Dogan Gönüllü - Academia.edu (original) (raw)
Papers by Dogan Gönüllü
Kocaeli tıp dergisi, 2021
GİRİŞ ve AMAÇ: Türkiye'de COVID-19'un yayılmasıyla, bu hastalığın tedavisi için kullanılan hastan... more GİRİŞ ve AMAÇ: Türkiye'de COVID-19'un yayılmasıyla, bu hastalığın tedavisi için kullanılan hastaneler bulaş açısından riskli bölgeler ilan edilmiştir. Bu bağlamda verilen sağlık hizmetlerinde de, özellikle cerrahi hizmetlerde kısıtlamalara gidilmiştir. Çoğunlukla elektif cerrahi vakalarının ertelenmesinin yanı sıra, acil cerrahi müdahalelerde tedavi protokollerinde değişime gidilmesine yol açmıştır.
Journal of Academic Research in Medicine
Objective: Laparoscopic cholecystectomy stands as the established surgical approach for gallbladd... more Objective: Laparoscopic cholecystectomy stands as the established surgical approach for gallbladder diseases. This study seeks to enhance the management of potential complications by anticipating the likelihood of operative complexity and the risk of requiring conversion to an open procedure. Methods: In this retrospective study, a total of 811 cholecystectomy procedures were undertaken, segregating patients into case and control groups. The case group comprised 24 patients who initiated laparoscopically but ultimately underwent open conversion. Exclusion criteria encompassed direct open procedures, patients below 18 years of age, and cholecystectomies performed concurrently with other surgeries. A control group of 276 patients was chosen, matched for age, gender, and body mass index, to evaluate the influential aspects governing conversion likelihood. Results: The study demonstrated a conversion rate of 3.09%. The preeminent determinant of conversion was the increased gallbladder wall thickness. Factors exerting influence on conversion included a history of endoscopic retrograde cholangiopancreatography, prior abdominal surgery, elevated C-reactive protein, lactate dehydrogenase, and direct bilirubin levels, instances of cholecystitis and cholangitis attacks, dense adhesions between the gallbladder and close organs, gallbladder hydrops, impacted stones, and a Callot dissection time exceeding 90 minutes. The Sugrue scoring system was also observed as a potentially valuable tool for predicting the likelihood of open conversion. Conclusion: The capacity to foresee potential complications proactively empowers optimal preoperative preparations. This approach ensures patients are well-informed about the surgery, potential complications, and the prospect of conversion to an open procedure. Moreover, it enables the possibility of conducting the operation within a more experienced medical center when warranted.
Turkish Journal of Colorectal Disease, 2021
Amaç: Kolorektal kanserlerde preoperatif klinik tanı ve postoperatif rezeksiyon piyesinde belirle... more Amaç: Kolorektal kanserlerde preoperatif klinik tanı ve postoperatif rezeksiyon piyesinde belirlenen patolojik evreleme sonuçlarının karşılaştırılması amaçlanmıştır. Yöntem: Ocak 2013-Ekim 2020 yılları arasında kolorektal tümör tanısı nedeniyle opere edilen 86 hastanın medikal verileri retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, Amerikan Anesteziyoloji Derneği skoru, komorbidite varlığı, tümör lokalizasyonu, preoperatif endoskopi yapılıp yapılmama durumu, operasyonun acil veya elektif yapılması, operasyonun açık veya laparoskopik yöntemle oluşu, operasyon şekli, ostomi varlığı, morbidite ve mortalite, patolojik tanı, radyolojik ve patolojik evrelemesi bilgileri kaydedilip incelendi. Bulgular: Araştırmada en sık komorbidite hipertansiyon olup, tümörlerin büyük kısmı (%36,0) sigmoid bölgede yerleşmiştir. Olguların %66,3'üne elektif operasyon uygulanmış, hastaların %76,8'ine rezeksiyon ve primer anastomoz yapılmıştır. Altmış beş yaş üzerindeki olguların %85'ine ostomi açılmıştır. Olguların %82,5'inde patolojik tanı non-müsinöz düşük derece adenokarsinom olup, yaklaşık her 10 olgudan 9'u patolojik ve radyolojik TNM evrelemesine göre Evre 2 ve Evre 3'te idi. Sonuç: Preoperatif dönemde radyolojik evreleme, postoperatif dönemdeki patolojik evreleme ile uyumludur.
Mustafa Kemal Üniversitesi Tıp Dergisi, 2021
Amaç: Araştırmada, yabancı cisim yutulması nedeniyle genel cerrahi kliniğinde acil endoskopi işle... more Amaç: Araştırmada, yabancı cisim yutulması nedeniyle genel cerrahi kliniğinde acil endoskopi işlemi uygulanan ve endoskopi işleminin yetersiz kaldığı durumlarda cerrahi yöntem ile tedavi edilen vakaların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Tanımlayıcı nitelikte yapılan araştırmanın verileri yabancı cisim yutan hastaların dosyalarından elde edilmiştir. 2017-2020 yılları arasında 21 yabancı cisim yutma vaka dosyaları taranmıştır. Araştırmanın verileri SPSS paket programında analiz edildi. Analizlerde frekanslar, yüzde ve ortalama, ortanca kullanıldı. Bulgular: Yabancı cisim yutanların yarıdan fazlası (%52.3) erkektir. Yabancı cisimlerin %57.1 organik olup, en fazla en fazla üst özofagusta yerleşmiştir (%47.6). En sık görülen semptom disfaji (%38.1), %57.1’i ayaktan tedavi edilerek yatışa gerek duyulmamıştır. Komplikasyon oranı %14.3’tür. Vakaların %90.5’i endoskopi ile tanı konularak tedavi edilmiştir. Sonuç: Yabancı cisimlerin gerek tanı ve gerekse tedavisinde en önemli...
