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Biomedical subjects

M A Yerdel

Publications and source records attributed to M A Yerdel.

At least 19 recordsLinked to original sources
PubMed1999

Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy.

BACKGROUND: Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress needle insertion during laparoscopic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study. RESULTS: Complication rate was significantly higher in the Veress needle group (14% versus 0.9%; P <0.01), and the two major complications, gastric perforation and iliac artery laceration, were also encountered in this group. CONCLUSIONS: Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.

Adult↗
PubMed1998

Repair of midline incisional hernias using polypropylene grafts.

We report herein our results of routinely performing tension-free repair for midline incisional hernias larger than 3 cm using a woven polypropylene graft between January 1990 and December 1995. Included in this study were 45 patients, 34 (73.1%) of whom had previously undergone a primary repair which had failed. The follow-up period ranged from 3 to 56 months with a mean of 36 months. Only one patient (2.2%) suffered a recurrence of the hernia. Although three (6.6%) developed a wound infection, one (2.2%) developed a wound sinus, and two (4.4%) developed wound seroma, none of these complications required removal of the graft. The findings of this study led us to conclude that Prolene grafts could be used as routine prosthetic material in the repair of incisional hernias. Moreover, during the follow-up period we observed that the modifications we made in the operative technique had a significantly positive effect on the outcome of the patients.

Female↗
PubMed1997

The fate of intraperitoneally retained gallstones with different morphologic and microbiologic characteristics: an experimental study.

Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known. This study was undertaken to assess the probable effects of stone morphology and clinically obvious infection on the outcome of retained gallstones in a mouse model. Forty albino mice were divided into four groups. Group I served as the control group (simple laparotomy, n = 10). Groups II, III, and IV (n = 10 in each group) were study groups. "Intact-sterile-cholesterol" (group II), "crushed-sterile-cholesterol" (group III), and "intact" (n = 5) [group IVa] and "crushed" (n = 5) [group IVb] "infected-cholesterol" gallstones aseptically retrieved from three different human patients were implanted to the peritoneal cavity of the animals. Group IV animals were implanted with stones retrieved from an acutely inflamed gallbladder with proven infection. Animals were sacrificed 6 and 12 weeks after the operations. Cultures and tissue samples were obtained. No animal was lost, no microscopic or macroscopic abnormality was observed in groups I and II, and cultures remained negative. In group III, adhesions surrounding the fragmented stones were evident at the 12th week, and no mortality was encountered. The histopathology revealed a fibroblastic reaction, and cultures remained negative in group III. In group IV, three animals from group IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice. All remaining mice showed severe adhesions with localized abscesses at the 12th week. In conclusion, intraperitoneally retained cholesterol gallstones remain inert and do not cause serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder. It is for this group of patients that laparotomy for total stone clearance is probably not justifiable. Better stone retrieval techniques or even laparotomy may be worthwhile considering in patients with crushed and particularly infected retained stones.

Animals↗
PubMed1997

Effect of haemodynamic variables on surgically created arteriovenous fistula flow.

BACKGROUND: The immediate success and flow rate of a newly constructed arteriovenous fistula is dependent on several haemodynamic factors affecting the inflow and outflow of the fistula. METHODS: In this study we evaluated the effect of preoperative arterial blood pressure, arterial inflow, subclavian venous flow, and operative venous outflow resistance on the immediate success, with special reference to the quantity of the fistula flow in 32 patients undergoing internal arteriovenous fistula operations. Flow measurements were done by utilizing colour flow duplex imaging and measurement of venous resistance of the fistula vein was accomplished indirectly by a newly developed simple system. RESULTS: A preoperative subclavian venous flow rate of less than 400 ml/min was associated with higher rate of immediate failures (P < 0.05) with a negative predictive value of 100% with 100% sensitivity. Regarding immediate failures, no other haemodynamic measurement was found to affect the success of a newly constructed fistula significantly. A linear correlation between the measured haemodynamic values and the quantity of postoperative fistula flow was not found. However, an arterial inflow value of > or = 40 ml/min was associated with higher fistula flow rates (P < 0.05). CONCLUSIONS: The immediate success and flow of a newly constructed arteriovenous fistula is mainly dependent on arterial inflow and subclavian venous flow. An arterial inflow rate of 40 ml/min or more and subclavian venous flow rate of 400 ml/min or more measured by colour flow duplex imaging prior to the operation will be associated with better outcomes, and therefore the use of colour flow duplex imaging is warranted during the evaluation of patients who are candidates for an arteriovenous fistula operation.

