Objective: The most important part of improving colorectal cancer prognosis is to detect and trea... more Objective: The most important part of improving colorectal cancer prognosis is to detect and treat in the early stage. The most effective way to do this is screening programs. Fecal occult blood test is one of the most frequently used methods in the screening program. In this study, we aimed to evaluate the colonoscopy and histopathological findings of patients who underwent colonoscopy due to positive fecal occult blood test. Methods: Patients who had a positive fecal occult blood test between January 2016 and December 2018 and underwent colonoscopy to investigate the etiology were included in the study. Demographic characteristics, colonoscopy findings and histopathological results of the patients were reviewed retrospectively from hospital records. Results: A total of 325 patients were included in the study. Of the patients, 146 (44.9%) were male, 179 (55.1%) were female, and their mean age was 58.4±9.3 years. Colonoscopic findings of 140 patients (43.1%) were normal. Polyps in 8...
Objective: To compare postoperative morbidity and mortality results in patients with and without ... more Objective: To compare postoperative morbidity and mortality results in patients with and without endoscopic and percutaneous transhepatic biliary drainage due to obstructive jaundice caused by a periampullary tumor and to examine the effect of intervals until surgery on postoperative morbidity and mortality in patients who underwent preoperative biliary drainage (BD). Methods: Patients were divided into 3 groups according to their BD status. Group1, no biliary drainage (NBD), Group2, Endoscopic biliary drainage (EBD), Group3, Percutaneous transhepatic biliary drainage (PBD). Patients who underwent biliary drainage before pancreaticoduodenectomy (PD) were divided into 3 intervals according to the time interval between drainage and surgery: Short interval; patients undergoing surgery in 21 days and <, Medium interval; between 22-42 days, Long interval; 43 days and >. Groups and intervals were compared in terms of postoperative morbidity and mortality. Results: Of the 122 patients who underwent PD, 76 (62.3%) were male, and 46 (37.7%) were female. Within these patients, 47 (38.52%) had NPD, 42 (34.42%) had EBD, and 33 (27.05%) had PBD. The rate of postoperative Grade B and C fistula was higher in the groups that underwent preoperative drainage compared to the group without preoperative drainage (p = 0.007). Conclusion: It was determined that the postoperative complication rate was lower in patients who did not undergo BD compared to patients who underwent biliary drainage. Besides, the endoscopic drainage method was observed to be associated with fewer complications than the percutaneous transhepatic drainage method. Key words: Preoperative biliary drainage, Pancreaticoduodenectomy, Periampullary tumors, Post procedure complication, Timing.
Mide kanserinin total laparoskopik cerrahisinde, transeksiyon hattını belirlemek zor olabilir. Bu... more Mide kanserinin total laparoskopik cerrahisinde, transeksiyon hattını belirlemek zor olabilir. Bu retrospektif çalışma, total laparoskopik gastrektomide rezeksiyon marjını belirlemede intraoperatif gastroskopinin klinik önemini değerlendirmeyi amaçlamaktadır. YÖNTEM ve GEREÇLER: Mart 2017 ve Ocak 2021 tarihleri arasında total laparoskopik gastrektomi sırasında rezeksiyon sınırını belirlemek için intraoperatif gastroskopi yapılan 55 hasta çalışmaya dahil edildi. Endoskopik görüntülemede lezyon yerleşimi tespit edildikten sonar ışık transillüminasyonu ile rezeksiyon sınırı belirlenerek transeksiyon yapıldı. BULGULAR: İntraoperatif gastroskopiile total laparoskopik gastrektomi uygulanan 55 hastanın 28' i(%50.9) erkek, 27' si (%49.1) kadın ve yaş ortalaması 59.89±11.18 idi. Tümör yerleşimi, 25 (%45.4) hastada proksimal 1/3, 9 (% 16.4) hastada orta 1/3 ve 21 (%38.2) hastada ise distal 1/3 yerleşimliydi. İntraoperatif gastroskopi yapılan ve total laparoskopik tamamlanan 19 (%34.5) hastaya subtotal gastrektomi, 10 (%18.2) hastaya vertical gastrektomi ve 26 (%47.3) hastaya total gastrektomi uygulandı. Hastalarda intraoperatif gastroskopiye bağlı komplikasyon görülmedi. Tüm olguların rezeksiyon marjının güvenli sınırlarda olduğu histopatolojik analiz ile gösterildi. TARTIŞMA ve SONUÇ: Total laparoskopik gastrektomide, tümör lokalizasyonunu belirlemek ve rezeksiyon sınır güvenliğini sağlamak amacıyla intraoperatif gastroskopi güvenilir bir prosedürdür.
