Yazar "Gokler, Cihan" seçeneğine göre listele
Listeleniyor 1 - 10 / 10
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe Acute Liver Failure following Sleeve Gastrectomy with Jejuno-Ileal Bypass(Elsevier Sci Ltd, 2021) Aktas, Aydin; Gokler, Cihan; Sansal, Mufit; Karadag, Nese; Kayaalp, CuneytIntroduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric surgery in recent years, and some modifications have emerged to improve its efficacy. Melissas has described SG plus jejuno-ileal bypass (JIB), which has reported good results in a few studies. We performed this procedure in 21 cases and in one case, we observed acute liver failure (ALF) that has not been reported before. Case presentation: A 38-year-old female (BMI: 56.1 kg/m(2)) underwent laparoscopic SG plus JIB. There was no sign of diarrhea, malnutrition or liver failure for eight months and her BMI was 43.0 kg/m(2). At the 9th month, she was hospitalized for abdominal pain, jaundice and ALF. The patient was treated by plasmapheresis and molecular absorptive recirculation system. She was planned to undergo liver transplantation but died of multiorgan failure on the 40th day of hospitalization. Conclusion: ALF can be observed following SG plus JIB. JIB reversal before compromising liver functions should be taken into consideration. (C) 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.Öğe Effect of Abdominal Drain on Patient Comfort in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study(Mary Ann Liebert, Inc, 2021) Gundogan, Ersin; Gokler, Cihan; Sumer, Fatih; Kayaalp, CuneytIntroduction:Sleeve gastrectomy is probably the most preferred morbid obesity surgery. It is important to provide patient comfort and early return to daily life after sleeve gastrectomy. Our aim was to investigate the effects of drain use on postoperative patient comfort. Materials and Methods:Fifty patients were randomly divided into two groups as no-drain and with-drain. The demographic characteristics and the intraoperative and postoperative findings of the patients were examined. Results:There were no differences between the two groups in terms of demographic data, intraoperative and postoperative findings except visual analog scale (VAS) scores. Two patients (8%) in no-drain group required drain placement. In the intention-to-treat analyses of the drain and the no-drain groups (25:25), the VAS values were 4.3 +/- 1.9 versus 3.9 +/- 2.1 (p = 0.48), 2.4 +/- 1.4 versus 2.4 +/- 1.6 (p = 0.98), and 1.8 +/- 1.5 versus 0.9 +/- 1.0 (p = 0.01) on the 1st, 2nd, and 3rd days, respectively. In the per-protocol analyses (27:23), the VAS scores on the first 3 days were 4.3 +/- 1.9 versus 3.9 +/- 2.1 (p = 0.78), 2.4 +/- 1.4 versus 2.4 +/- 1.6 (p = 0.98), and 1.8 +/- 1.4 versus 1.0 +/- 1.1 (p = 0.03), respectively. Conclusions:Routine abdominal drain use in sleeve gastrectomy negatively affects postoperative patient comfort by increasing pain. Randomized controlled trials are needed about the requirement of routine drain use in sleeve gastrectomy.ClinicalTrials.govID: NCT04333979.Öğe Emergency Laparoscopic Gastrectomy for Intraperitoneal Ruptured Gastric Gastrointestinal Stromal Tumor(Springer, 2019) Saglam, Kutay; Sumer, Fatih; Gokler, Cihan; Akatli, Ayse Nur; Kayaalp, Cuneyt[Abstract Not Available]Öğe Influence of Drain Placement on Postoperative Pain Following Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: Randomized Controlled Trial(Springer, 2018) Gundogan, Ersin; Kayaalp, Cuneyt; Aktas, Aydin; Saglam, Kutay; Sansal, Mufit; Gokler, Cihan; Cicek, EgemenThere is currently no evidence to support the routine use of an abdominal drain following laparoscopic Roux-en-Y gastric bypass (RYGB). Our aim was to investigate drain use in laparoscopic RYGB and its effects on postoperative pain. Sixty-six patients were randomly divided into two groups as no-drain (n = 36) and with-drain (n = 30). Intraoperative (time, blood loss, complications) and postoperative outcomes (morbidities, pain scores, hospital stay) were compared. Demographics of both groups were comparable. Three patients in the no-drain group required a drain (8.3%). Median visual analog scale scores for days 1-3 for with-drain and no-drain groups were 4.5 (2-9) vs. 3 (0-8) (p = 0.02), 3 (0-7) vs. 2 (0-7) (p = 0.10), and 2 (0-7) vs. 0 (0-4) (p = 0.0004), respectively. There was no difference between the groups in terms of complications and length of hospital stay. Drain use increased the postoperative pain following laparoscopic RYGB. Drain placement following laparoscopic RYGB should be selective instead of a routine application.Öğe Isolated Roux loop versus conventional pancreaticojejunostomy following pancreaticoduodenectomy(Edizioni Luigi Pozzi, 2022) Ozdemir, Egemen; Gokler, Cihan; Gunes, Orgun; Kaplan, Kuntay; Aydin, Mehmet Can; Sumer, Fatih; Kayaalp, CuneytAIM: This study aimed to examine the effects of isolated Roux loop (IP) versus conventional pancreaticojejunostomy (CP) techniques on the rate of postoperative pancreatic fistula and its severity. MATERIAL AND METHODS: This study included retrospectively collected data from 132 patients who underwent pancreaticoduodenectomy in a single institute. Collected data were compared between IP and CP groups. Postoperative pancreatic fistula and its grades were defined according to International Study Group on Pancreatic Fistula (ISGPF) definition. RESULTS: A total of 58 patients had IP and 74 patients had CP. Biochemical leak (IP 20.6% versus CP 14.9%, p=0.38) and grade B/C pancreatic fistula (IP 20.6% versus CP 32.4%, p=0.13) rates of both groups were similar. Durations of hospital stay and intensive care unit stay and 30-day mortality rates of the two groups were similar. CONCLUSION: Isolated Roux loop reconstruction following pancreaticoduodenectomy is not associated with a lower rate of pancreatic fistula but may contribute to reducing the severity of pancreatic fistula.