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Öğe Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult(Elsevier Sci Ltd, 2016) Sumer, Fatih; Kayaalp, Cuneyt; Karagul, Servet; Ertugrul, Ismail; Yagci, Mehmet Ali; Onur, AsimINTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this rare condition should be based on the individual's clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. PRESENTATION OF CASE: An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. DISCUSSION: Spontaneous rupture of the intrahepatic biliary duct is a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. CONCLUSION: Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient's clinical and comorbidity status. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.Öğe Comparison of Direct Trocar Entry and Veress Needle Entry in Laparoscopic Bariatric Surgery: Randomized Controlled Trial(Mary Ann Liebert, Inc, 2015) Ertugrul, Ismail; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Sumer, Fatih; Karagul, Servet; Tolan, KeremBackground: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery. Materials and Methods: Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant. Results: Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6 +/- 94.6 versus 217.6 +/- 111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage. Conclusions: DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.Öğe Comparison of Harmonic scalpel and Ligasure devices in laparoscopic Roux-en-Y gastric bypass(Termedia Publishing House Ltd, 2017) Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, Fatih; Yagci, Mehmet AliIntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most preferred bariatric procedures in the world for surgical treatment of morbid obesity. The Harmonic scalpel (HS) and LigaSure (LS) are the most commonly used devices in laparoscopic surgery. As far as we know, there is no comparative study of the two energy devices in LRYGB for morbid obesity. Aim: To compare the intraoperative performances of the two energy devices in LRYGB for morbid obesity. Material and methods: The HS and LS were used in 43 and 42 cases, respectively. The patient demographics of both groups were comparable. The duration of the procedures (gastric pouch creation time and total operation time), quantity of bleeding (during gastric pouch creation and total quantities of bleeding) and the number of pneumoperitoneum desufflations due to smoking that impaired sight fields were recorded prospectively. Results: Gastric pouch creation time (HS: 22.5 +/- 9.5 vs. LS: 19.5 +/- 9.7 min, p = 0.15), bleeding during gastric pouch preparation (HS: 15.3 +/- 30.5 vs. LS: 17.5 +/- 31.3 ml, p = 0.74), total operation time (HS: 183.2 +/- 47 vs. LS: 165.3 +/- 37.1 min, p = 0.06) and total bleeding (HS: 110 +/- 195.5 vs. LS: 102.5 +/- 70 ml, p = 0.81) were similar in the two groups. Only the mean number of pneumoperitoneum desufflations due to smoking was lower in the HS group (HS: 0.28 +/- 0.49 vs. LS: 0.57 +/- 0.78, p = 0.04). Conclusions: The HS and LS performed similarly in LRYGB, with fewer desufflations from smoking in the HS group.Öğe Comparison of Stapled Versus Stapleless Sleeve Gastrectomy with Natural Orifice Specimen Extraction (NOSE)(Wolters Kluwer Medknow Publications, 2021) Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, FatihBackground: Sleeve gastrectomy is a stapler dependent bariatric procedure. A stapleless sleeve gastrectomy can be necessary for certain circumstances. Aims: Here, we aimed to show whether laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) can be an alternative procedure o stapled sleeve gastrectomy. Patients and Methods: In the stapleless group (n = 6), no staplers were used and after vertical resection of the stomach by energy devices, the stomach remnant was closed by two rows of intracorporeal sutures. The resected specimen was removed through the mouth using an endoscopic snare. In the stapler group (n = 7), sleeve gastrectomy was carried out with linear stapler under the guidance of 36 Fr Bougie. The specimens were extracted from the left upper quadrant trocar site. Results: A total of 13 patients were compared (stapleless = 6 and stapled group = 7). All the sleeve gastrectomies were completed laparoscopically. The operative time was longer at 200 minutes (range 120-300) versus 120 minutes, (range 90-200) p = 0.07) and the amount of bleeding was higher at 100 ml (range 50-200) versus 30 ml (range 10-50) (p = 0.004) in the stapleless group. Leakage and gastrointestinal bleeding were seen in the stapleless group but no complications were found in the stapler group. No statistically significant difference was found between the metabolic outcomes of the two groups after the operation (p > 0.05). Decrease in BM at similar rates was observed in 5 postoperative year (stapleless group: 35 kg/m(2) (range 31-39) versus stapled group: 36.5 kg/m(2) (range 31-39), p > 0.05). Conclusion: Laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction has longer procedure time, more blood loss and complications.