We believe that the rate of 2.4% early return to the hospital in our series is a bit high when all the complications are taken into consideration. This retrospective analysis, however, has shown that this rate can further be decreased by taking simple measures.
Obesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was “Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery?” We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.
Inguinal hernia is a common problem. Occasionally surgeons are surprised with unconventional structures [1]. The most frequently incarcerated organs are the small intestines, omentum and colon [2]. Adhesions and bands that form in the inguinal hernia can cause strangulation and intestinal perforation [3]. In the inguinal hernia sac the bladder is very rare [4]. In this case of strangulated inguinal hernia operation, we found necrotic bowel and bladder in the hernia sac. An 80-year-old male patient had a mass in the right groin with swelling, abdominal pain, nausea and vomiting, and inability to defecate, and so he came to the emergency department with these complaints.On examination, the right inguinal skin rash, edema, and a painful palpable mass measuring about 6 × 8 cm was detected. Abdominal distension, rebound and defense were positive. Normal leukocytes in laboratory tests, urea: 180 mg/dl, creatine: 2.62 mg/dl, C-reactive protein (CRP): 199.92 mg/l were measured. Directly abdominal radiography showed the air-fluid level in the small intestine (Figure 1). The patient was diagnosed with strangulated inguinal hernia and operated on.In the operation the small bowel was necrotic and perforation was detected at 20 cm in multiple segments of the small bowel in the hernia sac. The bladder was also found to be necrotic. Because of the dirty and infected abdomen, the necrotic small bowel was resected and double barrel ileostomy was performed. We irrigated the abdomen with plenty of saline. Partial cystectomy of the bladder was performed. In the postoperative period the intubated patient was taken to the intensive care unit. On the first postoperative day the patient died because of cardiac arrest and multiorgan failure.The bladder and small bowel with both of them necrotic have not been reported in the literature. As a result, in cases of strangulated inguinal hernia in elderly patients who are operated on for strangulated hernia we should also keep in mind the bladder. Conflict of interestThe authors declare no conflict of interest.
Objective: Retrospective proctocolectomy is a distinguished, sphincter saving treatment used for the treatment of ulcerative colitis and FAP disease. We aimed to evaluate ileal pouch interventions performed at our clinic and their results in the light of literature. Material and Methods:Medical records of 35 restorative proctocolectomy and J pouch ileo-anal anastomosis surgeries performed at Necmettin Erbakan University, Meram School of Medicine between the years 2006-2013 were retrospectively examined. The patients were assessed according to their age, gender, length of hospital stay, diagnosis, follow-up duration and pouch-related complications. All patients were contacted by phone and they were scheduled for controls at the outpatient clinic.Results: Nineteen patients were male (54%) and 16 were female (46%). Their mean age was 45 years (21-74). The mean length of hospital stay was 11 (5-20) days. Twenty two (63%) patients were operated on due to FAP, 12 (34%) due to synchronous rectum cancer and colon tumor or polyp, and one (3%) due to ulcerative colitis. All patients received J pouch and protective ileostomy. After the closure of ileostomy, two cases were identified to have J pouch fistulas. The patients were followed up for 6 months to 7 years. They were contacted by phone and they were questioned about their active complaints, number of defecations, urinary and sexual dysfunctions. It was identified that they had 5 (3-8) defecations per day on average and that 4 (11%) cases had one nocturnal defecation. No pouchitis was identified in the follow-up endoscopic examinations. Conclusion:Restorative proctocolectomy and ileo-anal anastomosis technique is a surgical procedure that can be performed with low rates of morbidity and mortality, including the elderly.
We present a rare case of Dermatofibrosarcoma protuberans (DFSP) as a case report. A 65 years old man has been admitted with complaints of swelling in the left arm region for approximately five years. Local excision was performed with preliminary diagnosis of lipoma. The pathology was reported as DFSP. The borders of the surgery were positive. Call back the patient to the hospital and re excision was done. Surgical borders are reported as clean. As a new surgeon, we wanted to present this rare case to medical literature. We understand that how importantis to follow patihology of each patients and recards.
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