Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery

BACKGROUND

Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy.

MATERIALS AND METHODS

A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS).

RESULTS

A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups ( P =0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2 h VAS scores (mean±SD): Group 1: 3.58±1.07, Group 2: 3.86±1.12, Group 3: 1.20±0.67, and Group 4: 1.50±1.21 ( P <0.001)]; [4 h VAS scores (mean±SD): Group 1: 2.55±1.26, Group 2: 2.87±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [6 h VAS scores (mean±SD): Group 1: 2.50±0.91, Group 2: 2.53±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [12 h VAS scores (mean±SD): Group 1: 3.24±1.2, Group 2: 3.49±1.14, Group 3: 2.83±0.98, and Group 4 : 2.99±1.36 ( P <0.001)]; and [24 h VAS scores (mean±SD): Group 1: 3.75±0.99, Group 2: 4.01±0.91, Group 3: 3.61±1.34, and Group 4: 4.01±1.08 ( P <0.001)].

CONCLUSION

Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO 2 remaining under the diaphragm.

Comparison of Diagnostic Accuracies of USG, MG and MRI Modalities Defined with BI-RADS Classification System

BACKGROUND

BI-RADS classification provides facilitating information in diagnosis for radiologists. It allows radiologists to interpret mammograms accurately Objective: We aimed to compare the diagnostic accuracy of the modalities with the BI-RADS classification system made with imaging findings accompanied by USG, MG and MRI, which are a total of 3 modalities.

METHODS

This study included 82 patients who underwent Tru-Cut biopsy under the guidance of USG, MG, and MRI. Mammography, sonography and MRI were performed in the prone position.

RESULTS

Of the patients, 46.3%, 14.6%, and 39.0% were assessed in 4A, 4B, and 5 MRI BI-RADS categories, respectively. Based on the variable surgical/pathological diagnosis, 50%, 28.0%, and 22.0% of the patients were categorized as malignant findings, benign findings, and infection-inflammation-mastitis, respectively. The determination of the endpoints for the parameter of long-axis diameter (mm) was found to be statistically significant according to ROC analysis as a gold standard performed based on specificity levels of benign and malignant findings (p<0.05). A significant correlation was detected between the gold standard and the categorical variable MRI BI-RADS (χ^2=46.380, p<0.01).

CONCLUSION

When specificity and sensitivity of all three modalities in surgical/pathological diagnosis were compared, it was concluded that MRI was superior to the other modalities, and a valuable method in prediction of lesion malignancy and determination of biopsy prediction and priority.

Erratum: Comparison of cardiac magnetic resonance and cardiac ultrasound imaging findings in congenital and acquired heart diseases (2020, vol. 15, br. 2, str. 115-20, doi:10.24125/sanamed.v15i2.418)

The authors of this paper informed us about the existence of an error. Remzi Akturk has been listed as a co-author in this article. In order to prevent ethical issues, all authors of this article agreed that he should be listed as a guest author instead of co-author because he did not contribute in data collecting. Because of that, the name Remzi Akturk is removed from the author's list in this article. All authors send a signed agreement that the name of Remzi Akturk must be removed from the author's list. According to this, the list of the authors on pages 115 and 119 "Serdar Serinsoz, Remzi Akturk, Sibel Bayramoglu" should be replaced with: "Serdar Serinsoz, Sibel Bayramoglu"

The role of mesalazine co-treatment in the prevention of recurrence in subjects with subclinical inflammatory bowel disease and perianal fistula who are scheduled for surgical intervention

AIM

To investigate the impact of mesalazine co-treatment in addition to the surgical intervention on recurrence rate in subjects with subclinical inflammatory bowel disease (SIBD) who present with perianal fistula (PAF).

MATERIALS AND METHODS

All consecutive patients who had undergone surgery for PAF in our institutes were included in this retrospective analysis. Ileal tissue samples were obtained during colonoscopy for pathological evaluation. Patients with active chronic ileitis, structural distortion, erosion, ulceration, cryptitis, crypt abscess, fibrosis, and Paneth cell hyperplasia were defined as SIBD. Patients were divided into two groups according to the presence or absence of SIBD on pathological evaluation of ileal tissue samples (Group 1: SIBD +; Group 2: SIBD -). Rectal 5-aminosalicylic acid (mesalazine) of 2 gr once daily was administered to half of the subjects in each group for 8 weeks. The difference in 6 months recurrence rates of subjects receiving or not receiving mesalazine was the primary outcome measure.

RESULTS

The overall recurrence rate of subjects not receiving mesalazine was significantly higher than that of the subjects receiving mesalazine (9.7% vs. 4.4%, p = 0.020). Recurrence rate of the subjects with SIBD who received mesalazine co-treatment was significantly lower than those without mesalazine (1.6% vs. 12.6%, p=0.002). However, recurrence rate of the subjects without SIBD who received and not received mesalazine co-treatment was similar (6.8% vs. 7.8%, p=0.764).

CONCLUSION

Mesalazine co-treatment in addition to the surgical intervention was associated with lower 6 months recurrence rate compared to surgical intervention alone in patients with SIBD and PAF.

KEY WORDS

Inflammatory bowel disease, Mesalazine, Perianal fistula.

Comparing laparoscopic totally extraperitoneal inguinal hernia repair with and without mesh fixation

AIM

To compare totally extraperitoneal (TEP) repair in uncomplicated primary inguinal hernia patients with and without mesh fixation using tack in terms of peri- and post-operative complications, recurrence, return to work, and hospital stay.

