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Öğe Alterations of Thyroid Functions in Obesity: Is There any Impact of Co-Existence of Type 2 Diabetes Mellitus?(2018) Topaloğlu, Ömercan; Sümer, Fatih; Çetin, Sedat; Yoloğlu, Saim; Kayaalp, Cüneyt; İbrahim ŞahinAbstract: Aim: Little is known about the effect of coexistent type 2 diabetes mellitus (DM) on thyroid functions in obesity. We aimed to evaluate the thyroid function in the both diabetic and nondiabetic obese patients. Materials and Methods: 145 obese patients admitted to our department, between June 2014 and May 2016, were included in the study. The patients with known thyroid dysfunction were excluded from the study. The patients were grouped according to their BMI (body mass index), co-existence of type 2 DM, and TSH (thyroid stimulating hormone). Data were collected retrospectively and analyzed. Results: No difference was observed between diabetic and nondiabetic groups for the mean age, body weight, fT3 (free T3), fT4 (free T4), BMI, TSH. Primary hypothyroidism, subclinical hypothyroidism and hyperthyroidism were determined in 1.4, 0.7 and 2.8 % of the patients, respectively; no difference was found between diabetic and nondiabetic groups (p=0.588). There was no significant correlation between BMI and TSH (r=0.030, p=0.717).Distribution of patients in different TSH groups between diabetic and nondiabetic groups were similar (p=0.533). There were positive correlations between BMI and, fT4 or fT3 (r=0.274, p=0.001; r=0.280, p=0.002; respectively). Although 1.4% of all patients had isolated elevation of fT4, there was no difference between groups (p=0.178). 24.6% of diabetic, 28.4% of nondiabetic and 26.6% of all patients had isolated elevation of fT3; however, no difference was found (p=0.634). Conclusions: Our study suggested that obesity could be associated with elevated fT4 and fT3. Elevation of fT3 and fT4 with increasing BMI may be as response to increased metabolic rate. We found no difference between diabetic and nondiabetic groups concerning to fT4 and fT3 elevation. As a result, co–existence of type 2 DM seems to have no effect on thyroid functions.Öğe The association between psoas muscle area index and morbidity/mortality in laparoscopic gastric cancer surgery(2022) Turgut, Emre; Zengin, Akile; Bağ, Yusuf Murat; Kaplan, Kuntay; Güneş, Orgun; Karatoprak, Sinan; Sümer, FatihAs advanced gastric cancer often leads to obstruction or cancer-related cachexia, gastric cancer seems to have a closer association with sarcopenia than other types of cancer. Our study aim was to investigate the relationship between the psoas muscle area (PSMA) and morbidity and mortality in patients undergoing gastric cancer surgery. The data of patients who underwent laparoscopic gastric resection between November 2014 and April 2020 were analyzed retrospectively. The intervertebral disc space was verified at L3-4 in the sagittal plane. The PSMA on the right and left sides were measured separately and then added to obtain the total PSMA. This value was then divided by the patient's height (m2) to calculate the psoas muscle area index (PSMAI) (mm2/m2). The mean PSMAI of men (741.1 mm2/m2) was significantly higher than that of women (502.1 mm2/m2) (p<0.001). While there was a positive correlation between the PSMAI and BMI (r:0.352, p:0.019 in women; r:0.447, p<0.001 in men), the correlation between PSMAI and age was negative (r: -0.369, p:0.014 in women; r:-0.349, p<0.001 in men). PSMAI was statistically lower in patients with attendant morbidity (p:0.035). There was no significant relationship between PSMAI and the first 30-day mortality rate (p:0.096); however, the association between PSMAI and both the 90-day mortality rate (p:0.023) and the total mortality rate (p:0.046) were significant. In our opinion, assessing gastric cancer patients for sarcopenia and supporting them with the necessary nutrition and exercise program prior to surgery can help predict and lower postoperative morbidity and mortality rates.