Publications by authors named "Ahmet Rencuzogullari"

31 Publications

Laparoscopic revisional surgery for failed anti-reflux procedures.

Ann Ital Chir 2021 Mar 2;10. Epub 2021 Mar 2.

Aim: Failure ratio of an anti-reflux surgery is 2-17% in adults. After unsuccessful fundoplications, if necessary, revisional surgeries can be performed. Revisional surgeries are technically difficult to perform and require professionally advanced experience. On the other hand, it is still controversial which technique should be used in revisional surgery. The aim of this study is to present our experience with revisional surgical procedures for complications or recurrences after anti-reflux surgeries.

Material And Metods: A total of 18 patients, 16 of whom were referred to our clinic from other centers, and who underwent revisional surgery for failed fundoplication between 2014 and 2019 were retrospectively analyzed RESULTS: Five patients were male and 13 were female. The mean age was 40.3±11.7 years. The most common symptom was the persistence of reflux symptoms (61.2%). Indications for revisional surgery were recurrent hiatal hernia in 10 patients, thightness in 4 patients, mesh migration in 2 patients, mesh migration with recurrent hiatal hernia in 1 patient, and mesh migration with thightness in 1 patient. The mean operative time was 107.2+29.2 minutes. The median hospital stay was 2.9 days (range: 1-6 days). The most common surgical procedure performed was the repair of hiatal crura with mesh, and reconstruction of fundoplication and fixation of neo-fundoplication to the right crus (44.4%). In addition, other surgical procedures performed were takedown of the previous fundoplication (16.6%), takedown of the previous fundoplication and reconstruction of fundoplication (11.1%), cruroplasty and fundoplication with gastric wedge resection (11.1%), removal of the mesh and takedown of the previous fundoplication (5.6%), removal of sutures from the hiatal crura (5.6%), and gastric wedge resection (5.6%). Four patients (27.8%) developed morbidity due to gastric perforation and pleural opening during these procedures. The median follow-up period was 29 months (range: 6-69 months). Two cases (11.1%) who underwent revisional surgery failed, and re-revisional surgery was performed.

Conclusions: Revisionary surgical procedures performed for failed anti-reflux surgery are not limited to re-fundoplication. Different procedures such as takedown of the previous fundoplication, reconstruction of fundoplication, removal of the mesh, removal of the sutures or wedge resection may be necessary. These procedures can successfully be performed laparoscopically by experienced surgeons in well-equipped centers.

Key Words: Fundoplication, Gastroesophageal reflux, Laparoscopy, Revisional Surgery, Antireflux surgery.
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March 2021

Laparoscopic versus open complete meso-colic excision for right-sided colon cancer. Analysis of short-term outcomes.

Ann Ital Chir 2021 ;92:48-58

Scopo Dello Studio: L'emicolectomia destra per escissione mesocolica completa (EMC) laparoscopica mostrerebbe benefici comparabili a breve termine, nonché esiti patologici e oncologici per la chirurgia a cielo aperto. Lo scopo di questo studio era di confrontare la tecnica laparoscopica e la EMC aperta per i tumori del colon sul lato destro in termini di campioni patologici e risultati a breve termine.

Materiale E Metodi: I dati dei pazienti sottoposti a EMC laparoscopica (n=31) e EMC aperto (n=35) per adenocarcinoma del colon destro tra gennaio 2016 e giugno 2019 sono stati analizzati retrospettivamente. Sono stati confrontati dati demografici, parametri preoperatori, peroperatori e postoperatori e campioni di patologia dei due gruppi.

Risultati: Non ci sono state differenze statistiche tra il gruppo laparoscopico di EMC e il gruppo aperto di EMC in termini di età, sesso, indice di massa corporea, posizione del tumore, punteggio dell'American Society of Anesthesiologists (ASA), presenza di comorbidità, storia di altre neoplasie e precedente chirurgia addominale (p>0,05). I pazienti nel gruppo EMC laparoscopico presentavano lunghezze d'incisione più brevi, tempi operativi più lunghi, minore perdita di sangue operativa, tempi di mobilizzazione più brevi, recupero precoce del movimento intestinale, tempo più breve per dieta leggera, durata ridotta della degenza e dimensioni del tumore più piccole (p<0,05). Il numero medio di linfonodi raccolti in gruppi laparoscopici e di EMC aperti non era statisticamente significativo (29,83+8,90 e 31,34+13,10, rispettivamente). Non ci sono state differenze statistiche in termini di lunghezza del campione tra i gruppi laparoscopici e aperti di EMC (35,19+9,8 cm e 32,71+11,12 cm, rispettivamente). Il tasso di complicanze postoperatorie di 30 giorni era più elevato nel gruppo EMC aperto (35,5% contro 42,9%, rispettivamente), ma non statisticamente significativo (p>0,05).

Conclusioni: Patologici (lunghezze dei campioni, lunghezze dei margini di resezione, numero di linfonodi e resezione R0) e risultati a breve termine del gruppo laparoscopico di EMC erano comparabili. Inoltre, la EMC laparoscopica ha conferito benefici a breve termine in termini di lunghezze di incisione più brevi, minore perdita di sangue operativa, riduzione dei tempi di mobilizzazione, recupero precoce dei movimenti intestinali, minor tempo di dieta leggera e riduzione della durata della degenza ospedaliera. Sulla base di questi risultati, la EMC laparoscopica può essere considerata come un approccio elettivo di routine per il carcinoma del colon destro.
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January 2021

Intraoperative Colonoscopy During Colorectal Surgery Does Not Increase Postoperative Complications: An Assessment From the ACS-NSQIP Procedure-targeted Cohort.

Surg Laparosc Endosc Percutan Tech 2021 Jan 12. Epub 2021 Jan 12.

Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.

