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    Clinicopathologic features of obese patients with rectal cancer and short-term results of surgery
    (2018) Oter, Volkan; Ofkeli, Ozcem; Ulas, Murat; Ozer, Ilter; Bostanci, Erdal Birol
    Aim: Some authors related the increased body mass index (BMI) with postoperative complication rates also increase, number of harvested lymph nodes reduce and sparing the anal sphincter is much more challenging in the surgical management of rectal cancer. In this study, we evaluated clinic-pathologic features and short-term surgical results in obese and non-obese patients with rectal cancer. Material and Methods: 54 obese and 326 non-obese patients are evaluated for clinic-pathological features, postoperative complications, re-operation rates and mortality rates. Results: The rate of distally located rectal tumor is found significantly higher in obese patients than non-obese patients (p<0.05). Although anterior resection has been performed more commonly in Group-I, abdominoperineal resection procedure is found significantly higher in Group-II, (p<0.05)..Harvested lymph nodes ratio between two groups was quite close to each other so this difference is not statistically significant. .Postoperative results were similar between the groups except total postoperative complications and re-operations for anastomotic leak. Although re-operation rates for anastomotic leak are found different, they are quite close between the two groups and this difference is not statistically significant. In contrast to some of the previously published articles, there was not any significant difference in morbidity and mortality between the two groups in our study. Conclusion: In our opinion there is not a clear conclusion to change the operative strategy for enough number of harvested lymph nodes but meticulous technique should be utilized to reduce the rate of anastomotic leak and resultant re-operations in this group of patients
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    Effect of nebivolol on liver regeneration in an experimental 70% partial hepatectomy model
    (Elsevier Singapore Pte Ltd, 2017) Sumer, Fatih; Colakoglu, Muhammet Kadri; Ozdemir, Yilmaz; Ozsay, Oguzhan; Ilter, Ozer; Bostanci, Erdal Birol; Akoglu, Musa
    Background: Factors affecting liver regeneration are still relevant. The purpose of this study is to investigate the effect of nebivolol treatment on liver regeneration in rats in which 70% partial hepatectomy was performed. Methods: Three groups were created: the control group, the low dose group, and the high dose group, with 20 rats in each group and 70% hepatectomy was performed in all rats. Immediately after partial liver resection, 2 mL physiological saline solution was administered to the control group via oral gavage, 0.5 mg/kg nebivolol was administered via oral gavage to the low dose group and 2 mg/kg nebivolol was administered via oral gavage to the high dose group. On the 1st and 5th days after liver resection, 10 subjects were sacrificed from each group, and liver weights and the mitotic count and Ki-67 were measured. Results: Regenerating liver weight on the 1st and 5th days after partial hepatectomy was statistically different in the low dose and high dose nebivolol groups compared to the control group. Mitotic count on the 1st day after partial hepatectomy was significantly higher in the low dose and high dose nebivolol groups than the control group. There was no statistically significant difference detected between the three groups for the 5th day. On the 1st day, Ki-67 rates were significantly higher in both groups given nebivolol than the control group. However, 5th day results were not statistically significant. Conclusion: Nebivolol increases regeneration after partial hepatectomy in rats. (C) 2016 Asian Surgical Association and Taiwan Robotic Surgical Association. Publishing services by Elsevier B.V.
