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Öğe A comparative analysis of the liver retraction with long surgical gauze in three-port sleeve gastrectomy and the four-port nathanson retractor technique(2025) Ertekin, Süleyman Çağlar; Önsal, Ufuk; Turgut, Emre; Akyol, Hüseyin; Ünver, Mutlu; Demirpolat, Muhammed Taha; Akbulut, GökhanBackground: This study evaluated the long surgical gauze (SurG) technique as a liver retraction method in laparoscopic sleeve gastrectomy (LSG). Traditional methods involve the Nathanson retractor, associated with ischemia and necrosis complications. In addition, these techniques require an additional trocar with an incision that increases postoperative pain. Our aim, therefore, was to reduce such complications through the use of SurG and evaluate recovery and outcome implications. Methods: In this retrospective study, patients who underwent laparoscopic sleeve gastrectomy (LSG) between January and December 2023 were divided into two groups based on the liver retraction method used: NR or SurG. Demographic data, surgery times, postoperative liver enzyme levels (AST, ALT), C-reactive protein (CRP), pain scores, and analgesic use (VAS) were collected from medical records and statistically analyzed. Results: The SurG group demonstrated significantly lower postoperative pain scores and reduced analgesic use compared to the NR group (p < 0.001). Additionally, liver enzyme levels (AST, ALT, CRP) were lower in the SurG group, indicating less liver stress. Early mobilization was achieved more quickly in the SurG group, aligning with Enhanced Recovery After Surgery (ERAS) protocols. However, the SurG method showed some limitations during the dissection of the greater curvature due to the narrower field of view. Conclusions: The long surgical gauze method provides a viable alternative to the Nathanson retractor, offering advantages such as less postoperative pain, reduced liver stress, and quicker mobilization. Despite some technical limitations, this method can improve patient outcomes in sleeve gastrectomy.Öğe Changes in laboratory findings and early postoperative radiological evaluations following laparoscopic sleeve gastrectomy(2022) Akyol, Hüseyin; Erok, Berrin; Idrees, AbdulrahmanIntroduction: Obesity is an important public health problem with its related comorbidities associated with chronic inflammation. Secretion and continued release of inflammatory mediators such as tumor necrosis factor-alpha and interleukin-6 are caused by hypertrophic growth of adipose tissue and lead to chronic inflammation. In this study, we aimed to retrospectively evaluate the changes in the hematological and biochemical profiles and also to review complications established in post-operative radiological imaging studies following laparoscopic sleeve gastrectomy (LSG). Materials and Methods: The changes in the obesity-related biochemical and hematological parameters 6 months after LSG were retrospectively analyzed in 143 consecutive patients older than 18-year of age who underwent LSG. In addition, the findings of abdominal ultrasonography (US) examinations in all patients and computed tomography findings in patients who had been performed were retrospectively reviewed in terms of post-operative complications. Results: The decrease in body mass index (BMI) compared to the pre-operative BMI was statistically significant. Both inflammatory markers and glucose-lipid profiles showed improvement with a positive correlation parallel to the change in BMI. Neutrophil-lymphocyte ratio was found to be decreased significantly. However, no significant change was observed in PLR 6 months after LSG. Newly developed gallstones appeared in six of the patients when compared with their pre-operative abdominal US reports. None of the patients had gastric leak, perigastric collection, or hemorrhage. Conclusion: LSG is one of the most effective bariatric surgery methods in the treatment of obesity. We showed improvements in inflammatory markers in addition to glucose and lipid profiles with a positive correlation parallel to the changes in BMI.Öğe Evaluation of veress needle as a liver retraction technique in laparoscopic sleeve gastrectomy(2024) Ertekin, Süleyman Çağlar; Akbulut, Gökhan; Turgut, Emre; Akyol, Hüseyin; Ergenç, Muhammer; Yeğen, CumhurBackground: Liver retraction management in laparoscopic sleeve gastrectomy (LSG) is challenging for surgeons, especially in patients with enlarged livers. Traditional methods, such as the Nathanson retractor (NR), often necessitate additional incisions, potentially increasing liver enzymes and increasing the risk of complications. The aim of this study was to evaluate the efficacy of the use of a Veress needle (VN), an alternative liver retraction technique, in LSG surgery compared with NR. Materials and methods: This study was conducted at a university-affiliated hospital between May 2022 and December 2022. Patients who underwent LSG were divided into two groups: one utilizing the