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Öğe A case report of retrocaecal acute appendicitis with ureteral involvement due to inflammation(2018) Gunes, Orgun[Abstract Not Available]Öğe Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Minor Hepatectomy(Springer India, 2022) Aydin, Mehmet Can; Bag, Yusuf Murat; Gunes, Orgun; Sumer, Fatih; Kayaalp, CuneytNatural orifice specimen extraction (NOSE) is an emerging technique usually preferred for colorectal resections or cholecystectomy. NOSE following laparoscopic liver resections is limited to case reports, and there is no previous study comparing the outcomes of NOSE and transabdominal (TA) specimen extraction. Our aim was to compare NOSE and TA specimen extraction methods following laparoscopic minor hepatectomy. Thirty-one patients undergoing laparoscopic minor hepatectomy between 2014 and 2020 were evaluated. The patients were divided into two groups as NOSE (n: 12) and TA (n: 19). The patients' demographics, preoperative and postoperative findings, pain, and cosmetic scores were compared. Female ratio was higher in the NOSE group (83.3% vs 31.6%, p=0.005); other demographics were similar. The median length of incision was 6 cm in the TA group but only trocar incisions in the NOSE group. There was no difference between intraoperative and postoperative findings except pain and cosmetic scores. Pain scores on postoperative days 1, 2, and 3 and in total were lower in the NOSE group (4.1 +/- 0.6 vs. 5.6 +/- 1.1, p=0.001; 2.2 +/- 04 vs. 4.1 +/- 0.9, p<0.001; 1.7 +/- 0.6 vs. 2.4 +/- 0.8, p=0.025; 8.1 +/- 1.4 vs. 12.2 +/- 2.5, p<0.001). In addition, patients in NOSE group had better cosmetic scores (9.2 +/- 0.6 versus 7.0 +/- 0.6, p<0.01). Laparoscopic minor hepatectomy combined with NOSE is a safe and effective procedure in selected patients with the advantages of less postoperative pain and better cosmesis. NOSE is ideal for female patients with high cosmetic expectancy.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 Hirschsprung’s Disease Complicated by Sigmoid Volvulus: A Systematic Review(2021) Uylas, Ufuk; Gunes, Orgun; Kayaalp, CüneytAbstract: Background: Hirschsprung’s disease and sigmoid volvulus can sometimes be seen in the same patient.Aims: To investigate the presence of Hirschsprung's disease in patients with sigmoid volvulus and to discuss the diagnosis and treatment methods.Study Design: Systematic review.Methods: This systematic review has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the methodological quality of systematic reviews guidelines. The PubMed and Scopus databases were scanned using the keywords “Hirschsprung* volvulus*” and “congenital aganglionic megacolon volvulus*”. The reference list of the selected studies was reviewed for cross-checking. Two reviewers independently screened the available literature. Only the Hirschsprung’s disease cases involving sigmoid volvulus were included, and cases of patients with volvulus in other sites was excluded. There was no restriction with respect to the publication language and type of writing. The primary outcome was morbidity and mortality.Results: A total of 31 cases were analyzed in 22 articles; 97% of the patients were under the age of 40, 90% were male. There was a statistically significant difference in the necessity for relaparotomy between patients who were scheduled for sigmoid volvulus therapy with the suspicion of Hirschsprung’s disease and patients who were treated without suspicion of Hirschsprung’s disease (0% vs 37.5%, p=0.02). While there was no postoperative death in cases with suspected Hirschsprung disease, this mortality rate was 25% in cases without suspicion (p = 0.08).Conclusion: Hirschsprung's disease should be excluded with rectal biopsy if a patient with sigmoid volvulus is under 40 years of age and has complaints of constipation from childhood.Öğe 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) 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 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 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 Laparoscopic gastrectomy in remnant gastric cancer(Turkish Surgical Assoc, 2021) Cicek, Egemen; Zengin, Akile; Gunes, Orgun; Sumer, Fatih; Kayaalp, CuneytObjective: Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. Material and Methods: The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. Results: Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. Conclusion: Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.