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Öğe Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Minor Hepatectomy(Springer India, 2022) Aydin, Mehmet Can; Bag, Yusuf Murat; Gunes, Orgun; Sumer, Fatih; Kayaalp, CuneytNatural orifice specimen extraction (NOSE) is an emerging technique usually preferred for colorectal resections or cholecystectomy. NOSE following laparoscopic liver resections is limited to case reports, and there is no previous study comparing the outcomes of NOSE and transabdominal (TA) specimen extraction. Our aim was to compare NOSE and TA specimen extraction methods following laparoscopic minor hepatectomy. Thirty-one patients undergoing laparoscopic minor hepatectomy between 2014 and 2020 were evaluated. The patients were divided into two groups as NOSE (n: 12) and TA (n: 19). The patients' demographics, preoperative and postoperative findings, pain, and cosmetic scores were compared. Female ratio was higher in the NOSE group (83.3% vs 31.6%, p=0.005); other demographics were similar. The median length of incision was 6 cm in the TA group but only trocar incisions in the NOSE group. There was no difference between intraoperative and postoperative findings except pain and cosmetic scores. Pain scores on postoperative days 1, 2, and 3 and in total were lower in the NOSE group (4.1 +/- 0.6 vs. 5.6 +/- 1.1, p=0.001; 2.2 +/- 04 vs. 4.1 +/- 0.9, p<0.001; 1.7 +/- 0.6 vs. 2.4 +/- 0.8, p=0.025; 8.1 +/- 1.4 vs. 12.2 +/- 2.5, p<0.001). In addition, patients in NOSE group had better cosmetic scores (9.2 +/- 0.6 versus 7.0 +/- 0.6, p<0.01). Laparoscopic minor hepatectomy combined with NOSE is a safe and effective procedure in selected patients with the advantages of less postoperative pain and better cosmesis. NOSE is ideal for female patients with high cosmetic expectancy.Öğe Conversion in laparoscopic gastric cancer surgery a highlight on the abdominal access(2021) Zengin, Akile; Bag, Yusuf Murat; Aydin, Mehmet Can; Kayaalp, CuneytAim: The aim of this study was to compare the data of patients who underwent gastric cancer surgery as laparoscopically completed and converted to open surgery and draw attention to complications arising from trocar entry. Materials and Methods: This study included 211 patients who underwent laparoscopic gastric cancer surgery. Patients were divided in to two groups as laparoscopically completed and converted to open surgery. Demographics parameters and perioperative data were retrospectively analyzed. Results: The median age of the study group was 62 (19-91) years and 68.2% were males. Conversion occured in 16 patients (7.5%). The reasons for conversion were locally advanced tumor (n=6), complications due to trocar insertion (n=4), technical difficulty in performing esophagojejunostomy anastomosis (n=4), leakage in esophagojejunostomy anastomosis (n=1), and persistent bradycardia (n=1). Intraoperative blood loss was higher and time to oral intake was longer in the conversion group. No significant difference was found in terms of demographic parameters, operative time, length of hospital stays, the rate of postoperative complications, reoperation, 30-day mortality. Conclusion: Complications due to trocar entry is an unpredictable and preventable conversion reason in laparoscopic gastric cancer surgery. Thin patients are riskier for complications during abdominal access. Abdominal access should be performed with an open technique in thin patientsÖğe Helicobacter pylori Increases Gastric Compliance on Resected Stomach After Laparoscopic Sleeve Gastrectomy(Springer, 2021) Kaplan, Kuntay; Turgut, Emre; Okut, Gokalp; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytBackground The relationship between high body mass index (BMI) and Helicobacter pylori (HP) was reported previously. But the mechanism is not clear. We aimed to evaluate the effect of HP on gastric compliance and volumes in obese patients. Materials and Methods One hundred fifty-nine patients who underwent sleeve gastrectomy due to morbid obesity were enrolled in the study and were divided into two groups as HP+ (n = 86) and HP- (n = 73) according to the HP status in resection materials. Demographics, pathological data, specimen sizes, volume, and compliance were retrospectively analyzed. Results The median age of the study group was 34 years (17-64 years) while the median BMI was 43 kg/m(2) (35-64, 3 kg/m(2)). Most of the patients (n = 134, 