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Öğe Can rectal tube be used instead of ileostomy in patients undergoing rectal resection after neoadjuvant chemo-radiotherapy?(2020) Gündoğan, Ersin; Kayaalp, CüneytAbstract: Aim: Neoadjuvant chemo-radiotherapy and total mesorectal excision have become the standard treatment for locally advanced middle and distal rectal cancers. These types of patients carry a serious risk of anastomosis leakage. While the commonly technique is diverting ileostomy; rectal tube placement, with lower morbidity, has also been used in recent years. The aim of this study was to compare the results of ileostomy and rectal tube administration following rectal resection after neoadjuvant therapy. Material and Methods: We retrospectively reviewed the data from 25 patients with rectal cancer who received neoadjuvant chemoradiotherapy between 2013 and 2019. Patients were evaluated in two groups: ileostomy and rectal tube. Demographic data, operative findings, pathological results, and follow-up information were evaluated. Results: Twelve were in the rectal tube group and 13 were in the ileostomy group. There was no difference between the two groups in terms of tumor location in preoperative data. Patients with hepatic metastasis were found in the ileostomy group, while there were no such patients in the rectal tube group. The operation time (452±128 vs. 295±102 min, p=0.002) and blood loss (485±264 vs 105±80 ml, p=0.0001) were higher in the ileostomy group. The intraoperative complications of the patients were similar in the two groups, whereas the postoperative complications were higher in the ileostomy group (69%-25%, p=0.04). The mean follow-up period was 23.2±18.5 months. The total complication rate due to ileostomy was 20% and the stomata of 15% of the patients were not closed. The cosmetic scores of the patients were better in the rectal tube group (9.8±0.3 vs. 6.3±1.7, p=0.0001). Conclusion: The results of the rectal tube technique were not worse than those of the ileostomy technique in rectal cancers receiving neoadjuvant therapy and this technique may be preferred in appropriate cases.Öğe Comparison of intracorporeal or extracorporeal placement of stapler anvil in colorectal NOSE surgery(2020) Gündoğan, Ersin; Kayaalp, CüneytAbstract: Aim: The aim of this study is to compare the results of the patients for whom intracorporeal or extracorporeal anvil insertions were performed. Natural orifice specimen extraction (NOSE) surgery has been started from the 21st century onwards in order to reduce wound-related complications of laparoscopy. Two types of anvil placements, including intracorporeal or extracorporeal placements, are used in the application of NOSE, which is combined with distal colorectal surgery. Material and Methods: We retrospectively collected the data from 77 patients who underwent laparoscopic distal colorectal surgery combined with NOSE in our clinic between 2013 and 2019. Patients were evaluated in two groups as intra-corporeal and extracorporeal. Selection of the technique was based on the length of sigmoid colon and mesocolon. Demographic data, operative findings, pathological results and follow-up information were evaluated. Results: Of 77 patients who underwent distal colorectal surgery and circular stapler anastomosis; 44 were in the intracorporeal group and 33 were in the extracorporeal group. There was no difference between the two groups in terms of gender, age, BMI, comorbidity, and abdominal operation history of patients. The number of patients undergoing low anterior resection was higher in the extracorporeal group, and also the number of patients undergoing anterior resection was higher in the intracorporeal group. Peroperative findings, intraoperative and postoperative complications of patients were similar in both groups. The postoperative first-day pain scale was lower in the intracorporeal group (3.3±2.1 vs. 4.4±2.3, p=0.03). No significant difference was found between the two groups in other pain scales and cosmetic scores. The oncologic results were similar during the mean follow-up of 35.5±24.1 months. Conclusion: Although anvil placement techniques are not interchangeable, it is seen that neither method predominates the other in cases where both are suitable.