Intraoperative colonoscopy (IOC) is an adjunct in colorectal surgery to detect the location of the lesions and assessing anastomotic integrity. The authors aimed to evaluate the safety and feasibility and postoperative morbidity of IOC in left-sided colectomy patients for colorectal cancer. Patients undergoing elective left-sided colectomy without any proximal diversion for colorectal cancer between 2013 and 2016 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted database. Demographics, comorbidities, short-term outcomes, and postoperative morbidity of patients were evaluated. A total of 8811 patients were identified and IOC was performed for 1143 (12.97%) patients. There was no significant difference in postoperative complications between the IOC and non-IOC groups. Patients with IOC had shorter total hospital length of stay. The use of IOC does not adversely affect short-term outcomes after colorectal resections. Surgeons may utilize IOC liberally for left-sided colorectal resections.
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http://dx.doi.org/10.1097/SLE.0000000000000907DOI Listing
January 2021

Endosonograpy-confirmed long-term outcomes of ligation of the intersphincteric fistula tract procedure for complex perianal fistulas.

Ann Ital Chir 2020 ;91:512-519

Objective: As the short-term outcomes may overestimate the true success rates of sphincter-sparing techniques, and follow- up protocols that were reported based on clinical criteria do not ideally reflect real world outcomes associated with complex perianal fistulas (CPF), this study aimed to reveal clinically and three dimensional endosonograpy confirmed long-term outcomes and analyze the factors associated with recurrences of ligation of intersphincteric fistula tract (LIFT) procedure.

Patients And Methods: A retrospective cross-sectional review was conducted for patients who underwent the LIFT procedure for complex perianal fistulas between October 2015 and February 2017. Cox proportional regression model was used to estimate the mean failure free survival rates and log-rank test was used to compare the outcome distributions for patients who healed vs presented with failure.

Results: A total of 42 patients with the majority of males (n=34, %81), who underwent LIFT procedure for CPF were analyzed. None of patients were lost at follow-up. Endosonograpy-confirmed fistula types were high transsphincteric( n=35), horseshoe fistula (n=5) and suprasphicteric (n=2). After a median follow-up of 25.1 (15-36) months, the overall healing rate was 57.1%, which subsequently increased to 85.7% with a simple secondary intervention. Based on Cox regression analysis, previous perianal intervention was found to be independent risk factor for failure (p=0.025). Having prior perianal surgery significantly increased the risk of recurrence 6.7 times (OR:6,7 95% CI:1,9-24,1 p=0,003). Outcomes were confirmed by endoanal ultrasound for all patients.

Conclusions: Endoanal ultrasound confirmed long-term assessment of the LIFT procedure provides an acceptable success rate, especially when combined with secondary simple interventions, without impairment on continence for the complex perianal fistulas.

Key Words: Complex perianal fistulas, Endoanal ultrasound, Ligation of intersphincteric fistula tract.
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January 2020

Laparoscopic versus open total radical gastrectomy for advanced gastric cancer: surgical outcomes.

Ann Ital Chir 2020 Sep 28;9. Epub 2020 Sep 28.

Aim: The aim of this study is to compare the oncologic efficacy of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) for gastric cancer and to provide our experiences regarding this surgery.

Methods: A total of 107 patients who underwent curative total gastrectomy for gastric adenocarcinoma between September 2015 and September 2018 were included in this study. Demographic characteristics, operative parameters, histopathological results, postoperative morbidity and mortality results of the patients were evaluated.

Results: Of 107 patients, 70 were men and 37 women. OTG consisted of 89 patients and LTG consisted of 18 patients. The mean age in OTG was 59.4 years, the mean age in LTG was 57.3 years. The mean number of lymph nodes harvested was 30.5±14.6 in OTG and 33.0±10.1 in LTG. The number of metastatic lymph nodes harvested was 7.4±10.5 in OTG and 10.0±11.8 in LTG (p= 0.366), and there was no statistical difference between the two groups. The time of onset of oral intake, anastomotic leakage, and postoperative mortality was similar in both groups. Operative duration and length of hospital stay were significantly higher in LTG. Postoperative survival duration was similar in both procedures CONCLUSION: Laparoscopic total gastrectomy for gastric cancer is an oncologically safe procedure but had a longer operation time and a longer hospital stay. There was no significant difference number of harvested lymph nodes, number of metastatic lymph nodes, and tumor localization between the two groups KEY WORDS: Gastric cancer, Laparoscopy, Gastrectomy.
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September 2020

The importance of anorectal physiology tests in clinical diagnosis and treatment.

Ann Ital Chir 2020 Sep 29;9. Epub 2020 Sep 29.

Aim: In this study, we aimed to convert subjective findings to objective findings and to determine the effect of anorectal physiology tests on the diagnosis and treatment of patients with defecatory complaints.

Material And Method: Two hundred and forty patients who applied to the proctology unit between January 2015 and August 2017 were included in our study. The patients were divided into 3 groups based on their presentation complaints; Group 1: Obstructive defecation syndrome(ODS), Group 2: Peroperative except anal incontinence and control after sphincter repair, Group 3: Anal incontinence.Group 2 and Group 3 were divided into subgroups. The demographic data of the patients were retrospectively analyzed. The number of anorectal physiological tests in groups and the rates of referral to surgical or medical treatment were evaluated.

Findings: Two hundred and forty patients were included in our study. The highest mean age was in Group 3 (46.2±17.8) (p: 0.356) 43.3% of the patients in our study were female. Anorectal manometry was performed in all patients. Endoanal USG was most commonly performed in Group 2 (42.6%, p:0.013), defecography in Group 1 (47.4%, p: 0.0001), and EMG in Group 3(25.3%, p: 0,001). In Group 1, 33% of the patients with pathological defecography findings had surgical treatment (p<0.05). In Group 2a, the rate of surgical treatment was higher in patients who underwent anal USG with anorectal manometry (%25.6vs %40). In Group 3, the rate of surgical treatment was higher in patients who underwent anal ultrasound with manometry (%1.9 vs %32.6 p<0.005) DISCUSSION: Anorectal physiological tests are important for accurate diagnosis and treatment planning. The combined use of anorectal physiological tests in anal incontinence groups increased the rate of referral to surgical treatment.
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September 2020

Xanthogranulomatous cholecystitis: a rare gallbladder pathology from a single-center perspective.

