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Papers by BÜLENT ÇOMÇALI

Research paper thumbnail of Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity

Andrologia, Sep 24, 2021

In the current study, we aimed to compare sexual function and pain during the sexual activity of ... more In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p < .001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p < .001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p = .001 for the open group and p < .001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p = .002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

Research paper thumbnail of Diagnosis of Appendicitis in Patients with a Normal White Blood Cell Count; A Cross-Sectional Study

Bulletin of Emergency and Trauma, 2018

To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis ... more To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC). Methods: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome. Results: A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm. Conclusion: In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.

Research paper thumbnail of Validation of COLA score for predicting wound infection in patients undergoing surgery for rectal cancer

Annali italiani di chirurgia, 2017

The purpose of our study was to estimate the incidence of SSI (Surgical site infection) and the e... more The purpose of our study was to estimate the incidence of SSI (Surgical site infection) and the effect of COLA (contamination, obesity, laparotomy and ASA grade) score on SSI in patients undergoing rectal surgical procedures for rectal cancer. A total of 92 patients who underwent operation for rectum cancer were enrolled in this study. Wound surveillance was performed in all patients by a staff surgeon identified infected wounds during the hospital stay, and collected information for up to 30 days after operation. The overall rate of incisional SSI and organ/space SSI was 22.8% and 7.6% respectively. Surgical site infection rates were 14.2%, 20.58%, 40.7%, 57.1% for COLA 1,2,3 and 4 scores respectively. The area under the receiver/ operator characteristic curve for the score was 0,660. COLA scoring systems predict, with reasonable accuracy, the risk of SSI in rectal cancer patients undergoing elective rectal surgery. COLA score Rectal surgery, Surgical site infection, Risk predictio...

Research paper thumbnail of A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

The American Surgeon, 2020

The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary ... more The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis ( P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09–13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be consid...

Research paper thumbnail of İntratorasik Guatrın Histopatolojik Özellikleri Karar Vermede Önemlidir

Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi

Aim: The aim of the study is examining the factors determining the need for thoracic approaches t... more Aim: The aim of the study is examining the factors determining the need for thoracic approaches to remove an intrathoracic goitre. Material and Method: This retrospective study was conducted between 2011 and 2018. Patients were categorized into two groups; Group A consisted of patients who underwent surgery via the transcervical approach, and Group B consisted of patients who underwent surgery via the transcervical plus thoracic approaches. The extension, size, and localization of the intrathoracic goitre was measured on computed tomography scans. Histopathological examination results were recorded. Results: Group A was consisted of 268 patients, Group B was consisted of 17 patients. There was statistically significant difference in terms of recurrence between groups. There were no statistically significant difference for length of goitre in computed tomography, volume and superoinferior size of the specimen between groups. There was a statistically significant correlation between t...

Research paper thumbnail of Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?

TURKISH JOURNAL OF MEDICAL SCIENCES

Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies ar... more Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs). Materials and methods: Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results: One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21-81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01). Conclusion: We recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.

Research paper thumbnail of UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Thyroid Gland Hematoma After Blunt Neck Trauma Publication Date Thyroid Gland Hematoma After Blunt Neck Trauma

Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condit... more Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission. [

Research paper thumbnail of Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication rate

Annali italiani di chirurgia, 2021

Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication... more Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication rate AIM: Identification of recurrent laryngeal nerve (RLN), performed via different techniques, decreases nerve injury during thyroidectomy. We aimed to evaluate the effect of different anatomic levels at which RLN was identified on postoperative complications. MATERIAL AND METHODS The patients underwent total thyroidectomy or lobectomy without lymph node dissection were included. Two different surgical methods were performed: thyroidectomy identifying RLN at level of inferior thyroid artery (ITA) (Group 1); at level of Berry's ligament (Group 2). Patients were evaluated with indirect laryngoscopy on 3rd postoperative day, if nerve damage was determined, at each six months. Nerve damage and postop hypocalcemia were accepted transient up to 6th month, permanent after 6th month. Total serum calcium levels were postoperatively measured on 24th and 48th hours, and then monthly. RESULTS...

