1st APIMSF Congress BAKU 2018 And 30th Anniversary Meeting of APIMSF

World Journal of Surgery, Apr 2018

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1st APIMSF Congress BAKU 2018 And 30th Anniversary Meeting of APIMSF

World J Surg - APIMSF CONGRESS BAKU 2018 AND 30TH ANNIVERSARY MEETING OF APIMSF May 15-18, 2018 Baku, Azerbaijan Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Welcome Message of the President of 1st APIMSF Congress and 30th Anniversary Meeting of APIMSF, page s3 Military Surgery, page s4 Endoscopic Surgery, page s10 Trauma Systems and Quality of Care, page s15 Vascular Surgery, page s19 Intensive Care Medicine, page s21 Thoracic Surgery, page s23 Section 7 Miscellaneous, page s24 This supplement is sponsored by the Ambroise Pare´ International Military Surgery Forum (APIMSF) Welcome Message of the President of Congress Dear Colleagues, I cordially invite you to the 1st APIMSF Congress, organized by the Ambroise Pare International Military Surgery Forum in cooperation with the Military Hospital of the State Border Service of the Republic of Azerbaijan and the Turkish-Azerbaijani Endoscopic Surgeons Association. The Congress will take place between May 15-18, 2018 in the beautiful city of Baku. The event program is very rich both from scientific and practical perspectives. Republic of Azerbaijan stands out globally with its distinctive experience in military medicine. This gathering will prove to be a forum for discussing the experience gained over years, analyzing the results obtained, as well as improving services in the field of military surgery and disaster medicine and other medical issues. During the congress, medical centers with vast experience in military surgery will share their valuable experience with us. It is clear that compared to previous years we have come a long way in military medicine, especially in the field of military surgery, and we are looking forward to different opinions from our guests coming from all over the world. APIMSF has got over 30 years of experience shared by members and invited experts. This experience sharing and cooperation between colleagues made it possible to create a unique platform in the field of military surgery and made APIMSF one of the most prestigious and reputable organizations in the field. APIMSF is also a part of ISS-SIC and the biannual APIMSF meeting will take place under the auspices of the congress. Being a part of ISS makes APIMSF even stronger. The congress will host authoritative surgeons and other doctors who will deliver great lectures and guide the congress sessions. Furthermore, our local doctors with significant experience in the field of military surgery and disaster medicine will be pleased to share it with the colleagues from different countries. I must emphasize that we are going to have a rich social program during the congress. You will get to know Azerbaijan as a hospitable country with centuries-old traditions, with its pluralism and multiculturalism. I have no doubt that hosting this congress will contribute to development of the military surgery in our country and lay grounds for future achievements, which will contribute to the world medicine. I hope that the Congress will be useful and interesting for experienced surgeons and young doctors alike. With my warmest wishes, Prof. Dr. Kenan Yusif-zade, MD, PhD, MBA, FACS President of the 1st APIMSF Congress 2018 President of APIMSF (2017-2019) SECTION 1: MILITARY SURGERY Introduction: Negative pressure wound therapy (NPWT) is a modern method of treating wounds of various etiologies. However, the application of this method in the treatment of gunshot and blast injuries has not been sufficiently studied and therefore is rarely used. Materials and methods: The analysis of the application of NPWT in patients with gunshot injuries, undergoing treatment at the Republican Center for the treatment of patients with gunshot wounds and mineexplosive injuries was conducted. In the period from January 1, 2017 to March 1, 2018 NPWT applied in the treatment of 6 patients aged 24 to 57 years old. Five of them had gunshot wounds, and one had an explosive injury. We used the Water Lily system. In 4 patients NPWT was used to treat wounds of the extremities, in 1 patient – for the treatment of chest wounds, and in 1 patient – for complex treatment of multiple wounds of the upper, lower extremities and the chest. At the same time from 1 to 3 devices were used. Indications for the use of NPWT were extensive skin and soft tissue defects in the absence of visible foci of necrosis and stable hemostasis. Results: Our experience has shown the possibility of applying NPWT already from 2-3 days after injury, provided adequate debridement. The absence of the need for daily dressings eliminates the additional trauma to the patient and reduces the necessity for additional anesthesia, which as a whole allows stabilization of the patient’s general condition in a shorter time. Application of NPWT shortens the time of closing the wound surfaces by the use of sutures or free autodermoplasty. Conclusion: Application of negative pressure wound therapy in patients with gunshot trauma in combination with adequate debridement allows improving the results of treatment. Key words: Gunshot trauma, NPWT I have no potential conflict of interests to report. Abstract category: Abstract Managing the Bleeding Casualties: Common Civilian and Military Perspectives for Azerbaijan and Turkey Aytekin Unlu, Elgun Samadov, Soner Yilmaz, Aytach Chetinkaya, Ibrahim Eker, Nazif Zeybek Gulhane Medical Faculty, Department of General Surgery; Baku Avrasiya Hospital, Department of General Surgery; Gulhane Medical Faculty, Gulhane Regional Blood Bank; Sultan Abdulhamid Han Training and Education Hospital, Department of Infectious Diseases; Afyon Kocatepe University, Department of Pediatric Hematology; Gulhane Medical Faculty, Department of War Surgery Introduction: Approximately 85% of combat deaths occur in the prehospital period, 91% of the potentially survivable deaths (PSD) are due to blood loss. Thus, the Gulhane Trauma Hematology Research Group have started extensive indigenous research fort he future of national trauma care. Materials and methods: Our research concentrated on decreasing blood losses and increasing the availability of blood products (BP). Major concern was that majority ofPSDs were due to truncal, junctional and extremity injuries. Available literature data and potential fields of research pertinent to transfusion of blood products (BPs) for trauma have been studied. Results: We analyzed CAT tourniquet success rates, training goals and optimum windlass turn degrees to stop bleeding by two randomized prospective studies. Funded research for designing new extremity (HAYAT) and junctional tourniquets has been started. We studied and proposed a new anti-HBc positivity related re-entry mechanism too increase the National Blood Donor Pool. We have also demonstrated the efficacy of cryopreserved erythrocytes and platelets to create long term strategic blood stores for contingency situations. In two different studies, we showed that platelets cryopreserved with 0.9%NaCl and also storage of platelets at 4 0C showed superior hemostatic activities. In vitro, we lyophilized plasma (lyP) and demonstrated its efficacy. lyP seems promising for forward use of this product, in conjunction with erythrocyte suspensions, by forward surgical teams in the battlefield. Currently, a national research on preserving the stability of erythrocytes is currently underway. Also, we plan to build mobile, fast transfusion/infusion pumps with heating capability Conclusion: We need to adopt our findings to field trauma care in order to save more lives. Key words: Combat, Trauma, Blood I have no potential conflict of interests to report. Abstract category: Abstract An Analysis of Firearm Deaths in Malatya Between 2010 and 2014 Bedirhan Sezer Oner, Osman Celbis, Semih Petekkaya, Zeynep Yener, Servet Irgin Irtas, Abdullah Mert Unsal Amasya University Medical Faculty, Forensic Medicine Department; Inonu University Medical Faculty, Forensic Medicine Department; Abant Izzet Baysal University, Forensic Medicine Department; Council of Forensic Medicine Introduction: Firearm injuries has an important place in the practice of medicolegal autopsies. In our study; In Malatya Forensic Medicine Group Presidency, a retrospective screening study was carried out in order to determine the sociodemographic and forensic medical characteristics of deaths due to firearm injuries. Materials and methods: In the study, 756 cases of deaths due to firearm injuries that were autopsied during the period of 2010-2014 in Malatya Forensic Medicine Group Presidency were examined. Results: A total of 756 cases were identified and 141 (18,7%) were female and 607 (80,2%) were male. The sex of 8 (1,1%) cases could not be determined. The age of 681 was determined and the age range was 3-82, with an average age of 31,2. Origins; 8 (1,1%) were accidents, 226 (29,9%) were homicides, 121 (16,0%) were suicides, 294 (38,9%) were conflicts with security forces. The origin of 107 cases could not be determined. Death locations; house and surroundings 160, open land 362, health facility 48 (6,3%), and the other 181 (32,6%) was found. 183 (24,2%) of the cases in head and neck, 95 (12,6%) of them in chest, 16 (2,1%) of them in abdomen, 5 (0,7%) of them in the extremities, and 457 (60,4%) of them were injured in more than one region. Conclusion: It was determined that conflicts with security forces in the region increased the number of deaths due to the firearm injuries. Deaths due to firearm injuries are often seen to have more than one wound in more than one area. Depending on this, it is thought that it is useful to identify the characteristics of each wounds such as, mortality, entry or exit state, trajectory etc. for clarification of the cases. Key words: Firearm deaths, Autopsy I have no potential conflict of interests to report. Introduction: Over the past 10 years there were 75 terrorist attacks in Russia. On 3 April 2017 ISIS committed a terrorist act in the Saint Petersburg subway car. Improvised explosive device contained about 300 g of explosives. The bomb was equipped with metal projectiles. Materials and methods: One minute following the explosion Emergency Medical Service operator received the Event report. Within a short period, 50 ambulances arrived to the subway station. Triage and prehospital medical care was provided. 40 min after the explosion the last casualty was evacuated to the five nearest Trauma Centers. Results. According to final data, the total number of explosion casualties was 103. Bomb killed 11 peoples (including the terrorist) at the scene in the subway car (11%). Of the rest 92 casualties: 89 patients received care near the site of the explosion, 3 patients sought medical care later. 37 casualties were hospitalized on emergency, including 12 – severe and critical injury (T1 priority), 25 – moderately severe injury (T2 priority). The rest 55 casualties had soft tissue injuries, barotrauma and psychic trauma (T3 priority). 87 patients out of 92 (95%) recovered. 1 casualty (in extremis) died in ambulance on the way to hospital. Results: Lethal outcomes were recorded in 2 casualties on admission to Trauma Centers due to massive hemorrhage and fatal injuries. 2 more casualties died of septic complications and multiple organ failure. Conclusion: The majority of the subway car explosion casualties had blast injuries, barotrauma, craniocerebral trauma, multiple fragment injuries, burns. Gunshot and blast injuries differ markedly from common peacetime trauma. Combined blast injuries present a number of difficulties in diagnosis and providing surgical care for civil hospital surgeons. Damage control surgery was widely and efficiently used in the treatment of severe blast trauma. Key words: Blast trauma I have no potential conflict of interests to report. Abstract 5 Abstract category: Abstract Surgical Tactics Mine-Explosive Injuries with Tearing Off and Crashing of One Limb and Bone Ruptures with Tissue Defects of the Contralateral Limb Majid Masimov, Ilgar Omarov, Huseyn Masimov, Eldeniz Hajiyev, Taryel Guliyev Azerbaijan Medical University, Military Head Clinic Hospital, Military surgery, Orthopedy And Traumatology Department; Azerbaijan Medical University, Department Of Military Surgery Introduction: The surgical treatment of contact mine – explosive injuries of limbs, based on implication of a novel author-elaborated technique of skin-cellular tissue-fascial plastics of tissue defects, is recommended. Materials and methods: The research includes 162 mine-explosive cases. 18 (11.1%) patient of them were with tearing off and crashing of one limb and bone ruptures with tissue defects of the contralateral limb. In mine explosive injuries with tearing off and crushing of one limb, bone rupture and tissue defects of other one the elaborated technique of treatment includes step-by-step operations on the pathological loci. In reactive-toxic periods of traumatic diseases the surgical interventions are realized with keeping of the left tissues of the end of the removed or crushed limb segments. In recovery period the non-free skin-cellular tissue fascial scrap on two supporting feet is formed by cutting it from the ischemia trained left tissues of the limb and sewing its free ends to the surface of the wound defect of the contralateral limb with tissue defect. After 3.5-4.5 weeks the re-amputation of one limb and plastics of the wound defect of the other one with application of vascularized and ischemia-trained auto-transplant, formed from the saved tissue, are realized in one step. Results: In all cases positive morphological and functional issues are achieved (short and long-term-20 year results). Key words: Mine trauma, Treatment I have no potential conflict of interests to report. Abstract 6 Abstract category: Abstract Use of Cutaneous-Subcutaneous-Fascial Flaps Adopted to Hypoxia in Reconstruction-Restoration Surgery for Severe Gunshot Extremity Fractures (Long-Term Results 20-25 Year) Majid Masimov, Ilgar Omarov, Huseyn Masimov Azerbaijan Medical University, Orthopedy And Traumatology Department Introduction: Treatment of hard gunshot extremity fractures are one of the most actual problem in military surgery. Results of this pathology is not satisfactory always. Often injury finishing with amputation of extremity. Materials and methods: Treatment results for gunshot extra- and intra-articular fractures of the extremities of types A, B, C have been analyzed. Total number of patients was 310, i.e. with A type fractures 13.3%, B - 40.8% and C - 45.9%. Patients were admitted with « typical » purulent and serous wound inflammation (53,1%) and with various purulent necrotic complications (46.9%). In 39% of victims a defect of integumentary tissues in the fracture zone required the application of plastic surgery. Complex treatment consisted of advanced surgical technique for gunshot wound debridement and local pathogenic therapy. That method provided for optimization of the wound process course, prevention of secondary devitalization of the injured tissues and performance of early reconstruction-restoration treatment. To reconstruct soft tissue defects a new technique of nonfree autoplasty was elaborated. The method was based on the application of preliminary adopted to hypoxia cutaneous-subcutaneousfascial flaps. Surgical technique does not require angiography, special and microsurgical equipment. Results: Long-term results (20-25 year). Overall morph functional outcome was positive in 96,8% of patients. Mean duration of treatment made up 116.2 ± 4.5 days. Key words: Gunshot, Extremity, Fractures I have no potential conflict of interests to report. The Method of Continuous Passive Method (CPM) in Complex Rehabilitation of Patients with Gun-Shot Wounds of Hip Joint (HJ) Nizami Hasanov, Andrey Istomin, Oleksander Boroday, Anastasia Korolkova, Yuriy Klapchuk, Valentyn Zhuravliov Azerbaijan Medical University, Traumatology And Orthopaedy Department; Kharkiv National Medical University, Department Of Ph. Rehabilitation, Sports Medicine With A Course Of Physical Education And Health; Military Medical Clinical Center of the Northern region, Clinic of Injuries; Kharkiv National Medical University, The 3rd Medical Faculty Introduction: Patients with gun-shot wounds need a specialized treatment and further rehabilitation because of trauma‘s distinctive pathomorphological character. The result of damaging in anatomical difficult zone like a HJ would be a cause of different complications during treatment or rehabilitation. The applying of CPM-method using native developed machine ‘‘Legtronic’’ was proposed by our team to reach the release of rehabilitation process in such patients. Materials and methods: Analysis of 2 clinical groups with similar characters (age, sex, pathology and treatment) was carried out. The 1-st, main group, included injured 20 people, the 2-nd, control group, included 31 ones, who received surgical treatment of gun-shot wounds of HJ. Patients of control group got the standard restorative treatment while patients of main group were treated both by standard program and developed method of CPM using ‘‘Legtronic’’. A survey of patients conducted by accepted plan before, during and after treatment. Results: The estimation of CPM-method‘s efficiency was carried out in 2 groups immediately after start of rehabilitation, after 3 weeks and after 3 months. In the evaluation were included next characteristics: the degree of renovation in range of motion of HJ, using visual analogue scale, the dynamic of edema and restoration of vascular tone of low extremities. It was developed that CPM-therapy with ‘‘Legtronic’’ in main group leads to reliable shortening of rehabilitation by increasing range of motion compared to the control group, with a significant decreasing of pain and edema and getting back to average state of vascular tone. Conclusion: According to results of provided analysis in 2 groups the high potency of the developed machine « Legtronic » for CPMmethod in complex restorative treatment for patients with gun-shot wounds of HJ that allows recommending it for wide clinical use. Key words: Hip joint, Rehabilitation I have no potential conflict of interests to report. Abstract 8 Abstract category: Abstract Surgery of Injuries in the System of Rendering Care to Victims in Terrorist Acts and Catastrophes Pavel Brusov Introduction: Large diversions proceed as technogenic catastrophes. Therefore, each terrorist act is regarded as a catastrophe, connected with the threat of mass death of people. Materials and methods: In 1994, Russia established a disaster medicine service, which was engaged in providing assistance to the population in emergency conditions and terrorist attacks. After the publication of the orders of the Ministry of Health in 2009 and 2012, damage surgery (trauma system) was organized. The development of the system of trauma care in Russia went according to the generally accepted way in all countries. Results. During the period 1995-2017 in Russia, 22 major terrorist acts were committed in which 6226 people were killed. In 4 cities, 5,628 hostages were captured. When storming units of anti-terror and releasing hostages, 1,665 people were injured, 660 (ratio 2.5:1) were killed. When explosions in homes, airports, subway, trains, in the squares, 3047 people were injured, 854 (ratio 3.5:1) were killed. Results: Practically the surgical pathology of the terrorist attacks did not differ from the combat trauma. Mostly there was an explosive injury, combined and multiple injuries accounted for 70% with a predominant lesion of two or three areas of the body. Therefore, the concept of injury surgery is based on the fundamentals of military field surgery. Conclusion: The concept of modern injury surgery is inseparably linked with the medicine of catastrophes and the ambulance service, but the basic provisions are transferred from the practice of military field surgery. For the development of unified approaches to the treatment of polytrauma and gunshot wounds in peacetime, the interaction of military and civilian surgeons is necessary and clear implementation of plans for rendering assistance to the wounded in terrorist acts. Key words: Terroristic act I have no potential conflict of interests to report. Abstract 9 Abstract category: Abstract Increasing the Combat Trauma Readiness of Turkish Health Personnel Sahin Kaymak, Pelin Ozmen, M. Burak Asik, Sami Eksert, Nazif Zeybek, Aytekin Unlu Gulhane Medical Faculty, Department of General Surgery; Turkish armed forces health command, Military health services; Gulhene Medical Faculty, Department of otorhinolaryngology; Gulhene Medical Faculty, Department of Anesthesiology Introduction: In February 2018, the Department of War Surgery held a 5-day training course in Gulhane Medical Faculty, aiming to improve on-site trauma care capabilities of practitioner doctors assigned to military service. Materials and methods: Twelve practitioner doctors from different troops around Turkey attended the course. The course comprised 14 different medical disciplines and 36 lessons. Attendees were handed 29 multiple choice questions from targeted core topics as pretests and posttests. Statistical analyses were performed using SPSS Ver. 23. Results: Posttest results were significantly higher after each lesson (p \ 0.05).The order of medical disciplines’ success rates from high to low was, Anesthesiology, ENT, Orthopedics, Thoracic Surgery, War Surgery, Vascular Surgery, Neuro Surgery, Plastic Surgery, Infectious Disease and Blood Banking, respectively. Conclusion: All essential knowledge and capabilities were taught within a 5-day, albeit short, course schedule. Despite the ongoing training courses for combat personnel for 3 years, this was the first combat trauma course for practitioner doctors. Turkish Military has been actively fighting against threats around the country and medical personnel should remain well prepared for duty. Instead of knowledge based theoretic lessons, trainees will fare better from trauma training in simulated combat environment. Key words: Combat, Trauma, Training I have no potential conflict of interests to report. Military Field Surgery of Russia in the Modern Era of Local Wars: Ex-periens Gained and Prospects for Development Introduction: XXI century - the era of high-tech wars. Current trends in the development of military field surgery in the world are due to the increase in the specific gravity of a severe shockogenic combat injury to 20-25%. Today there is no single universal model of war. Therefore, it is necessary to strictly determine the main directions in the development of military field surgery, laid in peacetime. Materials and methods: A prospective analysis of the treatment results for the patients with thoracic trauma injuries associated with pleuro-pulmonary complications was carried out during the period 2016-2017 at the Institute of Emergency Medicine from Chis¸ina˘u, Republic of Moldova. 522 patients were included in the study. The ratio M:F – 2:1. Mean age 54.64 ± 3.43 years. 