Journal of Clinical and Investigative Surgery

Journal Information
ISSN / EISSN : 2559-5555 / 2559-5555
Published by: Digital ProScholar Media (10.25083)
Total articles ≅ 134
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, Mete Zeynal, Nuh Çağrı Karaavcı, Mehmet Kürşat Karadağ
Journal of Clinical and Investigative Surgery, Volume 6, pp 178-182.;

The head clamp system is one of the indispensable equipment of neurosurgery in terms of stabilizing the head and positioning it. In addition, in neurosurgery clinics, the use of pin head clamp is required to use the navigation system effectively. In pediatric cases, complications after the use of pins head clamp are rare, as reported in the literature. This paper presents a pediatric patient with posterior fossa tumor and hydrocephalus, who developed depression fracture and epidural hematoma after the use of Mayfield 3-pin clamp head. For this reason, the patient underwent emergency surgery a second time and the epidural hematoma was evacuated to obtain decompression. Epidural bleeding, which is a complication of the pinned clamped head, is frequently described in the literature, often in the pediatric cases accompanied by posterior fossa tumor and hydrocephalus. In this type of pediatric cases, a safe study for the use of pin clamp head is not yet available in the literature.
Murat Celiloglu, , Sefa Kurt, Orkun Ilgen
Journal of Clinical and Investigative Surgery, Volume 6, pp 170-174;

Uterine fibroids are the most common benign tumors in women in the reproductive age group. The incidence of fibroids during pregnancy varies between 1.6 and 10.7%. In 10% of these cases, fibroids lead to complications. The management in symptomatic patients is conservative, and the surgical treatment is delayed until after birth due to its risks. In the last two decades, it has been shown that myomectomy can be an alternative treatment in selected cases, especially in second-trimester pregnancies. However, the data on the success of myomectomies performed earlier in pregnancy are limited. In this case report, we present two cases who were admitted to our clinic during the first trimester of pregnancy and had complicated fibroids. The diagnosis, the follow up and the treatment are presented with the review of the literature.
Bulent Karslioglu, Ali Cagri Tekin, Esra Tekin, Ersin Tasatan
Journal of Clinical and Investigative Surgery, Volume 6, pp 116-120;

Objective. Ankle arthrosis is an end stage disease for the ankle that happens because of posttraumatic arthropathies or inflammatory diseases. Ankle arthrodesis is the gold standard for ankle arthritis. We present the functional outcome for a mid-term follow up study of the patients who underwent trans fibular ankle arthrodesis fixated with hexapod type external fixator through a distal fibular grafting technique. Materials and Methods. A number of 18 patients with trans fibular ankle arthrodesis were included in this study, out of which 6 were female and 12 were male. The mean age at surgery was 57.6 (ranging from 45 to 73). All the patients underwent follow up for a mean follow up period of 27.5 months (ranging from 24 to 35 months). One of the patients had undergone ankle-related surgery for 9 times. The others had undergone 4 or more ankle-related surgeries. Results. Ankle fusions resulted in bony union within postoperative 4.1 months (ranging from 3 to 6 months). None of our patients had superficial or deep infection, soft tissue problems or problems about the external fixator. The mean preoperative AOFAS score was 52.4, and the postoperative AOFAS score was 78.2. We had 7 excellent (38.8%), and 11 (61.1%) good results. We had two cm shortening in 2 patients, 1.5 cm shortening in 1 patient and 1 cm in 5 patients. Conclusions. We have found this method to be useful to be applied to patients, especially to those who undergo lots of surgeries and for whom amputation is a last option.
, Sefa Kurt, Deniz Gokcay, Emine Cagnur Ulukus
Journal of Clinical and Investigative Surgery, Volume 6, pp 161-165;

Objective. Endometriotic tissue implants rarely transform to malignant tissue, especially in a patient with a hysterectomy and bilaterally salpingo-oophorectomy. However, several cases with cancer arising from endometriosis after hysterectomy were reported in the literature. Hormone replacement therapy only with estrogen is a crucial risk factor for malignant transformation of persistent endometriotic tissue. Case Report. The present case demonstrates an endometrioid adenocarcinoma arising from persistent endometriosis tissue in a patient who was performed hysterectomy with bilateral salpingectomy 3 years ago. The histopathologic specimens of the previous surgery did not include any malignant tissue. After 3 years, she applied to the hospital with abnormal vaginal bleeding, and her histopathologic examination result found an ulcerated mass at the upper one-third of the vagina that is compatible with endometrioid adenocarcinoma. Conclusion. It is crucial to keep in mind the endometriosis history of the patient, to be able to diagnose cancer arising from endometriosis while evaluating the patient with a hysterectomy.
, Mehmet N. Karabulut, Ayşe Baysal, Rahmi Zeybek
Journal of Clinical and Investigative Surgery, Volume 6, pp 121-130;

