International journal of surgery (London, England)

Publications in this journal

• Article: Uterine sarcomas: Review of 26 years at the Instituto Nacional de Cancerologia of Mexico.

  David Cantú de León, Heliodoro González, Delia Pérez Montiel, Jaime Coronel, Carlos Pérez-Plasencia, Verónica Villavicencio-Valencia, Ernesto Soto-Reyes, Luis Alonso Herrera
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  ABSTRACT: Uterine sarcomas are a group of uncommon tumors that accountfor approximately 1% of malignant neoplasms of the female genital tract and between 3 and 8.4% of malignant uterine neoplasms. OBJECTIVE: To evaluate the factors associated with the clinical behavior of uterine sarcomas. MATERIALS AND METHODS: In the period from October 1983 to December 2009, clinical files of patients with a confirmed diagnosis of uterine sarcoma at the National Institute of Cancerology of Mexico (INCan) were reviewed and evaluated. RESULTS: We identified 77 cases with complete information; average age at presentation was 51.6 years (range, 14-78 years); most frequent histology was leiomyosarcoma (LMS) in 53/77 (68.8%) cases; most frequent symptom reported at the time of diagnosis was abnormal vaginal bleeding in 36/77 (46.7%) cases, and the most frequent clinical stage was clinical stage (CS) I in 31/77 (40.2%) cases. Initial treatment was total abdominal hysterectomy (TAH) and bilateral salpingo-oophrectomy (BSO) in 53/77 (68.9%) cases. Disease-free period was 27.8 months (range, 0-184 months), with disease recurrence in 33/77 (42.85%) cases, most frequent site as lung in 13/33 (39.39%) cases. Management of recurrences was surgery and chemotherapy (CT) in 5/33 (15.15%) and CT in 10/33 (30.30%) of cases. At present, 40.3% of the patients (31/77) are found to be Disease-free. CONCLUSION: Notwithstanding that uterine sarcomas are aggressive neoplasms, most accepted management to date is TAH+BSO, observing that the fact that this procedure is not performed by oncologists does not affect the DFP nor OS, contrary to what occurs in other gynecological neoplasms.
  International journal of surgery (London, England) 05/2013;
• Article: Cetuximab therapy in the treatment of metastatic colorectal cancer: The future frontier?

  D Gomez, A De Rosa, A Addison, A Brooks, H Z Malik, I C Cameron
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  ABSTRACT: BACKGROUND: To review the outcomes following cetuximab therapy in patients with metastatic colorectal cancer. METHODS: Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords "colorectal cancer", "cetuximab", "liver metastases", "liver resection" and "hepatectomy". RESULTS: Cetuximab was first used in the palliative setting and an increase in response rates were seen, however with no improvement in overall survival. Published data have observed that cetuximab may be beneficial as part of a down-staging programme. The addition of cetuximab to chemotherapy regimens in patients with KRAS wild-type colorectal cancer has been shown to increase the response rates and the number of patients being down-staged and offered potentially curative resection. The OPUS and CRYSTAL trials observed good response rates following the addition of cetuximab but low resection rates. The CELIM and POCHER studies reported higher resection rates due to better patient selection and study design. However, the majority of published studies tend to report minimal surgical data and lack short- and long-term outcomes. CONCLUSION: The use of cetuximab to conventional chemotherapy regimens may improve the efficacy of down-staging programmes, leading to more patients being offered potentially curative resection.
  International journal of surgery (London, England) 05/2013;
• Article: To cool or not to cool: evolution of the treatment of burns in the 18th century.

  Amer Hussain, Fouzia Choukairi
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  ABSTRACT: The 18th century represents a transitional period in evolution of surgery and burn treatment, a time just before major advances such as asepsis, burn excision and skin grafting, were to revolutionise surgical practice. The medical minds of this era first began to question the centuries of dogma and speculation that were at the heart of medicine. The evolution of the treatment of burns in this crucial time is reviewed from the perspective of two of the exceptional medical minds of that era John Hunter and James Earle. Many of their observations are still valid today and their influence would prove inspirational in ushering in modern era of burn management.
  International journal of surgery (London, England) 05/2013;
• Article: Anal Intraepithelial Neoplasia - Is Treatment better than Observation?