Research paper thumbnail of Amyand's Hernia: Really a Rare Condition?

The American Surgeon, 2013

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online... more Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.

Research paper thumbnail of Cysts of the Round Ligament Simulating Inguinal Hernia: Report of a Case

Journal of Nippon Medical School, 2013

Research paper thumbnail of Mortality and morbidity after surgery for cancer of the rectum in a non-specialized hospital

Istanbul Medical Journal, 2012

Bu çalışmada spesifikleşmenin olmadığı bir hastanede, rektum kanseri nedeniyle operasyon uygulana... more Bu çalışmada spesifikleşmenin olmadığı bir hastanede, rektum kanseri nedeniyle operasyon uygulanan hastalarda postoperatif komplikasyon ve mortalite gelişimi üzerine etkili risk faktörlerini araştırmayı amaçladık. Gereç ve Yöntem: Ocak 1999-Ocak 2008 tarihleri arasında kliniğimizde operasyon uygulanan ve rektum kanseri tanısı patolojik olarak doğrulanan tüm hastalar geriye dönük olarak incelendi. Ardışık olarak tanı konan 75 primer rektum kanserli hasta çalışmaya alındı. Bulgular: Mortalite ve morbidite etkilenen faktörler ileri yaş, düşük albümin düzeyi, perioperatif kan transfüzyonu ve postoperatif yoğun bakım desteği (p<0.05) idi. Sistemik hastalık varlığı, anemi, ameliyat öncesi beslenme desteği ve postoperatif komplikasyonlar gelişmesi ile mortalite arasında anlamlı ilişki bulundu (p<0.05). Cinsiyet, sigara alışkanlığı, ASA skoru, bağırsak temizliği, ileostomili veya ileostomisiz AAR ve tümörün evresi ile mortalite ve morbidite arasında istatistiksel olarak anlamlı ilişki bulunmadı (p>0.05). Sonuç: Tümör ile ilişkili faktörler ve seçilen cerrahi prosedür bağımsız olarak rektum kanseri için cerrahi sonrası mortalite ve morbidite ile ilişkili değildir. Bu nedenle cerrahi için hasta seçiminde hastanın klinik durumu üzerine odaklanılmalıdır. Hasta sayısının az olmasına rağmen sonuçlarımız spesifik merkezlerinkine benzerdir; hastaların klinik durumu mortalite ve morbiditenin en önemli nedenidir.

Research paper thumbnail of D1 versus D2 dissection in stomach carcinoma: evaluation of postoperative mortality and complications

Turkish Journal of Surgery, 2013

Objective: Surgery is the only curative treatment for patients with gastric cancer. However, the ... more Objective: Surgery is the only curative treatment for patients with gastric cancer. However, the extent of lymph node dissection is still debated. The aim of the study was to evaluate complications, postoperative length of hospital stay and postoperative mortality after D1 or D2 lymph node dissection for gastric cancer in a non-specialized hospital. Material and Methods: All patients who underwent surgery for pathologically confirmed gastric cancer at our 3rd General Surgery Department, Ankara Numune Training Hospital between January 1999 and 2007 were retrospectively reviewed. A consecutive series of 71 gastric cancer patients was identified. D1 resection (level 1 lymphadenectomy) was compared with D2 resection (levels 1 and 2 lymphadenectomy). Results: The D2 group had higher postoperative mortality (16% vs. 8%; p<0.005) and morbidity (54% vs. 34%; p<0.005), and their postoperative length of stay was longer. Splenectomy did not have an effect on postoperative morbidity and mortality in either the D1 or the D2 group. Conclusion: The D2 procedure was associated with significantly higher postoperative mortality, morbidity, and postoperative length of hospital stay.