Purpose. This study investigated the effects of levosimendan on renal functions in patients with a preoperative low ejection fraction undergoing open-heart surgery and cardiopulmonary bypass (CPB). Materials and Methods. The study retrospectively evaluated 64 patients with a diagnosis of mitral valve insufficiency and left ventricular dysfunction undergoing open-heart surgery with CPB. Patients were divided depending on the preoperative blood creatinine level less (Group 1) or more than 1.2 mg/dL (Group 2). A bolus dose of levosimendan was administered through the aortic arch at the end of the CPB, preceding an infusion of levosimendan intravenously in all patients. Demographic data, preoperative and 48-hour postoperative echocardiographic studies were done. The blood urea and creatinine levels were collected preoperatively and on postoperative days 1, 3, and 10. The use of inotropic support, intra-aortic balloon pump, and complications were recorded. Results. The demographic data were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p=0.01, p0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p<0.001). On postoperative day 1, serum creatinine levels of Group 1 were significantly lower than Group 2 (p0.05). Complications were similar between groups (p>0.05). Conclusions. In patients with low ejection fraction undergoing open-heart surgery, the use of levosimendan intraoperatively and 24 hours postoperatively prevents deterioration of renal functions in patients with or without preoperative disturbance in serum creatinine level.
Esra Durmayüksel, Fadime Çinar, Bulent Baris Guven, Fatma Eti Aslan
Journal of Clinical and Investigative Surgery, Volume 6, pp 94-103;

Objective. Delirium is a temporary neuropsychiatric syndrome characterized by fluctuations in cognition and attention. Delirium is one of the most common complications seen in old individuals after orthopaedic surgery. With a high incidence, the clinical picture of delirium increases the length of hospital stay and increases healthcare-related costs. This study has aimed to systematically review the national and international studies that investigated the risk factors leading to delirium in geriatric patients after orthopaedic surgery and to perform a meta-analysis using the data reported by those studies. Materials and Methods. A preliminary literature review was performed on six databases. The following English keyword combinations were used including 'Orthopaedic Surgery', 'Geriatrics', 'Elderly', and 'Delirium'. The results of trials were evaluated with random or fixed effect model according to the heterogeneity. Statistical evaluation was performed by using Comprehensive Meta Analysis version 3 programme. Results. The total sample size of the studies included in the analysis was 892. In geriatric patients; who had undergone orthopaedic surgery and developed delirium, the random-effects model revealed a high-level, in the positive direction, and statistically significant (p<0.05) overall effect size of 5.21 (CI; 1.33-20.33) for gender, 1.33 (CI; 0.58-2.06) for age, 11.30 (CI; 4.70-27.12 for polypharmacy, and a low-level, in the positive direction, and statistically significant (p<0.05) overall effect size of 0.12 (CI; 0.05-0.27) for mini-mental state examination as the risk factors leading to the development of delirium. Conclusions. Advanced age, female gender, polypharmacy, and a mini-mental state examination score of 17-23 are major risk factors for the development of delirium after orthopaedic surgery.
Fatih Sumer, Ramazan Kutlu, Mehmet Ali Yağcı, Cuneyt Kayaalp
Journal of Clinical and Investigative Surgery, Volume 6, pp 175-177;

Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. If it is detected intraoperatively, conversion to open surgery is usually inevitable. Here, we described a complete ureteral transection during laparoscopic low anterior resection, which was simultaneously repaired by laparoscopic uretero-ureterostomy. The most important points during the anastomosis of two tiny tubular tissues are dissecting the tubular organs without trauma, obtaining meticulous hemostasis without causing any necrosis, and achieving accurate approximation of tissues with the sutures. To the best of our knowledge, this is the first report that focused on laparoscopic repair of ureteral injury during laparoscopic colorectal surgery. As there are still few data on laparoscopic repair of ureteral lesions, no firm conclusions can be drawn. But, in appropriate cases, if intracorporeal suture expertise is available, laparoscopic repair can be done during colorectal surgery.
, Türkay Kırdak, Pınar Sarkut, Ekrem Kaya, Nusret Korun
Journal of Clinical and Investigative Surgery, Volume 6, pp 153-156;

