Hakan Erpek - Academia.edu (original) (raw)

Papers by Hakan Erpek

Acta Chirurgica Belgica, 2007

The techniques used for midline laparotomy affect healing in surgical wounds, but the relationshi... more The techniques used for midline laparotomy affect healing in surgical wounds, but the relationship between cold scalpel and haemostatic methods (harmonic scalpel, diathermy) regarding wound healing remains unclear. There are also limited studies concerning the effects of harmonic scalpel on abdominal fascia. This study was aimed at comparing myofascial wound healing following laparotomy incision on fascia by cold scalpel (CS), harmonic scalpel (HS), and diathermy in terms of hydroxyproline content, inflammatory changes and tensile strength. Twenty-seven male Wistar albino rats underwent midline laparotomy either with cold scalpel (CS), harmonic scalpel (HS) or diathermy. Fascia incisions were closed with continuous 4/0 polypropylene and skin incisions were closed with interrupted 4/0 polypropylene stitches. On the 7th postoperative day, the abdominal walls of the rats were tested for tensile strength. In addition, each abdominal fascia was evaluated for inflammation scores and hydroxyproline levels. HS caused less inflammation and necrosis in abdominal fascia compared to the diathermy group (p < 0.01 and p < 0.05, respectively), whereas the CS group showed no difference in inflammation scores, but had significantly lower necrosis scores than the HS and diathermy groups (p < 0.05 and p < 0.001, respectively). Hydroxyproline content of the fascia did not differ among groups, while the tensile strength of the wound was obviously higher in the CS group (p < 0.001). HS causes less inflammatory reaction and necrosis than diathermy, but more necrosis than CS. Fascia incisions with CS gains tensile strength faster than in other groups. HS appears to cause less tissue injury than diathermy and also has comparable results for wound healing. Further clinical studies on the impact of HS in fascia incisions are needed.

Acta Chirurgica Belgica, 2005

In this study, we investigated the effects of synchronous anastomosis on intestinal healing in ex... more In this study, we investigated the effects of synchronous anastomosis on intestinal healing in experimental colonic resection. Sprague-Dawley rats were randomized into 3 groups; control (group I), single anastomosis (group II) and synchronous (double) anastomosis (group III). Single and proximal anastomoses were located 3 cm distal to caecum, and distal anastomoses were done 3 cm distal to them. On the 7th postoperative day, bursting pressure, hydroxyproline level and histology of the anastomotic site were assessed. Bursting pressures and hydroxyproline levels indicated that impaired healing of proximal anastomoses in group III was evident. Proximal anastomoses in group III had the lowest hydroxyproline value and bursting pressure level. Significant fibrosis was observed in the histological examination of distal anastomoses in group III. Double colonic anastomoses is not as safe as single anastomoses and involves additional risk. The healing of proximal anastomosis is significantly altered after experimental synchronous resection.

Minerva chirurgica

Retroperitoneal perforation of duodenal ulcer is a rare condition. Diagnostic difficulties lead t... more Retroperitoneal perforation of duodenal ulcer is a rare condition. Diagnostic difficulties lead to high mortality. Two cases are presented in this report.