  M Orchard, A Roman, A C Parvaiz
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  ABSTRACT: Anal Intraepithelial Neoplasia (AIN) is an increasingly common condition for which the best treatment has not been well established. Traditional management was based on a 'watch and wait' strategy, but as the natural history of AIN and its progression to anal cancer is becoming better understood, more active treatment strategies are warranted. A Best Evidence Topic in Surgery was written according to a structured protocol to address the question whether treatment is indicated in patients with AIN. A total of 169 papers were identified using the defined search criteria. This included only one randomised controlled trial. Case series were therefore also included to help answer the question. The details of the papers were tabulated including relevant outcomes and study weaknesses. We conclude that treatment of high grade AIN, particularly in high risk groups is recommended to try to avoid progression to anal cancer. Treatment options that have shown some benefit include topical use of imiquimod cream or ablation directed by high resolution anoscopy.
  International journal of surgery (London, England) 05/2013;
• Article: Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer.

  Gil Jae Lee, Hyo Jun Kim, Jeong-Heum Baek, Won-Suk Lee, Kwang An Kwon
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  ABSTRACT: PURPOSE: The aim of this study was to compare short-term morbidities and mortalities of elective surgery after stent insertion and emergency surgery in obstructive colorectal cancer. METHODS: We retrospectively reviewed 77 patients with obstructive colorectal cancer that underwent elective surgery after stenting (stent group: SG, n = 49) or emergent surgery (emergency group: EG, n = 28) from January 2000 to July 2010. RESULTS: The American Society of Anesthesiologists (ASA) score of SG was lower than that of EG (p = 0.015). The percentages of open and laparoscopic surgery in SG were 73.5% (36/49) and 26.5% (13/49), respectively, whereas surgery in EG was performed using an open technique (p = 0.003). The rate of primary anastomosis, without constructing a stoma, was 87.8% in SG and 42.9% in EG (p < 0.001). There was no difference in a postoperative complication. Anastomotic leakage according to time between stent placement and surgery in SG were 3 cases for 1 to 9 days and 0 for more than 10 days (p = 0.037). Three-year overall survival rates were 68.8% and 51.3% (p = 0.430), respectively. CONCLUSION: Preoperative stent insertion in obstructive colorectal cancer seems to be safe and feasible, and may decrease second stage procedure. Waiting 10 days after stent placement may be a more optimal time for surgical intervention. Further prospective randomized studies are needed to determine the proper time bridge to surgery following stent insertion in obstructive colorectal cancer.
  International journal of surgery (London, England) 04/2013;
• Article: Atmospheric Pressure and Infra-renal Abdominal Aortic Aneurysm Rupture: A single observational study and a comprehensive review of literature.

  Ali Kordzadeh, Alan Askari, Yiannis Panayiotopoulos
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  ABSTRACT: INTRODUCTION: There have been various suggestions that abdominal aortic aneurysm rupture (rAAA) might have a seasonal variation depending on atmospheric pressure (AP) alteration. Despite above suggestions no study has yet examined the effect of fluctuation in AP on daily, seasonal, monthly, AAA size and co-morbidities to reach a conclusive outcome. METHODS: A total of fifty (n=50) ruptured AAA over a 5-year period were retrospectively studied. Local meteorological data on AP were obtained from UK Meteorological Office.The data was subjected to statistical analysis using Student's t-test, linear regression (Pearson correlation Coefficient) and Coefficient of determination to establish any casual link between AP and incidences of rAAA on daily, seasonal and monthly basis. The casual link was also assessed between AP, AAA size and co-morbidities. The outcome is presented in a format of comprehensive review of literature that detected only 6 papers in MEDLINE and EMBASE from 1951-2012 in UK. CONCLUSION: There appears to be a significant correlation between mean monthly pressures and mean monthly rupture incidence (Pearson)(n=12; r= -0.61; p <0.034; rsq= 0.37). The periods of low AP are associated with higher incidence of rupture (rAAA n=29 at mean atmospheric pressure 1012 mB Vs rAAA n=12 at mean atmospheric pressure 1016 mB Vs rAAA n=9 at mean atmospheric pressure of 1020 mB) in our study and all reviewed literature. In addition, no casual link between AP to co-morbidities (diabetes mellitus, hypertension ischemic heart disease, chronic obstructive pulmonary disease) and AAA size could be established or found in the literature.
  International journal of surgery (London, England) 04/2013;
• Article: Solid pseudopapillary tumour of the pancreas: Incidence, prognosis and outcome of surgery (Single Center Experience).