There have been many changes in number and place of trocars that have been described, since the f... more There have been many changes in number and place of trocars that have been described, since the first laparoscopic cholecystectomy (LC), but, in fact, all authors agree that laparoscopic procedure is accepted as gold standard. However, four trocars use in standard laparoscopic cholecystectomy, it has been argued that the fourth port is not necessary for grasping fundus of gallbladder so as to expose Calot&#39;s triangle. The aim of this study is to establish the safety of three-trocar LC in symptomatic gallbladder disease and also to determine the ratio of technical requirements of the fourth trocar. Between August 2010 and January 2016, 291 cases were operated in Kocaeli Derince Education and Research Hospital, department of general surgery for symptomatic gallbladder disease with three-port LC, and their records were examined retrospectively. Two hundred and twenty patients were female (75.6 %) and seventy one (24.4 %) were male. Two hundred and eighteen of two hundred and ninety-one cases (74.92 %) were operated with three- port LC in a secure way. In seventy-three cases (25.08 %), one more port was needed to use. Mean operative time was 33.76 ± 11:18 min. (15-90 min). In these cases, major complications, such as main bile duct injury or bile leakage, that may increase the mortality and morbidity, did not occur. Only in one case (0.34 %) postoperative bleeding was seen from the liver bed, which was required exploration. We concluded that in experienced hand, LC with three ports is safe and feasible technique if it is not endanger the course of the surgery.
Background/aim: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a... more Background/aim: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a number of favorable effects in patients undergoing cancer surgery. In this prospective study, we aimed to assess the perioperative use of enteral immunonutrition in patients undergoing radical gastrointestinal surgery for malignancy. Materials and methods: Forty-one patients with malignancy were included in this study and were randomized into one of the two following nutritional strategies: enteral only (EN) or enteral with enteral immunonutrition (ENIN). These regimens were followed for 7 days perioperatively by all patients. Nutritional parameters and postoperative morbidity, mortality, and length of hospital stay (LHS) were assessed. Results: Serum prealbumin levels increased significantly in the ENIN group (P = 0.033). Moreover, patients in the ENIN group showed a more marked decrease in the rate of postoperative infections (P = 0.021) and anastomotic leakage (P = 0.018) than patients fed with EN. In the EN group, LHS was significantly longer than that in the ENIN group (18 vs. 12 days) (P = 0.032). Rates of overall morbidity and mortality were similar in the two groups (P > 0.05). Conclusion: ENIN was found to have a favorable effect on the outcome of radical gastrointestinal surgery for malignancy. Meticulous preoperative assessment of malnutrition and at least a 7-day perioperative enteral use can increase the effectiveness of immunonutrition.
Turkish journal of trauma & emergency surgery, 2023
BACKGROUND: Simple appendectomy with a complicated appendicitis diagnosis could prove difficult, ... more BACKGROUND: Simple appendectomy with a complicated appendicitis diagnosis could prove difficult, sometimes requiring extended resection. Hence, we aimed to compare two procedures that are preferred for extended resection, ileocecal resection, and right hemicolectomy, in terms of patients' demographic data, preoperative laboratory values (white blood cell [WBC], Neutrophil-tolymphocyte ratio [N/L], C-reactive protein [CRP]), operation times, postoperative complications, length of hospital stay, and 1-month mortality rates. METHODS: We retrospectively reviewed patients who underwent extended resection with the diagnosis of complicated appendicitis in our clinic from February 2015 to December 2020. We divided the patients into two groups those who underwent right hemicolectomy and those who underwent ileocecal resection. RESULTS: Among the 55 patients who underwent extended resection with the diagnosis of complicated appendicitis, 32 (58.1%) underwent right hemicolectomy and 23 underwent ileocecal resection (41.8%). The groups did not differ statistically significantly in terms of demographic characteristics, preoperative laboratory values (WBC, N/L, CRP), Clavien-Dindo classification scores, mean hospital stay, or 1-month mortality rates (p>0.005). However, there was a statistically significant difference between the groups in terms of operation time (p<0.001). CONCLUSION: Ileocecal resection is a safe procedure for patients diagnosed with complicated appendicitis who are scheduled for extended resection.
