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Öğe Can rectal tube be used instead of ileostomy in patients undergoing rectal resection after neoadjuvant chemo-radiotherapy?(2020) Gundogan, Ersin; Kayaalp, CuneytAim: 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 chemo-radiotherapy 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 A case of vaginal recurrence following laparoscopic left-sided colon cancer resection combined with transvaginal specimen extraction(Wolters Kluwer Medknow Publications, 2019) Gundogan, Ersin; Cicek, Egemen; Sumer, Fatih; Kayaalp, CuneytHere, we presented a case of laparoscopic colon cancer resection who developed vaginal recurrence after transvaginal specimen extraction. To our knowledge, this is the first case report on natural orifice specimen extraction-site cancer recurrence. A 59-year-old female underwent laparoscopic left hemicolectomy due to left-sided colon adenocarcinoma, and the specimen was removed through the vagina. She was admitted to the hospital with the complaint of vaginal discharge after 1 year. Tumoural infiltration on the posterior vaginal wall was diagnosed, and biopsy was reported as adenocarcinoma. The patient underwent laparoscopic low anterior resection, total abdominal hysterectomy, bilateral salpingooferectomy and en bloc resection of the posterior vaginal wall due to the local recurrence of colon cancer. She had no recurrence or metastasis within the 3rd year after primary tumour surgery. Recurrence at the specimen extraction site after natural orifice surgery should be considered among the complications. For this reason, incision-preserving methods should not be neglected.Öğe Comparison of intracorporeal or extracorporeal placement of stapler anvil in colorectal NOSE surgery(2020) Gundogan, Ersin; Kayaalp, CuneytAim: 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 A Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Total Colectomy(Mary Ann Liebert, Inc, 2019) Gundogan, Ersin; Kayaalp, Cuneyt; Gunes, Orgun; Uylas, Ufuk; Sumer, FatihIntroduction: Natural orifice surgery has been increasingly used in colon surgery since the early 2000s. However, it is rarely used for total colectomy. In this study, we aimed to retrospectively compare natural orifice specimen extraction (NOSE) with transabdominal specimen extraction in patients undergoing laparoscopic total colectomy. Materials and Methods: Twenty-six patients who underwent laparoscopic total colectomy between 2013 and 2017 were enrolled and the patients were divided into two groups: NOSE (n = 13) and transabdominal group (n = 13). The patients' demographic characteristics, perioperative and postoperative outcomes, pathology results, visual analog scale scores, and cosmetic scores were compared. Results: There was no significant difference between the two groups in terms of demographic characteristics as well as perioperative and postoperative outcomes, including complications. Benign pathologies were more common in the NOSE group (85% versus 15%, P = .001). The pain scores of the postoperative first, second, and third days were significantly lower in the NOSE group 4.1 +/- 2.1 versus 7.1 +/- 1.3 (P = .005), 3.7 +/- 2.2 versus 6.0 +/- 1.5 (P = .003), and 2.2 +/- 2.0 versus 4.1 +/- 0.9 (P = .03), respectively. As expected, the mean cosmetic score was significantly better in the NOSE group (8.3 +/- 1.5 versus 6.7 +/- 1.8, P = .02). Conclusion: NOSE combined with laparoscopic total colectomy provided better patient comfort in benign diseases and small-sized malignant diseases.Öğe Dieulafoy lesion in a Hartmann stump(Wiley, 2020) Gundogan, Ersin; Karabulut, Ertugrul; Ersan, Veysel; Kayaalp, CuneytA 70-year-old man underwent laparoscopic anterior resection for sigmoid carcinoma, and on postoperative day 4, he required an emergency Hartmann procedure for bowel ischemia and anastomotic leakage. Five days after the emergency procedure, there was a massive hemorrhage through the anus that appeared in the abdominal drain. During exploration, the origin of the bleeding could not be found, and the rectal stump was closed over a urinary Foley catheter (with an inflated balloon) with the help of a purse-string suture. In the intensive care unit, massive hematochezia continued. Emergency transanal colonoscopy to the Hartmann stump found the rectum full of clotted blood. Active pulsatile arterial bleeding of a rectal Dieulafoy lesion was detected. After endoscopic hemostasis efforts failed, bleeding was stopped successfully by transanal suturing. The patient was discharged without any other problems, and no recurrent bleeding occurred during the 18-month follow-up. Here, we report a rectal Dieulafoy lesion in a Hartmann stump for the first time.