11 patients (13.8%). Upon multiple logistic regression analysis, visceral organ resection (of the small bowel and/or omentum) was the only independent predictor of significant morbidity (P < 0.05; odds ratio [OR]: 14.010, 95% confidence interval [CI]: 1.001-196.143). When diagnosed, femoral hernias should be electively repaired as soon as possible. The cumulative probability of strangulation rises over time. A requirement for bowel resection seems to significantly increase morbidity.
Aim: There are very few studies in the literature investigating the changes caused by the Nathanson retractors in liver function tests (LFT) after LG and its clinical significance. The present study investigated the changes made by the Nathanson retractor used during LG on LFT and its clinical significance.
Material and Method: The data of 236 patients, who underwent radical gastrectomy for primary gastric cancer at Surgical Oncology Unit in the period between January 2015 and January 2020 were retrospective studied. The patients were divided into two groups: laparoscopic gastrectomy (LG; 136 cases) and open gastrectomy (OG; 106 cases). Patients who have undergone cholecystectomy, with primary or secondary liver tumors, with chronic hepatic disease, who have preoperative high ALT, AST and bilirubin values were excluded from the study. LFT were measured preoperatively and postoperative day 1 (LFT1), LFT3, LFT5 and LFT7. LFT: ALT, AST and Total bilirubin (BIL).
Results: ALT1, ALT3, ALT5, ALT7 ALT values and AST1, AST3, AST5 AST values of the patients in the LG group were found to be significantly higher (P <0.001). Mean total bilirubin values of the groups were similar (P >0.05). In order to evaluate how the increase in LFT due to the use of the Nathanson retractors reflected on the patients' clinic, we divided the patients who underwent LG into two groups based on ALT increase in ALT1: Normal and Elevated. The in-hospital mortality rates (P = 0.080) and oral nutrition time (P = 0.913) of the groups were similar. No liver infarction developed in any of the groups. The duration of stay in the ICU was significantly longer in individuals with elevated LFT (P = 0.019).
Conclusion: Although the use of the Nathanson retractor during LG causes an increase in liver function tests, this does not cause major clinical problems in patients.
Key Words: Gastrectomy; gastric cancer; laparoscopy; liver enzymes; liver dysfunciton
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