GÝRÝÞ ve AMAÇ: Bu çalýþma, deneysel peritonitte karbondioksit pnomoperitoneumun inflamatuvar cevaba ve peritonit þiddetine etkisini araþtýrmak amacýyla planlandý.
YÖNTEM ve GEREÇLER: Çalýþmada kullanýlan 21 rat, kontrol, peritonit ve peritonit + CO2 pnomoperitoneum olarak 3 gruba ayrýldý. Ýlk gruba (kontrol grubu) hiçbir iþlem yapýlmadý. Ýkinci ve ucuncu gruptaki ratlara intraperitoneal Escherichia coli verilerek peritonit oluþturuldu. Escherichia coli verildikten 24 saat sonra, ucuncu gruba perkutan yolla intraperitoneal CO2 gazý verilerek 4 cm su basýncýnda pnomoperitoneum oluþturularak, bu basýnçta bir saat bekletildi. Her uc gruptaki tum ratlar aþýrý eter dozu ile sakrifiye edilerek alýnan kan orneklerinde lokosit ve CRP degerlerine ba­kildi. Alýnan periton biyopsileri, peritonit þiddeti acisindan degerlendirildi. Sonuclar Mann -Whit­ney U testi ile degerlendirildi. p<0.05 anlamlý olarak kabul edildi.
BULGULAR: CRP ve lokosit degerleri ve peritonit þiddeti peritonit ve peritonit + CO2 pnomoperitoeum oluþturulan grupta kontrol grubuna gore anlamlý derecede artýþ gozlendi. Pentonit + CO2 pnomoperitoneum oluþturulan gruptaki degerler ise, peritonit grubundan anlamlý olarak daha az bulundu.
TARTIÞMA ve SONUÇ: Escherichia coli verilerek peritonit oluþturulan ratlarda CO2 pnomoperitoneum uygulama­sý peritonitin þiddetini ve oluþan inflamatuvar yaniti azaltmaktadýr.

INTRODUCTION: The aim of the present experimental study was to investigate the effects of carbon­dioxyde pneumoperitoneum on inflammatory response and peritonitis severity score in experi­mental peritonitis.
METHODS: Twenty-one Wistar Albino rats were included. The experiments were assigned into 3 groups. Group 1 (n•7) consisted of control subjects; group 2 (n•7) and 3 (ns7) consisted of subjects with peritonitis and sepsis induced by intraperitoneally injected Escherichia coli. In addition. pneumoperitoneum was caused using carbodioxyde insufflations in group 3. Peritonitis severity score. (-reactive protein level and white blood cell count were assessed in all groups.
RESULTS: Peritonitis severity score, C-reactive protein level and white blood cell count were sig­nificantly higher in group 2 and 3 than group 1 (both, p<0.05), while significantly lower in group 3 than group 2 (p<0.05).
DISCUSSION AND CONCLUSION: Carbondioxyde pneumoperitoneum decreases the peritonitis severity and systemic inflammatory response in experiments with Escherichia coli peritonitis and sepsis.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: “Ýleri laparoskopik teknikler” icinde yer alan laparoskopik kolon-rektum cerrahisi, dunyada oldugu gibi ulkemizde de yayginlaþma egilimindedir. Buradan yola çýkarak bu yazýmýzda, dört malign ve bir benign hastalýk için ameliyat ettigimiz beþ olguluk ilk deneyimimizi paylaþmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ortalama ameliyat suresi 230 dakika, hastanede yatýþ suresi 11.6 (6-20) gundu. Tum hastalara ucuncu gun oral SIVI beslenme baþlandý. Bir olguda medikal tedavi ile duran alt gastrointestinal kanama goruldu. Bir olguda buyuk kitle ve dar pelvis nedeniyle açýk ameliyata donuldu.
BULGULAR: Bu has­tada, teknige baðlý olarak meydana geldigini duþundugumuz, rektovajinal fistul geliþti. Mortalite yoktu.
TARTIÞMA ve SONUÇ: Bu beþ olguya literatur bilgileri ýþýðýnda baktýðýmýzda, yeterli deneyime ulaþýlmasý koþuluy­la laparoskopininkolon-rektum hastalýklarýnda acýk cerrahi gibi guvenle uygulanabilecegini, acýk cerrahiye gore artmýþ bir komplikasyon orani gorulmedigi gibi, laparoskopik cerrahinin cok iyi bilinen avantajlarýnýn bu hastalar için de geçerli oldugunu düþünmekteyiz.

