Abstract | Full Text PDF

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Kasýk fýtýðý onarýmlarýnýn en önemli komplikasyonu olan nüks, deðiþik herni onarým tekniklerinin baþarýsýný karþýlaþtýrmada önemli kriterdir. Ayrýca nüks kasýk fýtýklarýnda ameliyata baðlý komplikasyon oraný primerlere göre daha fazladýr. Bu çalýþmanýn amacý laparoskopik yöntemle tedavi ettiðimiz nüks kasýk fýtýklý olgularýmýzý inceleyerek sonuçlarýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Eylül 1997 - Mart 2001 arasýnda nüks kasýk fýtýðý nedeniyle laparoskopik yöntemle ameliyat ettiðimiz 48 hastanýn sonuçlarýný inceledik. Hastalarýn 38'ine bir, 10'una birden fazla ameliyat yapýlmýþtýr.
BULGULAR: Tüm fýtýklarýn 43'ü unilateral iken 5'inde diðer tarafta primer fýtýk vardý. Nüks; hastalarýn 32'sinde (%66.6) pubik tüberküle yakýn mediyalde, 14'ünde (%29) iç halkada ve 2'sinde (%4.2) inferior epigastrik damar yaralanmasý, 1 hastada (%2.1) Retzius aralýðýna kanama ile karþýlaþýldý.Ameliyat sonrasý 1 hastada (%2.1) geçici uyluk uyuþmasý görüldü, 1 hastada (%2.1 inguinal hematom ve 1 hastada (%2.1) seroma oluþtu. Ortalama komplikasyon oraný %12.6 oldu. Bir hastada (%2.1) açýk tekniðe geçildi. Ortalama ameliyat süresi 56 dakika (20-110), hastanede kalýþ 1.2 gün (1-3) oldu. Hastalar medyan 28.4 ay (9-36) takip edildi. Bir hastada (%2.1) nüks görüldü.
TARTIÞMA ve SONUÇ: Nüks kasýk fýtýðý tedavisinde komplikasyonu ve rekürrensi düþük olan laparoskopik prostetik mesh onarýmý güvenle uygulanabilir.

INTRODUCTION: The aim of this study is to review the recurrent inguinal hernia patients we operated on laparoscopically and were evaluated retrospectively.
METHODS: We evaluated the results of the 48 recurrent inguinal hernia patients we operated on laparoscopically between September 1997 and March 2001.
RESULTS: While 43 of all hernias were unilateral, there were contralateral primary hernias in 5 cases. Recurrences were medially next to the public tubercle in 32 patients (%66.6), through the internal ring in 14 patients (29.1%) and at the both sites in 2 patients (4.2%). Inferior epigastric vascular damage in 2 patients (4.2%), bleeding into the Retzius space in 1 (2.1%), transient lateral cutaneous femoral nerve damage manifested as lateral thigh paresthesia in 1 patient (2.1%) has occured intraoperativelly. Postoperative inguinoscrotal hematoma 1 patient (2.1%) and seroma (2.1%) has occured. We had to convert open technique in 1 patient (2.1%). Overall complication rates were 12.8%. Mean operating time was 56 minutes (range,20 to 110). Mean hospital stay was 1.2 days (range,1 to 3). Recurrence has occured in 1 patient (2.1%).
DISCUSSION AND CONCLUSION: Laparoscopic prosthetic mesh repair can be used safely in the treatment of recurrent inguinal hernias with less complication and recurrence rate.

Abstract | Full Text PDF

Endoskopik cerrahide baþarýyý etkileyen faktörler cerrahýn tecrübesi ve kullanýlan malzemenin kalitesi olarak sýralanabilir. Histeroskopik polip rezeksiyonu sýrasýnda uterus perforasyonu ve rezektoskop ucunun kopmasý sonucu geliþen olgumuzu literatür bilgileri eþliðinde sunmak istedik.

The major factors having an impact on the success of endoscopic surgery are the experience of the surgeon and the quality of instruments and materials used. We present a case developed as a result of uterin perforation and a resectoscope's broken loop under the light of the literature.

