Eyüp Murat Yılmaz

Amaç: Yüksek yerleşimli anal fistüllerin tedavisinde pek çok cerrahi teknik tanımlanmış her cerrahi tekniğin kendine ait avantajları vardır. Bizde çalışmamızda yüksek yerleşimli anal fistüllerin cerrahi tedavisinde hibrid seton tekniği ile fistül yolunun lazer ablasyonu tekniğinin uzun dönem sonuçlarını kıyaslamayı amaçladık. Gereç ve Yöntemler: Haziran 2020- Nisan 2023 yılları arasındaki yüksek yerleşimli anal fistül nedeniyle lazer ablasyon tedavisi (LAFT) ve hibrid seton uygulanan hastalar çalışmaya dahil edilecek olup postoperatif takip süresi 6 aydan kısa olan hastalar çalışma dışı bırakılacaktır. Hastaların dosyaları retrospektif olarak değerlendirilerek hastaların postoperatif komplikasyonları, preop ve postop 1. ay Cleveland fekal inkontinans skorları(CCFFSI score), postop birinci gün birinci hafta visual analog scale (VAS) skorları, takip süreleri, nüks oranları değerlendirildi. Takip süreleri 6 aydan kısa olan hastalar, chrohn hastalığı nedeni ile anal fistül tedavisi uygulanan hastalar çalışma dışı bırakıldı. Bulgular: Toplam 74 hasta değerlendirildi. 32 hasta LAFT (grup1), 42 hasta hibrid seton tekniği (Grup 2) ile opere edildi. Grup 1 de 2, Grup 2 de bir hastada postoperatif anal apse gelişti. Takip süreleri sırasıyla 48,43±9,99, 39,26±11,17 hafta; postoperatif birinci gün VAS skorları sırası ile 4,53±1,36, 4,61±0,93 olarak hesaplandı. Postop 7. Gün VAS skorları sırası ile 0,96±1,14, 1,83±0,98 olarak hesaplandı. Preop CCFI skorları sırası ile 1,71±1,25, 2,19±0,7 olarak hesaplandı. Postoperatif CCFI skorları sırası ile 1,78±1,23, 3,76±1,26 olarak hesaplandı. Postoperatif grup 1 de 9 grup 2 de 4 hastada nüks gelişti. Sonuç: Fistül yolunun lazer ile ablasyonu inkontinansı etkilemeyen, postoperatif konforu yüksek bir yöntem olmasına rağmen nüks oranının yüksek olması göz önünde bulundurulmalıdır.

Aim and introduction: Considering the recurrence and fecal incontinence rates in high anal fistulas, surgical treatment of anal fistulas is a challenging process, although many treatments have been defined today. The aim of our study is to evaluate the long-term results of laser ablation of the fistula tract in high anal fistulas. Material and methods: The files of patients who underwent laser ablation of the fistula tract due to high anal fistula between June 2020 and January 2022 were evaluated retrospectively. Moreover, their postoperative complications, preoperative and postoperative Cleveland fecal incontinence scores (CCFFSI score), postoperative first day and first-week visual analog scale (VAS) scores, follow-up times, and recurrence rates were analyzed. Results: 26 patients were included in the study. The mean follow-up period was 39.88±14.34 weeks, and the postoperative first and 7th day VAS scores were 4.61±1.41 and 0.8±1.02, respectively. Preoperative and postoperative CCFI scores were calculated as 1.8±1.41, 1.65±1.32, respectively. Recurrence was observed in 7 patients postoperatively. Postoperative anal abscess developed in 1 patient. Conclusion: Although laser ablation of the fistula tract can be safely performed as a technique that does not affect incontinence, recurrence rates should also be considered. Furthermore, more extensive randomized prospective studies on this technique should be performed.

Gallstone ileus is a relatively rare pathology, most commonly obstructing the terminal ileum. Bouveret syndrome, leading to gastric outlet obstruction and seen with an incidence of less than 1%, is a syndrome met particularly in elderly patients and develops as the result of cholecysto-enteric fistula. In this report, it was aimed to present a 95-year-old case diagnosed with Bouveret syndrome.

Background: Nowadays, it is claimed that advanced laparoscopic methods are minimally invasive, provide quick recovery of normal functions in patients and cause less stress in the organism compared to similar open surgery techniques. There is only limited research on 8-OHdG and 8-OHG levels, which are the markers of oxidative stress in both laparoscopic and open surgery. In this experimental study, we investigated the stress level caused by the laparotomic and laparoscopic colon resections in rats with induced colorectal cancer model. Material and methods: In this study, colon cancer was induced with subcutaneous dimethylhydrazine (DMH) (20mg/kg) in 30 Sprague-Dawley male rats. After 12 weeks, rats were divided into three groups: Group 1 (control group; n=10), Group 2 (laparotomy group; n=10), and Group 2 (laparoscopy group; n=10). Afterward, blood and lung tissue samples were obtained, and 3-NT, 4-HNE, OHdG, PGF2, and NO levels were measured. Results: There was a statistically significant difference between the groups in terms of 3-NT (ng/ml), which is a biomarker of oxidative stress (p<0.01). After obtaining blood samples from rats, DNA and RNA were isolated, and a statistically significant difference was found between the laparotomy and laparoscopy groups in terms of 8-OHdG and 8-OHG molecules (p<0.01). Conclusion: Laparoscopy, which initiated a new era in the scientific field, provided various advantages over laparotomy and widely used in colorectal surgery. In addition, it was demonstrated that laparoscopic surgery caused less oxidative stress, had advantageous effects on the antioxidant defense system, and thus superior to laparotomy.