Turkish journal of trauma & emergency surgery, Jul 1, 2005
Ratlarda oluşturulan deneysel bakteriyel translokasyonunun (BT) selektif bağırsak dekontaminasyon... more Ratlarda oluşturulan deneysel bakteriyel translokasyonunun (BT) selektif bağırsak dekontaminasyonu (SBD) ve mekanik bağırsak temizliğiyle (MBT) engellenebileceği yönünde kanıtlar elde etmektir. GEREÇ VE YÖNTEM Deneysel çalışmamızda herbiri 250-300 gr ağırlığında 40 adet erkek ve erişkin Sprague Dawley rat kullanılmıştır. Ratlar her grupta 10 adet olmak üzere dört gruba ayrılmış ve birinci grup rat, kontrol grubu olarak alınmıştır. 2.grupta 19 mmHg İAH , 3. grupta 19 mmHg İAH ve SBD, 4. grupta ise 19 mmHg İAH + SBD ve MBT uygulanmıştır. SBD amacıyla 12 saat ara ile oral gentamisin 5 mg/kg and İM sefotaxim 100mg/kg uygulanmıştır. MBT ise sodyum fosfa-soda ile gerçekleştirilmiştir. 24 saat sonra tüm denekler sakrifiye edilerek, BT gelişimini araştırmak amacıyla steril şartlar altında mezenterik lenf nodu , dalak ve karaciğer biyopsileri alınmıştır. BULGULAR BT değerleri deneklere ve gruplara göre CFU/gr cinsinden hesaplanmış ve sonuçlar Kruskal Wallis testi kullanılarak değerlendirilmiştir. Kontrol grubu ile 3.grup ve kontrol grubu ile 4. grup arasında , 3. grup ile 4.grup arasında anlamlı fark bulunamamıştır (p>0.05, p=0.872). Kontrol grubu ile 2. grup arasında, 2. grup ile 3. grup arasında, ve 2. grup ile 4. grup arasında anlamlı fark bulunmuştur (p<0.001). SONUÇ Ratlarda, karıniçi hipertansiyon sonucu oluşan bakteriyel translokasyonu engellemede SBD ve mekanik bağırsak temizliği etkin bulunmuştur. Anahtar sözcükler: Bakteriyel translokasyon, selektif bağırsak dekontaminasyonu, karıniçi hipertansiyon, abdominal kompartman sendromu. BACKGROUND The objective of our study is to evaluate the preventive effects of selective digestive decontamination (SDD) and mechanical bowel preparation in rats with experimentally induced bacterial translocation. METHODS Fourty adult male Sprague Dowley rats weighing 250-300 g. were divided equally into four groups as Group 1 (sham [control]), Group 2 (experimentally induced IAH at 19 mmHg), Group 3 (SDD group) and Group 4 (SDD and mechanical bowel preparation with 19 mmHg intraabdominal pressure). Group 3 and 4 were treated at 12 hours intervals with oral gentamycine 5 mg/kg and IM sefotaxime 100mg/kg Mechanical bowel preparation was performed by oral administration of sodium phosphate. After 24 hours all rats were sacrified; mesenteric lymph nodes, spleen and liver biopsy specimens were harvested aseptically. Specimens were diluted and cultured in McConkey medium and the colony-forming units (CFU/gr) were calculated. RESULTS In Kruskal Wallis tests there were no significant differences between Group 1 and 3 or 4, and also Group 3 and 4 (p>0.05, p=0.872 respectively), while differences between Group 1 and 2, and also Group 3 and 4 were statistically significant (p<0.001) with respect to CFU/g estimates. CONCLUSION These data indicate that selective intestinal decontamination and mechanical bowel preparation prevent bacterial translocation due to intraabdominal hypertension.
Turkish journal of trauma & emergency surgery, 2008
Ulus Travma Acil Cerrahi Derg. Yıl: 2008 Cilt: 14 Sayı: 1 14-20. << Geri. Normobari... more Ulus Travma Acil Cerrahi Derg. Yıl: 2008 Cilt: 14 Sayı: 1 14-20. << Geri. Normobarik oksijenin deneysel peritonitin tedavisindeki yeri ve tedavinin izlenmesinde rektal ateş, lökosit, CRP ve prokalsitoninin etkinliği Tayfun Yücel ...
Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This... more Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This material was proved to be not completely inert, and may cause inflammatory responses like foreign body reactions. One of the physical results of this inflammatory reaction against the mesh is mesh shrinkage which is responsible for recurrence and pain. In this study, we aimed to investigate the effects of the suture technique on mesh shrinkage. For the first time, as far as we know, our work shows that we need to stabilize the mesh to prevent shrinkage. Even though statistically not significant, fixation of the mesh with interrupted sutures seems to be more advantageous compared to fixation with continuous sutures.
Singapore Medical Journal, Nov 1, 2008
Introduction: The present study was undertaken to define the prognostic factors for overall survi... more Introduction: The present study was undertaken to define the prognostic factors for overall survival subsequent to definitive surgery, and for survival after the development of distant metastasis in breast cancer patients who developed distant metastasis subsequent to definitive surgery. Methods: The records of 470 breast cancer patients with T1-3 tumours and distant metastasis following surgery were reviewed. Prognostic factors were compared to the first metastatic sites as solitary skeletal, multiple skeletal, and visceral metastases, and were analysed for overall survival following surgery and survival after metastasis. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. Results: 79 patients (17 percent) had a solitary skeletal metastasis, 105 (22 percent) had multiple skeletal metastases, and 286 (61 percent) had a visceral metastasis. The five-year overall survival was significantly better for patients with a solitary bone metastasis (73 percent) compared to patients who had multiple bone metastases (46 percent), or avisceral metastasis (22 percent) (pvalue is less than 0.0001). Pathological lymph node status 3, stage IIIC, grade 3, oestrogen receptor negativity, and visceral metastases were found to have independent detrimental influence on overall survival following surgery and survival after metastasis. A long-term metastasis-free interval affected post-metastatic outcome favourably. Radiotherapy improved overall survival. Conclusion: Pathological lymph node status, stage, grade, and oestrogen receptor status predicted survival after surgery as well as after the development of metastasis. Solitary bone metastasis has a more favourable prognosis than multiple bone metastases, and compared to visceral metastasis, skeletal metastasis has a more favourable prognosis.
Turkish journal of trauma & emergency surgery, 2008
AMAÇ: Deneysel peritonitte, antibiyotik kullanımına normobarik oksijen (O2) eklenmesinin, tedavid... more AMAÇ: Deneysel peritonitte, antibiyotik kullanımına normobarik oksijen (O2) eklenmesinin, tedavideki yeri ve bu tedaviye cevabın izlenmesinde, ateş, lökosit, C-reaktif protein (CRP) ve prokalsitoninin etkinliğinin araştırılması amaçlandı. GEREÇ-YÖNTEM: Normal değerleri saptayan ön ...