126(24.3%) patients had pleuropulmonary complications: 68(13%) – hemothorax, 58(11.1%) – posttraumatic pneumothorax. All patients with baseline pleuropulmonary complications were subjected to pleural drainage. Military conflicts are analyzed, in which the Russian Armed Forces participated: the war in Afghanistan (1979-1998), the conflicts in the North Caucasus (1994-1996 and 1999-2002) and South Ossetia (August 2008). Based on the experience gained, the reform of the medical service and reduction was carried out. Results: In the military conflict in Chechnya (1994-1996), the irretrievable losses amounted to 5552 people: killed in battle - 4513, died in hospitals from wounds - 338, died from noncombatant injuries 191, disappeared without enter - 484, were taken prisoner - 24. Sanitary losses amounted to 51 387 people: wounded – 16 098, sick 35 298. Mortality in hospitals was 1.03%, 78.9% of the wounded returned to work. Conclusion: To save lives seriously injured in the difficult conditions of modern combat, further improvement of the methods of medical assistance is necessary. The development of military medicine and the emergence of new technologies for damage surgery make it possible to carry out mature transformations with the timely equipping of military hospitals and the training of surgical personnel. The increasing complexity and severity of modern combat trauma repeatedly increases the task of training a military surgeon for future wars. Key words: Military, Surgery I have no potential conflict of interests to report. Atypical Trajectory of a Gunshot Injury Without Penetration Suzan Temiz, Gonul Gulmez, Omer Faruk Demir, Omer Onal Erciyes University Faculty of Medicine, Thoracic surgery Department Introduction: Gunshot injuries are common medical-legal issues. We aimed to present a case of an atypical gunshot wound that is directed to the gastrointestinal tract without causing lung damage by bumping into bone tissue. Case description: A 30-year-old male patient was referred from the external center after gunshot injury. On physical examination of the patient; the right scapula midline only had access to firearm injuries; there was redness and edema in the neck area. The vitals were stable. Scapula fracture, pneumomediastinum of thorax CT (Computed tomography) and foreign body (bullet) were seen in left chest cavity of thorax CT. Anteroposterior chest x-ray in our hospital showed no evidence of bullet, abdomen and thoracic CT was repeated. Thorax CT; pneumomediastinum starting from the neck region was observed, no bullet in the chest cavity. At the abdomen CT, a bullet was seen in the right lower quadrant nearby intestinal loops. ENT and General surgery were consulted for mediastinous gunshot injury, esophageal injury and possible larynx injury. On the endoscopic examination, a defective area was seen on the right side of the posterior pharyngeal wall. The idea was that the lead was in the intestinal system. Highdose antibiotherapy started. Surgical intervention was’t considered and the patient was followed up with daily pharynx examination. The second day, granulation tissue was observed. Third day, the defect was closed and ruffled on the mucosal wall. On the fourth day of follow-up, the patient’s regime was opened with only water. Later, bullet continued the process and went out. No bullets were seen on the patient’s control grafy. And when the antibiotics ended, the patient was discharged. Conclusion: In our case, it was seen that the bullet core changed direction without following a linear trace. Introduction: The analysis of the obtained data showed: for all patients, regardless of the area of damage, treatment began with debridement, application of negative pressure wound therapy from 24 h from admission, monitoring of wound condition, and from 5-7 days closure of the soft tissue defect was performed. Case description: There were revealed such feature in the treatment of hand injuries as: dissection of the carpal ligament to all patients with wounds in the hand area; primary osteosynthesis was performed using K-wires; in half the cases, the use of reconstructive-plastic methods for restoring soft tissue defects as well as on the bones (4finger pollicization) was required; restoration of tendons, the suturing of nerves and vessels was postponed until the edema and the ability to close the soft tissue defect were reduced. For the forearm, the principles are similar, in one case bilocal osteosynthesis of the forearm bones in the external C-frame was performed with a significant defect in both bones. Patients with lesions in the shoulder region required primary osteosynthesis by an external fixation. Significant soft tissue defects were restored at the same time by the displacement of the thoracodorsal artery perforator flap. The final osteosynthesis was performed not earlier than the soft tissue stabilization, in three cases free bone implantation was used with an autograft from the iliac crest. In two cases, posttraumatic neuropathy of the radial nerve was identified, for the correction of which the flexor tendons were transposed to the extensor position. Key words: Orthopaedic damage control I have no potential conflict of interests to report. Use of Endo-GIA Staplers in Transanal Mass Excision Sahin Kaymak, Mehmet Demir, Mustafa Tahir Ozer Gulhane medical faculty, Department of General Surgery Introduction: Due to the ongoing fight against terrorists in our country, high velocity gunshot injuries has been frequently encountered by surgeons. Outcomes are directly related surgeons’ experience. We, hereby, present our experiences in a gunshot injury management, operated and transported to Gulhane Medical Faculty General Surgery Department. Case description: A 30-year old male was shot and urgently transported to nearby hospital. The entry wound was on the left upper gluteal region and there was no exit wound. The laparotomy showed Grade IV left colon injury, iliopsoas muscle injury, multiple Grade 2-3 small bowel injuries and non-displaced left ilium fracture. Left colon resection, end colostomy, multiple small bowel repairs, left ilipsoas muscle bleeding hemostasis was performed. On the second day, he was transported and admitted to our hospital. Initial examination of casualty revealed left lower quadrant hyperemia/enduration under the colostomy. After 7th postoperative day, patient’s WBC count increased to 18.000/mm3 and 30.000/mm3, respectively and fever was [ 38.8 degrees. Surgical exploration of the abdomen showed two small bowel leakage zones on primary repairs. Muscle necrosis was found on the previously mentioned endurated left lower abdominal wall and also in the iliopsoas muscle. During the debridement of abdominal wall, necrosis also involved the surrounding wall muscles of colostomy. The patient was performed primary small bowel repair, colostomy transposition to right lower quadrant and wide debridement of iliopsoas muscle. He was taken to the operating room 4 times after the initial findings, for retroperitoneal and abdominal wall debridements. He was discharged from the intensive care unit 6 days after the last surgery and taken to the ward room. He was discharged 2 weeks later. Conclusion: The approach in the treatment of patients with severe trauma to the upper limb should be comprehensive, according to the principles of orthopaedic damage control, osteosynthesis should be consistent, the main role in assessing the severity and prognosis of treatment is played by soft tissues. Conclusion: Short segment multiple small bowel injuries should be treated by resection anastomosis. If an ostomy is required, it should be performed on the unaffected side of the abdominal wall. Key words: Gunshot, Colostomy, Reoperation I have no potential conflict of interests to report. Use of Vacuum-Assisted Closure System for the Management of Acute Traumatic Abdominal Wall Herniation with Evisceration Reconstruction of Combat Injuries of the Foot and Ankle: Distally Based Sural and Saphenous Flaps Mesut Yavas, Cagri Buyukkasap, Kursat Dikmen, Hasan Bostanci Konstantin Fiodorov, Alexandr Sukharev, Bohdan Vasiliy Gazi University, Department of General Surgery Introduction: Vacuum-Assisted Closure System (VAC) accepted as appropriate method for management of open abdomen. VAC system accelerate wound healing by increased blood flow, diminished inflammatory response, altered bacterial burden, changes in wound biochemistry. In this case report, we present use of VAC system for the management of acute abdominal wall herniation with evisceration. Case description: 41 years old male patient came to emergency room by working accident. There was loss of dermis, subcutaneous tissue, muscle and fascia from right 6th rib to inguinal region. There was colon and small bowel evisceration was out. Emergent laparotomy was done. In exploration there was no solid or luminal organ damage. There was a 5 cm defect on right hemidiaphragm and fractures on right 6, 7, 8, 9, 10th ribs. Defect on diaphragm was repaired primarly and chest tube was placed. Then abdominal VAC system (Genadyne Abdominal Dressing Kit) was applied with 80 mmHg negative pressure. VAC system was renewed two times after 3rd and 6th days. On 9. day patient underwent 4th surgery, periton and muscle tissues were repaired and VAC system renewed by 125 mmHg negative pressure. Patient got cefazolin and metronidazole treatment 16 day in our clinic. In 17th day patient was discharged from clinic with VAC system. After discharge VAC system was renewed under local anesthesia 5 more times in every 3 day. In 60. day skin autograft was implanted to wound area by plastic and recostructive surgeons. Today patient continues his visits. Main Clinical Military Medical Centre 432 of the Armed Forces of the Republic of Belarus, 2nd Trauma Department; Belarusion State Medical University, Military Faculty Introduction: We wanted, through our clinical experience use of distally based sural and saphenous flaps. The main issues under consideration could close the defect of soft tissues of the foot and ankle at high risk of using artery for reconstructive surgery (single artery, the small diameter of the terminal branches, concomitant diseases of the cardiovascular system, the high dose of anticoagulants), the use of distally based reverse fasciocutaneous neurovascular flaps in chronic post-traumatic inflammation (osteomyelitis ulcer), shortening the rehabilitation and rapid recovery of lower extremity function. Case description: The study included 20 patients with soft tissue defects in the foot and ankle. Mean age was 39.5 ± 7 years, all the patients were men. In 10 cases (50%) were treated in patients with chronic post-traumatic ulcers in 5 cases (25%) patients were operated on the various forms of chronic osteomyelitis of the tibia, the remaining 5 cases (25%) was a group of patients with ‘‘fresh’’ posttraumatic defects soft tissue. All patients with soft tissue defect on the anterior surface of the tibia was performed with distally based reverse fasciocutaneous neurovascular sural flap. In patients with localization process in the region of the Achilles tendon, calcaneal tuberosity and margin of plantar surface of the foot was made of plastic distally based reverse fasciocutaneous neurovascular saphenous flap, including with the use of modified techniques like maintenance of the fasciocutaneous strip above the neurovascular bundle. Conclusion: VAC system is an important choice in management of open abdomen and preparation for reconstruction. VAC system can be applied safely for acute traumatic abdominal wall herniation with evisceration after damage control surgery. Key words: Acute, Abdominal, VAC I have no potential conflict of interests to report. Conclusion: All patients, as a preoperative examination, ultrasonography was performed. All grafts taken root and provide good functional and esthetic results. Key words: Fasciocutaneous, Sural, Flap I have no potential conflict of interests to report. University of Health Sciences, Gulhane Training and Research Hospital, Department of Anesthesiology, Department of General Surgery Introduction: High-energy explosives not only damage organs, but also damage tissue integrity. Vacuum assisted wound closure (VAWC) methods are frequently used in the treatment of patients with such wide wound defects. This noninvasive method is accelerates the healing of wounds by providing negative pressure. However there is very few experience about VAWC technique at deep wounds caused by explosives. For this reason, we aimed to present the case of VAWC technique at patient with multitraumatic patient with large deep explosive caused wound. Case description: 25-years-old male patient was referred to our clinic with large tissue defects including multiple fractures at extremities and pelvic floor injury. Anal examination showed no rectal/anal injury but massive soft-tissue injury. Laparoscopic loop colostomy surgery was performed to prevent fecal contamination. Surgical debridement/ curettage/irrigation was performed and so infected/necrotic tissue was removed. Following repetitive surgical interventions, VAWC was performed while preserving the anal zone. Patient was re-operated for 15 times in every 2-4 days and wound was partially sutured if necessary. After the sessions were complete, full recovery of the perirectal wound was observed. Sphincter function was assessed with anal monometer resulting with normal continence. The colostomy of the patient was closed after 6 months. Conclusion: Deep tissue injuries of soft-tissue caused by high-energy explosions may be treated with VAWC technique which accelerates wound healing by increasing blood flow and granulation tissue and decreasing edema and exudates. It also prevents the systemic circulation of the local infection by the negative pressure, thus preventing the possible sepsis. We propose that this method, which has been shown to be successful in our complicated wound management case, is a feasible technique for post-explosive infected large tissue defects. Key words: Bile, Injury, Conservative I have no potential conflict of interests to report. Single-Stage Treatment with ERCP and Laparoscopic Cholecystectomy Versus Two-Stage Treatment with ERCP Followed by Laparoscopic Cholecystectomy Within 6 to 8 Weeks: A Retrospective Study Bahtiyar Muhammedoglu Kahramanamrash City Hospital, Department of General Surgery Introduction: Obstructive jaundice is one of the earliest symptoms of a hepatobiliary system disorder. The aim was to compare single-stage ERCP/laparoscopic cholecystectomy (LC) and two-stage ERCP and LC with respect to the frequency of using imaging methods, duration of anesthesia and the length of hospital stay at our clinic. Materials and methods: Of 350 patients undergoing ERCP between 01.01.2015 and 31.12.2016, 31 patients with single-stage ERCP and LC were assigned to Group A and 25 patients with two-stage ERCP followed by LC within 6-8 weeks were assigned to Group B. Eligibility criteria included ERCP duration, the difficulty of the procedure, bile duct stones as demonstrated by imaging methods, no contraindications for LC and no suspected or known malignancy. The same surgeon performed ERCP and LC in both groups (Tables 1, 2, 3). Results: No cases of morbidity or mortality occurred in any groups. The average length of stay was 8.03 ± 4.97 days in Group A and significantly longer (9.92 ± 4.05 days) in Group B (p \ 0.026). However, the length of stay (in days) was calculated as the time from presentation to hospital until discharge and not the time elapsed after the procedure. Imaging methods were used at 3.9 ± 3.07 occasions in Group A and significantly more frequently (5.92 ± 2.55 occasions) in Group B (p \ 0.001). Total duration of anesthesia was not statistically significant different between the study groups (154.06 ± 53.76 min in Group A and 167.04 ± 75.17 min in Group B). Conclusion: In conclusion, single-stage ERCP and laparoscopic cholecystectomy is associated with shorter hospital stay and lower frequency of using imaging methods and can be safely used in select cases. No cases of pancreatitis or mortality occurred following singlestage procedure. Single-stage procedure can be safely used in select patients with obstructive jaundice. Key words: Laparoscopic cholecystectomy, Ultrasonography I have no potential conflict of interests to report. P 0.220 Table 2 Patient characteristics by study group Variables Age* Male Gender Female Abstract category: Abstract Abstract 19 Mersin State Hospital, Department of Urology; Acibadem Hospital, Department of Urology; Gulhane Education and Research Hospital, Department of Urology; Liv Hospital, Department of Urology; Gazi University, Department of Urology Introduction: Robot-assisted laparoscopic prostatectomy (RALP) has recently become so popular as standard treatment modality for organconfined prostate cancer (PCa). Superior functional results have been demonstrated in terms of early continence, quality of life (QoL) after RALP, which are at least important as oncologic results. For preserving the bladder neck and neighboring anatomy as internal circular sphincter, some challenging surgical maneuvers are of extreme importance. In view of our limited surgical experience with long-term follow-up, we evaluated anatomic details for the relationship between the bladder neck and the prostate base. The aim of our study was to describe our novel surgical technique including dissection technique for preserving the bladder neck resulting with very early continence. Materials and methods: Between January2011-December2017, 331 RALPs were performed.Demographic, perioperative and postoperative data were recorded. Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal and postoperative 1st month control. Fatty connective tissue between bladder neck and prostate was introduced, and circular muscle fibers of the internal sphincter were seen in all patients. Complications were classified according to the Clavien-Dindo classification. Statistical analyses were performed. Mean follow-up was 15.7 ± 3.2 months; mean age was 62.2 ± 4.2 years.Our novel surgical technique for preserving the bladder neck was performed in 331 patients.Mean duration of catheterization was 7.1 ± 1.3 days and all patients were continent after catheter removal. There was a significant difference in QoL before RALP and after catheter removal, however there was no statistical difference between preoperative and postoperative 1st month control respectively (P \ 0.001,P = 0.5). Results: There were no complications as bladder neck stricture, urinary retention, Clavien III-V complications. In addition, conventional laparoscopy or open surgery was not required in any case. Conclusion: Our novel technique provided early continence at the time of catheter removal. This is a promising progress for early recovery and better QoL scores. Our challenging continence results can really establish the standard for preserving the bladder neck in RARP. Key words: Robotic, Incontinence, Bladder sparing I have no potential conflict of interests to report. Abstract category: Abstract Long-Term Result of Our Transperitoneal Laparoscopic Nephrectomy Technique (Tunc Technique): Retrospective Study Huseyin Gumustas, Serdar Yalcin, Engin Kaya, Eymen Gazel, Esat Ak, Lutfi Tunc Adana State Hospital, Department of Urology; Gulhane Research and Training Hospital, Department of Urology; Acibadem Hospital, Department of Urology; Mersin State Hospital, Department of Urology; Gazi Unversity, Department of Urology N/A: Not available RCC: Renal cell carcinoma TCC: Transitional cell carcinoma XGF: Xanthogranulomatous pyelonephritis NFK: Non- functioning kidney TLN: Transperitoneal laparoscopic nephrectomy Introduction: Previously we have described the transperitoneal descending laparoscopic nephrectomy (TLN) and in this study we aimed to present our long term analysis of this approach. Materials and methods: A total of 306 patients that underwent TLN between January 2011 and September 2017 were included to the study. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, pathologic margin status were analyzed. Results: A total of 306 patients underwent the TLN. Mean tumor size was 6.5 ± 1.83 (range 3,5-12 cm). Mean intraoperative estimated blood loss was 38 ± 6.91 mL. Mean operation time was calculated 24.97 ± 6.8 min. In subgroup analyses, mean operation time of right and left side were 23.47 ± 6.35 min and 26.95 ± 6.09 min, respectively. Duration of hospital stay was 1.85 ± 0.69 days. For hilar control, endogia vascular stapler was used in 74.7% (n:130) and 77.2% (n:102) of the patients right and left sided laparoscopic nephrectomy procedure, respectively. On the other hand, the patients who underwent endoclips were 25.3% (n:44) in right side and 22.8% (n:30) left side (Table 1).In current study, mean patient age was older Table 1 Comparison of the patient demographics and surgical outcomes between the current and initial studies p Value 306 196 110 174 132 than the initial studies’ population. No statistically differences were found in mean tumor size, mean estimated blood loss, complication rate and positive surgical margin. In current study, mean operation time and duration of hospital stay were significantly shorter than initial study (p:0.001, p:0.003). Conclusion: This study clearly demonstrates that descending TLN technique shows shorter operation time and hospital stay comparing and standard transperitoneal or retroperitoneal nephrectomy in the literature, and seems better. Key words: Nephrectomy, Laparoscopy, Technique I have no potential conflict of interests to report. Abstract 21 Gulhane Education and Research Hospital, Department of Urology; Acibadem Hospital, Department of Urology; Kahramanmaras Goksun State Hospital, Department of Urology; Liv Hospital, Department of Urology; Gazi University, Department of Urology Introduction: Holmium Laser enucleation of the prostate (HoLEP) is a foreground alternative to open prostatectomy (OP) the historical gold standard transurethral resection of the prostate (TURP), and other minimal invasive modalities in all sizes of prostates in the treatment of benign prostate hyperplasia (BPH). The aim of the present study was to evaluate our short-term results of HoLEP in our first 206 patients. Materials and methods: Between November 2015 and February 2018, 206 consequtive patients diagnosed BPH underwent HoLEP procedure. Peak flow rates (Qmax), postvoiding residual urine (PVR) and international prostate symptom score (IPSS) were assessed preoperative and postoperatively. Perioperative data and postoperative results were assessed. Results: The mean preoperative peak flow rates, the preoperative postvoid residual urine and preoperative IPSS results were 8.69 (SD 3.69) ml/sec, 178.83 (SD 115.79) ml and 22.97 (SD 5.89) respectively. During the operation, measured mean enucleation and morcellation time were 73.5 (SD 42.34) and 9.91 (8.9) minutes, respectively. Mean total operative time was 83.4 (SD 48.43) minutes. Hospital stay was 31.91 (SD 8.77) hours and the duration of urethral catheter was 48.87 (SD 30.59) hours. The mean postoperative peak flow rates, the postoperative postvoid residual urine and postoperative IPSS results were 29.07 (SD 12.02) ml/sec, 17.63 ml (SD 21.83) ml and 2.18 (SD 2.15) respectively. All improvements in the measures were statistically significant. Conclusion: Conclusion: Indications for HoLEP is irrespective of prostate volume. Our inital results showed similarity with the literature, randomized controlled trials and meta-analysis. Therefore, for the experienced endoscopic surgeons, this technique is feasible and effective even in the first cases. Key words: Holep, Benign prostate hyperplasia I have no potential conflict of interests to report. Abstract 22 Endosurgical Methods in Management of Acute Biliary Pancreatitis Suraddin Zeynalov Azerbaijan Medical University, Department of Surgical Diseases Introduction: The evaluation of efficacy of less invasive methods in management of acute biliary pancreatitis. Materials and methods: We have retrospectively analyzed the results of treatment of 68 patients (56 of them females) aged 34-78 who had been managed because of acute biliary pancreatitis 2011 through 2017 at the Department of Organ Transplantation of Teaching Surgical Clinic of Azerbaijan Medical University. Aged and elderly patients were prevalent (46 patients – 67.6%). Edematous type pancreatitis was in 42, and necrotizing in 26 patients. Results: 1 to 6 stones were removed at ERCP in 54 patients. In 1 patient a large stone was crushed by lithotriptor and then passed to duodenum. 9 patients developed negative outcomes after the endoscopic procedure. Some complications were detected at clinical, laboratory and instrumental investigations on 1-3 days postoperatively. Different size necrosis foci and fluid collection were found in pancreas parenchyma in 4 patients, bursa omentalis in 6 and parapancreatic tissue in 8 patients. 1 patient developed an abscess of bursa omentalis on 14th postoperative day. Puncture drainage under ultrasonic guidance was applied for such complications. 