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Öğe AKRABA YAŞLI CANLI DONÖRLERDEN YAPILAN BÖBREK NAKİLLERİ(2014) Pişkin, Turgut; Barut, Bora; Usta, Sertaç; Gönültaş, Fatih; Kayabaş, ÜnerÖz: AMAÇ: Son dönem böbrek hastalığının en iyi tedavi yöntemi böbrek nakli yapılmasıdır. Organ kısıtlılığı nedeni ile yaşlı donörlerin kullanımı giderek artmaktadır. Bizde Kasım 2010 ile Aralık 2013 tarihleri arsaında yaşı >= 60 olan canlı donörlerden 15 böbrek nakli yaptık. Bu çalışmamızda da bu 15 böbrek nakli ile ilgili deneyimlerimizi ve sonuçlarımızı paylaşmak istedik.GEREÇ VE YÖNTEMLER: Biz merkezimizde Kasım 2010 ile Aralık 2013 tarihleri arasında 98 böbrek nakli yaptık. Bunların 15'ini yaşı >= 60 olan canlı akraba donörlerden alıcılara naklettik. Bu 15 donör ve bunların alıcılarının verileri geriye doğru toparlanıp incelendi. BULGULAR: Donörlerin ve alıcılarını sırası ile yaş ortalamaları 64, 3 ve 40.1 idi. Alıcılar için ortalama takip süresi 18.8 aydı. Bu sürede graft sağkalımı %100'dü. Ancak bir alıcımız nakil sonrası dördüncü ayında intrakranial kanama nedeni ile foksiyone greftle kaybedildi. İnfeksiyon, teknik nedenler, tekrarlayan hastalık yada rejeksiyon nedeni ile börek kaybedilmedi. Donörlerimizde hayatlarını herhangi bir problem olmaksızın saglıklı bir şekilde sürdürmektedirler.SONUÇ: Yaşlı donörler ideal donörler değildir. Ancak alıcıların başka bir donörü yoksa yaşlı donörlerden nakil yapmak bu hastalar icin bir seçenek olmaktadır.Öğe Analysis of risk factors of mortality in abdominal trauma(2020) Gönültaş, Fatih; Kutlutürk, Koray; Gök, Ali Fuat Kaan; Barut, Bora; Şahin, Tevfik Tolga; Yılmaz, SezaiAbstract: BACKGROUND: The present study aims to analyze blunt and penetrating abdominal traumas that were evaluated in our emergency department, the treatment approaches and risk factors of mortality. METHODS: Six hundred and sixty-four patients were admitted to our emergency department for surgical evaluation for trauma between January 2009 and April 2019. After the exclusion of dead on arrival, patients with missing data and patients without abdominal trauma were excluded from this study. Hundred and thirteen patients with abdominal trauma admitted to our department were evaluated in this study. Demographic, clinical, prognostic and mortality related factors were retrospectively analyzed. RESULTS: The mean age of the patients was 36.08±16.1 years. There were 90 male patients. Eighty patients (70.8%) had blunt abdominal trauma (BAT). Twenty-eight patients (24.7%) had isolated liver and two patients (1.7%) had isolated spleen injury. Combined liver and spleen injury was found in two patients (1.7%). Twenty-two (19.4%) patients had mortality. Causes of mortality were an irreversible hemorrhagic shock (40.9%) and central nervous system (13.6%) injuries. BAT was the main mechanism of injury in patients with mortality (86.4% versus 67%; p<0.001). The frequency of retroperitoneal injury was significantly higher in patients with mortality (50% versus 16.5%, p<0.001). The frequency of extra-abdominal injury in patients with mortality was higher (68.1% versus 49.4%; p=0.047). Mean arterial pressure at admission was found to be significantly lower in patients with mortality (67±26.8 mmHg versus 84.3±17 mmHg; p=0.02). The number of packed erythrocytes transfused in patients with mortality was higher (8.8±8.6 versus 3.3±5.9 units; p=0.047). Mean international normalized ratio (INR) was significantly higher in patients with mortality (4.3±7.1 versus 2.7±4; p=0.016). Mean lactate dehydrogenase level was higher in patients with mortality (1685.7±333.8 versus 675.8±565.3 IU/mL; p<0.001). Mean alanine aminotransferase (ALT) was significantly higher in patients with mortality (430±619 versus 244±448 IU/mL; p<0.001). Mean alkaline phosphatase (ALP) level in patients with mortality was higher (76.9±72.8 versus 67.3±27.8 IU/mL; p=0.003). The presence of retroperitoneal injury and ALT >516 IU/mL were independent risk factors o mortality. CONCLUSION: We have found certain laboratory variables to increase in patients with mortality. These are related to the severity of trauma. Retroperitoneal injury and increased ALT levels being risk factors of mortality is the most important finding of this study. Our results can guide other centers in the evaluation of trauma patients, and high-risk groups can be identified.