Asian Journal of Surgery, 2019
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PubMed, 2003
Background: To determine whether conservative treatment in blunt abdominal solid organ injuries a... more Background: To determine whether conservative treatment in blunt abdominal solid organ injuries associated with extraabdominal trauma is safe or not. Methods: Between December 1998 and December 2001, 49 patients were admitted with blunt abdominal trauma, 34 of whom were hemodynamically stable. These 34 patients were divided into two groups. Seventeen patients had isolated abdominal solid organ injuries (Group I) and 17 patients had associated extraabdominal injuries (Group II). The results of conservative treatment, blood pressure values, pulse rates, ages, gender, abdominal solid organ injury scores, the etiologies of trauma, the number of the blood transfusions, morbidity and mortality rates, and hospital stays were compared. Results: The blood pressure values and pulse rates as measured in our emergency room, abdominal solid organ injury scores, ages, gender, the results of conservative treatment, the etiologies of trauma, morbidity and mortality rates were similar in both groups. Comparisons between hospital stays and numbers of the blood transfusion have show statistically significant differences in favour of group II. No patients had hollow viscus injury. Conclusion: Conservative treatment is safe for hemodynamically stable blunt abdominal trauma patients with solid organ injury but no hollow viscus injury, even if they have extraabdominal injuries. The existence of extraabdominal injuries, however, prolongs the hospital stay and increases the need of the blood transfusion.
Turkish Journal of Surgery, Jan 3, 2014
The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this... more The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. Material and Methods: One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. Results: The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. Conclusion: Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.
Journal of Academic Research in Medicine, Jan 14, 2014
Hemodinamik stabil penetran flank yaralanmalarında yaklaşım şekli hala tartışmalıdır; laparoskopi... more Hemodinamik stabil penetran flank yaralanmalarında yaklaşım şekli hala tartışmalıdır; laparoskopik eksplorasyon, yakın fizik muayene takibi, ve üç kontrastlı abdominal bilgisayarlı tomografi (BT) uygulanan yaklaşım alternativleridirler. Amacımız kliniğimiz deneyimlerini aktarmaktır. Yöntemler: Ocak 2003-Nisan 2013 yılları arasında penetran flank yaralanması olan 118 hasta retrospektif olarak gözden geçirilmiştir; abdominal flank, ön ve arka aksiler çizgiler arasında kalan, yukarıda 5. kaburga ile aşağıda iliak krest ile sınırlandırılan bölge olarak tanımlanmıştır. Bulgular: Hastaların 9'u ateşli silah, 109'u kesici delici alet yaralanması olmak üzere, penetran flank yaralanması olan 118 hasta irdelenmiştir; tüm hastalar erkekti. Hastalar 3 grup halinde irdelenmiştir: laparotomi grubu (13), laparoskopi grubu (16) ve üç kontrastlı abdominal BT çekilmiş ve konservatif takip edilmiş hastalar grubu (89, %75,4). Laparotomi endikasyonları, hemodinamik instabilite (3/13), ateşli silah yaralanması (7/13) ve peritoneal iritasyon bulguları (3/13) olarak bulunmuştur. Laparoskopi yapılmış olan 2 hastada tanjansiyel ateşli silah yaralanması, diğerlerinde kesici delici alet yaralanması mevcuttu. Bu grubun 5 hastasında izole diyafragma yaralanması mevcuttu ve laparoskopik olarak tamir edildiler, splenik rüptürü olan 2 hasta ve kolonik yaralanması olan bir hastada ise açık laparotomi ile devam edilmiştir; sekiz hastaya negatif laparoskopi yapılmıştır. Grup 3 hastaları (89, %75,4) konservatif takip edilmişlerdir, 3 hastada üçlü kontrast maddeli abdominal BT negatif olmasına rağmen 3. gün ameliyat edilmişlerdir (3/89). Hastanede ortalama yatış süresi 1. Grup hastaları için 8,7 gün, 2. Grup için 3 gün, 3. Grup için 3,5 gün olarak hesaplanmıştır. Sonuç: Kesici delici alet yaralanmalarında ve özellikle hemodinamik stabil olanlarda, yoğun klinik takip ile üç yoldan kontrast maddeli abdominal tomografi, laparotomi oranını azaltmaktadır. Diagnostik laparoskopi'nin ek olarak kullanılması diyafragma yaralanmalarının tanısında faydalıdır.
Journal of Academic Research in Medicine, May 24, 2013
Amaç: Kolorektal kanserli hastalarda, standart faktörlerin yanı sıra, tutulu lenf nodlarının çıka... more Amaç: Kolorektal kanserli hastalarda, standart faktörlerin yanı sıra, tutulu lenf nodlarının çıkarılan lenf nodlarına oranının (LNR), sağkalımla olan ilişkisinin belirlenmesi hedeflenmiştir. Yöntemler: Ocak 2003-Mart 2010 yılları arasında kolorektal kanser nedeniyle ameliyat edilen ve istenen kriterleri sağlayan 72 hastanın dosyaları, T, N ve M durumu ve evreleri, lenfovasküler ve perinöral invazyon varlığı, çıkarılan lenf nodu sayısı, tutulu lenf nodu sayısı, lenf nodu kapsül invazyonu varlığı ve LNR açısından incelenmiş ve bu parametrelerin sağkalımla ilişkileri retrospektif olarak araştırılmıştır. Bulgular: Kolorektal kanserli hastaların sağkalımlarıyla, LNR, lenf nodu evresi, tutulu lenf nodu sayısı, TNM evresi, PNI ve lenf nodu kapsül invazyonu varlığının korelasyon gösterdiği belirlenmiştir.
Bakırköy Tıp Dergisi, 2008
... Search result page. Title: Palpation, ultrasound and mammography for accurate measurement of ... more ... Search result page. Title: Palpation, ultrasound and mammography for accurate measurement of invasive breast cancer tumor size. Retrospective preliminary study. Author: Ferda N Köksoy ; Nilüfer Yazgan ; Doğan Gönüllü ; Mustafa Şit ; Emin Zeybek ; Ayşenur İğdem. ...
Turkish Journal of Surgery, Mar 11, 2013
Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid ka... more Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid kanser odaklarının dominant nodülle olan ilişkisi halen tartışılan konulardır. Birçok ana başvuru kaynağında nodüler guatrda genellikle sadece 1 cm den büyük dominant nodüller kanser için değerlendirmeye alınmalıdır (1, 2); çünkü bu nodüllerin klinik önemi olan kanser olma potansiyeli daha yüksektir denilmektedir (3). Nodüler guatrda dominant ve dominant olmayan nodüllerde kanser insidansı için bir çok çalışma yapılmıştır, ancak dominant nodül nedeniyle total tiroidektomi yapılan ve kanser saptanan hastalarda dominant ve dominant olmayan nodüllerdeki kanser insidansı konusunda çalışmalar çok azdır (4-6). Multinodüler guatrda (MNG) 1 cm'den büyük dominant nodülde ve dominant nodül dışındaki > (US) şüpheli nodüllerde İİAB yapılması da önerilmektedir (7, 8). Bu çalışma, nultinodüler guatrda 1 cm'den büyük ve dominant nodül olarak adlandırılabilecek bir nodüle yapılacak İİAB'nin sonuçlarını ve buna dayanarak lobektomi yapılması halinde elde edilecek sonuçları irdelemek için planlanmış; total tiroidektomi yapılmış ve patolojik incelemelerinde tiroid kanseri saptanmış olan hastaların retrospektif incelenmesiyle kanserin dominant nodül ile ilişkisi belirlenmeye çalışılmıştır.
