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Öğe Clip closure and division instead of stapling for the last small gastric bridge between gastric pouch and remnant stomach in laparoscopic Roux-en-Y gastric bypass(Elsevier Science Bv, 2017) Yuksel, Adem; Sumer, Fatih; Kayaalp, CuneytIntroduction: Here, a modification during gastric pouch forming was implemented in laparoscopic Roux-en-Y gastric bypass (LRYGB). We aimed to examine the feasibility of metallic clip closure for the remaining small stomach bridges (< 1 cm) between the pouch and the remnant stomach. Methods: During pouch creation, after the last stapler firing, the remaining small bridge was closed with clips and divided instead of using a new stapler. Metallic clips for this aim were used in 41 of 520 LRYGP between September 2010 and January 2017. Preoperative mean body mass index (BMI) was 47.3 +/- 5.3 kg/m(2) (male/female: 6/35, mean age 37.8 +/- 9.1 years). Results: Gastric bridges in 41 patients were successfully closed with metallic clips and divided. In one patient, intraoperative methylene blue test was positive from the anastomosis (not from the clipped place) and repaired by intracorporeal sutures. Abdominal drain was used selectively (32%). No postoperative leakage or other complications were seen. Mean length of hospital stay was 3.8 +/- 1.1 days. Mean BMI was 30.3 +/- 6.1 kg/m(2) after mean 17.6 +/- 11.3 months follow-up. Conclusion: In LRYGB metallic clip closure for a stomach bridge (< 1 cm) between the pouch and the remnant stomach is an easy, safe and reliable method. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Comparison of open and laparoscopic gastrectomy for gastric cancer: a low volume center experience(Turkish Surgical Assoc, 2021) Yuksel, Adem; Coskun, Murat; Turgut, Hamdi Taner; Sumer, FatihObjective: In gastric cancer, laparoscopic gastrectomy is commonly performed in Asian countries. In other regions where tumor incidence is relatively low and patient characteristics are different, developments in this issue have been limited. In this study, we aimed to compare the early results for patients who underwent open or laparoscopic gastrectomy for gastric cancer in a low volume center. Material and Methods: We retrospectively analyzed the data of patients who underwent curative gastric resection (open gastrectomy n: 30; laparoscopic gastrectomy n: 30) by the same surgical team between 2014 and 2019. Results: The tumor was localized in 60% (36/60) of the patients in the proximal and middle 1/3 stomach. In laparoscopic gastrectomy group, the operation time was significantly longer (median, 297.5 vs 180 minutes; p<0.05). In open gastrectomy group, intraoperative blood loss (median 50 vs 150 ml; p<0.05) was significantly higher. Tumor negative surgical margin was achieved in all cases. Although the mean number of lymph nodes harvested in laparoscopic gastrectomy group was higher than the open surgery group, the difference was not statistically significant (28.2 +/- 11.48 vs 25.8 +/- 9.78, respectively; p=0.394). The rate of major complications (Clavien-Dindo >= grade 3) was less common in the laparoscopic group (6.7% vs 16.7%; p=0.642). Mortality was observed in four patients (2 patients open, 2 patients laparoscopic). Conclusion: In low-volume centers with advanced laparoscopic surgery experience, laparoscopic gastrectomy for gastric cancer can be performed with the risk of morbidity-mortality similar to open gastrectomy.Öğe Comparison of Results of Minimal Invasive Surgery for Pilonidal Sinus with Karydakis Procedure: Less is More(2017) Ozyildiz, Mehmet; Yazicioglu, Murat Burc; Coskun, Murat; Turgut, Hamdi Taner; Tiryaki, Çağrı; Civil, Osman; Yuksel, Adem; Yildiz, Selim YigitAim: Controversy still remains regarding the best surgical technique to use for the treatment of pilonidal disease to minimize disease recurrence and patient discomfort. Minimal surgical procedures can be performed on an outpatient basis. In this study, the early results of our minimally invasive operative approach cases are compared with Karydakis flap reconstruction results.Öğe Comparison of the methods of intracorporeal knot and hem-o-lok clip to cover the stumps in laparoscopic appendectomy(2018) Subasi, Ozkan; Coskun, Murat; Yuksel, Adem; Yildiz, Selim Yigit; Turgut, Hamdi Taner; Gunes, AbdullahAim: Laparoscopic appendectomy (LA) is used in acute appendicitis treatment in many centers today. Various methods such as intracorporeal knot, endoloop, stapler and hem-o-lok clip are used to close of the appendix stump during LA. All of these methods has several advantages and disadvantages. In this study, we aimed to compare the effect of the intracorporal knot method with hemo-lok clip method to close of the appendix stump in LA. Material and Methods: Operative data, complications and follow-up results of 143 patients which treated with LA between January 2012 and December 2017 were evaluated retrospectively. Results: Sixty-four patients (44.7%) were males and 79 (55.2%) were females. Seventy-five patients (52.4%) were treated with 2/0 polyglactin (coated vicyrl, ethicon) sutures and 68 patients (47%) were treated with hem-o-lok clip XL (weck hem-o-lok polymer ligation system) for intracorporeal knot to close of the appendix stump. Patients were compared according to the duration of operation, the duration of hospitalization and postoperative complications and there were no statistically significant difference between the data of the cases according to the groups (p = 0.197, p = 0.902, p = 0.503, respectively). Conclusion: We identified that both techniques for appendix stump closure are effective and safe methods in LA.