Öğe Can an extended right lobe be harvested from a donor with gilbert’s syndrome for living-donor liver transplantation? Case report(Transplantation Proceedings, 2012) Yılmaz, Mehmet; Ünal, Bülent; Işık, Burak; Özgör, Dinçer; Pişkin, Turgut; Ersan, Veysel; Gönültaş, Fatih; Yılmaz, SezaiGilbert’s syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient’s selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1–2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is 30%. Livers with GS can be used successfully as grafts in LDLT recipients.Öğe Canlı donör hepatektomide postoperatif komplikasyonlar: İlk 500 olgu(İnönü Üniversitesi, 2012) Gönültaş, FatihEylül 2005 ve Ağustos 2011 tarihleri arasında canlı vericili karaciğer nakli için yapılan ardışık 500 donör hepatektomi olgusunun postoperatif komplikasyonları Clavien sınıflamasına göre incelendi. Materyal ve metod: Eylül 2007-Ağustos 2011 tarihleri arasında LDLT için yapılan 500 donör hepatektomiye ait komplikasyonlar retrospektif olarak incelenerek kaydedildi. Bulgular: Ortalama donör yaşı 32.1±4,ortalama takip süresi 32 ay (3 ile 58 ay arası) dır. 451 donöre sağ hepatektomi (%90.2), 14 donöre sol hepatektomi (segment 2,3,4) (%2.8), 30 donöre sol lateral segment rezeksiyonu (57) yapılmıştır. Toplam 500 donörün 96'sın da (%19.2) toplam 152 komplikasyon tespit edildi. Donör ölümü hiç olmadı. Sağ hepatektomi yapılan 88 donörde (%19.5), sol hepatektomi yapılan 5 donörde (%35.7) ve sol lateral segmentektomi yapılan 3 donörde (%8,5) komplikasyon gelişti. Gelişen 152 komplikasyonun 76 tanesi (%50) grade I ve 9 tanesi (%6) grade II komplikasyonlardı. Gelişen major komplikasyonlardan 28 tanesi grade IIIa (%18.4), 35 tanesi grade IIIb (%23) ve 4 tanesi grade IVa idi. Grade IVb ve grade V komplikasyonumuz olmadı. Yüz elli iki komplikasyon arasında en sık görülen, 54 (%35.5) komplikasyonla safra yolu komplikasyonlarıydı. Sonuç: Deneyimli merkezlerde, uygun hasta seçimi ve yoğun postoperatif takiple sağlıklı bireylerden kontrol edilebilir düşük morbiditeyle güvenilebilir şekilde karaciğer grefti elde edilebilir.Öğe Carcinoid tumors of appendix presenting as acute appendicitis(2019) Barut, Bora; Gönültaş, FatihAbstract: BACKGROUND: We aim to present the data of patients who underwent appendectomy due to acute appendicitis, and incidental carcinoid tumor was detected on pathology. METHODS: Retrospective analysis of the patient charts between January 1999 and September 2018 were performed. RESULTS: 2778 appendectomy was performed due to acute appendicitis. Appendiceal carcinoid tumor was detected in 12 (0.43%) patients. Eight patients were (66.7%) female. Median age 37.5 years (range: 21–60). The median tumor size was 0.7 cm (range: 0.1–2.5). No perforation was detected. Eleven patients underwent appendectomy, and one patient had right hemicolectomy. The median followup period was 41.5 months (range: 22–49). There were no recurrences. CONCLUSION: Appendix carcinoid tumors are quite rare, usually asymptomatic and diagnosed incidentally on histopathological examination after appendectomy. The treatment of carcinoid tumors of the appendix is directly related to the tumor size, localization, presence of lymphovascular and mesoappendix invasion, mitotic activation rate and level of Ki67. Thus, it is important to follow the histopathological results after appendectomy. The prognosis of appendix carcinoid tumors is very good if the appendix is non-perforated.