Ann Surg Treat Res 2020 Oct 24;99(4):230-237. Epub 2020 Sep 24.

Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey.

Purpose: The aim of this study was to review patients with xanthogranulomatous cholecystitis (XGC).

Methods: A total of 79 patients diagnosed with XGC were included in the study. The criteria for XGC in the pathology specimens were the presence of histiocytes, cholesterol deposits, lipids, and focal or widespread wall enlargement.

Results: Patients were diagnosed with XGC, of which 52 (65.8%) were male and 27 (34.2%) were female, creating a male-to-female ratio of 2:1. The mean age was 65.8 ± 14.3 years (range, 36-97 years). The most common presenting symptom was abdominal pain (63.3%), and the least common presenting symptom was jaundice (8.9%). Of the total, 25 patients were found to have pathological conditions with the potential to obstruct the bile duct or to slow bile flow. A frozen section examination was performed on 20 patients due to suspicion of a tumor by intraoperative macroscopic examination. However, no malignancy was detected in the cases who underwent a frozen section examination. An increase in wall thickness of the gallbladder was observed in 81.6% (n = 31) of the patients on computed tomography scans and in 81.8% (n = 18) of the patients on magnetic resonance imaging scans in which possible tumor lesions were reported, but no tumor was detected.

Conclusion: It is difficult to diagnose XGC either preoperatively or intraoperatively, and further imaging methods are needed in the preoperative period other than ultrasonography. However, a definitive diagnosis depends exclusively on pathologic examination.
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http://dx.doi.org/10.4174/astr.2020.99.4.230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520231PMC
October 2020

Retrorectal tumor: a single-center 10-years' experience.

Ann Surg Treat Res 2020 Aug 31;99(2):110-117. Epub 2020 Jul 31.

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Purpose: Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution.

Methods: A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated.

Results: Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma.

Conclusion: RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.
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http://dx.doi.org/10.4174/astr.2020.99.2.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406398PMC
August 2020

Prolapsed giant rectal gastrointestinal stromal tumor presented with incarceration A rare case of emergency rectal lesion.

Ann Ital Chir 2020 ;91:426-431

Prolapse of the tumor is an extremely rare clinical presentation in patients with rectal gastrointestinal stromal tumor (GIST). A 79-year-old male patient was consulted in the in-patient ward of internal medicine clinic of our hospital due to his incarcerated hemorrhagic mass protruding from the anal canal. Anal inspection revealed an incarcerated prolapsed hemorrhagic mass larger than 10 cm in diameter that looked like a cauliflower. The incarcerated rectal GIST protruding from the anal canal was removed by transanal excision under the emergency conditions. Clean surgical margins were obtained. No postoperative complications occurred. The histological diagnosis of high-risk GIST was made. Imatinib mesylate treatment was started postoperatively. The colorectum are the less common primary sites in adult GISTs (5%). Giant GISTs of the anorectum represent a real potential for anorectal emergency. They may be involved in rectal bleeding, obstruction, prolapse or incarceration. Prolapse of the tumor is an extremely rare clinical presentation in cases of rectal GISTs, and only a few cases have been reported in the medical literature so far. Complete surgical resection with en bloc excision of the tumor is the treatment of choice. Lower rectal GISTs are a rare entity that requires multidisciplinary management and long-term surveillance. We recommend, in case of lower rectal GIST, to perform an initial transanal local excision that achieves the essential R0 resection and define the risk of aggressive behavior and the involvement of the resection margins. Patients' close follow-up is mandatory to disclose as soon as possible local recurrences or metastases. Preoperative imatinib mesylate therapy and downstaging of the tumor may play an important role. KEY WORDS: Gastrointestinal stromal tumor, Incarceration, GIST, Prolapse, Transanal excision.
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January 2020

The efficacy of F-FDG PET/CT in the preoperative evaluation of pancreatic lesions.

Ann Surg Treat Res 2020 Apr 31;98(4):184-189. Epub 2020 Mar 31.

Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey.

Purpose: Since the treatment strategy for benign and malignant pancreatic lesions differ, we aimed to evaluate the clinical value of PET/CT in the diagnosis and management of pancreatic lesions.

Methods: Ninety patients who had a histologically confirmed pancreatic lesion were studied. Receiver operating characteristic (ROC) curve analysis was used to investigate the ability of PET/CT to differentiate malignant lesions from benign tumors.

Results: The malignant and benign groups comprised 64 and 26 patients, respectively. Despite the similarity in the size of primary tumors (P = 0.588), the mean maximum standardized uptake values (SUVmax) obtained from PET/CT imaging were significantly higher in malignant lesions (9.36 ± 5.9) than those of benign tumors (1.04 ± 2.6, P < 0.001). ROC analysis showed that the optimal SUVmax cutoff value for differentiating malignant lesions (to an accuracy of 91%; 95% confidence interval, 83%-98%) from benign tumors was 3.9 (sensitivity, 92.2%; specificity, 84.6%).

Conclusion: PET/CT evaluation of pancreatic lesions confers advantages including fine assessment of malignant potential with high sensitivity and accuracy using a threshold SUVmax value of 3.9.
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http://dx.doi.org/10.4174/astr.2020.98.4.184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118324PMC
April 2020

The effect of anorectal manometric examination on the surgical treatment plan in chronic anal fissure.

Ann Ital Chir 2021 ;92:59-63

Introduction: Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure.

Material And Methods: Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. In addition to the demographic characteristics of the patients, anal manometry findings and its effect on surgical treatment options were examined.

