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Öğe Chemotherapy Related Late Enterocutaneous Fistula Following Laparoscopic Total Gastrectomy for Cancer(Gazi Univ, Fac Med, 2021) Uylas, Ufuk; Sumer, Fatih; Kayaalp, CuneytPostoperative adjuvant chemotherapy is known to be effective for survival in advanced gastric cancer. However, some severe gastrointestinal side effects during chemotherapy can interrupt adjuvant therapy. A 47-year-old woman underwent laparoscopic total gastrectomy for advanced stomach cancer (T4N2M0: Stage IIIB). Cisplatin and 5-fluorouracil chemotherapy was started postoperatively. During the third course of chemotherapy (on the postoperative 102 day) some gastrointestinal content including bile appeared through the healed laparoscopic trocar site. Computed tomography revealed a retroperitoneal abscess connected with this fistula. After percutaneous drainage of the abscess, the fistula ceased spontaneously. The patient was evaluated for chemotherapy again. Chemotherapy-induced gastrointestinal fistula can be seen postoperatively and this can interrupt the patient's chemotherapy process.Öğe A Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Total Colectomy(Mary Ann Liebert, Inc, 2019) Gundogan, Ersin; Kayaalp, Cuneyt; Gunes, Orgun; Uylas, Ufuk; Sumer, FatihIntroduction: Natural orifice surgery has been increasingly used in colon surgery since the early 2000s. However, it is rarely used for total colectomy. In this study, we aimed to retrospectively compare natural orifice specimen extraction (NOSE) with transabdominal specimen extraction in patients undergoing laparoscopic total colectomy. Materials and Methods: Twenty-six patients who underwent laparoscopic total colectomy between 2013 and 2017 were enrolled and the patients were divided into two groups: NOSE (n = 13) and transabdominal group (n = 13). The patients' demographic characteristics, perioperative and postoperative outcomes, pathology results, visual analog scale scores, and cosmetic scores were compared. Results: There was no significant difference between the two groups in terms of demographic characteristics as well as perioperative and postoperative outcomes, including complications. Benign pathologies were more common in the NOSE group (85% versus 15%, P = .001). The pain scores of the postoperative first, second, and third days were significantly lower in the NOSE group 4.1 +/- 2.1 versus 7.1 +/- 1.3 (P = .005), 3.7 +/- 2.2 versus 6.0 +/- 1.5 (P = .003), and 2.2 +/- 2.0 versus 4.1 +/- 0.9 (P = .03), respectively. As expected, the mean cosmetic score was significantly better in the NOSE group (8.3 +/- 1.5 versus 6.7 +/- 1.8, P = .02). Conclusion: NOSE combined with laparoscopic total colectomy provided better patient comfort in benign diseases and small-sized malignant diseases.Öğe Different clinicopathological features of non-elderly sigmoid volvulus patients(Springer, 2020) Uylas, Ufuk; Kayaalp, CuneytPurpose Sigmoid volvulus is frequently seen in male patients over 60 years old. Here, we aimed to investigate the causes of sigmoid volvulus developing in patients under 60 years of age. Methods Patients diagnosed with sigmoid volvulus between 2009 and 2018 were retrospectively analyzed. The patients were divided into two as under 60 years old and above. The co-morbidity, mortality, morbidity, complications, age, and gender data were analyzed. Results A total of 134 patients were included. The median age was 70 (19-92), <= 59 age patients constituted 24% of all patients. Eighty-one percent (109/134) of the patients were male, and male/female ratio was lower in <= 59 age patients (2.0 vs 6.2,p = 0.01). Diseases that caused and underlying colon dilatation (mental retardation with hypomotility, pregnancy-puerperium, Hirschsprung's disease, etc.) were more common in <= 59 age patients, but no observed at <= 60 age patients (15.2% vs 0%,p = 0.0007). While there was no difference between the two groups in terms of mortality, it was proportionally higher in the <= 60 age group (3.0% vs. 13.9%,p = 0.12). Conclusion By decreasing age, male dominance disappears progressively, and it is likely to have an underlying colonic hypomotility in young sigmoid volvulus patients.Öğe Different clinicopathological features of non-elderly sigmoid volvulus patients (2020)(Springer, 2020) Uylas, Ufuk; Kayaalp, CuneytThe presentation of<= 60 age groupthroughout the article were incorrect. The data should have been presented as60 <= age group.Öğe Endoscopic Sign in Sigmoid Volvulus with Mucosal Ischemia: Autumn Leaves(Springer India, 2021) Uylas, Ufuk; Kutluturk, Koray; Sumer, Fatih; Kayaalp, CuneytColonoscopic examination is used in both diagnosis and treatment of sigmoid volvulus. If colon ischemia is detected during a colonoscopy, urgent surgery is unavoidably accepted. Here we presented an ischemic sigmoid volvulus and its resolution as seen through colonoscope after successful medical treatment. The patient was a 79-year-old male with Alzheimer's disease and cerebrovascular disease. Emergency surgery was canceled, and an elective laparoscopic sigmoid resection was done 1 month later uneventfully.