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Öğe Concurrent Acute Appendicitis and Cholecystitis: A Systematic Literature Review(Mdpi, 2025) Tuncer, Adem; Akbulut, Sami; Sahin, Emrah; Ogut, Zeki; Karabulut, ErtugrulBackground: This systematic review aimed to comprehensively evaluate the clinical, diagnostic, and therapeutic features of synchronous acute cholecystitis (AC) and acute appendicitis (AAP). Methods: The review protocol was prospectively registered in PROSPERO (CRD420251086131) and conducted in accordance with PRISMA 2020 guidelines. A systematic search was performed across PubMed, MEDLINE, Web of Science, Scopus, Google Scholar, and Google databases for studies published from January 1975 to May 2025. Search terms included variations of synchronous, simultaneous, concurrent, and coexistence combined with appendicitis, appendectomy, cholecystitis, and cholecystectomy. Reference lists of included studies were screened. Studies reporting human cases with sufficient patient-level clinical data were included. Data extraction and quality assessment were performed independently by pairs of reviewers, with discrepancies resolved through consensus. No meta-analysis was conducted due to the descriptive nature of the data. Results: A total of 44 articles were included in this review. Of these, thirty-four were available in full text, one was accessible only as an abstract, and one was a literature review, while eight articles were inaccessible. Clinical data from forty patients, including two from our own cases, were evaluated, with a median age of 41 years. The gender distribution was equal, with a median age of 50 years among male patients and 36 years among female patients. Leukocytosis was observed in 25 of 33 patients with available laboratory data. Among 37 patients with documented diagnostic methods, ultrasonography and computed tomography were the most frequently utilized modalities, followed by physical examination. Twenty-seven patients underwent laparoscopic cholecystectomy and appendectomy. The remaining patients were managed with open surgery or conservative treatment. Postoperative complications occurred in five patients, including sepsis, perforation, leakage, diarrhea, and wound infections. Histopathological analysis revealed AAP in 25 cases and AC in 14. Additional findings included gangrenous inflammation and neoplastic lesions. Conclusions: Synchronous AC and AAP are rare and diagnostically challenging conditions. Early recognition via imaging and clinical evaluation is critical. Laparoscopic management remains the preferred approach. Histopathological examination of surgical specimens is essential for identifying unexpected pathology, thereby guiding appropriate patient management.Öğe Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review(Baishideng Publishing Group Inc, 2020) Akbulut, Sami; Demyati, Khaled; Ciftci, Felat; Koc, Cemalettin; Tuncer, Adem; Sahin, Emrah; Karadag, NeseBACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue. AIM To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery. METHODS We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study. RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient. CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.Öğe Gastric Cancer Surgery Before and During the COVID-19 Pandemic in Turkey: A Multicenter Comparison of Prognostic Factors, Mortality, and Survival(Mdpi, 2025) Dalda, Yasin; Akbulut, Sami; Ogut, Zeki; Yilmaz, Serkan; Sahin, Emrah; Dalda, Ozlem; Tuncer, AdemBackground/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials and Methods: This retrospective, multicenter cohort study included 324 patients from three tertiary centers in Turkey who underwent gastric cancer surgery between January 2018 and December 2022. Patients were stratified into Pre-COVID-19 (n = 150) and COVID-19 Era (n = 174) groups. Comprehensive demographic, surgical, pathological, and survival data were analyzed. To identify factors independently associated with postoperative mortality, a multivariable logistic regression model was applied. For evaluating predictors of long-term survival, multivariable Cox proportional hazards regression analysis was conducted. Results: The median time from diagnosis to surgery was comparable between groups, while the time from surgery to pathology report was significantly prolonged during the pandemic (p = 0.012). Laparoscopic surgery (p = 0.040) and near-total gastrectomy (p = 0.025) were more frequently performed in the Pre-COVID-19 group. Although survival rates between groups were similar (p = 0.964), follow-up duration was significantly shorter in the COVID-19 Era (p < 0.001). Comparison between survivor and non-survivor groups showed that several variables were significantly associated with mortality, including larger tumor size (p < 0.001), greater number of metastatic lymph nodes (p < 0.001), elevated preoperative CEA (p = 0.001), CA 19-9 (p < 0.001), poor tumor differentiation (p = 0.002), signet ring cell histology (p = 0.003), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001). Multivariable logistic regression identified total gastrectomy (OR: 2.14), T4 tumor stage (OR: 2.93), N3 nodal status (OR: 2.87), and lymphovascular invasion (OR: 2.87) as independent predictors of postoperative mortality. Cox regression analysis revealed that combined tumor location (HR: 1.73), total gastrectomy (HR: 1.56), lymphovascular invasion (HR: 2.63), T4 tumor stage (HR: 1.93), N3 nodal status (HR: 1.71), and distant metastasis (HR: 1.74) were independently associated with decreased overall survival. Conclusions: Although gastric cancer surgery continued during the COVID-19 pandemic, some delays in pathology reporting were observed; however, these did not significantly affect the timing of adjuvant therapy or patient outcomes. Importantly, pandemic timing was not identified as an independent risk factor for mortality in multivariable logistic regression analysis, nor for survival in multivariable Cox regression analysis. Instead, tumor burden and aggressiveness-specifically advanced stage, lymphovascular invasion, and total gastrectomy-remained the primary independent determinants of poor prognosis. While pandemic-related workflow delays occurred, institutional adaptability preserved oncologic outcomes.Öğe Giant hydatid cyst of the liver: a case report with literature review(Springeropen, 2023) Sahin, Emrah; Dalda, Yasin; Dirican, AbuzerHydatid cyst is a parasitic infection most commonly localized in the liver. They may not be diagnosed early because they remain asymptomatic at small sizes and may reach large sizes at the time of diagnosis. In this situation, compression symptoms may occur and they may present with serious complications such as rupture and anaphylactic shock, which are rare. Treatment methods are determined by classification according to the imaging techniques used in the diagnosis. In the present case, echinococcal cysts originating from segments 5, 6, and 7 in the right lobe of the liver, reaching 35 cm in diameter, caused compression symptoms. The diagnosis was made by abdominal tomography showing characteristic daughter vesicles and calcified cystic wall. The patient underwent pericystectomy and had an uneventful postoperative course with no recurrence in the 5-year follow-up.Öğe Impact of the COVID-19 Pandemic on Colorectal Cancer Surgery: Surgical Outcomes and Tumor Characteristics in a Multicenter Retrospective Cohort(Mdpi, 2025) Sahin, Emrah; Akbulut, Sami; Ogut, Zeki; Yilmaz, Serkan; Dalda, Yasin; Tuncer, Adem; Kucukakcali, ZeynepBackground: Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delays in CRC diagnosis and treatment, and their potential negative effects on surgical outcomes. However, the extent of this impact remains uncertain. Aim: To compare the clinical characteristics, treatment strategies, and outcomes of CRC patients between the Pre-COVID-19 and COVID-19 Era groups, and to identify independent predictors of metastasis and mortality. Methods: This retrospective multicenter study included 397 CRC patients who underwent surgical treatment between 1 July 2018, and 1 August 2021, at three tertiary medical centers. Patients were divided into two groups: Pre-COVID-19 (n = 213) and COVID-19 Era (n = 184). Demographic data, tumor characteristics, surgical approach, postoperative complications, and survival outcomes were analyzed. Logistic regression analysis was conducted to identify independent predictors of metastasis and mortality. Results: The median age was 64 years (95% CI: 63-66), with 59.2% being male. Compared to the Pre-COVID-19 group, patients in the COVID-19 Era had significantly larger tumors (p < 0.001), with a significantly higher total LN retrieved (p = 0.006), more advanced T-stage (p = 0.007), higher N2 lymph node involvement (p = 0.027), and poorer tumor differentiation (p = 0.030). Intestinal perforation was more frequent in the Pre-COVID-19 group (p = 0.042). Multivariate analysis revealed increased odds of mortality associated with the positive LN retrieved (OR: 1.14; p = 0.001), moderate tumor differentiation (OR: 2.99; p = 0.043), poor differentiation (OR: 4.57; p = 0.023), undifferentiated histology (OR: 6.95; p = 0.028), intestinal obstruction (OR: 2.67; p = 0.007), intestinal perforation (OR: 11.76; p < 0.001), and distant metastasis (OR: 2.86; p = 0.008). Regarding metastasis, elevated preoperative CEA (OR: 1.02; p = 0.002), lymph node involvement (OR: 4.87; p = 0.002), and perineural invasion (OR: 2.17; p = 0.033) were independently associated with increased odds of metastasis. Conclusions: Although overall survival did not differ significantly between groups, patients treated during the COVID-19 Era exhibited more advanced histopathological characteristics, including a higher proportion of T4 tumors, increased N2 lymph node involvement, and poorer differentiation grades. Despite no significant differences in postoperative complications between groups, it is noteworthy that preoperative intestinal perforation was less frequent in the COVID-19 Era cohort.Öğe Laparoscopic Resection Rectopexy with Transanal Specimen Extraction for Complete Rectal Prolapse: Retrospective Cohort Study of Functional Outcomes(Mdpi, 2026) Ates, Mustafa; Akbulut, Sami; Sahin, Emrah; Sarici, Kemal Baris; Karabulut, Ertugrul; Sanli, MukadderBackground: Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes-ODS, Wexner incontinence score (WIS), and LARS-in patients undergoing LRR-TSE. Methods: This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse-Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons. Results: ODS improved significantly over time (p < 0.001), decreasing from 12.8 +/- 3.2 preoperatively to 2.4 +/- 2.1, 4.2 +/- 2.2, and 5.2 +/- 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 +/- 12.7 at 3 months to 8.8 +/- 6.8 at 6 months and 3.5 +/- 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 +/- 5.2), followed by improvement at 6 and 12 months (3.2 +/- 3.7 and 2.4 +/- 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged >= 50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme's procedure. Conclusions: LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months.