8 patients developed pancreatic peritonitis, and 1 patient developed a large size retroperitoneal phlegmone complicated with sepsis 3 weeks later. Laparoscopic abdominal drainage surgery, external drainage of the biliary ducts and cholecystectomy were applied to these patients. The patient with retroperitoneal phlegmon underwent open surgery with necrectomy, drainage of retroperitoneal tissue and bursa omentalis. Conclusion: Less invasive endoscopic and laparoscopic procedures play a special role in elimination of etiologic factor of acute biliary pancreatitis in comparison with more traumatic open surgery accompanied with high mortality. Key words: Biliary pancreatitis, Management I have no potential conflict of interests to report. Abstract category: Case report Conservative Approach to Biliary Injury Sahin Kaymak, Rahman Senocak, Salih Hamcan, Ahmet Uygun, Mustafa Tahir Ozer Gulhane medical faculty, Department of General Suregry; Gulhane medical faculty, Department of Radiodiagnostics Introduction: Laparoscopic cholecystectomy (LC) is still widely used in elective and laparoscopic general surgery and can easily be done in almost every center today. The rates of biliary injury are inversely proportional to the experience of the surgeon. In this article, non-operative management of a patient with biliary injury after LC has been discussed. Case description: A 31-year-old female patient underwent elective LC at peripheral center. On postoperative day 7, the patient applied to the same center with complaints of abdominal pain and swelling. In the laboratory tests, mild abnormalities were detected. MRCP was performed due to the absence of a pathological appearance in the abdominal ultrasonography and the proximal part of the common bile duct was visualized, but the distal part was not. She was referred to our clinic with a suspicion of bile duct injury. Abdominal ultrasonography showed diffuse free collections in the Douglas pouch. Percutaneous drainage catheter was placed and approximately 1500 cc bile came through. Endoscopic retrograde cholangiopacreatography (ERCP) was then performed. Opaque substance given in ERCP did not pass to the proximal and also the guide wire went out of the bile duct. Full or partial biliary tract injury was considered. The decision to implant a percutaneous transhepatic catheter(PTK) was then made. Transhepaticbiliary catheter was passed to the duodenum. At the same time, a percutaneous catheter was placed laterally to the liver. The bile content from the PTK increased while the bile from the drains of Douglas and liver was reduced and cut. The patient was followed up for approximately 3 weeks and underwent an ERCPguided choledocal stent placement. The drains were removed and she was discharged on the third day after the procedure. Case description: 26 years old male patient came to our clinic with nausea after meals and right upper quadrant pain. Patients was diagnosed with cholelithiasis and planned for laparoscopic surgery. After the introduction of scope to abdomen, proper hepatic artery was recognized over the gall bladder. Gall bladder was dissected starting from the hilum without injuring the hepatic artery and then cystic duct with cystic artery was clipped/transected. Proximal 1/3 of gall bladder was dissected from liver as described at critical view of safety. The gall bladder was then pulled upwards by the cystic hilum from posterior of proper hepatic artery to anterior through the bifurcation of proper hepatic artery. Then the gall bladder dissection was completed and was taken out of the abdomen. Patient was discharged without any complications. Conclusion: Bile duct injuries require a multidisciplinary approach. In experienced centers, we think that unnecessary surgeries can be avoided in appropriately selected cases by multidisciplinary approach. Key words: Bile, Injury, Conservative I have no potential conflict of interests to report. Abstract category: Case report Hepatic Artery Sailing Over Gall Bladder: A Rare Variation Struggling Surgeons Nazif Zeybek, Yasar Subutay Peker, Aytekin Unlu, Mehmet Fatih Can University Of Medical Sciences, Gulhane Training And Research Hospital, Department of General Surgery Introduction: Variation of hepatic vascular system and bile system is very common. Over 50 variations are reported for both luminal systems. This struggle the hepatic surgeons because surgeons must be sure of the kind of the tissue before transecting every luminal structure. One of the very rare variations of hepatic vascular system is proper hepatic artery sailing over gall bladder and entering to liver from the level of fundus. We wanted to share our experience of successful laparoscopic cholecystectomy at a case which proper hepatic sales over hepatic artery. Conclusion: Hepatobiliary system variations are common for both vascular and ductal system but proper hepatic artery sailing over gall bladder is very rare. Surgeons must keep in mind that variations of hepatobiliary system may cause morbidity and mortality but should not discourage the surgeon. Increasing experience of surgeons will provide them to deal with unexpected variations of hepatobiliary system as in our case. Key words: Laparoscopic cholecystectomy I have no potential conflict of interests to report. Abstract 25 Abstract category: Abstract Treatment of Chronic Calculous Cholecystitis in the Hospital One Day Maxim Chinikov, Fazil Kurbanov, Layla Alvendova, Rustam Azimov, Ilona Panteleyeva RUDN University, Department Of Hospital Surgery With The Course Of Pediatric Surgery Introduction: Currently, laparoscopic cholecystectomy (LCE) in some countries is done on an outpatient basis. Materials and methods: Results of treatment of 239 patients with chronic calculous cholecystitis between 2012 and 2016. All patients underwent the LCE. All patients are divided into 2 groups: group 1 59 patients who underwent LCE in a hospital for one day; group 2 180 patients treated in the surgical Department. Patients with uncomplicated forms of the disease, with class I-III risk of anesthesia (ASA classification) were selected for treatment in hospital of one day. Groups of patients were comparable by sex, age, risk class of anesthesia. Results: Intraoperative bleeding from the bladder bed occurred in 1 (1.7%) patient group 1 and 2 (1.1%) patients group 2. In all cases, the bleeding is stopped by coagulation. In 2 (1,1%) patients of group 2 completed the conversion of access in connection with the identified perivesical infiltration. The total number of postoperative complications until discharge in patients of the group 1 was 1.7%, group 2 was 6.7% (p \ 0.05). The average duration of postoperative treatment in patients of the group 1 amounted to 19.7 ± 1,4 h, group 2 67,2 ± 26,4 h. Based on the results obtained, an algorithm for treating patients with chronic calculous cholecystitis in a hospital for one day has been developed. Conclusion: Treatment of patients in hospital for one day did not lead to an increase in the frequency of postoperative complications. Performing LCE in hospital for one day is possible with careful selection of patients, mandatory patronage after discharge with the possibility of round-the-clock hospitalization in hospital. Key words: One-day cholecystectomy I have no potential conflict of interests to report. SECTION 3: TRAUMA SYSTEMS AND QUALITY OF CARE Abstract type: Abstract Modern Trends in the Diagnosis and Treatment of Trauma of Pancreas Andrey Singayevsky, Badri Sigua, Alexei Kurkov North-Western State Medical University named after I.I. Mechnikov, Department of Faculty Surgery named after I.I. Grekov Introduction: Injuries of a pancreas are rare. Postoperative complications arise in 32-75% cases. Lethality reaches 73%. Diagnostic in time and treatment is a current problem of surgery of damages. Materials and Methods: Results of treatment of 182 patients with injuries of pancreas treated from 1991 to 2015 were analyzed. 97 patients who were on treatment from 1991 to 2003 have made the I group, 85 from 2004 to 2015 – the II group. Ultrasonography has been performed on 46 patients with the closed stomach injury in the II group, at the same time pancreas damages are revealed only in two cases (4.3%). The sensitivity of this method was 84.8%. The CT has been executed at 7 patients from the II group. At the closed stomach injuries with injury of a pancreas the laparoscopy has been applied at 55.9% of patients in the II group in comparison with 31.7% in I. The resection was carried out in the most number at injury of a tail of pancreas. A pancreatoduodenal resection has been executed in one case at wound of a head of a pancreas. Plugging of a lesser sac in the II group took place only in 3 cases in comparison with 34 in I. All operations have been finished by drainage. Results: The most frequent complication of injuries was pancreatitis – 17.6% in the II group and 34.0% in I. Improvement of treatment and diagnostic has allowed to lower lethality from 24.7% to 18.8%. Conclusion: Modern methods of radiodiagnostics allow to reveal only indirect signs of injury of pancreas, but could reduce time of diagnostics. The operation has to be limited to drainage for the purpose. It is also expedient to limit use of plugging of a lesser sac only to medical tactics of ‘‘damage control’’. Key words: Trauma, Pancreas I have no potential conflict of interests to report. Abstract 27 What Proportion of Femoral Artery is not Amenable to Occlusion by the Field Extremity Tourniquets? Aytekin Unlu, Salih Hamcan, Shahin Kaymak, Ali Kagan Coskun, Elgun Samadov, Nazif Zeybek Gulhane Medical Faculty, Department of War Surgery; Gulhane Medical Faculty, Department of Radiology; Gulhane Medical Faculty, Department of General Surgery; Baku Avrasiya Hospital Introduction: Junctional exsanguinating hemorrhage constitute 19.2% of combat related preventable deaths in the prehospital period. Thus, we evaluated the computed tomography angiography (CTA) imaging features of the femoral arteries (FAs) beyond inguinal ligaments and determined its relations as a guide for future junctional tourniquet design. Materials and methods: A total of 101 patients who underwent CTA imaging of the abdominal aorta and/or lower extremity arteries for various clinical indications were analyzed retrospectively. FA length between the external groin line and inguinal ligament was measured as not amenable to tourniquet (NAT). All patients’ right and left groin regions were analyzed. Results: A total of 202 femoral arteries (FA) in 101 patients (93 male, 8 female) were evaluated. The mean left and right FA NAT lengths were 50 ± 14.7 and 50.8 ± 16.5 mm, respectively. CFA mean length was significantly higher in males. There were no statistically significant differences in mean FA lengths, mean external groin line (EGL) to spina iliaca anterior superior (SIAS) and EGL to FA lengths between the left and right groin regions. The left and right EGL to FA distances were significantly higher in the older (C 41 years) age group. Conclusion: This is the first morphological study that addresses the FA for mandatory junctional tourniquet application in case of an injury. Detailed analysis of FA revealed differences between genders and different age groups. CTA enabled a comprehensive evaluation of FA NAT to pinpoint its location for applying effective, self-compression by specifically designed tourniquets even in low light environment. Key words: Junctional, Injury, Tourniquet I have no potential conflict of interests to report. Abstract 28 Abstract category: Abstract Bringing PRBC to the Point of Combat Injury: Are We There Yet? Aytekin Unlu, Ozlem Yalchin, Soner Yilmaz, Riza Aytach Chetinkaya, Ibrahim Eker, Nazif Zeybek Gulhane Medical Faculty, Department of War Surgery; Koch University, Department of Hemorrhages; Gulhane Training and Research Center, Regional Blood Bank and Blood Training Center; Sultan Abdulhamid Han Training and Education Hospital, Department of Infectious Diseases; Afyon Kocatepe University, Department of Pediatric Hematology; Gulhane Medical Faculty, Department of War Surgery Introduction: Hemorrhage is the leading cause of injury related prehospital mortality. We investigated worst case scenarios and possible requirements of Turkish Military. As we plan to use blood resources during casualty transport, the impact of transport related mechanical stress on PRBC (packed red blood cell) were analyzed. Materials and methods: The in vitro experiment was performed in the environmental test laboratories of ASELSAN . Operational vibrations of potential casualty transport mediums such as Sikorsky Helicopters, Kirpi Armoured Vehicle and NATO vibration standard software MIL-STD-810G were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (B 7 days) and 10 units of old ([ 7 day) PRBC in a blood cooler box. The vibrations were simulated by TDS v895 Medium-Force Shaker Device. On site blood samples were analyzed at 0, 6th and 24th hours for biochemical and biomechanical analyses. Results: The mean age of fresh and old PRBCs was 4.9 (SD ± 2.2) and 32.8 (SD ± 11.8) days, respectively. Six-hour mechanical damage of fresh PRBC was demonstrated by increased erythrocyte fragmentation rates (p = 0.015), hemolysis rates (p = 0.003), supernatant potassium levels (p = 0.003) and decreased hematocrit levels (p = 0.015). Old PRBC hemolysis rates (p = 0.015), supernatant potassium levels (p = 0.015), supernatant Hb (p = 0.015) were increased and Htc levels were decreased (p = 0.015) within 6 h. Two (%13) units of fresh and none of the old PRBC were eligible for transfusion after 6 h of mechanical stress. Conclusion: When the austere combat environment was simulated for 24 h, fresh and old PRBC hemolysis rates were above the EDQM criteria. Currently, a technology to overcome this mechanical damage does not seem to exist. Key words: Combat, Trauma, Transfusion I have no potential conflict of interests to report. Abstract category: Abstract Nonoperative Management of Hepatic and Splenic Injury Caused by Blunt Abdominal Trauma, Clinical Experience Cagri Buyukkasap, Kursat Dikmen, Hasan Bostanci, Cagatay Cifter Gazi University, Department of General Surgery Introduction: The liver and spleen are the most frequently injured abdominal organs after blunt abdominal traumas. In selected patients with hepatic and splenic injuries can be accomplished using nonoperative management. The aim of this study was to conduct a clinical analysis of 20 cases of nonoperative managed hepatic and splenic traumas. Materials and methods: 20 patients who had hepatic and/or splenic injury caused by blunt abdominal trauma and were nonoperative managed were analyzed retrospectively. Results: 16 of the patients were male and 4 were female. The mean age was 39,5. 16 patients with blunt injury due to motor vehicle collisions and 4 were due to falls. 4 patients had only splenic injury, 12 patients had only hepatic injury, 4 patients had both hepatic and liver injury. 18 patients had associated injuries; 8 patients had rib fracture, 4 had pelvic fracture, 3 had chest injury, 2 had spinal cord injury, 2 had face bone injury, 1 had brain injury, 1 had kidney injury. 1 patient were pregnant and she had bilateral tibial fracture. 10 patients had minor liver injury (Grade I-II), 6 patients had major liver injury (Grade III-IV-V). 6 patients had minor splenic injury (Grade I-II), 2 patients had major splenic injury (Grade III-IV). Mean hemoglobine decrease was 3,22 g/dL. Median blood transfusion was 0 unit eritrocyte suspansion (range 0-4). Median hospitalisation was 5 days (range 1-12). Conclusion: Nonoperative management is the treatment of choice for hemodynamically stable patients with hepatic and splenic injury, regardless of injury grade. This management requires availability of resources, including availability of intensive care unit beds, blood bank support, immediate operating room availability. In patients who had associated injuries, multidiciplinary approach is important. Key words: Nonoperative, Hepatic, Splenic I have no potential conflict of interests to report. Abstract 30 Introduction: We wanted, through our clinical experience use of distally based sural and saphenous flaps. The main issues under consideration could close the defect of soft tissues of the foot and ankle at high risk of using artery for reconstructive surgery (single artery, the small diameter of the terminal branches, concomitant diseases of the cardiovascular system, the high dose of anticoagulants), the use of distally based reverse fasciocutaneous neurovascular flaps in chronic post-traumatic inflammation (osteomyelitis ulcer), shortening the rehabilitation and rapid recovery of lower extremity function. Materials and methods: The study included 20 patients with soft tissue defects in the foot and ankle. Mean age was 39.5 ± 7 years, all the patients were men. In 10 cases (50%) were treated in patients with chronic post-traumatic ulcers, in 5 cases (25%) patients were operated on the various forms of chronic osteomyelitis of the tibia, the remaining 5 cases (25%) was a group of patients with ‘‘fresh’’ posttraumatic defects soft tissue. All patients with soft tissue defect on the anterior surface of the tibia were performed with distally based reverse fasciocutaneous neurovascular sural flap. In patients with localization process in the region of the Achilles tendon, calcaneal tuberosity and margin of plantar surface of the foot was made of plastic distally based reverse fasciocutaneous neurovascular saphenous flap, including the use of modified techniques like maintenance of the fasciocutaneous strip above the neurovascular bundle. Results: All patients, as a preoperative examination, ultrasonography was performed. All grafts taken root and provide good functional and esthetic results. Key words: Abdomen, Defect, Closure Abstract 31 Abstract category: Abstract The New Scoring System Morpho-Functional Availability of Hip Joint Azerbaijan Medical University, Traumatology And Orthopaedy Department Introduction: Morphological and functionally objective evaluation of the hip joint is one of the most pressing problems in orthopaedy. The use of new methods and technologies in the arthroplasty of the hip joints over the past 20 years has led to a significant increase in the number of complications, as well as an increase in the number of complications. For this reason, the objective evaluation of the morpho-functional status of the hip joint before and after the operation is of prioritized importance. This, in turn, helps to prevent unnecessary transactions. Today, although there are many variance systems, the hip joint has not been fully and objectively evaluated before and after arthroplasty. Changing the anatomy and biomechanics of the hip joint, especially in dysplastic coxarthrosis, makes it difficult to evaluate. Materials and methods: From January 17, 2015 to November 17, 201, 81 patients undergoing dysplastic coxarthrosis at the Department of Traumatology and Orthopedics at the Educational-Surgical Clinic of the Azerbaijan Medical University were evaluated by a new morpho-functional assessment system before and after 90 postoperative surgeries. Of the patients 62 were women, 19 were men. The mean age of women was 50.6 (19-73) and men 46.8 (23-67). Overall average age was 49.6 (19-73). Patients are classified by the Crowe classification. Crowe I -36 patients, Crowe II -20 patients, Crowe III 17 patients, Crowe IV -15 patients. 32 patients were operated by subtrochanteric osteotomy and 58 patients without osteotomy. X-ray, CT, MRI were used. The proposed assessment system incorporates four basic provisions - morphology, pain, function, and volume of the joint. Results: The morpho-functional status of the hip joint has been more precisely evaluated based on the new system. This allowed clarifying the guidelines for the arthroplasty of the hip joint. Key words: Arthroplasty, Hip joint I have no potential conflict of interests to report. Abstract 32 Our Experience in Soft Tissue Reconstructions of Lower Extremity Mahir Aliyev Baku Medistyle Hospital, Plastic And Reconstructive Surgery Department Introduction: Reconstruction of soft tissue cover of lower extremities is an important issue in plastic surgery. This article deals with results of our clinical experience, which is based on common algorithms to select optimal reconstructive method according to etiology, anatomic location and tissue requirement of the specific defect. Materials and methods: Here we analyze age and sex, etiology, location, methods of reconstruction, complications and revision operations of patients that treated for soft tissue defects of lower extremities in Plastic and Reconstructive Surgery Department of the main clinical Hospital of Military Forces of Azerbaijan Republic between January 2007 and 2017. Results: Out of 80 patients 74 (92.5%) were males and 6 (7.5%) were females. We don’t analyze here age distribution as we lack pediatric patients. High energy fire-arm (including bullet and bomb) injures was the most frequent cause of defects together with various etiologic factors, including car accidents, venous insufficiency, diabetes, attrition by boots, industrial accidents, pressure ulcers, frostbite and toxicodermia. Totally 102 operations were performed on 80 patients, from which 18 were operated several times. Majority of defects were localized on leg and foot. The most employed method were skin grafting (52.5%). Areas non-suitable for grafting were reconstructed by local flaps (17.5%), reverse neurocutaneous flaps according to location (16.25%), axial fasciocutaneous island flaps (6.25%), muscle flaps (5%) and free flaps (2.5%). Conclusion: Reconstruction of soft tissue defects of lower extremities, particularly of those caused by high energy fire-arm remains challenging clinical problem. However, it is possible to achieve both functionally and aesthetically acceptable results by proper clinical assessment of the patient, selection of reconstruction method according to principles of plastic surgery and planning the operation using concept of reconstructive ladder. Key words: Lower extremity, Flap I have no potential conflict of interest to report. Abstract 33 Abstract category: Abstract The Correlation Between Clinical Monitoring and Scanning for Blunt Abdominal Traumas Murat Baki Yildirim, Ibrahim Tayfun Sahiner, Ramazan Topcu, Murat Kendirci, Murathan Erkent, Settar Bostanoglu Hitit University School of Medicine, Department of General Surgery Introduction: Traumas are one of the main reasons for the emergency (ER) visits. In this paper, the frequency of spleen injuries in patients admitting ER with blunt abdominal traumas, conservative approach and surgery results are presented. Materials and methods: The case of the patients, who has visited ER from 01.01.2016- 01.03.2018 and been referred to General Surgery consultation, are analysed retrospectively. Demographic characteristic, computerised cross-sectional scans (CT), surgical operations, mortality and morbidity of all the patients are examined. Results: A total of 690 patients with blunt abdominal trauma were admitted to ER and consulted in 27 months’ time. 91 patients were hospitalised.39,6%(n:36) of the patients were females. While overall trauma(29,7%, n:29),spleen laceration(39,6%),liver laceration (9,9%),spleen and liver laceration combination(7,7%)and free abdominal liquid(13,2%)have been found in CT, there was no obvious solid organ injury. Considering the clinical course of the patients, it was found that 58,2% of them monitored conservatively,34,1% underwent a splenectomy,4,4%had a primer treatment related to isolated liver injury and 3,3%(n:3) both underwent a splenectomy and had a primer treatment for liver injury as a result of multiple solid organ injuries. It was observed thatall patients with general traumas were monitored conservatively and none of them needed a surgery.9 patients diagnosed with spleen laceration throughout the scans managed nonoperatively,27 patients with unstable hemodynamics underwent a splenectomy. When the cases having onlyfree abdominal liquids without solid organ injuries in CT, it was observed that 10 of the patients treated conservatively and splenectomy was carried out for 2 patients. Conclusion: With the improvements in scanning and follow-up, conservative monitoring stands outfor particular patient groups. When the hemodynamics are stable,liver and spleen injuries diagnosed low grade within the scans should be given a chance of observation rather than surgery first. If the patients’ hemodynamics worsens, they should be evaluated again in terms of surgery. Key words: Trauma, Splenectomy, Conservative I have no potential conflict of interests to report. Abstract category: Case report A Difficult Rectal Injury Case Treated by Vacuum Assisted Closure from Posterior Rectal Fossa Skin Opening Aytekin Unlu, Mustafa Tanriseven, Elgun Samadov, Nazif Zeybek Gulhane Medical Academy, Department of General Surgery; Baku Avrasiya Hospital, Department of General Surgery; Gulhane Medical Faculty, Department of War Surgery Introduction: The patient inflicted high velocity missile related sacrum and grade IV rectum injury. Initially, he was operated in a nearby hospital and performed a colostomy leaving the rectal and sacral injuries untouched. He was transported to hospital on the 4th postoperative day. Materials and methods: A 24 year-old old male, shot by a high velocity missile was transported to Gulhane Medical Faculty. This was a difficult case, optimum treatment options not published on the literature. Case report data involves CT, intraoperative photographs and surgery reports. Case description: The missile enter penetrates from the right infra gluteal region, causes multiple sacral fractures and these fractures causes multiple, posterior rectal wall injuries starting from below sacral promontorium to dentate line. Initially he was performed sigmoid end colostomy and presacral drainage. Upon admitting the casualty, a CT was taken, he had tachycardia, presacral drain is unrevealing. Physical exam and CT showed posterior rectal abscess. He was performed a skin incision on posterior anal region and abscess was drained from the posterior rectal cavity, multiple fragmented foreign bodies were evacuated, cocyx was excised, Multiple rectal injuries above the dentate line were sutured, rest of the wide rectal defects were left for secondary healing. VAC therapy was started. Two options were present; should we perform intrarectal or extrarectal (via posterior skin opening) VAC? We performed 4 cycles of intrarectal VAC but due to patient discomfort and unsatisfactory results, we continued with extrarectal VAC. Twelve weeks after injury, posterior rectal wall defects were completely healed. Conclusion: Extraluminal posterior rectal wall injuries can successfully be treated by VAC applications. Key words: Rectal, Injury, VAC I have no potential conflict of interests to report. Abstract 35 The Clinical Case of Surgical Treatment Patient with Spine Destruction by Metal Construction ‘‘Stryker’’ Nizami Hasanov, Dmitriy Petrenko, Dmytro Istomin, Nikolay Grymailo Azerbaijan Medical University, Department of Traumatology and Orthopedic; The University Clinic of Kharkiv National Vedical University, Department of Traumatology and Orthopedics; Kharkiv National Medical University, Department of Traumatology and Orthopaedics; Kharkiv National Medical University, Department Of Ph. Rehabilitation, Sports Medicine With A Course Of Physical Education And Health Introduction: The treatment of spine affection is rather complicated theme. This case report shows possible way of treatment of severe spine trauma. Case description: Patient L. admitted to the hospital 23.08.2016 in the orthopedic-traumatological department with pain in the lesser pelvis, defection of support function and leisure activity. Anamnesis: the patient got trauma 11.08.2016 as a result of fall from the height. After this accident he was carried to Kharkiv Municipal Clinical Hospital of Emergency Medical Aid named after prof. Meshchaninov with acute pain in the lesser pelvis, numbness of low extremities, defection of support function. Patient was treated by immobilization. At the moment of entering to the hospital: defection of support function in low extremities, pain during movements. Paravertebral muscles of lumbar spine were severely strained, painful, especially in S1-S3 zone. Peripheral sensitivity was decreased in low extremities; circulation of blood was saved. Moreover, disorders of urination were existed. The diagnose was presented: transverse fracture with dislocation S1 and lateral mass of sacrum, compression-ischemic myelopathy of the lumbosacral spine with lower paraparesis and disfunction of pelvic organs; associated diagnosis: condition after acute closed traumatic brain injury, concussion of brain, non-compressive chronic subdural hydroma of the right frontal–temporalparietal zone, with cerebrospinal hypertension, vestibular disorders. 