Öğe Hirschsprung’s Disease Complicated by Sigmoid Volvulus: A Systematic Review(2021) Uylas, Ufuk; Gunes, Orgun; Kayaalp, CüneytAbstract: Background: Hirschsprung’s disease and sigmoid volvulus can sometimes be seen in the same patient.Aims: To investigate the presence of Hirschsprung's disease in patients with sigmoid volvulus and to discuss the diagnosis and treatment methods.Study Design: Systematic review.Methods: This systematic review has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the methodological quality of systematic reviews guidelines. The PubMed and Scopus databases were scanned using the keywords “Hirschsprung* volvulus*” and “congenital aganglionic megacolon volvulus*”. The reference list of the selected studies was reviewed for cross-checking. Two reviewers independently screened the available literature. Only the Hirschsprung’s disease cases involving sigmoid volvulus were included, and cases of patients with volvulus in other sites was excluded. There was no restriction with respect to the publication language and type of writing. The primary outcome was morbidity and mortality.Results: A total of 31 cases were analyzed in 22 articles; 97% of the patients were under the age of 40, 90% were male. There was a statistically significant difference in the necessity for relaparotomy between patients who were scheduled for sigmoid volvulus therapy with the suspicion of Hirschsprung’s disease and patients who were treated without suspicion of Hirschsprung’s disease (0% vs 37.5%, p=0.02). While there was no postoperative death in cases with suspected Hirschsprung disease, this mortality rate was 25% in cases without suspicion (p = 0.08).Conclusion: Hirschsprung's disease should be excluded with rectal biopsy if a patient with sigmoid volvulus is under 40 years of age and has complaints of constipation from childhood.Öğe Incidental cancer in colectomy specimens from patients with familial adenomatous polyposis: single centre experience and literature review(Springer, 2023) Uylas, Ufuk; Gundogdu, Ramazan; Sumer, Fatih; Samdanci, Emine; Kayaalp, CuneytBackgroundSince cancer development is inevitable in patients with familial adenomatous polyposis (FAP), we aimed to determine the incidence of incidental malignancy in prophylactic colectomy specimens.MethodsThe files of patients who underwent prophylactic surgery for FAP between 2010 and 2020 were retrospectively reviewed. The incidence of incidental malignancy in histopathological specimens was examined and a comprehensive literature review was made.ResultsFifty-five patients were included in the study, of whom 30 patients had a diagnosis of primary malignancy. Prophylactic colectomy was performed on 25 patients. The pathology results indicated that the specimens were benign in 12 patients (48%) and revealed carcinoma in situ in 11 patients (44%). Incidental malignancy was detected in 2 patients (8%). In the literature review, there were 243 patients who underwent prophylactic colectomy and incidental cancer was detected in 25 patients (10.3%) with the stages of 1 (7.4%), 2 (2.1%), and 3 (0.8%), respectively.ConclusionsIncidental cancer is not rare in patients who have undergone prophylactic colectomy for FAP. Hopefully. they are usually at early stages and unexpected advanced cancers are seen rarely.Öğe Intestinal perforation after regorafenib usage(AVES, BUYUKDERE CAD 105-9, MECIDIYEKOY, SISLI, ISTANBUL 34394, TURKEY, 2018) Sarıcı, Barış; Karakaş, Serdar; Uylas, Ufuk; Aktaş, Aydın; Dikilitaş, Mustafa; Kayaalp, Cüneyt[Abstract Not Acailable]Öğe Is Emergency Colectomy Inevitable for All Ischemic Sigmoid Volvulus Cases?(Springer India, 2020) Uylas, Ufuk; Kayaalp, Cuneyt[Abstract Not Available]Öğe Is lobectomy an effective treatment method in giant hepatocellular carcinomas?(2021) Gundogdu, Ramazan; Uylas, Ufuk; Caliskan, Kenan; Erkan, Serkan; Kus, MuratAim: Hepatocellular carcinomas (HCC) are diagnosed at a high frequency worldwide. The most effective treatment method is surgery. Surgical treatment of giant HCCs (HCCs ≥10 cm in diameter) remains controversial due to its advanced stage. In this study, we discuss the surgical treatment of patients with HCC with a tumor size ≥10 cm, as well as early complications and effect on survival. Materials and Methods: Patients who underwent surgical treatment for HCC in our clinic between 2011 and 2021 were retrospectively reviewed. Patients older than ≥18 years of age who were treated with anatomical lobectomy and whose files were not missing any data were included in the study. Demographic characteristics, surgery and pathology reports, and survival data of the patients were analyzed. Results: A total of seven patients, five of whom were men, were included in the study, and the median age was 66 years (range 28–76). The median tumor diameter was 20 cm (range 10.5–24). Anatomical lobectomy was performed in all patients. The median duration of hospitalization was 4 days (range 3–7). Perioperative morbidity and mortality were not observed. At least one liver recurrence was observed in all patients during follow-up. Pulmonary metastasis was detected in two patients during follow-up. The median survival was 24 months (range 7–60). Conclusion: We think that lobectomy can be applied with low perioperative morbidity and mortality in patients with selected giant HCCs in experienced centers such as our clinic.