The aim of this study was to compare the frequency of umbilical hernia repair during open and laparoscopic cholecystectomies. Consecutive patients who underwent laparoscopic and open cholecystectomy between January 1993 and June 2005 were retrospectively reviewed. Among those, cases of patients who underwent simultaneous cholecystectomy and umbilical hernia repair were included in the study, and the distribution of hernia repairs via laparoscopic and open cholecystectomy were investigated. In addition, patients who underwent umbilical hernia repair only during the study period were also screened and the type of repair was noted in order to be compared to the types of hernia repair in the patients who underwent cholecystectomy. In total, there were 3,028 patients who underwent cholecystectomy, out of which 2,281 were performed via laparoscopy. In total, 46 patients underwent cholecystectomy and simultaneous umbilical hernia repair; 44 underwent laparoscopic cholecystectomy and umbilical hernia repair at the same time (P < 0.001), out of which only 2 were repaired through the use of a mesh. In contrast, 284 patients underwent only umbilical hernia repair, out of which 156 underwent primary repair. Simultaneous umbilical hernia repair during laparoscopic cholecystectomy was more common than hernia repair during open cholecystectomy.
Ismail Selçuk, Nehir Selçuk, Bülent Barış Güven
Journal of Clinical and Investigative Surgery, Volume 6, pp 131-135;

Objectives. Coronary artery bypass grafting (CABG) is the most common procedure in cardiac surgery and the great saphenous vein (GSV) are the preferred conduits. The effects of saphenous vein incision (SVI) harvesting site choice on SVI wound complications, pretibial edema, and the need for compression stockings were evaluated retrospectively in patients undergoing CABG surgery. Materials and Methods. A total of 1900 patients operated for CABG between 2003 and 2021 in our clinic were included in this study, with GSV harvest performed at below-knee level (Group-A, n:841) and above-knee level (Group-B, n:1059). SVI was made 2 cm superior and 1 cm anterior to the medial malleolus in group-A; and 3 cm superior to medial epicondyle, extending to 3 cm inferior to the inguinal ligament in group-B. Examination for edema was made with 4-5 seconds of thumb pressure at the ankle level, then the depth of the pit was measured. Results. Ankle edema (Group-A n:132, Group-B n:25), the use of compression stockings (Group-A n:97, Group-B n:13), and paresthesia (Group-A n:51, Group-B n:10) were different between the two groups and the differences were statistically significant. However, prolonged wound healing (Group-A n:11, Group-B n:38), superficial wound infection (Group-A n:6, Group-B n:11), hematoma (Group-A n:4, Group-B n:9), and lymphorrhea (Group-A n:4, Group-B n:7) incidences were not statistically different between the two groups. Conclusions. Among patients with GSV extracted using the open conventional surgery technique, pretibial edema, paresthesia, and compression stocking use were observed less frequently in patients with preoperative doppler-ultrasonography evaluation and above-knee saphenous harvest.
Hosni Mubarak Khan,
Journal of Clinical and Investigative Surgery, Volume 6, pp 104-115;

Objective. This is a prospective study of 50 cases of inguinal hernias which were treated through open inguinal hernia repair techniques. The study was conducted with the objective of comparing the effectiveness of these procedures and complications. Materials and Methods. A number of 50 cases of inguinal hernias admitted to Dr. BR Ambedkar Medical College and Hospital were selected on the basis of the non-probability (purposive) sampling method. All the patients with direct and indirect uncomplicated hernias treated by means of an open approach were included. After the preoperative preparation, they were randomly chosen either for Desarda’s or Modified Bassini’s repair techniques. Results. In the postoperative period, moderate pain was experienced by 19 patients included in the Desarda group and 17 patients included in the Modified Bassini’s repair group on day 1. The postoperative wound infection developed in 2 cases of Desarda and 3 cases of Modified Bassini’s, erythema was observed in 2 cases of Desarda and 3 cases of Modified Bassini’s, 3 cases reported the occurrence of seroma in the Desarda group and 4 cases of seroma were recorded in the Modified Bassini’s group. Conclusions. The patients who underwent Desarda repair complained of a higher intensity of pain, which could probably be attributed to the extensive dissection involved. The duration of Desarda repair was longer due to the learning curve of the surgeons in our hospital. The return to normal gait and normal activities was significantly lower in the Desarda group. The duration of hospital stays and the postoperative complications was not significantly different in the two groups. There were no recurrences in either of the groups until the current study.
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