Abstract | Full Text PDF

Uterusta öyom nedeni ile ciddi menometrorajisi ve üst solunum yolu enfeksiyonu olan laparoskopik asiste vajinal histeroktomi olgusundaki kombine spinal-epidural anestezi (KSEA) deneyimimizi sunmayý ve laparoskopik giriþimlerde rejyonal anesteziyi irdelemeyi amaçladýk. Premedikasyon amacý ile midazolam 1 mg, meperidin 25 mg iv uygulandý. Sistolik ve diastolik kan basýncý,kalp atým hýzý gibi hemodinamik parametreler ve periferik oksijen satürasyonu kaydedildi. Sol lateral pozisyonda L3-4 interspinöz aralýktan KSEA tekniði ile 15 mg %0.5 izobarik bupivakain subaraknoid olarak uygulandý. Daha sonra 20 gauge epidural katater epidural aralýða yerleþtirildi. Anestezinin 10. dakikasýnda anestezi düzeyi T5-6 düzeyine ulaþtý ve operasyonun baþlamasýna izin verildi. Pnömoperitonyum oluþturulmadan önce ve pnömoperitonyumun 10. dakikasýnda kan gazý örneði alýnarak kan gazlarý analiz edildi. Giriþim süresince sistolik ve diastolik kan basýncý, kalp atým hýzý, SpO2 deðerleri kaydedildi. Trendelenburg pozisyonu 10° civarýnda tutulurken, intraabdominal basýnç 13 mmHg'da tutuldu. Olguda pnömoperitonyumun oluþturulmasýndan hemen sonra ortaya çýkan sað omuz aðrýsý saptandý. Omuz aðrýsýnýn midazolam 1 mg, fentanil 0.05 mg iv uygulamasý ile azaldýðý, pnömoperitonyumun boþaltýlmasý ile tamamen ortadan kalktýðý gözlendi. Operasyona daha sonra vajinal olarak devam edilerek olguya perine onarýmý da yapýldý. Operasyon süresince hipotansiyon, bradikardi, solunum depresyonu, hipoksi veya hiperkapni gibi komplikasyonlarla rastlanmadý. Sonuç olarak, kýsa süreli laparoskopik giriþimlerde, deneyimli cerrahi ekip ve dikkatli hasta takibi ile rejyonal anestezi tekniklerinin güvenli ve etkili olduðu kanýsýndayýz.

We aimed to reveal our ecperience of combined spinal-epidural anaesthesia for laparoscopic-assisted vaginal hysterectomy in a case that presented with severe menometrorrhagia caused by myoma uteri and had an upper airway infection and look over regional anaesthesia in laparoscopic procedures. Midazolam 1 mg and meperidine 25 mg intravenously were given for premedication. The haemodynamic parameters such as systolic and diastolic blood pressure, heart rate and peripheral oxygen saturation were monitored. Combined spinal-epidural anaesthesia technique was performed through L3-4 interspinous space; first 15 mg 0.5% izobaric bupivacain was given intrathecally and then a 20 G epidural catheter was places in the epidural interspace. After 10 minutes, level of anaesthesia reached to T5-6 level and the operation was started. Arterial blood gas samples were obtained and analyses before and 10 minutes after pneumoperitoneum was constituted. Systolic and diastolic blood pressures, heart rate, SpO2 were recorded throughout the operation. The patient was placed in Trendelenburg position at 10 degrees and intraabdominal pressure was kept at 13 mmHg. The patient complained about right shoulder pain just after pneumoperitoneum was constituted. It was observed that shoulder pain was decreased by administration of intravenous midazolam 1 mg+ fentanyl 0.05 mg and disappeared after the release of pneumoperitoneum. Afterwards the operation none of the possible complications like hypotension, bradycardia, hypoxia and hypercapnia were seen. We conclude that regional anaesthesia techniques are safe and efficacious for short duration laparoscopic surgical procedures in the presence of experienced surgical team and close patient monitorization.

Abstract | Full Text PDF

Bu yazýda 75 yaþýndaki bayan olguda hemodializ amaçlý katater takýlmasý sýrasýnda geliþen intratorasik J teli ekstravazasyonu ve düðümlenmesi bildirilmiþtir. Ýntratorasik ekstravazasyon sað apikal hematom ve total pnömotoraksa yol açmýþtýr. J teli videotorakoskopik olarak çýkartýlmýþtýr.