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 Evaluation of Muslim women's perspectives on natural orifice specimen extraction (NOSE) surgery(Ame Publishing Company, 2024) Gundogan, Ersin; Kayaalp, CuneytBackground: Patient perception of natural orifice transluminal endoscopic surgery, which is a minimally invasive surgical technique, is not clear. The purpose of the present study was to evaluate the perspectives of Asian women on this method. Methods: There were two groups in the study; medical personnel with 100 female participants and the general population. After a brief briefing on the method, a questionnaire with 25 questions was applied by the teams who were impartial and had knowledge about the method. Results: The mean age of the participants was 31.6 +/- 10.9 years, the mean height was 163 +/- 5.7 cm, and the mean weight was 63.5 +/- 12.3 kg. When the survey results were examined, it was found that 131 (68.9%) of the participants had a problem with the surgery scar and 191 (96.9%) wanted to have surgery without this scar. When asked why, aesthetic anxiety (85.5%), pain (73.9%) and hernia risk (73.4%) answers were given respectively. Although only 56 (28%) of the participants had heard of the natural orifice specimen extraction (NOSE) method, it was found that 92 (46%) of them were worried that this method would affect their sexual life, and 49 (24.5%) were not sure about this. It was also found that the participants preferred the transvaginal (52.1%) method the most, followed by the transoral (34.2%), and transanal (13.7%) method, respectively. The order of preference of cholecystectomy methods was laparoscopic (53.7%), NOSE (41.2%), and conventional (5.1%). Conclusions: Although the rate of awareness of natural orifice surgery is lower in Asian country than in other countries, it seems that this rate will increase with adequate information. Education level, sociocultural structure and insufficient public opinion seem to be the main reasons that decrease this rate.Öğe Gastrointestinal stromal tumors: Factors affecting prognosis and single-center surgery results(2019) Gundogan, Ersin; Gundogan Alinak, Gokcen; Kement, Metin; Cetin, Kenan; Acar, Aylin; Bildik, NejdetAim: 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 marginsÖğe The impact of splenectomy on human lipid metabolism(Upsala Med Soc, 2022) Gunes, Orgun; Turgut, Emre; Bag, Yusuf Murat; Gundogan, Ersin; Gunes, Ajda; Sumer, FatihBackground: Splenectomy impacts hematological, immunological, and metabolic functions of the patient. Since our understanding of its metabolic effects, in particular effects on lipid metabolism, is limited, this study aims to investigate the effects of splenectomy on lipid metabolism. Methods: The data from 316 patients undergoing splenectomy between 2009 and 2019 were retrospectively analyzed. Thirty- eight patients whose serum lipid values were measured both preoperatively and 1 year after surgery were included in this study. Results: Significantly higher levels of total cholesterol, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) lipid profile were found in the postsplenectomy measurements. However, no significant differences were recorded in levels of triglyceride, HDL, or very-LDL. Conclusion: We determined that splenectomy does impact lipid metabolism, and that the metabolic effects of splenectomy should further be investigated.Öğe The incidence of splenic hemangioma and its rupture risk(2018) Gundogan, Ersin; Sansal, Müfit; Gunes, Orgun; Akinci, Eray Can; Erkenekli, Tarik Emre; Sumer, FatihAim: 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 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 Is Ileostomy an Obligation Following Rectal Resection? The Role of Rectal Tube Instead of Ileostomy(Galenos Publ House, 2023) Gundogan, Ersin; Kayaalp, Cuneyt; Sumer, FatihObjective: In laparoscopic distal colon surgery, diverting ileostomy is often used to improve the anastomosis leakage and eliminate the need for secondary surgery. However, complications related to the stoma and its closure have led to new searches. The rectal tube has started to be used as another method to reduce the anastomosis leakage by reducing intestinal pressure and providing drainage. In this study, we aimed to compare the effect of the rectal tube and diverting ileostomy on the outcomes of patients who underwent laparoscopic pelvic subperitoneal surgery. Methods: Retrospective information was obtained from 66 patients who underwent laparoscopic pelvic subperitoneal surgery in our clinic between 2013 and 2019. The patients were evaluated in two groups: ileostomy and rectal tube. Demographic data, operation findings, pathological results, and follow-up information were evaluated. Results: Fourty-one of 66 patients who underwent colorectal pelvic peritoneal surgery were in the rectal tube group and 25 were in the ileostomy group. The majority of the patients in the ileostomy group were males (22-88% vs 23-56%, p=0.007); however, there was no difference between the two groups in terms of age, body mass index, comorbidity, and the previous abdominal operation. In the rectal tube group, the number of patients who were diagnosed as having rectal tumors and consequently underwent low anterior resection was higher. In the ileostomy group, the operation time was longer (476 +/- 130 vs. 341 +/- 114 mins, p=0.0001) and amount of peroperative bleeding was higher (261 +/- 260 vs 128 +/- 98 mL, p=0.02). Intraoperative and postoperative complications of the patients were similar in both groups. The pain scale on the postoperative second day was lower in the rectal tube group (2.8 +/- 1.5 vs. 4.7 +/- 2.9, p=0.008). Although the pain scales on day 1 and day 3 were lower in the rectal tube group, there was no statistically significant difference between the two groups. The oncological results were similar during the average follow-up period of 28.3 +/- 18.5 months. The cosmetic scores of the patients were better in the rectal tube group (9.3 +/- 0.9 vs. 7.2 +/- 1.9, p=0.001). Conclusion: In laparoscopic pelvic subperitoneal colorectal surgeries; it has been observed that the results of the rectal tube are not worse than ileostomy, it can be preferred in appropriate cases and reduce stoma-related problems.