INTRODUCTION: Laparoscopic colorectal surgery, which is considered as an advanced laparoscopic technique, tends to gain wide acceptance in our country as in the world. In this report, we aimed to share our preliminary experience on five cases, four with malign and one with benign disease.
METHODS: Mean operation time was 230 minutes and mean hospitalization length was 11.6 (6·20) days. Oral liq­uid diet was started to all patients on the third postoperative day. One patient had lower gas­trointestinal bleeding which responded to conservative therapy. In another patient, we had to convert to open surgery because of the size of the mass and narrow pelvis.
RESULTS: In this patient, a recto-vaginal fistula developed which can be attributed to the technique and equipment used. There was no mortality.
DISCUSSION AND CONCLUSION: We concluded that, provided that enough experience was obtained, laparoscopy can be performed as safe as in the open technique with no increase in complica­tion rate but having all the well-known advantages of it.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Son yýllarda laparoskopik Nissen fundoplikasyon iþlemi (LNFP), gastroozofageal reflu has­talýðýnýn (GORH) cerrahi tedavisinde yaygýn olarak kullanýlmaktadýr. Biz bu çalýþmada son üç yýl icinde þiddetli ozefajiti ve/veya Barrett ozofagusu nedeniyle LNFP uyguladýðýmýz toplam 25 olgu­nun postoperatif erken donem sonuclarýný prospektif olarak degerlendirdik.
YÖNTEM ve GEREÇLER: Ocak 2002-Þubat 2005 tarihleri arasýnda 25 olguya laparoskopik Nissen fun­doplikasyonu uygulandý. Yaþ ortalamasý 39 (28-69) olan hastalarýmýzýn 17'si kadýn 8'i erkekti. Tum hastalanmýza preoperatif donemde ozofagogastroskopi ve biyopsi ile Ost gastrointestinal sistemin baryumlu calýþmasý yapýldý. Olgularýn tumunde grade 3 veya 4 ozofajit vard1. Cerrahi in­dikasyon; 20 olguda (%80) týbbi tedaviye direnc; 3 (% 12) olguda týbbi tedavinin tolere edilme­mesi ve 2 (%8) olguda ise uzun sureli medikal tedaviye ragmen iyilesmemeydi.
BULGULAR: Hastalanmýzýn 11'inde (%44) kayýcý tipte hiyatus fýtýðý vardý. Olgulanmýzda LNFP ame­liyatý ortalama 110 dakika (70-190) surdu. Hiçbir olguda acýk ameliyata donulmedi. iki hastada ek olarak kolesistektomi uygulandý. Ýki olguda diafragmatik hiyatus, uygun buyuklukte bileþik ya­ma ile kapatýldý. Preoperatif donemde en sýk yakýnmalar olan retrosternal yanma ve regurjitas­yon postoperatif birinci ay sonunda tum hastalarda ortadan kalkarken, 21 olguda gozlenen dis­faji ayný surenin sonunda 11’e, ucuncu ay sonunda ise bire duþtu. Mortalite gorulmedi. Ortala­ma yatýþ suresi 4 gundu (2-12). Ortalama takip suresi 16 aydý (3-38). Klinik sonuc, olgularýn 11'in­de cok iyi, 10'unda iyi ve 4'unde orta olarak belirlendi.
TARTIÞMA ve SONUÇ: Tipik reflu semptomlan bulunan ve histopatolojik olarak þiddetli peptik ozofajit saptanan 25 hastamýzda, laparoskopik Nissen fundoplikasyon ameliyatý ile erken donemde baþarýlý semp­tomatik iyileþme saglanabilmiþtir.

INTRODUCTION: The aim of this study is to present the results of our laparoscopic Nissen fundoplica­tion operations in 25 patients with gastroesophageal reflux disease and severe esophagitis, keeping in mind that this procedure 1s widely used as the operation of choice for the treatment of this disease.
METHODS: From January 2002 to February 2005, laparoscopic Nissen fundoplica­tion was performed out in 25 patients. Seventeen patients were female, eight were male and the mean age was 39 (range 28-69 ). All patients underwent standard preoperative work-up, including upper gastrointestinal barium meal x-ray study and esophagogastroduodenoscopy with biopsy. All patients had grade 3-4 esophagitis and 11 patients had sliding type hiatal her­nia. The criteria of indications for laparoscopic Nissen procedure were; resistance to medical therapy (80%), noncompliance with medical therapy (10%) and prolonged medical therapy (10%).
RESULTS: The mean operating time was 110 minutes (range 70 to 190). We did not convert to an open procedure in any of the patients. Additionally, cholecystectomy was performed in two patients. Prosthetic reinforcement of the hiatal crura was carried out with appropriate sized composite mesh in two cases. There was no permanent disphagia and mortality. Mean hospital stay was 4 days (range 2-12). Mean follow-up was 10 months (range 3 to 24). In the first post­operative month, temporary disphagia was detected in 50% of the patients The clinical results were expressed as excellent, good and moderate by 11, 1 O and 4 patients, respectively.
DISCUSSION AND CONCLUSION: Laparoscopic Nissen fundoplication is an appropriate procedure for the treatment of patients with gastroesophageal reflux disease and severe histopathological esophagitis.

Abstract | Full Text PDF

Gastrik volvulus is a rarely seen condition. caused by torsion of the stomach on its vertical or horizontal axis. While it may be seen as a surgical emergency in its acute form; nonspesific abdominal symptoms are usually seen in its chronic form. The etiology is absence or weakness of some ligaments of the stomach. Predisposing factors like diaphragmatic defects or paraosephageal hernia can be seen in some cases. We believe that laparoscopic anterior gas­tropexy is one of the best choice for the treatment of selected and suitable cases.

Gastrik volvulus is a rarely seen condition. caused by torsion of the stomach on its vertical or horizontal axis. While it may be seen as a surgical emergency in its acute form; nonspesific abdominal symptoms are usually seen in its chronic form. The etiology is absence or weakness of some ligaments of the stomach. Predisposing factors like diaphragmatic defects or paraosephageal hernia can be seen in some cases. We believe that laparoscopic anterior gas­tropexy is one of the best choice for the treatment of selected and suitable cases.

Abstract | Full Text PDF