Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

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https://hdl.handle.net/20.500.12939/85

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Efficacy of ursodeoxycholic acid in reducing the necessity of cholecystectomy due to pre-existing and subsequently formed gallstones in patients who underwent laparoscopic sleeve gastrectomy
(2024) Demirpolat, Muhammed Taha; Çelikkaya, Muhammet Oğuz; Ertekin, Süleyman Çağlar; Başak, Fatih; Şişik, Abdullah
Background: In this study, we aimed to investigate whether ursodeoxycholic acid (UDCA) would reduce the necessity of cholecystectomy in patients diagnosed with asymptomatic gallstones after laparoscopic sleeve gastrectomy (LSG) and in patients diagnosed with asymptomatic gallstones before LSG. Methods: Between July 2020 and November 2022, at least 2-year follow-ups of patients who underwent LSG for obesity were retrospectively analyzed. Patients with pre-existing asymptomatic gallstones during preoperative evaluation, those with UDCA treatment (group 1), and observation group (group 2). Patients with newly formed gallstones in postoperative outpatient clinic follow-up, those with UDCA treatment (group A), and those without UDCA treatment (group B). Results: A total of 425 patients included. At the end of the first year, patients who had newly formed gallstones after LSG had a higher total weight loss percentages (TWL%) (39.8 ± 6.1) compared to those who did not develop gallstones (37.9 ± 7.4), which were statistically significant (p = 0.004). Among patients who developed gallstones postoperatively, UDCA treatment was associated with a significantly lower cholecystectomy rate in patients with newly formed gallstones postoperatively (p = 0.025), while no significant difference was shown in patients with preoperative gallstones (p = 0.631). Conclusion: UDCA is a promising option for reducing the need for cholecystectomy in patients with post-LSG gallstones, but it appears ineffective for pre-existing gallstones.
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, Gökhan
Background: 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.
De-escalation of nodal surgery in clinically node-positive breast cancer
(2025) Cabioğlu, Neslihan; Koçer, Havva Belma; Karanlık, Hasan; Gülçelik, Mehmet Ali; İğci, Abdullah; Müslümanoğlu, Mahmut; Uras, Cihan; Mantoğlu, Barış; Trabulus, Didem Can; Akgül, Giray; Tükenmez, Mustafa; Şenol, Kazım; Özkurt, Enver; Şen, Ebru; Karadeniz Çakmak, Güldeniz; Bademler, Süleyman; Emiroğlu, Selman; Yıldırım, Nilüfer; Kara, Halil; Dağ, Ahmet; Dilege, Ece; Altınok, Ayşe; Başaran, Gül; Varol, Ecenur; Uğurlu, Ümit; Bölükbaşı, Yasemin; Ersoy, Yeliz Emine; Zengel, Baha; Karaman, Niyazi; Özbaş, Serdar; Zer, Leyla; Kılıç, Halime Gül; Ağcaoğlu, Orhan; Sakman, Gürhan; Utkan, Zafer; Soyder, Aykut; Akcan, Alper; Ergün, Sefa; Yılmaz, Ravza; Aydıner, Adnan; Soran, Atilla; İbiş, Kamuran; Özmen, Vahit
Importance: Increasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC). Objective: To evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)-positive breast cancer and patients whose disease became cN negative after NAC (ycN negative). Design, setting, and participants: In the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated. Exposure: Treatment with SLNB or TAD after NAC. Main outcomes and measures: The primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated. Results: A total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P = .09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P = .03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥ .99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P = .50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P = .07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P = .03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P = .007). Conclusions and relevance: The short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed by regional nodal irradiation regardless of the SLNB technique or nodal pathology. Whether TAD might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up.