84.3%) were female. The median diameter of the widest point of the specimen was 22.5 cm (14-32 cm), and the median volume of the specimen was 790 cc (330-1920 cc). Both the diameter of the widest point and the volume of the specimens were significantly increased in the HP+ group compared to the HP- group (p < 0.001 and p = 0.017, respectively). In addition, the median compliance was 52.6 cc/mmHg, and the compliance was significantly higher (p < 0.001) in the HP+ group. There were no significant differences in specimen sizes between the two groups. Conclusion This is the first study showing that HP increases gastric compliance in obese patients who underwent LSG. The etiology and the effects of this increase in compliance have not been fully clarified yet. Further studies are needed to shed light on these effects.Öğe The impact of splenectomy on human lipid metabolism(Upsala Med Soc, 2022) Gunes, Orgun; Turgut, Emre; Bag, Yusuf Murat; Gundogan, Ersin; Gunes, Ajda; Sumer, FatihBackground: Splenectomy impacts hematological, immunological, and metabolic functions of the patient. Since our understanding of its metabolic effects, in particular effects on lipid metabolism, is limited, this study aims to investigate the effects of splenectomy on lipid metabolism. Methods: The data from 316 patients undergoing splenectomy between 2009 and 2019 were retrospectively analyzed. Thirty- eight patients whose serum lipid values were measured both preoperatively and 1 year after surgery were included in this study. Results: Significantly higher levels of total cholesterol, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) lipid profile were found in the postsplenectomy measurements. However, no significant differences were recorded in levels of triglyceride, HDL, or very-LDL. Conclusion: We determined that splenectomy does impact lipid metabolism, and that the metabolic effects of splenectomy should further be investigated.Öğe Is It Possible to Estimate the Liver Left Lobe Volume Using Preoperative Data Before Bariatric Surgery?(Springer, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytY Purpose Retraction of the left lobe of the liver (LLL) is an important step in bariatric surgical procedures. A good liver retraction will both facilitate the operation and reduce complications. The aim of the study is to identify patients with large LLL with preoperative anthropometric and laboratory data, and to reveal complications due to large LLL. Materials and Methods The data of 245 patients who underwent bariatric surgery in our department between April 2019 and March 2021 were retrospectively analyzed. The patients were divided into two groups according to the visibility of the caudate lobe of the liver, the left diaphragmatic artery-vein, and the fat pad on the esophagus after liver retraction. Results Univariate analyses revealed significant differences in BMI, waist and hip circumferences, TG, DM, and HbA1c values, but only BMI (p = 0.001) and the presence of DM (p = 0.017) were found to be independent predictors of LLL size. BMI >= 42.1 kg/m(2) indicates the size of LLL with 83% sensitivity and 49% specificity. Retractor-related complications were significantly higher in the large LLL group (p = 0.036). There was no difference between the two groups in terms of complications related to trocar insertion (p = 0.014) and postoperative liver enzyme levels (p = 0.714). The operation time (laparoscopic sleeve gastrectomy [LSG]; p = 0.021) (laparoscopic Roux-N-Y gastric bypass [LRYGB]; p = 0.020) and the amount of bleeding (LSG; p < 0.001) (LRYGB; p = 0.011) are higher in patients with large LLL. Conclusion Large LLL can be predicted and complications may be reduced with the help of preoperative data.Öğe Is Previous Abdominal Surgery an Obstacle to Laparoscopic Bariatric Surgery?