Research paper thumbnail of A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts

Surgery, 2013

Background. Hepatic hydatid cysts are common disorders in Turkey. Although most patients are trea... more Background. Hepatic hydatid cysts are common disorders in Turkey. Although most patients are treated by percutaneous drainage, some cases require operative intervention. Biliary fistula is a major complication of hydatid cyst operations. The purpose of this study is to identify preoperative predictors of cystobiliary fistula (CBF) and to develop a scoring system for this disorder. Methods. Overall, 135 patients with hepatic hydatid cysts were included in this study. The following variables were analyzed as potential predictors of CBF: Age, gender, findings on physical examination, complete blood cell count, liver function tests, and ultrasonographic features of the cysts (type, diameter, number, and localization). Results. CBF was detected in 33 of 135 patients. Univariate analyses showed significant differences in cyst diameter, levels of alkaline phosphatase (ALP) and direct bilirubin, platelet count, and white blood cell (WBC) count between patients with and without CBF. On multivariate analyses, WBC count > 9,000/ mm 3 (odds ratio [OR], 4.5), direct bilirubin level > 0.7 mg/dL (OR, 2.76), cyst diameter > 8.2 cm (OR, 5.48), and ALP level > 120 U/L (OR, 3.82) were significant and independent predictors of CBG. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.803 (95% confidence interval, 0.726-0.866). Conclusion. Preoperative detection and management of CBF are important issues in the treatment of hydatid cysts of the liver. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with hepatic hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice. (Surgery 2013;153:699-704.

Research paper thumbnail of Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?

European Journal of Trauma and Emergency Surgery, 2013

ABSTRACT Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of... more ABSTRACT Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, or laparotomy. We evaluated the histological data of patients who were believed to have mucocele of the appendix. These patients (n = 23) were compared with sex- and age-matched control subjects (n = 79) with appendicitis. The main reason for emergency surgery was lower right abdominal pain in 15 patients, and intestinal obstruction in three. Univariate analysis using sonography demonstrated that the larger appendiceal outer diameter was positively correlated with the diagnosis of appendiceal mucocele (p = 0.001) and the mean white blood cell count was negatively correlated (p = 0.023). In urine analysis, 41.7 % of the mucocele patients and 10 % of the appendicitis patients had microscopic hematuria, respectively (p = 0.019). An outer diameter of 10 mm or more was predictive of appendiceal mucocele diagnosis, with a sensitivity of 76.5 %, specificity of 81 %, positive predictive value of 76.5 %, and negative predictive value of 94.12 %. The overall diagnostic accuracy was 80.2 %. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.855 (95 % CI 0.741-0.969) for the score. The histological examination of the specimens revealed mucocele in 15 cases, mucinous cystadenoma in seven cases and mucinous cystadenocarcinoma in one case. Twenty patients underwent appendectomy, and three patients were treated with right colectomy. A threshold 10-mm diameter of the appendix under compression is a useful preoperative measurement for differentiating between appendiceal mucocele and acute appendicitis. Microhematuria is simple test that can provide a significant role in supporting the clinical diagnosis of appendiceal mucocele in the emergency department.

Research paper thumbnail of Yaşlı Politravma Hastalarında Mortaliteyi Etkileyen Faktörler Genç Hastalardan Farklı mıdır?

SDÜ Tıp Fakültesi Dergisi, 2020

Objectives: The purpose of this study was to evaluate the differences in mortality between young ... more Objectives: The purpose of this study was to evaluate the differences in mortality between young and elderly polytrauma patients. Materials and Methods: In the present study, all consecutive polytrauma patients treated at our hospital between January 2014 and December 2018 were reviewed retrospectively. Patients younger than 65 years old were classified as Group I (n = 60), and patients aged 65 years and older were classified as Group II (n = 60). Age, gender, mechanism of injury, time of injury, injury severity score (ISS), preclinical hemodynamics, hospitalization, operative treatment, intubation rate, intensive care unit (ICU) treatment, and 1-year mortality were analyzed. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were calculated. Results: The mean age was 36.6 ± 13.0 (18–64) years in Group I and 73.5 ± 7.4 (56–91) years in Group II. There was no difference in mortality rates between groups. Elder...