Öğe Circumferential fence with the use of polyethylene terephthalate dacron vascular graft for all in one hepatic venous reconstruction in right lobe living donor liver transplantation(Transplantation Proceedings, 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Gönültaş, Fatih; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Consequences of the use of extended criteria donors in living donor liver transplantation(Annals of Transplantation, 2015) Dirican, Abuzer; Özsoy, Mustafa; Ateş, Mustafa; Ersan, Veysel; Gönültaş, Fatih; Işık, Burak; Yılmaz, SezaiBackground: Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation (LDLT). This retrospective study reports our center’s experience in utilizing extended criteria donors for LDLT. Material and Methods: The charts of 342 LDLT donors who underwent right hepatectomy between September 2007 and December 2010 were reviewed. Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors. The surgical complications in the extended criteria donors and non-extended criteria donors were compared. Results: There were 61 extended criteria donors (21 male, 40 female; mean age 41 years) and 281 non-extended criteria donors (189 male, 92 female; mean age 31 Years). Surgical morbidities were observed in 70 (20.4%) of donors. The number of patients with complications according to Clavien’s system were: Grade I, 30 (43%); Grade II, 11 (16%); Grade IIIa, 12 (17%); Grade IIIb, 16 (23%); and Grade IV, 1 (1%). Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors (p>0.05). However, only the Grade IIIb complication rate in donors with extended criteria was significantly higher than in non-extended criteria donors (p=0.04). Complications developed in 3 of 7 donors aged >55 years and with BMI >30. There was no donor mortality. Conclusions: Although there was no statistical difference between the 2 groups’ postoperative complication rates, Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor’s postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.Öğe Conversion to stoppa procedure in laparoscopic totally extraperitoneal inguinal hernia repair(JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2012) Ateş, Mustafa; Dirican, Abuzer; Özgör, Dinçer; Gönültaş, Fatih; Işık, BurakBackground and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy.Öğe Donor complications among 500 living donor liver transplantations at a single center(Transplant Proc., 2012) Özgör, Dinçer; Dirican, Abuzer; Ateş, Mustafa; Gönültaş, Fatih; Ara, Cengiz; Yılmaz, SezaiIntroduction. Living donor liver transplantation (LDLT) has become necessary because of the shortage of cadaveric organs. We retrospectively analyzed 500 living donor hepatectomies using the Clavien classification system for complications to grade their severity. Materials and methods. We retrospectively identified and applied the Clavien clasification to 500 consecutive donors who underwent right for LDLT left hepatectomy between January 2007 and August 2011. Results. The 149 complications were observed in 93 of 500 (18.6%) donors who were followed for a mean 30 months. There wan no donor mortality. Complications developed in 85 (18.6%) right 5 (35.7%) left, and 3 (10%) left lateral segment hepatectomy donors. The overall incidence of reoperations was 7.2%. Seventy-seven of 149 complications were grade I (51.6%) or 9 grade II (6%). The major complications consisted of 27 (18.1%) grade IIIa, 35 (23.4%) grade IIIb, and 1 (0.6%) grade IVa. Grade IVb and grade V complications did not occur. The most common problems were biliary complications in 14 of 181 donors (7.7%). Conclusion. Donors for LDLT experienced a range of complications.