Aim: Laparoscopic appendectomy (LA) is used in acute appendicitis treatment in many centers today... more Aim: Laparoscopic appendectomy (LA) is used in acute appendicitis treatment in many centers today. Various methods such as intracorporeal knot, endoloop, stapler and hem-o-lok clip are used to close of the appendix stump during LA. All of these methods has several advantages and disadvantages. In this study, we aimed to compare the effect of the intracorporal knot method with hemo-lok clip method to close of the appendix stump in LA. Material and Methods: Operative data, complications and follow-up results of 143 patients which treated with LA between January 2012 and December 2017 were evaluated retrospectively. Results: Sixty-four patients (44.7%) were males and 79 (55.2%) were females. Seventy-five patients (52.4%) were treated with 2/0 polyglactin (coated vicyrl, ethicon) sutures and 68 patients (47%) were treated with hem-o-lok clip XL (weck hem-o-lok polymer ligation system) for intracorporeal knot to close of the appendix stump. Patients were compared according to the duration of operation, the duration of hospitalization and postoperative complications and there were no statistically significant difference between the data of the cases according to the groups (p = 0.197, p = 0.902, p = 0.503, respectively). Conclusion: We identified that both techniques for appendix stump closure are effective and safe methods in LA.
ö Background & aims: Spontaneous bacterial infection and septicemia due to increased bacterial tr... more ö Background & aims: Spontaneous bacterial infection and septicemia due to increased bacterial translocation (BT) in patients with obstructive jaundice result in signi¢cant morbidity and mortality. The present study evaluates the e¡ects of enteral nutrition with immune enhancing feeds on BTand intestinal villus histopathology promoted by obstructive jaundice. Methods: Fifty male Wistar-albino rats weighing 250^300 g were assigned into ¢ve equal groups of 10. Animals in Groups I, II, and III were fed with standard chow, those in Group IV were given glutamine 1g/kg/day and the remaining 10 animals in Group V were fed with an arginine, o-3 fatty acids, and RNA-supplemented enteral diet for (1g/kg/day amino acid and 230 kcal/kg) 7 days preoperatively. Group I underwent sham operation and the remaining animals in all other groups underwent common bile duct ligation. After operation, Group I had standard chow, Groups II and IV had glutamine, Groups III and V had an arginine o-3 fatty acids, and RNA-supplemented enteral diet for 7 days. All animals were sacri¢ced on the 8th postoperative day and evaluated both biochemically and histopathologically. Samples from blood, liver, mesenteric lymph nodes and spleen were cultured under aerobic conditions. Results: Signi¢cantly less BT was observed in groups fed with an arginine, o-3 fatty acids, and RNA-supplemented enteral diet or glutamine in pre-and postoperative periods as compared to others (Po0.001). Histologic evaluation also showed signi¢cant reduction in villus atrophy in these groups. Conclusions: Enteral immunonutrition using glutamine or arginine, o-3 fatty acids, and RNA-supplemented enteral diet during both pre-and postoperative periods seems to reduce BTand decrease atrophy of intestinal mucosal villi in rats with obstructive jaundice.
Perianal fistula is an anorectal disease that can significantly impair quality of life. The cours... more Perianal fistula is an anorectal disease that can significantly impair quality of life. The course of the disease can include chronic exacerbation and recurrence. Many surgical techniques have been developed to treat perianal fistula, but reappearance of the fistula is still a major problem. The aim of the present study was to evaluate the results of partial fistula tract excision (partial fistulectomy) and loose seton application in the treatment of primary and recurrent perianal fistula. Materials and Methods: Forty-two patients with a primary or recurrent perianal fistula who underwent a partial fistulectomy with loose seton placement at a single clinic between January 2015 and March 2020 were included. Clinical and demographic characteristics including the fistula location, postoperative recurrence, anal incontinence, and satisfaction rate were evaluated retrospectively. Results: Of the 42 patients, 15 were female and 27 were male. The mean age was 43.4±13.1 years and the median follow-up period was 10 months (range: 5-21 months). No statistically significant difference in disease recurrence was found in terms of age, sex, American Society of Anesthesiologists classification, smoking, abscess history, fistula type, or primary/ recurrence status (p>0.05). Total anal incontinence did not develop in any patient during the follow-up period. Recurrence of perianal fistula was observed in 2 patients (4.8%). Conclusion: The results of the present study indicated that partial fistula tract excision and loose seton implantation remains the primary treatment method of choice due to the low rate of recurrence and incontinence coupled with high patient satisfaction.