Öğe Efficacy of red cell distribution width and plateletcrit as predictors of subclinical inflammation in obesity(2019) Kuzu, Fatih; Ertugrul, IsmailAim: The present study aimed to investigate the relationship of the hematological predictors of inflammation in complete blood count with body mass index (BMI) and homeostatic model assessment for insulin resistance (HOMA-IR) values.Material and Methods: The study included 354 subjects, who were admitted to the endocrinology outpatient clinic between January 2016 and March 2018. According to their BMI values, the subjects were divided into five groups as class III obesity, class II obesity, class I obesity, overweight, and normoweight. In addition, the subjects were divided into two groups as HOMA-IR 2.7 and HOMA-IR ≥2.7 to evaluate insulin resistance. Medical records of all the patients were reviewed and the data were collected retrospectively. As the predictors of subclinical inflammation, the mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were compared among the study groups.Results:There were statistically significant differences among the BMI groups in terms of WBC, neutrophil count, lymphocyte count, RDW, platelet count, and PCT values. Hemoglobin, WBC, neutrophil count, lymphocyte count, RDW, platelet count, and PCT value were significantly higher in those having HOMA-IR value of ≥2.7. Multivariate linear regression analysis revealed significant correlations of BMI with RDW and PCT values, whereas HOMA-IR showed a correlation only with PCT value.Conclusion: RDW and PCT are simple and low-cost markers that are able to predict the development of cardiovascular complications and other comorbidities in overweight and obese subjects.Öğe Fibrin sealant use in pilonidal sinus: Systematic review(Baishideng Publishing Group Inc, 2016) Kayaalp, Cuneyt; Ertugrul, Ismail; Tolan, Kerem; Sumer, FatihAIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease. METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 +/- 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients. CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.Öğe Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report(Elsevier Sci Ltd, 2016) Ertugrul, Ismail; Tardu, Ali Tardum; Tolan, Kerem; Kayaalp, Cuneyt; Karagul, Servet; Kirmizi, SerdarINTRODUCTION: We aimed to present a patient with gastric pouch bezoar after having a bariatric surgery. PRESENTATION OF CASE: Sixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely. DISCUSSION: The gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints of these patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery. CONCLUSION: Possibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients. (C) 2016 The Author( s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.Öğe Identification of Ureter during Colorectal Surgery Cannot Always Avoid Ureteral Injury: Duplicated Collecting System(Southeastern Surgical Congress, 2015) Tardu, Ali; Kayaalp, Cuneyt; Ertugrul, Ismail; Yagci, Mehmet Ali[Abstract Not Available]Öğe The impact of bariatric surgery on hematological inflammatory parameters(2019) Kuzu, Fatih; Ertugrul, IsmailAim: The aim of this study was to evaluate hematological inflammatory parameters before and after bariatric surgery and investigate the effect of surgery on these parameters.Material and Methods: A total of 71 patients who underwent a Roux-en-Y gastric bypass (RYGBP) or a sleeve gastrectomy (SG) procedure were included in the study. The preoperative levels of the inflammatory parameters of C-reactive protein (CRP) and the white blood cell count (WBC), as well as the hematological inflammatory parameters of red blood cell distribution width (RDW), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and the neutrophil-to-lymphocyte ratio (NLR) were compared with the postoperative 6th and 12th month values.Results: Both the RYGBP and SG surgical techniques were used in this study. Significant reductions were seen in the postoperative 6th and 12th month values of CRP and WBC, which were used as an indicator of the severity of inflammation. Along with the decrease in BMI and the standard indicators of inflammation, there were also corresponding statistically significant changes in the levels of the more recently used hematological inflammatory markers of RDW, MPV, PDW, PCT, and NLR (p0.05).The statistical evaluation revealed a significant positive correlation between the serum WBC and CRP values and NLR measured at postoperative 6 th months. The postoperative 12 th month results indicated a significant positive correlation between the serum WBC and PCT values and also between the CRP and MPV values.Conclusion: Significant improvements were observed in previously elevated hematological inflammatory parameters in obese patients after bariatric surgery.