Öğe Hepatic artery thrombosis related risk factors after living donor liver transplantation single center experience from Turkey(Transplantation Proceedings, 2013) Ünal, Bülent; Gönültaş, Fatih; Aydın, Cemalettin; Otan, Emrah; Kayaalp, Cüneyt; Yılmaz, SezaiAim. The purpose of this retrospective study is to evaluate the risk factors hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) in a consecutive series from a single center. Materials and Methods. Between January 2010 and May 2012, we performed 278 living donor liver transplantations, including 189 males and 89 females. We compared the risk factors between HAT and non-HAT groups according to the following variables: age, gender, body mass index (BMI), graft weight, use of graft, Child-Pugh and model for end stage liver disease score, level of hemoglobin, blood pressure, operation time, blood transfusion, presence of ascites, international normalized ratio (INR) level, and etiology. Results. Eighteen patients, including 15 males and 3 female, had HAT after the operation (mean age, 45.1 years; age range, 22–60 years). There were no pediatric patients in the HAT group. HAT rate was 6.5% in our series. Graft loss and retransplantation due to HAT was 38.7% in a 2-year period. Biliary leakage was observed in 72 (25.8%) living donor liver transplantations; this rate was higher in patients with HAT (n 8; 44.4%). The infection rate was 50% (n 9) in the HAT group and was 32.7% (n 91) in the non-HAT group. Mean INR value was 2.15 in the HAT group and 1.72 in the non-HAT group. When we compared the groups according to use of graft for anastomosis, biliary lekage, infection, and INR value, the differences were statistically significant (P .05). Conclusion. Although the results of OLT have improved over the past years, HAT is still associated with substantial morbidity, high incidence of graft failure, and high mortality rates. The most important findings associated with HAT in our series were found as INR levels, bile leakage, and resistant infections. Use of vascular graft for hepatic artery anastomosis was found to increase HAT risk.Öğe İntestinal Obstrüksiyonun Nadir Bir Nedeni İleoçekal Endometriozis(Causapedia, 2016) Gönültaş, Fatih; Şamdancı, Emine; Yönder, Hüseyin; Sümer, FatihÖz: Endometrial stroma ve glandların uterus kavitesi dışındayerleşmesineendometriozis çok nadir görülür. En sık rektosigmoid verektovajinal septumda görülür. Ağrı, kanama ve barsaktıkanıklığı gibi durumlarda cerrahi endikasyonu vardır.Bu çalışmada ileoçekal bölgede endometriozis saptanan25 yaşında bekar ve daha önce geçirilmiş operasyonubulunmayan kadın hasta sunuldu. Yaklaşık 6 aydırözellikle menstürasyon dönemlerinde artan karın ağrısı,ve kilo kaybı olan hastada ileus tablosu gelişmesiüzerine kliniğimize yatırıldı. Yapılan tetkiklerindeileoçekal bölgede duvar kalınlaşması tespit edildi. Hastaoperasyona alındı ve çekumda lümeni tıkayıcı kitleolduğu görülerek sağ hemikolektomi operasyonu yapıldıve patoloji sonucu ileoçekal bölgede endometriozisolarak rapor edildi. Endometriozis tanısının preopdeğerlendirmede konması oldukça zordur. Tanıgenellikle histopatolojik inceleme sonucunda konurÖğe Is peritoneal dialysis prior to kidney transplantation a risk factor for ureteral stenosis after adult to adult live kidney transplantation(2020) Kutlutürk, Koray; Şahin, Tevfik Tolga; Çimen, Serhan; Dalda, Yasin; Gönültaş, Fatih; Doğan, Sait Murat; Toplu, Sibel; Ünal, Bülent; Pişkin, TurgutAbstract: Objective: Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient loss. The effect of peritoneal dialysis on post-kidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown. In this study, it was aimed to analyze factors effecting major ureteral complications after living donor kidney transplantation and impact of peritoneal dialysis and double J-stents (JJ stents). Material and Methods: This study included 116 adult to adult living donor kidney transplant patients. Factors effecting major urologic complications after living donor kidney transplantation were analyzed. The donors were primary relatives of the recipients. Results: Major urologic complications after living donor kidney transplantation was 8/116 (6.9%). Urinary leak was present in 2 (1.7%) patients. Ureteral stenosis was encountered in 6 (5.2%) patients. Double J stents were used in 84 (72.4%) of the cases. The effect of JJ ureteral stent was not statistically significant for urinary leak, ureteral stenosis (p= 0.074, p= 0.470, respectively). A total of 29 (25%) patients had peritoneal dialysis before kidney transplantation. Preoperative peritoneal dialyses and bacteriuria after kidney transplantation were independent risk factors for ureteral stenosis in multivariate analysis (p= 0.013, and p= 0.010 respectively). Conclusion: In the guidance of the results of the present study, peritoneal dialysis prior to kidney transplantation and bacteriuria are independent risk factors for ureteral stenosis after living donor kidney transplantation. JJ stents have no effect on urologic complications after living donor kidney transplantation.Öğe Karaciğer nakli alıcılarında herpes simpleks virüs viremisinin tanısı, klinik görünümleri ve tedavi yönetimi(2021) Köse, Adem; Toplu, Sibel; Gönültaş, Fatih; Koç, Cemalettin; Yakupoğulları, Yusuf; Otlu, Barış; Şamdancı, Emine TürkmenAim: We aimed to evaluate the clinical variations, possible risk factors and results of diagnostic procedures in liver transplant (LT) recipients who suffered from Herpes Simplex Virus (HSV) viremia in the post-transplant period, despite Cytomegalovirus (CMV) prophylaxis. Material and methods: The data of 1100 LT recipients were evaluated retrospectively. HSV DNA RT-PCR detected in blood and vesicular fluid samples of the patients with active painful mucocutaneous vesicular lesions and patients with organ involvement who had biopsy and confirmed HSV viremia were included in the study. The 110 recipients diagnosed with HSV viremia were included. Results: In 110 recipients, total 130 HSV viremia episodes were observed over sixty months. HSV viremia rate was 11.8%. Of the 130 HSV episodes, 120 (92.3%) were mucocutaneous form of the disease. In 10 cases, there was a specific organ involvement. HSV-1 was detected in all of viremia episodes. Sixty-four (49.2%) episodes developed six months after the LT, 41 (31.5%) episodes developed between the 1st and 6th months after LT, and 25 (20.3%) episodes were observed within the first postoperative month. All episodes were treated successfully with different antiviral therapy modalities. Conclusion: Despite CMV prophylaxis performed, HSV viremia may be occurred as a wide range of clinical presentation in LT recipients. It can be seen at any time point after the LT. HSV DNA RT-PCR from serum samples may not be sufficient for diagnosis of viremia, therefore the analysis of the vesicular fluid or the biopsy from the organs may be necessary for supporting the diagnosis.Öğe Laparoscopic Transanal Endoscopic Microsurgery via Single-Port: A Case Report(Turgut Özal Tıp Merkezi Dergisi, 2015) Gönültaş, Fatih; Koç, Cemalettin; Hatipoğlu, Sinan; Yönder, Hüseyin; Karakaş, Serdar; Ateş, Mustafa; Dirican, AbuzerÖz: Transanal endoskopik mikrocerrahi, rektumda bulunan patolojiler için minimal invaziv bir girişim olup, tek portun transanal endoskopik mikrocerrahide kullanımı mümkündür. Bu çalışmada, merkezimizde ilk kez tek port transanal laparoskopik cerrahi yöntemi ile yaptığımız rektal polip eksizyonu olgusunun sunumunu amaçlandık. Tek port, anal kanala yerleştirildikten sonra perianal bölgeye sütürlerle tespit edildi. Standart ve açılı laparoskopik cerrahi aletler yardımı ile rektumdaki polip rezeksiyonu tam kat gerçekleştirildi. Operasyon sonrası komplikasyon gelişmeyen hasta postoperatif birinci günde taburcu edildi. Histopatolojik incelemede, fokal yüksek dereceli displazi tespit edilen rezeksiyon materyalinin cerrahi sınırları negatif idi. Sonuç olarak, rektal polip rezeksiyonunun, anal kanala tek port uygulanarak laparoskopik cerrahi el aletleri yardımıyla rezeksiyonunun mümkün ve güvenli olduğu görüldü.