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 Splenic surgery: a ten years experience of a tertiary center in Turkey(Edizioni Luigi Pozzi, 2022) Gunes, Orgun; Bag, Yusuf Murat; Turgut, Emre; Gunes, Ajda; Sumer, Fatih; Kayaalp, CuneytAIM: Splenectomy has been performed for various indications. In this study, we aimed to present the experience of a tertiary center on splenic surgery and analyze what has changed in the last 10 years. MATERIAL AND METHODS: Three hundred and sixteen patients who underwent splenic surgery were enrolled in the study. Demographic data, comorbidities, American Society of Anesthesiologists score, indications, operation type, postoperative complications, and mortality were analyzed retrospectively. RESULTS: The most common indication was traumatic splenic injury. Immune thrombocytopenic purpura (ITP) and gastric cancer were the second and third. Splenectomy was performed on 300 (94.9%) patients. Splenorrhaphy, partial splenectomy, and splenopexy were the other procedures performed. Postoperative complications occurred in almost onethird of the patients (n=118, 37.3%). Most of them were grade 5 according to the Clavien-Dindo classification. CONCLUSIONS: Splenectomy has become a less preferred treatment option with the development of non-operative management in splenic trauma, medical treatments for hematological diseases, and a better understanding of the immune, hematological and metabolic functions of the spleen. In the future, minimally invasive and spleen-sparing surgeries will be performed more frequently for patients who need splenectomy even for those with trauma.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 Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?(Mary Ann Liebert, Inc, 2021) Aktas, Aydin; Kayaalp, Cuneyt; Gunes, Orgun; Kirkil, Cuneyt; Tardu, Ali; Aydin, Mehmet Can; Bag, Yusuf MuratBackground: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infection (SSI) on the one hand and irrational use of antibiotics on the other. The aim of this study was to determine the need/rationale for antibiotic prophylaxis in patients undergoing laparoscopic bariatric surgery, especially low-risk patients. Methods: This retrospective analysis involved 313 morbidly obese patients (body Mass Index [BMI] >= 40) who underwent laparoscopic BS at three medical centers between September 2018 and June 2019. During the trial, no inducement was given to use antibiotics, and the centers had chosen whether to use prophylaxis. The U.S. Centers for Disease Control and Prevention (CDC)-2016 criteria were used for the diagnosis of SSI. Results: Antibiotic prophylaxis was given to 181 patients, and the SSI rate in the entire series was 4.5% (14/313). There was no significant difference in SSI between the group who received antibiotics and that who did not (2.8% versus 6.8%, respectively; p = 0.09). Post-operative intra-abdominal complications were the main independent determinant for SSIs (p < 0.001). Antibiotic prophylaxis did not have any significant effect on the rate of SSI caused by these complications (2.2% versus 3.8%, respectively; p = 0.50). The second independent factor was the rate of SSI in patients with super-obesity (BMI >= 60), particularly incisional SSIs (p < 0.001). Antibiotic prophylaxis did not produce any significant decrease in the rate of SSI in patients with a BMI < 60 (2.8% versus 5.5%, respectively; p = 0.24). When these two independent factors were excluded, there were no patients with SSI in the no-antibiotics group, and only one in the antibiotic prophylaxis group (0.5%) (p = 1.00). Conclusions: Routine antibiotic prophylaxis should be questioned in laparoscopic BS. Prophylaxis may reduce incisional SSI in patients with a BMI of >= 60. In other cases, antibiotic prophylaxis does not provide a decrease in SSIÖğe 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 The use of ischemia modified albumin as a predictive and prognostic biomarker in patients with non-acetaminophen- induced acute liver failure(2022) Aktas, Aydin; Gunes, Orgun; Budak, Fatma Olmez; Diller, Nilufer; Tuncer, Adem; Akbulut, Sami; Taskapan, Mehmet CagatayAim: This study aimed to investigate to usability of ischemia modified albumin (IMA) and IMA/albumin ratio (IMAR) values in the follow-up of ALF patients. King College criteria (KCC) and Model for End-Stage Liver Disease (MELD) score are the most commonly used criteria in the follow-up of patients with acute liver failure (ALF). However, these criteria cannot always predict prognosis and the need for liver transplantation (LT). Materials and Methods: IMA and IMAR values of 23 ALF patients and 43 healthy volunteers were measured. Then IMA and IMAR values were compared with KCC and MELD score to predict LT requirement and prognosis in ALF patients. Results: IMA and IMAR values were significantly higher in ALF patients compared healthy volunteers (p=0.001, p=0.001; respectively). IMA and IMAR values predicted LT requirement in ALF patients such as KCC and MELD (?30) score (p=0.006, p=0.04, p=0.001, p=0.03; respectively). IMA values were found to better than KCC in predicting mortality (p=0.008, p=0.02; respectively). MELD (?30) score failed to predict mortality (p=0.44). Conclusion: IMA and IMAR values can be used as diagnostic biomarkers in ALF pa- tients. IMA is a better prognostic biomarker in the follow-up of ALF patients.
