Tuesday, October 14, 2025
Tuesday, May 27, 2025
InnovaHealth 2025, 25-28 Eylül 2025, Belgrad
TREATMENT OF ACUTE AND CHRONIC ANAL FISSURES: A
COMPARATIVE ANALYSIS OF CONSENSUS AND DIFFERENCES IN INTERNATIONAL GUIDELINES
Mehmet Eren Yuksel
Etlik City Hospital, Surgical Critical Care Unit,
Ankara, Turkiye
e-mail: doctormehmeteren@yahoo.com
Orcid ID: https://orcid.org/0000-0002-7110-0717
ABSTRACT
Introduction: Anal
fissures are a frequent cause of anorectal pain and bleeding, typically
presenting as linear tears in the anoderm. Four major societies, World Society
of Emergency Surgery and American Association for the Surgery of Trauma
(WSES/AAST), American College of Gastroenterology (ACG), Association of
Coloproctology of Great Britain and Ireland (ACPGBI) and American Society of
Colon and Rectal Surgeons (ASCRS) have published guidelines for their
management.
Method: This study
compared the latest guidelines from the WSES/AAST (2021), ACG (2021), ACPGBI
(2023), and ASCRS (2023).
Results and Discussion: All
four guidelines recommend dietary fiber, stool softeners, hydration, and sitz
baths for acute fissures. For chronic cases, ACPGBI and ASCRS prefer topical
diltiazem or glyceryl trinitrate, whereas ACG and WSES/AAST offer either option
without preference. Botulinum toxin is generally a second-line option, although
WSES/AAST allows for earlier use in high-risk patients. Lateral internal
sphincterotomy is universally accepted as the definitive treatment for
refractory cases, with ACPGBI and ASCRS emphasizing tailored approaches to
minimize incontinence.
Conclusion: A
unified evidence-based guideline incorporating diverse clinical scenarios would
support more consistent and patient-centered care.
Keywords: Anal fissure,
Botulinum toxin, Guideline, Lateral internal sphincterotomy
Saturday, December 07, 2024
8. Uluslararası Sağlık Bilimleri ve Yaşam Kongresi 16-19 Nisan 2025
Assoc. Prof. Mehmet Eren Yuksel
Ankara Etlik City Hospital, Surgical Critical Care Unit, Ankara, Türkiye
e-mail: doctormehmeteren@yahoo.com, ORCID: 0000-0002-7110-0717
HYPERTONIC
SALINE APPLICATION DURING HYDATID CYST SURGERY: RISK OF HYPERNATREMIA IN
POSTOPERATIVE SURGICAL CRITICAL CARE
Assoc. Prof. Mehmet Eren Yuksel
Ankara Etlik City Hospital, Surgical
Critical Care Unit, Ankara, Türkiye
e-mail: doctormehmeteren@yahoo.com, ORCID: 0000-0002-7110-0717
Introduction: Hydatid cyst
surgery, performed to treat disease caused by Echinococcus granulosus, involves
the use of protoscolicidal agents to eliminate protoscolices and prevent
recurrence. However, no protoscolicidal agent achieves the ideal balance of
efficacy and safety. Hypertonic saline (15–20%) is a widely used and effective
option, but its application carries risks, particularly hypernatremia,
requiring meticulous management during and after surgery.
Methods: This study
reviewed WHO guideline (Bulletin of the World Health
Organization, 1996) and clinical data to evaluate the role of protoscolicidal
agents in hydatid cyst surgery, focusing mainly on hypertonic saline.
Results: Protoscolicidal
agents such as 70–95% ethanol, 15–20% hypertonic saline, and 0.5% cetrimide
solution are effective when left in contact with cysts for at least 15 minutes.
However, challenges in vivo, including dilution by hydatid fluid and
difficulties penetrating daughter cysts, may reduce efficacy. Spillage into the
peritoneal cavity or excessive application of hypertonic saline can lead to
systemic absorption and hypernatremia. Symptoms range from seizures to coma and
cardiovascular instability. If the cyst communicates with the biliary tree,
applied protoscolicidal agents may cause chemical cholangitis, progressing to
sclerosing cholangitis.
Discussion and
Conclusion: Hypertonic saline is an option in hydatid cyst
surgery, demonstrating proven efficacy in eliminating protoscolices. However,
its use carries notable risks, particularly hypernatremia, underscoring the
need for strict adherence to established protocols. Controlled application
techniques and intraoperative sodium monitoring are essential to minimize
complications and ensure patient safety. To improve clinical outcomes, further
research should focus on developing safer and more effective alternatives to
current protoscolicidal agents.
Keywords: Echinococcus granulosus, hypertonic saline, hydatid cyst surgery, hypernatremia.
Wednesday, November 13, 2024
Süleyman Demirel Üniversitesi Tıp Fakültesi 3. Uluslararası / 6. Ulusal Sağlık Hizmetleri Kongresi
Tuesday, October 22, 2024
Genel Cerrahi Ameliyat Notları
Friday, October 18, 2024
Genel Cerrahi Ameliyat Notları
Wednesday, October 16, 2024
Sunday, September 29, 2024
Sunday, September 08, 2024
Erişkin Yoğun Bakım Hemşireliği Sertifika Programı
Ankara Etlik Şehir Hastanesi Erişkin Yoğun Bakım Hemşireliği Sertifika Programı
14. Gün (3 Ekim 2024 Perşembe), Doç. Dr. Mehmet Eren Yüksel, Yoğun Bakım Uzmanı
Wednesday, August 28, 2024
Irwin ve Rippe Yoğun Bakım Kitabı Çevirisi 9. Baskı
https://www.guneskitabevi.com/urun/irwin-ve-rippenin-yogun-bakim-tibbi-1-2-9-baski
Bölüm 20: Gastrointestinal Endoskopi
Bölüm 21: Beslenme Tüplerinin Endoskopik Yerleştirilmesi
Bölüm 22: Akut Varis Kanaması İçin Gastroözofagial Balon Tamponadı
Bölüm 23: Parasentez Ve Diagnostik Periton Lavajı

















































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