28.06.2016 According to plan of treatment surgical treatment: open reduction of fracture with dislocation S1, fixation by construction ‘‘Stryker’’. During postoperative period patient got regular changing of bandage and complex conservative therapy. The period in the hospital was marked by temperature without infectious locus, seams were removed on the 17th day after operation, metal construction wasn‘t disturbing for patient. Conclusion: In our case, it was seen that the bullet core changed direction without following a linear trace. Patient was discharged 12.09.2016. After 12 months of observation and rehabilitation leisure activity was renovated, although some sphincter disorders were noticed. Key words: Stryker, Spine destruction I have no potential conflict of interests to report. Abstract category: Case report Late Diaphragmatic Rupture after Blunt Abdominal Trauma Oguz Hancerliogullari, Yasar Subutay Peker, Kutan Kavakli, Ali Kagan Coskun University Of Medical Sciences Gulhane Training And Research Hospital, Department of General Surgery, Department of Thoracic Surgery Introduction: Traumatic diaphragmatic hernias may develop after blunt or sharp abdominothoracic trauma, or after diaphragmatic direct injury or increased intraabdominal pressure. This entity, first described in the 1500’s, can interfere with cardiac and pulmonary functions in an acute situation and may be mortal. However mortal traumatic diaphragmatic hernias at the late phase of trauma (after 24 h) are rare. In this case, we aimed to share our experience about late, mortal traumatic diaphragmatic hernia patient. Case description: A 57-year-old male patient was admitted to our hospital’s orthopedic clinic with a femur fracture following an in-car traffic accident. No other pathologies were detected except the hemothorax and perihepatic minimal fluid. Full body computerized tomography (CT) was performed with a multidisciplinary approach at the time of admission. The patient had stable hemodynamics but dyspnea and hypotension started at the 36th hour of administration. Upon detection of hypoxia and acidosis in the blood gas, abundant intestinal gas was seen at left lung on chest x-ray. An emergency thoracoabdominal CT showed a left mediastinal hernia.The patient whose hemodynamics started to deteriorate was taken to operating room for diaphragmatic hernia repair. Primary diaphragmatic suture with thoracic tube replacement was applied to the patient. Conclusion: Traumatic diaphragmatic hernia is an entity that should be managed by chest surgeons and general surgeons. An abdominal approach is recommended in acute hernia, although thoracic approach may be preferred in chronic cases. Traumatic diaphragmatic hernias usually develop at acute stage after blunt or sharp trauma, but occasionally minimal diaphragmatic injuries with trauma can cause late diaphragmatic hernias, which can be mortal by restrictive heart failure and impaired lung function. For this reason, late diaphragmatic rupture in abdominal trauma is a morbid condition that should be considered by trauma surgeons. Key words: Trauma, Diaphragmatic Hernia I have no potential conflict of interests to report. SECTION 4: VASCULAR SURGERY Abstract 38 An Evolution of Vascular Exposures in Trauma Kirov Military Medical Academy, Department of War Surgery Introduction: Open vascular exploration remains a significant challenge for trauma surgeons in civilian and military settings. Hemodynamic patient’s instability, severity of limb and/or organ ischemia, lack of surgeon’s experience, compromised anatomy are among the factors that may influence morbidity and mortality. This study presents an evolution of vascular exposures in trauma and demonstrates a paradigm shift in vascular trauma from open to endovascular to hybrid surgery. Materials and methods: A historical review of the available literature based on personnal experience in treatment of combat (armed conflicts in the North Caucasus, 1999-2002) and civilian vascular injuries (1998-2016). Results: Proximal arterial control is mandatory prior to direct access to a zone of vascular injury and very challenging in junctional areas such as thoracic outlet, a base of a neck, subclavian, gluteal, and hypogastric regions. Open exploration in these regions is often timeconsuming and results in significant blood loss and morbidity while endovascular capabilities provide precise vascular visualization and can be used for stent-graft placement. In resource-limited settings or on special indications (abdominal and pelvic trauma), the hybrid approach with proximal control by temporary balloon occlusion of a damaged artery followed by local wound exploration and vascular repair is acceptable to reduce blood loss and minimize morbidity. Extensive bleeding from the branches of major arteries, such as external carotid artery, internal iliac and gluteal arteries, deep femoral artery, end-organs’ arteries can be embolized with coils, gelfoam, glue or particles by trained hands when a C-arm and special armamentarium are available. Conclusion: Analysis of history and current trends in vascular exposures in trauma demonstrates a shift from classical proximal arterial control to minimally invasive approaches including pure endovascular techniques and hybrid « balloon-assisted » procedures. Key words: Vascular trauma, Access I have no potential conflict of interests to report. Abstract 39 Abstract category: Abstract Vascular Injuries due to Firearm Injury: 3 Year Study Osman Celbis, Erhan Kartal, Ahmaet Hakan Dinc, Bedirhan Sezer Oner, Omer Turan, Ismail Altin Inonu University Medical Faculty, Forensic Medicine Department; Malatya Training and Research Hospital, Emergency Department; The Grand National Assembly of Turkey Hospital; Amasya University Medical Faculty, Forensic Medicine Department; Medeniyet University Medical Faculty, Forensic Medicine Department Introduction: The percentage of deaths which are due to firearms varies greatly in different parts of the world both in terms of the type of weapon and the origin of the incident. The aim of the study was to discuss the age, gender, place where the event took place, month and season characteristics, most injured structures and vascular injuries as a result of firearm injuries. Materials and methods: I˙n our study Malatya Forensic Medicine Institution Group Presidency, death cases resulting in firearm injuries in 2012-2014 were examined retrospectively. Results: A total of 322 firearm autopsies had vessel injuries at 83. Of the cases, 71 were male and 13 were female. The mean age of the cases was 34,53 ± 15,687. 77 of the cases had artery, 28 had ven injury. There were both arterial and venous injuries in 22 cases. The most injured vessel was aorta. Only 45 cases had single vessel injuries and 38 cases had multiple vessel injuries. Lungs were the most affected organ injuries. Almost all of the cases had multiple organ injuries. In the toxicological examination of the cases, there were 6 cases of alcohol, 4 cases of drug and 2 cases of both alcohol and drug. Conclusion: Our study is the first study to examine the relationship between firearms and vascular injuries in autopsy series. It was reported that the cases were mostly in July. Seasonally reported to be the most in the summer. Most of the cases occurred in rural settings. Most of the cases shotguns were used. The shotguns were most used both in the rural settings and in the urban settings. The location of entrance the firearm was extremities with a maximum of 53 cases. Firearm-related deaths constitute a significant proportion of the forensic autopsy series. Key words: Firearms, Vascular injury I have no potential conflict of interests to report. Open and Endovascular Surgery in Combat Vascular Injuries Viktor Reva, Aleksandr Petrov, Igor Samokhvalov Kirov Military Medical Academy, Department of War Surgery Introduction: Vascular injuries remain one of the leading causes of mortality and morbidity in armed conflicts. The standard approach to a vascular injury is open arterial reconstruction, although endovascular procedures are also used in combat hospitals. The aim of this study is to analyze our recent combat vascular experience at a Role 2 Medical Treatment Facility (MTF). Materials and methods: Medical records of the casualties with vascular injuries admitted to a Role 2 MTF during a few months of a counter-terrorist operation were retrospectively reviewed. After the surgical operations performed by a vascular surgeon, the casualties were transported to a higher echelon of care by strategic evacuation. Results: Among twelve casualties in total, eight patients suffered from gunshot wounds, and four patients had blast injuries. Five patients underwent open primary vascular repair: 3 – autologous vein grafting (femoral, axillary, and posterior tibial artery), 1 – end-to-end anastomosis of the popliteal artery, 1 – lateral suture of the internal jugular vein. Temporary shunting was used intraoperatively (followed by autologous vein grafting) in two cases (common femoral and axillary artery injury). One anterior tibial artery thrombosed due to blast injury underwent no reconstruction and one upper extremity was amputated 8 h after injury. Four endovascular procedures were performed without fluoroscopy: three resuscitative endovascular balloon occlusions of the aorta (REBOA) for severe torso hemorrhage and one retrograde stent-graft implantation into the axillary artery. One secondary amputation (10%) was performed (after femoral artery injury – this patient died afterwards) and additionally one critically unstable REBOA patient died on the operation table. Conclusion: Open vascular repair remains the main option for saving lives and limbs at a Role 2 MTF. Endovascular procedures can also be effectively used in far forward MTFs. Key words: Vascular trauma, Endovascular COI disclosure: This study is supported by a Grant of RSF#17-7320318. Abstract 41 Abstract category: Abstract Prehospital and Military REBOA Viktor Reva, Aleksandr Petrov, Igor Samokhvalov Kirov Military Medical Academy, Department of War Surgery Introduction: Outcomes of patients with non-compressible torso hemorrhage (NCTH) depend on transport time and adequate prehospital interventions. The resuscitative endovascular balloon occlusion of the aorta (REBOA) has been demonstrated to be an option for temporary truncal hemorrhage control. We present a case series of the military REBOA and give perspectives to its early prehospital use. Materials and methods: We retrospectively reviewed all REBOA procedures performed during a few months of deployment. A prehospital REBOA kit was prepared for en-route REBOA during MEDEVAC, but the procedures at a Role 2 Medical Treatment Facility (MTF) were registered only. Indications for REBOA were hemodynamic instability and suspected abdominal or/and pelvic hemorrhage. Results: Three patients were admitted with signs of severe NCTH 3-4 h after injury. Two casualties (#1-2) suffered from blunt trauma with unstable pelvic fractures as a main cause of hemodynamic instability (undetectable blood pressure (BP) upon admission). The third patient (#3) had a gunshot wound to his left chest and systolic BP of 50-60 mmHg upon arrival. All patients were immediately taken to the operation room and underwent zone I REBOA that resulted in an increase of BP by 65-100 mmHg. Along with damage control resuscitation (DCR), #3 underwent negative left chest drainage and laparotomy/spleenectomy followed by balloon deflation in 25 min. #1 underwent negative laparotomy and pelvic packing followed by pelvic external fixation (16 min occlusion time). These two patients successfully recovered and discharged afterwards. #2 was rapidly deteriorating after a change to zone III REBOA despite DCR and finally died. Conclusion: REBOA is effective for temporary control of NCTH and saves lives in austere military settings. Extending this technique for prehospital stage of care may improve the outcomes. Key words: REBOA, Military, Prehospital COI disclosure: This study is supported by a Grant of RSF#17-7320318. Evaluation of Different Endovascular Techniques for Throughand-Through Recanalization of Completely Transected Major Arteries Viktor Reva, Aleksandr Pochtamik, Igor Samokhvalov Kirov Military Medical Academy, Department of War Surgery Introduction: Endovascular reconstruction of a completely transected artery in an exsanguinating patient might be challenging. The aim of our study is to evaluate different endovascular techniques of through-and-through recanalization. Materials and methods: Silicone tubes (inner diameter of 6 mm) were submerged in two containers filled with transparent gelatin mass with a distance between their edges of 2 and 4 cm. Through a sheath placed in the first tube, a multipurpose catheter was advanced overthe-wire into the « hematoma » . One of the following devices designed for capturing the wire was advanced through the second tube: 1) a 5-mm Amplatz GooseNeck Snare (Snare); 2) Vascular Retriever Cook (Loop); 3) a 22-mm Dormia basket (Basket); 4) a balloon catheter 7x40 mm (Balloon) for wire centering, 5) a folded 0.035’’ standard wire (Wire). Eight general surgeons unfamiliar with endovascular techniques consequently tested all the devices. Success and time of the procedure were recorded. Results: All but two attempts of recanalization with 2 cm gap in the Balloon group were successful. There was no difference between success rate of recanalization between groups in either 2 cm or 4 cm gap. Average time of recanalization was significantly higher for the Balloon group (3.14 [2.67-8.72] minutes) compared to other groups (maximum of 2.44 [2.10-3.27] minutes for the Loop group) in 2 cm gap only (p = 0.002). No difference was found for the 4 cm gap analysis. Conclusion: This study demonstrated that on a simulator throughand-through recanalization of a completely transected « artery » may be performed in a few minutes by any kind of retrieval device, even by an improvised loop (a folded wire). Key words: Endovascular, Artery, Transection COI disclosure: This study was funded by a Grant from the President of Russia #MR-5676.2018.7. Abstract 43 Abstract category: Case report Is Endovascular Revascularization Reasonable for Isolated Renal Artery Thrombosis Following Blunt Trauma? A Rare Case Report with Review Rahman Senocak, Oguz Hancerliogllari, Semra Ince University of Health Sciences, Gulhane Training and Research Hospital, Department of General Surgery, Department of Nuclear Medicine Introduction: The incidence of isolated renal artery thrombosis (RAT) after blunt abdominal trauma is extremely rare. Traumatic RAT hardly ever occurs as an isolated event and this usually indicates major injuries. Thanks to advanced imaging methods such as computed tomography (CT), there has been a relative increase in the diagnosis recently. We present a selective renal artery stent application in a patient with isolated RAT after blunt abdominal trauma. Case report Conclusion In young patients with RAT who applied late in the post-traumatic period, in order to protect kidney functions and prevent future renal HT, despite the possibility that the kidney may function poorly, we recommend minimal invasive intervention in the treatment. PER can be safely performed in place of surgical vascularization in these patients with minimal invasiveness and less morbidity. Case description: In this case, a young male patient who developed isolated unilateral RAT with left kidney involvement due to blunt thoraco-abdominal trauma was reported. However, there were no clinical or laboratory abnormalities. There was no thrombosis and contrast enhancement in the left renal artery in contrast enhanced CT. CT angiography revealed occlusion in a segment of approximately 2 cm in the middle of the left renal artery, and an endovascular stent was placed. In follow up, it was found that the blood stream in the left renal artery was patented. Percutaneous endovascular revascularization (PER) was successfully performed in the patient. Hypertension (HT) did not develop during short follow-up and scintigraphy showed minimal function of the kidney. Conclusion: In young patients with RAT who applied late in the posttraumatic period, in order to protect kidney functions and prevent future renal HT, despite the possibility that the kidney may function poorly, we recommend minimal invasive intervention in the treatment. PER can be safely performed in place of surgical vascularization in these patients with minimal invasiveness and less morbidity. Key words: Renal artery thrombosis I have no potential conflict of interests to report. SECTION 5: INTENSIVE CARE MEDICINE Abstract 44 Abstract type: Abstract Blood Reinfusion in Injuries of the Chest and Abdomen in the Conditions of Armenia’s Military Aggression Against Azerbaijan Adil Geybulla, Sakhavat Rafiyev, Nazim Hasanov, Adalat Rustam Azerbaijan Medical University, Department of Surgical diseases Introduction: The immediate results of blood reinfusion in 357 wounded of thoracic and abdominal organs with severe bleeding (blood loss of more than 2000 ml) in the conditions of military occupation of the territories of the Republic of Azerbaijan are analyzed. Materials and methods: Autologous blood had been prepared with the help of the apparatus of chest drainage and autotransfusion system. The technique of reinfusion of blood for various traumas with massive blood loss is described. Our experience showed that advantages of reinfusion are particularly noticeable in the provision of care wounded with intracorporeal injuries, when the time factor plays a decaying role. As soon as possible to compensate the mortgage, as soon as possible to stop bleeding – here are two major tasks from the implementation of which depends the life of the victim. Results: When injuries of the abdomen should be made sure of the integrity of the hollow organs, then in injuries of chest cavity (hemothorax) this condition disappears (where the blood can be obtained by pleural puncture). We managed to turn out the overwhelming majority of wounded (89.7%) lost blood in the first 2 h after the injury, which, of course, in a significant measure determined the fate of sufferers. Conclusion: Finally, it should be noted that, low costs, decreased use of banked blood, immediately available (without delay and storage), compatibility of blood, normothermicity, absence of allergic reaction, absence of risk of transmission of transfusion transmissive disease, hypocalcemia, and hyperkalemia, reduction in the risk of acute respiratory distress syndrome, makes reinfusion of autologous blood a valuable alternative for a timely, effective and vital assistance to seriously suffers with massive bleeding in war conditions. Key words: Reinfusion, Blood, Injury I have no potential conflict of interests to report. Ketamine Infusion for Postoperative Pain Control After Strumectomy for Thyroid Disease Aynur Isayeva Scientific Center of Surgery, Department of Anesthesiology Introduction: The objective of this study was to compare patients who were given ketamine intraoperatively along with opioids to patients who only received opioids preoperatively. Materials and methods: Retrospective, case control analysis of hospital patients and pharmacy data. Patients over the age of 25 who underwent strumectomy for Thyroid Disease. 25 patient charts were reviewed in each of the two groups. The Ketamine group (N = 25) underwent an open laparotomy and was treated with an intravenous ketamine bolus during induction followed by a low dose ketamine infusion (0 .05-0 .2 mg/kg/hr) for multiple days (2-5) in the perioperative period. The Control group (N = 25) consisted of patients that only received opioids in the preoperative period until hospital discharge. Results: The primary outcome of total opioids consumed, measured as IV Morphine equivalents, was not significantly different in Ketamine (K) vs. No Ketamine (No K) groups with a median of 212 .3 and 173 .5 and an interquartile (IQ) range Q1-Q3 of 82-584 and 116-341 respectively. VAS pain scores pre-operatively, in PACU, on post-op days 1-3 were examined. Analysis of variance showed there was no significant interaction (p = 0.23) and thus no significant effect on overall VAS scores. Days to ambulation were not significantly different for K vs. No K; median of 1 day for both groups. Conclusion: Optimizing pain control after strumectomy procedures is vital to patient recovery and discharge. In our study, we found that total opioid consumption, time to ambulation and pain scores were no different with exposure to ketamine in the perioperative period compared to patients who only received opioids. Despite its clinical advantage with previously demonstrated opioid sparing and analgesic effects, ketamine did not reveal such properties in our study for this particular patient population. Key words: Strumectomy, Pain, Ketamine I have no conflict of interests to report. Abstract 46 Noninvasive Artificial Ventilation of the Lungs in the Treatment of Respiratory Failure Arising After The Plasty of Large Ventral Hernias Fuad Hasanov, Narmina Musayeva, Geys Karimov, Makhrukh Abbasova, Gunel Mammadova Scientific Surgical Center named after acad. M.A. Topchubashev, Department of Anaesthesiology-Reanimatology Introduction: One of the post-operational complications of the plasties of large ventral hernia is the development of respiratory failure (RF). This is caused by increased intra-abdominal pressure (IAP), encountered in 62% of patients with large ventral hernia. Materials and methods: During the period 2007-2014 168 patients with ventral hernia underwent surgical treatment in SSC named after M.A.Topchubashev. Next post-operational period was complicated by acute RF in 62 (36.9%) patients – main group. Control group – 20 patients who underwent operation because of peptic ulcer of stomach and duodenum, without any malfunction of respiratory system. Results: The RF diagnosis was established by existence of the following criteria: the oxygenation index (PaO2/FiO2 \ 300), PaCO2 [ 45 mm Hg, pH \ 7.35, respiratory volume (RV) \ 5 ml/ kg, RR [ 25 a minute. 