Turkish Journal of Surgery, 2011

ABSTRACT GİRİŞ Gezici dalak (GD) nadir bir klinik durum olup, gastrosplenik ve splenorenal bağlar... more ABSTRACT GİRİŞ Gezici dalak (GD) nadir bir klinik durum olup, gastrosplenik ve splenorenal bağların yokluğu ya da gevşekliği nedeniyle dalağın normal yerleşim yerinde olmaması olarak tanımlanmaktadır (1). İlk kez 1667'de Van Horne tarafından tanımlan-mış ve 1885 yılında da torsiyon gelişmesi duru-mu sunulmuştur (2). Gezici dalağın etiyolojisi kesin olarak bilinmemekle beraber konjenital veya edinilmiş nedenlere bağlıdır. Embriyolojik dönemin 5. ve 6. haftalarında dorsal mesogastriu-mun füzyon eksikliği aşırı uzun bir pediküle ne-den olduğu bildirilmektedir (3). Ayrıca, Prune-Belly sendromunda olduğu gibi ön barsak (fore-gut) rotasyonundaki yetersizlik de GD nedeni olabilmektedir (4). Erişkinlik döneminde "edinil-miş" GD, dalağı yerinde tutan ligamanların hasa-rı veya bağ dokusu hastalıkları veya gebelik gibi bağları zayıflatan durumlara bağlı gelişir. Olgu-ların üçte biri 10 yaş altı çocuklardır. Erişkinlerin de %70-80'i 20-40 yaş arası bayanlardır (5,6). Gezici dalağın semptomları dalağın büyüklüğü-ne ve yerine göre değişir. Dalağın büyümesi ge-nellikle splenik damarların dönmüş olmasına ba-zen de dalak içinde pıhtı oluşumuna bağlı gelişen infarkta bağlı olur. Klinik olarak GD asemptoma-tik bir kitle veya tekrarlayan geçici karın ağrıları nedeni veya akut karın olarak kendini gösterir. OLGU SUNUMU 26 yaşında erkek hasta 3 günden beri devam eden karın ağrısı, bulantı, kusma ve iştahsızlık yakın-maları ile hastanemiz acil polikliniğine başvurdu. Klinik muayenede, orta derecede bir abdominal distansiyon ve özellikle sol alt kadranda şüpheli bir duyarlılık vardı. Ayakta direkt karın grafisin-de dilate multipl barsak segmenti saptandı. Daha önce gittiği sağlık kurumunda yapılan ultraso-nografik inceleme mesanenin üzerinde lokalize 16x6 cm lik solid bir kitleyi ve dilate intestinal segmentleri göstermekte idi. Laboratuar olarak, hemoglobin konsantrasyonu 12.4 g/dl, beyaz küre sayısı 18X10 3 /μl, ve trombosit sayısı ise 118x10 3 /L idi. Olgunun semptomları ve ultraso-nografik bulguları nedeniyle daha sonra bilgisa-yarlı tomografi (BT) incelemesi yapıldı. Kontrastlı BT incelemesi mezenterik kalınlaşma ve sigmoid volvulus ile uyumlu olarak bildirildi. Hastada sigmoid volvulus düşünülerek acil şartlarda ko-lonoskopik detorsiyon olanağımız da bulunma-dığından laparotomi kararı alındı. Operasyon OLGU SUNUMU

Turkiye Klinikleri Genel Cerrahi Ozel Dergisi, 2011

ANZ Journal of Surgery, 2004

Background: Elevated intra-abdominal pressure and colostomy have adverse effects on colonic anast... more Background: Elevated intra-abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model. Methods: Thirty-six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared. Results: Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P = 0.0003). Mean tissue hydroxyproline concentrations showed no difference (P > 0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P = 0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P = 0.0009). Conclusion: Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.

... BT özellikle obez hatalarda, derin yerleşimli apselerde daha iyi rezolüsyon ve alternatif eri... more ... BT özellikle obez hatalarda, derin yerleşimli apselerde daha iyi rezolüsyon ve alternatif erişim yolları sağlayarak apse drenajına olanak sağlamaktadır. ... Ann Surg 1990;212:65562. 6) Arda K. İntraabdominal apselerin ultrasonografi ve floroskopi eşliğinde kateter drenajı. ...

... Louis, 2001:1284-9. 2) Güzin K, Afşar S, Yiğit A, Eren SA, Özerden E, Kanadıkırık F. Pelvic g... more ... Louis, 2001:1284-9. 2) Güzin K, Afşar S, Yiğit A, Eren SA, Özerden E, Kanadıkırık F. Pelvic ganglioneuroma. Int J Gynecol Cancer 2008;18:553-6. 3) Singh KJ, Suri A, Vijjan V, Singh P, Srivastava A. Retroperitoneal ganglioneuroma presenting as right renal mass. ...

Turkish Journal of Surgery, 2009

Laparoscopic appendectomy has progressed to become a reliable surgical procedure in recent years.... more Laparoscopic appendectomy has progressed to become a reliable surgical procedure in recent years. However, there are some pros and cons comparable with open appendectomy. Materials and methods: The results of 91 patients with acute appendicitis who were operated either with laparoscopic or open technique were retrospectively evaluated. Results: Laparoscopic appendectomy was performed in 28 (30.7%) patients, whereas 63 (69.3%) cases underwent open procedure. Two (6.6%) laparoscopic procedures were converted to open because of perforation and anatomical problems. The duration of operation, hospital stay, and rate of complications did not differ among groups (p>0.05). One patient in each group developed intraabdominal abscess. Conclusions: Laparoscopic appendectomy does not increase postoperative complications as previously speculated, and therefore is a reliable alternative for open appendectomy.