Öğe The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score?(2017) İnce, Volkan; Barut, Bora; Özdemir, Fatih; Kutlutürk, Koray; Gönültaş, Fatih; Onur, Asım; Kutlu, Ramazan; Yılmaz, SezaiAbstract: OBJECTIVE: The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis.METHODS: The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed.RESULTS: In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 . All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more.CONCLUSION: Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.Öğe Management of acute cholecystitis in elderly (?65 years old) patients: A retrospective study comparing early versus delayed cholecystectomy(2023) Barut, Bora; Bağ, Yusuf Murat; Patmano, Mehmet; Gündoğan, Ersin; Tuncer, Adem; Dalda, Yasin; Gönültaş, FatihAim: Acute cholecystitis is the most common causes of acute abdomen in elderly popula tion. This study aimed to present the early postoperative period (? 30 days) outcomes of elderly patients (? 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Materials and Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and chole cystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and chole cystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conver sion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically signifi cant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no signif icant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group (5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient’s clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.Öğe Parathyroidectomy for primary hyperparathyroidism: The results of a single institution(2019) Gönültaş, Fatih; Işık, BurakAbstract: Aim: Prımary hyperparathyroidism (PHPT) is a clinical entity characterized by an excess synthesis of parathormone due to one or more autonomic parathyroid gland. The present study aims to evaluate the outcomes of parathyroidectomies performed due to PHPT. Material and Methods: The results of 52 parathyroidectomies performed due to PHPT between September 2014 and October 2018 were retrospectively evaluated for demographic, clinical, imaging and pathologic characteristics. Results: Fifty-two patients with primary hyperparathyroidism were included in the study. The mean age of the patients was 50±14.5 years. Forty-three (82.9%) patients were female and 9 (17.4%) were male. The most common complaints at admission were generalized muscle and bone pain in 13 patients (15.3%). In 2 patients (3.8%) osteoporosis and another 2 (3.8%) patients, nephrolithiasis was identified. Thirty- five (67.3%) patients had no complaints. The mean preoperative calcium level was 11.21±0.88 mg/dl. Mean preoperative phosphate level was 2.58±0.72 mg/ dl. Mean preoperative parathormone level was 278.65±317.67 pg/ml. Technetium 99m-sestamibi scintigraphy was obtained for 41 patients. Cervical ultrasonography was performed in 43 patients. The surgical localization of the parathyroid adenoma showed that the accuracy of ultrasonography was 60.4% whereas the accuracy of Technetium 99m-sestamibi scintigraphy was 80.4%. Three of the 12 (25%) patients with no localization in ultrasonography had parathyroid hyperplasia as the pathologic diagnosis. There were two patients in whom ultrasonography and scintigraphy could not localize the pathologic parathyroid tissue and all of them (100%) were found to have parathyroid hyperplasia as the pathologic evaluation. Pathologic evaluation of the surgical specimens showed that there was adenoma in 40 patients (76.9%), hyperplasia in 5 (9.6%), normal parathyroid tissue in 5 (9.6%), tumor with undetermined biologic potential in 1 patient (1.9%) and adenomatous parathyroid tissue in 1 patient (1.9%). In fifteen patients (28.8%) concomitant total thyroidectomy, right lobectomy in 7 patients (13.4%)and left lobectomy in 4 patients (7.6%) were performed. Conclusion: Parathyroid adenoma can be localized in places other than the expected locations; despite the advances in imaging technologies. Surgeons experience and accurate localization before the operation are important for a successful parathyroid operation. If scintigraphy and ultrasonography cannot localize the pathologic parathyroid tissue, hyperplasia should be suspected.