International Journal of Surgery, 2010
Aim: We have assessed the risk factors for mortality and morbidity subsequent to D2-gastrectomy i... more Aim: We have assessed the risk factors for mortality and morbidity subsequent to D2-gastrectomy in gastric cancer cases. Patients and method: The records (age, gender, comorbidity, ASA score, POSSUM score, type of gastrectomy, additional organ resection and pathologic TNM stage) were reviewed in 49 cases of D2 gastrectomies (between 2003 and 2008) retrospectively. Results: Mean age was 60.4 (range: 35e82). The factors of comorbidity (n ¼ 38) in 27 patients. The average quantity of lymph nodes was 21.2 (range: 16e31) in D2 dissections. The rate of mortality was 8.2% (4/49). All the patients who died had major comorbid diseases and all were submitted to total gastrectomy. Twenty-one morbidities were detected in 13 patients [morbidity rate was 26.5% (13/49)]. We have observed a nearly statistically significant (p ¼ 0.074) disadvantage of total gastrectomy versus subtotal gastrectomy [those who died had undergone total gastrectomy, and the morbidity rates were 36.4% vs 14.8%] in concordance with literature. Conclusion: In these studies, we have observed that our mortality (8.2%) and morbidity (26.5%) rates are in concordance with the data from medical literature, and POSSUM scores are the only parameter in positive statistical correlation with mortality. Preoperative and postoperative resuscitation are of great importance if the patients have POSSUM score >20.
Journal of Academic Research in Medicine, Apr 29, 2015
Even though the number and variety of materials used in hernia operations have increased consider... more Even though the number and variety of materials used in hernia operations have increased considerably, the ideal mesh is yet to be produced. The aim of this study is to review the current information on available meshes. Literature on the presently used grafts and the means of their usage were reviewed through Medline-PubMed. Large pores of lightweight grafts were shown to decrease the risk of infection and shrinkage. There is still no proven superiority in terms of the materials that are aimed for intra-abdominal use and have one side covered with adhesion preventers. The results prove that hernia surgeries using mesh (graft) provide a better outcome compared with conventional repair methods. Fiber type, tensile strength, and pore width have been indicated as the most important factors in mesh choice as well as determinants of biocompatibility. It is understood that the required tensile strength is less than expected, and lightweight meshes are superior in providing flexibility and comfort. In inguinal hernia repair, lightweight meshes suitable for the hernia type and lightweight or biomeshes that are absorbable in the presence of an infection are considered to be the better choice. Composite meshes that have one side covered in adhesion-preventive barriers are asserted to be the proper fit for the intraabdominal procedures.
Ejso, Feb 1, 2019
Background. The use of intraoperative ultrasound-guided lumpectomy (IOUS) in early breast cancer ... more Background. The use of intraoperative ultrasound-guided lumpectomy (IOUS) in early breast cancer (BC) presents advantages over other techniques. However, most of the studies include only patients who receive surgery as their first treatment. The aim of this study is to compare the excess of healthy breast tissue excised in IOUS vs wire localization-guided surgery (WL) in BC patients after neoadjuvant treatment (NAT). Material and methods. The study included patients treated with NAT prior to breast-conserving surgery (BCS) between July 2008-December 2012. In case a hydrogel marker was placed or residual tumor was visible on ultrasound, IOUS was performed (IOUS group). Patients with a standard marker or if the hydrogel marker was not visible on ultrasound before surgery underwent WL-guided surgery (WL group). The excess of healthy breast tissue excised was estimated with the calculated resection rate (CRR), dividing the total specimen volume by the optimal resection volume. Results. The study investigated 214 patients: 145 (67.8 %) in the IOUS group and 69 (32.2 %) in the WL group. There were no differences between groups in patient and tumor characteristics. There were no differences in surgical tumoral volume, specimen volume or optimal residual volume. For the patients who underwent IOUS, CRR was 31.38 and for de WL group was 46.79 (p ¼ 0.04). The rate of re-excision for positive or close margins was similar in the two groups (p ¼ 0.80). After a median follow-up of 65 months, there were no differences in OS (p¼0.12) or DFS (p¼0.55). Conclusions. Compared with WL surgery, IOUS excise less amount of healthy breast tissue after NAT without compromising margins, OS or DFS. IOUS is a feasible option in patients who receive BCS after NAT. Conflict of interest: No conflict of interest.
Journal of Academic Research in Medicine, Apr 30, 2021
Objective: Conservative treatment of perianastomotic pouch due to low anastomosis in rectal surge... more Objective: Conservative treatment of perianastomotic pouch due to low anastomosis in rectal surgery is possible in patients without generalized peritonitis. This report describes the treatment of this complication using Endo-SPONGE ® and transrectal endoscopic lavage. Methods: Sixteen patients with abscess resulting from anastomotic leakage after rectal resections were retrospectively reviewed; nine of them were treated with transrectal endoscopic lavage and the other seven patients were treated with endoscopic vacuum therapy. Results: During the initial operation, 13 patients underwent loop ileostomy. In three patients, diverting stoma was created after anastomotic leakage was observed. The mean volume of the abscess cavity was 82.6 cc (24.7-128) for those treated with EndoVAC (vacuum-assisted closure) and 33.3 cc (10.5-61.1) for those treated with endoscopic lavage. The number of sponges exchanged was 13.8 (5-25), and the time required for pouch closure was 74.3 days (20-136) for negative aspiration therapy and 66.1 days (30-210) for transrectal endoscopic lavage. As a late anastomotic complication, we recorded stricture in only one of seven patients (14.2%) treated with Endo-SPONGE ®. Four of nine patients (44.4%) that underwent endoscopic lavage developed strictures, which needed reoperative procedures. Conclusion: According to our experience, the sponge placement and negative pressure aspiration can be helpful in the treatment of anastomotic leakage after low anterior resections for rectal cancer. The results of time until cavity closure are not inferior to those of the conventional treatment, and a functional advantage over the conventional approach was observed. Patients with Endo-SPONGE ® placement had less stricture and defecation problems.
