Akciðer içi ve mediastende görülen kistik lezyonlarýn çoðu edinsel, daha az bir bölümü ise konjenital olarak meydana gelir. Konjenital, akciðer kistlerinden biri olan bronkojenik kistler sýklýkla çocuk ve genç yaþ döneminde görülür. Primer mediastinal kitlelerin %10-15'ini oluþturur ve çoðunlukla asemptomatiktir. Mediastinal kistik lezyonlu uygun olgularda video-yardýmlý torakoskopi (VATS) ile kist eksizyonu komplet rezeksiyon yapýlabildiði sürece torakotomiye tercih edilmelidir. VATS ile bronkojenik kist eksizyonu uyguladýðýmýz bir olgu da literatürü gözden geçirerek yöntemin etkinliðini tartýþmak istedik.

The cystic leþions of mediastinum and lung parenchyma are mostly acquired, and a small number is congenital. The bronchogenic cyst which is one of the congenital lung cysts, is frequently seen in children and adolescents. Bronchogenic cysts are 10-15% of primary mediastinal masses and mostly asymptomatic.ln âdequate lesions with mediastinal cystic leþions, cyst excision by VATS should be preferred instead of thorocotomy if complete resection can be done. We wanted to discuss the effectivity Of VATS Ýn a case in which we excissed.

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Literatürde rutin bilateral inguinal eksplorasyon sýrasýnda %40-60 oranýnda kontralateral patent prosesus vaginalis (KPPV) saptandýðý bildirilmektedir. Rutin eksplorasyon yapýlmayan olgularýn % 10-40'ý karþý tarafta fýtýk çýkmasý þikayeti ile tekrar baþvurmaktadýr. Çocuk yaþ grubuna uygun çap ve boyuttaki aletlerin geliþtirilmesi sonucunda pediatrik laparoskopik giriþimler popülarite kazanmýþtýr. Calýþmamýzda, tek taraflý kasýk fýtýklarýnda tanýsal amaçlý laparoskopi ile KPPV nin deðerlendirilmesi amaçlanmýþtýr. Gerçekleþtirmiþ olduðumuz prospektif çalýþmamýzda, kasýk fýtýðý tanýsýyla baþvuran 36 olgu KPPV açýsýndan deðerlendirilmiþtir. Olgulann dördü teknik nedenler, dördü ise bilateralite nedeniyle çalýþma dýþý býrakýlmýþtýr. Laparoskopi için fýtýk kesesinin kanulasyonunu takiben batýn 10 mmHg basýnç ile þiþirilmiþtir. Karþý taraf inguinal bölge palpasyonla KPPV bulgusu açýsýndan deðerlendirilmiþtir. Eksplorasyon 5-mm çapýnda, 45 derece açýlý bir kamera kullanýlarak gerçekleþtirilmiþ, KPPV saptanan olgularda onarým yapýlmýþtýr. 28 olgunun sekizinde (%29) KPPV saptanmýþ olup, bir yaþýn altýnda bu oran %40, bir yaþ üstünde %22 olarak bulunmuþtur. Sað tarafta kasýk fýtýðý olan olgularýn % 25'inde, sol tarafta olanlarýn ise % 33'ünde KPPV veya fýtýk olduðu saptanmýþtýr. Batýnýn þiþirilmesini takiben yapýlan manuel muayenenin güvenilir olmadýðý sonucuna varýlmýþtýr. Tek taraflý kasýk fýtýklannda uygulanacak tanýsal amaçlý laparoskopinin kolay, ucuz, ilerde yapýlabilecek ikinci bir cerrahi giriþimin maliyeti ile rutin eksplorasyon sýrasýnda kord yaralanmasý riskini ortadan kaldýracak bir yöntem olduðuna inanýyoruz.

