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    Assessment of risk factors on morbidity and mortality in patients undergoing percutaneous endoscopic gastrostomy
    (2018) Karaman, Kerem; Aziret, Mehmet; Ercan, Metin; Celebi, Fehmi; Akdeniz, Yesim; Ebiloglu, Tugce
    Aim: Percutaneous endoscopic gastrostomy (PEG) is a minimal invasive procedure that is performed in patients who are unable to take oral feeding. Herein, we aimed to assess the risk factors for morbidity and mortality in patients who undergo PEG. Material and Methods: This study was conducted, in a total of 143 patients who underwent PEG for enteral feeding, who were retrospectively analyzed in terms of clinical features, biochemical, hematological and microbiological parameters, and also morbidity and mortality. Results: The study enrolled 140 of 143 consecutive patients who underwent PEG, and a total of 206 interventions were performed. The rate of successful insertion was 98.5% (140/142). Complications were peristomal leakage (%29.3), infection due to PEG (9.3%), and tube blockage (6.4%), respectively. In multivariate logistic regression analysis; a ≤ 3.5cm length of the PEG tube between the gastric mucosa and the skin (95% CI: 1.290-33.442 and P= 0.023) and a low platelet lymphocyte ratio (OR = 0.994, 95% CI: 0.989- 0.999 and p = 0.022) were risk factors of peristomal leakage. The 30-day mortality rate was 16%. Discussion: In patient with PEG, the complication rate varies between 5% and 66% according to follow-ups in the literature. The mortality usually depends on the primary disease, and it has been reported between 5% and 20%. Conclusion: PEG is a safe, effective, and minimal invasive procedure. A ≤3.5 cm length of a PEG tube between the gastric mucosa and skin and a low platelet lymphocyte ratio are risk factors for the development of peristomal leakage.
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    Interaction between pancreatic fluid and three different hemostatic agents: an in-vitro study
    (2019) Oter, Volkan; Karaman, Kerem; Bal, Ali; Aziret, Mehmet; Ercan, Metin; Bostanci, Erdal Birol
    Aim: Although recent developments in surgery led to mortality reduction under 2%, postoperative pancreatic fistula (POPF) remains high reported from 20% up to 40%. Primary aim of the present in-vitro study was to determine the interaction between pancreatic fluid and three different hemostatic agents.Material and methods: Three different hemostatic agent; fibrin sealant Tisseel, Floseal and Ankaferd Blood Stopper (ABS) were mixed in tubes with pancreatic fluid in equal proportions. The length of the gel aggregate of each sample which covers the pancreatic fluid in the tube was measured as mm and thereafter statistically compared.Results: Tisseel significantly formed an intensely thicker gel than Floseal and ABS (Tisseel vs FloSeal; P0.0001, Tisseel vs ABS; P0.0001). Further, the thickness of the gel formation was significantly higher in FloSeal-pancreatic fluid mixture than the ABS-pancreatic fluid mixture (P0.0001). Under light microscope, Tisseel formed a much more homogenous and dens mixture than Floseal and ABS.Conclusion: Tisseel fibrin sealant has beneath its hemostatic properties also the potential of preventing pancreatic fistula development. Further in-vitro and in-vivo studies are needed to reach a definitive conclusion.Keywords: Hemostasis; Pancreatic Fistula; Hemostatic Agents; Interaction.
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    Surgical removal of a self-expanding metallic stent from jejunum in a patient with Roux-en-Y esophagojejunostomy
    (2020) Subasi, Ozkan; Karaman, Kerem; Aziret, Mehmet; Eminler, Ahmet Tarik; Koksal, Aydin Seref; Ercan, Metin
    Self-expanding metallic stent is useful in esophageal perforations, trachea-esophageal fistulas, benign esophageal strictures, and unresectable esophageal cancers. However, self-expanding metallic stent itself has the risk of mucosal necrosis with subsequent perforation and /or trachea-esophageal fistula development –particularly- in long-term usage. Further, gastro-esophageal reflux, stent occlusion, stent migration and intestinal obstruction are other common complications. We report surgical management of a case whose self-expanding metallic stent migrated from the esophagojejunostomy anastomosis towards to the jejunal Y-limp.
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    Transureteroureterostomy for non-urologic pelvic malignancy: A case report
    (2021) Karaman, Kerem; Halis, Fikret; Mansiroglu, Cemalettin Kaan; Koyun, Bulent; Aziret, Mehmet; Ercan, Metin
    The involvement of the ureter from a pelvic mass requires meticulous handling after resection of the invaded segment. The type of ureteral reconstruction depends on the location of the tumor and the length of the residual ureteral segment. Further, the type of reconstructive technique is also decisive in the patient’s life quality. We report a case with recurrent recto-sigmoid cancer whose tumor mass also invades the left ureter.