IntroductionHypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented.AimTo present 12 cases of AP successfully treated by insulin administration.Material and methodsThree hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients’ medical records were retrospectively evaluated in this study.ResultsSerum triglyceride levels decreased to < 500 mg/dl within 2–3 days. No complications of treatment were seen and good clinical outcome was observed.ConclusionsOur results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.

Objective: Pilonidal sinus disease (PSD) effects mainly young men's social and work life with frequent recurrence rate. Reoperation for unimproved or recurrent disease is somehow troublesome. Surgeons may think that changing treatment strategy after recurrence may prevent further relapses of PSD. We analyzed patients with recurrent pilonidal sinus to determine their predisposing features for recurrence and the outcomes of the preferred surgical methods. Material and Methods:From 2007 to 2012, out of 95 recurrent pilonidal sinus disease (rPSD) patients, 62 operated cases were included and examined retrospectively. Their retrospective data were examined for demographics, 1 st and 2 nd operation types, patient satisfaction and pain scores. For cases with insufficient preoperative or postoperative data, phone call and interviews were done to obtain data. Some were kindly invited to the outpatient examination. Student's t test, Mann-Whitney U test, and Kaplan Meier test for disease free survival time were used where appropriate. P values less than 0.05 were accepted to be statistically significant. Results:Total of 62 rPSD patients were examined. Male:female ratio was 2.9:1. The mean age after 1 st and 2 nd operations were 24.7 and 28.1 years, respectively. One and five-year recurrence rates were 33.9% and 66.1%, respectively. The mean interval between the 1 st and 2 nd operations was 45.6 months. Excision and midline closure was the most frequent type of operation followed by flap reconstructions and excision-lay open procedures. The 1 st operation types of rPSD cases were different from that of 2 nd operations. Pain perception and satisfaction scores were better in flap reconstruction groups. Conclusion:Reoperative surgery of rPSD is satisfactory with certain precautions. Relapses after flap reconstruction procedures with a well-being period should be referred as second primary disease. Changing surgical strategy is not always indicated as some patients with recurrence have relapsing or second primary disease that have distinct clinical course. Re-flap surgery after any kind of relapse is well appreciated.

BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that has a very high mortality rate and for which the diagnosis is frequently delayed. The aim of the present study was to assess the predictive value of the Mannheim Peritonitis Index (MPI) and platelet-to-lymphocyte (P/L) ratio in the prognosis of AMI.

Amaç: Laparoskopik kolorektal cerrahi günümüzde birçok merkezde yaygın olarak kullanılan bir prosedür halini almaya başlamıştır. Kliniğimizdeki ilk laparoskopik kolorektal cerrahi olgularımızın erken dönem sonuçlarını sunmayı planladık. Yöntem: Eylül 2014-Ağustos 2016 tarihleri arasında Adnan Menderes Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı Kliniği'nde laparoskopik kolorektal cerrahi uygulanan olgular çalışmaya dahil edilmiştir. Bulgular: Çalışmamıza toplam 30 hasta dahil edildi. On bir olguya (%36,7) Low anterior rezeksiyon, 10 olguya (%33,3) sağ kolektomi, yedi olguya (%23,3) anterior rezeksiyon, bir olguya (%3,3) total kolektomi, bir olguya da (%3,3) abdominoperineal rezeksiyon işlemi uygulandı. Ortalama ameliyat süresi 149,67 dakika (aralık, 100-300) olarak kaydedildi. Hastaların ortalama hastanede yatış süreleri 6,87 gün (aralık, 3-34) olarak belirlendi. Toplam iki hastada (%6,7) anastomoz kaçağı gelişirken, bir hastada (%3,3) üreter hasarı, beş hastada (%16,7) yara yeri enfeksiyonu gelişti. Sonuç: Laparoskopik kolorektal cerrahi sonuçlarımız literatür ile benzer sonuçlar vermektedir. Anahtar Kelimeler: Laparoskopi, kolorektal cerrahi, deneyim ABSTRACT ÖZAim: Currently laparoscopic colorectal surgery began to be a widely used procedure in many centers. We aimed to present early period outcomes of first group of patients who had laparoscopic colorectal surgery in our clinic. Method: Included were 30 patients who underwent laparoscopic colorectal surgery between September 2014 and August 2016 in Adnan Menderes University Faculty of Medicine General Surgery Clinic. Results: A total of 30 patients were included to this study. Low anterior resection were performed in 11 (36.7%) patients, right colectomy in 10 (33.3%) patients, anterior resection in seven (23.3%) patients, total colectomy in one (3.3%) patient, abdominal perineal resection in one (3.3%) patient. Median operation time was 149.67 (range, 100-300) minutes. The median postoperative length of stay was 6.87 (range, 3-34) days. Anastomic leakage occurred in two patients (6.7%), ureter damage in one patient (3.3%), and wound infection in five patients (16.7%). Conclusion: Our laparoscopic colorectal surgery outcomes and the literature shows similarity.

IntroductionAlthough all studies have reported that laparoscopic cholecystectomy (LC) is a safe and effective treatment for acute cholecystitis, the optimal timing for the procedure is still the subject of some debate.AimThis retrospective analysis of a prospective database was aimed at comparing early with delayed LC for acute cholecystitis.Material and methodsThe LC was performed in 165 patients, of whom 83 were operated within 72 h of admission (group 1) and 82 patients after 72 h (group 2) with acute cholecystitis between January 2012 and August 2013. All data were collected prospectively and both groups compared in terms of age, sex, fever, white blood count count, ultrasound findings, operation time, conversion to open surgery, complications and mean hospital stay.ResultsThe study included 165 patients, 53 men and 112 women, who had median age 54 (20–85) years. The overall conversion rate was 27.9%. There was no significant difference in conversion rates (21% vs. 34%) between groups (p = 0.08). The operation time (116 min vs. 102 min, p = 0.02) was significantly increased in group 1. The complication rates (9% vs. 18%, p = 0.03) and total hospital stay (3.8 days vs. 7.9 days, p = 0.001) were significantly reduced in group 1.ConclusionsEarly LC within 72 h of admission reduces complications and hospital stay and is the preferred approach for acute cholecystitis.