Photoprotective effects of quercetin on photoaging-induced rats
(2024) Kızılkan, Betül; Şereflican, Betül; Çetinkaya, Ayhan; Erdoğan Düzcü, Selma; Altuğ, Cevher; Kızılkan, Jehat
Purpose: Photoaging is characterised by cutaneous changes caused by exposure to ultraviolet light over time. Quercetin is a bioflavanoid with antioxidant, antineoplastic, and anti-inflammatory effects. This study investigated the therapeutic effects of topical quercetin on photoaging, a phenomenon not previously studied in ultraviolet A (UVA)-induced photoaging. Methods: A total of 40 rats were randomly categorised into 5 groups, each comprising 8 rats. A photoaging model was induced by applying UVA to the dorsal region of all rats, except for the negative control group. Topical 0.1% retinoic acid was applied to one UVA group, topical 0.3% quercetin to another UVA group, and both agents were applied in combination to yet another UVA group 5 days a week for 8 weeks. Subsequently, wrinkle values were measured, reactive oxygen species (ROS) and matrix metalloproteinase-1 (MMP-1) levels were analysed, and histopathological parameters were examined. Results: The wrinkle value of the UVA group was found to be significantly higher than that of the UVA + Quercetin group. Collagen damage was lower in the UVA + Quercetin group than in the UVA group, although this difference was not statistically significant. Compared with the UVA + Retinoic Acid group, the UVA + Quercetin group exhibited a more significant decrease in inflammation. MMP-1 values were considerably higher in the UVA + Retinoic Acid and UVA + Quercetin + Retinoic Acid groups as well as in the UVA + Quercetin group compared with the control and UVA groups. Conclusion: The present study showed that quercetin can be utilised in the treatment of photoaging, especially when combined with retinoic acid.
Differential diagnosis of submucosal gastric tumors: gastric schwannomas misdiagnosed as GISTs
(2024) Ünver, Mutlu; Ertekin, Süleyman Çağlar; Kebapçı, Eyüp; Ölmez, Mustafa; Ergin, Erhan; Öztürk, Şafak; Şahin, Erkan; Ortaç, Ragıp
Schwannomas commonly occur in the head and neck region but are rarely seen in the gastrointestinal tract; the stomach and small intestine are the most commonly involved sites. These tumors are usually misdiagnosed as gastrointestinal stromal tumors (GISTs) before histopathological confirmation due to radiological similarity. GI schwannomas show positivity for S100 protein and vimentin but are negative for CD 117 and CD 34, which helps in differentiating the tumor from GISTs. Case 1: a 70-year-old woman was referred to our hospital by complaints of abdominal pain and discomfort. Upper GI endoscopy demonstrated a protruding lesion at the lesser curvature of the gastric body, and fine-needle aspiration biopsy showed chronic inflammation without malignancy. Since the lesion was suspected to be GIST, this patient had surgery, and a gastric schwannoma was resected successfully. Case 2: a 66-year-old female with anemia and abdominal discomfort was found to have a submucosal elevated mass at the greater curvature of the antrum. Fine needle aspiration biopsy was suggestive of a spindle cell tumor resembling GIST. The patient underwent subtotal gastrectomy with Roux-en-Y reconstruction. Histopathology confirmed schwannoma. It is necessary to differentiate gastric schwannomas from other submucosal tumors of the stomach, especially GISTs. Surgical complete resection of schwannomas usually has a good prognosis with a low probability of recurrence. Though rare, gastric schwannomas should be included in the differential diagnosis of submucosal gastric tumors because the correct identification of this tumor type helps in proper management and evasion of unnecessary extensive surgery.
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, Hüseyin
Background: 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.
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, Mustafa
Background: 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.
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, Cumhur
Background: 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.