Öğe The predictivity of thyroid fine-needle aspiration biopsy varies depending on the radiologist experience: A retrospective cohort study(2019) Gönültaş, Fatih; Kutlutürk, Koray; Dalda, Yasin; Barut, Bora; Alan, Saadet; Ünal, BülentAbstract: Aim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results.Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized betweenDecember 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whosepreoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included inpreoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypiaof undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant.Histopathological results of patients with incidental malignancy were presumed benign.Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of thepatients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivitywas 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%.Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it wasseen that FNAB was not adequate alone tÖğe Sakruma invaze lokal nüks rektum kanserlerinde abdominosakral rezeksiyon(Kolon ve Rektum Hastalıkları Dergisi, 2009) Aydın, Cemalettin; Ölmez, Aydemir; Pişkin, Turgut; Gönültaş, Fatih; Kayaalp, Cüneyt; Yılmaz, SezaiÖz: AMAÇ: Posteriora fikse nüks rektum kanserli olgularda yapılan abdominosakral rezeksiyonları incelemek. YÖNTEMLER: Yaşları 25-63 arasında olan beş erkek, bir kadın toplam altı olgu ameliyat edildi. Tümüne daha önceden aşağı anterior rezeksiyon işlemi uygulanmıştı. Tüm olgularda tek evreli cerrahi işlem uygulandı. Sakrektomi seviyesi üç olguda sakral 2, diğer üç olguda ise sakral 3 seviyesindendi. İki olguya koloanal anastomoz, üç olguya abdominoperineal rezeksiyon, bir olguya pelvik eksantrasyon uygulandı. BULGULAR: Postoperatif hastanede kalış süresi 25-35 gün arasında değişti. Morbidite %100 olmasına karşın mortalite hiçbir hastada görülmedi. Altı olgudan ikisinde temiz cerrahi sınırlara ulaşılabildi. Bu olgularda ortalama yaşam süresi 40 ayın üzerindeydi. Cerrahi sınırları pozitif olanlarda ortalama yaşam süresi 15 aydı. Bir yıllık yaşam süresi %66 iken üç yıllık yaşam süresi %40 idi. SONUÇ: Abdominosakral rezeksiyonlar önemli morbidite ve uzamış hastanede kalma süresine neden olurlar. Buna rağmen, temiz cerrahi sınır elde edilecek ise hastalıksız uzun yaşam süresi sağlanacağından, sakruma invaze lokal nüks rektum kanserlerinde abdominosakral rezeksiyonu önermekteyiz.Öğe Tek port ile laparoskopik transanal endoskopik mikrocerrahi: bir vaka takdimi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Gönültaş, Fatih; Koç, Cemalettin; Hatipoğlu, Sinan; Yönder, Hüseyin; Karakaş, Serdar; Ateş, Mustafa; Dirican, AbuzerTransanal endoskopik mikrocerrahi, rektumda bulunan patolojiler için minimal invaziv bir girişim olup, tek portun transanal endoskopik mikrocerrahide kullanımı mümkündür. Bu çalışmada, merkezimizde ilk kez tek port transanal laparoskopik cerrahi yöntemi ile yaptığımız rektal polip eksizyonu olgusunun sunumunu amaçlandık. Tek port, anal kanala yerleştirildikten sonra perianal bölgeye sütürlerle tespit edildi. Standart ve açılı laparoskopik cerrahi aletler yardımı ile rektumdaki polip rezeksiyonu tam kat gerçekleştirildi. Operasyon sonrası komplikasyon gelişmeyen hasta postoperatif birinci günde taburcu edildi. Histopatolojik incelemede, fokal yüksek dereceli displazi tespit edilen rezeksiyon materyalinin cerrahi sınırları negatif idi. Sonuç olarak, rektal polip rezeksiyonunun, anal kanala tek port uygulanarak laparoskopik cerrahi el aletleri yardımıyla rezeksiyonunun mümkün ve güvenli olduğu görüldü.