Bilimsel ve teknoloji alaninda yasanilan yeniliklerden en cok etkilenen basta cerrahi bilimler ol... more Bilimsel ve teknoloji alaninda yasanilan yeniliklerden en cok etkilenen basta cerrahi bilimler olmak uzere Tibbi bilimlerdir. Yeni nesil cerrahi yontemler geleneksel cerrahiden ayrilarak cok farkli bir noktaya gelmistir. Bu kitap yazilirken bile bircok yeni yontem gelistirilmis ve bircok yontem ise populeritesini kaybetmistir. En degerli bilgi en guncel olan bilgidir. Bu nedenle surekli olarakkaynak kitaplarin revize edilip guncellenmesi gerekmektedir.
International Journal of Surgery Case Reports, 2019
INTRODUCTION: Renal cell carcinoma (RCC) is a rare tumor that comprises only 3% of adult cancers,... more INTRODUCTION: Renal cell carcinoma (RCC) is a rare tumor that comprises only 3% of adult cancers, while renal parenchymal tumors constitute 85% of all RCC cases. RCC frequently metastasizes to the lungs, bones, brain or liver; however, the gastrointestinal tract, particularly the colon, is an unusual location for metastasis. CASE REPORT: A 63-year-old male patient was admitted complaining of hematochezia. The patient had undergone left-side nephrectomy for RCC, 5 years previously. Computed tomography and colonoscopy detected a splenic flexure tumor and after left hemicolectomy and splenectomy, histopathological examination revealed a colonic metastasis of the renal cell carcinoma. DISCUSSION: Cases of colonic metastasis following resection of a RCC are uncommon in the literature and their location can be very varied, but include the sigmoid colon, splenic flexure, transvers colon and hepatic flexure. Recurrence of RCC is frequently seen during the first three postoperative years, and surgical resection is suggested for solitary non-metastatic tumor. CONCLUSION: RCC rarely metastases to the colon but may occur years after curative resection. Therefore, RCC patients should be closely followed for the long term. In case of isolated metastasis, long-term survival can be achieved with R0 resection.
INTRODUCTION: Synchronous primary tumors of the pancreas and kidney are extremely rare and poorly... more INTRODUCTION: Synchronous primary tumors of the pancreas and kidney are extremely rare and poorly documented in the literature. The aim of this study is to present a case with primary synchronous pancreatic adenocarcinoma and renal cell carcinoma in light of the literature. METHODS: A 60-year-old female patient was admitted to our outpatient clinic with a history of intermittent epigastric pain, nausea and vomiting for about 3 months. There was no family history of pancreatic and kidney disease or familial genetic syndromes. After the multidisciplinary team evaluation right nephrectomy with a Whipple procedure in the same session was performed. RESULTS: In laboratory examinations serum carbohydrate antigen 19-9 and carcinoembryonic antigen levels were elevated. Endoscopic retrograde cholangiopancreatography, protruding and infiltrating ampulla was observed. In magnetic resonance imaging of the entire abdomen; A space-occupied lesion with hyperintense necrotic areas is observed anteriorly at the junction of the upper and middle poles of the right kidney, and was reported as a suggestion of renal cell carcinoma. In positron emission tomography; Heterogeneous hypermetabolism appearance was noted in the focus thought to belong to the duodenal loops and in the region corresponding to the level of the ampulla of Vater, and distant metastasis was not defined. DISCUSSION AND CONCLUSION: More detailed epidemiological and molecular studies are needed to define the relationship between primary synchronous pancreatic and kidney tumors. In resectable cases radical surgical treatment is safe and should be considered as the primary treatment.
