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    Clinicopathologic features of obese patients with rectal cancer and short-term results of surgery
    (2018) Oter, Volkan; Ofkeli, Ozcem; Ulas, Murat; Ozer, Ilter; Bostanci, Erdal Birol
    Aim: Some authors related the increased body mass index (BMI) with postoperative complication rates also increase, number of harvested lymph nodes reduce and sparing the anal sphincter is much more challenging in the surgical management of rectal cancer. In this study, we evaluated clinic-pathologic features and short-term surgical results in obese and non-obese patients with rectal cancer. Material and Methods: 54 obese and 326 non-obese patients are evaluated for clinic-pathological features, postoperative complications, re-operation rates and mortality rates. Results: The rate of distally located rectal tumor is found significantly higher in obese patients than non-obese patients (p<0.05). Although anterior resection has been performed more commonly in Group-I, abdominoperineal resection procedure is found significantly higher in Group-II, (p<0.05)..Harvested lymph nodes ratio between two groups was quite close to each other so this difference is not statistically significant. .Postoperative results were similar between the groups except total postoperative complications and re-operations for anastomotic leak. Although re-operation rates for anastomotic leak are found different, they are quite close between the two groups and this difference is not statistically significant. In contrast to some of the previously published articles, there was not any significant difference in morbidity and mortality between the two groups in our study. Conclusion: In our opinion there is not a clear conclusion to change the operative strategy for enough number of harvested lymph nodes but meticulous technique should be utilized to reduce the rate of anastomotic leak and resultant re-operations in this group of patients
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    Effects of erythropoietin on renal tissue in an experimental rat model of septic shock
    (2018) Oter, Serdar; Oter, Volkan
    Aim: To examine the effect of erythropoetin on renal function and histological findings in experimental septic shock model, 24 Sprague-Dawley rats were used. Material and Methods: Rats were divided into control, septic shock, and erythropoetin-treated septic shock groups. Femoral vein and artery catheterization were performed on all rats. Rats in the control group underwent laparotomy and catheterization; in the test groups, cecal ligation-perforation and bladder cannulation were added. Rats in the treatment group received a single intraperitoneal (IP) injection of 250 mg/kg erythropoetin 60 minutes after cecal ligation perforation. Rats were monitored for blood pressure, heart rate, and body temperature to assess the postoperative septic response. The body fluids were replaced as necessary. At the end of 24 hours, rats were sacrificed and renal samples were collected. Results: In our study, although there were lessstudies about septic shock model with erythropoietin, we have achieved similar results as the data in the available literatures. WBC, fever, urinary volume, urinary creatinin, BUN, blood creatinin values were significantly better in sepsis treated by erythropoietin group than non-treated sepsis group (p<0,001, table 1)Significant improvements were observed in histological findings in rats treated with erythropoetin, compared to rats with untreated. Discussion: Our findings demonstrate that erythropoetin has antioxidant effects of sepsis as seen in other studies. We conclude that erythropoetin may be an effective treatment for oxidative damage due to renal tissue perfusion defects in cases of septic shock.
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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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    Management of difficult gallbladder and comparison of laparoscopic subtotal cholecystectomy with open subtotal cholecystectomy
    (2019) Muhammedoglu, Bahtiyar; Sikrikci, Vehbi; Colakoglu, Muhammet Kadri; Oter, Volkan
    Aim: Laparoscopic cholecystectomy is the optimal surgical treatment for benign gallbladder diseases. Under curtain conditions it is very hard to distinguish the Calot triangle and it becomes difficult to perform safe cholecystectomy. Subtotal cholecystectomy is a salvage option in such conditions. The aim of this study is to compare the results of open and laparoscopic subtotal cholecystectomy in difficult gallbladder management.Material and Methods: In this retrospective study results of all consecutive patients who were performed subtotal cholecystectomy between July 2014 and August 2017 were collected and laparoscopic and open methods were compared. Results:Forty-five of 396 laparoscopic cholecystectomy cases underwent subtotal cholecystectomy during the study period. Subtotal cholecystectomy was performed laparoscopically in 27 of 45 patients (Group I), and open method in 18 patients (Group II). Convertion rate was %34.1. No significant difference was observed in terms of both preoperative and postoperative laboratory results. There was no difference between two groups in terms of ERCP history. The rate of open operation was statistically higher in acute cases. The duration of surgery was significantly higher in laparoscopic group but length of hospital stay was significantly higher in open group. Total cost was higher in group 2 but this result did not reach statistical significance. Total bile leak rate was 2.2%.Conclusion: Laparoscopic subtotal cholecystectomy is a safe and appropriate method which can be compared with open subtotal cholecystectomy in difficult gallbladder management.
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    The results of perforated peptic ulcer surgery; A single center experience of 86 patients
    (2018) Oter, Volkan; Yalcin, Metin; Kafadar, Mehmet Tolga; Oter, Serdar
    Aim: At the present time, eradication of the Helicobacter pylori infection is dramatically reduced the risk of the peptic ulcer disease. Whereas, complication rate of the peptic ulcer, such as perforations or bleedings have not been reduced significantly yet. The aim of the current study is to analyze the surgical treatment outcomes of our experiences in 86 patients with peptic ulcer perforation. Material and Methods: Between January 2012 and December 2017, 86 patients who were operated emergently for perforated peptic ulcer disease with Graham’s omental patch procedure in our hospital were included in this study. Demographic, clinical data, diagnostic studies, surgical procedures, operative findings, postoperative complications and patient follow-up were analyzed. Results: The mean age was 41.57±16.09 years. Out of 86 cases there were 65 (75.6%) male patients and 21 (24.4%) female patients. The mean operation time was 66.98±18.61 minutes. The mean hospital stay period was 7.95±2.02. In three months of follow-up period, endoscopy was done to all of these patients and peptic ulcer disease was not seen in any of them. Conclusion: Our findings revealed that Graham’s omental patch repair is still a useful method for perforated peptic ulcer disease. Low complication rates, low duration of hospital stay and also low postoperative morbidity can be achieved with good preoperative and postoperative supportive care in open surgery for peptic ulcer perforation. Laparoscopic surgery should be performed only in the presence of experienced surgeon and also in the presence of sufficient laparoscopic materials.