Öğe Natural orifice specimen extraction versus transabdominal extraction in laparoscopic right hemicolectomy(Mexican Acad Surgery, 2021) Gundogan, Ersin; Kayaalp, Cuneyt; Gokler, Cihan; Gunes, Orgun; Bag, Murat; Sumer, FatihIntroduction: Natural orifice specimen extraction (NOSE) for colorectal resections, which further enhance the advantages of minimally invasive surgery, are being used increasingly more often. In this study, we aimed to compare NOSE and transabdominal specimen extraction methods in cases of totally laparoscopic right colon resections. Methods: Data of 52 patients who underwent laparoscopic right colon surgery between 2013 and 2019 were included in the study. Transabdominal specimen removal was done in 35 patients, while 17 patients underwent NOSE. Demographic data, operative findings, pathological results, and follow-up data were compared. Results: Female (94% vs. 28%, p = 0.0001), co-morbid (76% vs. 40%, p = 0.01), and previous abdominal surgery history (75% vs. 23%, p = 0.001) were higher in the NOSE group. All the other pre-operative features of the groups were comparable. Intraoperative blood loss, operation time, and complication rates were similar in both groups. Post-operative visual analog scale (2.8 +/- 1.2 vs. 4.5 +/- 2.4, p = 0.001) and cosmetic scores were better in the NOSE group (10 vs. 7, p= 0.0001). Oncologic results were similar after a mean follow-up of 27.4 +/- 20.5 (1-77) months. Conclusion: The NOSE method following laparoscopic right colon resection was a more advantageous method in terms of cosmetics and postoperative pain than transabdominal specimen extraction.Öğe Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass(Elsevier Science Bv, 2018) Gundogan, Ersin; Kayaalp, Cuneyt; Aktas, Aydin; Saglam, Kutay; Sansal, Mufit; Uylas, Ufuk; Gokler, CihanBackground: 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 Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single-center prospective cohort study(Wiley, 2019) Aktas, Aydin; Kayaalp, Cuneyt; Gunes, Orgun; Gokler, Cihan; Uylas, Ufuk; Cicek, Egemen; Ersoy, YaseminIntroduction Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Materials and Methods Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants; and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols. Results A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for >= 150 minutes, surgical duration of >= 600 minutes, intraoperative hemorrhage of >= 1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61. Discussion Organ/space SSIs were the essential part of SSIs following right lobe living donor liver transplantations. Donor-recipient age gap, prolonged cold ischemia time, complicated surgery, and postoperative biliary complications were the main causes of SSIs. Although they did not increase the perioperative mortality, they promote increased rate of reoperations, remote infections, prolonged intensive care unit, and hospital stays.Öğe Totally minimally invasive radical gastrectomy with the da Vinci Xi(R)robotic system versus straight laparoscopy for gastric adenocarcinoma(Wiley, 2020) Aktas, Aydin; Aytac, Erman; Bas, Mustafa; Gunes, Orgun; Tarcan, Serim Hande; Esen, Eren; Gokler, CihanBackground Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci Xi(R)robotic system versus straight laparoscopy for gastric adenocarcinoma. Methods Between December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes. Results Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p= 0.02,p= 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p= 0.052). Operating time in the robotic group was longer (p= 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p= 0.047). Conclusion Totally robotic technique with the da Vinci Xi(R)robotic system provides similar short-term results compared to laparoscopic surgery in radical gastrectomy.Öğe Transverse colon stenosis following laparoscopic total gastrectomy for gastric remnant carcinoma(Wolters Kluwer Medknow Publications, 2019) Cicek, Egemen; Sumer, Fatih; Gundogan, Ersin; Gokler, Cihan; Kayaalp, CuneytLaparoscopic surgery for remnant gastric cancer has been reported in a limited number of cases, and data on post-operative complications are lacking. A 58-year-old male was admitted with remnant gastric cancer. He had undergone open subtotal gastrectomy 9 years ago for gastric cancer. Laparoscopic total gastrectomy was performed, and he was discharged on the 10th day uneventfully. The patient had complained of nausea and vomiting in the 2nd post-operative month. He clinically and radiologically diagnosed as ileus and required open emergency surgery. There was a transverse colon stenosis near the splenic flexure. Hartmann's procedure was done, and he was discharged on day 17. We have limited knowledge about colonic complications after laparoscopic gastric surgery. The development of stenosis in the transverse colon is one of these complications that should be kept in mind. As far as we know, such a complication has never been reported before.