Objective: The most important part of improving colorectal cancer prognosis is to detect and trea... more Objective: The most important part of improving colorectal cancer prognosis is to detect and treat in the early stage. The most effective way to do this is screening programs. Fecal occult blood test is one of the most frequently used methods in the screening program. In this study, we aimed to evaluate the colonoscopy and histopathological findings of patients who underwent colonoscopy due to positive fecal occult blood test. Methods: Patients who had a positive fecal occult blood test between January 2016 and December 2018 and underwent colonoscopy to investigate the etiology were included in the study. Demographic characteristics, colonoscopy findings and histopathological results of the patients were reviewed retrospectively from hospital records. Results: A total of 325 patients were included in the study. Of the patients, 146 (44.9%) were male, 179 (55.1%) were female, and their mean age was 58.4±9.3 years. Colonoscopic findings of 140 patients (43.1%) were normal. Polyps in 8...
Objective: To compare postoperative morbidity and mortality results in patients with and without ... more Objective: To compare postoperative morbidity and mortality results in patients with and without endoscopic and percutaneous transhepatic biliary drainage due to obstructive jaundice caused by a periampullary tumor and to examine the effect of intervals until surgery on postoperative morbidity and mortality in patients who underwent preoperative biliary drainage (BD). Methods: Patients were divided into 3 groups according to their BD status. Group1, no biliary drainage (NBD), Group2, Endoscopic biliary drainage (EBD), Group3, Percutaneous transhepatic biliary drainage (PBD). Patients who underwent biliary drainage before pancreaticoduodenectomy (PD) were divided into 3 intervals according to the time interval between drainage and surgery: Short interval; patients undergoing surgery in 21 days and <, Medium interval; between 22-42 days, Long interval; 43 days and >. Groups and intervals were compared in terms of postoperative morbidity and mortality. Results: Of the 122 patients who underwent PD, 76 (62.3%) were male, and 46 (37.7%) were female. Within these patients, 47 (38.52%) had NPD, 42 (34.42%) had EBD, and 33 (27.05%) had PBD. The rate of postoperative Grade B and C fistula was higher in the groups that underwent preoperative drainage compared to the group without preoperative drainage (p = 0.007). Conclusion: It was determined that the postoperative complication rate was lower in patients who did not undergo BD compared to patients who underwent biliary drainage. Besides, the endoscopic drainage method was observed to be associated with fewer complications than the percutaneous transhepatic drainage method. Key words: Preoperative biliary drainage, Pancreaticoduodenectomy, Periampullary tumors, Post procedure complication, Timing.
Mide kanserinin total laparoskopik cerrahisinde, transeksiyon hattını belirlemek zor olabilir. Bu... more Mide kanserinin total laparoskopik cerrahisinde, transeksiyon hattını belirlemek zor olabilir. Bu retrospektif çalışma, total laparoskopik gastrektomide rezeksiyon marjını belirlemede intraoperatif gastroskopinin klinik önemini değerlendirmeyi amaçlamaktadır. YÖNTEM ve GEREÇLER: Mart 2017 ve Ocak 2021 tarihleri arasında total laparoskopik gastrektomi sırasında rezeksiyon sınırını belirlemek için intraoperatif gastroskopi yapılan 55 hasta çalışmaya dahil edildi. Endoskopik görüntülemede lezyon yerleşimi tespit edildikten sonar ışık transillüminasyonu ile rezeksiyon sınırı belirlenerek transeksiyon yapıldı. BULGULAR: İntraoperatif gastroskopiile total laparoskopik gastrektomi uygulanan 55 hastanın 28' i(%50.9) erkek, 27' si (%49.1) kadın ve yaş ortalaması 59.89±11.18 idi. Tümör yerleşimi, 25 (%45.4) hastada proksimal 1/3, 9 (% 16.4) hastada orta 1/3 ve 21 (%38.2) hastada ise distal 1/3 yerleşimliydi. İntraoperatif gastroskopi yapılan ve total laparoskopik tamamlanan 19 (%34.5) hastaya subtotal gastrektomi, 10 (%18.2) hastaya vertical gastrektomi ve 26 (%47.3) hastaya total gastrektomi uygulandı. Hastalarda intraoperatif gastroskopiye bağlı komplikasyon görülmedi. Tüm olguların rezeksiyon marjının güvenli sınırlarda olduğu histopatolojik analiz ile gösterildi. TARTIŞMA ve SONUÇ: Total laparoskopik gastrektomide, tümör lokalizasyonunu belirlemek ve rezeksiyon sınır güvenliğini sağlamak amacıyla intraoperatif gastroskopi güvenilir bir prosedürdür.
