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    How much more can minimally invasive surgery be minimized? Mini-laparoscopic Nissen fundoplication in adults
    (2021) Sümer, Fatih; Okut, Gokalp; Kaplan, Kuntay; Baran, Necip Tolga; Kayaalp, Cuneyt
    Introduction: Mini-laparoscopy has become a current issue as a minimally invasive technique in gastroesophageal reflux surgery, which does not require specimen extraction. There are a limited number of cases of Nissen fundoplication performed in the adult age group using the mini-laparoscopic method. In this article, our aim is to draw attention to the fact that mini-laparoscopy is a preferable technique in Nissen fundoplication surgery. Materials and Methods: Seven patients underwent mini-laparoscopic Nissen fundoplication between January 2010 and December 2019. Demographic data and perioperative parameters were analyzed retrospectively. Results: Three of our patients (43%) were female and the average age of our patients was 45.4±11.1. All patients presented with complaints of heartburn and regurgitation. There was Barrett metaplasia in the pathology results and no dysplasia was observed in any patient. Mean operation time was 117±49.9 min, bleeding amount was <10 ml in all surgeries. The median time to oral intake was 8th post-operative h, and no complications developed in any of our patients. In the post-operative period, there was no need for narcotic analgesic, after a single dose of nonsteroidal anti-inflammatory drugs, the treatment was continued with two doses of oral analgesic. Median length of stay hospital was 3 (2–4) days, the median follow-up period was 67 (29–120) months. Conclusion: Anti-reflux surgery can be easily performed, mini-laparoscopically since it is not a resective surgical procedure. It can provide advantages such as better cosmesis, less port site complications, and less analgesic use
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    Laparoscopic partial splenectomy: Our series of 3 patients
    (2021) Sümer, Fatih; Baran, Necip Tolga; Güneş, Orgun; Kaplan, Kuntay; Gündoğan, Ersin; Kayaalp, Cüneyt
    Abstract: Total splenectomy can cause many perioperative and postoperative complications. Partial splenectomy has been preferred in recent years in order to minimize the immunological complications associated with splenectomy. With this case series, we aim to present our own experiences with 3 patients.
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    A new model for prediction of bowel gangrene in sigmoid volvulus
    (Turkish Assoc Trauma Emergency Surgery, 2023) Ceylan, Cengiz; Baran, Necip Tolga; Kocaaslan, Huseyin; Gungorur, Omer; Cengiz, Emrah; Guzel, Mehmet; Angin, Yavuz Selim
    BACKGROUND: Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods.METHODS: In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann-Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis.RESULTS: Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19-88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797-41.211, p=0.001), CRP >= 0.71 mg/dl (OR: 8.107 CI 95%: 2.520-26.082, p<0.0001), potassium >= 3.85 mmoL/L (OR: 3.889; 95% CI): 1.333-11.345, p=0.013), and LDH >= 288 U/L (OR: 3.889; CI 95%: 1.333-11.345, p=0.013), whereas, in multivariate analyzes, only CRP >= 0.71 mg/dL (OR: 3.965; CI 95%: 1.071-15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737-0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was >= 7 (OR: 9.846; 95% CI: 3.016-32.145, p<0.0001).CONCLUSION: Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.
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    Predictive Factors of Postoperative Pancreatic Fistula in Geriatric Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancy
    (Coll Physicians & Surgeons Pakistan, 2023) Ceylan, Cengiz; Kocaaslan, Huseyin; Baran, Necip Tolga; Kulus, Mehmet; Saglam, Kutay; Aydin, Cemalettin
    Objective: To identify predictive factors associated with the occurrence of postoperative pancreatic fistula (POPF) following pancreato-duodenectomy (PD) in an increasingly geriatric population.Study Design: Observational study.Place and Duration of the Study: Department of General Surgery, Inonu University, Malatya, Turkey, from January 2010 to April 2022.Methodology: Demographic and clinicopathological data of 74 geriatric patients who underwent PD for periampullary tumours in the clinic at Inonu University were retrieved from the patient database. POPF was defined and categorised based on the guidelines established by the International Study Group for Pancreatic Surgery (ISGPS). The patients were stratified into two cohorts of POPF and no POPF. Univariate and multivariate analyses were conducted to compare variables between the two groups.Results: The median age of the patient population was 72 (65-92) years, and 51 (68.9%) individuals were male. Among the 74 patients, 35 (47.3%) experienced POPF. In the multivariate analysis, hypertension (HT, p=0.012), Wirsung diameter <3.5 mm (p<0.01), and pancreaticojejunostomy (PJ, p=0.022) emerged as independent risk factors for POPF.Conclusion: In the context of geriatric patients undergoing PD, HT, intraoperative wirsung diameter <3.5 mm, and PJ were identified as independent risk factors for POPF. These findings can guide the adoption of safer techniques in preoperative and intraoperative evaluations, as well as in postoperative follow-ups of patients presenting with these risk factors.
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    Ten years single center bariatric surgery experience
    (2021) Turgut, Emre; Kaplan, Kuntay; Okut, Gokalp; Cengiz, Emrah; Kocaaslan, Hüseyin; Baran, Necip Tolga; Karahan, Mehmet; Kayaalp, Cuneyt
    Introduction: Various surgical modalities have been developed to reduce the amount and absorption of nutrients in the fight against obesity. We aimed to share how the single-center experience was affected by the developments in the world and its change over time with the literature. Materials and Methods: The records of patients who underwent laparoscopic bariatric surgery between May 2010 and December 2020 were reviewed retrospectively. Demographic characteristics of the patients, indications for surgery, preparation for surgery, surgical technique, and post-operative follow-up stages were examined in detail. Results: A total of 1422 patients underwent bariatric surgery over a 10-year period. Laparoscopic Roux-n-Y Gastric Bypass (LRYGB) was performed in 946 patients and Laparoscopic Sleeve Gastrectomy (LSG) was performed in 476 patients. The operation time (p<0.001) and the intraoperative blood loss (p<0.001) in LRYGB were significantly higher than LSG. The difference was not significant in terms of length of hospital stay (p=0.149) and drain usage (p=0.782). While intraoperative complications occurred in 49 (5.1%) patients in LRYGB, this number was 5 (1%) in LSG (p<0.001). There was no significant difference in Clavien Dindo class 3 and higher complication rates between the groups (p=0.782). Mortality was seen in only 7 (0.5%) patients. Conclusion: Today, standard techniques are applied in both procedures and the choice is left to the patient. Regardless of the technique applied, laparoscopic bariatric surgery can be applied as an effective and safe method in the treatment of morbid obesity until an alternative treatment is found.