BackgroundLaparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA.Materials and methodsBetween July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I) or the SA TEP group (Group II). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg) and fentanyl (10 µg) were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation.ResultsAll the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001) and 4 h (P=0.002) after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020).ConclusionTEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA.

Fournier's gangrene is still a severe disease. Today, hyperbaric oxygen treatment is very effective in the treatment of this disease.

PurposeLaparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC.MethodsForty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups.ResultsAnesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group.ConclusionCSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.

Fasciola hepatica, an endemic parasite in Turkey, is still a very rare cause of cholestasis worldwide. Through ingestion of contaminated water plants like watercress, humans can become the definitive host of this parasite. Cholestatic symptoms may be sudden but in some cases they may be preceded by a long period of fever, eosinophilia and vague gastrointestinal symptoms. We report a woman with cholangitis symptoms of sudden onset which was proved to be due to Fasciola hepatica infestation by an endoscopic retrograde cholangiography.

LigaSure Precise + in der Schilddrü senchirurgieZusammenfassung. Grundlagen: Die meisten Komplikationen der Schilddrü senchirurgie sind mit Ligatur und Koagulation verbunden. LigaSure Õ ist eine alternative Methode zur Gefä ßversiegelung und Ligatur und kann mö glicherweise beitragen, postoperative Komplikationen zu vermindern.Methodik: Vierzig Patienten mit multinodulä rer Struma wurden in zwei gleich große Gruppen eingeteilt. Die erste Gruppe wurde mit konventionellen Methoden und die zweite mit LigaSure Õ operiert. Die Gruppen wurden in Bezug auf postoperative Komplikationen, Krankenhausaufenthalt und OP-Dauer statistisch verglichen.Ergebnisse: LigaSure Õ hat die OP-Dauer verglichen mit der konventionellen Gruppe signifikant verkü rzt (ungefä hr 13 Minuten kü rzer), und es gab keinen signifikanten Unterschied bei den Komplikationen und der Krankenhausaufenthaltsdauer.Schlussfolgerungen: LigaSure Õ in der Thyreoidektomie kann als eine sichere Methode angewandt werden. Es kann als wichtiges Gerä t bei Operationen der Schilddrü se erachtet werden.Schlü sselwö rter: LigaSure + , Schilddrü senchirurgie, chirurgische Komplikationen.Summary. Background: Most of the complications of thyroid operations are related to ligation and coagulation procedures. LigaSure Õ is an alternative method for vessel sealing and ligation and may decrease operative complications. This study analyzed the effect of LigaSure Õ use on duration of operation and on complication occurrence, compared to that of conventional methods.Methods: Forty patients with multinodular goiter were included. They were divided into two groups; the first operated with conventional methods and the second with LigaSure Õ . The groups were compared statistically for post-operative complications, hospital stay and operation time.Results: LigaSure Õ shortened the operation time significantly (approximately 13 min shorter) compared to conventional group and there was no significant difference on complication and hospital stay.Conclusions: LigaSure Õ can be safely used for thyroidectomy. It is considered to be a major tool in thyroid surgery.