  Ayman El Nakeeb, Mohamed Abd El Wahab, Wagdi F Elkashef, Mina Azer, Tharwat Kandiel
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  ABSTRACT: BACKGROUND: Solid pseudopapillary tumour (SPT) of the pancreas is a rare neoplasm of low malignant potential. The pathogenesis and guidelines for its treatment remain unclear. This study was designed to evaluate the diagnosis, surgical treatment and prognosis of SPT STUDY DESIGN: A retrospective study during the period between January 1995 to October 2012. PATIENTS AND METHOD: Cases with SPTs treated at our institution were reviewed. Demographic data, clinical manifestations, radiological, surgical, and pathological records were reviewed for patients with SPT. RESULTS: Twenty four patients with SPT were identified (22 women and 2 men with a mean age 24.83 ± 8.66 (12-52 years). The tumour was located in the head in (50%) and in the body (8.3%) and in the tail (41.7%). The mean size was 9.2 ± 5.3 (3-25 cm). The main clinical presentation was abdominal pain in (83.3%). All 24 patients had curative resection including pancreaticoduodenectomy (50%), central pancreatectomy (8.3%) and distal pancreatectomy (41.7%). Sex, age, symptoms, tumour size, CT image and tumour markers were not significant clinical factors to predict SPT with malignant behaviour. The recurrence rate was (8.3%) after 5 years postoperatively. No hospital mortality, all patients except 2 patients (8.3%) were alive at follow up period. The estimated 1, 3, and 5 year survival rate was 95%, 95%, and 88 % . CONCLUSION: SPT are rare neoplasms with malignant potential. Aggressive surgical resection is needed even in presence of local invasion, and also for recurrence as patients had a good long term survival.
  International journal of surgery (London, England) 04/2013;
• Article: Optimizing the technique of right laparoscopic adrenalectomy with a modified trocar arrangement and dynamic liver retraction: A comparative study with standard technique.

  Alireza Aminsharifi, Reza Mohammadian, Reza Niroomand, Firoozeh Afsar
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  ABSTRACT: OBJECTIVES: Right Laparoscopic adrenalectomy (LA) is technically more challenging than left LA, because of the anatomical position of the right adrenal gland and vein. We modified the technique for right LA to optimize the procedure, and compared the operative outcome with standard technique. PATIENTS AND METHODS: The operative outcome of 13 cases of right adrenal mass treated with modified LA were compared retrospectively with 29 cases of standard right LA. For modified right LA, we used a 4-port transperitoneal laparoscopic approach that omitted the subxiphoid trocar (classically used for liver retraction), and instead, an assistant applied continuous, dynamic upward liver retraction in a plane perpendicular to the inferior vena cava (IVC). RESULTS: Modified Right LA was done in 13 patients (3 men, 23.1%), without difficulty and with excellent direct exposure of the upper and medial aspect of the adrenal gland and adrenal vein. Mean operative time was significantly shorter compared with standard technique (122.3±20.1 vs. 165±33.6 min; P<0.0001) There were no bleeding complication and open conversion in modified technique which was promising compared with 2 bleeding complications in our experience with 29 cases of right LA using standard technique. CONCLUSION: Modified right LA with a 4-port approach and dynamic upward liver retraction in a plane perpendicular to IVC resulted in direct exposure of the upper and medial aspect of the adrenal gland and adrenal vein. This approach can be effective in challenging cases when the infrahepatic fossa is poorly exposed.
  International journal of surgery (London, England) 04/2013;
• Article: Postoperative Complications in The Oldest Old Gastric Cancer Patients.

