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    Effects of laparoscopy and laparotomy on stress and hemodynamics in experimental sepsis model in rats
    (2020) Unsal, Mustafa Gokhan; Carti, Erdem Baris; Yilmaz, Eyup Murat; Yenisey, Cigdem; Sekerci, Ulas Utku
    Aim: Laparoscopic abdominal surgery leads to reduced inflammatory response compared with laparotomy. However, there is controversial approaches are present in abdominal diseases complicated by diffuse or localized peritonitis. Materials and Methods: Experimental cecal ligation and puncture method is used in the study. A total of 24 rats were used in the study. We divided all rats randomly four groups: control, sepsis, laparotomy and laparoscopy. After sepsis model was applied, we took blood samples and lung and liver samples as well. In plasma samples we determined 8-OHdG, 3-Nitrotyrosine, HNE, PGF-2α via ELISA methods. The tissue samples were analyzed since the amount of blood samples were inadequate in all subjects. We measured MPO activity to assess the neutrophil infiltration rates. Results: 3-NT mean values in laparotomy and laparoscopy groups were found to be almost the same while the difference between sepsis and laparoscopy groups was statistically significant (p =0.015) and decreased in the group undergoing laparoscopy. MPO levels obtained in rats underwent laparoscopy in liver tissue were found to be lower when compared with control and laparotomy groups and the difference between them was statistically significant. Also, MPO levels was found higher in sepsis laparotomy model as compared sepsis laparoscopy models.Conclusion: Laparoscopy is accepted as golden standard in several elective procedures, since it is less stressful. Our results indicate that laparoscopy is superior to laparotomy in terms of inflammatory response in sepsis and should be preferred in septic patients.
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    Obturator Hernia in Elderly Female Patients
    (Int College Of Surgeons, 2018) Carti, Erdem Baris; Yilmaz, Eyup Murat; Ucar, Ahmet Deniz; Yildirim, Mehmet; Kutluturk, Koray
    Obturator hernia (OH) constitutes 0.07% to 0.4% of all intraabdominal hernias and 0.2% to 5.8% of small intestinal hernias. OH is usually seen in elderly, multiparous females and patients with a low body weight. This multicenter study includes patients who were treated in Adnan Menderes University Medical Faculty Hospital, Bozyaka Education and Research Hospital and inonii University Medical Faculty Hospital between January 2010 and June 2015. The diagnosis of OH was made preoperatively or perioperatively in patients who underwent emergency laparotomy for the treatment of ileus. A total of 14 patients were included in this study; 3 patients were treated by laparoscopic method (transabdominal approach) under general anesthesia and 2 of these patients (66.6%) died after the surgery. A total of 7 patients were treated by laparotomy. The remaining 4 patients were treated with a minimally invasive approach by using an epidural block without general anesthesia (3 patients with Pfannenstiel and 1 patient with a median inferior incision). The overall mortality rate was 42.8%. Anesthesia and surgery types have an important effect on mortality in elderly OH patients with multiple comorbidities. Minimally invasive approach with the use of epidural anesthesia can reduce the mortality rates in patients with OH. Abdominal computed tomography is the golden standard in the diagnosis of OH.
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    PATIENTS WITH SPONTANEOUS INTRAMURAL HEMATOMA AND OUR CLINICAL APPROACH
    (Derman Medical Publ, 2017) Carti, Erdem Baris; Yilmaz, Eyup Murat; Ucar, Deniz; Yilmaz, Mehmet; Kutluturk, Koray
    Aim: Non-traumatic, spontaneous small intestinal hematomas are very rare clinical conditions, diagnoses of which are difficult. These cases, in whom the diagnosis is made by the help of advanced visualization techniques, are usually attributed to anticoagulant therapy and obtaining a careful medical historyis suggested. We planned a retrospective study on our cases with spontaneous intestinal hematoma. Material and Method: In thismulti-center study involving three medical facilities, patients diagnosed with spontaneous intestinal hematoma between January 2010 and July 2016 were included in the study and their demographic data was recorded along with their treatments and radiological methods. Patients whose accurate data could not be acquired were excluded from the study. Results: A total number of 11 patients were diagnosed, 6 (54.5%) of which were women and 5 (45.5%) of them were men. The average age of the study group was 67.4 (58-78) years and the duration between the initiation of their complaints and the time of diagnosis was 5.0 (1-15) days. All patients were under anticoagulant therapy and their average INR value was 5.8 (3.2-8.4) when they were first admitted. The affected segment was jejunum in 6 patients (54.5%) whereas the ileum was involved in 5 patients (45.5%). All (100%) patients were discharged from the hospital as the result of conservative treatment. Discussion: Spontaneous intramural hematoma is a rare condition that has to be kept in mind when treating patients with anticoagulant therapy. Conservative treatment generally gives pleasing results in this condition.