(Springer India, 2021) Turgut, Emre; Kaplan, Kuntay; Okut, Gokalp; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytIt is generally considered that a previous history of abdominal surgery can negatively impact the patient's perioperative course. But the effects of it on laparoscopic bariatric surgery have not been sufficiently documented. Therefore, our study aims to analyse the impact of previous abdominal surgery on patients undergoing bariatric surgery. Data from patients who underwent surgery between January 2011 and November 2019 was analysed retrospectively. The study population was divided into the following four groups: those with no history of previous abdominal surgery (group A), those who had previously undergone lower abdominal (group B), upper abdominal (group C) and those who had both lower and upper abdominal surgery (group D). Patients' demographic data, type of surgical procedure, operative time, length of hospitalization, perioperative and postoperative complications were recorded for each patient in the database. In the case of 4 (0.3%) patients, conversion to open surgery from a laparoscopic intervention was required. No significant difference was found between the groups with previous abdominal surgery in terms of intraoperative complications (p: 0.551). The rate of postoperative complications was higher in patients who had previously undergone upper abdominal surgery; however, the difference in this rate compared to the other groups was found to be statistically insignificant (p: 0.189). We believe that during the decision-making process, neither patients nor surgeons should see previous abdominal surgery as an obstacle to laparoscopic bariatric surgery, thus permitting more freedom in selecting the most appropriate type of surgery for the patient.Öğe Is Prognostic Nutritional Index an Indicator for Postoperative 90-Day Mortality in Laparoscopic Gastric Cancer Surgery?(Routledge Journals, Taylor & Francis Ltd, 2022) Zengin, Akile; Bag, Yusuf Murat; Aydin, Mehmet Can; Kocaaslan, Huseyin; Kaplan, Kuntay; Sumer, Fatih; Kayaalp, CuneytGastic cancer is a life-threatening malignancy in the world. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a guiding marker for gastric cancer patients with laparoscopic gastrectomy. We retrospectively examined the medical records of 138 gastric cancer patients who had adenocarcinoma pathological diagnosis and operated laparoscopically. Patients were divided into two groups (survived and death) and these groups were compared with clinical and laboratory parameters results. The PNI was calculated as 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm(3)). Logistic regression analyses were performed to identify the risk factors of 90-day mortality. The median age of the study cohort was 62.5 (19-91) years, 98 (71%) were males, and 9 (6.5%) patients died during the 90-day after laparoscopic gastrectomy. The PNI levels were significantly lower in death group compared with survived group 37.5 (25-47.1) to 46.9 (22.8-64.9). The PNI (Odds Ratio = 0.81, 95% Confidence Interval 0.70-0.92, p = 0.003) was found as an independent factor for 90-day mortality in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 45.15 is the best-cutoff value for 90-day mortality after laparoscopic gastrectomy. 90-day mortality rate of PNI > 45.15 was 2.2% and PNI <= 45.15 was 13.6% found. Lower PNI is associated with increased 90-day mortality in laparoscopic gastrectomy for gastric cancer. The PNI may be a useful marker for predicting the 90-day mortality of gastric cancer patients after laparoscopic gastrectomy.Öğe Is Sleeve Gastrectomy or Roux-en-Y Gastric Bypass Better in Terms of Quality of Life?(Mary Ann Liebert, Inc, 2021) Turgut, Emre; Okut, Gokalp; Kaplan, Kuntay; Bag, Yusuf Murat; Sumer, Fatih; Kayaalp, CuneytIntroduction: Obesity has increased in frequency over recent years. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used technique worldwide, followed by the laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aims to compare the effects of these two techniques, LSG and LRYGB, on the patients' quality of life. Material and Methods: All patients who underwent surgery or postoperative checkups at our obesity clinic between December 2018 and December 2019 completed two face-to-face questionnaires: the Short Form 36 Health Survey and the Obesity-related Problems Scale. Information on each patient such as demographic data, American Society of Anesthesiologists scores, any previous surgeries, preoperative and/or postoperative complications, the type of surgery, and time elapsed since surgery was compared, retrospectively. Results: No significant statistical differences were found between the two procedures. A significant improvement in the postoperative quality of life was observed in all patients. Scores for female patients were observed to be lower than for male patients. No significant statistical difference was observed between the two age groups (50 years and older or <50 years) for either the LSG or LRYGB patients. Higher body mass index levels have prolonged hospital stay and score lower on many of the parameters.