There have been many changes in number and place of trocars that have been described, since the f... more There have been many changes in number and place of trocars that have been described, since the first laparoscopic cholecystectomy (LC), but, in fact, all authors agree that laparoscopic procedure is accepted as gold standard. However, four trocars use in standard laparoscopic cholecystectomy, it has been argued that the fourth port is not necessary for grasping fundus of gallbladder so as to expose Calot&#39;s triangle. The aim of this study is to establish the safety of three-trocar LC in symptomatic gallbladder disease and also to determine the ratio of technical requirements of the fourth trocar. Between August 2010 and January 2016, 291 cases were operated in Kocaeli Derince Education and Research Hospital, department of general surgery for symptomatic gallbladder disease with three-port LC, and their records were examined retrospectively. Two hundred and twenty patients were female (75.6 %) and seventy one (24.4 %) were male. Two hundred and eighteen of two hundred and ninety-one cases (74.92 %) were operated with three- port LC in a secure way. In seventy-three cases (25.08 %), one more port was needed to use. Mean operative time was 33.76 ± 11:18 min. (15-90 min). In these cases, major complications, such as main bile duct injury or bile leakage, that may increase the mortality and morbidity, did not occur. Only in one case (0.34 %) postoperative bleeding was seen from the liver bed, which was required exploration. We concluded that in experienced hand, LC with three ports is safe and feasible technique if it is not endanger the course of the surgery.
Background/aim: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a... more Background/aim: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a number of favorable effects in patients undergoing cancer surgery. In this prospective study, we aimed to assess the perioperative use of enteral immunonutrition in patients undergoing radical gastrointestinal surgery for malignancy. Materials and methods: Forty-one patients with malignancy were included in this study and were randomized into one of the two following nutritional strategies: enteral only (EN) or enteral with enteral immunonutrition (ENIN). These regimens were followed for 7 days perioperatively by all patients. Nutritional parameters and postoperative morbidity, mortality, and length of hospital stay (LHS) were assessed. Results: Serum prealbumin levels increased significantly in the ENIN group (P = 0.033). Moreover, patients in the ENIN group showed a more marked decrease in the rate of postoperative infections (P = 0.021) and anastomotic leakage (P = 0.018) than patients fed with EN. In the EN group, LHS was significantly longer than that in the ENIN group (18 vs. 12 days) (P = 0.032). Rates of overall morbidity and mortality were similar in the two groups (P > 0.05). Conclusion: ENIN was found to have a favorable effect on the outcome of radical gastrointestinal surgery for malignancy. Meticulous preoperative assessment of malnutrition and at least a 7-day perioperative enteral use can increase the effectiveness of immunonutrition.
Turkish journal of trauma & emergency surgery, 2023
BACKGROUND: Simple appendectomy with a complicated appendicitis diagnosis could prove difficult, ... more BACKGROUND: Simple appendectomy with a complicated appendicitis diagnosis could prove difficult, sometimes requiring extended resection. Hence, we aimed to compare two procedures that are preferred for extended resection, ileocecal resection, and right hemicolectomy, in terms of patients' demographic data, preoperative laboratory values (white blood cell [WBC], Neutrophil-tolymphocyte ratio [N/L], C-reactive protein [CRP]), operation times, postoperative complications, length of hospital stay, and 1-month mortality rates. METHODS: We retrospectively reviewed patients who underwent extended resection with the diagnosis of complicated appendicitis in our clinic from February 2015 to December 2020. We divided the patients into two groups those who underwent right hemicolectomy and those who underwent ileocecal resection. RESULTS: Among the 55 patients who underwent extended resection with the diagnosis of complicated appendicitis, 32 (58.1%) underwent right hemicolectomy and 23 underwent ileocecal resection (41.8%). The groups did not differ statistically significantly in terms of demographic characteristics, preoperative laboratory values (WBC, N/L, CRP), Clavien-Dindo classification scores, mean hospital stay, or 1-month mortality rates (p>0.005). However, there was a statistically significant difference between the groups in terms of operation time (p<0.001). CONCLUSION: Ileocecal resection is a safe procedure for patients diagnosed with complicated appendicitis who are scheduled for extended resection.
