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Öğe Aim: In the present study, we aimed to compare Dexmedetomidine-Remifentanil and Propofol-Remifentanil combinations in terms of postoperative cognitive functions in hysteroscopy attempts. Material and Methods: A total of 70 ASA I-II patients who were aged between 18 and 65 years were included in the study following the ethics committee approval. The patients were randomized into two groups (n=35), and standard routine monitoring were applied to them. The sedation depth was evaluated with Ramsey Sedation Score (RSS) before and after the sedation; and cognitive functions of the groups were evaluated with the Minimal Mental State Test (MMST). Propofol 1 mg/kg bolus 25-100 µg/kg/min infusion was administered to Group PR, and Dexmedetomidine 1 µg/kg bolus 0.4-0.7 µg/ kg/h infusion dose was administered to Group DR. Remifentanil 0.25 µg/kg bolus 0.04 µg /kg/min infusion was administered to the groups, and the groups were followed to ensure RSS≥4. Result: In cognitive functions, it was observed that there was significant regression in Group PR in postoperative period compared to the preoperative period (p<0.05). The hemodynamic parameters were lower in Group DR than in Group PR at 5th, 10th and 15th minutes following the hysteroscopy (p<0.05). The Modified Aldrete Score in Group DR were high, and pain scores were lower (p<0.05). Satisfaction with the surgeon, patient and anesthetist scores were higher in Group DR. No respiratory depression was observed (p<0.05). Conclusion: We believe that administering Dexmedetomidine-Remifentanil combination in sedation in hysteroscopy ensures better postoperative cognitive function, recovery conditions, analgesia, and patient and surgeon satisfaction compared to the PropofolRemifentanil combination.(2019) Gonultas, Fatih; Kutluturk, Koray; Barut, Bora; Dalda, Yasin; Alan, Saadet; Unal, BulentAim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results. Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized between December 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whose preoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included in preoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypia of 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 the patients 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 sensitivity was 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 was seen that FNAB was not adequate alone to detect malignancy. This situation suggests the importance of collaboration between radiologist, cytopathologist and clinician.Öğe Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy(Baishideng Publishing Group Inc, 2019) Akbulut, Sami; Koc, Cemalettin; Kocaaslan, Huseyin; Gonultas, Fatih; Samdanci, Emine; Yologlu, Saim; Yilmaz, SezaiBACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases. AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy. METHODS The demographic, biochemical, and histopathological data of 72 patients (Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients (Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1: 4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists. RESULTS Statistically significant differences were found between groups in terms of age (P = 0.044), white blood cell count (P < 0.001), neutrophil (P < 0.001), lymphocyte (P < 0.001), red cell distribution width (P = 0.036), mean corpuscular hemoglobin (P = 0.001), bilirubin (P = 0.002), appendix width (P < 0.001), and presence of acute appendicitis histopathologically (P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis (72.2%), fibrous obliteration (9.7%) and acute appendicitis (6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis (62.8%), perforated appendicitis (16.7%), lymphoid hyperplasia (8.3%), and appendix vermiformis (6.3%). CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when necessaryÖğe Consequences of the Use of Extended Criteria Donors in Living Donor Liver Transplantation(Int Scientific Literature, Inc, 2015) Dirican, Abuzer; Ozsoy, Mustafa; Ates, Mustafa; Ersan, Veysel; Gonultas, Fatih; Isik, Burak; Yilmaz, 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/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(Soc Laparoendoscopic Surgeons, 2012) Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, 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 An Elbow Patch Reconstruction Technique for Narrowed Remnant Portal Veins during Right Lobe Living Donor Hepatectomy: A Rescue Surgery(Mdpi, 2024) Usta, Sertac; Akbulut, Sami; Sarici, Kemal Baris; Garzali, Ibrahim Umar; Ozdemir, Fatih; Gonultas, Fatih; Baskiran, AdilBackground: Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the elbow patch reconstruction technique to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Methods: Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the elbow patch reconstruction technique were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Results: Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178-4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Conclusions: Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named elbow patch reconstruction technique. This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.