Research paper thumbnail of Comparison of the Effects of Clinicopathological and Radiological Findings on Survival in Women Younger Than 40 Years and Older Than 55 Years of Age with Breast Cancer

SDÜ Tıp Fakültesi Dergisi

Objective Tumors of women with breast cancer show clinical and biological differences depending o... more Objective Tumors of women with breast cancer show clinical and biological differences depending on the hormonal changes that develop with age. Therefore, in this study, we compared the radiologic, and clinicopathological features of breast cancer patient’s < 40 age and ≥55 age. Material and Method The files of a total of 759 patients, including 92 patients under 40 aged, and 322 patients 55 aged and over who were operated on for breast cancer over a 10-year period in three centres were retrospectively reviewed and Estrojen Reseptor (ER), Progesteron Reseptor (PR), Human epidermal growth factor receptor 2 (HER2), Lymphovascular invasion (LVI) status, presence of axillary lymph node metastasis (ALNM), multifocality, presence of Ductal Carsinoma İnsitu (DCIS) or Lobular Carsinoma İnsitu (LCIS), tumor size, tumor histopathological type, grade, and score were recorded. Results In patients under the age of 40, the tumor is less localized in the upper-inner and lower-inner quadrants of ...

Research paper thumbnail of Bölgemizde tiroid kanseri sıklığında ve bazı alt tiplerin dağılımında gözlenen değişimler; 4917 tiroidektominin retrospektif analizi

Turkish Journal of Clinics and Laboratory, 2020

Changes in the frequency of thyroid cancer and distribution of some subtypes in our region; Retro... more Changes in the frequency of thyroid cancer and distribution of some subtypes in our region; Retrospective analysis of 4917 thyroidectomies

Research paper thumbnail of Thyroid gland hematoma after blunt neck trauma

The western journal of emergency medicine, 2009

Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condit... more Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission.

Research paper thumbnail of Primer hiperparatiroidizm için cerrahi tedavi sonuçlarının değerlendirilmesi: Tek merkez deneyimi

Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi

Primary hyperparathyroidism (PHPT) is a disease characterized by excess parathyroid hormone (PTH)... more Primary hyperparathyroidism (PHPT) is a disease characterized by excess parathyroid hormone (PTH) secretion from one or more of the four parathyroid glands. Surgical removal of abnormal parathyroid glands is the most effective treatment method for the disease. This study aims to present our clinical and surgical experience of patients operated on for PHPT. MATERIAL AND METHOD: The data of patients who were operated with a diagnosis of PHPT in the breast and endocrine surgery department of our hospital between January 2014 and March 2019 were retrospectively analyzed. RESULTS: A total of 334 patients (range 16 to 86) with a median age of 54 were included in this study. Of these, 285 (85.3%) were female and 49 (14.7%) were male. In preoperative localization studies, the highest accurate detection rate was obtained sestamibi with singlephoton emission computed tomography and ultrasonography, which defined 85.7% of abnormal parathyroid glands. Minimally invasive method was preferred in 22.16% of the patients, and bilateral neck exploration was preferred in 76.94% of the patients. Sternotomy was required in 3 patients. Ectopic localization of pathological glands was present in 26 (7.78%) patients. Concomitant thyroidectomy was performed in 124 (37.12%) patients. Incidental thyroid malignancies were diagnosed in 14 (11.29%) patients. The prevalence of persistent and recurrent disease was determined as 6.88% and 4.19%, respectively. CONCLUSION: PHPT requires a multidisciplinary approach. Surgical treatment can provide over 95% improvement with low complication rates. We believe that careful localization studies for abnormal glands and detailed examinations for accompanying thyroid pathologies will further incress the the surgery success.

