Servet Karagul - Academia.edu (original) (raw)

Papers by Servet Karagul

Research paper thumbnail of An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018

Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal ca... more Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.0...

Research paper thumbnail of Early outcomes of laparoscopic total gastrectomy with hemi-double stapling technique in gastric cancer

Laparoscopic endoscopic surgical science, 2019

Research paper thumbnail of The first two laparoscopic pancreaticoduodenectomy cases in the eastern Black Sea region

Laparoscopic endoscopic surgical science, 2018

Research paper thumbnail of Tıkanma İkterine Yol Açan Dev Pankreas Psödokisti

Research paper thumbnail of Specimen extraction and anvil placement methods in laparoscopic colorectal surgery: A single surgeon's experience

Annals of medical research, 2018

Research paper thumbnail of An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

Colorectal Disease, 2021

AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperativ... more AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability ...

Research paper thumbnail of Surgical technique and short-term outcomes in esophageal squamous cell carcinoma : A single center experience

Annals of medical research, 2019

Esophagus cancers are the 8th most commonly seen cancers worldwide and the 6th cause of cancer-re... more Esophagus cancers are the 8th most commonly seen cancers worldwide and the 6th cause of cancer-related mortality. By the time they are diagnosed they are generally not resectable and therefore have a poor prognosis. This is a complex disease that requires a multidisciplinary approach. Apart from early stage tumors, surgery is recommended following chemoradiotherapy. Squamous cell carcinomas are seen more frequently and several surgical methods are applied for curative resection. The aim of this study was to present the surgical techniques applied to patients who underwent surgery for esophagus squamous cell carcinoma and to discuss the postoperative outcomes. Material and Methods: A retrospective review was made of the records of 14 patients with esophagus squamous cell carcinoma who underwent surgery in Samsun Training and Research Hospital between June 2016 and September 2018. Patients' demographic data, diagnoses, tumor characteristics, postoperative complications, mortality, and clinical findings during follow-up were recorded. Results: The study included 14 patients, comprising 9 females and 5 males with a median age was 65.3 years (range, 39-80 years). Transhiatal esophagectomy was applied to 12 patients and thoraco-laparoscopic (TL) esophagectomy to 2 patients. No intraoperative complications developed in the patients applied with TL esophagectomy. In 3 of the patients applied with transhiatal esophagectomy, pneumothorax developed. No early or late postoperative complications developed in the patients applied with TL esophagectomy. In the transhiatal esophagectomy group, anastomosis leakage was observed in 2 patients and wound site infection in 1. The median length of hospital stay was 14 days (range, 7-39 days), and median postoperative follow-up was 12.5 months (range, 4-22 months). Conclusion: Despite small number of patients and short follow up, our study suggest that surgery-related morbidity and mortality will be lower in minimally invasive esophagectomy.

Research paper thumbnail of Initial operative experience with pancreaticoduodenectomy after fellowship training

Annals of medical research, 2019

Pancreaticoduodenectomy is a challenging procedure used primarily for the treatment of pancreatic... more Pancreaticoduodenectomy is a challenging procedure used primarily for the treatment of pancreatic head cancers. The aim of this study was to share early outcomes of the first pancreaticoduodenectomy operations performed by our surgery team after completing a gastroenterological surgery and surgical oncology fellowship program. Material and Methods: Patients who underwent pancreaticoduodenectomy by the same surgical team between November 2015 and August 2018 were retrospectively analyzed. The patients' demographic data, diagnoses, tumor characteristics, postoperative complications, mortality, and clinical findings during follow-up were recorded. Results: A total of 35 patients (21 men and 14 women) with a mean age of 65.6±18.1 years were included in the study. Mean length of hospital stay was 16.8±7.3 days. Postoperative pancreatic fistula was observed in 5 patients. Postoperative hemorrhage occurred in 3 patients and delayed gastric emptying (DGE) in 2 patients. Three patients died in the early postoperative period. Mean follow-up time of the remaining 32 patients was 22.9±8.4 months. Conclusion: Our experience demonstrates that pancreaticoduodenectomy can be performed with acceptable outcomes after fellowship training that includes pancreatic surgery.