Öğe Influence of repeated measurements on small bowel length(Springer International Publishing Ag, 2016) Karagul, Servet; Kayaalp, Cuneyt; Kirmizi, Serdar; Tardu, Ali; Ertugrul, Ismail; Tolan, Kerem; Sumer, FatihPurpose: Measurement of small bowel length (SBL) is a common procedure in gastrointestinal surgery. When required, repeated SBL measurements can be done during surgery. Our aim was to evaluate whether these repeated measurements differ in SBL results. Methods: Small bowel length was measured during laparotomy in 28 patients between ligament of Treitz and caecum, using a standard measure, two times in each patient consecutively by two different surgeons from the anti-mesenteric border of the bowel. Results: The median age was 33 (19-67) including 18 male. There were 16 healthy donors for living related liver transplantations. Second measurements, performed immediately after the first measurements, significantly shortened the measured SBLs in the same patients (580 +/- 103 vs. 485 +/- 78 cm, p < 0.001). Conclusions: During surgery, repeated length measurements caused contractions in the small bowel and this resulted to a significant decrease in the SBL. This should be keep in mind to prevent mismeasurements.Öğe Laparoscopic Treatment of Primary Hydatid Cyst of Omentum(Int College Of Surgeons, 2019) Ertugrul, Ismail; Kayaalp, Cuneyt; Dirican, Abuzer; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarOmental hydatid cysts usually secondarily exist after the spontaneous, traumatic, or iatrogenic perforation of primary abdominal hydatid cysts. An isolated omental hydatid cyst in the absence of other organ involvement is very rare. Here, we present a 49-year-old male with a primary omental hydatid cyst. He was living in an urban area, but he spent his childhood in rural areas and worked with livestock. The differential diagnosis was not easy because of the negative serological test. Laparoscopic exploration revealed the diagnosis of hydatid cyst and it was removed by laparoscopy without spillage of the cyst contents. After the total excision, no albendazole treatment was prescribed. Isolated omental hydatid cysts should be in the differential diagnosis of the peritoneal cysts and its laparoscopic total excision is a feasible treatment.Öğe Management of Acute Sleeve Gastrectomy Leaks by Conversion to Roux-en-Y Gastric Bypass: a Small Case Series(Springer, 2017) Saglam, Kutay; Aktas, Aydin; Gundogan, Ersin; Ertugrul, Ismail; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarManagement of early sleeve gastrectomy leak remains challenging. The recommended approach is endoscopic stenting and abdominal drainage. Conversion to a Roux-en-Y gastric bypass (RYGB) is a common procedure used for late fistulas with distal obstruction. Here, we have presented three cases of early staple line leaks treated by conversion to RYGB. These patients had uncontrolled abdominal infections despite intensive medical treatments, and surgery was elected for abdominal drainage as well as to control the source of sepsis. All the patients were discharged without problems, and successful weight loss processes continued. Conversion to RYGB of a sleeve gastrectomy leak in an acute setting can be a feasible method in the case of inevitable surgical drainage for abdominal sepsis.Öğe Reresection of Colorectal Liver Metastasis with Vena Cava Resection(Hindawi Ltd, 2016) Tardu, Ali; Kayaalp, Cuneyt; Yilmaz, Sezai; Tolan, Kerem; Ersan, Veysel; Karagul, Servet; Ertugrul, IsmailThe best known treatment of the colorectal liver metastasis is the complete surgical excision with clean surgical margins. However, liver resections sometimes cannot appear technically feasible due to the high number of metastases in the liver, in cases of recurrent resections or invasion of the tumors to the major vascular structures or neighboring organs. Here, we presented a colorectal recurrent liver metastasis invading the retrohepatic vena cava, right adrenal gland, and right diaphragm. En masse resection of the tumor with caudate hepatectomy combined with vena cava resection and surrounding adrenal and diaphragm resections was accomplished. Caval reconstruction was done by a 5 cm in length cryopreserved vena cava homograft under isolated caval clamping. Postoperative period was uneventful and she was discharged on day 11. As a conclusion, combined liver and vena cava resection for a recurrent colorectal liver metastasis is a feasible procedure even with additional neighboring organ resections. Isolated vena cava occlusion with the preservation of the hepatic blood flow may decrease the risk of liver injury in case of previous chemotherapy for liver metastasis.