Journal of Clinical and Analytical Medicine, 2014

Amaç: Doppler Ultrason (DUS) karaciğer damarlarının değerlendirilmesinde güvenir bir yöntem olduğ... more Amaç: Doppler Ultrason (DUS) karaciğer damarlarının değerlendirilmesinde güvenir bir yöntem olduğu bilinmektedir. Karaciğer yağlanması sirozda olduğu gibi organ kanlanmasında değişiklik meydana getirmektedir. Alkolik olmayan diffüz karaciğer yağlanması (DKY) rutin ultrason uygulamasında sık karşılaşılan bir bulgudur. Kronik karaciğer hastalıklarında küçük karaciğer boyutları ile birlikte hepatik venlerde dalga form değişiklikleri izlenir. DKY olgularında hepatomegalinin varlığı bu değişimi etkilemekte midir, bu çalışmada değerlendirilmiştir. Gereç ve Yöntem: Yağlanma derecelerine göre sınıflanan olgular, (Grade I: 35 (%19.3); Grade II: 129 (%71.3); Grade III: 17 (%9.4)) hepatomegali 107 (%59.1) olguya eşlik etmekteydi. 74 olguda ise, (%40.9) hepatomegali yoktu. 35 erkek, 72 kadın olgunun yaş ortalaması 53.5 (± 11.1; 27-83) idi. Hepatik ven dalga formları Doppler ile incelendi. Trifazik, bifazik ve monofazik olarak gruplandı. Etyolojik faktörler arasında diyabet, hipertrigliseridemi ve kolesterolemi vardı. 119 olguda anormal dalga boyu saptandı (%65). DKY derecesi ile Hepatik ven Doppler ultrasonografik dalga boyu arasında korelasyon bulundu (p=0.03). Hepatomegali ile DKY derecesi arasında ilişki yokrtu (p=0.5). Bulgular: Sonuç olarak, hepatosteatoz derecesi ile Doppler ultrasonografik dalga boyu değişiklikleri arasındaki ilişki bilinmektedir ancak hepatomegalinin eşlik etmesi bulgularda anlamlı değişikliğe yol açmamaktadır.

İstanbul Kanuni Sultan Süleyman Tıp Dergisi

Adrenal myelolipoma is a rare benign tumor, and contrary to most of the adrenal tumors it is an e... more Adrenal myelolipoma is a rare benign tumor, and contrary to most of the adrenal tumors it is an endocrinologically inactive tumor. Mature adipose tissue, and active bone marrow components identified during histopathological examination are diagnostic clues. They are generally small in size, and detected incidentally. Its definitive etiology has not been determined yet. However multiple number of etiopathogenetic factors have been defined. Hematopoietic stem cell embolization in the adrenal gland is one of the most probable theories. In this case report we present a 31-year-old patient whose pregnancy was terminated 10 months previously who developed rapidly progressive giant adrenal myelolipoma during the course of her pregnancy. According to literature findings, our case presented in the study is the first case who presented with abdominal pain during postpartum period. We think that this progressively increasing mass during nearly 10 months might be related to pregnancy.