Kocaeli tıp dergisi, 2021
GİRİŞ ve AMAÇ: Türkiye'de COVID-19'un yayılmasıyla, bu hastalığın tedavisi için kullanılan hastan... more GİRİŞ ve AMAÇ: Türkiye'de COVID-19'un yayılmasıyla, bu hastalığın tedavisi için kullanılan hastaneler bulaş açısından riskli bölgeler ilan edilmiştir. Bu bağlamda verilen sağlık hizmetlerinde de, özellikle cerrahi hizmetlerde kısıtlamalara gidilmiştir. Çoğunlukla elektif cerrahi vakalarının ertelenmesinin yanı sıra, acil cerrahi müdahalelerde tedavi protokollerinde değişime gidilmesine yol açmıştır.
Journal of Academic Research in Medicine
Objective: Laparoscopic cholecystectomy stands as the established surgical approach for gallbladd... more Objective: Laparoscopic cholecystectomy stands as the established surgical approach for gallbladder diseases. This study seeks to enhance the management of potential complications by anticipating the likelihood of operative complexity and the risk of requiring conversion to an open procedure. Methods: In this retrospective study, a total of 811 cholecystectomy procedures were undertaken, segregating patients into case and control groups. The case group comprised 24 patients who initiated laparoscopically but ultimately underwent open conversion. Exclusion criteria encompassed direct open procedures, patients below 18 years of age, and cholecystectomies performed concurrently with other surgeries. A control group of 276 patients was chosen, matched for age, gender, and body mass index, to evaluate the influential aspects governing conversion likelihood. Results: The study demonstrated a conversion rate of 3.09%. The preeminent determinant of conversion was the increased gallbladder wall thickness. Factors exerting influence on conversion included a history of endoscopic retrograde cholangiopancreatography, prior abdominal surgery, elevated C-reactive protein, lactate dehydrogenase, and direct bilirubin levels, instances of cholecystitis and cholangitis attacks, dense adhesions between the gallbladder and close organs, gallbladder hydrops, impacted stones, and a Callot dissection time exceeding 90 minutes. The Sugrue scoring system was also observed as a potentially valuable tool for predicting the likelihood of open conversion. Conclusion: The capacity to foresee potential complications proactively empowers optimal preoperative preparations. This approach ensures patients are well-informed about the surgery, potential complications, and the prospect of conversion to an open procedure. Moreover, it enables the possibility of conducting the operation within a more experienced medical center when warranted.
Turkish Journal of Colorectal Disease, 2021
Amaç: Kolorektal kanserlerde preoperatif klinik tanı ve postoperatif rezeksiyon piyesinde belirle... more Amaç: Kolorektal kanserlerde preoperatif klinik tanı ve postoperatif rezeksiyon piyesinde belirlenen patolojik evreleme sonuçlarının karşılaştırılması amaçlanmıştır. Yöntem: Ocak 2013-Ekim 2020 yılları arasında kolorektal tümör tanısı nedeniyle opere edilen 86 hastanın medikal verileri retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, Amerikan Anesteziyoloji Derneği skoru, komorbidite varlığı, tümör lokalizasyonu, preoperatif endoskopi yapılıp yapılmama durumu, operasyonun acil veya elektif yapılması, operasyonun açık veya laparoskopik yöntemle oluşu, operasyon şekli, ostomi varlığı, morbidite ve mortalite, patolojik tanı, radyolojik ve patolojik evrelemesi bilgileri kaydedilip incelendi. Bulgular: Araştırmada en sık komorbidite hipertansiyon olup, tümörlerin büyük kısmı (%36,0) sigmoid bölgede yerleşmiştir. Olguların %66,3'üne elektif operasyon uygulanmış, hastaların %76,8'ine rezeksiyon ve primer anastomoz yapılmıştır. Altmış beş yaş üzerindeki olguların %85'ine ostomi açılmıştır. Olguların %82,5'inde patolojik tanı non-müsinöz düşük derece adenokarsinom olup, yaklaşık her 10 olgudan 9'u patolojik ve radyolojik TNM evrelemesine göre Evre 2 ve Evre 3'te idi. Sonuç: Preoperatif dönemde radyolojik evreleme, postoperatif dönemdeki patolojik evreleme ile uyumludur.
Mustafa Kemal Üniversitesi Tıp Dergisi, 2021
Amaç: Araştırmada, yabancı cisim yutulması nedeniyle genel cerrahi kliniğinde acil endoskopi işle... more Amaç: Araştırmada, yabancı cisim yutulması nedeniyle genel cerrahi kliniğinde acil endoskopi işlemi uygulanan ve endoskopi işleminin yetersiz kaldığı durumlarda cerrahi yöntem ile tedavi edilen vakaların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Tanımlayıcı nitelikte yapılan araştırmanın verileri yabancı cisim yutan hastaların dosyalarından elde edilmiştir. 2017-2020 yılları arasında 21 yabancı cisim yutma vaka dosyaları taranmıştır. Araştırmanın verileri SPSS paket programında analiz edildi. Analizlerde frekanslar, yüzde ve ortalama, ortanca kullanıldı. Bulgular: Yabancı cisim yutanların yarıdan fazlası (%52.3) erkektir. Yabancı cisimlerin %57.1 organik olup, en fazla en fazla üst özofagusta yerleşmiştir (%47.6). En sık görülen semptom disfaji (%38.1), %57.1’i ayaktan tedavi edilerek yatışa gerek duyulmamıştır. Komplikasyon oranı %14.3’tür. Vakaların %90.5’i endoskopi ile tanı konularak tedavi edilmiştir. Sonuç: Yabancı cisimlerin gerek tanı ve gerekse tedavisinde en önemli...
