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    Can the Drain Fluid pH Predict Anastomotic Leakage after Sleeve Gastrectomy?
    (Zamensalamati Publ Co, 2022) Kutluer, Nizamettin; Dogan, Serhat; Aksu, Ali; Ayyildiz, Hakan; Kalayci, Mehmet; Karagoz, Zuhal Karaca; Ozkan, Zeynep
    Background: Laparoscopic Sleeve Gastrectomy is the most common type of surgical treatment for morbid obesity. One of the most important complications is leakage from the stapler line. Early detection of a leakage is important in preventing undesirable events. Objectives: The aim of this study was to evaluate the predictive value of postoperative drain fluid pH on early detection of leakage. Methods: This study was performed with 63 patients including 33 patients who underwent laparoscopic sleeve gastrectomy for morbid obesity (Group SG) and 30 patients who underwent laparoscopic cholecystectomy (Group LC), as the control group. Fluid sample was obtained after surgery with intra-abdominal drain. The pH value of this fluid was measured using a pH meter at the Ohaus device in the biochemistry laboratory of study hospital. Results: When the differences in the mean pH values of patients who underwent obesity surgery and gallbladder surgery were evaluated; no statistically significant difference was found between the mean pH value of patients (p: 0.808> 0.05). Conclusion: None of our patient had leakage and unable to demonstrate how would be the drain fluid pH value if there was a leak, we suggest that drain fluid pH would not be a suitable alarming sign for a leakage in the early period. Because we know that most of the leaks occur at the proximal part of the stomach and that there is more saliva drainage through the line of leakage. Although it is known that the acidic fluid of the stomach can be drained from the same leak in this condition, it is not unlikely that saliva can bring the pH to normal levels. Therefore, if the pH of the drain fluid is close to normal, it is meaning that there is no leakage from the site.
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    Correlation between histopathological results and BI-RADS classification in breast masses
    (2019) Kutluer, Nizamettin; Aksu, Ali; Bozan, Mehmet Bugra; Kanat, Burhan Hakan; Kargici, Hulagu; Cay, Ferhat; Azak Bozan, Ayse
    Aim: The aim of this study was to determine the reliability of BI-RADS Classification by evaluating the correlation between BI-RADS Classification System and pathology results of patients admitted to the general surgery outpatient clinic of our hospital with the complaints of breast lump, breast pain and nipple discharge.Material and Methods: This retrospective study was conducted between 2009 and 2011. The study included a total of 150 female patients, who applied to the Research and Training Hospital General Surgery Polyclinics with the complaints of breast lump, pain and discharge which were classified as BIRADS-3, BIRADS-4 (4a, 4b, 4c) subcategories and BIRADS-5 category, and were evaluated using the epicrisis forms, test results (radiological imaging and tumor markers) and pathology reports.Results: The study included a total of 150 patients; 21 of which were classified as BI-RADS 3, 44 as BI-RADS 4a, 35 as BI-RADS 4b, 22 as BI-RADS 4c and 28 as BI-RADS 5. Of the masses determined to be benign, 21 cases (100%) were classified as BI-RADS 3, 43 cases (97.72%) as BI-RADS 4a, 34 cases (97.14%) as BI-RADS 4b, 8 cases (36.36%) as BI-RADS 4 and 1 case as BI-RADS 5 (3.57%). Of the malignant masses, 1 case (2.28%) was classified as BI-RADS 4a, 1 (2.86%) as BI-RADS 4b, 14 cases (63.64%) as BI-RADS 4c and 27 cases (96.43%) as BI-RADS 5.Conclusion: In the light of these data, we believe that the division of BI-RADS category 4 into sub-categories play an important role in management of breast masses.
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    The diagnostic efficacy of some ischemic markers (urotensin II and urotensin II related peptide) in early diagnosis of intestinal ischemia in experimentally increased intraabdominal pressure in rats
    (2019) Bozan, Mehmet Bugra; Ayten, Refik; Bulbuller, Nurullah; Camci, Cemalettin; Aygen, Erhan; İlhan, Necip; Ozercan, Hanfi Ibrahim; Azak Bozan, Ayse; Aksu, Ali; Kutluer, Nizamettin
    Aim: The purpose of this experimental study is evaluating the relation between plasma urotensin-II (U-II) and urotensin-II related peptide (URP) levels with intestinal ischemia caused by elevated intraabdominal pressure.Material-Methods: Wistar albino rats weighing 200–250 grams used.Group-1: Laparatomized group without abdominal pressure elevation in sixty minutes under general anesthesia.Group-2: Ten mmHg elevated intraabdominal pressure group in sixty minutes under general anesthesia.Group-3: Fifteen mmHg elevated intraabdominal pressure group in sixty minutes under general anesthesia.Group-4: Twenty mmHg elevated intraabdominal pressure group in sixty minutes under general anesthesia.After sacrifing, in general anesthesia blood and tissue samples were collected. Hematoxilen and eosyn stained tissue samples were examined under light microscope.Results: Plasma U-II levels changes insignificant in group 2 and 3 but in group-4 was changed significantly compared with the control group(respectevely p=0,609; p=0.848; p=0.04). Plasma URP levels changed significantly in all groups compared with the control group (p-values were p=0.018; p=0.018 and p=0.04 respectively).Conclusion: U-II levels could not be a useful parameter for the early diagnosis of the intestinal ischemic damage caused byintraabdominal pressure(IAP), because it is found in all vascular structures. On the other hand, plasma URP levels would be used for the early diagnosis of the intestinal ischemia. Because of the limitations of our study, we believe that our results should be confirmed with clinical studies.Keywords: Intrabdominal hypertension; intestinal ischemia; urotensin-ii; urotensin-ii related peptid; abdominal compartment syndrome.
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    A rare cause of mechanical intestinal obstruction in geriatric population: Gallstone ileus three cases
    (2019) Bozdag, Ahmet; Kutluer, Nizamettin; Aksu, Ali; Gulturk, Baris; Bozan, Mehmet Bugra; Gonen, Ayse Nur; Boyuk, Abdullah
    Gallstone ileus is an uncommon cause of mechanical intestinal obstruction. It often occurs in the elderly and patients with recurrent cholecystitis episodes. Making diagnosis can be challenging since the entity lacks any specific symptoms or signs. A vast number of patients were reported to be diagnosed during the course of operation. Gallstone ileus has high morbidity and mortality since it occurs in the geriatric population who already has various comorbidities. Abdominal CT provides quite beneficial information for the diagnosis of these patients. Appropriate treatment option should be selected for each patient considering some personal factors (such as age, comorbidity, clinical stability). The article presents three cases with gallstone ileus causing mechanical intestinal obstruction.
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    Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease
    (Editura Celsius, 2020) Kanat, Burhan Hakan; Yazar, Fatih Mehmet; Kutluer, Nizamettin; Solmaz, Ozgen Arslan; Bozan, Mehmet Bugra; Cay, Ferhat; Eroz, Erhan
    Objective: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +/- 5.18 (range, 14-36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p=0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. Conclusion: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.