We present a case of an intrathoracic guide-wire extravasation and knotting in a 75 year old woman following catheter insertion for hemodialiysis. Intrathorasic extravasation caused right apical hemotoma and total pneumothorax. The guide-wire was removed with thoracoscopic approach.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Video yardýmlý torasik cerrahi (VATS) son yýllarda malign plevral efüzyonun (MPE) tedavisinde daha çok yer verilen, ayný seansta hem taný ve hem de tedavi saðlayabilen bir yöntemdir, bu da VATS'ýn diðer yöntemlerden daha deðerli bir konuma getirir. Bu çalýþmada MPE'un taný ve tedavisinde VATS'ýn etkinliði incelenmiþtir.
YÖNTEM ve GEREÇLER: Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi 2. Cerrahi Kliniði'nde 1996-2002 yýllarý arasýnda MPE tanýsý ile izlenen 57 olgu retrospektif olarak incelendi. Olgularýn 31'i erkek, 26'sý kadýndý ve yaþ ortalamasý 55±12 (27-83) idi. 36 olguya tüp torakostomi ve plörodezis, 18 olguya VATS ve plörodezis ve 3 olguya da VATS ile plevrektomi uygulandý. Tüp torakostomi ve VATS gruplarý, plörodezis etkinliði açýsýndan karþýlaþtýrýldý.
BULGULAR: MPE'nin sýklýk sýrasýna göre nedenleri akciðer kanseri, malign mezotelyoma, meme ve over kanseri idi. Tüp torakostomi ile plörodezis uygulanan 36 olgunun 8'inde (%22.2) ilk 1 ay içinde nüks saptandý. Buna karþýn VATS ile plörodezis yapýlan 18 olgunun hiçbirinde nüks saptanmadý. Talk, 41 olgunun 23'ünde tüp torakostomi ve 18'inde ise VATS yolu ile uygulandý. VATS ile plörodezisin baþarý oraný %100 iken tüp torakostominin oraný %87 olarak saptandý. (p>0.05). VATS ile plörodezis yapýlan olgularýn toraks drenaj süreleri ortalama 4.5 gün ve tüp torakostomi ile plörodezis yapýlanlarda ise 7.3 gün olup aradaki fark istatistiksel olarak anlamlý idi (p<0.05).
TARTIÞMA ve SONUÇ: VATS; MPE'lu hastalarda direkt görüþ altýnda taný amaçlý biyopsilere olanak vermekte ve tedavi yöntemi hakkýnda hýzlý karar verme imkaný saðlamaktadýr. Ayrýca VATS ile yapýlan plörodezis iþlemi tüp torakostomiye göre istatistiksel olarak anlamlý olmasa da daha baþarýlýdýr.

INTRODUCTION: Video-assisted thoracic surgery (VATS) which is used more often in the treatment of malignant pleural effusions (MPE) provide both diagnosis and treatment. This study evaluated the efficiency of VATS in diagnosis and tretament of MPE.
METHODS: Between 1996-2002, 57 patients who were treated due to MPE in Yedikule Chest Surgery Center, 2nd Surgery Clinic were evaluated retrospectively. Thirty-one of the patients were male, and 26 female with a mean age of 55±12 (27-83). Thirty-six patients were treated with tube thoracostomy and pleurodesis was compared between tube thoracostomy and VATS groups.
RESULTS: The most common etiology of MPE were lung cancer, malignant mesothelioma, breast cancer, and ovarian cancer in decreasing order. Eight out of 36 cases treated with tube thoracostomy had recurrence in 30 days. Whilst none of the 18 cases treated with VATS and pleurodesis had recurrence. Talc was given by way of tube thoracostomy in 23 patients and by VATS in 18. VATS pleodesis was succesful in 100% of patients but tube thoracostomy achieved 87% success rate (p>0.05). The tube drainage time of tube thoracostomy and VATS were 7.3 and 4.5 days respectively, and the difference was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: VATS enables the physician to take multiple biopsies under direct vision for diagnosis, and also provides rapid decision about the treatment options. Besides VATS is more succesful than tube thoracoscopy although the difference is not statistically significant.

Abstract | Full Text PDF

29 ve 67 yaþýnda, arka mediasten yerleþimli kistik lezyonlarý olan iki olguya preoperatif hazýrlýklar yapýlarak videotorakoskopik cerrahi (VATS) ile kitle ekstirpasyon iþlemi uygulandý. Histopatolojik sonuçlarý bronkojenik kist olarak raporlandý. Hastalarýn postoperatif ve takiplerinde herhangi bir problem görülmedi. Mediastenin kistik lezyonlarýnda genellikle tanýnýn doðrulanmasý ve tedavi amaçlý cerrahi rezeksiyon gereklidir. Geleneksel cerrahi yaklaþým torakotomi olmasýna raðmen, VATS'ýn bu rezeksiyonlarda torakotomi yerine uygulanabilir yöntem olduðu düþünmekteyiz.

Two cases with cystic lesions situated on posterior mediastinum underwent cystic extirpation by video assisted thoracoscopic surgery (VATS) following preoperative evaluations. Histopathological outcomes were interpreted as bronchogenic cyst. No postoperative or follow-up complication was observed. It is often necessary to confirm the diagnosis and to perform a therapeutic surgical resection for cystic lesions in the mediastinum. Although the conventional surgical approach is thoracotomy, we suggest that video assisted thoracoscopic surgery is more convenient in such resections rather than thoracotomy.

Abstract | Full Text PDF

Abstract | Full Text PDF