Research paper thumbnail of Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity

Andrologia, Sep 24, 2021

In the current study, we aimed to compare sexual function and pain during the sexual activity of ... more In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p < .001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p < .001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p = .001 for the open group and p < .001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p = .002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

Research paper thumbnail of Diagnosis of Appendicitis in Patients with a Normal White Blood Cell Count; A Cross-Sectional Study

Bulletin of Emergency and Trauma, 2018

To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis ... more To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC). Methods: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome. Results: A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm. Conclusion: In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.

Research paper thumbnail of Validation of COLA score for predicting wound infection in patients undergoing surgery for rectal cancer

Annali italiani di chirurgia, 2017

The purpose of our study was to estimate the incidence of SSI (Surgical site infection) and the e... more The purpose of our study was to estimate the incidence of SSI (Surgical site infection) and the effect of COLA (contamination, obesity, laparotomy and ASA grade) score on SSI in patients undergoing rectal surgical procedures for rectal cancer. A total of 92 patients who underwent operation for rectum cancer were enrolled in this study. Wound surveillance was performed in all patients by a staff surgeon identified infected wounds during the hospital stay, and collected information for up to 30 days after operation. The overall rate of incisional SSI and organ/space SSI was 22.8% and 7.6% respectively. Surgical site infection rates were 14.2%, 20.58%, 40.7%, 57.1% for COLA 1,2,3 and 4 scores respectively. The area under the receiver/ operator characteristic curve for the score was 0,660. COLA scoring systems predict, with reasonable accuracy, the risk of SSI in rectal cancer patients undergoing elective rectal surgery. COLA score Rectal surgery, Surgical site infection, Risk predictio...

Research paper thumbnail of A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

The American Surgeon, 2020

The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary ... more The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis ( P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09–13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be consid...

Research paper thumbnail of İntratorasik Guatrın Histopatolojik Özellikleri Karar Vermede Önemlidir

Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi

Aim: The aim of the study is examining the factors determining the need for thoracic approaches t... more Aim: The aim of the study is examining the factors determining the need for thoracic approaches to remove an intrathoracic goitre. Material and Method: This retrospective study was conducted between 2011 and 2018. Patients were categorized into two groups; Group A consisted of patients who underwent surgery via the transcervical approach, and Group B consisted of patients who underwent surgery via the transcervical plus thoracic approaches. The extension, size, and localization of the intrathoracic goitre was measured on computed tomography scans. Histopathological examination results were recorded. Results: Group A was consisted of 268 patients, Group B was consisted of 17 patients. There was statistically significant difference in terms of recurrence between groups. There were no statistically significant difference for length of goitre in computed tomography, volume and superoinferior size of the specimen between groups. There was a statistically significant correlation between t...

Research paper thumbnail of Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?

TURKISH JOURNAL OF MEDICAL SCIENCES

Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies ar... more Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs). Materials and methods: Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results: One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21-81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01). Conclusion: We recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.

Research paper thumbnail of UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Thyroid Gland Hematoma After Blunt Neck Trauma Publication Date Thyroid Gland Hematoma After Blunt Neck Trauma

Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condit... more Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission. [

Research paper thumbnail of Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication rate

Annali italiani di chirurgia, 2021

Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication... more Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication rate AIM: Identification of recurrent laryngeal nerve (RLN), performed via different techniques, decreases nerve injury during thyroidectomy. We aimed to evaluate the effect of different anatomic levels at which RLN was identified on postoperative complications. MATERIAL AND METHODS The patients underwent total thyroidectomy or lobectomy without lymph node dissection were included. Two different surgical methods were performed: thyroidectomy identifying RLN at level of inferior thyroid artery (ITA) (Group 1); at level of Berry's ligament (Group 2). Patients were evaluated with indirect laryngoscopy on 3rd postoperative day, if nerve damage was determined, at each six months. Nerve damage and postop hypocalcemia were accepted transient up to 6th month, permanent after 6th month. Total serum calcium levels were postoperatively measured on 24th and 48th hours, and then monthly. RESULTS...