Turkish journal of trauma & emergency surgery, Jul 1, 2005
Ratlarda oluşturulan deneysel bakteriyel translokasyonunun (BT) selektif bağırsak dekontaminasyon... more Ratlarda oluşturulan deneysel bakteriyel translokasyonunun (BT) selektif bağırsak dekontaminasyonu (SBD) ve mekanik bağırsak temizliğiyle (MBT) engellenebileceği yönünde kanıtlar elde etmektir. GEREÇ VE YÖNTEM Deneysel çalışmamızda herbiri 250-300 gr ağırlığında 40 adet erkek ve erişkin Sprague Dawley rat kullanılmıştır. Ratlar her grupta 10 adet olmak üzere dört gruba ayrılmış ve birinci grup rat, kontrol grubu olarak alınmıştır. 2.grupta 19 mmHg İAH , 3. grupta 19 mmHg İAH ve SBD, 4. grupta ise 19 mmHg İAH + SBD ve MBT uygulanmıştır. SBD amacıyla 12 saat ara ile oral gentamisin 5 mg/kg and İM sefotaxim 100mg/kg uygulanmıştır. MBT ise sodyum fosfa-soda ile gerçekleştirilmiştir. 24 saat sonra tüm denekler sakrifiye edilerek, BT gelişimini araştırmak amacıyla steril şartlar altında mezenterik lenf nodu , dalak ve karaciğer biyopsileri alınmıştır. BULGULAR BT değerleri deneklere ve gruplara göre CFU/gr cinsinden hesaplanmış ve sonuçlar Kruskal Wallis testi kullanılarak değerlendirilmiştir. Kontrol grubu ile 3.grup ve kontrol grubu ile 4. grup arasında , 3. grup ile 4.grup arasında anlamlı fark bulunamamıştır (p>0.05, p=0.872). Kontrol grubu ile 2. grup arasında, 2. grup ile 3. grup arasında, ve 2. grup ile 4. grup arasında anlamlı fark bulunmuştur (p<0.001). SONUÇ Ratlarda, karıniçi hipertansiyon sonucu oluşan bakteriyel translokasyonu engellemede SBD ve mekanik bağırsak temizliği etkin bulunmuştur. Anahtar sözcükler: Bakteriyel translokasyon, selektif bağırsak dekontaminasyonu, karıniçi hipertansiyon, abdominal kompartman sendromu. BACKGROUND The objective of our study is to evaluate the preventive effects of selective digestive decontamination (SDD) and mechanical bowel preparation in rats with experimentally induced bacterial translocation. METHODS Fourty adult male Sprague Dowley rats weighing 250-300 g. were divided equally into four groups as Group 1 (sham [control]), Group 2 (experimentally induced IAH at 19 mmHg), Group 3 (SDD group) and Group 4 (SDD and mechanical bowel preparation with 19 mmHg intraabdominal pressure). Group 3 and 4 were treated at 12 hours intervals with oral gentamycine 5 mg/kg and IM sefotaxime 100mg/kg Mechanical bowel preparation was performed by oral administration of sodium phosphate. After 24 hours all rats were sacrified; mesenteric lymph nodes, spleen and liver biopsy specimens were harvested aseptically. Specimens were diluted and cultured in McConkey medium and the colony-forming units (CFU/gr) were calculated. RESULTS In Kruskal Wallis tests there were no significant differences between Group 1 and 3 or 4, and also Group 3 and 4 (p>0.05, p=0.872 respectively), while differences between Group 1 and 2, and also Group 3 and 4 were statistically significant (p<0.001) with respect to CFU/g estimates. CONCLUSION These data indicate that selective intestinal decontamination and mechanical bowel preparation prevent bacterial translocation due to intraabdominal hypertension.
Turkish journal of trauma & emergency surgery, 2008
Ulus Travma Acil Cerrahi Derg. Yıl: 2008 Cilt: 14 Sayı: 1 14-20. << Geri. Normobari... more Ulus Travma Acil Cerrahi Derg. Yıl: 2008 Cilt: 14 Sayı: 1 14-20. << Geri. Normobarik oksijenin deneysel peritonitin tedavisindeki yeri ve tedavinin izlenmesinde rektal ateş, lökosit, CRP ve prokalsitoninin etkinliği Tayfun Yücel ...
Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This... more Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This material was proved to be not completely inert, and may cause inflammatory responses like foreign body reactions. One of the physical results of this inflammatory reaction against the mesh is mesh shrinkage which is responsible for recurrence and pain. In this study, we aimed to investigate the effects of the suture technique on mesh shrinkage. For the first time, as far as we know, our work shows that we need to stabilize the mesh to prevent shrinkage. Even though statistically not significant, fixation of the mesh with interrupted sutures seems to be more advantageous compared to fixation with continuous sutures.
Singapore Medical Journal, Nov 1, 2008
Introduction: The present study was undertaken to define the prognostic factors for overall survi... more Introduction: The present study was undertaken to define the prognostic factors for overall survival subsequent to definitive surgery, and for survival after the development of distant metastasis in breast cancer patients who developed distant metastasis subsequent to definitive surgery. Methods: The records of 470 breast cancer patients with T1-3 tumours and distant metastasis following surgery were reviewed. Prognostic factors were compared to the first metastatic sites as solitary skeletal, multiple skeletal, and visceral metastases, and were analysed for overall survival following surgery and survival after metastasis. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. Results: 79 patients (17 percent) had a solitary skeletal metastasis, 105 (22 percent) had multiple skeletal metastases, and 286 (61 percent) had a visceral metastasis. The five-year overall survival was significantly better for patients with a solitary bone metastasis (73 percent) compared to patients who had multiple bone metastases (46 percent), or avisceral metastasis (22 percent) (pvalue is less than 0.0001). Pathological lymph node status 3, stage IIIC, grade 3, oestrogen receptor negativity, and visceral metastases were found to have independent detrimental influence on overall survival following surgery and survival after metastasis. A long-term metastasis-free interval affected post-metastatic outcome favourably. Radiotherapy improved overall survival. Conclusion: Pathological lymph node status, stage, grade, and oestrogen receptor status predicted survival after surgery as well as after the development of metastasis. Solitary bone metastasis has a more favourable prognosis than multiple bone metastases, and compared to visceral metastasis, skeletal metastasis has a more favourable prognosis.
Turkish journal of trauma & emergency surgery, 2008
AMAÇ: Deneysel peritonitte, antibiyotik kullanımına normobarik oksijen (O2) eklenmesinin, tedavid... more AMAÇ: Deneysel peritonitte, antibiyotik kullanımına normobarik oksijen (O2) eklenmesinin, tedavideki yeri ve bu tedaviye cevabın izlenmesinde, ateş, lökosit, C-reaktif protein (CRP) ve prokalsitoninin etkinliğinin araştırılması amaçlandı. GEREÇ-YÖNTEM: Normal değerleri saptayan ön ...