Comparison of the postoperative analgesic efficacy of serratus anterior plane block with different types of blocks for video-assisted thoracoscopic surgery: A systematic review and meta-analysis of randomized controlled trials
(Baycinar Medical Publishing, 2024) Dostbil, Aysenur; Kasali, Kamber; Aydin, Yener; Ince, Ilker; Ulas, Ali Bilal; Yilmaz, Mehmet Akif; Ceren, Muhammed; Eroğlu, Atilla; Ozgodek, Habip Burak; Ozkal, Mirac Selcen; Elsharkawy, Hesham
Background: The study aimed to compare the analgesic efficacy of single-shot serratus anterior plane block (SAPB) for video-assisted thoracoscopic surgery (VATS) with other regional block techniques. Methods: In this meta-analysis, randomized controlled trials published in the PubMed, Scopus, Web of Science, ClinicalKey, and PROSPERO electronic databases between March 24, 2014 and March 24, 2024 comparing the analgesic efficacy of SABP with other regional blocks in adult patients undergoing VATS were reviewed. Results: Nine randomized controlled trials consisting of a total of 537 participants (287 males, 250 females; mean age: 55.2±13.1 years) were included in this meta-analysis. Serratus anterior plane block was compared with erector spinae plane block (ESPB), local infiltration anesthesia (LIA), and thoracic paravertebral block (TPVB). The postoperative 24-h cumulative opioid consumption was statistically significantly higher in SAPB than in ESPB (standardized mean difference [SMD]=1.98; 95% confidence interval [CI], 0.23 to 3.73; Z=2.22; p=0.03; I2=97%; random effects model) and TPVB (SMD=0.63; 95% CI, 0.31 to 0.96; Z=3.84; p<0.001; I2=0%; fixed effects model) and lower than in LIA (SMD=–1.77; 95% CI, –2.24 to –1.30; Z=7.41; p<0.001; I2=0%; fixed effects model). Active pain scores 2 h postoperatively were statistically significantly lower in SAPB than in LIA (SMD=–2.90; 95% CI, –5.29 to –0.50; Z=2.37; p=0.02; I2=93%; random-effects model). At 12 h postoperatively, both passive pain scores (SMD=0.37; 95% CI, 0.07 to 0.66; Z=2.41; p=0.02; I2=0%; fixed effects model) and active pain scores (SMD=0.55; 95% CI, 0.25 to 0.85; Z=3.60; p<0.001; I2=0%; fixed effects model) were statistically significantly lower in ESBP than in SAPB. There was no difference between SAPB and the other groups in terms of the incidence of postoperative nausea and vomiting. Conclusion:After a comprehensive evaluation of postoperative analgesic effects, it appears that ESBP and TPVB may be better than SABP, and SABP may be better than LIA for analgesia of patients undergoing VATS. Further studies are required to determine the optimal regional analgesia technique in VATS.
Is immunohistochemical galectin-3 expression associated with the epithelial-mesenchymal transition in high- and low-grade invasive urothelial carcinomas of the bladder?
(2024) Cin, Merve; Akyıldız İğdem, Ayşenur; Bektaş, Sibel; Gündoğar, Özgecan; Cin, Selçuk; Komut, Neslihan; Çetin, Buğra
Background/Objectives: Bladder cancer, predominantly urothelial carcinoma, is an important malignancy of the urinary system. Despite the same histologic grade and stage, some patients seem to have a worse prognosis. In this context, the epithelial-mesenchymal transition (EMT), characterized by the loss of E-cadherin and gain of vimentin expression, is an important process in tumor progression. Galectin-3, a lactose-binding protein involved in various cellular processes, has been associated with increased tumor cell migration, invasion, and treatment resistance. Methods: In this study, 223 bladder cancer cases were examined, and E-cadherin, vimentin, and galectin-3 expression was evaluated by immunohistochemical staining in tumor budding areas and invasive components. These markers were also correlated with clinicopathological parameters, including tumor grade and stage. Results: The results indicated a significant decrease in E-cadherin expression and an increase in vimentin staining in higher-grade and higher-stage tumors, supporting EMT involvement. Galectin-3 expression was notably higher in T1 high-grade tumors but decreased in T2 stage tumors. Despite this, no significant correlation was found between galectin-3 and E-cadherin or vimentin, suggesting a complex role of galectin-3 in EMT. Conclusions: High galectin-3 expression in T1 high-grade tumors highlights its potential role in early tumor progression and as a therapeutic target. However, the decrease in its expression in advanced stages underscores the need for further research to understand its multifaceted involvement in bladder cancer. These findings suggest that while galectin-3 may contribute to the EMT and early tumor progression, its exact role and potential as a therapeutic target require more detailed investigation.
