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    High-dose botulinum toxin in chronic anal fissure treatment: Short term results
    (2019) Cinar, Hamza; Akalin, Cagri; Kesicioglu, Tugrul; Aydin, Ismail; Buyukakincak, Sercan
    Aim: Botulinum toxin (BT) injection into the internal anal sphincter is gaining popularity as a second line therapy for chronic anal fissures if medical therapy fails. There is no consensus on BT dosing to be used in chronic anal fissure (CAF) treatment. The aim of our study is to research the complication of high-dose BT in CAF treatment and its treatment effectiveness. Material and Methods: The data of 19 patients who underwent BT injection for CAF treatment between the years of 2014 and 2018 were analyzed retrospectively. Demographic characteristics of the patients, complications observed due to BT injection, healing and recurrence cases were recorded. Results: Nineteen patients who underwent 90 IU BT treatment followed for an average of 9.4 (min 3- max 46) months, It was observed that anal fissure was completely healed in 16 (84.2%) but no improvement was observed in 3 (15.8%). One of the recovered 16 patients was found to have recurrent anal fissure on the 5th month. In the patients who had BT, it was observed that 2 of the patients (%10.5) had abdominal pain in the first day requiring analgesic use, 2 of the patients (%10.5) had abdominal bloating (gas) which healed itself spontaneously within approximately one week, 2 (%10.5) of the patients had redness on the injection area on the first day and 3 (%15.8) of the patients had gas incontinence which healed itself spontaneously within approximately 2 weeks. Conclusion: High-dose BT injection can be safely performed with low complication, high recovery rate and low recurrence rate. Prospective studies in larger series of patients are needed to obtain clearer results.
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    Outcomes of percutaneous endoscopic gastrostomy: One surgeon experience
    (2019) Cinar, Hamza; Akalin, Cagri; Ozdemir, Ozlem
    Aim: We aimed to present our experience and findings in patients which in we applied percutaneous endoscopic gastrostomy (PEG) tube insertion because of the oral nutritional deficiency. Material and Methods: The data of 41 patients who had PEG tube insertion between 2014 and 2018 years in the General Surgery Clinic of Medicine Faculty of Ordu University were evaluated retrospectively. The indications, complications, mortality and shortterm outcomes of the patients were analyzed. Results: 43 patients underwent gastroscopy due to insertion of PEG. In 41(95.3%) patients, PEG insertion was successful. In 2(4.7%) patients, PEG insertion failed due to obesity. 16(39%) of the PEG patients were males and 25 (61%) were females. The mean age was 77.68 ± 13.9 (20-94) years. PEG indications were chronic neurological disease in 22 (53.6%) patients, cerebrovascular disease in 15 (36.6%) patients and malignancy in 4 (9.8%) patients. Minor complications in 11(26.8%) patients and major complications in 2 (4.9%) patients were observed. 10 (24.4%) of the complications were in the early period and 3 (7.3%) were in the late period. During the follow up, the PEG tube in 3 (7.3%) patients was pull out. No mortality due to PEG insertion was observed. During the mean follow-up period of 9.37 ± 7.8 months, 14 (34.1%) of the PEG-treated patients died due to their primary disease. Conclusions: PEG tube insertion is an easy method with the low rates of the complication and mortality in the patients with poor oral intake who have a functional gastrointestinal system. PEG is the first choice for long-term enteral nutrition in appropriate patients.