Asian Journal of Surgery, 2019
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PubMed, 2003
Background: To determine whether conservative treatment in blunt abdominal solid organ injuries a... more Background: To determine whether conservative treatment in blunt abdominal solid organ injuries associated with extraabdominal trauma is safe or not. Methods: Between December 1998 and December 2001, 49 patients were admitted with blunt abdominal trauma, 34 of whom were hemodynamically stable. These 34 patients were divided into two groups. Seventeen patients had isolated abdominal solid organ injuries (Group I) and 17 patients had associated extraabdominal injuries (Group II). The results of conservative treatment, blood pressure values, pulse rates, ages, gender, abdominal solid organ injury scores, the etiologies of trauma, the number of the blood transfusions, morbidity and mortality rates, and hospital stays were compared. Results: The blood pressure values and pulse rates as measured in our emergency room, abdominal solid organ injury scores, ages, gender, the results of conservative treatment, the etiologies of trauma, morbidity and mortality rates were similar in both groups. Comparisons between hospital stays and numbers of the blood transfusion have show statistically significant differences in favour of group II. No patients had hollow viscus injury. Conclusion: Conservative treatment is safe for hemodynamically stable blunt abdominal trauma patients with solid organ injury but no hollow viscus injury, even if they have extraabdominal injuries. The existence of extraabdominal injuries, however, prolongs the hospital stay and increases the need of the blood transfusion.
Turkish Journal of Surgery, Jan 3, 2014
The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this... more The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. Material and Methods: One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. Results: The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. Conclusion: Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.
Journal of Academic Research in Medicine, Jan 14, 2014
Hemodinamik stabil penetran flank yaralanmalarında yaklaşım şekli hala tartışmalıdır; laparoskopi... more Hemodinamik stabil penetran flank yaralanmalarında yaklaşım şekli hala tartışmalıdır; laparoskopik eksplorasyon, yakın fizik muayene takibi, ve üç kontrastlı abdominal bilgisayarlı tomografi (BT) uygulanan yaklaşım alternativleridirler. Amacımız kliniğimiz deneyimlerini aktarmaktır. Yöntemler: Ocak 2003-Nisan 2013 yılları arasında penetran flank yaralanması olan 118 hasta retrospektif olarak gözden geçirilmiştir; abdominal flank, ön ve arka aksiler çizgiler arasında kalan, yukarıda 5. kaburga ile aşağıda iliak krest ile sınırlandırılan bölge olarak tanımlanmıştır. Bulgular: Hastaların 9'u ateşli silah, 109'u kesici delici alet yaralanması olmak üzere, penetran flank yaralanması olan 118 hasta irdelenmiştir; tüm hastalar erkekti. Hastalar 3 grup halinde irdelenmiştir: laparotomi grubu (13), laparoskopi grubu (16) ve üç kontrastlı abdominal BT çekilmiş ve konservatif takip edilmiş hastalar grubu (89, %75,4). Laparotomi endikasyonları, hemodinamik instabilite (3/13), ateşli silah yaralanması (7/13) ve peritoneal iritasyon bulguları (3/13) olarak bulunmuştur. Laparoskopi yapılmış olan 2 hastada tanjansiyel ateşli silah yaralanması, diğerlerinde kesici delici alet yaralanması mevcuttu. Bu grubun 5 hastasında izole diyafragma yaralanması mevcuttu ve laparoskopik olarak tamir edildiler, splenik rüptürü olan 2 hasta ve kolonik yaralanması olan bir hastada ise açık laparotomi ile devam edilmiştir; sekiz hastaya negatif laparoskopi yapılmıştır. Grup 3 hastaları (89, %75,4) konservatif takip edilmişlerdir, 3 hastada üçlü kontrast maddeli abdominal BT negatif olmasına rağmen 3. gün ameliyat edilmişlerdir (3/89). Hastanede ortalama yatış süresi 1. Grup hastaları için 8,7 gün, 2. Grup için 3 gün, 3. Grup için 3,5 gün olarak hesaplanmıştır. Sonuç: Kesici delici alet yaralanmalarında ve özellikle hemodinamik stabil olanlarda, yoğun klinik takip ile üç yoldan kontrast maddeli abdominal tomografi, laparotomi oranını azaltmaktadır. Diagnostik laparoskopi'nin ek olarak kullanılması diyafragma yaralanmalarının tanısında faydalıdır.
Journal of Academic Research in Medicine, May 24, 2013
Amaç: Kolorektal kanserli hastalarda, standart faktörlerin yanı sıra, tutulu lenf nodlarının çıka... more Amaç: Kolorektal kanserli hastalarda, standart faktörlerin yanı sıra, tutulu lenf nodlarının çıkarılan lenf nodlarına oranının (LNR), sağkalımla olan ilişkisinin belirlenmesi hedeflenmiştir. Yöntemler: Ocak 2003-Mart 2010 yılları arasında kolorektal kanser nedeniyle ameliyat edilen ve istenen kriterleri sağlayan 72 hastanın dosyaları, T, N ve M durumu ve evreleri, lenfovasküler ve perinöral invazyon varlığı, çıkarılan lenf nodu sayısı, tutulu lenf nodu sayısı, lenf nodu kapsül invazyonu varlığı ve LNR açısından incelenmiş ve bu parametrelerin sağkalımla ilişkileri retrospektif olarak araştırılmıştır. Bulgular: Kolorektal kanserli hastaların sağkalımlarıyla, LNR, lenf nodu evresi, tutulu lenf nodu sayısı, TNM evresi, PNI ve lenf nodu kapsül invazyonu varlığının korelasyon gösterdiği belirlenmiştir.
Bakırköy Tıp Dergisi, 2008
... Search result page. Title: Palpation, ultrasound and mammography for accurate measurement of ... more ... Search result page. Title: Palpation, ultrasound and mammography for accurate measurement of invasive breast cancer tumor size. Retrospective preliminary study. Author: Ferda N Köksoy ; Nilüfer Yazgan ; Doğan Gönüllü ; Mustafa Şit ; Emin Zeybek ; Ayşenur İğdem. ...
Turkish Journal of Surgery, Mar 11, 2013
Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid ka... more Tiroid nodüllerinde hangi nodüllere ince iğne aspirasyon biyopsisi (İİAB) yapılacağı ve tiroid kanser odaklarının dominant nodülle olan ilişkisi halen tartışılan konulardır. Birçok ana başvuru kaynağında nodüler guatrda genellikle sadece 1 cm den büyük dominant nodüller kanser için değerlendirmeye alınmalıdır (1, 2); çünkü bu nodüllerin klinik önemi olan kanser olma potansiyeli daha yüksektir denilmektedir (3). Nodüler guatrda dominant ve dominant olmayan nodüllerde kanser insidansı için bir çok çalışma yapılmıştır, ancak dominant nodül nedeniyle total tiroidektomi yapılan ve kanser saptanan hastalarda dominant ve dominant olmayan nodüllerdeki kanser insidansı konusunda çalışmalar çok azdır (4-6). Multinodüler guatrda (MNG) 1 cm'den büyük dominant nodülde ve dominant nodül dışındaki > (US) şüpheli nodüllerde İİAB yapılması da önerilmektedir (7, 8). Bu çalışma, nultinodüler guatrda 1 cm'den büyük ve dominant nodül olarak adlandırılabilecek bir nodüle yapılacak İİAB'nin sonuçlarını ve buna dayanarak lobektomi yapılması halinde elde edilecek sonuçları irdelemek için planlanmış; total tiroidektomi yapılmış ve patolojik incelemelerinde tiroid kanseri saptanmış olan hastaların retrospektif incelenmesiyle kanserin dominant nodül ile ilişkisi belirlenmeye çalışılmıştır.