Öğe Extraction of kidney via suprapubic or inguinal incision in total laparoscopic donor nephrectomy(2019) Sümer, Fatih; Gündoğan, Ersin; Altunkaya, Neslihan; Aydın, Mehmet Can; Usta, Sertaç; Doğan, Sait Murat; Pişkin, Turgut; Kayaalp, CüneytAbstract: Introduction: The objective of this study was to investigate the results of the fist 48 patients who underwent total laparoscopic transperitoneal donor nephrectomy at a single institution and to present the impact of the kidney extraction site on ischemia time. Materials and Methods: The study included patients who underwent kidney donor surgery between February 2017 and December 2018. Evaluation of the kidney transplantation candidates was performed by the kidney transplantation council. A total of 4 trocars were used for a right-side nephrectomy, and 3 trocars were used for a left-side nephrectomy. The kidneys were extracted through a suprapubic incision in the fist 18 cases and through the inguinal region in the last 30 cases. A comparison was made of the demographic characteristics and the intraoperative and postoperative results of the 2 groups. Results: Of the study patients, 30 were female and 18 were male, with a mean age of 48.0±9.6 years (range: 30–71 years). All of the patients underwent a total laparoscopic transperitoneal donor nephrectomy. Four patients underwent a right-side nephrectomy and 44 underwent a left-side nephrectomy. There was no case of conversion to open surgery. The mean operative time was 251.4±72.4 minutes (range: 127–420 minutes). In the fist 18 cases, the organ was extracted through a suprapubic incision and the ischemia time was 318±140 seconds (range: 150–720 seconds). In the last 30 cases, the organ was extracted through an inguinal incision and the mean ischemia time was 151.5±55.1 seconds (range: 80–265 seconds). The mean length of hospital stay was 5.4±1.1 days (range: 3-10 days). Conclusion: The application of minimally invasive surgery in healthy individuals undergoing donor nephrectomy leads to better physical, psychological, and social outcomes. Surgical experience and the choice of extraction site can shorten the warm ischemia time signifiantly. Extraction through the inguinal region is recommended, as it provides for a faster removal and shortens the warm ischemia time. Laparoscopic donor nephrectomy can be used safely in centers with experience performing advanced laparoscopyÖğe Gastrointestinal stromal tumors: Factors affecting prognosis and single-center surgery results(2019) Gündoğan, Ersin; Alınak Gündoğan, Gökçen; Kement, Metin; Çetin, Kenan; Acar, Aylin; Bildik, NejdetAbstract: Aim: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The aim of this study was to investigate the clinical features and histopathological findings of GIST cases who underwent surgical treatment in our clinic in terms of prognostic criteria. Material and Methods: The patients operated for GIST between January 1, 2007 and May 31, 2014 were included in this study. Demographic data, presenting symptoms, ASA scores, diagnostic methods, tumor localizations, use of imatinib before surgery, surgical treatment methods, postoperative complications, tumor size, mitotic activity, immunohistochemical markers, prognostic risk classification, follow-up periods, use of imatinib after surgery, recurrence status and survival data were examined Results: A total of 60 patients were included in the study. The median age was 56.5 (29-81) years . Fifty five of patients were males. Synchronous tumors in more than one location existed in approximately 7% of the patients. The surgical margin was positive in 14 (23.3%) patients after the surgical procedure. The recurrence and metastasis rates of these patients were 14.3% and 42.8%, respectively. On the other hand, these rates were 10.8% and 17.3% respectively in the patients with negative surgical margin. The expected 5-year survival rates according to the risk classification was 66.7% for very low-risk patients, 85.7% for low-risk patients, 59.7% for moderate-risk patients and 47.7% for high-risk patients. Conclusion: GISTs have relatively good prognosis compared to epithelial malignant tumors but require long-term follow-up. In addition, satisfactory results can be obtained with the use of tyrosine kinase inhibitors and adequate surgical margins.Öğe The incidence of splenic hemangioma and its rupture risk(2018) Gündoğan, Ersin; Şansal, Müfit; Gunes, Orgun; Akinci, Eray Can; Erkenekli, Tarik Emre; Sümer, Fatih; Kutlu, Ramazan; Kayaalp, CüneytAbstract: Aim: The incidence of splenic hemangioma was reported in a wide range (0.03-14%) based on the autopsy data between the years of 1895-1965. The suggested treatment in an early systematic review was routine splenectomy due to the fear of splenic rupture. We aimed to determine the incidence of splenic hemangiomas in the modern imaging era, to evaluate the rupture risk and the necessity of splenectomy for every splenic hemangioma. Material Method: Between January and December 2016, the reports of all patients