Öğe Is routine pathological examination of hernia sac necessary?(2021) Gundogdu, Ramazan; Uylas, UfukAim: Minimally invasive hernia repair methods in which the hernia sac is not excised are applied frequently, bringing into question the necessity of routine pathological examination when the hernia sac is excised. Here, we aim to discuss the pathology results and unexpected histopathological findings of 437 sequential patients who underwent abdominal wall and inguinal hernia operation. Materials and Metods: Patients who underwent hernia surgeries and had the hernia sac sent for histopathological examinations at our hospital were retrospectively screened. Emergency and elective operated patients were included; hernia repairs without pathologic examination were excluded from the study. Pathology results were categorized into two groups as expected findings and unexpected findings. Results: A total of 437 patients were included in the study. Of these patients, 259 (59.3%) were male and the mean age was 51±16 years. Expected pathological findings were 98.9% and unexpected pathological findings were 1.1%. Unexpected pathological findings results were ranked according to frequency as follows: accessory adrenal cortex in two cases (0.4%), endometriosis in one (0.2%), skin pseudo epithelial hyperplasia in one (0.2%), and colon wall in one (0.2%). Conclusion: Histologically, unusual findings in hernia sacs were seen only in 1.1% and they were all benign. . For this reason, we think that microscopic examination of adult hernia sac specimens, other than those that cannot be clearly demonstrated to be benign macroscopically, unnecessarily increase the workload and cost.Öğe Laparoscopic cholecystectomy in pregnant women can be performed safely with cesarean section(2021) Gemici, Kazim; Uylas, Ufuk; Gundogdu, Ramazan; Alptekin, HusnuAim: The aim of this study is to demonstrate the efficacy of laparoscopic cholecystectomy performed during cesarean section in patients with symptomatic or complicated gallstones during pregnancy to prevent complications associated with gallstones in the early postpartum period.Materials and Methods: Patients were selected among the patients who were followed up in the obstetrics clinic between 2010 and 2015, who had gallbladder stones and showed symptoms such as acute cholecystitis, biliary pancreatitis, choledocholithiasis and biliary colic. Fifteen patients accepted our recommendation of laparoscopic cholecystectomy with cesarean section. Patients were evaluated together with general surgery clinic. Patients with biliary colic due to bile sludge and who underwent cholecystectomy during pregnancy were excluded from the study. Informed consent forms were obtained from the patients. The study was approved by the “Aksaray University Rectorate Human Research Ethics Committee” with the protocol number 2020/08-03.Results: Laparoscopic cholecystectomy was performed in the second trimester of pregnancy (two patients due to acute cholecystitis and one patient due to biliary pancreatitis) in three patients who did not respond to medical treatment. The other 12 patients underwent laparoscopic cholecystectomy simultaneously with cesarean section. Eight patients were discharged on postoperative first day and four patients were discharged on postoperative second day.Conclusion: We believe that laparoscopic cholecystectomy can be performed safely with caesarean section in pregnant women with symptomatic and complicated gallstones.Öğe Living Donor Liver Transplantation for Hepatocellular Carcinoma with Bile Duct Tumor Thrombi(Springer, 2018) Uylas, Ufuk; Tolan, Huseyin Kerem; Ince, Volkan; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Mucosal ischaemia and bowel gangrene can have different treatment options in sigmoid volvulus(WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, 2018) Uylas, Ufuk; Kayaalp, CüneytÖğe Operative and conservative treatment of right colon diverticulitis(2021) Uylas, Ufuk; Gundogdu, Ramazan; Cetin, Durmus Ali; Oztop, Burak; Demirli Atici, Semra; Calik, BulentAim: This study assessed the results of conservative and surgical treatment of right colon diverticulitis. Right colon diverticula contain all layers of the colon and are called true diverticula. Perforation of these diverticula is observed less frequently due to their full thickness.Materials and Methods: 150 patients treated for colonic diverticulitis between 