International Journal of Surgery, 2010
Aim: We have assessed the risk factors for mortality and morbidity subsequent to D2-gastrectomy i... more Aim: We have assessed the risk factors for mortality and morbidity subsequent to D2-gastrectomy in gastric cancer cases. Patients and method: The records (age, gender, comorbidity, ASA score, POSSUM score, type of gastrectomy, additional organ resection and pathologic TNM stage) were reviewed in 49 cases of D2 gastrectomies (between 2003 and 2008) retrospectively. Results: Mean age was 60.4 (range: 35e82). The factors of comorbidity (n ¼ 38) in 27 patients. The average quantity of lymph nodes was 21.2 (range: 16e31) in D2 dissections. The rate of mortality was 8.2% (4/49). All the patients who died had major comorbid diseases and all were submitted to total gastrectomy. Twenty-one morbidities were detected in 13 patients [morbidity rate was 26.5% (13/49)]. We have observed a nearly statistically significant (p ¼ 0.074) disadvantage of total gastrectomy versus subtotal gastrectomy [those who died had undergone total gastrectomy, and the morbidity rates were 36.4% vs 14.8%] in concordance with literature. Conclusion: In these studies, we have observed that our mortality (8.2%) and morbidity (26.5%) rates are in concordance with the data from medical literature, and POSSUM scores are the only parameter in positive statistical correlation with mortality. Preoperative and postoperative resuscitation are of great importance if the patients have POSSUM score >20.
Journal of Academic Research in Medicine, Apr 29, 2015
Even though the number and variety of materials used in hernia operations have increased consider... more Even though the number and variety of materials used in hernia operations have increased considerably, the ideal mesh is yet to be produced. The aim of this study is to review the current information on available meshes. Literature on the presently used grafts and the means of their usage were reviewed through Medline-PubMed. Large pores of lightweight grafts were shown to decrease the risk of infection and shrinkage. There is still no proven superiority in terms of the materials that are aimed for intra-abdominal use and have one side covered with adhesion preventers. The results prove that hernia surgeries using mesh (graft) provide a better outcome compared with conventional repair methods. Fiber type, tensile strength, and pore width have been indicated as the most important factors in mesh choice as well as determinants of biocompatibility. It is understood that the required tensile strength is less than expected, and lightweight meshes are superior in providing flexibility and comfort. In inguinal hernia repair, lightweight meshes suitable for the hernia type and lightweight or biomeshes that are absorbable in the presence of an infection are considered to be the better choice. Composite meshes that have one side covered in adhesion-preventive barriers are asserted to be the proper fit for the intraabdominal procedures.
Ejso, Feb 1, 2019
Background. The use of intraoperative ultrasound-guided lumpectomy (IOUS) in early breast cancer ... more Background. The use of intraoperative ultrasound-guided lumpectomy (IOUS) in early breast cancer (BC) presents advantages over other techniques. However, most of the studies include only patients who receive surgery as their first treatment. The aim of this study is to compare the excess of healthy breast tissue excised in IOUS vs wire localization-guided surgery (WL) in BC patients after neoadjuvant treatment (NAT). Material and methods. The study included patients treated with NAT prior to breast-conserving surgery (BCS) between July 2008-December 2012. In case a hydrogel marker was placed or residual tumor was visible on ultrasound, IOUS was performed (IOUS group). Patients with a standard marker or if the hydrogel marker was not visible on ultrasound before surgery underwent WL-guided surgery (WL group). The excess of healthy breast tissue excised was estimated with the calculated resection rate (CRR), dividing the total specimen volume by the optimal resection volume. Results. The study investigated 214 patients: 145 (67.8 %) in the IOUS group and 69 (32.2 %) in the WL group. There were no differences between groups in patient and tumor characteristics. There were no differences in surgical tumoral volume, specimen volume or optimal residual volume. For the patients who underwent IOUS, CRR was 31.38 and for de WL group was 46.79 (p ¼ 0.04). The rate of re-excision for positive or close margins was similar in the two groups (p ¼ 0.80). After a median follow-up of 65 months, there were no differences in OS (p¼0.12) or DFS (p¼0.55). Conclusions. Compared with WL surgery, IOUS excise less amount of healthy breast tissue after NAT without compromising margins, OS or DFS. IOUS is a feasible option in patients who receive BCS after NAT. Conflict of interest: No conflict of interest.
Journal of Academic Research in Medicine, Apr 30, 2021
Objective: Conservative treatment of perianastomotic pouch due to low anastomosis in rectal surge... more Objective: Conservative treatment of perianastomotic pouch due to low anastomosis in rectal surgery is possible in patients without generalized peritonitis. This report describes the treatment of this complication using Endo-SPONGE ® and transrectal endoscopic lavage. Methods: Sixteen patients with abscess resulting from anastomotic leakage after rectal resections were retrospectively reviewed; nine of them were treated with transrectal endoscopic lavage and the other seven patients were treated with endoscopic vacuum therapy. Results: During the initial operation, 13 patients underwent loop ileostomy. In three patients, diverting stoma was created after anastomotic leakage was observed. The mean volume of the abscess cavity was 82.6 cc (24.7-128) for those treated with EndoVAC (vacuum-assisted closure) and 33.3 cc (10.5-61.1) for those treated with endoscopic lavage. The number of sponges exchanged was 13.8 (5-25), and the time required for pouch closure was 74.3 days (20-136) for negative aspiration therapy and 66.1 days (30-210) for transrectal endoscopic lavage. As a late anastomotic complication, we recorded stricture in only one of seven patients (14.2%) treated with Endo-SPONGE ®. Four of nine patients (44.4%) that underwent endoscopic lavage developed strictures, which needed reoperative procedures. Conclusion: According to our experience, the sponge placement and negative pressure aspiration can be helpful in the treatment of anastomotic leakage after low anterior resections for rectal cancer. The results of time until cavity closure are not inferior to those of the conventional treatment, and a functional advantage over the conventional approach was observed. Patients with Endo-SPONGE ® placement had less stricture and defecation problems.