Meandros Medical and Dental Journal

Bilimsel kongrelerde bildiriler genelde sözlü veya poster olarak sunulmaktadır. Son zamanlarda vi... more Bilimsel kongrelerde bildiriler genelde sözlü veya poster olarak sunulmaktadır. Son zamanlarda video sunumu ve "e-poster" de öne çıkmaktadır. Sözlü bildiride videolar, resimler gösterilebilir ancak sunum süreleri kısıtlıdır. Posterlerin sunum süreleri uzundur, daha çok katılımcıya ulaşabilir, ama video gösterilemez. Video sunumlar ve e-posterlerde ise her çalışma için ayrı bilgisayar olmadığından az sayıda bilgisayara yüklenmiş olarak menüden seçilmeyi beklerler. İnteraktif poster, özel ekranı sayesinde, kongre boyunca sürekli sunum yapabilir, sayısız resim ve film gösterebilir. Amacımız interaktif poster ile kongrelerde bilgi paylaşımını artırmak ve interaktif hale getirmektir. Gereç ve Yöntemler: Bilgi işlemcisi ve 23 inç dokunmatik ekranlı poster hazırlandı. Özel ekranı ve sürekli sunum avantajıyla katılımcıların istedikleri zaman interaktif postere gelip yazıları okuma, yüzlerce resim ve videoyu izleyebilmelerine olanak sağlandı. Bilgi işlemci de kongre boyunca kaç kişinin çalışmayı okuduğunu, ekrana dokunduğunu belirleyecek şekilde ayarlandı. Öz Objective: The scientific presentations are usually in oral or poster form. Recently evolved methods are video and "e-poster" presentations. Video data and images can be presented in oral presentations but for a limited time. The presentation time is prolonged in poster technique and available for more people but video data can't be presented. The video presentations and e-posters are uploaded and ready to be selected through a menu in few computers because of the lack of available number of computers for every study. The interactive posters make the presentation of numerous images and video data to be accessible continuously during whole meeting period via its special screen. We aimed to increase sharing of knowledge and make it interactive during a limited period. Materials and Methods: A 23-inch touch screen with a data processor was used for poster presentation. The special screen was provided for participants to read text, multiple images and video data continuously. The data processor was set to count the number of people to touch screen to read the presented study during the congress period. Results: The interactive poster was set to be ready in 7 th Congress of Surgical Research. The continuous presentation was lasted all through the 3-day Congress Period and 938 clicks were counted by the processor. Conclusion: During a congress period, by touching the interactive screen it was possible to interchange between the menu topics. The software counting the clicks need to be developed to estimate the number of people evaluating the study as well as duration of interest and which image and video data were evaluated at most.

Meandros Medical and Dental Journal, Dec 1, 2018

Amaç: Kolon anastomozu ile ilgili kaçak nedenleri konusunda devam etmekte olan araştırmalar vardı... more Amaç: Kolon anastomozu ile ilgili kaçak nedenleri konusunda devam etmekte olan araştırmalar vardır. Bu çalışmada anastomoz dayanıklılığının ameliyat öncesinde beta-hidroksi-metil bütirat (HMB) ile artıp artmayacağı denetlenmiştir. Gereç ve Yöntemler: Kırk rat 4 gruba randomize edildi. Grup A (n=10) ratları standart rat yemi ile birlikte arjinin+glutamin+HMB'den zengin diyetle 7 gün beslendikten Öz Objective: The studies on anastomotic leakage which is one of the leading serious complications of colonic anastomoses keep going as well as other surgical researches. This study was designed to investigate effects of hydroxy-ß-methyl butyrate (HMB) on anastomotic healing. Materials and Methods: Forty rats were randomized into four groups. Group A (n=10) rats received chow food plus arginine+glutamine+HMB rich diet for 7 days before right colonic transection followed by an end-to-end anastomosis. Group B (n=10) rats received chow food plus arginine and glutamine rich diet for 7 days before the same surgical procedure. Group C (n=10) rats underwent the same procedure after a 7-day chow plus glutamin rich diet. Group D (n=10) rats had the surgery after a chow food only diet for seven days. All the subjects were fed accordingly to their groups for 7 days postoperatively. On the 7 th day, all rats were sacrificed under anesthesia to measure anastomotic bursting pressure and evaluate hydroxyproline levels as well as histopathological scoring of anastomotic line. Results: This study revealed significantly increased hydoxyproline level at the 7 th day in group A (p<0.002) and group B (p<0.001) relative to group D. There were no significant differences among the groups for anastomotic bursting pressures and histopathological scores. Conclusion: Enteral HMB support may result statistically significant increased biochemical anastomotic strength with an insignificant difference in biomechanical force. Although more studies are needed to delineate better efficacy, preoperative enteral HMB support may decrease postoperative morbidity and mortality.

Transfusion and Apheresis Science, 2010

Thrombotic microangiopathy occurs in 5–10% of patients with mucin-producing disseminated adenocar... more Thrombotic microangiopathy occurs in 5–10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the