Comparison of early postoperative outcomes of omentopexy and clips along the staple line during laparoscopic sleeve gastrectomy: a randomized study
(2024) Demirpolat, Muhammed Taha; İslam, Mehmet Muzaffer; Bacaksız, Mehmet Erman; Ertekin, Süleyman Çağlar; Şişik, Abdullah
Background: We aimed to compare the omentopexy and clipping reinforcement methods performed along the staple line during laparoscopic sleeve gastrectomy (LSG) in terms of the effectiveness on postoperative bleeding. Methods: In this prospective randomized controlled study, patients were divided into two groups: clips group (CG) and omentopexy group (OG). The groups were compared in terms of postoperative bleeding, duration of surgery, length of hospital stay, hospital readmissions in the postoperative first 30-days. Results: A total of 148 patients were included in the study. Postoperative bleeding was observed in 11 patients (14.9%) of CG and 2 patients (2.7%) of the OG, and the difference between the groups was found to be significant (p = 0.009). Similarly, the number of patients with bleeding that did not require intervention was 9 (12.2%) in CG and 2 (2.7%) in OG, and the difference between the groups was also significant (p = 0.028). The duration of surgery in the CG was 30 (27 to 36) minutes, whereas in the OG, it was 43 (39 to 45) minutes, with a significant difference noted (p < 0.001). Additionally, the rate of patients readmitted to the hospital within the first 30 days was 16 (21.6%) in the CG and 7 (9.5%) in the OG, with a significant difference observed (p = 0.041). Conclusion: In terms of bleeding requiring intervention, there was no difference between omentopexy and clipping techniques. In addition, omentopexy showed more satisfactory results than clipping in terms of non-interventional bleeding, but its clinical significance is unclear.
Laparoscopic repair vs open repair for perforated peptic ulcers: Quality of life assessment
(2024) Ertekin, Süleyman Çağlar; Çetindağ, Özhan; Ergenç, Muhammer; Yeğen, Cumhur
Purpose: Studies reporting patient-centered outcomes, including quality of life and satisfaction, in perforated peptic ulcer (PPU) treatment are insufficient. This study was designed to assess the relative efficacy of laparoscopic repair (LR) as opposed to open surgical repair (OR) in the treatment of and its impact on quality of life. Methods: This investigation performed a retrospective review of patients who underwent treatment for PPU at a secondary care hospital between January 2017 and April 2020. Patients were categorized into 2 separate groups according to the type of surgical procedure received: LR and OR. Comparisons were made based on a variety of factors, such as demographic data, intra- and postoperative metrics, pain control, patient contentment, and quality of life indicators. Results: In the analysis, there were no statistically significant differences in demographic or clinical characteristics between the LR (n = 35) and OR (n = 62) groups (P > .05). Conversely, the rates of incisional hernia and surgical site infection were significantly greater in the OR group (P < .05). Moreover, the LR exhibited benefits such as a shorter length of hospital stay (P < .05), more rapid resumption of a normal diet, and fewer surgical site infections-factors that contributed to a lower rate of overall postoperative complications. According to the quality-of-life questionnaire, the LR group exhibited significantly greater scores for physical function, role, pain, and general health by the 30th postoperative day (P = .003, P < .001, P = .006, and P = .001, respectively), and by the 1-year follow-up, the LR group showed substantial improvements in physical function, physical role, emotional role, pain and general health (P = .047, P = .004, P = .039, P = .001, and P = .021, respectively), indicating its effectiveness in patient recovery and quality of life enhancement after surgery. Conclusion: This study showed that LR could provide certain benefits in managing PPUs, such as reduced lengths of hospital stay and lower incidences of surgical site infections. Although LR reported promising directions in patient satisfaction and quality of life indicators, the limited duration of postoperative monitoring necessitates caution in broadly applying these results.
