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    The effect of surgeon’s fatigue on early term patency and complications of arteriovenous fistulas: A prospective cohort study
    (2018) Yabanoglu, Hakan; Bali, Cagla; Avci, Tevfik; Arer, İlker Murat; Yildirim, Sedat
    Aim: Examining the effect of surgeon’s fatigue on early term patency and complications of arteriovenous fistula (AVF). Material and Methods: AVFs created for hemodialysis in patients with end-stage renal failure were included in the study. The patients were divided into 2 groups as those operated in the first operation of that day (Group 1) and those operated after the first or second operations (Group 2). The patients were compared with respect to clinical, demographics, postoperative, surgical variables, and operation duration. Results: A total of 100 patients underwent AVF operation. No statistically significant differences were found between the groups with respect to clinical, demographic, surgical, and postoperative variables. Efficiency of dialysis was found to be higher and complication rate lower in Group 1. But no statistical significance was obtained in terms of early dialysis efficiency and complication rates in between the groups (p>0.05). Complication rate was higher in Group 2 when compared according to operation time as 120, 120-240, and 240< minutes. But no statistical significance was obtained in this manner (p>0.05). Conclusions: Although not statistically significant, surgical fatigue factor and long operation time increase the rate of early complications and reduce early dialysis efficiency. We think that early term patency of AVF can also be affected by the complication rate. The effect of this variable can be statistically significant with studies having larger sample size.
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    Retrospective cohort study of elderly patients with acute appendicitis
    (2017) Arer, Ilker Murat; Kus, Murat; Akkapulu, Nezih; Akdur, Aydincan; Hargura, Abdirahman Sakulen; Yabanoglu, Hakan
    Aim: Appendicitis is the most common surgical cause of abdominal pain among the patients being admitted to Emergency department. Although it affects younger patients, its incidence increases in elderly as the population gets older. Higher perforation and complication rates have been reported in elderly patients. The aim of this study is to investigate appendicitis in patients older than 65 years. Material and Methods: A total of 61 patients with performed appendectomy older than 65 years age were included in this study. Laparoscopic and open appendectomies were included. Data were collected retrospectively. Patients were analyzed according to demograhic data, operative findings, complications and mortality. Results: Of 61 patients, 34 (55.7%) were male and 27 (44.3%) were female. The mean age was found to be 71.59 years. The average duration of symptoms were 3.2 days. Laparoscopic appendectomy was performed in only 4 (6.6%) patients. The mean hospital stay was found to be 3.89 days. Complications were found in 13 (21.3%) patients. Mortality was found to be 3.3%. Perforated appendicitis was found to be associated with physical findings, CRP level and hospital stay (p<0.05). Abdominal ultrasound has a sensitivity of 45.2% and specificity of 66.7% and computerized tomography has higher sensitivity (82.1%) and specificity (100%). Conclusion: Prompt diagnosis and treatment should be performed in the elderly patients with suspected appendicitis in order to prevent complications and mortality. Radiological modalities should be used to ensure accurate diagnosis of appendicitis in elderly patients.
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    Surgical therapy of medullary thyroid cancer and our clinical experiences
    (2019) Akdur, Aydincan; Yabanoglu, Hakan; Arer, Ilker Murat; Hargura, Abdirahman Sakulen; Kocer, Nazim Emrah; Avci, Tevfik
    Aim: Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor that originates from the thyroid parafollicular C cells and produces calcitonin. It is a quite aggressive disease with a potential to cause serious morbidity and mortality. In this study we aimed to report treatment outcomes of MTC, which has a bad prognosis and is difficult to manage.Material and Methods: The medical records of 1287 patients who were operated on for thyroid cancer between 2009 and 2018 were retrospectively assessed. Twenty-one patients (1.6%) were diagnosed with MTC. Results: Eleven (52.4%) patients were females. The age range of the patients was 54(14-85) years. Sixteen (76.2%) cases were sporadic and 5 (23.8%) were familial. Twelve patients underwent bilateral total thyroidectomy + central and unilateral neck dissection, 5(23.8%) bilateral total thyroidectomy + central and bilateral neck dissection, 4(19%) bilateral total thyroidectomy. Pathology examination revealed lymph node metastasis in 13(61.9%) patients. Three (14%) patients had simultaneous papillary thyroid cancer. Mean duration of follow-up was 52(3-96) months. Five (23.8%) patients suffered recurrence cervical lymph nodes (6 months later), lungs and bone metastasis (at 12th and 18th months), lungs (at 12thmonth), mediastinal lymph nodes (at 15th months), liver metastasis (at 6th months). Seven (33%) patients underwent chemo-radiotherapy. Conclusion: Surgery is the gold standard to control loco-regional disease and the only curative method among the available therapies in MTC treatment. Despite having a low incidence, MTC may still lead to serious mortality and morbidity in delayed cases and/or when loco-regional control cannot be achieved. Keywords: Medullary Thyroid Cancer; Surgery; Recurrence.