Results: 20 patients (M/F:13/7) were included in the study. The mean age was 48.3+17.4 in Group 1 and 45.25 +24.45 in Group 2 (p:0.797). In the preoperative manometric examination, resting pressure(mmHg) range was 93.2+15.9 in Group 1, and44+11.2 in Group 2 (30-57) (p:0.001). Endurance to squeezing time was shorter in Group 2 (p:0.0138). There were no differences between the groups in terms of mean squeezing pressure, rectal sensation, and rectoanal inhibitor reflex (p>0.05). Of the four patients with low sphincter pressures, 3 underwent botulinum toxin injection and 1 underwent advancement flap instead of LIS. There was no significant difference between preoperative and postoperative CCFI scores in the LIS group (0.6±1.8 vs. 1.2±1.85, p>0.05).

Conclusion: In the treatment of chronic anal fissure, non-LIS methods were selected in 20% of the patients with the help of preoperative anal manometric examination. Manometric examination is important to minimize the risk of incontinence and to determine the choice of treatment correctly.

Key Words: Anal fissure, Anal incontinence, Anal manometry.
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January 2021

Short-term results of adipose-derived stem cell therapy for the treatment of complex perianal fistula A single center experience.

Ann Ital Chir 2019 ;90:583-589

Background: In this study, we aimed to investigate the early results of the safety and efficacy of adipose-derived stem cells (ADSCs) injection along with the repair of the internal orifice in the recovery of complex perianal fistula.

Methods: The study included patients who underwent autologous adipose tissue-derived stemcell injection for complex perianal fistula between December2017 and January2018. The FDA-approved Lipogems® system was used to prepare autologous micro-fragmented adipose stem cells. Demographic characteristics, history of inflammatory bowel disease, fistula type and length of fistula tract determined by endoanal ultrasound, mean operation duration, postoperative complications, and fistula healing of the patients were evaluated. Fistula healing was evaluated on the 30th ,90th days and 9th months.

Results: A total of 10 patients, with male predominance, were included in our study. The mean age was 47±13.1 and mean BMI was 28.3±4.79. None of the patients had inflammatory bowel disease Based on endoanal ultrasound findings, fistula type was transsphincteric, extrasphincteric and suprasphincteric for 7, 2 and 1 patients, respectively. Calculated length of fistula tract based on ultrasound was 4.45±1.69(2.5-6.4). Mean duration of operation was 45±7 minutes. None of the patients had any treatment related toxicity, however, two patients experienced bruising at the liposuction site. Healing rate in the follow-up of 30-day, 90-day and 9-month was 70%, 80% and 70%, respectively.

Conclusions: In addition to surgical treatment in the form of curettage and closure of the fistula tract, autologous micro-fragmented adipose tissue injection is a safe, feasible, and reproducible procedure that can be performed based on the early results in complex anal fistula healing.

Key Words: Lipogems®, Mesenchymal stem cell, Regenerative medicine, Adipose tissue-derived mesenchymal stem cell.
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July 2020

Predictors of ileus following colorectal resections.

Am J Surg 2020 03 5;219(3):527-529. Epub 2019 Oct 5.

Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Ohio, USA. Electronic address:

Background: Ileus following colorectal surgery is a significant burden for healthcare and can be challenging to manage. This study aims to evaluate risk factors for postoperative ileus in patients undergoing colorectal surgery.

Methods: Patients who underwent colorectal resections for any diagnosis were identified from our institutional database between 2009 and 2014. Patient demographics, pre-operative comorbidities, and operation-related variables were compared in patients with and without ileus within 30 days after surgery.

Results: A total of 5369 patients were identified with a mean age of 53 years. 892 patients (16.6%) developed postoperative ileus. Males were twice as likely (p < 0.001) and patients with anastomosis were 1.4 times more likely to develop ileus compared to those without (p < 0.001). Laparoscopic surgery and younger age were associated with lower ileus risk. Patients with colorectal cancer, Crohn's disease, and ulcerative colitis diagnoses were all more likely to develop postoperative ileus compared to patients with diverticular disease.

Conclusions: Evaluation of factors such as male gender, older age, anastomosis formation, diagnosis of cancer and inflammatory bowel disease, can help facilitate earlier diagnosis of postoperative ileus and may require consideration of prophylactic therapy.
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http://dx.doi.org/10.1016/j.amjsurg.2019.10.002DOI Listing
March 2020

Predictors of one-year outcomes following the abdominoperineal resection.

Am J Surg 2019 07 29;218(1):119-124. Epub 2018 Aug 29.

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address:

Purpose: This study aimed to determine one-year outcomes and the impact of various factors on the need for readmission and reoperation following abdominoperineal resection (APR).

Method: A multivariate logistic regression analysis was conducted to determine predictors of readmission and/or reoperation within one year of APR performed between January-2000 and December-2013.

Results: 536 patients were analyzed for whom the most common indication for surgery was rectal cancer(86.4%). Within one year of operation, 14.2% (n = 76) of patients have major (grade III/IV of Clavien-Dindo [CD]) and 26.1%(n = 140) of patients have minor complications (grade I/II of CD). Respective major and minor perineal wound complication(PWC) rates were 10.4% and 5.6%.Readmission and reoperation rates within 90 days following discharge were 25% and 8.8%, respectively. While PWC (n = 53,39.2%) and small bowel obstruction(n = 23,17%) were the most common causes of readmission within 90 days,PWC(n = 20,23.3%) and distant metastasis(n = 20,23.3%) were the main causes of long-term readmission(90-day to 1 year).

Conclusion: Perineal wound complications were the most common cause of readmission and reoperation within one year of APR. Well-coordinated efforts aimed at decreasing the perineal wound morbidity may impact the need for readmission and reoperation.
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http://dx.doi.org/10.1016/j.amjsurg.2018.08.021DOI Listing
July 2019

Outcome Comparison of Single-port Versus Multiport Versus Under Direct View Completion Proctectomy With Ileal-Pouch Anal Anastomosis for Patients With Ulcerative Colitis.

Surg Laparosc Endosc Percutan Tech 2019 Oct;29(5):373-377

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.