Research paper thumbnail of Surgical Approaches to Gastrointestinal Stromal Tumors

The International Annals of Medicine, Oct 5, 2018

Objective: Although gastrointestinal stromal tumor (GIST) is a rare type of cancer and treatment ... more Objective: Although gastrointestinal stromal tumor (GIST) is a rare type of cancer and treatment can vary from simple surgical resection to multiple organ resection. In this study, we evaluated the surgical techniques applied according to tumor features. Methods: The records of 24 patients who underwent surgery for GIST in our clinic between 2008 and 2013 were analyzed retrospectively. Patient age at diagnosis, gender, presenting complaints, intraoperative findings, surgical technique applied, and pathological findings were evaluated. Non-parametric values were evaluated with the Kruskall-Wallis and the Mann Whitney U tests. Continuous variables were expressed as mean ± standard deviation (SD) and non-continuous variables as median (minimum-maximum) values. A value of p<0.05 was accepted as statistically significant. Results: The patients comprised 14 (58.3%) males and 10 (41.7%) females with a mean age at diagnosis of 57 years (range, 32-77 years). Surgery was performed due to symptomatic disease in 58.3% of the patients and following incidental diagnosis in 41.7%. GIST origin was the stomach in all patients that presented with bleeding, and the small intestine in the patient that presented with ileus. Simple surgical resection was performed in 37.5%, organ resection in 37.6%, and debulking surgery in 20.8% of the patients. The tumor was evaluated as unresectable in 1 patient. The median follow-up period of the patients was 48 months and median disease-free survival was 38.5 months. In 3 patients, liver metastasis was detected at mean 24.3 months postoperatively and imatinib treatment was initiated. Conclusion: Conservative follow-up is recommended for asymptomatic patients with a tumor <2 cm in size, whereas surgery is recommended for all symptomatic tumors regardless of size. Although simple resection is sufficient if the tumor can be completely removed, organ resection can be used to treat patients with large tumors.

Research paper thumbnail of Our preferred surgical technique and outcomes in esophageal squamous cell carcinoma

Annals of medical research, 2019

Research paper thumbnail of Letter to the Editor Regarding “Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux‑en‑Y Gastric Bypass for Obesity: a Meta‑analysis and Systematic Review”

Obesity Surgery

We read with great interest the paper entitled "Efficacy and Safety of One Anastomosis Gastric By... more We read with great interest the paper entitled "Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review" published by Li X et al. [1]. The study you published was extremely valuable, as the number of studies comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass is limited. In the meta-analysis, the authors included eight prospective randomized trials. When we examined the evaluated studies in detail, noticed that one study was a retracted article [2]. Ruiz-Tovar et al., have reviewed their records and have identified errors in the transcription of data collected for their study [3].

Research paper thumbnail of Liver transplantation due to hepatic hydatid cyst surgery: Not expected but possible

International Journal of Surgery, Apr 1, 2022

Research paper thumbnail of Is Laparoscopy Assistance Always Necessary During Minimally Invasive Living Donor Liver Transplantation Using Upper Midline Incision?

Liver Transplantation, Sep 5, 2021

Many types of incisions have been tried for liver transplantation. Among them, the upper midline ... more Many types of incisions have been tried for liver transplantation. Among them, the upper midline incision is one of the most minimalist. It is an understandable choice by Suh KS et al. to prefer an upper midline incision for minimally invasive living donor liver transplantation, and we agree on this issue. However, according to us, laparoscopic assistance requirement in addition to midline laparotomy can not be necessary in all living donor liver transplantation cases. An upper midline incision alone (without laparoscopic assistance) has been used successfully for the explantation of the native liver as well as the implantation of the graft liver2 . Adding trocar entries, laparoscopic equipment, time-consuming procedures, and increasing operative cost can not be necessary.

