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Öğe Clinical and surgical approach to parathyroid adenomas: A single-center experience(2019) Topal, Ugur; Dalci, Kubilay; Unal, Ayse Gizem; Saritas, Ahmet Gokhan; Gunay, Isa Burak; Uguz, Aysun Hatice; Sakman, GurhanAim: Primary hyperparathyroidism is a clinical condition caused by excessive parathyroid secretion of the parathyroid glands and related hypercalsemia. Hyperparathyroidism is a common cause of hypercalcemia. In this study, we aimed to present the results of patients operated on due to parathyroidadenoma in our clinic.Material and Methods: IPatients who underwent surgery for parathyroid adenoma in our clinic between January 2007 and January 2019 were included in the study. Clinical characteristics, biochemical data, treatment methods and results of the patients were analyzed retrospectively.Results: 156 patients with a mean age of 50.8 years participated in the study. Female sex was 76.2%. Preoperative calcium level was found as 11.2+1.02 mg/dl, Parathormone level was found as 114.7+109.5 pg / ml. The most common clinical presentation was asymptomatic hypercalcemia (48.7%). While 89.7% of the patients had only parathoridectomy, 3.2% had total thyroidectomy and 7.1% had lobectomy due to associated thyroid pathology (10.3%). Intraoperative rapid parathormone was used in 54.4% of the patients. Frozen examination was performed in all patients. The most common localization was inferior left 39.7%. The most common ectopic localization was intratymic at 2.6%. The mean duration of postoperative hospital stay was 3.81+2.69 days. Three patients (1.9%) had persistent hyperparathyroidism and 6 patients (3.8%) had recurrent hyperparathyroidism. The mean follow-up was 57.2+39.5 months. Conclusion: Proper preoperative evaluation, careful exploration, frozen examination and rapid parathormone test increase the success of parathyroid adenoma surgery.Öğe Comparison of results of laparoscopic and open surgical techniques in adrenal masses larger than 6 cm(2019) Topal, Ugur; Dalci, Kubilay; Yalav, Orcun; Unal, Ayse Gizem; Eray, Ismail Cem; Sakman, GurhanAim: In this study, we aimed to compare the results of conventional and laparoscopic adrenalectomy in patients with adrenal masses greater than 6 cm.Material and Methods: Thirty-six patients with tumor size greater than 6 cm who underwent adrenalectomy between January 2011 and January 2018 were included in the study. Patients were divided into two groups as Group 1 conventional and Group 2 Laparoscopic surgery. The two groups were retrospectively compared in terms of age, sex, mass localization, mass size, duration of operation, amount of bleeding, duration of hospitalization, duration of onset of food intake, perioperative mortality, early period complications and re-admission to the hospital within 90 days. P0.05 was considered statistically significant.Results: There were 13 patients in Group 1 and 23 patients in Group 2. There was no statistically significant difference between the groups in terms of age, sex, tumor localization, tumor size, indications for operation, postoperative complications, perioperative mortality and readmission within 90 days. Duration of operation (min), amount of bleeding (ml), duration of oral intake (day) and duration of hospitalization (day) were higher in Group 1 and statistically significant.Conclusion: Laparoscopic adrenalectomy has demonstrated advantages in patients with a mass greater than 6 cm compared to conventional surgery, such as short operation duration, less blood loss, early onset of oral food intake and shorter hospital stay. It can be safely used in patients with a mass larger than 6 cm.Öğe The impact of previous open abdominal surgery on the outcome of laparoscopic colorectal surgery(2021) Eray, Ismail Cem; Topal, Ugur; Yalav, Orcun; Dalci, Kubilay; Saritas, Ahmet Gokhan; Rencuzogullari, AhmetAim: Although the laparoscopic approach is increasingly being used in colorectal surgery, it is anticipated that the technical problems caused by previous abdominal open surgery (PAOS) will adversely affect the outcomes. The aim of this study was to evaluate the outcomes of previous abdominal surgery in patients with colorectal cancer who underwent laparoscopic surgery for treatment. Material and Methods: Among the patients who underwent laparoscopic surgery for colorectal cancer between January 2015 and December 2018, those who had a history of previous abdominal surgery and those who did not were compared. Those with a history of laparoscopic abdominal surgery are not included in the PAOS group and short-term postoperative complications, conversion to open surgery, reoperations, hospital readmissions, and mortality rates were analyzed between the groups. Results: 21 of 140 patients who underwent laparoscopic surgery for colorectal cancer had PAOS. The groups with and without PAOS were similar in terms of age, sex, body mass index, ASA score, and comorbid disease. No difference was observed regarding conversion to open surgery (p = 0.513), postoperative complications (p> 0.05), reoperations (p = 0.162), unplanned hospital readmissions (p = 0.154), and perioperative mortality (p = 0.136) between the two groups. Conclusion: We believe that laparoscopy can be safely performed in patients with colorectal cancer who had previous abdominal open surgery with similar clinical and postoperative complication rates as in patients without a history of PAOS.