Purpose: Whether the reported theoretical benefits of single-port laparoscopic (SPL) approach can be converted to superior clinical outcomes is still unknown for ulcerative colitis (UC) patients undergoing second-stage proctectomy. This study aimed to compare the short-term postoperative and long-term pouch-related functional outcomes of SPL, multiport laparoscopic (MPL), and direct view (DV) completion proctectomy with ileal-pouch anal anastomosis (CP/IPAA).

Materials And Methods: Patients who underwent either SPL, MPL, or under DV CP/IPAA for UC between August 2009 and August 2014 were identified from an institutional review board-approved, prospectively maintained institutional database and reviewed. Demographics, patient characteristics, short-term and long-term complications, and morbidity were compared between the 3 groups. Multivariate logistic or Cox regression analysis was conducted for covariate adjustments.

Results: Groups (SPL: n=36; MPL: n=67; DV: n=97) were comparable in terms of preoperative characteristics and demographics except for age. The SPL group was associated with reduced estimated blood loss, reduced length of stay compared with the MPL and DV groups, and shorter operating time compared with the MPL group (P<0.001). Similar short-term postoperative and long-term pouch-related functional outcomes were noted without significant differences in quality of life scores among the 3 groups.

Conclusions: SPL CP/IPAA for UC can be safely performed with superior short-term outcomes such as reduced intraoperative blood loss and length of hospital stay compared with MPL and under direct view approaches, and shorter operating time compared with MPL.
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http://dx.doi.org/10.1097/SLE.0000000000000674DOI Listing
October 2019

An Effective Bundled Approach Reduces Surgical Site Infections in a High-Outlier Colorectal Unit.

Dis Colon Rectum 2018 Jan;61(1):89-98

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

Background: Surgical site infections are the most common hospital-acquired infection after colorectal surgery, increasing morbidity, mortality, and hospital costs.

Objective: The purpose of this study was to investigate the impact of preventive measures on colorectal surgical site infection rates in a high-volume institution that performs inherent high-risk procedures.

Design: This was a prospective cohort study.

Settings: The study was conducted at a high-volume, specialized colorectal surgery department.

Patients: The Prospective Surgical Site Infection Prevention Bundle Project included 14 preoperative, intraoperative, and postoperative measures to reduce surgical site infection occurrence after colorectal surgery. Surgical site infections within 30 days of the index operation were examined for patients during the 1-year period after the surgical site infection prevention bundle was implemented. The data collection and outcomes for this period were compared with the year immediately before the implementation of bundle elements. All of the patients who underwent elective colorectal surgery by a total of 17 surgeons were included. The following procedures were excluded from the analysis to obtain a homogeneous patient population: ileostomy closure and anorectal and enterocutaneous fistula repair.

Main Outcome Measures: Surgical site infection occurring within 30 days of the index operation was measured. Surgical site infection-related outcomes after implementation of the bundle (bundle February 2014 to February 2015) were compared with same period a year before the implementation of bundle elements (prebundle February 2013 to February 2014).

Results: Between 2013 and 2015, 2250 abdominal colorectal surgical procedures were performed, including 986 (43.8%) during the prebundle period and 1264 (56.2%) after the bundle project. Patient characteristics and comorbidities were similar in both periods. Compliance with preventive measures ranged between 75% and 99% during the bundle period. The overall surgical site infection rate decreased from 11.8% prebundle to 6.6% at the bundle period (P < 0.001). Although a decrease for all types of surgical site infections was observed after the bundle implementation, a significant reduction was achieved in the organ-space subgroup (5.5%-1.7%; P < 0.001).

Limitation: We were unable to predict the specific contributions the constituent bundle interventions made to the surgical site infection reduction.

Conclusions: The prospective Surgical Site Infection Prevention Bundle Project resulted in a substantial decline in surgical site infection rates in our department. Collaborative and enduring efforts among multiple providers are critical to achieve a sustained reduction See Video Abstract at http://links.lww.com/DCR/A438.
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http://dx.doi.org/10.1097/DCR.0000000000000929DOI Listing
January 2018

Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort.

Am Surg 2017 Jun;83(6):564-572

Postoperative ileus (POI) is a clinical burden to health-care system. This study aims to evaluate the incidence and predictors of POI in patients undergoing colectomy and create a nomogram by using recently released procedure-targeted nationwide database. Patients who underwent elective colectomy in 2012 and 2013 were identified from American College of Surgeons National Surgical Quality Improvement Program using the new procedure-targeted database. Demographics, comorbidities, and 30-day postoperative outcomes were evaluated. Variables in the final stepwise multiple logistic regression model for each outcome were selected in a stepwise fashion using Akaike's information criterion. A nomogram was created to aid in the calculation of POI risk for individual patients. A total of 29,201 patients met the inclusion criteria; 3834 (13.1%) developed POI with a male predominance (55.9%). Patients who developed ileus had longer length of hospital stay (11 vs 5 days; P < 0.001) and operative time (200 vs 174 minutes; P < 0.001). In the stepwise logistic regression model, the following variables were found to be independent risk factors for POI: older age (P < 0.001), male gender (P < 0.001), American Society of Anesthesiologists class III/IV (P < 0.001), open approach (P < 0.001), preoperative septic conditions (P < 0.001), omission of oral antibiotic before surgery (P < 0.001), right colectomy or total colectomy vs other procedures (P < 0.001), smoking (P = 0.001), decreased preoperative serum albumin level (P < 0.001), and prolonged operating time (P < 0.001). All postoperative complications were more frequently occurred in patients with POI. The nomogram accurately predicted POI with a concordant index for this model of 0.69. The use of minimal invasive techniques, control of preoperative septic conditions, oral antibiotic bowel preparation and shorter operative time are associated with a decreased rate of POI. External validation is essential for the confirmation and further evaluation of our logistic regression model and nomogram.
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June 2017

Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort.

Dis Colon Rectum 2017 May;60(5):527-536

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

Background: Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak.

Objective: This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient.

Design: This study was a retrospective review.