NR and the other employing the VN for liver retraction. Parameters such as operation duration, retraction time, liver laceration, trocar-induced hemorrhage, subxiphoid trocar site infections, pain scores measured via the visual analog scale (VAS) at various time points, pre- and postoperative liver enzyme levels (AST, ALT, GGT, ALP) and CRP levels were analyzed. Results: Data from 151 patients were analyzed. The AST/ALT elevations (P < 0.001) were significantly lower in the VN group (73 patients) than in the NR group (78 patients), while there was no significant difference in GGT/ALP levels. Retraction-related bleeding was significantly greater in the NR group than in the VN group (6.4% vs 0%, P = 0.035). Postoperative infection rate was lower in the VN group but not statistically significant (0% vs 3.8%, P = 0.135). CRP differences were significant on the first postoperative day (P < 0.001). Postoperative VAS scores were significantly lower in the VN group at all measured time points except at the 48th hour and 10th day. Conclusions: The VN technique in LSG significantly reduces liver enzyme elevation and the need for an extra trocar and incision, potentially lowering complication risk and enhancing patient outcomes.Öğe Gastric mucosal atrophy, intestinal metaplasia, and Helicobacter pylori status in patients with gastritis with or without bile reflux: Is the presence of bile reflux good or bad?(2020) Aydın, Muhammet Fatih; Namlı Koç, Şule; Aydın, Mehmet Akif; Akyol, HüseyinBackground and Aims: To investigate the relation between bile reflux and gastric mucosal atrophy, intestinal metaplasia, and Helicobacter pylori status in patients with gastritis. Materials and Methods: A total of 217 patients (mean ± SD; age: 33.2±7.9 years; 51.2% males) with gastritis were divided into two groups: patients with intragastric bile reflux (n = 134; confirmed by pathology in 20 patients) and without bile reflux (control group; n = 83). The status of Helicobacter pylori and presence of intestinal metaplasia and gastric atrophy were evaluated with respect to the presence of bile reflux. Results: A positive Helicobacter pylori status, intestinal metaplasia, and gastric atrophy were observed in 85 (39.2%), 72 (33.2%), and 66 (30.4%) patients, respectively. No significant difference was noted between patients with gastritis with or without bile reflux in terms of a positive Helicobacter pylori status (38.8% vs. 45.8%), intestinal metaplasia (32.8% vs. 33.7%), and gastric atrophy (30.6% vs. 30.1%). However, the pathological confirmation of bile reflux gastritis was associated with a significantly lower rate of Helicobacter pylori positivity (0.0% vs. 45.6%; p = 0.001), intestinal metaplasia (5.0% vs. 37.7%; p = 0.009), and gastric atrophy (0.0% vs. 36.0%; p = 0.003). In patients with bile reflux (n = 134), the intestinal metaplasia and gastric mucosal atrophy rates were similar with respect to the H. pylori status. Conclusion: The rates of Helicobacter pylori positivity, intestinal metaplasia, and gastric atrophy were similar in patients with gastritis with or without bile reflux. However, the frequency of Helicobacter pylori, intestinal metaplasia, and gastric mucosal atrophy was lower in patients with pathologically confirmed biliary gastritis.Öğe Impact of laparoscopic salpingectomy on clinical pregnancy, live birth, and miscarriage rates in women with hydrosalpinx(2022) Erşahin, Suat Süphan; Akyol, HüseyinIntroduction: This study was planned to investigate the effect of L/S salpingectomy to be performed before IVF/ICSI on clinical pregnancy, live birth, and abortion rates in infertile patients diagnosed with hydrosalpinx. Materials and Methods: Forty patients who were found to have hydrosalpinx in routine evaluations before ART were included in the study. The diagnosis of Hydrosalpinx (HX) was made by transvaginal ultrasonography or hysterosalpingography (HSG). Based on HSG or sonography, a unilateral or bilateral hydrosalpinx was noted as being present or absent. A hydrosalpinx was defined as an echo-free cyst-like fluid accumulation or irregular cystic lesion located outside the ovary and uterus. Salpingectomy was recommended because it may adversely affect ART results. The patients were divided into two groups according to their salpingectomy decisions. Group 1 (n=23) consisted of patients with uni or bilateral HX and accepted salpingectomy. Group 2 (n=17) consisted of patients who were found to have uni or bilateral HX but did not accept salpingectomy. Fifteen patients who did not have HX and were planned for IVF/ICSI due to unexplained infertility were accepted as the control group. The primary outcome measures of the study were detection of serum beta-hCG levels, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate. Results: Positive beta-hCG was detected in 11 of 23 patients who underwent salpingectomy (47.8%), while hCG was positive in six of 17 patients who did not undergo salpingectomy (35.2%). In the salpingectomy