Öğe Our surgical experience in cholangiocellular carcinoma(2020) Saritas, Ahmet Gokhan; Ulku, Abdullah; Topal, Ugur; Dalci, Kubilay; Aydin, Erdi; Akcam, TolgaAim: Cholangiocellular carcinomas are rare bile duct tumors. They are categorized as intrahepatic(iCCA), perihilar(pCCA) or distal(dCCA) cholangiocarcinomas according to their anatomical location. In this study, we aimed to present our clinical experience in patients with cholangiocellular carcinoma. Material and Methods: Patients who underwent curative surgery with the diagnosis of cholangiocellular carcinoma between 2010 and 2019 were retrospectively reviewed. Demographic and clinical characteristics, surgical procedures, tumor characteristics, short- and long-term results and survival of the patients were analyzed.Results: Twentynine patients were included in the study. The mean age of the patients was 63.3(±10.8) years, and 52% of the patients were older than 65 years. Male sex was 79.3%. Percutaneous biliary drainage was performed in 52% of the patients before the operation. Tumor localizations were distal (dCCA) in 12 (41.4%) patients, perihilar (pCCA) in 11 (38%) patients, and intrahepatic (iCCA) in 6 (20.6%) patients. Only biliary resection was performed in 69%, hepatic + biliary resection in 27.6%, and only hepatic resection in 3.4% of the patients. The mean tumor size was 3.08 cm (±1.91), tumor stage was commonly stage II (58.6%) and postoperative complication was seen in 13.8% of the patients. Ninety-day unplanned readmission was observed in 31.3%, postoperative mortality in 6.9%, and recurrence during postoperative follow-up in 24.2% of the patients. The mean survival time was 22.82(±13.72) months. Conclusion: The type of surgical approach to be performed in cholangiocellular carcinoma is related to the localization of the tumor. With the right patient selection, curative surgical treatment can be performed at low morbidity and mortality rates.Öğe Prognostic value of neutrophil-to-lymphocyte ratio in patients undergoing curative surgical resection for hepatocellular carcinoma(2020) Saritas, Ahmet Gokhan; Ulku, Abdullah; Topal, Ugur; Dalci, Kubilay; Eray, Ismail Cem; Akcam, TolgaAim: the purpose of this study is to determine the prognostic value of the preoperative Neutrophil-to-Lymphocyte ratio (NLR) in patients who underwent curative surgical treatment for hepatocellular carcinoma (HCC). Materials and Methods: Patients who underwent curative resection for HCC between 2004 and 2015 were included in the study. Patients were divided into two groups based on the cut-off value: Group 1 (NLR low) and Group 2 (NLR elevated). Demographics and clinical characteristics, tumor characteristics, and mean survival of patients were compared between the groups.Results: 41 patients were included in our study and Group 1 (NLR low) consisted of (n:11) patients; Group 2 (NLR elevated) consisted of (n:30) patients based on a cut-off value of 2.43. The number of males was higher in both groups (90.9% vs 90%, p:0.712). The Child-Plug class A was the most common one in both groups (81.8%vs76.7%, p:0.680). HBV infection was the most common etiological cause (81.8% vs 53.3%, p:0.344). Lesions were predominantly located in the right lobe (63.6% vs 66.7%, p:0.568). The total tumor diameter was similar (6.56 cm vs 8.69 cm, p:0.258). In the multivariate analysis for survival, tumor diameter greater than 5 cm (HR 1.412 95% - Cl0.345-5.780, p:0.018) and NLR higher than 2.43 (HR 0.100 95% -Cl 0.011-0.882, p:0.038) were independent risk factors. Overall survival time was found to be lower in Group 2 compared to Group 1 (171 vs 106 months p:0.033). Disease-free survival rates were similar in the groups (37 vs 43 months, p:0.485).Conclusion: Although the elevated NLR level was found to be a risk factor for decreased overall survival in our study, this was not related to clinicopathological variables.Öğe A rare cause of acute abdominal pain: Torsion of wandering spleen(2020) Topal, Ugur; Dalci, KubilayWandering spleen is a rare condition presenting as the spleen being found somewhere different from its usual location due to the looseness of the peritoneal ligaments of the spleen. Its occurrence rate among the major splenectomy series in medical literature is less than 0.5%. It usually presents itself between the ages of 20 and 40 and the majority of the patients are women. A 20-yearold female patient with recurrent abdominal pain was admitted to our emergency clinic with abdominal pain going on for 3 days, nausea, vomiting and loss of appetite. Computerised Tomography (CT) indicated a pelvis localised spleen and an infarctus due to a non-homogenous parenchyma area. The patient was operated on with a provisional diagnosis of wandering spleen. During exploration a relatively large, congested and mobile spleen was found in the pelvis and a splenectomy was performed. The wandering spleen presents itself on a spectrum ranging from asymptomatic to acute abdomen. Symptoms usually arise from complications related to torsion. The surgical methods performed on wandering spleen are splenorraphy and splenectomy. The deciding factor for determining the treatment method is the existence of infarction in spleen. Wandering spleen is very rare and a cause for acute abdominal pain, we think it is important to consider it for differential diagnosis in cases with acuteabdominal pain, especially the cases with intra-abdominal mass findings, for an accurate diagnosis and treatment plan.