5 stages were distinguished during the NAVL: I–RF diagnosing; II-the beginning of NAVL; III–setting of optimal NAVL mode; IV–completion of NAVL, V-transition to spontaneous respiration. It was decided to use NAVL in case of deterioration in two of the following indicators: PaO2 \ 55 mm Hg; PaO2/FiO2 \ 280; PaCO2 [ 45 mm Hg; pH of arterial blood \ 7.35; RV \ 4 ml/ kg; RR (respiratory rate) [ 25 a minute. Positive dynamics were noticed in general condition of patients from the beginning of stage II. During stage III the patients’ condition began to improve considerably. PaCO2 decreased to 44.2 ± 1.3 mm Hg, PaO2 increased up to 96.2 ± 0.5%, PaO2/FiO2 = 276.5 ± 5.1 indicated the elimination of arterial anoxemia. It became possible to separate patients from respiratory mask during 54.5 ± 2.5 min in stage IV. Respiration was stabilized in 96.4% of patients in stage V, PaO2/FiO2 indicator was inclined to normalization. Conclusion: Thus, applying NAVL after the plasty of large ventral hernia was effective and enabled to refuse a trachea intubation. Key words: Respiratory failure, Noninvasive ventilation I have no potential conflict of interests to report. Abstract 47 Abstract category: Case report Giant Rectus Hematoma Secondary to Subcutaneous Enoxaparin Use: Management Difficulties in Intensive Care Unit? Rahman Senocak, Oguz Hancerliogullari, Sahin Kaymak, Aytekin Unlu Gulhane medical faculty, Department of General Surgery Introduction: Low molecular weight heparin (LMWH) is increasingly used by doctors in many clinical situations such as deep vein thrombosis, atrial fibrillation and pulmonary embolism. LMWH is generally safe due to improved bioavailability and pharmacodynamics. In this article, it is aimed to present the problems encountered in the management of type 3 giant rectus hematomas due to subcutaneous LMWH for pulmonary embolism. Case description: Eighty-four-year-old female patient was admitted to the emergency service for suddenly beginning abdominal pain for two days without a history of trauma. The patient was treated for massive pulmonary embolism three weeks ago, then she was hospitalized with the complains of persistent dyspnea in chest clinics where LMWH was administered with a dose of 0.6 IU 2x1(enoxaparin). Laboratory tests revealed urea:150, creatinine 2.5, hemoglobin 8.2 g/dL. The patient was followed up in the surgical intensive care unit. Unenhanced abdominopelvic tomography revealed a 10x15 cm high-density area on the lower abdomen and a hematoma of 73x42 mm in the area of the right rectus (Fig. 1a-d). Anticoagulation was discontinued. Prophylactic interventional and surgical interventions were contraindicated due to concomitant embolism and renal failure, and therefore standard IV heparin was initiated at 5000 IU 2x1 infusion. Hemoglobin level increased to 10.4 mg/dl, aPTT values increased to 1.5 times normal, and oral intake of the patient was reversed. After the sudden drop in O2 saturation and development of respiratory distress, the patient required mechanical ventilation and was lost on the 14th day of admission. Conclusion: Patients receiving anticoagulants, those with large hematoma and advanced age and serious comorbidities have higher rates of morbidity and mortality. Rectus hematoma has been reported to have a mortality rate of 1.6-25%. The possible underlying mechanism is believed to be the combination of accidental intravenous injection of enoxaparin or damage of epigastric vessels and marked anticoagulant effect in the elderly. Key words: Rectus, Hematoma, Heparin I have no potential conflict of interests to report. Abstract 48 Abstract category: Case report The Role of Non-operative Management in High-Grade Liver Injury Secondary to Gunshot Wounds Rahman Senocak, Ali Kagan Coskun, Sahin Kaymak Gulhane medical faculty, Department of General Surgery Introduction: Despite widespread acceptance of conservative treatment options for blunt abdominal, there remains uncertainty about the choice of non-operative treatment for the abdomen with firearms. However, in a group of selected liver injuries over the last decade, a shift towards non-operative treatment has begun. There is no internationally agreed recommendation on this topic.. Case description: A 61-year-old male patient was brought to the emergency service after a gunshot injury from close range.The entrance point of project was at the level 8-9 rib on right midclavicular line and the exit hole was at level of posterior eleventh rib. The laboratory values were Hb: 12.3, ALT/AST: 100/106, LDH: 458, WBC: 15300. In abdominal contrast-enhanced CT, laceration (grade 4 liver injury) containing more than 25% of the right lobe and with a depth of 5 cm, perihepatic-perisplenic fluid content with 18 mm thick. Sampling from collection sites via perihepatic percutaneous drainage catheter revealed high detection of bilirubin values. The ERCP was performed, because of contrast leakage, right hepatic nasobiliary drainage catheter placement and sphincterotomy were performed. Pleural effusion of 1000 cc was drained. Later, abdominal findings and fever diminished. Nasobiliary catheter was withdrawn. No contrast escape was observed at ERCP. After 21 days of treatment, the patient was discharged without complications. Conclusion: Patients without signs of stabilization or peritonitis in terms of hemodynamics may be candidates for non-operative treatment. Complications that may develop in well selected patients with isolated high-grade solitary organ injuries can be treated by the widespread use of high-quality radiological imaging systems, as well as interventional radiology techniques and drainage of bile collections with ERCP and treatment of such infections. Key words: Gunshot, Liver, Injury I have no potential conflict of interests to report. SECTION 6: THORACIC SURGERY Abstract 49 Abstract category: Abstract Analysis of Purely Thoracic Injured Patients Applied to Malatya Training and Research Hospital Emergency Department Bilgehan Demir, Erhan Kartal, Nurset Ayaz, Abdullah Mert Unsal, Mufit Iris, Osman Celbis Malatya Training and Research Hospital, Emergency Department; Inonu University Medical Faculty, Forensic Medicine Department; Council of Forensic Medicine Introduction: It has been reported that injuries occurring in the thoracic region can cause complications at various grades by affecting the mainly respiratory system and the other systems. In our study, we investigated the cases of purely thoracic injuries applied to emergency service. Materials and methods: The medical documents of 91 patients with purely thoracic injuries who applied to Malatya Training and Research Hospital Emergency Department between 2015 and 2016 years were examined retrospectively and these cases were taken into consideration in terms of gender, age groups, months and seasons, etiology and types of injury, and additional diseases as well as comparisons were made between these areas. Results: 82 of the cases (90.1%) were male and 9 (9.9%) were females. It was determined that 57 of the cases (62.6%) were spontaneous and 11 of them had traffic accidents and high falls. It was determined that 82 of the cases (90.1%) were referred to the emergency service with unilateral pneumothorax. 76 of the cases (83.5%) were admitted to the chest surgery clinic for follow-up and treatment. Most of the cases are mostly applied in September. It was noted that there were traffic accidents and high falls in the second and third frequency following spontaneous cases when the patients. These cases were most commonly seen in the 30-39 age group, and it was understood that they most commonly occur in September and autumn. Conclusion: It is known that 30-39 age group is using more vehicles in traffic and also actively working in business. It was thought that the inability to adapt to the autumn season immediately after the summer season caused these traffic accidents and high falls also it is considered that the trainings to be done will be useful in these matters. Key words: Thoracic injuries, Pneumothorax I have no potential conflict of interests to report. Video-Assisted Thoracoscopy in the Thoracic Trauma Injuries Igor Maxim, Ion Cigareanu, Ion Florea, Gheorghe Rojnoveanu ,,Nicolae Testemi¸tanu’’ State University of Medicine and Pharmacy, Clinical Department of Surgery Introduction: Thoracic trauma (TT) is a major cause of morbidity and mortality in specialized surgery trauma centers. With the increased potential of the mini-invasive surgery, video assisted thoracoscopy (VATS) has become an elective method of treatment for these patients. Retained hemothorax and pleural empyema are the most common complications of TT. Materials and methods: A prospective analysis of the treatment results for the patients with thoracic trauma injuries associated with pleuro-pulmonary complications was carried out during the period 2016-2017 at the Institute of Emergency Medicine from Chis¸ina˘u, Republic of Moldova. 522 patients were included in the study. The ratio M:F – 2:1. Mean age 54.64 ± 3.43 years. 126(24.3%) patients had pleuropulmonary complications: 68(13%) – hemothorax, 58(11.1%) – posttraumatic pneumothorax. All patients with baseline pleuropulmonary complications were subjected to pleural drainage. Results: 4(0.76%) patients underwent VATS to manage pleuropulmonary complications over 24 h from hospitalization. 2 patients were identified with retained hemothorax. One patient suffering from pneumothorax as a result of pulmonary parenchymal lesion and another one with pleural effusion. No patient in the study group was subjected to conversion to open thoracotomy. The hospitalization period of patients after VATS was 5.0 ± 0.4 days, compared to 6.9 ± 0.8 days in patients with pleural drainage (p \ 0.05). Conclusion: Conclusion: VATS is a method of choice in patients with complicated thoracic trauma, unresolved by pleural drainage and performed over 24 h from hospitalization. This approach greatly reduces the rate of late complications and the hospitalization stay for these patients. Key words: Trauma, VATS, Drainage I have no potential conflict of interests to report. SECTION 7: MISCELLANEOUS Abstract 51 Abstract type: Abstract Mathematical Models for Predicting the Probability of Recovery and Complications of Esophageoplasty for Cancer Introduction: Based on the analysis of the results of 96 patients who underwent esophagoplasty for cancer, a model for the risk of early postoperative complications was created. Materials and methods: Considering the fact that the level of hemoglobin and total protein indicates the depth of the toxic intoxication and the state of the protein deficiency of organisms. In addition, the stage of the disease in patients with esophageal cancer directly affects the prognosis and outcome of the disease. Complex characteristics of these indicators, revealing the relationship between them would allow to create a reliable mathematical model by predicting the outcome of the disease, including recovery. For the creation of models on the prediction of recovery of patients after esophageoplasty regarding the pas of the esophagus, we have used the method of least squares. Results: The mathematical interdependence of the level of total protein and hemoglobin was revealed upon admission of esophagus in patients with cancer: OB = – 11.91 ? 0.7 * GLP To predict the probability of recovery, the following mathematical model was created: P = – 1.971 ? 0.014 * HBa ? 0.0199 * TP, where, P means the probability of recovery, Hba - hemoglobin level at admission to hospital, TP - amount of total protein of blood. The accuracy is revealed - 95,08%. To predict the probability of immediate postoperative complications, the following mathematical model was created: P = 3.89-0.018 HBA 0.0259 TP where, P means the probability of complications, HBa - the level of hemoglobin on admission, TP - the amount of total protein of blood. The accuracy is revealed - 90.16%. Key words: Model, Esophageal cancer I have no potential conflict of interests to report. Analysis of Liver Function Tests in Obese Patients After Abdominal Surgery Aygun Ibrahimova, Nuru Bayramov Azerbaijan Medical University, Department of Surgical diseases Introduction: Obesity is associated with non-alcoholic fatty liver disease. The aim of this study was estimate associations between postoperative levels of liver function tests (LFTs) and obesity indices in obese patients. Materials and methods: To investigate the associations between obesity and LFTs we measured body mass index (BMI) and hepatic biochemical parameters in 59 postoperative patients. A total no of 59 individuals were selected for the study and they were categorized into 3 groups: Group I Normal- BMI \ 25 (n = 30), Group II OverweightBMI 25.0- 29.9 (n = 20) and Group III Obese- BMI [ 25 (n = 9). Serum activities of alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), Bilirubin, INR and CRP were determined by standard methods. All patients were analyzed by examining the LFTs the day before, the 1, 3, 5 day after the abdominal surgery. Results: Values LFTs were within the normal references range in the I and II groups. Alterations in the LFTs were seen on the 1, 3 postoperative days in the III group. Mean activities (± SD) of serum ALT and AST in the I group were 22.9 ± 6.7 U/L and 23.2 ± 7.5 U/L(p \ 0.01), in the II group were 29.7 ± 7.2 U/L and 35.4 ± 8.3 U/L(p \ 0.01) and in the III group were 53.2 ± 13.4 U/L and 33.7 ± 9.8 U/L (p \ 0.01). Conclusion: Among subjects having high BMI, those with fatty liver showed significantly higher incidence of elevated hepatic enzymes, compared to those without fatty liver. In short, elevated serum hepatic enzyme activities are associated with BMI and a high prevalence of fatty liver is observed in subjects with elevated BMI. Key words: BMI, Liver, Obesity I have no potential conflict of interests to report. Abstract 53 Abstract category: Abstract CD133 Sensitivity in Colorectal Inflammatory Polyps Aynur Safiyeva, Nuru Bayramov, Mustafa Cihat Central Customs Hospital, Department of General Surgery; Azerbaijan Medical University, Department of Surgical Diseases, Erbakan University Introduction: Adenomatous polyps are the key to the development of colorectal cancer. Risk of colorectal carcinogenesis can be reduced by polypectomy. Gastrointestinal tract inflammatory diseases, ulcerative colitis and Crohn’s disease play a role in the formation of colorectal polyps as well. Thus, proliferation and apoptosis in inflammatory diseases in colon cells may increases the risk of carcinogenesis. The important role of cancer stem cells in adenomatosis polyps’ transformation to colorectal cancer are being actively discussed in recent studies. Materials and methods: Previously pathologically evaluated polyps at the Central Customs Hospital were re-evaluated at the PatoHistology Department of Meram Medical School in Erbakan University, The Republic of Turkey. Firstly, the preparations stained with Hamatoxylin Eosin are divided into groups with and without dysplasia. These tissues are then CD 133 staining was performed immunohistochemically on these sections (CD133 Polyclonal Antibody, ProteinTek, Catalog Number: 18470-1-AP). We investigated the CD133 sensitivity of inflammatory colorectal polyps. The classification of inflammatory polyps according to the degree of dysplasia was as follows: dysplasia was not found in 15 of 16 inflammatory polyps and dysplasia in only one patient. The size of the 15 inflammatory polyps was less than 1 cm and only one size was greater than 1 cm. In patients with dysplasia, the number of cells stained with CD Abstract category: Abstract The Effect of the Invasion of Helicobacter Pylori on the Quality of an Operation in the Gastric Stump During the Far Period of Gastric Resection Scientific Center of Surgery, Department of Gastroenterology Introduction: Some postgastroresection symptoms appear and decrease the quality of an operation in the far period of the gastric resection for complication of the gastric disease. We aim to define the effect of the level of Helicobacter pylori (Hp) invasion on the quality of an operation in the far period of the gastric resection. Materials and methods: 95 patients conducted with the gastric resection, were examined; 82 (86,5%) – men and 13(13,5%)- women. The bacterioscopy and urea’s test in the HP diagnostics, the secretory function of the stump was conducted with the hystological examination of the biopsy materials. The quality of the operation was defined according to the Visic scale. Results: Hp invasion was disclosed in 74(77,9%) patients: weak invasion- in 7,4%) patients, average - 20%, and high invasion in 50,5% patients. ‘‘Excellent’’ quality of the operation was defined in 10,5%)patients, ‘‘Good’’ quality in 52,6%, ‘‘Satisfactory’’-31,6%, ‘‘Unsatisfactory’’ quality in 4,2% patients. Conclusion: Different level of Hp invasion was disclosed in 77,9% cases of the gastric stump in the far period of the gastric resection; Direct correlation exists between the quality of the operation and the level of the Hp invasion. Key words: Gastric, Resection, Life I have no potential conflict of interests to report. Abstract 55 Abstract category: Abstract Intrahepatic Cholangioyeyunostomy (Segment-3 Bypass) as Bridge to Biliary Stending in Unresectable Hiliar Tumors Ruslan Mammadov, Nuru Bayramov, Elvin Isazade Azerbaijan Medical University, Department of Surgical Diseases Introduction: The aim of this study was to evaluate our experience on intrahepatic cholangioyeyunostomy operation (segment-3 bypass) in unresectable hiliar tumors. Materials and methods: From 1996 to 2017 total of 52 segment-3 bypass operations were performed by our group. Main indications for this procedure were obstructive jaundice due to unresectable hiliar tumors and absence of biliar stending. Age of patients ranges from 35 to 81. Etiology of biliary obstruction were hiliar cholangiocarsinoma (Klatskin tumor) in 23 patients, pancreatic adenocarsinoma 9, gallbladder cancer 8, distal CBD cancer 6, hepatocellular carcinoma 3, cavernoma 1, limfoma 1 and calcified hydatitouse cyst in one patient. Tumors were accepted as unresectable if there was any of: distant metastasis, multiple hepatic metastasis, advanced local invasion to hepatic hiliar and peripancreatic structure. No drainage procedure was performed before operation. Operation performed by standart technique with hepatotomy and parenchymal dissection by clumpcrashing, Ligasure or CUSA. Segment-3 bile duct identified at the level of its junction and side –to-side bilio-enteric anastomosis was performed. Results: No mortality (30 day) was noted. Anastomotic leakage occurred in 4 patients in whom transanastomotic drainage was not used. Reccurent attacks of cholangitis was most common morbidity occurred during fist postoperative months. 37 patients died and 15 patients live up to day. All patients with benign obstruction are living (13, 12 year). Median survival of died patients was 18,5 month (227 month). After development of anastomotic stricture by progressive tumor additional percutaneuse biliary dranage and stending was used in 16 patients, which get additional 3-9 month survival. Conclusion: Intrahepatic cholangioyeyunostomy (segment-3 bypass) is forgotten but good palliation for obstructive jaundice in unresectable hiliar tumors and may refer as bridge to biliary stending. Key words: Segment -3 bypass I have no potential conflict of interests to report. The Effect of the Invasion of Helicobacter Pylori on the Quality of an Operation in the Gastric Stump During the Far Period of Gastric Resection Gunel Shukurova Scientific Center of Surgery, Department of Endocrinology Introduction: For today there are unsolved problems in the diagnosis and surgical treatment of papillary thyroid cancer (PDT). We aim to improve the quality of preoperative diagnosis of the nodular thyroid gland with the use of mutation determination of the BRAF gene. Materials and methods: Twenty-six patients with nodular formations of the Thyroid gland of 1 cm or less in diameter were examined. Before the operation, aspiration material was used for genetic analysis. After thyroidectomy, BRAF is determined in a remote preparation. Standard Multi-plex PCR technique plus reverse hybridization with highly specific oligonucleotide probes on nylon strips were used (ViennaLabBRAFStripAssay). Results: The prevalence of BRAF mutation among patients was 68.2%. While studying the relationship between the clinical and morphological characteristics of the BRAF-status of the tumor, the following characteristics were obtained: in 87.5% of cases the multicentric tumors were BRAF-positive, 73.3% of the tumors with spreading to the side fiber of the neck had BRAF-positive status. After applying the multidimensional regression analysis of the dependence of all these criteria together with the presence of a mutation, a statistically significant correlation was revealed. Metastases in regional lymph nodes were revealed in 34.1% of cases, of which metastases to the central cellulose - in 9 patients, which allowed the process to be staged as N1a. Conclusion: Thus, the definition of the mutation on the BRAF will allow at the pre-operative stage to stratify the risk and select an adequate volume of surgical treatment. Assessment of these factors is possible only with the performance of thyroidectomy. The optimal volume of surgical treatment for BRAF ‘positive papillary carcinomas is thyroidectomy with central lymphodissection. Key words: Thyroid, BRAF, Mutation I have no potential conflict of interests to report. Abstract 57 Abstract category: Abstract Management of Iatrogenic Bile Duct Injures After Cholecystectomy: Single Center Experience Azerbaijan Medical University, Department of Surgical Diseases Introduction: Iatrogenic injuries and strictures of a extrahepatic bile ducts are one of the most serious complications of hepatobiliary surgery, which leads to long-term sometimes, lifelong disability of many patients and surgical management of this complication is challenge even for a skilled surgeon. Materials and methods: This study was conducted at the Scientific Center of Surgery named of after M. Topchubashov. 77 patients treated in our institution for BDI from January 2007 to September 2017 were retrospectively analyzed. There were 59 females and 18 males age ranged from 22 to 72. The Strasberg classification was used to determine the type of injury. Results: In total 77 patients included in the study. According to the Strasberg classification of BDI, there were 4 A type lesions, 3 C type lesions, 17 D type lesions. 