Settings: The database review of the American College of Surgeons National Surgical Quality Improvement Program was conducted at a single institution.

Patients: Patients aged ≥65 years who underwent elective segmental colectomy with an anastomosis at different levels (abdominal or low pelvic) in 2012-2013 were identified from the multi-institutional procedure-targeted database.

Main Outcome Measures: We constructed a stepwise multiple logistic regression model for anastomotic leak as an outcome; predictors were selected in a stepwise fashion using the Akaike information criterion. The validity of the nomogram was externally tested on elderly patients (≥65 years of age) from the 2014 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database.

Results: A total of 10,392 patients were analyzed, and anastomotic leak occurred in 332 (3.2%). Of the patients who developed anastomotic leak, 192 (57.8%) were men (p < 0.001). Based on unadjusted analysis, factors associated with an increased risk of anastomotic leak were ASA score III and IV (p < 0.001), chronic obstructive pulmonary disease (p = 0.004), diabetes mellitus (p = 0.003), smoking history (p = 0.014), weight loss (p = 0.013), previously infected wound (p = 0.005), omitting mechanical bowel preparation (p = 0.005) and/or preoperative oral antibiotic use (p < 0.001), and wounds classified as contaminated or dirty/infected (p = 0.008). Patients who developed anastomotic leak had a longer length of hospital stay (17 vs 7 d; p < 0.001) and operative time (191 vs 162 min; p < 0.001). A multivariate model and nomogram were created.

Limitations: This study was limited by its retrospective nature and short-term follow-up (30 d).

Conclusions: An accurate prediction of anastomotic leak affecting morbidity and mortality after colorectal surgery using the proposed nomogram may facilitate decision making in elderly patients for healthcare providers.
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http://dx.doi.org/10.1097/DCR.0000000000000789DOI Listing
May 2017

Colonic Diverticulosis and Diverticulitis in Renal Transplant Recipients: Management and Long-Term Outcomes.

Am Surg 2017 Mar;83(3):303-307

Data regarding management of colonic diverticulitis in renal transplant recipients (RTRs) are limited. This study aims to identify prevalence, risk factors, and outcomes in RTRs with colonic diverticulosis and diverticulitis. Between January 2004 and December 2013, all patients who underwent kidney transplantation were analyzed. Among all RTSs, patients who had a pretransplant colonoscopic diagnosis of diverticulosis and patients with a proven attack of diverticulitis were included in our analysis. There were 1578 RTRs with a mean age of 50 ± 14 years at the time of transplantation. Of these, 409 patients had colonoscopic evaluation and 174 (43%) were diagnosed with diverticular disease. Fifteen (0.9%) out of 1578 developed a primary attack of diverticulitis. Two patients underwent a Hartmann's procedure due to perforation. Among 13 patients who were initially treated nonoperatively, 4 required surgery due to refractory diverticulitis (n = 2) and recurrence (n = 2). Tobacco use (59% vs 48%, P = 0.02), increased age (58 vs 51 years, P < 0.0001), diabetes (33% vs 35%, P = 0.03), coronary artery disease (38% vs 22%, P = 0.001), and autosomal dominant polycystic kidney disease etiology (P = 0.04) were more common in RTRs with diverticulosis. Majority of RTRs with diverticulitis can be managed nonoperatively. Surgical treatment is warranted in patients with perforated, persistent, and recurrent diverticulitis. A special care and follow-up may be needed in RTRs with autosomal dominant polycystic kidney disease etiology, smoking history, and coronary artery disease due to higher risk of diverticulosis and subsequent potential diverticulitis.
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March 2017

Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life, and Complications.

J Gastrointest Surg 2017 01 10;21(1):56-61. Epub 2016 Nov 10.

Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA.

Introduction: It is uncertain whether the outcomes of patients with indeterminate colitis (IC) undergoing ileal pouch-anal anastomosis (IPAA) deteriorate over time. The aim of this study was to determine the long-term pouch function, quality of life, complications, and incidence of Crohn's disease after IPAA for patients with IC compared to ulcerative colitis (UC).

Methods: A case matched analysis was performed on patients undergoing IPAA for pathologically confirmed IC or UC, between 1985 and 2014. Patients were case matched for age ± 5 years, gender, date of surgery ± 3 years, type of anastomosis and presence of a diverting loop ileostomy. All patients were followed up for greater than six months.

Results: 448 patients were case matched, the average age was 36.8 year old and 52.7 % of patients were male. Mean follow-up was 122.06 months (+/- 80.77 months). There were statistically and clinically comparable number of daytime bowel movements (5.7 v 5.5, p = 0.45), rates of incontinence (26.1 % v 18.3 %, p = 0.09) and nighttime seepage in patients (23.1 % v 28.4 %, p = 0.28) with IC and UC. Quality of life markers and patient restrictions were comparable between the two groups. Rates of pelvic sepsis (IC 8.5 %, UC 8.5 %, p = 0.99) and anastomotic leak (IC 3.1 %, UC 4.0 %, p = 0.61) were similar but fistula formation (IC 15.6 %, UC 8.0 %, p = 0.01) and IPAA Crohn's disease rates (IC 6.7 %, UC 2.7 %, p = 0.04) were significantly increased in IC patients. There was no statistically significant difference in pouch failure rates for IC and UC (5.8 % vs.4.9 %, p = 0.58).

Conclusion: Patients undergoing IPAA for IC have a higher risk of post-operative fistulae and development of Crohn's disease, but comparable morbidity, functional outcomes, quality of life scores and pouch failure rates when compared to UC patients. Long-term data confirms that IPAA is a good surgical option in patients with IC.
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http://dx.doi.org/10.1007/s11605-016-3306-9DOI Listing
January 2017

Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution.

Surg Endosc 2017 03 12;31(3):1083-1092. Epub 2016 Jul 12.

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Foundation, A-30, 9500 Euclid Ave, Cleveland, OH, 44195, USA.

Background: Previous work from our institution has characterized the learning curve for open ileal pouch-anal anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA.

