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    Comparison of Sirolimus and Colchicine Treatment on the Development of Peritoneal Fibrozis in Rats Having Peritoneal Dialysis
    (Galenos Publ House, 2015) Sagiroglu, Tamer; Sayhan, Mustafa Burak; Yagci, Mehmet A.; Yalta, Tulin; Sagiroglu, Gonul; Copuroglu, Elif; Oguz, Serhat
    Background: Continuous ambulatory peritoneal dialysis is a successful treatment modality for patients with end-stage renal disease. Peritoneal fibrosis (PF) is the most critical complication of long-term peritoneal dialysis (PD). Aims: In our study, we aimed to compare the effects of colchicine and sirolimus on PF induced by hypertonic peritoneal dialysis solutions in rats. Study Design: Animal experiment. Methods: Twenty-four rats were randomly divided into three groups. The control group received an intraperitoneal injection (ip) of saline. The sirolimus group received the PD solution, plus 1.0 mg/kg/day Rapamune (R). The colchicine group received the PD solution ip plus 1.0 mg/kg/day of colchicine. Blood samples were taken to measure the serum levels of VEGF, TGF-beta, and TNF-alpha. Peritoneal tissue samples were taken for histopathological evaluation. Results: TGF-beta and TNF-alpha values in the sirolimus group were found to be statistically significantly lower than in the control and colchicine groups, but the differences between the control and colchicine groups were not statistically significant. No statistically significant differences were found between the groups regarding the VEGF values. Vascular neogenesis and peritoneal thickness were compared; the values in the sirolimus group were statistically reduced compared to the values in the control group. Mild fibrosis developed in 75% of all animals in the sirolimus group; there was no moderate or severe fibrosis observed. Fibrosis developed to varying degrees in 100% of the animals in the control and colchicine groups. Conclusion: The present study demonstrates that sirolimus might be beneficial for preventing or delaying the progression of PF and neoangiogenesis. These alterations in the peritoneal membrane may be connected with reduced TNF-alpha and TGF-beta levels. the control and colchicine groups, but the differences between the control and colchicine groups were not statistically significant. No statistically significant differences were found between the groups regarding the VEGF values. Vascular neogenesis and peritoneal thickness were compared; the values in the sirolimus group were statistically reduced compared to the values in the control group. Mild fibrosis developed in 75% of all animals in the sirolimus group; there was no moderate or severe fibrosis observed. Fibrosis developed to varying degrees in 100% of the animals in the control and colchicine groups. Conclusion: The present study demonstrates that sirolimus might be beneficial for preventing or delaying the progression of PF and neoangiogenesis. These alterations in the peritoneal membrane may be connected with reduced TNF-alpha and TGF-beta levels.
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    Laparoscopic Right Colon Resection With Transvaginal Extraction: A Systematic Review of 90 Cases
    (Lippincott Williams & Wilkins, 2015) Kayaalp, Cuneyt; Yagci, Mehmet A.
    Background:Natural orifice specimen extraction is a laparoscopic technique that reduces the procedure's invasiveness.Objective:We aimed to examine all the available data for the transvaginal extraction of laparoscopic right-sided colonic resections.Data Sources:A systematic search was conducted using PubMed/MEDLINE, Cochrane, Google Scholar, EBSCO, clinicaltrials.gov, and congress abstract databases.Study Selection:All case-control series, case series, and case reports were included, irrespective of age, region, race, obesity, comorbidities, or history of previous surgery. No restrictions were made in terms of language, country, or journal.Main Outcome Measures:Patient selection criteria and results of the cumulative data.Results:The search identified 10 studies including 90 cases. Most patients were elderly (mean, 65.9; range, 29 to 87 y) and had comorbid diseases (96%). 33.8% had a history of abdominopelvic surgery. The mean body mass index was 25.7 kg/m(2) (range, 18 to 50 kg/m(2)). Most patients (83%) had malign or premalign (14%) diseases and required regular or extended right hemicolectomies (99%). The mean operating time and blood loss ranges were 193 (140 to 471) minutes and 62.4 (0 to 300) mL, respectively. Overall, morbidities were seen in 18 patients (20%), and 3 of them were related to the transvaginal extraction. There were no abdominal wound related early or late complications. When compared with laparoscopic colon resections with transabdominal extraction, the procedure seems to result in decreased postoperative pain and length of hospital stay.Limitations:There are a limited number of comparative studies and an absence of randomized studies.Conclusions:Laparoscopic resection and transvaginal specimen extraction is a promising technique for some right-sided colon pathologies. For patient selection, an accessible vaginal port (patient acceptance and a vagina that is not narrow) and an en-mass lesion of 8 cm were necessary. Malignancy, previous abdominopelvic surgery, obesity, and old age were not considered as contraindications.