Öğe Aynı ailede iki primer kas içi kist hidatik olgusu(Dicle Tıp Dergisi, 2011) Dirican, Abuzer; Sümer, Fatih; Ünal, Bülent; Barut, Bora; Işık, Burak; Yılmaz, SezaiÖz: Otuz dokuz yaşındaki bayan hasta sol lumbar şişlik ve ağrı şikayetleri ile polikliniğe başvurdu. Hastanın aile öyküsünde 19 yaşındaki kızının sol gastrokinemius kasında primer kist hidatik sebebiyle bir yıl önce ameliyat olduğu öğrenildi. Hastanın fizik muayenesinde sol lomber bölgede derin palpasyonla ele gelen düzgün sınırlı 6x5 cm boyutlarında ağrılı kitle palpe edildi. Hastanın ecchinococcus granulosus indirekt hemaglutinasyon testi pozitifti. Radyolojik incelemelerde, lezyonun kist hidatikle uyumlu olduğu rapor edildi. Hastanın geçirilmiş kist hidatik öyküsü yoktu. Hastaya spinal anestezi altında parsiyel kistektomi ve drenaj uygulandı. Kistektomi materyali, asellüler lameller tabaka (kist hidatik) olarak rapor edildi. Postoperatif komplikasyon olmadı. Operasyon sonrası hastaya 15 mg/kg/gün Albendazol tedavisi 3 ay süreyle verildi. Hastanın 6 aylık izleminde kist hidatit nüksüne rastlanmadı. Kist hidatiğin endemik olduğu bölgelerde kas içi yerleşimli kistik kitlelerin ayırıcı tanısında kist hidatit de hatırlanmalıdır. Ailede geçirilmiş kist hidatit öyküsünün olması yol gösterici olabilir. Tedavide kist total çıkarılamıyorsa, parsiyel kistektomi ve drenaj kas içi kist hidatiğin cerrahi tedavisinde seçilebilir.Öğe Case report of non traumatic spontaneous intrahepatic bile duct rupture in an adult(International journal of surgery case reports, 2016) Sümer, Fatih; Kayaalp, Cüneyt; Karagül, Servet; Ertuğrul, İsmail; Yağcı, Mehmet Ali; Onur, AsımSpontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment ofthis rare condition should be based on the individual’s clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. DISCUSSION: Spontaneous rupture ofthe intrahepatic biliary ductis a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient’s clinical and comorbidity status.Öğe Dev Soliter Jejunal Divertikül Perforasyonu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2009) Dirican, Abuzer; Ünal, Bülent; Sümer, Fatih; Başsüllü, Nuray; Özgür, Dinçer; Kırımlıoğlu, VedatJejunum divertiküllerinin çoğu mezenterik yerleşimli psödodivertiküllerdir. Jejunal divertikül perforasyonu nadir görülen bir akut karın nedenidir ve tedavide segmenter barsak rezeksiyonu önerilir. Elli bir yaşındaki erkek hasta akut karın sebebiyle ameliyat edildi. Ameliyatta Treitz ligamanının 15 cm distalinde Jejunumun antimezenterik tarafında 6.6x9x3cm boyutlarında perfore gerçek divertikül mevcuttu. Divertikülektomi ve primer onarım yapıldı.Öğe Does body mass index affect the intraoperative and early postoperative outcomes in patients with laparoscopic distal gastrectomy for gastric cancer?(2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Kaplan, Kuntay; Sümer, Fatih; Kayaalp, CüneytThe effect of increased body mass index (BMI) on the short- and long-term outcomes of laparoscopic distal gastrectomy (LDG) is controversial. We aimed to evaluate the influence of BMI on intraoperative and early postoperative outcomes in patients with LDG for gastric cancer (GC). Eighty-six patients who underwent LDG for GC were included in this study retrospectively. The patients were divided into two groups as normal weighted (BMI=18.5-24.9 kg/m2, n=29) and overweighted-obese (BMI?25 kg/m2, n=57). Preoperative and intraoperative data, postoperative outcomes were retrospectively analyzed and compared between the two groups. The preoperative data were similar between the groups. The rate of the history of previous abdominal surgery (19.3% to 3.4%, p=0.05) and the median preoperative carcinoembryonic antigen (CEA) levels (1.7 ng/ml to 1 ng/ml, p=0.06) were higher in the overweighted-obese group but the differences were not significant. There were no significant differences in intraoperative data and early postoperative outcomes between the groups but the rate of postoperative serious complications (12.3% to 6.9%, p=0.71), the reoperation rate (10.5% to 6.9%, p=0.71), and 90-day-mortality rate (5.3% to 0%, p=0.5) were higher in the overweighted-obese group. Although the rates of postoperative serious com- plications, reoperation, and mortality were higher in the overweighted-obese patients, BMI had no significant effect on intraoperative and early postoperative outcomes in patients who underwent LDG for GC. LDG for GC is a feasible and safe approach for overweighted-obese patients.