  Hiroyuki Yamada, Tsuyoshi Shinohara, Masashi Takeshita, Tetsuya Umesaki, Yoshiro Fujimori, Kiyofumi Yamagishi
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  ABSTRACT: BACKGROUND: With the aging of the population, the number of elderly patients with gastric cancer is anticipated to increase. This study evaluated the feasibility of gastrectomy for patients over 85 years old. METHODS: A total of 176 patients who underwent gastrectomy for gastric cancer were assigned into two groups: 75-84 years group (n=152); and ≥85 years group (n=24). Preoperative comorbidities, operative results, and postoperative outcomes were retrospectively analyzed. RESULTS: In terms of concurrent illness, no significant differences were observed between groups. Preoperative lymphocyte (Lym) count, hemoglobin (Hb) level and serum albumin (Alb) levels were significantly lower in the ≥85 years group than in the 75-84 years group (Lym: 11.0±2.2 ×10²/mm³ vs. 14.9±3.2 ×10²/mm³, P=0.0009; Hb: 11.2±2.3 mg/dl vs. 12.4±1.5 mg/dl, P=0.038; Alb: 3.5±0.5 mg/dl vs. 4.1±0.3 mg/dl, P=0.0006, respectively). Percent vital capacity was likewise lower in the ≥85 years group than in the 75-84 years group (86.2±11.4% vs. 96.1±12.2%, P=0.04). Percentage forced expiratory volume in 1 second showed no significant difference. Incidence of postoperative pneumonia was higher in the ≥85 years group than in the 75-84 years group (P=0.006). Time to first flatus and postoperative hospital stay were similar in both groups. CONCLUSION: Patients over 85 years old are more likely to suffer postoperative pneumonia after gastrectomy than younger old patients. Preoperative risk assessment is essential for the oldest old patients.
  International journal of surgery (London, England) 04/2013;
• Article: Three decades of clinical-pathological trends in Gastric Cancer: prospective data from a Portuguese Hospital.

  Gil R Faria, João Pinto-de-Sousa, John R Preto, Hugo S Sousa, José A Barbosa, José Costa-Maia
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  ABSTRACT: INTRODUCTION: Gastric cancer is a heterogeneous disease, whose pathological and clinical patterns have changed in the last decades. In most western countries, decreases in incidence and mortality and a proximal migration have been reported. The clinical and pathological trends in an European country with high prevalence of gastric cancer were reviewed, based on the patients treated at a University Hospital. METHODS: Analysis of a prospective database with 1618 patients who underwent surgery for gastric cancer in the last 3 decades. The patients were divided in 3 groups according to decades and the cohorts were analyzed according to demographic, surgical and pathological factors. RESULTS: The mean age increased from 59.8 to 65.6 years. Antral tumors and intestinal cancer were the most frequent. The rate of complete resection increased as well as the percentage of total gastrectomies and D2-type lymphadenectomies. There was an increase both in early stage carcinomas and in surgically treated Stage-IV carcinomas. The median overall crude survival almost doubled from 14 to 22 months (p=.003), but once stratified for stage, only in stage II patients could we observe a significant increase in survival time. (29 to 47 months; p=.047). CONCLUSION: The proximal migration described for Western Europe was not observed and the intestinal-type carcinoma is still the most frequent. We are treating older patients, often with more advanced disease. In spite of an increasing surgical aggressiveness, the prognosis has only been significantly improved in Stage-II cancers. The prognosis for advanced cancer is still dismal, hence the need for effective adjuvant treatments.
  International journal of surgery (London, England) 04/2013;
• Article: Editor's perspectives - May 2013.

  R David Rosin
  International journal of surgery (London, England) 04/2013;
• Article: Hydroxyapatite-coated femoral stems in primary total hip arthroplasty: a meta-analysis of randomized controlled trials.

  Shuzhen Li, Baohua Huang, Yueping Chen, Hui Gao, Qie Fan, Jinmin Zhao, Wei Su
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  ABSTRACT: BACKGROUND: Controversy exists over the use of hydroxyapatite (HA)-coated femoral stems in primary total hip arthroplasty (THA). We conducted a meta-analysis of randomized controlled trials (RCT) to compare the clinical and radiologic outcomes of primary THA using HA-coated versus non-HA-coated femoral stems. METHODS: Databases including MEDLINE, EMBASE and the Cochrane Library were searched to find relevant RCTs comparing HA-coated versus non-HA-coated femoral stems in primary THA. Data analyses were performed using RevMan 5.0 (The Cochrane Collaboration). RESULTS: Seven studies (792 hips) met the inclusion criteria. The pooled weighted mean difference (WMD) for the postoperative Harris hip score was 3.04 (95% CI: -4.47 to 10.54, P=0.43). The cumulative risk ratios (RR) for the presence of endosteal condensation and radioactive lines were 1.02 (95% CI: 0.93 to 1.12, P=0.64) and 1.01 (95% CI: 0.90 to 1.14, P=0.81), respectively. CONCLUSIONS: This meta-analysis demonstrates that the use of HA-coated femoral stems in primary THA has no clinical or radiological benefits.
  International journal of surgery (London, England) 04/2013;
• Article: Concurrent Rib and Pelvic Fractures as an Indicator of Solid Abdominal Organ Injury.