MATERIAL AND METHODS

We retrospectively analyzed the medical records of patients who underwent TEP repair of uncomplicated primary inguinal hernia (American Society of Anesthesiologists score I/II) at our institute from January 2008 to December 2017.

RESULTS

In total, 354 patients were included in this study. There was no statistical difference in the body mass index (BMI) and duration of operation between patients with and without fixation. The mean number of days to return to work was significantly (p=0.000) higher in patients with use mesh fixation (9.06+1.749) compared to patients without mesh fixation (7.31+2.097). There was no difference between the two groups in terms of post-operative complications, except for seroma of the inguinal region, subcutaneous emphysema, and post-operative pain (p<0.05). The mean number of days of hospital stay was significantly (p=0.002) higher in patients with mesh fixation (1.11+0.329) compared to patients without mesh fixation (1.02+0.149). Evaluation of peri- and post-operative complications in BMI groups showed that obese patients and other groups had no significant difference (p>0.05).

CONCLUSIONS

Non-mesh fixation laparoscopic TEP repair is safe and feasible for primary and relapsed inguinal hernias. Patients experienced less chronic pain, shorter hospital stay, and shorter time to return to work. Furthermore, it might be safe in obese patients but requires additional study to confirm.

KEY WORDS

Hernia, Inguinal hernia, Laparoscopy, Mesh, Surgery.

Erratum: Comparison of cardiac magnetic resonance and cardiac ultrasound imaging findings in congenital and acquired heart diseases (2020, vol. 15, br. 2, str. 115-20, doi:10.24125/sanamed.v15i2.418)

The authors of this paper informed us about the existence of an error. Remzi Akturk has been listed as a co-author in this article. In order to prevent ethical issues, all authors of this article agreed that he should be listed as a guest author instead of co-author because he did not contribute in data collecting. Because of that, the name Remzi Akturk is removed from the author's list in this article. All authors send a signed agreement that the name of Remzi Akturk must be removed from the author's list. According to this, the list of the authors on pages 115 and 119 "Serdar Serinsoz, Remzi Akturk, Sibel Bayramoglu" should be replaced with: "Serdar Serinsoz, Sibel Bayramoglu"

Comparison of cardiac magnetic resonance and cardiac ultrasound imaging findings in congenital and acquired heart diseases

Objective: Nowadays, non-invasive methods are emerging in the evaluation of cardiovascular diseases. The aim of this study was to determine the diagnostic performance of cardiac magnetic resonance (CMR) imaging and cardiac ultrasound imaging (Echo) in cardiac patients diagnosed with Echo previously. Methods: In a total of 32 various cardiac patients with Echo findings including congenital and acquired heart pathologies who applied to our clinic were included in the study. The distribution of cardiac pathologies including valve dysfunctions, right and left ventricular wall lesions and movement disorders, atrioventricular hypertrophy, septal defect, pericardial effusion-mass, additional congenital or acquired vascular pathologies and additional thoracic pathology, age and gender correlations were determined. The CMR and Echo findings were compared statistically. Results: It was found that 12 (37.5%) of the individuals were female, 20 (62.5%) were male, aged between 6 and 80 years with an average age of 29.9 years. The cardiac parameters were positive in 27 (84.4%) patients according to Echo and were positive in 22 (68.8%) patients according to CMR. There was no statistically significant correlation between CMR and Echo for cardiac pathology detection rates (p > 0.05). However, only 18 out of 22 patients who were positive on CMR were positive on Echo. CMR was superior in detecting congenital cardiac pathologies. Conclusion: Echo has a diagnostic advantage and in general, CMR and Echo findings overlap in cases with valve dysfunctions, ventricular wall motion disorders, and hypertrophy, whereas we found that Echo findings were insufficient for diagnosis of congenital heart pathologies.

The effect of glyceryl trinitrate ointment on posthemorrhoidectomy pain and wound healing: results of a randomized, double-blind, placebo-controlled study

PURPOSE

Spasm of the internal sphincter may be a source of anal pain and delayed healing after hemorrhoidectomy. This study assessed whether glyceryl trinitrate (GTN) ointment reduces pain and promotes wound healing after hemorrhoidectomy.

METHODS

A prospective, randomized, double-blind, placebo-controlled trial was conducted comparing effects of an ointment containing GTN (0.2 percent) vs. a placebo ointment. The study preparations were self-applied by the patient to the surgical site twice per day for two weeks after the hemorrhoidectomy. Pain was assessed with a visual analog scale, and 24-hour analgesic use was recorded on postoperative days 1, 3, and 7. Complete healing was defined as complete epithelialization and evaluated at the end of the third postoperative week.

RESULTS

Sixty-nine patients were randomly assigned to receive topical 0.2 percent GTN group or placebo. Data from 30 patients in each group were available for analyses. Patients in the GTN group experienced significantly less postoperative pain than those with placebo on days 1, 3, and 7 (P < 0.05). Use of prescribed analgesics (metamizole and acetaminophen) was significantly greater for the placebo group on days 1 and 3. Wound healing at the end of the third postoperative week was significantly greater with GTN compared with placebo (76.7 percent vs. 46.7 percent, P = 0.02).

CONCLUSIONS

Compared with placebo, perianal application of 0.2 percent GTN ointment significantly decreases postoperative pain after hemorrhoidectomy and reduces analgesic requirements in the immediate postoperative period. GTN ointment also achieves more rapid healing of wounds.