Öğe Early term results of the left colic artery preservation in colorectal cancer surgery(2022) Kaplan, Kuntay; Gökler, Cihan; Bağ, Yusuf Murat; Cengiz, Emrah; Sümer, Fatih; Aydın, Cemalettin; Kayaalp, CüneytIntroduction: Colorectal cancer is a common type of cancer that causes significant morbidity and mortality. Post-resection anastomosis safety is important. The most important factor affecting anastomosis safety is blood accumulation in the anastomosis. In this study, we aimed to examine the early-term results of the preservation of the left colic artery (LCA) during laparoscopic anterior and low anterior resection (LAR) for the treatment of rectum and sigmoid colon cancers based on our clinical experience. Materials and Methods: A total of 192 archive files that were operated for rectum and sigmoid colon cancer in our center between April 2019 and October 2022 were reviewed retrospectively. The patients were diagnosed using colonoscopy and biopsy during the pre-operative period. The patients and their results were discussed in the oncology council, and the patients’ treatment plans were formed based on the council’s decision. Results: The patients’ mean age was 65.4±9.33 years and nearly half of them were males (n=8, 53.3%). Of the patients, 12 (80%) of them underwent LAR, while three patients (20%) underwent AR. The mean duration of surgery was 322.66±101.8 min, while the median bleeding amount was 50 (20–150) cc. One patient (6.7%) required reoperation due to an anastomotic leak, and abscess drainage was performed using the transanal method. No mortality was observed in patients at 30 days. Conclusion: In our study, the low ligation (LL) and LCA were preserved during laparoscopic AR and LARs for rectum and sigmoid colon cancers, preserving blood accumulation in the anastomosis. However, multi-center prospective randomized controlled studies are required to demonstrate whether LL significantly reduces anastomotic leaks.Öğe Extraction of kidney via suprapubic or inguinal incision in total laparoscopic donor nephrectomy(2019) Sümer, Fatih; Gündoğan, Ersin; Altunkaya, Neslihan; Aydın, Mehmet Can; Usta, Sertaç; Doğan, Sait Murat; Pişkin, Turgut; Kayaalp, CüneytAbstract: Introduction: The objective of this study was to investigate the results of the fist 48 patients who underwent total laparoscopic transperitoneal donor nephrectomy at a single institution and to present the impact of the kidney extraction site on ischemia time. Materials and Methods: The study included patients who underwent kidney donor surgery between February 2017 and December 2018. Evaluation of the kidney transplantation candidates was performed by the kidney transplantation council. A total of 4 trocars were used for a right-side nephrectomy, and 3 trocars were used for a left-side nephrectomy. The kidneys were extracted through a suprapubic incision in the fist 18 cases and through the inguinal region in the last 30 cases. A comparison was made of the demographic characteristics and the intraoperative and postoperative results of the 2 groups. Results: Of the study patients, 30 were female and 18 were male, with a mean age of 48.0±9.6 years (range: 30–71 years). All of the patients underwent a total laparoscopic transperitoneal donor nephrectomy. Four patients underwent a right-side nephrectomy and 44 underwent a left-side nephrectomy. There was no case of conversion to open surgery. The mean operative time was 251.4±72.4 minutes (range: 127–420 minutes). In the