Adolescent↗
PubMed1997

Effect of lactulose on bacterial translocation.

OBJECTIVE: To find out if lactulose can prevent the bacterial translocation that is induced by obstructive jaundice in rats. DESIGN: Laboratory experiment. SETTING: Teaching hospital, Turkey. MATERIAL: 50 male Wistar-albino rats. INTERVENTIONS: 10 rats were not operated on and used as controls; 20 rats underwent laparotomy and sham ligation of the common bile duct (CBD); 20 had the CBD ligated alone; and 20 had the CBD ligated and were given oral lactulose 2 ml/day until death. All rats were killed after 14 days. MAIN OUTCOME MEASURES: Presence of Escherichia coli in mesenteric lymph nodes (MLN), and bacterial overgrowth as indicated by counts of E coli in the caecum. RESULTS: There was significantly less bacterial translocation to MLN in the group that had been given lactulose compared with CBD-ligated and lactulose not given (2/20 compared with 8/20, p = 0.06). There was also a significant reduction in the number of Gram negative bacteria in that group (p = < 0.01). CONCLUSION: Lactulose seems to reduce the incidence of translocation from the gut to MLN in rats with obstructive jaundice.

Animals↗
PubMed1997

Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective study.

The results of open cholecystectomy ([OC] n = 7) versus laparoscopic cholecystectomy ([LC] n = 7) in cirrhotic patients were analyzed prospectively. Groups were well matched for surgical indication, presence of ascites/bleeding tendency, and Child's grade. There was no mortality. Mean operating time was significantly longer in the LC group (155 +/- 47 vs. 103 +/- 25 min, p < 0.05). Operative blood loss was significantly greater in the OC group (128 +/- 125 vs. 642 +/- 467 ml, p < 0.05). No patient in LC group required blood transfusion in contrast to three patients in OC group. Compared with 0% postoperative complications in LC group, wound infections developed in 43% of the patients in OC group (p < 0.05). Mean hospital stay in LC group was significantly less (6.7 +/- 4 vs. 17.4 +/- 7.3 days, p < 0.01). Thus, contrary to previous belief, cirrhosis per se is not a contraindication to LC. Laparoscopic cholecystectomy may be the procedure of choice whenever cholecystectomy is indicated in a cirrhotic patient because it may be associated with less bleeding and fewer incision-related complications.

Blood Loss, Surgical↗
PubMed1997

Surgical treatment of hepatic hydatidosis combined with perioperative treatment with albendazole.

OBJECTIVE: To evaluate the effect of albendazole combined with surgery on the incidence of recurrent hydatid disease. DESIGN: Prospective open study. SETTING: Teaching hospital, Turkey. SUBJECTS: 25 patients who presented with hepatic hydatid disease between December 1992 and October 1995. INTERVENTIONS: Albendazole 10 mg/kg/day for a month before ultrasonography and then excision, and then albendazole for a further two months. RESULTS: 2 patients were excluded because the albendazole caused disturbance of liver enzyme activities. Of the remaining 23 patients only 7 had viable cysts on ultrasonography. In 15 patients (65%) the germinal layer was partially or totally destroyed, and in 15 the fluid was either cloudy or stained with bile. During a mean follow up period of 29 months only one patient developed recurrent disease. CONCLUSION: Perioperative treatment with albendazole resulted in fewer recurrences than expected. A longer preoperative period of treatment may increase the success rate; this requires further study.

Albendazole↗
PubMed1995

Haemodynamic effects of pneumoperitoneum during laparoscopic cholecystectomy: a prospective comparative study using bioimpedance cardiography.