Öğe Mini-laparoscopic adrenalectomy with transgastric specimen extraction(Springer-Verlag Italia Srl, 2021) Sumer, Fatih; Bag, Yusuf Murat; Aydin, Mehmet Can; Evren, Bahri; Aydin, Emine Sener; Sahin, Ibrahim; Kayaalp, CuneytWe aimed to describe the initial experience of mini-laparoscopic adrenalectomy combined with transgastric specimen extraction and to assess its safety and feasibility. We used only 5-mm trocars, three ports for left adrenalectomy and four for right. Intraoperative gastroscopy was performed for specimen extraction through the mouth via an endoscopic snare. The gastrotomy was closed intracorporeally. Demographic, perioperative and pathological data were analyzed. There were 16 patients (12 females) with the mean age of 46.5 +/- 11.3 years and half of them had previous abdominal surgeries. The median operative time was 150 (45-432) min with a median blood loss of 88 (0-350) ml. The median oral intake time was 2 (1-4) days and the median length of hospital stay was 2 (2-5) days. There was no mortality and extraction-related complication. Histopathological median tumor length, width and depth were 3 cm, 2.15 cm, and 1.9 cm, respectively. The median specimen length, width and depth were 6.25 cm, 4 cm, and 2.2 cm, respectively. Mini-laparoscopic adrenalectomy combined with transgastric specimen extraction is a safe and feasible surgical technique. It provides a less invasive surgery and may also have some benefits on wound-related complications and cosmesis.Öğe A Novel Radiological Predictor for Postoperative Pancreatic Fistula After Stapled Distal Pancreatectomy(Sage Publications Inc, 2021) Bag, Yusuf Murat; Topel, Cagdas; Ozdemir, Egemen; Saglam, Kutay; Sumer, Fatih; Kayaalp, CuneytBackground Distal pancreatectomy (DP) is the main surgical treatment of benign and malignant lesions located in pancreatic body and tail. Postoperative pancreatic fistula (POPF) following DP is still a considerable cause of morbidity. Identification of risk factors for POPF after DP might provide some preventive applications. We aimed to evaluate the factors affecting POPF after DP and to present a new and easy radiological predictive factor. Materials and Methods Thirty-four patients underwent DP with stapler closure were included. Several risk factors for clinically relevant POPF (CR-POPF) were analyzed. Additionally, computed tomography findings of pancreatic thickness (PT), main pancreatic duct diameter (MPDD), and PT/MPDD ratio were evaluated for POPF. Results CR-POPF was observed in 10 patients (29.4%). Univariate and multivariate analyses showed that previous abdominal surgery and PT/MPDD ratio were predictive factors for CR-POPF after DP (P = 0.040, P = 0.034, respectively). The cutoff value for the PT/MPDD ratio was 8. Conclusion A PT/MPDD ratio greater than 8 (a wide pancreas with a narrow duct) is a significant predictive factor for CR-POPF following DP.Öğe Results of Intrahepatic Cholangiocarcinoma Resections: a Single-Center Analysis(Springer, 2022) Saglam, Kutay; Bag, Yusuf Murat; Bilen, Zafer; Isik, Burak; Aydin, Cemalettin; Yilmaz, SezaiIntroduction Intrahepatic cholangiocarcinoma (ICC) is the second most common primary neoplasm of the liver after hepatocellular carcinoma (HCC). Although an underlying cause is not usually found, liver flukes, cirrhosis, primary sclerosing cholangitis, and viral hepatitis have been found to increase the risk in recent years. In this study, we aimed to present our experience on ICC and compare the outcomes of patients with a concomitant liver pathology and with incidentally detected ICC. Patients and Methods Thirty-three patients who underwent surgical resection for ICC were included in the study. Patients were divided into two groups, group one (with concomitant liver disease, n = 13) and group two (incidentally detected ICC, n = 18). Demographics, perioperative findings, pathological properties, recurrence rates, and survival rates were retrospectively analyzed and compared between the groups. Results The mean age of patients was 59.77 +/- 9.81 years, of whom sixteen (51.6%) were males. Thirteen patients (41.9%) had concomitant liver disease, the most common being chronic hepatitis B infection. Eighteen patients (58.1%) had incidentally detected ICC. There were no significant differences