Öğe Outcomes of surgery for gallbladder cancer A single-center experience(Kare Publ, 2018) Baskiran, Adil; Sahin, Emrah; Karadag, Nese; Sahin, Tevfik Tolga; Barut, Bora; Ozgor, Dincer; Dirican, AbuzerOBJECTIVE: Gallbladder cancer (GBC) is a rare clinical entity that has a poor prognosis. Radical resection with meticulous lymph node dissection is the only treatment option. The aim of the present study is to evaluate the efficacy of radical resection for GBC in the early postoperative period with the viewpoint of clinicopathological correlation. METHODS: Patients (n=24) who underwent radical resection with lymph node dissection for GBC between 2015 and 2017 were included. Demographic data, histopathologic tumor type, preoperative tumor markers, pathologic tumor size/stage (depth of invasion), lymph node metastasis and metastasis rates, and postoperative early mortality were evaluated. The patients were grouped in two groups according to lymph node metastases: Group 1 (without lymph node metastasis) and Group 2 (with lymph node metastasis). RESULTS: The median age of the patients in Group 1 and Group 2 was 65 (range, 42-89) years and 68 (range, 48-87) years, respectively (p>0.05). The female/male ratio in Group 1 and Group 2 was 4/4 and 13/3, respectively (p>0.05). There was a tendency for increased metastasis in Group 2 compared with Group 1 (31% vs. 0%) (p>0.05). Also, 88% of the tumors in Group 2 were in the advanced stage, whereas the rate was 37% in Group 1 (p<0.05). There was early postoperative mortality in seven patients who underwent resection. Four of the seven patients (43%) were from Group 2 and three (37%) from Group 1 (p>0.05). CONCLUSION: Lymph node metastasis in GBC indicates advanced tumor stage. This causes a more complex surgical resection and therefore results in higher early postoperative mortality.Öğe Simple recommendation for cases requiring re-excision on breast surgery(Cukurova Univ, Fac Medicine, 2023) Dalda, Yasin; Sahin, Emrah; Kutluturk, Koray[Abstract Not Available]Öğe Squamous Cell Carcinoma Arising from Perianal Buschke-Lowenstein Tumor (Giant Condyloma Acuminatum): Comprehensive Literature Review(Springer, 2022) Ates, Mustafa; Akbulut, Sami; Tuncer, Adem; Sahin, Emrah; Karabulut, Ertugrul; Sarici, Kemal BarisPurpose This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum. Methods We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020. Results A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2). Conclusion Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.Öğe Undetectable Brain Metastasis of Hepatocellular Carcinoma by PET-CT After Liver Transplantation: a Case Report(Springer, 2023) Sahin, Emrah; Ince, Volkan; Sahin, Tolga T.; Kutlu, Ramazan; Pasahan, Ramazan; Yilmaz, SezaiPurpose Management of the unexplained AFP elevation after transplantation. F18 FDG PET/CT may not be helpful to detect post-transplant brain metastasis of hepatocellular carcinoma (HCC). Case Report A-61-year old male patient with HBV related HCC have undergone living donor liver transplantation after successfully downstaging. AFP level started to increase on Post-transplant one year and there was no detectable metastases on PET/CT, abdominal thorax tomography. Patient admitted to hospital with confusion and seizure on post-transplant 16th month and diagnosed brain metastasis by brain tomography. Surgical resection was performed but the patientd died on post-transplant 20th month. Conclusion In the unexplained elevation of AFP after transplantation, it is beneficial to keep brain metastases in mind and perform cranial scanning with conventional imaging methods (CT, MRI) rather than FDG PET.Öğe Xanthogranulomatous appendicitis: A comprehensive literature review(Baishideng Publishing Group Inc, 2021) Akbulut, Sami; Demyati, Khaled; Koc, Cemalettin; Tuncer, Adem; Sahin, Emrah; Ozcan, Mehmet; Samdanci, EmineBACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts. AIM To review the medical literature on xanthogranulomatous appendicitis (XGA). METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used were appendix vermiformis, appendectomy, acute appendicitis, and XGA. The search included articles published before May 2020, and the publication language was not restricted. The search included letters to the editor, case reports, review articles, original articles, and meeting presentations. Articles or abstracts containing adequate information about age, sex, clinical presentation, white blood cells, initial diagnosis, surgical approach, histopathological and immunohistochemical features of appendectomy specimens were included in the study. RESULTS A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. Twenty (52.6%) of the 38 patients, aged 3 to 78 years (median: 34; IQR: 31) were female, and the remaining 18 (47.4%) were male. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy. CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion. XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.