Mini transabdominal preperitoneal repair (mTAPP) of inguinal hernia: Better to use three 5 mm trocars
(Elsevier, 2024) Ertekin, Süleyman Çağlar; Ergenç, Muhammer
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Laparoscopic repair versus open repair for perforated peptic ulcers: quality of life assessment
(2024) Ertekin, Süleyman Çağlar; Çetindağ, Özhan; Ergenç, Muhammer; Yeğen, Cumhur
Purpose: This study was designed to assess the relative efficacy of laparoscopic repair (LR) as opposed to open surgical repair (OR) in the treatment of perforated peptic ulcer (PPU) and its impact on quality of life. Background: Studies reporting patient-centered outcomes, including quality of life and satisfaction, in PPU treatment are insufficient. Methods: This investigation performed a retrospective review of patients who underwent treatment for PPU at a secondary care hospital from December 2016 to November 2020. Patients were categorized into two separate groups according to the type of surgical procedure received: LR and OR. Comparisons were made based on a variety of factors, such as demographic data, intra- and postoperative metrics, pain control, patient contentment, and quality of life indicators. Results: In the analysis, there were no statistically significant differences in demographic or clinical characteristics between the LR (n=35) and OR (n=62) groups (p > 0.05). Conversely, the rates of incisional hernia and surgical site infection were significantly greater in the OR group (p < 0.05). Moreover, the LR exhibited benefits such as a shorter length of hospital stay (p < 0.05), more rapid resumption of a normal diet, and fewer surgical site infections-factors that contributed to a lower rate of overall postoperative complications. According to the quality of life questionnaire, the LR group exhibited significantly greater scores for physical function, role, pain, and general health by the 30th postoperative day (p=0.003, p<0.001, p=0.006 and p=0.001, respectively), and by the 1-year follow-up, the LR group showed substantial improvements in physical function, physical role, emotional role, pain and general health (p=0.047, p=0.004, p=0.039, p=0.001, p=0.021, respectively), indicating its effectiveness in patient recovery and quality of life enhancement postsurgery. Conclusion: This study showed that LR could provide certain benefits in managing PPUs, such as reduced lengths of hospital stay and lower incidences of surgical site infections. Although LR reported promising directions in patient satisfaction and quality of life indicators, the limited duration of postoperative monitoring necessitates caution in broadly applying these results.
Magnetic resonance arthrography with positional manoeuvre for the diagnosis of synovial fold of posterior shoulder joint capsule
(2024) Keleş, Papatya; Oğul, Hayri; Tuncer, Kutsi; Sakcı, Zakir; Ay, Mutlu; Kantarcı, Mecit
Objectives: The objective of this study is to prospectively assess the effectiveness of shoulder magnetic resonance (MR) arthrograms with positional manoeuvres in detecting posterior synovial folds. Methods: Two radiologists independently assessed all axial MR arthrograms in internal rotation, neutral position, and external rotation for the presence of a posterior synovial fold. The diagnostic performances of the MR arthrograms were then compared, with results validated through arthroscopy. Results: Arthroscopy was performed on 81 of the 150 patients included in the study. A posterior synovial fold was identified arthroscopically in eleven of these patients. Measurements of the posterior synovial fold obtained in external rotation and the neutral position of the arm showed a significant correlation with arthroscopic results (p < 0.05). For detecting the posterior synovial fold with arthroscopic correlation, the sensitivity and specificity values for observer 1 and observer 2 were 100-81.4% and 100-88.6%, respectively, for MR arthrograms in the neutral position; 100-52.9% and 100-62.9% for MR arthrograms in external rotation; and 100-95.7% and 81.8-98.6% for MR arthrograms in internal rotation. There was a fair agreement for MR arthrography in external rotation for detecting posterior synovial folds, while MR arthrograms in internal rotation and neutral position showed near-perfect and significant interobserver agreement. Conclusion: The rotational positions of the humeral neck during MR arthrographic examination can influence the diagnostic specificity and sensitivity of axial MR arthrograms in detecting the posterior synovial fold. Clinical relevance statement: The posterior synovial fold can mimic a posterior labral detachment. Therefore, its correct identification is crucial in order to avoid unnecessary surgical procedures. Key points: Movement of the shoulder may introduce variability in MR arthrography appearance. Rotation of the humeral neck during MR arthrography can affect diagnoses in posterior synovial fold detection. Given that posterior synovial folds can imitate posterior labral detachment, their correct identification is crucial to avoid unnecessary surgical procedures.
Comparing laparoscopic and open umbilical hernia repair: Quality of life and outcomes
(Elsevier Inc., 2024) Ertekin, Süleyman Çağlar; Ergenç, Muhammer
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The effect of breastfeeding on childhood otitis media
(Springer International Publishing, 2023) Pamukçu, Muhammet; Muluk, Nuray Bayar; Catalano, Peter
Throughout history, breastfeeding has been the obvious and natural way for mothers to feed their infants. Despite the widespread availability of alternatives to mothers breastfeeding their own offspring, in every culture and country the option to breastfeed remains a significant method for the nutrition of neonates. Breastfeeding, however, like other cultural practices, has waxed and waned over the years. Three hundred years ago, the infants born to mothers of high social class tended to be breastfed by wet nurses, and this trend then spread towards members of lower socioeconomic groups over the next 200 years [1, 2]. The trend in the twentieth century was towards fewer mothers breastfeeding infants, from a peak of around 90% to the current rate of 42%. Unlike many determinants of health, where less healthy practices are more common amongst lower income groups, breastfeeding is actually more prevalent in societies which are poorer overall. The decline in breastfeeding comes despite the accumulating evidence that breast milk has numerous advantages over artificial baby milk, such as providing immunity against frequently occurring pathogens encountered in infancy [3, 4].