Research paper thumbnail of Transgastric removal of a polycystic liver disease using mini-laparoscopic excision

Interventional Medicine and Applied Science, Jun 1, 2016

Surgical treatment is often necessary for patients with symptomatic or complicated polycystic liv... more Surgical treatment is often necessary for patients with symptomatic or complicated polycystic liver diseases (PLD). In this paper, we describe a 52-year-old female with symptomatic PLD that had resulted in the formation of liver cysts, the largest of which was 23 cm in diameter. The patient underwent mini-laparoscopic fenestration through 5-mm abdominal trocars. The walls of the cysts were unroofed using a harmonic scalpel. Four thickened rubber-like pieces of specimens (sizes ranged between 9 × 6 × 0.5 cm and 6 × 3 × 0.1 cm) were not suitable for extraction through the 5-mm trocars. A gastrotomy was performed, and the specimens were extracted through the stomach with the help of an endoscope. Transoral removal of the specimens was completed without any complications, and the gastrotomy was closed intracorporeally. The patient was permitted to take fluids on day one, and oral intake was gradually increased. She was discharged on day four and was asymptomatic after two months of follow-up. The combination of mini-laparoscopy and intraoperative endoscopic specimen extraction represented a minimally invasive surgical approach for the treatment of PLD. To the best of our knowledge, this was the first case report of the transoral extraction of a liver specimen.

Research paper thumbnail of Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation

Transplantation Proceedings, Jun 1, 2015

The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder sp... more The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors. The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers. A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other…

Research paper thumbnail of Retroperitoneal mass presenting as recurrent inguinal hernia: A case report

International Journal of Surgery Case Reports, 2016

INTRODUCTION: Retroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESEN... more INTRODUCTION: Retroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESENTATION OF CASE: A 53 year old male admitted with the symptoms of weight loss, abdominal discomfort and left sided recurrent inguinal hernia. Physical examination demonstrated an abdominal mass in the left flank and an irreducible, painless scrotal mass. He had a history of left sided inguinal hernia surgery six years ago. Computed tomography revealed a large enhancing left sided retroperitoneal mass invading the colon, pancreas and kidney and it was going down towards the left scrotum. Unblock tumor resection including the neighboring organs (left kidney, left colon, distal pancreas with spleen) was performed. Scrotal extension of the tumor was also excised and the inguinal canal was repaired primarily. Histopathology of the mass was myxoid-liposarcoma. The patient has disease free, without hernia recurrence but poor in renal function after twenty months follow-up. DISCUSSION: Large retroperitoneal tumors may grow towards the inguinal region and they can mimic an inguinal hernia. An irreducible, painless and hard scrotal mass should be considered from this perspective.

Research paper thumbnail of Comparison of Direct Trocar Entry and Veress Needle Entry in Laparoscopic Bariatric Surgery: Randomized Controlled Trial

Journal of Laparoendoscopic & Advanced Surgical Techniques, Nov 1, 2015

Background: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VN... more Background: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery. Materials and Methods: Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant. Results: Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6-94.6 versus 217.6-111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO 2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage. Conclusions: DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.

Research paper thumbnail of Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult

International Journal of Surgery Case Reports, 2016

INTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult t... more INTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this rare condition should be based on the individual's clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. PRESENTATION OF CASE: An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. DISCUSSION: Spontaneous rupture of the intrahepatic biliary duct is a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. CONCLUSION: Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient's clinical and comorbidity status.

Research paper thumbnail of Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer

International Journal of Surgery Case Reports, 2015

PURPOSE: Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic tec... more PURPOSE: Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. CASE: A 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. CONCLUSIONS: Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo-radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.

Research paper thumbnail of Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

Transplantation Proceedings, Jun 1, 2015

The aim of this study was to identify the risk factors related to mortality in liver transplant (... more The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test,…

Research paper thumbnail of An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018

Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal ca... more Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.0...