who had any abdominal imaging modalities in our hospital were electronically scanned for splenic hemangiomas. Repeated examinations were excluded. Age, gender, reason of radiological examination, imaging modality, number and the size of the splenic hemangiomas, hematological test and the follow-up results were evaluated. Results: Total 31 of 30,021 (0.1%) patients with abdominal imaging examinations were diagnosed as splenic hemangioma. Fiftyeight percent were female and the mean age was 50.1±15.4 (median and range, 52 and 12-75). Only two referred with abdominal pain but the pain localizations were incompatible with hemangiomas. Mean hemoglobin values were found to be 13.2±2.2 gr/dl and platelet counts were found to be 249.300±115.800. The dimensions of the detected lesions were mean 13.1± 8.1mm (median 1, range 0.5-4.5 cm) and only one patient had multiple involvement. Splenic rupture was detected in a patient with chronic renal failure and splenectomy was performed. Conclusion: Routine splenectomy for <4.5 cm splenic hemangiomas is not essential but longer follow-up is required. More studies for 4.5 cm< splenic hemangiomas are necessary.Öğe Laparoscopic partial splenectomy: Our series of 3 patients(2021) Sümer, Fatih; Baran, Necip Tolga; Güneş, Orgun; Kaplan, Kuntay; Gündoğan, Ersin; Kayaalp, CüneytAbstract: 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.Öğe Laparoscopic resection of choledochal cysts in adults: a series from Turkey(2019) Gündoğan, Ersin; Sümer, Fatih; Çolakoğlu, Muhammed Kadri; Çiçek, Egemen; Gökler, Cihan; Aydın, Mehmet Can; Kayaalp, CüneytAbstract: Objective: Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods: Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results: Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion: We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.Öğe Laparoscopic surgery for a liver gunshot injury(2019) Gündoğan, Ersin; Kayaalp, Cüneyt; Tuncer, AdemAbstract: Recently, non-operative follow-up in non-penetrating abdominal injuries is often preferred. However, emergency laparotomy still remains the most exclusive method of treatment for gunshot wounds of the abdomen and laparoscopic approach is rarely reported in selected cases. In this study, our aim is to share our experience in a case with abdominal gunshot wound who was treated by a laparoscopic surgery. A 52-year-old male patient admitted with a gunshot wound that was penetrating to the abdomen. The gunshot line was from left subcostal to the right mid-axillary. He was hemodynamically stable but had abdominal sensitivity. Computed tomography confimed the liver injury. Laparoscopic exploration was performed with three ports. A tunnel-shaped injury was detected through the liver segments 4–7 and hemostasis of the bleeding liver parenchyma was achieved by laparoscopy. No other abdominal organ injuries were detected. The patient had an uneventful postoperative course and discharged on the third day and had no complaints during the six months follow-up. In certain circumstances, laparoscopy can be used both for diagnosis and treatmentof penetrating gunshot wounds and may reduce the risk of unnecessary laparotomyÖğe 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 Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass(Elsevıer scıence bv, po box 211, 1000 ae amsterdam, netherlands, 2018) Gündoğan, Ersin; Kayaalp, Cüneyt; Aktaş, Aydın; Sağlam, Kutay; Sansal, Müfit; Uylas, Ufuk; Gökler, Cihan; Çiçek, Egemen; Sümer, FatihBackground: Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. Objectives: The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. Setting: University hospital. Methods: A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. Results: A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. Conclusions: In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.Öğe Rektum Yerleşimli Medüller Kanser: Olgu Sunumu(2017) Alınak Gündoğan, Gökçen; Özdemir, Gülnihal; Gündoğan, ErsinÖz: Obstrüktif uyku apne sendromu (OUAS), tanısı sıklıkla gecikerek konan acil bir sorundur. Klinik ve laboratuvar bulgularıyla OUAS tanısı konan ve etyolojisinde juvenil myastenia gravis tanısı alan 15 yaşında kız olgunun sunulması ve konuya dikkat çekilmesi amaçlanmıştır. Hastamızın polisomnografi (PSG) sonucuna göre ağır OUAS ile uyumluydu.( Apne index 96.7/saat, apne hipopne indeksi 148/saat ). Egzersizle artan kas güçsüzlüğü ve gün içinde de değişen kas gücü nedeniyle Myastenia gravis düşünülerek pridostigmine başlandı, klinik yanıt başarılı olduğundan tanısı kesinleşti. Uyku sırasında da maske ile BIPAP başlandıktan sonra karbondioksit retansiyonu geriledi.(pCO2: 46 mmHg)
