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    The efficiency of laparoscopy in patients with complicated appendicitis
    (2017) Kocatas, Ali; Kinaci, Erdem; Bozkurt, Mehmet Abdussamet; Gemici, Eyup; Akarsu, Cevher
    Abstract Aim: Laparoscopic approach for complicated appendicitis (CA) is a controversial issue. Although it has been generally recommended, conflicting results have been reported in literature. The aim of this study is to obtain the current results regarding laparoscopic surgery for CA. Material and Methods: Patients who underwent surgery for acute appendicitis between July 2009 and January 2011 in Dr Sadi Konuk Training and Research Hospital were retrospectively analyzed. Appendicitis was considered as CA when there were one of the following criteria; existence of accompanying intra-abdominal abscess, peritonitis, gangrene or perforation confirmed by a histopathological examination. The patients with CA were divided into two groups, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. Demographics, perioperative findings and postoperative course were compared. Results: 846 patients with the diagnosis of appendicitis underwent surgery at our center. Of these, 124 cases were complicated appendicitis. Eighty-five (68.5%) and 39 (31.5%) patients underwent to LA and OA, respectively. The mean ages in two groups were compatible (p=0.224). The mean body mass index was significantly higher in LA group. Presence of accompanying abscess and use of intra-abdominal drain were similar in both groups (p>0.05). Duration of operation was significantly higher in LA group (76.133.7 vs 57.8 22.5) (p=0.001). Although postoperative intra-abdominal abscess formation was slightly higher in LA groups (7 cases vs 1 case), there was no difference in postoperative complication between two groups. Length of hospitalization was also not different in both groups. Time to oral feeding was significantly earlier in LA group. Conclusion: Laparoscopy in complicated appendicitis can be the first choice with no increase in postoperative complications. However, the longer operation time is still a problem for laparoscopic technique despite increasing experience. According to us, future studies should be focused on this problem.
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    Enhanced recovery after surgery (ERAS) protocol in gastric cancer: Early term results
    (2018) Cikot, Murat; Gemici, Eyup; Kones, Osman; Akarsu, Cevher; Alis, H.
    Aim: To evaluate the effects of enhanced recovery after surgery (ERAS) protocol on morbidity and mortality in patients undergoing surgery due to gastric cancer. Material and Methods: Data of a total of 40 patients who were operated due to gastric cancer with ERAS between May 2016 and December 2016 were retrospectively analyzed. Morbidity and mortality results were evaluated as local or systemic depending on whether they developed within postoperative 30 days and whether they developed due to operation. The American Society of Anesthesiologists (ASA) classification was used to assess preoperative risk. Surgical complications were classified according to the Clavien-Dindo classification and pathological staging was performed according to the Tumor, Node, Metastasis (TNM) classification. Results: Four patients were in ASA I, 11 patients were in ASA II, 24 patients were in ASA III, and one patient was in ASA IV. The mean duration of surgery was 165 (range: 150 to 210) min in total gastrectomy and 115 (range: 95 to 140) min in subtotal gastrectomy. According to the TNM classification, four patients had Stage I, 10 patients had Stage II, and 26 patients had Stage III disease. The mean duration of hospitalization was nine (range: 6 to 21) days in total gastrectomy and six (range: 4 to 15) days in subtotal gastrectomy. The number of morbidities was 15% with a 2.5% mortality rate. Conclusion: Our study results suggest that ERAS protocol is an evidence-based quality protocol which can be reliably applied even in advanced stage gastric cancer with a high ASA score.
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    Laparoscopic approach for hospitalized women in reproductive period presenting with non-specific abdominal pain
    (2017) Cikot, Murat; Binboga, Sinan; Akarsu, Cevher; Surek, Ahmet; Gemici, Eyup; Sahbaz, Nuri Alper; Kartal, Bahadir; Alis, Halil
    Aim: The aim of this study is to evaluate nonspecific abdominal pain of hospitalized women in reproductive period and to make a contribution to the literature. Material and Method: Medical records from 201 women in reproductive period presenting with nonspecific abdominal pain admitted to emergency department between 2010 and 2014 are evaluated retrospectively. Results: Diagnostic laparoscopy was performed in 125 of 201 patients. The mean age of patients was 8.5 years, mean white blood cell (WBC) count:10.9 103/uL, mean C-reactive protein (CRP) levels: 2.6 mg/dl, mean preoperative follow-up time 7.8 hours, mean operation time 32 min., mean postoperative follow-up duration time was 15 hours. In ultrasonography, 38% of patients had minimal liquid in Douglas’s area. In Computerized Tomography (CT) with intravenous, oral-rectal contrast, 30% of patients had minimal liquid. In 89% of patients, who underwent laparoscopic exploration, cause of the abdominal pain was found. In 57 explorations, purulent fluid was detected and associated to pelvic inflammatory disease, in 42 patients sero-hemorrhagic fluid was detected and associated to hemorrhagic cyst rupture. 9 patients had acute appendicitis, 2 patients had Meckel’s diverticulitis and one patient had a left lower quadrant brid. Conclusion: Our results indicate that laparoscopy serves not only as diagnostic, but also as diagnostic tool for female patients in reproductive age with nonspecific abdominal pain.