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    Comparison of first-line eradication therapy protocols for Helicobacter pylori in regions with high clarithromycin resistance
    (2019) Bozkurt, Hilmi; Sert, Ozlem Zeliha; Kaplan, Esin; Aray, Emre; Olmez, Tolga; Uzun, Orhan; Koksal, Rabia; Polat, Erdal; Duman, Mustafa
    Aim: First-line eradication therapy protocols for Helicobacter pylori infection and their success rates still prove to be matter of interest for researchers. The aim of this study was to examine retrospectively eradication therapy protocols used in patients infected with H. pylori in our region with high resistance to clarithromycin, compare success rates and determine the factors affecting success rates. Material and Methods: Eradication therapies for dyspeptic patients who were found to be Helicobacter pylori positive as revealed by upper gastrointestinal endoscopy and biopsy results and success rates attained in the microscopic examination of stool in the 4th week after the therapy were analyzed. Group 1 (legacy triple therapy): clarithromycin 500 mg film-coated tablet 2x1, lansoprazole 30 mg capsule 2x1, amoxicillin 1000 mg tablet 2x1, 14-day therapy period; Group 2 (bismuth-free quadruple therapy): clarithromycin 500 mg film tablet 2x1, rabeprazole 20 mg tablet 2*1, amoxicillin 1000 mg tablet 2x1, metronidazole 500mg 2x1 tablet, 14-day therapy period; Group 3 (bismuthal quadruple therapy): bismuth subsalicylate 262 mg tablet 2x2, metronidazole 500 mg tablet 3x1, tetracycline 500 mg capsule 3x1, pantoprazole 40mg tablet 2x1, 10-day therapy period.Results: Data of 168 patients were analyzed. The patients were divided into Group 1 (classical therapy) with 80 patients, Group 2 (bismuth-free quadruple therapy) with 46 patients and Group 3 (bismuthal quadruple therapy) with 42 patients. Eradication success rates were as follows: Group 1 (80%), Group 2 (80.4%) and Group 3 (83.3%).Conclusion: Antibiotic resistance is the sole reason for the low success rate in eradication therapy for Helicobacter pylori. In regions with high clarithromycin resistance bismuth-free quadruple therapy can be employed as an alternative. In regions with metronidazole resistance in addition to clarithromycin resistance bismuthal therapy protocols can be employed. Keywords: Helicobacter pylori; eradication therapy; clarithromycin resistance.
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    Effects of polypropylene mesh on the component separation technique in complex incisional hernia surgery
    (2020) Olmez, Tolga; Colak, Tahsin
    Aim: Giant or complex hernia repair is an important risk factor for poor outcome compared with results after repair for smaller hernias. Various operation techniques have been described for this hernia types. In this study, we aimed to present our outcomes of component separation technique (CST) repair in patients with giant incisional hernia and compare the results of CST with or without mesh.Material and Methods: A comprehensive retrospective study was planned and performed on all patients who underwent the CST for complex incisional hernia between 2007 and2013 at study institution. Patients were divided into two groups according to polypropylene mesh use. Follow-up appointments were typically done at 2 weeks, 4 weeks, 2 months, 3 months, 6 months, 1 year and 2 years. Hernia recurrence was diagnosed by physical examinations and ultrasonography if needed.Results: A total of 91 patients were evaluated in this study, with 45 (49.4%) men and 46 (50.6%) women. The median age was 55(23-83) years and hernia defect size was 314 cm2 (62-940 cm2). Component separation group (CS) consisted of 13 women and 10 men with median age 56 years, whereas Component separation with mesh group (CS-M) comprised 35 women and 33 men with median age 55 years. A total of three patients (13%) had recurrence hernia in CS group vs. none of patients in CS-M group (p=0.015). Surgical site complication developed in 8 (34.7 %) patients in CS group, whereas in 28 (40.5%) patients in CS-M group (p=0.66). Statistical significant factors were associated with the development of complications including male gender (p=0.032), older than 60 years (p=0.045), and ASA score was 3 (p=0.017).Conclusion: Component separation technique could be preferred by surgeons in complex ventral hernias. Contrary to common belief, onlay polypropylene mesh placement was not increase the surgical site complications. Also, recurrence rates were lower in mesh group statistically significantly.