The haemodynamic effects of increased intra-abdominal pressure during laparoscopic cholecystectomy in 22 patients were compared with those in 11 patients undergoing open cholecystectomy; bioimpedance cardiography was used for monitoring at predetermined time intervals. In the laparoscopy group stroke volume, cardiac and ejection velocity indices were significantly decreased and the total peripheral resistance index was significantly increased during the insufflation period when compared with preinsufflation and corresponding values in the group undergoing open operation. Routine intraoperative parameters such as heart rate and blood pressure did not show any significant change or indicate alterations in cardiovascular performance during laparoscopic procedures. Continuous non-invasive cardiovascular monitoring by bioimpedance cardiography may be useful in patients with limited cardiac function.

Adult↗
PubMed1995

Value of high-resolution intraoperative ultrasonography in the determination of limits of horizontal tumor spread during surgery for gastric malignancy.

Determination of the resection margins during surgery for gastric malignancy is a subject of controversy because accurate detection of horizontal limits of tumor spread is difficult by current methods. In this study, we investigated the value of intraoperative-ultrasonography (IUS) in the detection of proximal and distal limits of horizontal tumor spread (HTS) in 19 gastric adenocarcinoma (Group I) and five gastric lymphoma (Group II) patients. After sonographic and clinical limits of HTS were marked, resections were carried out 2 cm away from the IUS limits, and biopsies from IUS limits and resection margins were obtained. Then, the gap between IUS and clinical limits were recorded and compared with results of pathology. In both groups, the distance from clinical to IUS limits ranged from 0 cm to 3 cm and IUS limits were never inside the clinical limits. In Group I, results of sonographic proximal limit detection were satisfactory in all patients excluding recurrent cases (n:2) and a patient with early gastric cancer. Sonographic accuracy of distal limit detection was 68%. In Group I, only one resection margin (distal) was found to be infiltrated with cancer. In Group II, the success rate of IUS-guided HTS detection was 40%. IUS seems to be a valuable method for determining the extent of HTS during operation for gastric adenocarcinomas, especially so for the most problematic proximal limits. In recurrent cancers and lymphomas, however, results of IUS may be frequently misleading. IUS can be advocated as a routine procedure to determine the tumor limits and thus the resection margins during surgery for primary gastric adenocarcinomas.

Adenocarcinoma↗
PubMed1995

Treatment of non-resectable pelvic malignancies by isolated pelvic perfusion. A preliminary study.

Management of non-resectable pelvic tumours by intra-arterial local chemotherapy was shown to be beneficial but systemic toxicity limits its use. To overcome this problem isolated pelvic perfusion (IPP) was introduced as an alternative. This study summarizes our preliminary experience with IPP in the treatment of 18 non-resectable pelvic tumours [recurrent rectal adenocarcinoma (six), soft tissue sarcoma (STS) (five), bone tumour (three), epidermoid carcinoma (two), prostatic adenocarcinoma (one), malignant melanoma (one)]. Results of IPP were regarded as complete remission (CR), partial remission (PR), stable disease (SD) and disease progression (DP) according to the changes in three parameters including; scoring in pain, tumour marker and tumour size measurements. Complete and partial remission were established in five (27%) and seven (39%) patients respectively indicating a benefit ratio of 66%. Objective pain relief was encountered in 53% of the cases. All patients with STS had undergone further surgical treatment after IPP with successful curative resections in four. No residual tumour was found at the laparotomy of the fifth patient. Presenting symptom of the prostatic adenocarcinoma patient was symptomatic hypoglycaemia which resolved completely after IPP. To our knowledge, this represents the first case reported in the English literature in whom tumour related hypoglycaemia was successfully managed by IPP. In conclusion; management of non-resectable pelvic tumours by IPP seems to offer serious palliation and increase in the quality of life without any systemic toxicity. Our preliminary experience suggests even resectability may be achieved in a number of patients especially in those with STS.

Abdominal Neoplasms↗
PubMed1993

Use of polyglycolic acid mesh with a new double pursestring technique in renal trauma: an experimental study.