Aim: Laparoscopic appendectomy (LA) is used in acute appendicitis treatment in many centers today... more Aim: Laparoscopic appendectomy (LA) is used in acute appendicitis treatment in many centers today. Various methods such as intracorporeal knot, endoloop, stapler and hem-o-lok clip are used to close of the appendix stump during LA. All of these methods has several advantages and disadvantages. In this study, we aimed to compare the effect of the intracorporal knot method with hemo-lok clip method to close of the appendix stump in LA. Material and Methods: Operative data, complications and follow-up results of 143 patients which treated with LA between January 2012 and December 2017 were evaluated retrospectively. Results: Sixty-four patients (44.7%) were males and 79 (55.2%) were females. Seventy-five patients (52.4%) were treated with 2/0 polyglactin (coated vicyrl, ethicon) sutures and 68 patients (47%) were treated with hem-o-lok clip XL (weck hem-o-lok polymer ligation system) for intracorporeal knot to close of the appendix stump. Patients were compared according to the duration of operation, the duration of hospitalization and postoperative complications and there were no statistically significant difference between the data of the cases according to the groups (p = 0.197, p = 0.902, p = 0.503, respectively). Conclusion: We identified that both techniques for appendix stump closure are effective and safe methods in LA.
ö Background & aims: Spontaneous bacterial infection and septicemia due to increased bacterial tr... more ö Background & aims: Spontaneous bacterial infection and septicemia due to increased bacterial translocation (BT) in patients with obstructive jaundice result in signi¢cant morbidity and mortality. The present study evaluates the e¡ects of enteral nutrition with immune enhancing feeds on BTand intestinal villus histopathology promoted by obstructive jaundice. Methods: Fifty male Wistar-albino rats weighing 250^300 g were assigned into ¢ve equal groups of 10. Animals in Groups I, II, and III were fed with standard chow, those in Group IV were given glutamine 1g/kg/day and the remaining 10 animals in Group V were fed with an arginine, o-3 fatty acids, and RNA-supplemented enteral diet for (1g/kg/day amino acid and 230 kcal/kg) 7 days preoperatively. Group I underwent sham operation and the remaining animals in all other groups underwent common bile duct ligation. After operation, Group I had standard chow, Groups II and IV had glutamine, Groups III and V had an arginine o-3 fatty acids, and RNA-supplemented enteral diet for 7 days. All animals were sacri¢ced on the 8th postoperative day and evaluated both biochemically and histopathologically. Samples from blood, liver, mesenteric lymph nodes and spleen were cultured under aerobic conditions. Results: Signi¢cantly less BT was observed in groups fed with an arginine, o-3 fatty acids, and RNA-supplemented enteral diet or glutamine in pre-and postoperative periods as compared to others (Po0.001). Histologic evaluation also showed signi¢cant reduction in villus atrophy in these groups. Conclusions: Enteral immunonutrition using glutamine or arginine, o-3 fatty acids, and RNA-supplemented enteral diet during both pre-and postoperative periods seems to reduce BTand decrease atrophy of intestinal mucosal villi in rats with obstructive jaundice.
Perianal fistula is an anorectal disease that can significantly impair quality of life. The cours... more Perianal fistula is an anorectal disease that can significantly impair quality of life. The course of the disease can include chronic exacerbation and recurrence. Many surgical techniques have been developed to treat perianal fistula, but reappearance of the fistula is still a major problem. The aim of the present study was to evaluate the results of partial fistula tract excision (partial fistulectomy) and loose seton application in the treatment of primary and recurrent perianal fistula. Materials and Methods: Forty-two patients with a primary or recurrent perianal fistula who underwent a partial fistulectomy with loose seton placement at a single clinic between January 2015 and March 2020 were included. Clinical and demographic characteristics including the fistula location, postoperative recurrence, anal incontinence, and satisfaction rate were evaluated retrospectively. Results: Of the 42 patients, 15 were female and 27 were male. The mean age was 43.4±13.1 years and the median follow-up period was 10 months (range: 5-21 months). No statistically significant difference in disease recurrence was found in terms of age, sex, American Society of Anesthesiologists classification, smoking, abscess history, fistula type, or primary/ recurrence status (p>0.05). Total anal incontinence did not develop in any patient during the follow-up period. Recurrence of perianal fistula was observed in 2 patients (4.8%). Conclusion: The results of the present study indicated that partial fistula tract excision and loose seton implantation remains the primary treatment method of choice due to the low rate of recurrence and incontinence coupled with high patient satisfaction.