It is stated that in 40 — 60 % of children with a unilateral inguinal hernia, a contralateral patent processus vaginalis (CPPV) is present during routine bilateral exploration. Other series report a 10 — 40 % return for a contralateral hernia repair when unexplored. Introduction of fine laparoscopic instruments suitable for infants and children has popularized the technique among pediatric surgeons. Our aim is to evaluate the presence of CPPV in children with a unilateral inguinal hernia by means Of diagnostic laparoscopy. In a prospective study we evaluated and treated 36 consecutive cases for a known inguinal hernia. Four patients with bilateral hernias and an additional four with complicated clinical situations or due to technical difficulties did not undergo laparoscopic evaluation. Following preparation of the ipsilateral hernia sac and cannulation, the abdomen was insufflated up to 10 mmHg. Contralateral inguinal region was manually examined for a suspect PPV. A diagnostic laparoscopy was performed via hernia sac using a 45-degree, 5-mm telescope. We found a CPPV in eight (29%) of the 28 cases. Children under one year Of age showed a 40% incidence, where those over One year showed a 22% incidence of CPPV. 25% of the cases with a right inguinal hernia and 33% of the cases with a left inguinal hernia had a CPPV. We found that insufflation is unreliable in determining the presence Of CPPV manually. We believe that diagnostic laparoscopy is an easy and cost effective procedure in determining the presence Of a CPPV. It decreases both the risk and cost Of a second operation and avoids injury of the cord in an unnecessary exploration.

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Laparoskopik cerrahi giriþim selim adneksiyal kitlelerin tanýsý ve tedavisinde güvenle kullanýlabilecek bir yöntemdir. Postoperatif dönemi hastanýn daha Ýyi tolere etmesi ve hastanede kalýþ süresini kýsaltmasý adneksiyal kitlelerin tedavisinde laparoskopik cerrahinin giderek daha fazla tercih edilmesine sebep olmaktadýr. Jinekolojik habis tümörlerde de laparoskopik cerrahi kullaným alam bulmasýna raðmen klasik yaklaþým þekli sadece selim ovarÝan kitlelerin laparoskopi ile tedavisi þeklindedir. Bu durum hastanýn preoperatÝf deðerlendirilmesini son derece önemli kýlmaktadýr. Bu makalede, CA-125 seviyesi yüksek, Transvaginal Ultrasonografi' de heterojen eko veren adneksiyal kitlesi olan bir hastaya yaklaþýmýmýzý sunmayý ve literatürün Iþýðý altýnda bu Olgularda izlenmesi gereken algoritmayý tartýþmayý amaçladýk.

Laparoscopic surgery is a safe method in the diagnosÝs and treatment Of benign adnexal masses. The better postoperative tolerance and the, shorter hospital stay gradually make the laparoscopic surgery the preferred method in the treatment of adnexal masses. Although the malignant tumors also may be managed laparoscopically, still the classical approach is to apply this kind of surgery for the treatment of benign ovarian lesions. This condition makes the preoperative evaluation of the patient extremely important.ln this article we presented a case with high CA 125 plasma levels and an adnexal mass with heterogenous echos on transvaginal ultrasound and tried to discuss the approach and the algorythm of management of this kind of patients.

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GÝRÝÞ ve AMAÇ: Safra kesesi kanseri tanýsý laparoskopik kolesistektomiden sonra konulan hastalarda trokar yeri metastazý ve saðkalýmý araþtýrmak.
YÖNTEM ve GEREÇLER: Laparoskopik kolesistektomi uygulanan 4391 hasta içinde ameliyat sonrasý histopatalojik inceleme ile safra kesesinde kanser saptanan hastalar trokar yerinde mtastaz oluþumu ve saðkalým açýsýndan analiz edilmiþtir.
BULGULAR: Laparoskopik kolesistektomi yapýlan hastalarýn sekiz(%0,18)'inde ameliyat öncesi veya sýrasýnda tanýnamayan safra kesesi kanseri saptandý. Takip edilebilen yedi hastanýn patalojik evreleri dört hastada pT2 ve üç hastada pT3 þeklindedir. Bir hastada %14,2) laparoskopik kolesistektomiden iki ay sonra trokar yerinde metastaz geliþti. Ortalama saðkalým 30 ay olarak bulundu.
TARTIÞMA ve SONUÇ: Safra kesesi kanseri tanýsý laparoskopik kolesistektomi sonrasý konulan hastalardaki tedavi yaklaþýmý cerrahýn tercihine baðlý olarak deðiþmektedir. Bu konunun tamamen aydýnlanmasý için varolan literatürden daha fazla sayýda çalýþmaya ihtiyaç vardýr.