fist 18 cases, the organ was extracted through a suprapubic incision and the ischemia time was 318±140 seconds (range: 150–720 seconds). In the last 30 cases, the organ was extracted through an inguinal incision and the mean ischemia time was 151.5±55.1 seconds (range: 80–265 seconds). The mean length of hospital stay was 5.4±1.1 days (range: 3-10 days). Conclusion: The application of minimally invasive surgery in healthy individuals undergoing donor nephrectomy leads to better physical, psychological, and social outcomes. Surgical experience and the choice of extraction site can shorten the warm ischemia time signifiantly. Extraction through the inguinal region is recommended, as it provides for a faster removal and shortens the warm ischemia time. Laparoscopic donor nephrectomy can be used safely in centers with experience performing advanced laparoscopyÖğe Fibrin sealant use in pilonidal sinus systematic review(World journal of gastrointestinal srgery, 2016) Kayaalp, Cüneyt; Ertuğrul, İsmail; Tolan, Kerem; Sümer, FatihTo review the current data about the success rates of fibrin sealant use in pilonidal disease. METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients. CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.Öğe Fitobezoara bağlı ince barsak obstruksiyonunun laparoskopik tedavisi(İzmir Atatürk Eğitim Hastanesi Tıp Dergisi, 2009) Dirican, Abuzer; Ünal, Bülent; Sümer, Fatih; Doğan, Paşa; Aydın, Cemalettin; Ersan, Veysel; Kayaalp, CüneytÖz: İnce barsak obstruksiyonunun tanı ve tedavisinde laparoskopinin kullanımı gittikçe artmaktadır. Fitobezoar ince barsak obstruksiyonunun nadir sebeplerinden biridir. Fitobezoara bağlı ince barsak obstruksiyonu olan hastaların laparoskopik tedavisinde fitobezoar fragmante edilerek ileoçekal valvden sağılır veya enterotomi yapılarak fitobezoar çıkarılır. Bu yazıda laparoskopik yöntemle tedavi edilen iki fitobezoara bağlı ince barsak obstruksiyon olgusu sunularak bu konudaki literatür gözden geçirildi. İlk olguda laparoskopi esnasında jejenumda tespit edilen fitobezoar endoklinç ile ezilerek lümen içine bırakıldı. Literatürde ince barsaktaki fitobezoarın laparoskopik tedavisinde fregmantasyon sonrası çekuma sağma ve enterotomi dışında sadece fragmantasyonla tedavi edilen olguya rastlanmadı. İkinci olguda ise distal ileumdaki sert fitobezoar endoklinç ile fragmente edilemeyince 10 mm. lik trokar yeri genişletilerek bu barsak ansı dışarı alındı ve fitobezoar fragmente edilerek çekuma sağıldı. Laparoskopik tedavi seçilmiş fitobezoara bağlı ince barsak obstruksiyonlarının tedavisinde güvenle kullanılabilir.Öğe Histopathological examination of explanted liver after transplantation in patients with cryptogenic cirrhosis(Transplantation Proceedings, 2015) Tardu, Ali; Karagül, Servet; Yağcı, Mehmet Ali; Ertuğrul, İsmail; Sümer, Fatih; Kırmızı, Serdar; Yaylak, Faik; Koç, Cemalettin; Hatipoğlu, Hamit Sinan; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. Cryptogenic cirrhosis is a common indication for liver transplantation. Diagnosis is made after exclusion of other causes of cirrhosis. In this study, the aim was to evaluate patients with cryptogenic cirrhosis after histopathological examination of explanted liver. Materials and Methods. A retrospective histopathological chart review of 117 patients with cryptogenic cirrhosis who had liver transplantation between November 2009 and June 2014 was performed. Age, sex, operative features, survival rates, and preoperative and postoperative diagnosis were evaluated. Results. During the study period, 123 liver transplantations were performed for these 117 patients. Deceased donor liver transplantations were performed in 23 (18.7%) of the cases. Retransplantations were performed in 5 patients. Median age was 48 years, and female-tomale ratio was 41:76. Hepatosteatosis were observed in 29 patients. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis were observed in 20 (12%) and 9 (7.7%) of these patients, respectively. Autoimmune hepatitis was observed in 2 patients. The definitive cause of cirrhosis was unclear in 68 (58%) of the patients. Incidental malignant and premalignant lesions were observed in 15 patients. Conclusions. Histopathological examination of the explanted liver after liver transplantation in those patients with cryptogenic cirrhosis may significantly help to diagnose the cause of cirrhosis, such as nonalcoholic steatohepatitis or autoimmune hepatitis, with using the scoring system developed by the International Autoimmune Hepatitis Workgroup. In addition, incidental malignant or premalignant lesions may be observed.Öğe How much more can minimally invasive surgery be minimized? Mini-laparoscopic Nissen fundoplication in adults(2021) Sümer, Fatih; Okut, Gokalp; Kaplan, Kuntay; Baran, Necip Tolga; Kayaalp, CuneytIntroduction: Mini-laparoscopy has become a current issue as a minimally invasive technique in gastroesophageal reflux surgery, which does not require specimen extraction. There are a limited number of cases of Nissen fundoplication performed in the adult age group using the mini-laparoscopic method. In this article, our aim is to draw attention to the fact that mini-laparoscopy is a preferable technique in Nissen fundoplication surgery. Materials and Methods: Seven patients underwent mini-laparoscopic Nissen fundoplication between January 2010 and December 2019. Demographic data and perioperative parameters were analyzed retrospectively. Results: Three of our patients (43%) were female and the average age of our patients was 45.4±11.1. All patients presented with complaints of heartburn and regurgitation. There was Barrett metaplasia in the pathology results and no dysplasia was observed in any patient. Mean operation time was 117±49.9 min, bleeding amount was <10 ml in all surgeries. The median time to oral intake was 8th post-operative h, and no complications developed in any of our patients. In the post-operative period, there was no need for narcotic analgesic, after a single dose of nonsteroidal anti-inflammatory drugs, the treatment was continued with two doses of oral analgesic. Median length of stay hospital was 3 (2–4) days, the median follow-up period was 67 (29–120) months. Conclusion: Anti-reflux surgery can be easily performed, mini-laparoscopically since it is not a resective surgical procedure. It can provide advantages such as better cosmesis, less port site complications, and less analgesic useÖğe 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 Influence of repeated measurements on small bowel length(Springerplus, 2016) Karagül, Servet; Kayaalp, Cüneyt; Kırmızı, Serdar; Tardu, Ali; Ertuğrul, İsmail; Tolan, Kerem; Sümer, FatihPurpose: Measurement of small bowel length (SBL) is a common procedure in gastrointestinal surgery. When required, repeated SBL measurements can be done during surgery. Our aim was to evaluate whether these repeated measurements differ in SBL results. Methods: Small bowel length was measured during laparotomy in 28 patients between ligament of Treitz and caecum, using a standard measure, two times in each patient consecutively by two different surgeons from the antimesenteric border of the bowel. Results: The median age was 33 (19–67) including 18 male. There were 16 healthy donors for living related liver transplantations. Second measurements, performed immediately after the first measurements, significantly shortened the measured SBLs in the same patients (580 ± 103 vs. 485 ± 78 cm, p < 0.001). Conclusions: During surgery, repeated length measurements caused contractions in the small bowel and this resulted to a significant decrease in the SBL. This should be keep in mind to prevent mismeasurements.