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Öğe The incidence of splenic hemangioma and its rupture risk(2018) Gundogan, Ersin; Sansal, Müfit; Gunes, Orgun; Akinci, Eray Can; Erkenekli, Tarik Emre; Sumer, FatihAim: 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 Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass(Elsevıer scıence bv, po box 211, 1000 ae amsterdam, netherlands, 2018) Gündoğan, Ersin; Kayaalp, Cüneyt; Aktaş, Aydın; Sağlam, Kutay; Sansal, Müfit; Uylas, Ufuk; Gökler, Cihan; Çiçek, Egemen; Sümer, FatihBackground: Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. Objectives: The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. Setting: University hospital. Methods: A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. Results: A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. Conclusions: In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.Öğe Recurrent gastric bezoar after roux-en-y gastric bypass for morbid obesity(Sprınger ındıa, 7th floor, vıjaya buıldıng, 17, barakhamba road, new delhı, 110 001, ındıa, 2018) Aktaş, Aydın; Sansal, Müfit; Sağlam, Kutay; Sümer, Fatih; Kayaalp, CüneytIn this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A 66-year-old patient, who had diabetes mellitus (DM) and hypertension (HT) and had LRYGB operation 3years ago, underwent the first endoscopic bezoar evacuation 26months after the operation due to the diagnosis of gastric bezoar following the examination due to the nausea-vomiting and inability to eat. The patient applied again 36months after LRYGB with similar complaints. A 3-cm gastric bezoar, which was detected with the endoscopic examination at the anastomosis site, was evacuated after disintegration. The possibility of a bezoar formation should be kept in mind in patients with Roux-en-Y gastric bypass, who complain of nausea and vomiting. The removal of the bezoar leads to a dramatic improvement in the complications. These patients should follow strictly their diets, chew their food thoroughly, take vitamin supplements, and solve their psychological problems in the postoperative period. Otherwise, gastric bezoar may recur.Öğe Vacuum-assisted closure in the treatment of biliary leakage following gunshot injury to the liver(2019) Şimşek, Arife; Kılcı, Mahmut Burak; Karabulut, Ertuğrul; Sansal, Müfit; Ünal, Bülent[Abstract Not Acailable]