Bilimsel ve teknoloji alaninda yasanilan yeniliklerden en cok etkilenen basta cerrahi bilimler ol... more Bilimsel ve teknoloji alaninda yasanilan yeniliklerden en cok etkilenen basta cerrahi bilimler olmak uzere Tibbi bilimlerdir. Yeni nesil cerrahi yontemler geleneksel cerrahiden ayrilarak cok farkli bir noktaya gelmistir. Bu kitap yazilirken bile bircok yeni yontem gelistirilmis ve bircok yontem ise populeritesini kaybetmistir. En degerli bilgi en guncel olan bilgidir. Bu nedenle surekli olarakkaynak kitaplarin revize edilip guncellenmesi gerekmektedir.
International Journal of Surgery Case Reports, 2019
INTRODUCTION: Renal cell carcinoma (RCC) is a rare tumor that comprises only 3% of adult cancers,... more INTRODUCTION: Renal cell carcinoma (RCC) is a rare tumor that comprises only 3% of adult cancers, while renal parenchymal tumors constitute 85% of all RCC cases. RCC frequently metastasizes to the lungs, bones, brain or liver; however, the gastrointestinal tract, particularly the colon, is an unusual location for metastasis. CASE REPORT: A 63-year-old male patient was admitted complaining of hematochezia. The patient had undergone left-side nephrectomy for RCC, 5 years previously. Computed tomography and colonoscopy detected a splenic flexure tumor and after left hemicolectomy and splenectomy, histopathological examination revealed a colonic metastasis of the renal cell carcinoma. DISCUSSION: Cases of colonic metastasis following resection of a RCC are uncommon in the literature and their location can be very varied, but include the sigmoid colon, splenic flexure, transvers colon and hepatic flexure. Recurrence of RCC is frequently seen during the first three postoperative years, and surgical resection is suggested for solitary non-metastatic tumor. CONCLUSION: RCC rarely metastases to the colon but may occur years after curative resection. Therefore, RCC patients should be closely followed for the long term. In case of isolated metastasis, long-term survival can be achieved with R0 resection.
INTRODUCTION: Synchronous primary tumors of the pancreas and kidney are extremely rare and poorly... more INTRODUCTION: Synchronous primary tumors of the pancreas and kidney are extremely rare and poorly documented in the literature. The aim of this study is to present a case with primary synchronous pancreatic adenocarcinoma and renal cell carcinoma in light of the literature. METHODS: A 60-year-old female patient was admitted to our outpatient clinic with a history of intermittent epigastric pain, nausea and vomiting for about 3 months. There was no family history of pancreatic and kidney disease or familial genetic syndromes. After the multidisciplinary team evaluation right nephrectomy with a Whipple procedure in the same session was performed. RESULTS: In laboratory examinations serum carbohydrate antigen 19-9 and carcinoembryonic antigen levels were elevated. Endoscopic retrograde cholangiopancreatography, protruding and infiltrating ampulla was observed. In magnetic resonance imaging of the entire abdomen; A space-occupied lesion with hyperintense necrotic areas is observed anteriorly at the junction of the upper and middle poles of the right kidney, and was reported as a suggestion of renal cell carcinoma. In positron emission tomography; Heterogeneous hypermetabolism appearance was noted in the focus thought to belong to the duodenal loops and in the region corresponding to the level of the ampulla of Vater, and distant metastasis was not defined. DISCUSSION AND CONCLUSION: More detailed epidemiological and molecular studies are needed to define the relationship between primary synchronous pancreatic and kidney tumors. In resectable cases radical surgical treatment is safe and should be considered as the primary treatment.
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