Öğe İntestinal Obstrüksiyonun Nadir Bir Nedeni İleoçekal Endometriozis(Causapedia, 2016) Gönültaş, Fatih; Şamdancı, Emine; Yönder, Hüseyin; Sümer, FatihÖz: Endometrial stroma ve glandların uterus kavitesi dışındayerleşmesineendometriozis çok nadir görülür. En sık rektosigmoid verektovajinal septumda görülür. Ağrı, kanama ve barsaktıkanıklığı gibi durumlarda cerrahi endikasyonu vardır.Bu çalışmada ileoçekal bölgede endometriozis saptanan25 yaşında bekar ve daha önce geçirilmiş operasyonubulunmayan kadın hasta sunuldu. Yaklaşık 6 aydırözellikle menstürasyon dönemlerinde artan karın ağrısı,ve kilo kaybı olan hastada ileus tablosu gelişmesiüzerine kliniğimize yatırıldı. Yapılan tetkiklerindeileoçekal bölgede duvar kalınlaşması tespit edildi. Hastaoperasyona alındı ve çekumda lümeni tıkayıcı kitleolduğu görülerek sağ hemikolektomi operasyonu yapıldıve patoloji sonucu ileoçekal bölgede endometriozisolarak rapor edildi. Endometriozis tanısının preopdeğerlendirmede konması oldukça zordur. Tanıgenellikle histopatolojik inceleme sonucunda konurÖğe Laparoscopic gastrectomy and transvaginal specimen extraction in a morbidly obese patient with gastric cancer(Journal of gastric cancer, 2016) Sümer, Fatih; Kayaalp, Cüneyt; Karagül, ServetLaparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.Öğe Laparoscopic partial splenectomy: Our series of 3 patients(2021) Sümer, Fatih; Baran, Necip Tolga; Güneş, Orgun; Kaplan, Kuntay; Gündoğan, Ersin; Kayaalp, CüneytAbstract: Total splenectomy can cause many perioperative and postoperative complications. Partial splenectomy has been preferred in recent years in order to minimize the immunological complications associated with splenectomy. With this case series, we aim to present our own experiences with 3 patients.Öğe Laparoscopic resection of choledochal cysts in adults: a series from Turkey(2019) Gündoğan, Ersin; Sümer, Fatih; Çolakoğlu, Muhammed Kadri; Çiçek, Egemen; Gökler, Cihan; Aydın, Mehmet Can; Kayaalp, CüneytAbstract: Objective: Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods: Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results: Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion: We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.Öğe Laparoscopic sleeve gastrectomy technique: How we do it(2018) Şansal, Müfit; Sağlam, Kutay; Gökler, Cihan; Sümer, Fatih; Kayaalp, CüneytA total of 1002 bariatric procedures were performed at our clinic between March 2006 and December 2016.The laparoscopic Roux-en-Y gastric bypass (LRYGB) technique was performed on 833 patients. Three ofthe LRYGB procedures were revisions of a previous laparoscopic sleeve gastrectomy (LSG). In 169 patients,the sleeve gastrectomy technique was used. One procedure was performed via laparotomy, but the otherswere performed laparoscopically. Six patients’ sleeve gastrectomy lines were transected and sutured usinga laparoscopic needle holder, while the others were closed with a stapling device. Ileojejunal bypass wasadded in 21 of the LSG procedures. This clinic’s experience with morbid obesity surgery began with opengastric bypass surgery and later evolved into use of the LRYGB method. Sleeve gastrectomy, which is popular in this country and around the world, has been performed since July 2014 (handmade as of May). Thisarticle describes some of the nuances and subtleties of the LSG technique.Öğe Laparoscopic total gastrectomy and lymphadenectomy for remnant gastric cancer treatment(2018) Yüksel, Adem; Coşkun, Murat; Sümer, FatihSurgery is the basis of treatment for remnant gastric cancer (RGC). The surgery consists of gastrectomywith meticulous lymphadenectomy. Gastrectomy and lymphadenectomy can be performed with minimallyinvasive surgical techniques. However, RGC surgery can be challenging in cases where changes occur following an earlier operation. The current report is a description of the surgical results of laparoscopic totalgastrectomy and lymphadenectomy performed for a patient with a history of subtotal gastrectomy for gastric ulcer 19 years earlier who had cancer develop in the remnant stomach. The data regarding laparoscopicsurgery for RGC is limited to case series. In the current study, a laparoscopic technique for RGC is presentedin the context of a discussion of the key points of surgery.