53 cases were classified Strasberg E1-5 (including 11 patients with anastomotic strictures). There were no associated with vascular injury. In 15 cases were done primary suture of the bile duct and drainage of bile with the placement T-tube. In 3 cases with ‘‘fresh’’ injures performed end-to-end biliary anastomosis on a drain. But most of patients (57 cases in this series) with Strasberg E type transection or strictures underwent surgical reconstruction by Roux-en-Y hepaticoyeyunostomy (HYS). Trans-hepatic drains were placed in 11 patients. In two patients with loss of confluence were performed Kasai portoenterostomy with the placement of biliary stents. Conclusion: Reconstruction and Roux-en-Y HYS are the choice of treatment-gold standart for the extrahepatic bile ducts injuries with Strasberg E type. These operations should be performed by an experienced biliary surgeon. Key words: Bile duct injures I have no potential conflict of interests to report. Probiotics Help Prevent Infections in Patients After Surgery for Colon Cancer Kutliyeva Guzal, Sarimbek Navruzov Institute of Microbiology of Uzbekistan, National Cancer Research Center of Uzbekistan Introduction: Colon cancer is the third most common cancer worldwide and remains one of the most pressing problems in Uzbekistan. Probiotics after colon resection may help restore bowel function improvement postoperative period and reduction of complications. To study the use of probiotics before and postoperative period after colon resection in patients with colorectal cancer, the study of intestinal microflora in patients with colorectal cancer, conducting diagnostic dysbiosis with subsequent correction of domestic probiotic preparations. Materials and methods: The object of study were 20 patients with colorectal cancer at the age of 40 -75 years. Surveys conducted before and after treatment. The results showed 100% presence of intestinal dysbiosis in patients with varying degrees: the complete absence of lactobacilli and bifidobacteria in 80% of patients, whereas when the norm of probiotic bacteria should be at least 107 CFU/1 g of feces. Among the pathogenic intestinal microflora dominated: Enterococcus faecalis (8,9 log10 CFU/g) 58%, Klebsiellapneumoniae (7 log10 CFU/g) 18%, Proteus vulgaris (5,7 log10 CFU/g) 10%, Staphylococcus aureus (4, 6 log10 CFU/g) was 10%, Candida spp. (6 log1 CFU/g) 2%, Pseudomonas aeruginosa (6 log10 CFU/g) 2%. Each patient was assigned individually probiotic preparation and dosage. Results: Obtained the first positive results on the restoration of the normal flora of the intestine. Found that in 80% of treated patients, a change in the disease in a positive way, connected with the restoration of the normal flora of the colon The number of opportunistic bacteria found within the acceptable norm. Conclusion: Thus, clinical trials have shown the effectiveness of probiotics domestic dysbiotic the correction of the patients. Holding probiotic improves the general condition and increasing immunity, enhances the efficiency of treatment, and protects the body against toxic effects of medicines. Key words: Probiotic, Colon, Cancer I have no potential conflict of interests to report. Abstract 59 Abstract category: Abstract Risk Factors of Colectomy in Acute Phase of Ulcerative Colitis – One Centre Study Michal Mik, Mariusz Turowski, Piotr Zelga, Lukasz Dziki, Radzislaw Trzcinski, Adam Dziki Medical University of Lodz, Department of General and Colorectal Surgery Introduction: Ulcerative colitis (UC) is a form of chronic inflammatory bowel disease, which is mostly manifested with relapse attacks, followed by remission periods. An acute attack of this disease is a life-threatening condition. Despite a huge array of drugs applied in treatment of this disease, still as many as around 20% of patients, hospitalized due to an acute attack of UC, require colectomy. Materials and methods: The aim of the study was to analyse factors which increase the risk of colectomy in patients with UC.The authors of the study made a retrospective analysis of 106 patients hospitalized due to exacerbation of UC in the Department of General and Colorectal Surgery of the University Teaching Hospital No. 5 between 2005 and 2015. 31 patients with UC exacerbation underwent an emergency surgery due to prior failure of conservative treatment. Results: Factors which significantly increased the risk of indication for a surgery included: tachycardia on admission OR 5.21 (2.10 12.89 95%CI), low serum albumin level on admission B 3.2 g/dL OR 4.22 (1.45 - 12.24 95%CI), high levels of CRP [ 90 mg/L OR 3.08 (1.28 - 7.38 95%CI) and prior administration of immunosuppressant drugs OR 3.07 (1.12 - 8.47 95%CI). Conclusion: On admission to hospital, some factors increasing the risk of emergency colectomy, required in an acute UC, should be identified since it might facilitate taking a decision to perform the surgical procedure. Key words: Colitis, Risk, Colectomy I have no potential conflict of interests to report. Abstract 60 Abstract category: Abstract Definition of Peculiar Prognostic Parameters in Recurrent Colorectal Cancers by the Contribution of Control or Restaging FDG-PET/CT Oguz Hancerliogullari, Kursat Okuyucu, Semra Ince, Yasar Subutay Peker, Nuri Arslan University of Health Sciences, Gulhane Training and Research Hospital, Department of General Surgery, Department of Nuclear Medicine Introduction: Colorectal cancer (CRC) ranks the third most frequent cancer in the world. Approximately 40% of the disease recurs after surgical resection. Determination of predictive parameters for recurrence may aid in stratification of patients and contribute to patient management. The aim of the study was to examine the predefined risk factors in metastatic development and evaluate clinical significance of 18F-fluorodeoxyglucose uptake. Materials and methods: The study was conducted with 56 patients for whom FDG-PET/CT was requested for the suspicious recurrence or metastasis by routine conventional screening tests.33 patients in whom recurrence/metastasis was established with final histopathologic diagnosis formed malign group, 23 patients benign group. Risk factors of age, serum CEA and Ca 19.9 levels, SUVmax, tumor size (TS), CT/MRI findings, sex, primary tumor localization (PTL), lymphovascular invasion (LVI), perineural invasion (PNI), initial neoadjuvant therapy (INAT), initial metastatic lymph node excision (ILNM), stage, tumor differentiation (DIF) were compared between these groups. Results: CEA, Ca 19.9, SUVmax, TS, PNI, ILNM, FDGP, CTP and DIF were found statistically significant by univariate analysis. After multivariate analysis, SUVmax and ILNM remained as the main risk parameters impacting metastasis/recurrence. Mean SUVmax was 7.25 in benign group, whilst it was 11.7 in malign group (p = 0.019). ILNM was present in 66.5% of malign group, 30.5% in benign group (p = 0.015). For an estimated cutoff value of 6.3 and 12.5 on ROC curve, the calculated specificities were 61% and 87%, respectively. Conclusion: ILNM and SUVmax are the main risk factors in recurrent colorectal cancer and these patients must be followed up carefully. FDG-PET/CT is very sensitive for the detection of recurrence/metastasis and SUVmax appears to improve its specificity. Key words: Colorectal cancer I have no potential conflict of interests to report. Treatment of Sialolithiasis Using Sialolithotripsy Said Aliyev, Rufat Meybalizada, Elshad Sadiqov, Parvin Akbarov Azerbaijan State Advanced Training Institute for Doctors named after A.Aliyev, Department of Stomatology and Maxillofacial Surgery; N. Tusi Memorial Clinic, Department of Radiology; N. Tusi Memorial Clinic, Department of Physical therapy and Rehabilitation Introduction: Sialolithiasis - is the most common disease among the pathology of the salivary glands. According to various authors, it accounts for 20.5% to 78%. All theories on the origin of sialolithiasis are polyethiologic, including congestion and thickening of saliva, penetration of microorganisms into the salivary gland duct, imbalance of mineral metabolism. Recently reported on the success of lithotripsy in the treatment of patients with sialolithiasis. Materials and methods: Since 2016, in N. Tusi Memorial Clinic, 39 patients had lithotripsy of salivary stones; in 37 cases, stones were located in the submandibular salivary gland and 2 in the parotid gland. The age of patients varied from 22 to 77 years. The size of the stones ranged from 0.2 to 2.0 cm. The positioning of the stone was carried out using ultrasound. On average, for a stone fragmentation, one patient needed 5-6 sessions (from 1 to 11) of lithotripsy - 1-2 sessions per week. Results: Following the lithotripsy or during the procedure, the calculus fragmentation happened after 1st session in 16 patients, after 2 sessions - in 8, after 3 session - in 6, after 4 - in 2 and after 5 - in 1 patient. In 3 patients the stone was completely fragmented, however, due to the narrow lumen of the main duct, it did not depart. In 3 patients with a concrement size from 0.3 to 1.8 cm, fragmentation was not obtained. It can be said that in 85% of cases the necessary effect was achieved. Conclusion: Given the complexity of surgical treatment of patients with sialolithiasis and the possibility of postoperative complications, especially when the stone was localized in parotid salivary glands, we concluded that extracorporeal lithotripsy is a promising alternative treatment for patients with sialolithiasis. Key words: Sialolithiasis, Lithotripsy I have no potential conflict of interests to report. Results of Delorme’s Operation with Prolapse of Rectum Solmaz Imanova Azerbaijan Medical University, Department of Surgical Diseases Introduction: We aim to study results of Delorme’s operation with prolapse of rectum. Materials and methods: This study included 32 patients of both sexes who underwent Delorme’ operation for the period 2013-2016 years at the age of 42-74. After exteriorization of the rectum to the outside, 1 cm above the anopectinate line, the mucosa was excised circularly, exposing muscles, and also circularly excised the latter to the above line. Muscular plication by corrugated sutures to the mucosal-skin boundary, also the anterior and posterior levatoroplasty are produced. Results: Early relapse (up to 6 months after surgery) is mainly due to inadequate choice of operating procedure and unqualified performance. The late relapses occur after 6 months from the operation. They are associated with prolonged, non-conservative treatment and a sparing diet, constipation, the duration of anamnesis, concomitant somatic diseases, not a change after the operation of the lifestyle and the nature of the food. In patients undergoing simultaneous posterior and (or) anterior levatoroplasty, a relapse was not observed. The dynamics of changes in functional symptoms and disorders was studied. Conclusion: Thus, the degree of anal incontinence is reduced by 1-2 degrees in practically all patients with preoperative insufficiency of the occlusion apparatus, improvement of intestinal activity, elimination of urinary retention and frequent urination. With respect to anal incontinence, a significant improvement was observed in those patients whose Delorme’s operation was supplemented with levatoroplasty. The stricture of the anal canal was not detected in any case. Key words: Perineal, Prolapse, Rectum I have no potential conflict of interests to report. Abstract 63 Abstract category: Case report Is Endovascular Revascularization Reasonable for Isolated Renal Artery Thrombosis Following Blunt Trauma? A Rare Case Report with Review Rahman Senocak, Oguz Hancerliogullari, Semra Ince University of Health Sciences, Gulhane Training and Research Hospital, Department of General Surgery, Department of Nuclear Medicine Introduction: The incidence of isolated renal artery thrombosis (RAT) after blunt abdominal trauma is extremely rare. Traumatic RAT hardly ever occurs as an isolated event and this usually indicates major injuries. Thanks to advanced imaging methods such as computed tomography (CT), there has been a relative increase in the diagnosis recently. We present a selective renal artery stent application in a patient with isolated RAT after blunt abdominal trauma. Case description: In this case, a young male patient who developed isolated unilateral RAT with left kidney involvement due to blunt thoraco-abdominal trauma was reported. However, there were no clinical or laboratory abnormalities. There was no thrombosis and contrast enhancement in the left renal artery in contrast enhanced CT. CT angiography revealed occlusion in a segment of approximately 2 cm in the middle of the left renal artery, and an endovascular stent was placed. In follow up, it was found that the blood stream in the left renal artery were patented. Percutaneous endovascular revascularization (PER) was successfully performed in the patient. Hypertension (HT) did not develop during short follow-up and scintigraphy showed minimal function of the kidney. Conclusion: In young patients with RAT who applied late in the posttraumatic period, in order to protect kidney functions and prevent future renal HT, despite the possibility that the kidney may function poorly, we recommend minimal invasive intervention in the treatment. PER can be safely performed in place of surgical vascularization in these patients with minimal invasiveness and less morbidity. Key words: Renal artery thrombosis I have no potential conflicts of interests to report. Abstract 64 Role of CT Liver Volumetry for Donor Selection in Living Donor Liver Transplantation Namig Novruzov, Nuru Bayramov, Emin Mammadov, Safiyeva Aynur Central Customs Hospital, General Surgery Department; Azerbaijan Medical University, Department of Surgical Diseases; Central Customs Hopsital, Radiology Department Introduction: In this article, we discuss the aspects in preoperative donor evaluation on multi-detector computed tomography. Materials and methods: The volume of the liver estimated by volumetry using 3D CT. Angiographic images were obtained after intravenous administration of non-ionic contrast agent was given at 1,5-2 ml/kg dose. Real-time bolus tracking was used and scanning was automatically triggered at a detection. Arterial, portal and hepatic venous phase images were acquired at 6, 26 and 35 s. The average duration of study was 14.5 ± 4.1 min. Results: A total of 48 donors were evaluated for potential recipients (31 men, 17 women; mean age, 33.2 years; range, 23–55 years). 42 (87,5%) donors not proceeding to donation. Mean measured total liver volume was 1266,7sm3 ± 22,4. Virtual planes of liver transection in donor hepatectomy was the right edge of the middle hepatic vein. An average right lobe (possible graft) volume was observed 7316sm3 ± 18.7 and mean remnant liver volume was 435,7sm3 ± 15,2. 7 (18,7%) candidates have not been selected for inadequate graft volume (GW/RW B 0.8%). In 14 (29,1%) cases inadequate remnant liver volume was observed. Liver attenuation values reflect the degree of fatty change and 17 (31,3%) volunteers not proceeding to donation because of negative liver attenuation index (-5 HU). In 2 (4,2%) cases unacceptable liver biopsy and in 2 (4,2%) patients anatomic vascular variations of the liver were contraindications. Donor reluctance was observed in 4 (8,3%) cases. Conclusion: The imaging provides a detailed evaluation of fatty infiltration in donor liver parenchyma, identification of normal and variant hepatic vascular anatomy, and estimation of segmental liver volumes along with their utility in donor selection. Key words: Donor selection, Volumetry I have no potential conflict of interests to report. Abstract 65 Abstract category: Abstract Study of TME Quality in the Abnormal Derivatives of the Rectum Elman Azimov Azerbaijan Medical University, Department of Surgical Diseases Introduction: As a result of the total mesorectal excision (TME) performed in the abnormal derivatives of the flat bowel, the likelihood of local recurrences has been reduced from 25% to 8%, but the results are still not heartwarming. Materials and methods: Patients were divided into two groups. 1) patients who performed laparoscopic TME (47 patients), 2) patients who had TME performed openly (56 patients). 57 patients were female and 46 were male. The age limit was 20-70 years. Of the patients, 5 were in T1 stage, 21 in T2 stage, 65 in T3 stage and 12 in T4 stage. Results: TME quality had a significant impact on the remaining 5 patients. The quality of TME in laparoscopic and open groups was as follows depending on the location of the derivatives: According to the lower, middle, and upper rectum derivatives, 38,4%, 50%, 56,2% and 43,7%, 50%,44,4% TME quality was recorded as grade 3(high), 27%, 38,8%, 31,2% and 25,0%, 36,3%, 33,3% as grade 2 (satisfactory), 38,4%, 11,1%,12,5% and 31,2%, 13,6%, 22,2% as grade 1(insufficient). In our opinion, changes in the TME quality on depending on the location of the derivatives are considered to be due to the technical difficulties associated with the removal of the lower layers and the visual impairment in the lower part of the flat bowel, as well as the weakness of the mesorectal fascia. Conclusion: Consequently, there is no statistically significant difference between laparoscopic operations and open operations in TME quality. The location of rectum cancer is one of the major factors affecting TME quality. Key words: Quality, Derivatives, Rectum I have no potential conflict of interests to report. Abstract 66 Abstract category: Case report Unusual Bilateral Multifocal Renal Angiomyolipomas: Case Report with Wunderlich’s Syndrome and Emerging Surgical Approach Elshad Sadigov, Anar Ismailov, Ilgar Ismailov Azerbaijan State Institute for Advanced Training of Doctors named A. Aliyev, Department of Radiology; Uzmanlar Medical Center, Department of Radiology; Republican Treatment and Diagnostic Center, Department of General Surgery Introduction: In this unusual case, a young girl who had a Wunderlich’s syndrome with bilateral multifocal AMLs was reported. Bilateral renal AMLs usually (80%) associated with tuberous sclerosis complex (TSC). Case description: A 15-year-old girl with complain of left flank pain was admitted to our hospital. Palpation revealed a mass in the left flank. Ultrasonography (USG) revealed multiple small cystic and solid lesions in both kidneys, as well as hypoechoic, hypervascular and heterogeneous large tumors in the lower third of both kidneys. The small solid lesions were highly echoic. In addition, USG revealed a hypoechoic mass in the left perirenal space (heamatoma). Computed tomography (CT) showed bilateral renal masses with fat component, suggesting a bilateral massive AML and perirenal heamatoma on the left side. A complete left and partially right nephrectomy (enucleation of the tumor) with a period of 1 month was performed. In present case we found unusual radiological findings (on USG mostly hypoechoic, atypical vasculature on USG and contrast CT) with perirenal haemorrhage, that do not have a connection with TSC. Histology revealed AML, found angiomyomatous infiltration in two paraaortic lymph nodes, did not reveal malignancy to retroperitoneal space. Within 1.5 years after the operation in the right kidney, previously existing small angiomyolipomas did not increase in size. Conclusion: Bilateral and multifocal renal AMLs most commonly behave in a benign fashion, however if they have atypical vasculature, can result in life threatening haemorrhage. When surgical treatment is indicated, we believe that it is necessary to follow the carcinological surgical rules, unless there is a high degree of confidence that the lesion is benign. Thus, early diagnosis and timely treatment are important in these cases to prevent life-threatening complications. Dynamic follow up of small tumours is necessary, as they can bleed or recur. Key words: AMLs, Haemorrhage I have no potential conflict of interests to report. Comparative Analysis of the Early Results of Surgical Treatment for Colon Cancer Patients Fazil Kurbanov, Zaur Khalilov, Aleksandr Kalinichenko, Rustam Azimov, Maksim Chinikov, Ilona Panteleyeva Peoples’ Friendship University of Russia, Department of Hospital Surgery with a course of pediatric surgery; Central Clinic Hospital, Department of General Surgery; Central Clinical Hospital of the Russian Academy of Sciences, Department of General Surgery Introduction: Laparoscopic operation is widely used in colorectal surgery. Laparoscopic interventions have a number of limitations, especially for older patients. This study analyzed results of elective treatment of colorectal cancer, taking into account age of the patients. Materials and methods: The study included 169 patients operated on for colon cancer. This group included 93 men and 76 women aged 21 to 89 years (mean age 68.4 ± 1.0 years). Patients were subject to surgical treatment, having previously been in a comparison groups. The first group included 108 patients aged 60 years and older, the second group included 61 patients under the age of 60 years. (p \ 0.01). Comorbid diseases were detected in 102 patients of the first group and in 28 patients in the second group (94.4% and 45.9%, p \ 0.05). The Charlson comorbidity index (1987) was calculated in order to clarify and confirm the significance of the differences. The differences were credible (p \ 0.01). Similarly, the groups were assessed according to the ASA scale. In the first group, 72% of patients were referred to the III and IV classes of ASA, in the second group - 29% of patients (p \ 0.05). Results: The analysis of intraoperative parameters included an estimation of the average operation time, the presence of intraoperative complications, and access conversions. Discussion: We obtained equally successful results of surgical treatment of patients with colon cancer of older age groups, compared with younger patients, regardless of the location and stage of the tumor, and the nature of the intervention performed. Conclusion: Laparoscopic operations are a method of choice in the elective surgery of elderly and senile age patients with colon cancer. Key words: Laparoscopy, Colorectal cancer I have no potential conflict of interests to report. Abstract 68 Abstract category: Abstract Possibilities of Multi-Field Emergency Hospital in Treatment of Patients with Acute Obstructive Colorectal Cancer Galina Martynova, Andrei Demko, Ivan Soloviev, Dmitri Surov, Nikolay Sizonenko, Andrei Sviatnenko Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine, Department of emergency surgery; S.M. Kirov Military Medical Academy, Navy surgery Department Introduction: Nearly 20% of patients with colorectal cancer go to emergency hospitals with various complications, most common of which is acute obstruction. Materials and methods: The study included 134 patients with acute obstructive colorectal cancer (2016-2017). The middle age of patients is 70,3 years. Patients with a clinical status of advanced peritonitis and/or phenomena of multiple organ dysfunction (group 1, n = 21 (15,7%)) are performed emergency. Patients with a symptoms of acute colonic obstruction without the phenomena of widespread peritonitis and multiple organ dysfunction were hospitalized in surgical department for multicomponent conservative therapy and to try endoscopic recanalization of tumor. If it was ineffective (group 2, n = 75 (56%)), then urgent surgery were performed. The positive clinical effect of conservative therapy (group 3, n = 38 (28,3%)) created conditions for pre-examination of patients and surgery in a deferred order. The main objectives of the operation are to eliminate life-threatening complications with modern principles of cancer. The main elements of intraoperative tactics were decompression of the colon and small intestine (according to indications), rejection of longterm nasogastrointestinal intubation, creation of conditions for early enteral support, minimizing the number of drains, and rectus sheath catheterization. Tactics of post-operation patient management was based on individual components of a multimodal rapid rehabilitation program adapted to the conditions of the urgent surgery. Results: Postoperative complications were developed in 17,2% of patients (n = 23): 4 patients – I-IIIa and 19 patients – IIIb-V grade by Clavien-Dindo classification. The highest number of severe complications (IIIb-V grade) was registered in patients of the first and second group: 9 and 6 causes, respectively. Total mortality is 12,7% (n = 17). Conclusion: This medical and diagnostic tactics is effective by improving the immediate results of surgical treatment. Key words: Colorectal cancer, Obstruction I have no potential conflict of interests to report. Abstract 69 The Significance of Spleen Elastography in Determining Portal Hypertension (Initial Results) Sevinj Salahova, Mehriban Huseynova, Nuru Bayramov Azerbaijan Medical University, Department of Surgical Diseases Introduction: To explore the results of liver and spleen elastography, varicose veins stages and bleeding in patients with portal hypertension. Materials and methods: : 54 patients with portal hypertension were performed liver, spleen Shear Wave elastography with Supersonic Aixplorer Multi Wave device and endoscopic examinations during the period from 2016 to 2017 at I Department of Surgical Diseases at the Training Surgical Clinic of Azerbaijan Medical University. 