2015-2020 were retrospectively screened. Following exclusions, a total of 26 patients data were assessed. The patients were divided into two groups as conservative or surgical treatment. The outcomes for these two groups were compared and analyzed.Results: Most patients in the sample were female (n=18, 69%). The average age was 47 (22-83). Data from the conservative treatment group (n=17, 65%) and the surgical treatment group (n=9, 35%) were examined. Comorbidity, recurrence, and white blood cell count were all greater following conservative treatment (p> 0.05). In the surgical group, two (22% of the group) patients developed wound infections. Patients with fever at admission were in the surgical group (p 0.01). All patients in the conservative group had a Hinchey classification of 1a, while those in the surgical group were Hinchey 1a, 1b, and 3 (p 0.05). The median hospital stay was higher for the surgical group (p 0.05). No mortality was observed.Conclusion: Right colon diverticulitis has low complications and it can be treated conservatively. The differential diagnosis of rightsided colonic diverticulitis should be kept in mind when relevant symptoms present to prevent unnecessary surgeries. Surgical treatment is inevitable in instances of recurrent diverticulitis, generalized peritonitis, and suspected malignancy.Öğe Percutaneous gas decompression can ease endoscopic derotation in sigmoid volvulus(Turkish Surgical Assoc, 2023) Uylas, Ufuk; Cicek, Egemen; Sumer, Fatih; Kayaalp, CuneytSigmoid volvulus is a disease of elderly and debilitated patients. In sigmoid volvulus patients, colonoscopic derotation is the most commonly applied approach as the first line treatment. However, colonoscopic derotation sometimes fail and then urgent surgery is required in these frail patients with high morbidity and mortality. Percutaneous colonic gas decompression has been described to sigmoid volvulus. In case of life-threating increase intraabdominal pressure and as a primary attempt before colonoscopy. However, this technique did not find wide acceptance in the literature. Here, we aimed to present a 78-year-old male with sigmoid volvulus in whom colonoscopic derotation failed and following percutaneous gas decompression, endoscopic derotation could be done successfully. Evacuation of percutaneous colon gas in the sigmoid volvulus may facilitate endoscopic derotation when the first colonoscopic attempt failed.Öğe Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass(Elsevier Science Bv, 2018) Gundogan, Ersin; Kayaalp, Cuneyt; Aktas, Aydin; Saglam, Kutay; Sansal, Mufit; Uylas, Ufuk; Gokler, CihanBackground: 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 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 Sigmoid Volvulus Provoked by Severe Diarrhea(Gazi Univ, Fac Med, 2020) Koc, Cemalettin; Uylas, Ufuk; Kayaalp, CuneytHere, we presented two sigmoid volvulus cases both presented after severe diarrhea episodes. A 69-year-old male with the symptoms of severe diarrhea for 2.5 months presented with left colonic obstruction. Sigmoid volvulus was diagnosed with plain abdominal X-ray, computed tomography and colonoscopy confirmed the diagnosis. After a successful colonoscopic detorsion, the patient underwent elective laparoscopic colon surgery. The second case was a 50-year-old male with mental retardation who complaint of diarrhea for four days. After sudden interruption of diarrhea, the abdomen was begun to swell. Sigmoid volvulus was diagnosed when a coffee bean sign was seen on his plain abdomen X-ray. Detorsion was applied by colonoscopy. The patient was planned for elective surgery but his relatives refused. Sigmoid volvulus is generally accompanied with constipation, whereas in our cases, diarrhea was the essential symptom before sigmoid colon volvulus. So far there has been only one reported case. Our aim was to underline that sigmoid volvulus can be seen after diarrhea.Öğe Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single-center prospective cohort study(Wiley, 2019) Aktas, Aydin; Kayaalp, Cuneyt; Gunes, Orgun; Gokler, Cihan; Uylas, Ufuk; Cicek, Egemen; Ersoy, YaseminIntroduction Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Materials and Methods Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants; and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols. Results A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for >= 150 minutes, surgical duration of >= 600 minutes, intraoperative hemorrhage of >= 1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61. Discussion Organ/space SSIs were the essential part of SSIs following right lobe living donor liver transplantations. Donor-recipient age gap, prolonged cold ischemia time, complicated surgery, and postoperative biliary complications were the main causes of SSIs. Although they did not increase the perioperative mortality, they promote increased rate of reoperations, remote infections, prolonged intensive care unit, and hospital stays.