  Ammar Al-Hassani, Ibrahim Afifi, Husham Abdelrahman, Ayman El-Menyar, Ammar Almadani, Jan Recicar, Hassan Al-Thani, Kimball Maull, Rifat Latifi
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  ABSTRACT: OBJECTIVES: To study the association of solid organ injuries (SOIs) in patients with concurrent rib and pelvic fractures. METHODS: Retrospective analysis of prospectively collected data from November 2007 to May 2010. Patients' demographics, mechanism of injury, Injury severity scoring, pelvic fracture, and SOIs were analyzed. Patients with SOIs were compared in rib fractures with and without pelvic fracture. RESULTS: The study included 829 patients (460 with rib fractures ± pelvic fracture and 369 with pelvic fracture alone) with mean age of 35±12.7 years. Motor vehicle crashes (45%) and falls from height (30%) were the most common mechanism of injury. The overall incidence of SOIs in this study was 22% (185/829). Further, 15% of patient with rib fractures had associated pelvic fracture. SOI was predominant in patients with concurrent rib fracture and pelvic fracture compared to ribs or pelvic fractures alone (42% vs. 26% vs. 15%, respectively, p=0.02). CONCLUSIONS: Concurrent multiple rib fractures and pelvic fracture increases the risk of SOI compared to either group alone. Lower RFs and pelvic fracture had higher association for SOI and could be used as an early indicator of the presence of SOIs.
  International journal of surgery (London, England) 04/2013;
• Article: Effectiveness of Collagenase in Preventing Postoperative Intra-abdominal Adhesions.

  Murat Cakir, Ahmet Tekin, Tevfik Kucukkartallar, Huseyin Yılmaz, Metin Belviranlı, Adil Kartal
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  ABSTRACT: INTRODUCTION: The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. METHODS: The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group Group 2: Normal saline group Group 3: Sterile Novuxol(®) group GROUP 4: The group where the intraperitoneal and systemic effects of sterile Novuxol(®) were investigated. Adhesion frequency and grades were scored on the post-op 11(th) day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. RESULTS: Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35±1.42 for Group 1, 0.31±1.15 for Group 2, and 0.20± 0.41 for Group 3. Adhesion stage of the Sterile Novuxol(®) Group was lower than all the other groups (p<0.05). Biochemical and hematological parameters were similar in all groups (p>0.05). Histopathological analysis revealed no hepatotoxicity. CONCLUSIONS: According to the results of our study, we believe that Sterile Novuxol(®) can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness.
  International journal of surgery (London, England) 04/2013;
• Article: Factors affecting outcomes in penetrating diaphragmatic trauma.

  Chien-Hung Liao, Chih-Po Hsu, I-Ming Kuo, Chun-Hsiang Ooyang, Shang-Yu Wang, Jen-Fu Huang, Chih-Yuan Fu, Shang-Ju Yang, Shih-Ching Kang
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  ABSTRACT: BACKGROUDS: Diagnosing penetrating diaphragmatic rupture (PDR) is a challenging aspect of managing thoracoabdominal injuries due to the lack of a typical clinical presentation. The mortality from PDR is variable and center-specific. In this study, we identified the incidence and clinical presentation of PDR at our institution and analyzed the factors that affected the length of hospital stay and mortality. METHODS: We collected all patients who were diagnosed with PDR from January 2001 through December 2010 at a Level I trauma center. We recorded demographic characteristics, clinical parameters, diagnostic images, trauma mechanism, location and severity of injuries, injury severity score (ISS), time to diagnosis, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and mortality. We analyzed the risk for mortality and prolonged hospitalization. RESULTS: Forty-one patients with a median age of 37 years were included. Thirty-six patients (87.8%) had an early diagnosis, and 5 patients (12.2%) had a delayed diagnosis requiring longer than 24 hours. The median ICU LOS and HLOS were 2 and 11 days, respectively. High-grade PDR and lung injury increased the ICU LOS and HLOS. The total mortality rate was 7.3%. Multivariate analysis showed that hypothermia and hypotension were independent risk factors for mortality. CONCLUSION: Overlooking diaphragmatic rupture in patients with thoracoabdominal penetrating injury is not infrequent. A high index of suspicion is important for making the diagnosis. A high-grade PDR and associated lung injury prolonged the length of hospital stay. Profound hemorrhagic shock and associated physical decompensation have an impact on mortality.
  International journal of surgery (London, England) 04/2013;
• Article: "Modified radical mastectomy: A pilot clinical trial comparing the use of conventional electric scalpel and harmonic scalpel"