Research paper thumbnail of Amyand's Hernia: Really a Rare Condition?

The American Surgeon, 2013

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online... more Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.

Research paper thumbnail of Cysts of the Round Ligament Simulating Inguinal Hernia: Report of a Case

Journal of Nippon Medical School, 2013

Research paper thumbnail of Mortality and morbidity after surgery for cancer of the rectum in a non-specialized hospital

Istanbul Medical Journal, 2012

Bu çalışmada spesifikleşmenin olmadığı bir hastanede, rektum kanseri nedeniyle operasyon uygulana... more Bu çalışmada spesifikleşmenin olmadığı bir hastanede, rektum kanseri nedeniyle operasyon uygulanan hastalarda postoperatif komplikasyon ve mortalite gelişimi üzerine etkili risk faktörlerini araştırmayı amaçladık. Gereç ve Yöntem: Ocak 1999-Ocak 2008 tarihleri arasında kliniğimizde operasyon uygulanan ve rektum kanseri tanısı patolojik olarak doğrulanan tüm hastalar geriye dönük olarak incelendi. Ardışık olarak tanı konan 75 primer rektum kanserli hasta çalışmaya alındı. Bulgular: Mortalite ve morbidite etkilenen faktörler ileri yaş, düşük albümin düzeyi, perioperatif kan transfüzyonu ve postoperatif yoğun bakım desteği (p<0.05) idi. Sistemik hastalık varlığı, anemi, ameliyat öncesi beslenme desteği ve postoperatif komplikasyonlar gelişmesi ile mortalite arasında anlamlı ilişki bulundu (p<0.05). Cinsiyet, sigara alışkanlığı, ASA skoru, bağırsak temizliği, ileostomili veya ileostomisiz AAR ve tümörün evresi ile mortalite ve morbidite arasında istatistiksel olarak anlamlı ilişki bulunmadı (p>0.05). Sonuç: Tümör ile ilişkili faktörler ve seçilen cerrahi prosedür bağımsız olarak rektum kanseri için cerrahi sonrası mortalite ve morbidite ile ilişkili değildir. Bu nedenle cerrahi için hasta seçiminde hastanın klinik durumu üzerine odaklanılmalıdır. Hasta sayısının az olmasına rağmen sonuçlarımız spesifik merkezlerinkine benzerdir; hastaların klinik durumu mortalite ve morbiditenin en önemli nedenidir.

Research paper thumbnail of D1 versus D2 dissection in stomach carcinoma: evaluation of postoperative mortality and complications

Turkish Journal of Surgery, 2013

Objective: Surgery is the only curative treatment for patients with gastric cancer. However, the ... more Objective: Surgery is the only curative treatment for patients with gastric cancer. However, the extent of lymph node dissection is still debated. The aim of the study was to evaluate complications, postoperative length of hospital stay and postoperative mortality after D1 or D2 lymph node dissection for gastric cancer in a non-specialized hospital. Material and Methods: All patients who underwent surgery for pathologically confirmed gastric cancer at our 3rd General Surgery Department, Ankara Numune Training Hospital between January 1999 and 2007 were retrospectively reviewed. A consecutive series of 71 gastric cancer patients was identified. D1 resection (level 1 lymphadenectomy) was compared with D2 resection (levels 1 and 2 lymphadenectomy). Results: The D2 group had higher postoperative mortality (16% vs. 8%; p<0.005) and morbidity (54% vs. 34%; p<0.005), and their postoperative length of stay was longer. Splenectomy did not have an effect on postoperative morbidity and mortality in either the D1 or the D2 group. Conclusion: The D2 procedure was associated with significantly higher postoperative mortality, morbidity, and postoperative length of hospital stay.