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    Effects of carbon dioxide pneumoperitoneum on hepatic function in obstructive jaundice: an experimental study in a rat model
    (Springer, 2010) Bostanci, Erdal Birol; Yol, Sinan; Teke, Zafer; Kayaalp, Cuneyt; Sakaogullari, Zisan; Turkcu, Ummuhani Ozel; Bilgihan, Ayse
    The physiology of the patient during laparoscopy differs from that of open surgery. Both pneumoperitoneum and obstructive jaundice impair the hepatic function, but the combined insult has not been previously examined. In this study, we aimed to investigate the effects of carbon dioxide (CO2) pneumoperitoneum on hepatic function in a rat model of obstructive jaundice. Forty-four male Sprague-Dawley rats were divided into four groups: group 1 (n = 10), sham-operated group; group 2 (n = 12), obstructive jaundice group; group 3 (n = 10), CO2 pneumoperitoneum group; and group 4 (n = 12), obstructive jaundice and CO2 pneumoperitoneum group. Common bile duct was ligated and divided in the obstructive jaundice groups. After 6 days, a 12-mmHg pneumoperitoneum was induced, maintained for 60 min, and released for 120 min. Blood samples were drawn for the measurement of white blood cell and platelet counts, serum liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin). Tissue samples were obtained for analyses of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) levels. We evaluated the degree of liver injury on a grading scale from 0 to 4, histopathologically. Pneumoperitoneum after biliary obstruction resulted in an increase in AST and ALT levels and a decrease in white blood cell and platelet counts. However, changes in liver tissue MDA, GSH, and SOD levels did not correlate with the changes in AST and ALT levels and white blood cell and platelet counts. After sham operation with pneumoperitoneum, the GSH levels in liver homogenate were significantly decreased in the group 3 when compared to the group 2. On the other hand, obstructive jaundice itself caused significant reduction in the SOD activity of liver homogenate in comparison to the group 3. Histopathologically, sinusoidal congestion and vacuolization were more severe in the group 3. Alterations in hepatic function occur in pneumoperitoneum applied jaundiced subjects. However, there were no statistically significant differences between the groups 2 and 4 with regard to white blood cell and platelet counts, serum liver enzymes including AST, ALT, and total bilirubin values, MDA and GSH levels and SOD activity of liver homogenate, and histologic damage. These results indicate that there is no additional risk on liver function associated with pneumoperitoneum performed in obstructive jaundice.
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    Interaction between pancreatic fluid and three different hemostatic agents: an in-vitro study
    (2019) Oter, Volkan; Karaman, Kerem; Bal, Ali; Aziret, Mehmet; Ercan, Metin; Bostanci, Erdal Birol
    Aim: Although recent developments in surgery led to mortality reduction under 2%, postoperative pancreatic fistula (POPF) remains high reported from 20% up to 40%. Primary aim of the present in-vitro study was to determine the interaction between pancreatic fluid and three different hemostatic agents.Material and methods: Three different hemostatic agent; fibrin sealant Tisseel, Floseal and Ankaferd Blood Stopper (ABS) were mixed in tubes with pancreatic fluid in equal proportions. The length of the gel aggregate of each sample which covers the pancreatic fluid in the tube was measured as mm and thereafter statistically compared.Results: Tisseel significantly formed an intensely thicker gel than Floseal and ABS (Tisseel vs FloSeal; P0.0001, Tisseel vs ABS; P0.0001). Further, the thickness of the gel formation was significantly higher in FloSeal-pancreatic fluid mixture than the ABS-pancreatic fluid mixture (P0.0001). Under light microscope, Tisseel formed a much more homogenous and dens mixture than Floseal and ABS.Conclusion: Tisseel fibrin sealant has beneath its hemostatic properties also the potential of preventing pancreatic fistula development. Further in-vitro and in-vivo studies are needed to reach a definitive conclusion.Keywords: Hemostasis; Pancreatic Fistula; Hemostatic Agents; Interaction.
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    Recovery of hypoglycemia symptoms after insulinoma negative pancreatic surgery: Case series
    (2017) Aziret, Mehmet; Ercan, Metin; Senturk, Adem; Bostanci, Erdal Birol; Akoglu, Musa
    Insulinoma, one of the most common endocrine tumors of the pancreas, is usually benign, solitary and has an intrapancreatic location. Precise localization of insulinoma is important for curative treatment. This study looks at 5 patients who underwent operation for insulinoma. The median age, body mass index, preoperative insulin and C-peptide levels, and length of hospital stay were 36 years, 27 kg/m2, 32 μU/ml, 7ng/ml and 21 days, respectively. An endoscopic ultrasound (EUS) and intraoperative ultrasound (I-OUS) were conducted on all of the patients. Enucleation was performed on 3 patients and distal pancreatectomy ± splenectomy on 2 patients. Furthermore, the histopathological examination conducted on the patients showed insulinoma in 3 patients and granulomatous lymphadenitis in 1 patient, with one observed to have normal pancreas tissues. Following the operation, the glucose level of all patients was found to be within a normal range. Distal pancreatectomy and enucleation can only be performed after determining precise localization of insulinoma via EUS and I-OUS.