  Gustavo Henrique Fabri Pereira Ribeiro, Ligia Maria Kerr, Raphael Luiz Haikel, Stela Verzinhasse Peres, Angelo Gustavo Zucca Matthes, Rodrigo Augusto Depieri Michelli, Antonio Bailão, José Humberto Tavares Guerreiro Fregnani, René Aloísio da Costa Vieira
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  ABSTRACT: BACKGROUND: The aim of this study was to compare the rates of local postoperative complications among women undergoing modified radical mastectomy with an electric scalpel (ES) or a harmonic scalpel (HS). It is thought that HS use has less postoperative complications, mainly seroma formation. METHODS: This study was a prospective non-randomised clinical trial (NCT01391988) among consecutive patients, performed in parallel. Patients underwent modified radical mastectomy using an HS or ES. We analysed the following operative variables: time, blood loss and seroma volume drainage. Postoperative complications, including seroma, flap necrosis, haematoma and infection were evaluated on the 7(th) and 14(th) days. RESULTS: Forty-six patients underwent a MRM with ES and 49 with HS; no differences were observed between the groups. The rate of local complications was 29% in the HS group and 52% in the ES group (p = 0.024). The rates of seroma (16.3% versus 28.3%; p= 0.161), necrosis (4.1% vs. 21.7%; p = 0.013; OR= 0.15), haematoma (2.0% vs. 8.7%; p= 0.195) and infection (2.0% vs. 6.5%; p= 0.351) were lower in the HS group. Adding the findings of all comparative studies using HSs in MRM to the seroma rates in the current study, the seroma rate, expressed as a categorical variable, did not decrease with HS. Seroma was present in 60/219 cases using an HS and in 69/239 cases utilising an ES (p=0.72). Based on a multivariate analysis, HS decreased the risk of skin necrosis (p=0.015). CONCLUSIONS: HSs do not decrease the seroma rate. However, this method may be useful in skin sparing mastectomy because it decreases skin flap necrosis.
  International journal of surgery (London, England) 04/2013;
• Article: Recurrence after groin hernia repair-revisited.

  Sri Vengadesh Gopal, Achuthan Warrier
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  ABSTRACT: One of the commonly performed operations all over the world is hernia repair. Various open and laparoscopic procedures are available now for hernia repair. They are judged mainly by the recurrence rate following operation. The recognition of the causes of recurrence makes their prevention / elimination possible.Articles on hernia recurrence published in various journals over the past 40 years have been analysed. This review article mainly focuses on the causes of recurrence of hernia and their prevention. The causes of recurrence following open and laparoscopic hernia repair have been analysed. In open repair, early recurrences are due to faults in operative technique and postoperative infection. Late recurrences are due to patient factors like collagen defects, age and medical morbidities. In laparoscopic repair, technical aspects of surgery like dissection, mesh placement and fixation are the important factors which decide hernia recurrence.
  International journal of surgery (London, England) 04/2013;
• Article: Is there a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer?

  George Garas, Babar Kayani, Neil Tolley, Fausto Palazzo, Thanos Athanasiou, Emmanouil Zacharakis
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  ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether there is a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer. A total of 125 papers were identified using the reported searches of which 2 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, study type, patient group, relevant outcomes and results are tabulated. Oesophageal surgery, similar to thyroid, parathyroid and cardiothoracic surgery poses a risk to the recurrent laryngeal nerves (RLN). Intraoperative RLN monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centres. The same does not hold true for three-stage oesophagectomy with high mediastinal lymph node dissection despite the inherent risks to the RLN being much higher with this type of surgery. There are only a handful of studies in the literature evaluating the role of IONM in three-stage oesophagectomy. As a result, there is limited evidence to provide robust guidance. The evidence from the present review supports the use of IONM during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer. IONM appears to have a protective role for the RLN and also reduce the risk of postoperative pneumonia without adding to the operative time. In patients due to undergo three-stage oesophagectomy, the use of IONM of the RLN should be considered during the high mediastinal lymph node dissection and cervical access parts of the operation.
  International journal of surgery (London, England) 04/2013;
• Article: The comparison of neuroprotective effects of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury.