INTRODUCTION: To research the survey and metastasis in port site in patients in whom gallbladder cancer was diagnosed after laparoscopic cholecystectomy.
METHODS: Of the 4391 laparoscopic choleccystectomy patients (0,18%) gallbladder cancer was diagnosed by the post operative histopathological investigation,were analysed on behalf of metastases in port site and survey.
RESULTS: In eight laparoscopic cholecystectomy patients (O,18 %) gallbladder cancer was diagnosed which was not being known before or during the operation. In four Of the seven followed patients pathological grade was pT2 and in three was pT3. In one patient (14,7 To) port site metastasis was developed two months after laparoscopic cholecystectomy. Mean surveillance time was 30 months.
DISCUSSION AND CONCLUSION: The tendecy for the treatment of patients whose gallbladder cancer was diagnosed after laparoscopic cholecystectomy depends on the choice of the surgeon. More reports are needed for this problem to be solved.

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GÝRÝÞ ve AMAÇ: Laparoskopik ventral fýtýk onarýmýnýn teknik özelliklerini ve sonuçlarýný incelemek.
YÖNTEM ve GEREÇLER: Ocak 1998 ve Ocak 2000 yýllarý arasýnda Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi Genel Cerrahi Anabilim Dalý Gürkan C servisinde toplam 22 ventral fýtýk olgusuna laparoskopik onarým uygulandý.
BULGULAR: Olgularýn 3'ü nüks olmak üzere 11'i umblikal, 10'u insizyonel, 1'i epigastrik fýtýk idi. Ýnsizyonel fýtýk olgularýnýn 6'sý Phannenstiel, 1'i göbek üstü median insizyon distalinden, 1'i göbek altý median insizyonun proksimalinden, 2'si sað transrektal insizyon yerlerinden geliþmiþti. Olgularýn 19'u kadýn, 3'ü erkekti. Serinin en genci 37, en yaþlýsý 70, ortalama yaþ 53.95 ± 2.03 idi. Olgularýn 2'sine uygun boyutlarda politetrafloroetilen mesh, diðerlerine polipropilen mesh ile fýtýk onarýmý yapýldý. Olgulann 6'sý ameliyat sonrasý birinci gün, diðerleri ameliyat sonrasý 2. gün taburcu edildiler. Nüks umblikal fýtýðý olan bir olguda ameliyat sonrasý erken dönemde göbek bölgesinde seroma tesbit edildi. Olgular en az 6 en £0k 12 ay, ortalama 9.14 ± 0.54 ay olmak üzere ameliyat sonrasý l, 3, 6 ve 12. aylarda rutin kontrollere çagrýldýlar. Takip süresince nüks tesbit edilmedi.
TARTIÞMA ve SONUÇ: Laparoskopik teknikle ventral fýtýklarda mesh uygulamasý mortalite, (1/22) %4.54 morbidite oranlarý, kýsalmýþ hastanede kalýþ süresi, kozmetik olarak daha tatminkar sonuçlar vermesi ve hastanýn günlük aktiviteye dönüþ zamanýnýn daha kýsa sürede gerçekleþmesi nedeniyle seçilmiþ vakalarda tercih edilebilecek güvenilir bir yöntemdir.

INTRODUCTION: Evaluation Of techniqual properties and outcomes of laparoscopic ventral hernia repair.
METHODS: Laparoscopic repair Was applied to 22 ventral hernia cases in Istanbul University, Cerrahpa¥a Medie-al Faculty, Department Of General Surgery, section of Gürkan C between January 1998-January 2000.
RESULTS: : Total number of cases Were 22. There were I I umblical hernia cases with three recurrences, 10 incisiOnal hernias and one epigastric hernia. Six of the incisional hernia cases were originated from Phannenstiel incision, one from distal part of the upper midline incision, one from proximal part of lower midline incision and two of the cases originated from right transrectal incisions. Nineteen Of the cases were female and three Of them were male. The youngest case Was 37 years Old and the oldest was 70 years old with the mean age of the series as 53.95±2.03 years. In two of the cases polytetrafloroetylene mesh of the appropriate size was used for repair of the hernia and polipropilene mesh was used in the remaining cases. Six of the cases were discharged from the hospital in the first postoperative day and the others were discharged in the second postoperative day. In a case of recurrent umblical hernia, seroma around the umblicus was detected in the early postoperative period. Cases were followed up between 6-12 month with a mean of 9.14 ± 0.54 months by regular follow-ups at 1st, 3rd, 6th and 12th months. No recurrence was observed during the follow up period.
DISCUSSION AND CONCLUSION: Laparoscopic ventral hernia repair with mesh application is a preferable and safe tecnique in selected cases with advantages of 0% mortality rate, 4.54% morbidity rate (1 / 22), shorter hospital stay, satisfactory cosmetic results and rapid return to daily activities.

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