Research paper thumbnail of A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts

Surgery, 2013

Background. Hepatic hydatid cysts are common disorders in Turkey. Although most patients are trea... more Background. Hepatic hydatid cysts are common disorders in Turkey. Although most patients are treated by percutaneous drainage, some cases require operative intervention. Biliary fistula is a major complication of hydatid cyst operations. The purpose of this study is to identify preoperative predictors of cystobiliary fistula (CBF) and to develop a scoring system for this disorder. Methods. Overall, 135 patients with hepatic hydatid cysts were included in this study. The following variables were analyzed as potential predictors of CBF: Age, gender, findings on physical examination, complete blood cell count, liver function tests, and ultrasonographic features of the cysts (type, diameter, number, and localization). Results. CBF was detected in 33 of 135 patients. Univariate analyses showed significant differences in cyst diameter, levels of alkaline phosphatase (ALP) and direct bilirubin, platelet count, and white blood cell (WBC) count between patients with and without CBF. On multivariate analyses, WBC count > 9,000/ mm 3 (odds ratio [OR], 4.5), direct bilirubin level > 0.7 mg/dL (OR, 2.76), cyst diameter > 8.2 cm (OR, 5.48), and ALP level > 120 U/L (OR, 3.82) were significant and independent predictors of CBG. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.803 (95% confidence interval, 0.726-0.866). Conclusion. Preoperative detection and management of CBF are important issues in the treatment of hydatid cysts of the liver. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with hepatic hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice. (Surgery 2013;153:699-704.

Research paper thumbnail of Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?

European Journal of Trauma and Emergency Surgery, 2013

ABSTRACT Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of... more ABSTRACT Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, or laparotomy. We evaluated the histological data of patients who were believed to have mucocele of the appendix. These patients (n = 23) were compared with sex- and age-matched control subjects (n = 79) with appendicitis. The main reason for emergency surgery was lower right abdominal pain in 15 patients, and intestinal obstruction in three. Univariate analysis using sonography demonstrated that the larger appendiceal outer diameter was positively correlated with the diagnosis of appendiceal mucocele (p = 0.001) and the mean white blood cell count was negatively correlated (p = 0.023). In urine analysis, 41.7 % of the mucocele patients and 10 % of the appendicitis patients had microscopic hematuria, respectively (p = 0.019). An outer diameter of 10 mm or more was predictive of appendiceal mucocele diagnosis, with a sensitivity of 76.5 %, specificity of 81 %, positive predictive value of 76.5 %, and negative predictive value of 94.12 %. The overall diagnostic accuracy was 80.2 %. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.855 (95 % CI 0.741-0.969) for the score. The histological examination of the specimens revealed mucocele in 15 cases, mucinous cystadenoma in seven cases and mucinous cystadenocarcinoma in one case. Twenty patients underwent appendectomy, and three patients were treated with right colectomy. A threshold 10-mm diameter of the appendix under compression is a useful preoperative measurement for differentiating between appendiceal mucocele and acute appendicitis. Microhematuria is simple test that can provide a significant role in supporting the clinical diagnosis of appendiceal mucocele in the emergency department.

Research paper thumbnail of Yaşlı Politravma Hastalarında Mortaliteyi Etkileyen Faktörler Genç Hastalardan Farklı mıdır?

SDÜ Tıp Fakültesi Dergisi, 2020

Objectives: The purpose of this study was to evaluate the differences in mortality between young ... more Objectives: The purpose of this study was to evaluate the differences in mortality between young and elderly polytrauma patients. Materials and Methods: In the present study, all consecutive polytrauma patients treated at our hospital between January 2014 and December 2018 were reviewed retrospectively. Patients younger than 65 years old were classified as Group I (n = 60), and patients aged 65 years and older were classified as Group II (n = 60). Age, gender, mechanism of injury, time of injury, injury severity score (ISS), preclinical hemodynamics, hospitalization, operative treatment, intubation rate, intensive care unit (ICU) treatment, and 1-year mortality were analyzed. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were calculated. Results: The mean age was 36.6 ± 13.0 (18–64) years in Group I and 73.5 ± 7.4 (56–91) years in Group II. There was no difference in mortality rates between groups. Elder...