Research paper thumbnail of Early outcomes of laparoscopic total gastrectomy with hemi-double stapling technique in gastric cancer

Laparoscopic endoscopic surgical science, 2019

Research paper thumbnail of The first two laparoscopic pancreaticoduodenectomy cases in the eastern Black Sea region

Laparoscopic endoscopic surgical science, 2018

Research paper thumbnail of Tıkanma İkterine Yol Açan Dev Pankreas Psödokisti

Research paper thumbnail of Specimen extraction and anvil placement methods in laparoscopic colorectal surgery: A single surgeon's experience

Annals of medical research, 2018

Research paper thumbnail of An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

Colorectal Disease, 2021

AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperativ... more AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability ...

Research paper thumbnail of Surgical technique and short-term outcomes in esophageal squamous cell carcinoma : A single center experience

Annals of medical research, 2019

Esophagus cancers are the 8th most commonly seen cancers worldwide and the 6th cause of cancer-re... more Esophagus cancers are the 8th most commonly seen cancers worldwide and the 6th cause of cancer-related mortality. By the time they are diagnosed they are generally not resectable and therefore have a poor prognosis. This is a complex disease that requires a multidisciplinary approach. Apart from early stage tumors, surgery is recommended following chemoradiotherapy. Squamous cell carcinomas are seen more frequently and several surgical methods are applied for curative resection. The aim of this study was to present the surgical techniques applied to patients who underwent surgery for esophagus squamous cell carcinoma and to discuss the postoperative outcomes. Material and Methods: A retrospective review was made of the records of 14 patients with esophagus squamous cell carcinoma who underwent surgery in Samsun Training and Research Hospital between June 2016 and September 2018. Patients' demographic data, diagnoses, tumor characteristics, postoperative complications, mortality, and clinical findings during follow-up were recorded. Results: The study included 14 patients, comprising 9 females and 5 males with a median age was 65.3 years (range, 39-80 years). Transhiatal esophagectomy was applied to 12 patients and thoraco-laparoscopic (TL) esophagectomy to 2 patients. No intraoperative complications developed in the patients applied with TL esophagectomy. In 3 of the patients applied with transhiatal esophagectomy, pneumothorax developed. No early or late postoperative complications developed in the patients applied with TL esophagectomy. In the transhiatal esophagectomy group, anastomosis leakage was observed in 2 patients and wound site infection in 1. The median length of hospital stay was 14 days (range, 7-39 days), and median postoperative follow-up was 12.5 months (range, 4-22 months). Conclusion: Despite small number of patients and short follow up, our study suggest that surgery-related morbidity and mortality will be lower in minimally invasive esophagectomy.

Research paper thumbnail of Initial operative experience with pancreaticoduodenectomy after fellowship training

Annals of medical research, 2019

Pancreaticoduodenectomy is a challenging procedure used primarily for the treatment of pancreatic... more Pancreaticoduodenectomy is a challenging procedure used primarily for the treatment of pancreatic head cancers. The aim of this study was to share early outcomes of the first pancreaticoduodenectomy operations performed by our surgery team after completing a gastroenterological surgery and surgical oncology fellowship program. Material and Methods: Patients who underwent pancreaticoduodenectomy by the same surgical team between November 2015 and August 2018 were retrospectively analyzed. The patients' demographic data, diagnoses, tumor characteristics, postoperative complications, mortality, and clinical findings during follow-up were recorded. Results: A total of 35 patients (21 men and 14 women) with a mean age of 65.6±18.1 years were included in the study. Mean length of hospital stay was 16.8±7.3 days. Postoperative pancreatic fistula was observed in 5 patients. Postoperative hemorrhage occurred in 3 patients and delayed gastric emptying (DGE) in 2 patients. Three patients died in the early postoperative period. Mean follow-up time of the remaining 32 patients was 22.9±8.4 months. Conclusion: Our experience demonstrates that pancreaticoduodenectomy can be performed with acceptable outcomes after fellowship training that includes pancreatic surgery.