Methods: Perioperative outcomes of 372 minimally invasive IPAA by 20 surgeons (10 high-volume vs. 10 low-volume surgeons) during 2002-2013, included in a prospectively maintained database, were assessed. Predicted outcome models were constructed using perioperative variables selected by stepwise logistic regression, using Akaike's information criterion. Cumulative sums (CUSUM) of differences between observed and predicted outcomes were graphed over time to identify possible improvement patterns.

Results: Institutional pelvic sepsis and other pouch morbidity rates (hemorrhage, anastomotic separation, pouch failure, fistula) significantly decreased (18.2 vs. 7.0 %, CUSUM peak after 143 cases, p = 0.001; 18.4 vs. 5.3 %, CUSUM peak after 239 cases, respectively, p < 0.001). Institutional total proctocolectomy mean operative times significantly decreased (307 min vs. 253 min, CUSUM peak after 84 cases, p < 0.001), unlike completion proctectomy (p = 0.093) or conversion rates (10 vs. 5.4 %, p = 0.235). Similar learning curves were identified among high-volume surgeons but not among low-volume surgeons. Learning curves were identified in the two busiest individual surgeons for pelvic sepsis (peaks at 47 and 9 cases, p = 0.045 and p = 0.002) and in one surgeon for operative times (CUSUM peak after 16 and 13 cases for both total proctocolectomy and completion proctectomy (p < 0.001 and p = 0.006) but not for other pouch complications (peak at 49 and 41 cases, p = 0.199 and p = 0.094).

Conclusion: Pouch complications, particularly pelvic sepsis, are the most consistent and relevant learning curve end points in laparoscopic IPAA.
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http://dx.doi.org/10.1007/s00464-016-5068-6DOI Listing
March 2017

Case-matched Comparison of Robotic Versus Laparoscopic Proctectomy for Inflammatory Bowel Disease.

Surg Laparosc Endosc Percutan Tech 2016 Jun;26(3):e37-40

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.

The present study reports an early institutional experience with robotic proctectomy (RP) and outcome comparison with laparoscopic proctectomy (LP) in patients with inflammatory bowel disease (IBD). Patients who underwent either RP or LP during proctocolectomy for IBD between January 2010 and June 2014 were matched (1:1) and reviewed. Twenty-one patients undergoing RP fulfilled the study criteria and were matched with an equal number of patients who had LP. Operative time was longer (304 vs. 213 min, P=0.008) and estimated blood loss was higher in the RP group (360 vs. 188 mL, P=0.002). Conversion rates (9.5% vs. 14.3%, P>0.99), time to first bowel movement(2.29±1.53 vs. 2.79±2.26, P=0.620), and hospital length stay(7.85±6.41 vs. 9.19±7.47 d, P=0.390) were similar in both groups. No difference was noted in postoperative complications, ileal pouch to anal canal anastomosis-related outcomes, Cleveland Global Quality of Life, and Short Form-12 health survey outcomes between RP and LP. Our good results with standard laparoscopy are unlikely to be improved with robotics in proctectomy cases. Potential benefits of robotic approach for completion proctectomy warrant further investigation as experience grows with robotics.
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http://dx.doi.org/10.1097/SLE.0000000000000269DOI Listing
June 2016

Primary gastric tuberculosis mimicking gastric cancer.

Ulus Cerrahi Derg 2015 1;31(3):177-9. Epub 2015 Sep 1.

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.
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http://dx.doi.org/10.5152/UCD.2014.2667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605117PMC
October 2015

Robotic rectal surgery.

J Surg Oncol 2015 Sep;112(3):326-31

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

Robotic technology is increasingly used in colorectal surgery during last decade. Whether this technology will translate into clinical efficiency and value of care remains to be determined. This review aims to discuss current data in robotic rectal surgery with emphasize on ergonomics, cost, and learning curve aspects. All relevant articles are reviewed in addition to published and unpublished work from the authors' own experience.
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http://dx.doi.org/10.1002/jso.23956DOI Listing
September 2015

Comparison of early surgical alternatives in the management of open abdomen: a randomized controlled study.

Ulus Travma Acil Cerrahi Derg 2015 May;21(3):168-74

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Background: Abdominal compartment syndrome (ACS) is a clinical syndrome characterized by progressive intraabdominal organ dysfunction resulting from an acute increase in intra-abdominal pressure (IAP). In the absence of prompt treatment, ACS can lead to lethal organ failure. Treatment of ACS is achieved by immediate decompression of the abdominal cavity. As to how and when decompression laparotomy should be performed depends on the clinical condition of the patients. There is limited data regarding outcomes of abdominal closure techiques. The present study aimed to investigate two different temporary closure methods, the vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who underwent decompressive laparotomy as part of the management of ACS.

Methods: The study included 40 patients who developed ACS during follow-up or following trauma and abdominal surgery. As part of the treatment for ACS, these patients underwent decompressive laparotomy at the Cukurova University Medical Faculty, General Surgery Department and followed up in the Intensive Care Unit of the same hospital. VAC and Bogota bag procedures were performed as temporary closure methods for the treatment of ACS. Patients were randomly assigned to each of the two groups according to the temporary closure method performed. Clinical, laboratory, mortality and morbidity results of the patients in both groups were compared.

Results: Demographic features of the patients (age, sex, body mass index, co-morbidities) were similar between the two groups. The most common reason of ACS was gastrointestinal perforation in 12 (30%) patients. Decrease in incision width was significantly faster in the VAC group than in the Bogota group. Primary closure of fascia was considered appropriate in 16.9 days in the VAC group and 20.5 days in the Bogota bag group. The decrease in abdominal pressure was similar between the two groups on days 1, 4 and 7 but appeared to be significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study. Among the deceased patients, 5 (12%) were in the VAC group, whereas, 7 (17.5%) belonged to the Bogota bag group.