Research paper thumbnail of Comparison of the Effects of Clinicopathological and Radiological Findings on Survival in Women Younger Than 40 Years and Older Than 55 Years of Age with Breast Cancer

SDÜ Tıp Fakültesi Dergisi

Objective Tumors of women with breast cancer show clinical and biological differences depending o... more Objective Tumors of women with breast cancer show clinical and biological differences depending on the hormonal changes that develop with age. Therefore, in this study, we compared the radiologic, and clinicopathological features of breast cancer patient’s < 40 age and ≥55 age. Material and Method The files of a total of 759 patients, including 92 patients under 40 aged, and 322 patients 55 aged and over who were operated on for breast cancer over a 10-year period in three centres were retrospectively reviewed and Estrojen Reseptor (ER), Progesteron Reseptor (PR), Human epidermal growth factor receptor 2 (HER2), Lymphovascular invasion (LVI) status, presence of axillary lymph node metastasis (ALNM), multifocality, presence of Ductal Carsinoma İnsitu (DCIS) or Lobular Carsinoma İnsitu (LCIS), tumor size, tumor histopathological type, grade, and score were recorded. Results In patients under the age of 40, the tumor is less localized in the upper-inner and lower-inner quadrants of ...

Research paper thumbnail of Bölgemizde tiroid kanseri sıklığında ve bazı alt tiplerin dağılımında gözlenen değişimler; 4917 tiroidektominin retrospektif analizi

Turkish Journal of Clinics and Laboratory, 2020

Changes in the frequency of thyroid cancer and distribution of some subtypes in our region; Retro... more Changes in the frequency of thyroid cancer and distribution of some subtypes in our region; Retrospective analysis of 4917 thyroidectomies

Research paper thumbnail of Thyroid gland hematoma after blunt neck trauma

The western journal of emergency medicine, 2009

Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condit... more Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission.

Research paper thumbnail of Primer hiperparatiroidizm için cerrahi tedavi sonuçlarının değerlendirilmesi: Tek merkez deneyimi

Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi

Primary hyperparathyroidism (PHPT) is a disease characterized by excess parathyroid hormone (PTH)... more Primary hyperparathyroidism (PHPT) is a disease characterized by excess parathyroid hormone (PTH) secretion from one or more of the four parathyroid glands. Surgical removal of abnormal parathyroid glands is the most effective treatment method for the disease. This study aims to present our clinical and surgical experience of patients operated on for PHPT. MATERIAL AND METHOD: The data of patients who were operated with a diagnosis of PHPT in the breast and endocrine surgery department of our hospital between January 2014 and March 2019 were retrospectively analyzed. RESULTS: A total of 334 patients (range 16 to 86) with a median age of 54 were included in this study. Of these, 285 (85.3%) were female and 49 (14.7%) were male. In preoperative localization studies, the highest accurate detection rate was obtained sestamibi with singlephoton emission computed tomography and ultrasonography, which defined 85.7% of abnormal parathyroid glands. Minimally invasive method was preferred in 22.16% of the patients, and bilateral neck exploration was preferred in 76.94% of the patients. Sternotomy was required in 3 patients. Ectopic localization of pathological glands was present in 26 (7.78%) patients. Concomitant thyroidectomy was performed in 124 (37.12%) patients. Incidental thyroid malignancies were diagnosed in 14 (11.29%) patients. The prevalence of persistent and recurrent disease was determined as 6.88% and 4.19%, respectively. CONCLUSION: PHPT requires a multidisciplinary approach. Surgical treatment can provide over 95% improvement with low complication rates. We believe that careful localization studies for abnormal glands and detailed examinations for accompanying thyroid pathologies will further incress the the surgery success.