Abnormalities of smell and taste in eating behaviour through life
(Springer International Publishing, 2023) Pamukçu, Muhammet; Cingi, Cemal; Scadding, Glenis
In the past, diagnosing and treating abnormalities of gustatory and olfactory perception presented several challenges, mainly because both normal and abnormal olfaction and gustation were little understood. Abnormalities can occur in primary disorders of smell or taste, or arise as a secondary effect of some other disease process.
Biliary atresia-splenic malformation (BASM) syndrome: a case report
(Elsevier Ltd, 2024) Alhashmi, Hadeil; Chawshly, Esra; Çelebi, Süleyman
Introduction and importance: Biliary atresia (BA) is characterized by the presence of persistent cholestatic jaundice during the neonatal period. This group of patients is at higher risk for liver disease and/or portal hypertension compared with other chronic liver diseases. Case presentation: We present a newborn patient who had biliary stools early postnatally, but her gallbladder was not seen on radiological examination and was referred to our clinic. On examination, polysplenia was seen, and the inferior vena cava was not seen. The patient's stool color changed to a creamy stool without bile three weeks postnatally. The neonate was diagnosed with biliary atresia and splenic malformation (BASM) syndrome. The patient underwent a Kasai portoenterostomy in the 3rd week of age and was preoperatively diagnosed with malrotation and treated with a Ladd procedure at the same time. The patient had a postoperative stool with bile and decreased bilirubinemia with a normal defecation period. Clinical discussion: BASM syndrome, clinically has different causes and a worse prognosis than isolated BA. The syndrome can lead to end-stage cirrhosis and liver failure if left untreated. Although timely Kasai surgery is the standard treatment for BA, the age of the patient at the time of the surgery is different depending on BA groups. Conclusion: The most important prognostic factors for BASM syndrome are early diagnosis and treatment. Despite this, the patients need careful follow-up. Postoperative adjuvant steroid therapy may have a good impact on the outcomes.
Treatment approach in bilateral pulmonary hydatid cysts: analysis of 107 consecutive cases
(Springer, 2024) Aydın, Yener; Ulaş, Ali Bilal; Kaşali, Kamber; Dostbil, Ayşenur; İnce, İlker
Objective: Bilateral pulmonary involvement is observed in around 14% of cases of pulmonary hydatid cysts and the treatment can be challenging. This study evaluates the clinical characteristics and treatment strategies used for cases of bilateral pulmonary hydatid cysts. Materials and methods: A retrospective examination was conducted on 107 consecutive cases of bilateral pulmonary hydatid cysts treated in our clinic between January 2003 and December 2023. Results: Out of the 107 cases analyzed, 57 (53.3%) were male and 50 (46.7%) were female. Surgical intervention was performed for pulmonary hydatid cysts in 92 cases (86.0%), while medical treatment was prescribed for the remaining 15 cases (14.0%). Bilateral thoracotomies were consecutively conducted in 77 cases; in 11 cases, thoracotomy was carried out on one side and contralateral hydatid cysts were treated medically. Three cases underwent sternotomy, and one underwent bilateral thoracotomy during a single session. One case experienced postoperative hemorrhage, three cases had prolonged air leakage, two cases had empyema, one case had a wound infection, and one case had a recurrence of hydatid cyst. For bilaterally operated cases, albendazole treatment commenced after the second operation and was carried out in two 15-day cycles. Patients who declined, or were not eligible for surgery, were treated with albendazole for an extended period. Conclusions: Consecutive bilateral thoracotomy, followed by two cycles of albendazole therapy, is a highly effective treatment for patients with bilateral pulmonary hydatid cysts. In cases with widespread involvement, ruptured small cysts, or serious comorbidities, long-term medical treatment including albendazole administration may be applied.

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