Öğe Lower gastrointestinal endoscopy results of surgical endoscopy unit(2019) Coskun, Murat; Turgut, Hamdi Taner; Yuksel, Adem; Yildiz, Selim Yigit; Firtina, GizemAim: Endoscopic examinations are gold standard methods with great potential for early diagnosis of colorectal adenomas and carcinomas and reduction of colorectal cancer incidence, and mortality. Our aim in this retrospective study was to evaluate our results regarding the patients who underwent lower gastrointestinal system endoscopy in the general surgical endoscopy unitin Derince Resear hand Training Hospital. Material and Methods: We retrospectively evaluated the data of patients undergoing colonoscopy or rectosigmoidoscopy after admission to the general surgery clinic between January 2015 and December 2017 due to complaints of the lower gastrointestinal system or for bowel preparation for control purposes. Results: Colonoscopies were performed to 57% (n = 2784) of the patients and rectosigmoidoscopy procedure was performed in43% (n = 2100) of 4884 patients. 49.5% (n = 2417) of the patients were males and 50.5% (n = 2467) were females. In 81.5% of the patients the procedure was completed adequately and successfully. The number of patients evaluated as inadequate procedure was 903 (18.5%). Reasons for inadequate procedure were insufficient bowel cleansing in 12.7% (625/4884) of patients and intolerance due to pain in 5.5% (270/4884) of patients. Endoscopic procedures revealed no pathology in 28.7% of the patients (n=1170), hemorrhoids in 30.1 % (n=1198), polyps in 15.7% (n=625), anal fissure in 6.3% (n=250), and malignant diseases in 4.6% (n=183). Conclusion: In this study we evaluated the endoscopy results of the lower gastrointestinal system in our unit, we found that the inadequacy rate of operation was high and the most important cause of this was insufficient bowel cleansing. Being more careful about patient preparation before the procedure, and informing the patient in detail will increase the success of the procedure and prevent unnecessary repetition of the procedure.Öğe Solitary cecal diverticulitis, a rare cause of right lower quadrant pain: four cases(Kare publ, concord ıstanbul, dumlupınar mah, cıhan sk no 15, b blok 162 kadıkoy, ıstanbul, 00000, turkey, 2018) Yuksel, Adem; Civil, Osman; Colakoglu, Muhammed Kadri; Sumer, Fatih; Eruyar, Ahmet TugrulSolitary cecal diverticulitis is a rare clinical condition. Like diverticulitis in other segments of the colon, it requires immediate surgical intervention if it is causing complications. Solitary cecal diverticulitis may be misdiagnosed as acute appendicitis, since it causes right lower quadrant pain, or as a cecal tumor or inflammatory bowel disease, due to an intraoperative appearance resembling an inflammatory mass. Four patients with solitary cecum diverticulitis presenting with acute right lower quadrant pain are discussed in this report. Three patients underwent surgery with a preliminary diagnosis of acute appendicitis or cecal tumor, and 1 patient was diagnosed with cecal diverticulitis and treated medically. The treatment approach may change depending on a preoperative or intraoperative diagnosis of cecal diverticulitis. Therefore, in areas where this disease is uncommon, cecum diverticulitis should not be forgotten in the differential diagnosis of acute right lower quadrant pain or inflammatory bowel mass.Öğe Solitary cecal diverticulitis, a rare cause of right lower quadrant pain: Four cases(Kare Publ, 2018) Yuksel, Adem; Civil, Osman; Colakoglu, Muhammed Kadri; Sumer, Fatih; Eruyar, Ahmet TugrulSolitary cecal diverticulitis is a rare clinical condition. Like diverticulitis in other segments of the colon, it requires immediate surgical intervention if it is causing complications. Solitary cecal diverticulitis may be misdiagnosed as acute appendicitis, since it causes right lower quadrant pain, or as a cecal tumor or inflammatory bowel disease, due to an intraoperative appearance resembling an inflammatory mass. Four patients with solitary cecum diverticulitis presenting with acute right lower quadrant pain are discussed in this report. Three patients underwent surgery with a preliminary diagnosis of acute appendicitis or cecal tumor, and 1 patient was diagnosed with cecal diverticulitis and treated medically. The treatment approach may change depending on a preoperative or intraoperative diagnosis of cecal diverticulitis. Therefore, in areas where this disease is uncommon, cecum diverticulitis should not be forgotten in the differential diagnosis of acute right lower quadrant pain or inflammatory bowel mass.