group, clinical pregnancy was detected in 10 patients (43.4%), nine patients had a live birth (39.1%), and abortion was found in 1 patient (9.0%). In the group that did not undergo salpingectomy, clinical pregnancy was detected in 5 patients (29.4%), three patients gave live birth (17.6%), and abortion was found in 2 patients (33.3%). Positive beta-hCG (47.8% vs. 35.2%, p<0.01), CPR (43.4% vs. 29.4%, p<0.002), and LBR (39.1% vs. 17.6%, p<0.001) were found to be significantly higher in the salpingectomy group compared to the nonsalpingectomy group. Abortion rates were significantly higher in the group that did not undergo salpingectomy (33.3% vs. 9.0%, p<0.01). The hCG positivity, CPR, and LBR of the unexplained infertile patients were similar to the salpingectomy group. In this group, pregnancy test positivity was found in seven of 15 patients (46.6%), clinical pregnancy was found in 6 patients (40%), and five patients had a live birth (33.3%). Abortion was detected in one case in the control group (14.2%). Conclusion: Performing salpingectomy for HX improves clinical pregnancy and live birth rates and reduces miscarriage rates.Öğe Quality of information available on YouTube videos pertaining to thyroid cancer(Springer, 2020) Aydın, Mehmet Akif; Akyol, HüseyinThe purpose of the present study was to assess the quality of information available on YouTube videos pertaining to thyroid cancer. A search of YouTube () was performed on February 12, 2018, using the search terms "thyroid cancer" and "thyroid cancer treatment." The first 50 videos that appeared on each search were reviewed and 52 videos were included in the analysis. Videos were independently analyzed by two authors for video characteristics including publishing source of upload, continent of origin, presence of animation, and numbers of views, likes, and dislikes. The quality of information provided was assessed using the DISCERN and JAMA benchmark scores, while video power index was also calculated. The median (min-max) DISCERN score was 19.5 (4-71) for reviewer 1 and 20.0 (4-72) for reviewer 2. The median (min-max) JAMA benchmark score was 2.0 (1-4) for both reviewers. JAMA scores were positively correlated with video power index in both reviewer 1 (r = 0.310, p = 0.025) and reviewer 2 (r = 0.356, p = 0.010) assessment. JAMA and DISCERN scores were positively correlated with duration of videos in both reviewer 1 (r = 0.454, p = 0.001 and r = 0.533, p < 0.001, respectively) and reviewer 2 (r = 0.541, p < 0.001 and r = 0.519, p < 0.001, respectively) assessment. In conclusion, our findings revealed poor quality of information provided by YouTube videos pertaining to thyroid cancer based on DISCERN and JAWA scores. Videos with longer duration and higher video power index seem to be associated with higher quality scores, whereas no impact of using animation was shown on quality scores as well as no association between video duration and video power index.Öğe Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome(2024) Akyol, HüseyinBackground: This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD). Methods: A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate were recorded in each patient and compared between KF and SiLaT groups. Results: The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively. Conclusions: SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.Öğe Splenic flexure mobilization: does body topography matter?(2024) Akyol, Hüseyin; Arslan, N. C.; Kocak, M.; Shahhosseini, R.; Pekuz, C. K.; Haksal, M.; Gogenur, I.; Onel, MustafaBackground: Splenic flexure mobilization can be technically challenging, and its oncological benefits remain uncertain. This study aims to explore the relationship between patient and clinical characteristics and splenic flexure mobilization time as well as the implications of prolonged splenic flexure mobilization duration. Methods: This retrospective cohort study includes 105 patients who underwent laparoscopic distal colorectal cancer surgery between 2013 and 2018. The study analyzed patient characteristics, duration of surgical steps, and postoperative outcomes. Splenic flexure mobilization time was assessed using operation videos, and the impact of patient-related factors on splenic flexure mobilization complexity was examined. Results: The study identified significant correlations of higher body mass index (BMI) (p = 0.0086), weight (p = 0.002), and height (p = 0.043) with longer splenic flexure mobilization time. Gender did not significantly influence splenic flexure mobilization duration. Splenic flexure mobilization time was correlated with the durations of other individual surgical steps (Step 1: medial-to-lateral dissection [p = 0.0013], Step 2: pelvic dissection [p = 0.067], Step 3: dissection of white line and mobilization of descending colon [p = 0.0088], Step 5: stapling, resection, extraction of the specimen, and anastomosis [p = 0.04]) and the overall operation time (p < 0.0001). A 10-min cutoff point predicts the total operation time more efficiently than other potential thresholds. Conclusion: This research suggests that patient characteristics including BMI, weight, and height may serve as indicators for prolonged splenic flexure mobilization time in laparoscopic distal colorectal cancer surgery. Longer splenic flexure mobilization durations were correlated with extended durations of other surgical steps. A BMI-based approach to anticipate SFM duration may enhance preoperative planning, potentially aiding in surgical decision-making.