Öğe Is partial omentectomy feasible at radical gastrectomy for advanced cancer?(Ame Publishing Company, 2017) Aktas, Aydin; Gundogan, Ersin; Sumer, Fatih; Kayaalp, Cuneyt[Abstract Not Available]Öğe J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results(Elsevier Science Bv, 2017) Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, MustafaPurpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Management of Acute Sleeve Gastrectomy Leaks by Conversion to Roux-en-Y Gastric Bypass: a Small Case Series(Springer, 2017) Saglam, Kutay; Aktas, Aydin; Gundogan, Ersin; Ertugrul, Ismail; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarManagement of early sleeve gastrectomy leak remains challenging. The recommended approach is endoscopic stenting and abdominal drainage. Conversion to a Roux-en-Y gastric bypass (RYGB) is a common procedure used for late fistulas with distal obstruction. Here, we have presented three cases of early staple line leaks treated by conversion to RYGB. These patients had uncontrolled abdominal infections despite intensive medical treatments, and surgery was elected for abdominal drainage as well as to control the source of sepsis. All the patients were discharged without problems, and successful weight loss processes continued. Conversion to RYGB of a sleeve gastrectomy leak in an acute setting can be a feasible method in the case of inevitable surgical drainage for abdominal sepsis.Öğe 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 Percutaneous Drainage of a Splenic Abscess via Laparoscopic Trocar in a Kidney Transplant Patient(Baskent Univ, 2022) Aktas, Aydin; Kayaalp, Cuneyt; Gundogan, Ersin; Gunes, Orgun; Piskin, TurgutSpleen abscess is a life-threatening disease. Treatment can be done by medical, radiological, or surgical methods. Here, we offer an innovative method of laparoscopic trocar-assisted percutaneous abscess drainage in the treatment of splenic abscess. Our patient, a 48-year-old male who had a kidney transplant 3 years previously, was admitted due to abdominal pain and fever. A-25-cm splenic abscess was detected, and ultrasonography-guided percu - taneous catheter 10F drainage was attempted. However, this attempt was not successful due to the high viscosity of the abscess content. Under general anesthesia, we then attempted abscess drainage percutaneously via a 12-mm laparoscopic trocar, and a large-bore drain of 28F was inserted into the abscess cavity. The drainage was successful (5300 mL high viscosity content) without any complications. The patient was discharged on day 8 and remained well at 9-month follow-up. Percutaneous drainage instead of splenectomy is preferred in the treatment of spleen abscess by preserving the immunologic functions of the spleen, particularly in immunocompromised patients. When percutaneous catheter drainage therapy fails, percutaneous treatment with a laparoscopic trocar is an innovative and reliable alternative.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 Relation of PTEN and Ki67 expression with prognosis in gastrointestinal stromal tumors(2020) Ege Gul, Aylin; Alinak Gundogan, Gokcen; Gundogan, Ersin; Karadayi, NimetAim: The purpose of the present study of ours was to examine the relation of Ki67 and PTEN expression with the prognosis in the pathologies of patients who undergo gastrointestinal stromal tumor surgery in our clinic. Gastrointestinal stromal tumors; In addition to being small incidental tumors; can be tumors with large size and malignant behavior. For this reason, the relation of a great number of macroscopic and microscopic parameters with prognosis was examined. The diameter, location and mitotic index of the tumor rank the first among these parameters; however, several pathological parameters like PTEN and Ki67 expression are also important.Material and Methods: The present study was conducted between January 2005 and April 2015 with patients diagnosed with gastrointestinal stromal tumors. The demographic data (age and gender), tumor localizations, tumor sizes, mitotic activities, prognostic risk classification, follow-up times, PTEN expressions, Ki67 proliferation indices, relapse and metastasis status, andsurvival data of the patients were examined retrospectively.Results: A total of 76 patients were included in the present study. A total of 33 (43.4%) of the participants were women, and the average age was 59.7±11.7 years. The relations of PTEN with risk scores (p=0.330), tumor diameter (p=0.360), location (p=0.169), and mitosis count (p=0.579) were not significant. The relation of PTEN staining rate with relapse (p=0.832), metastasis (p=0.626) and survival (p=0.069) was not found to be statistically significant. The relation of Ki67 expression with risk scoring (p=0.018) and mitosis count (p=0.003) was significant. Although the relation between Ki67 and relapse (p=0.019) and metastasis (p=0.003) was significant, the relation between survival (p=0.655) was not significant at a statistical level.Conclusion: The Ki67 expression was a prognosis-indicating index for relapse and metastasis when the baseline value was taken as 5%; however, no relation was detected between PTEN expression and prognosis.Öğe Resection of Adrenal Metastasis Invading Left Renal Vein Following Living Donor Liver Transplantation for Hepatocellular Carcinoma(Springer, 2020) Ince, Volkan; Gundogan, Ersin; Tolan, Kerem; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]