Research paper thumbnail of Surgical Approaches to Gastrointestinal Stromal Tumors

The International Annals of Medicine, Oct 5, 2018

Objective: Although gastrointestinal stromal tumor (GIST) is a rare type of cancer and treatment ... more Objective: Although gastrointestinal stromal tumor (GIST) is a rare type of cancer and treatment can vary from simple surgical resection to multiple organ resection. In this study, we evaluated the surgical techniques applied according to tumor features. Methods: The records of 24 patients who underwent surgery for GIST in our clinic between 2008 and 2013 were analyzed retrospectively. Patient age at diagnosis, gender, presenting complaints, intraoperative findings, surgical technique applied, and pathological findings were evaluated. Non-parametric values were evaluated with the Kruskall-Wallis and the Mann Whitney U tests. Continuous variables were expressed as mean ± standard deviation (SD) and non-continuous variables as median (minimum-maximum) values. A value of p<0.05 was accepted as statistically significant. Results: The patients comprised 14 (58.3%) males and 10 (41.7%) females with a mean age at diagnosis of 57 years (range, 32-77 years). Surgery was performed due to symptomatic disease in 58.3% of the patients and following incidental diagnosis in 41.7%. GIST origin was the stomach in all patients that presented with bleeding, and the small intestine in the patient that presented with ileus. Simple surgical resection was performed in 37.5%, organ resection in 37.6%, and debulking surgery in 20.8% of the patients. The tumor was evaluated as unresectable in 1 patient. The median follow-up period of the patients was 48 months and median disease-free survival was 38.5 months. In 3 patients, liver metastasis was detected at mean 24.3 months postoperatively and imatinib treatment was initiated. Conclusion: Conservative follow-up is recommended for asymptomatic patients with a tumor <2 cm in size, whereas surgery is recommended for all symptomatic tumors regardless of size. Although simple resection is sufficient if the tumor can be completely removed, organ resection can be used to treat patients with large tumors.

Research paper thumbnail of Our preferred surgical technique and outcomes in esophageal squamous cell carcinoma

Annals of medical research, 2019

Research paper thumbnail of Letter to the Editor Regarding “Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux‑en‑Y Gastric Bypass for Obesity: a Meta‑analysis and Systematic Review”

Obesity Surgery

We read with great interest the paper entitled "Efficacy and Safety of One Anastomosis Gastric By... more We read with great interest the paper entitled "Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review" published by Li X et al. [1]. The study you published was extremely valuable, as the number of studies comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass is limited. In the meta-analysis, the authors included eight prospective randomized trials. When we examined the evaluated studies in detail, noticed that one study was a retracted article [2]. Ruiz-Tovar et al., have reviewed their records and have identified errors in the transcription of data collected for their study [3].

Research paper thumbnail of Liver transplantation due to hepatic hydatid cyst surgery: Not expected but possible

International Journal of Surgery, Apr 1, 2022

Research paper thumbnail of Is Laparoscopy Assistance Always Necessary During Minimally Invasive Living Donor Liver Transplantation Using Upper Midline Incision?

Liver Transplantation, Sep 5, 2021

Many types of incisions have been tried for liver transplantation. Among them, the upper midline ... more Many types of incisions have been tried for liver transplantation. Among them, the upper midline incision is one of the most minimalist. It is an understandable choice by Suh KS et al. to prefer an upper midline incision for minimally invasive living donor liver transplantation, and we agree on this issue. However, according to us, laparoscopic assistance requirement in addition to midline laparotomy can not be necessary in all living donor liver transplantation cases. An upper midline incision alone (without laparoscopic assistance) has been used successfully for the explantation of the native liver as well as the implantation of the graft liver2 . Adding trocar entries, laparoscopic equipment, time-consuming procedures, and increasing operative cost can not be necessary.