31were men (58%) and 23 were females (42%), an average age was 51.06. Results: In patients without varisces, the liver stiffness was 22.3 kPa on average and 36.5 kPa respectively. In patients with grade 1 varices veins: liver - 19.3 kPa, spleen - 51.3 kPa; grade 2 varices: liver 26.4 kPa, spleen - 51.8 kPa; grade 3 varices: liver - 25.9 kPa, spleen 57.9 kPa; grade 4 varices: liver - 24.8, spleen - 69.8 kPa. Although there were no correlations in liver stiffness, there were differences in spleen stiffness measurments, especially in varicese grade 3 and 4. In patients with bleeding, there was a significant difference in both liver (37.1 kPa) and spleen stiffness measurments (61.5 kPa) and non-hemorrhage (liver - 22.7 kPa, spleen - 54.7 kPa). Conclusion: spleen elastography can reveal the portal hypertension at the primary stage of the examinations and it is possible to determine variceses and bleeding risk Key words: Elastography, Liver stiffness I have no potential conflict of interests to report. Abstract 70 Abstract category: Abstract Surgical Treatment of Benign Enterovesical Fistula in a Tertiary Referral Center Lukasz Dziki, Marcin Wlodarczyk, Michal Mik, Radzislaw Trzcinski, Adam Dziki Medical University of Lodz, Department of General and Colorectal Surgery Introduction: Enterovesical fistula (EVF) is a rare chronic disease characterized by difficult and complicated diagnosis and management. The aim of study was to analyze the most appropriate surgical approaches in patients with benign enterovesical fistula (EVF). The study analyses in detail whether the closure of the defect in the bladder wall is always necessary. Materials and methods: Fifty-nine patients with benign EVF and who were qualified for surgical treatment were enrolled. A surgical one-stage procedure was performed in all patients. After the separation of the offending bowel segment, the permeability of the bladder was examined by feeding methylene blue through a catheter into the bladder lumen. Only patients with a urinary bladder leakage were sutured while patients without a leakage didn’t undergo a bladder repair. Results: The most common intestinal fistula involving the urinary bladder was colovesical fistula, observed in 52.5% cases. The most commonly-observed primary disease was diverticulitis: 67.7% of patients. Conclusion: The analysis indicated no relationship between the presence of bladder sutures following EVF and perioperative complications. During the follow-up, a recurrent episode of EVF was observed in one patient with bladder suturing and in two patients without suture (p = 0.913). Key words: Entero-vesicalfistula, Treatment I have no potential conflict of interests to report. Abstract 71 Abstract category: Case report Yasar Subutay Peker, Nazif Zeybek, Cagdas Karaman, Oguz Hancerliogullari University Of Medical Sciences, Gulhane Training and Research Hospital, Department of General Surgery Introduction: Giant abdominal masses are rare because rare patient may be asymptomatic. If the mass is asymptomatic or the pain threshold level of the patient is high, then the abdominal masses may grow up to 50 cm as in our case. Few of the giant masses grow infiltratively without invasion. At this case report we wanted to share our experience of a patient with 49x28 cm abdominal mass whom we excised the mass. Case description: 38 years old male patient applied to our clinic with chronic abdominal pain which started to worsen his quality of life for last 3 months. His symptoms were, abdominal pain, gaining weight, abdominal distention and dyspepsia. Further evaluation by abdominal computerized tomography (CT) showed giant abdominal mass with length of almost 50 cm.Midline abdominal incision was done and mass was dissected from abdominal organs. Mass starting from subhepatic area to pubis was excised without any complication. Final measurement revealed a mass of 49x28 cm.Patient was taken to intensive care unit postoperatively and had hypotension due to giant abdominal mass excision. Inothrophic agents were initiated. Patient was followed up at ıntensive care unit for 2.5 months because of unstable hemodynamics which septic symptoms also interfere with unstable hemodynamics.Patient was lost due to septic shock. Final pathology of the patient was sclerosing liposarcoma. Conclusion: Giant mass excision from abdomen is a challenging operation for surgeons. Beside the troublesome surgery, postoperative instable hemodynamics which may usually occur after giant abdominal mass excision increases the postoperative morbidity and mortality. The postoperative hemodynamic instability after giant abdominal mass excision may be the result of fluid redistribution. However giant masses with malignant behavior should be excised for even cure or palliative approach. Surgeons dealing with abdominal giant masses should keep in mind the postoperative complications of the excisional surgery. Key words: Abdominal mass, Liposarcoma I have no potential conflict of interests to report. Diagnosis and Choice of Tactics for the Operation of the Cholelithiasis with Its Complications Nodirjon Ruzimurodov, Nazira Aripova, Umid Allazarov Tashkent medical academy, Department of Emergency Surgery Introduction: Timely diagnosis of cholelithiasis and its complications remains in our time an urgent problem in surgical hepatology. The reason for this is both an increase in the number of patients with this pathology, and an increase among them of persons of elderly and senile age. Materials and methods: 120 patients with cholelithiasis were examined for the period from March to December 2017. The sex ratio of 78 women and 42 men. Average age 61.3 years. Results: All patients were diagnosed with the following: a general blood test, a biochemical blood test, ultrasound, and a patient whose size was more than 8 mm made an MRI with cholangiography. In a clinical and biochemical study, in 68 cases out of a total of 120 patients, hyperbilirubinemia was detected and bilirubin values ranged from 75.6 mmol/l. In ultrasound 66 patients were diagnosed with acute calculous cholecystitis, (42 cases were obturation), 54 patients were diagnosed with chronic calculous cholecystitis. 43 patients made MRI with cholangiography. Of the 42 patients who defined the obstruction in 26 patients, the choledoch was dilated to 1.0 cm and the first stage was performed with EPST with choledochoextraction of the calculus. After arresting the attack, laparoscopic (11) and traditional (15) cholecystectomy was performed. In 30 patients hospitalized with chronic calculous cholecystitis, an eroded gallbladder with concrements was detected on ultrasound; 17 of them showed an increase in choledochus (in 4 the presence of a calculus in the terminal section of the choledochus was determined up to 8-10 mm in diameter). Out of 30 patients 28 cholecystectomy was performed, and 2 patients with the first stage performed EPTS with lithoextraction concrement followed by 3-4 days of laparoscopic chelecystostomy. Conclusion: Pre-operative diagnosis and investigations are useful to treat this disease on time. Key words: Cholelithiasis, Ultrasound, MRI I have no potential conflict of interests to report. Abstract 73 Abstract category: Case report Nazif Zeybek, Yasar Subutay Peker, Murat Urkan, Emin Lapsekili University Of Medical Sciences, Gulhane Training and Research Hospital, Department of General Surgery Introduction: Menetrier disease is characterized with giant mucosal folds and glandular atrophy causing decreased gastric acid secretion and protein loosing enteropathy. Actually, menetrier is a hypertrophic gastropathy which chronic gastritis, multiple hyperplastic polyps and lymphoid hyperplasia are other types. Menetrier is around the 10% of hypertrophic gastropathies. It is more common at female than male. At this case report, we wanted to share our experience out menetrier disease. Case description: 22 years old patient applied to our clinic with epigastric pain, nausea and weight loss. No extra-intestinal symptoms were present. Laboratory of the patient was in normal range and patient had the history of proton pump inhibitor (PPI) medication for more than 3 months. Patient was scheduled for endoscopy due to persistent epigastric pain. Endoscopic diagnose was hypertrophic gastropathy and biopsy results revealed menetrier disease. Total gastrectomy with Roux-n Y esophagojejunostomy was applied for treatment. Excised specimen was diagnosed as menetrier disease with foveolar hyperplasia and glandular atrophy. Patient was discharged without any complications. Conclusion: Etiology of menetrier disease is unknown. CMV and H. Pylori are suspicious infections for causing menetrier. Most common symptom of menetrier is epigastric pain as in our case. Patients with persistent epigastric pain sould be evaluated with endoscopy even if the patient is young due to rule out other etiologies of hypertrophic gastropathies. When the diagnose is certain for menetrier, eradication of H. Pylori, PPI medication, octreotides, steroids and TNF-alpha inhibitors are suggested but in order to rule out malignancy and prevent probable future gastric malignancies, gastrectomy is the most frequent treatment especially for young patients. Each general surgeon must keep in mind the menetrier disease when managing patients with persistent epigastric pain. Key words: Hypertrophic gastropathy, Menetrier I have no potential conflict of interests to report. Abstract 74 Risk Factors for the Development Incisional Hernia After Abdominal Surgery Natig Zeynalov, Elbrus Rustamov, Asif Hasanov Scientific Centre of Surgery named after acad. M.A. Topchubashev, Department of Upper Gastrointestinal Surgery Introduction: Incisional hernias (IH) are one of the most frequent complications of abdominal surgery. The role of factors affecting the appearance of these hernias is not fully elucidated. The aim of this study was to identify the risk factors for IH and predictors associated with it. Materials and methods: The study included 110 patients, which were divided into two groups. The main group consisted of 65 patients operated on for incisional hernias.The control group included 45 patients, who had previously undergone laparotomy from different abdominal pathology and who did not have postoperative hernia. Multivariate logistic regression analyzes was performed and statistically significant independent risk factors for IH were identified. Results: The analysis performed among the general patients was identified the weakness and ptosis of the abdominal wall (OR = 5,9; 95% CI 2,3-15,2 p \ 0,001) and varicose veins (OR = 4,3; 95% CI 1,6-11,6 p = 0,05) as an independent risk factor for IH. In a separate analysis of female patients BMI [ 30, age [ 50 and pelvic floor disorders (stress urinary incontinence and pelvic organ prolapse) and in analysis of male patients central obesity (Waist-to-Height Ratio [ 0.58) (OR = 21,1; 95% CI 1,5-299,9 p = 0,022), COPD and chronic coughing (, OR = 15,1; 95% CI 1,1-212,9 p = 0,044), prostatism (OR = 13,8; 95% CI 1,5-122,6 p = 0,019) were defined as an independent risk factors. Conclusion: Aging, tissue weaknesses of the abdominal wall, and mechanical factors, such as obesity, chronic coughing and prostatism are independent risk factors for the development of incisional hernia. Collagen associated pathologies, such as varicose veins and pelvic organs prolapses are predictors of connective tissue weakness, which creates a predisposition to these hernias. Key words: Hernia, Risk factors I have no potential conflict of interests to report. Abstract 75 Abstract category: Abstract Realization oF Surgery Saving Principle in Grave Gunshot Wounds of Limbs Majid Masimov, Ilgar Omarov, Huseyn Masimov,Zulfiye Ismailova, Eldeniz Hajiyev, Taryel Guliyev Azerbaijan Medical University, Military Head Clinic Hospital, military surgery, Orthopedy and Traumatology Department; Azerbaijan Medical University, Department Of Military Surgery Introduction: The goal of the study concludes in improvement of morphological and functional issues of grave gunshot wounds of the limbs through realization of surgery saving principle in regard to affected tissues and on the basis of orthopedic and surgical rehabilitation of wounded men. Materials and methods: The authors own data of treatment and study of 523 patients with grave fighting pathology of limbs: complicated with deep wounds of soft tissues (5.2%), contact explosive cutting and bashings (23.1%), hard fractures (71.7%), make basis of research. Results: The elaborated system of surgical rehabilitation, anticipating maximal shortening of stage of medical evacuation, is based on application of improved differentiated surgical tactics, methods of surgical wound treatment, general and local pathogenesis therapy, technology of early reconstructive and recovery operations. The system optimizes wound process and allows prevention and cessation of suppurative and necrotic complications and, for this account, to realize in practice the offered consept concerning possibility formation of vital vascular and non-vascular bone, soft tissue, bone soft tissue autographs from adapted to ischemia present tissue resources that are necessary for S&V therapy of damaged limb. Total lethal issues constituted 4.4%, the reasons of death were mostly grave injuries of brain and internal organs. ˙In contact explosive wounds with limb cutting, the complications were eliminated in all patients: besides, in 78% cases the affected segments and adjoining joints were succeeded to save. ˙In bone fractures amputations were realized in 13.5% cases, being conducted to vitality indications in relation to extremely grave pathology. I˙n the rest wounded men, in spite of presenting relative indications to amputations, in 96.8% cases positive morphological and functional issues are achieved (short and longterm-25 year results). Key words: Gunshot, Reconstructive surgery I have no potential conflict of interests to report. Abstract category: Abstract The Right of Compensation Military Personnel in Turkey Semeh Petekkaya, Bedirhan Sezer Oner, Osman Celbis, Omer Turan, Ahmet Dinc, Erhan Kartal Abant Izzet Baysal University, Faculty of Medicine, Department of Forensic Medicine; Amasya University, Faculty of Medicine, Department of Forensic Medicine; Inonu University Medical Faculty, Department of Forensic Medicine; Medeniyet University Medical Faculty, Department of Forensic Medicine; The Grand National Assembly of Turkey Hospital Introduction: Military personnel who intervene in the events are injured at different levels during their duties because of the situations that often threaten the contemporary affairs due to problems such as internal disturbances in the border neighbors and the frequency of social events and the geographical location of Turkey. Materials and methods: The vast majority of injuries are explosives, firearm injuries and blunt traumatic type injuries. Diagnosis and treatment of specific injuries can take a long time depending on the severity of the injury. Military personnel could not continue to work during this period thus occurred the loss of manpower. Military personnel are entitled to material and moral damages due to injury. Results: The principles and procedures of giving indemnity, pension and other benefits to those who died, injured and disabled during the duty of 2330 numbered ‘‘Nakdi Tazminat ve Aylık Bag˘lanması Hakkında Kanun’’. Under this law, the principles and procedures to be followed are discussed in detail of Nakdi Tazminat ve Aylık Bag˘lanması Hakkında Yo¨netmelik. If death comes, the highest rate is 103123 TL (26578 USD) for the year 2018, which is 100 times the gross amount of the civil servant salary. In case of injury, the amount of death compensation is determined by multiplying the amount of death compensation according to the severity of injury. Compensation is sent to the Forensic Medicine Institute and University Hospitals Forensic Medicine Branches for the purpose of determining the severity of the injury and writing a forensic report. Conclusion: In our study, the right to compensation standards in Turkey’s military personnel injured while on duty and should be held medical-legal documents aimed to discuss. Key words: Military personnel, Compensation I have no potential conflict of interests to report. Innovation in Wound Closure for Challenging Abdominal Wound in Trauma Andriy Fedorenko Bar Ilan Tel - Aviv University, Sieff Medical Centre, General Surgery and Pediatric Surgery Department Introduction: Abdominal closure remains a challenge following trauma and damage control surgery, especially when injury involves a large abdominal wall defect. Open abdomen may be further complicated by concomitant internal organ injuries, ‘‘frozen abdomen’’, fistulation, retraction of the fascial layers and infection. Early closure of the open abdomen is of extreme importance. Case description: A 7-year-old girl with multiple penetrating trauma of the abdomen following the shelling of her home, presented 12 h after injury in septic shock. The patient suffered from liver injuries, a perforated transverse colon with 8x16 cm oblique abdominal wall defect and an open distal humerus fracture. She underwent damage control laparotomy, suturing of the perforated colon and temporary closure of the abdomen using a Bagota bag. 12 h later the patient underwent a second look operation applying negative pressure wound therapy for temporary abdominal closure. Five days later the TopClosure was applied to close the lower part of the wound, incorporating the regulated negative pressure-assisted wound therapy (RNPT) system to the upper wound area. Three days later this method was repeated for complete primary closure of the abdominal wall. Four days later the patient was returned to the operating theatre for closure of a leak of the previously injured colon. A wedge colon resection and a loop ileostomy on the left mid abdomen were performed with immediate definitive primary closure of the abdominal wall with the TopClosure . Post-operative course was uneventful. The TopClosure was removed in stages within 3-4 weeks and Ileostomy closure was performed a week later. Conclusion: This case illustrates the use of simple innovative wound closure technology for early primary closure of an open abdomen, mitigating complications associated with challenging abdominal injuries with large abdominal wall defects Key words: Abdomen defect closure I have no potential conflict of interests to report. Abstract 78 Abstract category: Abstract Is It Safe to Eras Program in the Emergency Surgical Treatment of Patients of Elderly and Senile Age with Complicated Colorectal Cancer? Nikolay Sizonenko, Dmitry Surov, Ivan Soloviev, Andrey Demko, Galina Martynova, Oleg Babkov Kirov Military Medical Academy, Navy Surgery Department; Djanelidze Emergency Medicine Institute, Department of Emergency Surgery Introduction: Studied safety and efficiency of the enhanced recovery after surgery (ERAS) in the emergency surgical treatment of elderly and senile age patients with acute obstructive colorectal cancer. Materials and methods: The study included 67 patients aged 61-90 years. The patients of the ERAS group (n = 32) and control group (n = 35) were matched. In addition to the well-known components of the ERAS we also during the operation performed decompression of the colon and small (under indications) intestine, the small intestine lavage, embryology oriented surgery and D3lymphadenectomy, rectus sheath catheterization. Compared the postoperative pain syndrome level (NRS), terms of enteral insufficiency events relief terms, the occurrence of postoperative complications and fatal cases, duration of the post-operative period. Results: ERAS group: the pain was 4 (3,5;4) points in the first day and 1 (1;2) point by the fourth day. 24 (75%) patients had no nausea and vomiting and began to enteral feeding in 24-36 h. Intestinal peristalsis sound appeared within 12-24 h, gases discharge – in 24-36 h and stool discharge – in the first 48 h. 6 patients (18,8%) had postoperative complications (Clavien-Dindo I-IIIa – 5, IIIb-V – 1), 3 patients (9,7%) died. The post-operative period was 8 (5,5;12,5) days. Control group: the pain was 6 (5;6) points and 21 (60%) patients had nausea and vomiting during the first 48 h. Events of postoperative intestinal paralysis were eliminated by the 4-5th day. 11 cases (31,4%) of postoperative complications were recorded (I-IIIa – 7, IIIb-V – 4). 4 patients (11,4%) underwent relaparotomy. 7 (20%) patients died. The post-operative period was 13 (9,5;18) days. Conclusion: The ERAS is safe and effective due to improving the immediate results of surgical treatment. Key words: Obstructive colorectal cancer I have no potential conflict of interests to report. Abstract 79 Oguz Hancerliogullari, Yasar Subutay Peker, Aytekin Unlu, Ali Kagan Coskun University of Health Sciences, Gulhane Training and Research Hospital, Department of General Surgery Introduction: The formation of mass in the gastrointestinal tract (GIS) of undigested foreign bodies is called bezoar and called phytobezoar when caused by vegetable fibers. We aim to present a rare case which is elderly patient with phytobezoar-induced ileus. Case description: 66-years-old man was applied to our clinic with complaint of nausea, vomiting and constipation for 3 days who was diagnosed as ileus. The patient’s complaints began 3 days before, just after eating large amount of popcorn. His physical examination showed abdominal distension. His laboratory showed leukocytosis and increased LDH levels. Computerized tomography of the patient showed brid ileus who had history of gastrectomy due to peptic ulcer. Patient was operated due to increasing abdominal distention. Abdominal exploration resulted with popcorn bezoar located at ileum causing proximal dilatation. Bezoar was stroked to cecum without need for intestinal resection. Patient was discharged on postoperative day 3 without any complication. as depression, anxiety, obsessive compulsive disorder or mental retardation patients. Most common bezoars are phytobezoars which cause small intestinal obstruction frequently at jejunum. Ileal phytobezoars as in our case are very rare. We suggest surgeons to evaluate patients with their histories and to remember phytobezoars as the rare cause of small intestinal obstructions. Key words: Ileus, Phytobezoar I have no potential conflict of interests to report. Abstract 80 Abstract category: Case report Necrotizing Fasciitis in Lower Extremity Secondary to Perforation Rectosigmoid Cancer Rahman Senocak, Emin Lapsekili, Oguz Hacerliogullari, Sahin Kaymak, Aytekin Unlu Gulhane medical faculty, Department of General Surgery Introduction: The diagnosis of necrotizing fasciitis in early stages is difficult, but progressive with 50-70% mortality. Necrotizing fasciitis due to colorectal malignancy with isolated limb involvement is extremely rare. In this case, it is aimed to present the management of a rectosigmoid tumor perforation, of which the first finding is lower extremity necrotizing fasciitis. Case description: A 68-year-old woman, being treated with systemic chemotherapy for metastatic colorectal cancer, was referred to general surgery clinics with complaints of left lower extremity pain, swelling and fever that continued 3-4 days. Crepitus, edema and swelling in the upper thigh skin are much prominent than in the right thigh (Fig. 1a). No vascular pathology was detected in the Doppler ultrasound except a gas-like appearance. Abdominal tomography showed malignant asymmetric wall thickening in rectosigmoid region, collections of gas and fluid extending to the left thigh and more distally. At exploration, a mass in the rectosigmoid region at the pelvic peritoneum, which showed invasion into retroperitoneal structure, bladder and femoral region anteriorly (Fig. 1b-c) and so many colonic content and odor in lower extremity were detected. The sigmoid colon and the upper part of the rectum were resected and end colostomy was performed. The upper thigh was opened medially and the colonic contents and necrotic tissues were debrided. After abdominal vacuum treatment for 4 sessions and thigh for 10 sessions, abdomen was closed. The defect in the upper thigh was covered with muscle flaps (Fig. 1d). Approximately 2 months after the intensive Conclusion: Bezoars are more common in women than man especially at younger ages. It is more common at psychiatric patients such Fig. 1 Necrotizing fasciitis: clinical appearance and stages of surgical treatment care treatment, sacral pressure scarring and colostomy problems continue now. Conclusion: Development of necrotizing fasciitis that spreads to the upper thigh and lower extremity is very rare. Despite the presence of polymicrobial infection, mortality did not develop. In cases with necrotizing fasciitis, frequent debridement, vacuum therapy combined abdominal and lower limb, limb loss and even mortality can be prevented. Key words: Necrotizing, Fasciit, Perforation I have no potential conflict of interests to report. A Very Rare Cause of Ileus: Cecal Volvulus Ramazan Topcu, Ibrahim Tayfun Sahiner, Murathan Erkent, Murat Baki Yildirim Hitit University School of Medicine, Department of General Surgery Introduction: Cecal volvulus (CV) is a rare cause of ileus and accounts for 1-1.5% of all intestinal obstructions. In this study, we shared the experience of CV. Case description: 78 years old female patient applied to the ER with complaints of abdominal pain, nausea, vomiting, gas, and defecation problems. In the physical examination of the patient, there was abdominal distension, common sensitivity, rebound and defenses. A severe dilated bowel whose air-fluid level was observed, completely filling out to the left upper quadrant extending toward the lower right side was seen in the direct abdominal radiograph of the patient. The patient was hospitalized with the diagnosis of Ileus/volvulus. Emergency laparotomy was performed after adequate fluid resuscitation. Operative findings were terminal ileum and dilatation of the right colon, CV was seen with local serosal defects. The cecum mobilisation and visceral rotation were incomplete.The right hemicolectomy were performed. The patient who had no problems was discharged on the 7th postoperative day. mass, chronic constipation, ileus, advanced stages of the pregnancy, colonoscopy and abdominal surgery history. In direct abdominal graphics of 30% of the patients, It can be seen coffee seed appearance in the upper left quadrant, bird-beak, vortex findings, obstruction of mesenteric vessels and appendicitis filled with gas. Optimal treatment of CV is surgical to remove an intestinal obstruction. Surgical methods for the treatment of CV are simple detortion, cecopexy and colon resection. It is important to suspect the diagnosis of CV, to control it with fast and proper treatment and to prevent gangrene changes and perforation in the intestine. The most appropriate treatment is metabolic support, the surgical treatment should be decided according to the condition of patient and intestines. Key words: Cecal volvulus, Ileus I have no potential conflict of interests to report. Abstract 82 Abstract category: Abstract Our Experience of Omentopexy for Sleeve Gastrectomy Procedure Taryel Omarov, Nadir Zeynalov, Nuru Bayramov, Farhad Ahmadov Azerbaijan Medical University, Department of Surgical Diseases Introduction: We aim to analyze the results of omentopexy applied to obese patients in sleeve gastrectomy procedure. Materials and methods: 120 obese patients have undergone a sleeve gastrectomy (stomach restriction) procedure in Azerbaijan Medical University and Modern Hospital clinic 2012 through 2018 years. 