Öğe Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers(Lippincott Williams & Wilkins, 2020) Gonultas, Fatih; Akbulut, Sami; Barut, Bora; Kutluturk, Koray; Yilmaz, SezaiObjective The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT). Methods Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated. Results There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications. Conclusion GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.Öğe Liver transplant for large hepatocellular carcinoma in Malatya: The role of gamma glutamyl transferase and alpha-fetoprotein, a retrospective cohort study(Baishideng Publishing Group Inc, 2020) Ince, Volkan; Carr, Brian, I; Bag, Harika Gozukara; Ersan, Veysel; Usta, Sertac; Koc, Cemalettin; Gonultas, FatihBACKGROUND There is increasing interest in transplanting patients with hepatocellular carcinoma (HCC) with tumors greater than 5 cm (Milan criteria). AIM To investigate possible prognostically-useful factors for liver transplantation in HCC patients with large tumors. METHODS In this clinical study, 50 patients with HCC who were transplanted at our Liver Transplant Center between April 2006 and August 2019 and had tumors greater than 6 cm maximum diameter were retrospectively analyzed. Their survival and full clinical characteristics were examined, with respect to serum alpha-fetoprotein (AFP) and gamma glutamyl transpeptidase (GGT) levels. Kaplan-Meier survival estimates were used to determine overall survival and disease-free survival in these patients. The inclusion criterion was evidence of HCC. Exclusion criteria were the presence of macroscopic portal vein thrombosis or metastasis and a follow-up period of less than 90 d. RESULTS Using receiver operating characteristic curve (ROC) analysis, cutoff values of AFP 200 ng/mL and GGT 104 IU/L were identified and used in this study. Significantly longer overall survival (OS) and disease-free-survival (DFS) were found in patients who had lower values of either parameter, compared with higher values. Even greater differences in survival were found when the 2 parameters were combined. Two tumor size bands were identified, in searching for the limits of this approach with larger tumors, namely 6-10 cm and > 10 cm. Combination parameters in the 6-10 cm band reflected 5-year OS of 76.2% in patients with low AFP plus low GGT vs 0% for all other groups. Patients with tumors greater than 10 cm, did not have low AFP plus low GGT. The most consistent clinical correlates for longer survival were degree of tumor differentiation and absence of microscopic portal venous invasion. CONCLUSION Serum levels of AFP and GGT, both alone and combined, represent a simple prognostic identifier in patients with large HCCs undergoing liver transplant-ation.Öğe Living Donor Liver Transplantation for Acute Liver Failure Due to the Ingestion of Fireworks Containing Yellow Phosphorus(Wiley-Blackwell, 2011) Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Cemalettin, Aydin; Isik, Burak; Ara, Cengiz; Gonultas, Fatih[Abstract Not Available]Öğe Management of acute cholecystitis during pregnancy: A single-center experience(Turkish Assoc Trauma Emergency Surgery, 2019) Barut, Bora; Gonultas, Fatih; Gok, Ali Fuat Kaan; Sahin, Tevfik TolgaBACKGROUND: This study aimed to present to evaluate the results of two different approaches in the management of acute cholecystitis during pregnancy: immediate surgery and delayed surgery following conservative management. METHODS: In this study, 20 pregnant women who were treated in our clinic for acute cholecystitis between 2010 and 2018 were included in the analysis. Demographic characteristics, parameters related with acute cholecystitis (gallbladder wall thickness, laboratory data), duration of hospitalization, readmission rates, and preterm labor rate were retrospectively evaluated. RESULTS: The median age was 29.5 years. The median gestational week was 20 (6-32) weeks. Laparoscopic cholecystectomy was performed in 6 (30%) patients on admittance. When compared with the conservative management group, patients who received immediate surgery had higher gallbladder wall thickness. WBC count, and CRP, ALT, AST, ALP, and GGT levels (p<0.05). Furthermore, readmission rate and duration of hospitalization were lower in the patients who underwent immediate surgery (p<0.05). The preterm labor rate in conservative management and immediate surgery groups were 28.5% and 0%, respectively (p>0.05). CONCLUSION: In this study, even though these patients had thicker gallbladder wall and higher inflammatory markers suggesting severe inflammation, the outcome of early surgery was better than conservative management. Although the characteristics of the conservative management group was more favorable, complication rate seemed to be high.Öğe Microvascular Venous Invasion in Hepatocellular Carcinoma: Why Do Recurrences Occur?