Repair of major kidney lacerations with conventional techniques is extremely difficult and 'through and through' suturing is associated with further loss of viable tissue because it promotes scarring. In this study, we investigate the haemostatic and viable parenchyma salvaging effect of an alternative, new wrapping technique in an experimental renal trauma model. This resulted in immediate haemostasis in all 25 animals, while the same injury caused excessive haemorrhage with 50 per cent mortality in eight untreated controls. This technique differs from other wrapping methods because no additional suturing for the application of PAM or haemostasis is required. It is an easy, rapid procedure which decreases the operating time and may allow successful repair in major lacerations of the kidney.

Animals↗
PubMed1993

Laparoscopic cholecystectomy in cirrhotic patients: expanding indications.

Cirrhosis, portal hypertension, and bleeding disorders are being considered as relative or absolute contraindications to laparoscopic cholecystectomy (LC). This report describes four cirrhotic patients with clinical portal hypertension in three and mild to severe bleeding tendency in all. Laparoscopic cholecystectomy was uniformly successful in these patients with no complications. If the surgeon exercises extreme caution in securing hemostasis and does not overlook some details concerning patient management, LC can be efficiently and safely performed in cirrhotic patients. Compared with open cholecystectomy, LC may be even more advantageous concerning the virtual elimination of incision-related complications. Our preliminary experience is encouraging and suggests more liberal use of LC in cirrhosis-portal hypertension-bleeding tendency disease complex.

Aged↗
PubMed1992

Acute superior mesenteric artery syndrome following left hemicolectomy: a case report.

Acute superior mesenteric artery syndrome (SMAS) following a major surgical procedure is extremely rare, and represents an iatrogenic cause of postoperative upper gastrointestinal obstruction. In this report, the first documented case of acute SMAS following a left hemicolectomy is presented in an obese patient. Upper gastrointestinal roentgenographic series and conservative management remain to be the first line diagnostic and therapeutic modalities and were successful in our patient. Up to date no patient with SMAS reported to be obese but apparently obesity per se, can not be considered as an insurance. A postoperative acute SMAS is impossible to predict depending on the previous history, predisposing factors and the physique of the patient. Therefore, the surgeon should be aware of the SMAS and it is his task to secure all the precautions in order to preclude excessive traction on the mesenteric vasculature and vascular compression of the duodenum during surgery. In cases in which SMAS is suspected during extended colonic resections with lymph node dissection, duodenal mobilization seems to be selectively justifiable.

Acute Disease↗
PubMed1992

Laparoscopic cholecystectomy report of 30 cases.

Laparoscopic cholecystectomy (LSC) was attempted in 30 patients and was accomplished in 29 during the nine months between March and November 1991. Twenty eight patients had cholelithiasis with or without adenomyosis, and two had adenomyosis of the gall-bladder. Mean operative time was 219 min and postoperative pain was slight. Two complications (6.9%), including necrosis of the common hepatic duct and subcutaneous emphysema, were encountered. Patients with subacute and severe chronic cholecystitis were included in the cases. Thus this technique is recommended for almost all patients who require the removal of the gall-bladder for benign diseases.

Adolescent↗
PubMed1992

Use of autologous fibrin glue in the treatment of splenic trauma: an experimental study.

There is little doubt that preserving the spleen will contribute to a much more favourable outcome in patients undergoing splenic surgery, as a result of avoiding the well known risks of splenectomy. Among many operative methods described for splenic salvage, application of autologous fibrin glue (AFG) is particularly promising because of its unique characteristics. The use of AFG has been evaluated and its efficacy and tissue compatibility assessed in the treatment of splenic trauma in 15 partially splenectomized New Zealand White rabbits. The application of the AFG to the resected splenic surface achieved complete haemostasis in all animals. The animals were divided into four groups and were killed at varying intervals ranging from 24 h to 10 weeks. During re-exploration there was no evidence of recurrent bleeding and histopathological examination revealed progressive absorption of the AFG with a minimal inflammatory response. It is concluded that AFG is an effective haemostatic agent with good systemic and local compatibility and can be used in splenic salvage, which thereby avoids the use of non-autologous products with their risks of disease transmission.

Animals↗