between the groups except for follow-up time and recurrence rate. The recurrence rate was significantly higher in the incidentally detected ICC group (61.1% versus 7.7%, p = 0.003). Follow-up time was significantly higher in patients with concomitant liver disease (42 versus 17.5 months, p = 0.007). The mortality rate was higher in the incidentally detected ICC group (55.6 to 23.1%, p = 0.071) but the difference did not reach statistical significance. Conclusion Surgical resection in ICC patients with underlying liver disease is associated with better prognosis than in incidentally detected ICC patients. Incidental ICC may be a different tumor with different biology, hence the high recurrence rates.Öğe Splenic surgery: a ten years experience of a tertiary center in Turkey(Edizioni Luigi Pozzi, 2022) Gunes, Orgun; Bag, Yusuf Murat; Turgut, Emre; Gunes, Ajda; Sumer, Fatih; Kayaalp, CuneytAIM: Splenectomy has been performed for various indications. In this study, we aimed to present the experience of a tertiary center on splenic surgery and analyze what has changed in the last 10 years. MATERIAL AND METHODS: Three hundred and sixteen patients who underwent splenic surgery were enrolled in the study. Demographic data, comorbidities, American Society of Anesthesiologists score, indications, operation type, postoperative complications, and mortality were analyzed retrospectively. RESULTS: The most common indication was traumatic splenic injury. Immune thrombocytopenic purpura (ITP) and gastric cancer were the second and third. Splenectomy was performed on 300 (94.9%) patients. Splenorrhaphy, partial splenectomy, and splenopexy were the other procedures performed. Postoperative complications occurred in almost onethird of the patients (n=118, 37.3%). Most of them were grade 5 according to the Clavien-Dindo classification. CONCLUSIONS: Splenectomy has become a less preferred treatment option with the development of non-operative management in splenic trauma, medical treatments for hematological diseases, and a better understanding of the immune, hematological and metabolic functions of the spleen. In the future, minimally invasive and spleen-sparing surgeries will be performed more frequently for patients who need splenectomy even for those with trauma.Öğe Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?(Mary Ann Liebert, Inc, 2021) Aktas, Aydin; Kayaalp, Cuneyt; Gunes, Orgun; Kirkil, Cuneyt; Tardu, Ali; Aydin, Mehmet Can; Bag, Yusuf MuratBackground: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infection (SSI) on the one hand and irrational use of antibiotics on the other. The aim of this study was to determine the need/rationale for antibiotic prophylaxis in patients undergoing laparoscopic bariatric surgery, especially low-risk patients. Methods: This retrospective analysis involved 313 morbidly obese patients (body Mass Index [BMI] >= 40) who underwent laparoscopic BS at three medical centers between September 2018 and June 2019. During the trial, no inducement was given to use antibiotics, and the centers had chosen whether to use prophylaxis. The U.S. Centers for Disease Control and Prevention (CDC)-2016 criteria were used for the diagnosis of SSI. Results: Antibiotic prophylaxis was given to 181 patients, and the SSI rate in the entire series was 4.5% (14/313). There was no significant difference in SSI between the group who received antibiotics and that who did not (2.8% versus 6.8%, respectively; p = 0.09). Post-operative intra-abdominal complications were the main independent determinant for SSIs (p < 0.001). Antibiotic prophylaxis did not have any significant effect on the rate of SSI caused by these complications (2.2% versus 3.8%, respectively; p = 0.50). The second independent factor was the rate of SSI in patients with super-obesity (BMI >= 60), particularly incisional SSIs (p < 0.001). Antibiotic prophylaxis did not produce any significant decrease in the rate of SSI in patients with a BMI < 60 (2.8% versus 5.5%, respectively; p = 0.24). When these two independent factors were excluded, there were no patients with SSI in the no-antibiotics group, and only one in the antibiotic prophylaxis group (0.5%) (p = 1.00). Conclusions: Routine antibiotic prophylaxis should be questioned in laparoscopic BS. Prophylaxis may reduce incisional SSI in patients with a BMI of >= 60. In other cases, antibiotic prophylaxis does not provide a decrease in SSI