Öğe Successful kidney transplantation in case of completely occluded inferior vena cava and iliac veins: a case of inherited antithrombin deficiency(Asociacion Regional de Dialisi y Transplantes Renales de Capital Federal y Provincia de Buenos Aires, 2021) Tekin, Sabri; Erok, Berrin; Win, Nu Nu; Agolli, Elidor; Uçak, Alper; Akyol, Hüseyin; Mounjali, Assiya ElProduced in the liver, Antithrombin III, now simply antithrombin (AT), is a vitamin K-independent serine protease inhibitor in the coagulation pathway. It is the most important primary physiologic inhibitor of thrombin in the human body. In addition to thrombin, AT also inhibits other coagulation serine proteases including VIIa, IXa, Xa, XIa, XIIa. (1-2) The deficiency of AT may be inherited or acquired. The incidence of inherited AT deficiency is about 1:2000-5000 in general population and is the least common of the three main anticoagulant deficiencies (the other two being protein C deficiency and protein S deficiency). (3) Its inheritance is generally in autosomal dominant fashion. The resultant procoagulant state leads to unprovoked recurrent venous thromboses and thromboembolic events such as deep vein thrombosis or pulmonary embolism which generally appear at the post-pubertal period, compared to the very low occurrence in the prepubertal period.(4) The diagnosis is based on both quantitative and qualitative measurement of AT level.(5) The measured AT activity in functional tests in healthy subjects is generally around 80% to 120%, and AT level of less than 70% is considered as being AT deficiency. This evaluation should be made while not on anticoagulation therapy, because heparin decreases AT levels for up to 10 days following its discontinuation and warfarin increases its level. (6) Patients with inherited AT deficiency rarely develops renal failure which may be caused by renal vein thrombosis or glomerular injury associated with fibrin accumulation. (7) In these young patients with end stage renal disease (ESRD), renal transplantation is currently the best therapeutic option to improve the quality of life and to avoid the risk of complications of other renal replacement treatment particularly thrombosis of the hemodialysis access. Kidney transplantation in patients with an occluded iliac veins and inferior vena cava (IVC) is a very challenging surgery to perform.(8-9) Despite the reported success in few cases for children, kidney transplant surgeries with thrombotic diseases in adults remain very limited in the literature. Herein, we present a successful kidney transplantation by using a polytetrafluoroethylene (PTFE) graft in a young male patient with AT deficiency associated with totally occluded IVC and iliac veins. © 2021, Asociacion Regional de Dialisi y Transplantes Renales de Capital Federal y Provincia de Buenos Aires. All rights reserved.Öğe Thirty-minutes infusion rate is safe enough for bevacizumab; no need for initial prolong infusion(Humana Press Inc, 2014) Yanmaz, Mustafa Teoman; Güner, Şebnem İzmir; Satılmış, Bahar; Akyol, Hüseyin; Aydın, Mehmet AkifBevacizumab (Bev) is a vascular endothelial growth factor-A monoclonal antibody that targets tumor angiogenesis. The transfusion rate of Bev is 90 min in the first dose, 60 min in the second and than from the third dose it is 30 min if no hypersensitivity reaction occurs in the first two doses. The purpose of this study determines whether these initial prolonged infusions are really necessary or not. Between 2007 and 2009, we were using the standard schedule for Bev infusions. In July 2009, we reviewed our medical reports, nursing orders and adverse drug reaction forms to identify the Bev used patients and possible hypersensitivity reactions (HSRs). Depending on that information between August 2009 and July 2014, we started to make Bev infusions in 30 min from the first dose of the therapy. In this study, we documented the findings of these 30-min infusion used patients. From August 2009 to July 2014, we treated 145 patients with 1,145 Bev infusions each one in 30 min. Out of 145 patients, 12 of them received only single dosage of Bev infusion treatment. Bev doses were 5 mg/kg for 87 patients, 7.5 mg/kg for 64 patients, 10 mg/kg for four patients and 15 mg/kg for only one patient. No HSRs were reported during these transfusions. Initial prolonged infusion times are unnecessary for Bev. Thirty-minute infusion rates can be used safely for all courses.