  Feyzi Celik, Cüneyt Göçmez, Kağan Kamaşak, Adnan Tufek, Abdulmenap Guzel, Orhan Tokgoz, Uğur Fırat, Osman Evliyaoğlu
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  ABSTRACT: BACKGROUND: The purpose of this study is the investigation of the effects of intrathecally injected dexmedetomidine and methylprednisolone and their dominancy over one another in rats with generated Spinal Cord Injury (SCI). METHODS: 40, female, adult Wistar Albino rats weighing 220-260g were included in the study. The rats were fixed with Intrathecal catheter (IT) and divided into four groups. All subjects were applied T7-10 laminectomy after catheter. Group S (n:10) was injected with IT 10μL isotonic saline; Group C (n:10) with IT 10μL isotonic saline after SCI; Group D (n:10) with IT one doze 10μL of dexmedetomidine after SCI; Group M (n:10) IT one dose 10μL of methylprednisolone. The subjects were sacrificed 72 hours after this operation. The damaged area was removed biochemically and histopathologically examined. RESULTS: Antioxidant and inflammatory parameters searched for in all damages tissue were statistically different in all groups from group S. They were different in group M and group D than group C (p<0.001). After the comparison of group D and group M, PON and IL6 values were higher in group D (p=0.003, p=0.035) while the other two biochemical parameters were similar in both groups (Table 1). After histopathologic trials, oedemas, bleeding and necrosis were found less in group S while at the most in group C (p<0.001). In group M and group D, however, they were higher than group S and lower than group C (p<0.001). After the comparison of group D and group M, while there was no difference in terms of oedema necrosis, the amount of bleeding was lower in group D (p<0.001) (Table-2). CONCLUSIONS: It has been discovered that intrathecal use of dexmedetomidine caused neuroprotective effects similar to methylprednisolone.
  International journal of surgery (London, England) 03/2013;
• Article: Radiological incidence of parastomal herniation in cancer patients with permanent colostomy: What is the ideal size of the surgical aperture?

  Alexander Hotouras, Jamie Murphy, Niall Power, Norman S Williams, Christopher L Chan
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  ABSTRACT: BACKGROUND: Parastomal herniation frequently complicates stoma formation. Aperture size has been shown to be an independent predictor of hernia development but there is a paucity of data regarding the ideal stoma diameter. The aim of this study was to establish the radiological incidence of herniation in patients with a permanent colostomy and correlate it with the size of the abdominal wall defect in order to identify an aperture diameter associated with a reduced herniation risk. METHODS: All patients who underwent permanent colostomy formation for colorectal cancer over a five year period in a single institution were recruited to the study. Patient demographics, operative details and stoma-related symptoms were recorded. Post-operative CT scans were reviewed for evidence of parastomal herniation. The diameter of the abdominal wall defect was measured radiologically. RESULTS: 43 patients (mean age 69 years) were included in the analysis. Radiologically, 25/43(58%) had evidence of a parastomal hernia. The median aperture diameter was 35mm (range 25-58mm) in patients with a parastomal hernia and 22mm (range 10-36mm) in patients without herniation (p<0.0001). There were no cases of herniation with an abdominal wall defect size <25mm.The median follow up was 26.0 months (range 6-55) in patients with herniation as opposed to 16.0 months (range 7-36) in patients without herniation (p=0.11). CONCLUSION: The majority of patients with a permanent colostomy develop a parastomal hernia within the first two postoperative years. Parastomal herniation appears unlikely to develop with an abdominal wall defect diameter ≤25mm provided this does not enlarge with time. Surgical techniques that utilise stapling devices to form a 'custom-made' and rigid trephine might reduce the herniation risk.
  International journal of surgery (London, England) 03/2013;