92% of patients were females, 28% were males, mean age was 37.9 (15-59) years. Preoperative weight of patients ranged from 102 to 220 kg, BMI 35.7-80.5 kg/m2. The patients were randomized to 2 groups depending on operative technique applied. 1st group patients underwent a standard sleeve gastrectomy surgery with uncovered stapler line (65 patients). 2nd group patients underwent the same sleeve gastrectomy completed with omentopexy over the stapler line starting from the stomach fundus (55 patients) to investigate if it could reduce typical complications arising from the stapler line. The follow up period for all patients was 36 months. Results: 2 patients of the 1st group developed a repeating bleeding from the stapler line resulted in reoperation, 1 patient was complicated by a functional stricture at the level of cardioesophageal sphincter, 1 patient was diagnosed a bowel torsion in a projection of angular incisure, and an important complication of stapler line leakage in the cardioesophageal region was noted in 1 patient. All complications were managed by according radical treatment. 2nd group patients did not face any of the complications mentioned above. Conclusion: Intrahepatic cholangioyeyunostomy (segment-3 bypass) is forgotten but good palliation for obstructive jaundice in unresectable hiliar tumors and may refer as bridge to biliary stending. Key words: Obesity, Sleevegastrectomy, Omentopexy I have no potential conflict of interests to report. Abstract 83 Abstract category: Abstract Iatrogenic Biliary Tree Injuries: Evaluation of Our Clinical Experiments Tolga Kalayci, Umut Haluk Iliklerden Yuzuncu Yıl University School of Medicine, Department of General Surgery Introduction: Biliary tree injuries are most serious complications of hepatobiliary surgery. While biliary tree injuries are most commonly seen during cholecystectomy, biliary system injuries can also be seen in external surgeries. Our goal is to present our experience of biliary tree injuries. Materials and methods: In our study, we evaluated retrospectively the biliary tree injuries that we cured surgically between 2010-2018 at Department of General Surgery of Yuzunc Yıl University School of Medicine. Results: There were 12 case (male = 3 and female = 9) with biliary tree injuries. Median age of cases were 50,2 ± 15,4(30-74 age). The first surgical indication of the cases were acute cholecystitis (n = 7), cholelithiasis (n = 4) and pyloric stenosis (n = 1).8 of the cases came from other surgery centers.4 of the cases(one of the case was pyloric stenosis) were our clinical injuries. The time elapsed between first surgery and patient’s application to us varied from 0 day to 11 days (median = 4,8 ± 3,4). When we looked at Strasberg-Bizmut Classification of injuries, we saw Class D injury (n = 6), Class E1 injury (n = 3),Class E2 injury(n = 1) and Class C injury(N = 1). In one case Class A and D injuries were present together. All patients in our study were treated surgically. Choledochoplasty over a T-tube drain was the most employed technique, being held in 6 patients. In 4 patients we conducted by Roux-N-Y hepaticojejunostomy. In one patient an anastomosis between choledochus and the jejunum was performed.In one patient Whipple prosedure was applied.The total length of hospital stay was between 5 day to 48 day(median = 19,8 ± 12,5 day).The complications that occurred during hospitalization, pleural effusion occurred in four of the cases and chest tube fitted two of pleural effusion cases. Conclusion: I˙atrogenic biliary tree injuries are a rare condition and can be difficult to follow due to the morbidity/mortality situations that can result. The management of biliary tree injuries is almost cured by surgical techniques. Key words: Biliary Tree, Cholecystectomy, Injury I have no potential conflict of interests to report. Abstract 84 Abstract category: Case report A Rare Case Report: Cholecystoduodenal Fistula and Gallstone Ileus Tolga Kalayci, Oztekin Cikman Yuzuncu Yıl University School of Medicine, Department of General Surgery Introduction: Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. In our case presentation,we want to show our clinical approach to the gallstone ileus and cholecystoduodenal fistula. Case description: A 74-year-old male, presenting with two-day constipation, was applied to the Department of General Surgery of Yu¨zu¨ncu¨ Yıl University School of Medicine (Van, Turkey) in March 2018. There was no feature (trauma, operation history etc.) on his resume. At the physical examination of the patient, there was minimal distention at the inspection. Bowel voices were hyperactive at the auscultation. At the anal exploration, there was no feces in the anal cavity. At the laboratory studies; the white blood count was 2,75 10^3/uL,serum creatine 2,71 mg/dl(0,9-1,5 mg/dl),total bilirubin 1,66 mg/dl(0,3-1,2 mg/dl),direct bilirubin 0,83 mg/dl (0,1-0,5), amylase 174 U/L and CRP 134 mg/L (0-5). At the direct X-Ray, there were multiple air-fluid levels. We thought ileus at the patient and hospitalized the patient to our intensive care unit. Firstly, nasogastric tube and foley catheter fitted. Oral nutrition stopped and ıntravenous fluid treatment started. Daily physical examinations done. Daily laboratory tests and X-Ray screenings done. When creatine values fell, we took contrast-enhanced computed tomography. At the tomography report, there was a cholecystoduodenal fistula and a large size (50*40 mm) gallstone at the jejunal segments causing ileus was seen. The patient was scheduled for surgery on the worsening vital signs and worsening of the abdominal examination findings. At the operation, we saw an inflammatory gall bladder, cholecystoduodenal fistula and a large gallstone causing obstruction at the distal jejunal segments. We made cholecystectomy, fistula tract deterioration and primary duodenal closure, removal of gallstone with enterotomy and primary closure of intestine. Conclusion: In this case report, we aimed to emphasize the condition of gallstone which is a rare cause of ileus and to contribute to the treatment algorithm. Key words: Cholecystoduodenal Fistula, Gallstone ileus I have no potential conflict of interests to report. Abstract 85 Schwannoma Abstract category: Case report Yasar Subutay Peker, Nazif Zeybek, Muharrem Oztas University Of Medical Sciences, Gulhane Training and Research Hospital, Department of General Surgery Introduction: Schwannomas are benign tumors of peripheral nerve sheath most commonly seen at 3rd and 6th decades. Schwannomas are capsuled tumors which the capsule originates from epineurium. Schwannomas are most commonly found atcranium which the vestibular schwnnoma is the most frequent. However a schwannoma may be found at anywhere at the body which a peripheral nerve can be found. At this case, we wanted to share our experience about patient who had pelvic localized abdominal schwannoma and treated surgically. Case description: 28 years old male patient applied our clinic with abdominal pain and distention. Further evaluation of the patient revealed pelvic intraabdominal mass of 17x15 cm with smooth borders. MRI evaluation resulted with the diagnosis of soft tissue tumor without any positive lymph nodes. Excision of the symptomatic mass was decided for the mass instead of needle biopsy to also provide symptomatic treatment. Patient was taken to the operation and median incision was done. Mass was excised with blunt and sharp dissection. Final diagnosis of the mass was schwannoma in which no further treatment was needed. Patient was discharged on postoperative day 2 without any complication. Conclusion: Schwannomas are rarely found ıntraabdominally. Smooth bordered masses without any positive lymph nodes may commonly be evaluated with benign soft tissue tumors which schwannoma is one of them. These masses should be excised for symptomatic treatment and for histopathologic diagnosis. Besides, they must also be excised to rule out malignant schwannomas. Very rare cases as pancreatic schwannomas are also reported which means that every undiagnosed mass located at the abdomen has the probable diagnosis of schwannoma. For this reason, every abdominal surgeon must keep in mind the schwannoma as a rare cause of abdominal pain and mass. Key words: Bile, Injury, Conservative I have no potential conflict of interests to report. Abstract category: Case report Gafarov R.I., Mammadov F.N., Salahov A.S., Yusif-zade K.R. Introduction: Hepatodiaphragmatic interposition (HDI) (synonyms: Chilaiditi syndrome, pseudopnevmoperitoneum) of the colon is a sufficiently rare anomaly, with segmental interposition of the colon between the liver and right diaphragm. Case description: A 56-year-old male patient applied to our clinic on 12.12.2017 (medical record § 1948) with complaints of abdominal pain, nausea, dizziness. Objective examination included stiffness in the abdomen, acute pain in the upper right quadrant and leukocytosis (17,000 k/ul) in laboratory examination. Abdominal sonography shows hepatosteatosis grade II, colon segments extending to the right subdiafragmatic area with the front surface of the liver and gas artifacts. The patient is thought to have Chilaiditi syndrome. Abdominal CT scan shows, where the hepatic curvature of the colon is partially located in the right subdipragmatic area extending over the front surface of the liver,the ileocecal passage is located at the level of the right kidney lower pole and the retrocecaly located pathologically modified appendics with a diameter of 8 to 10 mm was detected. The patient was been rapidly laparotomy for acute appendicitis. Postoperative diagnosis: Acute phlegmonous appendicitis. Conclusion: Entering the colon segments between the two organs is called colon interposition and it can be complete or partial. The colon can interpose between the liver and diaphragm, spleen and diaphragm, spleen and left kidney, stomach and pancreas. As the interposition of the colon between diaphragm and liver is called Chilaiditi sign, if the same sign observes with clinical symptoms, it is named as Chilaiditi syndrome. It is one of the important conditions for continual care of rare pathologies both clinically and radiological, as well as stage-by-stage diagnostic algorithms. Key words: Chilaiditi syndrome, Hepatodiaphragmatic interposition I have no potential conflict of interests to report. Abstract 87 The Histological Pattern of Endometrium Samples in Postmenopausal Women with Abnormal Uterine Bleeding Sayyara Hajiyeva, Anar Isayev, Turab Janbakhishov Azerbaijan Medical University, Department of Obstetrics and Gynecology, Department of Pathological Anatomy Introduction: Abnormal uterine bleeding is one of the most significant clinical problems in gynecological practice and is a sign of various pathologies. In perimenopausal women shortening in menstrual cycles, menstrual irregularities, reduction of activity of ovaries usually happen. Existing menstrual irregularities are related to anovulation or incomplete growth of follicles in cycles in the perimenopausal period. These changes increase the risk of endometrial hyperplasia and cancer resulted in abnormal uterine bleeding. Materials and methods: The study was conducted in the Department of Obstetrics and Gynecology of Educational-Surgical Clinic of Azerbaijan Medical University between November 2014 and January 2018. The study included 65 postmenopausal women with abnormal uterine bleeding at ages between 40-76. All of the endometrial samples were taken under general intravenous anesthesia by ‘‘Dialtation and Curettage’’ and sent to the histological examination. The results calculated with Kruskal–Wallis H test by SPSS (version 15, Inc, USA) among age groups and p value \ 0.05 was considered statistically significant. p* 0.02 0.02 0.03 0.07 A cross-table of age groups and histological samples Histological samples Atrophic Simple Without endometrium hyperplasia atypia With Endometrial Malignancy atypia polyps 40-50 age 3 (17.6%) 51-55 age 6 (26%) 56-60 age 3 (21.4%) 61-76 age 3 (27.2%) Total 15 (23%) 3 (17.6%) 3 (13.0%) 1 (7.1%) 1 (9.0%) 8 (12.3%) 2 (11.7%) 0 (0%) 8 (47%) 1 (5.8%) 2 (8.6%) 11 (47.8%) 1 (4.3%) 4 (28.5%) 6 (42.8%) 0 (0%) 2 (18.1%) 3 (27.2%) 2 (18.1%) 10 (15.3%) 28 (43%) 4 (6.1%) *p\ 0.05 statistically significant Total 17 (100%) 23 (100%) 14 (100%) 11 (100%) 65 (100%) Results: The average age of postmenopausal women included in the study was 54.8 ± 6.4. The duration of abnormal uterine bleeding was 1-17 months (1.5 year). Polyp of endometrium 28 (43%), atrophic endometrium 15 (23%), hyperplasia without atypia 10 (15.3%), simple hyperplasia 8 (12.3%), malignancy 4 (6.1%), hyperplasia with atypia 0 (0%) patients were detected. Polyps of the endometrium were found in most cases, particularly at the age of 40-55 compared to other pathologies and age groups, and this finding was statistically significant. During the analysis of age groups and histological results, malignancy at the 61-76 age group was found to be 2 (18.1%) cases. The relationship between parity and histological samples were reviewed: P0-1 - 0 (0%), P2 - 1 (5.5%), P3 - 3 (10%), P4-9 - 0 (0%) malignancy was detected. Conclusion: The endometrium polyp can be found more frequently between 40-55 age due to peri- and postmenopausal hormonal changes. Different studies showed 10-20% malignancy risk in endometrial hyperplasia. Therefore, an early evaluation and detection of abnormal uterine bleeding is crucial to exclude malignancy in postmenopausal women. Our analysis showed that the polyps of the endometrium were found to be more at the age of 40-45 compared to other pathologies. Key words: Postmenopausal, Bleeding, Histological I have no potential conflict of interests to report. Abstract 88 Abstract category: Abstract Pregnancy and Neonatal Outcomes in Pregnant Women Undergoing Fetal Hemotransfusion Because of RhIsoimmunization Fidan Hajiyeva, Turab Janbakhishov Azerbaijan Medical University, Department Of Obstetrics And Gynecology Introduction: Rh-isoimmunization is Rh-incompatibility condition appearing between rhesus positive fetus and rhesus negative mother. Intrauterine hemotransfusion (IUH) is the method of treatment of anemia caused by Rh-isoimmunization. Materials and methods: Fourteen pregnant women admitted to our hospital between August 2015 and December 2017 with the diagnosis of isoimmunization were included to the study. In 10 cases no fetal anemia was found and these patients were included into control group. We used 0 (I) Rh negative, filtered, concentrated and radiated blood for IUH. We entered the umbilical vein though amniotic cavity using spinal needle (20-22 G). Fetal hematocrit was checked before and after the procedure. Results: We determined 4 cases of fetal anemia and 7 FUHs were performed in total in our study. For every FUH procedure we used in average 180 ml (96 ml – 350 ml) of blood. Average hemoglobin (hgb) before the procedure was 6,4 (1,7-9,2) g/dL, and after – 14,4 (10-18,3) g/dL. Gestational age at birth and neonatal weight were smaller in the fetal anemia group compared to control group and the difference was statistically significant (31,5 and 39 weeks, p = 0,04; 2130 and 3332 g, p = 0.04). Nevertheless, at the time of delivery fetuses underwent FHT had higher HGB levels (21,1 and 15,1 g/dL, p = 0,03). One case of FHT was complicated by fetal demise. One neonate needed hemotransfusion after delivery. Mean gestational 31.5 (25-35) w age Vaginal delivery 2 (50%) Cesarean section 2 (50%) N 180 ml (96 -350 ml) Hemotransfusion 1 (25%) in neonate Neonatal total bilirubin level Fetal demice 1 (25%) *p \ 0.05 statistically significant Control group 7 3 (47) 3.5 (1.868.22) p* 0.04 0.03 0.06 Conclusion: Negative pregnancy and neonatal outcomes are usually seen in severe hydrops cases. The rate of livebirthes is considered as 85-90%. Intrauterine death as complication of the FHT procedure is seen in 4,7% cases. During the transfusion Mean Cerebral Artery Peak Systolic Volume is usually determined on Doppler examination. When done by experienced specialist, FHT is effective and safe method of treatment of fetal anemia caused by Rh-isoimmunization. Key words: Fetal anemia, Hemotransfusion I have no potential conflict of interests to report. Abstract 89 Abstract category: Abstract Efficacy of Cervical Cerklage in Pregnant Women with Cervical Insufficiency Melek Gafarli, Turab Janbakhishov Azerbaijan Medical University, Department of Obstetrics and Gynecology Introduction: Cervical insufficiency is seen approximately in 1% of pregnant women and in 8-9% of cases results in preterm birth. The choice of treatment in such cases is placement of circular suture on cervix. Materials and methods: 22 pateints with cervical cerclage were observed in Azerbaijan Medical University Department of Obstetrics and Gyneocology between December 2014-February 2018. Patients were divided into 2 groups: A – prophylactic, B – emergency cerclage. Prophilactic cerclage was placed in women with [ 1 s trimestr loss or with multiple pregnancy, emergency – in women with cervical length \ 25 mm on transvaginal ultrasound scan, with cervical funneling and membranes prolapse or full cervical dilatation. Cervical cerclage was performed by modificated Shirodcar method using Mercilen tape. Results were calculated using SPSS (version 15, Inc. USA), Mann–Whitney U test and p \ 0,05 was considered statistically significant. There was no neonatal death in the prophylactic group, but in emergency group it was seen in 18.7% of cases. Results: Among all procedures 5 (22,7%) were prophylactic, 17 (77,25) - emergency. Before the procedure cervical length in group A was 31,6 (28-25) mm which was longer than in group B with length 13,5 (0-25)mm and the difference was statistically significant (p = 0.03). Moreover, the difference in the period between the procedure and the birth, neonatal weight and need for neonatal reanimation between two groups was statistically significant (p = 0,03, p = 0,02, p = 0,02) Pregnancy and neonatal outcomes in two Cerclage groups Multiple pregnancy 2 (40%) Parity Mean age Nuliiparas Multiparas Gest. age at Cerclage time Number of abortions Gestational age Cervical length Before After Vaginal birth Live birth Mean birth weight Group A n (%) 5 (22.7%) 27.2 (21-43) 1 (20%) 4 (80%) *14 (11-18) 2 (40%) 31.6 (28-35) 1 (20%) 3 (60%) 2540 (2200 – 2970) Group B n (%) 17 (77.2%) 29.9 (20-37) 0.12 2 (11.7%) 15 (88.2%) 2 (11.7%) *21.7 (16 28) 1 (5.8%) 13.5 (0-25) 23.6 (18.5 – 31.5) 11 (1-22) 2 (11.7%) 16 (94.1%) 2179 (7503380) 0.23 0.31 – – – Cerclage-Brith time 16 (6-25) Gest. age at birth 36.2 (34-39) 33.7 (26-39) 0.39 NICU admission 3 (18.7%) – 2 I-36 w II-32 w Conclusion: According to our findings the emergency cerclage improved gestational age at birth and neonatal outcomes. Only one pregnancy resulted in miscarriage 1 week later. In 7 out of 16 nenonates (43,7%) intensive care (NICU) admission was needed: in 4 of them results were satisfactory, but in 3 (18,7%) death occurred. There was no significant difference in gestational age at birth between two groups (36,2/33,7), nevertheless neonatal outcomes differed significantly: the need for NIC was 2,6 times lesser (16,6%) and no neonatal death (ND) was observed in prophylactic group. Placement of prophylactic cervical cerclage based on history significantly reduces the rate of ND and NICU admission. Key words: Cerclage, Cervical insufficiency I have no potential conflict of interests to report. Reproductive Outcomes in Women with Intrauterine Septum After Histeroscopic Metroplasty Reyhan Muradova, Turab Janbakhishov Azerbaijan Medical University, Department of Obstetrics and Gynecology Introduction: We aim to study the effectiveness of histeroscopic resection of intrauterine septum on reproductive outcomes in women with primary and secondary infertility and recurrent pregnancy losses Materials and methods: we observed reproductive outcomes in 23 women after histeroscopic metroplasty in our hospital between 2015-2018 years. 12 of patients (52.17%) had primary and 9 (39.1%) - secondary infertility and 2 (8.69%) had recurrent miscarriages. During the surgery the septum was resected using ‘‘T’’ form resectoscope until full visualization of tubal orifices was achieved. Postoperative follow-up period was 18 ± 17 months. Postoperative results between 3 groups were calculated using SPSS (version 15,Inc,USA), Kruskall-Wallis H test and p value \ 0.05 was accepted statistically significant. ART Pregnancy Ectopic pregnancy (9.52%) 1 (10%) 9 5 (55.5%) 2 (100%) 23 21 1 1 10 1 2 5 2 Results: Mean age of women was 24.3 ? -13.1. In 11/23 (47.82%) patients other reasons of infertility were found. Before histeroscopic metroplasty 39.1% of women had history of spontaneous miscarriage, 4.34% - ectopic pregnancy, 13.4% - preterm birth and 8.7% - term birth. We studied reproductive outcomes in 21 out of 23 women after histeroscopic metroplasty. Pregnancy fact was registered in 3 of 10 (30%) women with primary, in 5 out of 9 (55.5%) women with secondary infertility and in all of 2 women with recurrent miscarriages. Pregnancy rate in women with secondary infertility was accepted more statistically significant. Pregnancy outcomes in women after histeroscopic metroplasty Total Pregnancy desire 10 (83.3%) 9 (39.1%) 2 (8.7%) *ART - assisted reproductive technologies; **˙IUI˙ - intrauterine insemination; ***postoperative observation period Conclusion: intrauterine septum is consisted of fibro-elastic tissue with inadequate circulation and has a negative impact on fetal placentation by interrupting the connections between miometrial and endometrial vessels. Miscarriage rate after surgery was reduced from 39.1% to 0%, preterm birth rate from 13.4 to 9.1% and term birth rates increased from 8.7 to 22.72%. Histeroscopic metroplasty is effective and safe treatment method in women intrauterine septum with history of infertility and recurrent pregnancy losses. Key words: Intrauterine septum, Metroplasty I have no potential conflict of interests to report. 133 was 33.60 ± 15.22 and 3.47 ± 3 .62 in non-dysplasia cases. From all inflammatory polyps CD 133 stained cells were high only in one polyp, dysplasia is also was encountered in this polyp . Results: Statistically significant CD133 expression was detected in cases with dysplasia and malignancy . Conclusion: The investigation of CD133 expression in inflamed colorectal polyps may be important in determining malignancy development . Key words: Colorectal, Polyp, CD133 I have no potential conflict of interests to report .


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1st APIMSF Congress BAKU 2018 And 30th Anniversary Meeting of APIMSF, World Journal of Surgery, 2018, 1-41, DOI: 10.1007/s00268-018-4620-z