(Springer, 2020) Isik, Burak; Gonultas, Fatih; Sahin, Tolga; Yilmaz, SezaiPurpose Hepatocellular carcinoma is the most common primary cancer of the liver. It is almost always associated with cirrhosis and it is usually diagnosed in later stages of the disease. Furthermore, recurrence rate following liver transplantation ranges between 15 and 30%. The most important factor determining the recurrence is vascular invasion. Methods In this review, the issue of microvascular invasion causing hepatocellular carcinoma recurrence is reviewed. Macroscopic vascular invasion is almost easy to diagnose on radiologic evaluation. However, microscopic vascular invasion is almost always diagnosed with pathologic evaluation. On the other hand, microscopic vascular invasion is associated with early recurrences and reduced disease-free survival. The type of vessel that is invaded determines the nature of the spread of the tumor cells. Invasion of the hepatic venous tributaries leads to systemic metastasis whereas portal venous invasions lead to intrahepatic spread of the tumor. Microscopic vascular invasion should be diagnosed before liver transplantation or liver resection in order to deliver the appropriate therapy to the patients. Results Yet, there is no ideal marker to suggest microscopic vascular invasion before any intervention. Markers such as alpha-fetoprotein, des carboxy prothrombin, or gamma-glutamyl transferase have been found to be correlated with microscopic vascular invasion. These parameters are not very efficient to be used in routine clinical practice. Conclusion Therefore, further research is needed to define ideal marker associated with microscopic vascular invasion.Öğe Parathyroidectomy for primary hyperparathyroidism: The results of a single institution(2019) Gonultas, Fatih; Isik, BurakAim: Primary 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 Safety of Donors with Extended Criteria in Living Donor Liver Transplantation(Wiley-Blackwell, 2011) Dirican, Abuzer; Ates, Mustafa; Ersan, Veysel; Gonultas, Fatih; Isik, Burak; Ara, Cengiz; Yilmaz, Sezai[Abstract Not Available]Öğe Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature(Termedia Publishing House Ltd, 2017) Gundogan, Ersin; Aktas, Aydin; Kayaalp, Cuneyt; Gonultas, Fatih; Sumer, FatihWe present two cases of natural orifice specimen extraction (NOSE) after laparoscopic total colectomy and ileorectal anastomosis (TC-IRA), and we also review all of the previously reported cases. Our aim was to focus on patient selection for NOSE after TC-IRA. The PubMed and Google Scholar databases were scanned. Demographic features, surgical indications, and techniques were analyzed. Basic calculations were used for statistical analysis. A total of 13 cases were detected in addition to our 2 cases. All of the specimens were removed through the natural orifices successfully. No case required a diverting ileostomy. No patients were converted to open surgery or to conventional laparoscopy. Complications were reported in three patients. Transanal extractions were performed in 12 cases (10 colonic inertia, 2 polyposis), and transvaginal extractions were performed in 3 cases (2 malignancy, 1 colonic inertia). Both transanal and transvaginal specimen extractions after laparoscopic TC-IRA can be preferred. However, transanal extraction seems to be feasible in cases of TC for benign disease with a limited mesenteric-omental resection. If the indication is a malignancy requiring a mesenteric-omental resection, a transvaginal route should be preferred for a voluminous specimen.Öğe Usability of Inferior Vena Cava Interposition Graft During Living Donor Liver Transplantation: Is This Approach Always Necessary?(Springer, 2020) Gonultas, Fatih; Akbulut, Sami; Barut, Bora; Usta, Sertac; Kutluturk, Koray; Kutlu, Ramazan; Yilmaz, SezaiPurpose To share the outcome of caval reconstruction technique in patients who underwent living donor liver transplantation (LDLT) with inferior vena cava (IVC) interposition grafting. Methods Between January 2009 and December 2018, an artificial or homologous interposition vascular graft was used for the continuity of resected native (IVC) due to various reasons in 29 of 1740 patients who underwent LDLT at our institute. Demographic, clinical, and radiological data were prospectively collected and retrospectively analyzed. Results Sixteen female and 13 male patients ranging 6-67 years of age were included. Right, left, and left lobe lateral segments were used in 22, 5, and 2 patients, respectively. The three leading LDLT indications were primary or idiopathic Budd-Chiari syndrome (BCS) (n = 12), alveolar echinococcosis (n = 7), and secondary BCS (n = 5). The three leading indications for IVC interposition grafting were thrombosis, dense fibrosis, and IVC invasion caused by tumor or echinococcosis. Homologous IVC graft was used in 17, homologous aortic graft in 7, and Dacron graft in 5 patients. Throughout the follow-up period, ascites +/- pleural effusion and elevated liver enzymes were detected in 12 and 4 patients, respectively. Stenosis and/or thrombosis requiring one or more procedures such as 1-6 sessions balloon angioplasty, stent, and thrombus aspiration were observed in half of the patients. Conclusion Retrohepatic IVC damages are not a contraindication for LDLT. The presence or absence of venous collateral circulation is an important indicator of the need for IVC interposition graft use.