Conclusion: Based on these results, it is suggested that VAC has advantages when compared to the Bogota bag as a temporary closure method in the management of abdominal compartment syndrome.
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http://dx.doi.org/10.5505/tjtes.2015.09804DOI Listing
May 2015

A functional HOTAIR rs920778 polymorphism does not contributes to gastric cancer in a Turkish population: a case-control study.

Fam Cancer 2015 Dec;14(4):561-7

Department of Biology, Faculty of Science and Letters, Adıyaman University, 02040, Adıyaman, Turkey.

An aberrant up-regulation of HOX transcript antisense intergenic RNA (HOTAIR), a long non-coding RNA (lncRNA), is associated with human cancers including gastric cancer (GC) and worse clinicopathological features. A naturally occurring functional single nucleotide polymorphism (SNP) rs920,778 (C→T) in the intronic enhancer of HOTAIR gene has been demonstrated to affect HOTAIR expression and cancer susceptibility. To investigate the association of the HOTAIR rs920778 polymorphism on the risk of GC susceptibility in Turkish population, a hospital-based case-control study was carried out consisting of 104 GC and 209 healthy control subjects matched on age and gender. The genotype frequency of HOTAIR rs920778 polymorphism was determined by using TaqMan Real-Time Polymerase Chain Reaction. No statistically significant differences were found in the allele or genotype distributions of the HOTAIR rs920778 polymorphism among GC and healthy control subjects (P > 0.05). Our results demonstrate that the HOTAIR rs920778 polymorphism has not been in any major role in genetic susceptibility to gastric carcinogenesis, at least in the population studied here. Independent studies are needed to validate our findings in a larger series, as well as in patients of different ethnic origins.
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http://dx.doi.org/10.1007/s10689-015-9813-0DOI Listing
December 2015

18F-FDG activitiy PET/CT and CA-19.9 levels for the prediction of histopathological features and localization of peri- ampullary tumors.

Turk J Gastroenterol 2015 Mar;26(2):170-5

Department of General Surgery, Çukurova University Faculty of Pharmacy, Adana, Turkey.

Background/aims: We sought to investigate the roles of maximum standardized uptake value (SUVmax) and serum carbohydrate antigen 19-9 (CA 19-9) in predicting the histopathological features of periampullary tumors.

Materials And Methods: Thirty-four patients with histologically confirmed periampullary tumors were classified into two groups, according to the localizations of their tumors (ampulla Vateri or pancreas). SUVmax was obtained from [(18)F]-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT). SUVmax and CA 19-9 levels were measured and compared with histopathological features of the tumors. Logistic regression was used to assess the significance and independence of predictive factors.

Results: 18F-FDG PET/CT SUVmax (<2.5 vs. ≥2.5; p=0.031) and CA 19-9 level (normal vs. elevated; p=0.045) were significantly and independently predictive of the histopathological origin of the tumors (ampulla Vateri vs. pancreas). The ratio of CA 19-9 levels and SUVmax were found to be higher in cases of poorly differentiated tumors and tumors greater than 2 cm in diameter.

Conclusion: A surgical approach to treatment may be considered for patients who have both i) an established or suspected diagnosis of periampullary tumors and ii) low SUVmax and CA 19-9 levels.
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http://dx.doi.org/10.5152/tjg.2015.7870DOI Listing
March 2015

Unusual Presentation of Meckel's Diverticulum: Gangrene due to Axial Torsion.

Case Rep Emerg Med 2015 22;2015:571847. Epub 2015 Feb 22.

Department of General Surgery, Cukurova University Medical Faculty, 01330 Adana, Turkey.

Meckel's diverticulum is the most common congenital anomaly of the small bowel. The majority of cases are asymptomatic; however, life-threatening complications can also take place. We present a case of a 37-year-old male who was admitted with symptoms of acute, severe abdominal pain in the right iliac fossa. The patient was operated on with the preoperative diagnosis of acute appendicitis but the operative findings were consistent with torted Meckel's diverticulum due to presence of mesodiverticular band and he was treated successfully with surgical resection.
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http://dx.doi.org/10.1155/2015/571847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352490PMC
March 2015

The prognostic value of pro-calcitonin, CRP and thyroid hormones in secondary peritonitis: a single-center prospective study.

Ulus Travma Acil Cerrahi Derg 2014 Sep;20(5):343-52

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Background: Infections and sepsis remain the leading cause of morbidity and mortality in secondary peritonitis. Clinicians are still challenged with the task of finding an early and reliable diagnosis of septic complications. The role of inflammatory markers (Procalcitonin (PCT), C-reactive Protein (CRP) and thyroid hormones in determining the severity of secondary peritonitis was evaluated in this study.

Methods: On the preoperative and first, third, fifth, seventh, and fourteenth postoperative days, PCT, CRP, and thyroid hormone concentrations were measured in serum taken from eighty-four consecutive patients who were operated on for secondary peritonitis between January 2008 and January 2010. All data was entered and analyzed using the Statistical Package for Social Sciences, version 15.0 and clinical parameters were compared using the student's t-test.

Results: For the groups diagnosed with perforated viscus, PCT concentrations were significantly low in contrast to high thyroid hormone levels in patients who developed postoperative complications or died when compared to patients whose postoperative course was uneventful or discharged. The PCT concentration significantly correlated with the CRP concentration and WBC count.

Conclusion: In the absence of postoperative complications, PCT is a better predictor of outcome than CRP in secondary peritonitis. Our study showed that a low thyroid hormone level can serve as an important prognostic parameter of disease severity in secondary peritonitis.
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http://dx.doi.org/10.5505/tjtes.2014.98354DOI Listing
September 2014

Retention of vacuum-assisted closure device sponge leading to a perianal abscess and fistula.

Int Wound J 2015 Dec 10;12(6):739-40. Epub 2014 Mar 10.

Department of General Surgery, Balcali Hospital, Cukurova University School of Medicine, Saricam, Adana, Turkey.

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http://dx.doi.org/10.1111/iwj.12200DOI Listing
December 2015