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    Missed injuries in patients with abdominal gunshot trauma: risk factors and mortality rates
    (Springer Wien, 2016) Ugur, M.; Akkucuk, S.; Koca, Y. S.; Oruc, C.; Aydogan, A.
    Introduction The aim of this study was to investigate the incidence, risk factors, and mortality rates of injuries missed during laparotomy in patients with high-kinetic energy gunshot trauma. Methods The retrospective study included 20 patients who underwent relaparotomy due to high-kinetic energy gunshot trauma at our hospital between 2010 and 2015. Mechanism of injury, time between initial laparotomy and relaparotomy, the method of incision used for laparotomy during the initial laparotomy, the organs detected with missed injury, and the mortality rates were recorded. Results All the patients were male, with a mean age of 24.90 +/- 5.2 years. Missed injuries were markedly more common in the patients who underwent incomplete incision during the initial laparotomy (p < 0.05). Mortality occurred in 11 (55 %) patients. In these patients, time between laparotomy and relaparotomy was longer and the Injury Severity Score (ISS) was significantly higher compared to other patients (p < 0.05). Discussion A complete midline incision allowing optimal exposure should be performed in patients with penetrating abdominal trauma caused by high-kinetic energy gunshot. A systematic surgical exploration should be performed, including meticulous inspection of all the intraabdominal and retroperitoneal organs. Conclusion Damage control surgery (DCS) should be performed in patients with severe trauma and hemodynamic instability. Proper administration of DCS may lead to reduced incidence of missed injuries and thus may decrease the mortality rates.
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    Surgical outcomes of a civil war in a neighbouring country
    (Bmj Publishing Group, 2016) Akkucuk, Seckin; Aydogan, A.; Yetim, I.; Ugur, M.; Oruc, C.; Kilic, E.; Paltaci, I.
    Objectives The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. Methods 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. Results The median age of the patients was 30.05 (18-66years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.284.44h and 58.11 +/- 44.08h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). Conclusions In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.