Öğe Retroperitoneal mass presenting as recurrent inguinal hernia: A case report(Elsevier Sci Ltd, 2016) Tardu, Ali; Yagci, Mehmet Ali; Karagul, Servet; Ertugrul, Ismail; Kayaalp, CuneytINTRODUCTION: Retroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESENTATION OF CASE: A 53 year old male admitted with the symptoms of weight loss, abdominal discomfort and left sided recurrent inguinal hernia. Physical examination demonstrated an abdominal mass in the left flank and an irreducible, painless scrotal mass. He had a history of left sided inguinal hernia surgery six years ago. Computed tomography revealed a large enhancing left sided retroperitoneal mass invading the colon, pancreas and kidney and it was going down towards the left scrotum. Unblock tumor resection including the neighboring organs (left kidney, left colon, distal pancreas with spleen) was performed. Scrotal extension of the tumor was also excised and the inguinal canal was repaired primarily. Histopathology of the mass was myxoid-liposarcoma. The patient has disease free, without hernia recurrence but poor in renal function after twenty months follow-up. DISCUSSION: Large retroperitoneal tumors may grow towards the inguinal region and they can mimic an inguinal hernia. An irreducible, painless and hard scrotal mass should be considered from this perspective. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.Öğe Small bowel perforation due to a migrated esophageal stent: Report of a rare case and review of the literature(Elsevier Sci Ltd, 2015) Karagul, Servet; Yagci, Mehmet Ali; Ara, Cengiz; Tardu, Ali; Ertugrul, Ismail; Kirmizi, Serdar; Sumer, FatihINTRODUCTION: Endoscopic esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although stent placement is safe and effective method, complications are increasing the morbidity and mortality rate. We aimed to present a patient with small bowel perforation as a consequence of migrated esophageal stent. PRESENTATION OF CASE: A77-years-old woman was admitted with complaints of abdominal pain, abdominal distension, and vomiting for two days. Her past medical history included a pancreaticoduodenectomy for pancreatic tumor 11 years ago, a partial esophagectomy for distal esophageal cancer 6 months ago and an esophageal stent placement for esophageal anastomotic stricture 2 months ago. On abdominal examination, there was generalized tenderness with rebound. Computed tomography showed the stent had migrated. Laparotomy revealed a perforation localized in the ileum due to the migrated esophageal stent. About 5 cm perforated part of gut resected and anastomosis was done. The patient was exitus fifty-five days after operation due to sepsis. DISCUSSION: Small bowel perforation is a rare but serious complication of esophageal stent migration. Resection of the esophagogastric junction facilitates the migration of the stent. The lumen of stent is often allow to the passage in the gut, so it is troublesome to find out the dislocation in an early period to avoid undesired results. In our case, resection of the esophagogastric junction was facilitated the migration of the stent and late onset of the symptoms delayed the diagnosis. CONCLUSION: Patients with esophageal stent have to follow up frequently to preclude delayed complications. Additional technical procedures are needed for the prevention of stent migration. (C) 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Öğe Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer(Elsevier Sci Ltd, 2015) Sumer, Fatih; Kayaalp, Cuneyt; Ertugrul, Ismail; Yagci, Mehmet Ali; Karagul, ServetPURPOSE: Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. CASE: A 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. CONCLUSIONS: Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo-radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy. (C) 2015 The Authors. Published by Elsevier Ltd.Öğe Transgastric removal of a polycystic liver disease using mini-laparoscopic excision(Akademiai Kiado Zrt, 2016) Sumer, Fatih; Kayaalp, Cuneyt; Polat, Yilmaz; Ertugrul, Ismail; Karagul, ServetSurgical treatment is often necessary for patients with symptomatic or complicated polycystic liver diseases (PLD). In this paper, we describe a 52-year-old female with symptomatic PLD that had resulted in the formation of liver cysts, the largest of which was 23 cm in diameter. The patient underwent mini-laparoscopic fenestration through 5-mm abdominal trocars. The walls of the cysts were unroofed using a harmonic scalpel. Four thickened rubber-like pieces of specimens (sizes ranged between 9 x 6 x 0.5 cm and 6 x 3 x 0.1 cm) were not suitable for extraction through the 5-mm trocars. A gastrotomy was performed, and the specimens were extracted through the stomach with the help of an endoscope. Transoral removal of the specimens was completed without any complications, and the gastrotomy was closed intracorporeally. The patient was permitted to take fluids on day one, and oral intake was gradually increased. She was discharged on day four and was asymptomatic after two months of follow-up. The combination of mini-laparoscopy and intraoperative endoscopic specimen extraction represented a minimally invasive surgical approach for the treatment of PLD. To the best of our knowledge, this was the first case report of the transoral extraction of a liver specimen.
