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    Comparison between Karydakis flap repair and primary closure for surgical treatment of sacrococcygeal pilonidal sinus
    (Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2008) Polat, Nihat; Albayrak, Dogan; Ibis, Abdil Cem; Altan, Aydin
    Objectives: In this prospective study, we compared primary closure and Karydakis flap repair which has recently proved a popular technique for surgical treatment of pilonidal sinus. Patients and Methods: The study included 48 patients (46 males, 2 females) who were operated on for pilonidal sinus. The patients were randomized to two groups. After sinus excision, 33 patients (group 1) underwent primary closure, and 15 patients (group 2) underwent Karydakis flap surgery. The mean follow-up was 6.8 months (range 4 to 11 months) in group 1, and 6.2 months (range 3 to 10 months) in group 2. Results: Serous liquid collection and discharge were seen at the site of the lesion in four patients (12.1%) in group 1, and in two patients (13.3%) in group 2. Subcutaneous hematoma was detected in one patient (6.7%) in group 2. During the follow-up period, none of the patients developed wound infection. Recurrences were seen in one patient (3%) in group 1, and in one patient (6.7%) in group 2. Conclusion: Excision and primary closure can be the preferred method for the treatment of pilonidal sinus in selected patients due to its advantages such as ease and simplicity, shorter recovery time, and limited scar formation.
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    A Different Technique of Primary Indirect Inguinal Hernia Repair by Inserting a Synthetic Mesh into the Pre and Retroperitoneal Spaces to Wrap the Peritoneal Reflection: Preliminary Report
    (Aks Publications, 2011) Altan, Aydin
    In most methods of indirect inguinal hernia repair, the region of the sac stump remains a potential site of recurrence. A different technique that covers the site of the indirect sac stump is presented. Anterior parietal peritoneum is reflected posteriorly in the inguinal canal. In cases with Gilbert type I-II inguinal hernia, after the indirect sac is removed, the pre and retroperitoneal spaces in this region are dissected. A synthetic mesh is placed into these spaces, lateral to the inferior epigastric vessels. The posterior wall of this type hernia is intact. In cases with Gilbert type III inguinal hernia, either posterior wall repair is accomplished by using one of the tissue approximation techniques after placing a mesh in the region of the sac stump, or the entire peritoneal reflection in the inguinal canal is wrapped with a mesh after dissecting the pre and retroperitoneal spaces. This technique was performed in five patients. Of five patients, mesh was inserted on the region of stump in three (Gilbert I and II) and along the entire peritoneal reflection in two (Gilbert III). There were no postoperative complications such as seroma and pain and no recurrence till follow-up. This technique effectively wraps the peritoneal reflection and may prevent recurrences in primary indirect inguinal hernia, but it needs to be performed in a large number of cases for further evaluation.
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    Primary Hydatid Disease of Pancreas Mimicldng Cystic Neoplasm
    (Lippincott Williams & Wilkins, 2009) Ibis, Cem; Albayrak, Dogan; Altan, Aydin
    Primary hydatid disease of the pancreas is very rare. We report a 33-year-old female who was admitted to the hospital with abdominal discomfort due to the pancreatic mass. A diagnosis of a pancreatic cystic mass was established through abdominal ultrasonography and computed tomography scan. Hydatid disease as well as a cystic neoplasm of the pancreas were both thought in the differential diagnosis. Distal pancreatectomy with splenectomy was performed. The histopathologic evaluation of the specimen revealed a hydatid cyst affecting the tail of the pancreas. Hydatid disease Should be considered in the differential diagnosis of all cystic masses of the pancreas, especially in endemic regions.
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    A RARE CAUSE OF BENIGN BREAST TUMOR: BREAST HAMARTOMA
    (Aves, 2009) Sezer, Atakan; Yalcin, Omer; Altan, Aydin
    Introduction: Breast hamartomas are uncommon benign lesions. The aim of this paper is to discuss, breast hamartom, a rare benign tumor of breast. Method: On the base of the preoperative examinations and the operative fi nding a tumor of breast was suspected, and only the postoperative pathohistology examination verifi ed the proper diagnosis. Case Presentation: A 28 years-old woman presented with a history of palpable mass on her left breast for 6 months' duration. Physical examination demonstrated a mobile, smooth, painless, ovoid mass on the left breast. There were no palpable axillary lymph nodes. Ultrasonography revealed a well-circumscribed 20x15 mm mass with an echogenic pattern that was diff erent in echogenicity from the normal breast tissue. Mammography was not performed. The patient had excisional biopsy. The histological diagnose was hamartoma of breast. The postoperative course was uneventful and the patient was discharged on the second postoperative day. Conclusion: Hamartoma of the breast is a rare entity that is frequently underdiagnosed by physicians. The clinical diagnosis must be made on the basis of a combination of radiologic and pathologic features.
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    The Value of Intra-abdominal Pressure Measurement in Patients with Acute Abdomen
    (Elsevier Singapore Pte Ltd, 2009) Ibis, Cem; Altan, Aydin
    AIM: To find out the potential benefit of bladder pressure (BP) measurement as a diagnostic tool for acute abdomen. BACKGROUND: Acute abdomen is one of the most important clinical entities among general Surgical clinics. The diagnosis can be achieved by considering the patient's history, physical examination, laboratory analysis or by different imaging modalities. Abdominal compartment syndrome (ACS) occurs due to elevated intra-abdominal pressure (IAP), and can be diagnosed by measurement of BP. We observed in our clinical routine elevated IAP levels in patients with acute abdomen. METHODS: Two groups were established: one containing 65 consecutive patients diagnosed as having acute abdomen in the emergency room, and the control group of 10 consecutive patients with no acute abdominal complaints elected for laparoscopic operation. IAP measurements were performed before the operations. BP was measured in the supine position with 50 mL of sterile saline instilled into the bladder after the bladder had been emptied. The catheter was connected to a water manometer with the reference point being the symphisis pubis, BP levels greater than 7 cmH(2)O were accepted as abnormal and interpreted as a diagnostic criteria for acute abdomen. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value and the accuracy are calculated 95.4%, 80%, 96.9%, 72.7%, 93.3%, respectively. CONCLUSION: We found elevated IAP may support the physician's diagnosis of acute abdomen with approximately 27.3% false negative rate. [Asian J Surg 2009;32(1):33-8]