Research paper thumbnail of Transgastric removal of a polycystic liver disease using mini-laparoscopic excision

Interventional Medicine and Applied Science, Jun 1, 2016

Surgical treatment is often necessary for patients with symptomatic or complicated polycystic liv... more Surgical treatment is often necessary for patients with symptomatic or complicated polycystic liver diseases (PLD). In this paper, we describe a 52-year-old female with symptomatic PLD that had resulted in the formation of liver cysts, the largest of which was 23 cm in diameter. The patient underwent mini-laparoscopic fenestration through 5-mm abdominal trocars. The walls of the cysts were unroofed using a harmonic scalpel. Four thickened rubber-like pieces of specimens (sizes ranged between 9 × 6 × 0.5 cm and 6 × 3 × 0.1 cm) were not suitable for extraction through the 5-mm trocars. A gastrotomy was performed, and the specimens were extracted through the stomach with the help of an endoscope. Transoral removal of the specimens was completed without any complications, and the gastrotomy was closed intracorporeally. The patient was permitted to take fluids on day one, and oral intake was gradually increased. She was discharged on day four and was asymptomatic after two months of follow-up. The combination of mini-laparoscopy and intraoperative endoscopic specimen extraction represented a minimally invasive surgical approach for the treatment of PLD. To the best of our knowledge, this was the first case report of the transoral extraction of a liver specimen.

Research paper thumbnail of Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation

Transplantation Proceedings, Jun 1, 2015

The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder sp... more The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors. The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers. A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other…

Research paper thumbnail of Retroperitoneal mass presenting as recurrent inguinal hernia: A case report

International Journal of Surgery Case Reports, 2016

INTRODUCTION: Retroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESEN... more INTRODUCTION: Retroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESENTATION OF CASE: A 53 year old male admitted with the symptoms of weight loss, abdominal discomfort and left sided recurrent inguinal hernia. Physical examination demonstrated an abdominal mass in the left flank and an irreducible, painless scrotal mass. He had a history of left sided inguinal hernia surgery six years ago. Computed tomography revealed a large enhancing left sided retroperitoneal mass invading the colon, pancreas and kidney and it was going down towards the left scrotum. Unblock tumor resection including the neighboring organs (left kidney, left colon, distal pancreas with spleen) was performed. Scrotal extension of the tumor was also excised and the inguinal canal was repaired primarily. Histopathology of the mass was myxoid-liposarcoma. The patient has disease free, without hernia recurrence but poor in renal function after twenty months follow-up. DISCUSSION: Large retroperitoneal tumors may grow towards the inguinal region and they can mimic an inguinal hernia. An irreducible, painless and hard scrotal mass should be considered from this perspective.

Research paper thumbnail of Comparison of Direct Trocar Entry and Veress Needle Entry in Laparoscopic Bariatric Surgery: Randomized Controlled Trial

Journal of Laparoendoscopic & Advanced Surgical Techniques, Nov 1, 2015

Background: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VN... more Background: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery. Materials and Methods: Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant. Results: Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6-94.6 versus 217.6-111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO 2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage. Conclusions: DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.

Research paper thumbnail of Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult

International Journal of Surgery Case Reports, 2016

INTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult t... more INTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this rare condition should be based on the individual's clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. PRESENTATION OF CASE: An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. DISCUSSION: Spontaneous rupture of the intrahepatic biliary duct is a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. CONCLUSION: Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient's clinical and comorbidity status.

Research paper thumbnail of Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer

International Journal of Surgery Case Reports, 2015

PURPOSE: Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic tec... more PURPOSE: Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. CASE: A 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. CONCLUSIONS: Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo-radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.

Research paper thumbnail of Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

Transplantation Proceedings, Jun 1, 2015

The aim of this study was to identify the risk factors related to mortality in liver transplant (... more The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test,…